1.Etiology and pathogenesis
Intervertebral disc degeneration, excessive strain, joint synovial joint misalignment and intervertebral soft tissue calcification are the main pathological changes of spinal injury; Qi and blood deficiency, liver and kidney deficiency, external invasion, trauma and strain are the Chinese etiology of spinal injury; spinal small joint disorders compressing the vegetative nerves is the basis for the pathogenesis of related diseases caused by spinal injury.
2.Comprehensive treatment
The disorder of small joints in the spine causes neck, shoulder and lumbar pain, which is widespread, long-lasting and difficult to heal, so it is inevitable that there are limitations in treating these diseases by one method alone.
2.1 Three-dimensional balancing chiropractic (manipulation) Three-dimensional balancing chiropractic, also known as “three-dimensional fixed-point balancing chiropractic”, is based on the anatomy and physiology of the spine and biomechanics, the traditional massage, i-extension, inclined plate, rotational pressure and other techniques into one, with traction i-extension, tendon flicking, pressure combing, rotational reset and other rectification techniques to act on the The main treatment goal is to correct the spinal misalignment and restore the biomechanical balance of the spine, thus treating the spinal lesions and various related diseases caused by them.
Three-dimensional balancing chiropractic manipulation emphasizes “three-dimensional, fixed point, balance, spinal correction and chiropractic”. Pointing: The location of the lesion is determined based on the patient’s symptoms, signs and imaging data. According to the lesion site to determine the focus of chiropractic treatment and the main correction of the vertebral body and the direction of adjustment of the vertebral body to be corrected. Balance: focus on the balance of the internal and external, tendons and bones, up and down.
That is, emphasize the balance of spinal disease and spine-related disease treatment, but also pay attention to the balance of bone and soft tissue, in the whole treatment also requires the entire spine as a whole, in the treatment of cervical spondylosis at the same time must pay attention to its thoracolumbar changes. Chiropractic and Chiropractic: To “correct” the body’s misaligned and unbalanced vertebrae, and to “adjust” the abnormal spinal bone relationship. Treatment once a day, 5 times a week for a course of treatment.
2.2 Acupuncture, cupping, massage Director Shi Bin’s acupuncture attaches importance to the identification of meridians and internal organs, and acupuncture according to the disease, the person and the time. If the disease is on the surface, the needling is as shallow as floating; if the disease is on the inside, the needling is deep to the bone. And consider the patient’s physical condition and tolerance, some patients bladder meridian and the Governor’s meridian needles more than 50 stitches; while some patients are very afraid of pain, may only 1 or 2 stitches. At the same time, Director Shi Bin also applied the anatomical theory of Western medicine in the selection of acupuncture points, the conventional selection of points at the same time, in the muscle starting and ending point needling.
The director said that “the well is the origin of the meridian qi”, which refers to the location of the origin of the meridian qi, and that the same muscle pain should also stimulate the “well” of the muscle, i.e., the starting and ending point of the muscle. Needling is usually done once a day, five times a week. In case of cold stagnation of the meridians, paralysis of qi and blood, moxibustion or warm acupuncture is usually added. Patients are routinely treated with Tui Na and cupping after acupuncture.
Director Shibin is also very particular about tui-na, which is both a forceful and technical job. Tui Na must identify the evidence, to meridian tui Na. Before massage, we must fully understand the patient’s condition and combine it with pulse diagnosis to decide the meridian and strength of the massage according to the patient’s pulse condition. Always achieve “lasting, strong, even, gentle and penetrating”.
2.3 Physiotherapy For aseptic inflammation, treatment with ultrashort wave, hyperthermic frequency and laser irradiation is given; for osteoporosis in the elderly, treatment with osteoporosis treatment device is given. 1 time per day. Physiotherapy is prohibited for women with rings, those with metal in their bodies or those with pacemakers, and for women who are menstruating or pregnant. Attention must be paid to special areas such as the eyes and testicles.
2.4 Medication Conventional medication: mannitol or sodium heptaosaponin for local edema, gowu methotrexate for pain caused by aseptic inflammation, bone peptide for osteoporosis, bone loss or hyperplasia, etc.; at the same time, nerve-nourishing drugs such as methylcobalamin are given by acupuncture point injection. Director Shi Bin suggests that during the acute pain period or edema period, the patient must be cautious in the use of blood-activating drugs to reduce the adverse effects of drugs on edema and inflammatory factor absorption.
Chinese medicine dialectical treatment: for symptoms such as numbness of the upper limbs in cervical spondylosis use the cervical pain relief patch, 2 patches once a day; for those with osteoporosis or reduced bone mass with soft liver and healthy spleen soup [7] (formula: 12g of Radix Codonopsis, 10g of fried Atractylodes, 10g of Poria, 20g of Astragalus, 10g of Cornus, 12g of Fructus Lycii, 15g of Yam, 6g of Glycyrrhiza, 12g each of Red and White Peony, Angelica l0g, Chai Hu 9g, Citrus Aurantium 12g, Radix et Rhizoma 9g, Chuan Du Zhong 12g, Epimedium 12g, Radix et Rhizoma 15g, Salviae Miltiorrhizae 20g, Scorpion 9g, Xian Ling Spleen 10g, Zi He Che 12g, Tortoise Plate 12g, Panax notoginseng 10g), decocted in water, 1 dose daily; for hyperplasia and obvious bone changes apply compound blood activation cream [8], 2 patches each time, 1 time daily.
