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Guangwen Xu
Abstract: Huang Di’s Inner Classic (also known as The Yellow Emperor’s Inner Canon) and other classic medical works included extensive theories on the regulation of physiological functions, activities, and movements of the human body This paper mainly summarizes and discusses the regulation of reproduction, body temperature, sleep, spirit mind, affect mind, respiration, digestion and absorption, blood circulation, qi transformation, body fluid metabolism, the qi dynamic, the five sensory organs, physical movement, and defense.
Key words: TCM theory; Living Human Body; Physiological Regulation.
In The Yellow Emperor’s Inner Canon (also known as Huang Di’s Inner Classic), the physiological activity of the living human body is regulated by dynamic balance. The physical energy and physiological functions of the living human body manifest in life activities and movements.
Physiological regulation of reproduction
Human growth and development includes the maturation of sexual function and the reproductive organs. Women menstruate, men ejaculate, and when men and women copulate (the union of yin and yang) this leads to pregnancy and birth. When the five viscera are debilitated, women enter menopause, while men no longer produce sperm, and they are no longer fertile. This whole process of human physiology is first seen in the first chapter of the Inner Canon, “Discourse on the True ［Qi Endowed by］ Heaven in High Antiquity”, which states:
“In a female, at the age of 7, the qi of the kidneys abounds. ［…］ With 2 times 7, the heaven gui ［heavenly tenth or tiangui］ arrives, the controlling vessel is passable and the great thoroughfare vessel abounds ［with qi］. The monthly affair moves down in due time and, hence, ［a woman］ may have children. ［…］ With 6 times 7, the 3 yang vessels weaken ［…］ With 7 times 7, the controlling vessel is depleted and the great thoroughfare vessel is weak and ［its contents are］ diminished. The heaven gui is exhausted. The way of the earth is impassable. Hence, the physical appearance is spoilt and ［a woman can］ no ［longer］ have children. In a male ［…］ With 2 times 8, the qi of the kidneys abounds; the heaven gui arrives and the essence qi flows away. Yin and yang find harmony. Hence, he can have children.… With 7 times 8, the qi in the liver weakens; the sinews can no longer move. The heaven gui is exhausted. The ［remaining］ essence is diminished. The kidney is weak. With eight times eight ［…］ ［at this age］ now the 5 viscera are all weak. ［…］ The heaven gui is used up entirely. ［…］ no ［longer］ has children.”［1］
There is a particularly close relationship between reproductive physiological regulation and the heart, liver, kidneys, essence, life gate fire, the thoroughfare vessel (Chong Mai) and the conception vessel (Ren Mai), the liver meridian of foot reverting yin, the sinews, the uterus, and the testicles. This is described in the following excerpts:
1. The essence of the kidneys regulates reproduction:
The Inner Canon states: “The kidneys store essence”. “The 5 depots are responsible for storing the essence.”［2］“The kidneys rule the water; they receive the essence from the viscera and 6 bowels and they store it.”［1］“At the beginning of a person’s life, the essence is the first to form. Once the essence has formed, brain and marrow are generated.”［2］“Now, the essence, it is the basis of the body.”［1］“When two spirits strike at each other, their union results in the formation of a physical appearance. That which usually precedes the generation of a human body is called ‘essence’”［2］ This explains that the kidneys store the essence of the 5 viscera; kidney essence is the foundation (substance and energy) that promotes growth and reproduction. Therefore, the kidney essence regulates reproduction.
2. The channel vessels regulate reproduction
The Inner Canon says:
a.“The’uterine vessel’ is connected with the heart and forms a network inside the uterus.”［1］
b. “The network［vessel］ of the uterus is tied to the kidneys.”［1］
c. “The liver governs the tendons.” ［1］
d. “The liver and the sinews constitute one unit. The sinews meet in the yin organ ［penis］.” ［2］
e. “The ceasing yin ［qi］ conduits of the liver ［…］ enter the ［pubic］ hair. They pass the yin organ ［genitals］. ［…］ A branch ［…］ ascends into the testicles and links up with the penis.” ［2］
f. “The ceasing yin vessels move along the yin organ ［genitals］ and enclose the liver.“［1］
g. “The front yin ［pudendum］ is where the basic sinews come together.”［1］
h. “The sinew of the foot major yin ［conduit］. ［…］ Its straight course wraps. … Meets with the yin organ.”［2］
i. “The sinew of the foot ceasing yin connects with the yin organ.” ［1］
j. “Both the Chong Mai ［thoroughfare vessel］ and the Ren Mai ［controlling vessel］ start from the ［uterus］ bladder. … They constitute a sea that supplies the channels and network ［vessels］.” “［They emerge］ out of the pudendum.”［2］
k. “The thoroughfare vessel is the sea of the 5 viscera and bowels. All the 5 viscera and 6 bowels receive their supplies from there.” ［2］
l. “The controlling vessel emerges from the ［uterus］ bladder, comes out of the pudendum below, and pass the mons pubis.” ［2］
The channel vessels and channel sinews are internally ascribed to the heart, liver, and kidneys; they connect to the uterus and the genital area in women, and to the testicles and penis in men. The thoroughfare and controlling vessels start at the uterus, and are nourished and regulated by essence and blood from the 5 viscera. Therefore, the channel vessels regulate reproductive physiology.
3. Regulatory role of the life gate fire
The life gate fire regulates sexual desire and promotes fertility; it is the root and foundation of life. The regulation and arousal of sexual desire depends on the energy of the life gate fire. It is the driving force that promotes healthy conception, growth, and development.
4. The heart and liver regulate sexual desire
Chapter 44 of Elementary Questions, entitled “Discourse on Limpness”, states: “When pondering is without limits, when one does not get what one had longed for, when ［lewd］ sentiments flow unrestrained to the outside and when one enters the ［women’s］ chambers excessively, ［then］ the basic sinew slackens. This develops into sinew limpness. It also causes white overflow. Hence, the Lower Classic states: “sinew wilting is generated by the liver sending inwards.”［1］ Because “the heart stores the mind”, the heart spirit controls thinking and mental activity. If one indulges in delusions, thereby damaging essence and blood, the heart will be deprived of nourishment, which then leads to impotence, and affects sexual desire and fertility. This explains how the liver and heart regulate sexual desire and reproduction.
