Outline:
Ischemic necrosis of femoral head is a disease of bone necrosis due to disturbance of blood circulation in the femoral head. It is common in the people aged between 30 - 60, particularly in men. It mostly occurs in both sides and its prognosis is not good.
 
This condition is of many causes, and its pathogenesis is different. The pathogenic factors can be roughly summarized into three kinds: traumatic (fracture of neck of femur or injury of hip joint), non-traumatic (administration of glucocorticoid, long term of excessive drinking, radiation injury, diver's disease, sicklemia, mountain sickness, renal post transplantation, rheumatoid arthritis, hemophilia, and some angiopathies) and children ischemic necrosis of capitular epiphysis of femur (epiphysitis of femoral head, post-treatment of congenital dislocation of hip joint). According to different causes, it can be classified into traumatic, iatrogenic, radiation damage, dysbarism, hematopathy, and idiopathic (with no definite cause) necrosis of femoral head. Pathologically it may be divided into six stages according to the severity of hip pain and X-ray findings.
 
Major points for diagnosis
1. The patient has a history of hip trauma, long term of taking hormone in a large dose, excessive drinking, hematopathy, roentgenopathy, decompression disease, etc.

2. At the beginning, there is vague pain in one or two hips, and gradually the pain gets serious. There occur claudication and limitation of abduction, intorsion and extorsion of hip joint. Severe patients need crutches when walking. The patients with necroses of femoral heads in two sides have trouble in walking.
 
3. The sick limb becomes shorter, with flexion, adduction and contracture deformities. There is muscular atrophy, or even sign of semiluxation. Figure-of-4 test, Thomas' sign and Allis’ sign are positive.

4. X-ray film shows no positive signs at the early stage of ischemia. At the late stage, there may be enlarged shadow of articular capsule, widening of articular space, osteoporosis in the center of femoral head or coexistence of osteoporosis and osteosclerosis may be found. During the period of blood supply reconstruction, the femoral head gets condensed in density and flat in shape, gradually uneven in density with vesicular spaces or crack and the femoral neck becomes wider and shorter. At the healing stage, the bone density of femoral head gradually gets normal. The contours of head and neck of femur get almost or completely normal in some cases; the head of femur gets flat with high density but no crack and the femoral neck becomes wider and thicker in some cases.

During the period of survival deformity, there may be findings of flatness of femoral head, widening and thickening of femoral neck, narrowing of articular space, relatively upward dislocation of greater and lesser trochanters, or semiluxation, and bony arthritis after a long time. MRI and SPECT examinations can early find ischemic necrosis of femoral head. Assay of internal pressure of bone and intrabone venography can reveal the condition of venous circulation.

Herbal therapy
Internal treatment based on syndrome differentiation

(1) Syndrome of qi and blood stagnation
 
Main symptoms and signs:
Hip stabbing pain in fixed spots worsened at night, impaired movement of the joint, dark tongue or with petechiae, stringy or deep choppy pulse.
   
Therapeutic methods:
Promoting blood flow to remove blood stasis, dredging collaterals to stop pain.
    
Reeipo and herbs:
Modified Shentong Zhuyu Decoction. Specifically, Danggui ( Radix Angelicae Sinensis) 15 g, Qinjiao ( Radix Gentianae Macrophyllae ) 10 g, Chuanxiong ( Rhizoma Ligustici Chuanxiong ) 10 g, Qianghuo (Rhizoma seu Radix Notopterygii ) 10 g, Moyao (Myrrha) 10 g, Wulingzhi (Excremebtum Trogopteri) 10 g, Xiangfu ( Rhizoma Cyperi Rotundi ) 10 g, Yanhusuo (Rhizoma Corydalis) 15 g, Niuxi (Radix Achyranthis Bidentatae ) 10 g, Dilong ( Lumbricus ) 10 g, Honghua ( Flos Carthmi ) 6 g and Gancao ( Radix Glycyrrhizae) 3 g.
 
(2) Syndrome of blockage of pathogenic wind-cold dampness
Main symptoms and signs:
Hip pain worsened when the weather changes, impaired movement of the joint, numbness, preference to warmth and intolerance of cold, white and thin tongue coating, stringy and slipping pulse.
    
Therapeutic methods:
Warming meridians and dredging collaterals, expelling dampness and cold.
 
Recipe and herbs:
Modified Duhuo Jisheng Decoction. Specifically, Duhuo (Radix Angelicae Pubescentis) 6 g, Sangjisheng (Ramulus Loranthi ) 10 g, Fangfeng ( Radix Ledebouriellae Divaricatae) 6 g, Chuanxiong ( Rhizoma Ligustici Chuanxiong  ) 10g, Niuxi (Radix Achyranthis Bidentatae) 10 g, Chishaoyao (Radix Paeoniae ) 10 g, Qinjiao (Radix Gentianae Macrophyllae ) 10 g, Danggui (Radix Angelicae Sinensis) 10 g, Fuling ( Poriae ) 10 g, Shengdihuang ( Radix Rehmanniae ) 15 g, Xixin (HerbaAsari) 3 g and Gancao (Radix Glycyrrhizae ) 3 g.

(3) Syndrome of collateral blockage by phlegm dampness
Main symptoms and signs:
Hip pain with heavy sensation and fixed area, swollen joint with impaired movement, numbness of skin, obesity, greasy tongue coating, slippery or soft-moderate pulse.

Therapeutic methods: Expelling phlegm and dredging collaterals.
 
Recipe and herbs:
Modified Zhimi Fuling Pill. Specifically, Fuling ( Poriae ) 12 g, Zhibanxia ( Rhizoma Pinelliae Praeparata ) 10 g, Zhike ( Fructus Citri Aurantii) 10g, Sangzhi ( Ramulus Mori Albae ) 10g, Jianghuang ( Rhizoma Curcumae longae) 10g, Baijiezi (Semen Sinapis Albae ) 6 g, Guizhi ( Ramulus Cinnamomi Cassiae ) 6 g, Weilingxian ( Radix Clematidis ) 12 g, Zexie (RhizomaAlismatis) 10 g and Gancao (Radix Glycyrrhizae ) 5 g.

External therapy:
Xiaoyu Zhitong Paste or Shangke Xiaoyan Paste may be externally applied; or Haitongpi Decoction may be chosen for local fumigation and bathing.

Fixation therapy:
Generally, the patient should take bed rest. For the patient with serious condition, abduction splints, support or plaster should be used to fix the two lower limbs at an abduction and intorsion position; moreover, skin traction of the lower limbs may be used to control movement.