The Internal Treatment of Traumatic Injury

The focus of this paper is the treatment of traumatic injury with internally ingested Chinese herbal formulas. Whereas the strategy for external treatment of traumatic injury is governed by clinical manifestation, internal treatment strategies are governed by proper identification of progressive stages.

General Signs/Symptoms of Acute Injury There are three distinct stages of traumatic injury, which are expressed by a limited number of clinical manifest- ations. The three primary manifestations of the early stages of trauma are heat, swelling, and pain. Western medicine, since the time of the great Roman physician, Galen, has specified five signs, but the differences, from our point of view, is negligible. The five signs discussed by Western medicine are: pain, swelling, redness, heat, and loss of function. Oriental medicine combines heat and redness into one sign, since both a sensation of warmth and the visible sign of redness are classified as heat. The “loss of function” sign is seen by Oriental medicine as a mechanical consequence of significant qi and blood stasis, and cannot be addressed separately from qi and blood stasis by internal treatments. Thus, both East and West are in basic agreement about the signs of early stage injury. If acute injury develops into a chronic issue, other signs can come into play, such as numbness/tingling, localized weakness, and aggravation by external evils such as cold.

A Word about Bleeding Bleeding is a special manifestation of traumatic injury, and is a pattern unto itself. In most injuries where there is bleeding, it must be stopped before further assessment is made.

The Stages of Trauma TheFirst Stage of Trauma is the most distinct and is marked by the three chief manifestations of pain, heat, and swelling. Blood stasis and toxin are beginning to form. All traumatic injury involves the first stage of trauma, which can last anywhere from a few hours up to two weeks, depending on the type and severity of injury. Heat usually manifests as localized redness, but in the absence of redness, heat might also be experienced by the patient as the sensation of heat at the site of the injury, or the area may be hot to the touch. In minor injuries, the heat may not be detectable, but it is always present. The treatment strategy is to clear heat and resolve toxin, dispel stasis, and relieve pain. The formulas used to treat stage one trauma are the coldest formulas of the three stages; they emphasize eliminating heat-toxin while helping the body move out damaged tissue. TheSecond Stage of Trauma is in phase when the initial inflammation first subsides. What remains is blood stasis combined with congestion of qi and fluids in the local area. This congestion causes stiffness and pain. The damaged tissue weakens the defense against the invasion of external pathogens such as wind and damp. Swelling may remain a factor, especially if treatment during the first stage was neglected, insufficient, or if the damage was severe. The treatment strategy for the second stage of trauma is similar to the first stage, but clearing heat becomes secondary to moving blood and dispelling stasis. Herbs are added to dispel wind and damp so that these pathogenic factors do not become lodged in the area, leading to chronic bi syndrome. TheThird Stage of Trauma is traditionally marked by the need to rebuild tissue and dispel exogenous pathogens that may have transformed into wind-cold-damp bi syndrome. There is often residual blood stasis that contributes to the lingering pain. As a result, there is inevitable overlap between the second and third stage trauma formulas. Both should move blood, dispel stasis, and relieve pain, but in the second stage, heat may still be a minor factor, and the formulas are cooling or neutral. Third stage trauma formulas are the warmest of the formulas that treat trauma; they often contain kidney-supplementing herbs to stimulate the regeneration of ligaments, bones, and cartilage. Lingering heat in the injured area should be cleared before ©2015 Herbal Medicine Press The Internal Treatment of Traumatic Injury 2 In addition to vasodilation, the chemical inflamma the surrounding tissue creates localized swelling. movement plasmathe fluids outvessel andinto of of color and heat associated with inflammation. The blood cells outside the vessel responsible is for the to leak out into the injured site. The presence red of Vasodilation allows both red and white blood cells endothelial cells. The increasedresultis permeability. only thing that gets larger the is space between the notdoes actually become larger vasodilation; in the theline the vessel. inner wall of The as a vesselwhole permeable by increasing the space between cells that thetion endothelial of cells makes the vessel more cells)lial the in smaller vessels contract. The contrac loss. Then, the cells thatline theinner wall (endothe thein capillaries at the injured site to reduce blood larger vessels contract, which slows the flowblood of traction. First all, of the smooth muscle around the Vasodilation con occurs the as two of result types of Increased (b) adhesion properties to certain cells. (a) Vasodilation, and 2. These chemicals cause: kinens. and prostaglandins, inflammatory mediators, suchhistamines,as chemical of release a causes damage Tissue 1. reaction to injury can simplified be as: inflammation. The generalof picture vascular the environment and supplying the all material for vessels, and the vessels respond by creating the chemical inflammatory mediators are the local to injury, owing to the fact that the the targets of collectively referred to the as reaction”“vascular acute inflammationi. These chemical responses are chemicals have identified been as playing a rolein interactions and histological changes. 180 Over aninjury extremely is complex chemical series of not engaged. been inflammatory The response to occurred where the inflammatory response has can occur without injury, no said injury is to have general.in In other words, though inflammation its understanding inflammatory of of response Biomedicine traumatic discusses asubset injury as A P T employing awarm-property formula. he B athogenesi ody ’ s R espon

