On the 5 Major Physiological Regulatory Systems of the Brain as Spirit Storehouse in TCM
Xu Guangwen, Switzerland
Abstract: Centered on the holistic view that “the form and spirit are together” and the theory of“5 spirit storehouses” in Huangdi Neijing [The Yellow Emperor’s Inner Canon], this article integrates discussions of the “5 spirit storehouses” and brain functions in Traditional Chinese Medicine (TCM) classic texts and by medical experts throughout history. From viewpoints such as the brain and the 5 viscera, the 5 offices and the brain, the 5 viscera and the eyes, the channels and network vessels and the brain, the brain and marrow, marrow and the kidneys, essence, qi, and spirit, along with diagrams, it attempts to explore and explain the dual nature of the 5 storehouses (the physical viscera and the spirit storehouses), which are of “unified form and spirit”, as well as physiological connections such as that between the brain and the 5 storehouses. It demonstrates that “the 5 viscera store spirits and the spirit storehouses gather in the brain” and clearly identifies the brain as the “5 spirit storehouses” (the heart stores the spirit, the lung stores the corporeal soul, the liver stores the ethereal soul, the spleen stores reflection, and the kidneys store the mind), which are 5 major physiological regulatory systems. Research shows that the 5 storehouses in TCM are unified bodies consisting of the physical forms of the viscera and the spirit storehouses; the spirit storehouses reside in the brain and govern vital activities. Through the channels and network vessels (all channels gather at the head and enter the network vessels of the brain), the spirit storehouses regulate the physiological functions of the human body. This provides a foundation and thought process for innovation in TCM brain physiopathology and the prevention and treatment of diseases related to the brain.
Keywords: TCM theory; brain as spirit storehouse; 5 spirit storehouses; unified form and spirit; physiological regulatory system
Introduction
Modern research on basic TCM theory is influenced by perspectives from textbooks on basic TCM theory that state that“Nei Jing [The Inner Canon] attributes the functions of the brain to the 5 viscera”, causing some scholars to have an unclear understanding of the independent physiological status of the TCM brain and even leading to the misunderstanding that “there is no brain in TCM”[1]. In actuality, starting with Huangdi Neijing [The Yellow Emperor’s Inner Canon], there was already a systematic understanding of brain functions in TCM; the core is not “attributed to the 5 viscera”, but rather is “the brain as spirit storehouse”. The spirits stored by the 5 viscera all gather in the brain. The brain, as the center for the “5 spirit storehouses”, constitutes 5 major physiological regulatory systems that govern vital activities.
On the basis of the “form and spirit are together” and the“5 spirit storehouses” theories in Huangdi Neijing, this article integrates discussions by medical experts throughout history such as Zhang Zhong-jing, Yang Shang-shan, Li Shi-zhen, and Wang Qing-ren to demonstrate the theoretical origins and physiological mechanisms of the “brain as spirit storehouse” in terms of “unity between the physical viscus and the spirit storehouse”, “connections between the brain and the viscera, bowels, channels, and network vessels”, and “5 major functional connotations of the spirit storehouse”. By reviving the original theory of the TCM brain and storehouse manifestations, it provides a standardized framework for TCM brain science research.
1. The TCM theory of “unified form and spirit” and the dual nature of the 5 storehouses
1.1 Theoretical origins and core connotations of “unified form and spirit”
“Unified form and spirit” is the core of the TCM view of life, originating from chapter 1 of Huangdi Neijing Suwen [The Yellow Emperor’s Inner Canon: Plain Questions], entitled “Treatise on Heavenly Truth from Remote Antiquity”, which states that “the form and spirit are together, and [therefore] they lived to the end of their natural life-span”. It also says that “[true men of antiquity] stood for themselves and guarded their spirit, [and their] muscles and flesh were as one”[2]. Neijing clearly states that “form” is the material basis of the human body, including its flesh and blood as well as the viscera and bowels (i.e. the “physical viscera”); “spirit” is the mental consciousness that governs vital activities, including the spirit-mind, thought, and emotion, with the “brain spirit light” as the core [3]. It emphasizes that form and spirit are mutually dependent and inseparable from each other, and collectively they constitute a living whole “with the 5 storehouses as the center”[4].
