mach5_kel
06-Nov-2005, 08:05 PM
Here is a quick little bit of my notes from an Orthopedics Class on TCM. Really it is TCM and western orthopedics together.
I know the spelling and grammer is off (its notes, not a book and lots of it is translated from Chinese), and I really dont care to edit them now. But if you are intrested, read on. Ill update it a little bit later sometime with some more practical stuff. This is just an intro. Some of the TCM terms seem simple when translated into english (ie blood stasis) but latin is just the same (but western medicine leaves it in latin instead). Simple terms dont mean simple concepts.
Qi, Blood, Spleen, Liver, Kidney, etc, refer to the TCM terms, not the western organs, etc. The organ liver has nothing really to do with tendons, but the Liver (TCM) controls the tendons of the body. Ie, smooth Lv (Liver qi) means healthy tendons.
1-1 Introduction: History and Development
Orthopedics: Treatment of illness and disorders of the skin, muscles, bones, Qi & blood, zang fu, channels and collaterals.
Correction of deformities, treatment of metaskeletal problems, joints, soft tissues (muscles, tendons ligaments), and bone tumors.
The American Heritage Dictionary…
Orthopedics: The branch of medicine that deals with the prevention or correction of injuries or disorders of the skeletal system and associated muscles, joints, and ligaments.
*Experience shows that about 50% of patients or more seek TCM help due to orthopedic type problems.*
The classical and modern sign for orthopedics is a crooked tree splinted.
The earliest records of TCM are about 2000 BC. Around 200 BC what appears to be bone doctors appear. Then later Hua Tou invents the 5 animal frolic and introduces anesthesia (for surgery). This appears to be the first true appearance of TCM orthopedics. Traction has been around for about 1000 to 500 years for the treatment of fractures.
Note:
Hua To (Hua Tuo) [110-207 A.D.] was the first recorded Chinese surgeon. He developed the use of anesthesia, and helped to expand Chinese knowledge of anatomy. Hua To also introduced the practice of the 5 animal frolic, which is now considered a type of Qi Gong and still practiced today. "Hua To Acupuncture Needles" are named after this famous physician.
-------------------------------------
4 Principles for the Treatment of Fractures
1) Combination of movement and rest
(Immobilizing of the joint such as casting, splinting, taping, and continued exercise of surrounding structures.)
Key: “association of activity and inertia”
2) Paying attention to both the bone and tendon (soft tissues)
(All bones are covered and aided by soft tissues. When a fracture occurs, damage to the soft tissue occurs. Bone break > blood stagnation > heat builds locally and systemically in the body, therefore treatment of the bone and the whole body is necessary.)
Key: “emphasis on both bone and soft tissue”
3) Both external and internal treatment
(Even when orthopedic problems require surgery, other treatment is still necessary). Major and many minor fractures show with blood stagnation and heat (creating consitpation, inhibited urination, etc)
Key: “treat external with internal”
4) Cooperation of the doctor and patient
(It is not only the doctors job to treat the patient, but we must educate them as well. We must involve them in their own health and well being to reach desired health goals).
Key: “doctor and patient co-operation”
Applying these 4 principles to treatments result in reduced healing times, less pain and secondary symptoms, and better return to normal function than by surgery alone.
-------------------------------------------
The Bone
The human skeleton in made up of two types of bones.
1) Cortical Bone (compact bone)
Key: “cover, protect, and make bones hard”
Cortical bone represents nearly 80% of the skeletal mass. It is also called compact bone, because it forms a protective outer shell around every bone in the body. Cortical bone has a slow turnover rate and a high resistance to bending and torsion. It provides strength where bending would be undesirable as in the middle of long bones.
