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中醫文獻中的腦——論腦之內部結構

醫案日記(ji) 2023-05-12 17:40:40

摘要:腦(nao)(nao)之(zhi)內(nei)部結(jie)構歷代(dai)文(wen)獻略而(er)不詳,多(duo)散(san)在于(yu)歷代(dai)古(gu)籍和道(dao)家(jia)記錄中(zhong),由道(dao)家(jia)“內(nei)視法(fa)”洞察(cha)而(er)得。腦(nao)(nao)之(zhi)內(nei)部結(jie)構劃分為(wei)九(jiu)瓣(ban)(ban)、四(si)方、四(si)隅及中(zhong)央共九(jiu)個區域,稱之(zhi)為(wei)九(jiu)宮。其中(zhong)貫穿(chuan)著血(xue)(xue)絡(luo)(luo)、脈絡(luo)(luo)、細皮(pi)和腦(nao)(nao)氣(qi)筋。九(jiu)瓣(ban)(ban)由細皮(pi)分割;筋絡(luo)(luo)把腦(nao)(nao)之(zhi)各(ge)宮聯絡(luo)(luo)在一(yi)起;血(xue)(xue)絡(luo)(luo)、脈絡(luo)(luo)貫通(tong)氣(qi)血(xue)(xue)以養腦(nao)(nao)體;腦(nao)(nao)髓滋養腦(nao)(nao)體,化生神(shen)氣(qi)。九(jiu)宮各(ge)宮神(shen)君(jun)各(ge)司其職,司命下屬(shu)。各(ge)神(shen)君(jun)之(zhi)所以能(neng)發揮其神(shen)明(ming)作用,還由于(yu)其與全身百節相通(tong),與腎氣(qi)相通(tong)。

關于腦之內部結構,祖國醫學記載略而不詳,其論述主要見于道家著作。道家對其論述,并非揣意,而是通過內視法洞察而得之。張錫純《醫學衷中參西錄·醫學宜參丹經論》寫道:“內經與丹經皆始于黃帝,然內(nei)經為(wei)世俗共(gong)用(yong)之(zhi)(zhi)書,故(gu)其書顯傳(chuan)于后世。丹經為(wei)修(xiu)士獨善之(zhi)(zhi)書,故(gu)其書秘(mi)傳(chuan)有專家,所謂教外別傳(chuan)也。其后分門別派,或(huo)書籍留貽,或(huo)口訣授(shou)受,著述雖紛(fen)不一致(zhi),而(er)當其內(nei)視(shi)(shi)功深之(zhi)(zhi)候,約皆能洞見(jian)臟腑,朗(lang)若掣電,深究性(xing)命,妙能悟真,故(gu)其論說皆能與(yu)內(nei)經相發(fa)明(ming)。”道家練內(nei)功,達至精深時,通過內(nei)視(shi)(shi),能洞察(cha)到腦、臟腑、骨骼、血脈(mo),以及他們之(zhi)(zhi)間之(zhi)(zhi)內(nei)在聯(lian)系,然后將洞察(cha)到腦之(zhi)(zhi)內(nei)部結構(gou)劃分為(wei)九(jiu)宮(gong)、九(jiu)瓣、四方、四隅(yu)九(jiu)個區域。后世醫(yi)家和科(ke)學家對(dui)其進一步研究,又補充(chong)了血絡、脈(mo)絡、細皮和腦氣筋等,從而(er)腦之(zhi)(zhi)內(nei)部結構(gou)日(ri)趨完善。

