Tong zhi bu tong; Bu tong zhi tong

(“Where there is free flow, there is no pain; where there is pain, there is no free flow.”)

This is the one I’ve been dreading to write. I considered publishing an article before football season started so I could provide the information without a player getting hurt to prompt writing about concussions. While they can be “mild” and my not be season-ending, concussions are very serious. A torn ACL or rotator cuff can be repaired. A hip can be replaced somewhere down the road. You only get one brain, and the effects of head trauma can endure long after the initial injury and symptoms subside.

Injury

Thankfully, Christen Cunningham’s injury has been reported to be mild. He is said to have taken a fall in practice last week, after which he felt a bit off. He entered the concussion protocol and sat out during Louisville’s game against Robert Morris. At the time of writing, there is no word on whether he will be available on December 29 when the Cards take on Kentucky.

Diagnosis

Concussions are often diagnosed based on the injury event and its severity, since symptoms may take hours or days to manifest. This is why many athletes continue to play following injury and why it’s so important, in the realm of sports, to begin evaluation with and at the time of the injury itself. Concussions are the result of traumatic brain injury but are not necessarily due to direct contact to the head. While it’s common to see concussions after collisions in football, basketball, soccer, and baseball and softball, the head itself does not have to be stuck to damage the brain. A concussion can occur with neck or spinal trauma, and it’s not unusual to see a concussion after a hard fall on one’s butt – the force of the impact on the sacrum is conducted through the spine and rattles the skull and brain nonetheless.

The method of diagnosis on which the concussion protocol is based includes physical exam, neurological exam (testing vision, hearing, strength, sensation, reflexes, balance, coordination), and cognitive exam (testing memory, recall, concentration, emotional factors). A CT scan is used to image the brain to detect skull fractures and brain bleeding and swelling.

Symptoms and Anatomy

The most common symptoms of a concussion are headache, disorientation, and memory loss. Many patients may not remember the injury itself. In the hours and days after the trauma, any or all of these symptoms may develop: pain or pressure in the head, loss of consciousness or coma, confusion, brain fog, amnesia, dizziness, ringing in the ears or auditory disturbances, visual disturbances, nausea, vomiting, difficulty speaking, fatigue, light sensitivity, disturbed sleep, mood and personality changes, neurological issues such as temporary paralysis or weakness of the limbs.

There are a lot of serious symptoms that one could possibly experience. It is not an exaggeration to say that this is due to the injury rattling and bruising the brain. There can be bleeding and swelling, and depending on what part of the brain is affected, all manner of aspects of the body’s normal functioning can be in disarray.

Standard Treatment

Treatment is primarily rest and limiting physical and mental exertion. The brain simply needs time and space to heal. The biggest component is observing the patient for 24 hours to ensure that symptoms don’t worsen and that they can awaken normally. Acetaminophen (but not ibuprofen or aspirin) may be used for headaches.

Dr. Colby’s Treatment

In Chinese medicine, we look at concussions as external head injuries which sever the acupuncture channels and blood vessels in the head and brain, causing headache, dizziness, forgetfulness, difficulty thinking, and shen si huang hu, meaning abstraction of the spirit.

When the vessels of the head become damaged, the blood which has bled out becomes static and obstructs the “orifices of the head,” which is the TCM (Traditional Chinese Medicine) way of describing not only the sense organs of the head but also the neural pathways of the brain. Disruption of these neural pathways accounts for the headache, dizziness, brain fog, forgetfulness, etc. Static blood also obstructs the free flow of Qi, so Qi stagnation signs such as irritability, depression, and emotional instability may develop. Just like other sports injuries, concussions are all about a disruption of the normal circulation in the body and the havoc that causes.

The two main patterns of concussion and post-concussion syndrome that TCM identifies are essentially differentiated by severity and acute or sub-acute phases of the initial injury.

A more severe concussion being addressed in the acute phase will focus more on treating stasis obstructing the orifices of the brain. Right after an injury, there will be unclear thinking, unclear speech, vexation, agitation, restlessness. The person’s affect will appear clouded and hazy, and their complexion will look dark. There will be headache and dizziness. The tongue will also appear dark, and the pulse will feel choppy. (Side note: “obstruction of the orifices of the brain” is also the diagnostic terminology used for coma in TCM). The treatment can be both herbal and acupuncture with a focus on promoting circulation in the head to open orifices and arouse the spirit. Acupuncture points in the head are used to stimulate healing in the brain.

The other pattern is more or less a milder version of the first: Qi and blood stasis and stagnation in the head. The symptoms are similar but less severe because, while there is a lack of proper circulation in the head, the orifices are not wholly obstructed. This is usually the presenting pattern hours or days after the injury. Here again we’ll use acupuncture points and herbs to rectify free flow in the head.

Moving further away from the time of the initial injury, symptoms should subside, but without treatment beyond the standard rest and recuperate, some may not. It’s not uncommon for post-concussion syndrome to last for years in the form of recurring brain fog, forgetfulness, tinnitus, and depression or other emotional or personality changes. The more concussions a person suffers throughout their athletic career (or from whatever source), the more susceptible they are to recurrent concussions and prolonged post-concussion symptoms. In more chronic cases, the treatment approach shifts more towards focusing on the pattern associated with their symptoms rather than the head injury. For example, a person with long-standing depression stemming from head trauma might be primarily treated for Liver Qi Stagnation, a common acupuncture diagnosis for emotional depression, but knowing that their medical history includes concussion(s), scalp acupuncture would be utilized, as well.

One thing of note that I find extremely interesting as an herbalist (though you may find extremely gross as a normal person reading a sports medicine article) is that the herbal formulas for extreme head trauma with severe blood stasis and obstruction of the vessels in the brain include the use of worm or insect medicinals. Whether treating neurological damage from trauma or stoke, many formulas include things like earthworm, silkworm, wingless beetle, or scorpion. This is because the properties of these medicinals are extremely good at opening damaged and collapsed blood vessels and neural pathways, restoring functionality to damaged parts of the brain and healing things such as paralysis and impaired cognition and speech. The reasoning is fascinating, too. Worms and insects burrow through the earth, so it is believed that their medicinal properties have a similar burrowing effect in the body. Surely, if you’ve been reading my articles, you know by now that Chinese medicine is weird but has its own strange logic to it.

Prognosis

As always, it depends on the severity of the injury and the overall constitution of the body. Thankfully, CC seems to be doing well after his fall, which Coach Mack called “nasty.” He’s been active on social media and seemed in good spirits at the last basketball game even though he did not play. The biggest thing is rest and being mindful of post-concussion symptoms, which can be subtle but still there as time goes on. Hopefully, he’s back in action soon and doesn’t need to drink any of my bug tea!

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Colby Helton is a Louisville native who pronounces it "Louie-ville." He has lived in Chicago, Germany, China, and San Diego, but people don't watch college basketball in those places, so he moved home. He did his undergraduate studies at Northwestern University and has a Master's of Science in Traditional Oriental Medicine and a Doctorate of Acupuncture and Oriental Medicine from the Pacific College of Oriental Medicine. Colby is also co-owner of AcuBalance Acupuncture & Integrative Medicine in Middletown. He is passionate about UofL basketball, bourbon, and enjoying the two together.

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