TCM Acupuncture and Massage

Chapter 70 Bone and Joint Diseases (8)
2. Nutritional factors The maintenance of bone mass largely depends on the supplementation of nutrients and mineral salts, especially protein and calcium.Decreased calcium intake, malabsorption, and increased excretion are the main causes of negative calcium balance.Long-term lack of protein nutrition results in decreased plasma protein, insufficient bone matrix protein synthesis, and lagging behind in new bone formation. If there is calcium deficiency at the same time, osteoporosis will accelerate.Drinking alcohol can reduce calcium intake and increase urinary calcium excretion, and excessive caffeine intake can also cause loss of urinary calcium and endogenous fecal calcium.

3. Disuse factors The size of bone mass is closely related to mechanical load.The greater the load, the more developed the bones.Disuse for various reasons such as plaster immobilization, paralysis or severe arthritis, due to inactivity and no weight bearing, the mechanical stimulation to bones is reduced, the activity of osteoblasts is weakened, and the activity of osteoclasts is relatively enhanced.For patients who have been bedridden for a long time, their urinary calcium and fecal calcium also increase significantly, resulting in a negative calcium balance, so osteoporosis occurs.

4. Genetic and immune factors Osteogenesis imperfecta is an autosomal dominant inheritance. Osteoblasts produce less bone matrix, like osteoporosis, often accompanied by blue sclera and deafness.Homocystinuria is mainly caused by the deficiency of cystathionine synthase, which is an autosomal recessive genetic disease, clinically manifested as spinal and lower limb deformities, osteocytopenia, and embolic lesions.Rheumatoid arthritis is often accompanied by atrophy of connective tissue, including skeletal collagen tissue. If it is lost or treated with glucocorticoids, it is more likely to cause osteoporosis.

(1) Clinical manifestations The onset of osteoporosis is slow, and the general clinical manifestations are mild. The details are as follows: 70. Pain is the most common symptom, and low back pain is more common (accounting for 80-12%).The pain spreads along the spine to both sides. The pain is relieved when lying on the back or sitting, and the pain is aggravated when standing upright or standing or sitting for a long time. The pain is mild during the day and aggravated at night and when waking up in the morning. Aggravated by straining to defecate.Generally, it can appear when the bone mass is lost by more than [-]%.In senile osteoporosis, the vertebral body is compressed and deformed, the spine flexes forward, and the lumbar and back muscles contract double in order to correct the spinal flexion, causing muscle fatigue and even spasm, resulting in pain.

2. Shortened body length and hunchback often appear after pain.The load on the vertebral body is relatively large, and it is easy to compress and deform, causing the spine to lean forward, aggravating the curvature of the back, and forming a hunchback. With age, osteoporosis will aggravate and the curvature of the hunchback will increase.Each person has 24 vertebral bodies, and the height of each vertebral body is about 2cm in normal people. In the case of osteoporosis in the elderly, the vertebral bodies are compressed, each vertebral body is shortened by about 2mm, and the body length is shortened by an average of 3-6cm.

3. Fracture This is the most common and serious complication of degenerative osteoporosis.

4. Decreased respiratory function, thoracic and lumbar compression fractures, and thoracic deformity can significantly reduce vital capacity and maximum ventilation volume, and patients often have symptoms such as chest tightness, shortness of breath, and dyspnea.

Most patients seek medical treatment with fractures, and generally there is no obvious trauma or minor damage.Sudden aggravation of pain in the patient's lower back indicates that a fracture may occur, and precautions should be taken.

([-]) Diagnosis and inspection

The diagnosis of osteoporosis depends on the comprehensive analysis and judgment of clinical manifestations, X-ray films, bone mass measurements, and biochemical indicators of bone turnover.

1. Biochemical examination Determination of minerals in blood and urine and some biochemical indicators can help determine the state of bone metabolism and the speed of bone turnover rate, which is of great significance for the differential diagnosis of osteoporosis.

2. Bone density measurement The reduction of bone density can be used for the diagnosis of osteoporosis and the observation of the progress of osteoporosis and the effect of treatment.

3. X-ray examination usually should check the lateral lumbar spine, pelvis and proximal femur frontal and lateral films, and bimanual radiographs.In the early stage, the bone trabeculae are reduced, thinned and bone thinning, and the structure of the trabecular bone in the vertebral body is sparsely latticed.In order to maintain the supporting function of the bone, the upper and lower vertical bone trabeculae arranged along the stress line are relatively obvious, in the shape of a grid column, and the transverse bone trabecula disappears, which can be used as the basis for early diagnosis of osteoporosis.In the late stage, the longitudinal bone trabeculae are also absorbed, and the upper and lower edges of the vertebral body are relatively obvious like charcoal outlines. One or more compression fractures often occur, wedge-shaped deformation can be seen in the thoracic spine, and the lumbar vertebral body is biconcave due to the upward expansion of the intervertebral disc.Simple X-ray examination is of little significance in diagnosing early osteoporosis, because when X-ray can reflect osteoporosis, the bone loss has already exceeded 30-50%.

