Orthopedics and Traumatology

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Therapeutic Methods
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Therapeutic Methods

The treatment of orthopedic and traumatological diseases should take syndrome differentiation as its basis. And the therapeutic principles of taking both motion and quiescence into consideration, paying attention to both bone and soft tissue, combination of external and internal treatments, and cooperation of the doctor and the patient should be implemented. 

Treatments in orthopedics and traumatology may be classified into two kinds of internal therapy and external therapy, which may be purposely used according to concrete condition of the disease. 

Internal Therapy

Internal therapy is a method to treat both the local and the whole disorders through oral administration.

1. Eliminating stasis by purging
It is suitable for blood stasis in the early stage of injury from falls and knocks. The symptoms are swelling in limbs or abdominal distending pain, constipation, yellow tongue coating, and rapid pulse, etc. Commonly used recipes are Taohe Chengqi Decoction, Jiming Powder, Dacheng Decoction, and Lidong Pill. The method belongs to a purgative therapy, usually taking purgation with bitter-cold herbs for eliminating blood stasis. 

The efficiency is quite drastic, so, it can not be indiscriminately used clinically. It should be contraindicated or used with caution for a patient who is old and weak, or whose qi and blood are deficient, or who suffers from a massive bleeding or a chronic strain, or a patient who is pregnant, or who is in her puerperium or in her menstrual period.
 

2. Activating qi and promoting blood circulation
This is suitable for the local swelling and pain with qi and blood stasis but without interior-excess-heat syndrome, or the blood stasis internally with old injury or the case that can not be treated with drastic purgative because of some contraindications. 

The commonly-used recipes are those mainly removing stasis by promoting blood circulation, such as Fuyuan Huoxue Decoction and Huoxue Zhitong Decoction, and those mainly activating qi, such as Chaihu Shugan Powder and Fuyuan Tongqi Powder, and those both activating qi and promoting blood circulation, such as Gexia Zhuyu Decoction and Shunqi Huoxue Decoction. Clinically they may be flexibly used according to the condition of traumas.

3. Clearing away heat and cooling blood
The treatment includes methods of clearing away heat and poison, and cooling the blood to stop bleeding. The method of clearing away heat and poison is suitable for internal fire-poison, accumulation of heat pathogen leading to production of poison in traumatic infection. The commonly used recipes are Supplemented Xijiao Dihuang Decoction, Huanglian Jiedu Decoction, and Wuwei Xiaodu Decoction, etc. 

The method of cooling the blood to stop bleeding is suitable for traumatic bleeding. The commonly used recipes are Shihui Powder, Sishen Pill, and Xiaoji Decoction, etc. The recipes of cooling the blood to stop bleeding are mainly composed of cool and cold herbs, so, make sure that the cool-cold herbs are not used too many, which may cause blood stasis internally.

therapeutic methods


4. Harmonizing the nutrient qi to alleviate pain
This is suitable for the injuries in the middle stages of trauma in which there are still blood stasis, qi stagnation, swelling and pain. But continuous application of this method may damage the healthy qi. The commonly used recipes are Heying Zhitong Decoction, Dingtong Hexue Decoction, Zhenggu Zijin Pillet, and Qili Powder, etc.

5. Reuniting bone and muscle and ligament
This is suitable for the injuries in the middle stage of trauma in which bone, muscle and ligament have reunited, but the reunion is not firm. The commonly used recipes are Xngu Huoxue Decoction, Xinshang Xuduan Decoction, Jiegu Pillet, and Jiegn Zijin Pillet, etc.

6. Relaxing tendons and activating collaterals
The method is, through using drugs functioning to activate blood, expel wind and dredge collaterals as well as to regulate qi, effective to eliminate blockage of qi and blood, remove stasis, relax tendons and activate collaterals. It is suitable for the injuries in the middle stage of fracture, dislocation and tendon injury in which there are contracture of tendons, rigidity and impaired movement of joint due to blood stasis and adhesion of muscles and ligament or accompanied by invasion of wind and dampness. The commonly used recipes are Shujin Huoxue Decoction, Shujin Decoction, and Juanbi Decoction, etc.

7. Replenishing qi and nourishing blood
The method is to use drugs to replenish qi and nourish blood to make qi-blood abundant for nourishment of bones and tendons. It is suitable for those patients with deficiency of qi and blood or great consumption of qi and blood. The commonly used recipes are Sijunzi Decoction, Siwu Decoction, Bazhen Decoction, and Shiquan Dabu Decoction, etc.

8. Strengthening the spleen and stomach
The method is suitable for those cases in the late stage of trauma in which there is weakness of limbs, emaciation, atrophy of muscles, slow recovery of injured bones and tendons, weak and forceless pulse. The commonly used recipes are Shenling Baizhu Decoction, Jianpi Yangwei Decoction, and Guipi Decoction, etc.

9. Tonifying the liver and kidney
This is also called method of strengthening the bones and tendons. It is suitable for those cases in the late stage of trauma in the old or weak patients with slow heal of fracture and osteoporosis due to asthenia of the liver and kidney. The commonly used recipes are Zhuangjin Yangxue Decoction, Shengxue Busui Decoction, Zuogui Pill, and Yougui Pills, etc.

10. Warming meridians and activating collaterals
In this method, the medicinal herbs of warm-heat nature with the actions of expelling wind, cold and dampness are used and herbs with the action of harmonizing nutrient qi and defensive qi or tonifying the liver and kidney are used as the auxiliary. The effects are to eliminate the wind-cold-dampness pathogens in joints and meridians, and promote blood circulation, relax tendons, lubricate joints and dredge meridians. 

It is suitable for the injury of sluggish circulation of qi and blood after trauma, or invasion of wind-cold-dampness pathogens on meridians due to weakness of yang-qi and porousness of the striae; or qi-blood stasis and retention of wind-cold-dampness pathogens in an old trauma improperly treated. The commonly used recipes are Magui Wenjing Decoction, Wutou Decoction, Dahong Pill, Dahuoluo Pillet, and Xiaohuoluo Pillet, etc.


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