by John Scott and Andrew Elli

A Guide for using Golden Flower and Spring Wind Formulas to Treat Trauma

Overview

Traumatic injury can be separated into three stages with a variety of clinical manifestations; each of these variations requires a different treatment strategy. In order for treatment to be truly effective it is important to match the treatment strategy to both the stage and manifestation of the injury. That is why Golden Flower Chinese Herbs, along with Spring Wind Herbs, now offers a complete line of internal and external-use trauma formulas. Please use this paper as your guide for treating traumatic injury.

General Guidelines

In general, it is the stage of trauma that is the key to choosing the correct internal formulas, while the guidelines for choosing external treatment should be clinical manifestations. Obviously, there are more patterns of manifestation than there are stages, therefore, Spring Wind Herbs has created 13 external formulas to address the multiple manifestations and Golden Flower Chinese Herbs offers 4 internal formulas to address the three stages of trauma. It is important to monitor the treatment closely so that strategy can be modified to match the stage and manifestations.

The First Stage of Trauma is the most distinct and is marked by the signs of pain, heat, and swelling. Heat usually manifests as redness, but in the absence of redness, heat might also be experienced by the patient as the sensation of heat, or may be palpated by the practitioner. This stage can last anywhere from a few hours up to two weeks, depending on the type and severity of injury. 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.

The Second Stage of Trauma is in phase when the initial inflammation first subsides. What remains is blood stagnation 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, becoming chronic bi syndrome.

The Third 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 some residual blood stasis that is contributing to the lingering pain. As a result there is inevitable overlap between the second and third stage of trauma formulas. Both should move blood, dispel stasis and relieve pain, but in 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 employing a warm-property formula.

Guidelines For Internal Treatment Of Trauma

Match internal formulas to the proper stage of trauma.

Trauma 1 Formula

This formula is for first stage trauma when the manifestations of heat, pain, and swelling are all present. This stage can last from a few hours up to two weeks, depending on the type and severity of injury. 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. Trauma 1 Formula contains herbs that resolve heat toxin, which commonly proliferates in the area immediately following an injury. It strongly moves blood, clears heat, and reduces the swelling and pain occurring at the onset of traumatic injury. Stage one trauma is treated as pure excess and the emphasis of this formula is to clear, move, dispel and resolve the excesses associated with the initial phase of an injury.

Tieh Ta Formula

This is a general application trauma formula based on traditional formulas used to treat martial arts injuries. Tieh Ta Formula strongly reduces pain; it moves and builds blood, regenerates tissue, and reduces swelling. It is excellent when pain is the main symptom and heat is not a major factor in an injury and is therefore perfect for early second stage trauma. Tieh Ta Formula can address minor bleeding problems sustained from injury and help reduce bruising. It can be used before an event to reduce pain and tissue damage from sports injuries.

Trauma 2 Formula

For second stage trauma, this formula is best applied shortly after the initial inflammation and swelling have significantly receded. The second stage of trauma can begin anywhere from the second day to two weeks after the initial injury. This formula can be used to treat pain, stiffness and swelling in an injury where the heat and rubor have subsided. The injury is no longer treated as pure excess; some deficiency is acknowledged and addressed in this formula. In addition to clearing away the remaining stasis and relieving pain and swelling, Trauma 2 Formula dispels wind and damp, clears residual heat, and assists the body in the reconstruction of tissue. Third stage trauma can be avoided if the constitution is strong, if tissue damage is not severe, and if the first two stages are managed properly. Trauma 2 Formula can be used to treat bruises, sprains, strains, jammed fingers or toes, torn ligaments or cartilage. If the area is still red, it is better to use Trauma I Formula; if it has turned purple or yellow, or if no discoloration is present and the injury is still new, you can use Trauma 2 Formula or Tieh Ta Formula. The key difference between using Tieh Ta Formula or Trauma 2 Formula is the presence of wind-dampness: Trauma 2 Formula dispels wind and damp; Tieh Ta Formula does not.

Bone and Sinew Formula

Bone and Sinew Formula is used in late second stage and third stage trauma. It is a combination of the classic formulas Du Huo Ji Sheng Tang and Shu Jing Huo Xue Tang with the addition of medicinals that supplement the kidney to help knit bones and sinews. Proper application of this formula assumes that the heat and rubor have cleared completely and that there remains an invasion of wind and damp (and possibly cold) in the injured area, causing the pain to linger. Because damaged tissue is an issue, we have created Bone and Sinew Formula .to mend sinews and properly set bones. Use it for second and third stage torn ligaments, tendons, damaged cartilage, or broken bones.

San Qi Formula

San Qi Formula is our version of the famous Chinese formula for staunching bleeding, Yun Nan Bai Yao. It can be employed anytime bleeding is the main issue, whether it is internal or external bleeding. In addition to external trauma, it can control uterine bleeding; it can be used to treat an acute attack of Crohn's disease, phlebitis, vomiting or coughing of blood, rectal bleeding, bleeding ulcers, etc. In short, use San Qi Formula to stop acute bleeding.

Guidelines for External Treatment of Trauma

Match the plaster or compress to the manifestations of the injury. Plasters are generally used in first and early second stage of trauma, while compresses, since they can be applied while warm, are generally used in the 2nd and 3rd stages of trauma. Soak/compresses are excellent for treating patients who have just had a cast removed and suffer from stiffness and aching.

Plasters

Soft Plaster #1 (Ma's Wu Shu Soft Plaster)
For general application of 1st stage sinew damage. Heat, swelling, pain, redness are present.

Soft Plaster #2 (Stasis-dissipating, Pain-relieving Soft Plaster)
For 1st stage sinew damage, similar to #1. More strongly moves blood, so, better when pain is prominent.

