.Hongliang Chen
Seeking common ground among differences
The membranes are located in certain areas and network vessels run through them. The 3 positions and 9 indicators pulse method allows one to examine the qi and blood of the whole body. A person’s life is nothing more than the time from birth until death; and as for joy, anger, sorrow, happiness, diet, and lifestyle, although these are the external manifestations of the body’s internal forms, they are actually the work of the bowels, viscera, skin, and flesh throughout the body.
Chapter 56 of the Inner Canon, entitled “Discourse on Skin Sections”, states: “The yang ［skin section］ of the yang brightness ［channel］ is called the ‘door leaf’. The same principles apply above and below. The superficial network vessels observed in this section are all yang brightness network vessels. If their color is mostly green-blue, there is pain. If it is mostly black, there is impediment. If it is yellow and red, there is heat. If it is mostly white, there is cold. If all 5 colors are visible, there is heat and cold. If the network vessels are exuberant ［i.e. full］, then ［an evil］ has entered and is visiting the channel. Yang governs the external, while yin governs the internal. The yang ［skin section］ of the lesser yang ［channel］ is called the ‘pivot holder’. The same principles apply above and below. The superficial network vessels observed in this section are all lesser yang network vessels. If the network vessels are exuberant ［i.e. full］, then ［an evil］ has entered and is visiting the channel. Therefore, that ［evil］ which is in the yang ［section］ governs ［entering］ the internal, and that which is in the yin ［section］ governs exiting, from which it seeps into the interior. All channels are like this.
The yang ［skin section］ of the greater yang ［channel］ is called the ‘gate pivot’. The same principles apply above and below. The superficial network vessels observed in this section are all greater yang network vessels. If the network vessels are exuberant ［i.e. full］, then ［an evil］ has entered and is visiting the channel.
The yin ［skin section］ of the lesser yin ［channel］ is called the ‘pivot bracket’. The same principles apply above and below. The superficial network vessels observed in this section are all lesser yin network vessels. If the network vessels are exuberant ［i.e. full］, then ［an evil］ has entered and is visiting the channel. It enters the channel from the yang section and pours into the channel, while that which exits ［does so］ from the yin ［section］ and pours into the bones internally.
The yin ［skin section］ of the heart ruler is called the ‘shoulder door’. The same principles apply above and below. The superficial network vessels observed in this section are all heart ruler network vessels. If the network vessels are exuberant ［i.e. full］, then ［an evil］ has entered and is visiting the channel. The yin ［skin section］ of the greater yin ［channel］ is called the ‘gate peg’. The same principles apply above and below. The superficial network vessels observed in this section are all greater yin network vessels. If the network vessels are exuberant ［i.e. full］, then ［an evil］ has entered and is visiting the channel.”
This introductory passage serves as one of the foundations for external treatment methods in Chinese medicine. It not only uses visual examination to refer to internal and external pattern diagnosis relationships, but also mentions the relationship between channels and network vessels. It includes the interior and exterior, the internal and external, the 5 colors, and cold and heat. Most important of all is its argument regarding external signs. Of course, that which is external is simply the skin on the body surface, as well as the sinews and flesh beneath the skin…
Although there are variations in physiological characteristics among different human bodies despite sharing the same features, there are always similar causes of disease and pathomechanisms. Based on different body parts, we can still seek differences in common ground and common ground in differences, and do more with what we have. We can observe local areas to understand the bowels and viscera. Through the perspective of yin and yang pattern diagnosis and holistic determination of treatment approaches, we can integrate local areas on the chest and abdomen with mutual relationships in the body as a whole. In addition to knowing the independent and integrated properties of the viscera and bowels, as well as the status of changes in the channels and vessels, this train of thought also requires us to truly experience and thoroughly understand where the basis for these ancient methods comes from and why we treat holistically in Chinese medicine.
When cord-like membranes with specific functions are arranged densely in layers, they gradually form the muscles, sinews, tendons, and connective tissues of the human body… Below, we will incorporate human anatomy into a deeper layer of discussion.
