CLINICAL APPLICATIONS

* Atrophy and wasting of muscles, ligaments, and tendons 

* Cartilage damage from chronic wear and tear

* Decreased range of motion and mobility of the joints

* Rehabilitation from chronic or late-stages of musculoskeletal injuries

* Prevention against wear and tear or breakdown of cartilage and soft tissue surrounding joints

* Individuals engaging in repetitive motions who wish to maintain healthy joints and connective tissue

 

WESTERN THERAPEUTIC ACTIONS

* Chondroprotective effect to protect cartilages

* Osteogenic and antiosteoporotic functions to promote generation of bones

* Neuroregenerative effect to facilitate healing of nerves and neurons

* Adaptogenic effect to facilitate rehabilitation

* Analgesic, anti-inflammatory, and muscle-relaxant effects

 

CHINESE THERAPEUTIC ACTIONS

* Tonifies qi and blood

* Activates qi and blood circulation

* Nourishes yin

* Dispels wind-damp

* Strengthens muscles, tendons, ligaments, and bones

 

DOSAGE

Take 4 to 6 capsules three times daily. This formula should be taken during the mid-to-late stages of recovery and rehabilitation. It should not be taken during the acute phases of injuries, where there may be bleeding and bruises.

 

INGREDIENTS

Bai Shao (Radix Paeoniae Alba)

Chu Shi Zi (Fructus Broussonetiae)

Chuan Niu Xi (Radix Cyathulae)

Dang Gui (Radix Angelicae Sinensis)

Dang Shen (Radix Codonopsis)

Di Huang (Radix Rehmanniae)

Qian Nian Jian (Rhizoma Homalomenae)

Wu Jia Pi (Cortex Acanthopanacis)

Xu Duan (Radix Dipsaci)

Zhi He Shou Wu (Radix Polygoni Multiflori Praeparata)

 

 

BACKGROUND

Musculoskeletal and connective tissue injuries lead to over 10 million clinic visits per year in the United States.[1] Causes of these injuries may be external (sports injuries, car accidents, trauma), internal (chronic wear and tear of muscles, ligaments and tendons; bones weakened by osteoporosis), or both. Acute injuries are characterized by severe pain, swelling and inflammation, and in some cases, internal bleeding. Treatment of acute injuries should focus on relieving pain, reducing swelling and inflammation, and stopping bleeding. Chronic injuries are characterized by dull pain, stiffness and numbness, and decreased muscle mass and strength. Treatments of chronic injuries include relief of pain and restoration of physical and physiological functions.

 

FORMULA EXPLANATION

Flex (MLT) is designed specifically to treat chronic or mid-to-late stages of musculoskeletal injuries, with atrophy of the soft tissues (muscles, tendons, ligaments, and cartilage), decreased mobility of the joints, cartilage degeneration, and generalized weakness and pain. This formula contains herbs to tonify blood, activate blood circulation, nourish yin, and dispel wind-damp.

        In this formula, many herbs are used to tonify the underlying deficiencies. Dang Shen (Radix Codonopsis) tonifies qi. Dang Gui (Radix Angelicae Sinensis), Di Huang (Radix Rehmanniae), and Bai Shao (Radix Paeoniae Alba) nourish blood and yin. Healthy joints depend on healthy surrounding cartilage and soft tissue. Because there is no blood supply to the cartilage, it gets nutrition and oxygen from the surrounding joint fluids. Therefore, adequate blood supply to the surrounding areas of the cartilage will ensure a healthy joint. Dang Gui (Radix Angelicae Sinensis) tonifies blood and promotes blood circulation to generate new tissues. Chuan Niu Xi (Radix Cyathulae) tonifies the Liver and Kidney, strengthens tendons and bones, and helps Dang Gui (Radix Angelicae Sinensis) move blood. Together, they stimulate soft tissue (tendons, ligaments and cartilage) growth and restoration. Furthermore, Wu Jia Pi (Cortex Acanthopanacis), Qian Nian Jian (Rhizoma Homalomenae), and Xu Duan (Radix Dipsaci) dispel wind-damp, strengthen bones and tendons, and relieve pain. Chu Shi Zi (Fructus Broussonetiae) and Zhi He Shou Wu (Radix Polygoni Multiflori Praeparata) tonify Liver and Kidney to strengthen muscles, tendons, cartilage, and ligaments. The yin tonics of this formula, Bai Shao (Radix Paeoniae Alba), Zhi He Shou Wu (Radix Polygoni Multiflori Praeparata), and Chuan Niu Xi (Radix Cyathulae), prevent the narrowing of the space between joints, especially in the vertebrae or the knee joint due to degeneration.

        In summary, Flex (MLT) works to support connective tissues around the joints. It contains herbs that tonify the underlying deficiencies and facilitate healing and recovery. It treats chronic or mid-to-late stages of musculoskeletal injuries with soft tissue degeneration as it encourages repair and restoration.

