Dr. Hongwei Liu

Abstract: Based on 30 years of systematic research, this article builds on the foundation of leading contemporary TCM kidney disease expert Professor Shi Zhensheng’s theory of treating the kidneys, and gives full play to the diagnostic and therapeutic characteristics of TCM’s holistic concepts and evidence-based treatment to propose that the theoretical construction of the male reproductive axis in TCM consists of “the kidneys; tian-gui; thoroughfare, controlling, governing, and girdling vessels; and essence chamber”. This serves as a theoretical basis for the treatment of male diseases in TCM, with “the kidneys as the foundation; the kidneys, heart, liver, and spleen as the core; the thoroughfare, controlling, governing, and girdling vessels as links; and the essence chamber as the target point”. This basis provides improved guidance for the clinical use of acupuncture and medicinals; makes the most of the therapeutic advantages of TCM and acupuncture, which enable regulation via multiple pathways, levels, links and targets; and constantly improves the theoretical understanding of the human reproductive system in TCM.

Keywords: male, kidney, tian-gui, thoroughfare vessel, controlling vessel, governing vessel, girdling vessel, essence chamber, reproductive axis

TCM has a long history of recognizing human reproduction; in TCM, it is thought that “the kidneys govern reproduction”, and a theoretical system of reproduction gradually formed with the “kidneys” as the core. Dr. Shi Zhensheng, a leading expert on contemporary TCM and kidney disease, was engaged in clinical and scientific research on TCM and kidney disease as early as the 1950s, and in the 1980s, he put forward concepts related to “the kidneys; tian-gui; thoroughfare, controlling, governing, and girdling vessels; and essence chamber” in Chinese medicine and men’s health. After more than 30 years of clinical research, the author has put forward the theory that the male reproductive axis in TCM consists of “the kidneys; tian-gui; thoroughfare, controlling, governing, and girdling vessels; and essence chamber”, with a view to improving the understanding of the theoretical system of human reproduction in TCM. The following is a brief introduction to the theory of the reproductive axis of the “the kidneys; tian-gui; thoroughfare, controlling, governing, and girdling vessels; and essence chamber”. If there are any inaccuracies, corrections are welcome.

I. The relationship between the kidneys and reproduction

1. The kidneys store essence and govern reproduction, growth, and development

TCM considers the essence to be the basic substance that makes up the human body. For instance, chapter 10 of  Ling Shu [The Magic Pivot], entitled “Channel Vessels”, states: “At the beginning of human life, the essence of life is formed first; then the brain and the marrow form”. Chapter 8 of the same text, entitled “The Spirit”, states: “That which enables life to come [into being] is called the essence”. Chapter 30, entitled “Understanding Qi”, states: “When 2 spirits [i.e., yin and yang] approach each other, they combine to create a form; the substance that exists prior to the body is called the essence.” Because the reproductive essence is characterized by reproduction, it is also known as the earlier heaven essence. Although the earlier heaven essence is endowed with the reproductive essence of the parents, it is not the same as the reproductive essence of the parents; rather, it is the subtle substance inherent in the body that determines the individual’s heredity, growth, and developmental characteristics and abilities. The earlier heaven essence is engendered by the kidneys alone, determining the basic characteristics of human growth and development. The later heaven essence can be generated by the 5 viscera and mainly plays a nutritional role. Just as Zhang Jingyue said: “The beginning of a person’s life is rooted in the source of essence and blood; once a person is born, they are nourished by water and grain […] The governance of essence and blood is in the life gate, and the governance of water and grain is in the spleen and stomach, which depend on the control of earlier heaven, and the sea of essence and blood depends on the resources of earlier heaven.” Li Dongyuan also said: “The true qi, also known as original qi, is the essence qi of the body that is produced before the body and then must be nourished by stomach qi.” 

Chapter 9 of Su Wen [Plain Questions], entitled “Treatise on the 6 Periods and Visceral Manifestations”,  states: “The kidneys govern hiding, and are the root of sealing and storing; they are the location of the essence.” Therefore, in TCM it is believed that the kidneys store the essence. The development and maturation of the human reproductive organs and reproductive capacity are dependent on the essence qi in the kidneys. After a person is born, the earlier heaven essence is nourished and continuously enriched by the later heaven essence, producing the tian-gui. Tian-gui has the function of promoting the development and maturation of the human reproductive organs and maintaining reproductive function. After middle age, the essence qi in the kidneys gradually declines, and the tian-gui also decreases or may even be exhausted. The reproductive organs of the human body will shrink and reproductive function will decline until it is lost. The essence qi of the kidneys serves to promote and maintain the reproductive function, growth, and development of the human body, so it is said that “the kidneys are responsible for reproduction, growth, and development”.    

2. Fill tian-gui and promote the production of reproductive essence

Tian-gui is a unique term in TCM. It is cultivated in the embryonic stage of the human body and gradually matures as the kidney qi develops. Only when tian-gui is nourished by the kidney qi to a certain extent can the human body engender reproductive essence and only then will the physiological activities of human reproductive function have a sufficient material basis. Tian-gui promotes the formation, development, and maturation of reproductive essence through the thoroughfare, controlling, governing, and girdling vessels. The reproductive essence, which is stored in the kidneys, is the material basis for the reproduction of life and the beginning of embryonic formation. Chapter 1 of Su Wen, entitled “Treatise on Heavenly Truth from High Antiquity” says: “When a woman is 7 years old, her kidney qi is exuberant, she grows new teeth, and her hair grows longer. When she is 14 years old, her tian-gui arrives, her controlling vessel is open, her great thoroughfare vessel is exuberant, and menstruation occurs at the appropriate time, so she can bear a child. At the age of 21, her kidney qi reaches the normal status [of an adult], so her permanent teeth grow and her hair reaches its fullest length. At the age of 28, her sinews and bones are firm, her hair is at its fullest length, and her body is exuberant and strong. At the age of 35, her yang brightness vessel weakens, her face starts to become parched, and her hair begins to fall out.  At the age of 42, her 3 yang vessels [i.e., greater yang, yang brightness, and lesser yang] all begin to decline from the top, her face is completely parched, and her hair begins to turn white. By the age of 49, her controlling vessel is vacuous, her great thoroughfare vessel is declining, her tian-gui is exhausted, and her tunnel is blocked, so her form decays and she can no longer bear children.” 

“For a man, at 8 years old, his kidney qi is replete, his hair grows, and he grows new teeth.  At the age of 16, his kidney qi is exuberant and tian-gui arrives. The essence and qi overflow, and yin and yang are harmonious, so he is able to father a child. At the age of 24, his kidney qi reaches the normal status [of an adult], his sinews and bones are strong, so his permanent teeth grow and reach their fullest state. At the age of 32, his sinews and bones are very strong and his muscles are full. By the age of 40, his kidney qi declines, his hair falls out, and his teeth begin to wither. At the age of 48, his yang qi is exhausted at the top, his face is parched, and the hair on his temples is white. By the age of 56, his liver qi declines, his sinews cannot move, his tian-gui is exhausted, his essence is scarce, his kidneys decline, and his body is at its limit. At the age of 64, his teeth and hair are gone.”

“The kidneys control water; they receive the essence of the 5 viscera and 6 bowels and store it. Therefore, when the 5 viscera are exuberant, then [the kidney essence] can drain out. Now, the 5 viscera are all declining, the sinews and bones are slack, and the tian-gui is exhausted. Therefore, the hair on the temples is white, the body is heavy, walking is difficult, and it is impossible to bear children.”

3. The kidneys govern the bones, generate marrow, and connect to the brain

In TCM, it is believed that the kidneys govern the bones, produce marrow, and are connected to the brain.  As chapter 10 of Ling Shu says: “At the beginning of human life, the essence of life is formed first; then the brain and marrow are formed. The bones serve as the structure, the vessels act as connections, the sinews provide hardness, the muscles serve as walls, the skin is firm, and the body hair grows.” The kidneys store essence, the essence generates marrow, the marrow fills the bones, and the brain is the sea of marrow. When the brain marrow is full, the spirit will be clear and energetic, and the mind will be flexible, assisting the heart spirit in controlling the body. If the kidney essence is adequate and the brain marrow is sufficient, the brain spirit will be clear and will regulate the normal storage and release of the essence chamber, so the essence orifice and urine orifice will be opened and closed appropriately. If this is not the case, the brain spirit’s regulatory function will be disturbed, the kidneys’ storage and release will be abnormal, the essence chamber will malfunction, and disorderly opening and closing of the essence orifice and urine orifice will lead to abnormal semen ejaculation and urination.

