Commonly Used Diagnostic Approaches in Tuina
Commonly Used Diagnostic Approaches in Tuina
Tuina therapy has a wide scope of indications. It involves diseases in traumatology, surgery, internal medicine, gynecology and pediatrics. In clinical practice, its examination and treatment should be conducted under the guidance of the basic theory of TCM and in combination with modern medical knowledge. That is to say, tuina treatment should be based on an overall understanding of a patient's general condition and local symptoms, a comprehensive analysis and a correct diagnosis by means of inspection, auscultation and olfaction, inquiring and palpation diagnoses in TCM as well as modern medical physical and laboratory examinations.
The common knowledge of inspection, auscultation and olfaction, inquiring and palpation diagnoses can be gained by reference to diagnostics of TCM. The diagnosis
and examination of the spinal column and the limbs included in inspection and palpation diagnoses of TCM are important means of tuina diagnosis.
Physical Examinations of the Spinal Region
The normal functions of the spinal column
A normal spine has the function of ventriflexion, retroflexion, lateroflexion to the right and left and rotation. The cervical vertebrae can normally ventriflex 350, retroflex 350, lateroflex 450and rotate 300. The normal lumbar vertebrae ventriflex 900, retroflex 300, lateroflex 200and rotate 300.
Inspection diagnosis
Inspection diagnosis of the spinal area should be first concentrated in whether there is any change in the spinal physiological curve and whether there is any deformity of the spinal column. The normal spine has four physiological curves, i.e. the cervical anterior curvature, thoracic posterior curvature, lumbar anterior curvature and sacrococcygeal posterior curvature. In examinations, inspection should also be made on the abnormal conditions of a patient's posture such as spinal lateral curvature (scoliosis) or inclination, humpback, aggravation or lessening of the lumbar anterior curvature, pelvic obliquity.
Deformity of the spinal anterior curvatures (lordosis) mostly results from poor posture or infantile poliomyelitis. Deformity of the spinal posterior curvatures manifested in angular form like a hump is often seen in infantile rickets and tuberculosis of the spine. Deformity" of the spinal posterior curvatures shaped as an arc with a stiff posture is often seen in rheumatoid spondylitis. Kyphosis in
old patients commonly occurs in the thoracic section.Scoliosis often results from improper posture, different lengths of the lower limbs, deformity of the shoulder,
rupture of the fibrous rings of the thoracic intervertebral disk, infantile poliomyelitis and chronic pathologic changes of the thoracic cavity or thorax. Scoliosis caused by improper posture may disappear on lying flat and bending the waist.
Attention should also be paid to the color of the skin,fine hair, swelling of local soft tissues. For example, coffeecolor spots of different shape on the lower back indicate the existence of neurofibroma or proliferative fibrosis.Too long fine hair in the lumbosacral area and dark skin suggest congenital sacral rupture. Swelling of the mesal soft tissue in the waist indicates bulge of the dura mater of spinal cord, and swelling in lumbar trigone of one side often means multiple abscess.
Palpation diagnosis
When palpation diagnosis is conducted, the patient takes a standing position or a lying position. Pressure pain points in spinal examinations are divided into superficial,deep and indirect tenderness. Superficial tenderness shows pathologic changes in the superficial layer such as that in the supraspinal and interspinal ligaments, while deep and indirect tenderness indicates that pathologic changes take place in the deep areas such as in the vertebral body, small joints, intervertebral discs. In most cases of strain of soft tissues in the back, myospasm and tenderness can be found in the affected area. For instance, strain of the interspinal ligaments can cause interspinous tenderness. Strain of the supraspinal ligaments has supraspinal tenderness. Strain of the lumbar fascia commonly causes tenderness and thick sense or myospasm or streak node beside the transverse process of the third lumbar vertebra. Strain of the lumbodorsal muscles has the reflection of tenderness and spasm of local muscles.
In the case of rupture of the fibrous rings of the cervical and lumbar intervertebral disk, there can be found deep tenderness and radiating pain in the interspinal area and both sides of the diseased intervertebral discs. If there is only aching pain, or vague pressure pain point, or no tenderness at all, or a comfortable sense when the waist is being stricken with a fist, that is the sign of symptomatic lumbago of retroversion of uterus, nephroptosia, neurosism, etc. Pressure pain points on the back and lumbar regions should also be identified whether they are the reflected pain points of the visceral diseases in this area. For example, heart diseases may sometimes have tenderness around the left acupoint Xinshu (BL 15), while the pressure pain point of diseases of the liver and gallbladder may appear at the right acupoints Ganshu (BL 18) and Danshu (BL 19). In clinic, therefore, careful and overall observation and examination are quite necessary.
Specific examinations
Percussion test on the vertex
The patient sits straight, and the doctor knocks the patient's vertex with one hand in fist separated by the palm of the other hand. If that causes pain in the neck, serial pain and numb sensation in the upper limb or pain in the lower back and lower limb of the affected side, the test proves to be positive, which indicates that the cervical or lumbar nerve roots are being compressed.
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