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Once the Damaged and weakened tissue always is highly E by restricting flowwithin the vessels themselves. situation both by increasing pressure swelling, via and and this accumulation complicates the blood stasis ing toxin, therefore, atendency has to accumulate, cooked been has by injury. In Oriental medicine, we say that blood that adhesion properties the reaction vascular part as of to described how chemical stimulators cause increased area by compressing blood vessels . Above, it was sure from swelling decreases blood flow to theinjured the vesselout of into the surrounding tissue. Pres allows for blood—both red and white cells—to leak the increased the reaction permeability vascular of comes from the reaction vascular to injury. Thatis, impact. extravasation Some occurs at impact, but also Primary vessel damage occurs at the moment of 4. Increased adhesion. 3. Pressure from swelling, and 2. Extravasation, 1. 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(dang gui) (dang ormulas F ive Third Stage Third Second Stage First StageFirst Stage Stage of Trauma Tieh Ta Formula strongly reduces pain; it moves and builds blood, regenerates tissue, and reduces swelling. swelling. reduces and tissue, regenerates builds blood, and moves it pain; reduces strongly Formula Ta Tieh Tieh Ta Formula Formula Ta Tieh injuries. arts martial treat to used formulas basedtraditional on formula trauma application Thisgeneral is a can be used to treat injury to muscles, tendons, bone, ligaments, or cartilage and can be used to treat sprains, sprains, treat be used can to and cartilage or ligaments, bone, tendons, muscles, to injury treat be usedcan to swell the reduces and heat, clears blood, moves strongly It fractures. and bones, broken contusions, strains, injury. onset of the at traumatic occurring pain and ing Trauma 1 Formula 1 Formula Trauma It present. are all swelling and pain, heat, of manifestations the when trauma stage first for is formula This F stretch in the correct direction so as to optimize the the so optimize as to direction correct in the stretch strength of the new tissue. take from a few weeks to a few years. a few to weeks a few from take stresses the to according orients new tissue the eling, gently to important is therefore It it. upon imposed together to produce functioning tissue. Depending Depending tissue. functioning produce to together can remodeling of damage, severity initial the the on up to four weeks. After there are enough new cells, new cells, enough are there After weeks. four to up cells knit new The over. takes stage remodeling the New blood bathes the nascent cells; as they mature, mature, as they cells; nascent the bathes blood New phase lasts proliferation The begin proliferate. they to help reduce the formation of use by of tissue scar formation the reduce help blood nourishing and invigorating such as substances, angelica root also be “non-specific” cells. If these are not removed, removed, not If are these cells. “non-specific” also be can Chinese herbs tissue. scar into evolve can they enough to involve several types of tissue, there may may there types of several tissue, involve to enough The Internal Treatment of Traumatic Injury 6 v Inflammation,”Course of iv Research Human Monocytic Cell LineMONO-MAC-1,” H.G. “A Model System Haematology in and Immunology: The iii Basis entific ii College, PA, March 2003. Penn State University Athletic Training Conference, State i Endnotes issue, whether internal it is or external bleeding. employed be Can when acute bleeding the is main San Formula Qi bones. torn ligaments, tendons, damaged cartilage, or broken properly bones. set Use it for second and third stage Formula to can used be mend sinews and help to injured area, causing the pain to linger. Bone &Sinew andinvasion wind damp (and possibly of cold) the in have cleared completely and that there remains an this formulation of assumes that the heat and rubor throughout the third trauma. stage of Proper applica This formulain lateused is second stage and Bone &Sinew Formula ligaments, or cartilage. bruises, sprains, strains, jammed fingers or toes, torn thein reconstruction tissue. of It to can used be treat and damp, clears residual heat, and assiststhe body pain and swelling, Trauma 2Formula wind dispels to clearing away the remaining and stasis relieving where the heat and rubor have subsided. In addition toused treat pain, stiffness, and swelling in injury an ing have significantly receded. This formulabe can plied shortly after the initial inflammation and swell For second stage trauma, this formula best ap is Trauma 2Formula scarring. prevent and problems sustained from injury, help reduce bruising, injury. Tieh Ta Formula can address minor bleeding applicableis first any in secondor phaseof stage therefore perfect for early second stage trauma, but and heat not is amajor factor an in injury, and is It excellent is when the pain is main symptom Merrick,Mark A., Cotran, R., Kumar, V., Collins, T, and Robbins, S. S. Robbins, T, and V., Kumar, Collins, R., Cotran, Frontera, Walter ed., R., Jansa, P., Kratky, J., Pattern“Enzyme Macrophages of the in Steube, K.G., Teepe, D., Meyer, C., Zaborski, M., Drexler, , 21(4): 327-335, 1997. , Blackwell Science Ltd, 2003.

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- - - , Repair,” x 1980. ic bilitation,” viii Medicine vii 1191–7. Beginning The Programs the End,” vi pany, 1998. Pathologic ofDisease. Basis Barlow, Y., Willoughby, J., Soft Tissue of “Pathophysiology Evans, P. “The Healing Process,” Serhan CN, J(2005). Savill Inflammation: of “Resolution Wiseman, N., Ye, Feng, Houglum, PA, “Soft Tissue Healing and Its Impact on Reha British Medical Bulleti British , Paradigm Publications, 1998. Journal Rehabilitation, Sport of A Practical Dictionary of Chinese Chinese of Dictionary Practical A Philadelphia: W.B Saunders Com n, 48(3): 698-711. Physiotherap Nature Immunology 1(1): 19-39, 1992. y 66: 8256-259, , 6(12): - - Origins: A modern formulation based on Trauma 1 Formula Die Da 1 Hao Fang traditional principles.

Trauma 1 Formula (Die Da 1 Hao Fang) is a modern formulation for the treatment of the first stage of traumatic injury.

General Signs/Symptoms This formula is for first stage trauma when the manifestations of heat, pain, and swelling are all present. It can be used to treat injury to muscles, tendons, bone, ligaments, or cartilage and can be used to treat sprains, strains, contusions, broken bones, and fractures. It strongly moves blood, clears heat, and reduces the swelling and pain occurring at the onset of traumatic injury. This stage can last from a few hours to a few weeks, depending on the type and severity of injury.

Actions 1. Clears heat to reduce swelling 2. Resolves toxin 3. Invigorates blood to dispel and inflammation stasis and relieve pain

