TCM Acupuncture and Massage

Chapter 69 Bone and Joint Diseases (7)
3. Diet therapy There are no special requirements for the diet of patients with rheumatoid arthritis, because it is not a nutritional deficiency, and the choice of diet does not need to be a burden for the patient.It is necessary to properly supplement protein, various vitamins and minerals in the daily diet.Note that the intake of food must vary from person to person, with food as a supplement.When anemia occurs in rheumatoid arthritis, you can consider adding some iron-containing foods, such as animal liver, lean meat, etc.; for patients with obvious osteoporosis, in addition to increasing protein, vitamin D and calcium should also be added; long-term Patients taking corticosteroids should eat more foods rich in potassium and calcium.

4. Drug treatment There are various drug treatments at present, but all drugs, including Chinese herbal medicine, cannot completely control joint destruction, but can only relieve pain, alleviate and delay the development of inflammation.Commonly used drugs for the treatment of rheumatoid arthritis usually include 4 categories, namely non-steroidal anti-inflammatory drugs (NSAIDs), disease-modifying antirheumatic drugs (DMARDs), glucocorticoids and herbal medicines.

(1) Non-steroidal anti-inflammatory drugs (NSAIDs): It is the basic drug for the treatment of this disease.Although these drugs have analgesic and anti-inflammatory properties that reduce joint pain and swelling, they do not alter the course of the disease or prevent joint destruction, so they should not be used alone.The main side effects are gastrointestinal damage, liver and kidney damage.

(2) Disease-modifying antirheumatic drugs (DMARDs): These drugs act slower than NSAIDs, and it takes 1 to 6 months from use to clinical symptoms to improve, so they are also called slow-acting drugs (SAARDs).Although it does not have immediate pain relief and anti-inflammatory effects, it can affect the abnormal immune function of patients, thereby improving and delaying the progress of the disease.In recent years, there is a trend of early application of such drugs.Common side effects include bone marrow suppression, gastrointestinal adverse reactions, liver and kidney dysfunction, rash, hair loss, headache, etc.

(3) Glucocorticoids: Glucocorticoids have powerful anti-inflammatory effects, can quickly reduce joint pain and swelling, and also have immunosuppressive effects.It is a very good anti-inflammatory painkiller, but many patients are afraid of adverse reactions and refuse thousands of miles. In fact, glucocorticoids are a double-edged sword. It is not unavailable. The key is to use them properly. dose.The dosage of glucocorticoids should be kept at the minimum effective dose, that is, a large dose should not be used when a small dose can be used.Although high doses (shock therapy) are also used clinically for patients with severe conditions, they need to be very cautious.The main side effects are osteoporosis, high blood pressure, peptic ulcer, fluid retention, elevated blood sugar, cataract, potential premature arteriosclerosis and opportunistic infection.Therefore, the clinical dose needs to be adjusted according to the specific situation, and the drug should be gradually reduced when the drug is stopped.

(4) Herbal medicine: Chinese herbal medicine generally combines disease identification and syndrome differentiation, and emphasizes early diagnosis and staged treatment.Generally, it is divided into five types: wind-cold-damp numbness type, rheumatism-heat numbness type, blood stasis type, liver-kidney yin deficiency type, and qi-blood deficiency type.

5. Physiotherapy is the use of all normal factors in the process of material, energy, and information transformation between the human body and the environment, and plays a role in rehabilitation by mobilizing the body's own functions.It is an important treatment measure for the acute attack period and remission period of the disease.Its purpose includes relieving pain, controlling the development of the disease, and more importantly, protecting and restoring the various functional activities of the patient, so as to preserve the patient's ability to work and live, prevent the occurrence of disability or reduce its degree.Physical therapy mainly includes: direct current drug iontophoresis therapy (also known as drug ion penetration therapy), paraffin therapy (referred to as wax therapy), magnetic field therapy (referred to as magnetic therapy), light therapy (including ultraviolet therapy and infrared therapy).

6. Biotherapy
(1) Bee venom therapy: Bee venom has anti-inflammatory, immunosuppressive and antibacterial effects.Its analgesic effect is particularly good, but it cannot prevent the progression of the disease.

(2) Ant therapy: Ants live in a humid environment for a long time without getting sick, which has attracted people's attention.Ants contain a variety of active ingredients and rich zinc, which can be used to treat this disease and receive a good effect.Usage: Dry the big black ants, grind them into fine powder, take half a spoonful each time, 3 times a day, take with boiling water.Or add traditional Chinese medicine for expelling wind and dampness to take together.

