Further sharing with Tong-Wa

趙醫生︰

抱歉這麼遲才回覆，香港人都忙，但忙，很多時不能成為藉口。另一個藉口是，我喜歡看信報練乙錚的文章，很佩服他的研究精神，認為 文章必須言之有物，沒有研究就沒有發言權，要做到這樣很難，我以此自勉，因此不敢動筆。

但不動筆卻是不敬，答應了趙醫生會回覆，我會努力 去做，即使明知可能做得不夠好。

這歸正傳，本文要討論的重點是，到底中醫對「腎」的理解是否不正確。（腎非Kidney，下同，如指 Kidney，就用英文原文）

首先，什麼叫腎？根據內經︰
(1) 腎的位置在腰。
《素問 脈要精微論篇》「腰者，腎之府，轉搖不能，腎將憊矣」。

(2) 腎藏精，主生殖，起滋潤全身的作用。腎主骨、其華在髮、開竅於二陰。
《素 問上古天真論篇》︰「歧伯曰：女子七歲，腎氣盛，齒更髮長；二七而天癸，任脈通，太衝脈盛，月事以時下，故有子；三七，腎氣平均，故真牙 生而長極……」
《素 問痿論篇》︰「腎者水藏也。今水不勝火，則骨枯而髓虛，故足不任身，發為骨痿。」
《素問六節藏象論篇》「腎者，主蟄，封藏之本，精之處也，其華在 髮，其充在骨，為陰中之少陰，通於冬氣。」
《素問金匱真言論篇》︰「北方黑色，入通於腎，開竅於二陰，藏精於腎」。

(3) 足少陰經屬腎。
《靈樞經脈》︰「腎足少陰之脈，起於小指之下，邪走足心，出然谷之下，循內踝之後，別入跟中，以上踹內，出膕內廉，上股內後廉，貫 脊，屬腎絡膀胱；其直者，從腎上貫肝膈，入肺中，循喉嚨，挾舌本；其支者，從肺出絡心，注胸中。」

(4) 腎開竅於耳︰
《靈樞脈 度》︰「腎氣通於耳，腎和則耳能聞五音矣。」

以上引文，旨在說明，為什麼我說︰「你認為中醫的腎，指的只是那個器官，如果是這樣，恐怕是 你的誤解了」。我在上次留言又說︰腎「包括了實體，也包括了功能、部分內分泌系統的功能等」，現在我想補充，還應該包括了足少陰腎經的功能。

如 果你問我的根據，我說來自內經，你問何以根據內經，我將不知道如何回答，因為中醫這個醫學體系的發展，就在內經的基礎上發展而來，內經對腎的界定，就是我 們中醫對腎的界定。

接著的問題是，如果我們同意內經如此界定腎，那麼這個理解是否不正確，以致我們可以稱之為「謬誤」？

我 的答案︰不是，不能稱為謬誤。
(1) 如果說腎是一個實體器官。我反對。因為根據內經的界定，腎這概念不單指實體器官kidney，還包括了其他部分，見上面所述。

(2) 由內經時代開始，超過二千年，我們這樣界定腎，這樣使用腎的概念，有何不正確和謬誤可言？

(3) 如果說內經中腎的概念很複雜，不好掌握。我同意，因為我學過，知道其困難。但卻非不能掌握，需要時間和頭腦靈活，歷史上那麼多著名醫家都能掌握，何以我們 不能。

(4) 如果說中醫的腎與西醫的Kidney不同。我同意，但那又如何，這不是問題，全部人都知道它們的分別最好，否則，最少我們做醫生的人一定要清晰。不能因為 兩者不同而說中醫的腎的概念是謬誤。

(5) 如果說應該將中醫的腎的概念用西醫的kidney, testes, ovaries and endocrines等等概念翻譯清楚，方便大家學習。我不反對，如果有人有這樣的能力和興趣，也是一種貢獻。

(6) 如果說必須將中醫腎的概念，用kidney取代。我反對，因為腎的概念範圍大，kidney的概念範圍少，不能取代。

(7) 我認為學中醫者，應該好好掌握中醫腎的概念，因為累積了二千年的醫書，都在這樣的基礎上去論述腎，如不理解，將無法登入中醫之堂奧。當然也必須小心，不同 醫家的理解有所偏差，有些人說腎時可能在說腎經、有些人在說其內分泌功能的一面、有些人在說實體器官的功能，必須根據上文下理，小心閱讀，才不會如墮五里 霧之中。

趙醫生，以上謹就我對中醫腎的理解，加以討論。我非常感謝你對這樣的討論有興趣，並給予我學習機會。我相信你會同意，真理越辯越 明，如果行文之中，有令你感到不快的地方，這決非我本意，只是我辭不達意而已。我真誠希望，透過這樣的討論，我們彼此都有所得益。

另，如 你同意，我希望將相關討論文字亦放在我的Blog上，我的Blog已很久沒有更新。^^

許冬華

Dear 冬華,

Thanks for the discussion, and here is my response.
[我真誠希望，透過這樣的討論，我們彼此都有所得益]。
This is also my attitude, hence we are on the same platform to seek after knowledge.
It is nothing personal at all, we are talking about our understanding of certain tcm concept, and you have been very polite with your wordings, so no need to be apologetic by saying [ 如果行文之中，有令你感到不快的地方，這決非我本意，只是我辭不達意而已。]
Let's go back to the main point of discussion by defining our disagreement, in order to be more focus.