Membranes in anatomy
From an anatomical perspective, connective tissue is worth taking note of; most of the operations of the nervous system and blood vessels in the body are done under the protection of this tissue. It is one of the fundamental tissues in the human body. It consists of cells, fibrous bodies, and a matrix. The cells include macrophages, fibrocytes, plasma cells, and mast cells. The fibers include collagenous, elastic, and reticular fibers, which primarily serve to connect various tissues and organs. The matrix is a slightly gluey fluid substance that fills the spaces between cells and fibers, and serves as the medium for the metabolism of the tissues. The fibers and matrix are collectively referred to as the “interstitial matrix”, which comprises the majority of the mass of the connective tissue. Connective tissue has a very strong capacity to regenerate, most injuries relying on the proliferation of these tissues to heal. Connective tissues can be categorized as “loose” connective tissue (such as the subcutaneous tissues), “dense” connective tissue (such as sinews and tendons), and adipose tissue. This discussion is focused on the anatomical aspects of connective tissue because it serves like a central transfer hub in the human body; its structure consists of “extracellular matrix cells with interconnected protrusions that form a web between cells”. We can see that there is some common ground with Chinese medicine, namely that in the various life processes, like growth and development, fighting disease, and metabolism, the human body is unified, and its components help each other to exist. Thus, from this stage-based model of human life, we can understand the effects generated in the interoperation of internal tissues and systems.
Membranes in Chinese medicine
When the human body forms in the womb, all of its parts are soft (including the bits of the qi and blood that will form the bones). As soon as it is born, qi and blood will act swiftly through the operation of membrane network vessels to act out the growth of the body. This happens through the “like attracts like” combination of the qi of earlier heaven with the qi of later heaven (from the perspective of western medical theory, this is the grouping of cells of the same type). In terms of the external form, the skeleton is built as a framework according to the needs of the various parts of the human body and how they operate, and the locations of soft tissues are then derived from this framework. At the same time, the role of the membrane network vessels is to gradually complete the overall layout of the human body through the processes of the viscera and bowels.
Of course, in this process, the membrane network vessels themselves are constantly undergoing metabolism and expansion, and gradually bring about a synchronized completion together with other aspects of development. Likewise, the “life, aging, disease, and death” processes of the human body start here. In the process from the fetal stage, to infancy, childhood, adolescence, and young adulthood, and then middle age, old age, and death, how does the human body change and express itself, and what brings about all the abnormal factors that appear during this process? Although the qi of the viscera and bowels are the main factors, the membrane network vessels are the most notable hub in this process. While the various viscera and bowels interoperate by means of the channels and vessels, they each have their own independent functions. As qi and blood are dispersed towards the exterior layers, they are distributed through their specific “tunnels”.
