Ultimate First Aid Remedy (please read!!)

Late Sunday night, I got the call…an intrepid mountain biking friend had just launched off a jump when he realized he was going too fast and would overshoot his landing. He landed front tire first, the bike “endo-ed”, and he went flying… A visit to the Emergency Room showed a broken collar bone, and the doctor recommend immediate surgery. My friend was in a lot of pain, but he didn’t want surgery because of the cost and his belief that future shoulder mobility would be impaired.

I sent him home with a jar of herbs, and some rolled gauze. I told him to mix the herbs with egg whites and pack the resulting poultice all around the swollen, bruised area, then wrap it with the gauze and call me in the morning. The next day, I gave him an acupuncture treatment and after consulting with a local Chinese Bonesetter, decided that the break could heal without surgery. Fast forward 3 months, and my friend was back in the saddle, resuming his hair-raising jumps…

San Huang San (三黄散, "The Three Yellows"), is the herbal poultice that reduced my friend’s inflammation, broke up blood stasis, and let him get a good night’s sleep. It was the first step in a remarkable recovery, which you can have, too, if you know what to do when accidents happen.

Use San Huang San on ACUTE injuries where tissues are hot, swollen and/or bruised. I emphasize ACUTE here because the swifter you treat this kind of injury, the more dramatic the recovery can be. Get this remedy on an injury within the first 24 - 48 hours, otherwise it's not going to help. You use it like ice, but for reasons I'll explain below, San Huang San is a better choice because it reduces inflammation without the long-term problems that ice introduces.

Everyone should have this remedy in their pack, their glove compartment, their home. It stores for years and travels easily in a small package. You can carry it as a dry powder or in a ready to apply salve. All you need is the formula and a bandage to keep the poultice in contact with the skin. No refrigeration needed.

1) What's special about San Huang San?

Like traditional ice, San Huang San reduces the inflammation of hot, swollen tissue. But unlike ice, the herbs in San Huang San have a unique ability to reduce inflammation while breaking up "blood stasis". Blood stasis in Traditional East Asian Medicine ("TEAM") the blood that gets stuck where it doesn't belong. In a tissue injury this happens as blood vessels and capillaries are torn and damaged, and blood is released into areas where it is not accessed by the circulatory system. When this happens, these blood cells, rather than bringing oxygen and removing waste, become trapped in tissue at the site of the injury, and interrupt the healing process.

When ice does nothing to deal with the blood stasis. Sure, inflammation is reduced, but blood and other byproducts of the repair process become trapped in the tissue. In addition, unlike San Huang San, the ice will cause the muscles and sinews to contract, further limiting the blood supply and its repair cells. This compromises the healing of the tissue and is why some injuries take weeks or months to heal or result in permanent disability.

Another benefit of using the herbal poultice over ice is that it's remarkably easy to apply. Ice requires multiple applications ("20 minutes on, 20 minutes off") and it can be uncomfortable to leave it in place. San Huang San is typically applied right after the injury is stabilized, and then left in place for 24 hours. Though this poultice is often called "herbal ice", it doesn't feel cold on the skin and doesn't cause any (additional) discomfort. It can stay on the injury continuously and you won’t notice it’s there.

If you're interested in the problems of using ice, ibuprofen and cortical steroids, I encourage you to check out this excellent 3-part article on inflammation science.

2) WHEN to use San Huang San

The first thing to know is that if the area you're applying it to is not swollen and hot, then San Huang San is not used. Also, if the skin is broken (like in a compound fracture), you can't use it then either—the skin must be intact.

Use it for sprains or tendon strains of the ankle, knee, wrist, elbow, fingers.

Use it for contusions, blunt trauma, like when you:

• take a hard fall on the ice (ribs, elbows, wrists)

• hit a tree while skiing

• hurt your wrist snowboarding

• fall off your mountain bike; smash your shin with the pedal

• drop something heavy on your foot or hand

• jamb a finger playing basketball

• get clipped by a dog chasing a ball at the dog park

I've used it countless ankle sprains, broken toes, sprained wrists

Even if you suspect a broken bone, San Huang San is going to make you better off. Because of its blood-moving qualities, it reduces the buildup of collagen, proteoglycans, glycoproteins, and other proteins that form a cloud of repair material over the injury site in the hours following an injury. Often when an X-ray is inconclusive, it’s because that cloud obscures the break site. With a single application of San Huang San, tissue swelling is noticeably reduced, and x-rays are easier to read.

3) How to use it

Use San Huang San within the first 24 - 48 hours of the injury.

San Huang San is a ‘gao’ (高) or poultice. You can obtain it either as a pre-mixed product (typically a beeswax-sesame oil emulsion), OR, you can carry it as a ground powder. Each form has benefits. Pre-mixed is the fastest and easiest to apply. Powder is light-weight and takes up less space. Powder also gives you the option to choose the delivery medium which is just the fluid you use to turn the powder into a paste or gao.