7. Surgical treatment is generally considered when the disease cannot be completely controlled by drug treatment, the synovitis is severe, the joint swelling and pain are intolerable, the range of motion of the joint is limited, or joint deformity is caused by the destruction of the joint structure.Common surgical methods include synovectomy, arthroscopic minimally invasive surgery, joint orthopedics, artificial joint replacement, arthrodesis, and soft tissue release.

[-]. Point massage

(1) Acupuncture therapy is based on the selection of acupoints for the whole body, combined with local acupoint selection. [-]. Point selection ①Main points: Ganshu, Shenshu, Guanyuan, Xuehai, Mingmen, Zusanli, Dazhui.

②Acupoints: For upper extremity lesions, add Jianlian, Quchi, Yangxi, Yangchi, Yanggu, Hegu, and Baxie; for lower extremity lesions, add Knee Eye, Jiexi, Taixi, Kunlun, Taichong, and Bafeng.

2. Positioning
Ganshu—back, below the spinous process of the 9th thoracic vertebra, 1.5 cun laterally.

Shenshu—waist, below the spinous process of the second lumbar vertebra, 2 cun laterally.

Guanyuan—lower abdomen, on the front midline, 3 cun below the middle of the navel.

Sea of ​​Blood—Inner thigh, 2 inches above the inner side of the bottom of the patella, inside the quadriceps muscle

The hump on the side of the head.

Mingmen—waist, on the posterior midline, in the depression under the spinous process of the second lumbar vertebra.

Zusanli - anterolateral side of the calf, 3 cun below the calf's nose, one finger (middle finger) from the front edge of the tibia.

Dazhui—on the posterior midline, in the depression under the spinous process of the seventh cervical vertebra.

Shoulder—shoulder, upper deltoid, when the arm is abducted or extended forward, when the acromion is in the depression anteriorly and inferiorly.

Quchi—the lateral end of the cubital crease, when the elbow is flexed, it is the midpoint of the line connecting Chize and the lateral epicondyle of the humerus.

Yangxi—on the radial side of the transverse crease on the dorsum of the wrist, in the depression between the tendons of the extensor hallucis brevis and extensor hallucis longus when the fingers are turned up.

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

Yanggu—on the ulnar side of the wrist, in the depression between the ulnar styloid process and the triquetrum.

Hegu—the back of the hand, between the 1st and 2nd metacarpal bones, at the midpoint of the radial side of the 2nd metacarpal bone.

Baxie - back of hand, slightly clenched fist, 1st to 5th fingers, at the red and white flesh border behind the web edge, 8 points in total on the left and right.

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.

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 toe longus tendon.

Taixi - behind the medial malleolus on the inside of the foot, the depression between the tip of the medial malleolus and the Achilles tendon.

Kunlun – behind the lateral malleolus, in the depression between the tip of the lateral malleolus and the Achilles tendon.

Taichong—on the dorsal side of the foot, in the depression behind the first metatarsal space.

Bafeng - dorsal side of the foot, between the 1st to 5th toes, at the red and white flesh border behind the web edge of the toes, 4 points on one foot, 8 points in total on the left and right.

([-]) 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. Twisting method Use the twisting method to operate on the joints between the fingers for about 5 to 10 minutes.

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

5. 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.

Osteoporosis

An overview of the disease

([-]) Relevant knowledge

Osteoporosis is a systemic bone metabolism that is characterized by damage to the microstructure of bone tissue, a decrease in the proportion of bone mineral components and bone matrix, bone thinning, decreased number of bone trabeculae, increased bone fragility, and increased risk of fracture. Disorder disease.The bone mass of normal adults decreases with age, so the elderly often have physiological osteoporosis.Osteoporosis is a manifestation of aging and should be considered a disease if it is accompanied by fractures, significant low back pain, or neurological symptoms.It can be divided into primary osteoporosis, not accompanied by other diseases or disorders that cause osteoporosis; secondary osteoporosis, mostly caused by endocrine gland dysfunction.The prevalence rate of the elderly is 60.72% for men and 90.47% for women.

([-]) Etiology and pathogenesis

1. Normal endocrine factors The synthesis of bone tissue by human gonadal hormones and the anti-synthetic effect of adrenal corticosterone on bone tissue are in a dynamic balance.Due to hypogonadism in the elderly, the synthesis of steroids (estrogen, androgen) decreases, which affects the synthesis of proteins, resulting in insufficient bone matrix formation.Estrogen stimulates osteoblasts, which make bone matrix.If the level of estrogen decreases, the activity of osteoblasts decreases and bone formation decreases.

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