2.5 Acupuncture and 3D traction treatment The acupuncture technique was applied to release the scar contracture of adhesions of spinal related conditions as a whole. At the site of application, after disinfection with vital iodine, local infiltration anesthesia with 1% lidocaine, 1 ml of medicine was injected into each treatment site, the needle was inserted strictly according to the four-step protocol, the needle knife reached the lesion tissue through the skin, subcutaneous tissue, and fascia, and the longitudinal sparing and transverse peeling were performed for 3 strokes, after the operation, the needle knife was withdrawn, local pressure was applied to stop bleeding for 3 minutes, and a band-aid covered the needle eye. After surgery, 3 days of oral amoxicillin was routinely administered to prevent infection. Once a week, 3 times for 1 course of treatment.
For patients with lumbar disc herniation caused by small joint disorders of the lumbar spine, computer-controlled three-dimensional traction therapy is feasible, with a traction distance of 45-60 mm, a flexion of 11°-16°, and a rotation of 0°-18° to the left and right, and the above-mentioned acupuncture treatment is performed at the same time after traction if conditions permit. Absolute bed rest (supine) within 8 hours after traction, and bed rest as much as possible within 3 days, with 2-75px thick bath towel under the waist flat umbilicus for 20 days to 2 months. Traction once a week, usually 2-3 times.
2.6 Chinese medicine fumigation Patients with non-acute pain, no edema and no soft tissue damage, with muscle tension and high muscle tone in the neck, back and lumbar region were given Chinese medicine fumigation with a formula prepared by Director Shi Bin to relieve pain and activate blood circulation. Wu Jia Pi 30g, Bai Zhi 30g, Frankincense 20g, Myrrh 20g, Chuan Wu 30g, Cao Wu 30g, Soapberry 30g, Ice Chips 20g, Raw Gardenia 30g, Raw Phellodendron 30g, Raw Rhubarb 30g, Wei Ling Xian 30g, Haitong Pi 30g. 1 time a day, or 1 time every other day for 40 minutes, taking care to prevent the patient from burns and local swelling.
After the patient is discharged from the hospital, according to his condition, let him use this formula to decoct externally, or make a medicine bag to apply hot compresses on the neck, waist and knee, once a day for 20 minutes each time, and use one pair of medicine for 3 days (3 times), for 2 weeks to 3 months continuously, in order to continue the treatment and consolidate the curative effect.
2.7 Psychological treatment of chronic pain patients generally have a long history of illness, and patients suffer internally when they are suffering from pain, and the long-lasting pain makes patients have symptoms such as anxiety and depression.
3. Examples of cases
3.1 Female, 41 years old. Left upper abdominal pain for 1 year, aggravated for 2 months. The patient had pain in the left upper abdomen after lifting heavy objects 1 year ago, and the diagnosis of gastroscopy was “gastric sinusitis”. The pain was sporadic, and 2 months ago she had persistent vague pain in the left upper abdomen with no obvious cause, and occasionally severe pain for a short time, but it was relieved within a few minutes. Physical examination: body temperature, pulse and blood pressure were within normal range. He was clear and mentally competent. There was no abnormality in cardiopulmonary auscultation. The abdomen was flat and soft, without pressure pain and rebound pain, and the bowel sounds were normal.
The left side of the T8 spine was painful (+). X-ray of the thoracic spine showed that the left side of the T8 spine was distorted. Diagnosis: small joint disorder of the thoracic spine. First in the patient’s back to perform conventional massage techniques, relax the back muscles, and then use the spinal rotation trigger method, the doctor thumb or palm heel of one hand on the top of the T8 spinous process to the right side, the other hand pull the right shoulder so that the spine to the left side of the rotation, hands coordinated force, often heard the “clucking” sound of reset, indicating the success of the reset. At the same time, acupuncture, cupping, physiotherapy, fumigation and medicine were performed. After two weeks of continuous treatment, the patient reported no pain and no pressure pain on both sides of the T8 spinous process on physical examination.
3.2 Female, 38 years old. She was diagnosed with cervical spondylosis in a local hospital 3 years ago after a long period of ambulatory work, and her condition was temporarily relieved after acupuncture, massage and other treatments and oral anti-inflammatory and pain-relieving drugs. He went to many hospitals but did not see any significant improvement.
Examination: no abnormality in cranial nerve examination, no deformity in thoracic back, no abnormality in cardiopulmonary auscultation, muscle pressure pain on both sides of the lower cervical spinous process on palpation (+), pressure pain in the medial scapula (+), pressure pain on the left side of the T4 spinous process (+), nodules on deep palpation, normal muscle strength and muscle tone of the limbs, normal biceps triceps reflexes bilaterally, bilateral brachial plexus nerve pull test (-), bilateral intervertebral foraminal squeeze test (-), bilateral Hoffmann’s sign (-). Cervicothoracic spine plain film showed that the spinous processes of C5 and C6 cervical vertebrae were skewed to the left, and no significant thoracic vertebrae were seen.
Diagnosis: cervical spondylosis (cervical type). Treatment: 1 cervical recumbent rotational pulling manipulation. 2 acupuncture, massage, cupping, Chinese medicine fumigation treatment. 3 anti-inflammatory and pain relief, nerve nutrition, muscle spasm relief and other drug applications. 4 acupuncture and knife release of adhesions on a later date. After 1 week of treatment, the patient’s pain and soreness improved; after 1 month, the pain and soreness disappeared and healed. He was advised to take a light and nutritious diet, pay attention to warmth and exercise appropriately.