How to do rehabilitation through Chinese medicine for spinal cord injury?

Overview of Spinal Cord Injury

Spinal cord injury (spinalcordinjury, SCI) refers to a serious and disabling disease that causes damage to the structure and function of the spinal cord due to direct or indirect factors, resulting in various kinds of motor and sensory disorders and dysfunction of two stools, as well as muscle tone abnormalities, pathological reflexes, and other corresponding changes in the corresponding segments of the injury. Spinal cord injury can cause paraplegia, quadriplegia and other serious consequences.

The name "spinal cord injury" is not found in the ancient Chinese medical books. Combined with the clinical manifestations of this disease, spinal cord injury should belong to the Chinese medicine "impotence", "paralysis", "impotence", "body laziness

In the case of spinal cord injury, it should fall into the categories of "impotence", "paralysis", "impotence paralysis" and "body laziness" in Chinese medicine.

In the TCM rehabilitation treatment of spinal cord injury, the following points should be clarified first:

1. The diagnosis and evaluation of spinal cord injury refer to the International Standard for Neurological Classification of Spinal Cord Injury (revised in 2006) and the evaluation standard of modern rehabilitation medicine.

2. Modern medical therapies are not yet able to cure spinal cord injuries, and Chinese rehabilitation therapies are no exception.

3. Chinese medicine rehabilitation therapy can improve bladder function, reduce muscle atrophy and neuralgia, and promote the recovery of motor function and sexual function in incomplete spinal cord injury.

4. It has better prevention and treatment effect on various complications.

The etiology of the disease

There are fewer records of the disease in ancient Chinese medical books. The earliest record of "spinal cord injury" is found in the "Ling Shu cold and hot disease", "if there is a fall, the limbs are slack and do not collect, the name is the body is lazy. After the "Neijing", a more complete description of the symptoms of the record in the Ming Dynasty Zhao Xian can be "Medical Guan": "There is a class of people, the body half of the above are unaffected as the ordinary people, half of the body below, weakness and paralysis, urination or astringent or self-laundering," but did not mention the etiology of the disease and the treatment method. From Han to Ming and Qing dynasties, according to other ancient medical books, spinal cord injury has not been described. Combined with modern clinical, the common causes of spinal cord injury are car accidents, falling, smashing and diseases (such as myelitis, spinal cord tumors, etc.), while most of the wartime firearms injuries.

The anatomical and physiological functions of the spinal cord are similar to those described by the ancients for the Directing Vessel. The Directing Vessel originates in the middle of the cell, descends out of the perineum, goes straight up the neck to the top of the head, and descends to the nasal column to the Gingival Crossing Point at the upper lip tie, where it meets the Ren Vessel. The Twenty-eight Difficulties of the Classic of Difficulties states, "The Directing Vessel originates from the Yu of the Lower Extremity, goes up to the Fengfu, and enters the brain." The hands and feet of the three Yang meridians and the Vertebra meet, the Vertebra of the body's Yang meridians have a commanding, supervisory role, so the Chinese medicine has the Vertebra "Governor of the Yang" and the Vertebra for the "sea of Yang veins," the statement. The Su Wen bone empty theory "and said" the Governor Vein "," through the spine belongs to the kidneys ". Therefore, the normal function or not, can affect the kidney Yang's prosperity.

The pathogenesis of spinal cord injury in Chinese medicine is the damage of the dong chi and the deficiency of kidney yang. Specific content is as follows:

(a) the ducal vein trauma, qi disorders, yin and yang imbalance ducal vein "governor of the yang", "the sea of yang veins". The ducal vein injury, meridian blood stagnation, yang gas can not be transmitted through the ducal vein to warm the limbs and bones, the tendons and muscles lose their warmth, so the limbs are numb without paralysis. At the beginning of the paralysis, if the treatment is timely, the method is appropriate, the broken bones and tendons can be healed, blood stasis can be removed, the passage of the vein, the prognosis is better; otherwise, the prognosis is not good.

(2) the dui chi injury, kidney yang insufficiency

dui chi injury after prolonged treatment, the kidney yang loss of its warm smoked, kidney off unfavorable, two bowel loss.

(3) the liver and kidney yin deficiency, false wind internal movement of the ducal vein injury delayed for a long time, yang loss and yin, liver and kidney deficiency, tendons and veins can not be moistened, the liver wind internal movement, the limbs are seen straight contracture.

