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Die Da Wan (Trauma Pills or “Hit” Pills)

Die Da Wan (“Trauma Pills” or “Hit Pills”) are an important tool in treating traumatic injury. The application of Trauma Pills as a treatment modality is very specific, yet like many tools in Chinese medicine there is some room for flexibility and creativity in their usage.

Since the publication of A Tooth From the Tiger’s Mouth, I have received many questions about Die Da Wan, questions which have made me realize that there is some confusion about its manufacture, composition and application. This article will hopefully answer some of those questions. 
There are many different prescriptions for Die Da Wan pills. As with Die Da Jiu (Trauma Liniment), every Kung Fu school has a secret recipe for trauma pills that they feel is the best.

Let’s start by looking at the basic formula as presented in A Tooth From the Tiger’s Mouth. This is the classic and perhaps the most elegant of the various Die Da Wan prescriptions.

Die Da Wan

20 grams       Ma Huang 麻黃

10                   Dang Gui 當歸

10                   Chuan Xiong 川 芎

10                   Yu Jin 鬱金 (or substitute: Xue Jie 血竭)

10                   Mo Yao 没药

10-20             Ru Xiang 乳香

10                   Tu Bie Chong 土蟞蟲

10                   Zi Ran Tong 自然銅

The herbs are ground to a fine powder and made into honey pills.

Analysis of Die Da Wan Formula

For discussion purposes we can divide the functioning of the herbs in this formula into three groups:

1) Dang Gui; Chuan Xiong; Yu Jin (Xue Jie); Mo Yao, and Ru Xiang. These herbs invigorate blood and transform blood stasis. The three resins: Mo Yao. Ru Xiang and Xue Jie in particular transform stasis, stop pain and reduce swelling.

2) Tu Bie Chong and Zi Ran Tong. These herbs also invigorate blood and transform blood stasis but additionally they help knit sinews and bones. Their presence makes Die Da Pills suitable for fractures and dislocations.

3) Ma Huang stands alone in its own category. Ma Huang is usually associated with treating asthma and other lung problems. Because Ma Huang disseminates the lung qi, one of its functions is to unblock the channels and collaterals and enter and break up accumulations of blood and phlegm. Ma Huang strongly moves qi and fluids in the layers between the skin, flesh and muscles, making it ideal for clearing blockages caused by trauma. In this context, Ma Huang also acts to lead and guide the other herbs in the formulas to break up accumulations.

Controversy about Ma Huang

Ma Huang has become very difficult to obtain in recent years partially due to its notoriety in relationship to a few deaths caused by its misuse in herbal diet pills, where its very activating action was used to aid in weight loss.

Used properly – in combination with other appropriate herbs, proper methods of extraction, and in correct dosages and duration – there is little or no problem with Ma Huang. Some people are sensitive to it, and  even in low doses it can make them feel jittery. However the dosages in a single Die Da Wan pill are extremely small and have not been concentrated by extraction. Also, Die Da Wan are only prescribed for a short duration – no more than 1-4 pills over 1-2 days.

In large doses of 30-40 grams, or if taken too long in smaller doses, Ma Huang can be toxic and cause undesirable effects. Ma Huang was taken by the imperial guards to stay awake during night sentry duty. [1] Ma Huang contains substances that are central nervous system stimulates, and it can raise blood pressure and cause insomnia and restlessness. Ma Huang contains Ephedra, which is also widely used by athletes who misunderstand its correct application and dosage, and take it in spite of a lack of evidence that it enhances athletic performance. Another reason for the ban on Ma Huang may also be because it can be used as a precursor in the manufacture of methamphetamine.