九(jiu)(jiu)宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong):從(cong)總體上(shang)(shang)講,腦之內部總稱(cheng)之為(wei)(wei)(wei)腦宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)。然其內部又劃分為(wei)(wei)(wei)九(jiu)(jiu)個區(qu)域(yu),稱(cheng)之為(wei)(wei)(wei)九(jiu)(jiu)宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)。正如《修真(zhen)十書雜著捷徑·存守九(jiu)(jiu)宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)訣》所云:“頭(tou)(tou)有九(jiu)(jiu)宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong),上(shang)(shang)象九(jiu)(jiu)天,下(xia)法九(jiu)(jiu)地(di)。”九(jiu)(jiu)宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)即明(ming)堂(tang)(tang)宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)、洞(dong)(dong)房(fang)(fang)宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)、丹田宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)、流(liu)珠(zhu)宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)、玉帝(di)(di)宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)、天庭宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)、極真(zhen)宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)、玄(xuan)(xuan)丹宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)和(he)太皇(huang)宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)。各宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)在(zai)腦中的具體位置,《洞(dong)(dong)真(zhen)太上(shang)(shang)道(dao)君元丹上(shang)(shang)經(jing)》寫道(dao):“凡一(yi)(yi)(yi)頭(tou)(tou)中有九(jiu)(jiu)宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)。兩(liang)眉(mei)間上(shang)(shang)卻(que)(que)一(yi)(yi)(yi)寸(cun)(cun)(cun),為(wei)(wei)(wei)明(ming)堂(tang)(tang)宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)。卻(que)(que)入二寸(cun)(cun)(cun),為(wei)(wei)(wei)洞(dong)(dong)房(fang)(fang)宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong),卻(que)(que)入三(san)寸(cun)(cun)(cun),為(wei)(wei)(wei)丹田宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)。卻(que)(que)入四寸(cun)(cun)(cun),為(wei)(wei)(wei)流(liu)珠(zhu)宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)。卻(que)(que)入五寸(cun)(cun)(cun),為(wei)(wei)(wei)玉帝(di)(di)宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)。明(ming)堂(tang)(tang)上(shang)(shang)一(yi)(yi)(yi)寸(cun)(cun)(cun),為(wei)(wei)(wei)天庭宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)。洞(dong)(dong)房(fang)(fang)上(shang)(shang)一(yi)(yi)(yi)寸(cun)(cun)(cun),為(wei)(wei)(wei)極真(zhen)宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)。丹田上(shang)(shang)一(yi)(yi)(yi)寸(cun)(cun)(cun),為(wei)(wei)(wei)玄(xuan)(xuan)丹宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)。流(liu)珠(zhu)上(shang)(shang)一(yi)(yi)(yi)寸(cun)(cun)(cun),為(wei)(wei)(wei)太皇(huang)宮(gong)(gong)(gong)(gong)(gong)(gong)(gong)(gong)。”大致描(miao)述了腦之內部區(qu)域(yu)之劃分。

道(dao)家認為,九(jiu)宮之(zhi)(zhi)(zhi)中各有(you)神(shen)(shen)(shen)君(jun)(jun)居之(zhi)(zhi)(zhi)。何(he)為神(shen)(shen)(shen)君(jun)(jun)?《說文》寫道(dao):君(jun)(jun)者(zhe)“尊也”,為至尊無尚之(zhi)(zhi)(zhi)義(yi),“神(shen)(shen)(shen)君(jun)(jun)”是對各宮之(zhi)(zhi)(zhi)神(shen)(shen)(shen)之(zhi)(zhi)(zhi)尊稱。因(yin)為腦為思維意識器官,有(you)統帥全身之(zhi)(zhi)(zhi)德,似國家君(jun)(jun)主之(zhi)(zhi)(zhi)地位(wei),故(gu)(gu)喻之(zhi)(zhi)(zhi)神(shen)(shen)(shen)君(jun)(jun)。周楣聲(sheng)注《黃庭內(nei)景經》時寫道(dao):“天(tian)有(you)九(jiu)宮,故(gu)(gu)人腦亦有(you)九(jiu)瓣,即(ji)四方、四隅并中央九(jiu)位(wei),內(nei)藏九(jiu)真。真者(zhe),真元之(zhi)(zhi)(zhi)神(shen)(shen)(shen)也。房(fang)者(zhe),洞(dong)房(fang),即(ji)腦神(shen)(shen)(shen)所居之(zhi)(zhi)(zhi)處(chu)也。”這些不同部位(wei)元真之(zhi)(zhi)(zhi)氣,即(ji)所謂神(shen)(shen)(shen)君(jun)(jun),神(shen)(shen)(shen)君(jun)(jun)所居之(zhi)(zhi)(zhi)洞(dong)房(fang)稱之(zhi)(zhi)(zhi)為宮。換言之(zhi)(zhi)(zhi),九(jiu)宮之(zhi)(zhi)(zhi)中各有(you)神(shen)(shen)(shen)君(jun)(jun)居之(zhi)(zhi)(zhi)。

