Traditional Chinese spinal orthopedic manipulation

Liu-Xin Qu,Li-Yang Xing,Song Gao,Ping Li,Guang-Juan Ke,Lu-Ye Wang

1Zhongda Hospital,School of Medicine,Southeast University,Nanjing 210009,China.

Abstract Traditional Chinese spinal orthopedic manipulation (TCSOM) is an external therapeutic method of traumatology and orthopedics of traditional Chinese medicine to treat trauma and set bone. The doctor exerts his force through thumb or bilateral upper extremities on the spine or acupoints of the patient, applying various manipulatory techniques according to the conditions. Correcting the abnormal position or state of the spine serve as the most important theoretical foundation for TCSOM to treat spinal disorders and spinogenic disorders. This paper presented the definition and function of the TCSOM, with a special focus on how to make a preliminary diagnosis of spinal segments disorders,and the indications of TCSOM in different spinal segments.

Keywords: Traditional Chinese spinal orthopedic manipulation, Spinal manipulation, Indication, Spinal disorders,Spinogenic disorders Abbreviations:

Background

Traditional Chinese spinal orthopedic manipulation(TCSOM) is an external therapeutic method of traumatology and orthopedics of traditional Chinese medicine to treat trauma and set bone. Under the guidance of “concept of holism” and “balance of Yin-yang” of traditional Chinese medicine (TCM)theory, TCSOM develops on basis of human anatomy,spinal imaging, spinal biomechanics and study on physiological and pathological changes. Using the upper extremities to press, rotate, pull the spine,TCSOM could correct the displacement of the vertebrae and intervertebral disc.By means of TCSOM,traction and exercising, TCSOM can effectively prevent and treat spinal diseases and spinogenic diseases[1].

The functions of TCSOM

According to classical literature of traditional Chinese medicine and our previous studies, the functions of TCSOM in the treatment of spinal diseases and spinogenic diseases are as follows[2]:(1)reducing the transposition of the spine joint and intervertebral disc and adjusting the disorder of the spine; (2) relieving stagnation of qi and blood, dredging meridians and collaterals, regulating and harmonizing viscera,balancing Yin and Yang; (3) resolving swelling and removing stasis, relaxing adhesion, relieving muscular spasm; (4) promoting the flow of qi and blood,activating meridians and collaterals, expelling wind and dampness,relieving swelling and stopping pain.

The common TCSOM techniques and pictures

The common TCSOM techniques mainly include cervical thumb pressing manipulation, cervical pulling and rotating manipulation, cervical rotating manipulation, thoracic thumb pressing manipulation,lumbar thumb pressing manipulation, thoracic palm crossed pressing manipulation, pulling shoulder and pressing thoracic manipulation, and lumbar obliquely pulling manipulation(Figure 1).

Indications for TCSOM of different segments

The dislocation of different vertebral joints(intervertebral disk displacement) can stimulate or compress the nerves,sympathetic nerves,blood vessels,ligaments and muscles of the corresponding spinal segments. This dislocation of the vertebral joints can also block channels and collaterals, occlude Qi and blood flowing. The aims of TCSOM are correcting the dislocation, dredging meridians and collaterals,promoting the flow of Qi and blood, adjusting the Yin and Yang balance of the spine, leading to the effect of relieving symptoms. In addition to the reduction of the dislocation of the spine, it can also stimulate the Jiaji(EX-B2) acupoint, the points of the bladder meridian beside the spine and the points on the Governor Vessel(Figure 2) to obtain these acupoints' clinical treatment effects [2]. Therefore, spinal orthopedic manipulation in different spinal segments mainly tackle the symptoms caused by this segment. For example, the displacement between lumbar 4 and lumbar 5 can stimulate and compress the fifth lumbar nerve from intervertebral foramen between lumbar 4 and lumbar 5.The displacement between lumbar 4 and lumbar 5 will affect Qi and blood from the viscera and meridians effuse and infuse in Yaoyangguan (GV 3) acupoint.The place of the Yaoyangguan (GV 3) acupoint also is the innervation area of the fifth lumbar nerve. spinal orthopedic manipulationcan reduce and restore the lumbar 4 and lumbar 5 vertebra displacement,decrease the stimulation and compression of the fifth lumbar nerve and, dredge the Qi and blood from the viscera and meridians at Yaoyangguan(GV 3)acupoint.

