A Novel Apprehension of the Primary Lung Meridian, Sinew Channel, Divergent Channel, Luo-Connecting Channel Acting as a Single Unit System to Serve Respiration Function Based on Modern Neurophysiology and Kinesiology

The TCM philosophy of a meridian and associated channels pertains to the specific function of one or more organs. We define the Lung Primary Meridian (LUM) together with the Lung Sinew (LUSC), Divergent (LUDC), Luo-connecting (LULCC) Channels as a system of routes plus some parts of the body (such as muscles) to fulfil respiration, as a main function under different situations. There is very limited information about the Lung associated channels in classical literature of TCM. With a clear focus on the function of respiration, we have carried out a detailed analysis of the biomedical consequence of stimulating the LUM, analysed the roles played by LUSC, LUDC, and LULCC. The updated LUM and LUDC include acupoints of other meridians, serving the same purpose of performing satisfactory respiration starting from checking the quality of the inflow through the nose. The LUSC includes the respiratory muscles (plus the associated connective tissues) extending to various parts of the body. The muscles of the limb (as part of the LUSC) embrace the nerves that provide routes for somatosensory reflexes and play the role of locomotion, providing voluntary respiration via the pectoralis muscles. The muscles of LUSC are bounded by stiff connective tissue layers, forming compartments, and are part of the pulley system for various body locomotions. Within a compartment, the interstitial fluid, blood, lymph flows must be potent to protect the associated nerves related to LUM;the healthy state of the LUSC also provides freedom of various types of locomotion. The LULCC exists because the vagus nerve has a part of it passing through the spinal cords all the way down to the sacrum domain, with exiting nerve innervating two-third of the large intestine. The crucial steps of our deductions are supported by experimental evidence based on modern neurophysiology and kinesiology. We discover that all the four channels stated above work as a unit system to allow respiration to be possible under various postures/conditions. The complexity of structures and processes is eased off by providing 29 figures and 13 tables for the relevant muscles and nerves. In addition to respiration, the Lung system in TCM context includes interaction of this system with the sweat gland and neuroendocrine system;such aspects will be left to another study.

Study on Traditional Chinese Medicine theory of lung being connected with large intestine

OBJECTIVE:The theory of lung being connected with large intestine,which is a major topic in Traditional Chinese Medicine(TCM),has guided clinical practice for thousands of years in China.METHODS:In this study,we analyzed the history,main contents,clinical application,and material basis of the theory,to attempt to improve the potential clinical significance of "lung being connected with large intestine" in China.RESULTS:The lung being connected with large intestine was first described in "Huang Di Nei Jing",and formed one of the basic theories of TCM.For thousands of years,the majority of TCM practitioners explored this theory continuously,leading to its development and use as an important theory in the guidance of TCM clinics In the last decade,researchers in the field of integrated TCM and Western medicine have studied clinical applications and biomedical mechanisms with experimental methods to explore the implications of the theory.CONCLUSION:With the further development of science and technology,research concerning the theory of lung being connected with large intestine will be greatly stimulated and contribute to the modernization of TCM.

基于“肺与大肠相表里”理论和“整体观念”探讨慢性肺系病合并功能性便秘的诊治思路

慢性肺系病和功能性便秘均是临床常见的难治性疾病,且易合并出现。对二者分别进行干预是现代医学的常规治疗模式,但疗效及安全性均不能令人满意。课题组在临床实践中发现,中医药治疗慢性肺系病合并功能性便秘具有独特的优势。笔者在中医“肺与大肠相表里”理论和“整体观念”指导下,提出慢性肺系疾病合并功能性便秘的病机涉及肺失宣肃致腑气不通、大肠传导失司致肺气上逆、脾失健运、肾精亏损、气血两虚、久病瘀滞等方面,治疗当以“肺肠合治”为总则,辅以健脾益肾、补气养血以扶本虚,行气化瘀以祛实邪,并据此整理临床常用方药,系统总结了本病的中医诊治思路。

