Pathology 2 muscle 1
病理学 2 肌肉 1

Fibromyalgia: (-algia = pain)
纤维肌痛： （-algia = 疼痛）

is a painful, non-articular rheumatic condition of at least three months’ duration. widespread muscular achiness and specifically the palpation of tender points at 11 of 18 locations on the body=
是一种疼痛的非关节风湿性疾病，至少持续三个月。广泛的肌肉疼痛，特别是在身体 18 个位置中的 11 个位置触痛点 =

diagnosis based on the presence of 11 of the following 18 tender points (Rattray 982)
根据以下 18 个压痛点中的 11 个进行诊断 （Rattray 982）

occipital at the level of suboccipital muscle (point 1 and 2)
枕骨位于枕下肌水平（点 1 和 2）

C-spine, anterior aspect of C5-C7 b/w TVP and SP (intertransverse spaces) point (11 & 12)
C 脊柱，C 5 -C 7 前部 b/w TVP 和 SP（横突间隙）点（11 和 12）

At anterior of neck:
颈前部：

hyoid bone: (level C2), from EOP =Innion my finger inferiorly, first palpable bony structure is spinous process of C2,
舌骨：（C2 级），从 EOP =Innion 到我的手指下方，第一个可触及的骨性结构是 C2 的棘突，

thyroid cartilage: b/w C4-C5
甲状软骨：黑白 C4-C5

cricoid cartilage: (first ring of trachea) @ C6; anterior tubercle / cricoid tubercle of TVP of C6 (see book palpation bone and muscle)
环状软骨：（气管第一环）@ C6；C6 的 TVP 前结节 / 环状软骨结节（参见书籍触诊骨和肌肉）

it is clinic significant landmark; it is the level for tracheostomy;
是临床的重要标志，是气管切开术的水平；

trapezius muscle @ midpoint of upper fold (point 3 & 4)
斜方肌 @ 上褶中点（点 3 和 4）

origin of supraspinatus (above of superior of medial boarder of spine of scapula) (point 5 & 6)
冈上肌起点（肩胛冈内侧缘上方）（点 5 和 6）

- insertion of supraspinatus is located on superior facet of great tubercle of humerus
- 冈上肌的止点位于肱骨大结节的上部

middle facet of great tubercle: is the insertion of the infraspinatus;
大结节中部：是冈下肌的插入处；

inferior facet of great tubercle: is the insertion of the teres minor
大结节下部：是小圆肌的插入处

2^nd rib, esp. at 2^nd costal chondral junction (2^nd rib attach at Louis angle which is b/w manubrium and body of sternum) (point 13 & 14)
第二^根肋骨，特别是第二^根肋软骨交界处（第二^根肋骨附着于路易斯角，路易斯角位于胸骨柄和胸骨体之间）（点 13 和 14）

2cm distal from lateral epicondyle of humerus; (point 15 & 16)
距肱骨外上髁远端 2cm；（点 15 和 16）

over gluteus Medius (upper lateral quadrant of gluteal) (point 7&8)
臀中肌上方（臀肌外侧上象限）（点 7&8）

2cm posterior to greater trochanter (point 9 & 10)
大转子后方 2 厘米（点 9 和 10）

knees: medial fat part proximal to knee (point 17 & 18)
膝盖：膝盖近端内侧脂肪部分（点 17 和 18）

control points: no pain at these points,
控制点 ：这些点没有疼痛，

middle forehead, muscles in anterior forearm; thumbnail; muscles of anterior thigh
前额中部、前臂前部的肌肉、拇指指甲、大腿前部的肌肉

these patients have more “substance P” secretion, substance P is pain cause hormone
这些病人有更多的“P 物质”分泌，P 物质是引起疼痛的激素

Most of these patients have different level of insomnia; the patient difficulty in achieving restful sleep due to abnormal brain wave patterns while sleeping
这些患者大多有不同程度的失眠， 由于睡眠时脑电波异常，患者难以获得安稳的睡眠

Fibromyalgia may relate with Sleeping disorder:
纤维肌痛可能与睡眠障碍有关：

Normal stages of sleep:
正常的睡眠阶段：

REM = rapid eye movement ----- stage 1= alpha stage (light sleep)
REM = 快速眼动 ----- 第 1 阶段 = α 阶段（浅睡眠）

non-REM= non rapid eye movement stage ----- stage 4= delta stage (deep sleep which is important for growth hormone secretion from pituitary gland, the cells of tissue regeneration and repairing)
non-REM=非快速眼动阶段-----阶段 4=δ阶段（深度睡眠，对脑垂体生长激素的分泌、组织再生和修复的细胞很重要）