 

CAUTIONS & CONTRAINDICATIONS

* This formula should not be taken during the acute phases of injuries with bleeding and bruises, as there are many tonic or warm herbs that may worsen the condition.

* This herbal formula contains herbs that invigorate blood circulation, such as Dang Gui (Radix Angelicae Sinensis). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.[2]^,[3],[4]

* According to most textbooks and contemporary references, the classic entry of "He Shou Wu" is now separated into two entries: the unprepared Sheng Shou Wu (Radix Polygoni Multiflori) and the prepared Zhi He Shou Wu (Radix Polygoni Multiflori Praeparata), as they have significantly different therapeutic effects and side effects. Sheng Shou Wu (Radix Polygoni Multiflori) is a stimulant laxative that treats constipation, but may cause nausea, vomiting, abdominal pain, diarrhea, and in rare cases, liver disorder (dose- and time-dependent, and reversible upon discontinuation).[5] On the other hand, Zhi He Shou Wu (Radix Polygoni Multiflori Praeparata) is a tonic herb that is safe and well-tolerated. The dramatic changes in the therapeutic effect and safety profile are attributed to the long and complicated processing of the root with Hei Dou (Semen Sojae) through repeated blending, cooking, and drying procedures. When properly processed, the chemical composition of the root changes significantly. Many new compounds are generated from the Maillard reaction (four furanones, two furans, two nitrogen compounds, one pyran, one alcohol and one sulfur compound). Furthermore, the preparation process causes changes in the composition of sugars and 16 kinds of amino acids; it also reduces the pH of the herb from 6.28 to 5.61.[6],[7] In summary, these changes give rise to the tonic effects of the prepared roots, and eliminate the adverse reactions associated with the unprepared roots. Note: Due to medical risks and legal liabilities, it is prudent to exercise caution and not use this herb in either prepared or unprepared forms in patients with pre-existing or risk factors of liver diseases.

 

CLINICAL NOTES

* Cold packs should be used during the first 24 to 48 hours of acute injuries to reduce swelling and inflammation. On the other hand, hot packs should be used for chronic injuries to promote blood circulation and enhance healing in the affected area.

* This formula should be taken during the recovery and rehabilitation phases after an injury, but not during the acute phases with acute pain and severe inflammation.

* There are three excellent formulas for post-surgical recovery. Flex (TMX) should be taken after the surgery for 5 to 10 days to facilitate the immediate healing of wounds. Continue herbal treatment with Flex (MLT) and Osteo 8 for one to three month to facilitate healing and recovery of soft tissues and bones, respectively.

 

SUPPLEMENTARY FORMULAS

* For recovery from chronic neck and shoulder injuries, combine with Neck & Shoulder (CR).

* For recovery from chronic low back pain, combine with Back Support (CR).

* For recovery from chronic arm (shoulder, elbow, and wrist) injuries, combine with Arm Support.

* For recovery from chronic knee and ankle injuries, combine with Knee & Ankle (CR).

* With osteoarthritis, add Osteo 8.

* With bone spur, add Flex (SPR).

* For individuals with severe weakness and deficiencies, combine with Imperial Tonic.

 

ACUPUNCTURE TREATMENT

Master Tung’s Points by Dr. Chuan-Min Wang:

* Tendon, ligament disorders: Cesanli (T 77.22), Cexiasanli (T 77.23), Zhengjin (T 77.01), Zhengzong (T 77.02)

 

Balance Method by Dr. Richard Tan:

* Left side: Ququan (LR 8), Rangu (KI 2), Dazhong (KI 4), Fuliu (KI 7), Neiguan (PC 6), Tongli (HT 5)

* Right side: Waiguan (TH 5), Yangxi (LI 5), Zusanli (ST 36), Yanglingquan (GB 34)

 

Auricular Medicine by Dr. Li-Chun Huang:

* Low back pain, lumbar ligaments disease: Lumbar Vertebral Area near the antihelix middle line positive point, Lumbar Vertebral Area of the Groove of Spinal Posterior (select the positive point).

 

NUTRITION

* Sea cucumber is very beneficial because it has a rich amount of lubricating compounds that are needed in all connective tissues, especially joints and joint fluids. Gelatin is also recommended.

* It is important to consume an adequate amount of multiple vitamins and minerals, as they are essential to prevent bone loss and promote bone growth.

* Glucosamine sulfate and chondroitin sulfate are great nutritional supports. They are important for the formation of bones, tendons, ligaments, and cartilages.

 

LIFESTYLE INSTRUCTION

* While it is important to relax and rest during the recovery process of injuries, it is also important not to stay completely bedridden. Gentle exercises will not only facilitate recovery, but will also prevent muscle atrophy and muscle wasting.

