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Commonly used in diagnostic approaches Tuina

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Updated: Saturday, Mar 07,2009, 1:53:13 PM
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Tuina therapy has a broad range of indications. These are diseases in trauma, surgery, internal medicine, gynecology and pediatrics. In clinical practice, examination and treatment should be performed under the direction of the basic theoryadmin

Tuina therapy has a broad range of indications. These are diseases in trauma, surgery, internal medicine, gynecology and pediatrics. In clinical practice, examination and treatment should be performed under the direction of the basic theory...

Tuina therapy has a broad range of indications. These are diseases in trauma, surgery, internal medicine, gynecology and pediatrics. In clinical practice, examination and treatment should be performed under the direction of the basic theory of traditional Chinese medicine and in combination with modern medical science. Ie, Tuina treatment should be based on a comprehensive understanding of the patient's general condition and symptoms, a comprehensive analysis and a correct diagnosis through inspection, auscultation and olfaction, research and palpation diagnosis in traditional Chinese medicine and modern medicine, physical and laboratory examinations.

Knowledge of inspection, auscultation and olfaction, research and palpation of diagnoses can be obtained by reference to the diagnostics of Traditional Chinese Medicine. Diagnosis
and examination of the spine and the members in the inspection and palpation of the diagnostics of traditional Chinese medicine are important means of diagnosis Tuina.

Physical examination of the region of the spine
   
The normal functioning of the spine
      
A normal spine is designed to ventriflexion, retroflection, lateroflexion right and left and rotation. The cervical vertebrae are normally ventriflex 350, retroflex 350, lateroflex 450and rotation 300. The normal lumbar vertebrae ventriflex 900 retroflex 300 lateroflex 200and rotation 300.
   
Inspection, diagnosis
      
Inspection diagnosis of the area of the spine must first be concentrated in the existence of a possible change in the curve of the spine physiological and if there is a spinal deformity. The spine has four normal physiological curves, ie the earlier cervical curvature, posterior thoracic curve, lumbar curve before and after curvature tailbone. In the examinations, inspections must be made on the abnormal posture of a patient, such as lateral spine curvature (scoliosis) or the inclination, to bosse, aggravation or decrease of the lumbar curvature previous pelvic obliquity.
      
The deformation of the spine earlier curvature (lordosis) mainly results from poor posture or infantile poliomyelitis. The deformation of the posterior spine curve is evident in the angular form, as a painter is often seen in infantile rickets and tuberculosis of the spine. The deformation of the posterior spine curve shaped arch with a rigid posture is often seen in rheumatoid spondylitis. In kyphosis
former patients occurs in the thorax section.Scoliosis often the result of poor posture, the different lengths of the lower limbs, deformity of the shoulder,
rupture of the fiber rings of thoracic intervertebral disc, poliomyelitis and infantile chronic pathological changes of the chest cavity or thorax. Scoliosis caused by poor posture May disappear flat and bending the waist.
      
It should also pay attention to the color of skin, hair, swelling of soft tissues. For example, coffeecolor different spots on the lower back, the presence of neurofibroma or proliferative fibrosis.Too long hair in the lumbosacral region and the dark skin suggest congenital sacral fracture. The mesal swelling of soft tissues in the waist shows bulging of the dura mater of the spinal cord, and swelling in the lumbar Trigone one side often means multiple abscesses.
   
Palpation diagnosis
      
During palpation of the diagnosis is made, the patient takes a standing position or lying down. Pressure pain in the spinal cord examinations are divided into superficial and deep tenderness and indirect. Superficial tenderness shows pathological changes in the surface layer, such as the above-interspinal and ligaments, while deep tenderness and indirect indicate that pathological changes occur in large areas such as the vertebral body, small joints, intervertebral discs. In most cases of deformation of soft tissues in the back, and tenderness myospasm can be found in the affected area. For example, the strain of the ligaments can cause interspinal Interspinous tenderness. Strain of the ligaments above a supra-tenderness. Strain of the lumbar fascia causes tenderness and depth of meaning or myospasm or drag node adjacent to the transverse axis of the third lumbar vertebra. Lumbodorsal strain of a muscle reflects the tenderness and muscle spasms.
  