然而(er)各(ge)宮所居之(zhi)神君(jun)(jun),并不(bu)孤立存在(zai)(zai),而(er)是相互呼應。正如梁丘子《黃庭內景玉(yu)經(jing)注》所云:“神通丹(dan)田而(er)外”、“三老同坐各(ge)有朋(peng)”、“百神流通”。各(ge)宮神君(jun)(jun)在(zai)(zai)泥丸神君(jun)(jun)之(zhi)主宰(zai)統調下,各(ge)司其職,相互協(xie)作地(di)發(fa)揮各(ge)自的作用(yong)。

泥(ni)丸(wan)宮(gong)(gong)(gong):泥(ni)丸(wan)宮(gong)(gong)(gong)即丹田宮(gong)(gong)(gong)。居九(jiu)宮(gong)(gong)(gong)之(zhi)(zhi)(zhi)中(zhong)央。近(jin)于泥(ni)丸(wan)宮(gong)(gong)(gong)之(zhi)(zhi)(zhi)四宮(gong)(gong)(gong),稱(cheng)為(wei)四方(fang),遠于泥(ni)丸(wan)宮(gong)(gong)(gong)之(zhi)(zhi)(zhi)邊緣區域之(zhi)(zhi)(zhi)四宮(gong)(gong)(gong),稱(cheng)為(wei)四隅。前文(wen)曾稱(cheng)“并中(zhong)央”之(zhi)(zhi)(zhi)“中(zhong)央”即指(zhi)泥(ni)丸(wan)宮(gong)(gong)(gong)。道(dao)家對(dui)泥(ni)丸(wan)宮(gong)(gong)(gong)之(zhi)(zhi)(zhi)稱(cheng)頗多(duo)(duo),有天腦、黃(huang)庭(ting)、昆侖、天谷(gu)等幾十種之(zhi)(zhi)(zhi)稱(cheng)。所以(yi)《紫清指(zhi)玄集》寫道(dao):“頭有九(jiu)宮(gong)(gong)(gong),上應(ying)九(jiu)天,中(zhong)間一宮(gong)(gong)(gong),謂之(zhi)(zhi)(zhi)泥(ni)丸(wan),亦曰(yue)黃(huang)庭(ting)、又曰(yue)昆侖、又名天谷(gu),其(qi)名頗多(duo)(duo)。”

