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Treating Overstretched Ligaments & Tendons with Chinese Medicine: Part 1 by Tom Bisio

Injuries to the tendons and ligaments, what Chinese medicine collectively refers to as the sinews, can be difficult and slow to heal. For the martial artist and athlete these kind of injuries can be frustrating as they make joints, unstable, weak and prone to re-injury. This series of articles will present a multi-modality approach to treating sinews that are overstretched due to extensive tearing and/or repeated injury. The treatments discussed have been shown to be effective in modern clinical situations and in “Kung-Fu” medicine (Sports Medicine) applications.

Ligaments attach bone to bone. Along with the tendons, which attach muscle to bone, ligaments and the thick fibrous tissue of the joint capsule are instrumental in maintaining the integrity of the joints. In Chinese Medicine, ligaments, tendons and other thick fibrous tissue – including some of the fascia – are collectively referred to as Jin (Sinews). When a joint has been injured, it is not uncommon for the sinews to become overstretched. Usually this happens if the bones start to move apart and then snap back suddenly. This is a common scenario in ankle sprains, but it can also occur with knees, ankles, wrist, elbows and shoulders as well.

Often the sinews spasm in response to this kind of overstretching. This is the body’s way of protecting and splinting the joint so that it cannot be injured further. Several days after the injury, when the initial swelling has gone down, the joint is often stiff and hard to move, and there is usually residual pain and swelling. In these instances herbal soaks, like the Tendon Relaxing Soak, can be very useful to help relieve symptoms.

Tendon Relaxing Soak

當歸尾              Dan Gui Wei               5 qian (15 grams)

红 花                 Hong Hua                   5 qian (15 grams)

蘇木                  Su Mu                         5 qian (15 grams)

白 芷                 Bai Zhi                        5 qian (15 grams)

薑黃 (姜黄)       Jiang Huang            5 qian (15 grams)

威靈仙              Wei Ling Xian           5 qian (15 grams)

羌 活                 Qiang Huo                 5 qian (15 grams)

五加皮              Wu Jia Pi                    5 qian (15 grams)

海桐皮              Hai Tong Pi                5 qian (15 grams)

牛膝                   Niu Xi                         5 qian (15 grams)

川 楝 子            Chuan Lian Zi            5 qian (15 grams)

土伏苓              Tu Fu Ling                  5 qian (15 grams)

乳香                  Ru Xiang                     2 qian (6 grams)

川椒                 Chuan Jiao                  3 qian (3 grams)

透骨草              Tou Gu Cao                10 qian (30 grams)

This formula is for one soak that lasts about 6 days of daily use.

To make it more effective, add 1 quart/liter of alcohol and 1 quart or liter of white vinegar after cooking the herbs as described in step 1 below.

Using Soaks:

  1. Cover the ingredients in a half gallon or more of water. Bring to a boil, then turn down the flame, cover the pot and simmer for 30-40 minutes.
  2. When the decoction is still hot you can steam the injured area, fumigating it completely with the steam. This allows the formula to penetrate the superficial layers of the skin and flesh.
  3. Then soak towels or cloth in the formula and use them as compresses over the injured area. Have at least two cloths so that as soon as one cools down you can replace it with another. Make sure to let the cloths cool slightly before putting them on the skin so as not to burn yourself.
  4. If the injured area is on the hand or foot you can immerse it in the liquid.
  5. Save the herbs and liquid and reheat for the next use. There is no need to boil and simmer the herbs after the first time. Simply warm the herbs up to the appropriate temperature (ie: very warm, but not burning or scalding) and use as directed above.

Note: One soak, as listed above, will last for six days, if used 1-2 times a day. 

Over-Stretched Sinews

However, sometimes, particularly if a joint has been repeatedly injured, sinews will stay overstretched. Repeated overstretching of the sinews can be the result of overstretching or even kicking or punching incorrectly. For example, the whipping hand techniques of the Fukkien White Crane are meant to create a loose, whip-like power and strong tendons. However, when done incorrectly, these movements can destabilize the joints. A more common cause of overstretched sinews in martial arts are the joint locks common to many styles. Repeatedly taking the joints beyond their normal limits can gradually overstretch the soft tissue and create micro-tears that destabilize the joint. This kind of injury can be difficult to treat and often requires an integrated and sophisticated treatment plan. Many of the principles of treating lax sinews can be applied to other problems.

Whatever the cause, if the sinews become lax the joint will be destabilized, setting it up for further injury. This situation can be particularly serious for individuals who already have hyper-mobile joints or fail to receive proper nutrition. When there is chronic laxity of the tendons and ligaments and “loose joints,” treatment in Chinese medicine differs slightly from the normal Die Da (trauma) protocols. Rather than simply restoring free-flow of qi and blood, treatment must be specifically directly at restoring the integrity of the sinews (tendons, ligaments), which are ruled by the liver.

The integrity of overstretched sinews can be restored through a diligent, multi-modal treatment program which has seven interlocking aspects.  

1) Liniments:

Several times a day gently massage tendon lotion into the injured area to bring increased circulation to the damaged sinews. Because tendons and ligaments rely on peripheral circulation of blood and fluids for nutrition, this will help stimulate circulation, bringing the necessary nutrient building blocks to the local area.