2) Trabecular Bone aka Cancellous Bone (spongy bone)
Key: “lots of holes and blood inside”
This kind of bone only represents 20% of the skeletal mass, but 80% of the bone surface. Trabecular bone is less dense, more elastic and has a higher turnover rate than cortical bone. It is found in the epipheseal and metaphysal regions of long bones and throughout the interior of short bones. Trabelcular bone constitutes most of the bone tissue of the axial skeleton: bones of the skull, ribs and spine. It is formed in an intricate and structural mesh. Trabecular bone forms the interior scaffolding, which helps bone to maintain their shape despite compressive forces. Trabecular bone is rigid but appears spongy, it is composed of bundles of short and parallel strands of bone fused together. The center of the bone contains red, yellow marrow, bone cells and other tissues.
(Therefore all fractures have a lot of bleeding. A major fracture can cause the loss of 1 liter to 1.5 liters of blood. In some cases up to 1/3 of the entire bodies blood can be lost. These massive amounts of blood loss can quickly result in death. Blood transfusions are immediately necessary before further tests are done to asses the extent of the trauma.)
------------------------------------------------
1-3 Etiology of trauma – Cause of Injury
4 Exogenous pathogenic factors (pg 16)
There are a total of four forces: direct force, indirect force, forced myotasis and chronic strain.
1) Direct force: The trauma occurs in the region directly acted on by the external forces such as fall, crush, impact, sprain and beating. The fracture caused by direct forces is often comminuted or transverse; the trauma is often open and the soft tissue is seriously damaged; the dislocation is often complicated by avulsion of the epiphysis; the tendon injury is often of contusion.
“Major reason for trauma. I.e., being hit by a car or being hit with a hammer. Also causes soft tissue damage of skin, and muscles of an open wound type. If not open, then large contusion (swelling and internal bleeding).”
2) Indirect force: The trauma occurs in the region away from the part acted on by the external force. For example, transmitting force, rotation force, and lever force, etc. may cause fracture, dislocation and tendon in-jury in corresponding parts. In the case of fall from a high place, if the hip first touches the ground, it may cause compression fracture of T12 or L1 due to the force from both the impulsion of the body and the reaction of the
ground. The fracture caused by indirect force is often oblique. spiral or compressive; the tendon injury is often of sprain and generally milder than that caused by direct force.
“I.e., falling hands down and shoulder gets dislocated. Jumping from a high place and fracturing T12 / L1.”
3) Forced myotasis: In the case of sport or work, the muscle contracts strongly because of great exertion, which may cause breaking of the tendon or bone fracture. For example, throwing a javelin may cause a fracture of humeral shaft because of strong contraction of the muscle. The fracture caused by forced myotasis is commonly avulsed or spiral.
“Sudden pulling of muscles that fractures bones. Happens when throwing a baseball sometimes.”
(4) Chronic strain: Constant walking, constant standing, overstrain or prolonged abnormal posture may result in diseases because of constant overwork of the muscle, tendon and joint. For example, constantly bending over the desk may cause strain of cervical muscles; trudging over long distance may cause fatigue or fracture of second metatarsal bone. The condition of chronic strain gradually deteriorates.
“Over-standing leading to arthritis, over-walking leading to tendon damage, poor posture at work, in front of TV or computer, soldiers fracture of second metatarsal due to forced marches.”
Invasion by six exogenous pathogenic factors and poisons
Invasion by six exogenous pathogenic factors or poisons may cause diseases of tendons, bones and joints. For example, attack by pathogenic wind, cold and dampness in the case of trauma may cause pain of the joints of the waist and the limbs, or impaired movement. Invasion by poisons in the case of trauma may give rise to infection of the local part or the whole body often complicated by various diseases.
“Bi syndrome of the joints, poisoning”
Endogenous pathogenic factors
1) Age
There are different predilection sites and incidence of trauma in persons with different ages. For example, in the case of fall with the hip first touching the ground and the same external force, fracture of neck of femur often occurs in old people, seldom in young people. Children are subject to fracture because of their delicate bones. But their fractures are often incomplete because of their thicker and flexible periosteum. The injury of epiphysis often occurs in young people who are in their growth and developmental periods and whose epiphyses are not occlusal. People in the prime of life seldom get fracture when falling, for their tendons and bones are strong.
