BLUE POPPY PRESS RECENT RESEARCH REPORT #134

Concussion & Closed Head Injuries

Concussion is characterized by post-traumatic loss
of consciousness lasting less than 24 hours
(usually much less) without structural lesions in
the brain. Although unconscious, the patient with
concussion is rarely deeply unresponsive.
Pupillary reactions and other signs of brainstem
function are intact. Lumbar puncture shows that
the cerebrospinal fluid is clear. Convalescence
after any severe head injury is marked by amnesia
for the periods both immediately preceding and

following loss of consciousness. Retrograde

amnesia is usually brief. Giddiness, attention
difficulties, anxiety, and headache, so-called postconcussion syndrome, occur for a variable period
after concussion. Most recovery after severe head
injury occurs in the adult within the first six
months, with smaller improvements continuing for
perhaps as long as two years. Children improve
more rapidly but also continue improvement for a
longer period of time.

(From A Clinical Audit of the Treatment of 50 Cases of Concussion of the Brain with Nao Shang San
[Brain Damage Powder] by Zhang Yi, Liu Jian-xiong & Qiao Le, Xin Zhong Yi [New Chinese
Medicine], #2, 1998, p. 18-20)
Concussion is a commonly seen injury of the
brain. After closed head injury, patients commonly
exhibit headache, dizziness, lack of strength,
nausea, vomiting, difficulty thinking, and
decreased memory power. The acute period lasts
for 1-2 weeks after injury, during which these
symptoms are relatively pronounced. During the
recovery period (weeks 2-4 after injury) these
symptoms gradually improve. In a small number of
patients, these symptoms may persist for months or
even years. This is referred to as post-concussion
sequellae or as post external injury to the brain
syndrome. Previously, this condition has mostly
been treated with Western medicine and there is
not much written on it in the Chinese medical
literature. The authors of this study used Nao
Shang San No. 1 and Nao Shang San No. 2 to treat
50 cases of concussion and compared these to
another 50 cases of concussion who were treated
with Western medicine. This study describes the
main points of comparison between these two
groups.

Cohort description
Of the total of 100 patients, 34 were in-patients
and 66 were out-patients. These 100 patients were
divided into two groups, a treatment group and a
comparison group. Of the 50 patients in the
treatment group, 36 were male and 14 were
female. They ranged in age from 8-63, with a
median age of 35.5 years. Fifteen patients had
been in car accidents, 18 had been injured by
falling, and 17 had been struck in fights. Thirtytwo cases were in the acute period, and 18 were in
the recovery period. In the comparison group,
there were 32 males and 16 females. Their ages
ranged from 9-61, with a median age of 35 years.
Ten cases had been hurt in car accidents, 21 had
fallen, and 19 had been hit. Twenty-nine were in
the acute period, and 21 were in the recovery
period. Based on the above criteria, there was no
marked statistical difference between the members
of these two groups (P , 0.05).
In terms of inclusion criteria, none of the patients
had been unconscious for more than 30 minutes

after their injury. All of them had some degree of

headache, dizziness, nausea, vomiting, lack of
strength, vexation and agitation, difficulty
thinking, and/or decreased memory power.
Neurological examination was negative for organic
lesions. X-rays of the skull showed no bone
fractures, and examination of cerebrospinal fluid
was normal. CT scan also showed no
abnormalities. In addition, the patients in this
study had not had hypertension before their injury
nor suffered from any cerebrovascular disease.

B1 , two tablets each, 2-3 times per day.

Both groups were treated for one month and then
re-examined. If their condition worsened, they
received a repeat CT scan, and they were watched
carefully for any sign of intracranial bleeding or
swelling.

Outcomes
Marked improvement was defined as obvious
decrease or complete disappearance of the clinical
symptoms. Some improvement meant that the
clinical symptoms decreased. No effect meant that
there was no change in clinical symptoms from
before to after treatment. Based on these criteria, it
was found that, in the treatment group, 32 cases or
64% experienced marked improvement. Thirteen
cases or 26% got some improvement, and five
cases or 10% registered no effect. Thus the total
amelioration rate in the treatment group was 90%.
In the comparison group, 14 cases or 28%
registered marked improvement, 15 cases or 30%
got some improvement, and 21 cases or 42% got
no effect. Thus the total amelioration rate in the
comparison group was 58.0%. This means that
there was a high statistical difference in treatment
outcomes between these two groups (P + 0.01) both
in terms of amelioration rates and the percentages
of ineffectiveness.