Indications for TCSOM in cervical segments

The atlantoaxial joint dislocation is clinically common especially above the third cervical vertebra (C3). The dislocations of cervical intervertebral joint above C3 can stimulate the occipital nerve,vertebral artery and sympathetic nerve., which will lead dizziness, vertigo,headache, occipital pain, nausea, vomiting, insomnia,blurred vision,tinnitus and deafness,tongue numbness,torticollis, amnesia and hypertension [3-10, 13-15].TCSOM could benefit the recovery of the occipital nerve.

The dislocation of the atlanto-occipital joint (C0, 1)can stimulate suboccipital nerve and vertebral artery,resulting in the corresponding symptoms of stimulation:cervicogenic headache, dizziness, nausea, vomiting,eye pain, occipital pain, insomnia, dysphoria, memory loss, cervicogenic hypertension. TCSOM can restore the dislocation, which further relieve these symptoms.The dislocation of the atlantoaxial joint (C1, 2) can stimulate greater occipital nerve, vertebral artery and ganglion cervical superius, resulting in the corresponding symptoms of stimulation: neck pain,torticollis, pain and numbness in the occipital region and cheeks, numbness in the lips and tongue,cervicogenic headache, dizziness, nausea, vomiting,blurred vision, tinnitus and deafness. TCSOM can restore the dislocation of the atlantoaxial joint and relieve these symptoms in C2 and C3 (C2, 3): neck pain, torticollis, pain and numbness in the occipital region and cheeks, numbness in the lips and tongue,cervicogenic headache, dizziness, nausea, vomiting,blurred vision,tinnitus and deafness.

The dislocation of the intervertebral joints,intervertebral disc displacement from C3 down to the first thoracic vertebra (T1) mainly stimulates the cervical nerve root, resulting in the corresponding symptoms of stimulation and compression of the posterior branch of the cervical nerve [3, 5, 7, 11-15].TCSOM relieve the following symptoms by bonesetting: (1) neck and shoulder pain, limited shoulder joint movement, chest pain (about the pectoralis major), upper chest and shoulder sensory disturbance, diaphragmatic spasm and pharyngeal foreign body sensation (fourth cervical nerve symptoms)(C3 and C4(C3,4));(2)shoulder joint pain and limited movement, lateral arm weakness and sensory disturbance (fifth cervical nerve symptoms)(C4 and C5 (C4, 5));(3) anterolateral arm forearm and thumb pain, numbness and weakness, abnormal biceps tendon reflex (sixth cervical nerve symptoms) (C5 and C6 (C5, 6)); (4) posterior neck and shoulder, lateral arm and forearm, index and middle finger pain,numbness and weakness, abnormal triceps tendon reflex (seventh cervical nerve symptoms) (C6 and C7(C6, 7)); (5) the innervation of Dazhui (GV 14) and Dingchan(EX-B1)is the posterior branch of the eighth cervical nerve.Needing Dazhui(GV 14)can treat neck and back pain and rigidity, common cold, febrile diseases, afternoon fever, malaria, cough, asthma,epilepsy. The acupuncture of Dingchan (EX-B1) can treat neck rigidity, shoulder and back pain, asthma,cough, rubella [11]. Therefore, the indications of the TCSOM between C7 and T1 (C7, T1) include neck pain and rigidity, upper back, posterior of shoulder,posterolateral upper limb, ring finger and little finger pain, numbness and weakness (eight cervical nerve symptoms), afternoon fever, febrile diseases, asthma,cough, common cold, malaria, epilepsy and rubella.(Table 1)

Figure 1 The common TCSOM techniques. a, cervical thumb pressing manipulation; b, cervical pulling and rotating manipulation;c,cervical rotating manipulation;d, thoracic thumb pressing manipulation;e, lumbar thumb pressing manipulation; f, thoracic palm crossed pressing manipulation; g, pulling shoulder and pressing thoracic manipulation;h,lumbar obliquely pulling manipulation.