基于烟草对癌变的影响探讨肺与大肠相表里

目的 通过分析烟草对人体各部位癌症发病率的影响,探讨肺肠轴理论与“肺与大肠相表里”的中医理论的关系。方法 收集从2017年—2021年来院就诊的137591人中的2477例肿瘤患者的一般信息、吸烟史、肿瘤原发部位等,对收集的资料进行肿瘤发病率统计分析和比较。结果 吸烟可提高消化系统癌症的病发率,仅次于呼吸道并远高于其他部位的癌症病发率。这一现象符合“肺与大肠相表里”的中医理论和现代医学中肺肠轴学说。结论 肺系疾病易引发肠道疾病,而肠道疾病也易引发肺系疾病,此现象可用中医“肺与大肠相表里”解释,肺-肠轴理论可作为“肺与大肠相表里”理论的翻译。

《黄帝内经》肺与大肠相表里理论临床体会

脏腑表里理论历史悠久,源远流长,是中医藏象学说的重要组成部分。此文通过医案举例,介绍肺与大肠相表里理论,强调该理论在临床中的治疗作用,得出应用此理论在辨证论治肺系、肠系相关疾病时,脏腑同治较脏病治脏、腑病治腑收效更佳。总之,运用肺与大肠相表里理论,为临床疾病治疗肺系、肠系疾病扩宽了思路,值得临床推广。

基于“肺合大肠”理论探讨针灸调控肠道菌群治疗呼吸系统疾病

“肺合大肠”理论起源于《黄帝内经》,阐述了肺与大肠在病理上相互影响、生理上相互作用和经络上相互络属的表里关系。近年来,研究发现肠道菌群发生紊乱时,会出现多种炎性反应,免疫系统遭到抑制,出现肺部疾患。针灸可通过调控肠道菌群对呼吸系统疾病发挥效应。本研究结合中医理论及现代实验研究,基于肺合大肠理论与呼吸系统疾病和肠道菌群的对应关系探讨针灸调控肠道菌群治疗呼吸系统疾病的可行性以及针灸通过调控肠道菌群治疗呼吸系统疾病的作用机制,以期为临床治疗呼吸系统疾病提供新的中医诊疗思路。

“肺气虚”大鼠模型肺、皮肤、大肠Fas、Fas-L表达相关性的实验研究

目的:在分子水平上探讨肺与皮肤、大肠之间的内在联系。方法:单纯烟熏法建立大鼠“肺气虚”病理模型,将20只大鼠随机分为正常对照组和病理模型组。采用免疫组化SP方法,分别检测Fas、Fsa-L在两组动物肺、皮肤和大肠组织中的表达水平,并进行比较。结果:“肺气虚”病理模型组的肺、皮肤、大肠组织中Fas、Fas-L与正常对照组比较明显增高,具有显著性差异(P<0.01)。结论:肺、皮肤、大肠三种组织中Fas、Fas-L的表达水平呈平行相关性,从分子水平上提示肺与皮肤、大肠之间可能存在着内在联系,证实了中医学“肺外合皮毛”及“肺与大肠相表里”的重要理论。

从“脑肠相通”假说探讨肺性脑病辨治

肺性脑病为慢性阻塞性肺疾病后期的严重阶段,此病发展影响到神经系统时,往往出现肠道运动功能异常,或肠道功能异常早于神经系统症状出现。它或者是主要致病机理,或者是病情恶化的主要因素。"脑肠相通"假说为临床预防和辨治肺性脑病提供了新的思维模式,即采取脑病问肠,肠病询脑,脑肠同治措施,从而达到"通腑安脑,脑安腑畅"的目的。

以AQP4表达诠释“肺液”与“肠津”于“肺病及肠”病理传变中的意义

目的了解慢性支气管炎大鼠模型肺与结肠病理变化关系,揭示"肺病及肠"病理传变的可能分子机制。方法采用改良烟熏法制备慢性支气管炎大鼠模型,观察正常对照组(对照组)与慢性支气管炎模型组(模型组)大鼠粪水含量;采用免疫组化法观察肺与近端结肠水通道蛋白4(AQP4)表达变化;采用ELASA法检测大鼠血浆、肺泡灌洗液及肺与近端结肠组织匀浆中血管活性肠肽(VIP)及P物质(SP)的含量。结果 与对照组相比,模型组大鼠粪水含量增加,近端结肠AQP4表达显著下降;对照组与模型组大鼠血浆、肺泡灌洗液及肺与结肠组织匀浆中VIP与SP的含量表达无差异。结论 AQP4可能是"肺液"与"肠津"联系的分子生物学基础。

