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Use of Guide Herbs in Trauma (Die Da) Formulas

One way of modifying Chinese formulas is to add guide herbs (envoy herbs) which convey the action of the herbal ingredients to the desired area. In this article we will discuss the use of guide herbs in trauma formulas, looking at two important Die Da Formulas and how to modify them using guide herbs.

Using Guide Herbs in Trauma (Die Da) Formulas

Although hit pills are often used for the first stage of traumatic injury, this is largely because hit pills are convenient. Hit pills can be pre-made and are easily transportable. However, taking a raw herb formula internally, in cases of both soft-tissue and osseous injuries, can be more effective and more specific, because formulas that are decocted (reduced by cooking) are stronger and can be modified to fit the individual and the situation.

One way of modifying formulas is to add guide herbs, or envoy herbs, which convey the action of the herbal ingredients to the desired area. Internally ingested herbs have a generalized action on the entire body. While this can be effective for internal conditions involving blood stasis and qi stagnation, in the case of injuries the effectiveness of an internal formula is greatly increased by the inclusion of herbs that guide the action of the formula to the injured area. These herbs are called ‘guide herbs’ or ‘envoy herbs’.

The two formulas below, General Die Da Decoction and Modified Shaolin Thirteen Flavors Formula, were mentioned earlier in the Article on Dead Blood. They are flexible formulas that can be used for many types of traumatic injuries. These formulae are particularly effective when guide herbs are added.

IMPORTANT: Remember, these kind of blood activating formulas cannot be taken if there is bleeding or hemorrhage, either internally or eternally. Use with extreme care in cases of concussion.

One must also realize that that these kinds of formulas cannot be used for long periods of time, nor are they meant to be. Usually one takes a Die Da formula for 1-3 days. The formulas must be used carefully and judiciously, particularly with weaker patients.

Both formulas are contraindicated for pregnant women.

The dosages below are for one package (bag) – ie: one dose. One dose or package of herbs is taken per day.

General Die Da Decoction

Dosage of all the herbs in this formulas is 2.5 Qian, or approximately 7 grams.

Prepare as a standard decoction. Instructions for cooking a decoction can be found at the end of this article.

  • Sheng Di Huang
  • Qing Pi
  • Fang Feng
  • Wei Ling Xian
  • San Qi (dissolve powder into cooked decoction)
  • Dan Shen
  • Zelan
  • Ru Xiang
  • Mo Yao
  • Tao Ren
  • Jie Geng
  • Ziran Tong
  • Gu Sui Bu
  • Gancao

Modified Shaolin Thirteen Flavors Formula [1]

Prepare as a decoction for all kinds of contusions and injuries.

4.5 gms          Yuan Zhi
6                     Liu Jin Nu
4.5                  Rou Gui
6                     Chen Pi
6                     Du Zhong
9                     Dang Gui
6                     Yan Hu Suo
6                     Sha Ren (add the last five minutes of cooking
6                     Wu Jia Pi
6                     Wu Ling Zhi
6                     Pu Huang (raw)
4.5                  Zhi Ke
9                     Ze Lan

Breakdown of the Ingredients:

The first formula, General Die Da Decoction, contains many herbs that quicken the blood and break stasis, including Ze Lan, Dan Shen, Mo Yao, Ru Xiang, Tao Ren, and San Qi.

However, the first two herbs in this formula, Sheng Di Huang and Qing Pi, 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.

The other interesting inclusion vis-a-vis dead blood is Jie Geng and Fang Feng. Jie Geng is added because it dispels phlegm due to impairment of lung diffusion (of the qi). It also diffuses lung qi and courses the exterior. In this formula, it is a unique addition aimed at preventing pockets of dead blood and stagnant fluids from accumulating. Fang Feng eliminates wind and dampness in the channels and network vessels and in sinews and bones.[2] With Jie Geng, it clears and moves stasis in the network vessels and exterior layers of the body.