Membranes maintain harmony in diversity
If we observe the skeleton, muscles, sinews, tendons, skin, and all related tissues from the viewpoint of membranes, network vessels, qi, and blood, and use these inherent connections and reflections of external signs to survey the internal parts of the human body, although there are different cells making up different tissues, at the end of the day they are all undergoing metabolism and interacting with each other in the same living organism. In other words, “life particles” with different functions 〖JP2〗make up a living community and, in the course of development, they must replenish each other with different forms of energy in order for the body as a whole to be healthy and strong. In fact, there is common ground shared in certain discussions of Chinese and western medicine; the difference is that western medicine tends to prioritize theoretical refinement, while Chinese medicine values clinical integration. This can be seen from the anatomical description of connective tissue alone. Therefore, as Chinese medicine practitioners, although we must respect the refinement of western medicine, we must never forget the fundamental perspectives of Chinese medicine in diagnosis and treatment.〖JP〗
Before an infant is born, the whole structure of the viscera, bowels, channels, and vessels has already been completed. As soon as the infant is born, the special functions of these parts will start to have an effect on the completion of the infant’s entire life. This must still be carried out by means of the membrane network vessels because the soft tissue in the human body has a relatively synchronized growth process, which includes the muscles, sinews, tendons, ligaments, and connective tissues. The viscera and bowels transport qi and blood through the channels and network vessels to moisten and nourish specific locations in the human body, but their effects vary, which is why Chinese medicine includes the “study of visceral manifestations”. For example, the spleen governs movement and transformation, controls the blood, and governs the flesh and four limbs. Its bloom is in the lips and it opens at the mouth. This description not only encompasses the spleen’s functions in modern medicine, but more importantly, it summarizes some of the functions of the digestive, excretory, and endocrine systems. From the various explanations given above, it is clear that the ancients performed their analysis entirely in terms of the independent and integrated properties of the interactions between viscera, bowels, channels and network vessels. Although the ancients’ analysis is not as refined as that of modern people, their perspectives on the explanation, observation, and application of these interoperating functions in the human body are extremely clear. In addition, in these structural models, the membrane network vessels move qi and blood in an orderly fashion to and from the viscera, bowels, and exterior. Through changes in speed, color, and temperature, they can show us the health status of the viscera and bowels, and when the body surface is affected or injured, they replenish the necessary qi and blood from the viscera and bowels in a timely manner. These points actually prove what western medicine discovered a thousand years later. The Merck Manual of Diagnosis and Therapy states that “in an autoimmune disorder, antibodies or cells produced by the body attack the body’s own tissues. Many autoimmune disorders affect connective tissue and a variety of organs. Connective tissue is the structural tissue that gives strength to joints, tendons, ligaments, and blood vessels.” From this, we can clearly see that both Chinese and western medicine are already aware of the intrinsic interconnections in living organisms, but it seems that their paths diverge in terms of how this awareness is applied clinically.
While the ancients’ analysis of the human body is not as refined as that of modern medicine, we can gain insight into its logical and integral properties from the mutual relationships among the 12 regular channels and the 8 extraordinary vessels, as well as various point locations and combinations. The movements of the 12 regular channels are the movements of qi and blood of the individual viscera and bowels, but how is their qi formed as a whole? Here, the 8 extraordinary vessels play a key role. “Outside of the regular channels, there are extraordinary channels; the 8 vessels have their own separate domains and names. The controlling vessel covers the front and the governing ［vessel］ is on the back. The thoroughfare ［vessel］ starts at the meeting of yin and runs along the kidney ［channel］. The yang springing ［vessel］ diverges from the outer bladder ［channel］, while the yin ［springing vessel］ starts anterior to the heel and follows the lesser yin ［channel］. The yang linking ［vessel］ links and connects all the yang vessels, while the yin linking ［vessel］ links and connects in all the yin ［vessels］. The girdling vessel surrounds the waist like a belt. ［Since these are］ not constrained by normal ［limits］, they are called extraordinary channels.” This is Li Shizhen’s description in An Examination of the 8 Extraordinary Vessels. The end of this description uses the phrase “not constrained by normal ［limits］”, which highlights the key point. Given that the viscera and bowel qi of the 12 regular channels requires the qi of other viscera and bowels to support and move it as it circulates, it must be subject to the effects of the membrane network vessels, and these effects require management, restraint, and harmonizing. By contrast, the 8 extraordinary vessels run through the membrane framework (source) in their own special ways. They mix and combine channel qi, and then transport it back to the various major channels connected to the viscera, bowels, and other areas. So it is not an overstatement to say that these vessels are the pharmacy of the human body.