Ingredients Pinyin Pharmaceutical English Percent of Formula Tao Ren Persicae (semen) Peach kernel, Persica seed 12% Lian Qiao Forsythiae (fructus) Forsythia fruit 12% Jin Yin Hua Lonicerae (flos) Japanese Honeysuckle flower 12% Hong Hua Carthami (flos) Safflower, Carthamus flower 10% Ru Xiang Olibanum Frankincense 9% Mo Yao Myrrha Myrrh 9% Huang Qin Scutellariae (radix) Chinese Skullcap root, Scutellaria, Scute 8% Dang Gui Angelicae sinensis (radix) Purple Angelica root 8% Chai Hu Bupleuri (radix) Bupleurum root 8% Da Huang Rhei (radix et rhizoma) Chinese Rhubarb root and rhizome 5% Bai Zhi Angelicae dahuricae (radix) Angelica root 4% Gan Cao Glycyrrhizae (radix) Chinese Licorice root 3% General Indications • Traumatic injury in the first stage • Sprains • Jammed toes or fingers with heat, swelling and pain • Cartilage damage • Promote post-surgical healing • Muscular strain • Torn ligaments or tendons • Cuts, lacerations (after bleeding • Bruises • Fractures or broken bones has stopped) Synergy of Ingredients Persica (tao ren) and safflower(hong hua) are two herbs that are commonly combined to enter and invigo- rate the blood in the channels and collaterals. When combined with rhubarb (da huang), this becomes a powerful combination for use with traumatic injuries. Da huang adds the ability to eliminate blood stasis and accumulated heat of inflammation through purgation. Forsythia (lian qiao) and honeysuckle (jin yin hua) decrease the inflammation from traumatic injury by clearing heat and eliminating toxin. Frankincense (ru xiang) and myrrh (mo yao) are a strong blood moving combination with analgesic effects. The additional advantage of ru xiang is its ability to relax tendons, thus it is commonly used to relieve musculo-skeletal pain. Mo yao disperses blood and eliminate blood stasis. Both mo yao and ru xiang generate flesh and promote healing from flesh wounds. Trauma 1 Formula 8 stools become overly become stools loose. dosage if abdominal pain if develops or strong with patients digestion. Decrease a day in of severe cases inflammation in 3times many as 5tablets, as prescribe a day. Practitioner discretion may 3times at 2tablets, begins adults The minimumeffective dosagefor D rin. Warfarin such or as Hepa thinners, blood those deficiencies, taking or K who easily, bruise vitamin in as of people cases in Contraindicated and make the taste bitter. milk may irritate the infant’s digestion, ing, bitter properties these herbs of Not for while use nursing. The cool pregnancy. during Contraindicated C Choppy, or tight, wiry. P bloodand stagnation. qi tongue indicating veins the under red or distended purple reddish with The body color pale could be normal, trauma. the after immediately of qi the blood and stagnation mayThe tongue not showtheeffects T • Relieves pain • • Invigorates blood to dispel stasis Resolves• toxin inflammation and • Clears heat to reduce swelling F on uls ormula ontraindication osa g e ue ge

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heat, and pain. particularly bleeding, is visible still there used when weeks after the injury) involves local qi and blood blood qi and local involves injury) the after weeks redness, inflammation—swelling, with stagnation, Trauma to Bones Trauma • Stage First of 1-2 about stage to The initial injury (up bone moved, and nutrients can once again freely enter the the enter again freely once can nutrients and moved, area. traumatized tate the movement of blood and qi so that normal normal of qi so that and blood movement the tate be re can products waste is restored, circulation injury. Range considerably. of is decreased motion injury. in herbs The moderate sprain with incomplete or partial rupture rupture partial or incomplete with sprain moderate pain significant is There tendon. or of ligament the the after 24-72 hours even bruising, visible and swelling, and range of motion is still good, even if even of is good, still motion the range and swelling, of 2 consists a Grade motion. during a bit hurts area of Grade 1 or 2 injuries. Grade 1 describes a mild a mild 1 describes Grade injuries. 2 1 or of Grade is typically There tearing. microscopic with sprain mild little or no visible pain, some bruising, local passive range of passive range motion. 1 Formula Trauma one can differentiate a ligament sprain by checking checking by sprain a ligament differentiate can one of end the at of especially increase occurring pain for cases, and particularly in the initial stage of injury, of stage initial in injury, the particularly and cases, or passive of kind any is with pain movement, there instance, For be still used. can tests these yet active, moves the limb without assistance), then it is likely is it likely then assistance), without limb the moves in many Of course, tendons. the to be a strain to a ligamentous sprain or bone injury. If the pain is pain If the injury. bone or sprain a ligamentous patient the of (e.g., motion range active with worse of motion, it will pull on the ligaments. Pain that that Pain ligaments. will it the pull on of motion, the of (e.g., motion range passive by is aggravated suggests physician) the by is limb moved patient’s Ligaments function to preserve the structure of a structure the preserve to function Ligaments range physiological its beyond If moves a limb joint. a muscle or the muscle-tendon unit, whether from from whether unit, muscle-tendon the or a muscle stretch. forcible orviolent excessive contraction structure. When this occurs, small hemorrhages and and hemorrhages small occurs, this When structure. Strains, can occur. of fibers ligament the in the tears to is trauma there when occur hand, other the on past its physiological range of motion—the limits of motion—the range physiological its past rigid rather ligament’s the by imposed of movement A sprain occurs to a ligament when a joint is forced is forced joint a when a ligament to occurs sprain A Trauma 1 Formula 10 mon &Schuster, 2004, p. 12. iii Moon Publishing, 2003, p. 387. ii 2004, p. 71. AFormulations, Approach i Endnotes Trauma.” Press handout entitled, Spring Wind Plasters, Soft seethe Herbal Medicine plasters. For specificinstructions on how use to #4 these plasters may combined be with nally. there If an excess is heat, amount of any of for aswitch to first stage of trauma.first stage of Predominating pain may call when the pain is most prominent symptom the in trauma. of stage first during #2 flammation are the primary symptoms. first stage trauma when redness, swelling, andin PlasterSoft #1 Plaster #1, #2, #3, or #4could applied be externally. mula redness, inflammation, and swelling, In the trauma, initial stage of when there more is Trauma 1Formula Spring Wind Plasters Soft with formula’s ability to stop bleeding. with combined Jennes, Fred, Flaws, Bob, Flaws, Fred, Jennes,

Ellis, Andrew, Bisio, Tom, to increase the heat clearing the ability other of is used when used is swelling the is primary symptom may taken be internally and Spring Wind Soft

A Tooth from Tiger’s the Mouth Notes from South Mountain, Tieh TaFormula Trauma 1Formula is the is general purpose all plaster for Herb Toxicities Interac and Drug

, Boulder, CO: Blue Poppy Press, “The External External “The Treatment of Soft PlasterSoft #3 to taken be inter to increase the Berkley, CA:Thin Trauma 1For Soft PlasterSoft , New York: Si Soft PlasterSoft is used used is - - - - - Origins: A modern formulation based on Tieh Ta Formula Die Da Wan traditional principles.

Tieh Ta Formula (Die Da Wang) is based on modern formulations used to treat martial arts injuries. There are components from the namesake formula,Die Da Wan and from Qi Li San. Qi Li San, Seven Thousandths of a Tael Powder, was published in the Collection for the Common Pursuit of Longevity, originating in 1762. It was formulated for external application and later used internally. Die Da Wan is attributed to a much more recent origin, published in the Nationwide Collection of TCM Patent Formulas in 1962.

General Signs/Symptoms Pain, swelling, and bruising that result from traumatic injury. Most effectively used in early second stage trauma, or in the first stage when there is little or no heat.

