Dr. Steve Chan R.TCM.P., M.D. 陈思德博士 R.TCM.P., M.D.
Dr. of Med.(China) 中国医学博士 B.Sc.(Hons) (UK), M.Sc (UK), B.Sc.(Hons) (英国), M.Sc (英国),
B. Chinese Med. (HK) B. 中国医学（香港） B.H.Sc. (Chinese Med) (Australia) B.H.科（中国医学）（澳大利亚）
Dip. Clinical Acupuncture(HK) 临床针灸文凭（香港）
W08-20250627
The Thoraicic and Lumbar Spine I Lateral curvature of spine 胸椎和腰椎 I 脊柱侧弯
Structural scoliosis - there is alteration in vertebrae shape and mobility, the deformity cannot be corrected by alteration of posture. The causes may be: 结构性脊柱侧弯 - 椎体形状和活动性发生改变，畸形不能通过改变姿势来矫正。可能的原因有：
congenital 先天性
hemivertebrae - only half of a single vertebra is fully formed 半椎体 - 单个椎体只有一半完全形成
Fused vertebrae 融合椎体
Absent/fused ribs 缺失/融合肋骨
Secondary scoliosis 继发性脊柱侧弯
a. Paralytic Scoliosis - the deformity is secondary due to loss of supportive action of the trunk and spinal muscle, nearly always as sequel to poliomyelitis a. 麻痹性脊柱侧弯 - 这种畸形是由于躯干和脊柱肌肉失去支撑作用而引起的，几乎总是由小儿麻痹症后遗症引起
It is a highly contagious infectious disease. The poliovirus destroys nervous system causing paralysis. The poliovirus spreads most often from fecal-oral contact. 这是一种高度传染性的传染病。脊髓灰质炎病毒破坏神经系统导致瘫痪。脊髓灰质炎病毒最常通过粪口接触传播。
MUSCLES COMMONLY WEAKENED BY POLIO 小儿麻痹症常使以下肌肉无力
Poliomyelitis 脊髓灰质炎
These symptoms include:- 这些症状包括：-
loss of reflexes 反射消失
-severe spasms and muscle pain - 严重的痉挛和肌肉疼痛
-loose and floppy limbs, sometimes on just one side of the body - 肢体松软无力，有时仅发生在身体一侧
-sudden paralysis, temporary or permanent - 突发性瘫痪，暂时性或永久性
-deformed limbs, especially the hips, ankles, and feet - 肢体畸形，尤其是髋部、踝部和脚部
b. Neuropathic Scoliosis - a damage to or disease affecting nerves, which may impair sensation, movement, gland or organ function, or other aspects of health, depending on the type of nerve affected. b. 神经性脊柱侧弯 - 神经损伤或受疾病影响，可能损害感觉、运动、腺体或器官功能，或健康的其他方面，具体取决于受影响的神经类型。
c. Muscular dystrophy - weakening and breakdown of skeletal muscles over time due to muscle diseases. Many people will eventually become unable to walk, this diseases may be associated with problems in other organs. c. 肌营养不良 - 由于肌肉疾病导致骨骼肌随时间逐渐衰弱和破坏。许多人最终将无法行走，这种疾病可能与其他器官的问题有关。
d. Idiopathic Scoliosis - This is most common. The term idiopathic means “occurring without known cause.” Idiopathic scoliosis affects 2-3% of children aged 10-18 years old, more common among females than males. In idiopathic scoliosis, the specific cause is unknown; however it is largely thought to be a genetic disorder. d. 特发性脊柱侧弯 - 这是最常见的。特发性意味着“无已知原因发生”。特发性脊柱侧弯影响 10-18 岁儿童的 2-3%，女性比男性更常见。在特发性脊柱侧弯中，具体原因尚不清楚；但普遍认为这是一种遗传性疾病。
Most patients do not have many symptoms, but larger curves may cause a noticeable deformity, such as a rib hump, or pain. In severe cases the curve may even begin affecting heart or lung function. 大多数患者没有许多症状，但较大的弯曲可能导致明显的畸形，如肋骨隆起，或疼痛。在严重情况下，弯曲甚至可能开始影响心脏或肺功能。
Cobb method Cobb 方法
Measuring the degree of scoliosis : - 测量脊柱侧弯程度：-
choose the most tilted vertebrae above and below the apex of the curve. 选择曲线顶点上方和下方的最倾斜椎体。