The description of the 8 extraordinary vessels in the Classic of Difficult Issues states, “They follow each other up and down, flowing like a spring; like the movements of the sun and moon, they never stop to rest. Thus, the yin vessels are constructed in the 5 viscera and the yang vessels are constructed in the 6 bowels. Yin and yang link with each other, like a loop without an end. Nobody knows its cycles; it ends and then starts again. The qi that spills from this flow enters the extraordinary channels and diverts to irrigate them. Internally, it warms the viscera and bowels; externally, it moistens the interstices. The 8 vessels of the extraordinary channels are not restricted by the 12 regular channels; they do not have exterior-interior pairs, so they are called ‘extraordinary’. The regular channels are like canals and ditches, while the extraordinary channels are like lakes and marshes. When the vessels of the regular channels descend into exuberance, ［qi］ spills into the extraordinary channels.” The statement that “internally, it warms the viscera and bowels; externally, it moistens the interstices” happens to align with the role of the triple burner. Therefore, no matter whether we look at the explanations given in the Inner Canon, On Cold Damage, or Thousand Gold Pieces Formulary, we can analyze the content in these texts in a practical way. While there is no obvious exposition on how the form of the human body is constructed, we cannot ignore the fact that these texts use their own unique methods to gain insight by linking intrinsic systems together to form a whole. Moreover, this foundation is used to treat disease.
Western medical exploration is becoming increasingly refined and treating disease is someone else’s job; it is the job of medications and surgeons. By contrast, Chinese medicine approaches the human body using the 12 regular channels, 8 extraordinary vessels, and acupuncture points to unify and describe principles for health maintenance and the treatment of disease. The basic directions of the 8 extraordinary vessels are also shown in a highly systematic, rational, and methodical way through point locations on the membrane framework (source). The biggest difference from western medicine is that the latter analyzes all tissues, systems, and even physical structures in the human body in terms of each part, and then assigns an expert practitioner to diagnose and treat each part or system (such as each toe). If any specialist so much as suspects that something is not within the scope of their specialty, they will transfer the patient to be examined by a different specialist. Ultimately, medications and surgery are the primary treatments.
When using the theory of membrane network vessels to explain western anatomy, especially in terms of treatment, if we can fully comprehend the circulation and changes in the 8 extraordinary vessels, organize our approach to diagnosis and treatment based on the relationships among the relevant acupuncture points, and completely understand the underlying principles, then we will feel that Chinese medicine itself is a scientific method of thinking. As various practitioners have said, “the 8 extraordinary vessels are the great pharmacy of the human body”.
The influence of scars on membranes
If we observe the relationships between the girdling vessel and the various tissues in the pelvic cavity from an anatomical perspective, we can more directly understand some of the causes that can inhibit the girdling vessel. In the pelvic region, there are several factors that we must pay attention to: (1) abnormal phenomena caused by scars from abdominal surgery; (2) the status of the abdominal muscles; (3) the sinews and tendons that extend upward and laterally from the pubic bone area; (4) the status of the psoas major muscle extending into the pelvic cavity; (5) the status of both sides of the dorsal coccyx and L4-L5; and (6) the status of both hips. When these symptoms appear, the depletion of qi and blood is still just a manifestation. Aside from dysfunction of the viscera and bowels, another main cause of these symptoms is that tension, stickiness, depression, or stasis has formed in the membrane network vessels due to some kind of interference, which leads to stoppage of qi and blood. This makes it difficult for the 8 extraordinary vessels to harmonize the 12 regular channels, ultimately causing injury to the viscera and bowels. Moreover, these “repletion signs” due to causes of disease in the human body are often important elements that Chinese medicine can resolve.
Another example is the spine
The spine not only has a close relationship with the central nervous system, but also serves as a framework for balancing the blood vessels and lymphatic circulation. Changes in the spine have a large impact on the nerves and blood vessels distributed throughout the body; the main blood vessels include the vertebral artery, the abdominal aorta, and the iliac artery. There are 3 body cavities anterior to the spine. The heart and lungs are on top; the liver, gallbladder, and spleen are on the sides; the stomach, small intestine, pancreas, and kidneys are in the back; and the bladder and uterus are below. Nerves link the spine to the various organs and blood vessels also interconnect with them.