Actions 1. Moves blood and transforms 2. Reduces swelling 3. Alleviates pain blood stasis

Ingredients Pinyin Pharmaceutical English Percent of Formula San Qi, Tian Qi Notoginseng (radix) Tienqi Ginseng, Psuedoginseng root 14.35% Dang Gui Angelicae sinensis (radix) Chinese Angelica root, Tang Kuei 14.35% Yu Jin Curcumae (radix) Tumeric, Curcuma tuber 9.5% Bai Dou Kou Amomi rotundus (fructus) Chinese Amomum 9.5% Da Huang Rhei (radix et rhizoma) Chinese Rhubarb root and rhizome 9.5% Hong Hua Carthami (flos) Safflower, Carthamus flower 7.1% Huai Niu Xi Achyranthis bidentatae (radix) Achyranthes root 7.1% Xu Duan Dipsaci(radix) Japanese Teasel root, Dipsacus 7.1% Gu Sui Bu Drynariae (rhizoma) Drynaria rhizome 7.1% Xiang Fu Cyperi (rhizoma) Cyperus, Nut-Grass rhizome 4.8% Ru Xiang Olibanum Frankincense 4.8% Mo Yao Myrrha Myrrh 4.8%

General Indications • Bruises • Muscle strains • Traumatic injury • Fractures and broken bones • Pain and distension from injury • Post-Traumatic Stress Disorder • Joint dislocations • Post-operative pain and swelling • Torn or sprained ligaments • Sports injury

Synergy of Ingredients Notoginseng root (san qi), is the chief ingredient in this formula. Many of the modern Die Da formulations use daemonoropis resina (xue jie) instead of san qi. San qi is not only stronger to stop bleeding, an action it shares with xue jie, but it also is strong in its actions to invigorate blood and relieve pain. It can be helpful with internal bleeding and hematomas, as well as external bleeding. Although Chinese angelica root (dang gui) is known for its ability to tonify blood, when used in a formula to treat traumatic injury, its inclusion is for the purpose of invigorating blood to prevent blood stasis, reduce swelling, and limit the formation of scar tissue. Dang gui is found in a number of classic formulas used to treat traumatic injuries and is often used in treatment of trauma in Chinese hospitals. Tieh Ta Formula 12 stools become overly become stools loose. dosage if abdominal pain if develops or strong with patients digestion. Decrease such post-surgical as trauma, in a day in of significant cases trauma, 3times many as 5tablets, as prescribe a day. Practitioner discretion may 3times at 2tablets, begins adults The minimumeffective dosagefor D Heparin. Warfarin such or as thinners, blood those deficiencies, taking or K who easily, bruise vitamin in as of people cases in Contraindicated nursing. while or pregnancy Contraindicated during C Choppy, or tight, wiry. P recent. is trauma the indications if diagnostic Theremay tongue be no significant T pain Alleviates • swelling Reduces • blood stasis • Moves blood and transforms F on uls ormula ontraindication osa g e ue ge

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ward. When combined with safflower the added advantage directing the the of formula actions of down and qicirculation. It astrong has also descending action and has pain. It goes directly to the tendons and bones to activate blood Achyranthes cificallyin the more superficial layersofbody. the contribute to the formula’s ability to transform blood stasis, spe channels and collaterals and moves blood stasis. These actions Rhubarb counterbalance the the effects colderof herbs on themiddle guides toguides the rib area and the liver channel, the and helpful is if and blood flow more smoothly and thusis pain relieved. liver qistagnation. When liver qiflows more smoothly,both qi Cyperus kidney and heal bone and tendon. often combined for their synergistic effects to tonify theliver and increases bone absorption calcium. of blooddispelling stasis. Modern research shown has that goes directly to the kidney and liver and tonifies the kidney, while Gu sui bu monly herbs used trauma in hospitals. departments Chinese of invigorates blood circulation. kidney and liver channels strengthens it also bone and sinews and and collaterals to reduce swelling and pain. Since it enters the Dipsacus remedy for musculoskeletal pain from external injuries. xiang) Safflower and regulate dosage such in cases. kou) counterbalanced is dency by the amomum addition of loose stools patients in with weak digestion. Although this ten huang Da bruises, swellings, and associated masses with traumatic injury. downward and disperses blood stasis. It helpful is when there are and move middle Amomum age yin, there especially little if is or no dampness present. due to its bitter, cold nature. use The of not have qiand blood stagnation and those with deficiency, yin injury. This herbis contraindicated with foruse patients who do way it can reduce inflammation and swellingin a recent traumatic blood and qi,of but cools also blood and clears excess heat. In this Curcuma to the formula equal amount, in advisable it is to monoitor and myrrh and (xiang fu) (xuduan) means “mender shattered of bones”. This herb (drynaria) (da huang) represents this formula, almost 10%of it could produce (yu jin) (yu (hong hua)(hong (bai dou kou) dou (bai (huai niu xi) niu (huai not only the has ability to activate the movement jiao (mo yao) is included is this in formula primarily to ease has astrong has action to dredge the channels enters the blood level to purge heat-toxin invigorates the blood circulation the in of qi, and to dampness. dry This addition may has been added been has to this formula to warm is often is to used relieve musculoskeletal , this in it formula, is as an it excellent is Xu duan Gu sui bu is one of the most com most the of one is (hong hua) (hong yu jin yu could further dam and and , frankincense xu duan xu (bai dou (bai gu sui bu gu Xiang fu jiao are are - - (ru (ru - . -