Tendon Lotion

草烏          Cao Wu              4 qian (12 grams)

川烏          Chuan Wu          4 qian (12 grams)

桃仁          Tao Ren              4 qian (12 grams)

麻 黃         Ma Huang          4 qian (12 grams)

乳香          Ru Xiang            4 qian (12 grams)

没药          Mo Yao              4 qian (12 grams)

自然銅      Zi Ran Tang        4 qian (12 grams)

大黄          Da Huang           4 qian (12 grams)

路路通      Lu Lu Tong         4 qian (12 grams)

樟 木         Zhang Mu          4 qian (12 grams)

Add 1 Gallon of Vodka (approx. 100-120 proof 0r %50-60 alcohol) to Herbs and let sit in cool dark place for at least 3 months – 1 year is better – Shake occasionally. Decant into smaller bottles for use.

Tendon Lotion is for External Use Only! Do Not apply over open wounds. Apply with caution if you are pregnant. 

2) Poutices/Plasters (Gao):

Some Poultices or Gao can be very helpful in healing over-stretched sinews. The Bone-Sinew Gao is particularly effective for these kinds of sinew injuries because one of its actions is to astringe and tighten the sinews. It is important to make sure the bones are properly aligned before using this poultice.

The herbs listed below must be finely ground. This is usually best done at a Chinese Herbal pharmacy which has industrial machines specially made for grinding herbs. To make this Gao, Put an appropriate amount of the powdered herbs in a small pot and cover with whisky. On a low flame cook the mixture, stirring occasionally, until it thickens and becomes darker in color. Then add a dollop of honey. Cook a little longer, until the mixture has the consistency of thick mud. Let it cool slightly until it won’t burn you and apply to the injured area, covering it completely with a thick layer of the mixture. Cover over with a dressing of gauze and elastic bandage. The bandage should hold the herbal material against the skin but not restrict circulation. Leave one to two days. Then remove for a day to let the skin breathe and then re-apply. If your skin is sensitive it may cause a rash. In that case apply for shorter periods, with more time in between.

Bone–Sinew Gao

川烏                   Chuan Wu          1 qian (3 grams)

草烏                   Cao Wu              1 qian ((3 grams)

白 芷                 Bai Zhi               5 qian (15 grams)

木 香                 Mu Xiang           2 qian (6 grams)

厚朴                   Hou Po               3 qian (9 grams)

小茴香              Xiao Hui Xiang   3 qian (9 grams)

肉 桂                 Rou Gui              3 qian (9 grams)

乳香                  Ru Xiang            5 qian (15 grams)

没药                  Mo Yao              5 qian (15 grams)

血竭                   Xue Jie                5 qian (15 grams)

羌 活                 Qiang Huo           5 qian (15 grams)

獨 活                 Du Huo              5 qian (15 grams)

香附                  Xiang Fu             5 qian (15 grams)

牛膝                   Niu Xi                5 qian (15 grams)

續 斷                  Xu Duan             5 qian (15 grams)

自然銅              Zi Ran Tong       5 qian (15 grams)

木瓜                  Mu Gua              5 qian (15 grams)

當歸                  Dang Gui           8 qian (24 grams)

紫荊皮              Zi Jing Pi            8 qian (24 grams

鹿筋                 Lu Jin                  5 qian( 15 grams)* 

This formula warms and clears stasis in the channels and collaterals, kills pain, strengthens sinews and bones, and clears wind-cold-damp, which can lead to arthritic conditions.

Gou Pi Gao (狗皮膏)

An alternative to the Tendon-Bone Poultice is the Gou Pi Gao (Gou Pi Plasters). Gou Pi Plasters are available in most Chinese Pharmacies. The herbs are dissolved in a pine resin base. Pine Resin is a Chinese herb, which relaxes the sinews and aids penetration of the herbal material to the level of the sinews and bones. The Gou Pi Plaster contains herbs that drive out wind-damp-cold and strengthen tendons and bones.

The Gou Pi plaster consists of a piece of leather folded in half. When you pull the halves apart, you will see something that looks like a glob of hardened tar. This glob is the herbal mixture already cooked into a pine resin base and allowed to dry. Heat the plaster in a toaster oven, or face up in a frying pan over a low flame. In a pinch, you can hold the plaster near a candle flame. Let the heat soften the pine resin. As it softens you can open and refold the plaster several times to spread the mixture more evenly over the leather. Let the plaster cool a little and then apply. Gou Pi Plasters can be used two or three times. Simply reheat to soften the plaster and reapply.

Gou Pi Plasters are particularly useful for injuries to tendons, ligaments and bones. They are somewhat warming and should be used after the initial inflammation and swelling have been reduced. Gou Pi Plasters penetrate through and disperse accumulations of Qi, blood and fluid. They also strongly stimulate local circulation, which helps damaged tissues to heal more quickly.

Important Note About Gou Pi Gao:

As you probably know, pine resin is extremely sticky and hard to remove. Pine resin will stain clothes and some residue will probably remain on the skin after you remove the plaster. Mineral spirits can help to remove this residue. Shave off any hair in the injured area before applying a Gou Pi Plaster. The pine resin will adhere to the hair, making the plaster almost impossible to remove. The first time I put a Gou Pi Plaster on my sprained wrist, I could not get it off the next day. It took a combination of pulling and tugging and snipping hairs with scissors to remove it. Now I remember to first remove any hair from the area I am applying the Gou Pi plaster

Notes:

*The traditional recipe calls for tiger bone. As tigers are an endangered species, this herb is generally replaced with another kind of bone, often dog or cat bones. For tendon injuries, I usually replace this herb with deer tendon (Lu Jin).

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