Substitutions for Ma Huang

However, we must recognize that FDA regulations in the US and EU regulations abroad make it difficult or impossible to manufacture traditional Die Da Wan. Hence one must either substitute other herbs for Ma Huang, use a different Die Da Formula, or use one of the various patent versions of Die Da Wan which do not contain Ma Huang. Two interesting substitutions for Ma Huang are listed below:

1) Ma Huang Substitution #1

Si Gua Luo 5 grams

Lu Lu Tong 10 grams

Wei Ling Xian 5 grams

  • Si Gua Luo (loofah) is a medicinal that is said to be network-like in form – it looks like a net or mesh. It helps to free the network vessels and channels.
  • Wei Ling Xian is an interesting addition. It opens the 12 channels and collaterals. It transforms damp, and phlegm. Because it it said to “move without staying,” Wei Ling Xian is useful in cases where accumulated phlegm has combined with blood stasis to form lumps and nodes.
  • Lu Lu Tong unblocks the channels and collaterals in order to promote the flow of qi and blood. In Die Da medicine it is often employed for its ability to unblock the twelve channels, expel damp and soothe spasms.

2) Ma Huang Substitution #2

Qing Pi 10grams

Bai Jie Zi 10 grams

  • Bai Jie Zi is warming and unblocks the channels and collaterals. It is used for phlegm nodules obstructing the channels and collaterals. Bai Jie Zi enters the channels and collaterals with the lung qi to disperse clumps of cold causing pain in the joints.[2]
  • Qing Pi spreads the qi and breaks up stagnant Qi. In trauma medicine, Qing Pi is used in cases of Qi stagnation with blood stasis because it dissipates clumps and helps restore the Qi dynamic.

 

There are many alternative versions of Die Da Wan. One interesting variation is listed below:

Die Da Wan Variation #1

10 qian          Jiu Zhi Chi Shao (wine-fry) 酒炙赤芍

10                   Jiu Zhi Dang Gui (wine-fry) 酒炙當歸

10                   Tao Ren 桃仁

10                   Hong Hua 红花

10                   Su Mu 蘇木

10                   Sheng Di Huang 生地黃

7                     Qing Pi 青皮

7                     Jiu Zhi Da Huang (wine-fry) 酒炙大黄

7                     Jiu Zhi Yu Jin (wine-fry) 酒炙鬱金

4                     Sheng San Qi (Raw) 生三七

4                     Tu Bie Chong 土蟞蟲

3                     Zi Ran Tong 自然銅

Remember a qian is approximately 3 grams, so simply multiply by three to convert qian to grams.

This formula has four herbs that are pre-prepared by frying them in Wine (Bai Jiu, ‘rice alcohol’ that is 100-120 proof). Frying these specific herbs in alcohol increases their ability to move and course blood and Qi. Two herbs in this formula form an important combination used by Die Da experts. This combination is specifically aimed at preventing the formation of dead blood. Sheng Di Huang both clears heat and cools the blood and moistens and enriches yin. Qing Pi breaks qi binds (qi that is bound up)  in order to disperse stagnation. Together these herbs moisten and move blood that is static.

Die Da Wan Variation #2

Equal amounts of the following herbs:

赤芍 Chi Shao

琥珀 Hu Po

當歸尾 Dang Gui Wei

防風 Fang Feng

红花 Hong Hua

桃仁 Tao Ren

碎補 Gu Sui Bu

生三七 Sheng San Qi (Raw)

木瓜 Mu Gua

續 斷 Xu Duan

川 芎 Chuan Xiong

土蟞蟲 Tu Bie Chong

血竭 Xue Jie

路路通 Lu Lu Tong

没药 Mo Yao

乳香 Ru Xiang

牛膝 Niu Xi

牡丹皮 Mu Dan Pi

羌 活 Qiang Huo

獨 活 Du Huo

荊芥 Jing Jie

木 香   Mu Xiang

栀 子 Zhi Zi

This is a bit of a shotgun approach to moving blood and Qi, but it is a strong, effective and comprehensive formula.

One very valuable alternative to Die Da Wan is Qi Li San or “Seven-Thousandths of a Tael Powder.”[2] This formula was traditionally used for a wide variety of traumatic injuries, and could be applied externally as well as internally. Traditionally 1-2 grams was taken with warm water or wine (Bai Jiu).