4. The kidneys govern the transformation of qi and regulate the excretion of urine and semen

The qi transformation of the kidneys is the central link in regulating the balance of water and fluid metabolism in the human body.  Chapter 34 of Su Wen, entitled “Treatise on Disharmony”, points out: “The kidneys are the water viscera and govern body fluids.” Only when the kidney qi is abundant, the qi transformation is normal, and there is appropriate opening and closing can the distribution and excretion of water proceed normally. If the qi transformation function of the kidneys is abnormal and there is inappropriate opening and closing, illness will occur. Too much opening and too little closing may lead to increased nocturia, profuse urination, or incontinence; too much closing and too little opening may lead to a weak urine stream, incomplete urination, or urinary block. 

Male genitals include an essence orifice and a urine orifice. The 2 orifices are combined into a single outer opening, and are nourished by the kidney yin fluids in the thoroughfare, controlling, governing, and girdling vessels. Through the synergistic action of the kidneys, the essence orifice governs the opening and closing of the essence chamber and controls the excretion of semen. Chapter 8 of Su Wen, entitled “Treatise on the Arcane Book of the Orchid Chamber in the Spirit Tower”, says: “The kidneys hold the office of labor and strength, from which ingenuity emanates”. Yijing Jingyi [Essential Meaning of Medical Classics], written by Tang Rongchuan, states: “There is an essence orifice in the anterior yin [i.e., the genitals], which is paired with the urine orifice, but they are different. The urine orifice connects internally to the bladder, and the essence orifice connects internally to the essence chamber.” This text also says: “The essence chamber is an intersection point of qi and blood, the place where essence is transformed into the fetus; it is the most important.” “The place where men store essence is controlled by the kidneys in particular.” That is to say, the kidneys govern the 2 anterior yin orifices and can make the penis erect, open the essence gate, and excrete the reproductive essence from the essence orifice, thereby reproducing new life. The synergistic action of the kidneys and bladder regulates the excretion of urine, which comes out through the urine orifice. If the kidneys store and release appropriately, the essence orifice and urine orifice will open and close in an orderly manner; if the kidneys store and release in a disorderly way, the storing and releasing of the essence chamber will be dysfunctional, and the opening and closing of the essence orifice and urine orifice will be disordered, leading to abnormal ejaculation and urination.

5. The kidneys hold the office of labor and strength, from which ingenuity emanates

The statement that “the kidneys hold the office of labor and strength, from which ingenuity emanates” comes from chapter 8 of Su Wen. Zhongyi Dacidian [The Great Dictionary of Chinese Medicine], compiled by Li Jingwei, states: “The office of labor and strength refers to the kidneys. Zhang Zhicong’s commentary says: The kidneys store the mind. If the mind is established, it will be strong in its labors. If it can labor internally, it will be ingenuous externally. Ma Shi’s commentary says: Only the kidneys are capable of labor and strength; men and women form the essence, engendering people and things, and ingenuity emanates from this. Therefore, if the kidney qi is exuberant, the essence spirit will be fortified and effulgent, the sinews and bones will be strong, and the movements will be agile; at the same time, the reproductive capacity will be normal, and the fetus will be produced.” Tang Rongchuan’s Yijing Jingyi adds: “The marrow is produced by kidney essence; if essence is sufficient, the marrow will act [to serve its function]. The marrow is in the bones; if the marrow can act, the bones will be strong, so they can labor and enable outstanding ability. Essence generates spirit; if the essence is sufficient to make the spirit strong, there will naturally be a lot of ingenuity. If there is insufficient marrow, one will not have much strength. If there is insufficient essence, one will not have much wisdom.” Hu Tianxiong’s Suwen Bushi [Supplemental Thoughts on Plain Questions] states: “Labor and strength means to be strong in one’s actions, and ingenuity means to be refined and versatile. According to the theories that the kidneys govern the bones, the kidneys produce the bone marrow, and the brain is the sea of marrow, it is known that when kidney qi is effulgent, the bone marrow will be full, the bones will be strong, the sea of marrow will be full, and brain power will be strong, so [the kidneys] have strong, refined, and versatile effects.” Just as chapter 33 of Ling Shu [The Magic Pivot], entitled “Treatise on Seas”, says: “If there is excess in the sea of marrow, one will be energetic and strong, and naturally exceed one’s limits; if the sea of marrow is insufficient, the brain will spin, the ears will ring, the shins will be sore, there will be veiling dizziness, the eyes will not be able to see, and one will be lazy and want to rest.” In summary, the reason for labor and strength is that the kidneys control the bones, produce marrow, and control the strength of the body, so they hold the office of labor and strength. What is referred to as “ingenuity” is the fact that that the kidneys store the essence of the body. These essences exist between the intangible and the tangible. They can reach throughout the whole body and transform into things that the body needs. Those who have ingenuity are quick to change; there is nothing at which they cannot succeed and there is no path that is blocked for them. Therefore, ingenuity in reproduction, thought, and behavior emanates from the kidneys.

To sum up the above, in TCM, it is believed that the kidneys store essence and govern reproduction and development. The kidneys are the core of the human reproductive and sexual systems.

II. Understanding tian-gui

1.  About tian-gui: Tian-gui is an important concept in TCM. It is related to TCM physiology and pathology, and plays a decisive role in human sexual activities and reproduction. We believe that tian-gui is an essential substance that promotes sexual development and maintains sexual functions (including reproductive functions). Its functions include promoting the development and maturity of male and female sexual characteristics and reproductive organs, maintaining sexual functions, stimulating sexual desire and sexual impulses, and participating in the transformation of reproductive essence to produce offspring. This functional scope is completely consistent with the function of kidney qi in “governing reproduction”. In terms of tian-gui’s material, essential, vital, and stimulating properties, it also fully possesses the key elements of “qi” in TCM. Therefore, there is reason to infer that tian-gui is the essential system of kidney qi that dominates sex and reproduction. It belongs to the category of kidney qi, but it is not equivalent to all kidney qi; rather, it is an important branch of kidney qi that dominates human reproduction. The statement that the kidneys govern reproduction is realized through tian-gui.

2. About the material basis and functional form of tian-gui:

(1) The material basis of tian-gui: Kidney essence is the material foundation of tian-gui, and this kidney essence should be the earlier heaven essence in the kidneys, that is, the reproductive essence. Since the reproductive essence contains the life information of each parent, when tian-gui promotes the physical development of the human body, this information also affects the offspring in all aspects. This is heredity. It can be said that tian-gui is an important material for human inheritance.

(2) The function of tian-gui: This refers to the physiological fire that stimulates human beings to have sexual desire and engage in sexual activities. It is also called “the fire of lust” and “ministerial fire” (which is part of kidney qi). After the production of tian-gui, the human body not only can reproduce, but also has the desire to “attract the opposite sex” and engage in sexual activities with them. Both of these have complementary roles in completing the continuation of future generations. The higher the level of tian-gui, the stronger the ministerial fire. After humans enter the change of life, the level of tian-gui decreases, and the ministerial fire also decreases along with it.