In the case of rupture of fibrous rings cervical and lumbar intervertebral disc, there may be found deep tenderness and radiating pain in the region and interspinal both sides of the intervertebral discs sick. If there is pain, pressure or pain point wave, or no tenderness at all, or a comfortable sense that the size is hit with a fist, which is the symptom of low back pain of retroversion of the uterus, nephroptosia, neurosism etc. pain pressure points on the back and lumbar regions should also be identified if they are the reflection of the visceral pain of the disease in this field. For example, heart disease May have some tenderness around the left Xinshu acupoints (BL 15), while pressure from the pain of diseases of the liver and gallbladder May appear at the right Ganshu acupoints (BL 18) and Danshu (BL 19). In the clinic, so the careful and comprehensive observation and examination is very necessary.
   
Examinations
      
Percussion test on the vertex

      
The patient is sitting upright, and strikes the patient's doctor vertex with one hand fists separated in the palm of one hand. If this causes pain in the neck pain and numb feeling set in the upper limbs or pain in the lower back and lower limbs of the person concerned, the test is positive, indicating that the neck the uterus or lumbar nerve roots are compressed.
      
Test pressing and pressing the intervertebral foramen
      
The patient is sitting up, and the doctor presses the top of the patient with both hands simultaneously overlap and makes the cervi
cal vertebrae pressed and pressed in different directions. If this causes pain in the neck or the neck or radiating pain, it indicates that the test is positive and the nerve roots of the cervix are compressed.
      
Tensile test of the brachial plexus
      
The curves of the patient or his neck forward. The doctor submits the patient's head with one hand holding the wrist of the affected side with the other and pulls in the opposite direction. The pain and numbness in the limbs of patients to prove that the test is positive, suggesting that the brachial plexus is compressed and pathological changes in the cervical vertebrae are.
      
Test bending neck
      
The patient is in a prone position and bends the neck, actively or passively, for 1 - 2 minutes. If the pain is caused in the lumbar and lower parts of the test result is positive, indicating that the lumbar nerve roots are compressed.
      
Test stick in the abdomen
      
The patient is lying on his back, sticks to the abdomen, because of lower back and pelvis to leave the bed and a cough. Pain in the leg lumbus and shows a positive reaction, indicating that the lumbar nerve roots are compressed.
      
Test to lift one leg straightened
      
The patient is lying on his back with legs and stretching of the joints of the right knee, and then does the leg movement of the leg after the other. Measure the angle of recovery lazy legs ie the angle between the bed and the lifting of the leg. The angle of less than 600 shows the positive reaction, indicating that the lumbar nerve roots are compressed lumbar vertebrae and pathological changes exist.
      
Test of dorsiflexion of the big toe
      
The patient is in supine position with his lower limbs stretching. The patient's doctor presses his big toes with two inches, in turn asks the patient to bend backward with their strength because of countermeasures against back. If the patient the strength of dorsiflexion decreases or disappears at the moment, it indicates that the test is positive and the 4th and 5th lumbar intervertebral nerve roots are compressed and pathological changes occurred in the lumbar vertebrae.
      
Test of the big toe of the plantar flexion
      
The patient is lying on his back and straighten the limbs. The doctor submits the palmar aspect of the patient's great toe with his hands and asks the patient to flex the great toe because of countermeasures against back. If the patient force of plantar flexion decreases or disappears at the moment, it indicates that the test is positive and the intervertebral nerve roots between the 5th lumbar and 1st sacral vertebrae are compressed and some pathological changes have taken place.

    Physical examination of the Upper Extremities
   
The normal function of the upper limbs

      
Physical examination of the upper limbs include tests of the shoulder, elbow wrist joints. When the scapula is still maintained, the activity of the normal range of shoulder joint is as follows: abduction, 900; adduction, 450 ventriflexion, 900; retroflection, 450; internal rotation 700 - 900 ; external rotation, and 300 livestock, 1800 (removal of attorney or activity, including the rotation of the scapula). The business range includes the elbow joint flexion, 1300 - 1500; pronation, 800 - 900; supination, 800-900. Whereas the dorsiflexion of the wrist is 300 - 600, Volar flexion, 500 - 600, Removal, 150 - 200and adduction, 300 - 400 "
   
