TCM Acupuncture and Massage

Chapter 66 Bone and Joint Diseases (4)
([-]) Self-massage
1. Knead the waist Use the palms of both hands to massage the lumbosacrum and the affected thigh. The force should not be too strong, and the operation should be done for 3 minutes according to the degree of comfort.

2. Acupuncture Points are pressed on the above-mentioned points, each point for 1 minute, with local soreness as the degree.

3. Stand upright, keep your feet together, lift your heels off the ground rhythmically, and then put them down, and do this alternately for 1 to 2 minutes.

4. Kicking exercise Put your hands on your hips or hold an object with one hand, and alternately kick your lower limbs forward and backward in a rhythmic manner, and operate 10 to 20 times.

5. Stretching exercise: Hold the object with both hands, stretch the lower limbs alternately, touch the ground with the toes, and stretch the waist backward as much as possible, operate 10 to 20 times.

6. Turn the waist and stand naturally, with the feet shoulder-width apart, the elbow joints of the upper limbs flexed and extended flat, and the upper limbs are moved rhythmically from side to side to drive the waist to rotate, 10 to 20 times.

7. Stretch the legs in a supine position, alternately bend the knees and lift up the lower limbs, as close to the lower abdomen as possible, repeat 10 to 20 times.

8. Waist-lifting exercise: Lie on your back, bend your knees, make fists with both hands, bend your hands and put them on your sides, lift your waist and hips as much as possible, and keep your chest up, slowly performing 10-20 times.

9. Rear stretching exercise: Lie on the prone position, straighten the arms and legs naturally, lift up the lower limbs alternately, repeat 10-20 times.

10. Boat-shaped exercise in prone position, with elbows bent, hands crossed behind the waist, both lower limbs lifted and lowered rhythmically, while chest and head raised, repeat 10-20 times.

11. Rub the palms of both hands on the Shenshu and turn back, and use the rubbing method to operate on the Shenshu, with local diathermy as the degree.

Knee osteoarthritis
An overview of the disease

([-]) Basic knowledge

Knee osteoarthritis is non-inflammatory degeneration of articular cartilage caused by old age or other reasons, and osteophytes form on the joint margins. Clinically, it can produce knee joint pain, limited mobility, and joint deformity.

1. About osteophytes
(1) What is osteophyte?Osteophytes, also known as hyperosteogeny and spurs, refer to bone hyperplasia on the edge of bone joints, which is a manifestation of osteoarthritis.Due to the widespread use of X-ray examinations in recent years, more and more cases of bone hyperplasia have been found.

(2) Is hyperosteogeny an "incurable disease"?Bone hyperplasia is a physiological compensatory function of the human body, and it is also a defensive response produced by the human body to adapt to changes in the environment. It is both physiological and may turn into pathological.It can strengthen the destabilized bone joints, which is beneficial to the stability of the bone joints, but it may also cause compression on peripheral nerves, blood vessels, etc., and corresponding clinical symptoms appear, but this only accounts for a small part.

有研究表明，20岁以下鲜见骨质增生，20～30岁的骨质增生占11％，31～40岁占36％，41～50岁占78％，51～60岁占93％。可见骨质增生是中老年时期骨关节的生理性退行性变化，乃是人体衰老的必然结果。它的形成与年龄、骨关节及椎体承受的压力以及解剖生理特点有着密切的关系。

Clinical practice has also proved that not all people with bone spurs will have clinical symptoms; on the contrary, those who have clinical symptoms will not all have bone hyperplasia.Because the presence, size, and number of bone spurs are not directly proportional to the severity of clinical symptoms.The direct cause of the clinical symptoms is not bone spurs.Bone hyperplasia does not mean a disease in most cases, but a physiological tissue response.

(3) Can the bone spur be felt?Can conservative treatment remove it?Bone spurs are more common in parts that are subject to high pressure. Because they are located in the deep layer and are surrounded by tissues such as muscles, ligaments, tendons, and joint capsules, they cannot be felt by hand except for the bone spurs located in the superficial parts. The only way to determine its location is to observe its shape and size through X-ray films.

