CLINICAL APPLICATIONS

* Bone spurs with pain and inflammation

* Joint stiffness

* Calcification of joints

* Plantar fasciitis

* Spine pain

 

WESTERN THERAPEUTIC ACTIONS

* Analgesic action to relieve pain associated with bone spurs

* Anti-inflammatory influence to reduce inflammation

 

CHINESE THERAPEUTIC ACTIONS

* Invigorates blood circulation and breaks up blood stagnation

* Relieves pain

* Dispels phlegm

 

DOSAGE

Take 3 to 4 capsules three times daily as needed to relieve pain. For maximum effectiveness, take the herbs on an empty stomach with two tall glasses of warm water.

 

INGREDIENTS

Bai Zhi (Radix Angelicae Dahuricae)

Chen Pi (Pericarpium Citri Reticulatae)

Da Ding Huang (Caulis Euonymi)

Dang Gui (Radix Angelicae Sinensis)

Fang Feng (Radix Saposhnikoviae)

Gan Cao (Radix et Rhizoma Glycyrrhizae)

Huang Jin Gui (Caulis Vanieriae)

Jin Yin Hua (Flos Lonicerae Japonicae)

Liu Zhi Huang (Herba Solidaginis)

Mo Gu Xiao (Caulis Hyptis Capitatae)

Mo Yao (Myrrha)

Po Bu Zi Ye (Folium Cordia Dichotoma)

Ru Xiang (Gummi Olibanum)

Tong Cao (Medulla Tetrapanacis)

Zao Jiao (Fructus Gleditsiae)

Zao Jiao Ci (Spina Gleditsiae)

Zhe Bei Mu (Bulbus Fritillariae Thunbergii)

 

BACKGROUND

Bone spurs form in response to pressure, rubbing, or stress on the same joint over a long period of time. As the body tries to protect and repair itself, it builds extra bone on top of normal bone. Most bone spurs are smooth and do not cause pain. However, some bone spurs may press or rub on other bones or soft tissues, causing pain, inflammation and burning sensations.

 

FORMULA EXPLANATION

Flex (SPR) is formulated to relieve pain due to bone spurs and joint stiffness arising from overuse. According to theories in traditional Chinese medicine, bone spurs form as the result of repetitive use and are diagnosed as stagnation of blood and phlegm.

        Po Bu Zi Ye (Folium Cordia Dichotoma) regulates qi circulation and relieves pain. Unbeknownst to most practitioners, it is one of the most effective herbs in the Chinese Materia Medica to treat bone spurs. Mo Gu Xiao (Caulis Hyptis Capitatae), Liu Zhi Huang (Herba Solidaginis), and Huang Jin Gui (Caulis Vanieriae) have anti-inflammatory and analgesic effects and are often used to treat acute pain associated with traumatic injuries or sprains and strains. Da Ding Huang (Caulis Euonymi) further reduces inflammation and relieves pain. Ru Xiang (Gummi Olibanum), Mo Yao (Myrrha), and Dang Gui (Radix Angelicae Sinensis) have potent effects to move blood, disperse blood stagnation, and relieve pain. Jin Yin Hua (Flos Lonicerae Japonicae), Bai Zhi (Radix Angelicae Dahuricae), Zhe Bei Mu (Bulbus Fritillariae Thunbergii), Zao Jiao (Fructus Gleditsiae), and Zao Jiao Ci (Spina Gleditsiae) break up phlegm that is obstructing the channels and joints to restore proper qi and blood circulation. Chen Pi (Pericarpium Citri Reticulatae) regulates qi, while Fang Feng (Radix Saposhnikoviae) disperses wind and releases pain lodged in peripheral levels of the body. Tong Cao (Medulla Tetrapanacis) drains accumulation of damp and phlegm out of the body via urination. Lastly, Gan Cao (Radix et Rhizoma Glycyrrhizae) relieves pain and harmonizes the entire formula.

        In summary, Flex (SPR) is an effective formula with both immediate and long-term therapeutic benefits.

 

CAUTIONS & CONTRAINDICATIONS

* This formula is contraindicated during pregnancy and nursing.

* Though there are no known side effects or adverse reactions, it is prudent to not recommend this formula for infants or young children, as the long-term impact on the growth of teeth and the skeleton is unclear.