My main idea is :

1 ) I believe all along the 內經 and other old canons, old tcm books' understanding of all internal organs are referring to physical / anatomical organs. The notion of 中醫 talking about a functional concept and system 概念(rather than physical / anatomical organs) is only recent and wrong (though wrongly and widely accepted by tcm society).

2 ) The 內經 and other old books believe that those internal physical anatomical organs have important physiological functions. Compare those functions mentioned with recent medical knowledge, some are correct and some are not.
[中醫對「腎」的理解是否不正確 ? ]
Yes and No, 不全部 是正確because many functions mentioned and believed to be due to the 中醫「腎」is not the function of the kidneys.


My arguments to prove my hypothesis are :

The article 2010年3月16日星期二 心非心 腎非腎 是其是 非其非 , dear Tong-wa, you have not argue against any of my reasons in it. Please refer to it and argue against my points.
Yes, the 內經 mentioned a lot of important functions attributed to the 中醫「腎」, but it does not prove that 中醫「腎」is a functional system or concept, it just means that 中醫 believe that those functions belong to a physical / anatomical organ kidneys, and according to today's knowledge, those functions are not due to kidneys, hence the conclusion is 中醫對「腎」的理解是否不正確 ? Yes and No, 不全部 是正確


My response to your points :

[ 因為根據內經的界定，腎這概念不單指實體器官kidney，還包括了其他部分，見上面所述。] Well, may I interpret that we at least agree that even in 內經, and other tcm traditional books腎means kidneys, right ?
《醫貫》：「腎有二，精所居也， 生於脊膂十四椎下，兩旁各一吋五分，形如豇豆，相並而曲 附於脊外。有黃脂包裹，裏白外黑，各有帶二條，上條繫於心包，下條過屏翳穴後趨脊骨。」 『靈樞. 背腧』：腎腧在十四椎之間；『難經. 四十難』：腎有兩枚，重一斤一兩
；One must agree that at certain passages, 腎 means physical / anatomical organ, = kidneys, as you have said 腎這概念不 單 指實體器官kidney right ?

The question is whether in other passages, 腎 has a different meaning, ie a kind of conceptual system, functional non-physical unit rather than a solid organ (with useful functions, whether those functions are really due to solid organ kidneys is another issue).

You believe that 腎 is not just [單指實體器官], but also a concept [腎這概念] because of the passages you quoted,[見上面所述].
I have read all the passages you have quoted when I was in tcm school and again when I wrote my articles, but unfortunately I cannot draw the conclusion that you have made, and wonder how can you make such a conclusion.

May I share with you how I interpret those passages :
《素問 脈要精微論篇》「腰者，腎之府，轉搖不能，腎將憊矣」。Here talks about the anatomy of a solid organ 腎 in the 腰.

《素 問上古天真論篇》︰「歧伯曰：女子七歲，腎氣盛，...ie talks about the substance (chemical) 氣 from the solid organ 腎 and the usefulness of this chemical 腎氣......

《素 問痿論篇》︰「腎者水藏也。今水不勝火，則骨枯而髓虛，故足不任身，發為骨痿。」
meaning the solid organ 腎 is responsible for water homeostasis, and if diseased the 骨 (a solid structure) will 枯而髓虛.

《素問六節藏象論篇》「腎者，主蟄，封藏之本，精之處也... the solid organ 腎 is responsible for 封藏, the 處 storage place of the 精.

《素問金匱真言論篇》︰「北方黑色，入通於腎，開竅於二陰，藏精於腎」。The function of the solid organ 腎 is to physically store safely 藏 the 精. Also二陰 is an anatomical structure here.

《靈樞經脈》︰「腎足少陰之脈，起於小指之下，邪走足心，出然谷之下，循內踝之後，別入跟中，以上踹內，出膕內廉，上股內後廉，貫 脊，屬腎絡膀胱；其直者，從腎上貫肝膈，入肺中，循喉嚨，挾舌本；其支者，從肺出絡心，注胸中。」This passage clearly proves that the physical organ 腎 is linked to other physical structure by a 脈, and not meant to be a concept.

《靈樞脈 度》︰「腎氣通於耳，腎和則耳能聞五音矣。」Both the 耳ear (organ) and 腎 are regarded as solid structure/organ, not a imaginative system, and the氣 (chemical from 腎) communicate / pass onto 通 the ears.

Your points 2-7 need not be answered because it is based on the idea of 腎as a 概念, and if you are mistaken here , then question 2-7 are redundant.
Look forward to find out the truth with you by further discussions.

Dr Chiu
ps it is my pleasure if you put our discussion onto your blog : )