Xing Wan, Hui-Xin Yan, Qi Tao, Jian Yu, Ming-Xi Shao

1. Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210029, Jiangsu, China 2. Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China

Keywords:Shao Mingxi Jiansi acupoint Awn needle Four-finger push method Knee osteoarthritis

ABSTRACT Objective: To introduce the clinical experience and treatment characteristics of Professor Shao Mingxi's acupuncture penetrating "Four Four Points" to treat knee osteoarthritis. Methods: By following the teacher's professor Shao Mingxi, he should learn to pierce "Four Points", collect their test cases for the diagnosis and treatment of knee osteoarthritis, and summarize their diagnosis and treatment experience and clinical characteristics. Results: The method of Professor Shao Ming-Xi’s “Bin Si Xue” connected with four fingers push in treatment of knee osteoarthritis is notably effective. Conclusions: Professor Shao Mingxi's unique experience in treating knee osteoarthritis with acupuncture needles at "Four Points" The effect is remarkable, and the preliminary summary is summarized to inherit the experience of famous old Chinese medicine.

1. Introduction

Shao Mingxi (1939-), male, professor, doctoral supervisor, chief TCM physician, famous Chinese medicine practitioner of Jiangsu Province, Mr. Shi Chengsheng, is the first-generation heir of the four-finger massage massage school, and has been engaged in acupuncture massage orthopedics for more than 50 years. He is good at Use awn needle penetration, four-finger push method to treat spinal, limb bone, joint and soft tissue diseases [1]. In recent years, Professor Shao applied awn needle penetration commonly used in the lumbar buttock and lower limb muscles to the limb joints. Under the guidance of "Tendresis of Meridians and Pain" [1,2], based on meridian theory and knowledge of bone and joint anatomy, combined with many years of clinical experience, it is concluded that the use of awn needles to penetrate "Four Points" is supplemented by four The finger push method [1,3] has a significant effect on the treatment of knee osteoarthritis. The author is fortunate to follow Professor Shao to learn and diagnose the disease, and now I will write his experience book at the tip of the pen to follow the same path.

2. Overview of knee osteoarthritis

Modern medicine believes that knee osteoarthritis is a type of chronic degenerative osteoarthritis [4,5] characterized by osteoarticular cartilage degeneration, destruction, and bone hyperplasia.The main clinical manifestation is knee swelling and pain, with varying degrees of stiffness and deformation. Knee joint pain is mostly paroxysmal in the beginning and more persistent in the later stages. It is overworked, overactive, and prone to aggravate at night. Restrictions often have "interlocking", which is different when running, jumping and squatting. The degree is limited and even lameness [1,6]. This disease is more common in middle-aged and elderly people, and there are more women than men, which are mostly related to age, sex, weight, trauma, osteoporosis, decreased knee muscle strength and genetic factors [7] Studies have shown that the prevalence of this disease reaches 10% in people over 40 years old, 70% in people over 65 years old, and 80% in people over 75 years old, and the disability rate is extremely high [8,9]. Knee osteoarthritis belongs to the categories of "osteoporosis", "muscle paralysis", "knee paralysis", and "knee pain" in traditional Chinese medicine [10,11]. Most doctors often use oral non-steroidal anti-inflammatory analgesics or take blood to remove blood stasis. Tongluo's traditional Chinese medicine, or topical plaster, can obtain short-term analgesic effect, but it is also difficult to control its pain and improve its function.With little success [12].

Lao Shao concluded that knee osteoarthritis is mostly the same disease of the bones and bones, and the cause is mostly liver and kidney deficiency, fatigue injury or external evil invasion, that is, the liver and kidney are the main tendons, the kidneys are the main bones, and the liver and kidneys are deficient. In addition, fatigue, injury, or invasion by external evils lead to qi and blood meridian obstruction and pathogenesis. "Su Wen · The Essentials of Pulse Essentials" in the cloud: "The place where the knees are tendons," that is, where the knees are gathered. For the gathering of the tendons, the Meridians of the Foot Sanyin and Sanyang Classics all start from the feet and converge on the knees; in the "Su Wen · Wei Luan Pian", "Zong Jin is the main bone and the organs are beneficial", that is, Zong The tendons can restrain the joints and benefit the whole body joints. Therefore, Professor Shao believes that the treatment should be based on the principle of "treating bones and bones together, focusing on tendons". The local acupoints of the three yin and three yang meridians of the knees should be used for penetration. "Four points" mainly combined with four-finger push method to "kill tendons and blood circulation, Tongluo analgesic, relieve adhesions, smooth joints" to treat knee osteoarthritis, the clinical effect is significant.