Inspection, diagnosis
      
Contrast examinations must be made in inspection diagnosis. The observations are first made whether the two shoulders are the same height, and both upper limbs are the same thickness and length. Physical observations are made on the color and if there is deformity, swelling, phyma and muscle atrophy, etc. Erection of the scapula indicates congenital erect scapula. If the inner edge of the scapula is back, particularly noticeable when the hands are placed on a wall, it suggests paralysis of the serratus anterior muscle, also known as the pterygoid muscle. In case of serious injury, the apparent swelling on the back of the shoulder suggests the dislocation of the shoulder or fractore of the scapula. Loss of the deltoid tuberosity and the formation of a square indicates the shoulder especially luxafion of the shoulder. Compare the two shoulders and see if the other end of the clavicle has been blocked and hit the shoulder displaced downward, forward or inward. The first shows the dislocation of the acromioclavicular joint or fracture of the tip of the clavicle, and it is the sign of the dislocation of the sternoclavicular joint or fracture of the clavicle. The elbow joint angle of a portable 50to 70 in a straightened position, and angle of women is generally greater than that of men. Increases in average cubitus valgus angle of the elbow, while the decrease of the laptop or the angle of the forearm to the ulnar indicates cubitus varus elbow.

The medial condyle and lateral condyle of the humerus and the ulna olecranon form an isosceles triangle, called triangle 900flexion elbow in the elbow. When the elbow joint dislocates, the normal relationship of the elbow triangle will be broken. When Supracondylar fracture occurs, the person often retains an arm semiflexion position. When Supracondylar extension fracture of the humerus or dislocation of the rear part of the elbow joint occur, clearly the olecranon sticks back. In patients with babies semiluxation of Capitulum radii, deformation of the forward rotation of the forearm is often perceived. Silver fork-shaped or bayonet-shaped deformation is often seen in fracture of the distal radius. Radial nerve injury in May ptosis because of the wrist. Median nerve injury allows the thumb are not able to oppose the actions of volatile and abduction, the thumb and index finger, unable to be moved, and hy perextension. Thenar atrophy main RESUL
ts into a monkey paw. Ulnar nerve injury of the thumb causes are not able to supply, the other fingers are not in a position of adduction and abduction and the 4th and 5th metacarpophalangeal joints unable to flexion and extension. Minor atrophy of the thenar led to claw hand. Symmetric diamond swollen interphalangeal joints of the proximal end of the two sides said rheumatoid arthritis.

Clubbed finger all the finger suggests heart disease or lung bronchiectasis, or cyanotic congenital heart disease etc. As for the diseases of infants under three years of age, color of the finger vein (ie the surface radial venules on the palmar surface of the index) May be used as references for determining the severity of diseace. The 1st joint of the index is called the wind move the qi and the 2nd pass 3rd pass life in pediatric diagnosis. Normal finger vein is red in color and occupations in the wind passes. Bright red finger vein is due to the invasion of exogenous pathogens. Purple finger vein indicates pyretic pathogen. Dark blue indicates convulsion. And the color is pale, asthenia, cold syndrome. Abnormal color of the finger vein seen in the wind is the sign of the mild disease. When it comes to move qi, the disease was very serious. Its penetration in life, go watch a critical state of the disease.
   
Palpation diagnosis
      
In the diagnosis of palpation of the shoulder, it is necessary to understand its normal anatomic structure, circulation and bone range brands. The acromion is a bony projection above outer shoulder. Below the acromion, the bony projection is the largest tuberosity of the humerus. Prior to the acromion is the end of the clavicle. The coracoid process is in place above the median head of the humerus and a finger width of less than 1 / 3 of the crossing of the square outer and middle clavicle . Palpation in the diagnosis, careful consideration must be made with the thumb to look for tenderness point to take note of the fact that the structure is normal, if the abnormal movement, friction sound and look to exclude fracture. Examination of the point tenderness over the shoulder must be combined with the functions of the shoulder joint to determine the location of pathological changes. Tenderness on the front underside of the acromion area denotes minor pathological changes in the tuberosity of the humerus. On the external aspect of the acromion indicates pathological changes around the great tuberosity of the humerus. Tenderness of the external humeral epicondyle suggests external humeral epicondylitis (tennis elbow), while tenderness felt on the domestic market shows humeral epicondyle internal epicondylitis of the humerus.

Pathologic change in the ulnar nerve causes significant local tenderness and thickening of the sensation on the ulnar side lateral elbow and numbness of the series on the upper arm. Limitation to abduction and adduction of the forearm of an injury from the end of the internal and external flexors and extensors of the forearm or injury to ligaments or guarantees of the avulsion fracture internal and external epicondyle. Tenderness on the styloid process of the radius is most often caused by tenosynovitis of the long and short extensor muscles of the abductor muscle of thumb. Tenderness on the palmar surface of the joints metacarpephalangeal is often seen in tenosynovitis of the 1st, 2nd, 3rd and 4th fingers. Tenderness on the central part of the cross bracelet wrist palmar aspect of the radiating accompanied by pain and numbness of the fingers are the symptoms of carpal tunnel syndrome. Localized mass, which is palpable on the dorsal wrist and can move slightly along the tendon of the muscle in the vertical direction, but can not move in the direction parallel, is generally thecal cyst.
   