Figure 2 The acupoints of the bladder meridian beside the spine and the acupoints on the Governor Vessel

Indications for TCSOM in thoracic segments

In the thoracic segments,the recovery of dislocation of the thoracic intervertebral joint by the TCSOM can remove or slow down the stimulation of thoracic spinal nerves and sympathetic nerves. Meanwhile, when the TCSOM is applied to press,pull and rotate the thoracic vertebra, it can also act on the Jiaji (EX-B2) acupoints[2, 7, 11-15]. The corresponding adjacent acupoints and the indications of TCSOM in different thoracic segments are described as following.

The innervation of Taodao (GV 13) and Dazhu (BL 11) is the posterior rami of the first thoracic nerve.Needing Taodao (GV 13) can treat headache, stiffness of the back, febrile diseases, malaria [11]. The acupuncture of Dazhu (BL 11) can treat headache,neck and back pain,neck rigidity,scapular pain,cough,fever [11]. Therefore, the indications of the TCSOM between T1 and T2 (T1, 2) include headache, neck,shoulder and back pain, aversion to cold, fever,cough,febrile disease, malaria. (2) The innervation of Fengmen (BL 12) is the posterior rami of the second thoracic nerve. Needing Fengmen (BL 12) can treat headache, backache, neck rigidity, cough, fever and common cold [11]. So, indications of the TCSOM between T2 and T3(T2,3)include headache,backache,neck rigidity, cough, fever and common cold. (3) The innervation of Feishu (BL 13)and Shenzhu (GV 12)is the posterior rami of the third thoracic nerve. Needing Feishu (BL 13) can treat chest pain, asthma, cough,afternoon fever, spitting of blood, night sweating. The acupuncture of Shenzhu (GV 12) can treat back and chest pain,cough, asthma, epilepsy and furuncles [11].So,indications of the TCSOM between(T3 and T4(T3,4)include back and chest pain,cough, asthma, spitting of blood, afternoon fever, night sweating, epilepsy and furuncles. (4) The innervation of Jueyinshu (BL 14) is the posterior rami of the fourth thoracic nerve. The function of Jueyinshu (BL 14) includes cardiac pain,stuffy chest, palpitation, vomiting and cough [11]. So,indications of the TCSOM between(T4 and T5(T4, 5)includes pain in the chest and back,cardiac pain,stuffy chest, palpitation, vomiting and cough. (5) The innervation of Shendao(GV 11)and Xinshu(BL 15)is of the posterior rami of the fifth thoracic nerve.Needing Shendao (GV 11) can treat pain and stiffness of the back, cardiac pain, palpitation, poor memory,cough and anxiety [11]. The acupuncture of Xinshu(BL 15) can treat palpitation, cardiac pain, cough,spitting of blood, night sweating, nocturnal emission,loss of memory, panic, epilepsy and mania [11]. So,indications of the TCSOM between T5 and T6 (T5, 6)include posterior shoulder blade pain, chest and back pain, palpitation, angina pectoris, asthma, cough,hematemesis, night sweeting, nocturnal emission,panic, amnesia and epilepsy. (6) The innervation of Lingtai (GV 10) and Dushu (BL 16)is of the posterior rami of the sixth thoracic nerve, with the functions of neck rigidity, back pain, asthma, cough and furuncles in Lingtai (GV 10) [11], and angina pectoris, chest oppression, asthma, abdominal pain, alternate chills and fever in Dushu(BL 16)[16].So,indications of the TCSOM between T6 and T7 (T6, 7) include neck rigidity, back pain, chest oppression, angina pectoris,asthma, cough, furuncles, abdominal pain, alternate chills and fever.