In addition, damage to the ducal vein, yang qi insufficiency, the clinical evidence of many changes. If yang qi is insufficient, the guard is not solid, the slightest external evil attack, the evil and the positive fight and fever. Insufficient yang qi in the lungs and kidneys can lead to abnormal qi and respiratory difficulties. Most of the impotent people can not take care of their own life, the pubic area is not clean, coupled with the lack of yang qi, the dirty evil is easy to invade the bladder into the hot and humid and issued as gonorrhea. If the kidney is weak, the lower part of the body is not solid, and thus the urine is dripping for gonorrhea. Long-term deficiency of kidney yin and yang will lead to bone thinning without bone marrow. The paralyzed limbs are not running smoothly, coupled with long-term bedridden, localized pressure for a long time, such as not turning over in time, can lead to pressure on the bone protruding skin and flesh decay and ulceration for decubitus ulcers.

In short, the spinal cord injury is located in the ducal vein, and the liver, kidney, lung, spleen organs related. Spinal cord injury is mostly manifested as insufficiency of liver and kidney, phlegm and stagnation of meridians, yang qi is not enough to warm the limbs and bones, so that the muscles and sinews lose moistening, lung qi is not declared, and in the long run, the yang loss and yin, resulting in yin and yang deficiencies.

Three, class syndrome identification

Paralysis refers to the wind, cold, dampness, heat and other external evils attacking the body, blocking the meridians, qi and blood running poorly caused by the muscles, muscles, bones, joints, aches and pains, numbness, heavy, flexion and extension of the unfavorable, and even joints swollen and burning, etc., as the main clinical manifestations of the disease. Paralysis is mainly due to the lack of positive qi, feel the wind, cold, dampness, heat of the evil caused.

Impotence is a disease in which the muscles and veins of the limbs are flaccid and weak, and the muscles atrophy over time due to the inability to move freely.

"Suwen xuanji original disease style five transport main disease": "impotence, said the hands and feet impotence, weakness, inability to run also." "Impotence" refers to limb impotence, "crippled" refers to the lower limbs are weak, can not walk meaning. The "Neijing" pointed out that the main pathology of impotence for the "lung heat leaf focus", lung dryness can not lose the essence of the five organs, so the five organs are not nourished, resulting in impotence and soft symptoms.

The symptoms of both are mainly in the limbs and joints. Paralysis is to sinews, muscles, joints, soreness, heavy, flexion and extension as the main clinical features, sometimes with numbness or swelling, but no paralysis and impotence; while impotence is characterized by limb weakness and muscle thinning. The limbs of the impotence syndrome are generally painless, while the paralysis syndrome has pain.

Four, identification and treatment

(A) identification and medication

1. damage to the ducal vein, blood stasis and obstruction of collaterals

[Points for identification] localized swelling and pain or tingling at the injury site, the pain is fixed and does not move, cervical spinal cord injury presents quadriplegia, thoracic and lumbar spinal cord injury in the lower extremities of the sensation is completely or incompletely disappeared, pain and itching do not know, numbness and numbness, tendon slow and not collected, constipation, urine retention, and often the constipation of urine, and the constipation and retention of urine. The patient is often accompanied by abdominal distension and poor appetite, disturbed and less sleepy, with petechiae and bruises on the tongue and astringent pulse.

[Treatment] Activating blood circulation and removing blood stasis, dredging up the dugu vein.

[Prescription] Tongdu Huayu Tang: Angelica sinensis, red peony, peach kernel, safflower 10g each, panax notoginseng powder 3g, 15g of yuanhu, 8g of rhubarb, 15g of Chuanjie, 15g of hyssop, 8g of Ganoderma lucidum, boiled with water, 1 dose per day.

In the formula, angelica, red peony, peach kernel, safflower to activate blood circulation and eliminate blood stasis, panax ginseng, rhubarb to remove blood stasis and generate new blood, Chuanjian, Sichuan hyssop to replenish the kidneys and strengthen the tendons, appendicia to warm the yang to help dredge the dugu vein, and yuan hu to activate the blood and move qi to relieve pain. If there is concurrent evidence of liver depression, 10g of Chai Hu, 10g of Yu Jin and 10g of Calamus can be added to relieve liver depression.

2. Damage to the Directing Vessel, kidney yang insufficiency

[Points to recognize] limbs or both lower limbs tendons and veins flaccid, impotence, the affected limbs cold, pain and itching do not know, constipation, urinary incontinence or retention, and see the face of the white and fear of cold, pale moss on the tongue, pulse sinking late. Most often seen in soft paralysis.

[Treatment] dredge the dong chi, warm and tonify kidney yang.

[Prescription] soft paralysis Kang: deer antler 15g, antler 30g, dry ripe land 80g, 20g of raw land, 25g of Sichuan hyssop, Cortex Eucommiae 30g, cornelian cherry meat 25g, cannon with 20g of epimedium, Cistanchis 20g, goji berry 30g, chickweed vine 25g, wine angelica 30g, hot dillon 15g, schizandra 15g.

*** for the end of the honey as pills, musk 5g for clothing, 10 pills per pill, and the other 5 pills per capsule, the other 5 pills per capsule, the other 10 pills per capsule, the other 10 pills per capsule. 5g as coating, 10g per pill, 1 pill each time, warm boiled water to take down, 2 to 3 times a day.

