Brexit, an arduous path to make Britain great again

            BY TAN CHYE HONG

June 23, the world will be in complete stew about whether Britons will vote for Brexit. According to Bloomberg’s news, those voting for “Yes” and “No” to Brexit come close to around within few percentage point in favour to leave, and younger voters incline than older voters to remain in the Bloc.

Many older Britons are still nostalgic, beguiled by erstwhile glory when Britain built its empire. Harkening back to the bygone days, buoyant with national pride left them into believing that Britain will be great again if it goes solo. Is that true?

Well, at its worst, Brexit does not spell the end of the day. However, times have changed, the notion of what constitutes as a great nation also changed. Great nation pooh-poohs about land-grabbed globally type of empire-building. Especially, the West has not recovered from war-fatigue. Empire building is no longer an enviable task. It is a shibboleth.

A great nation will leverage its strength exerting influence in global affairs for the common good of the world. Our world needs better managed in that all nations abide the rules of law ubiquitously agreed upon and also international norms, peaceful means of resolution of conflicts, better tackle climate change, eliminate poverty etc. It is great because it wins many a heart to care of global good over those bellicose brawns that run roughshod over others, many countries are too inward focus that render paucity of global issues attenuated; such as the migrant issue. It will not go away if Britain chooses to leave, the issue will continue to pester Britain, and its intricacies are better managed by interested parties together. Coupled with the US is receding its global influence; for this, it is monumental if Britain can sagaciously play an exemplary role as a global leader to fill that vacuum. Britain finds back its lost lustre.

Being in the network will largely amplify Britain’s influence in global affairs, size does matter; you aim to have a tilt by getting your voice heard louder as a prominent leader in the EU. Consider the number of EU members in the permanent UN Security Council, in IMF, and other global institutions that play to Britain’s favour. In other words, being in the bloc provides the platform that exalts Britain to a higher level that chimes with great again ambition. It would be blinkered if you vote for Brexit, you deprive your political leader a chance using that platform to leverage on global affairs, and certainly your lone voice is overshadowed by the hubbub surrounding and marginalised by other global powers. You find discomfiting in an arduous path to project a towering figure’s image.

Security is also a major concern that you cannot ignore. The major threat is from the North. In a recent American military report, in the past one year, Russia nuclear submarine activities were frequent in North Atlantic. Although Brexit Britain will remain in NATO, the entire security structure will be chipping away. Strategically, it will be a different ballgame. Exit will only let Mr. Vladimir Putin sneer surreptitiously. A broken Europe enhances Russia military leverage in the rickety region. Now the crux of an effective defence is for the EU to establish an impregnable cohesive front with NATO. After the cold war, many EU countries rest on their laurels, run their defence budget on a shoestring. And now it is dawn on them the real threat coming from Russia. Brexit will certainly aggravate the security concern in the EU. The breakup will derail NATO’s plan, as the two are now separate entities. EU has a written law to treat every member’s security as their own that is the major concern Mr Vladimir Putin ineluctably to take deep contemplation before any military deliberation, not any Britain’s enviable military assets. How NATO works with EU in the rise of the occasion in case of military confrontation has yet been tested. Brexit makes it more tenuous.

On the economic front, there are many papers predict pessimistic outcome for ensuing economic growth after breakup. It is hard to reckon an accurate projection. But one thing is for sure, despite the uncertainty, we can expect short-term adversity at least. Especially badgering the banking sector, this is Britain’s major asset. Brexit will change the trade relationship of British banks with its European business partners. British banks have majority of their customers from EU, and there is also about 51% trade of goods with EU business partners. The breakup will not unwind everything right off the bet, but certainly Britain will be taken as outsider subject to different yardsticks. In other words, Britons will live in uncertainty for a period of time of painful adjustments.