* 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.[1]^,[2],[3]

 

CLINICAL NOTES

* Flex (SPR) is formulated by Dr. Jimmy Wei-Yen Chang with herbs that treat bone spurs, relieve pain, and reduce swelling. Flex (SPR) has helped many patients with bone spurs to relieve pain and improve their range of movement.

* The primary purpose of Flex (SPR) is to relieve pain related to bone spurs. However, it can be taken as a supplemental formula to relieve pain. Some patients may experience immediate relief, while others may require as much as half a year for relief of the pain. Adequate rest of affected joints is essential to a complete recovery.

* According to clinical experience, patients taking Flex (SPR) generally have an all-or-none response for treating bone spurs. Most patients will experience varying degrees of relief from pain and inflammation. Up to 20 to 30% will experience long-term resolution of pain. However, it is possible that some patients will not notice any change. Evaluation of patients¡¦ condition should be done every one to two months to determine the progress of the patient and the efficacy of the formula.

* Flex (SPR) has been used with good success to treat animals with joint pain.

* According to Dr. Luo Jun-Qing, a tui-na master from China, patients who suffer from bone spur of the knee should not over-exercise their knee. Mild to moderate movements such as those in tai chi chuan [tai ji chuan] and walking should suffice.

* In addition to taking Flex (SPR) orally, herbs should also be applied topically to enhance the overall treatment. The topical preparation is made by cooking herbs in water and filtering out the herb residue. Use the herbal decoction topically by soaking a towel in the decoction while hot, and apply the decoction-soaked towel to the affected area while warm. The towel should be re-soaked in the decoction as needed to keep warm, for a total duration of 30 minutes. Perform this procedure twice per day. One herbal formula that has been used with good results contains the following herbs: Dang Gui (Radix Angelicae Sinensis) 15g, Chi Shao (Radix Paeoniae Rubra) 15g, Chuan Xiong (Rhizoma Chuanxiong) 12g, Hong Hua (Flos Carthami) 12g, Dan Nan Xing (Arisaema cum Bile) 12g, Bai Jie Zi (Semen Sinapis) 15g, Ji Xue Teng (Caulis Spatholobi) 20g, Wei Ling Xian (Radix et Rhizoma Clematidis) 15g, Ru Xiang (Gummi Olibanum) 15g, Mo Yao (Myrrha) 15g, Gui Zhi (Ramulus Cinnamomi) 15g and Du Huo (Radix Angelicae Pubescentis) 15g.

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Upper body bone spur: Ren pulse, a thin, straight, long, wiry pulse that extends proximally to the right chi.

* Lower body bone spur: Ren pulse, a thin, straight, long, wiry pulse that extends proximally to the left chi.

* Note: Ren pulse is one of the eight extra meridian pulses.

 

SUPPLEMENTARY FORMULAS

* For bone spurs in the neck and shoulder, add Neck & Shoulder (AC).

* For bone spurs in the lower back, add Back Support (AC).

* For bone spurs in the back with herniated disks, add Back Support (HD).

* For bone spurs in the arm (shoulder, elbow or wrist), add Arm Support.

* For bone spurs in the knees, add Knee & Ankle (AC).

* For arthritis, add Flex (Heat) or Flex (CD).

* For bone spurs with nerve pain, combine with Flex (NP).

* For severe pain, add Herbal ANG.

* For degeneration of muscles, tendons, ligaments, and cartilage, add Flex (MLT).

* For severe blood stagnation, add Circulation (SJ).

* With excess heat, add Gardenia Complex.

* With severe inflammation, combine with Astringent Complex.

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Bone spurs in the neck: Dazhui (GV 14), Fengchi (GB 20), Jianjing (GB 21)

¡± With numbness and pain in the arms, add Jianyu (LI 15), Quchi (LI 11), and Hegu (LI 4).

* Bone spurs in the back: Yaoyangguan (GV 3), shu (transport) points on the back; ah shi points on the affected areas

* Sciatica with bone spurs: Huantiao (GB 30), Yanglingquan (GB 34), Quchi (LI 11)

* Bone spurs of the knees: Xiyan, Heding, Zusanli (ST 36)

* Technique: use even method. Leave the needle in place for 30 minutes. Perform one acupuncture treatment daily or every other day, for 12 treatments per course of treatment prior to evaluation.