Examinations
      
   Removing test the shoulder joint
      
Loss of function of the shoulder joint accompanied by pain suggests the dislocation and fracture of the shoulder joint. Need to carefully removed with sharp pain suggests clavicular fracture. Feeling no pain at the beginning of the abduction and the worst pain arising from the shoulder horizontal indicates the accession of the shoulder joint. The pain felt during the abduction and no pain during fall shows subdeltoid bursitis. The pain felt during the removal and within the range of 600 - 1200raising, but no pain beyond the range indicates tendinitis of supraspinatus muscle. The pain felt during the abduction of children and raise suggests periarthritis of the shoulder.
      
Test of long tendon of biceps muscle
      
Ask the patient to extreme internal rotation, which is bent with the elbow to the forearm in the back. If the cause of pain in the shoulder, it is Tenosynovitis of the long head of biceps brachii.
      
Test tennis elbow
      
The patient looks a little bit of your forearm and fist latches first half and tries to bend the wrist, as far as possible, and can not complete the pronation of the forearm and finally straighten the elbow. If at that time, the pain is shown in the lateral aspect of humeroradial articulation, the test is positive, indicating that pathological changes of the external humeral epicondyle.
      
Resistance Test
      
The patient extends his fingers and no dorsiflexion of the wrist, the examiner supports the patient with the palm of his hand, and the patient flexes the wrist against resistance. If pain is felt, the test is positive and pathological changes appears to have occurred in the medial epicondyle of the humerus.
      
Test shaking his fist
      
The patient sick latches fist with the thumb inside and outside the four fingers and flexes the wrist to the ulnar side town. Pain in the styloid process of the radius shows that the test is positive, indicating tenosynovitis stenosans.
      
Test bending of the wrist
      
If the bending of the wrist of the patient Joi
Commonly used in diagnostic approaches TuinaFrom: TCM_xiaozhong Time: 9/13/2008 9:34:19 AMAcupuncture: TCM to a breakthrough in the world "national essence of acupuncture," the history of the United States use specific acupuncture "national essence of acupuncture," the history of the United States use of acupuncture nt at the extreme limit causes numbness of his fingers, the test reveals a channel syndrome carpal tunnel.

Physical examination of the Lower Extremities
   
The normal functioning of the lower limbs
      
On physical examination of the lower limbs, the item should be placed on the test measuring the displacement of the town and accompanied by symptoms.
      
The normal functions of the hip joint are. flex 1300 - 1400, retroflection 100 - 300, the removal of ~ 45 - 600, external rotation 400 - 500, and internal rotation, 300 - 450, those of the knee joint are as follows: flexion 1200 - 1500 while the ankle: 350 dorsiflexion and plantar flexion 450.
   
Inspection, diagnosis
      
The observations were made on the existence of hyperadduction, shortness of breath and deformation in the abduction, abnormal conditions of the length and thickness and atrophy of muscles of lower limbs. Swelling of the hip joint can lead to plumpness of the groin. Lateral protrusion of the upper joint of the hip most often the results of congenital dislocation or semiluxation. Lower lateral swelling of the hip joint is primarily for the pathological changes greater trochanter or is caused by injection of pus himbosacral because of infection. The asymmetry of the bilateral buttock Rugae often in infants shows congenital dislocation of the hip. A normal knee has only 50 of hyperextension.Hyperextension over 50 strain belongs to retroextension or back of the knee, while the inability to stretch the right is a bending deformation. Under normal conditions, the thigh and shank to slightly eversion 50to 80. If eversion is more or less than 50to 80, it is eversion deformation or deformation inversion. Swelling of the synovium scholarship above the kneecap bursitis suggests synovitis. Plumpness two Xiyan (pitting on both sides of the knee) and swelling around the knee because of hydrarthrosis. The swelling of the tibia and femur condyle or swelling of the metaphysis of the bones suggest tumor. Swelling of the tibial tubercle means osteochondritis.