A “nation migrant reception attitude survey” caught my attention recently, lo and behold; Britain ranks second in the world after China and ahead of Germany as the nation most welcome migrants. I am not sure how truthful and representative is the survey. It seems to me anti-immigration campaign forms a chorus for Brexiteers. I think in the broader sense, before we enmesh in immigration issue, we need to recognise there are two different characteristics of migrant issues involved, One is under EU’s Schengen agreement that offer free movement of the people within the EU that borderless is one of the four freedoms of the rules regarded as basic  to EU membership. That rule is an idealism somewhat that lately proved to have severe loopholes; such as in counter terrorism and in refugees unfettered moving around the borderless bloc.

Euro-sceptics raise concern about the loss of sovereignty due to free flow of migrants, last year alone; migrants to Britain hit second record high of 333,000. “The Economist” adopting a forbearing attitude made such a calculation: “EU migrants living in Britain at around 1.8m to 1.9m is roughly the same as that of Britons living in the rest of EU. Many of the British are retirees and impose healthcare costs on their hosts, whereas younger EU workers in Britain pay more taxes than they consume in benefits.” But those advocates for exit have legitimate reason for opposing free flow of workers too. For one, it is to blame the languishing world economy, many unemployed Britons feel threatened by an influx of EU migrants, those in the job worry about job security. Forget the law of one price; it is propitious to take advantage of exchange differences to work in Britain to receive Pounds than Euros in the Eurozone. There are impetuses for Southern and Eastern Europeans move to the rich North for jobs. However, the stark economic reality exhibits a diabolical job market growth. We are all living in macro-constraints. Increasing job seeker supply without corresponding job creation, only make competition intensity worse. There is more than what we simply ascribe as xenophobia. So, there can be a slight twist of the rule that still free flow of people, but job seeking is restricted to the host country’s needs only.

The second type of migrant is refugees; there is a grain of truth that refugee migrant issue is a tussle between humanity principle and economic reality. The major concern is assimilation to the host country’s cultures. The culture diversity between refugee migrants and host countries cannot be more real at every turn laden with political backlash; all hell broke loose, making veritable humanity look all the worse that compelled Dr Angela Merkel quick reversal of her migrant policy. The grave concern is no one can tell the scale of refugee migration. A receptive approach also sends a wrong signal for those risk-taking migrants that they are most welcome to Europe. Refugee migrants aggravate the nascent economic recovery in Europe. So there must be a realistic solution that fits into individual country’s circumstances. But the root causes are the political conflicts in the Middle East and economic poverty in Northern Africa. So, tackle problems out of pickle at the source is much efforts saving than futile receptive approach.

Another reason to vote for “in” is trade reason. EU, a close to homogeneous mature market that breeds middle class willing to spend for British luxury goods and services, both share proximately similar culture, value and belief. It is an ideal market which proximity reduces non-value added transport costs especially for transporting goods to countries farther afield. Relatively high wages and living standard in some EU countries certainly lead us to conclude that trading with EU partners can sustain high wages in Britain.

In any rate, I am a strong sceptic about the following practice: In cost cutting exercise, companies relentlessly first target at labour costs either through furlough or lay off workers in droves to maintain or raise company’s earnings in order to pander the market. I believe any business firm should have a social objective. Competitiveness is not a race to cut wages to match those of the Emerging markets. Why there are so many outcries by economists about wages stagnant, unequal distribution of wealth, wage growth disparity. It is mortified that Capitalism goes the wrong way. You just cannot reconcile conflicting objectives of on the one hand to relentlessly cut wages to lower costs and on the other expecting it also lifting living standard. A business firm should maintain healthy workforce with social obligation to take care of employees in good times and bad. Competitiveness in a sense is not to compare British wages with those of emerging markets. It embraces product attributes, quality as a whole. If that is not the case, why so many Chinese middle class rush to buy European goods? So, it is borne out by evidence that don’t forsake EU market which brings you the lifeline.

Living in a world in EU which is fastidious about rules and regulation is difficult to bear for some Britons, those self-proclaimed free market advocates dislike rule based governance and fret about circumscription compromises Britain’s sovereignty, for example, the European Court of Justice can overrule British courts. The best option is not to opt-out but participate in decision process to make change. Since Britain the second biggest contributor coughed up almost 10 billion pounds tax payer’s money in 2014 alone to EU’s coffer, it should have a say about EU’s policy, even Britain not a Eurozone member. Many institutions confer more rights to member with bigger contribution. IMF also adopts such practice. It is only participation of decision process can change the ineptitude of a Neanderthal institution.

