TCM Acupuncture and Massage

Chapter 57 Endocrine and Metabolic Diseases (4)
3. Treatment of different stages of gout

(1) General treatment: Alcohol consumption must be limited, especially beer and wine.A low-purine and low-fat diet should be adopted.Drink plenty of water to increase urine output and promote uric acid excretion.Exercise properly to avoid overweight and obesity.

(2) Treatment of initial arthritis attack: The purpose of treatment is to control the attack, so the main focus is on pain relief, joint immobilization and appropriate anti-gout drugs can be taken.Generally, gout attacks can be controlled within 24 hours, and no later than 2 weeks.Pain medications are discontinued once the arthritis flare is fully controlled.

(3) Initial treatment to control uric acid: about 3 to 6 months.Generally, it is carried out during the intermittent period. First use a small dose and gradually increase it to a sufficient amount. After the blood uric acid reaches the ideal level, it will be reduced to the maintenance dose.

(4) Lifelong treatment for uric acid control: After 6 months of initial treatment for uric acid control, a maintenance dose can be used.Since hyperuricemia generally does not decrease without drug treatment, only by insisting on taking medicine can the blood uric acid be kept at a normal level, so in this sense, lifelong treatment is required.However, with long-term treatment, the uric acid pool in the body will continue to decrease, and finally only a small dose of drugs can be used to achieve the therapeutic purpose.

(5) Treatment of chronic arthritis and tophi: Most of the patients in the chronic phase are caused by lack of early treatment or irregular treatment, and the treatment effect is relatively poor.The principle of treatment is still to avoid recurrent arthritis and protect joint function.

(6) Treatment of gouty nephropathy and gouty urolithiasis: Controlling hyperuricemia is the key, avoiding unfavorable factors harmful to the kidneys, preventing and treating urinary tract infections, and treating complications such as hypertension, arteriosclerosis, and diabetes.

4. Drugs for gout

(1) Analgesic and anti-inflammatory drugs: mainly used to treat the symptoms of acute attack of gouty arthritis, eliminate redness, swelling and heat pain in the joints, and at the same time reduce fever and improve systemic symptoms.These drugs mainly include colchicine, nonsteroidal anti-inflammatory drugs, and corticosteroids.

(2) Drugs that inhibit uric acid synthesis: currently there is only one type of allopurinol.

(3) Drugs that promote the excretion of uric acid by the kidneys: three commonly used drugs are probenecid, benzbromarone, and sulfazone.

(4) Chinese medicine: Chinese medicine also has a certain therapeutic effect on gout.

([-]) Prevention

1. Preventive measures
After suffering from gout, measures should be taken to actively prevent the recurrence of gout.The specific methods are:

(1) First of all, you should control your diet, avoid eating a lot of high-purine foods, strictly abstain from alcohol, and drink more alkaline drinks.

(2) Drink plenty of water to help excrete uric acid.

(3) Prevent obesity.

(4) Keep a happy spirit and avoid overwork, mental stress, cold and damp, joint damage and other predisposing factors.

(5) Drugs that inhibit uric acid excretion, such as hydrochlorothiazide and furosemide, should not be used.

(6) Accept drug treatment to reduce blood uric acid, and actively prevent and treat complications.

(7) Receive regular follow-up and regular review of blood uric acid.

(8) The prevention of secondary gout is mainly to actively treat primary diseases such as leukemia, multiple myeloma, and chronic kidney disease.

2. Precautions for drinking water for gout patients

Gout patients are required to drink more water in order to increase urine output and promote uric acid excretion.Proper drinking of water can also reduce blood viscosity, which is beneficial to the prevention of gout complications (such as cardiovascular and cerebrovascular diseases).But we must pay attention to drinking water scientifically and drink water reasonably.

(1) Drinking habits: To develop drinking habits, insist on drinking a certain amount of water every day, and do not stop drinking at ordinary times and drink too much temporarily.

(2) Drinking time: Do not drink a lot of water within half an hour before meals and immediately after eating, as this will dilute the digestive juices and gastric acid, affect appetite and hinder digestion.The best times to drink water are between meals and in the evening and early morning.Evening refers to the period from 45 minutes after dinner to before going to bed, and early morning refers to 30 minutes after waking up to breakfast.

