十七：强直性脊柱炎（AS：Ankylosing Spondylitis）合股骨頭壞死 (ONFH: Osteonecrosis of the Femoral Head)

某男， 57歲，體重122斤，身高170cm。 接診：2012.7.8

病史：1979年，搬運重物時腰部受傷，針灸治療後未遵醫囑繼續治療除根。86年右腿感受風寒，開始感到疼痛不適。以後，腰習慣性扭傷，達30-40多次，每次需臥床數天至數周，均靠針灸治療緩解。2010年起，腰脊晨僵，能俯身不能後仰，遇寒加重。另，2000年，胸骨錯位，全癱，中醫正骨治愈。2003年曾因急性前列腺炎在舊金山總醫院住院，做激素治療。2009年7月右髖突然劇痛，針灸後緩解。2010年開始感到右髖疼痛明顯加劇，右臥股骨頭壓痛，不能超過5分鐘，必須換姿勢。2012年7月7日外出，突然右髖劇痛，無法行走，打出租回家。

刻診：脈細弱，心悸，體溫36°，心率55。舌紅、苔薄，面色無華，右腿外展、蹬腿疼痛、受限。右側股骨頭叩擊疼痛。腎區無叩擊痛。夜尿3次以上。失眠。

診斷：風濕骨病，尚未化熱

病機：早年風寒受傷，寒凝遲滯血脈，致使供血不足，腰為腎之府，大腿後外側，乃膀胱經、膽經循行路線，不得溫煦，受血不足，久則腰腿退行性病變，加之心血不足（脈細弱），血脈瘀阻不通（右腿靜脈曲張明顯），加之激素毒戕害真陰，最終形成股骨頭壞死。

治則：驅風燥濕、補腎活血、涼血。勿強行進行腰腿鍛煉！

針灸、方劑治療。期間，腰髖痛減、晨僵稍減，但仍不能右臥，蹬腿外展疼痛未明顯改善。2012年10月6日在外出差住地下室，夜間突然腰部疼痛難忍，隨即終止活動返回家鄉。

服藥、針灸至2013.4.1 腳踢腿外展已無無任何感覺，可高頻跑步。仍有晨僵。至2013年12月，面色晦暗消失，全面轉為紅潤，體重增加10斤，達133斤，體溫36.5°，心率64。無晨僵、可通宵右臥，無明顯不適。右側股骨頭無叩擊痛。大腿肌肉較前豐滿。向後折腰甚至大於病前的角度。自稱腰部感覺30年未有過的有力，駝背也好了，昂首挺胸，步姿健康。負重100斤，胸椎、腰椎無任何不適。至2014年底，治療三年中未發生習慣性扭傷。但腰髖遇冷仍有輕微不適，遵囑繼續服藥，劑量、頻率均已大減，但須保持數年，方可保病不返，或可完全治愈。

這兩個病在西醫雖是兩個不同的病名，但病機是相同的，中醫治則也相同，並無沖犯。關鍵在於，患者必須明白此病得之非一時之事，去之需時。因為股骨頭壞死是因為缺血性，說明身體自身救贖供血困難，所謂冰凍三尺非一日之寒。究其原因，可能是患肢受過外傷、寒邪、濕邪，未及時治療復原。還有患者有過激素治療病史，激素毒被認為是本病的重要致病源之一。但如果未及時確診，服止痛藥可能稍有緩和，卻於病無補，反延誤治療。等到股骨頭酥掉、臼窩塌陷，中醫也回天乏術。突然疼痛加重，出現劇痛，往往是酥掉的碎骨調入大轉子和臼窩之間的空隙，走路時摩擦所致。西醫可以做髖關節置換手術，但成本高，且不僅材料壽命的時間限制，而且此為骨病，一般骨質疏松，更換髖關節需要有堅實的骨質安定義肢。若骨質疏松，將無處安置。有的安裝義肢之後，就是因為骨質惡化，最後脫落。所以，本病有“輕則致殘，重則致癱”的說法。中醫可以通過針、藥補腎活血，逐漸恢復血供。強直性脊柱炎後期疼痛難忍，活動受限，被稱為不死的癌癥，生活質量極低。中醫治療骨病從腎論治，有數千年的經驗，療效可靠，不致因為此病而致殘。

17. A.S (Ankylosing Spondylitis) with ONFH (Osteonecrosis of Femoral Head)

Male, 57 years old, H: 5”4; W: 133lb.  Clinic visit: 7/8/2012

In 1979 lumbar sprain, almost recovery after taking acupuncture. 1986, right leg catches a cold and suffered chronical dull pain afterwards. Habitual dislocation of lower back dozens of times. All recovered via acupuncture. 2003 received hormone treatment at San Francisco General Hospital. From 2010, felt obvious stiffness in the morning. At first bend forward ok, later neither way will work. 2000, dislocation of thoracic vertebrae fixed by CM doctor.

From 2010, felt pain on femoral head of the right side. Lying on right side can’t last for five minutes. 7.7.2012 while shopping at a mall, felt sharp pain on right pelvic, crippled walk instantly, took taxi back home.

Palpitation, low body temperature: 36°(96.8°）, pulse: 55times/minute; red tongue, pale, insomnia, right leg pain in pelvic and femoral head when doing abductive and pedaling movement check. In the morning lower back stiffness increased.

Caused by coldness hit the leg and blood supply is less and less till totally stopped.

Diagnosis: Rheumatism (Ischemic necrosis)

Acupunctured and herbal therapy.

advice: don't exercise by moving sick leg.

Pain eased almost from day one. with less pain, patient took less and less frequency of herbs. Oct 6, 2012, when out of town on business, stayed in a basement hotel room that triggered great pain. Patient cancelled trip and return home, continuing treatment.

Till April 1, 2013, sick leg kicking and outside doesn’t feel any pain, still sensitive under pressure. able to run at fast speed. morning stiffness still exists. Till Dec 2013, appearance improved greatly, turning bright and white from dark and gloomy look. Weight increase by 11 lbs., body temperature 36.5°（97.7°）, pulse: 64. Thigh muscle as rich as the left leg. could bend backward close 90°. Carrying 110 lbs. without feel any pain on both legs and lower back. Then low frequent herb taking and acupuncture.

The above were two different disease names and to TCM the root is the same. The key point is the patient must understand it has developed for years from very small coldness or injury one might not feel it. But slowly but surely, the channels to the sick place closed and the blood supply stopped. In WM, it was incurable because they can't find a way to restore blood supply. The other reason may be Hormone usage which greatly injure the body essence with years passing by, depending on patient's health condition, for seniors, it only took a couple of years to feel hip pain the beginning of ONFH.

According to WM, surgery is almost the only way to solve this problem. the best gears can only take fifteen years, not to speak of the costly expenses in gears and drugs administration lasting years after the operation.

TCM combined with acupuncture and herbal therapy (not pain stopper) can definitely help your dead bones blood supply recovery. and most likely you will be spared a surgery.

TCM with right herbal therapy and acupuncture on correct points will keep the limb your parent and Mother Nature gave you. In the mealtime, with your bone recovery, you will find your body constitution improve a lot and your kidney problems (if any) are gone because TCM believes bone problems are connected with the kidney.

To me, the money even you can afford for s surgery, will enough for TCM treatment and tuition for you learning TCM as a beginner till you get a licensed TCM partitioner.