The current institution in Brussel is centralised, garners too much power, but govern a bloc with huge historical differences and cultures that needs great tact and flexibility. Intransigency bounds to botch. The ideal structure is a political union where member states are elected to the council to lead, coordinate, trade-off in order to reach consensus among member states, decide on policies related to common interests. The structure is largely decentralised. To have a better chance to spur reform in current EU, Britain should go the whole hog by participating in the decision making process.  If Britons opt to stay out, everything in EU will still be in situ; you are still immeasurably encumbered by those rules in future dealing with EU.

EU to Britain is like centripetal; the smaller mass are ensnared to the larger mass by short distance. I am not a physicist. It is felicitous to apply the same analogy in the making for Taiwan which abutting its border to Mainland China. The new president thought it can extricate economic dependency on Mainland China by developing southward trading strategy mainly with South East Asia. The quick answer to her strategy effectiveness is: she can’t get away with the gravitational effect of the Mainland China’s centripetal force. Many Western businesses are bedevilled with hate and love about doing business in China, hate because a swaggering China wields its economics’ clout, infiltrates business rules with noxious party politics and ideology to bulldoze blustering practices by fair means or foul; a blasé attitude many foreign investors feel unpalatable. Love because of its vast market that many don’t mind being gravitated. There is no such scruple for Britain and EU. Both share common value and belief, whether you are progressive or conservative. With compromise, things certainly can be ironed out. Nothing is insuperable.

In the nick of time, if you vote “yes” on a whim, your vote will be a dicey twist. Britain will unmoor to EU, and the Scots ditch Britain. And the balance has gone the other way, the “yes” votes cast a pall over the great again hope, and scupper. Britain will be truly shrinking fast in size. It is indubitably in your interest and the interest of the world to vote for “no” on the 23 of June to Brexit to save the day. 

How to stop Zika Virus become Pandemic?

It is in vain to be in distraught, to cry over spilt milk when Vaccines are not ready till this September (according to the latest news), a slow remedy that cannot meet the Urgency. I am writing to tell you how to manage the outgrowth not until it becomes widespread Pandemic.

1.     Small scale test trial my prescription

I am pretty confident that my prescription will work the wonder, if you are not intransigent to elude TCM’s cure as an alternative preferring to leave money on the table. (Which means prefer to cling to the belief that I am a little more than a demagogue, and that TCM is not scientific, perversely believing the outmoded threadbare that vaccine is the only putative cure). That argument is probably spurious.

The stark fact is you have no other effective panacea to control the speed of the spreading of Zika at its efflorescence, and it is soon become pandemic. Offhand, there is something worth the trails.

To save lives and stop afflicted area become wide-spreading calamity, the first step to do is to test trails my prescription in small scale in stricken areas. Quickly examine and conclude whether to move to the second step below.

2.    Move forward to mass production phase

If my prescription is truly workable, you can move to mass production stage. There are manufacturers in mainland China, Hong Kong, Singapore and Malaysia; they are specialized to produce herbal mixture liquid, Granules, Tablet, and Pills, so is to uplift the production quantity immediately instead of the cumbersome brewing of the herbs, It saves time and is convenient for wide distribution and usage. 

By doing so, you will be able to bring the pandemic under control.

Zika Virus, from a Traditional Chinese Medicine perspective

Zika Virus is a mosquito-borne disease. Aedes mosquitoes are considered as main vectors.

Outbreak distribution: in tropical Africa and in some areas of Southeast Asia. Since 2007, several islands of the Pacific region have experienced outbreaks. In 2015, ZIKV disease outbreaks were reported in South America for the first time. ZIKV disease is now considered as an emerging infectious disease.