“Seniors tend to more fractures. Especially due to falls causing wrist, hip and Lumbar/ Cervical fractures”
2) Physique
The strength of physique is closely related to the occurrence of trauma. Young and vigorous people with abundance of Qi and blood, rich kidney essence and strong tendons and bones seldom suffer from trauma. Old and weak people with deficiency of Qi and blood, asthenia of the liver and kidney and osteoporosis are susceptible to trauma. For example, when falling on a level ground with the hip first touching the ground, they may also get fracture of neck of femur or intertrochanteric fracture even the external force is small.
“What is there body constitution like? Some older people have the body of a much younger person for example. Maybe they don’t eat well and suffer from Spleen Qi defiecy. This will then affect the muscles and these people will be more prone to fractures.”
3) Anatomic structures
Trauma is related to the anatomic structures to a certain extent. Transmitting force acting on a bone usually causes fracture in the junction between compact bone and spongy bone. For example, the part 2 to 3 cm away from the lower end of radius is the junction of compact bone and spongy bone; it is subject to fracture when the palm touches the ground in a fall. The clavicular fracture often occurs in the junction of the two arcuations without protection of ligaments. Take occult cleft spine of S1 as another example, because there is no spinous process, the supraspinal and interspinal ligaments are short of their attachments, thus the stability of lumbosacral joint decreases, the weak part is susceptible to trauma.
“Most fractures happen where the spongy and compact bone meet called the neck”
4) Occupation
The occurrence of trauma is to a certain degree related to occupation. For example, mechanical workers without necessary safety devices are subject to the trauma of hand. Workers constantly bending over or shouldering heavy load are subject to chronic lumbar strain. Athletes, acrobats and Gongfu actors are subject to various sport injuries. And middle-aged people constantly bending over the desk are subject to cervical spondylopathy.
“Lots of bending and lifting jobs. Or computer workers with neck problems.”
----------------------------------
If you read this far, congrats. I hoped you enjoyed it and it gave you a little knowledge. I realize if you dont know anything about TCM, some of the terms prolly dont mean anything. Such as spleen qi defiency, or stuff like the Liver nourishing the tendons. But I am sure you can find a TCM primer on the internet.
I know the spelling and grammer is off (its notes, not a book and lots of it is translated from Chinese), and I really dont care to edit them now. But if you are intrested, read on. Ill update it a little bit later sometime with some more practical stuff. This is just an intro. Some of the TCM terms seem simple when translated into english (ie blood stasis) but latin is just the same (but western medicine leaves it in latin instead). Simple terms dont mean simple concepts.
Qi, Blood, Spleen, Liver, Kidney, etc, refer to the TCM terms, not the western organs, etc. The organ liver has nothing really to do with tendons, but the Liver (TCM) controls the tendons of the body. Ie, smooth Lv (Liver qi) means healthy tendons.
1-1 Introduction: History and Development
Orthopedics: Treatment of illness and disorders of the skin, muscles, bones, Qi & blood, zang fu, channels and collaterals.
Correction of deformities, treatment of metaskeletal problems, joints, soft tissues (muscles, tendons ligaments), and bone tumors.
The American Heritage Dictionary…
Orthopedics: The branch of medicine that deals with the prevention or correction of injuries or disorders of the skeletal system and associated muscles, joints, and ligaments.
*Experience shows that about 50% of patients or more seek TCM help due to orthopedic type problems.*
The classical and modern sign for orthopedics is a crooked tree splinted.
The earliest records of TCM are about 2000 BC. Around 200 BC what appears to be bone doctors appear. Then later Hua Tou invents the 5 animal frolic and introduces anesthesia (for surgery). This appears to be the first true appearance of TCM orthopedics. Traction has been around for about 1000 to 500 years for the treatment of fractures.
Note:
Hua To (Hua Tuo) [110-207 A.D.] was the first recorded Chinese surgeon. He developed the use of anesthesia, and helped to expand Chinese knowledge of anatomy. Hua To also introduced the practice of the 5 animal frolic, which is now considered a type of Qi Gong and still practiced today. "Hua To Acupuncture Needles" are named after this famous physician.