(3) Tian-gui has time limits and rhythms: Huangdi Neijing [The Yellow Emperor’s Inner Canon] states that tian-gui has obvious time limits. It is produced at the age of 14 (2 x 7) or 16 (2 x 8), and is exhausted at the age of 49 (7 x 7) or 56 (7 x 8). It only exists in the childbearing stage of life. After this, the level of tian-gui decreases sharply. Women undergo menopause, no longer produce eggs, and lose their fertility. Although men can still produce a certain amount of sperm, the quality of the sperm is greatly reduced. At the same time, the secondary sexual characteristics of men and women, controlled by tian-gui, begin to atrophy, and sexual desire and sexual function are greatly reduced. In addition to time constraints, tian-gui also has various forms of rhythm, including an annual rhythm, seasonal rhythm, monthly rhythm, and daily rhythm. The monthly rhythm of tian-gui is particularly obvious for women and forms the physiological basis of the menstrual cycle. In men, the annual and daily rhythms of tian-gui are relatively obvious; this can be confirmed by their level of testosterone secretion. Peripheral testosterone levels in adult men are highest in autumn and lowest in spring. During the day, they are highest in the early morning and lowest at night.

(4) Tian-gui is closely related to the channels and network vessels, especially the thoroughfare, controlling, governing, and girdling vessels.  After the formation of tian-gui, the thoroughfare, controlling, governing, and girdling vessels gradually become full; specific changes begin to appear in the internal and external genitalia, women’s breasts, and men’s Adam’s apple and voice, and fertility becomes possible. The statement that “the thoroughfare vessel is the sea of blood and the controlling vessel controls the womb and fetus” is realized under the influence of tian-gui. From a practical point of view, the thoroughfare, controlling, governing, and girdling vessels are the main pathways by which tian-gui is transmitted in the body. In addition to relying on tian-gui to perform their functions, these 4 vessels also use their connections with other channels and network vessels to deliver tian-gui to the 5 viscera, 6 bowels, 4 limbs, and the skeleton, thereby expanding the effects of tian-gui to the entire body. It can be imagined that once the thoroughfare, controlling, governing, and girdling vessels are damaged, the effects of tian-gui will inevitably be impacted along with it.

To sum up, kidney qi and tian-gui are independent and separate from each other, but also mutually restricting and unified, thus forming a contradictory unity of diversity and stages of kidney qi, which promotes the normal progress of various life activities of the human body and reproduction of offspring. 

III. Understanding the essence chamber

“Essence chamber” is a unique term in TCM andrology. It is also referred to as the “essence house”, the “palace of essence”, and “the male womb”, and it is classified among the male extraordinary organs. It is the place where the reproductive essence is stored. It has the functions of producing, storing, secreting, and seeding sperm, thus playing a role in reproduction and producing offspring. It is dominated by the kidneys and is a male reproductive organ that participates in maintaining male sexual function. It is closely related to the 5 viscera and 6 bowels, qi, blood, body fluids, and the thoroughfare, controlling, governing, and girdling vessels. It is an important component of the kidneys’ control of reproduction and corresponds to the “female womb” in gynecology.

(I) Physiological functions of the essence chamber  

1. The essence chamber governs the production and storage of essence: 

First, the essence chamber is the place where reproductive essence is produced and stored. In TCM, it is believed that the production of reproductive essence is related to age and tian-gui. For example, chapter 1 of Su Wen says, for a man, “at the age of 16, his kidney qi is exuberant and tian-gui arrives. The essence and qi overflow, and yin and yang are harmonious, so he is able to father a child.” Second, the essence chamber is where the essence is stored. Chapter 9 of Su Wen states: “The kidneys govern hiding, and are the root of sealing and storing; they are the location of the essence.” According to Nanjing [The Classic of Difficult Issues], reproductive essence is stored in the life gate: “The life gate is where the essence spirit resides. In men, it is used to store essence; in women, it is used to fasten the womb, and its qi is connected with the kidneys.” Qing dynasty medical expert Tang Rongchuan said in Xuezheng Lun [On Blood Patterns]: “A man’s womb, also known as the essence chamber, is where essence is stored.” This explains that a man’s womb (essence chamber) is where essence is stored, and “the essence stored in the essence chamber comes from the abundance of kidney yang qi. When the kidney qi is sufficient, the essence and qi are abundant, and the fire of the life gate is abundant, the essence chamber will be full, and when it is full, it will overflow. It is connected to the essence orifice.” The essence orifice, also known as the essence gate, refers to the opening of the ejaculatory duct. Semen is mainly composed of sperm produced by the testicles and secretions from glands including the seminal vesicles, prostate gland, and bulbourethral glands. Although sperm is produced in the testicles, it must pass through the epididymis and vas deferens to mature. The essence chamber does not refer to a specific physical organ, but rather is a functional summary of the storage of male reproductive essence (including sperm and semen). Tang Rongchuan said in Yijing Jingyi: “There is an essence orifice in the anterior yin [i.e., the genitals], which is paired with the urine orifice, but they are different. The urine orifice connects internally to the bladder, and the essence orifice connects internally to the essence chamber.” He also said: “The essence chamber is an intersection point of qi and blood, the place where essence is transformed into the fetus; it is the most important.” “The place where men store essence is controlled by the kidneys in particular.”  Zhang Xichun’s Yixue Zhongzhong Canxi Lu [Records of Chinese Medicine with Reference to Western Medicine] considers the essence chamber to be the “place where essence is produced” and “where essence is transformed.” The essence chamber produces essence, promotes the maturation of reproductive essence, and has essence storage and reproductive functions.

2. The essence chamber is responsible for secreting essence and seeding sperm:

Semen consists of sperm and seminal plasma. The essence chamber is an important site of storage and secretion in the male reproductive system. The normal function of the essence chamber depends on whether the kidneys’ yang qi is sufficient. When the kidney qi is exuberant, it will be full of essence. The excretion of essence requires the nourishment of body fluids and kidney yin has the function of nourishing yin fluids. The secretion of semen and the activity of sperm complement each other. If the yin and yang in the kidneys are harmonious, the sperm will be abundant and the secretion of semen will be sufficient; thus, the sperm will be secreted and seeded to successfully carry out the function of procreation and reproduction. If the lower burner or essence chamber is disturbed by external evils or toxins, damaged by the affect-mind, or invaded by dampness and heat, the palace of essence will be damaged, and even if the yin and yang of the kidneys are harmonious, the secretion of semen will be obstructed. If the yin and yang of the kidneys are depleted, essence production will be insufficient. If there is little fluid, there will be difficulty moving the essence, thus impairing the reproductive function.

The essence chamber’s function to produce and store essence is like that of the viscera, while its function to secrete essence is like that of the bowels. It can store as well as secrete, and the substances secreted are not waste products from the body. Therefore, it should be classified among the “extraordinary organs” in men. Since the essence chamber is where the essence is stored, it should be filled up regularly with essence so that male sexual and reproductive functions can proceed normally. Only when the essence is full can there be strong sexual desire, and only when the essence is sufficient can offspring be produced. However, if there is excessive sexual activity involving the repeated release of semen without storage, then the essence in the essence chamber will have difficulty assisting the sexual desire, so it will ultimately become a fire without a source, which will make it difficult for there to be strong desire. If one indulges in sexual desire, has frequent sexual intercourse, and releases semen without storage, one is likely to dissipate the essence and damage the fluids, resulting in an empty essence chamber, depleted fluids, kidney vacuity, and exhaustion of essence, and it will be hard to produce offspring. Therefore, the essence in the essence chamber should not be released recklessly. This is why Huangting Neijing Jing [The Classic of Inner Light of the Yellow Court] says: “Guard the essence chamber carefully and do not discharge it recklessly. Keep it closed and treasure it so that you can live longer.” The essence chamber is responsible for the discharge of sperm, so its nature should be unblocked and not stagnant. The essence in the essence chamber should not be too full and stagnant; the key is that it should be circulated, so there is no need to deliberately abstain from sex. Since reproductive essence is continuously produced, it can be appropriately discharged from the body through sexual activity or seminal emission to maintain normal male physiological functions. 

Jingyue Quanshu [Jingyue’s Complete Compendium] states: “There are those who are in their prime with exuberant qi, but have abstained from sexual activity for a long time and still emit [semen]. In such cases, the emission is due to fullness.” This refers to the physiological emission of semen. As another example, in Yixue Yuanliu Lun [Treatise on the Origin and Development of Medicine], it is said that “thus, the essence as a material substance will be created if there is the desire to move, and it will not be created if it is no movement. If it can be in its natural state without movement, this is beneficial; if it is forced, this is harmful, and if it is overused, it will be exhausted. Letting it be natural without forcing it is the way to preserve the essence.” When the essence chamber is full, it is discharged through sexual activity, seminal emission, or masturbation; as the essence decreases, desire also decreases. The essence in the essence chamber continues to be generated and accumulates until it reaches a full state again.