The formula includes deer antler, deer horn, epimedium, cistanchis, eucommia, musk to warm the yuan-yang, cornelian cherry, raw and ripe ground, wolfberry, schizandra to tonify the kidney, astringent yin and fill in the essence to help the kidney yang, henbane, angelica sinensis, diabetic dragon, Sichuan cow's knee to activate blood and pass to the governor.

3. Yang damage and yin, false wind within the movement

[Points of identification] limbs or both lower limbs tendons and veins constricted, convulsions and not use, aggravated by cold, cold limbs cold, limb pain and itching do not know or self-conscious pain in the limbs, urinary retention, pale tongue, moss white or petechiae, pulse sinking tight. Most often seen in hard paralysis.

[Treatment] Invigorate blood and pass through the directory, warm the yang and astringe the yin, soften the liver, dispel wind and relieve spasm.

[prescription] hard paralysis Kang: antler 15g, antler 20g, Cortex Eucommiae 20g, cornelian cherry 10g, ripened earth 20g, raw earth 20g, frankincense 10g, myrrh 10g, Wu Ling Zhi 15g, wine Angelica sinensis 20g, shelled Chuanwu 10g, sizzling Maqian Zi 0.4g, white adenosine 9g, the whole scorpion 6g, Wu Snake Meat 10g, white peony 60g, chickweed vines 15g, raw glycyrrhiza glabra 15g.

***For the end, refined honey as pills, musk 5g for the coat, 9g per pill, 1 pill each time, warm boiled water to take, 2 to 3 times a day.

The formula of deer antler, antler, Cortex Eucommiae, cornelian cherry, raw and ripe ground, musk warms the kidney yang, five lingzhi, shelled Chuanwu, sizzling Maqianzi, white aconite, whole scorpion, Wu Snake Meat to dispel wind and spasmodic collaterals, white peony, chickweed vine, angelica to nourish the blood and astringent yin, soften the liver to spasmodic, frankincense, myrrh to invigorate the blood and relieve pain.

Because of the long course of this disease, in addition to the above three types, there are clinical variations, according to the specific conditions of diagnosis and treatment.

(2) Acupuncture therapy

1. The main mechanism of spinal cord injury is damage to the duchenous vein and insufficient kidney yang. The treatment should be to dredge the ducal vein, access to yang as the principle of treatment. Electro-acupuncture of the duchenous vein can dredge the duchenous vein and run the qi and blood.

Operating method: In the damaged spinal cord plane above and below the 1 ~ 2 vertebral space, each selected a point of the duchenous vein, the selection of points should be avoided surgical scars. Needling along the spinous process tilt direction into the needle, the depth of needling to reach the epidural until. The depth of the needle must be strictly controlled, too shallow to affect the efficacy, too deep may cause new spinal cord injury. Especially caution should be taken when needling the cervical and upper thoracic segments. In order to avoid infection and other mishaps, the operator is required to have sufficient experience in acupuncture and strictly observe the aseptic operating procedures, and the depth of needle insertion should be adjusted according to the individual differences of the patient when needling the neck, so as not to injure the spinal cord. After the needling in place, the upper and lower needles are connected to the two electrodes of the DC pulse electroacupuncture instrument on the handle. Before connecting the electrodes, the switch of the electroacupuncture instrument should be turned off and the intensity knob should be adjusted to zero, and the current intensity of its stimulation should be gradually increased from a small amount, and the current intensity should be used to cause obvious contraction of the muscles, and the patient should be able to tolerate it.

2. The head needle therapy head for spinal cord injury patients with motor function and limb spasm state improvement has a certain role in promoting.

Methods: motor disorders take bilateral motor area, the affected limb spasticity take dance tremor area. The use of large-scale twisting maneuver, each row of needles 3 ~ 5min, can be left 20 ~ 30min, once a day.

3. Hua Tuo pinch spine therapy is generally selected along the lesion vertebrae on both sides of the upper 2 to 4 vertebrae to the lumbosacral pinch spine points, lifting and inserting twisting.

Electrical stimulation can be added for poor needle sensation.

4. Body acupuncture body acupuncture in the treatment of spinal cord injury, is more widely used in a treatment method, has a certain effect.