The muscles and ligaments serve as support structures that enable the spine to remain upright and move in different directions. The spinal ligaments also link the vertebrae together and maintain the stability of the spinal column. The ligaments consist of tough connective tissue with a criss crossed structure; they link the vertebrae into a unified whole and play a role in movement and protection. aking human anatomy into account, let us consider the main point of membrane network vessel theory: “membrane network vessels make up a framework for life, while qi and blood make up the driving force for life”. This is perfectly clear if we understand its significance as a whole based on the mutual relationship of the parallel paths of the bladder channel and governing vessel on the back, as well as the names of a few major acupuncture points. Moreover, when treating many modern disease symptoms, we can resolve the membranes and enable the movement of the network vessels, and there are many ways to reach a solution. The network vessel of the governing vessel is one of the 15 network vessels. It diverges from the governing vessel at the point Long Strong ［GV-01］, then runs up along the border of the muscles on both sides of the spine to reach the neck, and spreads out on the head. It also branches out to the right and left on the shoulders and scapulae, heading towards the foot greater yang channel and running through the muscles on both sides of the spine. From this, we can see the relationship between network vessels and membranes.
As soon as symptoms appear in this condition of alternating vacuity and repletion, in mild cases there will be lumbar aches, back pain, and cervical spondylosis; in severe cases, there will be ankylosing spondylitis or damage to the viscera and bowels. Therefore, the governing vessel truly lives up to its title as “the sea of yang vessels”; whenever