How TCM understands and treats ONFH

In the view of traditional Chinese medicine, osteonecrosis shall fall into the scope of "bone erosion", "bone bi (arthralgia and impediment)", "bone fistula" and "congestion". The morphology and pathological mechanism of osteonecrosis match with the concepts of "bone erosion" in “Cijie Zhenxie” of Lingshu, and of "bone fistula" in “On Fistula” of Suwen. Meanwhile, its symptoms and signs are close to those of the bi syndrome.

On the etiology and pathogenesis of osteonecrosis of femoral head (ONFH), TCM experts have proposed many theories emphasizing on different points:

Some propose that, the disease manifests mostly symptoms of the kidney yang-deficiency syndrome, especially in the middle and late-stage patients. Due to the kidney yang deficiency, the marrow cannot be warmed, and the kidney qi is too insufficient to drive the blood flow; the blockage of qi and blood flow causes blockage of meridian vessels, so the bone withers and the marrow reduces; when the femoral head cannot get sufficient blood supply, ischemic necrosis occurs. The disease belongs to the bi syndrome, mostly caused by the invasion of dampness and heat pathogens, qi stagnation and blood stasis, kidney function insufficiency or deficiency of kidney yin and/or yang.

Also proposed is that the occurrence of this disease is related to the deficiency of innate endowment. When the body has no strong enough guard against external pathogens, it is frequently invaded. Glucocorticoids and other heat-natured drugs can be considered as heat pathogens, the use of which are easy to injure the yin blood, leading to nutrition insufficiency of tendons and muscles, and causing finally fistula.

Some believe that the disease belongs to the "bone bi in the hip caused by internal damage", namely, impediment and arthralgia caused by the fire and heat pathogen obstructing the blood, damaging the qi and causing blood coagulation, followed by the mutual escalation of blood coagulation and heat. This is in fact, as Suwen Xuanji Yuanbingshi (Exploration to Mysterious Pathogenesis and Etiology Based on the Plain Questions) deducts, "overheat in the kidney interfers the foot Jueyin meridian, so the internal court is disorderly and stagnates; as the heat escalates, the qi and blood cannot be unblocked, so the fistula and bi are caused”.

Some view the disease as a syndrome with deficiency causes and excessive symptoms, which is caused by the internalization of evil pathogens that penetrate the tendons and bons and persist for long, due to the head converted by excessive coldness, induced by the weakness of the body.

Some also deduct that the disease shall occur as the kidney qi and marrow become insufficient, when the yin deficiency escalation reaches the kidney, which is induced by the blood flow and meridian blockage following the yin deficiency and blood stagnation due to the consumption of yin essence after the lasting application of hot and dry-natured hormone drugs, adding to the often constitutionally weak kidney qi.

Also believed is that the disease is caused by the stasis of turbid phlegm, blood stasis and meridians blockage.

To sum up, the internal cause of this disease is congenital weakness, and the external cause is the invasion of exogenous damp and heat pathogens. As the invasion goes on, the constitution becomes even weaker, and the kidney deficiency becomes more serious. The disease can be subtyped into kidney deficiency, blood stasis and phlegm dampness, and the kidney deficiency can be deficiency of yang or yin.

In terms of treatment, guided by the holistic view of traditional Chinese medicine, following the basic principles of "combination of movement and stillness, concentration on both the muscle and bone, overall treatment on the internal and external, and cooperation between doctors and patients", the disease causes and symptoms are both paid attention to, and adopted are drugs for blood circulation promotion and blood stasis removal, kidney and bone tonification, phlegm elimination and dampness removal, which can help early stage patients to relieve pain, improve joint function, promote necrosis repair and prevent collapse, and patients of the middle and late stages to complement the surgical repair operation and improve the surgical effect.