Complete spinal cord injury patients, spinal cord injury below the plane of sensory disappearance, often no needle sense, so in the treatment of commonly used electric body acupuncture. There are two types of acupoints:

(1) taking acupoints according to the meridian: the foot yangming stomach meridian, the foot sun bladder meridian, the foot less yang gallbladder meridian, the directing vein, the ren vein is the main. Gastric meridian take Liangmen, Tianshu, ShuiDao, GuLai, ThighGuan, YinShi, FootSanLi, JuHu; bladder meridian take the viscera back YuYu points and diaphragm YuYu points; gallbladder meridian take JingMen, HuanJian, FengShi, YangLingQuan, JieBiao, QiuXiu, FootLinXiu, TaChyong; dui chi take big vertebrae, tao dao, body column, zhi yang, hangshu, lumbar yangGuan, shen dao, tendon shrinkage, life; Ren chi take the middle epigastrium, jianLi, moisture, qi hai, guanYuan, zhongJi. It is also possible to choose Zhangmen, Sanyinjiao, Diqi, Blood Sea, Yongquan and so on. Each meridian acupoint, alternating in turn, 1 group each time, every other day or once a day, 30 times for a course of treatment.

After a course of treatment, rest for a week before proceeding to the next course of treatment. Needles are generally thicker and the amount of stimulation is stronger, especially in the vicinity of the normal sensory plane, the needles should be thicker and the stimulation should be stronger.

(2) According to the evidence to take acupuncture points: regulating the second bowel movement choose eight soles, Tianshu, Qihai, Guanyuan, Sanyinjiao; lower limb muscle strength is poor, the anterior side of the thighs take Thigh Guan, Fubu, Liangqiu, the lateral side of the wind city, Yanglingquan, foot Sanli, Jiezhi, the posterior side of the Chengfu, Yinmen, Kunlun; foot prolapse to take the solution of Xixi, Shangqiu, Taichong; foot externally take the Zhaohai; foot inward turn take the Shen pulse.

(C) other therapies

1. Moxibustion spinal cord injury, bowel dysfunction of Chinese medicine mechanism is mainly for the lack of kidney yang, moxibustion can be warmed through the yang, improve bowel function. You can choose Guanyuan, zhongji for wooden box moxibustion, salt moxibustion and so on.

Spastic paralysis is often accompanied by pain in the affected limbs, the pathogenesis of kidney yang insufficiency, cold condensation of the tendons and veins, the treatment should be given to warm the cold, available moxibustion, the selection of acupuncture points can be referred to the body acupuncture therapy, the selection of moxibustion points.

2. Tui na rehabilitation therapy commonly used techniques are press, kneading, shaking method, shake method, take method, rubbing method.

Pressing and kneading Baihui for 5min, applying the method to the waist and back, selecting and kneading the points of Liver Yu, Spleen Yu, Kidney Yu, Huanjiao, Fengshi, Yanglingquan, Foot Sanli, Bianzhong, Chengshan, Xiexi, Taichong, 1~2min for each point; applying patting to the Directing Vessel to the extent that the skin is slightly reddish; applying the method of shaking and shivering to the lower limbs locally. Tui na has an auxiliary therapeutic effect on improving blood circulation of the affected limbs, preventing muscle atrophy and relieving muscle spasm. Tui na 1 ~ 2 times a day, each 30min. 15d per course of treatment, rest 2 ~ 3d, the next course of treatment.

3.Bathing therapyBathing therapy is the use of water, sunlight, air, mud and sand and other natural physical factors, so that it acts on the body surface, through the physical and chemical effects of these physical factors, to promote recovery.

Warm water bath, that is, the patient's whole body immersed in 39 ~ 41 ℃ warm water, each time about 15min. In the water can do active and passive movement of paralyzed limbs, and massage or self-massage. With the help of buoyancy effect can reduce the movement resistance of paralyzed limbs. Its mechanical buoyancy and hydrostatic pressure can play the role of massage, swelling and pain relief; its warmth effect can promote the operation of qi and blood, relieve muscle tension and fatigue; minerals and trace elements in the hot spring also help patients recover. On top of that, you can also add a decoction of peach kernel, safflower, bone marrow, wugapi, cinnamon stick, fine Xin and other traditional Chinese medicines to soak the paralyzed limbs.

Precautions: It is recommended that warm baths not be taken on an empty stomach or after a full meal, and the soaking time should not be too long, as the patient's paralyzed limbs have sensory deficits, and care should be taken to prevent burns.

In addition to the above therapies, can also be silkworm sand fried hot external ironing, wine vinegar therapy, sun therapy, etc., are helpful to the limbs of the meridians and circulation of the operation of qi and blood.

4. Qigong therapy is mainly practiced in the prone position, at the beginning of the intention to guard the dantian (Guanyuan point), natural deep breathing, at the same time, the focus of thought on the paralyzed parts of the repeated imagery of relaxation of the muscles from top to bottom and silently recite the word "loose". After a period of practice, the mind can relax and concentrate at will, then concentrate the mind and silently recite the word "motion", and gradually expand the range upward from the movement of the distal fingers or toes. Successful experience tells us that the qigong method should be practiced persistently for several years.