there is damage and pain, the yang qi will be blocked, causing restricted mobility during the day and restlessness at night. Because this is a syndrome of alternating vacuity and repletion, the exterior should be treated by external methods, while the interior should be treated with formulas based on symptoms. Working on both aspects will yield results over time.
While there are various perspectives and theories on “membranes” in Chinese medicine, I hope we can seek common ground and put aside our minor differences. In the future, I will publish discussions on network vessels, membranes, and the interstices. Thank you!
Author information:
Chen Hongliang went to the United States in early 1980. He is a Chinese American and the founder of “Fingertip Yijin Therapy”.
In 2003, he graduated from Richmond Medical Massage College in Virginia, USA.
He founded a natural therapy clinic.
In September 2015, he served as the vice president of the World Federation of Chinese Medicine’s Tumor Treatment Research Professional Committee; and a director of the World Chinese Medicine Association’s Diabetes Committee.
膜絡與人體解剖學
陳虹樑
異中求同
膜有所居，絡有所行，三部九候，遍診週身之氣血。縱人一生，不外乎生而至死，然喜怒哀樂、飲食作息，雖為一身之內形而外顯，實為週身臟腑之勤、皮肉之勞也。
《內經皮部第五十六論》陽明之陽，名曰害蜚，上下同法，視其部中有浮絡者，皆陽明之絡也。其色多青則痛，多黑則痺，黃赤則熱，多白則寒，五色皆見，則寒熱也。絡盛則入客於經。陽主外，陰主內。
少陽之陽，名曰樞持。上下同法，視其部中，有浮絡者，皆少陽之絡也。絡盛則入客於經，故在陽者主內，在陰者主出，以滲於內，諸經皆然。
太陽之陽，名曰關樞。上下同法，視其部中，有浮絡者，皆太陽之絡也。絡盛則入客於經。
少陰之陰，名曰樞儒。上下同法，視其部中，有浮絡者，皆少陰之絡也。絡盛則入客於經，其入經也，從陽部注於經，其出者，從陰內注於骨。
心主之陰，名曰害肩，上下同法，視其部中，有浮絡者，皆心主之絡也。絡盛則入客於經。太陰之陰，名曰關蟄。上下同法，視其部中，有浮絡者，皆太陰之絡也。絡盛則入客於經。”
此段引論可為中醫外治法的基礎之一。其中不但以望診提到了內外的辨證關系，也提到了經和絡的關系。
有表裏和內外，有五色寒熱，最重要的是對表象觀察的論點。當然，表者不為乎體表之膚，及膚下之筋、肌等……
雖然由於人體不同，生理特性各別，盡管特徵相類，但是總有病因相同，病機相似者，我們仍可根據不同部位，同中求異，異中尋同，因勢利導，察局部、明臟腑，通過陰陽辨證、整體論治的觀點，從胸腹的局部結合全身的相互的關系，思路除了要知道臟腑的獨立性及綜合性，經脈的變化狀態，我們更要真正去體會和悟透古人的這些方法的根據從何而來？和為什麼在中醫診療中要整體而治？
當具有特定功能的膜以緊密的條索狀並層層相壘的層次時，逐步形成了人體的肌肉，筋腱，結締組織。
下面我們就結合人體解剖學作來比較深層次的探討。
解剖學的膜