In a pinch, you can use water or even saliva, but there are several other choices. Here are a few different mediums, and the effect they have and when you'd use them...

medium	effect
vaseline, beeswax/sesame oil	neutral
aloe gel	cooling, for sunburned skin
green or chrysanthemum tea	cooling, if the skin feels particularly hot or on a hot day
egg whites	guides the action to cartilage, sinew, tendons and muscle injuries
pine resin, turpentine (real)	guides deep, to bone level injuries and contusions
honey	draws out infection (but attracts ants!)
echinacea tincture	neutralizes brown recluse spider venom

Before applying, note that San Huang San STAINS (and won't come out of clothing). So after wrapping the site in a bandage, it's best to cover the bandage with some sacrificial clothing. An old sock with the toe cut off makes a great cover for anything on the arms or legs.

If you start with powder, mix it with your chosen medium and make a paste. It should have the consistency of a very thick mud. If you press into it with your fingers, you’ll see a little fluid collect.

Whether the gao is from powder + medium or you had the pre-mix, apply it liberally, like cake frosting to the injured, swollen skin, up to about an 1/4" thick. Cover the with area with one or more 4x4" gauze (as needed), then wrap with a roll of gauze, and finally a loose sock or other fabric to protect clothes and bedding. Leave it on overnight, and up to 24 hours. After 24 hours, unwrap it and rinse off the area with warm water. The swelling should be down considerably.

4) Q: Then what?? A: Get Treated!

You've got 'gao' on the injury within 20 minutes of the injury, wrapped it, and you're off to a great start. Depending on the severity and mechanism of the injury, you can consider going to an Emergency Room, or if the pain isn't debilitating, make an emergency visit to your acupuncturist. Most practitioners who are familiar with treating these injuries will gladly make space for you in their schedule because the treatment is fairly quick, fairly simple, and the results can be profound. As acupuncturists, we love it when you come in with a serious injury, we treat it and a day or two later, you're saying, "I guess my __________ wasn't as bad as I thought". It's our chance to be a humble superhero. Even if you plan on going to the ER, stopping at the acupuncture clinic is only going to take about 40 minutes. What are the chances that you'll be seen in an ER in the first 40 minutes?!?

If you have an injury which required San Huang San, an acupuncturist will likely do some or all of the following (which I explain below):

1. bleed a point distal to the area on an effected channel/meridian

2. do a couple of acupuncture points to restore the flow of qi/blood/fluids to the affected area

3. give you herbs to take internally

4. apply 'E-Stim'

Bleeding a distal point, sound medieval, but really all it is, is just pricking something like a finger or toe, and squeezing out a couple of drops of blood. The finger or toe chosen corresponds to the meridian (channel) most affected by the injury. Bleeding sends a signal to your body to effectively "flush" the affected channel, and get things flowing again below the injury site. You can think of it as "draining the swamp", though it far more effective than it's political equivalent, I assure you.

The other acupuncture points will help your muscles and nerves release from the shock of the injury. When you were first injured, your body tensed and gripped to limit the damage of the injury. But often this tension is not released even after the threat has been removed, perhaps even months later! The sooner this tension is cleared, the faster the repair and recovery will be.

Like San Huang San, internal herbs contain blood invigorating, and stasis breaking components that are delivered internally through the blood stream to the site of the injury. Depending on the injury and the number of hours since it occured, the practitioner might give you something called a "Hit Pill". You can think of it like a little depth charge that breaks up the 'log jam' of excess repair tissues that is causing the area to swell, clouding X-rays and slowing the healing process. Like San Huang San, it can significantly alter the trajectory and severity of an injury if it's taken in the first few hours. Often, if you call your practitioner shortly after the injury, they'll tell you to come in to pick up a hit pill, and then they can see you a day or two later without degrading the effectiveness of an early treatment. So while helping the situation from the inside of the body, it also buys you a couple of days to get treated.

Lastly, E-Stim is the passing of a tiny electrical micro-current between 2 acupuncture needles, typically above and below the injury site. Because the collagen fibers (which are laid down to repair the injured area) have piezo-electric qualities (similar to a crystal), using E-stim helps the fibers align along the electrical pathways, rather than the random patchwork of fibers that is characteristic of scar tissue than inhibit range of motion.

Once you're past this acute, inflammatory phase of the injury, additional acupuncture visits will continue to shorten the recovery time, restore range or motion, and reduce pain. In addition to needling, there are later stage gao/poultices as well as herbal soaks that are used to get you back to doing a full range of activities.

5) WHERE can I get San Huang San?

• I stock both the 'gao' and the powder in my office in Uptown Kingston. You can email me at info@innerwatersacu.com to make pick up or mailing arrangements.

  • the pre-mixed Gao (from Kamwo Herb in NYC) is $21 for a 2 oz. plastic tub. Enough for 2 or 3 uses.

  • the powder (that I ground myself) is $15/oz
    

• You can find the powder and pre-mix sold online from various sources (even Amazon!), but I don't have experience with any of these suppliers. Some do not include all the herbs in the formula I use. Look for a formula with the following herbs at a minimum:

  • Da Huang (Rhizoma Rhei - Rhubarb)

  • Huang Qin (Radix Scutellaria Baicalensis - skullcap root)

  • Huang Bai (Cortex Phellodendri - phellodendron bark)

  • Pu Gong Ying (Herba Taraxaci Mongolici - dandelion)

  • Zhi Zi (Fructus Gardenia Jasmonoidis - gardenia)

  • Hong Hua (Flow Carthami Tinctorii - safflower)