According to passages from the Inner Canon regarding the reproductive physiology of men and women, the physiological regulatory axis of female menstruation, reproduction, and sexual desire is composed of: the 5 viscera—kidneys—tiangui—the controlling vessel, the great thoroughfare vessel and the reverting yin liver channel—the ovaries and uterus (internal genitalia) and the external yin organ (external genitalia).
The physiological regulatory axis of male sexual desire and reproduction is composed of: the 5 viscera—kidneys—tiangui—the reverting yin liver channel, the controlling vessel and the great thoroughfare vessel—the testicles and the penis.
Temperature regulation
The body’s normal dynamic temperature is collectively controlled by mutual action, transformation, engendering, and regulation among yin and yang, construction and defense qi, original qi, qi and blood, and fluids.
1.The warming function of qi
“Qi warms the body”. This refers to the fact that qi transformation engenders heat, thereby warming the body. In particular, original qi is the driving force for the body’s heat energy. Qi has a warming and promoting effect on the physiological activities of the viscera and bowels, the channels and network vessels, the interstices, and the triple burner, as well as the movement and distribution of blood and fluids.
2. Yin and yang regulate body temperature
The Inner Canon says: “When the yang dominates, then there is heat; when the yin dominates, then there is cold.” ［1］ “When the yang is depleted, then the outside is cold, when the yin is depleted, then the inside is hot. When the yang abounds, then the outside is hot, when the yin abounds, then the inside is cold.” ［2］ “In the case of yang ［qi］ domination, heat results. In the case of yin ［qi］ domination, cold results.” ［1］ The relative exuberance or vacuity of yin and yang can cause changes between heat and cold. Thus, yin and yang can regulate body temperature.
3. Defense qi regulates body temperature
The Inner Canon says: “The defense qi serve to warm the partings of the flesh. They fill the skin, fatten the skin structures, and are responsible for their opening and closing,” ［2］ “The upper burner releases qi (defense qi). It isto them to supply the partings of the flesh with warmth, and to nourish the bones and the joints, as well as to penetrate the interstices.” ［2］ This indicates that the defense qi helps to warm, moisten, and aid in nourishing the skin and muscles. It can also adjust the interstices and regulates body temperature by opening or closing the pores.
4. Lung qi diffusion regulates body temperature:
“The lung governs qi” and “the lung governs the skin and ［body］ hair”. ［1］ Ye Tianshi’s text On Warm Heat says: “The ［fact that the］ lung governs qi pertains to defense ［qi］, ［while the fact that］ the heart governs blood pertains to construction ［qi］.” Lung qi diffuses and transports defense qi and fluids to warm and moisten the muscles, skin, and body hair. The lung regulates the defense qi, controlling the opening and closing of the pores to regulate the appropriate excretion of sweat and thereby adjust body temperature. At the same time, the lung controls respiration; the clear qi inhaled by the lung, along with the essence of grain and water absorbed by the spleen and stomach, transforms and engenders defense qi. The lung exhales turbid qi and hot qi to regulate body temperature.
5. The function of the pores, interstices, and triple burner to regulate body temperature
The interstices connect to the triple burner; the interstices and triple burner are the site of qi transformation and the passageway for fluids, defense qi, and original qi［3］. The interstices and triple burner regulate the movement of fluids and defense qi, with fluids coming out of the sweat pores in the form of sweat. Thus, the defense qi of the interstices adjusts the opening and closing of sweat pores and the excretion of sweat, functioning to regulate body temperature.
6. The sweat can regulate body temperature
The Inner Canon says:“That which is released to flow out of the skin structures, when sweat leaves profusely, that is what is called’ jin liquid’” ［2］ “The fluids are transformed by the 5 viscera. The heart generates sweat.” ［2］ Therefore, in later times, it was said that “The sweat is regarded as the fluid of the heart”. The sweat is transformed from body fluids; “when yang is added to yin, this is called ‘sweat’.” ［1］ “When one is hot, then the interstice structures open and the construction［qi］ and defense［qi］ pass through. Sweat flows out profusely. Hence, qi flows out.” ［1］ “When one was frightened and has lost essence, the ［resulting］ sweat originates from the heart. When one bears a heavy load and walks over a long distance, the ［resulting］ sweat originates from the kidneys. When one runs fast and is in fear, the ［resulting sweat originates from the liver. When one agitates the body and works hard, the ［resulting］ sweat originates from the spleen.”［1］
The above description explains how sweat can regulate body temperature. Sweating is mostly due to yang and heat causing the interstices and sweat pores to open; body fluids leak out and expel hot qi, which can reduce the body temperature. As for the opening and closing of the interstices and sweat pores, the regulation of sweat is closely linked to the 5 viscera, as well as the overall regulatory function of yin and yang, construction and defense, original qi, qi and blood, and fluids. Normal body temperature can only be guaranteed when yin and yang are balanced, construction and defense are harmonized, original qi is sufficient, fluids and blood are abundant, the 5 viscera are harmonized, the interstices are regulated, and the sweat pores open and close appropriately.
Physiological regulation of sleep
The physiological regulation of normal sleep requires the normal regulatory functions of the 5 viscera, as well as abundance and harmony of construction, defense, qi, blood, essence and marrow. When the brain, heart, and spirit are effulgent, and yin and yang are in balance, there will be normal sleep.
1. Yin and yang regulate sleep
The Inner Canon says:“When the yang qi are exhausted, while the yin qi abound, vision is dimmed ［i.e. one falls asleep］. When the yin qi are exhausted, while the yang qi abound, one wakes up.”［2］This simply and clearly describes the important function of the waxing and waning of the human body’s yin and yang in the regulation of sleep.