Qi Li San

30 grams       Xue Jie

4.5                  Hong Hua

4.5                  Ru Xiang

4.5                  Mo Yao

7.5                  Er Cha

.36                  Bing Pian

.36                  She Xiang

3.6                  Shui Fei Zhu Sha (prepared Cinnabar)

This formula is not used today because of the toxic nature of cinnabar and because musk comes from an endangered species of deer. However, the Health Concerns company markets a safe, modern version of Qi Li San that has wide applicability under the name: Resinall K. It treats pain and swelling due to traumatic injuries, sprains, strains, contusions, fractures, broken bones, torn sinews, bleeding, bruising, lacerations.

Resinall K

Xue Jie (Dragon’s blood resin)

San Qi (pseudoginseng root)

Er Cha (Catechu herb)

Yan Hu Suo (Corydalis rhizome)

Hong Hua (Carthamus flower)

Mo Yao (Myrrh resin)

Ru Xiang (Frankincense gum)

Bing Pian (Borneol resin)

Resinall K is already in an alcohol base so it is easy to take. It is used by many practitioners of Chinese medicine as a post-surgical medication that speeds recovery. Do not use it for post-surgical healing without consulting a licensed practitioner of traditional Chinese medicine as there are many considerations that must be taken into account after surgery. Dosage is 1/2 dropper-full under the tongue 2-3 times a day. It is more suitable than Die Da Wan for children or debilitated individuals.

Die Da Wan Patent Remedies

Commercial (Patent Remedy) trauma pills can also be bought in Chinese pharmacies. Quality varies, None of  them are as effective as the traditional formula, but they are cheap, easily accessible and conveniently packaged. There are three main brands, all of which contain similar herbs, generally those that dispel stagnant blood, activate the blood and kill pain.

1) Liang Cai Xin Die Da Wan

These come in a box with six honey pills – each is wrapped and inside a wax ball. 2 pills a day for 3 days is a course of treatment.

2) Shao Li Die Da Wan Trauma Pills (Circu-Herb Tea Extract)

Each pill is in its own individual box and there is a plastic ball containing a number of small honey pills. One dose is all the small pills in the plastic ball. 2 Plastic balls a day for 2-3 days is a course of treatment.

3) Five Photos Brand Tien Ta Wan Herbal Supplement

Named for the five photos of famous doctors/martial arts practitioners on the tin box. Each tin box contains one honey pill which is inside a wax ball. 2 pills a day for 2-3 days.

Contraindications to Using Die Da Wan

  • Pregnancy
  • Bleeding injuries and suspicion of internal bleeding
  • People on medications such as Coumadin (Warfarin) that “thin the blood”
  • Should not be take on a regular basis
  • Concussions

Application of Die Da Wan

Die Da Wan are generally used immediately following a traumatic injury where there is either significant bruising or swelling and/or stasis of blood and qi. An obvious example is immediately following a severe sprain, as in a sprained ankle, or torn meniscus or ligaments in the knee. Another is immediately following a fracture. In the context of sports and martial arts injuries, trauma pills are useful in cases where someone has taken an extremely hard blow to the body. As long as there is no internal bleeding, a hit pill is invaluable in preventing the sequelae of a shocking blow which can cause and immediate blockage of the qi – characterized  by blood stasis and fluid accumulation because the qi dynamic has been interrupted and the ability of the qi transport these substances is impaired.

For this reason, hit pills are very useful after auto accidents where the whole body had been shocked. It is very common for someone to walk away from an auto accident with no injuries, receive a clean bill of health from the hospital and days later develop pains that over time become chronic. At our clinic we have had patients who took a trauma pill after an car and bicycle accidents immediately after being cleared by the hospital, thereby preventing the occurrence of these kinds of symptoms. However, in cases of head trauma, Die Da Wan should not be administered as they can lead to complication of the injury.

Die Da Wan should not be administered regularly. A common question I have received after the publication of A Tooth Form the Tiger’s Mouth is, “I spar and train hard several days a week and regularly get hit and have bruises and contusions. Can I take a trauma pill following these kinds of workouts?” The answer is “No”. Die Da Wan are too dispersing to take regularly and should be reserved for more damaging blows and trauma. There is another category of formulas – martial art training formulas – that are intended for regular use in instances when someone is playing contact sports or regularly engaging in hard training.