1.2 The dual nature of the 5 storehouses as “physical viscera” and “spirit storehouses”
The “5 viscera” in TCM are not merely anatomical organs, but rather are unified bodies consisting of “physical viscera” and “spirit storehouses”: the “physical viscera” are the flesh-and-blood viscera in the thoracic and abdominal cavities (e.g., the “flesh-and-blood heart” resides below the lung and above the liver; its form is like a lotus flower that has not yet bloomed). The “spirit storehouses” are the brain spirit light functions controlled by the 5 storehouses (e.g., the “spirit-light heart” governs all things as an empty spirit that never darkens)[5]. The Ming dynasty text Yixue Rumen [The Gateway to Medicine], written by Li Ting, clarifies this attribute: “There is a heart of flesh and blood; its form is like a lotus flower that has not yet bloomed, and it resides below the lung and above the liver. There is a heart of spirit light; the spirit […] governs all things. This is an empty spirit that never darkens, and thus form and spirit always resemble each other”[5]. Extending this to the 5 storehouses, this dual nature is ubiquitous: the “flesh-and-blood liver” stores blood and governs the sinews, while the “spirit-light liver” stores the ethereal soul, and governs emotions and the subconscious. The “flesh-and-blood lung” governs qi and is in charge of breathing, while the “spirit-light lung” stores the corporeal soul and governs instinctive perception. The “flesh-and-blood spleen” governs movement and transformation, and engenders blood, while the “spirit-light spleen” stores reflection, and governs memory and cognition. The “flesh-and-blood kidneys” store essence and govern water, while the “spirit-light kidneys” store the mind, and govern willpower and endurance [6]. Both aspects are “unified in form and spirit”: the physical viscus provides material essence qi to the spirit storehouse (e.g., kidney essence engenders marrow to fill the brain), while the spirit storehouse governs the physiological functions of the physical viscus (e.g., the brain spirit regulates the beating of the heart; the breathing of the lung; the movement, transformation, and absorption of the spleen, and so on).
2. Theoretical evidence for “the brain as spirit storehouse”: from Neijing to the consensus of medical experts through the ages
2.1 The cognitive foundation of the brain in Huangdi Neijing
Although Huangdi Neijing does not include a chapter dedicated to “the brain storehouse”, its discussion of the brain’s physiological status and functional connotations establishes a theoretical basis for “the brain as spirit storehouse”[5]:
2.1.1 The brain is engendered by the transformation of earlier heaven essence and serves as “the house of essence, marrow, and spirit light”
Chapter 10 of Lingshu [The Magic Pivot], entitled “Channel Vessels”, proposes that “at the start of a person’s life, essence forms first; once the essence forms, the brain marrow is engendered”[2]. A commentary on chapter 47 of Suwen, entitled “Treatise on Strange Diseases”, emphasizes that “a person’s life begins with the brain; the brain must exist in order to have bone marrow”; it specifies that the brain is engendered by the transformation of earlier heaven essence and its formation precedes the other viscera and bowels, serving as the origin of vital activities. Chapter 33 of Lingshu, entitled “On Seas”, calls the brain “the sea of marrow”. Chapter 17 of Suwen, entitled “Treatise on the Essential Subtleties of the Pulse”, points out that “the head is the house of bright essence”. An annotation by Zhang Zhi-cong states that “the spirit qi of all the yang [channels] goes up to converge at the head and gathers up in the brain; therefore, the head is the house of essence, marrow, and spirit light”, directly naming the brain as the place where essence and marrow gather and the spirit light resides[4].