(3) Drinking water and thirst: The common habit of people is to drink water only when they are thirsty. Gout patients should take the initiative to drink water and not wait until they feel thirsty before drinking water, because the body is already in a state of water shortage when thirst is obvious , Drinking water at this time is less effective in promoting uric acid excretion.

(4) Drinking tea: Many people in my country like to drink tea. Gout patients can drink tea instead of plain water, but tea contains tannic acid, which easily combines with iron in food to form insoluble precipitates, which affect iron absorption.In addition, the tannic acid in tea can still combine with certain proteins to form tannic acid protein that is difficult to absorb.Therefore, if you drink tea immediately after a meal, it will affect the absorption of nutrients and easily cause iron deficiency anemia.A better method is to start drinking tea 1 hour after a meal, and light tea is suitable.

[-]. Point massage

In the acute stage of gouty arthritis, the swelling and pain are very severe, so acupoint massage is not suitable.This therapy can be performed on each joint during the remission period to prevent flare-ups.

([-]) Acupuncture therapy

1. Take acupuncture points
It is advisable to select acupoints in parts.

(1) Metatarsophalangeal joint: Bafeng.

(2) Ankle joints: Jiexi, Qiuxu, Taixi.

(3) Knee joint: knee eye, Liangqiu, Yanglingquan.

(4) Wrists, palms, and knuckles: Yangchi, Zhongquan, Daling, and Baxie.

(5) Elbow joints: Quchi, Shaohai, Patio.

(6) Shoulder joint: shoulder skull, shoulder iliac, front shoulder.

2. Positioning
Bafeng - dorsal side of the foot, between the 1st to 5th toes, between the red and white flesh on the posterior edge of the toe web, four points on one side, a total of eight points on the left and right sides.

Xiexi—in the central depression of the transverse crease at the junction of the dorsum of the foot and the calf, between the extensor longus tendon and the extensor digitorum longus tendon.

Qiuxu—in the front and lower part of the lateral malleolus, in the depression on the outside of the extensor digitorum longus tendon.

Taixi—In the depression at the midpoint of the line connecting the highest point of the medial malleolus and the Achilles tendon.

Knee eye - knee flexion, the depression on both sides of the patellar ligament.They are called inner and outer knee eyes respectively.

Liangqiu—on the connecting line between the anterior superior iliac spine and the lateral end of the patella, 2 cun above the patella.

Yanglingquan—the depression anteriorly and inferiorly to the head of the fibula.

Yangchi—in the transverse crease of the dorsum of the wrist, in the depression on the ulnar edge of the extensor common tendon.

Zhongquan—in the transverse crease of the dorsum of the wrist, in the depression on the radial side of the extensor tendon.

Daling—the center of the transverse wrist crease, between the flexor carpi radialis tendon and the palmaris longus tendon.

Baxie—on the back of the hand, slightly clenched fist, between the 1st and 5th fingers, at the point between the red and white flesh behind the edge of the web, there are a total of eight points on the left and right.

Quchi—elbow flexion, at the midpoint of the line connecting the lateral end of the transverse cubital crease and the lateral epicondyle of the humerus.

Shaohai—elbow flexion, at the midpoint of the line connecting the medial end of the transverse cubital crease and the medial epicondyle of the humerus

Patio—the depression about 1 inch above the olecranon ulna when the elbow is flexed.

Scapula—When the upper arm is abducted, two depressions appear, in the depression anteriorly and inferiorly to the acromion.

Scapula—When the upper arm is abducted, two depressions appear, in the depression posterior and inferior to the acromion.

In front of the shoulder - 1 cun in front of the shoulder skull.

([-]) Self-massage
1. Press and knead Use the press and knead method to operate on the joints of the limbs, focusing on the diseased joints, for about 10 minutes.

2. Acupuncture Use the thumb or middle finger to press the acupuncture points near the affected joints for about 1 minute.