Fifth, the complications of Chinese medicine rehabilitation treatment of spinal cord injury patients as the course of the disease, there may be a lot of complications that may occur, these complications bring pain to the patient, affecting the life of self-care, and even life-threatening. Traditional Chinese medicine has certain curative effect on common spinal cord injury complications, and better curative effect can also appear for some complications.

(I) Depression syndrome

Spinal cord injury patients suffer from accidental trauma and appear to be emotionally uncomfortable, do not want to eat and drink, dystocia and rib distension and pain, or easy to be angry, or silent. This syndrome appears in a long period of time after spinal cord injury, if not given timely improvement, the patient's recovery and the family and society will bring negative impact. Chinese medicine has certain advantages in treating this syndrome.

This syndrome is mainly due to the spinal cord injury, the patient is physically and mentally traumatized, emotional and emotional discomfort, resulting in the loss of liver detoxification, the spleen loss of transportation, the heart and the spirit of the disorder, the viscera yin and yang qi and blood disorders and become. According to the clinical manifestations of this syndrome, the identification and typing are as follows:

1. Liver qi stagnation

[Points for identification] mental depression, emotional restlessness, chest tightness, good breath, chest and hypochondriac distension and pain, pain in no place, abdominal distension and nausea, tongue red, moss white greasy (white), pulse stringy (number).

[Treatment] Dispersing the liver, regulating qi and relieving depression.

[Prescription] Chaihu Shuanhe San plus reduction: 12g of Chaihu, 10g of Citrus aurantium, 10g of Xiangsui, 10g of Chenpi, 12g of Ligusticum chuanxiong, 12g of Paeoniae lactiflora, 10g of licorice, 10g of Uljin, 10g of Qingpi.

The soup can be accompanied by Yuejiu Pills, which can help to move the qi and relieve the depression. The main reason for this evidence is trauma, clinical blood stasis and qi stagnation, so it is appropriate to add angelica, danshen, peach kernel, safflower and other blood activating and removing blood stasis herbs.

2. Qi depresses and transforms into fire [points of identification], irritability, chest and hypochondriac distension, noisy acid swallowing, dry mouth, bitter, constipated, or headache, red eyes, tinnitus, red tongue, yellow moss, stringy pulse or slippery string.

[Treatment] Clearing liver and fire, relieving depression and harmonizing the stomach.

[prescription] dan jia jiao free powder combined with zuo jin wan: angelica 12g, white peony 15g, atractylodes macrocephala 10g, chai hu 12g, poria 15g, danpi 10g, gardenia 10g, licorice 10g, peppermint 6g, luteolin 10g, wu juju 3g.

such as mouth bitter, moss yellow, constipation can be added to the large yellow, gentian herb diarrhea and laxative.

(2) Lung infection

Because of the decrease of intercostal muscle strength and the impairment of lung ventilation after cervical spinal cord injury, lung infection is one of the common complications after cervical spinal cord injury, which accompanies all stages after spinal cord injury and is often accompanied by persistent high fever. In addition to the infectious factors, the elevated body temperature is often related to the dysfunction of sweating below the injury plane, so physical cooling is particularly important in the treatment.

Lung heat congestion: spinal cord injury for the damaged ducal vein, yang qi insufficiency, the guard surface is not solid, coupled with a long period of bed rest, lying down for a long time to injure the gas, the invasion of foreign evils, the evil offenders lung guard. External sensation of heat, heat evil burns the fluid, visible body heat, upset, but the head sweating (damage to the plane of sweating disorders).

The lungs can't transmit the fluid to the whole body, so the muscles and skin are not nourished, and the limbs are impotent. Lung fluid can't moisturize the throat, which can be seen as dry mouth and thirst. The lungs and the large intestine are superficial, the lungs can not transmit the large intestine, so the urine is yellow and red, constipation, red tongue, moss yellow or yellow greasy, pulse flooding or slippery.

[Treatment] Clearing away heat and diarrhea of the lungs to clear the bowels.

[Prescription] Ma apricot Shi Gan Tang and Cheng Qi Tang: ephedra 6g, almonds 10g, gypsum 30g, licorice 10g, rhubarb 10g, thick Park 10g, Citrus aurantium 15g.

If constipation, dry as sheep dung is difficult to get down, you can add 10g manganese nitrites, increase the effectiveness of the ventilation of the internal organs of the heat; the late stage of fever, the residual heat has not been cleared, to take the bamboo leaf gypsum soup with additional reductions.

Cervical spinal cord injury patients due to the decline in respiratory muscle strength, ventilation dysfunction, coughing weakness, sputum is not easy to cough out, it is advisable to often take the lung phlegm medication, and with the phlegm training in order to facilitate ventilation, prevention of infection.

(3)Vertigo

Vertigo is one of the common complications after spinal cord injury, and it occurs suddenly in the wheelchair, which is mild and stops while lying on the ground, but in serious cases, it is like sitting in a car or a ship, rotating indefinitely, and it is often accompanied by nausea, vomiting, sweating, and even transient loss of consciousness.

