胰的正名与中医功用探微

Reconstruct the definition of pancreas and its functions in traditional Chinese medicine

中医学无论五脏还是六腑中都没有胰。作为全身第二大腺体,胰脏发挥着不可替代的生物学功能。胰的古字是“??”,我国晋代就有用动物的胰脏作药的记载了,但是清代以前的中医典籍中一直没有提到人体之“胰”。胰到底是哪个脏腑呢?目前主要形成以下五种说法:①胰是“散膏”;②胰是脾;③胰是命门;④胰是三焦;⑤胰是奇恒之腑。然而,胰不是脾,不是散膏,不是三焦,也不是命门。通过系统回顾相关文献,笔者认为奇恒之腑中“胆”应是“胰”的说法最为合理。《黄帝内经》中奇恒之腑之“胰”,是古人对人体之胰最早的描述。从脏腑理论来看,中医的脏腑是功能上的脏腑,而非解剖上的脏腑,故笔者又进一步对胰的功能做了探讨。以往不分内、外分泌部,对“胰”含混而论的做法是不可取的。胰的内、外分泌部分别行使着中医“肾”和“脾”的功能,分属于两大脏腑体系。明确胰的名称和功用必将对诊治胰腺相关疾病大有裨益。

Pancreas is an organ that belongs to neither five zang-organs nor six fu-organs in traditional Chinese medicine(TCM).It has an irreplaceable biological function as the second largest gland in human body.The pancreas was known as“??”in Chinese in ancient times.The medicine use of animal pancreas was recorded in the TCM books early in the Jin Dynasty,but it had not been mentioned until the Qing Dynasty.What kind of organ is the pancreas in TCM?Now there have been five statements about the question:①The pancreas is Sangao;②The pancreas is the organ Pi;③The pancreas is Mingmen;④The pancreas is Sanjiao;⑤The pancreas is an extraordinary organ.However,in our opinion,the pancreas is not Sangao,the organ Pi,Mingmen or Sanjiao.We systematically reviewed relevant literatures and made the conclusion that the pancreas is an extraordinary organ where the“organ Yi”was mistaken by the“organ Dan”.If that is true,the pancreas would be the extraordinary organ Yi as described in Huang Di Nei Jing(Yellow Emperor's Inner Canon)early before the Han dynasty.According to Zang-Fu theory,Zang-Fu was attributed by function rather than anatomy in TCM.After further discussion,we redefined the function of the pancreas.The ambiguous definition of the pancreas without dividing the endocrine and exocrine in the past is not desirable.To some extent the endocrine and exocrine parts of the pancreas respectively perform the functions of the organ Shen and organ Pi that belong to such two Zang-Fu systems.We believe that to find out the origin and redefine the function of the pancreas will be very helpful in the diagnosis and treatment of pancreatic diseases.