In summary, the physiological functions of the essence chamber are essence production, essence storage, essence secretion, and seeding of sperm. The functions of the “essence chamber” are closely related to the exuberance and debilitation of the kidney essence and qi, so it is dominated by the kidneys and is an important part of the kidneys’ reproductive function. It involves multiple tissues and organs of the entire male reproductive system, such as the testicles, epididymis, prostate, seminal vesicles, and vas deferens in modern anatomy. However, we should emphasize that the essence chamber, like the 5 viscera and 6 bowels, cannot be matched one-to-one with the physical organs from an anatomical point of view alone. What TCM emphasizes is its functional role.

(I) The relationship between the essence chamber, the viscera and bowels, and the channels and network vessels 

1. The relationship between the essence chamber and the viscera and bowels

Essence is the foundation of male health, and essence and blood have the same origin. Essence and blood are mutually transformed and generated, and both essence and blood come from the viscera and bowels. Among the viscera and bowels, the kidneys store essence, which transforms into blood; the heart governs blood, the liver stores blood, and the spleen controls blood. The spleen and stomach are both the source of engendering transformation of qi and blood. They are responsible for the engendering, transformation, control, and regulation of blood. Thus, when the viscera and bowels are harmonious, the blood flows smoothly through the vessels, and the sea of blood is full, the essence will fill up and overflow naturally. Therefore, among the 5 viscera, there is a particularly close relationship between the essence chamber and the kidneys, liver, heart, and spleen.

(1)The essence chamber and the kidneys:

The kidneys are the foundation of earlier heaven, storing essence and producing marrow. The exuberance and debilitation of kidney essence and qi govern the growth and development of the human body and its reproductive capacity. The relationship between the kidneys and the essence chamber is first reflected in the exhaustion of tian-gui and in terms of reproduction. Huangdi Neijing Suwen Zhuzheng Fawei [Commentary and Elaboration on the Yellow Emperor’s Inner Canon Plain Questions] states: “Tian-gui is yin essence; the essence of both men and women controls the kidney water, so it can all be called tian-gui.” Tian-gui is an important substance necessary for promoting the development of reproductive organs and the maturation of reproductive functions. It is the product of the kidney essence being filled to a certain degree. Therefore, when a man reaches puberty, his kidney essence is full; through the action of tian-gui, his essence palace matures, his essence overflows, and he becomes fertile, so the conditions are ripe for bearing offspring. Conversely, when he enters old age, due to the decline of kidney essence, tian-gui gradually becomes exhausted; his fertility declines along with it and may even be lost.

Secondly, the essence chamber belongs to the kidneys, which store essence and control reproduction. Through the action of the kidney essence and qi, the essence chamber transforms, stores, and releases the reproductive essence. If the kidney yang is depleted, the life gate fire is debilitated, or the kidney essence is depleted such that the ability to transform essence is weakened, then there will be symptoms of seminal cold and thin or scant semen. If the kidney yin is insufficient, with fire effulgence due to kidney yin vacuity and burning vacuity fire, or the kidney yang is insufficient, with vacuity cold in the essence palace, then it can lead to symptoms such as semen failing to be transformed into fluid.

Thirdly, the relationship between the kidneys and the essence chamber is also reflected in the fact that the storage and discharge of the essence chamber is subordinate to the storage and discharge of the kidneys. Given that “the kidneys store essence and control reproduction” and “the kidneys control water”, the essence chamber, through the action of the kidney essence and qi, regulates the opening and closing of the essence orifice and the urinary orifice by means of the essence chamber. If the kidneys store and discharge appropriately, the essence orifice and urinary orifice will open and close in an orderly manner; if the kidneys store and discharge irregularly, the essence chamber’s storage and discharge will malfunction, and the essence orifice and urinary orifice will open and close chaotically, resulting in abnormal ejaculation and urination.

(2) The essence chamber and the liver:

The liver governs free coursing and stores blood; it serves as the hub of qi and blood regulation for the whole body. The main physiological function of the essence chamber is to store and release semen. Essence and blood are the material basis of semen; essence is stored in the kidneys and blood is stored in the liver. Essence can produce blood and blood can transform into essence. Essence and blood have the same origin, since the liver and kidneys are of the same source, and they support each other. The liver is the sea of blood and is responsible for storing blood. When the liver blood is sufficient and the blood storage function is normal, the liver blood will pour into the sea of blood, so the thoroughfare vessel will be exuberant and the sea of blood will be full. Therefore, the essence chamber will also be full of semen at the same time, and if the controlling vessel is unblocked and the great thoroughfare vessel is exuberant, a man’s essence will fill to the point of overflowing. The liver governs free coursing and it regulates the free flow of the qi dynamic. When the liver qi flows smoothly and can course freely, the qi dynamic will be regulated, the qi and blood will be peaceful, and the heart will be at ease. Only then can the essence chamber play its normal role of producing, storing, secreting, and seeding essence. Therefore, the kidneys’ reproductive function must rely on the cooperation and coordination of the liver.

At the same time, the liver governs the ancestral sinew and the liver channel vessel runs through the anterior genitals. Internally, it carries the ministerial fire, which has the functions of arousing the genitals, opening and closing the essence orifice, and governing the overflow of semen. If the liver qi is well regulated, it helps to maintain normal male sexual function. Therefore, the relationship between the liver and the essence chamber is mainly reflected in the normal male reproductive and sexual function. If the liver does not store blood, does not govern the sinews, or fails to course freely, it can lead to many male diseases such as impotence, difficulty in ejaculation, seminal emission, efflux discharge, and even symptoms such as scant semen, weak sperm, seminal cold, sperm deformity, and infertility. In addition, the liver’s free coursing function can also affect emotions. If there is emotional damage such that the liver does not store blood or fails to course freely, this can lead to scant blood in the thoroughfare and controlling vessels or inhibited flow of qi and blood, and can also cause abnormal essence chamber function and infertility. Therefore, many male diseases in clinical practice are mostly treated from the perspective of the liver.

(3) The essence chamber and the spleen (and stomach):

The spleen and stomach are the “root of later heaven” and “the source of qi and blood formation”. They control the center burner qi and govern the blood. The stomach is responsible for absorption; it is the bowel that serves as the sea of water and grain, and has copious qi and blood. Blood is the essence qi of water and grain, which is harmonized in the 5 viscera and spread in the 6 bowels. The kidneys are the root of earlier heaven, control the essence chamber, and dominate the growth, development, reproduction, and aging of the human body. The spleen and kidneys support each other and complement each other so that the human body can function normally. The earlier heaven essence is stored in the kidneys; it is transformed into reproductive essence through the nourishment of the later heaven essence of water and grain and the catalysis of tian-gui. When the spleen and stomach are functioning normally and the qi and blood have a source from which to be formed, the kidney essence can be moved and transformed. Conversely, when the kidney essence is full, qi and blood can be generated, so both systems complement each other. As Zhang Jingyue said: “The beginning of a person’s life is rooted in the source of essence and blood; once a person is born, they are nourished by water and grain […] Without essence and blood, there is no way to establish the foundation of the body; without water and grain, there is no way to achieve the full vigor of the body. The control of essence and blood is in the life gate, and the control of water and grain is in the spleen and stomach. Therefore, the life gate obtains the earlier heaven qi, and the spleen and stomach obtain the later heaven qi. This is why the sea of water and grain depends on the control of earlier heaven, and the sea of essence and blood necessarily depends on the resources of later heaven.” Therefore, the relationship between the essence chamber and the spleen and stomach mainly affects the essence chamber’s transformation of reproductive essence. If the spleen qi is fortified such that its source of transformation is sufficient and its control is strong, then the essence chamber will fill up and overflow normally, and the reproductive essence will be vigorous. If the spleen’s movement and transformation function becomes abnormal such that the qi and blood lack a source, it can often lead to a lack of kidney essence and insufficient reproductive essence. On the one hand, this can lead to low sperm count and infertility; at the same time, it can also cause dampness and phlegm due to spleen vacuity, which can obstruct the qi dynamic, leading to symptoms such as perineum and smaller-abdominal distension and pain, essence turbidity, and sterility. In addition, according to Li Dongyuan’s yin fire theory, spleen and stomach qi deficiency with downward flow of grain qi and hyperactivity of yin fire can also cause some forms of sexual dysfunction.

