Kung Fu injuries: pathophysiology and new Dit Da Jow for pain and swelling based on new scientific concepts

1. KUNG FU INJURIES:
PATHOPHYSIOLOGY & DIT DA JOW REMEDY
By
Kevin KF Ng, MD, PhD Gina Ng
Former Assoc. Professor of Medicine and Formulator
Division of Clinical Pharmacology MD Natural Care Inc.
University of Miami, Florida, USA Snellville GA, USA
email address: kevinng68@gmail.com
Presented at Seminars for Martial Art practitioners, Health Care Providers
and Professional Athletes 2015 -2017.

2. Kung Fu: Chinese martial art
for health maintenance
and defence or attack
Dit Da Jow: a liniment for bruise
and contact injuries

3. 0
20
40
60
80
100
120
karate tae kwan do aikido kung fu tai chi
Number of injuries in five martial arts: total 263
Number Injuries
Adapted from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1725005/pdf/v039p00029.pdf

4. Prevalence of bodily injuries in Kung Fu competitions
Total number of participants (248)
https://www.degruyter.com/view/j/bhk.2010.2.issue--1/v10101-010-0008-8/v10101-010-0008-8.xml

5. Classification of Kung-Fu tissue injuries
• Bruise/hematoma
• Muscle strain
• Ligament sprain
• Muscle tear
• Joint dislocation
• Bone fracture
Common mild injuries
Infrequent severe injuries:

6. Signs and symptoms of Kung Fu external injuries
▪Bruise (contusion)
▪Bleeding (closed or open wound)
▪Pain
▪Swelling
▪Loss of function

7. Concepts of tissue injury
Chinese concept
▪ Stagnation of qi
▪ Yin yang imbalance
Scientific concept
▪ Injury results in acute inflammation
▪ Inflammation is caused by mediators
▪ Mediators are produced by WBC, platelets
and endothelium
endothelium
Yang
Yin

8. Traditional Chinese Medicine concept on Injury

9. Chinese philosophical idea on Pain
When Qi circulates, there is no pain.
Qi is the life force of the body.
When Qi is stagnated, pain develops.

10. Western concept of Injury and Pain: Inflammation
Inflammation
• Chemical mediators are released from
damaged tissues.
• Mediators cause vasodilation,
swelling, pain, and loss of function.
• Pain is caused by activation of
nociceptive receptors at nerve
endings.
• Nerve impulse travels along peripheral
nerve, spinal cord to brain

11. http://www.healthline.com/health/bruise-colors#overview1
What is a Bruise/Hematoma/Contusion ?
A collection of blood in the tissue
healthline.com/health/bruise-colors#overview1

12. Events of Biochemical changes in Bruise or Hematoma
1. Rupture of blood vessels.
2. Leakage of blood into injured site giving a red color.
3. Deoxygenation of blood gives rise to blue discoloration.
4. Breakdown of hemoglobin to biliverdin which gives the greenish color.
5. The conversion of biliverdin to bilirubin which gives rise to the yellowish color.
Hemoglobin Heme Biliverdin Bilirubin

13. http://www.forensicmed.co.uk/wounds/blunt-force-trauma/bruises/microscopy-of-bruises/healthline.com/health/bruise-colors#overview1
Perls-positive macrophages
Evidence for Clearance of blood components by macrophages

14. What is a Strain? Tearing of mmuscle fibres

15. https://www.sciencedaily.com/releases/2015/11/151125083938.htm
Infrared thermography of right quadricep strain

16. Muscle strain: histological changes from onset to recovery
(day 0 to day 7)
https://www.slideshare.net/MuscleTechNetwork/quadriceps-muscle-injuries-william-garret-eduard-alentorgeli

17. What is a sprain?

18. Signs and Smyptoms of Ligament Sprain
http://kingsleyphysio.com/common-conditions/acute-chronic-recurrent-ankle-sprains/

19. http://www.davidlnelson.md/articles/Tendon_laceration.htm
Microscopy of normal and damaged tendon

20. Signs and symptoms of Bruise, Muscle Strain and Ligament Sprain
▪Pain
▪Swelling
▪Redness
▪Warmth
▪Loss of Function
INFLAMMATION
(set on fire)

22. Purpose and Events in Acute Inflammation
To prepare the damaged tissues for repair and resolution:
1. coagulation (blood changes from a liquid to a gel)
2. dilatation of blood vessels (vasodilation)
3. exit of white blood cells (diapedes)
4. release of pro-inflammatory chemical mediators
5 actions of mediators on their respective receptors
5. switch to release of pro-resolution chemical mediators (SPM)
6. removal of dead cells and debris from damaged tissues (phagocytosis)
7. return to homeostasis

23. Formation of a Blood Clot
https://www.pinterest.com/pin/335870084686282762/?lp=true https://medlineplus.gov/ency/imagepages/19462.htm

