bubble_chart Concept

Weakness of the loins and knees refers to a condition of weakness and lack of strength in the loins and knees. In mild cases, it is called weakness of loins and knee weakness. Since these two symptoms often occur simultaneously, it is also referred to as weakness of the loins and knees. In severe cases, it is called flaccidity and weakness of the loins and knees. Weakness of loins is often accompanied by knee weakness, but knee weakness can occur independently. Knee weakness is caused by various external injuries that damage the cartilage within the knee joint or by overuse of the knee joint, leading to weakness and lack of strength in the knee as one of the typical symptoms. The disease cause, mechanism of disease, and treatment methods are different from those of weakness of the loins and knees.

Weakness of the loins and knees, especially weakness of loins, often occurs simultaneously with symptoms of soreness in the loins, which is then referred to as soreness and weakness of the loins and knees or sore loins and weak knees. In the Neijing, chapters such as Hai Lun and Jueqi mention "soreness of the shins"; chapters like "Five Stagnations of Body Fluids" mention "pain in the loins and back with soreness of the shins"; and Jingui Yaolue mentions "soreness and emaciation," all of which actually refer to soreness and weakness of the loins and knees (possibly accompanied by lumbago). The difference is that "soreness of the loins is related to kidney deficiency due to sexual overindulgence" (Zhangshi Yitong{|111|}), while weakness of the loins and knees can also be caused by factors such as cold-dampness and dampness-heat, in addition to overuse and kidney deficiency.

bubble_chart Pattern Analysis

1. Liver and Kidney Deficiency︰Weakness in the lumbar and knee regions, possibly accompanied by soreness in the waist, lumbago, cold knees, lingering discomfort, and persistent fatigue, which may slightly alleviate after rest but worsen with exertion. Cold hands and feet, fear of cold, preference for warmth, deafness, tinnitus, clear and frequent urination, loose stools or diarrhea, alopecia areata, and loose teeth; in severe cases, seminal emission or impotence. A sense of exhaustion, mental fatigue, and shortness of breath, which worsen after physical labor; the tongue texture is pale, and the pulse is deep and thin. Weakness in the lumbar and knee regions is one of the main manifestations of kidney deficiency. Neijing states: "The liver governs the tendons," "The kidneys govern the bones," and "The waist is the residence of the kidneys." Insufficient kidney qi leads to weakness and soreness in the loins, lumbago, and worsening with overexertion. The liver and kidneys share the same origin; kidney qi deficiency results in insufficient liver blood, leading to malnourishment of the tendons and causing knee weakness or even "decline of liver qi, inability of tendons to move," resulting in weak legs and difficulty walking. Chronic strain conditions often arise from carrying heavy loads over long distances, prolonged standing that injures the bones, or prolonged walking causing tendon misalignment. Clinically, these are often caused by excessive sexual activity depleting kidney essence and liver blood. Alternatively, they may occur after prolonged or severe illness, when original qi has not recovered, leading to insufficient kidney essence and liver blood, resulting in malnourishment of the bones and tendons and causing lumbar and knee weakness. Clinically, cases often manifest as kidney yang deficiency, presenting with cold limbs, cold waist and knees, deafness, tinnitus, clear and frequent urination, diarrhea, and even seminal emission, impotence, a pale tongue, and a deep, thin pulse—symptoms of kidney yang deficiency. Treatment should focus on nourishing liver blood and replenishing kidney qi. Additionally, as deficiency in the lower energizer (liver and kidneys) often allows dampness (either cold-dampness or dampness-heat) to invade the lumbar and knee regions, formulas for tonifying the liver and kidneys should include herbs for warming and resolving cold-dampness or clearing dampness-heat. Prescriptions such as Dipsacus pills or enriching yin kidney-tonifying pills with modifications may be used. Liang Gong wine can also be taken regularly.
2. Cold-dampness︰Weakness and lack of strength in the waist and knees, accompanied by coldness in the waist and knees, or soreness, heaviness, and pain in the waist and knees. Symptoms worsen in cold, damp, or rainy weather and improve with warmth. The tongue manifestation is normal or with a white coating, and the pulse is deep and thin or slow. This is a cold pattern, specifically cold-dampness Xieke affecting the waist and knees, with dampness as the predominant pathogenic factor, falling under the category of dampness stroke obstruction syndrome. Neijing states: "When injured by dampness, the lower body is affected first," hence cold-dampness often invades the lower body, particularly the waist and knees. When cold-dampness lingers and obstructs yang qi, symptoms such as weakness, soreness, and pain in the waist and knees may occur, with a deep, thin, or slow pulse. Additional symptoms often include heaviness in the waist, discomfort and soreness in the knee joints, coldness in the waist and knees, relief with warmth, and aggravation in cold, damp, or rainy weather. In the initial stage [first stage], this syndrome is mostly an excess pattern, and treatment should focus on dispelling dampness and unblocking obstruction, using the Dampness-Dispelling Obstruction-Resolving Decoction with modifications. For chronic cases often accompanied by deficiency of both the liver and kidneys and insufficiency of qi and blood, the treatment should nourish the liver and kidneys, tonify qi and blood, strengthen the waist and knees, and expel cold-dampness, using Pubescent Angelica and Taxillus Decoction with modifications. Regardless of whether the condition is new or chronic, deficiency or excess, Wuji Jiaojiao Wine can be taken.
3. Dampness-heat︰Weakness in the waist and knees, lower wilting impediment, inability to endure prolonged walking or standing. May be accompanied by redness, swelling, and pain in the knees and feet. Scanty and dark urine, constipation. Tongue coating yellow or greasy, pulse wiry or rapid. This is a heat pattern, often caused by dampness-heat pathogenic qi multiple abscess in the lower energizer. Commonly seen in atrophy-flaccidity disease and beriberi. The clinical manifestations mostly present as a pattern of dampness and heat. In addition to weakness in the waist and knees, if accompanied by redness and swelling in the knees and feet, scanty and dark urine, constipation, yellow and greasy tongue coating, rapid pulse, etc., it is an excess pattern; if accompanied by fever, vexing heat in the chest, palms, and soles, night sweats, dry mouth, red tongue, thin and rapid pulse, etc., it is a deficiency pattern. For the excess pattern, use Two Wonderful Herbs Pill, Atractylodes Rhizome Powder, or Pain-Relieving Decoction with modifications; for the deficiency pattern, use Hidden Tiger Pill with modifications.