基于肺与大肠相表里理论浅谈糖尿病与结肠癌的关系

中医有“肺与大肠相表里”的理论,肺和大肠二者在生理病理上均有重要联系,基于此理论,临床治疗常有肺肠同治,肺病治肠,肠病治肺,糖尿病中上消与肺相关,其与结肠癌的发生发展相关也被越来越多的临床研究证实,糖尿病患者容易引起结肠癌,两者在治疗上也有一定的相关性。此文就“肺与大肠相表里”这一理论来论述糖尿病与结肠癌的关系。

Analysis on clinically drug-used law for lung-intestine related diseases

OBJECTIVE:To analyze the application laws of clinical drugs by descriptive statistical method with the clinical literatures guided by "lung being connected with large intestine" used as the object.METHODS:Retrievepubliclypublishedclinicalliteratures about "lung being connected with large intestine"inrecent30years,establishthedatabaseofclinical literature,and study on the clinically drug-used lawsbydescriptivestatisticalanalyticmethod.RESULTS:The common high frequent drugs used for the lung-intestine related diseases were Gualou(Ructus Trichsanthis),Dahuang(Radix et Rhizoma),Kuxingren(Semen Armeniacae Amarum),Gancao(Radix Glycyrrhizae),Houpu(Cortex Magnoliae Officinalis),Zhishi(Fructus Aurantii Immaturus).For the different clinical syndrome types,in the commonly used drugs there were different characteristics,reflecting the principle of TCM syndrome differentiation treatment.CONCLUSION:The common high frequent drugs used for the lung-intestine related diseases are Gualou(Fructus Trichsanthis),Dahuang(Radix et Rhizoma),Kuxingren(Semen Armeniacae Amarum),Gancao(Radix Glycyrrhizae),Houpu(Cortex Magnoliae Officinalis),Zhishi(Fructus Aurantii Immaturus),which are commonly-used drugs for the lung-intestine related diseases,with differences for different syndrome types.

论“肺合大肠,大肠者,皮其应”的理论内涵及生物学机制

“肺合大肠,大肠者,皮其应”是肺藏象学说的重要命题,高度概括了肺、大肠、皮肤之间生理病理内外呼应的关系,并以“肺病治肠”“肠病治肺”“皮病治肺”“皮病治肠”等同调互治辨治形式,广泛应用于多种肺、大肠及皮肤难治性疾病的治疗。本文从系统思维、主客一体、逻辑推理等视角,分别阐释“肺合大肠”“肺合皮毛”“大肠者,皮其应”等脏腑形体应合的理论内涵,明确了“肺-肠-皮肤”相互应合的逻辑关系,而基于“肺-肠”轴、“肺-皮肤”轴、“肠-皮肤”轴等双向互作网络探讨其生物学机制,对于丰富及拓展中医“皮”概念的内涵及外延、构建“态靶结合”的“肺-肠-皮肤”病证治疗新模式具有重要的启迪意义。

针刺肺俞和天枢对哮喘模型大鼠肺功能及组织炎症的影响

目的:对比观察肺俞和天枢联用与肺俞单用对哮喘模型大鼠肺功能和组织炎症的影响。方法:将48只Sprague-Dawley大鼠根据随机数字表法分为正常组、模型组、从肺论治组和肺肠同治组,每组12只。除正常组外,其余三组大鼠采用卵清白蛋白致敏和雾化激发的方法制备哮喘模型。模型制备成功后,从肺论治组大鼠针刺双侧肺俞30 min;肺肠同治组大鼠先后针刺双侧肺俞和天枢各15 min,共计30 min。每天1次,连续14 d。其余两组大鼠不干预。干预结束后,肺功能测定仪测定各组大鼠的肺功能;光镜下观察苏木素-伊红染色的肺组织病理学改变、Masson染色的肺组织胶原沉积程度以及瑞-吉染色的肺泡灌洗液(BALF)中炎症细胞的含量;酶联免疫吸附法检测各组大鼠肺组织中白介素(IL)-4、IL-5、IL-13、IL-17、IL-25、IL-33、半胱氨酸白三烯(LT)、胸腺基质淋巴细胞生成素(TSLP)和前列腺素D2(PGD2)的含量。结果:与正常组相比,模型组大鼠最大呼气流量(PEF)、动态肺顺应性(Cdyn)、呼出25%肺活量时最大呼气流量(FEF25%)、一秒用力呼气容积占用力肺活量比(FEV1/FVC)、最大呼气中期流量(MMEF)均显著下降(P<0.01或P<0.05),肺阻力(RL)、胶原沉积程度、IL-4、IL-5、IL-13、IL-17、IL-33、LT、TSLP、PGD2及BALF中的中性粒细胞占比显著增加(P<0.01或P<0.05)。与模型组相比,从肺论治组大鼠肺功能中FEF25%和FEV1/FVC显著升高(P<0.01,P<0.05),胶原纤维沉积程度、IL-4、IL-5、IL-13、IL-17、LT、TSLP及PGD2的含量均显著降低(P<0.01或P<0.05);肺肠同治组大鼠肺功能中PEF、FEF25%及FEV1/FVC均显著升高(P<0.01或P<0.05),RL、胶原纤维沉积程度、IL-4、IL-5、IL-13、IL-17、IL-33、LT、TSLP、PGD2及BALF中的中性粒细胞占比显著降低(P<0.01或P<0.05)。与从肺论治组相比,肺肠同治组大鼠肺组织中IL-5的含量降低(P<0.05)。结论:从肺论治及肺肠同治针刺对哮喘模型大鼠肺功能、肺组织炎症及BALF中的炎症细胞均具有良好的改善效果;肺肠同治在改善IL-5含量方面优于从肺论治;肺俞和天枢联用治疗哮喘有优于单用肺俞的趋势。