24. Movement of Leukocyte across blood vessel wall (endothelium)
http://idamalonemicrojournal.blogspot.com/Source: Anthony L. Mescher: Junqueira’s Basic Histology, 14th Edition

26. Source of chemical mediators in Inflammation
Source Mediators ( > 20 ) Result
▪ Cellular injury Amines
▪ Nerves Cytokines
▪ Blood vessels Chemokines
▪ White blood cells Lipid mediators
▪ Platelets Free radicles
▪ Plasma Peptides
INFLAMMATION
Pain
Swelling
Redness
Warmth

27. Life span of white blood cells
https://www.slideshare.net/P-Z0-3/white-blood-cells-39413127

29. Mediators of inflammation and resolution

30. Pro-inflammatory and pro-resolving mediators of inflammation
http://www.anti-agingfirewalls.com/2016/12/14/inflammation-part-3-resolving-inflammation-resolvins-protectins-maresins-and-lipoxins/

31. Treatment of bruise, strain and sprain
Traditional Chinese Method
▪ Poultice
▪ Dit Da Jow (Fall Hit Wine)
▪ Acupuncture
▪ Moxibustion
▪ TCM herbs
Western Scientific Method
▪ RICE (rest, ice, compression, elevation)
▪ Western Dit Da Jow
▪ Liniment, lotion, cream, gel, patch
▪ Assistive bandage, brace, sling
▪ Oral OTC analgesic

32. WHAT IS DIT DAT JOW?
A LINIMENT MADE WITH HERBS AND ALCOHOL
FOR SOFT TISSUE INJURIES

33. Evolution of Dit Da Jow: Poultice to Liniment
Dit Da Jow literally means Fall Hit Wine/Iron Strike Wine
Recipe is a family secret passed down from one generation to another
https://www.goldendragonproducts.com/picture-galleryhttp://eastmeetswest.com/herbal-alternatives-to-viagra
Mixture of herbs Dit Da Jow Liniment
Poultice

34. Herbs used in preparation of Chinese Dit Da Jow
Chinese herbs for martial arts by Brian Wilkes
12 Herbs
A. Chuan Xiong- River parsley
B. Kuei Chih – Cinnamon twigs
C. Mo Yao – Myrrh
D. Ru Hsiang – Frankeincense
E. Huang Hua – Safflower
F. Kan Tsao – Licorice
G. Tang Kuei Mei – Dong quai “tails”
H. Pai Shao – White peony root
I. Tien Chi – Pseudo – ginseng
J. Lien Tzu – Lotus root
K. Huang Sun – Skullcap
L. Di Huang - Rehmannia

35. Herbs used in preparation of American Dit Da Jow
http://eastmeetswest.com/american-dit-da-jow/ 1/9
14 ingredients

36. Ingredients of Chinese and Western
Poultices & Dit Da Jow
Chinese herbs
▪ Ginseng root
▪ Ginger root
▪ Galangal root
▪ Lemon grass leaves
▪ Cypress leaves
▪ Peony root
▪ Frankincense resin
▪ Myrrh resin
▪ Cinnamon bark
▪ Tumeric root
▪ Green tea leaves
Western herbs

37. Preparation of Dit Da Jow (Iron Hit wine)
https://www.wingchunillustrated.com/2014/04/28/dit-da-jow-scientific-evaluation-iron-hit-wine/

38. Functions of Dit Da Jow
1. Remove blood stagnation
2. Remove Qi stagnation
3. Tonify blood
4. Tonify Qi
5. Reduce pain
“Qi moves, blood flows,
Blood moves, Qi flows”

39. Interpretation of physical signs: East vs West

40. FAQ
▪Is 5 year old Jow more potent than 1 year old Jow?
▪How does Dit Da Jow work pharmacologically?

41. ANALYSIS OF BIOACTIVE CHEMICALS IN
DIT DA JOW
https://www.wingchunillustrated.com/.../dit-da-jow-scientific-evaluation-iron-hit-wine

42. Comparison of bioactive ingredients in
1 year and 5 year old Dit Da Jow
1 year old Dit Da Jow
▪ Chrysophanic acid
▪ Coumarin
▪ Salicylic acid
▪ Vasodilator
▪ Unknown
5 year old Dit Da Jow
▪ Acetic acid
▪ Acetoglyceride
▪ Columbianetin
▪ Coumarin
▪ Rhododrendol
▪ Vanillin
https://www.wingchunillustrated.com/.../dit-da-jow-scientific-evaluation-iron-hit-wine...