Treatment method
During the acute period, the patients in the
treatment group received Nao Shang San No. 1
administered in gelatin capsules. These consisted
of 0.45g of uncooked herbs in capsule of : Radix
Angelicae Sinensis (Dang Gui), Radix Ligustici
Wallichii (Chuan Xiong), Flos Carthami Tinctorii
(Hong Hua), Semen Pruni Persicae (Tao Ren),
Sclerotium Poriae Cocos (Fu Ling), Rhizoma
Alismatis (Ze Xie), Secretio Moschi Moschiferi
(She Xiang), and Radix Angelicae Dahuricae (Bai
Zhi). Six capsules were given each time, 2-3 times
per day.
During the recovery period, patients in the
treatment group were orally administered Nao
Shang San No. 2, also in gelatin capsules. This
consisted of: Radix Codonopsitis Pilosulae (Dang
Shen), Rhizoma Atractylodis Macrocephalae (Bai
Zhu), Sclerotium Poriae Cocos (Fu Ling), Radix
Glycyrrhizae (Gan Cao), Radix Auklandiae
Lappae (Mu Xiang), Rhizoma Cyperi Rotundi
(Xiang Fu), Os Draconis (Long Gu), Concha
Ostreae (Mu Li), Radix Polygalae Tenuifoliae
(Yuan Zhi), and Rhizoma Acori Graminei (shi
Chang Pu). Each capsule contained 0.48g of
uncooked herbs. Six capsules were administered
each time, 2-3 times per day.

Discussion
The authors quote the Su Wen (Simple Questions),
Treatise on the Vessels Dependence on the Finest
Essence when they state, The head is the
mansion of the essence brightness. They quote
the Lei Jing (Categorized Classic) when they say,
All the essence qi of the five viscera and six
bowels ascends and is upborne to the head in order
to produce the function of the seven
orifices.When the head receives a strong external
blow, the brain bowel vessels and network vessels
suffer detriment. The qi and blood of the sea of
marrow thus is consumed and damaged, and the
spirit brightness loses its nourishment. In addition,
dead blood obstructs the channels, congealing and

During the acute period, the comparison group

received Lu Tong Ding (Skull Pain Stabilizer) and
Nao Fu Kang (Brain Restore Health), two tablets
each, 2-3 times per day. During the recovery
period, they received a multivitamin and vitamin

binding to form lumps. Thus there is pressure

within the brain marrow, the clear orifices are
blocked and congested, and lack of free flow leads
to pain.

freed. Hence headache is relieved, stasis is

removed, and new blood can be engendered. Once
the brains network vessels are freely flowing, then
the spirit is automatically bright.

The Xue Zheng Lun (Treatise on Bleeding

Conditions) says, If there is aching and pain, it is
because static blood is congealing and stagnating.
During the acute period of concussion, headache is
the main symptom. Mostly one sees head pain
which is fixed in location, dizziness, brain
distention, a purple, dark tongue with possible
static macules on its edges, and a bowstring,
choppy pulse, all symptoms of stasis obstructing
the network vessels of the brain. Therefore, the
appropriate treatment principles are to transform
stasis and free the flow of the network vessels.
Nao Shang San No. 1 is a modification of Tong
Qiao Huo Xue Tang (Free the Flow of the Orifices
& Quicken the Blood Decoction). Within this
formula, Ligusticum and Dang Gui quicken and
supplement the blood. Persica and Carthamus
break static blood. Poria and Alisma seep
dampness and disinhibit water, thus leading blood
and water accumulated above downward. In
addition, a small amount of Musk is used to
penetrate the network vessels, opening and freeing
the flow of all the orifices, while Angelica
Dahurica dispels wind, stops head pain, and guides
the other medicinals to move upward. Static blood
is thus transformed and scattered and the brain
network vessels are coursed and their flow is

During the recovery period, one mostly sees bodily

fatigue and lack of strength, devitalized essence
spirit and devitalized eating and drinking,
insomnia, impaired memory, a pale white tongue,
and a fine, weak pulse. These are all symptoms of
central qi insufficiency not upbearing clear yang.
Treatment, therefore, should mainly boost the qi
and upbear yang, assisted by transforming
stagnation and quieting the spirit. Nao Shang San
No. 2 is an experiential formula. Within it,
Codonopsis, Atractylodes, Poria, and Licorice all
supplement the qi and fortify the spleen.
Auklandia and Cyperus regulate and rectify the
stomach and intestines, move the qi and transform
stagnation. Dragon Bone and Oyster Shell warm
and pull together heart yang, while Polygala and
Acorus nourish the heart and quiet the spirit. Thus
the central qi obtains supplementation, clear yang
is upborne above, and yang qi can do its duty.
Hence the essence spirit and eating and drinking
are both vitalized. This formula is based on the
idea that when yang is engendered, yin grows and
when the qi and blood are sufficient, they are able
to engender the essence. When the essence is
sufficient, the brain marrow is filled. Therefore,
the patients are able to recover.

