.
Ning Ma Clark， Strider
“It is all about mastering skin, muscle, sinews and fascia, and vessels; when the function of the Channels and Collaterals is discussed”. Channels and Collaterals have broadly been accepted as the translation of JingLuo (经络) in English. Channels and Collaterals are the structural network of body tissues when skin (皮), muscle (肉), vessels (脉), sinew and fascia (筋) are connected in the body. “Skin, muscle, sinew and fascia, and vessels respectively have their own locations, structures, functions, and diseases, but they all support and benefit each other (in the network). Their diseases have to be treated respectively”. Even though the terms of Channels and Collaterals had not been mentioned in the statement above, the way of the wording and expression are the exact same in the two sentences. Therefore, Channels and Collaterals are unified body structures made by tissues like skin, muscle, vessels, sinew, and fascia. They also remain independent in body composition regarding the perspectives of anatomy, physiology, pathology and treatment of diseases.
“In view of movements contrary to and in accordance with the Five Structures (五体) , it apples to what is the size difference in the bones and joints, whether the muscle presents as firm or brittle, whether the skin presents as thick or thin, whether the blood presents as clear or turbid in quality, whether the qi movement presents as smooth or rough, whether the vessels present as long or short, whether the blood presents are rich or poor in quantity, and how many major passageways in the Channels and Collaterals ”. Five Structures are named in order to group structural tissues like skin, muscles, bone, vessels, sinew and fascia in the statement above. The paragraph can be interpreted as: When we talk about Channels and Collaterals, it actually is discussing how the Five Structures build the body and how the Qi and blood (气血) move in the body. Therefore, Channels and Collaterals are not only a structural composition, they are also a substantial assembly.
The Yellow Emperor’s Inner Cannon endued a two-fold meaning to Channels and Collaterals: The structural meaning and the substantial meaning. In view of the structure, Channels and Collaterals are not only the connection of the Five Structures, but also developed three new functional systems. They are the JingJin (经筋), JingMai (经脉) and PiBu (皮部). Bone was not mentioned in the Channels and Vessels because it only applies to its attachment to the sinews and fascia. It did not physically participate in the circulation of Qi and blood. In view of the body tissue, Channels and Collaterals not only contain tissues 〖JP3〗like skin, muscle, bone, vessels, sinew and fascia, but also include Qi and Blood which circulate in the Channels and Collaterals. It is focused on rebuilding the structural model in my book of “Anatomy of Channels and Collaterals”.
The structural perspective of the Channels and Collaterals
Fascia and Sinew Chains (JingJin) is a structural complex
“The head, the face and the entire body are tied to bones and connected through sinew and fascia”. The human body is connected by fascia. Fascia connects all different structural tissues in the horizontal and vertical planes. It connects inwardly to the bone and outwardly to the skin in the horizontal plane, while muscles, vessels and nerves are wrapped by fascia and kept in the middle. Modern medicine divides the body tissues into different functional systems, such as the muscular system, the blood vessel system, the nervous system by the separations made by fascia. Traditional Chinese Medicine (TCM) focused on the vertical connection of the structural tissues. Fascia connects all different tissues such as muscles, vessels and nerves into a chain. The Yellow Emperor’s Inner Cannon named it JingJin, and translated it as Fascia and Sinew Chains, or simply the Chain.
Fascia plays the most important role in the Fascia and Sinew Chains. Fascia is one of four body tissues in the group of the Sinew and Fascia. They are the fascia, tendons, ligaments and even the nerve stems. They are all fibrous in nature. Fascia wraps different structural tissue around and connects them together at the same time. It must be noted that muscles, vessels and nerves are only the carrier of the fascia in the Chain. “All sinew and fascia are belonging to the joints”. The place where the tendon and fascia attach to the joints or their ligaments is called the “node” of the Chain. This attachment makes it possible to view the vessels and nerves as “a section” of the Chain to match the layout of muscles. This attachment also makes it became possible to allow the fascia to switch among different types of the structural tissues. It also allows the Fascia and Sinew Chains to change the direction. In the Yellow Emperor’s Inner Cannon, the purpose of allowing fascia to switch among different carriers is to create a passageway for qi and blood to travel. It is not for the purpose of serving as a muscle strength line.
