Some people hear cracking sounds when moving their knees... Wear and tear of knee joint cartilage is one of the most common issues. As the joint bearing the heaviest load and undergoing the most movement in the human body, the knee is also the earliest to degenerate and the most prone to injury.
"The pain is in the joints, the root is in the cartilage, and the source lies in the wear of articular cartilage." Many joint-related diseases, such as bone spurs, meniscus injuries, and degenerative arthritis, are caused by cartilage damage.
In daily life, when people experience joint pain, they often attribute it to the invasion of wind-cold pathogens and use warming and cold-dispersing herbs to counteract it. However, not all pain is caused by wind-cold; some may result from phlegm-dampness.
When both qi and blood are deficient, there isn't enough energy to nourish the limbs, muscles and bones, which can lead to qi and blood stagnation, as well as phlegm accumulation, ultimately causing this type of pain.
Dr. Que Poh Yuen Albert, a TCM expert at Singapore's Gong Fang Tang TCM, explains that knee joint pain is referred to as "knee bi" in traditional Chinese medicine. Conditions like knee pain, knee degeneration, hyperplasia, and knee osteoarthritis all fall under the category of knee bi.
Joints are connected by bones and tendons, so joint problems essentially stem from issues with the bones and tendons.
Let's look at two Chinese patent medicines:
Two Chinese Patent Medicines to Nourish Knee Joints
The Compendium of Medical Formulas states: "When phlegm resides in the lungs, it causes coughing; in the stomach, vomiting; in the head, dizziness; in the heart, palpitations; in the back, coldness; in the ribs, distension—its manifestations are endless." When phlegm-dampness enters the body's meridians and blood vessels, it blocks the flow of qi and blood. Over time, it accumulates and obstructs circulation. In TCM, it is said that "blockage leads to pain." The first step is to resolve the phlegm-dampness in the body. Once the meridians are clear, qi and blood can flow smoothly, nourishing all joints and alleviating pain.
For this purpose, Zhimu Fuling Wan (Pinellia and Poria Pill) can be used. It consists of Pinellia (Banxia), Poria (Fuling), Mirabilite (Xuanmingfen), and Bitter Orange (Zhiqiao). Pinellia dries dampness, while Poria promotes diuresis—together, they address phlegm-dampness. Mirabilite breaks up accumulated phlegm, enhancing the effects of Pinellia and Poria. Finally, Bitter Orange regulates qi flow, ensuring smooth blood circulation.
Resolving phlegm-dampness is only a temporary solution. To address the root cause, it is essential to warm and tonify the spleen and kidneys. These organs, representing the acquired and innate foundations of the body, are fundamental to health. A weak spleen leads to recurrent dampness accumulation, while the kidneys govern bones—most joint pain is related to kidney deficiency. Therefore, strengthening the spleen and kidneys is key to resolving pain.
For this, Fuzi Lizhong Wan (Aconite Center-Regulating Pill) can be used. Its ingredients—dried ginger (Ganjiang) and aconite (Fuzi)—are warm and acrid, dispersing cold and warming spleen-kidney yang. Atractylodes (Baizhu) not only eliminates dampness but also strengthens the spleen, while licorice (Gancao) harmonizes the formula and regulates spleen-stomach qi.
Using these two medicines together can effectively relieve pain caused by phlegm-dampness while preventing its recurrence.
Medical Case
Patient: Zeng, male, 53 years old, long-term outdoor work.
Chief Complaint: Left shoulder and bilateral knee pain for the past 2 years, worsening with cold and alleviating with warmth.
Present Symptoms:
Significant limitation in left shoulder abduction, elevation, and extension
Severe tearing pain upon forceful shoulder lifting
No bowel movement for 3 days
Fatigue and poor complexion
Profuse white phlegm
Pale-purple tongue with white greasy coating
Wiry and thin pulse
Diagnosis: Bi syndrome due to blood stasis (Frozen Shoulder)
Prescription: Modified Zhimu Fuling Wan, Wutou Tang, and Huangqi Guizhi Wuwu Tang:
Pinellia (Banxia) 20g
Poria (Fuling) 15g
Bitter Orange (Zhiqiao) 5g
Mirabilite (Xuanmingfen) 10g (divided and infused)
White Mustard Seed (Baijiezi) 10g
Prepared Aconite (Zhi Fuzi) 30g (pre-boiled with honey)
Prepared Sichuan Aconite (Zhi Chuanwu) 15g (pre-boiled with honey)
Honey-fried Astragalus (Zhi Huangqi) 30g
Turmeric (Jianghuang) 10g
Honey-fried Astragalus (Zhi Huangqi) 30g
Cinnamon Twig (Guizhi) 15g
Red Peony (Chishao) 15g
Safflower (Honghua) 5g
Honey-fried Licorice (Zhi Gancao) 10g
Fresh Ginger (Shengjiang) 6 slices
Jujube (Dazao) 6 pieces
3 doses
Second Visit:
Loose stools 1-2 times daily, relief after bowel movements
Significant reduction in knee pain
Left shoulder pain decreased
Reduced phlegm, now thin and white
Modified prescription with Shuangbi Jianbo Tong Fang, Fuzi Tang, and Huangqi Guizhi Wuwu Tang
Follow-up:
Phlegm disappeared
Shoulder pain greatly reduced, able to resume previous work
Knee pain nearly resolved.