 

Classic Master Tung¡¦s Points:

* Needle contralateral to the pain. If the pain is in the center, needle bilaterally or the side with the more ah shi points. If the pain is bilateral, needle bilaterally.

* General spur: Minghuang (T 88.12) and two points 5 cun above and below it; Linggu (T 22.05), Dabai (T 22.04), Zhongbai (T 22.06), Xiabai (T 22.07), Wanshunyi (T 22.08), Wanshuner (T 22.09), Zhengjin (T 77.01), Zhengzong (T 77.02), Houhui (T 1010.06), Simashang (T 88.18), Simazhong (T 88.17), Simaxia (T 88.19), Guciyi (T 44.21)*, Gucier (T 44.22)*, Gucisan (T 44.23)*

* Back spur: Linggu (T 22.05), Chongzi (T 22.01), Chongxian (T 22.02), Chengshan (BL 57), Zhengjin (T 77.01), Zhengzong (T 77.02), Zhongjiuli (T 88.25), Dan (T 11.13), Minghuang (T 88.12), Tianhuang (T 88.13), Qihuang (T 88.14), Guciyi (T 44.21)*, Gucier (T 44.22)*, Gucisan (T 44.23)*, Zhengji (T 44.24)*  

* Neck spur: Wanshunyi (T 22.08), Wanshuner (T 22.09), Huochuan (T 33.04), Tianhuang (T 88.13), Sizhi (T 77.20), Minghuang (T 88.12), Qihuang (T 88.14), Guciyi (T 44.21)*, Gucier (T 44.22)*, Gucisan (T 44.23)*, Huofu (T 88.41)*, Huoliang (T 88.42)*, Huochang (T 88.43)*, Sojingdian (T 22.19)*  

* Heel spur: Muguan (T 22.26)*, Guguan (T 22.24)*, Zhongguan (T 22.25)*, nuxi point (where the red and white skin meet at the bottom of the Achilles tendon on the foot), Guciyi (T 44.21)*, Gucier (T 44.22)*, Gucisan (T 44.23)*  

* Plantar fasciitis: Muguan (T 22.26)*, Guguan (T 22.24)*, Zhongguan (T 22.25)*, nuxi point (where the red and white skin meet at the bottom of the achilles tendon on the foot)

 

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

* Neck spur: Minghuang (T 88.12), Tianhuang (T 88.13), Qihuang (T 88.14), Houzhi (T 44.05), Jianzhong (T 44.06)

* Back spur: Minghuang (T 88.12), Tianhuang (T 88.13), Qihuang (T 88.14), Houzhui (T 44.02), Shouying (T 44.03)

* Heel spur: Minghuang (T 88.12), Tianhuang (T 88.13), Qihuang (T 88.14), Wuhu 5 (T 11.27)

* Plantar fasciitis: Bleed local tender area. Needle ipsilaterally Huoquan (T 88.16), Tianhuangfu [shenguan] (T 77.18), Sizhi (T 77.20), Taixi (KI 3).

 

Balance Method by Dr. Richard Tan:

* Treatment depends on the individual presentation and the location of the spur.

 

Auricular Medicine by Dr. Li-Chun Huang:

* Spurs: Large Auricular Nerve, Lesser Occipital Nerve, Sympathetic, Nervous Subcortex, Shenmen, and corresponding point (seed the front and the back). Bleed Ear Apex.

 

NUTRITION

* Patients are encouraged to increase their intake of vinegar.

* Discourage the intake of bamboo and acidic fruits, such as orange or grapefruit.

* Minimize the consumption of seafood and red meat to avoid creating additional deposits of uric acid.

 

LIFESTYLE INSTRUCTIONS

* Rest is essential to the recovery of bone spurs. If possible, discontinue repetitive movement and overuse of the joint where the bone spur is located.

* Slow stretching exercises of the affected area are effective to reduce or diminish pain.

* Initially in the first 24 hours, use ice packs to reduce swelling and inflammation. However, long-term use of ice packs is not recommended, as it may cause more stagnation.

