bubble_chart Concept

Knee swelling and pain refers to the swelling and pain in the knee area.

"Knee swelling and pain" was discussed as early as in the Neijing. In the Lingshu．Jingmai chapter, the diseases of the stomach foot Yangming meridian include "swelling and pain of the knee and patella," and similar descriptions are found in other chapters. Subsequent medical works often discuss it under categories such as bi syndrome, pain wind, crane knee wind, and multiple arthralgia. Lingshu．Zabing chapter also mentions "pain in the knee," which, although similar to this condition, involves pain without swelling and thus is not described here.

bubble_chart Pattern Analysis

1. Deficiency of Both Qi and Blood︰Swelling and pain in the knees, soreness and weakness in the limbs, complexion shallow yellow, dizziness, palpitation, tongue texture pale red or tender red, tongue coating thin white, pulse deep and thin. It is the early stage, mild, with loss of muscle fullness but not yet emaciated, and still able to walk.
2. Liver-Kidney Deficiency︰Swollen and painful knees, aching pain in the waist, muscle wasting in the lower limbs, difficulty walking, dizziness and mental fatigue, thin or enlarged tongue, pale or dark tongue texture, thin white coating, deep and weak pulse. It is the advanced stage; in terms of the tendency of the disease, it is severe; in terms of symptoms, there is muscle wasting, gradually leading to only skin and bones remaining; difficulty starting to walk. In terms of treatment, both focus on tonification with dispersion as an auxiliary. For qi and blood deficiency damage, it is appropriate to tonify qi and blood, warm the meridians, and dispel wind-dampness, with the prescription being Major Saposhnikovia Decoction; for liver and kidney deficiency damage, it is appropriate to tonify the liver and kidneys, replenish essence and marrow, and dispel cold-dampness, with the prescription being Three Qi Decoction.
3. Dampness-heat︰The knees are swollen and painful, with a local sensation of heat upon palpation. The complexion is yellow and greasy, the urine is yellow, and the stool is initially dry followed by loose. The tongue texture is tender and red with thin yellow coating, and the pulse is slippery and rapid or soggy and rapid. The treatment principle is to clear heat and eliminate dampness, as well as to unblock the joints. The recommended formula is the modified Two Wonderful Herbs Powder.
4. Cold-dampness Obstruction︰The knees are swollen and severely painful, making it difficult to walk, with cold limbs and aversion to cold. The complexion is pale with a slight bluish tint, the tongue texture is purplish-dark, with a white and slippery coating, and the pulse is deep and tight or deep and slow. The treatment principle is to dispel cold, warm the channels, eliminate dampness, and activate blood circulation. The recommended formulas are Five Accumulations Powder or Yang-Harmonizing Decoction.
5. Internal Invasion of Heat Toxin︰The knee joint is red and swollen with severe pain, as if bitten by a tiger, and movement is difficult, accompanied by body heat, irritability, thirst, scanty dark urine, dry stool, a red tongue texture with dry yellow coating, and a slippery, rapid pulse. This condition has two scenarios: one is caused by external trauma, such as falling, bumping, or being struck, leading to localized bruising, sluggish blood flow, and the generation of toxic heat, resulting in knee swelling and pain; the other is due to invasion of wind toxin, which clashes with blood heat, allowing heat toxin to attack internally, causing knee swelling and pain. The former has a history of trauma, with the knee joint being red, swollen, hot, and painful to the touch, the skin feeling soft upon pressure, heat increasing with pain and pain intensifying with heat. Over time, fluid accumulates in the joint, and if it ruptures, pus flows out like paste or yellow fluid. The onset is rapid, but recovery is slow. The latter is characterized by pronounced swelling and pain on both sides of the knee, with pain as sharp as a drill, making it unbearable to touch, accompanied by fever and irritability, historically termed "knee eye wind." For knee swelling and pain caused by trauma, treatment should focus on {|###|}clearing heat and removing toxin{|###|}, activating blood to benefit the joints, using the formula Five-Ingredient Toxin-Eliminating Decoction combined with harmonizing collaterals and efficacious spirit pill. After rupture, use Ten Major Tonics Decoction to tonify both qi and blood. For "knee eye wind," the approach should be {|###|}clearing heat and removing toxin{|###|}, {|###|}subduing swelling to relieve pain{|###|}, using the formula Immortal Formula Life-Saving Decoction with the addition of Achyranthes Root. Knee swelling and pain due to {|###|}dampness toxin{|###|} accumulation and knee swelling and pain from {|###|}heat toxin{|###|} internal attack! Both are caused by internal pathogenic toxins, hence the intense pain. However, dampness is yin, and heat is yang. {|###|}Dampness toxin{|###|} cases have a slow onset, while {|###|}heat toxin{|###|} cases have a rapid onset. In {|###|}dampness toxin{|###|} cases, the knee joint is diffusely swollen but not red, whereas in {|###|}heat toxin{|###|} cases, the knee joint is red and swollen. Other pulse, tongue, and symptom characteristics also differ. For cases caused by {|###|}dampness toxin{|###|} accumulation, treatment should focus on {|###|}draining dampness{|###|}, dispelling wind, and {|###|}invigorating blood to remove toxin{|###|}, using Coix Seed Decoction.
6. Dampness Toxin Accumulation︰The knee joint is diffusely swollen with heavy pain, accompanied by a heavy head, a heavy body, limb distension and fatigue, abdominal distension and fullness, occasional nausea and vomiting, loose stools, a pale red or dull tongue with a white, greasy, and moist coating, and a deep, slow or wiry, slippery pulse. Dampness toxin accumulation causing knee swelling and pain versus heat toxin attacking internally causing knee swelling and pain! Both are caused by internal pathogenic toxins, so the pain is severe. However, dampness is yin, while heat is yang. Dampness toxin cases have a slow onset, whereas heat toxin cases have a rapid onset. In dampness toxin cases, the knee joint is diffusely swollen without redness, while in heat toxin cases, the knee joint is red and swollen. Other pulse, tongue, and symptom characteristics also differ. For cases caused by dampness toxin accumulation, the treatment should focus on draining dampness, dispelling wind, and invigorating blood to remove toxins. The recommended formula is Coix Seed Decoction.