 

CASE STUDIES

* K.L., a 42-year-old male, presented with right hip and leg pain and numbness. He was using crutches with decreased impaired mobility for the previous three months. Symptoms of stiff neck, frozen ankle, and pain affecting his sleep were present. The patient had a tendency to get injuries due to his poor balance. The practitioner diagnosed the condition as bi zheng (painful obstruction syndrome) with blood deficiency and blood stasis with qi constraint. His Western diagnosis was muscle atrophy. The patient was given Flex (MLT) and directed to take it for eight weeks with the addition of Knee & Ankle (CR) for four weeks. With both formulas and receiving acupuncture treatment for the eight weeks, the patient regained 100% use of his leg, moving from crutches to a cane. The patient resumed sleeping flat after three weeks and riding a bicycle after eight weeks. Pain reduced from 10 to 0 on a 1-10 scale. The patient was very pleased with the herbs, started practicing yoga, and has become more enthusiastic towards life. Submitted by K.F., Honolulu, Hawaii.

* M.K., a 39-year-old female, presented with a previously treated ankle sprain; however, the pain was still present due to increase of pressure and activity. Objective findings include swelling and pain upon palpation on the lateral side of the right ankle. The practitioner diagnosed this condition as qi and damp bi zheng (painful obstruction syndrome). Upon diagnosis the practitioner prescribed Flex (MLT) for the recovery stage of the patient’s ankle sprain. With the addition of Flex (MLT), the swelling and pain reduced and the patient was able to tolerate standing for long periods of time without pain or fatigue. Submitted by L.H., Chicago, Illinois.

* B.B., 62-year-old female, presented with multiple symptoms including a stiff lower back, low grade pain bilaterally on both legs, as well as pain on the heel of the left foot. The patient had been previously diagnosed with plantar fasciitis. Objective findings included areas of the legs having knots within the muscles. The practitioner diagnosed this condition as qi and blood stasis, with underlying Liver and Kidney yin deficiencies. For treatment, the patient had received acupuncture, which had relieved the pain for only a few days. With the addition of Flex (MLT), it had accelerated the progress and reduction of the pain. The patient had commented that her legs had never felt as loose before. Submitted by L.H., Chicago, Illinois.

* M.W., a 58-year-old male, presented with pain located on the right knee. He had mentioned that he had had ten previous operations on it, one being a knee replacement in 2009. The TCM diagnosis was qi and blood stagnation; Western diagnosis was arthritis of the knee. Flex (MLT) was prescribed, followed with taking Knee & Ankle (CR). Overall the herbs reduced the pain, especially when walking, and it continued to improve. Submitted by M.P., Muskego, Wisconsin.

* K.W., a 50-year-old female, presented with a swollen right ankle. She mentioned she had broken it about a month ago and it had become stiff as well, making it hard to drive and run. Objective findings were swelling and pain upon palpation. The practitioner diagnosed the condition as qi and blood stagnation, as well as Liver and Kidney yin deficiencies. Flex (MLT) was prescribed at 3 capsules twice daily. After one week of taking the herbs as directed, the pain had resolved and the swelling had improved. The patient stopped taking the herbs after two weeks. Submitted by M.P., Muskego, Wisconsin.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Flex (MLT) is an excellent formula for rehabilitation of patients who suffer from chronic musculoskeletal injuries. After acute injuries (such as broken bones, bone fracture, and tear of muscles, tendons or ligaments), patients are often asked to rest for an extended amount of time. As a result, lack of movement on a long-term basis often contributes to atrophy of the soft tissues (muscles, tendons, ligaments, and cartilage), decreased mobility of the joints, and generalized weakness and pain. Flex (MLT) is designed specifically to treat this condition, and it contains herbs with chondroprotective effects to benefit cartilages, osteogenic activity to promote generation of bones, neuroregenerative benefit for healing of nerves, and adaptogenic functions to facilitate rehabilitation.