Taste and Dosage

Some people don’t like the taste of Die  Da Wan. In that case the pills can be cut up into pieces and swallowed. For children, one half or quarter pill can be taken, although for children under 7 years of age trauma pills are too strong and a light dosage of Resinall K is more appropriate.

Again, the basic dosage is 1-2 pills a day for 1-2 days maximum. In some cases Die Da Wan can be taken during the second stage of an injury if the initial stasis of blood and qi was not cleared properly immediately after the injury. In these instances the dosage would be the same as above.

An interesting variation of Die Da Wan is the Zheng Gu Jin Dan: Bone Setter’s Purple-Gold Special Pill.

Zheng Gu Zi Jin Dan (Bone Setter’s Purple-Gold Special Pill) [3]

12 qian          Ding Xiang 丁香

12                   Mu Xiang 木香

12                   Xue Jie 血竭

12                   Er Cha 兒茶

12                   Zhi Da Huang(prepared) 炙大黃

6                     Mu Dan Pi 牡丹皮

12                   Hong Hua 红花

24                   Dang Gui Tou

24                   Lian Zi 蓮子

24                   Fu Ling 茯苓

24                   Bai Shao 白芍

4                     Gan Cao 甘草

This formula differs from Die Da Wan in that it addresses 2nd stage trauma which can be from 3-7 days after the initial injury. This time frame is adjustable depending on the severity of the injury and whether it was treated properly or not in the first stage. In 2nd stage of trauma the initial swelling and inflammation have decreased, but there is stiffness, pain or discomfort and residual stasis with pockets of swelling. In addition to pain and stiffness, the 2nd stage injury is characterized by a yellow purple color – hence the name of the formula. [4] In this stage, there is also the potential for penetration of wind, damp and cold due to the impairment of the Wei Qi and the relative deficiency of normal Qi in the local area. This formula moves stasis and kills pain, but it also focuses on nourishing blood and aiding the spleen in moving damp, which helps prevent the penetration of wind and dampness. The inclusion of Ding Xiang warms and moves the qi and its aromatic nature penetrates obstruction.

Making Die Da Wan

  1. Have the herbs ground to a fine powder.
  2. Bring honey to boil in a pot or a large frying pan. There is no set proportion of honey to herbal powder. Let the honey boil for several minutes until it is liquefied.
  3. Stir in the powdered herbs a little at a time until the herb and honey mixture has the consistency of dough. There is no set proportion of honey to herbal powder. The process is like cooking, done by eye. That is why one should add the powder little by little to the liquefied honey until a doughy consistency is achieved.
  4. Use vegetable oil to oil a large cookie sheet. Oil your hands as well to prevent the herbal mixture from sticking to them.
  5. Put the herbal mixture on the cookie sheet and knead it like dough as it cools. Be careful not to burn yourself.
  6. Roll the herbal mixture out into long rolls.
  7. Pick off sections of the roll and form them into balls the size of  large marbles.
  8. Wrap each pill in wax paper and store in a cool dry place.

Note: Since making pills is a bit time consuming, I recommend making a large amount that will last for a long time. Cooking the herbs with honey preserves them if they are kept out of the sunlight. For long term storage, put the pills in the refrigerator.

[1] A Tooth Form the Tiger’s Mouth by Tom Bisio. New York: Simon and Schuster, Fireside Books, 2004. p. 138.

[2] Chinese Herbal Medicine Materia Medica 3rd Edition, by Dan Bensky, Steven Clavey and Erich Stoger with Andrew Gamble. Seattle: Eastland Press, 2004, p. 424.

[3] This formula is found in Chinese Herbal Medicine: Formulas and Strategies complied and translated by Volker Scheid, dan Bensky, Randol Barolet, and Andrew Ellis. Seattle: Eastland Press, 2000, p. 573

[4] Ibid. p. 574.

[5] Ibid.

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