2. Construction and defense regulate sleep
The Inner Canon states: “The defense ［qi］ move through the yang ［conduits］ during daytime. At midnight they move into the yin ［conduits］. The yin ［qi］ dominate during the night. During the night, ［the people］ are asleep.” ［2］The Classified Canon says: “All people go to bed or get up due to the defense qi. The defense qi move through the yang during the daytime, so their activity makes ［one］ awake; they move through the yin at night, so their calm makes ［one］ go to sleep.” ［2］“The defense qi must not enter the yin and generally stay in the yang. When they stay in the yang, the yang qi are full, and when the yang qi are full, the yang springing ［vessel］ is exuberant. They must not enter the yin, or else ［there will be］ yin qi vacuity ［and］ thus the eyes will not sleep.” ［2］ “Now, the defense qi, during daytime they always pass the through the yang realm; during night they pass through the yin realm. The fact is: When the yang qi are exhausted, then one falls asleep. When the yin qi are exhausted, then one is awake.” ［2］
“The defense qi ［…］ in daytime move through the yang, ［and］ in nighttime move through the yin, ［…］ when they move through the yang, the yang qi are full, and when the yang qi are full, the yang springing ［vessel］ is exuberant. They must not enter the yin; ［if there is］ yin vacuity, then the eyes will not sleep.”［2］ “The movement of their construction and defense ［qi］ never loses its regularity. Hence they are of a clear ［mind］ during daytime, and they close their eyes at night.” ［2］
3. The liver regulates sleep
The liver governs free coursing and regulates emotions; if one is in a good mood, then one will have high quality sleep. The liver yin and liver blood nourish and moisten the liver yang, thereby preventing the liver yang from rising excessively to disturb the heart spirit and affect sleep. People’s sleeping and waking habits regulate the liver blood: the Inner Canon states that “the liver stores blood,” which Wang Bing explains as: “The liver stores the blood and the heart moves ［the blood］. When the body moves, blood circulates in the channels; when at rest, it flows back to the liver.” Thus, when one sleeps, the blood returns to the liver for storage, and when one wakes, the blood moves in the channels. When one sleeps, the liver blood is abundant and liver blood can transform into kidney essence. When blood and essence are sufficient, the heart spirit will be nourished, ensuring tranquil sleep and exuberant energy upon waking.
4. The heart spirit regulates sleep
The heart plays a key role in sleep regulation. The Inner Canon says: “The heart stores the spirit” and “the heart holds the office of monarch, from which the spirit light emanates”.［2］ If the heart spirit is calm, then one can sleep easily; when the heart spirit becomes active, one starts to wake up. Heart blood and heart yin are the material support for the heart spirit. When heart qi and blood are sufficient and their movements are smooth, the heart spirit is nourished. The heart yin restrains the heart yang so the heart spirit can be calm. When the spirit is calm, it is easy to fall asleep.
5.T he heart and kidneys regulate sleep
(1) When the heart fire and kidney water help each other, they enable interaction between the heart and the kidneys; thus the heart spirit will be calm and when one lies down at night, it will be easy to fall asleep. During the daytime, the heart spirit is active, so one will wake up.
(2) When the heart and kidney yin and yang are harmonized, at night the heart yang will enter the kidney yin and one will lie down to sleep.
(3) The kidney essence engenders marrow to fill the brain, and essence and marrow nourish the brain. When the brain is fortified, the spirit will be calm, and when the spirit is calm, it is easy to fall asleep when one lies down at night.
The 5 viscera regulate the spirit mind
The Inner Canon says: “The 5 viscera, they serve to store the essence spirit, as well as the ethereal and corporeal souls.” ［2］“The heart stores the spirit. The lung stores the corporeal soul. The liver stores the ethereal soul. The spleen stores reflection ［or the intellect］. The kidneys store the will.” ［1］ “When the qi can ascend and descend, the 5 viscera are calm and stable, the blood vessels are harmonized and uninhibited, and the essence and spirit are sedentary.” ［2］ This shows how the 5 viscera store the spirit in order to regulate the spiritmind. There is a close relationship between the activities of the spiritmind and the 5 viscera, primarily the heart and kidneys. This is because the heart stores the spirit and the kidneys store the will.
1. The production of spiritmind activity is rooted in the kidneys
The Inner Canon states: “The mind serves to reign over the essence spirit. It controls the ethereal and corporeal souls.” ［2］ Wang Bing commented on chapter 62 of Elementary Questions, entitled “Discourse on Regulating the Channels”, saying: “The mind generally refers to the 5 spirits ［of the 5 viscera］.” “At the beginning of a person’s life, the essence is the first to form. Once the essence has formed, brain and marrow are generated.” ［2］ The marrow of the brain is produced from the earlier heaven (or prenatal) essence of one’s parents. The brain is the hub of the spirit light, which is the central regulator of spiritmind activities. The essence of grain and water absorbed by the spleen and stomach transform into later heaven (or postnatal) essence, which is stored in the kidneys. “The kidneys store the essence. The essence hosts the will.” The will is a highlevel overview of the activities of the spiritmind; it is a concentrated expression of mental activity, possessing the function of regulating and controlling various mental and psychological activities.［4］ Because “the kidneys generate the bones and the marrow,” spinal marrow is connected to the brain, “the brain is called the sea of marrow,” ［1］ and “the marrow is ruled by the brain,” the kidneys are connected to the brain. The kidney essence generates marrow, which connects to the brain. The brain consists of essence, marrow, and spirit light, while the kidneys govern the will. The spirit and will are unified as one, so the brain and kidneys regulate the mind. When essence is sufficient and marrow is abundant, the spirit will be effulgent.
2. The heart governs spiritmind activity
The Inner Canon says: “The heart stores the spirit” and “the heart holds the office of monarch, from which the spirit light emanates”. ［2］ “That which controls things is called the heart.” ［2］ This shows that the heart spirit governs and coordinates the viscera and bowel functions of the whole body, as well as people’s spiritmind activities. It enables people to make correct judgments about and responses to things in the external environment, and sets off a series of “spirit” activities to adapt to those things.