The angle between intersecting lines drawn perpendicular to the top of the top vertebrae and the bottom of the bottom vertebrae is the Cobb angle. 从顶部椎体的顶部和底部椎体的底部画出的垂直线之间的夹角是 Cobb 角。
A cobb angle is measured from x-rays to evaluate the degree of curvature. Cobb 角通过 X 光测量来评估弯曲程度。
2. Kyphosis 2. 脊柱后凸
exaggerated, forward rounding of the back, affects generally major part of thoracic spine 背部过度前凸，通常影响胸椎的大部分
occur at any age but most common in older women. 可发生在任何年龄，但最常见于老年女性。
age-related kyphosis is often due to weakness in the spinal bones that causes themselves to compress or crack. 与年龄相关的脊柱后凸通常是由于脊柱骨的虚弱，导致它们自身压缩或断裂。
can appear in infants or teens due to malformation of the spine or wedging of the spinal bones over time. 脊柱畸形或随时间推移椎骨楔形变可能导致婴儿或青少年出现这种情况。
Severe kyphosis can cause pain, put pressure on lungs, can compress digestive tract, causing acid reflux and difficulty with swallowing. 严重的驼背会引起疼痛，压迫肺部，挤压消化系统，导致反酸和吞咽困难。
kyphosis-video-what-kyphosis
What TCM treatment we can adopt ? 我们能采用哪些中医治疗方法？
a. Scheuermann’s disease etiology is not known. In lateral radiographs, spine are seen narrower anteriorly than posteriorly. It is named after Holger Scheuermann. a. 强直性脊柱炎的病因尚不清楚。在侧位 X 光片上，脊柱的前方比后方更窄。它以霍尔格·舒尔曼的名字命名。
Scheuermann’s disease is found mostly in teenagers and presents a significantly worse deformity than postural kyphosis. 强直性脊柱炎主要发生在青少年身上，其畸形程度显著重于姿势性驼背。
Patients cannot consciously correct their posture. 患者无法有意识地纠正他们的姿势。
apex of their curve, located in the thoracic vertebrae, is quite rigid. 他们的曲线顶点位于胸椎，非常僵硬。
feel pain at the apex of the curve, which is aggravated by physical activity and by periods of standing or sitting 他们在曲线顶点感到疼痛，这种疼痛在身体活动和站立或坐着时加剧。
curves in the lower thoracic region cause more pain, whereas curves in the upper region present a more visual deformity. 下胸椎区域的曲线引起更多疼痛，而上胸椎区域的曲线则呈现更明显的畸形。
The T7th and T10 are most commonly affected. What types of TCM treatments will you apply? T7 和 T10 节段最常受影响。您将应用哪些类型的中医治疗？
3. Lordosis 3. 骨盆前倾
Defined as an excessive inward curve of the spine. The spine’s natural curves position the head over the pelvis and work as 定义为一度脊柱向内弯曲。脊柱的自然曲线使头部位于骨盆上方，并发挥作用。 shock absorbers to distribute mechanical stress during movement. 减震器用于在运动过程中分散机械应力。
The patient may appear swayback, with the buttocks more prominent, and in general an exaggerated posture. Lumbar lordosis can be painful, too, sometimes affecting movement. 患者可能呈现驼背状，臀部更加突出，整体姿势显得夸张。腰椎前凸也可能引起疼痛，有时会影响活动。
Some degree of Lordosis allows for an efficient walking gait which acts like a spring to absorb the body weight impacting on the hip. 一定程度的腰椎前凸有助于实现高效的行走步态，如同弹簧般吸收冲击在髋部的体重。
Exaggerated lumbar curve 夸张的腰椎曲线
Lumbar hyperlordosis will give rise to stress or extra weight and is arched to point of muscle pain or spasms, experiencing lower back pain, mostly happens to dancer. 腰椎过度前凸会产生压力或额外负担，肌肉疼痛或痉挛会指向弯曲的顶点，导致下背部疼痛，这种情况多见于舞者。