(From The Treatment of 42 Cases of Post-traumatic Intracranial Hematoma with Nao Shang Ling
[Efficacious {Remedy for} Brain Injury] by Su Lu-xia, Shang Hai Zhong Yi Yao Za Zhi [Shanghai
Journal of Chinese Medicine & Medicinals], #3, 1998, p. 10)
Since 1994, the author of this article has treated 42
cases of post-traumatic intracranial hematoma on
the basis of its being categorized as blood stasis in
Chinese medicine, thus using the methods of
quickening the blood and transforming stasis
through their self-composed Nao Shang Ling.

the youngest was 16 years old. The shortest

duration of disease was three days and the longest
was 30 days. All had received various degrees of
closed head injuries and manifested varying
degrees of blood stasis signs and symptoms. For
instance, there was headache which was
lancinating, sharp, and fixed in location and which
had endured for days without healing. This was
accompanied by dizziness, vexation and agitation,
possible difficulty thinking and/or impaired

Cohort description
Of the 42 patients described in this report, 27 were
male and 15 were female. The oldest was 48 and

memory, a purple, dark tongue with static macules,

and a fine, choppy or rough pulse. CT scan showed
varying degrees of hematoma. The largest
hematoma was 30-40mm and the smallest was 1020mm.

These patients were considered cured. Another 14

cases were considered improved. This meant that
CT scan showed that their hematomas were
basically resolved, their vexation, agitation, and
disquietude (i.e., restlessness), mental confusion,
and any vomiting all had disappeared, but there
was still occasional or intermittent headache
and/or dizziness. Another two cases were defined
as having gotten some effect. This meant that CT
scan showed that their hematomas had partially
resolved. However, there was still some slight
mental confusion as well as headache, vexation,
agitation, and disquietude, even though these
symptoms were markedly decreased.

Treatment method
The basic formula consisted of: Radix Angelicae
Sinensis (Dang Gui), 20g, Radix Ligustici
Wallichii (Chuan Xiong), Semen Pruni Persicae
(Tao Ren), Flos Carthami Tinctorii (Hong Hua),
Rhizoma Corydalis Yanhusuo (Yan Hu Suo),
Radix Rubrus Paeoniae Lactiflorae (Chi Shao
Yao), Radix Rubiae Cordifoliae (Qian Cao), Radix
Polygalae Tenuifoliae (Yuan Zhi), stir-fried Semen
Zizyphi Spinosae (Zao Ren), 15g @, Tuber
Curcumae (Yu Jin), Radix Pseudoginseng (San
Qi), 10g @.

Discussion
Like the authors of the previous article, the author
of this protocol also emphasizes the treatment of
blood stasis in the treatment of closed head injury.
However, in this case, there is actual intracranial
hematoma. In their discussion, the author of this
present article quotes the saying, If static blood is
not removed, new blood is not engendered. This
concept helps explain why closed head injuries are
often eventually accompanied by qi and blood
vacuity symptoms along with other blood stasis
signs and symptoms. After all, the blood is the
mother of the qi and the viscera can only function
if they receive sufficient blood to nourish them. In
addition, the author points out that the use of
Pseudoginseng and Rubia is in order to stop
bleeding at the same time as quickening the blood
and transforming stasis.

If there was simultaneous qi vacuity, Radix

Astragali Membranacei (Huang Qi), Radix
Codonopsitis Pilosulae (Dang Shen), and Rhizoma
Atractylodis Macrocephalae (Bai Zhu) were added.
If there was simultaneous blood vacuity, cooked
Radix Rehmanniae (Shu Di Huang), Fructus Lycii
Chinensis (Gou Qi Zi), and Gelatinum Corii Asini
(E Jiao) were added. If there was simultaneous qi
stagnation, Rhizoma Cyperi Rotundi (Xiang Fu)
and Radix Auklandiae Lappae (Mu Xiang) were
added. And if there was simultaneous damp
stagnation, Sclerotium Poriae Cocos (Fu Ling),
Semen Coicis Lachryma-jobi (Yi Yi Ren), and
Fructus Gardeniae Jasminoidis (Shan Zhi) were
added. These were decocted in water and
administered, one ji per day in two divided doses,
morning and evening.

The author suggests that use of the methods of

quickening the blood and transforming stasis in the
treatment of closed intracranial hematomas might
prevent the suffering of surgical treatment while
still resolving the hematomas.

Treatment outcomes
In 26 cases, CT scan showed that intracranial
bleeding and swelling were completely resolved,
clinical symptoms disappeared, and the patients
were able to return to normal work and lifestyles.

Functionally translated by Bob Flaws Copyright 1998

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