Stage 2 & 3: are stages b/w 1 and 4
第 2 和第 3 阶段：是第 1 和第 4 阶段之间的阶段

Fibromyalgia patient: alpha interrupt the delta stage, people cannot have enough in delta stage; the tissue can’t repair properly
纤维肌痛患者：α 干扰 δ 阶段，人们在 δ 阶段无法获得足够的能量；组织无法正常修复

Other disturbances:
其他干扰：

sleep apnea: during the sleep, spontaneously stopping breathing
睡眠呼吸暂停：睡眠期间，自发停止呼吸

nocturnal myoclonus: during sleep muscle spasm/ cramp, restless legs syndrome during sleeping
夜间肌阵挛：睡眠期间肌肉痉挛/抽筋，睡眠期间不安腿综合征

bruxism: ground the teeth during sleep; (this also cause the TMJ syndrome) (open mouth = depression of TMJ; close mouth = elevate of TMJ
磨牙症：睡眠时磨牙；（这也会导致颞下颌关节综合征）（张嘴 = 颞下颌关节下陷；闭嘴 = 颞下颌关节抬高

chewing muscles: masseter, Temporal, lateral pterygoid, and medial pterygoid; only lateral pterygoid is for depression of TMJ= open the mouth
咀嚼肌：咬肌、颞肌、翼外肌和翼内肌；只有翼外肌用于颞下颌关节的下压=张开嘴

Associate conditions: allergies, chest pain,
相关症状：过敏、胸痛、

Irritable bowel syndrome (IBS) (stress is trigger): constipation and diarrhea alternatively, abdomen pain, bloating …..
肠易激综合征（IBS）（压力是诱因）：便秘和腹泻交替发生，腹痛，腹胀......

- cystitis = bladder is suffering non infection inflammation;
-膀胱炎=膀胱患有非感染性炎症；

paranesthesia (abnormal feeling numbness or tingling sensation altered);
感觉异常（异常感觉麻木或刺痛感改变）；

Sensitivity to the environment about noise, smell, light…, sensitivity amplification;
对噪音、气味、光线等环境的敏感性，敏感性增强；

Skin problems (eczema, psoriasis …)
皮肤问题（湿疹、牛皮癣……）

swelling/edema,
肿胀/水肿，

Sicca syndrome (the mouth and eyes dry out);
干燥综合征（口干和眼干）；

TMJ syndrome (TMJ tight to open, reduce the ROM, tenderness...),
颞下颌关节综合征（颞下颌关节紧张、活动度减少、压痛……），

irritability, headache/ migraine (50% of the patients complain);
烦躁、头痛/偏头痛（50% 的患者抱怨）；

dizziness, confusion, or slowly tissue healing
头晕、意识模糊或组织愈合缓慢

The theories about causes:
关于原因的理论：

neurotransmitter imbalance: too much substance – P (the hormone to cause pain); too little serotonin (the hormone/ neurotransmitter to control/ suppress the substance –P)
神经递质失衡 ：P 物质（引起疼痛的激素）过多 ；血清素（控制/抑制 P 物质的激素/神经递质）过少

The emotion effect (anxious, angry, depression) hormonal effect, vessel dilation in brain, leading to migraine
情绪效应（焦虑、愤怒、抑郁）荷尔蒙效应，脑血管扩张，导致偏头痛

amino acid: body need to have complete amino acid (22 types) to synthesis the proteins for regeneration the cells or tissues, imbalance of amino acid or lower amount of amino acid may be leading to poor tissue repairing
氨基酸 ：人体需要完整的氨基酸（22 种） 来合成蛋白质，以再生细胞或组织，氨基酸失衡或氨基酸含量较低可能导致组织修复不良

Protein synthesis also need vitamins (Vitamin C and folic acid, vitamin E)
蛋白质合成也需要维生素（维生素 C 和叶酸、维生素 E）

One of the amino acids is called tryptophan which is deficiency, may cause poor tissue repairing. (Tryptophan is rich in Turkey meat)
其中一种氨基酸叫做色氨酸，缺乏色氨酸可能会导致组织修复不良。（火鸡肉富含色氨酸）

oxygen in tissues: because imbalance of neurotransmitter cause hypoxia due to mal-control of blood flow; cause muscle spasm--- muscle pain
组织中的氧气 ：由于神经递质失衡导致血流失控而引起缺氧；引起肌肉痉挛---肌肉疼痛

viruses and immune system: along or combine virus infection
病毒和免疫系统：单独或联合病毒感染

or post infection: herpes, rubella, enteron virus…. cause abnormal immunity reaction, The lower-level activity of killer T-cell, helper T-cell or suppress T cell
或感染后：疱疹、风疹、肠道病毒……引起异常免疫反应，杀伤性 T 细胞、辅助性 T 细胞活性降低或抑制性 T 细胞