Furthermore, in TCM it is believed that the spleen and stomach are responsible for moistening the ancestral sinew. For example, chapter 44 of Su Wen, entitled “Treatise on Wilting”, says: “The yang brightness [channel] is the sea of the 5 viscera and 6 bowels; it controls the moistening of the ancestral sinew. The ancestral sinew controls the leashing of the sinews and bones, and disinhibits the joints”. Chapter 75 of Ling Shu, entitled “Needling Divisions, True and Evil [Qi]”,  states: “The male genitalia is the mechanism of the body, the leader of yin essence, and the pathway of body fluids”. Chapter 45 of Su Wen, entitled “Treatise on Reversal”, points out: “The anterior yin is the place where the ancestral sinew gathers, and it is where the [channels of] greater yin [i.e., the spleen] and yang brightness [i.e., the stomach] unite.” Chapter 44 of Su Wen•says: “The thoroughfare vessel is the sea of channels and network vessels. It controls the permeation and irrigation of the ravines and valleys [i.e., the contours of the body]. It unites with the yang brightness [channel] at the ancestral sinew. Yin [channels] and yang [channels] combine at the ancestral sinew and meet at the Qi Thoroughfare [ST-30], and the yang brightness [channel] is their leader.” This shows that the yang brightness channel and thoroughfare vessel merge at the ancestral sinew. The thoroughfare vessel originates from the uterus (essence chamber), belongs to the kidneys, and is an important pathway for the movement of tian-gui. Therefore, the water and grain essence produced by the spleen and stomach can be transported through the channels and network vessels to the genitals to meet their growth and development needs and maintain sexual function.

(4) The essence chamber and the heart (and brain)

The essence chamber is an extraordinary organ. The heart governs the spirit and holds the office of monarch (the brain is the house of the original spirit). The heart (brain) is the master of the viscera, bowels, channels, and network vessels. The heart (brain) can affect male sexual function and the physiological “storage and overflow” functions of reproductive essence by regulating the storage and discharge of the essence chamber. For instance, chapter 33 of Su Wen, entitled “Treatise Discussing Heat Disease”, says: “The uterine [or essence chamber] vessel belongs to the heart and is connected to the essence chamber.” At the same time, in TCM it is believed that the heart and kidneys are the hubs of human physiological activities. The kidneys are the basis of reproduction, the source of tian-gui, and the home of yin and yang; the reproductive essence also comes from the kidneys. When the heart and kidneys interact, and water and fire are in harmony, together they maintain the balance of yin and yang. Essence and blood are mutually generated. The heart governs blood and stores spirit. Heart blood can transform into essence to replenish the kidneys, and kidney essence can also transform into blood to nourish the heart and calm the spirit. If the heart blood and kidney essence are deficient such that the brain spirit is not nourished, or the brain spirit is dim, then there will be low sexual desire; or if there is a loss of regulation resulting in disorder of the storage and discharge of the essence chamber, such that the essence orifice opens or closes excessively, then there will be premature ejaculation, seminal emission, or other symptoms.

If the heart blood is insufficient or the heart vessels are blocked, and the heart spirit is not nourished, this can lead to insufficient heart yin and heart yang, resulting in symptoms such as low libido and failure of the ancestral sinew to rise. Insufficient heart blood supply can also lead to the brain spirit being deprived of nourishment and irregularity of the essence chamber, resulting in issues like seminal emission, premature ejaculation, and essence turbidity, accompanied by symptoms such as insomnia, forgetfulness, palpitations, and oppression in the chest, or headache, anxiety, impatience, and irascibility. If the kidney water is insufficient and the heart fire is hyperactive, it can lead to vacuity and delirium of the brain spirit, resulting in vexation, agitation, irascibility, insomnia, and hyperactive sexual desire. If the heart fire is insufficient such that the kidney water is too cold, the essence chamber will lose its warmth, resulting in issues such as scant semen, seminal efflux, thin semen, and frequent nocturia. If the heart and kidney yang are vacuous, the body and the limbs will be cold, the libido will be low, there will be wilting and a lack of firmness, and there will be frequent long voidings of clear urine. If the heart and kidney yin are vacuous with vacuity fire harassing the inner body, the mouth and throat will be dry, and the semen will be scant and thin or even bloody. If both the heart and kidneys are deficient, the ministerial fire will move recklessly, disturbing the essence chamber and causing issues like seminal emission, premature ejaculation, and seminal turbidity.

2. The essence chamber, channels, and network vessels:

The essence chamber is an important organ of the male reproductive system. It is closely related to the viscera and bowels in terms of channels, network vessels, and functional connections. The thoroughfare, controlling, governing, and girdling vessels are classified as “extraordinary vessels”, and the essence chamber is classified as an “extraordinary organ”. The thoroughfare, controlling, and governing vessels start from the uterus and intersect with the girdling vessel. The thoroughfare, controlling, governing, and girdling vessels are connected to the 12 channel vessels. Therefore, the physiological function of the essence chamber is closely related to the functions of the thoroughfare, controlling, governing, and girdling vessels. As Tang Rongchuan of the Qing Dynasty said in Zhongxi Huitong Yijing Jingyi [Essential Meaning of Chinese and Western Integrated Medical Classics]: “According to these 4 vessels, the governing vessel is on the back and governs all yang, and it belongs to earlier heaven. The controlling vessel is on the abdomen and governs all yin, and it belongs to later heaven. The thoroughfare vessel disinhibits the yang brightness [channel] and passes through the uterus; it is the one that connects later heaven to the earlier heaven of the kidneys. The girdling vessel originates from the kidneys and circulates around the location of the spleen; it is the one that connects earlier heaven to the later heaven of the spleen. These 4 vessels’ functions are mutually dependent and it is necessary to study them in detail.”

（To Be Continued）

中醫男性“腎-天癸-沖任督帶-精室”生殖軸理論構建

紐約   劉宏偉   博士

摘要：本文在繼承當代中醫腎病泰斗時振聲教授治腎理論的基礎上，充分發揮中醫學整體觀念與辨證論治的診療特色，經過三十多年的系統研究，整理提出中醫男性“腎-天癸-沖任督帶-精室 ”生殖軸理論構建，為中醫治療男科疾病“以腎為本，腎心肝脾為核心, 沖任督帶為紐帶，精室為靶點”提供理論依據，從而更好地指導臨床針藥並用，發揮中醫針灸從多途徑、多層次、多環節、多靶點進行調節的治療優勢，並不斷完善中醫對人類生殖理論體系的認識。

主題詞：男性 腎 天癸 沖任督帶 精室 生殖軸

中醫對人類生殖的認識歷史悠久，認為“腎主生殖”，並逐漸形成以“腎”為核心的生殖理論體系。 當代中醫腎病泰斗–時振聲教授早在二十世紀五十年代從事中醫腎病的臨床和科學研究，並於八十年代提出了中醫男科“腎、天癸、沖任督、精室”的相關概念，筆者經過三十多年的臨床研究，整理提出中醫男性“腎-天癸-沖任督帶-精室 ”生殖軸理論，以期不斷完善中醫對人類生殖理論體系的認識。下面，就有關“腎-天癸-沖任督帶-精室”生殖軸理論，做一簡要介紹，不妥之處，請諸同仁指正。

