《內經》經筋理論在現代的臨床應用

《內經》中記載經筋分佈運行之特點為：1.起於四肢指爪，循行總向呈向心性；2.伴同名經脈分佈，但不入臟腑；3.有結聚之性，符合“諸筋者，皆屬於節”的特點。經筋的作用為連接四肢百骸，維繫周身。經筋病的臨床表現可概括為經筋分佈之處的筋肉攣急、疼痛、麻木、掣引、痹痛、強直、弛緩、關節疼痛、屈伸不利等症。早在《內經》時也早已提出“不通則痛”的論述，即：“一經上實下虛而不通者，此必有橫絡盛加於大經之上，令之不通”，可以看出“橫絡盛加”是導致不通的主要原因。“横絡就是“筋肉”組織損傷的病理變化。現代醫學已知肌肉、韌帶、滑囊、脂肪墊、滑車與骨性纖維管，都是承受非生理性損害的部位。這些部位的反復的損傷、修復，就會出現病理性的“橫絡”，即粘連、瘢痕、攣縮、阻塞。從而導致頑固性疼痛發生。解除“橫絡卡壓”即可治療疼痛。《靈樞．經筋》中提出經筋病治則“治在燔針劫刺”的方法。《靈樞．刺節真邪》提出解結法，應用針刀直接鬆解經筋病灶點，解除引起氣血痹阻的器質性原因，使脈道通暢。此二法提示，現代治療經筋病最好的方法就是火針療法與針刀療法。近年來，隨著現代醫學的介入，對經筋的實質有較多的探討和闡釋。但經筋療法的研究尚未執行到循證醫學階段，仍缺少統一客觀的評價指標，療效可比性不足，因此對於經筋實質與理論的認識，仍具有廣泛研究的空間。

關鍵字

經筋；病理；治療；火針；針刀

並列摘要

The characteristics of the distribution and operation of the meridian-sinos recorded in the "Nei Jing" (Internal Classics) are as follows: 1. Starting from the fingers and clawsof the limbs, the general direction of the movement is centripetal; 2. It is accompanied by the distribution of meridians of the same name, but does not enter the viscera; 3. "All tendons belong to joints". The function of tendons is to connect the limbs and bones and maintain the whole body. The clinical manifestations of meridian-sinos disease can be summarized as muscle cramps, pain, numbness, tension, arthralgia, stiffness, laxity, joint pain, and difficulty in flexion and extension at the distribution of the meridian-sinos. As early as mentioned in the book "Nei Jing", the argument of "pain caused by obstruction" has already been put forward, that is: "Once a certain meridian has upper excess and lower deficiency, there must be horizontal collateral affected by strong evil Qi andattached on main meridian, making it obstructed." It can be seen that "Horizontal Collaterals affected by strong Qi" is the main cause of failure. Horizontal collaterals are the pathological changes of "tendon-muscle" tissue damage. Modern medicine has known that muscles, ligaments, synovial bursa, fat pads, pulleys and bone fiber tubes are all parts that bear non-physiological damage. Repeated damage and repair of these parts will lead to pathological "horizontal collaterals", that is, adhesions, scars, contractures, and obstructions, resulting in intractable pain. The pain can be treated by releasing the "horizontal collateral compression". In "LingshuJingjin", it is proposed that the treatment of meridian and tendon diseases should be "cured by the burnt needle". "LingshuPricking the True Evil" proposes the method of untangling knots, usingacupotomy to directly loosen the lesion points of the meridian-tendons, remove the organic causes of qi and blood blockage, and make the veins unobstructed. These two methods suggest that the best methods for treating meridian-sinos diseases in modern times are fire needle therapy and acupotomy therapy. In recent years, with the intervention of modern medicine, there have been more discussions and interpretations on the essence of tendons. However, the research on meridian-sinos therapy has not yet reached to the stage of evidence-based medicine, and there is still a lack of unified and objective evaluation indicators, and the comparability of curative effects is insufficient. Therefore, there is still space for extensive research on the understanding of the essence and theory of meridian-sinos therapy.