Spinal cord injury in traditional Chinese medicine is recognized as damage to the dong chi. The ducal vein is the sea of yang meridians, the governor of the body's yang qi. Damage to the ducal vein, yang can not warm the five organs, the five organs of qi and blood biochemical lack of source, qi deficiency is clear yang does not show, blood deficiency is the brain loss of nourishment, so see the color of the face is less gorgeous, lips and nails pale, fatigue, less breath lazy speech, tongue pale, pulse weak.

[Treatment] Strengthen the spleen and tonify the kidney, benefit the qi and nourish the blood.

[Prescription] Gui Spleen Pill combined with Liu Wei Di Huang Wan: 15g of Codonopsis, 15g of Astragalus, 12g of Atractylodes macrocephala, 15g of Poria, 12g of jujube seed, 15g of Longan meat, 10g of Chen Pi, 15g of Angelica sinensis, 10g of Yuan Zhi, 10g of Jujube, 10g of licorice, 10g of Cornu Cervi Pantotrichum, 20g of Rehmanniae Praeparata, 15g of Chinese yam, 12g of Dampi.

Such as the middle qi is insufficient, the clear yang does not rise, and there is dizziness from time to time. If there is insufficient middle qi, Qing Yang does not rise, there is dizziness from time to time, the color of the face is dark, and it is often not possible to stand upright, it is advisable to tonify the middle qi, and tonify the middle qi soup with additional subtractions can be taken. If the limbs are tired, short of breath and lazy, the mouth is thirsty, sweaty, weak pulse, restlessness, sleep and sleep, you can add the pulse powder.

(D) urinary tract infection

Urinary tract infection is an inflammation caused by pathogens that grow and multiply in the urine in the body and invade the mucous membranes or tissues of the urinary tract. The main symptoms are urinary frequency, urinary urgency, urinary pain, fever and back pain. According to the clinical manifestations of the urinary system, it mostly belongs to the category of gonorrhea in Chinese medicine. The Jingyue Encyclopedia of Gonorrhea has a more specific description, "Gonorrhea is a disease in which the urine is painful and astringent and dripping, wanting to go and not go, and wanting to stop and not stop is also the case." The main etiology of urinary tract infections: in the early stage of dampness and heat in the bladder, over time can be from solid to virtual, or mixed with virtual and real. Due to the presence of sensory impairment in patients with spinal cord injury, urinary tract infections often do not have symptoms of bladder irritation such as urinary frequency, urinary urgency, urinary pain. Diagnosis is mainly based on laboratory tests. Routine urinalysis is the easiest method, and the diagnosis can be confirmed by more than 5 leukocytes per high magnification field of view under the microscope. Patients with spinal cord injury are more prone to urinary tract infections than normal people because of the presence of bladder dysfunction in patients with spinal cord injury and the presence of residual urine, which facilitates the survival of pathogenic bacteria. When the bladder dysfunction is not well resolved, ureteric reflux is easy to occur, and pathogenic bacteria in the bladder retrograde with urine, causing pyelonephritis. Reduced immunity below the plane of injury in spinal cord injury patients is also an important factor. In addition, because of the spinal cord injury after the mobility, urinary and fecal control is poor, the perineum unclean, also increases the chance of infection.

The Chinese medicine treatment of urinary tract infection is mainly based on clearing dampness and heat, and those with qi deficiency can add ginseng, astragalus and other traditional Chinese medicines to support the positive and drive away the evil. In terms of nursing, it is advisable to keep the perineum clean and dry. Regularly check the urine routine, early detection, early treatment. Once a urinary tract infection occurs, anti-inflammatory treatment can be carried out at the same time, with traditional Chinese medicine to identify and treat.

Dampness-heat is the main cause of this disease, and its dampness-heat underflow exists in the whole process of the disease, only the clinical manifestations are light and heavy, therefore, clearing the dampness-heat is the main law of the treatment of this disease. According to the clinical manifestations of this complication, identification and typing are as follows:

1. bladder dampness-heat

[Points of identification] chills and fever, cloudy urine or urinary frequency, urgency, pain in urination, yellowish greasy moss, slippery pulse.

[Treatment] Clearing away dampness and heat, diuresis and drenching.

[Prescription] Lian Dioscorea Zhi Bai Tang combined with Bazheng San with the addition and subtraction of: Lian Dioscorea Zhi Bai 15g, Dioscorea Dioscorea 15g, Zhi Mu 6g, Cyperus rotundus 6g, Plantago ovata 15g, Bian Zhi 30g, Qu Mai 15g, talcum 10g.