 

CASE STUDIES

* E.L., a 40-year-old female patient, presented with pain at the bottom of her heel due to a bone spur along with right hip flexor pain. It was reported that her pain level was a seven out of ten. She was formerly diagnosed with calcaneum calcium deposit. The TCM diagnosis was qi and blood stasis as well as Kidney yin deficiency. For treatment, Flex (SPR) was given at 4 capsules three times daily for two weeks. It was noted that the patient had almost immediate cessation of her pain, the swelling decreased, and she was able to return to her regular activity of running after five days. Submitted by J.W., San Francisco, California.

* M.A., a 60-year-old female, presented with pain located on her left foot due to a heel spur. X-rays had confirmed the presence of a calcaneal spur. The practitioner diagnosed this condition as phlegm and qi and blood stagnation. Flex (SPR) was prescribed at 4 capsules three times per day. Over the course of two months, the patient had noticed a decrease in her foot pain and after three months noticed that the pain had resolved. She was very pleased with the herbs and how they helped her. Submitted by M.P., Muskego, Wisconsin.

* E.F., a 60-year-old male, presented with knee pain located above the right patella beginning two days prior. X-rays had confirmed there was a bone spur present. It was noted that it became aggravated by any weight bearing or change of position. Objective findings included slight swelling and warm temperature. There was no trauma preceding the condition. The practitioner diagnosed this condition as qi and blood stagnation. Knee & Ankle (AC) and Flex (SPR) were prescribed at 2 capsules each three times per day. After taking the herbs for six weeks the condition had resolved. Submitted by L.L., Greenwich, Connecticut.

* A 53-year-old female presented with neck and shoulder pain which had been occurring for the previous 12 years. Current X-rays had shown a bone spur located in the C6-7 area. No curvature of the spine was seen. The practitioner had diagnosed the condition as yin and qi deficiencies with local qi and blood stagnation. Neck & Shoulder (CR) and Flex (SPR) were both prescribed. After taking the herbs, the patient had reported that her pain had decreased from a 7-8/10 to a 3-4/10 pain level. Submitted by H.C., Sydney, New York.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Flex (SPR) is specifically designed to treat bone spurs. Pharmacologically, this formula contains herbs with analgesic effects to relieve pain and anti-inflammatory effects to reduce swelling and inflammation. Clinically, it resolves bone spurs characterized by ¡§hardness and nodules,¡¨ as described in traditional Chinese medicine.

        Po Bu Zi Ye (Folium Cordia Dichotoma) is an indigenous herb in Taiwan. It has been used historically for treatment of ¡§sharp pain of the heel.¡¨ This traditional use has been expanded as Po Bu Zi Ye (Folium Cordia Dichotoma) is now recognized by many experts as the chief and most effective herb for treating bone spurs affecting various parts of the body. Mo Gu Xiao (Caulis Hyptis Capitatae), Liu Zhi Huang (Herba Solidaginis), Huang Jin Gui (Caulis Vanieriae), and Da Ding Huang (Caulis Euonymi) are four other indigenous herbs from Taiwan. These four herbs are commonly used to treat various types of musculoskeletal conditions with pain and inflammation.[4]

        Zao Jiao Ci (Spina Gleditsiae), Zao Jiao (Fructus Gleditsiae) and Po Bu Zi Ye (Folium Cordia Dichotoma) are three important herbs for treating bone spurs. Historically, these herbs have been used to treat various types of ¡§hardness and nodules.¡¨ Today, they have been used successfully to treat various conditions characterized by pain and inflammation. Pharmacologically, Zao Jiao Ci (Spina Gleditsiae) and Zao Jiao (Fructus Gleditsiae) both exert marked anti-inflammatory effects.[5] Clinically, Zao Jiao Ci (Spina Gleditsiae) has been used successfully to treat sciatica in 117 patients (73 had complete recovery, 20 had significant improvement, 18 had moderate improvement, and 6 had no improvement).[6]^,[7] Furthermore, it has also been used with good success to treat hyperosteogeny. According to one study, 41 patients with hyperosteogeny were treated with significant improvement in 26 cases, improvement in 12 cases, and no effect in 3 cases. The herbal formula was administered as a decoction daily, and contained the following ingredients: Zao Jiao Ci (Spina Gleditsiae), Dang Gui (Radix Angelicae Sinensis), Hong Hua (Flos Carthami), Shan Zhu Yu (Fructus Corni), Chuan Xiong (Rhizoma Chuanxiong), Ji Xue Teng (Caulis Spatholobi), and others as needed.[8]

