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TCM for Sprains and Strains

Monday, March 18, 2013 | By:

So you’ve just sprained your ankle fighting for that offensive rebound (you should have stuck to defense) or maybe you just stepped on an uneven patch of pavement. In either case you’ve been taught to religiously recite the sacred mantra RICE – Rest Ice Compression and Elevation. Well, that’s not a bad idea and it will work over time; however some would argue that if you try the TCM approach, you’re ankle will heal even faster and you’ll be off playing basketball again in no time. Unlike RICE, the tenets of TCM say if you sprain or strain a joint, the first thing you should do is to immediately and aggressively massage the injured area using tuina (推拿 tuīná) to prevent the blood from over clotting and qi from stagnating. With this approach, the most painful part of the healing process is the very beginning because it is believed that the more aggressively you massage the injured area, the faster it will heal. This means a lot more pain in the beginning, but it is believed that the resulting improved circulation will promote faster healing and less pain, including chronic pain in the long run. Rather than worsening the bruise, many Chinese believe that rapidly massaging the injured area will prevent bruising or at least lessen the amount of time it is present. Before going any further, if you are in doubt about whether or not you have broken a bone, you should get x-rays first.

An example of my homemade Dit Da Jow brew based on a secret kung fu recipe

An example of my homemade Dit Da Jow brew based on a secret kung fu recipe

Ideally, one should massage the injured area with a liniment such as what is known in Cantonese as dit da jow or in Mandarin diedajiu (跌打酒 diē dǎ jiǔ, falling and hitting wine). Dit da jow is well known in kung fu circles as an analgesic and for its ability to reduce inflammation, increase circulation and prevent infection in martial arts-related injuries. Two key ingredients that are old friends of yours from biblical lore are Frankincense (乳香 rǔxiāng) and Myrrh (没药 mòyào), which both turn out to be extracted from tree resins in the Arabian Peninsula and northeastern Africa. These ingredients combined with others such as Safflower (红花 hónghuā) remove stasis in the blood and invigorate (活血huóxuè) it so that blockages are cleared and circulation is increased to and through the injured area. Each kung fu school has its own secret recipe of numerous Chinese herbs that are fermented in wine for at least six months to achieve the optimal healing results. Different recipes of dit da jow are designed for different purposes such as conditioning for iron palm training or, in this case, healing. Some Chinese medicine stores sell various brands of dit da jow over the counter while some Mom and Pop shops may even have their own homemade brew, the latter are preferable as the product sold over the counter is usually not as potent. Apply dit da jow liberally up to six times a day until healing is complete.

If dit da jow isn’t available, Red Flower Oil (正红花油 Zhènghóng huāyóul) is another alternative. If the injury is to the bone such as a bone bruise on the shin or forearm, you can apply Zhenggushui (正骨水, Bone Rectifying Liquid), which is specifically designed for healing bone bruises and hairline fractures but can be used to some extent to soft tissue injuries as well. Another option is Deer musk (麝香 shèxiāng), which can also be quite effective, but your friends as well as deer may be able to smell the musk on you from far away. All of the aforementioned liniments are for external use only and none should be applied if there are any open sores. To stop bleeding, Yunanbaiyao (云南白药, Yunan White Medicine) powder should be applied until the bleeding stops and keep any of liniments mentioned away from the cut.

If a trained TCM practitioner is available, the next step is to start to manipulate the joint in the opposite direction that it was injured in. Unlike Western medicine where the emphasis is immobilizing the injured joint as soon as possible, Chinese medicine advocates working on reestablishing range of motion immediately. If you’ve rolled your ankle inwards, the Chinese approach is to press it outwards in the opposite direction of the injury to start establishing the proper motion of the joint. They will also soon moving the joint in all structurally correct directions. The idea is to introduce more range of motion much earlier in the healing process to ensure that there is less atrophy and loss of mobility once the joint has healed. Manipulating your joints in this way is not advisable without the aid of qualified TCM physician, nor is the amount of pressure required easy to achieve on one’s own as the pain prevents many from treating themselves effectively. Chinese doctors also often augment this treatment with acupuncture and moxibustion (艾灸术 àijiǔshù), the latter being a kind of heat treatment with mugwort sticks.

Instead of packing the wound in ice, which the Chinese believe is detrimental as it stagnates blood and qi circulation, an herbal poultice can be applied to the wound such as Sanhuansan (三黄散 Sān huáng sàn, Three Yellows Powder). The three yellow herbs in Sanhuangshan - 黄芩 (Huángqín, Baikal Skullcap Root),黄柏 (Huángbò, Chinese Corktree Bark),大黄 (Dàhuáng, Rhubarb) - all have a cooling effect on swelling while enabling flow of blood and bodily fluids to flow at normal body temperature, unlike ice. You can request these three herbs from a Chinese medicine shop and make the concoction yourself, or there are some herbal websites online that sell the ready made product. The main thing is that it has at least the three herbs mentioned (often there are a couple more added for extra effect). If you’re trying to figure out where to start, Tongrentang (同仁堂 Tóngréntáng) is the best known Chinese herbal drug store chain in the world, and though sometimes more expensive than other shops, it has a relatively good reputation.