3. The liver governs free coursing and regulates the spirit mind
The Inner Canon says: “The liver stores the ethereal soul.” “That which comes and goes following the spirit, that is called the ethereal soul.” ［2］ “The liver stores the blood. The blood hosts the ethereal soul.” ［2］ “The liver holds the office of general; it is responsible for making strategies.” The heart spirit primarily regulates the mind and emotions through the liver’s adjustment of the qi dynamic. The heart controls the spirit mind and the liver governs free coursing, so they mutually reinforce each other to regulate the spirit mind. They coordinate people’s spirit mind activities, enabling the normal function of the spirit mind.
The regulation of respiratory movement
According to the Inner Canon, the lung governs qi and is in charge of respiration. The lung is the main organ involved in respiratory movement, and is the place where air is exchanged in and out of the body. The kidneys and the ancestral qi are also important for respiratory regulation.
1. The lung controls respiration
The Inner Canon states: “The lung governs qi.” “All qi is tied to the lung.” ［1］ ”The lung is the basis of the qi.“［1］ ”The qi of heaven communicate with the lung. ［1］
2. The ancestral qi is responsible for exhalation and inhalation
The Inner Canon says: “The ancestral qi collect in the chest, they leave ［the chest］ through the windpipe. They penetrate the heart vessels, and they are responsible for exhalation and inhalation.” ［2］ “In the case of a mutual beating of massive qi and their failure to move on, accumulations in the chest result. The ［place where they accumulate］ is called the ‘s ea of qi.’ ［The qi］ emitted by the lung, they follow the throat. The fact is: When one exhales, then they are emitted. When one inhales, then they enter.” ［2］
3. The lung and kidneys regulate respiration
According to Jing Yue’s Complete Compendium:“The lung exhales qi and the kidneys absorb qi; therefore, the lung is the master of qi and the kidneys are the root of qi.” The Inner Canon says: “The minor yin ［vessels］ are associated with the kidneys. Upward, the kidneys are linked with the lung. Hence ［the minor yin vessels］ control 2 viscera ［lung and kidneys］.” ［2］ This shows that the lung is connected to the kidneys and both regulate respiration.
4. The 5 viscera regulate respiration
The kidneys govern qi absorption; the clear qi inhaled by the lung depends on the kidneys’ containment and absorption to prevent shallow respiration. “The lung acts as the controller of qi and the kidneys are the root of qi. The lung governs respiration and the kidneys govern qi absorption. ［When］ yin and yang interact, respiration is harmonious.”(Systematized Patterns with Clear Cut Treatments). The liver governs free coursing and regulates the qi dynamic. The liver qi upbears on the left, while the lung qi downbears on the right. When there is appropriate upbearing and downbearing, the qi dynamic moves smoothly and respiration is unhindered. The spleen upbears the essence and qi of water and grain that is moved and transformed by the stomach and spleen; when this meets with the qi from the lung’s respiration, it engenders ancestral qi. Ancestral qi moves through the respiratory tract to drive respiration; it penetrates the heart vessel to move qi and blood. “The heart governs blood”, providing blood to nourish the lung in order to aid in respiration. Therefore, the 5 viscera and ancestral qi collectively regulate respiratory movement.
The 5 viscera regulate digestion and absorption
The Inner Canon states:a. “The regular qi of a normal person is supplied by the stomach. The stomach ［qi］ is the regular qi of the normal person. ［…］ Man requires water and grain as his basis.” ［1］
b. “The 5 viscera are supplied with qi by the stomach. ［Hence］ the stomach is the basis of the 5 viscera.” ［1］
c. “That from which man receives his qi, that is the grain. Where the grain flows, that is the stomach. The stomach is the sea where water and grain, the qi and blood gather. ［…］ The qi and the blood leaving the stomach, they follow the channels. These channels constitute the big network ［vessels］ linking the 5 viscera and 6 bowels.” ［2］
d. “The qi of food enters the stomach. ［The stomach］ spreads essence to the liver. ［…］ The qi of food enters the stomach. The turbid qi returns to the heart. ［…］ Beverages enter the stomach. Overflowing essence qi is transported upward to the spleen. The spleen qi spreads the essence.” ［1］
e. “The spleen and the stomach are the officials responsible for grain storage. The 5 flavors originate from them. The large intestine is the official functioning as transmitter along the Way. Changes and transformations originate in it. The small intestine is the official functioning as recipient of what has been perfected. The transformation of things originates in it.” ［1］
f. “The spleen and the stomach, the large intestine, the small intestine, the triple burner, and the urinary bladder are the basis of grain storage. They are the location of the construction ［qi］. They are named containers. They are able to transform the dregs. They are ［the places］ where the substances are turned and enter and leave.” ［1］
g. “Man receives his qi from the grain. The grain enters the stomach, and from there ［its qi］ are transmitted to the lung. This is how all the 5 viscera and 6 bowels receive qi.” ［2］
h. “The center burner is like foam.”
i. “The ［qi of the］ center burner also merge with the center of the stomach. ［…］ The qi received there are discharged as dregs, steamed as body fluids, and transformed to refined essence. ［The latter］ pours upward into the lung vessel where it is transformed to blood, which in turn is supplied to the entire body.” ［2］
j. “The fact is: Water and grain are regularly present together in the stomach. There they are transformed to dregs and together they descend into the large intestine. Where they constitute the lower burner, where its liquids seep in, a separate juice is secreted along the lower burner and seeps into the urinary bladder.” ［2］
“The lower burner discharges into the curved intestine and pours into the urinary bladder, where its liquids seep in.” ［1］
k. “The 5 flavors enter through the mouth and are stored in the intestines and in the stomach. When the flavors have a place where they are stored, this serves to nourish the 5 qi. When the qi are generated in harmony and when the body liquids complete each other, then the spirit will be alive by itself.” ［1］
The Inner Canon provides a clear understanding of the physiological process of digestion and absorption. The center burner includes the spleen, stomach, liver, gallbladder, large intestine, and small intestine. The spleen and stomach govern digesting and absorbing the essence of water and grain, and transform them into qi, blood, and body fluids, transmitting them up to the heart and the lung. At the same time, the stomach qi descends, and the small and large intestines separate the clear from the turbid by conveying food dregs to the anus to be excreted from the body and letting turbid water seep down to the kidneys and bladder.
