Bone setting therapy of traditional Chinese medicine
Bone-setting, traditional Chinese medicine refers to the treatment of fracture, dislocation and other diseases by pushing, pulling, pressing and pressing. Orthopaedics, as a specialty name, is a specialty for the diagnosis and treatment of injuries. It is also one of the thirteen branches of ancient medicine, also known as traumatology or orthopaedics.
Bone-setting objects are mainly bone, joint and soft tissue injuries caused by external forces, but also internal organ injuries caused by similar causes. The word "Zheng" acts as a noun here. That is to say, it is a science and technology to remedy limb deformations caused by bone and joint injuries.
In the official medical system of Yuan Dynasty, there was "Orthopedics and Jinfuke". Therefore, Wei Yilin, a physician specializing in orthopaedics in the Yuan Dynasty, set up "Orthopedics and Golden Radix" in Volume 18 of his "Shiyi Yifang" to specialize in the treatment of bone and joint injuries and diseases caused by Golden Edge. "Medicine Zong Jinjian" points out that "orthopaedics today is the syndrome of injury caused by ancient falls and strikes."
The word "Zheng" acts as a noun here. That is to say, it is a science and technology to remedy limb deformations caused by bone and joint injuries. In the official medical system of Yuan Dynasty, there was "Orthopedics and Jinfuke". Therefore, Wei Yilin, a physician specializing in orthopaedics in the Yuan Dynasty, set up "Orthopedics and Golden Radix" in Volume 18 of his "Shiyi Yifang" to specialize in the treatment of bone and joint injuries and diseases caused by Golden Edge. "Medicine Zong Jinjian" points out that "orthopaedics today is the syndrome of injury caused by ancient falls and strikes."
Bone setting is mainly divided into fracture and dislocation. Fracture refers to a disease in which the bone is partially or completely broken due to trauma or pathology.
Its main clinical manifestations are: limited pain and tenderness at the fracture site, local swelling and ecchymosis, loss of limb function, complete bone deformity and abnormal activity; dislocation is the contact of bones (usually finger joints) due to external force, so that they can no longer be corrected. Often play a role. Dislocation may also be congenital or a complication of rheumatoid arthritis. People who have suffered joint injuries are prone to dislocation.
Bone-setting is a kind of treatment for soft tissue injury by using skilled methods to correct reduction of displaced fracture ends. Therefore, in the implementation of manual reduction, the first thing to do is to check and diagnose the fracture. On this basis, the purpose of fracture reduction can be achieved by eye view, hand touch and heart understanding.
Direct or indirect violence acts on the limbs or trunk, causing local bone fracture. Because of the size of the force on the part, the different positions held and the contraction of muscles, all kinds of fractures can be caused. Because of the different types of fractures, the methods of reduction are also different. For complete fracture, close-press method is used; for depressed fracture, lift-push method is used to restore the depressed; for comminuted fracture, pinch-press method is used to restore; for spiral fracture, screw-press method is used to connect; for protruding fracture, stretch-press method is used to restore; for embedded fracture, such as coccyx, hook-press and stretch-press method is used to restore; for internal and external condyles of humerus, etc. Branch fracture is reduced by rubbing, pushing and squeezing method; for those with overlapping displacement and shortening of fracture ends, the principle of "want to close first, leave and compound" is applied. Before the operation, gently press and massage the injured part to relax the contracted muscles and relieve the pain. Then the overlapping fracture ends can be reduced by pulling and stretching traction; the opposite displaced part can be restored by lifting and shaking and pushing; for the fracture of the two parallel parts of the bone, the broken ends can be separated by buckling and squeezing and splitting, while the clamp is used. Extrusion reduction. In the process of bone setting, besides using appropriate and skilled methods, the treatment must be timely, and the action should be bold, meticulous, accurate and agile. If too much force is exerted during the operation, there will be a risk of injury of bone and soft tissue; if the force is too small, the purpose of reduction can not be achieved. When performing the operation, we should correctly use the skills and strive to complete the restoration at one time. Repeated operation not only damages fracture ends, but also has adverse effects on healing, and will bring more pain to patients. The sooner the skill is applied, the better. Fractures of limbs should be performed within half an hour after injury. At this time, numbness of the injured limbs, no serious edema, low tension of the affected part and slight pain are the best orthodontic period. If the local swelling is serious or the skin is broken, it needs proper treatment. After the swelling subsides, the skin heals and the muscle spasms relax, the manipulation is performed again. However, delays in treatment should be prevented in order to avoid old fractures caused artificially.