從人體學中去觀察，其中值得注意的是結締組織，人體的神經系統，血管的運作大部分都是在結締組織的保護中進行。“它是人體的基本組織之一。由細胞，縴維體和基質組成。細胞有巨噬細胞、縴維細胞、漿細胞、肥大細胞等。縴維包括膠原縴維、彈性和網狀縴維等，主要是聯繫各組織和器官的作用。”基質是略帶膠粘性的液質，填充於細胞和縴維之間，為物質代謝交換的媒介。縴維和基質又合稱“間質”，是結締組織中最多的成分。結締組織具有很強的再生能力，創傷的愈合多數要通過它的增生而完成。結締組織又分為疏鬆結締組織（如皮下組織）、致密結締組織（如筋腱）、脂肪組織等。在此僅引申結解剖學的結締組織，是因為在解剖學中，結締組織在人體中如同一個中轉樞紐，它的結構“間充質細胞呈星狀，細胞間以突起相互連接成網”。從人體學的闡述中，我們完全可以感覺到其中與中醫學的某些共同點。就是人體在生命的發展，生存、對抗疾病、新陳代謝等，是統一和互助共存的。所以,從這個人體生命中的階段式中，我們可以認識到內部組織、系統的互相運作過程產生的作用。
中醫學的膜
人體在胞宮的形成，一切都是軟性的（其中包括將形成骨髂的氣血粒子），一旦出生，氣血會迅速的通過膜絡運作而對人體的成長起效，這是由於“同氣相求”的先天之氣與後天之氣的結合（從西醫理論上來講，是同類的細胞組合）。在外形上，根據人體不同的部位的運作方式和需要組成了以骨架為支架，並以此支架為主體延伸軟組織的定位，同時膜絡的作用，又以此將臟腑對此形成所起的過程，逐步完成人體整個佈局。
當然在這過程中，膜絡本身也不斷進行新陳代謝和擴展，與各方面的形成逐漸進行一個同步的完成方式。同樣，人體的“生老病死”過程由此開始。胎兒——嬰兒——童年——少年——青年——壯年——老年——死亡，那麼在這段過程中，人體的變化和表現方式呢？以及這個過程中所發生的一切不正常因素是怎樣發生的？雖然臟腑之氣為主要因素，可是膜絡卻在這個過程中是最為突出的樞紐。因為各臟腑雖通過經脈互為運作，但畢竟有其各個獨立功能，氣血在向表層散佈的過程中，通過其特殊的“道隧”而佈局。
和而不同的膜
如將骨髂、肌肉、筋腱、皮膚等一切有關組織以膜、絡、氣血的觀點來觀察，並將這種內在的聯繫和從表象的反映上去觀察人體內部，雖然是不同的細胞組成了不同的組織，但歸根結底都在同一個生命體中新陳代謝並互為作用，也就是不同功能的“生命微粒”組成了生命的共同體，並且在發展過程中，必須以不同的能量互相補充，才能有一個健康，健全的整體，其實中西醫的某些探討有着相同之處，不同的是西方醫學較注重理論上的細致化，但中醫學是注重臨床上的整體化，僅從人體學闡述結締組織一項，已可見一斑。所以雖然我們要尊重西方醫學的精細化，但作為一個中醫工作者，更要堅持在診療中時刻不忘中醫學的基本觀點。
不同的臟腑和經脈在嬰兒出生前已完成了整個構建，一旦嬰兒出生，就會將各自的特殊功能對整體生命的完成起作用，這仍然是要通過膜絡的運作來完成。因為人體的軟組織相對來講，是一個同步的生長過程，其中包括肌肉、筋腱、韌帶、結締組織等。各臟腑則通過經絡將氣血輸送至人體特定之位濡養，但其作用有殊有異。所以中醫有“藏象學”。例如: 脾臟主運化，主統血，主肌肉四肢，其華在唇，開竅於口等……。在述說中它除了具有現代醫學脾的功能之外，更主要的是概括了消化系統、排泄系統和內分泌系統的部分作用。從上述的種種解釋中，很顯然，古人是完全在臟腑、經絡等互相之間的運作的獨主性和綜合性上分析的。雖然古人沒有象現代人那樣分析得那麼細致，但是在解釋、觀察、應用之這些人體互為運作功能的觀點上，卻非常清楚。而且這些以膜絡的結構方式，將氣血有條有序的往返於臟腑和表層。它會把臟腑健康狀況通過速度、顏色、溫度等變化向我們顯示，又會在體表在受到影響或傷害時，及時返回臟腑將所需補充的氣血及時送達。這些論點，其實也論證了千年後西方醫學的探索。默沙東診療手冊闡述“自身免疫性疾病是一種自身產生的抗體或細胞攻擊自身組織的疾病（自身免疫性疾病）。多數自身免疫性疾病影響許多器官的結締組織。結締組織是關節、肌腱、韌帶和血管的基礎。”從中我們清楚的看到無論是中、西醫學對於生命內在的互相聯繫，都早已觀察到，但是在臨床如何應用上，卻似乎分道揚鏢。
雖然古人對於人體沒有現代醫學分析得那麼細致，但我們可從十二正經，奇經八脈的相互關系中，從各個穴位所定之處及配伍中，卻可以悟到其中的邏輯性和整體性。