With hematuria or occult blood in the urine (+), add leucocephala root 15g, small artichoke 10g; qi deficiency, urinary protein (+), add astragali 30g, Radix et rhizoma Ginseng 15g; stool dryness, add raw dahuang 6g. Add 6g of rhubarb for dry stool; add 10g of gardenia and 10g of scutellaria baicalensis for those with bitter and turbid mouth, red tongue and yellow fur; add 15g of smallpox powder and 10g of saxifrage for those with dry mouth and tongue, red tongue and little fluid.

2.

[Treatment] Cleanse the liver and gallbladder and regulate the water channels.

[prescription] gentian diarrhea liver soup plus reduction: gentian 10g, gardenia 10g, scutellaria 10g, chaihu 5g, psyllium 30g, zedoary 10g, raw land 15g, licorice tip 5g.

The above two types often with high fever, no sweat add gardenia black bean soup; Cold heat exchanges with sweating, can be added to use small chaihu soup.

3. Kidney yin insufficiency, dampness and heat to stay in [identification points] dizziness, tinnitus, waist and knee soreness and weakness, dry throat and lips, frequent and short urine, urinary astringency and pain, wanting to come out, or accompanied by low fever, tongue reddish, moss is thin, the pulse is thin and number.

[Treatment] Nourish yin and benefit the kidney, clear heat and reduce fire.

[Prescription] Zhi Bai Di Huang Wan plus flavor: Dampi 10g, Poria 12g, Zedo 10g, yam 10g, 16g, Zhi Mu 10g, cypress 10g, Dendrobium 12g, Cornu Cervi Pantotrichum 10g, Tong Cao 3g, Psyllium 15g, Glycyrrhiza glabra 6g.

4. Spleen and kidney deficiencies, the residual evil is not yet cleared [Points to note] the face is floating and swollen feet, dullness and abdominal distension, fatigue, dizziness, ringing in the ears, bowels, and the spleen. The first is that there is no need to be a doctor, but there is no need to be a doctor, so there is no need to be a doctor, so there is no need to be a doctor.

[Treatment] Strengthening the spleen and kidney, clearing heat and promoting dampness.

[Prescription] Ginseng and Atractylodes Macrocephalae San combined with Erxian Tang plus subtraction: Codonopsis pilosula 10g, Astragalus 15g, Atractylodes macrocephala 15g, Semen Coix lacryma 15g, Semen cynomorium 10g, Cyperus vulgaris 10g, Zhimu 10g, Semen lindane 10g, Radix Angelicae Sinensis 10g, Chinese yam 10g, Poria 15g, Plantago Ovatae 15g.

In the treatment of medication, the disease of acute or chronic eruption of the author, most often see the damp-heat condensation, Qi transformation disorder of solid heat evidence, the disease of the spleen and kidney. The actual heat evidence of qi and chemical disorders. Acute is to treat the symptoms in order to get rid of the disease for this, the use of heat detoxification drugs, the dose is larger than the usual amount. In the chronic stage, the disease is long and prolonged, positive qi has been weak, should be both the symptoms and the root cause of the disease.

In addition, on the basis of evidence-based treatment, can also be based on modern Chinese medicine pharmacological research, plus the use of E. coli have a role in the drug such as half a lotus, white hair Xia Gu Cao, silver flower, forsythia, scutellaria, fenugreek, Hai Jin Sha, etc., with a broad-spectrum anti-bacterial effect of the Chinese herbs Dazhou Ye, Banlangen, gardenia, ZiHuadiding, seven leaves of the flowers, and so on.

(E) spinal cord injury pain

spinal cord injury neuralgia refers to the spinal cord injury patient injury plane below the torso pain, more cut-like, burning-like, needle-like, the degree of light and heavy, serious pain patients can not stand. Its nature is similar to phantom limb pain, aggravated at night or when the weather changes, affecting the patient's daily life and sleep. At present, the mechanism of spinal cord injury neuralgia is not completely clear.

The theory of traditional Chinese medicine believes that its main mechanism should be blood stasis and stagnation of qi, and the meridians are blocked, and if they are not blocked, it is painful. The treatment should be to promote blood circulation and blood circulation, and to move qi to relieve pain as the treatment principle.

1. Traditional Chinese medicine

(1) Blood stasis and paralysis

[Points to note] The pain is immovable, especially at night, and the tongue is purple or there are petechiae and ecchymosis, and the pulse is dull and astringent.

[Treatment] Activate blood circulation and eliminate blood stasis, and clear the veins to relieve pain.

[Prescription] Hematopoietic Blood Stasis Relief Soup with additions and subtractions: Angelica sinensis 10g, safflower 10g, Citrus aurantium dulcis 12g, Chaihu 9g, hyssop 10g, Ligusticum chuanxiong 15g, Paeonia lactiflora 10g, Diluentia sinensis 10g, Cynomorium henselae 30g, Glycyrrhiza glabra 10g.