Soft Plaster #3 (Dissipation Soft Plaster)
For 1st stage trauma, when pain is secondary to swelling.

Soft Plaster #4 (Double-cooling Soft Plaster)
Best when heat and rubor are prominent. This plaster can be combined with any of the other plasters to make them colder.

Soft Plaster #5 (Tri-color Application)
This one is warm and therefore NOT for first stage trauma. Use when cold and damp are predominating factors in the pain. It has a secondary function to assist the healing of tears in ligaments and tendons.

Soft Plaster #6 (Blood-quickening Soft Plaster)
Also warm. Similar to #5. Use when there is pain and swelling, but little or no heat. A standard 2nd stage trauma plaster.

Soft Plaster # 7 (Sinew-soothing Application)
More neutral in temperature. Use when heat and swelling are not significant but there is persistent pain and aching.

Soak/Compresses

Soak/Compress #8 (Ma's Post-trauma Soak/Compress)
The most neutral/generic of the soak/compresses. It is a combination of # 9 and #10.

Soak/Compress #9 (Pain-relieving Soak/Compress)
Focuses on the pain of second stage trauma (no heat.) It is general for wind damp bi and is useful to repair tissue damage.

Soak/Compress #10 (Stasis-dissipating Soak/Compress)
Special for sharp pain. The strongest one for moving blood and relieving pain. Can be used for deep bruises with dark purple color.

Soak/Compress #11 (Eight Immortals Hardness-dissipating Decoction)
Can be used for hot or cold type wind damp bi syndrome. Softens hardness and dissipates masses such as calcification, cysts, etc.

Soak/Compress #12 (Joint Injury Soak/Compress)
Warming. Special for chronic soreness and aches in tendons and ligaments. Stronger to move blood than #13. Can be used for sore lumbar and knees.

Soak/Compress #13 (Sinew-penetrating Soak/Compress)
Warmer than #12, contains Ma Huang and Fu Zi. Used for bi syndrome that is noticeably worse in cold.

Directions For Use Of Soft Plasters

• Spread soft plaster evenly on gauze. The plaster should be spread to a thickness of about 1/8th of an inch.
• Place the dressing on the affected area and secure with medical tape or with a gauze bandage. Do not apply the dressing too tightly; it should maintain contact with the skin but not hinder circulation or cause pain.
• Change dressing daily.
• Soft plasters may stain clothing, bedding or other fabric. You may want to cover the dressing with an old sock or T-shirt, or even plastic wrap.
• Discontinue use and consult your practitioner if redness or irritation of the skin develops.
• (Optional: before applying the soft plaster to the gauze, you may add a capful of Dr. Shir's Liniment to the plaster and stir into the top portion of the plaster. After you use up that portion of the plaster, stir in another capful of Dr. Shir's Liniment. This both enhances the efficacy of the plaster and makes it easier to spread.)
• (Optional: before applying the soft plaster to the gauze, you may peel back the top layer of the gauze, apply the soft plaster inside and fold the top layer back into place to make a sandwich. Apply the gauze with the single-layer side facing down on the affected area. This method is a tidier alternative.)

Soak/Compresses

As Steam Soak:
Place herb pack in 4 cups of water and bring to a boil. Lower heat and simmer for 25 minutes. Immediately place herb pack in appropriate basin and hold affected limb over the steaming liquid, drape towel over the limb to keep in steam. When decoction cools, bathe limb in the liquid, immersing the traumatized area if possible. Do this 2 times per day. To enhance the effects of the soak, add 2 tablespoons of rice wine to the water at the beginning of the steam. Liquid can be re-used and re-heated for up to 3-4 days.

As a Compress:
When it is not possible to soak a traumatized area such as the shoulder you will need to use a compress. Cook the pouch in 2 cups of water, bring to a boil and simmer for 25 minutes. Remove the bag and as soon as it has cooled enough to place on the skin, place it over the traumatized area, covering with a hot pack or hot water bottle to keep in heat. Leave on for about 25 minutes. You can also add 2 tablespoons of rice wine to the hot water before taking out the pouch to enhance the effects.

Soaks and compresses penetrate the tissues and leave them open for a while after treatment. It is therefore important to keep the area covered after application to avoid invasion of wind and cold. It is advisable to follow up a steam soak or compress treatment with one of the three products below.

Spring Wind Amber Massage Salve:
Moves blood, moistens skin and clears heat. This salve can be used whenever massage is appropriate. It was designed as a massage lubricant, but can be rubbed into bruises, strains, sprains, inflexible tendons, and can treat numbness and peripheral neuropathy. It is very good right after a steam soak or compress treatment.

Dr. Shir's Liniment:
This formula has been handed down from the Shao Lin Temple. It can treat all stages of trauma. It moves blood, dispels wind-damp and is balanced for pain and swelling. Rub liniments very lightly in a circular motion on affected area for 15 minutes, then cover to protect area from external invasion. Dr. Shir's Liniment contains grain alcohol and can be drying. This makes it highly effective for stiff joints or pain that is fixed in a small area, but for large areas, especially when dry skin is a problem, we recommend Spring Wind Muscle and Joint Rub. Dr. Shir's Liniment can be added to soft plasters to improve their action and make them easier to spread.

Spring Wind Muscle and Joint Rub:
This lotion soothes aching muscles and sore joints; it quickens blood, clears heat, dispels wind, moves qi, dissipates swelling, and relieves pain. Muscle and Joint Rub can be applied to sprains, strains, arthritis, tendonitis, stiff muscles and joints, bi patterns, and other musculo-skeletal disorders. It is an excellent massage lubricant and can cover large areas without leaving a greasy residue.