Bath Megan, Owens Justin
Marian University College of Osteopathic Medicine
Philadelphia College of Osteopathic Medicine
In 1907, an osteopathic researcher named Louisa Burns observed that "a very important, if not the only, pathway of viscerosensory impulses enters the spinal cord through its posterior roots." She went on to explain that "somato-visceral reflexes are less circumscribed and less direct than are viscerosomatic reflexes" and clarified that "normal visceral activity depends in part upon the stimulation derived from the somatosensory nerves…the possibility of recognition of abnormal viscerosomatic reflexes as an aid in diagnosis is inferred". She had been studying the mechanisms of reflex arcs in animal models to understand better the complex interactions between the viscera, spinal cord, and soft tissues. These landmark statements paved the way for extensive osteopathic study from the likes of future leaders in osteopathic education such as Wilbur Cole, DO, H. V. Halladay, DO, John Martin Littlejohn, MD, DO, William Smith, MD, DO, Irvin Korr, Ph.D., John Stedman Denslow, Ph.D., and William Johnston, DO, FAAO. The result was an explanation of the phenomenon that would later be known as somatic dysfunction. Somatic dysfunction is defined as "impaired or altered function of related components of the somatic (body framework) system: skeletal, arthrodial, and myofascial structures, and related vascular, lymphatic, and neural elements." the acronym T-A-R-T may help clinicians remember the criteria for the diagnosis of somatic dysfunction: issue texture changes; symmetry; estriction of motion; enderness (primarily used for specific osteopathic manipulative techniques, namely counterstrain). These criteria are commonly referred to as "TART changes". One or more of the criteria are required to diagnose somatic dysfunction. It is important to note that tenderness is subjective and considered a controversial criterion. Similarly, the examining physician should consider a finding of focal tenderness concerning the entire clinical picture, developed by way of a thorough history and physical, before establishing a definitive diagnosis of somatic dysfunction. There are many causes of the aforementioned criteria, and thus, there are many causes of somatic dysfunction. Dr. Burns' research explained viscerosomatic reflexes as a contributing etiology. This article portends to explain the anatomical basis for viscerosomatic reflexes, detail their mechanism of development, outline their pathophysiology, and delineate their clinical significance.
1907年，一位名叫路易莎·伯恩斯的整骨疗法研究者观察到，“内脏感觉冲动的一条非常重要（即便不是唯一）的途径是通过脊髓后根进入脊髓”。她接着解释说，“躯体-内脏反射比内脏-躯体反射的范围更不局限，也更不直接”，并阐明“正常的内脏活动部分取决于来自躯体感觉神经的刺激……由此推断，识别异常的内脏-躯体反射有助于诊断”。她一直在动物模型中研究反射弧的机制，以便更好地理解内脏、脊髓和软组织之间的复杂相互作用。这些具有里程碑意义的陈述为整骨疗法的广泛研究铺平了道路，未来整骨疗法教育的领军人物，如威尔伯·科尔博士、H. V. 哈勒代博士、约翰·马丁·利特尔约翰医学博士、威廉·史密斯医学博士、欧文·科尔博士、约翰·斯特德曼·登斯洛博士和威廉·约翰斯顿博士等人都参与其中。结果是对后来被称为躯体功能障碍的现象做出了解释。躯体功能障碍的定义是“躯体（身体框架）系统相关组成部分的功能受损或改变：骨骼、关节和肌筋膜结构，以及相关的血管、淋巴管和神经成分”。首字母缩写词T-A-R-T可能有助于临床医生记住躯体功能障碍的诊断标准：组织质地改变；对称性；运动受限；压痛（主要用于特定的整骨手法技术，即对抗牵引）。这些标准通常被称为“TART改变”。诊断躯体功能障碍需要满足一项或多项标准。需要注意的是，压痛是主观的，并且是一个有争议的标准。同样，在确定躯体功能障碍的最终诊断之前，检查医生应通过全面的病史和体格检查，考虑与整个临床情况相关的局灶性压痛发现。上述标准有许多成因，因此，躯体功能障碍也有许多成因。伯恩斯博士的研究将内脏-躯体反射解释为一个促成病因。本文旨在解释内脏-躯体反射解剖学基础，详述其发生机制，概述其病理生理学，并阐述其临床意义。