Liver and kidney deficiency leading to weakness in the lower back and knees is often caused by overexertion, improper sexual activity, and other factors, mostly presenting as a deficiency pattern. Weakness in the lower back and knees due to cold-dampness is caused by dampness invading the lower energizer, often manifesting as an excess pattern. Weakness in the lower back and knees due to dampness-heat is caused by dampness-heat affecting the lower energizer, which may present as either an excess or deficiency pattern, but most commonly as a complex combination of deficiency and excess.

bubble_chart Documentation

1. "Mai Yin Zheng Zhi": "Weakness of loins, due to hidden heat in the liver and kidney, should be treated with Phelloendron Bark and Stephania Tetrandra." "Jie Yi syndrome, shortage of qi, unwilling to speak, neither cold nor hot, neither strong nor weak, neither stopping nor moving, is due to deficiency of essential qi and excess of kidney evil. It should be treated with Ze Xie and Fu Ling to disperse kidney excess, and Rehmannia, Achyranthes Root, and Ophiopogon Tuber to supplement essential qi."
2. "Zabing Yuanliu Xizhu" ． "Jie Yi syndrome": "Jie Yi is a disease of liver and kidney deficiency. ... It is indeed due to deficiency of the liver and kidney meridians. The liver governs the tendons, and the kidney governs the bones. Liver deficiency leads to weak tendons and lack of strength to bind, ... kidney deficiency leads to withered bones and inability to strengthen oneself ... It is suitable to use Fanxian Jiji Dan (Phelloendron Bark, Chinese Yam, Achyranthes Root, Ginseng, Eucommia Bark, Morinda Officinalis, five flavors, Barbary Wolfberry Fruit, Poria, fennel fruit, Cistanche, Cornus, Milkwort Root, Acorus, Prepared Rehmannia Root, Anemarrhena, Unprocessed Rehmannia Root, Dodder Seed, Ophiopogon Tuber, Black Gardenia, Chrysanthemum, Dried Tangerine Peel)."