3. Professor Shao's special points

3.1 "Four Points"

Professor Shao summed up the painful sites of knee osteoarthritis in combination with years of experience in knee treatment. Under the guidance of the principle of "menstrual tendon as disease, pain as palate", according to the theory of meridian theory and anatomical knowledge of bones and joints, he initiated the treatment of "Four Points" Diseases of the knee joint. "Four points of the patella" are around the sacrum, that is, the inside and outside of the upper and lower edges of the sacrum. The four meridian points and the extraordinary meridian points are also not recorded in the ancient and modern literature, so they are named "Binyan point"). The knee eye points are located at the lower part of the sacrum, the depressions on both sides of the sacral ligament, and one point on the inside and outside of the lower edge of the sacrum. The medial end is the medial knee eye and the lateral end is the lateral knee eye.The sacral eye is located at the upper part of the sacrum. Exophthalmos. As shown in Figure 1), because it passes through or is adjacent to the three Yin and Sanyang meridians of the knee, it can have the effects of relieving muscles and promoting blood circulation, relieving pain, and smoothing joints. The main treatment of knee osteoarthritis is to use a 3-5 inch awn needle to puncture the joint space between the four joints or the soft tissue around the knee.To the knee joint or in the joint space to make it work quickly and directly to the clinic; from an anatomical point of view, the anatomical location of the "Four Points" is the patellofemoral joint, tibiofemoral joint and proximal tibiofibular joint It is also easy to produce direct meridian stimulating effects, and it can achieve significant curative effects without leaving needles.

In general, the traditional acupuncture treatment of knee osteoarthritis should be based on the local acupoints of the knees, the three yin and the three yang meridians, and the routine clinical acupoints are usually taken from the crane crown, calf nose, knee eyes, Weizhong, Xuehai, Liangqiu Points such as Yanglingquan, Yanglingquan, Yinlingquan [13,14]. Shao believes that although the above-mentioned local acupoint method has analgesic effects, there are many acupoints taken, the operation is tedious, and the patient is prone to fear, and the analgesic effect is not lasting. It is due to the fact that the position is mostly in the soft tissue around the knee or in the knee joint space, and the acupuncture is shallow. It is difficult to reach the disease directly. Therefore, Professor Shao originally created his "Four Points" penetration treatment, which not only has a few points, but also is easy to operate, and The curative effect is good.

Figure 1 Schematic diagram of "Four Points"

3.2 Dialectical acupuncture

In the clinical treatment of knee osteoarthritis, Professor Shao differentiated between the symptoms and signs, and agreed with each other. He believed that acupuncture treatment should be based on the experience of acupuncture and points-based treatment. Yu; those with wind and fever, plus needles and pools of blood, sea of blood; those with rheumatism, plus needles and sea of blood, Yinlingquan; those with loss of internal organs, plus needles, liver and kidney, and those with deficiency of blood, plus needles, sea of blood, and blood

3.3 Application of Ashi Point

In the "Lingshu · Meridian" chapter: "Take pain as a cricket, and know as the degree". Professor Shao has been treating knee joint disease for many years, and found that there are many pain points on the related muscles around the knee joint after the onset. When taking the pain point as a breakthrough, take Ashi acupoints, but often encounter multiple pain points, that is, there are still multiple pain points outside the "Four Four Points". The theory of "the machine touches the outside, cleverly born inside, the hand turns the heart, and the law comes out of the hand" points out that the clinical treatment of the syndrome must be identified, the major and the minor, the main points, the priorities, the pain points, and the root cause Sexual pain points can be targeted when acupuncture or massage is used, and satisfactory results are obtained [15].

4. Professor Shao's special push method

4.1 Application of Acupuncture

Professor Shao's mang needle penetration method has strong acupuncture feeling, good meridian conduction effect, and significant effects can be achieved without leaving the needle. Professor Shaochang chooses 3-5 inch mang needle according to the patient's body shape and pain point, and routinely disinfects the knee skin of patients and doctors. Fingers, use the left thumb and the remaining four fingers to relax the knee skin, and use the right thumb and three fingers of the middle ring to pinch the needle quickly around 1/3 of the needle body, making the patient unaware of the pain. It is required that the needle body and the skin be at an angle of about 15 ° when piercing the "double eye", and the needle penetration direction and depth in the subcutaneous muscle layer are penetrated from the "inner eye" to the direction of Yinlingquan by 2-4.5 inches. The external squinting eye pierces 2-4.5 inches in the direction of Yanglingquan; piercing and penetrating "double knee eyes" directly under the sitting knee flexion requires that the needle body and the skin be at an angle of about 90 °, and the needle is inserted into the knee joint vertically. 2-3 inches through the gap. In severe cases, you can use double needles and puncture to enhance the sense of acupuncture. "Lingshu · Nine Needles and Twelve Originals" in the cloud: "Xu Erji is real, but disease is Xu", so Shao The old clinical card is used for acupuncture according to the pain of knee osteoarthritis. It is considered that its acute pain is mostly empirical. The acupuncture should be performed quickly. After the gas is reached, the air is drawn outward and the needle is released slowly. This is diarrhea. Law; chronic painFalse evidence, the needle needs to be moved slowly, slowly adjust the needle to the depth of the disease, bleed air inward, and the needle needs to be released quickly. This is the supplement method [2]. Rapid static tremor, which makes a strong soreness under the needle, so that the needle feeling is transmitted around the knee joint or in the joint cavity. At first, the doctor had a tight and astringent feeling under the needle. Gradually feel the needle is soft, if you enter the cotton wool, you can remove the awn needle and press the pinhole with a cotton swab for a moment [16,17]. Other acupoints usually use a 1.5-inch mill needle to pierce 1-1.5 inches, and lift and twist 3 -5 Remove the needle after leaving it without leaving the needle.

