Treating Musculoskeletal Disorders With Chinese Herbal Formulas - Part 1: Acute
By Jake Paul Fratkin, OMD, LAc
Many acupuncturists will support their treatments for pain and trauma with Chinese herbal products. Because of the abundance of both classical and modern formulas, it is useful to know how the various formulas are differentiated, so as to choose the appropriate prescription.
First, one should separate acute conditions from chronic. Secondly, one has to weigh the following conditions for preponderance: dampness, blood stasis, deficiency, heat and cold, as well as take into account underlying deficiencies of qi, blood or yang. Thirdly, in either choosing herbs for a custom prescription or evaluating products by their ingredients, one needs to know which herbs target different areas: upper, lower, arms, legs, back, neck, etc. We will discuss this in two articles. This first article is concerned with acute conditions involving heat, dampness and blood stasis. The second article will discuss herbal formulas for chronic bi presentations.
Acute patterns are found in trauma, as well as active flare-ups of gout or rheumatoid arthritis. In all three of these cases, heat presents itself, and herbs that clear heat are often used. For rheumatoid arthritis, classical formulas include xuan bì tang 2 and sì miào san. 3 Modern formulas include Clerodendron 6 by Seven Forests.
A typical custom formula for gout contains herbs that clear heat, drain damp, and move blood. A recently published formula contains the following: huáng bai (Cortex Phellodendri Chinensis), sheng dì huáng (Radix Rehmanniae), jin yín hua (Flos Lonicerae Japonicae), dú huó (Radix Angelicae Pubescentis), cang zhú (Rhizoma Atractylodis), zé xiè (Rhizoma Alismatis), yì yi rén ( Semen Coicis), fáng ji ( Radix Stephaniae Tetrandrae), niú xi (Radix Achyranthis Bidentatae), and chì sháo (Radix Paeoniae Rubra).
For acute trauma, there are numerous prescriptions that are available as products, both internally and as external applications. In acute trauma formulas, the treatment strategy is to move blood, break stasis, clear heat, and address swelling due to accumulation of damp. Herbs for blood stagnation are actually divided into two groups, herbs that move blood (huó xuè), and herbs that break stasis (pò yu). The herbs that move blood are gentler, and are used in many formulas for bi syndrome. The stronger break-stasis herbs are used for acute and chronic trauma, and for bi syndrome due to blood-stasis. They are contraindicated during pregnancy (including topically), and for patients on blood-thinners such as Coumadin.
Classical formulas for acute trauma include jin gu die shang wán and huó luò xiào líng dan . In jin gu die shang wán, we find an interesting collection of herbs. The lead herb is tián qi (Radix/Rhizoma Notoginseng), a remarkable medicinal that has properties of stopping bleeding, moving blood, and resolving the stasis causing bruising and clotting. In this formula, it comprises 20 percent of the formula. Supportive herbs to break stasis include xuè jié (Sanguis Draconis), ru xiang (Olibanum) and mò yào (Myrrha); while milder blood-moving herbs include dang gui (Radix Angelicae Sinensis) and hóng hua (Flos Carthami). The final herb is xù duàn (Radix Dipsaci), which favorably addresses both traumatic swelling and bone injury.
Huó luò xiào líng dan is a much smaller formula developed in the early part of the 20th century, containing only four herbs in equal proportions: dang gui (Radix Angelicae Sinensis), dan shen (Radix/Rhizoma Salviae Miltiorrhizae), ru xiang (Olibanum) and mò yào (Myrrha). These two formulas offer immediate intervention for injury with swelling or bruising. There are numerous modern formulas that also address acute trauma, and the availability of these products provides the trauma-oriented acupuncturist with a definite advantage for shortening the course of swelling and bruising.