General treatment can only improve or alleviate the symptoms, but the bone spur still exists after taking X-ray film at this time, which further shows that conservative treatment cannot remove it.

2. Relevant knowledge
(1) How to prevent low back and leg pain for people who often stand: People who often stand, such as teachers, surgeons, salespersons, etc., often need to stand to work, the pressure on the lumbar intervertebral disc is very high, and the psoas muscles are often in a state of tension, which can easily cause low back and leg pain .Therefore, special attention should be paid to: often change postures when standing, often change stressed lower limbs and minimize standing time.

(2) Which posture when standing can prevent low back pain: the correct standing posture is that the center of gravity of the body falls on the heels, so that the upper body is slightly bent forward, and both knees or one knee are slightly bent.

(3) How to prevent low back and leg pain for people who often sit for a long time

① Try not to sit for a long time.

②The seat should be comfortable, and the back should be leaned against the backrest, so that most of the back muscles can be relaxed to reduce the stress on the waist, which is especially important for long-distance bus drivers.

③ Changing posture frequently.

④ After working for a period of time, get up and do some lower back activities, such as turning 2 to 4 times to the right, then 2 to 4 times to the left, bending over, and straightening your chest hard.

⑤ often participate in some sports activities such as ball games, swimming, aerobics and so on.

(4) How to prevent low back and leg pain for people who exercise regularly: Athletes and sports enthusiasts often suffer from sprains because they often participate in sports, especially sports with strong resistance.If you don't pay attention, it will cause the cumulative effect of the wound and become a chronic injury that is difficult to heal for a long time.Therefore, it should be noted that before strenuous exercise, sufficient preparatory activities must be done first, so that the muscles can be activated before exercise to prevent muscle strain.

Sports injuries basically have bleeding and tearing of local muscles and tendons, so it is necessary to take enough rest and treatment to allow the injury to heal completely before participating in sports activities.This time is at least 2 weeks.In addition, keep warm before and after exercise, especially during the interval between games.

(5) What should people with low back and leg pain pay attention to in daily life: People with low back and leg pain should pay special attention to their movement posture to prevent re-injury of the waist.Sleep on a hard board bed, so that the psoas muscles are in a relaxed state, which is conducive to the recovery of injuries.The steel wire soft bed keeps the psoas muscles in a state of constant adjustment and contraction.In addition, exercise the back muscles frequently, such as lying on your stomach or supine, with your arms straight, and forcefully bring your arms and legs closer together in an arched shape.Also take part in some physical exercise moderately.

([-]) Etiology and pathology

The main lesions of chronic osteoarthritis of the knee are degeneration of articular cartilage and secondary hyperosteogeny.According to the etiology, it is divided into two types: primary and secondary.

1. Primary osteoarthritis refers to the degeneration of human joints caused by old age.With age, connective tissue degenerates, cartilage grows and wears with age, and then invades bone, proliferates and forms osteophytes.

2. Secondary osteoarthritis is cartilage damage caused by trauma, deformity and disease, leading to osteoarthritis over time.

([-]) Clinical manifestations

1. Age mostly occurs after the age of 50, and it is more common in obese people.

2. Knee pain gradually increased.The pain is particularly obvious when getting up in the morning or standing up from a sitting position. The symptoms can be relieved after a little activity, but the pain will be aggravated by excessive activity.

3. Joint movement disorder, friction sound when knee joint is moving, inconvenient up and down stairs, up and down slopes, aggravated joint pain.

4. Joint swelling, severe cases can cause quadriceps atrophy.

([-]) Auxiliary inspection

1. Laboratory examination was normal.

2. X-ray examination indicated that the edge of the tibial plateau became sharper and the joint space narrowed.

([-]) Diagnosis

1. It is more common in middle-aged and elderly people, and it is more common in obese people.

2. Pain in the knee joint, aggravated by initial activity and relieved by rest, and then persistent pain, accompanied by joint stiffness, which improved after activity.

3. Knee joint mobility disorder, especially inconvenient to go up and down stairs, up and down slopes.

4. X-ray examination showed degenerative changes of the knee joint.

([-]) Treatment

Osteoarthritis is a degenerative change, and the natural course of the disease is generally irreversible. However, through treatment, symptoms can be relieved, activity levels can be improved, joint stability can be enhanced, and the process can be delayed.

