Studies On The Theory Of Diagnosis And Treatment Of Orthopedics And Traumatology Of TCM Based On The Ancient Literature

This is a part of the research contents of the national key basic research and development program(973 Program) "studies on the framework and structure of TCM theoretical system"(2013CB532004)which sub topic is "studies on the framework and structure of theory of diagnosis and treatment of orthopedics and traumatology of TCM"(2013CB532004-2-3)Based on the ancient classics of TCM and modern research progress and achievements, this thesis intended to develop insights into the TCM literatures about the orthopedics and traumatology in the ancient times, refined theoretical concepts of diagnosis and treatment from orthopedics and traumatology of TCM, found out the connotation of the concepts,established the conceptual system of the theory of diagnosis and treatment of orthopedics and traumatology of TCM, explored the formation and development of TCM traumatology theory and built the theoretical framework of orthopedics and traumatology of TCM, leading by the logical thinking, following the principles of integration, returning to the nature and taking in the fresh, adopting the methods of literature, hermeneutics, terminology, methods of theoretical research, etc. Thereby the studies will lay a solid foundation for completion of the national 973 project and provide the more theoretical guide for the clinical practice in orthopedics and traumatology department.Firstly, the thesis made sure the bibliography to be studied, made the screening principles and methods of basic conception of the theory of diagnosis and treatment of orthopedics and traumatology of TCM. Secondly, the thesis explored the law and nature of the theoretical system of orthopedics and traumatology of TCM from the two dimensions of "time" and "space". Both from the point of view of history, the thesis researched on the origin and evolution of the theoretical concepts. And from the point of view of the spatial orientation,it studied the discussion of the academic insights of the same concept between the contemporary physicians, in order to extract the theoretical congcepts of orthopedics and traumatology of TCM fully. The thesis hackled and summarized 402 concepts of diagnosis and treatment theory of orthopedics and traumatology of TCM, according to the "Dictionary of Traditional Chinese Medicine" "Traditional Chinese Medicine Nouns", the nationalcolleges and universities textbook "osteology and traumatology of TCM" and other modern research results,selected representative, earlier or high frequency concepts for the formal natmes, while others as the variant names, including 89 concepts of etiology(30 formal names, 59 variant names), 75 concepts of pathogenesis(41 formal names, 34 variant names),159 concepts of disease and syndrome names(93 formal names, 66 variant names), 79 concepts of therapeutic principles and methods. The paraphrase of the concept is the definition of the concept, based on the "Dictionary of Traditional Chinese Medicine", "Chinese Dictionary" and other dictionaries. The paraphrase of the concepts which cannot been looked up in the dictionaries are studied out based on the context.The cases selected the sentences in which the concepts firstly appeared in the ancient books to make sure the source of the concepts, at the same time, considering and choosing the sentences those can embodiment the development of the concepts. The conceptual system of the etiology,pathogenesis, syndrome, and therapeutic principles and methods was made up by the concepts belonging to different levels. Each concept item had variant names, paraphrase and case, in order to build the conceptual system of the theory of diagnosis and treatment of orthopedics and traumatology of TCM, which had distinct levels and reasonable structure.Centered around the etiology, pathogenesis, syndrome, and treatment, according to the time sequence, the thesis demonstrated systematically and probed into the formation and development of the theory of orthopedics and traumatology of TCM from the Qin and Han Dynasties to Ming and Qing Dynasties, which summed up the theory of the origin and evolution of orthopedics and traumatology of TCM. The Warring States to the Qin Dynasty is the initial formed period of the theory of diagnosis and treatment of the orthopedics and traumatology of TCM, providing the theoretical basis for which the later physicians paid attention to the holistic concept, treatment determination based on syndrome differentiation,the pathogenesis of Qi and blood and dysfunction of Zang-fu viscera. Orthopedic clinical medicine emerged in the Three Kingdom period, Two Jin and the Northern and Southern Dynasties, when there was a doctor for treating diseases of trauma and fracture. The department of orthopedics and traumatology of TCM formed in the Sui and Tang Dynasties,when the first deprtement of orthopedics monograph and the earliest TCM monograph on the etiologies, pathogenesis and symptoms of diseases were written. At that time, the injury disease was divided into trauma and internal damage. Orthopedics and traumatology of TCM grew up in the Song, Jin and Yuan Dynasties, when the symptoms after injury were written more detailedly. During that time, the doctor summaried facture and dislocation as "Six Luxation" and "Four fracture". Orthopedics and traumatology of TCM developed in the Mingand