Treatment of the Three Stages of Sinew Damage Employing External Applications

By Andrew Ellis

In Chinese medicine the term used to describe injury to soft tissue (ligaments, tendons, etc.) as a result of sprains, strains or contusions is sinew damage (jin shang).  This is distinct from bone fractures, dislocations, cuts and lacerations, or those injuries that result in internal damage to the head, chest or abdomen.  Treatment for sinew damage combines massage, acupuncture, external application of herbs, internal ingestion of herbs and exercise therapy.  This publication centers on the use of external applications.

For the purposes of external application of herbs in the treatment of sinew damage each injury is first classified in stages.  First-stage is defined as the period during which swelling, pain and rubor are prominent; this usually lasts 4-7 days but can be 2-3 days in light cases.  The second-stage of sinew damage is that period during which swelling and pain still exist but in a much less severe form; this stage lasts up to three weeks.  The third-stage of sinew damage is defined as the period beginning three weeks to one month after the initial insult when swelling and rubor have disappeared and visible signs of stasis are minimal.  Often a persistent aching and stiffness remains as the only symptom.

Successful treatment of trauma requires an understanding of its pathology.  After initial trauma the local blood vessels dilate, blood flow to the region increases and fluids are exuded into the inflammatory focus.  The result is the swelling, rubor and pain associated with inflammation.  The principal of treatment at this point is to move blood, clear heat, dissipate swelling and relieve pain.  Acupuncture and application of soft plasters or liniments form the basis of treatment.  Soaks, steams and compresses are avoided because they aggravate inflammation by dilating blood vessels and encouraging hyperemia.

After a few days the circulatory system begins to clear away damaged tissues and swelling and pain decrease.  At this point the local area begins to turn deep-red and purple indicating stasis of blood and qi.  The treatment principle at this juncture is to soothe the sinews, dissipate stasis and quicken blood.  Massage (above and below the traumatized location), liniments, steams, soaks, acupuncture and soft plasters are primary treatment.

When pain and swelling have subsided and what remains is the nagging pain of an enduring injury or pain that is exacerbated by damp or cold the principle of treatment is to move qi, quicken collaterals, disperse cold, dispel damp, dissipate stasis and relax sinews.  Acupuncture and moxabustion are useful in treatment of this stage of traumatic damage as are massage (including the traumatized location and employing massage salves or liniments), steams, soaks, hot compresses and the application of hard plasters.

I.  First-stage sinew damage

  • Ma’s Wu Shu Soft Plaster (#1)is a good general application to relieve the pain and swelling of first-stage sinew damage.
  • If pain is prominent apply Stasis-Dissipating, Pain-Relieving Soft Plaster (#2).
  • If swelling is prominent apply Dissipation Soft Plaster (#3).
  • If rubor and heat are prominent apply Double-cooling Soft Plaster (#4).
  • The above soft plasters can be combined to meet presenting symptoms and Double-yellow Soft Plaster (#14) can be added if swelling, pain and rubor are severe.

II.  Second-stage sinew damage

Soft Plasters

Apply Tri-color Application (#5) if there are symptoms of cold or damp.
  • Blood-Quickening Soft Plaster (#6) is especially appropriate if swelling and pain are prominent and heat and rubor are not.
  • If swelling is minimal but pain and aching persists apply Sinew-Soothing Application (#7).

Soak-Compresses

Ma’s Post-trauma Soak-Compress (#8), Pain-relieving Soak-Compress (#9) and Stasis-dissipating Soak-Compress (#10) are three steam-soaks that are good for second-stage sinew damage.  The first is a combination of the two latter formula and is the best general formula.  As the names suggests Pain-relieving Soak-Compress (#9) is appropriate if pain is severe and Stasis-dissipating Soak-Compress (#10) is suitable for post-trauma blood stasis (especially blood-stasis joint pain).

III.  Third-stage sinew damage

Soak-Compresses

The following soak-compresses are appropriate for treatment of either third-stage sinew damage or old injuries.  They can also be used to treat patients who have just had their cast removed and suffer from stiffness and aching.

  • Eight Immortals Hardness-Dissipating Decoction (#11) can dissipate hard knots and relieve the aching and tightness that accompanies enduring or third-stage sinew damage.  It is balanced in nature so it can treat wind-damp bi that is either hot or cold.
  • Joint Injury Soak-Compress (#12) is warming.  It moves qi and blood, dispels wind and is especially effective for treatment of joint pain.
  • Sinew-Penetrating Soak-Compress (#13) is a general formula for third stage trauma especially of the muscles and tendons.  While Joint Injury Soak-Compress (#12) is particularly suited for joints this formula is best for fleshy areas.

Hard plasters

Application of hard plasters such as gou pi gao are standard treatment for long-term or third-stage sinew damage.

IV.  Other external applications for treatment of sinew damage.

In addition to the above applications the following products can be rubbed into the affected area.  Vigorous massage of the traumatized area is inappropriate if tendons or ligaments are severed or detached or if there is any indication that this type of damage has occurred.  These products however, may still be rubbed gently into the affected area.

  • Massaging Amber Massage Salve into an affected area will relieve pain, quicken blood dissipate swelling.  It is appropriate for any disorder that benefits from massage.
  • Dr. Shir’s Liniment is unique in that is designed to treat all stages of trauma.  It is a balanced formula that relieves pain and swelling, quickens blood, dispels wind-damp and dissipates stasis.  Liniments should be rubbed very lightly, in a circular motion, into the affected area.  To achieve best results keep the spot moist with liniment as you rub for 20-30 minutes.

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