After the poultice has been applied for three days, the concern switches from reducing swelling and inflammation and now becomes primarily increasing circulation and mobility. It is important to resume massaging and manipulating the joint, and there are a number of different variations of liniments that you can use to expedite this process. If you have a good dit da jow recipe, you can simply continue to apply that liberally and rigorously. Alternatively, you can use a combination of White Flower Analgesic Balm and Tiger’s Balm, the two have similar ingredients and can be used individually to good effect, but combined they are like a tiger with wings (如虎添翼 rúhǔtiānyì). Apply the White Flower Analgesic Balm first to open up the pores and then apply the Tiger Balm (虎标万金油 hǔbiāo wànjīnyóu) so it can penetrate more deeply and have more of an effect. Both balms will aid in relieving residual pain and stiffness in the injury as it nears full recovery. Tiger Balm also now is sold as a plaster, essentially a patch that you can stick to the injured area for several hours at a time.

Herbal Remedy for Joint Injury

The following is a more sophisticated TCM recipe to treat joint injuries such as sprained ankles and knees that is can be used if you have access to a well-stocked Chinese herbal medicine shop:

桂枝 (Guìzhī, Cassia Twig) 20ɡ,红花 (Hónghuā, Safflower) 20ɡ,细辛 (Xìxīn, Manchurian Wildginger Herb) 10ɡ,威灵仙 (Wēilíngxiān, Chinese Clematis Root) 60ɡ,伸筋草 (Shēnjīncǎo, Buck Grass) 40ɡ,昆布 (Kūnbù, Kelp) 40ɡ,海藻 (Hǎizǎo, Seaweed) 40ɡ,路路通 (Lùlùtōng, Chinese Sweet Gum) 40ɡ,续断(Xùduàn, Himalayan Teasel Root) 40ɡ,海桐皮 (Hǎitóngpí, Oriental Variegated Coralbean Bark) 40ɡ,透骨草 (Tòugǔcǎo, American Lopseed) 40ɡ,防风 (Fángfēng, Divaricate Saposhnikovia Root) 20ɡ,艾叶 (Àiyè, Argy Wormwood Leaf) 60ɡ,五加皮 (Wǔjiāpí, Slenderstyle Acanthopanax Root-bark)30ɡ,芒硝 (Mángxiāo, Mirabilite) 50ɡ   (external use only: bathe)

Put the herbs in 1500-2000 ml of water, add 200 ml vinegar and then boil the mixture.

Step 1:  Keep the temperature of the herbal formula at 120-160 F to fumigate the injured area of the body.  In other words, place the piping hot water near the injured area to let the water vapors reach the joint.

Step 2: When the temperature lowers down to 110, soak and cover the joint in the fluid until it is normal body temperature. Usually, it takes 15-20 minutes.

Step 3: Wrap the herbs in a cloth and then place that over the injured area. Remember the residual herbs which have been boiled should still be warm.  Do this for 20 minutes.

Step 4: Massage it for 10- 20 minutes.

Step 5: Activate the local joints. The last step is to start gently moving the joint around to start to reestablish natural range of motion.

You can break this formula into several smaller batches of herbs, each of which can be used twice, thus giving you up to 2 weeks of treatment if necessary.

The purpose of this blog is to provide information on several different herbal options to treat injured joints. It is advisable to choose only one of the treatment options listed above for your injury based on what is available in your area. Over time, you can try different methods. Like any medication, there is always the possibility of an allergic reaction, so exercise caution.

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4 Responses to TCM for Sprains and Strains

  1. Pingback: Hao Hao Report


  2. bin says:

    Application of RICE does two things: it reduces swelling and it numbs the area. Most modern recommendations are to alternate hot and cold on the area. Massaging the area and adding treatments to stimulate bloodflow allows the area to heal faster; it works better, but it doesn’t necessarily address swelling/inflammation. Reducing inflammation first can be important depending on the injury (i.e. you do not want the tendons around a twisted ankle to stay stretched out and heal that way, or a second injury is more likely). TCM is very case-specific, so it’s best to consult with a qualified practitioner, but there is no “one way or the other”. TCM herbs are a good addition while also massaging, alternating ice, and elevating the area.

    • Keoni Everington (华武杰) says:

      In Tom Bisio’s book “A Tooth from the Tiger’s Mouth”, he quotes famous Xingyi master Xu Hongji as saying “Ice is for dead people.” His point is that ice reduces swelling and inflammation at a price: the contraction of blood vessels, muscles, ligaments, and tendons. This can result in long term blockages of blood circulation and qi that will take the body longer to process than with the Dit Da Jow or herbal poultice alternatives. Right, there is not necessarily “one way or the other” and ice can be used when there is a lack of any alternatives. I’m just trying to provide some alternative and supplemental treatments that may help achieve better results.

  3. Melanie says:

    Thank you for posting this informative article.

    I have used San Huang San (Herbal Ice) for years, on my own injuries and applied to my martial arts students’ sprained ankles, etc. It is extremely effective and much better than ice at reducing pain and inflammation and speeding healing.