- Tieh Ta Formula 13

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(hong hua) (pu ying) gong Trauma 2 Formula Trauma can also be can used Zheng Gu Shui Zheng Gu Tieh Ta Formula Ta Tieh , phellodendron bark bark phellodendron , , also called “herbal ice”. For For “herbal ice”. also called , , and safflower safflower and , or Xue Fu Zhu Yu Tang, Zhu Yu Fu Xue Tieh Ta Formula Ta Tieh (zhi zi) (zhi (huang qin) San Huang San San Huang , (the three yellows), dandelion dandelion yellows), three (the , to move qi and blood into the area. area. the into blood qi and move to Disorder Stress Post-Traumatic in emotional results sometimes injury Traumatic asinjury well. from results that “stasis” emotional the move to the that way same the in much injury traumatic classic formula, bai) fruit gardenia into powder resulting mix the and herbs these Grind egg or whites. tea, green Vaseline, as such a medium with cover then as plaster a soft area the to Apply certainly can rest and elevation, Compression, gauze. ofstage this initial in betrauma. beneficial by taking combined can be suggestions These 1 Formula Trauma inflam reduce heat, clear to effect the accentuate to an in after hours 24-48 first in the pain and mation medicine of number Oriental a other are There jury. traumat initial in the be included may that methods such as local cupping, ic bleeding, injury protocol, and plasters, soft liniments, acupuncture, local and inflammation, swelling, redness, the Once of hassensation dissipated, heat and occasionally, applied Warmth, be started. may will help injury, the on depending movement, gentle many other liniments that can be used to treat treat be used can to that liniments other many as such externally injuries a name to Soft Plasters, Wind’s Spring or Liniment, specifically more covered willoptions These be few. Combinations sectionin Formula the below. for of part treatment has been a standard Icing contracts cold but time, a long for injury traumatic re-injury induce can and tendons, sinews, muscles, Ifcontinued is icing flexibility. less creating by leave can it of stage initial injury, the beyond cold-wind- re-injury, to prone area injured the from atrophy and pain, chronic invasion, damp alternative An healing. incomplete and improper formula herbal is a simple medicine Oriental from called site the to applied as a poultice application external of amounts equal each combine injury of traumatic rhubarb granules: or of bulk herbs the scutellaria - -

- - - - or relieve Trauma Trauma is stronger is stronger “Tong ze bu tong, bu tong, ze “Tong Tieh Ta For Ta Tieh (mo yao) (mo Die Da Gao Tieh Ta Formula Ta Tieh serves this principle serves principle this Ru xiang Ru

is stronger to move qi and qi and move to is stronger and myrrh and myrrh

When there is flow, there is no is there is flow, there When Mo yao (ru xiang) (ru Tieh Ta Formula Ta Tieh iscussion s pplication was developed by martial artists to treat treat to artists martial by was developed combined with a topical application. D A means “fall and strike.” This term refers to refers term This strike.” and “fall means is: move blood and transform blood stasis to stasis to blood transform and blood move is: ormula ormula F culoskeletal pain. culoskeletal pain. pain. relieve stasis to blood dispersing thus blood, pain by moving blood and qi stagnation; they also they qi stagnation; and blood moving by pain wounds. heal to flesh generate mus relieve to tendons relax and blood invigorate to qi, phlegm, food, fire, and damp. and fire, food, phlegm, qi, Frankincense texts indicate that this herb enters all twelve chan alltwelve enters herb this that indicate texts blood, of stagnation factors; all six relieves and nels, injury includes broken or bruised ribs. Some ancient Someancient ribs. bruised or broken includes injury is one of dozens of variations on this formula. ofis one formula. this on of dozens variations to counterpart internal the This is Traumatic Injury Traumatic Die Wan Da of version This injury. traumatic F and this is counterbalanced by the warming herbs. herbs. warming the by is counterbalanced this and with treated be would better Inflammation 1 Formula The formula has little ability to clear heat since since heat clear to ability has little formula The herbs, of up is made cold 19% of formula only the main focus of of stage injury. second early and first in the this ancient Chinese medical axiom, axiom, Chinese medical ancient this tong”—“ ze bu tong The flow.” is no is there pain there when and pain Looking at the treatment principle from the perspect- the from principle treatment the at Looking remember to is it helpful organism of whole ive the and allowing the body to direct its energies to heal to energies its direct body to the allowing and trauma. the ing blood stasis. The two chief herbs enable the formula formula the chief enable The two herbs stasis. blood bleed of results internal the also treating focus on to bruising,ing, and swelling, thus relieving stagnation relieve pain and promote healing. Ten of the twelve of twelve the Ten healing. promote and pain relieve transform to ability some have formula in this herbs The primary treatment principle of principle treatment primary The mula marily in whether they clear heat or are warming. All All warming. are or heat clear they in whether marily the relieve to qi and blood move of formulas these pain of traumatic injury. a group of formulas developed in Chinese medicine in Chinese of developed medicine a group formulas pri vary formulations The injury. traumatic treat to “ Ti e h Ta” Tieh Ta Formula 14 topically while using using while topically Spring Wind Amber Massage Salve can used be combination with the appropriate soft plaster. gauze, not plastic.liniment This be can appliedin Cover with something that breathable is such as order to protect it from external pathogenic invasion. the tissues. It then is advisable to cover the area in increase the absorption the herbal of medicine into into the injury. area of open will thepores This to Dr. Shir’s can massaged gently be and superficially with combined Dr. use The of Shir’sLiniment externally be can and secondarily to relieve pain and clear heat. treatmentthe primary of focus to is reduce swelling, medicine for the traumatic first stage of injury when Use this combination internal of and external herbal Plaster #3 Tieh Ta Formula with Spring Wind Soft inflammation. move blood to relieve pain, clear well as as heat and when the treatment principle to is more strongly medicine for the traumatic first stage of injury Use this combination internal of and external herbal Plaster #2 Tieh Ta Formula with Spring Wind Soft heat, swelling, and redness are present. medicine for the damagesinew first when stage of Use this combination internal of and external herbal Plaster #1 Tieh Ta Formula with Spring Wind Soft that the develop into injury will achronic issue. given these in first two stages,highlyis it unlikely to moderate injury, the appropriate if treatment is traumatic injury its in first andsecond stage. mildIn external applications an effective is strategy to treat Tieh TaFormula F stress disorder originating from physical injury. 2 tablets, 3times daily for treating post-traumatic or one-third thehalf suggested standard dosage of often given in “spirit dosages”. Consider using one- Formulas for used resolving emotional issues are for the same purpose. ormula C

ombinations Tieh TaFormula combined with the appropriate Tieh TaFormula

taken internally. internally. reduce pain by invigorating blood and qilocally. traumaticof injury to move blood and clear heat, to Amber Massage Salve acts on first secondor stage Origins: A modern formulation based on Trauma 2 Formula Die Da 2 Hao Fang traditional principles.

Trauma 2 Formula (Die Da 2 Hao Fang) is a modern formulation for the treatment of the second stage of traumatic injury.

General Signs/Symptoms This formula is useful in treating the second stage of trauma when the initial inflammation is noticeably subsiding. The chief symptom that remains is pain from blood stagnation, combined with qi and fluid congestion in the local area. This congestion causes stiffness and can amplify the pain. The treatment strategy for the second stage of trauma is similar to the first stage, but clearing residual heat is secondary to moving blood and dispelling stasis. Herbs are added to dispel wind and damp so that these pathogenic factors do not become lodged in the area, becoming chronic bi syndrome.