There are two kinds of branches in the Fascia and Sinew Chains. This notion may be contrary to the understanding of scholars from ancient times to the present day. They are the connecting branches (ZhengBie 正别) and the communicating branches (JingBie 经别). The Connecting Branch physically bridges the Fascia and Sinew Chains connecting to organs they belong to and the organ they are associated with. Therefore, the connecting branches have three feathers: 1) The structural tissue of the Connecting Branches have the capacity to go into the body cavity. 2) The branch with Yin nature always follows it’s associated yang branch. 3) The branch reaches the organ it belongs to first and then connects to the organ it is associated with. The space surrounding the Connecting Branches normally serves as the path in the section inside the 〖JP2〗body of the Channels and Vessels. The communicating branches physically 〖JP4〗connect between the Yin and Yang related Chains. This is achieved by utilizing the structures such as muscle, nerve and vessels; which they can physically go through or step across the intermuscular septum. The space surrounding the Communicating Branches allows exchanges of qi and blood in the Yin and Yang correlated Channels, which are located in the different osteofascial compartments.
Channels and Vessels (JingMai) is the passageway of the Qi and Blood.
“JingMai is the structure to circulate the blood and Qi (气) , and balance Yin and Yang”. JingMai is translated as Channels and Vessels in English, or simply the Channel. It is a structural unit including vessels and interstitial spaces inside the body that circulates blood, YingQi (营气), and Weiqi (卫气) . “YingQi travels inside of the vessels, WeiQi spreads outside of the vessels”. There are two separated spaces in the Channel; Therefore, it presents as a casing model with double membranes. A vessel-either a blood vessel or a lymphatic vessel, is in the center of the Channel. It is the passageway for the passage of blood and YingQi. The wall of the blood or lymphatic vessels serve as the inner membrane of the Channel. The outer membrane is made of fascia and the intermuscular septum, such as the neurovascular bundle or the sheath to form the osteofascial compartment. The space between the inner and outer membranes is called JingShui (经水) . This is translated as Water Channel. It is filled up with interstitial tissues, and allows WeiQi and body fluids to move in the body. It is the key factor in determining the types of Channels and Vessels by whether there is a complete existing outer membrane. When a section in the Channel has a complete outer membrane, it creates an enclosed structure of the Channels and Vessels. However, when there is no outer membrane existing in the section, it leads to the Channel becoming an open structure. This makes Channel Water have no physical border. It also allows WeiQi and the body fluids in different Channels to merge together. The passageway of the Channels and Vessels is continued in switching between the section of the enclosed structure and the section of the open structure.
Zhao had mentioned there are two main components in the Channels and Vessels: The vessel and the Chain. Vessels are the core structure of the Channel. When the vessel exists, the Channel performs the full function of transporting the blood and Qi. Whether it is in either a closed or open structure when the vessels are absent. The Fascia and Sinew Chain is only a structure in the channel. In that circumstance, Channels and Vessels are only able to transport WeiQi and the body fluids in the surrounding space of the Chain. Therefore, the minimal functionality of the Channels and Vessels is to transport the WeiQi and the body fluids.
There are branches in the system of Channels and Vessels. It is translated as the Communicating Channels (络脉). It usually utilizes the space surrounded the communicating branches of the Chain to exchange Qi and blood between the Yin and Yang correlated Channels.
Section of the Shin (PiBu) is the projection of the Channels and Vessels on the skin.
Skin is the barrier of the human body. Skin is understood as a complex structure, including tissues like epidermis and dermis, subcutaneous tissue, hair, and sudoriferous glands. The subcutaneous tissue is called CouLi (凑理). There are blood vessels in it. Some of them become the subcutaneous veins. “Puncture the blood vessel on the section of the skin and let the blood out.” The Yellow Emperor’s Inner Cannon called the subcutaneous vein “FuLuo (浮络).” “WeiQi is the valiant Qi from water and grain, which is swift and smooth in movement. It cannot enter vessels, but it flows in the skin and intermuscular space.” The Yellow Emperor’s Inner Cannon recognized WeiQi traveling in the structure of the skin. When skin is considered as a standalone structural tissue in the Five Structures, it has the full functions of the Channels and Vessels to circulate Qi and blood. Therefore, skin itself can be considered an extension of the Channels and Collaterals.