        Flex (SPR) contains many herbs with analgesic effects to relieve pain and anti-inflammatory effects to reduce swelling. Fang Feng (Radix Saposhnikoviae) shows a marked effect to suppress inflammation via the inhibition of nitrite production by inducible nitric oxide synthase.[9] Jin Yin Hua (Flos Lonicerae Japonicae) demonstrates significant analgesic and anti-inflammatory effects via the inhibition of cylcooxygenase-2, inducible nitric oxide synthase, and 5-lipoxyfenase activities.[10] Gan Cao (Radix et Rhizoma Glycyrrhizae) has demonstrated a marked anti-inflammatory effect by enhancing the effect of glucocorticoid through increased production and secretion as well as decreased metabolism by the liver.[11] In terms of anti-inflammatory actions, the comparison of cortisone to glycyrrhizin and glycyrrhetinic acid, two compounds from Gan Cao (Radix et Rhizoma Glycyrrhizae), is approximately 10:1.[12] Clinical applications of Gan Cao (Radix et Rhizoma Glycyrrhizae) include pain, inflammation, edema, arthritis, spasms, and cramps.[13]^,[14] Lastly, Ru Xiang (Gummi Olibanum) and Mo Yao (Myrrha) have an analgesic effect to relieve pain and an anti-inflammatory effect to reduce swelling and inflammation.[15],[16] These two herbs also show an antiarthritic effect by reducing edema and decreasing arthritic scores in subjects with adjuvant-induced arthritis. The mechanism of action is attributed to the suppression of pro-inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-£\) and interleukin-1beta (IL-1£]).[17] Furthermore, use of Ru Xiang (Gummi Olibanum) and Mo Yao (Myrrha) is also beneficial to facilitate wound healing by stimulating maturation and differentiation of white blood cells.[18] Clinically, they have been used effectively to treat pain associated with various types of trauma and external injuries.[19]

        In summary, there are very few treatments available for bone spurs. Flex (SPR) offers a much-needed treatment option for those who suffer from this disorder.

 

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. For neuropathic pain due to bone spurs, drugs such as antiseizure [Dilantin (phenytoin) and Neurontin (gabapentin)] and antidepressant medications [Elavil (amitriptyline)] are prescribed. Though effective, these drugs are associated with numerous and significant side effects. Antiseizure drugs cause side effects such as bleeding, burning sensations, clumsiness or unsteadiness, confusion, irregular eye movements, blurred or double vision, swollen glands in neck or underarms, slurred speech, delusions, dementia, bone malformations, and many others. Antidepressant drugs cause blurred vision, confusion or delirium, hallucinations, constipation (especially in the elderly), problems in urinating, decreased sexual ability, difficulty in speaking or swallowing, eye pain, fainting, fast or irregular heartbeat, loss of balance control, mask-like face, nervousness or restlessness, slowed movements, stiffness of arms and legs, and shortness of breath or troubled breathing. In short, these drugs should be prescribed only when benefits significantly outweigh the risks. Furthermore, use of these drugs must be monitored carefully to avoid developing serious side effects and complications. Lastly, these drugs treat the symptom (pain) and not the cause (bone spurs). When the pain becomes intolerable, or if drugs cause too many side effects, the last option is surgery.

        Bone spurs are caused by repetitive use of, or recurrent injuries to, the affected joint(s). Bone spurs are diagnosed as blood and phlegm stagnation, and are treated with herbs that activate blood circulation, resolve phlegm, and relieve pain. Clinically, herbal treatment of bone spurs has been shown to be relatively effective, though the required duration of treatment must be longer than one to two months.

        Treatment of bone spurs is a challenge to both drug and herbal medicine. While drugs do not treat bone spurs, they do offer potent and effective means to control pain. On the other hand, herbs are relatively effective to treat pain and resolve spurs, but may require a prolonged period of treatment. In light of limited options, herbs should definitely be tried before considering surgery.