Actions 1. Moves blood and dispels 2. Disperses wind and 3. Clears heat blood stasis , relieves pain dampness

Ingredients Pinyin Pharmaceutical English Percent of Formula Dang Gui Angelicae sinensis (radix) Chinese Angelica root, Tang Kuei 9% Ru Xiang Olibanum Frankincense 9% Mo Yao Myrrha Myrrh 9% Chuan Niu Xi Cyathulae (radix) Cyathula root 9% Fang Feng Saposhnikoviae (radix) Siler root 9% Ji Xue Teng Spatholobi (caulis) Spatholobus stem 9% Chi Shao Paeoniae rubrae (radix) Red peony root 9% Fu Ling Poria Poria, Tuckahoe 8% Hong Hua Carthami (flos) Safflower 7% Su Mu Sappan (lignum) Sappan wood 6% San Qi / Tian Qi Notoginseng (radix) Pseudoginseng, notoginseng root 5% Bai Zhi Angelica dahurica (radix) Angelica root 4% Da Huang Rhei (radix et rhizoma) Rhubarb root and rhizome 4% Gan Cao Glycyrrhizae (radix) Licorice root 3%

General Indications • Traumatic injury in the second • Bruises • Fractured or broken bones stage marked by stiffness and/or • Sprains • Jammed toes or fingers pain • Cartilage damage • Promotes post surgical healing • Muscular strain • Torn ligaments or tendons Synergy of Ingredients Chinese angelica root (dang gui) is the chief ingredient in this formula. It invigorates the blood to prevent blood stasis and reduce pain. (See page 8 for more details.) Frankincense (ru xiang) and myrrh (mo yao) are a strong blood moving combination with analgesic effects. The additional advantage ofru xiang in treating traumatic injury is its ability to relax tendons, thus, it is com- monly used to relieve musculoskeletal pain. Mo yao is stronger to disperse blood and eliminate blood stasis. Both ru xiang and mo yao generate flesh and promote healing from flesh wounds. Trauma 2 Formula 16 The The minimumeffective dosagefor D Warfarinners, such or as Heparin. thin blood those ficiencies, taking or Kde who easily, bruise vitamin in as of people cases in Contraindicated and make the taste bitter. milk may irritate the infant’s digestion, ing, bitter properties these herbs of Not for while use nursing. The cool loose. pain overly become if develops or stools a day. Decrease dosage if abdominal 3times many as 5tablets, as prescribe a day. Practitioner discretion may 3times at 2tablets, begins adults Contraindicated during pregnancy. during Contraindicated C Choppy, or tight wiry. P qi blood and indicating stagnation. veins, may have sublingual distended may purple bereddish or purple and The body change. tongue colorcan by second the this stage of trauma but trauma the after immediately of qi the blood and stagnation mayThe tongue not showtheeffects T heat Clears • damp and wind Dispels • relieves pain • Move blood, dispels stasis, F on ormula uls ontraindication osa g e ue ge

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- - - Licorice bowel movements while taking this formula. a tendency to loose stools may experience an increased frequency of with invigorate blood and remove blood stasis, especially when combined Rhubarb this formulaof to the lower body. balancesThis the action of the upper and body to the S to move stagnation to relieve pain. channels and collaterals to improve the qi and flow blood and of Sappan wood contributes to reducing pain due to stagnation. ing swelling or edema the in trauma. area of In this way may accumulate due to inhibited blood circulation and qi, of caus Poria pain. acts with ondarily, peony Red and therefore is contraindicated pregnancy. in the in stasis micro-vessels. It astimulating has effect on the uterus unblock stagnation, thus relieving pain. tendons. It the has also ability to openchannels and collaterals to relieve pain. This herb enters theliver channel to relax sinews and Spatholobus damp-cold, which could lead to the development of Siler matic injury. strengthen sinews and bones and assist with the trau healing of lower body. the formulafects of downwards to strengthen its effects on the (safflower) to treatmusculoskeletal pain.guides also It the ef Angelica bruises and stops extravasation the blood. of and strengthen the vessels. This promotes the quick healing of andstasis relieves pain. It acts much like Cyathula to twelve all meridians. It an anti-inflammatory has also action. an qi an hong hua hong (fang feng) (fang (fu ling) (fu is used to used is invigorate blood to relieve pain, stop bleeding, (gan cao) (gan (da huang) chi shao chi (bai zhi)(bai ji xue teng (chuan niu xi) niu (chuan (chi shao) (chi Chuan niu xi niu Chuan (ji xue teng) (ji and and (su mu) (su is added is to this formula to drain dampness that is added is to prevent pathogenic invasion wind- of goes to the blood level to move blood and stasis harmonizes the herbs the in formula and guides is added is to direct the this formula action of to dang gui dang to openthe channels and collaterals to relieve is added is to this formula for its ability to clears heat, which its primary is action. Sec is another is ingredient that moves blood actswith enters the liver and kidney channels to has been added been adeputy has herb as to . Individuals who are sensitive and have yangming chuan niu xi, niu chuan ru xiangru level to move qistagnation. which the guides actions Ji xue teng ji xue teng , mo yao,mo and can unblock unblock can to openthe bi syndrome. hong hua hong fu ling fu - also also -

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Traumatic Injury when there are still signs of heat/ Use Trauma 1 Formula inflammation(up to 2 weeks after initial injury)

Traumatic injury with secondary injury caused by Use Trauma 1 Formula or Tieh Ta Formula movement of the injured area

Traumatic injury in first or second stage when there is little or no heat, and pain and bruising are the Use Tieh Ta Formula primary symptoms

Traumatic injury in second stage with inflammation obviously diminishing. Pain is greater than heat, Use Trauma 2 Formula but heat was recently a major manifestation

Traumatic injury with internal or external bleeding Use San Qi Formula

Traumatic injury with internal or external bleeding Use San Qi Formula and inflammation

Recovery from traumatic injury, after all inflammation has passed, and primary stasis has Use Bone & Sinew Formula been dispersed

Traumatic injury where pain has become chronic Use Bone & Sinew Formula and/or is aggravated by weather changes

Post-surgical trauma with bruising and little or no Use Tieh Ta Formula or Trauma 2 Formula inflammation

Post-surgical trauma with bleeding Use San Qi Formula

Post-surgical trauma with bleeding and Use San Qi Formula inflammation

To reduce the chance of permanent scarring after Use Tieh Ta Formula injury or surgery

Post-traumatic stress disorder after injury or surgery Use Tieh Ta Formula

Note: Traumatic injury includes sprains, strains, ligament tears, cartilage damage, tendon tears, fractures, surgery (post-operative), contusions, torn muscles, joint dislocations, and moderate to severe sports injury. Origins: A modern formulation based on Bone & Sinew Formula Zheng Gu Xu Jin Fang traditional principles.