4.2 Application of Four-finger Inference

Professor Shao believes that knee osteoarthritis is mostly a lack of tendon and bone, and acupuncture combined with massage can often achieve mutually beneficial effects, which can further consolidate the effect of acupuncture. Massage should be used to relieve tendons and blood circulation, smooth joints, and release. Adhesion is the rule.The main method is four-finger push. The unfavorable person cooperates with knee flexion and knee passive movement [1] .Fourfinger push should appropriately change the direction of force and power distribution according to different surgical sites. Subtract the "push" and "hold" components to suit the human factors [18,19]. The specific operation is that the patient lies in a supine position, a pillow is placed under the knee joint, and the doctor applies four-finger push to the upper thigh. Quadriceps, sacroiliac ligaments, medial and lateral collateral ligaments, focusing on points such as "Four Points", Crane Peak, Yanglingquan, Yinlingquan, and Ququan. The disadvantaged people cooperate with flexion and extension of the knee and flexion and extension of the knee joint. Passive movement of internal and external rotation; in the prone position of the patient, the doctor applies four-finger push method to the lower end of the hamstring muscle on the back of the thigh, the popliteal fossa, and Chengshan point for about 10 minutes.

5. Knee Osteoarthritis Test

Patient, male, 56 years old, young and long-distance running enthusiast.At 15:00 on March 28, 2017, he was seen at the Massage Department of Jiangsu Provincial Hospital of Traditional Chinese Medicine. He complained of injury to the left knee ligament due to running 2 years ago. He immediately consulted Nanjing. Orthopedics in a hospital, oral administration of selenium, has obvious analgesic effects, and the pain has changed from reduced to disappeared. Recently, the left knee pain was unbearable for 3 days. Standing and walking can induce pain, and it is even worse when going up and down the stairs. Symptoms of "lockup", often accompanied by stiffness in the morning, unfavorable activity, and ineffective consultations in multiple places, then came for treatment, painful face, and appealed for hospitalization. No significant swelling and deformity of the knee joint was found on examination; self-score of 8 points for pain X-ray film showed degenerative changes of the knee joint, blurred tibiofemoral articular surface, and osteoproliferation at the sacral margin. Diagnosed as knee osteoarthritis. Professor Shao chose the "Acupoint 4" as the main acupuncture point and cooperated with Yanglingquan. "Acupoints" and Yanglingquan both use the awn needle penetration method, combined with four-finger push method, knee flexion and knee passive movement, push the needles simultaneously, the pain is reduced immediately, and the pain is scored by 4 points. Second time, the discomfort of the knee disappears, the movement is free, and the pain self-score is 2 points after the activity. It is recommended that the patient strengthen the knee after the condition is relieved.Functional training, mainly to strengthen the quadriceps, hamstrings strength training. In early July 2017 follow-up, the knee so easily, readme stop pin and then did not attack.

Words: 1. Knee osteoarthritis should rest in bed during the onset, less up and down stairs and climbing; 2, supine knee extension penetrating the "double eye" of "Four Points" is easier to penetrate, sitting under the knee It is easier to penetrate the "Knee Eyes" of the "Four Points" into the joint space of the knee joint; 3.For the points of the knees, the needle should have a certain depth and the shallow puncture effect is not good; 4. Acupuncture is mainly used after the acupuncture is assisted by the four-finger push method, which can further consolidate the effect of acupuncture, which shows that the simultaneous push of a needle can take into account the "dot line surface" of the knee, both inside and outside, so that it can reach directly The disease has rapid onset and significant effects.

6. Conclusion

Professor Shao Mingxi has been collating ancient literature for many years, inheriting the ancient times, carrying forward the studies, studying academically, innovating new ideas, good at treating diseases with thorn needles, specializing in acupoints, and cooperating with the unique four-finger method, especially for traumatic diseases. It is unique in the treatment of knee joint disease [20]. Shao believes that the knee joint is an important weightbearing joint in the human body. When knee osteoarthritis suffers, the knee pain is unbearable, the movement is unfavorable, and the standing is unstable, resulting in a serious decline in quality of life. .After many years of clinical experience and summary of Professor Shao's experience, through identifying the disease and identifying the location, it was found that the needles penetrated the "Four Points" and directly penetrated to the soft tissue of the knee and the joint space of the knee. Strongly and vigorously stimulate meridian qi, strengthen the connection between meridians and acupoints, and make the qi and blood in the knees run smoothly, so that Dashujinhuoxue, Tongluo analgesic, smooth joint effect, analgesic effect and joint function improvement effect is very obvious. The four-finger push method, combined with acupuncture, often has rapid onset of clinical effects and obvious results, providing a new idea for comprehensive treatment of knee joint disease.