Lastly, Dan Shen, Gui Sui Bu and Wei Ling Xian are also interesting additions. Dan Shen dispels stasis, but also helps engender new blood and cools the blood and calms the spirit. Gu Sui Bu supplements the Kidneys to join broken bones and tissues, but also quickens the blood – so it appears in many trauma formulas where there is injury to the sinews and bones. Wei Ling Xian dispels wind and damp. It is said to reach all parts of the body eliminating phlegm and dispersing accumulations. It is used for joint pain with inhibited bending and stretching.

In this formula, there is an interaction of herbs that move stasis with herbs that prevent the common trajectories of damp accumulation and blood heat leading to dead blood. At the same time, yin and new blood are engendered, which also prevents blood from drying. The true brilliance of this prescription, however, lies in the inclusion of Wei Ling Xian, Fang Feng and Jie Geng, which help clear the network vessels, prevent the penetration of external evils into the weakened area, and at the same time forestall the possible formation of phlegm, which might otherwise combine with blood stasis.

The Modified Shaolin Thirteen Flavors Formula also contains a number of herbs which move qi and quicken blood to break stasis: Liu Jin Nu, Yan Hu Suo, Zhi Ke (or Zhi Qiao) and Ze Lan. Dang Gui both supplements and quickens the blood. Wu Ling Zhi and raw Pu Huang together quicken the blood, and dispel stasis. Wu Ling Zhi is warming and Pu Huang cools the blood.

The next group of herbs work together to prevent accumulation of dampness and the formation of phlegm. Wu Jia Pi disinhibits dampness and disperses swelling, and can strengthen sinew and bone, while Yuan Zhi dispels phlegm and calms the spirit.  Chen Pi moves qi, but also dries dampness and disperses phlegm.  Sha Ren also dries dampness, and moves the qi, but it dries dampness at the deepest levels of the body, even down to the bone marrow.[3]

Lastly, Rou Gui  supplements kidney yang, but also warms and diffuses the blood vessels. This warmth frees congestion in the vessels that can be the result of cold or stasis. Du Zhong supplements the kidneys and liver and strengthens sinews and bones.

Here again we see not just the expected blood quickening and qi rectifying medicinals, but the important inclusion of herbs that address, from the outset, the possible undesired trajectories the aftermath of the injury can take:

  • The penetration of wind damp and cold resulting from or combining with stasis.
  • Dampness becoming phlegm and combining with dead blood.
  • A cooling element – in this case Pu Huang – to dispel the heat buildup that can result from stagnant blood and qi accumulating.

Adding Guide Herbs

Both of these formulas are designed to be modified by adding one or more herbs that guide the formula to specific areas of the body. Usually the addition of a single guide herb is enough, but in some cases two or three can be added.

The lists below are fairly comprehensive, although the Shaolin Modified Thirteen Flavors Formula has many more modifications: for example, adding Huang Lian, Ce Bai Ye, and Di Yu if there is blood in the feces after the injury.[4] For other modifications of the Shaolin Modified Thirteen Flavors Formula, see Shaolin Secret Formulas for the Treatment of External Injury – Revised Edition, transmitted by Patriarch de Chan. Translated by Zhang Ting-liang and Bob Flaws.

Guide herbs can also be prescribed according to the jing-luo (channels and collaterals) or meridians. For example, if the injury is to the back of the shoulder, herbs like Ge Gen that guide the formula to the Taiyang channel may be added, as Hand Taiyang passes through that area.

Simply add the guide herb(s) to the main formula and cook as a decoction.

Guide Herbs by Area of the Body

Sinuses: Cang Er Zi, Xin Yi Hua

Head:

  • Forehead and Front of Face: Bai Zhi
  • Temporal Area: Man Jing Zi
  • Vertex: Gao Ben
  • Occipital Area : Qiang Huo; Gao Ben
  • Entire Head: Fang Feng, Tian Ma, Nu Zhen Zi.
  • Right Side Head: Chuan Xiong
  • Left Side Head: Bai Zhi
  • Whole Head: Chuan Xiong and Bai Zhi