The purpose of orthodontic fixation is to strengthen the effect and local relative stability after reduction, so as to accelerate the healing of fracture. Fixed scope should be appropriate. Too large will affect the activity of injured limbs; too small to achieve the purpose of fixation, long-term immobilization of injured limbs, will hinder the movement of Qi and blood, prone to muscle atrophy, joint stiffness, osteoporosis, delaying fracture healing and other adverse consequences. If a transverse fracture occurs, it can be pushed along the axis of the shaft after reduction and fixation, and if the lower limb bone is pushed aside, it can be stepped on the ground, so as to determine whether it has been correctly repositioned and to facilitate the connection. For the first failed reduction or displaced fracture, the method of "moving treatment" can be used to correct the fracture by pulling out and shaking and then restoring and fixing. Long bone fracture was fixed by three-point bandage. The effect of three-point compression is conducive to the alignment of the axis of the fracture segment. It can not only achieve the anatomical reduction of the fractured limbs, but also solve the functional disorder of the injured limbs caused by the contradiction between movement and motility of the limbs. Fracture ends were well docked and limb function recovered. The X-ray showed that the callus passed through the fracture line, and the fracture line was basically blurred, so the fixation could be relieved.
Bone-setting massage is a unique method of bone-setting in Mongolian medicine. It is also one of the assistant treatment methods of bone setting. The different stages of fracture, the use of massage techniques are also different. There are:
Initial massage: Within a week after fracture, local soft tissues, blood vessels and lymphatic vessels were damaged to varying degrees, resulting in hyperthermia of blood and Sheila fever, and symptoms of blood stasis, pain and swelling. In this regard, it is advisable to adopt the method of resolving benevolence and stasis and eliminating swelling. That is, daily rubbing with spray-stimulated liquor in the fixed space and upper segment of the splint, massage at the lining, centripetal rubbing on the injured limbs, insertion rubbing on the painful parts, rubbing on the adjacent joints of the injured limbs, and rubbing on the relevant acupoints. The above massage can help improve blood circulation, promote metabolism and accelerate fracture healing.
Medium-term massage: After initial comprehensive treatment, the fracture site was basically stable, tendon stretching, swelling and pain relief. According to the theory of "kidney storing essence, essence producing marrow, marrow nourishing bone" and "liver promoting blood, blood nourishing muscle", the principle of treatment should be tonifying kidney, liver and bone. Therefore, liver, spleen, heart, kidney, lung and other acupoints should be taken for massage. First, spray liquor, shake or rub with thumb; push or massage along the spine with palm; or rub horizontally to further improve blood circulation and accelerate fracture healing.
Later massage: After initial and intermediate treatment, callus was basically formed and fracture healed completely. However, due to internal injury and long-term bedridden, it often leads to three imbalances, weakness of Qi and blood, joint stiffness, muscle atrophy and so on. At this time, besides continuing mid-term massage, liquor should be sprayed on the stomach, large intestine, bladder and other relevant acupoints, rubbing, shaking and rubbing, local massage and rubbing, rubbing, rubbing and rubbing on affected limb muscles, rubbing and rubbing on affected limb joints, rubbing and rubbing, rolling and rubbing on affected limb joints, finger (toe), and rubbing on affected limb joints. The traction method is adopted. Through the massage mentioned above, the Qi and blood of the injured limbs can be unblocked, the bones and muscles can be strengthened, and the function can be restored.
Massage method: from light to heavy, slightly wide range, careful operation. For the weak, the technique should be light and slow; for the strong, it should be slightly heavy and fast. However, attention must be paid to maintaining the stability of the affected area. The method of spraying alcohol and massage is based on the viewpoint that "blood is fed by the essence of food, and blood follows gas". It can not only prevent heat invagination and tightness of tendons and tendons, but also accelerate fracture healing and recovery of limb function.
Internal medication. According to the different stages and symptoms of fracture, the principle of medication, like massage, is divided into three stages: initial, middle and later.
Initial stage: manifested hyperactivity of blood, Sheila fever, blood stasis, swelling and pain in affected part. Common prescriptions are: Qizhen powder, Qixiong pill, borneol 17 flavor powder, borneol 25 flavor powder, black cloud fragrance four flavor soup, etc. If accompanied by chest burning, palpitation and anxiety, can be thrown aloes eight flavors soup, Ruyi Zhibao pills and other prescriptions. If cough and expectoration are unfavorable, we can use the four-flavor soup of Salvia miltiorrhiza or the single-flavor powder of Notoginseng to eliminate poisoning. If there is urinary obliteration, you can use the traditional prescription of bone injury - eating egg yolk; dry stool can be put into sesame single pearl soup, or add a small amount of walnut kernels, honey for internal use; local fever should be coated with turtle blood.
