C hinese M edical T raumatology and O rthopedics by Robert Chu, PhD, LAc, QME 2011 Disclaimer Please note that the author and publisher of these lecture notes are NOT RESPONSIBLE in any manner whatsoever for any injury that may result from practicing the techniques and/or following the instructions given within. Since the material deals with prior knowledge of acupuncture described herein, it will be too complex in nature for some readers to engage in safely, and it is essential that a licensed acupuncturist be consulted prior to application. These lecture notes are to be used as a supplement when taking a course with Robert Chu and are not to be distributed to others who have not taken the course on Chinese Medicine Orthopedics and Traumatology with Robert Chu. 1 Author's Preface: Since 2002,1 have begun seminars publicly on my paradigm of acupuncture and how to use the system in a practical and systematic way in English. In this edition of this book, I hope to guide my fellow colleagues into the intricacies of Chinese Medicine Traumatology and Orthopedics and the use of Master Tung's Acupuncture and my own paradigm called Optimal Acupuncture in Traumatology and Orthopedics, and share the principles and concepts that make it a highly useful in the clinical setting. I discuss here the principles and concepts that are used in the clinic and of particular use to the Licensed Acupuncturist who also practices Chinese Herbology. There are thousands of prescriptions for Traumatology and Orthopedics and after studying the subject for over 20 years and reading almost every book in Chinese that dealt with the subject matter, I still like to distill the essentials and approach work in a practical manner, and for one to use clinically on a daily basis. It is hoped that the reader can use these principles and concepts here and achieve amazing results in his or her practice, as these are the principles and concepts I use in my own practice daily with amazing results! I will, in future revisions of this work, further explain the analysis and understanding of each of the points. It is hoped that reader's questions and interest will lead to new revisions of this book. I would like to thank my masters Kwan Jong Yuen, Yee Chi Wai, Lui Yon Sang, Chan Tai Shan, Gong Duk Foon, for their early instruction in Chinese Dit Da methods and stimulating me to further study Chinese medicine. I would also acknowledge my teacher, Dr. Young Wei-chieh for instructing me in Master Tung's Acupuncture, and Dr. Chen Chao for teaching me his I Ching Acupuncture system, without which I could not create Optimal Acupuncture. I would also like to thank my many teachers of Acupuncture, Tui Na and Chinese Medicine for helping me along this path. I would also like to thank my students for helping me develop the ITARA Master Tung Acupuncture system and Optimal Acupuncture. My good fortune of having talented people like David McKinnon, L.Ac, and Jack Chang, L.Ac, has always made things worthwhile during these years of travel and seminars. 2 Note of Abbreviations used in this text In this text we use the following abbreviations for the various channels: Lu = Lung Channel LI = Large Intestine Channel St = Stomach Channel Sp = Spleen Channel H = Heart Channel SI = Small Intestine Channel UB = Urinary Bladder Channel K = Kidney Channel Pc = Pericardium Channel SJ = Sanjiao Channel GB = Gallbladder Channel Liv = Liver Channel Ren = Ren Channel Du = Du Channel 3 Introduction Over thousands of years man has sought to alleviate pain and suffering, and trauma is the most common disease, outside of affliction of the mind by greed, anger and stupidity. Man has sought relief through herbals and other material medica, which spawned various indigenous medical systems. In China, Chinese medicine was used to allieve pain, stop swelling, engender flesh, set broken bones, and care for wounds in many forms - herbology was practiced in many flexible methods: burning it as moxibustion, ingesting it by decoction, infusion, pills, used topically as powders, pastes, liniments, lotions, wraps, fulmigation, soaks, washes and oils; Cupping was used to relieve exterior wind, cold, and damp or to move stagnant blood; Acupuncture and blood letting methods were used to move the Qi and blood in the 12 channels and 15 collaterals, as well as the 8 extra vessels. The literally thousands of prescriptions created by the various doctors of yesteryear could take thousands of years to learn, categorize and memorize. Rather than memorizing prescriptions of herbs or acupuncture, we should seek to instate and create prescriptions based upon logical principles and concepts. In this way, we do not have to be bound by tradition. My own creation of Optimal Acupuncture as a clinically efficient system, breaks down the art of acupuncture based on signs and symptoms of the channels, and the use of flexible principles and concepts to apply them clinically. Similarly, herbals used for Traumatology and Orthopedics should also be applied in this manner. In this spirit, we will now examine the art of Chinese Medical Traumatology and Orthopedics. Since the scope of this book is concentrated, we will concentrate primarily on the use of the herbals and acupuncture for Traumatology and Orthopedics. 