一、腎與生殖 

 1、腎藏精，主生殖與生長發育

中醫認為精是構成人體的基本物質，如《靈樞•經脈篇》曰：“人始生，先成精，精成而腦髓生”；《靈樞•本神篇》：“生之來，謂之精”；《靈樞•決氣篇》曰：“兩神相搏，合而成形，常先身生，是為精。”由於生殖之精具有繁衍後代的特點，故又稱為先天之精。先天之精雖稟受於父母的生殖之精，但又不等於父母的生殖之精，而是自身內部固有的決定個體遺傳、生長發育特性和能力的精微物質。先天之精由腎單獨化生，決定人體生長發育的基本特徵；後天之精五臟皆可化生，主要起營養作用。誠如張景嶽所言：“人始生，本乎精血之源；人之既生，由乎水穀之養……精血之司在命門，水谷之司在脾胃，本賴先天為之主，而精血之海又必賴後天為之資。”李東垣亦說：“真氣又名元氣，乃先身生之精氣也，非胃氣不能滋之。”

《素問•六節髒象論》曰：“腎者主蟄，封藏之本，精之處也”，故中醫認為腎藏精。而人體生殖器官的發育成熟及生殖能力的具備，均有賴於腎中精氣。人出生後，先天之精在後天之精的滋養下不斷充盈，產生天癸。而天癸具有促進人體生殖器官發育成熟和維持生殖機能的作用。中年以後，腎中精氣漸衰，天癸亦隨之減少，甚至衰竭。人體生殖器官日趨萎縮，生殖機能衰退，直至喪失。可見，腎中精氣具有促進和維持人體生殖機能和生長發育的作用，因此說“腎主生殖與生長發育”。  

2、充天癸，化生生殖之精 

天癸是中醫的特有名詞，蘊育於人體胚胎時期，隨著腎氣的發育旺盛，而漸趨成熟。天癸經腎氣充養到一定程度，才能促使人體化生生殖之精，人的生殖功能的生理活動才會有足夠的物質基礎。天癸通過沖任督帶四脈促使生殖之精的化生、發育和成熟。生殖之精藏於腎，是繁衍生命的物質基礎，是胚胎形成的始基。正如《素問•上古天真論》所雲：“女子七歲，腎氣盛，齒更發長。二七而天癸至，任脈通，太沖脈盛，月事以時下，故有子。三七腎氣平均，故真牙生而長極。四七筋骨堅，發長極，身體盛壯。五七陽明脈衰，面始焦，髪始墮。六七三陽脈衰於上，面皆焦，髪始白。七七任脈虛，太沖脈衰少，天癸竭，地道不通，故形壞而無子也”。

“丈夫八歲，腎氣實，髪長齒更。二八腎氣盛，天癸至，精氣溢瀉，陰陽和，故能有子。三八腎氣平均，筋骨勁強，故真牙生而長極。四八筋骨隆盛，肌肉滿壯。五八腎氣衰，發墮齒槁。六八陽氣衰竭於上，面焦，髮鬢頒白。七八肝氣衰，筋不能動，天癸竭，精少，腎臟衰，形體皆極。八八則齒發去”。

“腎者主水，受五臟六腑之精而藏之，故五臟盛，乃能瀉。今五臟皆衰，筋骨懈惰，天癸盡矣，故髮鬢白，身體重，行步不正，而無子耳”。

3、腎主骨，生髓通於腦  

中醫認為腎主骨，生髓通於腦。正如《靈樞•經脈篇》所說：“人始生，先成精，精成而腦髓生。骨為幹，脈為營，筋為剛，肉為牆，皮膚堅而毛髮長”。腎藏精，精生髓，髓充骨，腦為髓海。腦髓充實，則元神清靈精力充沛，思維靈活，輔助心神支配軀體。腎精足，腦髓充，則腦神清，正常調節精室藏泄，精竅與溺竅開闔有度。反之，腦神調控失常，腎藏泄無度，精室失用，精竅、溺竅開閉無序，就會出現排精和排尿異常。

4、主氣化和前陰二竅，司尿液與精液之排泄 

腎的氣化是調節人體水液代謝平衡的中心環節。《素問•逆調論》指出：“腎者，水髒，主津液”。腎氣充盛，氣化正常，開闔適度，水液的輸布與排泄方能正常進行。如腎之氣化功能失常，開闔失度，則會出現病態。若開多闔少，可致夜尿增多、尿崩或失禁；闔多開少，則會出現排尿無力、小便滴瀝不盡或尿閉。

男子前陰之中有精竅、溺竅，二竅之外口合一，通過沖任督帶四脈中的腎之陰液滋養。在腎的協同作用下，精竅司精室的開闔，主精液的排泄。《素問•靈蘭秘典論》曰：“腎者，作強之官，技巧出焉”; 唐容川《醫經精義》說：“前陰有精竅，與溺竅相對，而各有不同，溺竅內通膀胱，精竅內通精室”，又說：“精室，乃氣血交會，化精成胎之所，最為重要”，“男子藏精之所，尤為腎所司”, 即指腎主前陰二竅，能使陰莖勃起，開啟精關，從精竅排泄生殖之精，從而繁衍新的生命；在腎與膀胱的協同作用下，調節尿液之排泄，由溺竅而出。腎藏泄有度，精竅、溺竅開闔有序；若腎藏泄失調，則精室藏泄失用，精竅、溺竅開閉無序，就會出現排精和排尿異常。

 5、腎者，作強之官，伎巧出焉  

“腎者，作強之官，伎巧出焉” 出自《素問•靈蘭秘典論》。李經緯等編著《中醫大辭典》：“作強之官：指腎。張志聰注：腎藏志，志立則強於作用，能作用於內，則伎巧施於外矣。馬蒔注：惟腎為能作強，而男女構精，人物化生，伎巧從是而出。故腎氣盛則精神健旺，筋骨強勁，動作敏捷；同時生殖能力正常，胎孕從而化生。”唐容川《醫經精義》進一步補充說：“蓋髓者，腎精所生，精足則髓作。髓在骨內，髓作則骨強，所以能作強，而才力過人也。精以生神，精足神強，自多伎巧。髓不足者力不強，精不足者智不多。” 胡天雄《素問補識》：“作強有強於作用之意，伎巧有精巧多能之意。根據腎主骨、腎生骨髓、腦為髓海諸說，知腎氣旺盛，則骨髓充盈，骨骼堅強，髓海豐滿，腦力強健，故有強於作用、精巧多能之效”。正如《靈樞•海論篇》所雲：“髓海有餘，則輕勁多力，自過其度；髓海不足，則腦轉耳鳴，脛酸眩冒，目無所見，懈怠安臥。” 綜上可知作強是因為腎主骨生髓，主一身之力，故為作強之官。所謂伎巧，蓋腎藏一身之精微，這些精微在無形與有形之間，可通達全身，又可化生一身所需之物。伎巧者，善變之，無工不利，無往不通。因此，無論生殖伎巧、思維伎巧、還是行為伎巧無不由腎而出。

綜上所述，中醫認為腎藏精、主生殖和發育，腎臟是人類生殖系統和性系統的核心。

二、對“天癸”的認識

1、天癸：

天癸是中醫學中的一個重要概念，它涉及中醫的生理及病理，對人類性活動及繁衍後代起著舉足輕重的作用。我們認為：天癸是促進性發育和維持性功能（包括生殖機能）的一種精微物質，其職能是：促進男女性徵及生殖器官的發育和成熟；維持性功能；激發性欲和性衝動；參與生殖之精的化生以繁衍後代等。這一職能範疇，與腎氣在“主生殖”方面的功能完全一致。而從天癸的物質性、精微性、活潑性、促動性而言，它亦完全具備中醫學“氣”的要素。因此有理由推論，天癸即是腎氣在主導性與生殖方面的精微體系，它隸屬於腎氣範疇，但又不等同於全部腎氣，而是腎氣在主導人類生殖方面的重要分支。所謂腎主生殖，即是通過天癸實現的。