Pathology:

According to Wiki, Zika virus is enveloped and icosahedral with a non-segmented, single-stranded, positive-sense RNA genome. It is most closely related to the Spondweni virus and is one of the two viruses in the Spondweni virus. The pathogenesis of the virus is hypothesized to start with an infection of dendrite cells near the site of inoculation, followed by a spread to lymph nodes and the bloodstream. Flaviviruses generally replicate in the cytoplasm, but Zika virus antigens have been found in infected cell nuclei. : It was suggested that Zika virus can be sexually transmitted between humans.

Symptoms:

Most of the infections remain asymptomatic (between 60 to 80%). a short-lasting self-limiting febrile illness of 4–7 days duration without severe complications, with no associated fatalities and a low hospitalisation rate.

Symptoms are similar to other Flaviviruses, such as Dengue fever or Chikungunya; but are milder in form and usually last four to seven days.

Common symptoms include mild headaches, maculopapular rash. It is a red area on the skin that is covered with small confluent bumps, often starts on the face and then spreads throughout the body.); fever (low-grade), malaise, pink eye (e.g. light sensitivity), and joint pains, mainly in the smaller joints of the hands and feet). Muscle pain, vomiting. Zika fever has been a relatively mild disease with limited scope, with only one in five persons developing symptoms, with no fatalities, but its true potential as a viral agent of disease is unknown. For pregnant woman it has been suspected (but not proven) that a transplacental infection of the fetus may lead to microcephaly and brain damage.

Treatment

No vaccine or medications are available to prevent or treat Zika infections

Treatment from TCM perspective

In TCM, It is exterior pathogenic dampness heat（外感湿热） to be the cause of the disease.

由于湿热交织，则热不甚。湿浊伤清阳之气(湿甚阳微) 清阳出上窍，发腠理

，实四肢，故见头痛，湿热流注，邪伏膜原，见瘙痒，湿热入于血分，见疹斑，流注关节，则疼痛。邪客肝经，肝藏血，开窍于目，怕光，红眼，湿热蕴织中焦，胃失和降，则呕吐。

In TCM terms,

Owing to dampness and heat intertwined, patient develops mild fever, predominant turbid and moist pathogenic factors harm the “yang qi” which is characterised by lightness (轻扬) and upward mobility（上行）, the disruption of “Lucid Yang” (清阳) ascending to the upper orifices, causing the symptom of headache; The latent pathogen of dampness  heat in 膜原， (膜原 is the space outside the viscera in the neighbourhood of the stomach, and also in TCM term, usually indicating the position of pleura and the diaphragm), developing the symptom of itchiness, malaise. 

The dampness heat reaching the blood phase湿热入于血分, patient develops rashes, when reaching the joints, inflicting joints’ pain. The exterior pathogen stations in liver meridian, the function of liver is to store blood, the eye is the orifice to the liver, that evil（Dampness heat） causes pink eyes and light sensitivity. The evil (Dampness heat) in middle-warmer (中焦) ， the stomach loses the function of descending of “qi” causing vomiting.

It is all right if you can’t apprehend what a picture I was trying to depict. All the more, TCM is so much philosophical. That piece is just to determine the pathogenic factors and derive the following prescription based on the differentiation of symptoms and signs. (辩证求因).

TCM prescription:

生山栀3钱(Cape Jasmine Fruit)  片姜黄2钱(Gurcuma )  荆芥穗3钱(Schizonepeta Spike) 金蝉衣3钱( Cicada Slough) 生大黄（后下）2钱(Rhubarb)  白僵蚕2钱( Batryticated Silkworm)，飞滑石1两(Talc)，京赤芍3钱(Red Peony Root)  蕤仁肉3钱  (Prinsepia uniflora Batal)草豆蔻3钱 (Alpinia Katsumadai Hay.) 嫩青蒿3钱(Herb 0f Sweet Wormwood) 广藿香3钱(Cablin Patchouli)  北柴胡3钱(Bupleurum),  净连翘3钱(Capsule of Weeping Forsythia) 徐长卿3钱(Paniculate swallowwort root) 白花蛇舌草5钱 (Oldenlandia) 粉甘草1钱(Liquorice root)

Reference: Wikipedia 

Alopecia areata（斑秃）, why not try Chinese Medicine?

