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Orthopedics and traumatology of TCM is a subject to study the prevention and treatment of osteoarticular and periarticular soft tissue injury and disease. It is a clinical subject in TCM with a unique therapeutic theory and rich clinical therapeutic methods. These therapeutic methods are quite effective for orthopedic and traumatic diseases.
TCM orthopedics and traumatology has a long history. It is a subject initiating and gradually developing in Chinese people’s struggle against various osteoarticular injuries and diseases.
Main Contents of Orthopedies and Traumatology
Traumatology and osteopathy in TCM is composed of the following two parts.
Traumatology
It mainly includes fracture, dislocation, injury of muscle and tendon, and internal traumatic syndrome.
1. Fracture
Fracture refers to the breaking of continuity or integrity of the bone due to violent external forces. Its main clinical symptoms are local pain, swelling, functional disturbance, deformity, abnormal movement and bony crepitus. Fracture is a kind of disease commonly and frequently encountered in clinic. A systematic theory has been developed and rich clinical experience has been accumulated during a long period of practice. Excellent effects have been achieved in reduction manipulation, splint fixation, functional exercise and herbal treatment. Their results are satisfactory in relieving the patients’ sufferings, shortening the therapeutic courses and recovering the functions.
2. Dislocation
Dislocation means that the articular epiphyseal surface is broken away from its normal location, with articular dysfunction. The main clinical symptoms are localized pain, swelling, functional disturbance, articular malformation, vacancy of the glenoid cavity, and elastic fixation. Articular dislocation is also a kind of commonly encountered traumatic disease.
3. Injury of Muscle and Tendon
Injury of muscle and tendon refers to the traumas caused by sprain, contusion, stabbing and cut of such tissues as skin, muscle, fascia, tendon and ligament, cartilage, peripheral nerves and great blood vessels. The domain of injury of muscle and tendon is large, including various acute and chronic injuries of soft tissues all over the body. The clinical symptoms are various.
4. Internal Traumatic Syndrome
This means the visceral injuries and the subsequent dysfunction of qi and blood, viscera and meridians. The main symptoms are bleeding, pain, fever, flatulence and coma. The main injury may be summarized as qi injury and blood injury.
(1) Qi Injury
This means the disorder of qi activities of the human body caused by trauma, including qi stagnation, qi blockage, qi deficiency and qi collapse.
(2) Blood Injury
This means the blockage of blood circulation, or blood stasis, or blood extravasation from the vessels, or great loss of blood caused by trauma, including blood stasis and blood exhaustion.
Osteopathy
Osteopathy is of a large domain. It can be classified into the following sorts.
(1)Congenital bone Malformation
It mainly refers to some congenital diseases of the bone and articulation, including developmental disorders of the bone and articulation, congenital defects of the spine and the limbs. The causative factors have not been completely understood now. It is mostly due to the abnormalities of fetal development, with a remarkable family history in some cases. The common ones are bone and joint maldevelopment, congenital neck diseases, congenital spinal malformation, and congenital limb malformation.
2. Carbuncle of the Bone
This is a kind of suppurative infective disease resulting from the invasion of pyogenic bacteria in the bones and joints. It is mostly caused by dissemination of the residual toxin, invasion of the exogenous six pathogenic factors, internal injuries of the seven emotions, and sexual overstrain. The commonly encountered carbuncles are acute pyogenic osteomyelitis, suppurative arthritis and bone syphilis.
3. uberculosis of the Bone and Joint
This is a kind of destructive chronic pyogenic disease caused by invasion of Mycobacterium tuberculosis in the bone and joint. The diseases, commonly seen in children and youth, are mostly due to infection of Mycobacterium tuberculosis on the basis of constitutional asthenia of the liver and kidney or injury of the spleen and kidney from acquired malnutrition. Clinically, there are simple bone tuberculosis, simple synovial tuberculosis and panarticular tuberculosis. Tuberculosis may occur in both the joints and bones of the whole body.
4．Osteoarticular Bi-syndrome
This is a kind of disease with symptoms of muscular and articular aching, numbness, heaviness and swelling, and limited movement of the joint resulting from impaired circulation of qi and blood in the meridians by the exogenous pathogenic wind, cold, dampness and heat. Included are rheumatic arthritis, rheumatoid arthritis, ankylosing spondylitis, gouty arthritis, traumatic arthritis, menopausal arthritis, neurodermatitis, intra-articular corpus liberum, articular synovitis, psoriatic arthritis, and hemophilic arthritis.
5．Wei-syndrome
This is a kind of disease with symptoms of flaccidity of the body, thin muscles, and weakness and numbness of the limbs caused by invasion of pathogenic factors on the body, trauma, or weakness of the healthy qi. Included are polyneuritis, dermatomyositis, infantile paralysis, cerebral paralysis, hemiparalysis, paraplegia, myopathic paralysis and myoatrophy.
6．Tendon Spasm
This is a kind of disease with articular dysfunction resulting from continuous contraction of the muscle or loss of normal elasticity due to contracture of the skin, joint capsule or ligament caused by congenital disturbance of development, trauma, ischemia, and invasion of pathogenic factors. Included are ischemic contracture, contracture of the musculus flexor digitorum, contracture of the aponeurosis palmaris, contracture of the iliotibial band, and contracture of the joint.
7. Osteoarticular Degenerative Disease
This means chronic arthritis due to osteoarticular hyperplasia and hypertrophy with retrograde degeneration and chondronecrosis. It may occur in the spine and articulations of the whole body. The causative factors are congenital maldevelopment, deficiency of the kidney qi, asthenia of the liver and kidney, injury from external forces, and invasion by exogenous wind, cold and dampness. It belongs to the category of Bi-syndrome, and pain of the neck, shoulder, waist and leg in TCM. Included are interlumbar articular syndrome, hyperplastic spondylitis, spinal canal stenosis, and osteoarthropathy of the hip, knee and ankle joints.
8. Osteochondrosis
This refers to the ossification disturbance in the ossification center during the developmental period of the bone resulting from interference of some factors. The disorder occurs in epiphysis, so it is also called osteochondritis or epiphysitis. The causative factors are trauma, diminished blood supply or genetic factor. Included are osteochondrosis of capitular epiphysis of the femur, epiphysis of the spine, epiphysis of the navicular bone, epiphysis of tubercle of the tibia, and epiphysis of tubercle of the calcaneus.
9. Metabolic Osteopathy
This means the disorder of metabolism of bone minerals or bone matrix, and the resultant symptoms and signs due to biochemical and morphological changes of bone tissues. Clinically, there may occur osteoperosis, growth disorder and maldevelopment of the bone or osteonecrosis. The pathogeneses are weakness of the bone and tendon due to congenital defect, injury of body and mind involving the five zang-organs due to mental and physical or sexual overstrain, and failure of the spleen and stomach to generate qi and blood for nourishing the bone caused by injury from improper diet. Clinically, common diseases are rickets, osteomalacia, osteoporosis, parathyroid dysfunction, renal osteodystrophy and osteonecrosis.
10. Bone Tumor
This refers to the tumor occurring in the bone and its accessory tissues. The pathogenic factors of bone tumor have been not fully understood up to now. The initial recognition believes that there are multiple pathogenic factors in physics, chemistry, biology, genetics, nutriology, immunology and mental state. The classification of bone tumors is quite complicated. For example, it may be classified according to tissue morphology and origin of cell, but for some tumors the classification is not the same because of different recognition. It may also be classified according to malignancy of the tumors as benign, middle and malignant types, but there is no strict limit between them.