Rhomboid swollen knees indicates tuberculosis of the knee joint or rheumatoid arthritis. Swelling of the medial and lateral ankles and pain caused by the rupture of dorsiflexion suggest malleolus. Disappearance of the opponent below the ankle, calcaneus broardened and pain at the point of rupture of the Achilles tendon suggests calcaneus. Disappearance of normal pitting below the ankles and on both sides of the Achilles tendon with corrugated sensation indicates hydrarthrosis or hematoma. If the swelling is limited to one side, the loss of security is often seen ligament. Swelling of the posterior area of the foot indicates Achilles tendinitis, bursitis synovitis and hyperosteogeny, etc.
   
Palpation diagnosis
      
The patient is lying down. The examiner touches and strong support with its two inches of the zone of 2 cm from the midpoint of the inguinal ligaments on both sides and observe the reaction, or strikes of the greater trochanter or the heel with a fist. If the pain in the hip joint is the cause, pathological changes in this area is proposed. Superficial tenderness on the lateral side of the largest tochanter indicates bursal synovitis in this section. Tenderness on the side of the whirbone shows malacoplakia bones of the hip. Tenderness on the tibial tubercle indicates osteochondritis of tibial tubercle. Tenderness at the point of attachment of the lesion shows collateral ligament ligament of the guarantee. Tenderness in the Achilles tendon suggests pathological changes of the tendon itself or
next to the membrane of the tendon. Tenderness on the medial and lateral calcaneus indicates the pathological changes of the calcaneus itself. Tenderness directly below the medial and lateral ankle on both sides of the calcaneus shows pathological changes of the Subtalar Joint.
   
Examinations
      
Bending test of knees and hips
      
The patient is positioned supine and flexes his knees and hips. The occurrence of pain at least bending indicates 900of pathological changes in the hip joint. Pain 900. 1200flexion suggests pathological changes of the sacro-iliac joint and pain in more than 1200shows pathological changes of the lumbar spine or lumbosacral joint.
      
Hyperextension test the hip joint
      
The patient is lying down and straighten the legs. The doctor patient presses the sacroposterior fix his pelvis with one hand and supports up to the tail used to make its hip hyperextend. The occurrence of pain at this time indicates pathological changes of the hip joint.
      
Percussion test heel of the foot

      
The patient is in supine position, with two legs. The doctor raised the leg with one hand and strikes him with his foot to the heel of the palm. Pain in the hip joint indicates a positive test and pathological changes of the hip joint.
      
Number "4" form test
      
The patient is lying on his back with the normal of the lower limb and right lateral ankle sick branch to branch during normal knee. And the doctor
Presses the iliac spine earlier upper normal with members on the one hand, and presses the sick knee downwards with your other hand (forming a "4" form). If pain in the test is too severe for the test to be pursued at that time, it shows the pathological changes in the hip joint. If the pain does not hinder the test, it suggests the emergence of disease in the sacro-iliac.
      
Grinding test
      
The patient takes a recumbent position, straighten the hip and knee bends to hit 900. The doctor determines the patient's legs, holds the patient's affected foot with both hands, pull the patient's knee and rotates its tail. If the pain is caused, he said meniscus injury. However, raise the tail to get the area of the knee joint extended and then rotate it. If the pain is caused, it suggests the wounds of collecting
Commonly used in diagnostic approaches TuinaFrom: TCM_xiaozhong Time: 9/13/2008 9:34:19 AMAcupuncture: TCM to a breakthrough in the world "national essence of acupuncture," the history of the United States use specific acupuncture "national essence of acupuncture," the history of the United States use of acupuncture ral ligaments.
      
Test for rotation of the knee joint
      
The patient is lying on his back. The physician supports the patient in the knee with one hand and holding the ankle with your other hand to the knee joint not passive flexion and extension movements. If the patient feels the pain of the queue when it adducts and turns outwards and extends the right, he said meniscus injury of the middle part. When the stem removed, rotates and extends inward and feel the pain, he said meniscus injuries of the face side.
      
Drawer test
      
The patient is supine, flexes the knee to 900and relaxes muscles. The doctor holds up the patient's stem pushes and pulls it forward and back repeatedly. If the patient feels pain and a feeling of dislocation as a drawer out of the groove when the doctor pushes forward, it shows the pathological changes of the anterior cruciate ligament. If pain and feels
feeling of dislocation of a drawer is embedded into the patient pulling on the back of the tail of his superior, there must be the problem of pathogenic posterior cruciate ligament.
      
   Internal and external rotation test foot
      
The examiner determines the patient's stem with one hand and takes her foot with the other hand, then turned his ankle inwards and outwards, to an extreme measure. If pain is felt in the same aspect, it indicates the possibility of a fracture of the inner or outer ankle. If pain is felt in the opposite side, he said paraligament injury.

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