The following is a response to the local newspaper publishing a Alopecia areata patient's predicament.

I read your medical condition with sympathy.  You are too pessimistic. The disease is not without cure. According to my research, elsewhere hospitals used Chinese medicine to treat Alopecia areata’s patients. The statistical evidence showed encouraging results. The effective rate is as high as 90%. There are also wide variety of treatments available, such as Skin needle(皮肤针), Body acupuncture(体针), Point injection(穴位注射), Catgut embedding(穴位埋线), Laser acupuncture(穴位激光照射), Bloodletting(刺血).They are all passed clinical tests with flying colors.

In ancient China, there was widespread ignorance about the disease, commonly known as "receive many" alopecia (鬼剃头).And now we know that neural spirit factors are thought to be primary factors; such as anxiety, sadness, depression, endocrine disorders, stress resulting the onset of the disease. Besides, people with genetic allergy background are a cause of alopecia areata. Autoimmune disease, another cause that causes the surrounding of hair follicles and lower part of lymphoid cell infiltration; a part of it infiltrates hair follicle wall, resulting stromal cells (hair matrix cells) degeneration.  Its follicle vessel branches also vasculitis, blood vessels are damaged, that reduces vascular network, making blood supply insufficient, causing hair loss.

I suggest herbal treatment for you.  Try my prescription every day, three times a day for a month. If those herbs worked wonder for others, I don’t see why you are exceptional. You need to be patient, some of the herbs are meant for boosting immune system. It takes time to build a stronger system.

何首乌1两，炙黄芪1两，明天麻3钱，侧柏叶5钱，升麻3钱，白蒺藜3钱，杭白芍3钱，楮实子5钱，酒川芎 3 钱，西红花2钱，墨旱莲3钱，女贞子3钱，菟丝子3钱，五味子3钱，紫丹参3钱，牡丹皮3钱，生地黄3钱，熟地黄3钱，金蝉蜕2 钱，北柴胡3钱，广郁金3钱，土茯苓3钱。

Let me explain to you the meaning of the prescription and why I use those herbs. In TCM, the sudden loss of hair is due to wind (风)There is a well-quoted ethology."高巅之上，唯风可及” It  literally means "High up the peak, only the ethology factor of wind can reach the height. 内经有云：风者，善行而数变，wind has the characteristics of “mobility”, “change”, “abruptness” Wind is caused by deficiency of blood (血虚生风)( 何首乌, 明天麻, 白蒺藜, 酒川芎, 升麻,杭白芍,熟地黄, 金蝉蜕)The kidney is reflected by our hair(其华在发)(Hair loss is due to deficiency of liver and renal yin(肝肾阴虚)( 墨旱莲, 女贞子, 菟丝子, 五味子, 楮实子) Deficiency of liver and renal yin can be the result of disharmony of hepatic qi (肝郁气滞(北柴胡, 广郁金)the chain effect will be stagnant blood(血瘀，血热生风，风往上行)( 牡丹皮, 生地黄, 西红花, 侧柏叶) There are immune system strengthening herbs (炙黄芪, 土茯苓). Some of the herbs mentioned above also carry immune system boosting effect.

My prescription can be purchased from local Chinese medical hall. My best esimate is it costs within twenty dollars per pack. You need a pot specially to brew the herbs; the pot can be bought at pottery shop. You pour four rice bowls of water just cover the top of the herbs, and use big flame till it boiled, and switch to small flame for another twenty minutes, you should get a bowl of brewed herbs. A pack can be brewed three times just to get your money worth.  The residue of the herbs can be used by pouring warm water into it to hand wash the scalp.

It took me three hours to type and research; I hope you take my suggestion seriously.

注解：
经免疫学研究，这种斑秃可出现抗甲状腺球蛋白、抗肾上腺细胞、抗甲状腺细胞等抗体，而无抗毛囊抗体，故认为是一种自体免疫性血管炎性秃发。

膝关节骨性关节炎 膝关节骨性关节炎 (Osteoarthritis),

在电视中医药节目中，郝老先生确实很酷,能蹲站几十下,又能耍滑轮.事实上, 这样做是否值得效仿呢? 对很多年长者来说,应做力所能及的运动.随年龄的增长, 老年人的反应及灵活性已降低, 不必强求做一些难度过高的运动.