Skin has been virtually divided into sections in both TCM and modern medicine. Modern medicine divides the skin partition according to the cutaneous nerves and its segmental distribution. TCM divides the skin according to the passageway of the Qi and blood under the skin layer. The Yellow Emperor’s Inner Cannon called it PiBu, which is translated as Sections of the Skin, or simply the Section. TCM believes the nature of the Qi and blood in the Section of the Skin is the same as the Qi and blood in the Channels and Collaterals which the section belongs to. In the area especially in the extremities, Sections of the Skin are mapped by the distribution of the subcutaneous veins. In that area, there are no visible subcutaneous veins, and the section is mapped by the projection of the Channel from inside the body. Therefore, “All the subcutaneous vessels and twelve Channels are the principle to set up the partitions of the skin.”
Substantial perspective of the Channels and Collaterals
Histology believes all human structures derive from four types of tissues: epithelial tissue, muscle tissue, nervous tissue, and connective tissue.
Connective tissue is further divided into three groups: blood and lymphatic fluid, bone and cartilage, and connective tissue proper. Connective tissue proper is further divided into dense connective tissue, loose connective tissue, reticular tissue and adipose tissue.
Dense connective tissue can be divided into dense regular connective tissue, dense irregular connective tissue and elastic tissue. While loose connective tissue consists of cells, fiber and matrix.
Matching the Five Structures, Qi and blood under the scope of the Channels and Collaterals to the classification in histology, we found: Muscle in TCM and modern medicine are the same. Skin and Vessels are made by multi tissues, but their functional layer is endothelium. Therefore, Skin and Vessels belong to the epithelial tissue. “At the beginning of the embryo, the blood vessel is only made by the endothelial cell. Later it is added on the muscle tissue and connective tissues on the blood vessel wall ” . Sinew and Fascia in TCM are covered by two subcategories in histology. Fascia, tendons and ligaments all belong to the dense connective tissue, but nerve has its own category in histology. Bone of the Five Structures matches bone and cartilage. Blood and