1. Systemic therapy protects the diseased joints from damage or excessive movement, so as to avoid osteophytes, fractures or fluff falling off the joint cavity.In severe cases, rest, or use plaster or splint for external fixation to relieve pain and prevent deformity.The joints can be treated with heat or physical therapy.If you are too obese, you should lose weight.

2. Drug therapy Traditional Chinese medicine for promoting blood circulation and removing blood stasis can relieve symptoms and slow down the course of the disease.

If there is localized tenderness, local injection of prednisolone 25mg (with an appropriate amount of 2% procaine) can be given, 2 times a week, every 3 times as a course of treatment.Its function is anti-inflammatory, it cannot change its degeneration, and it should not be injected too much, so as to avoid steroid-induced joint disease.Pain can be relieved with oral NSAIDs.

3. Physical therapy Appropriate joint activities can enhance muscle strength and improve joint stability, but it should not cause fatigue.

4. Surgical therapy If the patient has persistent pain or progressive deformity, surgical therapy may be considered.Surgery mainly includes arthroplasty and joint replacement.

[-]. Point massage

Therapeutic principles: activating blood circulation, warming meridians, dredging collaterals, nourishing tendons

([-]) Acupuncture therapy

1. Select acupoints Liangqiu, Xuehai, Heding, Weizhong, Knee Eye, Yanglingquan, Yinlingquan, Zusanli.

2. Locate Liangqiu—the front of the thigh, on the line connecting the anterior superior iliac spine and the lateral end of the patella bottom, 2 inches above the patella bottom.

Sea of ​​Blood - Inner thigh, 2 cun above the inner end of the bottom of the patella, when the medial head of the quadriceps protrudes.

Crane's top—the upper part of the knee, the depression above the midpoint of the bottom of the patella.Weizhong—the midpoint of the popliteal crease, between the biceps femoris and semitendinosus tendons.

Knee eye - knee flexion, the depression on both sides of the patellar ligament.The inner one is called inner knee eye, and the outer one is called outer knee eye.Yanglingquan—on the outer side of the calf, in the depression anteriorly and inferiorly to the head of the fibula.Yinling Spring—the inner side of the calf, in the depression below the medial condyle of the tibia.Zusanli - anterolateral side of the calf, 3 cun below the nose of the calf, a transverse finger (middle finger) next to the front edge of the tibia.

([-]) Self-massage
1. Finger kneading method is applied around the knee joint for about 3 to 5 minutes.

2. Press and knead the inner and outer knee eyes, Yanglingquan, Yinlingquan, Heding, Xuehai, Zusanli, Weizhong, and focus on the inner and outer knee eyes and Heding. Each point is about 3 ~5 minutes.

3. Apply the palm massage method to the knee joint and its surrounding area for about 5 minutes until it feels warm and penetrating.

4. Shake the patella, put the thumb and index finger on both sides of the patella and lift it up, and shake the patella left and right.

5. Pull and extend the knee joint.

6. If the pain is severe, add rubbing method and moist heat compress.

Rheumatoid arthritis
An overview of the disease

([-]) Relevant knowledge

1. What is rheumatoid arthritis
Rheumatoid arthritis is joint inflammation caused by rheumatic fever.The so-called rheumatic fever is an inflammatory disease caused by upper respiratory tract infection caused by group A hemolytic streptococci. It is a systemic disease that mainly invades connective tissue.Got rheumatic fever and can show as rheumatoid arthritis.During childhood and adolescence, when you find that your joints are red, swollen, painful, nodules or erythema appear under the skin; when you find that you have sore throat, fever and other reactions, you should think whether you have rheumatoid arthritis.For people over the age of 50, when you find that you are often limited to a few joints and muscle soreness attacks, and the disease is slow and persistent, you should also think about whether you have rheumatoid arthritis.

Rheumatoid arthritis is a common disease. If it is not treated in time, it can lead to joint deformity and stiffness, which seriously affects the quality of life of patients.Therefore, it is necessary to improve the awareness and understanding of the disease among the general public.