至于蹲站数十下,真的对膝关节好吗?我研究了中西有关文献,有与该节目不同的见解.在国内,主流意见认为这是一个误区.有文章写道:"平时不注意自我保护，如经常蹲下或跪下取物、坐矮凳子、睡低床等，这会增加关节的摩擦和负重。错误锻炼也可加剧关节炎，如膝骨关节炎患者喜欢用打太极、爬山等运动来锻炼关节，这些都会使关节磨损更厉害。"

另一篇则这么写道"要特别注意避免关节的机械性损伤，尽量减少关节的负重和磨损，如膝、踝关节的骨性关节炎患者平日要尽量避免上、下楼梯，长时间下蹲、站立、跪位和爬山及远途跋涉等较剧烈的对关节有损伤的运动，尤其在关节肿胀时,更应避免.我曾接诊过多位剧烈运动后病情加重的患者，如有的老年人要参加迪斯科舞蹈比赛，练习时间较长，结果出现膝关节肿胀、疼痛、不能行走。北方农民常以蹲姿干农活，膝、踝的骨性关节炎很常见。为了达到锻炼身体的目的，患者可以选择游泳、骑车、做体操等关节负重较轻的运动，也可利用把手、手杖、护膝、步行器、楔形鞋垫或其他辅助设施来辅助关节运动."这些是有关国内的报导.

在国外,强调多运动,尤其是体力的活动,来帮助肌力,身体的活动性 ，以及关节的健康.可是令人感到很遗憾的是很多膝骨关节炎患者, 就不爱运动.由於关节腔中缺少了粘性的滑液（关节液），导致原本应該充當軟垫的軟骨不正常的磨擦，造成了破坏與退化。当軟骨退化後，便無法保护骨頭表面，在行走或站立時，身体重量使退化的关节不胜负荷。由于懼怕痛苦，自然減少了运动, 于是那裡的肌肉也跟隨萎縮，并且韌帶也变得更加鬆弛,很多患者以为关节痛是运动造成的.其实, 造成真正疼痛是因为他们参与高强度运动, 忽视了他们体能的局限.这些患者应参与的是低强度运动.

什么是低强度运动?那就是不让关节过度负荷的运动; 具体来说, 健步走, 骑脚车, 伸展运动（如膝盖伸展运动, 大腿内侧伸展运动，大腿与臀部伸展运动等等）， 一部分的瑜珈姿势, 和游泳都是, 水中健走也有俾益.

什么是高强度运动? 好比跑步,打篮球,排球，足球，打网球,滑雪这些都是让膝盖关节与身体重心对抗的活动. 这些活动虽然对骨质密度有好处,但膝骨关节炎患者应更关心的是如何提高肌力及关节的活动度,不是让疼痛更厉害,让关节加倍损伤.

有膝骨性关节炎, 那些是值得推荐的锻炼呢?

最推荐的是肌力锻炼： 因为膝骨关节炎患者的股四头肌多有不同程度的萎缩。肌肉协调运动和肌力增强可有效减轻关节疼痛症状。为增强关节周围的肌肉力量和耐力，进行适当的体育锻炼是非常有益的。股四头肌强化训练在缓解疼痛及功能改善方面有明显的效果。 练习股四头肌的方法及要求是：让病人仰卧，两腿伸直平放于床上，抬腿时要伸直膝关节抬离床面，足跟稍离床即可，根据病人肌力大小，可在腿上加上适当的重量。抬腿以不超过45。高度，要慢慢抬高, 然后慢慢放下。当把腿抬到适当高度时, 停一下，约3秒～5秒, 再放下来，然后再抬，这样反复练习以不疲劳为度。一般要求病人每2小时练习一次，每次5分钟～10分钟。