2.1.2 The brain governs essence-spirit, vision, hearing, and movement, serving as a vital pivot
Chapter 33 of Lingshu, entitled “On Seas”, records that “when the sea of marrow is insufficient, the brain spins and the ears ring, the lower legs are sore and the head is dizzy, the eyes see nothing, and [the person] is sluggish, fatigued, and sleeps soundly”[2]. This description of pathology proves that whether the brain marrow is full directly influences vision, hearing, movement, and mental status. Chapter 52 of Suwen, entitled “Treatise on Needling Contraindications”, further emphasizes that “the brain must not be damaged; when needling, if [one] needles the head at GV-17 (Brain’s Door) and enters the brain, [the patient] will die immediately”[2]. This shows an awareness of the brain as the central pivot for vital activities that precedes western medicine. (Western medical research on brain anatomy started in the 16th century [China’s Ming dynasty], believing that the brain included “the chief soul, the sum of the animal spirits, whose functions were distinctly mental”. Thus, Huangdi Neijing predates the year 1500.)
2.1.3 As the “pivot of yin and yang”, the brain regulates the yin and yang channels and network vessels of the whole body
Neijing proposes that “the head is the convergence of all yang [channels]” (Suwen chapter 3, “Treatise on Vital Qi Connecting with Heaven”) and “the yang qi of the whole body gathers up in the brain”. At the same time, “the brain is the sea of marrow” and marrow is yin in nature (Suwen chapter 81, “Treatise Explaining Subtle Essence”). Therefore, the brain is the “pivot of yin and yang” where the qi of both yin and yang gather[5]. In terms of channels and network vessels, chapter 21 of Lingshu, entitled “Cold and Heat Diseases”, states: “The foot greater yang [channel] has [a part that] connects to the nape and enters the brain, which belongs to the root of the eyes, and its name is called the eye tie.” Chapter 60 of Suwen, entitled “Treatise on Bone Hollows”, points out that “the governing vessel […] passes through the spine and belongs to the kidneys; together with the greater yang [channel], it rises at the inner corner of the eye, goes up the forehead, intersects with the vertex, and enters to connect with the brain”[2]. These passages show how channels and network vessels enter the brain through the “eye tie” and “governing vessel”; the brain spirit uses the channels and network vessels to regulate the qi and blood of the viscera and bowels and physiological functions throughout the body.
2.2 Theoretical development of “the brain as spirit storehouse” by medical experts through the ages
After Neijing, generations of medical experts continued to enrich the theory of “the brain as spirit storehouse” and clarified the key idea that “the spirits of the 5 viscera gather in the brain”:
Sui dynasty, Yang Shang-shan: Huangdi Neijing Taisu [Grand Simplicity of the Yellow Emperor’s Inner Canon] proposes that “the head is where the heart spirit resides”[4]. This is the first time that the “spirit-light heart” was defined as residing in the brain, breaking away from the superficial interpretation of “the heart governs spirit light” to identify the physical aspect of the brain as spirit storehouse.
Ming dynasty, Li Shi-zhen: Bencao Gangmu [Herbal Foundation Compendium] states that “the brain is the house of the original spirit” and “the Mud Ball Palace is where the spirits congregate” [5], defining the brain as the place where the “original spirit” (the core of the brain spirit) resides. “Mud Ball Palace” is another term for the brain, emphasizing that the brain is the center where the hundred spirits converge.
Qing dynasty, Wang Qing-ren: The chapter of Yilin Gaicuo [Correction of Errors in Medical Classics] entitled “Discussion of the Brain and Marrow” uses clinical observations to propose that “ideas and memory are not located in the heart, but in the brain” and “the 2 eyes are engendered by brain fluid; the 2 eye ties are like threads that grow in the brain, and the things that [the eyes] see return to the brain”. “At the center of the tongue there are 2 tubes that internally connect to the brain qi, enabling the tongue to move and create speech” [5]. In terms of vision, speech, and memory, this text confirms that the brain is the central hub of mental activity.
