【Abstract】
Tuina Combining acupressure Therapy includes：digital pressing、traction、cupping、medicated hot compress therapy and electrotherapy. The author uses this combining therapy for osteoarthritis in clinic these years，it shows satisfying effects，especially for the hyperplasia of neck and lumber.

【Descriptor】
Osteoarthritis of neck and lumber、tuina，digital pressing，traction，cupping，medicated hot compress therapy，electrotherapy.

Osteoarthritis is an obstinate disease. It usually appears on the edge of vertebra，especially on the cervical vertebra and lumber vertebra，then on the heel bone and other joints. digital tuina，also called digital therapy. By using digital pressing、pressing、kneading、plucking on JiaJi points to stimulate spinal nerves directly，it can release the meridian Qi stagnation，regulate Zang and Fu organs，connect interior and exterior；Traction can relieve the ligament spasm，enlarge the vertebral space，relieve the pressure symptom induced by hyperplasia；Cupping can regulate the circulation of Qi and Blood，turn Blood stasis into fresh blood；medicated hot compress therapy can soften and resolve hard mass，dispel cold and eliminate dampness；electrotherapy can stop pain，promote circulation of Blood；combining these five therapies can enhance the functions of removing blood stasis、dredging meridians and collaterals、softening and resolving hard mass and stopping pain.

1. Clinical cases
In 298 cases，there are 114 cases of cervical vertebra osteoarthritis，120 cases of lumber vertebra osteoarthritis，64 case of heel and knee joint osteoarthritis；there are 48 cases of male cervical vertebra osteoarthritis，34 cases of lumber vertebra osteoarthritis，34 cases of heel bone and knee joint osteoarthritis；66 case of female cervical vertebra osteoarthritis，42 cases of lumber vertebra osteoarthritis，30 cases of heel and knee joint；Minimal age is 32，maximal age is 77；Shortest course of the disease is 3 months，longest course of the disease is 20 years.

2. Pathogenesis and pathology
This disease is mostly appears in the middle-aged and the aged. According to modern medical science，the problem is mostly caused by the senile degeneration and weak constitution after middle age. It also occurs when people sit、stand、work or walk with a fixed improper posture for a long time，which cause rupture、bleeding and other injuries of muscles，the organization of hematoma leads to lipping or thorny spur，stimulation of the spur to soft tissue and swell、bleeding and injure of soft tissue induced by trauma. In the theory of TCM，this disease belongs to"Gubi"syndrome. Qi and Blood insufficiency、liver and kidney deficiency、invasion of exogenous pathogenic wind and cold or injury of fall and sprain may all lead to Blood stasis and Qi stagnation of meridians，which will cause obstruction resulting in disorder.

3. Treatment
Skipped...

4. Cautions
In the course of tuina，the manipulations should be even、persistence、forceful、gentle and penetrating，from light to heavy. Acupoints should be selected accurately.
The time of cupping should not be too long，and force should not be too strong. Generally，the cup is retained on the location for about 10 minutes，until the local shin turns red-purplish.
Traction force should be moderate. If it is too mild，the therapeutic effects will be poor，while too strong，it will injure the muscles and tendons.
The temperature of medicated bag should be controlled all the time. If the temperature is too high，it will damage the shin and affect the treatment.
Before electrotherapy，turn off all switches，put the electrodes on the acupoint（the electrode should contact skin closely and remain wet）. Then，turn on the buttons of stimulators after switching on the power supply. The stimulation should be controlled properly in accordance with the endurance of the patient.

5. Curative effect standard
Recovery:function and movement recover completely with pain disappeared.
Improvement:function and movement are improved with pain reduced greatly.
Ineffective:function and movement are not improved and pain is not relieved。

6. Therapeutic result
Typical case
Tang Miqing、female、64，retired teacher of Dongshan Primary School of Zhongjiang County. Main complains were shoulders and neck pain which aggravated at night、headache、vertigo、limitation of shoulder joint movement，the patient felt difficult to fall asleep. The X-ray showed osteoarthritis of C3-4-5-6. Medicines did not work. May. 1994，the patient came for treatment. After given this combining therapy for 3 courses of treatment，all symptoms of the patient disappeared. The patient was so happy and sent a red silk banner as gratitude. The author recommended the patient to do some exercise. After 8 years，the author paid return visit，those symptoms of the patient did not reoccurred.

Xiong Qingyun、male，driver of Automobile Transportation Company of Zhongjiang County. The patient could not drive motorcar for lumbar and leg pain. X-ray showed osteoarthritis of L3-4-5，especially L4-5. Medicines did not work，disease aggravated. It was hard for the patient to walk，when walked，there was feeling of walking on the cotton. It was the first visit on 16th Oct. 1994. After given this combining therapy for 3 courses of treatment，all symptoms of the patient disappeared. After 9 years，author paid return visit，those symptoms did not reoccurred.

Zhang Kaixiu、female、61、worker of Transportation Company of Zhongjiang County. Patient could not walk for heel pain. X-ray showed hyperplasia of heel. Medicines did not work，It was the first visit on 5th Jun. 1994. After given this combining therapy for 2 courses of treatment，all symptoms disappeared. To test and verify curative effect，the patient walked for 30 km and walked with 30 kg burden，no pain appeared. After 9 years，author paid return visit，those symptoms did not reoccurred.

7. Discussion and realization
The treatment of TCM and western medicine for osteoarthritis only can relieve symptoms，can not cure thoroughly. In recent years，the author applies this combining therapy（digital pressing、traction、cupping、medicated hot compress therapy and electrotherapy）in clinic and receives satisfying effect. According to the author's observation，with the standard combining therapy（once each day，a course of treatment is 10 times ），the patients about 30 can recover after 1-2 courses，the patients about 40 can recover after 2-3 courses，the patients about 50 can recover after 3-4 courses，the patients about 60 can recover after 3-5 courses，the patients about 70 are very hard to recover，but can get obvious improvement.

In the author's opinion，combining all these therapies together can prolong the curative time（above 2 hours），improve the curative effect. Different therapies can stimulate the acupoints and foci alternately，regulate the circulation of meridian Qi and Blood，promote the absorption of hyperplasia，soften the foci and renew physiological function.

Ding Jipu

Advanced Training Class of Acupuncture and Tuina College of Chengdu University of TCM

18th Nov. 2003