Regulation of blood circulation
Over 2000 years ago, the Inner Canon already included a definite understanding of blood circulation. The text states: “The qi of food enters the stomach. ［The stomach］ spreads essence to the liver. ［…］ The turbid qi turns to the heart. Excessive essence ［flows］ into the vessels. The qi in the vessels flows through the conduits. The qi in the conduits turns to the lung. The lung invites the 100 vessels to have an audience with it. They transport essence to the skin and the body hair. The hair vessels unite the essence and they move qi to the palaces. The essence of the palaces and the spirit brilliance remain in the 4 viscera.”［1］
The text notes that the spleen and stomach move, transform, and absorb the essence of water and grain, which is transformed to engender qi and blood. This qi and blood then move through the liver into the heart. Blood flows through the channels and vessels, and returns to the lung, as the lung invites the 100 vessels to have an audience with it. The lung qi assists the heart to promote blood circulation, so that the blood, essence, and qi are transported to all the channels, the skin, and the body hair, as well as to the viscera and bowels. It then flows back to the heart and lung by means of the blood vessels, viscera, and bowels. Blood returns to and leaves the heart in an endless cycle. Blood circulation mainly relies on the heart, but the lung, spleen, liver, and kidneys are very important to help with its regulation.
The heart governs blood; the Inner Canon says: “All blood is tied to the Heart.” “The Heart governs the blood vessels.” ［1］ “The Heart stores the qi of the blood and the vessels.” ［1］ Thus, the heart qi drives blood circulation throughout the whole body. “The Liver stores blood”. Wang Bing commented: “The liver stores the blood and the heart circulates ［the blood］. When the body moves, blood circulates in the channels; when at rest, it flows back to the liver.” So the liver regulates the amount of blood in the whole body to help the heart regulate blood circulation.
“The spleen controls blood”; this refers to the fact that the spleen controls blood circulation inside the vessels and prevents it from flowing out of the vessels. Therefore, “the blood of the 5 viscera and 6 bowels, they all rely on the spleen qi,s control and containment.” (From Shen Mingzong’s commentary on Essential Prescriptions of the Golden Coffer)
“The camp ［qi］ are in the vessels. The guard ［qi］ are outside the vessels.” “In the blood vessels the camp and guard ［qi］ flow without cease.” ［2］ Qi and blood regulate each other and circulate throughout the body.
Therefore, normal blood circulation is primarily related to the heart, the lung, the spleen, and the liver. The heart qi is the fundamental motive power that propels blood circulation. The lung is in charge of the qi of the whole body, as the lung faces the hundred vessels and the ancestral qi enters the vessels of the heart to promote the movement of qi and blood. The spleen controls and contains the blood of the whole body, thereby keeping the blood circulating normally within the vessels and preventing it from extravasation. The liver stores blood and regulates the volume of blood in the body. The kidneys store essence, which can transform into blood. At the same time, the essence engenders marrow, which can transform into blood, ensuring an abundance of blood and normal circulation. The channels and network vessels move and regulate qi and blood. These collectively coordinated functions ensure normal qi and blood circulation.
Circulation and regulation of body fluids and waterways
Regarding the formation, distribution, and excretion of body fluids, chapter 21 of Elementary Questions, entitled “Further Discourse on the Conduit Vessels”, gives the following overview: “Beverages enter the stomach. Overflowing essence qi is transported upward to the spleen. The spleen qi spreads the essence, which turns upward to the lung. ［The latter］ frees and regulates the paths of the water, it transports ［the water］ downward to the urinary bladder. The essence of water is spread to the 4 ［cardinal points］, it moves through all the 5 conduits simultaneously.” ［1］
“The triple burner is the official functioning as opener of channels. The paths of water originate in it.”［1］ “The lower burner discharges into the curved intestine and pours into the urinary bladder, where its liquids seep in. The fact is: Water and grain are regularly present together in the stomach. There they are transformed to dregs and together they descend into the large intestine. Where they constitute the lower burner, where its liquids deep in, separate juice is secreted along the lower burner and seeps into the urinary bladder.” ［2］
These passages from the Inner Canon describe how:
1. Body fluid is formed from the essence of water and grain that is moved and transformed by the spleen and stomach, separated into the clear and the turbid by the small intestine, and spread as essence by the spleen qi. 2. The distribution and excretion of turbid body fluid are accomplished by the joint action of the 5 viscera, 6 bowels, interstices, and triple burner, including the moving, transforming, upbearing, and downbearing functions of the spleen, the diffusing and depurative downbearing functions of the lung, and the functions of the kidneys to regulate the waterways, as well as the kidney yang’s function of steaming effusion that upbears the clear and downbears the turbid. 3. The interstices and triple burner are the passageways for the distribution and excretion of body fluid, so that “the essence of water is spread to the 4 ［cardinal points］, it moves through all the 5 conduits simultaneously.” The fluids are distributed throughout the body to enrich, moisten, and nourish the viscera, bowels, sinews, bones, muscles, skin, and body hair. They also engender and transform into qi and blood, and regulate yin and yang.
Channels and network vessels regulate the movement of body fluids: “The foot major yang ［conduits］, externally they link up with the clear waters of the Qing ［river］; internally they are tied to the urinary bladder.” ［2］ “The hand major yang ［conduits］, externally they link up with the water of the Huai ［river］; internally they are tied to the small intestine, and the paths of water originate in it.” ［2］ Thus, the channels and network vessels circulate and regulate body fluid distribution.
About the Author:
Xu Guang wen was born into a family of TCM practitioners ,graduated from ShanHai University of TCM in China ,and holds a Master’s degree. Xu is a chief of hief TCM, ph.and British registered practitioner of Chinese medicine.