Important herbal products are available for topical application, and acupuncturists should be aware of them. Perhaps the most astonishing is die da zhi tòng gao, commonly known as either Plaster for Bruise and Analgesic or Pain Relieving Medicated Plaster. One cuts the plaster to size to cover the swollen area, changing after showering. Although best for traumatic bruising, it is also effective for pain and swelling without bruising. I have seen deep bruising disappear by 70 percent after even a single eight-hour application. Acupuncturists should definitely keep this product in their armory.
The main herb is ér chá (Catechu), which reduces pain and swelling. Herbs that move blood or break stasis include xuè jié ( Sanguis Draconis), mò yào (Myrrha), xù duàn (Radix Dipsaci) and hóng hua (Flos Carthami). Dà huáng (Radix/Rhizoma Rhei) acts to both move blood and clear heat. Other heat-clearing herbs include zhi zi (Fructus Gardeniae), jin yín hua (Flos Lonicerae Japonicae) and pú gong ying (Herba Taraxaci). Lóng gu (Os Draconis) has an effect on stopping internal bleeding.
Zheng Gu Shui is a commercially available liquid that can be used for contusions, swelling, and bruising. It was originally used as an herbal wrap following bone-setting. It can be applied liberally to gauze and applied to the area. The longer one lets the herbs soak the affected area, the better. The ingredients include hu zhàng (Rhizoma Polygoni Cuspidati), ji gu xiang (Radix Croton Crassifoli), bái zhi (Radix Angelicae Dahuricae), qian jin bá (Radix Moghaniae), é zhú (Rhizoma Curcumae) and tián qi (Radix/Rhizoma Notoginseng).
There are other commercially available topicals worth knowing about. Andrew Ellis at Spring Wind developed 12 salves, compresses and plasters for different stages of acute and chronic trauma. Blue Poppy also has topical liniments and ointments.
In the next issue of Acupuncture Today, we will continue Treating Musculoskeletal Disorders With Chinese Herbal Formulas with Part 2: Treating Chronic Presentations.
"Diffuse Painful-Obstruction Decoction". Source text: Wen Bìng Tiáo Biàn, 1798, authored by Wú Táng. Availability: Xuan Bi Teapills (Plum Flower.)
"Four Marvelous (Ingredients) Powder". Source text: Chéng Feng Biàn Dú, 1904, authored by Zhang Bing-cheng. Availability: Four Marvel Teapills (Plum Flower); Four Wonders (Kan); Si Miao Wan (Herbal Times).
Chinese External Medicine, Chen, Li and Han. People's Medical Publishing House, 2011, p. 725.
Herbs that break blood-stasis include ru xiang (Olibanum), mò yào (Myrrha), é zhú (Rhizoma Curcumae), táo rén (Semen Persicae), xuè jié (Sanguis Draconis), (Rhizoma Sparganii), (Faeces Trogopterori) and (Eupolyphaga seu Steleophaga).
"Muscle, Bone Traumatic Injury Pill", authored by Xiè Yuán-qìng . Source text: Fang Jí Yè, 1842. Availability: Jin Gu Die Shang Wan (Herbal Times); Tieh Ta Formula (Golden Flower).
"Invigorate Collaterals Effective Efficacious Elixer". Source text: Yi Xué Zhong Zhong Can Xi Lù, 1918-1934, authored by Zhang Xi-chún. Availability: Invigorate the Collaterals (Kan); Red Vessel Teapills (Plum Flower).
Bone & Sinew Formula (Golden Flower); Great Mender Teapills (Plum Flower); Resinall E (Health Concerns); Resinall K (Health Concerns); San Qi 17 (Seven Forests); Trauma 1 Formula (Golden Flower); Trauma 2 Formula (Golden Flower); Traumanex (Evergreen), etc.
"Traumatic Injury Stop Pain Plaster", a modern patent medicine. Availability: Plaster for Bruise and Analgesic or Wu Yang Brand Pain Relieving Medicated Plaster, Guangzhou Medicines & Health Products.
In-depth descriptions of Andy Ellis' soft plasters and hot compresses for trauma can be found at gfcherbs.com or at springwind.com
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