-------------------------------------
4 Principles for the Treatment of Fractures
1) Combination of movement and rest
(Immobilizing of the joint such as casting, splinting, taping, and continued exercise of surrounding structures.)
Key: “association of activity and inertia”
2) Paying attention to both the bone and tendon (soft tissues)
(All bones are covered and aided by soft tissues. When a fracture occurs, damage to the soft tissue occurs. Bone break > blood stagnation > heat builds locally and systemically in the body, therefore treatment of the bone and the whole body is necessary.)
Key: “emphasis on both bone and soft tissue”
3) Both external and internal treatment
(Even when orthopedic problems require surgery, other treatment is still necessary). Major and many minor fractures show with blood stagnation and heat (creating consitpation, inhibited urination, etc)
Key: “treat external with internal”
4) Cooperation of the doctor and patient
(It is not only the doctors job to treat the patient, but we must educate them as well. We must involve them in their own health and well being to reach desired health goals).
Key: “doctor and patient co-operation”
Applying these 4 principles to treatments result in reduced healing times, less pain and secondary symptoms, and better return to normal function than by surgery alone.
-------------------------------------------
The Bone
The human skeleton in made up of two types of bones.
1) Cortical Bone (compact bone)
Key: “cover, protect, and make bones hard”
Cortical bone represents nearly 80% of the skeletal mass. It is also called compact bone, because it forms a protective outer shell around every bone in the body. Cortical bone has a slow turnover rate and a high resistance to bending and torsion. It provides strength where bending would be undesirable as in the middle of long bones.
2) Trabecular Bone aka Cancellous Bone (spongy bone)
Key: “lots of holes and blood inside”
This kind of bone only represents 20% of the skeletal mass, but 80% of the bone surface. Trabecular bone is less dense, more elastic and has a higher turnover rate than cortical bone. It is found in the epipheseal and metaphysal regions of long bones and throughout the interior of short bones. Trabelcular bone constitutes most of the bone tissue of the axial skeleton: bones of the skull, ribs and spine. It is formed in an intricate and structural mesh. Trabecular bone forms the interior scaffolding, which helps bone to maintain their shape despite compressive forces. Trabecular bone is rigid but appears spongy, it is composed of bundles of short and parallel strands of bone fused together. The center of the bone contains red, yellow marrow, bone cells and other tissues.
(Therefore all fractures have a lot of bleeding. A major fracture can cause the loss of 1 liter to 1.5 liters of blood. In some cases up to 1/3 of the entire bodies blood can be lost. These massive amounts of blood loss can quickly result in death. Blood transfusions are immediately necessary before further tests are done to asses the extent of the trauma.)
------------------------------------------------
1-3 Etiology of trauma – Cause of Injury
4 Exogenous pathogenic factors (pg 16)
There are a total of four forces: direct force, indirect force, forced myotasis and chronic strain.
1) Direct force: The trauma occurs in the region directly acted on by the external forces such as fall, crush, impact, sprain and beating. The fracture caused by direct forces is often comminuted or transverse; the trauma is often open and the soft tissue is seriously damaged; the dislocation is often complicated by avulsion of the epiphysis; the tendon injury is often of contusion.
“Major reason for trauma. I.e., being hit by a car or being hit with a hammer. Also causes soft tissue damage of skin, and muscles of an open wound type. If not open, then large contusion (swelling and internal bleeding).”
2) Indirect force: The trauma occurs in the region away from the part acted on by the external force. For example, transmitting force, rotation force, and lever force, etc. may cause fracture, dislocation and tendon in-jury in corresponding parts. In the case of fall from a high place, if the hip first touches the ground, it may cause compression fracture of T12 or L1 due to the force from both the impulsion of the body and the reaction of the
ground. The fracture caused by indirect force is often oblique. spiral or compressive; the tendon injury is often of sprain and generally milder than that caused by direct force.
“I.e., falling hands down and shoulder gets dislocated. Jumping from a high place and fracturing T12 / L1.”