([-]) Treatment The principle of treatment is to restore bone mass, prevent further bone loss, and relieve symptoms.

1. Medication
(1) Bone resorption inhibitors

① A new generation of bisphosphate drugs: it can inhibit the formation, aggregation and dissolution of calcium phosphate crystals at the bone tissue interface (including the outer surface, inner surface and surface of trabecular bone), thereby inhibiting bone resorption.Commonly used drugs are Gubang.

②Calcitonin: It is a hormone that is found in everyone's body, and it has a good effect on relieving bone pain symptoms.However, since calcitonin is decomposed in the stomach, it must be administered by injection or nasal spray, which is inconvenient to use.Side effects include nausea, sweating, and diarrhea.

③ Hormone replacement therapy: When using hormones, the principle of individualized treatment should be emphasized, that is, each person may need different doses, and the smallest effective dose should be selected for each person, so it must be used under the guidance of a doctor.And there will be some side effects when applying estrogen, including short-term side effects and long-term side effects.Recent side effects include: changes in blood pressure, weight gain, gastrointestinal reactions, rash, migraine, dizziness, breast tenderness, general swelling, increased vaginal secretions and bleeding.Long-term side effects include: endometrial hyperplasia, canceration, increasing incidence of breast cancer, and possible slight increase in biliary stones.Of course, estrogen therapy also has its obvious benefits: alleviating the symptoms of menopausal syndrome, reducing the incidence of osteoporotic fractures, and reducing senile dementia.

(2) Some other commonly used auxiliary drugs
① Calcium supplements: If you do not take in enough calcium from your diet, you can consider taking calcium supplements as a supplement.Although calcium supplements help maintain healthy bones, they are not enough to prevent bone loss and osteoporosis after menopause.In addition, calcium intake may be harmful if it exceeds the body's requirements.Therefore, you also need to choose calcium that suits you under the guidance of a doctor.

②Vitamin D: The body needs vitamin D to help absorb calcium.Vitamin D also has a protective effect on bones, reducing bone loss.

2. Exercise therapy Take a walk in the sun for at least 30 minutes every day during the day, which can not only exercise but also absorb light.

([-]) Prevention

For osteoporosis, there is currently no effective way to restore bone mass to normal levels in patients who have lost significant bone mass.Like other senile diseases, osteoporosis should focus on early prevention.Generally, proper nutrition can be paid attention to in childhood, physical exercise should be strengthened, and bad living habits should be corrected, which may reduce the incidence of osteoporosis and fractures.Therefore, it is never too early to prevent osteoporosis, and a good lifestyle is beneficial to prevent osteoporosis.details as follows:
1. Quit smoking and alcohol, avoid alcoholism and excessive drinking of coffee and carbonated drinks.

2. Participate in exercise, exercise appropriately, and increase the sunshine time.Exercise will increase muscle strength and stress stimulation to bone tissue, prevent bone loss, and exercise can also improve individual resilience, flexibility, muscle coordination and balance, and reduce wrestling.Participating in sports should be persevering, step by step, within one's ability, and should not be rushed, so as not to feel tired or feel pain in the limbs.

3. Eat a reasonable diet, eat more foods rich in calcium, protein and vitamins, such as: milk, soy products and fresh vegetables, etc., to ensure the balance of various nutrients.

4. Reduce or avoid trauma, go out for activities, get on and off the car and ship, and get up at night with extra care, avoid taking drugs that may cause balance dysfunction, and use hip and waist protectors for high-risk groups of fractures.

5. If osteoporosis has already occurred, you should persist in treatment and take medication as prescribed by the doctor to prevent bone density from continuing to decline.Consult and check regularly to understand the effect of treatment and prevent side effects caused by drugs.

[-]. Point massage

([-]) Acupuncture therapy

1. Select acupoints: Dazhu, Mingmen, Shenshu, Zhishi, Guanyuan, Qihai, Zusanli, Juegu, and Taixi.

2. Positioning
Dazhu—back, below the spinous process of the first thoracic vertebra, 1 cun laterally.

Mingmen-waist, under the spinous process of the second lumbar vertebra.

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

Zhishi—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 ​​Qi—lower abdomen, on the front midline, 1.5 cun below the middle of the navel.

Zusanli - 3 inches below the calf's nose, a finger across from the front edge of the tibia.

Juegu—outside of the calf, 3 cun above the tip of the lateral malleolus, on the front edge of the fibula.

Taixi—the midpoint of the line between the tip of the medial malleolus and the Achilles tendon.

([-]) Self-massage
1. The method of eating jade spring refers to swallowing body fluid to nourish the joints.First lick the upper palate with the tongue, and stir the tongue from side to side. After body fluid is present, rinse with mouth closed to gradually fill the mouth with body fluid.Then, swallow three times, and each time can be swallowed three times and nine times in a row.This method is better when you wake up in the morning and have not gotten up.

2. Stretch both hands back to wipe Shenshu, rub the Shenshu points on both sides, and use local diathermy as the degree.

(End of this chapter)