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Diagnostic Essentials for Joint Tuberculosis (Flowing Phlegm) in Chinese medicine:
(1) It often occurs in children and teenagers related to a history of tuberculosis in other position, pulmonary tuberculosis in particular.
(2) The pathogenic positions are mostly in the spinal column, then in the joints of the hip, knee and ankle of the lower limb, and further in the joints of shoulder, elbow, wrist and fingers of the upper limb.
(3) In accordance with the clinical manifestations at the different periods, it is often divided into three stages.

Initial Stage: Although there is pathological change in the bone, there is no change in the external form. Only insidious aching pain is felt in the infected area, without red color, heat sensation, and obvious tumefaction. Progressively, the motor impairment in the joints can be present, with the pain aggravated by motion and relieved by rest. Children can often "cry at night" during sleep because of pain. At this stage, the general symptoms are not obvious.

Middle Stage: From half a year to over one year after onset, the muscles around the infected areas become atrophic and the involved joints become swollen gradually,with abscess formed distal to the infected areas. In suppuration, the skin becomes slightly red in the infected areas and felt slightly warm in the fingers by pressure, accompanied by obvious general symptoms.

Late Stage: Mter rupture of suppuration, pus is as thin as sputum, mixed with bad cotton-like substance. If it lasts longer, the wound is depressed and the skin around the wound becomes purple dark. Then, it is easy to form a sinus and difficult to heal the wound. If it occurs in the four limbs, the muscles become atrophic progressively. In those with the pathogenic change in the cervical, thoracic and lumbar vertebrae, motor impairment or paralysis of the four limbs or incontinence of urine and defecation can be present, accompanied by obvious general symptoms.

(4) The total count of peripheral leukocyte and hemoglobin content are reduced. Lymphocyte ratio is enhanced. Erythrocyte sedimentation rate gets higher. X-ray photograph shows phenomena of early tumefaction of synovium, Osteoporosis and decalcification. Progressively, there can be chondroclasis, or pathological dislocation, obvious sabotage of the osteoarticular surface and formation of sequestrum.