2. Does rheumatoid arthritis have anything to do with the environment?

The occurrence of rheumatoid arthritis is closely related to the quality of living conditions.Crowded housing and poor sanitation are conducive to the growth and reproduction of germs, while long-term malnutrition will lower the body's resistance and easily cause the occurrence of this disease.The occurrence of this disease is also related to climate.Cold or humid climate in winter and spring is an important predisposing factor.It occurs in the cold winter in the northern area, and it is easy to be popular in the rainy and humid season in the southern area.

3. Who are susceptible to rheumatoid arthritis
There is no significant gender difference in rheumatoid arthritis, and the prevalence of men and women is similar.Initial cases are common in children and adolescents, especially school-age children, and infants under 3 years of age rarely suffer from this disease.In recent years, the age of onset has been delayed, and many initial cases are adults.

4. Is rheumatoid arthritis related to genetics?
Genetic factors are closely related to the pathogenesis of rheumatoid arthritis.Among those with streptococcal infection, not all will develop rheumatoid arthritis, and many people do not have the disease, indicating that streptococcal infection is not a sufficient condition to cause rheumatoid arthritis.The disease is an autoimmune disease caused by streptococcal infection on the basis of genetic susceptibility, and the related genetic material is located in the HLA-B5 gene.After streptococcal infection, due to the abnormality of genetic material, an excessively strong immune response will be generated, which will cause damage to the own tissue.

5. Why rheumatoid arthritis is prone to osteoporosis
During the onset of arthritis, due to joint swelling, pain, and deformity, the patient's activities are limited, the amount of exercise is reduced, and the intensity is reduced.The stretch stimulation of skeletal muscles plays an important role in maintaining normal bone density.Lack of exercise stimulation will cause bone calcium to fall off and bone density to decrease.In addition, if the patient rests in bed for a long period of time, the calcium metabolism will be out of balance due to the increased excretion of calcium in the urine, which will cause abnormal blood calcium and osteoporosis in the long run.

6. Can rheumatoid arthritis patients really predict the weather?

Normal body cells have a perfect regulation mechanism for changes in the external environment. When the external humidity increases and the air pressure decreases, the intracellular fluid seeps out.In patients with rheumatoid arthritis, because the joint inflammation affects the regulation mechanism of the tissue, the intracellular pressure cannot adapt to the change of the environment in time, so the joint pain is aggravated.

([-]) Etiological diseases
1. Etiology The onset of rheumatoid arthritis is due to infection with type A streptococcus.Streptococcus is a Gram-positive coccus, which widely exists in nature and on the body surface, mouth, nose and intestinal tract of humans and animals. It is named because it is arranged in chains during culture.There are many kinds of streptococcus, which can be divided into 18 groups, and the one related to rheumatoid arthritis is group A hemolytic streptococcus.

2. Pathogenesis Rheumatoid arthritis is an autoimmune disease.The human immune system protects the body from illness.In medicine, microbes such as bacteria and viruses in the outside world and aging and distorted cells in the human body are called antigens. Under normal circumstances, the immune system can produce an immune response to the above-mentioned antigens.It can defend against the damage of microorganisms such as bacteria from the outside and remove aging and abnormal cells inside the human body, thereby eliminating the harm of these antigens to the human body.If the immune response is against the body's own substances, it is autoimmune.However, when the autoimmune reaction is too intense, exceeds the normal limit or lasts too long, and loses normal regulation, it will cause damage and dysfunction of the own tissues, leading to diseases and transforming into autoimmune diseases.

Certain components and bacterial products of group A hemolytic streptococcus have the same antigenicity as human tissue, such as hyaluronic acid secreted by bacteria and the joint fluid and synovial components of the human body have the same antigenicity, and the components of the middle layer of the cell wall have the same antigenicity as the components of the human heart. Valve and cartilage glycoproteins have the same antigenicity. After group A hemolytic streptococcus enters the human body, due to the antigenicity of its bacterial components or bacterial products, it can induce an autoimmune reaction in the human body, and the antibodies produced act on both the bacteria and human tissues with the same antigenicity. Can lead to pathological changes in joints and other tissues.

(End of this chapter)