簡述《內經》对人體生理活動的調節的论述(一)
徐廣文
摘要：《內經》和經典醫著，歷代醫家對人體生理功能，生理活動和運動調節，有豐富的理論。本文試從生殖調節、體溫調節、睡眠調節、神志調節、情志調節、呼吸調節、消化和吸收調節、血液循環調節、氣化調節、氣機調節、體液代謝調節、五官調節、運動調節、防禦調節等方面進行歸納整理和探討簡述。
關鍵詞：基礎理論 黃帝內經 生命人體 生理調節
《內經》生命人體是動態平衡的生理調節，生命人體的物質能量和生理功能，皆體現在生命活動和運動的調節過程中。
生殖生理調節
人的生長發育，性機能和生殖器的成熟，女子月經來潮，男子泄精，男女交媾(陰陽合），孕育生子。到五臟皆衰，天癸盡竭，女子絕經，男子無精，不能孕育的生理全過程，始見於《黃帝內經.素問》的首篇，上古天真論：
“女子七歲腎氣……二七而天癸至，任脈通，沖脈盛，月事以時下，故有子。……七七任脈虛，太沖脈衰少，天癸竭，地道不通，故形壞而無子也。 丈夫……二八腎氣盛，天癸至，精氣溢瀉，陰陽和，故能有子。……七八肝氣衰，筋不能動，天癸竭，精少, 腎臟衰。……八八……今五臟皆衰，……天癸盡矣……而無子耳。”［1］
生殖生理調節與心肝腎、腎精、命門之火、沖任、厥陰肝經、宗筋、女子胞、（男子為睪丸）等關係最為密切。如上下經文：
1.腎精調節生殖
經云“腎藏精”［2］；“五臟主藏精者也。”［2］ “腎者主水，受五臟六腑之精而藏之。”［1］ “人始生，先成精”［2］；“夫精者，身之本也”［1］；“兩神相搏，合而成形，常先身生，是謂精。”［2］說明腎藏五臟之精，腎精是促進生長發育和生殖之本(物質和能量)。故腎精調節生殖生理。
2.經脈調節生殖
經云：“胞脈者,屬心而絡於胞中。”［1］ “胞絡者，繫於腎。”［1］ “肝主筋”［1］； “肝者，筋之合也，筋者，聚於陰器。”［2］“肝足厥陰之脈……入毛中，過陰器。……足厥陰之別，……其別者，經脛上睪，結於莖。”［2］ “厥陰脈循陰器而絡於肝。”［1］ “前陰者，宗筋之所聚。”［1］《靈樞·經筋篇》：“足太陰之筋……其直者……聚於陰器。”［2］ “足厥陰之筋，……結於陰器。”［2］ “沖脈任脈皆起於胞中，……為經絡之海。” “出於會陰部。”［2］ “沖脈者，五臟六腑之海也, 五臟六腑皆稟焉。”［2］ “任脈起於胞中，下出於會陰部，經陰阜。”［2］
經脈經筋內屬心肝腎，連絡女子胞宮陰部，男子睪丸陰莖；沖任起於胞宮, 受五臟精血之調養。故經脈調節生殖生理。
3.命門之火的調節作用
命門之火調節性欲和促進孕育。命門之火是生命之根；是調節激發性欲的能量，是促進健康懷孕和發育成長的原動力。
4.心肝調節性欲
《素問·痿論》 云：“思想無窮，所遠願不得，意淫於外，入房太甚，宗筋弛縱，發為筋痿，及為白淫。故下經曰，筋痿者，生於肝，使內也。”［1］因 “心藏神”［1］，主思想情志。肝主疏泄，調節情志。當妄想縱欲，耗傷精血，則心肝失養，導致陽痿，而影響性欲和生育。說明心肝調節性欲和生殖。
根據《內經》相關男女生殖生理的經文，女子生殖，月經和性欲的生理調節軸是：
五臟—腎—天癸—沖任和肝經—女子胞(內生殖器)和外陰(外生殖器）
男子生殖和性欲的生理調節軸是：五臟—腎—天癸—肝經和沖任—睪丸陰莖
體溫調節
人體的體溫是由陰陽、營衛、元氣、氣血、津液，和五臟等，相互作用，相互化生，相互調節，而共同調節人體正常的動態體溫。
1.氣的溫煦作用
“氣主煦之” 指氣有氣化生熱，溫煦人體，調節體溫的作用。尤其元氣為人體熱能的源動力。氣對人體臟腑、經絡、腠理三焦之生理活動，和血液、津液的運行與輸佈，均有溫煦推動作用。
2.陰陽調節體溫
經云：“陰勝則寒，陽勝則熱”［1］；“陽勝者則為熱，陰勝者則為寒。”［2］“陽虛則外寒，陰虛則內熱；陽盛則外熱，陰盛則內寒。”［2］陰陽偏盛偏虛，皆可引起寒熱變化，故體內陰陽調節體溫。調節陰陽可調節體溫。
3.衛氣調節體溫
經云：“衛氣者，所以溫分肉，充皮膚，肥腠理，司開闔者也。”［2］“上焦出氣，以溫分肉而養骨節，通腠理。”［2］說明衛氣溫柔肌膚，調節腠理，司汗孔開合，而調節體溫。
4.肺氣宣發調節體溫
“肺主氣”，“肺主皮毛”。葉天士 《溫熱論》：“肺主氣屬衛，心主血屬營。”肺氣宣發輸佈衛氣和津液，以溫養和滋潤肌膚皮毛。肺調節衛氣，司汗孔開合，調節汗液排泄適度，以調節體溫。同時，肺主呼吸，肺吸入的清氣與脾胃所吸收的水穀精微之“焊氣”化生為衛氣；肺呼出濁氣和熱氣，調節體內溫度。
5.汗孔和腠理三焦對體溫的調節作用
腠理通三焦，腠理三焦是津液、衛氣、元氣生成的氣化場所和運行通道［3］。腠理三焦調節津液和衛氣運行，津液出於汗孔為汗液。故腠理之衛氣調節汗孔開闔和汗液的排泄，有調節體溫的作用。