YingQi in the Channels and Collaterals match Blood and lymphatic fluids. They are all the main components of the connective tissue. While WeiQi and body fluids in the Channel are composed of cells and matrix of the loose connective tissue. Therefore, the classification of The Five Structures, and Qi and blood in the Yellow Emperor’s Inner Cannon has a perfect match with the 4 categories of tissue in histology. They just stand on different angles, using different languages.
Conclusion
One day we may prove the structure and system of the Channels and Collaterals with anatomic evidence. It would be proof that ancient sages who taught the Yellow Emperor’s Inner Cannon, had mastered the mystery of human embryology and anatomy. They discovered how the human body is built and how qi and blood are circulated. It is the greatest contribution not only to the theory of Channels and Collaterals, but also to the understanding of human life. It demonstrated that Traditional Chinese Medicine had already become an advanced, and complete medical system 2000 year ago.
Author information:
1. 馬寧，博士， 針灸基石紐約中心。30 E.40th Street, Suite 902,New York, NY 10016 USA [email protected]
2. 克拉克·斯特里德，L.Ac.英文编辑。Clark， Strider， L.Ac. English Editor.
介紹《經筋、經脈、皮部—黃帝內經經絡解剖學》
馬寧 克拉克·斯特里德
“皮肉筋脈各有所處者，言經絡各有所主也。”《靈樞·小針解》認為經絡是皮、肉、筋、脈等組成人體的結構物質在相互連接的過程中形成的結構總成。
其中皮就是皮膚，肉是肌肉，脈就是血管或淋巴管，屬於筋的結構物質具有纖維的特性，包括了筋膜、肌腱、韌帶和神經等結構組織。
“皮肉筋脈各有所處，病各有所宜，各不同形，各以任其所宜”，雖然《靈樞·九針十二原》的描述中沒有使用經絡，但是以同樣的句式說明皮肉筋脈在經絡總成當中仍保持著獨立的結構、獨特的生理功能，並且有各自的疾病，不同疾病的治療方法也具有針對性，但是他們在經絡系統中彼此高度依賴、並相互支持。
“逆順五體者，言人骨節之小大，肉之堅脆，皮之厚薄，血之清濁，氣之滑澀，脈之長短，血之多少，經絡之數。”《靈樞根結》不僅命名了五體，也指出了經絡不僅是人體的結構總成，而且是人體的物質總合，經絡包括了參與形成經絡的五體結構，同時包括了在經絡結構當中循行的氣血。
《黃帝內經》賦予了經絡二重意義。
在結構方面，經絡是皮肉筋脈等組成人體的結構總成，在形成經絡的同時，也形成了經筋、經脈和皮部等三種複合系統。骨頭只為筋脈肉提供附著，沒有實際參與經絡複合結構等形成，也沒有實際參與氣血的運行，因而沒有在經絡的描述中出現。
在物質方面，經絡包括了組成人體結構和營養人體結構的所有物質。在《經筋、經脈、皮部-黃帝內經經絡解剖學》一書中重點對經絡結構進行了解剖還原。
具有結構屬性的經絡
經筋是組合人體的結構
“首面與身形也，屬骨連筋。”人體是由筋膜連接而成的，筋膜以縱向和橫向的形式將人體的各種結構連接稱一個整體，橫向連接是筋膜內連於骨，外附於皮，將肌肉、神經和血管等結構固定於其中,現代醫學的肌肉、血管和神經等組織系統就是筋膜在橫向連接的基礎上，對人體的結構組織進行分離而成的；縱向連接是筋膜將肌肉、神經和和血管等連接成的一個鏈狀系統，《黃帝內經》強調筋膜的縱向連接，並且將肌肉、神經和血管等不同的結構組織連接成一條經筋。
筋是以纖維為特徵的一類結構組織，包括了筋膜、肌腱、韌帶、甚至神經等結構組織，其中筋膜是組成經筋的主體，筋膜所包裹或覆蓋的肌肉、血管和神經只是經筋的載體。“諸筋者皆屬於節”，筋膜、肌腱、韌帶在向關節和固定關節的韌帶附著時形成了經筋鏈中的結，血管和神經在關節處通過筋膜向關節附著，使得血管和神經等系統性結構呈現出節段性。《黃帝內經》透過結的形式將血管和神經等結構組織作為經筋鏈中的節段，結的存在使經筋能夠在不同的載體之間轉移，而且允許經筋改變方向。因此、筋膜是形成經筋鏈的關鍵物質。《黃帝內經》中的經筋沒有像現代解剖一樣按照肌肉、神經和血管等系統歸類，而是允許筋膜在肌肉、血管和神經等載體之間轉移，其目的是保證貫通的經脈通道，而非僅僅作為增強運動合力的綜合力線。