Bone & Sinew Formula (Zheng Gu Xu Jin Fang) is a modified combination of two classics, Du Huo Ji Sheng Tang (Duhuo and Loranthus Formula) and Shu Jing Huo Xue Tang (Course & Quicken Formula). Additional herbs were added to support the kidney function to help knit the bones and sinews.

General Signs/Symptoms Bone & Sinew Formula was designed to treat stage three of traumatic injury to bone, tendon, ligament, and cartilage. Stage three begins when symptoms of aches and pains, stiffness, and limited range of motion have entered the chronic phase, or when the body’s response to injury has become focused on tissue rebuilding. The most effective time to administerBone & Sinew Formula is right after the primary blood stasis has been resolved and there is little or no remaining inflammation. In the case of a broken limb that has been set and cast, this time would occur about at the midpoint of the cast period.

Actions 1. Dispels wind and dampness 2. Knits bones and sinews 3. Tonifies and moves blood 4. Relieves pain

Ingredients Pinyin Pharmaceutical English Percent of Formula Sang Ji Sheng Taxilli (herba) Loranthus, Chinese Mistletoe 10% Dang Gui Angelicae sinensis (radix) Chinese Angelica root 8% Shen Jin Cao Lycopodii (herba) Clubmoss, Lycopodium 8% Hong Mao Wu Jia Acanthopanacis Giraldii (cortex) Acanthopanax stem bark 8% Ji Xue Teng Spatholobi (caulis) Spatholobus stem 8% Du Zhong Eucommiae (cortex) Eucommia bark 8% Du Huo Angelicae Pubescentis (radix) Pubescent Angelica root 8% Gu Sui Bu Drynariae (rhizoma) Drynaria rhizome 7% Bu Gu Zhi Psoraleae (fructus) Psoralea fruit 7% Xu Duan Dipsaci (radix) Japanese Teasel root, Dipsacus 7% Ru Xiang Olibanum Frankincense 6% Mo Yao Myrrha Myrrh 6% Qiang Huo Notopterygii (rhizoma seu radix) Notopterygium root and rhizome 5% Hong Zao / Da Zao Jujubae (fructus) Jujube fruit, Chinese Red Date 3% Zi Ran Tong Pyritum Pyrite 1% General Indications • Second and Third stage of • Torn ligaments and tendons • Post-traumatic onset of bi zheng traumatic injury • Sprains syndrome • Fractures and broken bones • Disc degeneration, herniation and • Sciatic pain • Bone weakness or degeneration prolapse • Osteoporosis • Cartilage damage • Post arthroscopic or other limb / • Femoral avascular necrosis joint surgery Synergy of Ingredients Loranthus (sang ji sheng) and Chinese angelica (dang gui) are the chief herbs in Bone & Sinew Formula. Sang ji sheng is the chief herb in the classic formula Du Huo Ji Sheng Tang (Duhuo and Loranthus Formula), while Chinese angelica (dang gui) is one of the chief herbs in the classic formula Shu Jing Huo Xue Tang (Course & Quicken Formula). Both formulas are combined in this modification. Bone & Sinew Formula 20 loose. pain overly become if develops or stools a day. Decrease dosage if abdominal 3times many as 4tablets, as prescribe a day. Practitioner discretion may 3times at 2tablets, begins adults The minimumeffective dosagefor D hypertension. for medications diuretic of the effects effect, and therefore maypotentiate sheng ji Sang drugs.anticoagulant coumadin or any antiplatelet and Use with caution with heparin and pregnancy. during Contraindicated C atrophy. from Choppy, or tight wiry, may beweak P have white coat. thin May tongue. veins under distended Red-purple or purple light with T Relieves pain • Tonifies• movesand blood sinews and bones Knits • dampness and wind Dispels • F on uls ormula ontraindication osa g e ue ge

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order to strengthen sinew and bone and relieve pain. bines with eucommia dampness. It the is sage herb for treating sheng ji Sang Pubescent angelica ing the traumatic healing of injuries. blood the in channels and collaterals, lessening the pain and increas liver and kidney. their synergisticof action to strengthen sinew and bone and tonify Eucommia strong as neutrophil counts. and RBC In that similar but also it not is sense as thein micro-vessels. Research shown has that ji xue teng and Spatholobus stronger.but adrying effect, has also muchlike thediuretic actions of and tonify kidney and liver to relieve and liver. Its acrid, warm, and bitter qualities wind-dampness dispel Acanthopanax treat Acrid, warm, and dispersing, it acts to release tendon/joint pain and It treats tightness the in sinews, especially due to traumatic injury. Lycopodium ment to the bones and sinews to promote healing and reduces scarring. hospitals Chinese in toused treat traumatic injury. It provides nourish pain. In combination with blood moving herbs, gui Dang tion and treatment of osteoporosis. treatment and of tion calcium, thus aiding recovery in from bone fractures and preven in on the kidney shown been and has to increase bone absorption of to reduce swelling and relieve pain. en bone and tendon, to promote healing, and invigorate blood flow Drynaria wind, cold, and dampness, and relieve pain. bone.well as huo Du huo medicine,Chinese there are some advantages distinct to each. these two herbs were interchangeably used the in early history of together to wind-cold-dampness dispel and relieve pain. Though can release the exterior and actsprimarily on the upper body. wu jiawu pi bi zheng bi actson the liver channel, and therefor benefits theas sinews is the is sage herb for tonifying and invigorating blood to relieve dang gui dang (gu sui bu)(gu is its ability is to tonify the blood and invigorate blood flow (du zhong) is acrid, is bitter, and warm, enabling it to wind- dispel to relieve obstruction. painful The added advantage of syndrome. (ji xue teng) (ji Du huo’sDu (shen jin cao) jin (shen (hong mao jia wu pi)(hong Xu duan . (du huo) (du and dipsacus and dipsacus (du zhong) action primarily is on the lower to body dispel has much has the same effectas s has aspecific has action on theliver channel. adds the ability to invigorate the flow of and notopterygium notopterygium and to tonify the liver and kidney in (xu duan) directs its action to the kidney Gu sui bu (xu duan) bi zheng bi bi zheng bi acttogether to strength is stronger is its in action . are combined because are because combined Hong mao jia wu pi ji xue teng dang gui gui dang (qiang huo) syndrome. It com ang ji sheng ang ji is commonly commonly is can increase sang ji sheng ji sang also act also Qiang Qiang