        Flex (MLT) incorporates many herbs to facilitate the healing and recovery from chronic musculoskeletal injuries. Chu Shi Zi (Fructus Broussonetiae) and Qian Nian Jian (Rhizoma Homalomenae) have been used traditionally to strengthen the soft tissues, such as muscles, ligaments and tendons.[8] Chuan Niu Xi (Radix Cyathulae) is an excellent herb to protect the cartilage from repetitive and stress-induced injuries. According to one study, the extract of Chuan Niu Xi (Radix Cyathulae) has a potent effect to inhibit the induction of MMP-13, an important enzyme for the degradation of the cartilage collagen matrix, especially under arthritic conditions. By down-regulating the MMP-13 activity, Chuan Niu Xi (Radix Cyathulae) shows great chondroprotection against cartilage degrading disorders.[9] Dang Gui (Radix Angelicae Sinensis) is an effective herb to promote the generation of bones. According to one study, the water extract of Dang Gui (Radix Angelicae Sinensis) has been found to contribute to the formation of bones and treatment of bone injuries. It directly stimulates the proliferation, alkaline phosphatase activity, protein secretion and particularly type I collagen synthesis of human osteoprecursor cells in a dose-dependent manner.[10] According to another study, Dang Gui (Radix Angelicae Sinensis) shows a marked stimulatory effect in osteoblast proliferation and differentiation systems, as well as in a fibroblast-secreted hyaluronic acid assay. This herb enhanced the deposition of hyaluronic acid and proliferation of osteoblasts in vitro, as well as bone regeneration.[11] Xu Duan (Radix Dipsaci) has significant osteogenic and antiosteoporotic properties to promote generation of new bones and prevent osteoporosis. According to a bone cells culture experiment, administration of Xu Duan (Radix Dipsaci) shows a potential effect to increase the proliferation and differentiation of osteoblasts without affecting osteoclast activity. The researchers conclude that these herbs can effectively increase the rate of tissue regeneration of damaged bones.[12] Lastly, Dang Shen (Radix Codonopsis) has been shown in one study to promote neuron regeneration in a dose-dependent manner.[13]

        The rehabilitation of chronic musculoskeletal and connective tissue disorders is often accompanied by mental and physical stress. Dang Shen (Radix Codonopsis) has a regulatory effect on the central nervous system to help with adaptation to various stressful environments.[14] Wu Jia Pi (Cortex Acanthopanacis) enhances physical adaptation by increasing endurance and performance.[15] Together, these two herbs exert adaptogenic effects to help patients cope with mental and physical stress during the transition of rehabilitation.

        In addition, many herbs in this formula have marked analgesic effects to relieve pain, and anti-inflammatory effects to reduce swelling and inflammation. Dang Gui (Radix Angelicae Sinensis) has marked analgesic and anti-inflammatory effects, with potency similar to or stronger than that of acetylsalicylic acid.[16]^,[17] Wu Jia Pi (Cortex Acanthopanacis) also has excellent analgesic and anti-inflammatory effects, with duration of action lasting up to five hours.[18]^,[19] Bai Shao (Radix Paeoniae Alba) and Di Huang (Radix Rehmanniae) have anti-inflammatory and antipyretic effects to reduce inflammation and swelling and relieve burning sensations in the affected areas.[20]^,[21] Clinically, these herbs have been used with great success to treat a wide variety of musculoskeletal conditions, including but not limited to muscle wasting, muscle atrophy, chronic soft tissue injuries, and various types of pain.[22],[23] Lastly, Bai Shao (Radix Paeoniae Alba) has an excellent muscle-relaxant effect to relieve spasms, cramps, and muscle stiffness.[24] This efficacy has been demonstrated in both smooth and skeletal muscles.

        In summary, Flex (MLT) is an excellent formula for chronic or mid-to-late stages of musculoskeletal injuries. With chronic injuries, degeneration of the soft tissues (muscles, tendons, ligaments, and cartilage) leads to decreased range of motion and mobility of the joints. With mid-to-late stages of musculoskeletal injuries, muscle wasting and muscle atrophy due to lack of exercise and physical movement are the main concern. Flex (MLT) is developed specifically to address all of these conditions by using herbs that compliment the rehabilitation process and complete the recovery from these illnesses.

 

COMPARATIVE ANALYSIS

Pain is a basic bodily sensation induced by a noxious stimulus that causes physical discomfort (such as pricking, throbbing or aching). Pain may be of acute or chronic state, and may be of nociceptive, neuropathic, or psychogenic origin.

        Western medicine excels in treatment of acute pain. There are many drugs with potent and reliable analgesic effects. Furthermore, many drugs are available as injection for immediate pain relief. However, these drugs treat the symptom of pain but do not alter the underlying disease. Furthermore, long-term use of these drugs for chronic pain are likely to cause more side effects, and complicate the condition further. In short, while drugs are effective for treating acute pain, they should be used sparingly to manage chronic pain.

        Treatment of pain is a sophisticated balance of art and science. Proper treatment of pain requires a careful evaluation of the type of disharmony (excess or deficiency, cold or heat, exterior or interior), characteristics (qi and/or blood stagnations), and location (upper body, lower body, extremities, or internal organs). Furthermore, optimal treatment requires integrative use of herbs, acupuncture, and tui-na therapies. All these therapies work together to tonify the underlying deficiencies, strengthen the body, and facilitate recovery from chronic pain. TCM pain management targets both the symptom and the cause of pain, and as such, often achieves immediate and long-term success. Furthermore, TCM pain management is often associated with few or no side effects.

        For treatment of mild to severe pain due to various causes, TCM pain management offers similar treatment effects with significantly fewer side effects.