十二正經運轉的是臟腑獨立的氣血運轉，但它們的綜合之氣是如何形成的？奇經八脈正是在此起了關鍵作用。“正經經外是奇經，八脈分司各有名，任脈衽前督於後，沖起會陰腎同行。陽蹻跟外膀胱別，陰起跟前隨少陰，陽維維絡諸陽脈，陰維維絡在諸陰。帶脈圍腰如束帶，不由常度號奇經。”這是李時珍在《奇經八脈考》中的描述。在這描述的結語中，用了“不由常度”四字，正是畫龍點晴處。
十二正經的臟腑之氣在循行過程中，既然需要其它臟腑的氣來共同扶持和運作，就必須也通過膜絡的作用，而這個作用則需要管理和約束並調和，而奇經八脈以其獨特的方式穿行於膜架（原）之間，將經氣相融和綜合運用，續再輸回各大經相通臟腑及各處，所以稱之為人體藥房，確不為過。
《難經》對奇經八脈的形容曰“相隨上下，如泉之流，如日月之行，不得休息。故陰脈營於五臟，陽脈營於六腑。陰陽相貫，如環無端，莫知其紀，終而復始。其流溢之氣，入於奇經，轉相灌溉，內溫臟腑，外濡腠理。奇經凡八脈，不拘制於十二正經，無表裏配合，故謂之奇。蓋正經猶夫溝渠，奇經猶夫湖澤。正經之脈降盛，則溢於奇經。”其中“內溫臟腑，外濡腠理”又恰於三焦作用共舉。
所以,無論是《內經》、《傷寒論》、《千金方》的闡述中，我們可以切實地分析他們所著的內容，對於人體構造的形式雖沒有明顯的闡述，卻都以自己獨特的方法，以內在系統聯成一體的見解，是我們不能忽視的,而且這個基礎卻是為了治病而用。
西方醫學的探索越來越細，而治病是別人的事，是藥物和手術醫生的事。中醫學卻將人體以十二正經、奇經八脈和穴位的方式統一闡述了健康和治病的法則，而且奇經八脈基本走向，大部分以膜架（原）的定點，以一種非常系統，合理，有章法的方法療法展示出來。西方醫學的最大不同處是西方醫學對人體所有組織、系統甚至所有肢體構造分析到每個部位。又將每個系統，部位分配給專業醫生診治（如每個腳趾）。而每個專科醫生只要有一點認為並不屬於本科范圍，就會轉去另一不同專科檢查，最後基本還是以藥物、手術為主。
以膜絡的理論來解釋西方的人體學，特別是在療法中，如果能深入理解奇經八脈的循行變化，從相關穴位的聯繫中理出診療思路，如悟透了其中的道理會認為中醫學本身就是個科學的思維方法。正象各醫家所說“奇經八脈就是人體的大藥房”。
疤痕對膜的影響
如果從人體學看帶脈與盆腔各種組織的關係中去觀察，對一些造成帶脈不利的起因，會有更直接的一些理解。在盆腔的部位有幾個方面需要重視。1）腹部手術的疤痕引起的不正常現象。2）腹肌的狀況。3）由恥骨處向上延伸和向兩側延伸的筋腱。4）大腰骼肌向盆腔內延伸的狀況。5）背後尾骨兩旁及L4、L5的狀況。6）兩邊胯部的狀況。當這些症狀出現時，氣血功能虧損仍是個現象，造成這些病症現象的主因，除了臟腑不力，另一個主因就是膜絡由於受到某種原因干擾發生緊、粘、鬱、瘀等致使氣血不通，奇經八脈難和十二正經，終使臟腑受損。而且這些人體病因產生的“實象”，往往是中醫能夠解決病症的重要環節。
再舉例脊椎
脊椎不但與中樞神經有緊密關系，而且也是血管、淋巴循環的平衡的支架。脊柱的變化會對體內分佈的神經和血管產生極大影響，在血管方面主要是椎動脈，腹主動脈、髂動脈等。脊柱前面有三個體腔，心、肺居上，肝、膽、脾居兩側，胃、小腸、胰、腎居後，膀胱、子宮居下。脊柱與各個器官有神經聯繫，有血管相通。
肌肉和韌帶作為支持結構能使脊柱保持直立和在各個方位上移動。脊柱韌帶還將脊椎骨連結在一起和維持脊柱的穩定。韌帶是堅韌的縴維組織，以交叉的方式構成，將脊柱連結成一個整體和起運動和保護作用。
以人體解剖學相結合思考一下膜絡論的主要觀點“膜絡組成了生命的構架，氣血組成了生命的動力”。從中醫學膀胱經和督脈在後背的循行並列的相互關系中，和一些主要穴位的定名中去理解這個論整體的治的意義，可見一斑。
而且在現代的許多病症時，以解膜而使絡行，解決的方法眾多。督脈之絡為十五絡脈之一，從長強穴處由督脈分出，然後在脊柱兩旁肌肉邊上上行，直達項部，散絡於頭上。再則在肩胛部左右有分支，走向足太陽經脈，穿入於脊柱兩旁肌肉之內。從中可以看出絡與膜的關系。
這種虛實相間的狀況一旦出現病症，輕則腰酸背痛，頸椎病，重則有強直性脊椎炎，或傷及臟腑。所以督脈被稱為“陽脈之海”名符其實，一旦傷痛便陽氣受閉便日難行，夜難安。故由於為虛實相間之症，應以外治法治其表，循症以方劑調其內，雙管其下假以時日可奏效。
對於中醫學的“膜”各方均有不同看法，不同論點之處，只願求大同，存小異，以後將陸續發表“言絡、言膜、言腠理”，謝謝！
作者簡介:
陳虹樑，1980年初赴美。美籍華人，“指尖易筋療法”創辦人。2003年畢業於美國維州瑞奇蒙醫療按摩學院。創辦自然療法所。
2015年9月任世界中醫藥聯合會腫瘤經方治療研究專業委員會付會長。世界中醫藥學會糖尿病委員會理事。