Qing dynasty, Feng Zhao-zhang: Jinnang Milu [Secret Record of the Brocade Bag] concludes that “the brain is the house of the original spirit; it governs and holds the 5 spirits in order to regulate the use of the viscera, bowels, yin, yang, the 4 limbs, and hundred bones”[5]. This directly highlights how the brain regulates the whole body by “governing and holding the 5 spirits”, serving as the functional core of the “5 spirit storehouses”.
（To be continued）
論中醫腦為神藏五大生理調節系統
徐廣文瑞士
摘要：本文以《黃帝內經》“形與神俱”的整體觀和“神藏五”理論為核心，結合梳理中醫經典醫著及歷代醫家對“神藏五”和腦功能的論述，試從腦與五臟、五官與腦、五臟與目、經絡與腦、腦與髓、髓與腎、精氣神和圖示等方面，探討闡述“形神合一”的五藏雙重屬性（形臟與神藏）、腦與五藏等生理關聯切入，論證“五臟藏神，神藏聚腦”，明確腦為“神藏五”（心藏神、肺藏魄、肝藏魂、脾藏意、腎藏志）五大生理調節系統。研究顯示，中醫五藏是形臟與神藏的統一體；神藏居於腦，主宰生命活動。神藏通過經絡（諸經匯聚頭部，入腦絡）調節人體生理功能。為中醫腦生理病理學創新及腦相關疾病防治提供依據與思路。
關鍵詞：中醫理論；腦為神藏；神臟五；形神合一；生理調節系統
引言
現代中醫基礎理論研究中，受《中醫基礎理論》教材，“《內經》將腦功能分屬於五臟”觀點影響，使部分學者對中醫腦獨立生理地位認知模糊，甚至產生“中醫無腦”誤解[1]。實則自《黃帝內經》始，中醫對腦功能已有系統認知，核心並非“分屬五臟”，而是“腦為神藏”，五臟所藏之神皆匯聚於腦，腦作為“神藏五”中心，構成主宰生命活動的五大生理調節系統。
本文以《黃帝內經》“形與神俱”“神藏五”理論為根基，結合張仲景、楊上善、李時珍、王清任等歷代醫家論述，從“形臟與神藏統一性”，“腦與臟腑經絡關聯性”，“神藏五大功能內涵”，論證“腦為神藏”理論淵源與生理機制，還原中醫腦藏象理論本源，為中醫腦科學研究提供規範理論框架。
1 中醫“形神合一”理論與五藏的雙重屬性
1.1“形神合一”的理論淵源與核心內涵
“形神合一”是中醫生命觀核心，源自《黃帝內經·素問·上古天真論》“形與神俱，而盡終其天年”。“獨立守神，肌肉若一”[2]。《內經》明確：“形”為人體物質基礎，含血肉之軀、臟腑（即“形臟”）；“神”為主宰生命活動的精神意識，含神志、思維、情感等，核心為“腦神明”[3]。強調形與神相互依存、不可分割，共同構成“以五藏為中心”的生命整體[4]。
1.2 五藏的“形臟”與“神藏”雙重屬性