Throat: Jie Geng, Niu Bang Zi, Chan Tui

Upper Back, Neck and Shoulders: Qiang Huo, Gou Teng, Ge Gen

Spine: Gou Ji

Upper Back: Nu Zhen Zi; Yan Hu Suo

Shoulders: Jiang Huang. Left: Dang Gui, Right: Huang Qi

Flank: Chuan Lian Zi; Qing Pi

Chest: Dan Shen; Zhi Ke, Hou Po (cook only five minutes)

Heart Area: Yu Jin

Diaphragm to Collarbone: Xiang Fu

Rib Cage: Chai Hu, Qing Pi, Chuan Lian Zi, Xiang Fu

Floating Rib: Bai Jie Zi

Lower Abdomen: Wu Yao

Lower Back: Du Zhong, Du Huo

Inguinal Area: Chuan Lian Zi

Urethra: Gan Cao Shao (tips)

Testes: Li Zhe He (may work for the ovaries as well)

Legs:

  • Muscular or damp conditions: Wu Jia Pi
  • Tendons: Mu Gua

Knee: Mu Gua, Niu Xi, Xu Duan

Heel: Bu Gu Zhi

Guide Herbs by Channel Affected

Hand & Foot Taiyang
1. Gao Ben – Head, Vertex, Teeth, Occiput, Upper end of Du Mo
2. Qiang Huo – Taiyang & Du Mo, Upper Limbs, Nape, Upper Back, Spine
3. Ge Gen – Shoulders, Neck, Occiput

Hand & Foot Yangming
1. Bai Zhi – Yangming Channel of the Face
2. Sheng Ma – Throat & Face
3. Shi Gao – Foot Yangming

Hand & Foot Shaoyang
1. Zhi Zi – Hand Shaoyang
2. Chai Hu – Foot Shaoyang
3. Qing Pi – Foot Shaoyang

Hand Taiyin
1. Jie Geng – Chest
2. Cong Bai – Lung & Stomach
3. Bai Zhi – Nose & Lung

Foot Taiyin
1. Bai Shao (Dry Fry)
2. Bai Zhu (Earth Fried)
3. Cang Zhu

Hand Shaoyin
Huang Lian – use small dose, 3g

Foot Shaoyin
1. Du Huo
2. Rou Gui
3. Niu Xi
4. Huang Bai
5. Zhi Mu
6. Xi Xian

Hand Jueyin
1. Chai Hu
2. Mu Dan Pi

Foot Jueyin
1. Chai Hu
2. Qing Pi
3. Wu Zhu Yu

Instructions for Cooking a Decoction:

Step 1: Put the herbs in a pot with 4 cups of water and bring the water to a boil. Then turn down the flame, cover the pot and simmer the herbs until about 1 cup of liquid remains.

Step 2: At this point, add any herbs that can only cook a short time – like Sha Ren or Hou Po – and cook five more minutes.

Step 3: Take the pot off the flame and strain the liquid into a container and save.

Step 4:
At this point stir in any powders, like San Qi, that should not be cooked.

Finally, drink the herbs while they are warm.

Dietary Considerations

When taking these kinds of Die Da formulas, one should avoid shellfish, as well as cold, raw foods like salads and fruit juices, iced drinks and ice cream. It is also worth avoiding overly fried or roasted foods for a few days.

Notes:

[1] Shaolin Secret Formulas for the Treatment of External Injury – Revised Edition, transmitted by Patriarch de Chan. Translated by Zhang Ting-liang and Bob Flaws. Boulder, CO: Blue Poppy Press, 1995, 120-21.

[2] Ten Lectures on the Use of Medicinals from the Personal Experience of Jiao Shu-De, Translated by Craig Mitchell, Nigel Wiseman, Marnae Ergil and Shelly Ochs. Brookline MA: Paradigm Publications, 2003, p. 17.

[3] Qianyang Dan: A Key Formula of the Sichuan Fire School: An In-Depth interview with Heiner Freuhauf, June 8, 2009, p. 4 –  classicalchinesemedicine.org

[4] Shaolin Secret Formulas for the Treatment of External Injury – Revised Edition, p. 128.