Medium term: medicines with the functions of draining yellow water, reducing heat potential and reinforcing tendons and bones can be selected, such as Liuwei Tongqian Powder, Bawei Zhusha Powder, Sanwei ocher Powder, Liuwei Shi Cassia Powder, Liuwei Eucommia Powder, 25wei Jiegu Powder, etc.
Later period: it is appropriate to take strong muscles and bones, inhibit Heyi, strengthen the body and moisten stiff drugs, such as Jianwei pomegranate powder, 25-flavor powder, 35-flavor powder of aloes, 18-flavor powder of mercury, etc. Drug immersion or drug rubbing can be applied to affected parts, especially joints. Generally, liquor, vinegar, water and so on are used to decoct and soak, or to soak in hot water with green salt, or to decoct and soak with water cypress branch, red sandalwood and Artemisia annua.
For open fracture, debridement, reduction and dressing should be done first, and the wound should be sutured. In addition to the use of antistickers and antipyretics to prevent infection, we should also consider the use of myogenic drugs to promote wound healing. For example, Pearl Wuwei Powder, Musk Seventeen-flavor Powder are applied to wounds, and Honghua Bawei Powder is taken internally, which has the effect of continuous vein connection, hemostasis and muscle formation. For white vein injuries, thirteen flavors of Dapeng Golden Wing Pills can be given, and sweater dung or musk, sheep dung and liquor can be used to heat the external application.
Nursing care of fracture
Nursing is very important for the treatment of fracture. Patients'bedclothes and underwear should be washed regularly and kept clean, especially in affected areas. Keep the affected limbs stable when urinating or defecating. To prevent the occurrence of bedsore, often pay attention not to make splint displacement and maintain the tightness of the tie. Eat and live well. In the early stage of fracture, fresh cheese, yogurt, butter and other foods such as porridge, fruits, vegetables, cattle, sheep and goats should be eaten. Fat meat, wine and fish should be forbidden. In the middle stage, it is advisable to eat fried rice, millet, Cereals, cows, sheep and pigs and other cartilage, liver, kidney and Cucumis and soybeans as nutritious things, and often give sheep bone soup, fasting lean dead meat, vinegar and tofu and other foods. In the later period, it is suitable to eat five grains, such as poultry meat, eggs and vegetables as milk, pheasant, chicken and quail, and to fast deteriorating meat and raw and cold food that is not easy to digest. In daily life, it is advisable to recuperate in a quiet and cool environment, sleep adequately, and feel comfortable; be careful not to worry and overwork, and absolutely prohibit housing.
Six Functions Exercise
Functional exercise is an indispensable adjuvant therapy in the whole process of fracture treatment. It can further improve the local and systemic blood circulation, so that the affected part can get sufficient nutrients, and help to accelerate callus formation. Promote fracture healing.
Hand touching heart
Before fracture reduction, the doctor touched the fracture site with his hand, requiring that the manipulation should be light and heavy, from shallow to deep, from far to near, with opposite ends. He really knew the specific orientation of the displacement of the fracture end in the limb, and combined with the displacement of the fracture end shown by X-ray, formed a stereoscopic image of the displacement of the fracture in the brain in order to achieve good results. Good therapeutic effect.
The main quotation is to overcome muscle antagonism, correct the contraction and displacement of affected limbs, and restore the length of limbs. According to the principle of "separation before closure, separation and compounding", the limbs should be kept in the original position at the beginning of traction, along the longitudinal axis of the limbs, and the distal and near fracture segments should be used as opposing traction. Then, the direction of the limbs is changed according to the steps of the restoration, and the traction is continued. The size of traction force should be based on the muscle strength of the patient. It should be appropriate and stable. Generally speaking, young and middle-aged male patients, muscular development, pull-out traction should be greater; on the contrary, elderly, young and female patients, the traction required should not be too large. For the limbs with abundant muscle groups, such as femoral shaft fracture, bone traction should be combined; but for the humeral shaft fracture, although the muscles are developed, if too much effort is exerted, the broken ends are often separated, resulting in nonunion.