3. Active joint flexion and extension, shaking, rubbing, pulling and extending the affected joints.

4. Rubbing method Use the rubbing method to operate on the affected joints, and then apply the patting method to make the heat penetrate the joints.

Menopausal syndrome
An overview of the disease

([-]) Relevant knowledge

A person's life is a gradual and continuous process of development and change. Different ages have different physiological and physical characteristics. Menopause is a medical term.Refers to the transition period from childbearing to old age, and menopause also exists in men.However, because the men's gonads (testicles) start to age later and fewer people have symptoms, the boundary of male menopause is generally not obvious, and its importance is relatively small.In women, menopause includes a period from the few years before the complete cessation of menstruation to several years after menopause, starting from about 40 years old to about 70 years old on average, about 30 years.During this period, the ovarian function begins to decline, the menstrual cycle gradually prolongs, and the menstrual volume gradually decreases until it stops completely.Although menopause is a clear sign of menopause, it is only a milestone in menopause and does not include the entire process of menopause.Women have a gradual decline in ovarian function before menopause. According to surveys, the average is 4 to 5 years, and the longest is 8 years, which is called the transition period of menopause.After menopause, the ovarian function is even lower, resulting in a series of physiological and pathological changes due to the lack of estrogen in postmenopausal women, which generally takes 15 to 20 years, or even longer.So menopause is: the sum of menopausal transition, menopause, and postmenopause.During this period, menopausal syndrome occurs due to the reduction or even disappearance of sex hormones.

Some scholars believe that menopause is the breaking point of the aging process, which needs attention and research.In our country, people's life expectancy is generally extended, more and more women are getting rid of poverty and gender discrimination, social status is constantly improving, nutrition and health care are strengthened, and the number of women who will experience menopause is increasing, and the social significance of menopause is becoming more and more important .Some scholars have pointed out that because the impact of preventing menopause is neglected, so that they seek medical treatment when it is difficult to deal with it, it is necessary for medical personnel and women's health workers to conduct publicity, education and consultation for women after the age of 40, and popularize menopausal self-care. Protect the knowledge of when and from whom to seek care.The whole society should give assistance to carry out some feasible census clinics or establish institutions to create conditions for early diagnosis and treatment of menopausal syndrome for women after the age of 40.Waiting until after menopause to start taking health care measures is too late for many people.Therefore, it has become an urgent problem to fully understand and pay attention to menopause, conduct menopause consultation and health care, and actively diagnose and treat menopause syndrome.

Menopause is predominantly female, but males are also affected.Due to the long-term existence of male testicles, androgen will continue to be produced, so the decline in male androgen levels seems to be declining steadily from the top of the mountain. Although it declines with age, it is still maintained at a level close to the normal low limit. The normal range of hormones is large, ranging from 300 to 1200 ng/dl, and some men's androgen levels remain within the normal value throughout their lives.Therefore, men's menopause is not only more than ten years later than women's (beginning around the age of 55), but only about 30% of them have symptoms.Abroad, andropause is called partial androgen deficiency in middle-aged and elderly males (PADAM).

([-]) Etiology and pathogenesis

It is generally believed that the decline of ovarian function is the main factor causing the metabolic changes and clinical symptoms of menopause.After women enter menopause, the ovarian function begins to decline, the function of follicles to secrete estrogen and progesterone decreases, and the activity of the hypothalamus-pituitary-ovary axis changes.Changes in the endocrine balance state of menopausal women lead to dysfunction of the autonomic nervous system center, resulting in different degrees of clinical symptoms of autonomic nervous system dysfunction.The emergence of symptoms is related to the speed and degree of estrogen secretion reduction, that is, the rapid reduction of estrogen, the more serious menopausal symptoms.When estrogen is reduced to the point that it can no longer stimulate the endometrium, menstruation will stop, secondary sexual characteristics will gradually degenerate, reproductive organs will shrink slowly, and other tissues related to estrogen metabolism will also shrink.

Therefore, the causes of menopausal syndrome can be roughly divided into 4 categories:
1. Dysautonomia.

2. Insufficient secretion of estrogen.

3. Psychological factors.

4. Social and educational factors.

(End of this chapter)