2、關於天癸的物質基礎與功能形式：

（1）天癸的物質基礎：腎精是天癸的物質基礎，而這種腎精應當是腎中的先天之精，亦即生殖之精。由於生殖之精中包含著父母各自的生命資訊，所以天癸在促化人身形體發育時，亦將這種資訊從各個方面影響子代，這就是遺傳。可以說，天癸是人類遺傳的重要物質。

（2）天癸的功能：是指激發人類產生性欲、並進行性活動的生理之火，亦稱“情欲之火”、“相火”（屬腎氣的一部分）。天癸產生以後，人體不但有了生育能力，而且產生了“異性相吸”並與之進行性愛活動的欲望。二者在完成延續後代方面的作用是相輔相成的。天癸水準越高，相火越旺。人類進入更年期後，天癸水準下降，相火亦隨之降低。

（3）天癸有時限性和節律性：《內經》所述：天癸有明顯的時限性。其二七、二八而生，七七、七八而竭，只存在於生命的育齡階段。在此之後，天癸水準則急劇降低，女子絕經，不再產生卵子，失去生育能力；男子雖仍能產生一定數量的精子，但精子品質則大為降低。同時，由天癸支配的男女第二性征開始萎縮，性欲及性功能都大為下降。除了時限性，天癸還有各種形式的節律性，如年節律、季節律、月節律、日節律等。天癸的月節律於女子特別明顯，是構成月經週期的生理基礎。而在男子，天癸的年節律及日節律相對明顯，此點可以男子睪酮的分泌水準加以印證。成年男子的外周血睪水準在秋季時最高，在春季最低。而一天之中，在清晨最高，在夜間最低。

（4）天癸與經絡密切相關，特別是與沖任督帶四脈最為密切。天癸產生以後，沖任督帶四脈漸次充盛，內、外生殖器及女子乳房、男子喉結及音聲等方面開始呈現特異性變化，並有了生育能力。所謂“沖為血海，任主胞胎”，就是在天癸的作用下實現的。從實踐來看，沖、任、督、帶四脈是天癸在體內傳送的主要通道。此四脈除了自身靠天癸行施職能，還借助與其它經絡的聯繫將其送達五臟六腑、四肢百骸，從而使天癸的作用擴大到全身。可以設想，一旦沖、任、督、帶受損，則天癸的作用必然隨之而損。

綜上所述，腎氣與天癸既相互獨立、相互分離，又相互制約、相互統一，從而構成腎氣多元性和階段性的矛盾統一體，推動人體各種生命活動的正常進行和對後代的繁衍。

三、對“精室”的認識 

精室，是中醫男科的特有名詞，又名“精房”、“精宮”、“男子胞”，屬男子奇恒之府。為生殖之精藏蓄之處所，具有生精、藏精、泌精、種子之功，從而起到生殖繁衍後代的職能，為腎所主，是男性生殖器官，參與維持男子性功能，與五臟六腑、氣血津液及沖任督帶等有密切的聯繫，是腎主生殖的重要組成部分。它與婦科的“女子胞”有對應關係。

（一）精室的生理功能 

1、主生精、藏精：

首先，精室是生殖之精生成和貯藏之所。中醫認為生殖之精的產生與年齡和天癸有關。如《素問•上古天真論》說：男子“二八，腎氣盛，天癸至，精氣溢瀉，陰陽和，故能有子”。其次，精室是藏精之所。《素問•六節髒象論》說：“腎者，主蟄，封藏之本，精之處也。” 《難經》認為生殖之精藏於命門，“命門者，精神之所舍也，男子以藏精，女子以系胞，其氣與腎通”。清•唐容川《血證論》中說：“男子之胞，一名精室，乃藏精之處。”說明男子胞（精室）為貯精之處，“精室的貯精來自於腎之陽氣的充足，腎氣足，精氣盛，命門火盛，則精室貯滿充盈，其滿則溢，與精竅相通”。精竅也稱精關，當指射精管口，精液主要由睪丸所產生的精子和精囊腺、前列腺、尿道球腺等腺體的分泌液組成。精子雖產生於睪丸，但必經附睪及輸精管才能得以發育成熟。由此可見，精室並不是指某一具體的實體器官，而是對藏蓄男性生殖之精（包括精子、精液）的功能概括。唐容川《醫經精義》說：“前陰有精竅，與溺竅相對，而各有不同，溺竅內通膀胱，精竅內通精室”，又說：“精室，乃氣血交會，化精成胎之所，最為重要”，“男子藏精之所，尤為腎所司”。張錫純《醫學衷中參西錄》則認為精室為“生精之處”和“化精之所”。可見，精室有生精，並促成生殖之精成熟以及藏精和生育功能。   

2 、主泌精、種子：

精液由精子和精漿兩部分組成。精室是男性生殖系統的重要貯藏及排泌之處。精室功能的正常，有賴於腎之陽氣的充足與否，腎氣盛則精滿。精之排泄需津液的滋潤，腎陰有滋養陰液的作用。精液的分泌與精子的活動相輔相成，若腎中陰陽和諧，則精子化生充旺，精液分泌充足，從而可以泌精、種子，以期順利完成生育繁衍後代之功能。若下焦精室被外邪毒物所擾、情志所傷、或濕熱所犯，精宮受損，即使腎之陰陽和諧，精液排泌也會發生障礙。若腎之陰陽虧損，則精化不足，液少精也難行，從而使生育功能受損。

精室生精藏精的功能似髒，而其泌精的功能又似腑，能藏能泌，且排泌之物非體內糟粕，故當隸屬男子“奇恆之腑”。精室既為藏精之處，其所藏精氣宜常充盈，方能使男性的性功能和生殖功能發揮正常。 精充方顯欲強，精足方能育嗣。但若房事過度，屢泄不藏，則性欲難得胞精之助，終成無源之火，欲也難強；若恣情縱欲、房事頻仍、泄而不藏，則易耗精傷液，胞空液虧，腎虛精竭，也難有嗣。故精室之精不可妄泄，故《黃庭內景經》說：“急守精室勿妄泄，閉而寶之可長活”。 精室又司施泄之職，其性宜通不宜滯，精室之精又不宜過於滯滿 ，而貴在流通 ，故亦不需刻意禁欲 。由於生殖之精持續產生，故通過房事或遺精適度地排出體外，才能維持男子正常的生理功能。

《景嶽全書》所謂：“有壯年氣盛，久節房欲而遺者，此滿而遺者也。”就是指生理性的遺精。又如《醫學源流論 • 腎藏精論 》曰 :“故精之為物 ，欲動則生 ，不動則不生 ，能自然不動則有益 ，強制則有害 ，過用則衰竭。任其自然，而無所勉強，則保精之法也。” 精室之精盈滿後，通過房事、遺精或手淫排出，泄精之後，精減欲降，精室之精不斷化生、蓄積，再次達到盈滿狀態。

綜上可見精室的生理功能是：生精、藏精、泌精和種子。“精室”的功能與腎之精氣盛衰密切相關，故為腎所主，是腎主生殖的重要組成部分。它涉及現代解剖學中的睪丸、附睪、前列腺、精囊、輸精管等整個男性生殖系統多個組織器官。但是，我們應該強調的是，精室如同五臟六腑一樣，不能僅從解剖學上與實體器官一一對應，中醫學更強調的是功能上的作用。 

 （二）精室與臟腑經絡的關係 

1. 精室與臟腑：The relationship between the essence chamber and the Zang-fu

男子以精為本，而精血同源，精血互化互生，而精血皆來源於臟腑。在臟腑之中，腎藏精，精化血，心主血，肝藏血，脾統血，脾與胃同為氣血生化之源，它們分司血的生化、統攝、調節等重要作用。故臟腑安和，血脈流暢，血海充盈，則精滿自溢。故在五臟之中，精室與腎、肝、心、脾的關係尤為密切。

（1）精室與腎：

腎為先天之本，主藏精，生髓。腎中精氣的盛衰，主宰著人體的生長發育和生殖能力。腎與精室的關係首先體現在天癸的至竭和生殖方面。《黃帝內經素問注證發微》說：“天癸者，陰精也，蓋男女之精皆主腎水，故皆可稱為天癸也”。天癸是促進生殖器官的發育和生殖機能成熟所必需的重要物質，是腎中精氣充盈到一定程度的產物。因此，男子到了青春期，腎精充盈，在天癸的作用下，精宮發育成熟，精滿溢瀉，並有了生育能力，為生育後代準備了條件。反之，進入老年，由於腎精衰少，天癸由少而至衰竭，於是生育能力也隨之衰弱，甚至喪失。

