三焦:以胰腺为中心的中医解剖结构

Tri-burners:Pancreas Related Anatomic Structural System in TCM

以人体解剖学基础考证《黄帝内经》中有关三焦的实际结构,发现三焦是以胰腺为中心的一系列解剖结构。首先,三焦是六腑之一,"从三焦注胆"确定了六腑之三焦就是胰腺,命名为胰腺三焦。"苦入于胃,五谷之气,皆不能胜苦,苦入下脘,三焦之道皆闭而不通,故变呕"中的三焦,是指由胰腺标记的消化吸收中心,命名为胃肠三焦,其中胃为上焦,胰腺所连接的十二指肠为中焦,小肠的近十二指肠段为下焦。三焦同时是人体的主要体腔,胸腔当中的纵隔属于上焦,腹膜腔属于中焦,腹膜后隙属于下焦,命名为体腔三焦。"上行注膻中,散于三焦"是指胰腺三焦和十二指肠所处的腹膜后隙,命名为膜后三焦,是下焦所属解剖空间的一部分。《难经》对膜后三焦的生理功能有完整论述,弥补了《黄帝内经》只强调盆筋膜间隙为下焦体腔的不足。胰腺三焦是消化管道内体液的主要来源,体腔三焦承载和调节体内的细胞外液,体液的调控是在肾的主导下,体腔三焦与膀胱协调完成的,其中胰腺三焦参与体液调控的机制可能与Na+的摄入有关。

This article discovered that the term of tri-burners in the Inner Canon of Huangdi meant to many different anatomic structures,but they are all related to the pancreas. First of all,tri-burners is one of six bowel organs. It is identified as the pancreas by 'to connect the gall bladder on tri-burners' since pancreas is the only organ outside of digestive track to connect to gall bladder. It had been named as pan-creatic tri-burners in this article. 'The bitter taste is the hardest to human digestion. It will stay in the lower burner of the digestive track once it has been taken. It will lead the stagnation and spasm to all the tri-burners in the digestive track,and will cause vomit',this tri-burners indicates the most important sections in the digestive track which take place of absorption of nutrition. Therefore,it has been named as the gastric tri-burners. The stomach is the upper burner section,the duodenum with pancreas is the middle burner section,and small intestine is the lower burner section. The three major body cavities are also called tri-burners. The mediastinum is the upper burner,the peritoneal cavity is the middle burner and the retro peritoneal cavity is the lower burner. At this circumstance it has been named as the cavity tri-burners. The lower burner in cavity tri-burners was named as two parts:Inner Cannon of Huangdi actually emphasized the pelvic cavity. The part above the posterior superior iliac spine was also called as tri-burners since 'it is occupied by the tri-burner and then travels up into the mediastinum.' It is named as retro tri-burners in this article. The structure and function of the retro-burners had been descripted in Nanjing,the functions of the tri-burners are most related to the body fluid circulation,which the pancreas tri-burner is the major source of the digestive fluids and cavity tri-burners participates the circulation of the body. The function of tri-burners is under the regulation of the kidney and coordinated with bladder. The mechanism of the tri-burners regulating the body fluids probably relates to the Na+circulation in the body.