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Thoughts About Ingredients in Chinese Die Da Formulas

A number of readers of A Tooth from the Tiger’s Mouth, have commented on the unusual ingredients in herbal formulas or the difficulty in obtaining key herbs. While substitutions are sometimes possible in herbal formulae, key ingredients are not always easy to replace.
Tu Bie Chong (土鱉蟲)

Tu Bie Chong (wingless coackroach), actually a beetle that does not in appearance resemble the insect found in New York City apartments, does not sound particularly appetizing, yet it is an important  herb in Injury medicine. In Chinese medicine, “herbs” can be animal, vegetable or mineral. Tu Bie Chong is a common ingredient in many Die Da (trauma) formulations that treat fractures, contusions, and congealed masses of blood. Because Tu Bie Chong breaks accumulations of static blood and disperses concretions (hardened accumulations), it is present in most Die Da Liniments that treat bruising, and lumps and bumps from hit/fall injuries.

Tu Bie Chong is also said to “join bones and sinews”, a function not shared by many other blood activating herbs and is therefore often included in fracture formulas or in cases where the tendons and ligaments have been severely twisted. A large percentages of non-healing fractures ultimately stem from the initial swelling and blood stasis at the fracture site not dispersing properly. This inhibits normal circulation and inhibits bone healing. Tu Bie Chong is one of the few herbs that strongly breaks this stasis without interfering with the formation of bone. That is why for centuries it has been a key ingredient in “bone-knitting” formulas and Die Da Wan (trauma pills).

Zi Ran Tong (自然銅)

Zi Ran Tong (Pyrite) is often found in trauma formulas especially when there is a fracture. Zi Ran Tong dispels blood stasis and helps the healing of bones and sinews (tendons and ligaments). It is usually only taken for a short time, or in the case of fractures until the bones have knit. Because Zi Ran Tong is a mineral and therefore heavy relative to lighter herbs like flowers or leaves, it settles the qi and therefore is said to “anchor and settle the spirit”. This is important in treating injuries as the shock of a traumatic injury can disturb and scatter the qi and spirit.

Ma Huang (麻黃)

Ma Huang (Herba Ephedra) is another herb that has unique functions not easily reproduced by other medicinals in the Chinese Materia Medica. Ma Huang gained some notoriety when it was employed in diet pills and caused the death of a famous baseball player. Despite the fact that this was a serious misuse of an herb that has many valuable functions (arthritis; bronchitis, asthma, pneumonia – to name a few) when used properly, the FDA has banned its inclusion in pills, making it increasingly hard to obtain. Many Chinese pharmacies have stopped selling it altogether in order to avoid problems.

The inclusion of Ma Huang in Trauma Pills (Die Da Wan) is generally safe for healthy people – particularly because Trauma Pills are taken for only one to two days immediately following an acute injury where there is fracture, sprain, contusion, and or bruising without hemorrhage.  It is also included in soaks and liniments used for injuries to the tendons and ligaments.  This is because Ma Huang courses the qi and fluids through the superficial layers of the body, penetrating the obstructions of blood and fluid that lodge in the skin, flesh and muscle layers of the body. This function is enhanced by its combination with blood-quickening medicinals. No other herb targets the exterior layers of the body in this precise way.

Chuan Wu (川烏) and Cao Wu (草烏)

Chuan Wu (Sichuan Aconite Root) and Cao Wu (Wild Aconite Root) are very acrid and hot in nature. They are often used together to treat chronic joint pain particularly when the pain increases with cold, damp weather. These herbs are considered toxic, therefore they are banned in the EU and can be difficult to obtain even in the United States. These herbs are usually detoxified by cooking them with ginger and licorice root and/or by cooking them for extended periods on order to burn off the volatile oils. They should not be taken internally unless prescribed by a knowledgeable practitioner of traditional Chinese medicine. However, in liniments and poultices they are usually quite safe and they are common ingredients in trauma liniments (Die Da Jiu), herbal soaks and externally applied formulas that address chronic tendon and ligament problems.

Hu Gu (虎骨 – Tiger Bone)

Tiger bone was traditionally an ingredient in many injury formulas particularly where there is damage to the sinews and bones. Because tiger bone homes to the bones, it appeared in many formulas for fractures. Tiger Bone is warm and yang so it was also useful in chronic injuries with wind and damp obstruction with pain and atrophy particularly in the legs. For obvious ethical and economic reasons, today tiger bone is either dropped from these kind of formulas or replaced. Traditional replacements are cat bone or dog bone because these bones in particular have some of the characteristics of tiger bone.

Generally the inclusion of marrow bones from cows or pigs is an acceptable substitute in the case of fractures. Although often an easier and more effective way to “use bones to treat bones” is to make bone broth and add in Chinese herbs. This is part of the traditional treatment for fractures. In tendon injuries, Lu Jin (鹿筋 – Deer Tendon) is often substituted for Tiger Bone. If you are making a decoction with deer tendon, it needs to be soaked overnight and cooked longer than the rest of the herbs in the decoction. Traditionally tendon soup is often prescribed for healing tendon injuries.

Recipes for tendon and bone soup will be subjects of future articles.

Western Herbs

Some readers have asked about substituting Western herbs that grow locally for Chinese herbs. A modern trend in herbal medicine is to ascribe Chinese medicinal properties to Western herbs so that combinations of Western and Chinese medicinals can be made. Without getting into a long debate on this subject, I can only say that this is new trend, whereas the use of injury formulas in China has a long and rich history with many thousands of case studies written over hundreds of years. Doctors of traditional Chinese medicine have written and commented on the use of herbs for two millennia, creating a rich written tradition. In modern times, herbal formulations have been used in hospitals of traditional medicine specializing in trauma and orthopedic injuries. This is not true of the Western herbal tradition, although I imagine in the future, our local herbs (like American Ginseng, which long ago became part of the Chinese Herbal Materia Medica) will slowly become staple ingredients in Chinese herb formulas.