“大筋緛短,小筋弛长”与运动神经元病相关性初探

Preliminary Study on Correlation between “Large Tendons Shrinking, Small Tendons Loosening” and Motor Neuron Disease

“大筋緛短,小筋弛长”系外感湿邪,湿酿化热,煎熬阴津,筋脉失养所致。历代医家对大筋和小筋所指部位存在疑议,亦未点明緛短及弛长的具体表现。笔者结合现代疾病,从病因病机、临床表现、辨治方药及其机制角度对“大筋緛短,小筋弛长”与运动神经元病(MND)的相关性进行探究,发现“大筋緛短,小筋弛长”或为MND最早的文献记载。大筋緛短系上运动神经元损伤,表现为肌张力增高、腱反射亢进等,以整个肢体为主,呈痉挛性;小筋弛长系下运动神经元损伤,表现为肌肉萎缩、肌张力降低、腱反射减弱甚或消失等,以肌群为主,呈迟缓性。“大筋緛短,小筋弛长”既可共同亦可独立出现。

“Large tendons shrinking,small tendons loosening” are caused by exogenous dampness,dampness being transformed into heat,damaging yin fluid,resulting in tendons and vessels lossing nourishing.Physicians of all dynasties had doubts about the meaning of large tendons and small tendons,and did not point out the concrete manifestations of shrinking and loosening.Combining with modern diseases,this study explored the relationship between “large tendons shrinking,small tendons loosening” and motor neuron disease(MND) from etiology,pathogenesis,clinical manifestation,syndrome differentiation and treatment mechanism.It found out that "large tendons shrinking,small tendons loosening" may be the earliest documented evidence of MND.It is considered that large tendons shrinking is upper motor neuron injury characterized by increased muscular tension,hyperreflexia of tendons,and mainly occurs in the whole limbs,and showing spasms;whereas small tendons loosening is lower motor neuron injury characterized by atrophy of muscles and decrease of muscle tension,weakened or even disappeared tendon hyperreflexia,mainly occurs in muscle groups,and showing tardiness.“Large tendons shrinking,small tendons loosening” can appear together or independently.