與現代和歷代的中醫學者的觀點不同，正別和經別被作為經筋的分支，因為正別和經別都是以肌肉、血管和神經為載體的結構，在實現經筋與所屬臟腑和對應經筋之間的結構連結的基礎上，形成了運行氣血的通道。正別是經筋連接所屬臟腑的交通支，正別的基本特徵是能夠進入體腔，而且以陰性正別跟隨其對應的陽性正別進入體腔；正連接臟腑的基本規律是：先連接腑，後連接臟。經別是連接在陰陽對應的經筋之間的分支，經別的基本特徵是能夠穿過或跨越肌間隔，把分佈在不同骨筋膜鞘當中的經筋結構連接為一體，因此、正別可視為經筋連接臟腑的體腔分支，而經別則是陰陽對應的經筋之間的交通支。
經脈是運行氣血的通道
“經脈者·所以行血氣而營陰陽，濡筋骨，利關節者也。”經脈是運行氣血的通道，也是一個同時運行營血和衛氣的複合結構，“營在脈中，衛在脈外”，典型的經脈結構呈雙膜套管模式，主幹血管或淋巴管的管壁構成經脈的內膜,包裹血管的血管神經束、或形成骨筋膜鞘的筋膜和肌間隔構成經脈的外膜。血脈或淋巴管是經脈的核心結構，經脈通過血脈和淋巴管運行營血；筋膜內和血管外的空間是經脈的套管，其中充填著大量的疏鬆結締組織，成為經脈運行衛氣和津液的空間，經脈中的套管結構稱為經水。雙膜套管結構是典型的經脈結構，也被稱為閉合型的經脈模式；但是在許多情況下經脈並沒有外膜，經水處於開放的狀態，這種非典型的結構被稱為開放型的經脈模式，在開放型的經脈結構中，鄰近經脈的衛氣和津液相互融合。經脈通道在閉合式和開放式两種模式之間轉換。
趙氏1發表在微信公眾號–紐約中醫論壇的書評中指出：經脈中包括了經和脈两種結構成分，脈是指血脈，經是指經筋。在有血脈穿行的經脈節段，血脈是經脈的核心，經脈是一個運行營血和衛氣的通道，這種情況多出現在閉合型的經脈模式中；在沒有血脈穿行的經脈節段，經筋是此經脈段落的主體，經脈透過由經筋形成的組織間隙來運作衛氣和津液，因此、通行衛氣和津液是經脈的基礎生理功能。
經脈的分支叫絡脈，多數情況下絡脈以經筋的經別分支為基礎，基於經別穿過或跨越肌間隔，貫通不同的骨筋膜鞘的特點，絡脈透過經別形成的組織間隙實現陰陽對應的經脈之間的氣血交換。
皮部是經脈在皮膚上的投影
皮膚是人體獨立於宇宙之外的屏障。與現代醫學對皮膚的認知一樣，《黃帝內經》中的皮膚是一個包括了皮膚、皮下組織、皮毛和汗腺的複合結構。
《黃帝內經》將皮下組織稱為湊理，將分佈在皮膚中的淺層血管成為浮絡、或者血絡，如“視其皮部有血絡者盡取之”；同時皮部中灌注有衛氣，“衛者,水穀之悍氣也,其氣剽疾滑利，不能入於脈也,故循皮膚之中，分肉之間”。
說明皮膚作為五體結構中的獨立系統，本身就具備經脈的運作氣血的功能，因此皮可以被視為是經脈在皮膚中的延伸。
中醫和現代醫學都對皮膚進行了分區，與現代醫學以淺層神經在表皮的分佈範圍對皮膚進行分區不同，《黃帝內經》按照覆蓋在皮膚之下的經脈通道進行分區，不同的皮部由來自不同經脈的氣血進行灌注，依照經脈特性對皮膚的分區稱為皮部。“凡十二經絡脈者，皮之部也”皮部在表淺血管豐富的手足部，皮部按照淺表血管的分部區域進行劃分；在沒有明顯表淺血管的部位，皮部只是經脈在皮膚上的投影。
具有物質屬性的經絡
組織胚胎學將組成人體的基本物質分為四類：上皮組織、神經組織、肌肉組織、結締組織等，結締組織的組成和分類較為複雜，首先結締組織的一級分類中包括了包括了血液和淋巴、骨組織和軟骨組織、和固有結締組織等三種成分，固有結締組織的再次分類劃分出緻密結締組織、疏鬆結締組織、脂肪組織和網狀組織等；對緻密結締組織的繼續分類又劃分出規則緻密結締組織和不規則緻密結締組織，對疏鬆結締組織的繼續分類又劃分出細胞、纖維和基質等。
將參與經絡組成的五體和在經絡當中循行氣血與以上四類人類生命的基本組織進行對比發現：肌肉的中西醫分類和命名方法一致；皮膚和血管都是由多組織形成的結構，但是它們的功能層都是由上皮組織形成的，因此皮和脈都與上皮組織對應，最初、心血管只是內皮性管道，隨著血流動力學的變化及胚體的發育，其周圍間充質分化出肌層和結締組織。屬於筋的物質具有两類屬性：筋膜、筋健和韌帶都屬於緻密結締組織和彈性組織，但神經具有獨立的組織屬性。骨、血液和淋巴液都是結締組織的重要組成部分，因此經絡當中骨和營血直接屬於結締組織，但是衛氣和體液則屬於疏鬆結締組織當中的細胞和基質，因此、經絡中五體和氣血液所包括的人體組織與組織學分類的四類基本組織完全一致，只是從不同的角度進行的分類和使用了不同的語言來描述。
結語
如果在今後的解剖實驗中能夠進一步確定經絡解剖還原的真實性和合理性，說明二千年前的《黃帝內經》已經完全掌握了胚胎髮育和人體結構的奧秘，並以氣血為中心建立了獨立的經絡體系，這不僅是對經絡實質研究的巨大貢獻，而且證明中華文明在二千年前就已經具備了現代科學對人體和生命的認識水平，已經成為一個先進的、完整的和科學的醫學體系。
作者簡介:
1. 馬寧，博士， 針灸基石紐約中心。30 E.40th Street, Suite 902,New York, NY 10016 USA [email protected]
2. 克拉克·斯特里德，L.Ac.英文编辑。Clark， Strider， L.Ac. English Editor.
參考文獻
軟金,推薦一本值得認真閱讀的書《經筋經脈皮部-黃帝內經經絡解剖學》.微信公眾號:紐約TCM論壇，2024-02-18
高英茂，宋天保等.組織學與胚胎學［M］. 北京,人民衛生出版社, 2006:416.
楊傳華.序.經筋、經脈、皮部-黃帝內經經絡解剖學［M］.濟南山東科技出版社,2023:001.