43. How Traditional Chinese Medicinal herbs work?
• One herb
• Two herbs
• Three herbs
• Four herbs
Synergy

44. Western Theory of Action of Drugs (lock & key)
http://pharmacymagazine.blogspot.com/2013/11/how-do-drugs-work.html
Histamine + receptor on blood muscle > vasodilation
Histamine + receptor on nerve endings > pain

45. Inflammatory targets of 1 year old Dit Da Jow
Bioactive
ingredients
chemical mediators

46. Inflammatory targets of 5 year old Dit Da Jow
chemical mediators
Bioactive
phytochemical

47. RESEARCH INTO
BIOACTIVE PHYTOCHEMICALS
AMONG FOOD, SPICES AND HERBS
TO
DEVELOP A MODERN DIT DA JOW
BASED ON SCIENCE

48. Development of a modern Dit Da Jow based on Science
▪ Selection of spices or herbs with known bioactive ingredients on molecular targets.
▪ Selection of bioactive ingredients that are safe and soluble in oil.
▪ Extraction with olive oil instead of alcohol.
▪ Blend four or more spices/herbs that target most
of the known inflammatory mediators.
▪ Preliminary test with oil extracts on patients.
▪ Perform Randomized double-blind placebo controlled trials.

49. A new Dit Da Jow formula made from spices and herbs for
Pain and Swelling
chemical mediators
Spices
Herbs

50. Clinical trials of modern Dit Da Jow on patients
▪ Contusion of buttocks
▪ Muscle strain: trapezius, gastronemius, sacro-iliac strain
▪ Ligament sprain: sprained ankle, tendonitis
▪ Delayed onset muscle soreness

51. 42 yr old Asian Female slipped in bathroom. She
sustained an injury to her head and buttock. There
was no loss of consciousness. She complained of
severe pain in her buttock areas and a bump on
her head. Topical application of a 5 ingredient
phytochemical extracts to the contusion on her
head and buttocks relieved the pain and swelling
in 15 minutes. She returned to work the next
morning.
Case of Contusion of Buttocks

52. Trapezius muscle strain
Delayed onset muscle soreness
80 yr old Chinese male with severe throbbing
pain (10/10) in right trapezius 12 hours after
working the in the yard. The muscle was
swollen and tender to touch. Topical
application with L35 formula relieved pain from
10/10 to 2/10 within 30 minutes.

53. 31 yr old black male with pain in right hand since Jan
2017. Sustained injury when he tried to swing his
luggage bag at NY airport. Pain was 10/10 and made
worse by movement of right thumb. Totally unable to
write. Examination showed a swollen and tender
ligaments to the right thumb. 2 tables of Advil 3 times a
day for 3 months did not help him much. Topical
application of L35 relieved the pain from 10/10 to 5/10 in
10 minutes and down to 2/10 in 30 minutes. Application
three times daily for one week brought the pain down to
1/10. Rang of movement was almost normalized.
Case of Tendonitis

54. 74 yr old Chinese female twisted her right ankle while going
down the staircase. She was unable to stand up because of the
severe pain. Physical examination showed a tender bruised
right ankle with limited range of movement. Topical application
of oil extracts containing four ingrediants were applied three
times a day followed by imbolilisation with an ankle brace. Pain
was reduced from10/10 to 2/10 within 15 minutes. She
became pain free after 1 day and ambulatory after 2 days.
Case of Sprained Right Ankle in 2011

55. Sacro-iliac strain
68 yr old W/F was brought to exam room on a
wheel chair. She c/o of severe back pain after
moving a cupboard in her bed-room. Physical
exam showed tenderness in left sacro-
iliac joint. L35 was rubbed onto left saco-iliac
area. Pain was reduced from 10/10 to 5/10 within
10 min. She was able to walk out of the exam room.
Follow-up in one week showed that she was pain free.

56. Effects of L35 Formula on Contusion, Strain and Sprain
L35 = blend of 5 spices and herbs in massage oil
Scale
Time
pain
swelling

57. Pain relief comparison between L35 topical liniment
and 400 mg Advil
Scale
Time
pain
swelling

58. Conclusions
▪ All Kung Fu contact injuries result in acute inflammation.
▪ Inflammation involves the release of chemical mediators from white blood cells, plasma,
blood vessel endothelium, and nerve endings.
▪ The chemical mediators acting on their receptors cause pain, swelling, redness and
warmth which are the cardinal signs of inflammation.
▪ Inflammation is normally followed by resolution which is orchestrated by switching pro-
inflammatory mediators to pro-resolving mediators.
▪ Dit Da Jow liniment is an alcohol extract of anti-inflammatory phytochemicals which
reduce pain and swelling by targeting the inflammatory mediators.
▪ Evidence in this study shows that anti-inflammatory phytochemicals from spices and
herbs share the same properties as traditional Dit Da Jow herbs.
▪ Dit Da Jow is therefore an anti-inflammatory liniment.

59. Any Question?
Seminars can be arranged for martial art practitioners, body builders, professional
athletes, sports clubs, fitness centers, physical therapists, chiropractors, massage
therapists and Traditional Chinese Medicine Institutions.
CONTACT:
Kevin KF Ng, MD, PhD
email address: kevinng68@gmail.com