泥(ni)丸宮有(you)(you)上元(yuan)真君(jun)居(ju)(ju)之(zhi)(zhi)(zhi)。上元(yuan)真君(jun)古(gu)代醫籍(ji)中多稱為(wei)(wei)泥(ni)丸君(jun),亦(yi)有(you)(you)稱之(zhi)(zhi)(zhi)太乙(yi)帝君(jun)、太乙(yi)元(yuan)真者(zhe)。今多稱元(yuan)神(shen)和腦(nao)(nao)神(shen)。如張景(jing)岳《類經》注道(dao):“人之(zhi)(zhi)(zhi)腦(nao)(nao)為(wei)(wei)髓海,是(shi)謂上丹(dan)田,太乙(yi)帝君(jun)所居(ju)(ju)。”所謂“太乙(yi)”,即一身(shen)(shen)之(zhi)(zhi)(zhi)祖宮,位居(ju)(ju)至尊無尚,是(shi)諸陽之(zhi)(zhi)(zhi)會,萬神(shen)總會之(zhi)(zhi)(zhi)都。所以(yi)《修(xiu)真十書》云(yun):“天腦(nao)(nao)者(zhe),一身(shen)(shen)之(zhi)(zhi)(zhi)宗(zong),百神(shen)之(zhi)(zhi)(zhi)會,道(dao)合(he)太玄(xuan),故曰泥(ni)丸。”《道(dao)樞·平都篇》亦(yi)云(yun):“天腦(nao)(nao)者(zhe),一身(shen)(shen)之(zhi)(zhi)(zhi)靈也(ye),百神(shen)之(zhi)(zhi)(zhi)命(ming)窟(ku),津液(ye)之(zhi)(zhi)(zhi)山源,魂精之(zhi)(zhi)(zhi)玉室也(ye)。夫能腦(nao)(nao)中園虛以(yi)灌真,萬空真立,千(qian)孔生煙,德備天地,洞同(tong)大方,故曰泥(ni)丸。泥(ni)丸者(zhe),形之(zhi)(zhi)(zhi)上神(shen)也(ye)。”九宮雖各有(you)(you)神(shen)君(jun)居(ju)(ju)之(zhi)(zhi)(zhi),又各自司命(ming),然均聽命(ming)于(yu)泥(ni)丸君(jun)。泥(ni)丸君(jun)統(tong)帥諸神(shen),為(wei)(wei)腦(nao)(nao)中之(zhi)(zhi)(zhi)腦(nao)(nao),腦(nao)(nao)中之(zhi)(zhi)(zhi)中心(xin),核心(xin)之(zhi)(zhi)(zhi)核心(xin)。

各(ge)(ge)宮神(shen)(shen)(shen)(shen)(shen)君(jun)(jun)各(ge)(ge)司(si)其(qi)職,司(si)命(ming)(ming)(ming)(ming)下(xia)屬。如《道藏·太上老(lao)君(jun)(jun)內(nei)觀經》謂曰(yue):“太乙帝君(jun)(jun)在(zai)(zai)頭,曰(yue)泥丸君(jun)(jun),總(zong)眾神(shen)(shen)(shen)(shen)(shen)也(ye)。照生(sheng)識(shi)神(shen)(shen)(shen)(shen)(shen),人之魂(hun)也(ye)。司(si)命(ming)(ming)(ming)(ming)處(chu)心,納生(sheng)之也(ye)。元英居(ju)左(zuo),制三魂(hun)也(ye)。白元居(ju)右,構三魄也(ye)。桃核住臍,深精根(gen)也(ye)。照諸百(bai)節(jie)。生(sheng)百(bai)神(shen)(shen)(shen)(shen)(shen)也(ye)。所(suo)以(yi)周身不空也(ye)。文氣(qi)入鼻,灌(guan)泥丸也(ye)。所(suo)以(yi)神(shen)(shen)(shen)(shen)(shen)形(xing)固安也(ye)。運(yun)動(dong)住止,關其(qi)心也(ye)。所(suo)以(yi)謂生(sheng)由(you)(you)然也(ye)。”各(ge)(ge)宮神(shen)(shen)(shen)(shen)(shen)君(jun)(jun),上下(xia)左(zuo)右互用而相(xiang)應,均在(zai)(zai)泥丸神(shen)(shen)(shen)(shen)(shen)君(jun)(jun)統一(yi)協(xie)調(diao)下(xia)發揮整體(ti)神(shen)(shen)(shen)(shen)(shen)明之德。《道藏·指(zhi)玄(xuan)篇·修(xiu)仙(xian)辨(bian)惑論》把(ba)泥丸君(jun)(jun)在(zai)(zai)人之機體(ti)生(sheng)命(ming)(ming)(ming)(ming)活動(dong)中(zhong)之至(zhi)關重(zhong)要作用,故《云笈七簽·元氣(qi)論》把(ba)它與人體(ti)健(jian)康聯系在(zai)(zai)一(yi)起:“腦實則(ze)(ze)神(shen)(shen)(shen)(shen)(shen)全,神(shen)(shen)(shen)(shen)(shen)全則(ze)(ze)氣(qi)全,氣(qi)全則(ze)(ze)形(xing)全,形(xing)全則(ze)(ze)百(bai)關調(diao)于(yu)內(nei),八邪消(xiao)于(yu)外。”由(you)(you)于(yu)泥丸與生(sheng)死聯系在(zai)(zai)一(yi)起:“中(zhong)間一(yi)宮,謂之泥丸。……乃元神(shen)(shen)(shen)(shen)(shen)所(suo)住之宮,其(qi)空如谷,而神(shen)(shen)(shen)(shen)(shen)居(ju)之,故曰(yue)谷神(shen)(shen)(shen)(shen)(shen)。神(shen)(shen)(shen)(shen)(shen)存則(ze)(ze)健(jian),神(shen)(shen)(shen)(shen)(shen)去則(ze)(ze)死,日則(ze)(ze)接于(yu)物,夜則(ze)(ze)接于(yu)夢,神(shen)(shen)(shen)(shen)(shen)不能安其(qi)居(ju)也(ye)。”正因(yin)為(wei)泥丸有神(shen)(shen)(shen)(shen)(shen)所(suo)居(ju),真(zhen)(zhen)氣(qi)存于(yu)內(nei),為(wei)人生(sheng)命(ming)(ming)(ming)(ming)中(zhong)樞,所(suo)以(yi)《素問·刺(ci)禁論篇》強調(diao)指(zhi)出:“刺(ci)腦,中(zhong)腦戶(hu),入腦立死。”腦死亡才是(shi)生(sheng)命(ming)(ming)(ming)(ming)真(zhen)(zhen)正終結(jie)。