Rotary flexion and extension
It is mainly used to correct rotation and angulation deformity of fracture ends, especially for fractures near joints. This technique makes up for the deficiency of simple pull-out and traction. When the limb has rotation deformity, the surgeon can hold the distal part of the limb and rotate left or right around the longitudinal axis of the limb under pull-out to restore the normal physiological axis of the limb. When flexion and extension, the surgeon fixes the proximal part of the joint with one hand and swings the limb along the crown axis of the joint with the other hand to restore the fracture and dislocation. If a straight supracondylar fracture of the humerus occurs, the rotation deformity of the fracture should be corrected first, and the elbow joint should be flexed under traction to make the distal end of the fracture converge with the proximal end. Extended supracondylar fracture of femur can be pinned at the tibial tubercle and tracted at the knee; conversely, flexion supracondylar fracture of femur requires pinning at the supracondylar of femur and traction of the knee joint in the semi-flexion position to reduce the fracture.
Lift and press end extrusion
It is mainly used to correct lateral displacement of fracture. Lateral displacement can be divided into anterior and posterior (i.e. upper and lower or dorsal palmar) displacement and lateral (left and right) displacement. When performing the manipulation, the doctor placed the palm and finger at the front, back and left of the broken end of the fracture respectively, forcing the reduction of the fracture by forceful clamping and squeezing. For patients with anterior and posterior displacement of fracture, the doctor pressed his thumb with both hands on one end of the protruded fracture downward, and the other end of the collapsed fracture was raised upward, so that the two ends of the fracture were closed. For patients with internal and external displacement of fracture, end-pressing technique is used. The doctor fixes the proximal end of the fracture with one hand, holds the distal end of the fracture with the other hand, and forces the end with four directions to the doctor. The protruding end of the fracture is pushed inward with the reverse force of thumb. It is required that proper force and correct direction should be exerted during the manipulation. Doctor's fingers should be in close contact with patient's skin so as to avoid the damage caused by rubbing back and forth on the skin.
This technique is mainly suitable for transverse and serrated fractures. After the above manipulation, the fracture can be basically reduced, but there may still be space between the broken ends of transverse and serrated fractures. In order to make the fracture end close contact and increase stability. The operator can fix the fracture with both hands, and the assistant gently rocks the distal part of the fracture from left to right or from front to back under stable traction until the bone fricative sound between the fracture ends gradually decreases or disappears. When the transverse fracture occurs at the metaphyseal end, the doctor can fix the splint of the fracture with one hand and tap the distal end of the fracture with the other hand after the reduction of the fracture and splint fixation of the affected limb, so that the fracture ends are inserted tightly and the stability is increased.
Clamping and Bone Separation
This technique is suitable for the correction of lateral displacement of fractures in the two bone juxtapositions. There are interosseous membranes or interosseous muscles between tibia and fibula, ulna and radius, metacarpal or metatarsal shaft. After fracture, the fracture segments are pulled together by interosseous membranes or interosseous muscles to form lateral displacement. When the fracture is reconstructed, the doctor squeezes the gap between the two bones with the thumb of both hands and the third finger .
The overlapping displacement can not be completely corrected by traction force alone after the occurrence of transverse or serrated fracture in muscular patients, and the folding method can be applied. During the operation, the surgeon's thumbs were placed at one end of the protruding fracture, while the other four fingers were overlapped and encircled at the other end of the sagging fracture. Under traction, the thumbs of both hands pressed down the protruding fracture end, and increased the angular deformity of the fracture. Depending on the feeling of the thumb, it was estimated that when the cortex of the distal and proximal end of the fracture had reached the same end, it suddenly reversed. When the fracture is reversed, the four fingers encircling the other end of the fracture are lifted up violently, while the thumb continues to press down the protruding end of the fracture, which makes it easier to correct the overlapping displacement deformity.
This manipulation is suitable for the treatment of soft tissue around fracture after fracture reduction. It can make twisted and tortuous muscles and tendons stretch and reach along with fracture reduction, which is particularly important for the fracture near the joint. During the operation, the manipulation should be gentle, according to the direction of the muscles and tendons, the tendons should be pushed up and down along the bone to achieve the purpose of dissipating blood stasis and relaxing the tendons.