(7)Zhiyang(GV 9)and Geshu(BL 17)are in the innervation of the posterior rami of the seventh thoracic nerve, with the functions of stiffness of the back, chest and back pain, jaundice, cough and asthma in Zhiyang (GV 9), and difficulty in swallowing, hiccup, belching, vomiting, spitting of blood, cough, asthma, measles, afternoon fever and night sweating in Geshu (BL 17) [11]. So, indications of the TCSOM between T7 and T8 (T7, 8) include chest and back pain, hypochondriac pain, cough,asthma, hiccups, belching, vomiting, spitting of blood,jaundice, afternoon fever, night sweating, difficulty in swallowing and measles.(8)Weiwanxiashu(EX-B3)is in the innervation of the posterior rami of the eighth thoracic nerve. Needling Weiwanxiashu (EX-B3) can treat chest pain, hypochondriac pain, diabetes,abdominal pain and vomiting [11]. So, indications of the TCSOM between T8 and T9 (T8, 9) include chest pain, hypochondriac pain, diabetes, abdominal pain and vomiting. (9) Jinsuo (GV 8) and Ganshu (BL 18)are in the innervation of posterior rami of the ninth thoracic nerve, with the functions of stiff back,epilepsy and gastric pain in Jinsuo (GV 8), and backache, hypochondriac pain, jaundice, blurring of vision, night blindness, redness of the eye, epilepsy,mental disorders, epistaxis and spitting of blood in Ganshu (BL 18) [11]. So, indications of the TCSOM between T9 and T10 (T9, 10) include stiff back, back pain, hypochondriac pain, gastric pain, jaundice,blurring of vision, night blindness, redness of the eye,epilepsy, mental disorders, epistaxis and spitting of blood. (10) Danshu (BL 19) and Zhongshu (GV 7) are in the innervation of posterior rami of the tenth thoracic nerve. Needling Zhongshu (GV 7) can treat low back pain, stiffness of the back, epigastric pain[11]. The functions of Danshu (BL 19) include chest pain, hypochondriac pain, jaundice, bitter taste of the mouth, afternoon fever and pulmonary tuberculosis[11]. So, indications of the TCSOM between T10 and T11 (T10, 11) include chest pain, hypochondriac pain,low back pain, stiffness of the back, epigastric pain,jaundice, bitter taste of the mouth, afternoon fever and pulmonary tuberculosis.(11)Jizhong(GV 6)and Pishu(BL 20) are in the innervation of the posterior rami of the eleventh thoracic nerve, with the functions of epigastric pain,stiffness and pain of the back,diarrhea,jaundice and epilepsy in Jizhong (GV 6), and epigastric pain, backache, abdominal distension,jaundice, vomiting, diarrhea, dysentery, bloody stools,anorexia, edema and profuse menstruation in Pishu(BL 20) [11]. So, indications of the TCSOM between T11 and T12 (T11, 12) include epigastric pain,stiffness and pain of the back, abdominal distension,jaundice, vomiting, diarrhea, dysentery, bloody stools,anorexia, epilepsy, edema and profuse menstruation.(12)Weishu(BL 21)and Sanjiaoshu(BL 22)are in the innervation of the posterior rami of the twelfth thoracic nerve and first lumbar nerve, with the functions of chest pain, epigastric pain, borborygmus, abdominal distension, anorexia, nausea, vomiting and diarrhea in Weishu (BL 21), and lower back pain, abdominal distention, borborygmus, indigestion, vomiting,diarrhea, dysentery and edema in Sanjiaoshu (BL 22)[11]. So, indications of the TCSOM between T12 and L1 (T12, L1) include chest pain,epigastric pain, lower back pain, abdominal distention, borborygmus,indigestion, anorexia, nausea, vomiting, diarrhea dysentery and edema.(Table 2)