Massage treatment is indicated for fibromyalgia patients, as long as do not do too much painful techniques within client’s pain tolerance; over all consider the condition, reduce the sympathetic
按摩治疗适用于纤维肌痛患者，只要在病人的疼痛耐受范围内，不要做太多痛苦的按摩技巧；总体考虑病情，减少交感神经

nerve firing (warm hydrotherapy, Swedish massage techniques are indicated); if there is trigger point, may use stripping, origin and insertion techniques, Golgi tendon organ techniques, muscle approximation and P.N.F. (working on body proprioceptor function, the muscle belly too much pain to touch, to instead ischemia compression)
神经激发（温水疗法、瑞典式按摩技术适用）；如果有触发点，可以使用剥离、起源和插入技术、戈尔基腱器官技术、肌肉近似和 PNF（作用于身体本体感受器功能，肌肉腹部疼痛难以触摸，而是缺血压缩）

Short term aims: reduced the pain, reduced sympathetic firing, increase ROM
短期目标：减轻疼痛，减少交感神经兴奋，增加活动范围

Long term aims: encourage healthy life style (diet with nutrition, and exercises and enough sleep, reduce the stress level); find the causes;
长期目标：鼓励健康的生活方式（营养饮食、锻炼和充足的睡眠，减轻压力）；找出原因；

Autoimmune diseases:
自身免疫性疾病 ：

In normal health body: after infection by certain virus or bacteria, your body produced the antibody to conquer the pathogen; and B lymphatic cells memorized the antibody, if 2^nd time meet this pathogen, right away, the specific antibody release to fight with the pathogen, so the body does not get sick again
在正常健康的身体中 ：当身体被某种病毒或细菌感染后， 会产生抗体来对抗病原体；而 B 淋巴细胞会记住这种抗体，如果第二^次遇到这种病原体，就会立即释放特异性抗体来对抗病原体，这样身体就不会再次生病

auto antibodies mistakenly attack own body’s tissues as antigen/ pathogen, cause the tissue inflammation and tissue damage. This is called autoimmune disease
自身抗体误将自身组织视为抗原/病原体，导致组织炎症和组织损伤。这被称为自身免疫性疾病

* Rheumatoid arthritis: auto antibody attack synovium membrane of joints as an antigen, eventually attack other connective tissue, even internal organs.
* 类风湿性关节炎 ：自身抗体以抗原形式攻击关节滑膜，最终攻击其他结缔组织，甚至内脏器官。

* Lupus: auto antibody attack nucleus of connective tissue in the body (skin, joint, even other internal organs including heart, kidneys or spleen)
* 狼疮 ：自身抗体攻击体内结缔组织的核心（皮肤、关节，甚至其他内脏器官，包括心脏、肾脏或脾脏）

* Multiple sclerosis: auto antibody attacks the myelin sheath in central nervous system. Oligodendrocytes (it is neuroglia) are damaged due to antibody attack, myelin sheath damaged, replaced by fibrous scar tissue, nervous system become malfunction
* 多发性硬化症 ：自身抗体攻击中枢神经系统的髓鞘。 少突胶质细胞 （神经胶质细胞）因抗体攻击而受损，髓鞘受损，被纤维瘢痕组织取代，神经系统功能障碍

* Psoriasis: T cell mistakenly attack the squamous cells in epidermis, make the epithelium cells premature dead, accumulate the corneum layers
* 牛皮癣 ：T 细胞错误地攻击表皮鳞状细胞，使上皮细胞过早死亡，堆积在角质层上

Anti-inflammatory medications:
抗炎药物：

NSAIDS (non - steroid anti-inflammatory drug: Tylenol, Advil, Aspirin…) pain relieve due to the medication inhibit the prostaglandin which is secreted by mast cell during the inflammation
NSAIDS（非甾体抗炎药：泰诺、艾德维尔、阿司匹林……）通过抑制炎症期间肥大细胞分泌的前列腺素来缓解疼痛

Corticosteroid medication is stronger anti-inflammatory drug which prescribed by Dr. but if for long term use, may have undesirable side effects, tissue become very fragile and healing process will be slower
皮质类固醇药物是医生开出的更强的抗炎药物，但如果长期使用，可能会产生不良副作用，组织变得非常脆弱，愈合过程会更慢

polymyositis or myositis: idiopathic, possible autoimmune, virus or connection with other connective tissue disorders. inflammation of skin, connective tissue or skeleton muscle, cause skin lilac rash, muscle weakness and pain; effect on muscle at proximal of limbs; effect age 30-60 years, gradual onset;
多发性肌炎或肌炎 ：特发性，可能由自身免疫、病毒或与其他结缔组织疾病有关。皮肤、结缔组织或骨骼肌的炎症，引起皮肤淡紫色皮疹、肌肉无力和疼痛；影响四肢近端肌肉；发病年龄 30-60 岁，逐渐发病；