Qing Dynasties, when it was emphasized that the trauma injuried the outside, while the Qi and Blood were destoried from the inside. Meanwhile the fisrt momograph on the internal injury of the orthopedics and traumatology of TCM was written.The etiology of orthopedics and traumatology of TCM mostly come from external force,referring to metal wound, falling from a height, tumble, press, being beaten and sprain. In addition, TCM regards the human body as an organic whole, poor emotion and overstrain leads to disorder of the function of Zang-fu viscera, and aggravate the condition changes after injuries. External force can make the people fracture with broken tendon, which can lead to destroy the Qi and the blood. As well as Qi, blood and body fluid are the fundamental substances of the Zang-fu viscera function and activities. The meridians and collaterals can connect and nourish the skin, muscles and bones, which are the passageway for transporting Qi and blood. Local damage of skin, muscles and bones can destroy the Qi and blood,Zang-fu viscera, and the meridians and collaterals. Therefore, the pathogenesis of orthopedics and traumatology of TCM are divided into 3 categories, including destroying the Qi and blood, injuring the Five Zang viscera, and disturbing the meridians and collaterals.The disease and syndrome names of orthopedics and traumatology of TCM mostly include fracture, injury of tendon, fracture and injury of tendon, dislocation, contusion, metal wound, and miscellaneous diseases from internal injury. The therapeutic principles of the orthopedics and traumatology of TCM are classified into the therapeutic principles of fracture with broken tendon, the therapeutic principles of dislocation, the therapeutic principles of contusion, the therapeutic principles of metal wound, and the therapeutic principles of miscellaneous diseases from internal injury, which mainly contains dissipating the blood stasis, stopping pain, continuing the bone and tendon, soothing the collaterals, emolliating the liver and reinforcing the kidney, regulating and invigorating the spleen Qi, etc. Besides using herbs, therapeutic methods of orthopedics and traumatology of TCM also contain external treatment, the moxibustion separated from the paper and thunder fire needle, etc.This thesis gave a comprehensive overview about the existing theoretical framework of Chinese orthopedics ancient literatures, the framwork of some books are the most representative, which concludes the Medical Secrets of an Official(Waitai Miyao), General Medical Collection of Royal Benevolence(Shengji Zonglu), Effective Formulae Handed Down for Generations(Shi Yi De Xiao Fang), Important Classification on Zhengti Department(Zhengti Leiyao), Department of Traumatology Integration(Shangke Huizuan).Medical Secrets of an Official(Waitai Miyao) integrated the disease framework and prescription and syndrome framework. General Medical Collection of Royal Benevolence(Shengji Zonglu) elaborated the theory of orthopedics and traumatology of TCM, and the theoretical framework of etiology, pathogenesis, syndrome and treatment in detail. Effective Formulae Handed Down for Generations(Shi Yi De Xiao Fang) summed up as "Hand(Foot)Six Luxation and Four fracture" for the first time, which established the theoretical framework of diagnosis and treatment of internal injury. From the point of etiology, Department of Traumatology Integration(Shangke Huizuan) classified the injury diseases into 11 categories,including metal wound, arrow wound, magnetic and sharp wound, stab wound, trauma due to a fall, tumble wound, contusion wound, press wound, iron wound, brick-stone injury, wood instrument wound, then taking the pathogenesis combined with syndrome and treatment for the next classification, as well as filling some content on treatment and Chinese herbs for its framework. This theoretical framework based on etiology, pathogenesis, syndrome, and treatment is the inheritance of the previous experience and enlightenment of later generations.Based on the common,practical and representative theory of the diagnosis and treatment of orthopedics and traumatology of TCM which was analysed, comparied, extracted and intergrated, the thesis built the trauma framework and internal injury framework by using this kind of theory that had emerged in the maximum frequency and the content was complete on etiology, pathogenesis, syndrome, and treatment, and taking blood stasis and hemorrhagia for the general principles with the eight principal syndromes.The trauma framework took Qi stagnation and blood stasis, bleeding or hemorrhagia caused by the fracture, contusion, metal wound, and dislocation for the general outline, taking the therapeutic principles of managing the fracture and connecting the tendon, making the Qi and blood move freely, stopping bleeding and pain, etc. The internal injury framework took the blood stasis, blood deficiency or heavy deficiency of blood, deficiency of Qi and blood for the general outline, taking the therapeutic principles of promoting the blood circulation for removing blood stasis, tonifying Qi and nourishing blood and yin, invigorating the spleen and stomach, soothing the liver and Qi, etc. This thesis built the framework of the common theory of diagnosis and treatment of orthopedics and traumatology of TCM preliminarily, in order to provide more theoretical guide for clinical practice in orthopaedics.