我是老病号，可以手术治疗吗？

一般可用关节镜插入在髌骨周围所开的其中一个小孔，透过荧幕来观察关节内部的情况，切除已损坏的半月板软骨，滑膜，並清理关节的软骨碎片。譬如，骨刺切除，並让血液中促进软骨再生细胞，助软骨再生。抑制发炎症状。

另一种手术是高位胫骨截骨手术，针对O 型腿。O 型腿者的负重线会较偏向膝盖内侧，导致内侧软骨磨损，O 型腿更加明显，疼痛加剧。高位胫骨截骨手术，最大的优点是术后无论工作或运动，几乎无任何限制。

接下来给膝骨关节炎的患者谈谈病理及个人的体会

膝关节骨性关节炎 (Osteoarthritis), 是因为膝关节的软骨故障[. 膝盖的骨头包括股骨，胫骨腓骨及髌骨。骨头与骨头是由关节软骨组成。胫骨关节须承担较大的负担，除了关节软骨外，还有一片板状的半月软骨，覆盖在关节骨两端 白色而有光泽的部分,它是构成关节的重要物质,令关节两边骨骼不会互相摩擦,又能高度吸震,由于状像新月的纤维软骨,一般称半月板软骨(Articular Cartilage).

韧带是条外观细长的带状组织，连接骨头，结构强韧，具有伸缩性，能固定骨头的位置，与肌肉一起控制膝盖的活动。一般，十字韧带控制膝盖的前后移动与旋转等动作，侧副韧带可支配膝盖的左右运动。

关节囊是负责包覆关节的膜状组织，内部充满关节液，关节液由滑膜分泌，成分是水分及玻尿酸，氧气与营养成分，当关节伸展弯曲时，关节囊就会产生压力，像海绵般的软骨协助吸收关节液中的氧气与营养。

膝骨关节炎最常见的是 退行性的关节炎(Degenerative joint disease),几乎都发生在中老年人身上，它是由长期磨损造成的(Wear and tear),磨损的原因有长期姿势不良,负重用力,重度肥胖,创伤,膝内翻或外翻外伤后膝十字韧带断裂,内外侧副韧带断裂,关节囊松弛,造成关节不稳.此外随着老龄化，新陈代谢功能减退，软骨越来越薄，容易受伤。

若关节软骨或半月板软骨受压部位变粗糙,变薄,并有小块脱下,局部炎性反应, 在软骨破坏边沿,体内游离钙聚集补充,软骨增殖, 局部硬化, 钙化产生骨赘,脱落后形成游离体,此时滑膜增生,有的伴液体大量渗出.由于关节表面粗糙，关节液就须更多时间渗透到软骨内，缺乏冲足关节液的膝盖就因磨檫而产生不适与疼痛。

软骨内是没有神经，血管或淋巴分布，是不会产生疼痛的，最主要的疼痛是滑膜发炎引起的身体为了防御产生的免疫反应，炎症为修复受伤的组织，滑膜分泌大量的关节液，它含有一种叫细胞激素的物质，能恶化整个状况，使疼痛加剧。

这里顺便交代一下症状: 五大症状： 局部发红（充血引起）肿胀（细胞激素与白血球渗出至血管外引起）疼痛（肿胀压迫周围组织引起） 发热（充血引起） 及功能障碍（肿胀，疼痛，患部瘢痕化引起）。一旦转成慢性，会造成滑膜肥厚，瘢痕化。若避免活动膝盖，软骨碎片或细胞激素就不易排出，使疼痛逐渐加剧，关节液滞留，大量分泌，滑膜发炎，软骨碎片刺激滑膜，发炎更严重化。

通常最早出现的症状是疼痛,发生在活动之后, 也容易出现"膝软"的现象,那就是行走中膝关节突然发软，欲跪倒或摔倒的现象，可伴有剧痛。也有患者出现“胶着”的现象：即关节在某一位置较长时间静止不动之后，再活动时非常疼痛，屈伸引起不能，必须缓慢地逐渐活动一会之后，“胶着”现象才会消失，膝关节才能屈伸运动.也有患者出现绞锁现象, 即在行走等运动过程中，膝关节突然被锁在某一位置上不能运动，像有东西将关节“卡住”一样，常需要试探着将关节摇摆屈伸，往往在感到“咯噔”响后，关节才恢复原先的活动。关节软骨剥脱形成的游离体及破裂的半月板是引起关节绞锁的常见原因。关节交锁也常见见于半月板部分撕裂、十字韧带断裂、内侧副韧带断裂；内侧副韧带断端嵌顿在关节间隙间而引起.