CM: Lilac rash= macular papular erythematic = red rash with papular (eczema like) dermatitis, face, shoulders, arms or upper chest
CM： 淡紫色皮疹 = 斑丘疹性红斑 = 伴有丘疹（类似湿疹）皮炎的红疹，面部、肩部、手臂或上胸部

periorbital edema (around the eyes), lilac rash around eye/ nose and cheek
眶周水肿（眼周）、眼/鼻和脸颊周围出现淡紫色皮疹

proximal muscle groups (upper arm or thigh) muscle weakness and contracture
近端肌肉群（上臂或大腿）肌肉无力和挛缩

some patients may have dysphagia: difficult to swallow
有些患者可能出现吞咽困难：吞咽困难

Lupus (SLE= systemic lupus erythematosus) 紅斑狼瘡 Lupus = wolf; it is severe autoimmune disease
狼疮 (SLE= 系统性红斑狼疮) 红斑狼疮 Lupus = 狼；这是严重的自身免疫性疾病

Auto anti-nucleus antibody attacks multiple tissues, great imitator = the disease of the thousand faces
自身抗核抗体攻击多种组织，伟大的模仿者=千面疾病

Early symptoms of SLE involve the joint pain, skin rash (butterfly rash), eventually other internal organs (kidney: chronic nephritis, heart: pericarditis, pleuritis (inflammation of the membrane wrapping the lung….)
系统性红斑狼疮的早期症状包括关节疼痛、皮疹（ 蝶形红斑 ），最终影响其他内脏器官（肾脏：慢性肾炎， 心脏：心包炎、胸膜炎（包裹肺部的膜发炎……））

Treatment: corticosteroid for anti-inflammation and suppress the immunity
治疗：皮质类固醇抗炎和抑制免疫力

Massage indicates for only relaxation during the remission period, no deep tissue work, no friction; do not fatigue the patient, no extreme heat treatment
按摩仅用于缓解期的放松，无需深层组织工作，无需摩擦；不要使患者疲劳，无需极端热疗

No tapotement, no any stimulate techniques to trigger the condition flare up
无需拍打，无需任何刺激技术来引发病情

discoid= only effect face skin, skin lesion of face = butterfly rash= malar rash is common, loss the hair, circle bald spots = alopecia; 10% discoid lupus develop to systemic lupus
盘状=仅影响面部皮肤，面部皮损= 蝶形红斑 = 常见颧部红斑 ，脱发，圆形秃斑=脱发； 10%盘状狼疮发展为系统性红斑狼疮

systemic = all body systems involved; from primary skin lesion & joint pain, effect kidney & heart, nervous system;
系统性 = 涉及所有身体系统；从原发性皮肤病变和关节疼痛，影响肾脏和心脏、神经系统；

flare up usually in spring and summer b/c sun is trigger.
通常在春季和夏季爆发，因为太阳是诱因 。

Lupus patient should carefully avoid sun exposure; sun protection is important; women with SLE have high risk of miscarriage or still birth
狼疮患者应小心避免日晒；防晒很重要；患有系统性红斑狼疮的女性流产或死产的风险很高

- pathogenesis: immune system unable to get rid of virus or bacteria ------ white blood cells (B Cells) abnormal produce auto-antibodies combine to antigen form an immune complex---
- 发病机制 ：免疫系统无法清除病毒或细菌------白细胞（B 细胞）异常产生自身抗体与抗原结合形成免疫复合物---

deposit in vascular tissue---- ANA (anti-nucleus antibody) in blood attack the any types of the cells in own body
血管组织沉积----血液中的 ANA（抗核抗体）攻击自身体内任何类型的细胞

Diagnosis base on 4 out of 11 symptoms:
诊断依据 11 个症状中的 4 个 ：

skin rash or discoid rash = butterfly rash
皮疹或盘状皮疹=蝴蝶皮疹

photosensitivity: allergy reaction to sun shine
光敏性：对阳光的过敏反应

arthritic joint pain
关节炎关节疼痛

frequently ulcer in the mouth & nose
经常出现口腔和鼻腔溃疡

chronic cough
慢性咳嗽

heart complication (palpitation, valve incompetence, heart disease)
心脏并发症（心悸、瓣膜功能不全、心脏病）

lung complication
肺部并发症

kidney malfunction
肾功能障碍

neurological disorder
神经系统疾病

blood disorder (blood vessel inflammation, thrombosis)
血液疾病（血管炎症、血栓形成）

immunity abnormality
免疫异常