中醫“五藏”非單純解剖臟器，而是“形臟”與“神藏”的統一體：“形臟”為胸腔腹腔內的血肉之臟（如“血肉之心”居肺下肝上，形如未開蓮花）；“神藏”為五藏所主的腦神明功能（如“神明之心”主宰萬事萬物，虛靈不昧）[5]。明代李梃《醫學入門》明確此屬性：“有血肉之心，形如未開蓮花，居肺下肝上是也；有神明之心，神者……主宰萬事萬物，虛靈不昧者是也，然形神亦恆相同”[5]。推及五藏，此雙重屬性普遍存在：肝之“血肉之肝”主藏血、主筋，“神明之肝”藏魂、主情緒潛意識；肺之“血肉之肺”主氣、司呼吸，“神明之肺”藏魄、主本能感知；脾之“血肉之脾”主運化、生血，“神明之脾”藏意、主記憶認知；腎之“血肉之腎”主藏精、主水，“神明之腎”藏志、主意志耐力[6]。二者“形神合一”：形臟為神藏提供物質精氣（如腎精生髓充腦），神藏主宰形臟生理功能（如腦神調節心臟搏動、肺之呼吸、脾之運化吸收等）。
2．“腦為神藏”的理論依據：從《內經》到歷代醫家的共識
2.1《黃帝內經》對腦的認知基礎
《黃帝內經》雖未設“腦藏”專篇，但對腦生理地位、功能內涵的論述，為“腦為神藏”奠定理論根基[5]：
2.1.1 腦由先天之精化生，為“精髓神明之府”
《靈樞·經脈》提出“人始生，先成精，精成而腦髓生”[2]；《素問·奇病論》（全注）強調“人先生於腦，緣有腦則有骨髓”，明確腦由先天之精化生，且生成早於其他臟腑，為生命活動本源。《靈樞·海論》稱腦為“髓之海”，《素問·脈要精微論》指出“頭者，精明之府”，張志聰注“諸陽之神氣，上會於頭，諸髓之精，上聚於腦，故頭為精髓神明之府”，直接點明腦是精髓匯聚、神明所居之處[4]。
2.1.2 腦主精神、視聽與運動，為生命中樞
《靈樞·海論》記載“髓海不足，則腦轉耳鳴，脛酸眩冒，目無所視，懈怠安臥”[2]，從病理反證腦髓充足與否直接影響視覺、聽覺、運動及精神狀態。《素問·刺禁論》更強調“腦不可傷，若針刺時，刺頭、中腦戶，入腦立死”[2]，早於西醫認識到腦為生命活動核心中樞，損傷則危及生命。（西醫大腦解剖研究始於 16 世紀（是中國的明朝時代）。其認為腦包含 “主要靈魂，即動物精神總和，其功能無疑是精神層面的”。故《黃帝內經》早於1500年）
2.1.3 腦為“陰陽之樞”，總調全身陰陽經絡
《內經》提出“頭為諸陽之會”（《素問·生氣通天論》），“全身陽氣皆上匯於腦”；同時“腦為髓海”，髓屬陰（《素問·解精微論》），故腦是陰陽二氣匯聚的“陰陽之樞”[5]。經絡層面，《靈樞·寒熱病》：“足太陽有通項入於腦者，正屬目本，名曰眼系”，《素問·骨空論》指出“督脈……貫脊屬腎，與太陽起於目內眥，上額交巔上，入絡腦”[2]，說明經絡通過“眼系”“督脈”入腦，腦神借經絡調節全身臟腑氣血，和生理功能。
2.2 歷代醫家對“腦為神藏”的理論發展
《內經》之後，歷代醫家不斷豐富“腦為神藏”理論，明確“五臟之神聚於腦”的核心觀點：
隋代楊上善：《黃帝內經太素》提出“頭者，心神所居”[4]，首次明確“神明之心”居於腦內，打破“心主神明”表面解讀，直指腦為神藏的物理載體。
明代李時珍：《本草綱目》云“腦為元神之府”“泥丸之宮，神靈所集”[5]，將腦定義為“元神”（腦神核心）所居之處，“泥丸宮”為腦別稱，強調腦是百神匯聚中心。
清代王清任：《醫林改錯·腦髓說》通過臨床觀察提出“靈機記性不在心在腦”“兩目即腦汁所生，兩目系如線，長於腦，所見之物歸於腦”。“舌中原有兩管，內通腦氣，使舌動轉能言” [5] ，從視覺、語言、記憶維度證實腦是精神活動中樞。
清代馮兆張：《錦囊秘錄》總結“腦為元神之府，主持五神，以調節臟腑陰陽，四肢百骸之用” [5] ，直接點明腦通過“主持五神”調節全身，是“神藏五”功能核心。（待續）