It is an inflammatory disease that, over time, can cause some of the vertebrae in your spine to fuse. This fusing makes the spine less flexible and can result in a hunched-forward posture. If ribs are affected, it can be difficult to breathe deeply. The disease is progressive, the sacro-iliac joints are almost involved at an early stage. 这是一种炎症性疾病，随着时间的推移，可能会导致您脊柱中的一些椎骨融合。这种融合使脊柱的灵活性降低，并可能导致驼背姿势。如果肋骨受影响，深呼吸可能会很困难。该疾病是进行性的，骶髂关节在早期几乎都会受影响。
Healthy spine 健康脊柱
Symptoms: 症状：
affects men more often than women 男性比女性更常见
typically begin in early adulthood 通常在成年早期开始
no cure for ankylosing spondylitis, but treatments can lessen the symptoms and possibly slow progression of the disease 强直性脊柱炎目前没有治愈方法，但治疗可以减轻症状，并可能减缓疾病的进展
pain and stiffness in lower back and hips, especially in the morning and after periods of inactivity 下背部和臀部疼痛和僵硬，尤其在早晨和久坐不动后
neck pain and fatigue also are common 颈部疼痛和疲劳也很常见
4. Senile Kyphosis 4. 老年性驼背
The aging patient becomes progressively stooped and shorter in stature through degenerative thinning of the intervertebral discs. Pain may occur if there is associated osteo-arthritis, mostly elderly women, the kyphosis may be 老年患者因椎间盘退行性变薄而逐渐驼背且身材变矮。如果伴有骨关节炎，可能会出现疼痛，尤其是老年女性，驼背可能更为严重 aggravated by senile osteoporosis or osteomalacia which lead to anterior vertebral wedging and often pathological fracture 加剧于老年性骨质疏松或骨软化，导致椎体楔形变和常发生病理性骨折
It occurs in the lower thoracic and upper lumbar vertebrae. 它发生在下胸椎和上腰椎。
source of infection is usually outside the spine. 感染源通常在脊柱之外。
most often spread from the lungs via the blood. 通常通过血液从肺部传播。
There is a combination of osteomyelitis (bone infection) and infective arthritis 存在骨感染（骨髓炎）和感染性关节炎的组合
usually more than one vertebra is involved and mostly at anterior part of the vertebral body 通常涉及多个椎体，主要在前部椎体
Tuberculosis may spread from area to adjacent intervertebral discs. 结核病可能从区域传播到相邻的椎间盘。
Back pain is the most earliest and common symptoms 腰痛是最早和最常见的症状
Neurologic symptoms (50% of cases) 神经症状（50%的病例）
May or may not have night sweats, fever, fatigue, weight loss 可能或不可能有夜间出汗、发烧、疲劳、体重减轻
6. Spondylolysis & spondylolisthesis 6. 椎弓裂与椎体滑脱
Spondylolysis and spondylolisthesis are conditions affecting the joints that align the vertebrae one on top of the other. Spondylolysis is a weakness or stress fracture in the facet joint area. This weakness can cause the bones to slip forward out of normal position, called spondylolisthesis, and kink the spinal nerves. Treatment options include physical therapy to strengthen the muscles. 脊柱裂和椎体滑脱是影响椎骨之间对齐关节的病症。脊柱裂是指关节突关节区域的薄弱或应力性骨折。这种薄弱可能导致骨头向前滑出正常位置，称为椎体滑脱，并扭曲脊椎神经。治疗选项包括物理治疗以增强肌肉。 https://www.youtube.co m/watch?v=DIJM2kLGwUI (2 min)
7. Osteo-arthritis (OA) 7. 骨关节炎 (OA)
chronic joint condition. 慢性关节病症。
With OA, the cartilage between the two bones breaks down, causing the bones within the joint to rub 在骨关节炎中，两块骨头之间的软骨会逐渐退化，导致关节内的骨头相互摩擦
This can cause pain, stiffness, and other symptoms. 这会引起疼痛、僵硬和其他症状。
OA occurs most often in older people 骨关节炎最常发生在老年人身上
OA is also called degenerative joint disease, degenerative arthritis, and wear-and-tear arthritis. 骨关节炎也被称为退行性关节病、退行性关节炎和磨损性关节炎。