6.汗液調節體溫
經云：“腠理發泄，汗出溱溱，是謂津。”［2］ “五臟化液，心為汗。”［1］故後世有“汗為心液”的說法。汗為津液所化,“陽加於陰，謂之汗”；“炅則腠理開，榮衛通，汗大泄，故氣泄。”［1］ “驚而奪精，汗出於心；持重遠行，汗出於腎，疾走恐懼，汗出於肝；搖體勞苦，汗出於脾。”［1］
說明汗液調節體溫。汗出多為陽熱，致腠理汗孔開，津液外泄，散發熱氣，可使體溫下降。而腠理汗孔的開合，汗液的調節與五臟，和陰陽、營衛、元氣、氣血、津液的整體調節作用密切。陰陽平衡，營衛調和，元氣充足，津血充盈，五臟調和，腠理通調，汗孔開合有度，才能保證正常的體溫。
睡眠的生理調節
正常睡眠的生理調節，須五臟調節功能正常，營衛氣血精髓充盈調和，腦心神旺，陰陽平衡，則寐寤有常。
1.陰陽調節睡眠
經云：“陽氣盡，陰氣盛，則目瞑；陰氣盡而陽氣盛，則寤矣。”［2］ “陽入於陰則寐，陰出於陽則寤。”［2］簡明了人體陰陽的消長對睡眠調節的重要作用。
2.營衛調節睡眠
經云：“衛氣晝日行於陽，夜半則行於陰，陰者主夜，夜者臥。”［2］《類經》：“凡人之寤寐，由於衛氣。衛氣者，晝行於陽，則動而為寤；夜行於陰，則靜而為寐。”“衛氣不得入於陰，常留於陽。留於陽則陽氣滿，陽氣滿則陽蹻盛，不得入於陰則氣虛，故目不寐矣。”［2］ “ 夫衛氣者，晝日常行於陽，夜行於陰，故陽氣盡則臥，陰氣盡則寤。”［2］
“衛氣者，……晝日行於陽，夜行於陰，……行於陽則陽氣盛，陽氣盛則陽橋滿，不得入於陰，陰虛，故目不瞑。”［2］ “營衛之行，不失其常，故晝精而夜瞑。”［2］
3.肝調節睡眠
肝主疏泄調節情志，情緒好則睡眠質量好。肝陰肝血柔濡肝陽，抑制肝陽過升而干擾心神影響睡眠。人的寐寤調節肝藏血量：內經：”肝藏血”，王冰注解說:“肝藏血,心行之,人動則血運於諸經,人靜則血歸於肝臟。” 故寐則血歸肝藏，寤則血運諸經。寐則肝血充盈，肝血可化腎精，精血足則心神得養而使睡眠安靜，醒後精力旺盛。
4.心神調節睡眠
心為睡眠調節之主，經云：“心藏神”，“心者,君主之官,神明出焉。”［2］心神安則易寐，心神動則始寤。心血心陰是心神的物質保證。心氣血充足、運行通暢，心神得養。心陰制約心陽，心神則安，神安則易入眠。
5.心腎調節睡眠
1)心火腎水相濟，使心腎相交，則心神安靜，夜臥易入眠。晝時心神活動，則人醒寤。
2)心腎陰陽調和，夜則心陽入於腎陰，人臥入寐。
3)腎精生髓充腦，精髓養腦，腦健則神安，神安則夜臥易入眠。
五臟調節神志
經云：“五臟者，所以藏精神魂魄者也。”［2］ “心藏神，肺藏魄，肝藏魂，脾藏意，腎藏志。” ［1］“氣得上下，五臟安定，血脈和利，精神乃居。”［2］說明五臟藏神而調節神志。
神志活動與五臟有密切的相關，以心腎為主。因心藏神，腎藏志。
1.神志活動產生之根在於腎
經云：“意志者，所以御精神，收魂魄。” ［2］王冰注 《素問·調經論》說：“志意者，通言五神之大凡也。”“人始生，先成精，精成而腦髓生。”［2］源於父母的先天之精生成腦髓。腦為神明之樞，總調神志活動。由脾胃吸收的水穀精微所化生的後天之精藏於腎。“腎藏精，精舍志。” 而志是對神志活動的高度概括，是精神活動的集中體現，具有調節、控制各種精神心理活動的作用。［4］因“腎生骨髓”，髓貫脊通於腦，“腦為髓海”，“髓者，以腦為主。” ［1］故腦腎相通，腎精生髓通腦，腦為精髓神明，腎主志，神志合一，則腦腎調節神志，當精充髓盈則神旺。
2.心主神志活動
經云：“心藏神”；“心者，君主之官，神明出焉。” ［2］“所以任物者謂之心。” ［1］說明心神統領和協調全身臟腑功能和人之神志活動，使人能對外界事物做出正確判斷和反應，並激發帶動一系的“神”活動以適應之。
3.肝主疏泄，調節神志
經云：“肝藏魂” “ 隨神往來者，謂之魂。” “肝藏血，血舍魂” ［1］“肝者，將軍之官，謀慮出焉。” ［1］心神主要通過肝調暢氣機來調節精神情志。心主神志和肝主疏泄，相輔相成，調節神志，協調人的神志活動，使人的神志活能夠正常的進行。
呼吸運動的調節
《內經》認為肺主氣，司呼吸。肺是人體呼吸運動的主要器官，是體內外氣體交換的場所。腎和宗氣也對呼吸調節非常重要。
1.肺主呼吸
經云：“肺主氣”，“司呼吸”；“諸氣者，皆屬於肺。”［1］ “肺者，氣之本。” ［1］“天氣通於肺。”［1］
2.宗氣行呼吸
經云：“宗氣積於胸中，出於喉嚨，以貫心脈，而行呼吸焉。”［2］ “其大氣摶而不行者，積於胸中，命曰氣海，出於肺，循喉咽，故呼則出，吸則入。”［2］
3.肺腎調節呼吸
《景岳全書·傳忠錄》：“肺出氣也，腎納氣也，故肺為氣之主，腎為氣之本也。” 經云：“少陰屬腎，腎上連肺，故將兩臟。”［2］說明肺腎相連，而調節呼吸。