3) Forced myotasis: In the case of sport or work, the muscle contracts strongly because of great exertion, which may cause breaking of the tendon or bone fracture. For example, throwing a javelin may cause a fracture of humeral shaft because of strong contraction of the muscle. The fracture caused by forced myotasis is commonly avulsed or spiral.
“Sudden pulling of muscles that fractures bones. Happens when throwing a baseball sometimes.”
(4) Chronic strain: Constant walking, constant standing, overstrain or prolonged abnormal posture may result in diseases because of constant overwork of the muscle, tendon and joint. For example, constantly bending over the desk may cause strain of cervical muscles; trudging over long distance may cause fatigue or fracture of second metatarsal bone. The condition of chronic strain gradually deteriorates.
“Over-standing leading to arthritis, over-walking leading to tendon damage, poor posture at work, in front of TV or computer, soldiers fracture of second metatarsal due to forced marches.”
Invasion by six exogenous pathogenic factors and poisons
Invasion by six exogenous pathogenic factors or poisons may cause diseases of tendons, bones and joints. For example, attack by pathogenic wind, cold and dampness in the case of trauma may cause pain of the joints of the waist and the limbs, or impaired movement. Invasion by poisons in the case of trauma may give rise to infection of the local part or the whole body often complicated by various diseases.
“Bi syndrome of the joints, poisoning”
Endogenous pathogenic factors
1) Age
There are different predilection sites and incidence of trauma in persons with different ages. For example, in the case of fall with the hip first touching the ground and the same external force, fracture of neck of femur often occurs in old people, seldom in young people. Children are subject to fracture because of their delicate bones. But their fractures are often incomplete because of their thicker and flexible periosteum. The injury of epiphysis often occurs in young people who are in their growth and developmental periods and whose epiphyses are not occlusal. People in the prime of life seldom get fracture when falling, for their tendons and bones are strong.
“Seniors tend to more fractures. Especially due to falls causing wrist, hip and Lumbar/ Cervical fractures”
2) Physique
The strength of physique is closely related to the occurrence of trauma. Young and vigorous people with abundance of Qi and blood, rich kidney essence and strong tendons and bones seldom suffer from trauma. Old and weak people with deficiency of Qi and blood, asthenia of the liver and kidney and osteoporosis are susceptible to trauma. For example, when falling on a level ground with the hip first touching the ground, they may also get fracture of neck of femur or intertrochanteric fracture even the external force is small.
“What is there body constitution like? Some older people have the body of a much younger person for example. Maybe they don’t eat well and suffer from Spleen Qi defiecy. This will then affect the muscles and these people will be more prone to fractures.”
3) Anatomic structures
Trauma is related to the anatomic structures to a certain extent. Transmitting force acting on a bone usually causes fracture in the junction between compact bone and spongy bone. For example, the part 2 to 3 cm away from the lower end of radius is the junction of compact bone and spongy bone; it is subject to fracture when the palm touches the ground in a fall. The clavicular fracture often occurs in the junction of the two arcuations without protection of ligaments. Take occult cleft spine of S1 as another example, because there is no spinous process, the supraspinal and interspinal ligaments are short of their attachments, thus the stability of lumbosacral joint decreases, the weak part is susceptible to trauma.
“Most fractures happen where the spongy and compact bone meet called the neck”
4) Occupation
The occurrence of trauma is to a certain degree related to occupation. For example, mechanical workers without necessary safety devices are subject to the trauma of hand. Workers constantly bending over or shouldering heavy load are subject to chronic lumbar strain. Athletes, acrobats and Gongfu actors are subject to various sport injuries. And middle-aged people constantly bending over the desk are subject to cervical spondylopathy.
“Lots of bending and lifting jobs. Or computer workers with neck problems.”
----------------------------------
If you read this far, congrats. I hoped you enjoyed it and it gave you a little knowledge. I realize if you dont know anything about TCM, some of the terms prolly dont mean anything. Such as spleen qi defiency, or stuff like the Liver nourishing the tendons. But I am sure you can find a TCM primer on the internet.