This condition is commonly seen in adults, but children can also suffer from it, known as "Crane's Knee." It is often due to congenital deficiencies in children, weak kidney qi, and the accumulation of pudendal coldness in the knee area, leading to swelling and pain. The treatment should focus on tonifying the kidney and strengthening the fire. The ancients recommended the Six-Ingredient Rehmannia Pill supplemented with Pilose Antler and Achyranthes Root for treatment. This formula does not treat wind but strengthens the kidney, enabling the kidney to become robust, and the toxicity of pudendal coldness will naturally dissipate. Additionally, there is another condition where the knee causes pain, with mild swelling and mild fever, known as "Wandering Wind of the Knee." The treatment should aim to regulate qi, expel wind, and unblock the meridians, with the main treatment being the Garnet Pill.

The ancients believed that knee swelling and pain are "mild if it occurs in one knee, severe if it occurs in both knees. If the left knee heals and then the right knee becomes ill, or the right knee heals and then the left knee becomes ill, it is called 'Crossing Knee Wind,' which is dangerous." ("The Great Dictionary of Chinese Medicine")

bubble_chart Documentation

1. Yimen Falu．The Miscellaneous Methods of Wind Gate: "Crane knee wind is a condition where wind-cold dampness causes obstruction in the knee. If the knee bone enlarges daily and the muscles above and below gradually wither and thin, do not treat the knee immediately. First nourish the blood and qi to gradually enrich the muscles, and then treat the knee."
2. Zhangshi Yitong．Crane Knee Wind: "The crane knee wind syndrome in women is caused by the disharmony of childbirth and menstruation, or by the damage of liver and spleen due to depression and anger, and is further injured by external contraction. Initially, there may be muscular spasm in the limbs, followed by gradual enlargement of the knee and thinning of the leg, resembling the shape of a crane's knee. If there is high swelling and red pain, it is easy to treat; if there is diffuse swelling without red pain, it is difficult to treat. If it ulcerates within two or three months with thick pus, it is easy to treat; if it ulcerates after half a year with clear pus, it is difficult to treat. Misuse of purgative methods that further damage the original qi makes it even more difficult to treat. The main approach should be to strengthen the original qi. For those with reduced appetite and physical fatigue, use Six Gentlemen Decoction; for those with afternoon fever, internal heat, and alternating chills and fever, use Peripatetic Powder; for fever and chills, use Ten Major Tonics Decoction; for insomnia and palpitations, use Guipi Decoction; for delayed menstruation, use Middle-Tonifying Qi-Replenishing Decoction; for advanced menstruation, use Supplemented Peripatetic Powder; for kidney water deficiency, use Six-Ingredient Rehmannia Pill; for kidney deficiency with wind invasion, use Anshen Pill and Kidney Qi Pill in combination. After ulceration, it is essential to greatly tonify the spleen and stomach. If pus discharge is accompanied by pain, or symptoms such as chills, fever, thirst, etc., these are all signs of qi and blood deficiency, and should be treated with tonification to ensure a favorable outcome."