泥(ni)(ni)丸(wan)(wan)君與(yu)(yu)各神(shen)(shen)君之所以能發揮神(shen)(shen)明作用。還有下(xia)列兩個原因:一為(wei)泥(ni)(ni)丸(wan)(wan)與(yu)(yu)全身(shen)百節相通(tong)(tong):周楣聲《黃庭經醫疏·至(zhi)道章·第(di)七疏注(zhu)(zhu)》“至(zhi)道不煩存決真(zhen),泥(ni)(ni)丸(wan)(wan)百節皆有神(shen)(shen)”時(shi)云(yun)(yun):“在(zai)這一大泥(ni)(ni)丸(wan)(wan)之中(zhong),其(qi)中(zhong)不同節度,皆能與(yu)(yu)全身(shen)各部的神(shen)(shen)氣(qi)息(xi)(xi)息(xi)(xi)相通(tong)(tong)。”各臟腑(fu)(fu)之神(shen)(shen)氣(qi)能通(tong)(tong)過“息(xi)(xi)息(xi)(xi)相通(tong)(tong)”之路(lu)(lu),上(shang)(shang)潮泥(ni)(ni)丸(wan)(wan),同時(shi),泥(ni)(ni)丸(wan)(wan)之神(shen)(shen)明又能通(tong)(tong)過“息(xi)(xi)息(xi)(xi)相通(tong)(tong)”之路(lu)(lu),下(xia)行(xing)臟腑(fu)(fu)和各節度,從而形(xing)成(cheng)上(shang)(shang)通(tong)(tong)下(xia)達(da)之傳達(da)通(tong)(tong)路(lu)(lu),而效(xiao)神(shen)(shen)明之德。二(er)為(wei)泥(ni)(ni)丸(wan)(wan)與(yu)(yu)腎氣(qi)相通(tong)(tong)。《道樞·黃庭篇》云(yun)(yun):“腎者(zhe),其(qi)左少陰,其(qi)右太陽,上(shang)(shang)通(tong)(tong)諸氣(qi),常隨呼吸而出(chu)焉,內灌于生(sheng)門,上(shang)(shang)入于泥(ni)(ni)丸(wan)(wan),上(shang)(shang)下(xia)流通(tong)(tong),如日月之運行(xing)。心之動靜、呼吸、心宮常存諸也。氣(qi)者(zhe)出(chu)入于下(xia)丹田,流注(zhu)(zhu)于身(shen)。”從而形(xing)成(cheng)腎→腦(nao)→腎→全身(shen)神(shen)(shen)氣(qi)之路(lu)(lu),以致腎氣(qi)隨呼吸出(chu)入,上(shang)(shang)潮于腦(nao),使腦(nao)效(xiao)其(qi)神(shen)(shen)明之德。