8. Rheumatoid Arthritis (RA) 8. 类风湿性关节炎（RA）
It is autoimmune disorder, RA occurs when the immune system mistakenly attacks the synovium (the lining of the membranes that surround the joints). 它是一种自身免疫性疾病，当免疫系统错误地攻击滑膜（包围关节的膜层）时，RA 就会发生。
Inflammation thickens the synovium, eventually destroying the cartilage and bone within the joint 炎症会使滑膜增厚，最终破坏关节内的软骨和骨骼。
RA affects the lining of joints, causing a painful swelling, eventually resulting in bone erosion and joint deformity. RA 影响关节的衬里，导致疼痛性肿胀，最终导致骨质侵蚀和关节畸形。
The tendons and ligaments that hold the joint together weaken and stretch. Gradually, the joint loses its shape and alignment. 连接关节的肌腱和韧带会变弱和拉伸。渐渐地，关节会失去其形状和排列。
1987 Rheumatoid Arthritis Classification Criteria American College of Rheumatology 1987 类风湿关节炎分类标准美国风湿病学会
标准 1-4 必须存在 >= 6\geq 6 周。
Criterion
Criteria 1-4 must have been present for >= 6\geq 6 weeks.
Criterion
Criteria 1-4 must have been present for >= 6 weeks.| Criterion |
| :--- |
| Criteria 1-4 must have been present for $\geq 6$ weeks. |
Definition 定义
1. Morning stiffness 1. 早晨僵硬
Morning stiffness in and around the joints, lasting at least an hour before maximal improvement 关节周围早晨僵硬，持续至少一小时才达到最大改善
2. Arthritis of >= 3\geq 3 joint areas 2. >= 3\geq 3 关节区域关节炎
>= 3\geq 3 joints areas simultaneously have had synovitis observed by a physician >= 3\geq 3 关节区域同时出现医师观察到的滑膜炎
3. Arthritis of hand joints 3. 手关节关节炎
At least 1 area swollen in a wrist, MCP, or PIP joint 至少一个手腕、掌指关节或近端指间关节肿胀
4. Symmetric arthritis 4. 对称性关节炎
Simultaneous involvement of the same joint areas on both sides of the body 身体两侧相同关节区域同时受累
5. Rheumatoid nodules 5. 类风湿结节
Subcutaneous nodules, over bony prominences, extensor surfaces or juxta-articular regions 皮下结节，位于骨突起处、伸肌表面或关节附近区域
6. Serum RF 6. 血清 RF
Positive RF RF 阳性
7. Radiographic changes 7. X 线影像变化
Radiographic changes typical of RA in posteroanterior hand and wrist radiographs 后前位手和腕部 X 线影像中典型的类风湿关节炎改变
2/7 Criteria satisfied = RA 2/7 标准满足 = 类风湿关节炎
"Criterion
Criteria 1-4 must have been present for >= 6 weeks." Definition
1. Morning stiffness Morning stiffness in and around the joints, lasting at least an hour before maximal improvement
2. Arthritis of >= 3 joint areas >= 3 joints areas simultaneously have had synovitis observed by a physician
3. Arthritis of hand joints At least 1 area swollen in a wrist, MCP, or PIP joint
4. Symmetric arthritis Simultaneous involvement of the same joint areas on both sides of the body
5. Rheumatoid nodules Subcutaneous nodules, over bony prominences, extensor surfaces or juxta-articular regions
6. Serum RF Positive RF
7. Radiographic changes Radiographic changes typical of RA in posteroanterior hand and wrist radiographs
2/7 Criteria satisfied = RA | Criterion <br> Criteria 1-4 must have been present for $\geq 6$ weeks. | Definition |
| :--- | :--- |
| 1. Morning stiffness | Morning stiffness in and around the joints, lasting at least an hour before maximal improvement |