4 Chinese Medical Traumatoloav and Orthopedics What is Trauma? Trauma is from: Accidents Surgery Radiation Chemotherapy Exercise Physical Therapy Chiropractic Acupuncture Invasive procedures Dental Work Falls Fights Sports Burns 5 Why Study Traumatology and Orthopedics? Generally not taught in schools Pain is the most frequent complaint in the clinic A new way to look at Rx's and Chinese Medicine Better treatment plans for Sports Injuries, Pain Management, Orthopedic problems, Neuro Musculoskeletal Problems Traumatology and Orthopedics is in stages of healing from initial to intermediate to resolution. After that the Traumatology and Orthopedics practitioner must support the patient in further health. Common formulas are also used in Traumatology and Orthopedics: Gan Mai Da Zao Wan - is used when people are fearful, depressed, and can't get over their accident/injury Curing Pills - when there are damp heat toxins that the internal bleeding causes, you need to purge them! Er Chen Wan - is the base of treating old painful injuries! Old injuries have both phlegm and damp and blood stasis! Si Jun Zi Tang - Is at the resolution stage when you need to tonify the qi to have them heal faster! Liu Jun Zi Tang - Same as in Si Jun Zi Tang - for the resolution stage to speed up healing, strengthen Sp/St Jiao Gu Lan - Strengthens Wei Qi to fight pernicious Wind, cold, damp Yu Ping Feng Wan - For old injuries that arise because the Wei qi is impaired Ma Zi Ren Wan - When there is constipation in the initial stage of trauma, this is a gentle purgative. Tao Ren Wan - As is this, a gentle purgative to relieve internal blood stasis Nu Ke Ba Zhen Wan - to build up Qi and blood after trauma/trauma of childbirth! Xiao Yao Wan - To relax patients who are freaking out while they are injured This is only the tip of the iceberg! It is just that many people do not have this knowledge as they approach herbals from an internal medicine point of view. Also many medicinals can be combined for a superb effect! In this manner, we treat a patient with a month - 2 months treatment plan, as we already know the stages! 6 A Long History of Traumatology and Orthopedics in China: Moxibustion Classic/52 Rx's from Early Han Ma Wang Dui excavation Acupuncture Nei Jing Ling Shu Nan Jing Jia Yi Jing Zhen Jiu Da Cheng Shang Han Lun/Jin Gui Yao Lue Zhou Hou Fang Qian Jin Yao Fang Various Families: Wang, Su, etc. Shaolin Martial Arts Traditions Famous Rx's passed down from many masters Li Shi Zhen, Sun Si Miao, Ge Hong, Wang Qing Ren - Yi Lin Gai Cuo 7 Some Maxims about Gu Shang Ke: Pain Management is about functionality, not absence of pain. Pain is a good thing; tells you to be cautious. Initial Pain is from Qi and Blood Stagnation; Chronic Pain is mainly from Wind/Cold/Damp entering tissues due to leakage/seepage of Wei Qi at pain site Things that limit Acupuncture and herbals: 1. If surgery is required 2. If the patient is on certain medications - blood thinners, anticoagulants, neurotransmitters, anti-depressants, NSAIDs, Opiates, other analgesics 3. Qi and Blood Deficiency 4. Elderly - usually means they are qi/blood deficient, or emaciated Diagnosis of Traumatology and Orthopedics: Signs and Symptoms History Injury Site Channels Pulse ROM Orthopedic Testing X Rays, MRI's, Radiologist's Report of Findings 8 Summary view of Strategies and Basic Principles: Week 1-2 • Move Qi and Stagnant Blood • Remove Stasis, Relieve swelling • Clear Heat and Toxins • Move Blood, Calm Shen Week 3-6 • Relieve Pain, Regulate Ying • Engender Flesh, Join Bones Week 7-8 • Relax Muscles and Tendons, Move Qi Blood in Jing Luo • Tonify Qi and Blood • Strengthen Spleen/Stomach • Tonify Liver/Kidney Chronic Pain: • Continue strategies above, plus • Remove Phlegm • Remove Blood Stasis • Clear Wind/Cold/Damp • Exercises to rehabilitate the body 9 Strategies and Basic Principles in detail: Not all injuries follow this pattern and time frame, however we can use this as a general roadmap and elicit the most appropriate strategies and principle to fit the situation. Here all the treatment principles are suggested, they need to correspond with your diagnosis. Week 1-2 • Move Qi and Stagnant Blood This is for all local blood stasis, swelling, and pain. Focus is on moving qi and blood, and modified accordingly to heat, cold, excess or deficiency.