The patient was lying prone on the treatment bed and relaxed. The doctor is on the left side of the patient. According to the principle of "light-heavy-light", the soft tissues on both sides of the patient's lumbar spine were relaxed by massage for about 5-10 minutes. When the local soft tissue is completely relaxed, the patient is in lateral position. The doctor holds one hand against the front shoulder of the patient, the other hand against the buttock, or one hand against the back shoulder of the patient, and the other hand against the anterior superior iliac spine. When the waist is rotated passively to the maximum, the two hands will flicker in the opposite direction at the same time (the action must be decisive and fast, the force must be stable, the two hands should coordinate, and the pulling range can not exceed the range of physiological activities of each joint). The patient lay on the other side of the bed, and the other side of the waist was pulled obliquely by the same method. Finally, local relaxation therapy was performed by kneading and pressing method for about 0.5 to 1 minute. Each treatment lasts about 15 minutes. Treatment once a day, 5 times as a course of treatment. Ultrashort wave therapy was given after orthopaedic treatment. The instrument used homemade landing ultrashort wave therapy instrument. The patients were supine on the treatment bed. The treatment electrodes were placed in front of and behind the waist and abdomen. The output of the instrument was suitable for patients to feel comfortable and warm in the treatment area. Each treatment lasted 15 minutes. Treatment once a day, 5 times as a course of treatment.
。 The amount of exercise can be adjusted according to the patient's age, sex, condition and constitution. Each action was performed 5 to 10 times, once a day, five times as a course of treatment. The specific methods are as follows: (1) supine position. Bend your knees to the abdomen and hold your knees in your hands so that your waist is flat on the bed and your psoas muscles and lower back muscles relax. (2) Prone position, two-handed bed. Raise your head and upper body. (3) Prone position. Straight legs raised, alternating sides. (4) In prone position, put both hands behind your back. Raise your head and upper body. _Supine position. Put your back out of bed. _Supine position. Raise your hips and get out of bed.
If the patients often adhere to exercise training after clinical cure, they can constantly increase the stability of the waist, consolidate the curative effect and prevent the recurrence of the disease. Specific methods can be exercised according to the content and steps of exercise therapy. Exercise for 1 to 2 months for 1 course is enough.
Bone-setting, a term that has been gradually forgotten in medical circles and unfamiliar to more young doctors, is moving further and further away from our society in the way of vertical acceleration.
Economics, profits, when the interests of hospitals are no longer simply the income of doctors, medical expenditure can not be reduced in any case. Because the income of those who are executing the reduction of medical expenses is directly related to the medical income. It's ridiculous to say that! For our ordinary people, it can only be helpless. Then, I hope that I can pay less for myself, which is enough!
The backwardness of bone-setting technology led to its decline. I believe a lot of orthopaedics are saying that. It has become the goal of all doctors to learn the most advanced medical technology in the West and then apply it to our clinical practice. Unfortunately, the orthopaedic surgeon learned to come back for surgery, but he did not learn to come back. In the western orthopaedics, there is also a "reduction of fracture with a pin", that is, the "orthopaedic bone" in traditional Chinese medicine. The reason is simple, economic.
For a large number of fractures in children. In the textbooks of orthopaedics of Western medicine, most of them are non-surgical. Orthopaedic textbooks in China are also non-surgical. However, in China, the rest is surgery or surgery. Few hospitals can carry out non-surgical treatment! Why? It's the economy. In this regard, the very grass-roots hospitals and the very high-level hospitals are insisting on non-surgical treatment.
Fracture, now left in addition to surgery or surgery, such a status quo, doctors absolutely have to bear most of the responsibility. Many doctors say that "the patient's requirement for fracture also makes it impossible for us to choose surgery". Indeed, many patients will now have a high demand for X-ray after treatment. Then they go around and ask different orthopaedics, and if they stay and meet a doctor who says, "This should be operated on", and when it happens, parents are not satisfied with the child's treatment, then the doctor who chose non-surgical treatment at that time may face disaster. However, if the doctor had an operation, and if another doctor said, "This can be treated without surgery." It will be considered that the doctor is not skilled, and the operation will not be. And the treatment effect of children is also not ideal. At that time, doctors who had undergone surgery could have no problems. The fact is that the same angle of change, but the treatment is very different.
Because, children fracture surgery is normal, is the choice of most doctors, and post-operative X-ray fracture alignment is very ideal, and the problem is surgical complications, all operations have, it is beyond reproach. However, non-surgical, often X-ray does not have the ideal of surgery. If the effect is unsatisfactory later, it can be attributed to the unsatisfactory position at that time. It's hard to say that "a non-operative doctor is a kind-hearted person who does something wrong". However, I have always believed that the root cause of this problem is the surgeon's public instigation and the current medical environment. Patients are ignorant, who initially told those so-called "post-operative fracture 100% alignment" to "clinically many fractures do not need 100% anatomical reduction, the same to achieve a satisfactory treatment effect" and who abandoned it! Therefore, for this reason, it should be attributed to the surgeon's own problems, as well as the current medical environment in China.