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Medical Acupuncture Medical ibid, .p. 6. Dharmananda, Subhuti. “Treatment of Avascular Necrosis Necrosis ofAvascular “Treatment Subhuti. Dharmananda, Beers, Mark H. and Robert Berkow, Ed. T Ed. Berkow, Robert and H. Mark Beers, Lyttleton, Jane, “Topics in Menopause “Topics Jane, Lyttleton, Beers, op. cit., p. 449. p. cit., op. Beers, Chen, J., “Recognition and Prevention of Herb-Drug Interac of Herb-Drug “Recognition Prevention and J., Chen, 1990. vi A Osteoporosis: Discussion,” iv v Traditional Medicine (online database), December 2002, pdf 2002, December database), (online Medicine Traditional file, p. 1. iii for Institute Chinese with Herbs.” Head of Femoral the ii Therapy. and of Diagnosis 453. p. 1999, Laboratories, Research Merck tions,” tions,” 9-13. constitutions. Endnotes i blood, yin, and yang, while gently invigorating the blood. the invigorating gently while yang, and yin, blood, weak with patients those for support extra provides It tendons, and joints for patients who are elderly or feeble. feeble. or elderly are who patients for joints and tendons, Formula Restorative Bone & Sinew Formula and Restorative Formula Restorative and Formula & Sinew Bone os treating ofwhen ideal is formulas combination This muscles, in body the pain lower chronic and teoarthritis Use insteadUse of liver. in the especially signs, heat are there Bupleurum & Tang Kuei Formula Kuei Tang & Bupleurum heat. clear and blood invigorate to stronger it make to Bone & Sinew Formula and and Formula & Sinew Bone Plus Wanderer & Easy Free Plus Wanderer Easy and Free relieve pain due to liver qi stagnation, and open channels and qi stagnation, liver to due pain relieve pain. relieve to collaterals and tion and spleen qi and blood deficiency, this combina this deficiency, blood qi and spleen and tion sinews, relax to synergistically work of can tion formulas Bupleurum & Tang Kuei Formula Kuei Tang & Bupleurum pain or osteoarthritis, sciatica, pain, back lower When qi stagna liver by exacerbated are injury traumatic from dress the branch symptoms. symptoms. branch the dress and Formula & Sinew Bone Wei Di Huang Wan DiHuang Wei allowing cause root the References http://drmirkin.com/fitness/why-ice-delays-recovery.html.

Barlow, Y., Willoughby, J., “Pathophysiology of Soft Tissue Repair,” British Medical Bulletin, 48 (3), 1992. Beers, Mark H. and Robert Berkow, Ed. The Merck Manual of Diagnosis and Therapy. 17th Ed. Whitehouse Station, NJ: Merck Research Laboratories, 1999. Bensky, Dan and Barolet, Randall. Chinese Herbal Medicine Formulas and Strategies. Seattle, WA: Eastland Press, 2009. Bisio, Tom, A Tooth From the Tiger Mouth, NY, NY, Simon and Schuster, 2004. Bock, D. “Guide to Chinese Martial Arts Herbal Trauma Formulas: Part 2” Herbal Medicines Grouped by Type. Chen, John K. and Chen, Tina T. Chinese Herbal Formulas and Applications, City of Industry, CA, Art of Medicine Press, 2009. Chen, John K. and Chen Tina T. Chinese Medical Herbology and Pharmacology, City of Industry, CA, Art of Medicine Press, 2004. Chu, Robert. “Common Herbs and a Recipe for ‘Trauma Wine’ ”, Acupuncture Today , 6 (10), October 2005. Cotran, R., Kumar, V., Collins, T, and Robbins, S. Robbins Pathologic Basis of Disease. Philadelphia: W.B Saunders Company, 1998. Dharmananda, Subhuti. “Treatment of Avascular Necrosis of the Femoral Head with Chinese Herbs, ” Portland: Institute for Traditional Medicine (online publication), December 2002.

Evans, P. “The Healing Process,”Physiotherapy 66:(8), 1980. Flaws, Bob. Treatment of Modern Western Diseases with Chinese Medicine. Boulder, CO: Blue Poppy, 1994. Frontera, Walter R., ed., Rehabilitation of Sports Injuries—Scientific Basis, Blackwell Science Ltd, 2003. Gaeddert, Andrew. “What Chinese Herbs are used for Back Pain,” Acupuncture Today. 1 (10), October, 2000. Houglum, PA, “Soft Tissue Healing and its Impact on Rehabilitation, Journal of Sport Rehabilitation,” 1 (1) 1992. Jansa, P., Kratky, J., “Enzyme Pattern of Macrophages in the Course of Inflammation,” Annals of Hematology, May 16, 2005. Lyttleton, Jane. Topics in Menopause—Part Two, Osteoporosis: A Discussion, Journal of Chinese Medicine, No. 34, September 1990. Merrick, Mark A., “Inflammation and Secondary Tissue Damage,” Pennsylvania State University Athletic Training Conference, State College, PA, March 2003.

Mirkin, Gabe, Sportsmedicine, Little, Brown 1978. Serhan CN, Savill J. Resolution of inflammation: the beginning programs the end, Nature Immunology, 6 (12), 2005. Scott, John, Monda Lorena, and Heuertz, John. Clinical Guide to Commonly Used Chinese Herbal Formulas, 6th ed. Placitas, NM: Herbal Medicine Press, 2014. Steube, K.G., Teepe, D., Meyer, C., Zaborski, M., Drexler, H.G. “A Model System in Haematology and Immunology: The Human Monocytic Cell Line MONO-MAC-1,” Leukemia Research, 21(4), 1997. Wiseman, N., Ye, Feng, A Practical Dictionary of Chinese Medicine, Paradigm Publications, 1998.