If it is exacerbated by cold, and if it becomes comfortable when it gets warmer, then add 9g of turmeric and 6g of gui zhi, and if it is painful when it gets hot, add 10g of dandeleonium, 9g of hematopodium sulphuricum. p>(2) Liver qi stagnation [points of identification] spinal cord injury below the plane of limb pain, aggravated by emotional and emotional depression, distension and natriuresis, thin moss and stringy pulse.

[treatment] dredge the liver and regulate qi, warm the menstruation and relieve pain.

[prescription] chaihu shu hepatic散加减:柴胡15g，枳壳10g，白芍20g，川楝子10g，香附10g，川芎15g，甘草10g，延胡索15g.

lower limb pain is very bad add chuan niu knee 10g，du huosuo 5g; qi depresses and transforms into fire, symptomatic fever and mouth dryness, red tongue with yellow fur, pulse stringy can add dandelion, gardenia.

2.acupuncture treatment

(1) electroacupuncture therapy: using direct current pulse electroacupuncture instrument, stimulation frequency 50 ~ 100Hz, intermittent wave, stimulation intensity should be small to large, slowly adjusted to the patient can tolerate for the maximum, stimulation time for 20 ~ 30min. distal lower limb pain choose both sides of the Yongquan acupoints; anus pain choose Changqiang, lumbar yangguan. This electro-acupuncture method is effective for severe pain where other therapies are ineffective.

(2) head acupuncture therapy: acupuncture nerve pain corresponding to the sensory area (Jiao's head acupuncture zoning), such as the right lower limb neuralgia, prick the opposite side of the sensory area of the upper 1/5.

(3) body acupuncture therapy: the application of the lower pain on the method of taking, i.e., lower extremity pain, prick the upper extremity of the same side of the same name meridian corresponding acupuncture points or the corresponding part of the pain reaction points.

(6) Spasticity

Spasticity is a common complication in patients with quadriplegia and paraplegia, and severe limb spasticity often affects their rehabilitation training and ability to take care of themselves in daily life.

Chinese medicine theory suggests that spasticity in patients with spinal cord injury is due to insufficient kidney yang after the injury of the ducal vein, and yang qi can not properly warm the tendons and veins, and the cold stagnation in the internal and lead to the collection of the pull; or due to the yin and yang of the liver inversion of the disorder, false wind in the internal; or due to the deficiency of yang qi, the blood flow is delayed, resulting in tendon loss of moistening. Therefore, the principle of treatment is to dredge the dugu vein, nourish the blood and soften the liver, quench the wind and disperse the cold.

1. Chinese medicine treatment to spasm Pingning main formula, with the evidence of addition and subtraction.

The main formula: 60g of white peony, 15g of papaya, 3g of scorpion, 1 centipede, 15g of Wang Jiangnan, 10g of Angelica sinensis, 10g of Xu Changqing, 10g of Glycyrrhiza glabra.

2. Acupuncture treatment

(1) ducal vein electro-acupuncture therapy: spasm, although manifested in the tendons, the origin of which is the damage to the ducal vein, so dredge the ducal vein, adjusting the qi, blood, yin and yang, can be restored to the balance of spasm, natural relief. The spasm will be relieved naturally. The purpose of acupuncture is to dredge the duchenous vein, which is an important acupuncture method for the treatment of spasms. Specific methods refer to the acupuncture treatment part of this section.

(2) head acupuncture therapy: acupuncture spasm corresponding to the dance tremor area (Jiao's head acupuncture zoning), such as lower limb spasm stab bilateral dance tremor area on the upper 1/5.

(7) secondary osteoporosis secondary osteoporosis on the recovery of patients with spinal cord injuries is more harmful, and in serious cases easy to cause fracture, so it must be actively prevented and treated.

Chinese medicine believes that the kidney is the main bone and marrow, drug prevention and treatment of osteoporosis should be based on tonifying the kidney and strengthening the bone. Clinical Zuo Gui Wan as the basis of the addition and subtraction. Prescription: 15g of ripened huangdihuang, 15g of wolfberry, 15g of raw astragalus, 15g of poria, 10g of cuscuta, 10g of hyssop, 10g of tortoise board gum, 10g of antler gum, 15g of dragon bone, 15g of oyster, 15g of horny goatweed, 15g of bone marrow, 20g of bone marrow, 10g of snake beds, 10g of danshen, 15g of chuanxian, 15g of dusun, 15g of bone marrow, 15g of bone marrow.In addition to the medication, adhere to the exercise, especially standing and walking training. Especially standing and walking training is also very important for the prevention and treatment of osteoporosis secondary to spinal cord injury. The above training must be carried out in a standing cabinet or wearing a brace, and the training must be protected by the accompanying personnel to avoid fracture.

(H) pressure ulcers

1. External treatment of decubitus ulcers