九(jiu)(jiu)(jiu)瓣:周楣聲(sheng)《黃庭經醫疏》云(yun):“道(dao)家謂天有九(jiu)(jiu)(jiu)宮(gong)(gong),故(gu)人(ren)腦亦有九(jiu)(jiu)(jiu)瓣,即四(si)(si)方、四(si)(si)隅,并(bing)中(zhong)央九(jiu)(jiu)(jiu)位(wei),內(nei)藏九(jiu)(jiu)(jiu)真。真者,真元之(zhi)(zhi)神也。”所謂“九(jiu)(jiu)(jiu)瓣”即腦宮(gong)(gong)以細(xi)皮隔開(kai)的九(jiu)(jiu)(jiu)個(ge)(ge)自(zi)然分區(qu),每(mei)個(ge)(ge)瓣內(nei)有一(yi)(yi)宮(gong)(gong),由于(yu)(yu)泥丸宮(gong)(gong)居于(yu)(yu)中(zhong)央部位(wei),故(gu)曰(yue)“并(bing)中(zhong)央”,其他各(ge)有一(yi)(yi)宮(gong)(gong),居于(yu)(yu)泥丸宮(gong)(gong)之(zhi)(zhi)四(si)(si)旁和(he)四(si)(si)個(ge)(ge)角隅,故(gu)稱之(zhi)(zhi)“四(si)(si)方”和(he)“四(si)(si)隅”。

血(xue)絡(luo)(luo)(luo)(luo)、脈絡(luo)(luo)(luo)(luo)、筋(jin)(jin)絡(luo)(luo)(luo)(luo)和細(xi)(xi)皮(pi)(pi):腦宮到處貫穿著血(xue)絡(luo)(luo)(luo)(luo)、脈絡(luo)(luo)(luo)(luo)、筋(jin)(jin)絡(luo)(luo)(luo)(luo),并(bing)布(bu)滿細(xi)(xi)皮(pi)(pi)。《性(xing)源廣嗣·胎孕(yun)化形(xing)生稟(bing)元質(zhi)次序(xu)論》描述道:“腦顱及頭角有骨、筋(jin)(jin)、髓、細(xi)(xi)皮(pi)(pi)等(deng)類為其全體(ti),既非再為二者之血(xue)所結(jie),必須用(yong)精質(zhi)之純體(ti)以結(jie)成(cheng)(cheng)矣。如(ru)血(xue)絡(luo)(luo)(luo)(luo)、脈絡(luo)(luo)(luo)(luo)、筋(jin)(jin)絡(luo)(luo)(luo)(luo),與凡(fan)體(ti)節(jie)之血(xue)絡(luo)(luo)(luo)(luo)及細(xi)(xi)皮(pi)(pi)等(deng)類之質(zhi)體(ti)”以構成(cheng)(cheng)。筋(jin)(jin)絡(luo)(luo)(luo)(luo)把腦之各宮網(wang)絡(luo)(luo)(luo)(luo)在一(yi)起。血(xue)絡(luo)(luo)(luo)(luo)和脈絡(luo)(luo)(luo)(luo)貫通(tong)氣血(xue)以養腦體(ti)。細(xi)(xi)皮(pi)(pi)將腦宮劃分為九瓣(ban),并(bing)粘合成(cheng)(cheng)一(yi)個(ge)整體(ti)。