| 2. Arthritis of $\geq 3$ joint areas | $\geq 3$ joints areas simultaneously have had synovitis observed by a physician |
| 3. Arthritis of hand joints | At least 1 area swollen in a wrist, MCP, or PIP joint |
| 4. Symmetric arthritis | Simultaneous involvement of the same joint areas on both sides of the body |
| 5. Rheumatoid nodules | Subcutaneous nodules, over bony prominences, extensor surfaces or juxta-articular regions |
| 6. Serum RF | Positive RF |
| 7. Radiographic changes | Radiographic changes typical of RA in posteroanterior hand and wrist radiographs |
| 2/7 Criteria satisfied = RA | |
9. Spina Bifida 9. 脊柱裂
It is a birth defect where there is incomplete closing of the backbone and membranes around the spinal cord 这是一种出生缺陷，表现为脊柱和包裹脊髓的膜未完全闭合
10. Spinal Stenosis 10. 脊柱狭窄
Abnormal narrowing of the spina canal, resulting in pressure on the spinal cord or nerve roots. 脊柱管异常狭窄，导致对脊髓或神经根的压力
Symptoms are pain, numbness, or weakness in the arms or legs. 症状为手臂或腿部疼痛、麻木或无力
Symptoms are typically gradual in onset and improve with bending forwards. 症状通常逐渐出现，弯腰前会好转。
Severe symptoms may include loss of bladder control, loss of bowel control, or sexual dysfunction 严重症状可能包括失禁、失禁或性功能障碍
May include osteoarthritis, rheumatoid arthritis, spinal tumors, trauma, scoliosis, spondylolisthesis. 可能包括骨关节炎、类风湿性关节炎、脊柱肿瘤、创伤、脊柱侧弯、椎间盘滑脱。
It can be classified by the part of the spine affected into cervical, thoracic, and lumbar stenosis. 可按受影响的脊柱部位分为颈椎狭窄、胸椎狭窄和腰椎狭窄。
Lumbar stenosis is the most common followed by cervical stenosis. Diagnosis is generally based on symptoms and medical imaging. 腰椎狭窄最为常见，其次是颈椎狭窄。诊断通常基于症状和医学影像。
11. Prolapse intervertebral disc 11. 椎间盘突出
The disc between L5 and S1 most commonly involved L5 与 S1 之间的椎间盘最常受累
Followed by order L4-L5 and L3-L4 其次是 L4-L5 和 L3-L4
Back pain is produced by the annular tear and protective lumbar muscle spasm 背痛是由纤维环撕裂和腰椎保护性肌肉痉挛引起的
Herniated Disc Surgery-1 椎间盘突出手术-1
Herniated Disc Surgery -2 椎间盘突出手术 -2
A 59 years old lady walked into the clinic and claimed that she fell backward with her buttock hitting on the ground 2 months ago. He family doctor had ordered a X-ray check for her and the results showed that there was no bone fracture. She was treated with steroid injection and took pain relief medication. She is now complaining that she has numbness on the right side, radiating down from the buttock to the dorsal part of the right foot and toe. Discuss the causes of the pain and the acupuncture treatments you will perform. 一位 59 岁的女性走进诊所，声称两个月前向后摔倒时臀部着地。她的家庭医生为她安排了 X 光检查，结果显示没有骨折。她接受了类固醇注射和止痛药物的治疗。现在她抱怨右侧有麻木感，从臀部放射到右脚背和脚趾。讨论疼痛的原因以及你将进行的针灸治疗。
Acupuncture Demo 针灸演示
Thank You! 谢谢！
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shock absorbers to distribute mechanical stress during movement.
aggravated by senile osteoporosis or osteomalacia which lead to anterior vertebral wedging and often pathological fracture