导致膝关节不能完全伸直如受伤时膝内有啪啦声，同时伴有局限性撕裂样剧痛，患肢不能持重，不能行走，提示可能发生韧带完全撕裂或膝关节联合损伤。膝关节扭伤者如局限于某一处, 则肿胀较轻.如局部肿胀较大，并有皮下瘀斑，如韧带完全断裂, 则浮髌试验阳性.扭伤不同部位都会出现压痛，如在压痛点处摸到局部组织有缺损性凹陷，多为韧带完全断裂的表现。

如果累及髌骨软骨,主要症状为髌后疼痛，在活动或半蹲位出现，初期为酸乏不适，后期发展为持续或进行性的酸痛。往往在开始活动时疼痛明显，活动后减轻，活动结束或休息时疼痛又加重。在上下楼梯，尤其在下楼或下坡时酸痛明显。有时有关节交锁症状。一般上有髌骨磨压痛, 将髌骨向远端推挤，同时股四头肌收缩，髌下出现酸痛,单腿半蹲试验为阳性是髌骨软骨病最显著而又有诊断价值的体征之一.股四头肌萎缩多较明显, 尤其以内侧头更为显著.膝关节积液征在中后期多为阳性, 浮髌试验可助诊断.髌骨软骨病并发周围软组织炎症时，用示指指甲扣刮髌周可以出现疼痛。

最后说说体会,我膝关节骨性关节炎发作已两次,第一次在四年前,去年也再发作,中医当为痹症,骨痹.辩证认为肝主筋,肾主骨,又说膝者筋之府,年过半百,多半有肝肾亏虚,容易遭外邪就是风.寒.湿邪的影响,此外,外湿易与内湿胶结,形成痰浊,痰湿阻滞筋脉,关节内外组织损伤,则瘀血阻络.如有红肿热痛,沉重感,多有湿热下注.遇寒痛甚,得热则减者多寒痹.疼痛剧烈,固定不移,局部肿胀或瘀斑,舌紫暗者多瘀血.

我从肝肾亏虚,着痹(湿痹)及瘀血阻络着手,针药并用.

自拟方(请在医师指导下使用) 鹿衔草5钱, 豨莶草5钱,透骨草5钱,老鹳草5钱, 威灵仙3钱,骨碎补3钱,川牛膝3 钱,宣木瓜3钱,川萆懈3钱,路路通3钱,广地龙3钱,穿山龙3钱,鸡血藤5钱,川独活3钱,海风藤3钱,皂角刺2钱,伸筋草3钱.

针灸:   我用的是常用穴: 膝眼,犊鼻,鹤顶,这些都是膝关节附近的穴位,筋会阳陵泉可透阴陵泉,其他如委中,血海,足三里都用的着,最主要的是针上灸,每个穴位,烧上3 到5壮,特别是有关节积液者,针后感觉很好!

还有就是做穴位注射,用复方当归注射液注射(由医师操作),止痛效果立竿见影.真正活动如常, 一般要3到4 周.

以我的经验,像打太极拳,登高后,肿痛会加剧,打太极拳可能跟脚分阴阳,一些姿势,如蹬腿,下势,金鸡独立,这些都加重膝关节的负担有关,本来针灸好些了,又再搞砸了.瑜珈的一些姿势也会加剧伤势, 我把它改为简单, 杀伤性不强的姿势.所以, 你要自己看着办, 照顾好你的膝关节.

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本文是中华医药节目“好腿脚，蹲出来”，希望对膝关节骨性关节炎 患者有用！