通腑对哮喘模型小鼠肺及肠组织VIP、TFF3及NKA含量的影响

目的:观察通腑对卵清蛋白(OVA)致哮喘小鼠肺、肠组织血管活性肠肽(VIP)、肠三叶因子(TFF3)及神经激肽A(NKA)含量的影响,从神经肽角度探讨"肺合大肠"脏腑相关联络机制。方法:40只C57BL/6小鼠随机分为正常组、模型组、模型给药组及正常给药组,采用卵清蛋白致敏激发建立支气管哮喘小鼠模型。造模第14天-20天,正常组、模型组蒸馏水灌胃,模型给药组、正常给药组以大承气汤灌胃,连续7d。检测各组小鼠肺支气管肺泡灌洗液(BALF)中细胞分类计数和肺、肠组织中VIP、TFF3、NKA含量。结果:与正常组比较,模型组小鼠BALF中淋巴细胞、中性粒细胞、嗜酸性粒细胞计数及肺、肠组织中NKA含量均明显增高(P<0.01,P<0.05),肺、肠组织中VIP和TFF3含量均明显降低(P<0.01,P<0.05)。与模型组比较,模型给药组BALF中淋巴细胞、中性粒细胞、嗜酸性粒细胞计数及肺、肠组织NKA含量明显降低(P<0.01,P<0.05),肺组织TFF3含量明显升高。Spearman简单相关显示:肺、肠组织中NKA、TFF3含量,BALF中嗜酸性粒细胞计数与肺组织中NKA、VIP、TFF3含量,淋巴细胞计数与肺组织中VIP、TFF3含量,中性粒粒细胞计数与肺组织中NKA、VIP含量均呈明显相关关系(P<0.01,P<0.05)。结论:大承气汤可明显减轻OVA致哮喘模型小鼠肺部炎症,这一效应的发生可能与肺、肠神经肽NKA、TFF3及VIP的变化密切相关。

生长激素释放肽在慢性阻塞性肺疾病大鼠中含量变化的观察

目的:探讨不同时间点慢性阻塞性肺疾病(COPD)大鼠血浆、肺组织和结肠组织中生长激素释放肽(ghrelin)表达的变化。方法:采用单纯熏烟法建立COPD大鼠模型,将34只Wistar随机分为正常组、4周模型组和8周模型组,分别记录各组大鼠食量、体质量,用放免法测定大鼠肺、肠及血浆中ghrelin含量。结果:模型组大鼠肺、肠组织病理改变显著;与正常组相比,模型组食量减少,体质量下降;8周模型组血浆ghrelin水平较正常组显著性降低(P<0.05);4周、8周模型组肺组织ghrelin水平与正常组比较显著降低(P<0.05),但两组之间无显著性差异;4周、8周模型组肠组织ghrelin水平与正常组比较显著性升高(P<0.05),但2组之间无显著性差异。结论:通过观察熏烟引起的COPD大鼠的各脏器病理变化、食量、体质量以及ghrelin在肺、肠、血清中的变化可以看出,肺肠之间可能存在着某种互动调节机制。