4.五臟對呼吸的調節作用
腎主納氣，肺所吸入之清氣有賴腎的攝納，防止呼吸淺表。“肺為氣之主，腎為氣之根，肺主呼氣，腎主納氣，陰陽相交，呼吸乃和。”(《類證治載》）肝主疏泄，調暢氣機。肝氣升於左，肺氣降於右，升降得宜則氣機舒展，呼吸順暢。脾胃運化的水穀精氣由脾上升，與肺的呼吸之氣相合而生成宗氣。宗氣走息道而行呼吸，貫心脈以行氣血。“心主血”，供血養肺以助呼吸。所以，五臟和宗氣共同調節呼吸運動。
五臟調節消化吸收
經云：“平人之常氣稟於胃，胃者平人之常氣也,……人以水穀為本。”［2］“五臟者，皆稟氣於胃；胃者，五臟之本也。” ［1］
“人之所受氣者，穀也；穀之所注者，胃也；胃者，水穀氣血之海也。……胃之所出氣血者，經隧也。而隧者，五臟六腑之大絡也。”［2］
“食氣入胃，散精於肝……食氣入胃，濁氣歸心，……飲入於胃，游溢精氣，上輸於脾，脾氣散精。［1］”
脾胃者，食廩之官，五味出焉。大腸者，傳道之官，變化出焉。小腸者，受盛之官，化物出焉。” ［1］
“脾、胃、大腸、小腸、三焦、膀胱者，倉廩之本，營之居也，名曰器，能化糟粕，轉味而入出者也，” ［1］
人受氣於穀，穀入於胃，以傳與肺，五臟六腑，皆以受氣。”［2］ “中焦如漚”。
“中焦亦並胃中, ……此所受氣者，泌糟粕，蒸津液，化其精微，上注於肺脈乃化而為血，以奉生身。”［2］
“ 故水穀者，常並居於胃中，成糟粕，而俱下於大腸，而 成下焦，滲而俱下，濟泌別汁，循下焦而滲入膀胱焉。”［2］
“下焦者，別回腸，注於膀胱而滲入焉。”［2］ “五味入口，藏於腸胃，味有所藏，以養五臟氣。氣和而生，津液相成，神乃自生。” ［1］
《內經》對消化吸收的生理過程已非常明確：中焦者，納脾胃肝膽，大小腸。脾胃主消化吸收水穀精微，化生氣血津液，上輸於心肺以營養全身。同時胃氣下降，大小腸分清別濁，下傳食物糟粕從肛門排出體外；而將濁水下滲入腎與膀胱。消化吸收以脾胃為主，各臟腑密切協調相助，保證了消化吸收生理功能正常。
氣血循環調節
2000多年前《內經》就對氣血循環有了明確的認識。如經云：“食氣入胃，散精於肝，……濁氣歸心，淫精於脈，脈氣流經，經氣歸於肺，肺朝百脈，輸精於皮毛；毛脈合精，行氣於府，府精神明，留於四臟。”［1］
經文說明：脾胃運化吸收的水穀精微化生的氣血經肝臟注入心臟，血液流於經脈而歸於肺，肺朝百脈，肺氣助心推動血液運行，使血液精氣輸運於諸經及皮毛，和內至臟腑。由血脈和臟腑而回流心肺。向心與離心而循環不息。血液循環以心為主，但與肺脾肝腎四臟相助調節很重要。
心主血，《內經》云：“諸血者，皆屬於心。”；“心主身之血脈。”［1］ “心藏血脈之氣也。”［1］故心氣推動全身的血液運行。“肝藏血”； “故人臥血歸於肝。”［1］王冰注：“肝藏血，心行之，人動則血運於諸經，人靜則血歸於肝臟”。故肝調節全身血量, 以助心調節血液循環。
“脾統血”，是指脾有統攝血液在經脈之中流行，防止逸出脈外的功能，“五臟六腑之血，全賴脾氣統攝”（《金匱要注》）。
“營行脈中，衛行脈外”；“血脈營衛，周流不休。”［2］氣血相互調節，循環周身。
所以，正常氣血循行主要與心肺脾肝的共同調節作用密切。心氣是推動血液循行的原動力。肺主司一身之氣，肺朝百脈，和宗氣貫注入心脈以促進氣血的運行。脾氣統攝血液在脈管中循環，防止血液外溢。肝儲藏血液，調節血量；腎主藏精，精化血，同時精生髓，髓生血，保證血液充盈和循環正常；經絡運行和調節氣血。共同的協調作用保證氣血循環正常。
津液水道的循環調節
對人體津液的生成、輸佈、排泄，《素問·經脈別論》概括為：“飲入於胃，游溢精氣，上輸於脾，脾氣散精，上歸於肺，通調水道，下輸膀胱，水精四布，五經並行。”
“三焦者，決瀆之官，水道出焉。”［１］ “下焦者，別回腸，注於膀胱而滲入焉。故水穀者，常並居胃中，成糟粕而俱下於大腸，而成下焦，滲而俱下，濟秘別汁，循下焦而滲入膀胱焉。”［2］
《內經》經文說明：
1.津液由脾胃運化的水穀精微所化生、小腸進行分清別濁、脾氣散精，上歸於肺，通調水道，下輸腎和膀胱。
2.津液的分佈全身和濁液的排泄體外是由五臟六腑，腠理三焦共同調節完成。如脾胃的運化升降功能、肺的宣發肅降，通調水道功能、腎陽的蒸發升清降濁功能。
3.津液以腠理三焦為通道進行分佈和排泄，才能使“水精四布，五經並行”，輸佈於全身，以滋潤濡養臟腑筋骨，肌膚皮毛，和生化氣血，調節陰陽。
經絡調節津液運行：經云：“足太陽外合清水，內屬膀胱，而通水道焉”、“手太陽外合於淮水，內屬於小腸，而水道出焉。”［2］故經絡運行和調節津液輸佈。
未完，下期繼續
作者簡介：徐廣文 出生於中醫世家，畢業於上海中醫藥大學，碩士，主任醫師。英國注冊中醫師。