其次，精室為腎所屬，腎藏精主生殖，精室在腎中精氣作用下，以化生、貯藏和疏泄生殖之精。若腎陽虧虛，命門火衰，或腎精虧虛，化生精液能力減弱，則會出現精冷、精稀、少精之症。若腎陰不足，陰虛火旺，虛火煎灼，或腎陽不足，精宮虛寒，則可導致精液不液化等症。

其三，腎與精室的關係還表現在精室的藏泄從屬於腎的藏泄。“腎藏精，主生殖”、“腎主水”，精室在腎中精氣作用下通過精室以調控精竅、溺竅開闔。腎藏泄有度，精竅、溺竅開闔有序；若腎藏泄失調，則精室藏泄失用，精竅、溺竅開閉無序，就會出現排精和排尿異常。

（2）精室與肝：

肝主疏泄和藏血，為全身氣血調節之樞紐。精室的主要生理作用在於精液的藏與泄。精和血都是精液的物質基礎，精藏於腎，血藏於肝，精能生血，血又能化精，精血同源，乙癸同源，相互資生。肝為血海，主藏血。肝血充足，藏血功能正常，肝血下注血海，則沖脈盛滿，血海充盈，故精室精液亦同時充盈，而任脈通，太沖脈盛，男子則精滿溢泄。肝主疏泄，調暢氣機，肝氣條達，疏泄正常，則氣機調暢，氣血平和，心情舒暢，則精室始能正常發揮生精、藏精、泌精、種子之功，故腎主生殖的功能必賴肝的配合和協調。

同時，肝主宗筋，肝之經脈循行於前陰，內寄相火，具有鼓動陰器，啟閉精竅，主司精液溢瀉的作用。若肝氣調達，有助於維繫男性性功能的正常功能。因此，肝與精室的關係主要體現在男子生殖功能和性功能的正常。若肝不藏血，肝不主筋，或肝失疏泄等均可導致眾多男科疾病如陽痿、射精困難，或遺精、滑泄，甚至可見少精弱精、精冷、精子畸形、不育等症。此外，肝的疏泄功能還可影響情志。若情志所傷，肝不藏血或肝失疏泄，可致沖任血少或氣血不暢，也可造成精室功能異常和不育等症。因此，臨床上許多男科疾病，多從肝論治。

（3）精室與脾（胃）：

脾胃為“後天之本”、“氣血生化之源”，主中氣而統攝血液；胃主收納，為水穀之海、多氣多血之腑。血者水穀之精氣，和調於五臟，灑陳於六腑。腎為先天之本，主精室，並主宰人體的生長發育生殖與衰老。脾之與腎，先後相資、脾腎互贊，方可使人體機能正常。先天之精藏於腎，在後天水谷精微滋潤濡養以及天癸的催化下，轉化為生殖之精。脾胃運化功能正常，氣血化生有源則腎精得以運化。反之，腎精充盈而氣血得以化生，二者相輔相成。誠如張景嶽所說：“蓋人之始生，本乎精血之源；人之既生，由乎水穀之養。……非精血，無以立形體之基；非水谷，無以成形體之壯。精血之司在命門，水谷之司在脾胃。故命門得先天之氣，脾胃得後天之氣也。是以水穀之海本賴先天為之主，而精血之海又必賴後天為之資”。故精室與脾胃的關係，主要影響精室化生生殖之精。若脾氣健旺，化源充足，統攝有權，則精室精滿溢泄正常，生殖之精旺盛。若脾的運化功能失常，氣血乏源，每可導致腎精匱乏，生殖之精不足，一方面可導致精少不育；同時也可因脾虛生濕釀痰，阻滯氣機，導致會陰及小腹脹痛、精濁、不育等症。另外，根據東垣陰火學說，脾胃氣虛，穀氣下流，陰火亢盛，亦可以引起一些性功能異常。

再者，中醫認為脾胃主潤宗筋，如《素問•痿論》說：“陽明者，五臟六腑之海，主潤宗筋。宗筋主束骨而利機關也”；《靈樞•刺節真邪篇》：“莖垂者，身中之機，陰精之侯，津液之道也”；《素問•厥論篇》指出：“前陰者，宗筋之所聚，太陰陽明之所合也”。《素問•痿論》說：“沖脈者，經脈之海也，主滲灌溪谷，與陽明合於宗筋，陰陽縱宗筋之會，會於氣街，而陽明為之長。”說明陽明經與沖脈在宗筋匯合。而沖脈起於胞中（精室），隸屬於腎，為天癸運行的重要通道。故脾胃運化產生的水穀精微，可通過經脈，輸送到陰器，以供其生長、發育之需，並維持性功能。

（4）精室與心（腦） 

精室為奇恒之腑，心主神，為君主之官（腦為元神之府），心（腦）是臟腑經絡的主宰。心（腦）可通過調控精室的藏泄來影響男子的性功能和生殖之精的“蓄溢”的生理功能。《素問• 評熱病論》曰：“胞脈者，屬心而絡於胞中”。同時，中醫認為心腎為人體生理活動樞紐，腎者，為生殖之本，天癸之源，陰陽之宅，生殖之精亦來源於腎。心腎相交，水火既濟，共同維繫陰陽平衡。精血互生，心主血藏神，心血可化精充腎，腎精亦能化血養心安神。若心血腎精虧虛，腦神失養，或腦神不明，則見性欲低下；或調控無方，致精室藏泄失調，精竅開闔無度，則見早洩、遺精等。

若心血不足或心脈瘀阻，心神失養，可致心陰、心陽不足，從而導致性欲低下、宗筋不起等，還可因心血供養不足，導致腦神失養，精室失常，則見遺精、早洩、精濁等，同時伴隨失眠健忘、心悸胸悶等，或頭痛焦慮急躁易怒。若腎水不足，心火亢盛，可致腦神虛妄，則見煩躁易怒、失眠、性欲亢盛等。若心火不足致腎水過寒，精室失於溫煦，則出現精少、滑精、精液稀薄、夜尿頻多等。若心腎陽虛，則見形寒肢冷、性欲低下、痿而不堅、尿頻清長等。若心腎陰虛，虛火內擾，則口乾咽燥、精少稀薄，甚則精液帶血。若心腎兩虛，相火妄動，擾動精室出現遺精、早洩、精濁等。

2．精室與經絡：

精室是男性生殖系統的重要器官，它與臟腑有密切的經絡聯繫和功能聯繫。沖、任、督、帶四脈屬“奇經”，精室為“奇恒之腑”，沖、任、督三脈下起胞宮，上與帶脈交會，沖、任、督、帶又上連十二經脈，因此精室的生理功能主要與沖、任、督、帶四脈的功能密切相關。誠如清•唐容川《中西匯通醫經精義》所說：“按此四脈，督在背，總統諸陽，屬先天。任在腹，總統諸陰，屬後天。沖脈利於陽明而通於胞宮，由後天以交於先天腎者也。帶脈出於腎中，以周行脾位，由先天以交於後天脾者也。四者互為功用，不可不詳究焉”。

(未完待續)

參考文獻 References

[1]馮玲.路志正脾胃學術思想探微——新時代內傷脾胃的致病因素[J].中華中醫藥雜志,2010,25(5): 694-696.

[1] Feng Ling. A study on Lu Zhizheng’s academic thoughts on spleen and stomach – pathogenic factors of internal injury to spleen and stomach in the new era[J]. Chinese Journal of Traditional Chinese Medicine, 2010, 25(5): 694-696.

作者簡介：

楊田野,北京市西城區廣外醫院復健科,主治醫生。

About the author:

Yang Tianye, attending physician in Rehabilitation Department, Guangwai Hospital, Xicheng District, Beijing