低氧及限水对大鼠肺和肠黏膜细胞因子含量的影响

目的:通过观察低氧、限水条件下大鼠肺、肠黏膜细胞因子IL-1β、IL-2、IL-6含量的变化,探讨"肺与大肠相表里"可能的生物学机制。方法:实验设立正常组(常态环境饲养)、低氧组(10%氧浓度饲养)、限水组(给予正常日饮水量的1/2),比较各组肺泡灌洗液、肠黏膜灌洗液中IL-1β、IL-2、IL-6含量的变化。结果:低氧及限水条件下,大鼠肺泡灌洗液、肠黏膜灌洗液中IL-1β、IL-2、IL-6的含量,与正常组大鼠比较,均呈现降低趋势。其中低氧组肺泡灌洗液中IL-2及肠黏膜灌洗液中IL-1β含量的降低,限水组肺泡灌洗液中IL-2、IL-6及肠黏膜灌洗液中IL-2含量的降低,与正常组大鼠相比差异有统计学意义(P<0.01,P<0.05)。结论:肺肠在黏膜免疫方面的变化具有相关性,这可能是肺与大肠表里相关关系的生物学基础之一。

Literature-based analysis on relationship of symptoms,drugs and therapies in treatment of intestinal diseases

OBJECTIVE:To evaluate clinical articles published in the past 30 years using the Traditional Chinese Medicine(TCM)theory of the lung being connected with large intestine to treat intestinal diseases.We also analyzed the relationship between symptoms,drugs and therapies with data-excavating technology to aid management.METHODS:After retrieving relevant clinical articles,we set up a database,used Microsoft Structured Query Language Server 2005 Analysis Services as a data-excavating tool,and applied the association rule to study the relationship between the symptoms,drugs and therapies of intestinal diseases.RESULTS:The key symptoms of dyschesia,constipation,abdominal fullness,fatigue and pale tongue could be treated with Kuxingren(Semen Armeniacae Amarum),Huangqi(Radix Astragali Mongolici)and Gualou(Fructus et Semen Trichosanthis)to invigorate Qi and moisten the intestine.Among these agents,Kuxingren(Semen Armeniacae Amarum)was used most frequently.Clearing Fu-organs was the most prevalent therapy for abdominal fullness,dyschesia,constipation and red tongue.Clearing Fu-organs could be achieved with Kuxingren(Semen Armeniacae Amarum)and Gualou(Fructus et Semen Trichosanthis),whereas Qi could be invigorated using Huangqi(Radix Astragali Mongolici),Gancao(Radix Glycyrrhizae),Baizhu(Rhizoma Atractylodis Macrocephalae)and Kuxingren(Semen Armeniacae Amarum).Moistening the intestine was possible with Kuxingren(SemenArmeniacae Amarum),Huomaren(Fructus Cannabis)and Jiegeng(Radix Platycodi).Also,moistening the lungs was done with Kuxingren(Semen Armeniacae Amarum),ventilating the lungs with Kuxingren(Semen Armeniacae Amarum)and Gualou(Fructus et Semen Trichosanthis),and nourishing the lungs with Huangqi(Radix Astragali Mongolici),Gancao(Radix Glycyrrhizae)and Kuxingren(Semen Armeniacae Amarum).These data demonstrated that Kuxingren(SemenArmeniacaeAmarum)was a key agent.CONCLUSION:Our analyses of the literature showed clear relationships between symptoms(constipation,dyschesia,abdominal fullness),drugs[Gualou(Fructus et Semen Trichosanthis),Kuxingren(Semen Armeniacae Amarum),Huangqi(Radix Astragali Mongolici)]and therapies(moistening the intestine,clearing Fu-organs,invigorating Qi,ventilating the lungs).

基于“肺合大肠”理论探讨肠道微生态、黏膜免疫与支气管哮喘之间的相关性

支气管哮喘是一种气道慢性炎症性疾病。随着其发病率的逐年增加,学界对其防治愈加重视。目前,随着分子生物学研究的进一步深入,肠道微生态在肺部疾病发生发展过程中所扮演的角色日益被关注,且肺-肠黏膜免疫功能间相关性的研究俨然成为学界的研究热点。而中医自古即有“肺合大肠”的经典之论,故文章基于“肺合大肠”理论探讨肠道微生态、黏膜免疫与支气管哮喘之间的关系,以期为中医药运用肺肠同治法防治支气管哮喘提供新思路及理论依据。