SOFT TISSUE INJURY: DIAGNOSIS AND TREATMENT
Contusion, sprain, strain, muscle/ligament injury due to surgical operation
Usually acute soft tissue injury symptoms will subside within 7 days, but if the injury is severe, deep, or the constitution is weak, symptoms will last longer or become chronic.
If qi and blood stasis become chronic, blood fails to nourish the tissues, qi and blood deficiency develops, wind-cold-damp invade easily.
First Stage: can last for a few days, and up to about 7 days
Swelling
Pain at site with tenderness to touch
Redness
Limited mobility
Takes 2-3 days for extravasated blood to coagulate
Treatment Principles:
Move Blood Stasis, Clear Heat
Reduce Swelling, Relieve Pain
Invigorate Channels and Collaterals
Second Stage: lasts 10 days to 2-3 weeks
Swelling and pain begins to subside
Bruising remains - purple blue skin discoloration
Skin usually feels warm
If injury is mild, this stage may begin 2-3 days after initial injury
Treatment Principles:
Invigorate Blood, Move Stasis
Relax ligaments and tendons
Invigorate Channels and Collaterals
Relieve Pain
Third Stage: may be prevented if treated properly in stage 1-2, or can become chronic
Almost no pain and swelling
Mobility improved
Bruise color is light yellow brown
Pain exacerbated by damp or cold and physical movement
Treatment Principles:
Move Qi and any residual Blood stasis
Disperse Cold and Damp
Relax ligaments and tendons
Warm and Harmonize Channels and Collaterals
Tonify Liver / Kidney if indicated
INDIVIDUAL HERBS IN THE TREATMENT OF TRAUMA
Invigorate Blood
Tao Ren
Hong Hua
Dang Gui Wei
Xue Jie
Niu Xi
Chuan Xiong
Yu Jin
Shen Jin Cao
San Qi
Ru Xiang
Mo Yao
Ji Xue Teng
Da Huang
Alleviate Pain
Ru Xiang
Mo Yao
Zi Ran Tong
Xue Jie
Reduce Swelling
blood invigorating herbs
Di Long
Tu Bie Chong
Wei Ling Xian
Fu Ling
Che Qian Zi
Mu Tong
Hai Tong Pi
Promote Bone and Tendon Growth
Zi Ran Tong
Xue Jie
Gu Sui Bu
Tu Bie Chong
Strengthen Tendons / Bonedue to Liv/Kd Def
Niu Xi
Xu Duan
Gou Ji
Du Zhong
Qian Nian Jian
Wu Jia Pi
Disperse Wind Damp Obstruction
Qin Jiao
Qiang Huo
Du Huo
Wei Ling Xian
Hai Tong Pi
Mu Gua
Wu Jia Pi
Sang Zhi
Gui Zhi
Song Jie
Di Long
FORMULAS FOR SOFT TISSUE INJURY
Stage 1-2:
Extravasated blood, maybe clots, stabbing pain, pain is worse with pressure, hematoma or bruising with swelling is dominant, decreased ROM, tongue may be purple or normal
He Ying Zhi Tong Tang
Chi Shao 10-15
Dang Gui Wei 10
Chuan Xiong 6-10
Su Mu 10-15
Tao Ren 10
Xu Duan 10
Ru Xiang 6
Mo Yao 6
Wu Yao 6
Mu Tong 6
Chen Pi 6
Gan Cao 6
If there is also qi stagnation - especially if in chest/abdomen (wandering pains, worse with exertion, difficult or labored breathing):
Add Chai Hu, Bai Shao, Zhi Ke, Xiang Fu
If bleeding (due to injured blood vessels in local tissue, or internal bleeding):
Add San Qi or Yunan Bai Yao, or use San Qi alone for 1-2 days
If there is heat with the stasis - slight fever or feels hot, restless, poor sleep, thirst, tongue is red with thin yellow coat, pulse is rapid and slippery:
Add Mu Dan Pi, Zhi Zi, Sheng Di, Huang Bai
Subtract Chuan Xiong, Wu Yao
If there is heat due to local infection:
Add Wu Wei Xiao Du Yin
(Jin Yin Hua, Pu Gong Ying, Zi Hua Di Ding, Ye Ju Hua, Zi Bei Tian Kui)
If purulent (wind-damp-heat):
Add Chi Fu Ling, Mu Dan Pi, Huang Lian, Xia Ku Cao
To stop bleeding:
Add Chi Shao, Sheng Di, Mu Dan Pi
For blood in stool, add Di Yu, Huan Hua Mi
For blood in urine, add Da Xiao Ji, Bai Mao Gen, Ou Jie
For vomiting blood, add Ce Bai Ye, Bai Mao Gen
Golden Flower Chinese Herbs Trauma 2 Formula:
San Qi, Dang Gui, Ru Xiang, Mo Yao, Hong Hua, Su Mu, Da Huang, Ji Xue Teng
Chi Shao, Chuan Niu Xi, Fu Ling, Bai Zhi, Fang Feng, Gan Cao
For blood stasis in the chest/rib cage (thorasic or hypochondral pain) due to injury or surgery:
Fu Yuan Huo Xue Tang
Chai Hu 10-12
Tao Ren 10
Dang Gui Wei 8
Tian Hua Fen 8
Da Huang 8
Hong Hua 5
Gan Cao 5
For more pain relieving action: Add Ru Xiang, Mo Yao, Yu Jin
For post-herpetic pain: Add Xuan Shen, Yan Hu Suo, Bai Shao
For intercostals neuralgia: Add Chuan Lian Zi, Bai Shao
Stage 3: later stage or chronic
Shu Jin Tang
Dang Gui 10 - tonifies blood
Gu Sui Bu 6-10 - repairs bones, decreases scar tissue
Guan Jin Teng 6-10 - loosens, stretches muscle fibers
Jiang Huang 10 - treats residual pain and stasis
Xu Duan 10 - tonify Liver/Kidney, generates new tissue
Chen Pi 6 - move qi, assists digestion
Qiang Huo 6 - treats or prevents wind-cold-damp invasion
Song Jie 15 - treats or prevents wind-cold-damp invasion
Hai Tong Pi 3-5 - unblocks channels and wind damp
Fang Feng 2-3 - disperses wind
Bai Shao 10-15 - nourishes Liver blood, with Gan Cao treats spasms
Gan Cao 3-6 - harmonizes formula, with Bai Shao treats spasms
For upper extremeties:
Add Qiang Huo, Jiang Huang
For lower extremeties:
Add Du Huo, Niu Xi
If limited ROM and rigidity:
Add Wu Gong, Tu Bie Chong
If deep, severe pain:
Add Gui Zhi, Fu Zi, Ru Xiang, Mo Yao, Di Long
If nodules due to phlegm:
Add Bai Jie Zi, Zhe Bei Mu, Tian Nan Xing
For later stage chronic conditions with Liver/Kidney Deficiency
Weakness in injury region, difficulty moving muscels or limbs, dull aching or no pain, maybe repeated fractures or osteoporosis, maybe chronically weal tendons or low back, maybe significant muscle atrophy
Du Huo Ji Sheng Wan
Tonifies Kidney and Liver, Qi and Blood, disperses Wind-Cold-Damp
Emphasis on treatment of low back and lower body
Jian Bu Hu Qian Wan modified
Niu Xi 10
Dang Gui 10
Shu Di 10
Gui Ban 10
Suo Yang 10
Bai Shao 10
Du Zhong 10
Xu Duan 10
Chen Pi 6
Gan Cao 6
If Kidney yang deficiency:
Add Lu Jiao Jiao
If Kidney yin deficiency with empty heat:
Add Zhi Mu, Huang Bai
If residual pain and stasis:
Add Hong Hua, Tao Ren, Ru Xiang, Mo Yao
If decreased ROM, spasticity, or numbness:
Add Di Long, Mu Gua
FRACTURE FORMULAS
Stage #1: severe fixed pain, worse with pressure, swelling
Fu Yuan Huo Xue Tang modified
Dang Gui 10
Tao Ren 10
Hong Hua 6
Ru Xiang 6
Mo Yao 6
Xue Jie 10
Dan Shen 10
Zhi Da Huang 10-15
Wang Bu Liu Xing 10-15
Tian Hua Fen 10
Gan Cao 6
Stage #2: swelling decreased, pain with use and pressure
Xue Jie 6-10
Hong Hua 6
Dan Shen 10
Tu Bie Chong 6
Wang Bu Liu Xing 10-15
Di Long 10
Gu Sui Bu 12
Zi Ran Tong 10
Dang Gui 10
Stage #3: limited range of motion due to muscular rigidity
Dang Gui 10-15
Ji Xue Teng 15-20
Xu Duan 10
Hong Hua 6-10
Chuan Xiong 6
Yu Jin 10
Sang Zhi 12-15
Gui Zhi 6
Qin Jiao 10
Qiang Huo 10
Gu Sui Bu 10
Mu Gua 6
Di Long 15
Golden Flower Chinese Herbs: Bone and Sinew Formula
Dang Gui, Xu Duan, Du Zhong, Sang Ji Sheng, Bu Gu Zhi, Da Zao
Shen Jin Cao, Wu Jia Pi, Gu Sui Bu, Zi Ran Tong, Du Huo, Qiang Huo,
Ru Xiang, Mo Yao, Ji Xue Teng