Indications for TCSOM in lumbar segments

In the lumbar segment, the reduction of dislocation of the lumbar intervertebral joint by the TCSOM can remove or slow down the stimulation of lumbar spinal nerves and sympathetic nerves. Meanwhile, it can take effect on the Jiaji(EX-B2)acupoints,the points (at the same innervations of the spinal nerve) of the bladder meridian beside the Governor Vessel to affect the indications of these points [2, 7, 11-15]. The points and the related indications are showed as following.

(1) Qihaishu (BL 24), Shenshu (BL 23) and Xuanshu(GV 5)are in the innervation of the posterior ramus of the first and second lumbar nerve. Xuanshu (GV 5)indications are lower back pain, indigestion, diarrhea;Qihaishu (BL 24) indications are low back pain,dysmenorrhea, irregular menstruation, asthma;Shenshu (BL 23) indications are low back pain,weakness of the knee, dizziness, blurring of vision,tinnitus, deafness, impotence, nocturnal emission,irregular menstruation, leukorrhea, enuresis, asthma,edema and diarrhea [11]. So, indications of the TCSOM between L1 and L2 (L1, 2) include low back pain, knee joint pain, knee weakness, pain and sensory disturbance in groin, base of penis, testis (labia) and medial upper thigh (first and second lumbar nerve symptoms), indigestion, diarrhea, dysmenorrhea,irregular menstruation, leukorrhea, dizziness, blurring of vision, tinnitus, deafness, impotence, nocturnal emission, enuresis, asthma and edema. (2) Mingmen(GV 4),Qihaishu(BL 24)and Dachangshu(BL 25)are in the innervation of the posterior ramus of the third lumbar nerve. Mingmen (GV 4) indications are low back pain, nocturnal emission, impotence, leukorrhea,irregular menstruation, indigestion and diarrhea;Qihaishu (BL 24) indications are low back pain,asthma, dysmenorrhea, irregular menstruation;Dachangshu (BL 25) indications are low back pain,sciatica, lower extremities pain, numbness and motor impairment, muscular atrophy, abdominal distension,borborygmus, diarrhea and constipation [11]. So,indications of the TCSOM between L2 and L3(L2,3)include pain and sensory disturbance in lower back,femoral triangle, groin, testis (labia), medial thigh,knee joint, the knee joint weakness, muscular atrophy(third lumbar nerve symptoms), sciatica, nocturnal emission, irregular menstruation, impotence,indigestion, leukorrhea, borborygmus, abdominal distension, diarrhea and constipation. (3) The indications of the TCSOM between L3 and L4 (L3, 4)include lumbosacral, anterolateral gluteal, anterior thigh, anteromedial leg pain and sensory disturbance,quadriceps femoris weakness (fourth lumbar nerve symptoms). (4) Yaoyangguan (GV 3) and Guanyuanshu (BL 26) are in the innervation of posterior ramus of the fifth lumbar nerve.Yaoyangguan(GV 3)indications are lumbosacral pain,lower extremities pain, muscular atrophy, motor impairment, numbness, irregular menstruation,impotence and nocturnal emission; the indications of(Guanyuanshu (BL 26) are low back pain, sciatica,diarrhea, abdominal distension, frequent urination and enuresis[11].So the indications of L4 and L5(L4,L5)are lumbosacral pain, posterolateral gluteal,posterolateral thigh, anterolateral leg back foot and great toe pain and sensory disturbance, extensor muscles weakness of great toe, sciatica, muscular atrophy, motor impairment (fifth lumbar nerve symptoms),irregular menstruation,nocturnal emission,impotence, abdominal distension, diarrhea, enuresis and frequent urination. (5) Shiqizhui (EX-B7) and Xiaochangshu (BL 27) are in the innervation of posterior ramus of the first sacral nerve, with the functions of Lumbar pain, thigh pain, paralysis of the lower extremities, dysmenorrhea, irregular menstruation in Shiqizhui (EX-B7) [11], and lower back pain, sciatica, lower abdominal pain and distension, dysentery, nocturnal emission, enuresis,hematuria and morbid leukorrhea in Xiaochangshu(BL 27). So the indications of TCSOM between L5 and S1(L5, S1) are lower back pain, sciatica, paralysis of the lower extremities, lumbosacral, posterior gluteal, thigh and leg,posterolateral heel and lateral three toes painand sensory disturbance, toes flexion muscles weakness (first sacral nerve symptoms), lower abdominal pain and distension, nocturnal emission,enuresis, dysmenorrhea, irregular menstruation,dysentery and hematuria.(Table 3)

Table 1 Indications for TCSOM in cervical segments

Table 2 Indications for TCSOM in thoracic segments

Table 3 Indications for TCSOM in lumbar segments

Conclusion

TCSOM is an effective external therapy for treating spinal disorders and spinogenic disorders. In order to emphasize the point of clinical practice, the major point for indications for TCSOM in different spinal segment, which are commonly encountered clinically,are paid particular attention to.It is believed that in the future, TCSOM will be more and more used in the treatment of orthopedic and traumatological diseases.