Outline:
Traumatic pain refers to the pain of the body caused by all kinds of exogenous forces. Strike of direct violence or sprain and strong contraction of muscle due to indirect violence can all lead to injury of qi and blood and cause pain. Injury of qi and blood can lead to stagnation of qi flow and accumulation of stagnant blood, thus, pain will occur because of blockage. Generally speaking, sprains of the chest and waist are a pathological change of qi stagnation; various contusions are a pathological change of blood stasis, and the other injuries of qi and blood are usually pathological changes of qi stagnation and blood stasis simultaneously.

After trauma, the healthy qi is damaged, and what is more, if one lives long in a wet condition, or is invaded by exogenous wind and cold, which may also result in blockage of qi flow and hence cause pain. An open injury or unresolved stasis and invasion of pathogenic poison may lead to stagnation of qi and blood and the blockage of meridians, which may also result in pain.


Major points for diagnosis  
1. There is a definite traumatic history or cold-catching history.
 
2. There is distending pain with no fixed site in the case of qi stagnation; there are stabbing pain with fixed site, ecchymoses or hematoman in the case of blood stasis; there are aching pain with heavy sensation, preference to heat and aversion to cold in the case of excessive pathogenic wind-cold-dampness; there are redness, swelling and heat in the case of excessive pathogenic poison.

3. X-ray film can confirm whether there are fracture and dislocation. In the case of infection by pathogenic poison, there is leukocytosis.


Treatment  
Herbal therapy
Internal treatment based on syndrome differentiation

(1) Syndrome of qi stagnation
Main symptoms and signs:
Distending pain in traumatic part, migratory or diffuse pain, or even failure in bending over, stretching and turning about, or difficulty in turning over, or aggravated by cough, respiration and moving bowel, pale tongue and stringy pulse.

Therapeutic method: Regulating qi to stop pain.
 
Recipe and herbs:
Modified Liqi Zhitong Decoction.Specifically, Chaihu ( Radix Bupleuri )6 g, Danshen (Radix Salviae Miltiorrhizae)10 g, Qingpi (Pericarpium Citri Reticulatae Viride )6 g, Zhixiangfu (Rhizoma Cyperi Rotundi Praeparata)10 g, Chuanlianzi (Fructus Meliae Toosendan )10 g, Zhike ( Fructus Citri Aurantii)10g, Chishaoyao (Radix Paeniae Rubrae)10 g, Yanhusuo (Rhizoma Corgdalis)15 g, Lulutong (Fructus Liquidambaris)10 g and Gancao (Radix Glycyrrhizae)3g.
 
(2) Syndrome of blood stasis
Main symptoms and signs:
Stabbing pain in the traumatic part, swelling, pressure refusal, ecchymoses or hematoma, purplish dark tongue, thready and choppypulse; there is traumatic history of sprain and contusion.

Therapeutic method: Removing the stasis to stop pain.

Recipe and herbs:
Modified Siwu Zhitong Decoction. Danggui ( Radix Angelicae Sinensis )10 g, Chishaoyao ( Radix Paeniae Rubrae )10 g, Chuanxiong ( Rhizoma Ligustici Chuanxiong ) 10 g, Shudihuang (Radix Rehmanniae Praeparata ) 10g, Ruxiang ( Gummi Olibanum )10 g, Moyao (Mgrrha)10 g, Zhechong (Eupolyphaga seu Steleophaga )10 g, Xuejie ( Resina Draconis )3 g, Zhike (Fructus Citri Aurantii)10 g, Honghua (Flos Carthmi)6 g and Gancao (Radix Glycyrrhizae )3 g.
 
(3) Syndrome of pathogenic wind-cold-dampness
Main symptoms and signs:
Local aching pain with heavy sensation induced or aggravated in rainy days and relieved in warm days, difficulty in extension and flexion or numbness of limbs, preference to heat and aversion to cold; frequent and slow onset with a long course, white greasy tongue coating, and moderate pulse. The patient has a history of living long in a wet environment after trauma or invasion by pathogenic wind and cold.
 
 
Therapeutic method: Expelling the wind, cold and dampness.

Recipe and herbs:
Modified Juanbi Decoction. Specifically, Qianghuo (Rhizoma seu Radix Notopterygii )10 g, Fangfeng ( Radix Ledebouriellae Divaricatae )10 g, Jianghuang ( Rhizoma Curcumae longae )10 g, Chishaoyao (Radix Paeniae Rubrae)10g, Duhuo (Radix Angelicae Pubescentis )10 g, Huangqi (Radix Astragall seu Hedysari )12 g, Danggui ( Radix Angelicae Sinensis)10 g, Fuling (Poriae)10 g, Weilingxian (Radix Clematidis )15 g, Shengjiang ( Rhizoma Zingiberis Recens )6 g and Gancao (Radix Glycyrrhizae)3 g.
 
External therapy:      
For the syndrome of stagnation of qi and blood, Xiaoyu Zhitong Paste or Sanse Application may be topically applied. For the syndrome of pathogenic wind-cold-dampness, Goupi Plaster may be externally applied. For the syndrome of pathogenic poison, Shuangbai Powder may be externally used.