“肾脑相济”与“肾开窍于耳”相关性探讨

Discussion on the Correlation between“Kindey-Brain Interaction”and“Kidney Opening at Ear”

自先秦时期开始,肾与脑的关系就受到众多医家的关注。“肾脑相济”即肾与脑升降互济,神识相通。研究发现,中医学中“肾”的功能与下丘脑-垂体-肾上腺轴(HPA轴)联系密切,海马为HPA轴的高级调控中枢,海马-HPA轴失衡是“肾脑失济”发生的根本和关键。“肾开窍于耳”是中医藏象学说的重要内容,耳结构与功能的正常有赖于肾的充养,耳的感知功能是脑功能活动的具体表现,故耳廓的形态饱满及耳窍通利是“肾脑相济”的体现。刺激耳穴可以达到调理脏腑、补肾助脑的作用。现代研究证实,耳穴疗法的作用机制与迷走神经反射相关,刺激经迷走神经耳支通过大脑孤束核调节海马-HPA轴功能。基于中西医理论对肾本质的研究和耳-迷走神经反射机制,从肾主导耳的结构和功能角度出发,结合现代医学耳穴在“肾脑失济”疾病中的应用,文章提出耳穴刺激经迷走-孤束核调控海马-HPA轴功能,改善肾阳虚,从而治疗“肾脑失济”疾病。创新性探究“肾开窍于耳”的内涵,为中医藏象思想的临床应用提供新的思路。

Since the pre-Qin Period,the relationship between kidney and brain has been concerned by various doctors.“Kindey-brain interaction”is the kidney and brain up and down communication,codominant life activities.It is found that the function of kidney in TCM is closely related to the hypothalamicpituitary-adrenal axis(HPA axis).The disorder of HPA axis is the root and key of“kidney brain dysfunction”.“Kindey opening at ear”is an important content in the theory of traditional Chinese medicine.The structure and function of the ear depend on the nourishing of the kidney.The sensory function of the ear is the concrete expression of the brain function.Therefore,the full shape of the auricle and the normal hearing of the ear are the embodiment of“kindey-brain interaction”.The mechanism of auricular acupuncture therapy is related to vagus reflex,and the function of HPA axis is regulated by vagus auricular branch through nucleus tractus solitarius.Based on the study of the essence of kidney and the mechanism of ear vagus reflex in the theory of traditional Chinese and Western medicine,from the perspective of the structure and function of kidney dominated ear,combined with the application of ear acupoints in modern medicine in“kidney brain dysfunction”,this paper proposes that ear acupoints stimulate the vagal nucleus tractus solitarius HPA axis to regulate the nerve channel endocrine function,improve the kidney yang deficiency,so as to treat“kidney brain dysfunction”.To explore the connotation of“kindey opening at ear”innovatively,and to provide new ideas for the clinical application of the thought of visceral manifestation of traditional Chinese medicine.