腦(nao)(nao)(nao)氣(qi)筋(jin)(jin):此說(shuo)由張錫純提出。他在《醫學衷中參西錄·腦(nao)(nao)(nao)氣(qi)筋(jin)(jin)辨(bian)》寫(xie)道:’人(ren)之(zhi)知(zhi)覺運動其(qi)(qi)樞機(ji)皆(jie)關(guan)(guan)于腦(nao)(nao)(nao)氣(qi)筋(jin)(jin),此尤(you)拘于跡(ji)象之(zhi)談,而非探(tan)本(ben)窮(qiong)源(yuan)(yuan)之(zhi)論(lun)也(ye)。夫腦(nao)(nao)(nao)氣(qi)筋(jin)(jin)者,腦(nao)(nao)(nao)髓之(zhi)所滋生也(ye)。……故善知(zhi)覺……故善運動。此乃腦(nao)(nao)(nao)氣(qi)筋(jin)(jin)先天之(zhi)本(ben)源(yuan)(yuan)也(ye)。”張氏所指之(zhi)腦(nao)(nao)(nao)氣(qi)筋(jin)(jin)系腦(nao)(nao)(nao)神經,它是腦(nao)(nao)(nao)的(de)至關(guan)(guan)重要組成部分(fen),其(qi)(qi)輸(shu)入輸(shu)出皆(jie)賴其(qi)(qi)力。

腦(nao)(nao)髓(sui):腦(nao)(nao)宮(gong)盈(ying)滿(man)髓(sui)液(ye),稱之為(wei)(wei)腦(nao)(nao)髓(sui)。由于(yu)腦(nao)(nao)宮(gong)充滿(man)之髓(sui)液(ye)較脊髓(sui)腔和骨腔為(wei)(wei)多,且(qie)是髓(sui)液(ye)集聚之處,所以腦(nao)(nao)宮(gong)又稱之為(wei)(wei)“髓(sui)之海”。因此,《靈樞·海論篇》云:“腦(nao)(nao)為(wei)(wei)髓(sui)之海,其(qi)輸上在于(yu)其(qi)蓋,下在風府。”腦(nao)(nao)宮(gong)上至天(tian)靈蓋,下至天(tian)柱骨,都盈(ying)滿(man)著髓(sui)液(ye)。故《奇病論》謂(wei)“髓(sui)者,以腦(nao)(nao)為(wei)(wei)主”。腦(nao)(nao)髓(sui)不僅滋養腦(nao)(nao)體(ti),化生(sheng)神(shen)氣(qi),并且(qie)與五(wu)臟六腑(fu)相聯(lian)系(xi),從(cong)而形(xing)成(cheng)統一的整(zheng)體(ti)。

腦顱:腦顱居于頸項之上,由(you)腦宮外圍(wei)多塊骨骼組成(cheng)。《性源廣(guang)嗣(si)》提出:“腦顱之體(ti),所以須用多精之體(ti)……及頭角有(you)骨。”腦顱其頂為顱鹵(lu),又名天(tian)靈蓋。下與天(tian)柱骨相(xiang)接,前有(you)額骨,后有(you)頑(wan)骨的(de)枕骨,側(ce)有(you)鬢骨。腦象似天(tian),前后長、左右(you)短、其形(xing)圓(yuan)。其度(du)大小《靈樞·骨度(du)篇(pian)》謂“發之復者,顱至項尺二寸”、“頭之大骨圍(wei)一尺六寸”之約。它圍(wei)于腦之周(zhou),起衛護腦體(ti)、使腦髓(sui)和真氣不致(zhi)外泄(xie)。

總之,腦位于機軀之首,頸項之上,顱(lu)骨之內(nei)(nei)。內(nei)(nei)設九瓣(ban),瓣(ban)內(nei)(nei)設宮(gong),各瓣(ban)以細皮包裹,并相粘合。各宮(gong)之間以筋絡(luo)相網絡(luo),其(qi)氣(qi)血以脈絡(luo)和(he)血絡(luo)相貫(guan)(guan)通,以腦氣(qi)筋相呼(hu)應,腦髓盈其(qi)中,內(nei)(nei)藏九真,從而(er)形成一個貫(guan)(guan)穿前(qian)后左右上下的有機整體。

西(xi)苑醫院(北京,100091) 靳 冰

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