Prescription
Main formula
Juan bi tang
Alternative formulas
Yi yi ren tang
Ma xing yi gan tang
Du huo ji sheng tang
Modifications
Patent remedy
Main points
Explanations
Alternative points
Modifications
Diagnosis
Principle of treatment
Acupuncture treatment
Explanations
Downward Flow of Damp-Heat
Symptoms and signs
Principle of treatment
Prescription
Main formula
Si miao san
Alternative formulas
Bai hu jia gui zhi tang and san miao wan
Modifications
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Knee pain
Remove Painful Obstruction Decoction. Besides the effect of dispelling the Wind, eliminating the Cold, resolving the Damp, promoting the Qi and Blood circulation and relieving the pain, this is indicated in knee pain due to invasion of Wind, Cold and Damp with stagnation of Qi and Blood. Chuan Xiong Radix Ligustici Chuanxiong 10g, Hai Feng Teng Caulis Piperis Futokadsurae 10g, Du Huo Radix Angelicae Pubescentis 10g, Huai Niu Xi Radix Achyranthis Bidentatae 10g, and Sang Zhi Fructus Gardeniae 10g should be added to relieve the pain.
Coicis Decoction. This formula has a strong function which can dispel the Wind, eliminate the Cold, resolve the Damp and relieve the pain especially indicated in knee pain due to invasion of Wind, Cold and Damp. Huai Niu Xi Radix Achyranthis Bidentatae 10g and Qin Jiao Radix Gentianae Macrophyllae 10g, etc, could be added to the prescription to relieve the pain.
Ephedra Apricot Kernel, Coicis and Licorice Decoction. This formula can be used to treat knee pain in the early stage due to invasion of Wind, Cold and Damp. It could only eliminate Wind, Cold and Damp in general.
Huai Niu Xi Radix Achyranthis Bidentatae 10g, Qin Jiao Radix Gentianae Macrophyllae 10g, Rou Gui Cortex Cinnamomi 6g, Cang Zhu Rhizoma Atractylodis 12g, Qiang Huo Rhizoma et Radix Notopterygii 12g and Du Huo Radix Angelicae Pubescentis 10g could be added to the prescription to eliminate the External pathogenic factors and relieve the hip pain.
Angelica Pubescens and Sangjisheng Decoction. This formula is indicated in chronic knee pain and lower back pain due to invasion of Wind, Cold and Damp with deficiency of Liver and Kidney. Chuan Xiong Radix Ligustici Chuanxiong 10g, Hai Feng Teng Caulis Piperis Futokadsurae 10g and Sang Zhi Fructus Gardeniae 10g should be added to relieve the pain.
1. If there is fever and chills, add Gui Zhi Ramulus Cinnamomi 10g to relieve the External symptoms and reduce the fever
2. If the knee joints are swollen, add Han Fang Ji Radix Stephaniae Tetrandrae 10g to dispel the Damp, reduce the swelling and sedate the pain
3. If there is a headache, add Man Jing Zi Fructus Viticis 10g to dispel the Wind and relieve the headache.
Jing Fang Bai Du Pian Schizonepeta and Ledebouriella Tablet to Overcome Pathogenic Influences
Han Shi Bi Chong Ji Cold-Damp Bi Syndrome Infusion
Tian Ma Qu Feng Bu Pian Gastrodia Dispel Wind Formula Tablet
TE-5 Waiguan, LI-4 Hegu, GB-31 Fengshi, GB-35 Yangjiao, SP-6 Sanyinjiao and some local Ah Shi points. Reducing method is used on these points. Moxibustion is applied on the local Ah Shi points.
▪ TE-5 and LI-4 dispel External pathogenic Wind and relieve the External symptoms
▪ GB-31 dispels the External Wind and eliminates the Damp in the lower limbs
▪ GB-35, the Accumulation point of the Yang Linking Vessel, harmonises the collateral, promotes the circulation of Qi and Blood and relieves the knee pain
▪ SP-6, the crossing point of the Kidney, Spleen, Liver channels, activates the circulation of Blood, eliminates its stasis and relieves the knee pain
▪ The Ah Shi points around knee joint with moxibustion regulate the circulation of Qi and Blood in the local areas and relieve the knee pain.
LU-7 Lieque, SP-9 Yinlingquan, LR-3 Taichong, GB-34 Yanglingquan and GB-40 Qiuxu, etc.
When there is knee pain with involvement of different channels, corresponding points have to be combined.
1. If there is knee pain along the Bladder channel, add BL-36, BL-40, BL-58 and BL-63 to harmonise the collateral and relieve the pain
2. If there is knee pain along the Gallbladder channel, add GB-34, GB-36, GB-40 and GB-41 to promote the circulation of Qi and Blood in the channel and relieve the pain
3. If there is knee pain along the Stomach channel, add ST-34, ST-35, ST-36, ST-40 and ST-42 to promote the circulation of Qi and Blood in the channel, relieve the blockage and arrest the pain
4. If there is knee pain along the Liver channel, add LR-3, LR-5, LR-6 and LR-8 to harmonise the collateral, promote the circulation of Qi and Blood in the channel and relieve the pain
5. If there is knee pain along the Kidney channel, add KI-3, KI-4, KI-5 and KI-10 to strengthen the Kidney, regulate the circulation of Qi and Blood in the channel and relieve the pain
6. If there is knee pain along the Spleen channel, add SP-3, SP-4, SP-8 and SP-10 to activate the Spleen, promote the circulation of Qi and Blood in the channel, harmonise the collateral and relieve the pain
7. Some corresponding points on the elbow should be added in order to increase the therapeutic effect
8. If there is a slight fever and chills, add LU-7 to dispel the Wind, relieve External symptoms and reduce the fever
9. If the knee joint is swollen, add SP-9, the Sea point of the Spleen channel, to remove the Damp and reduce the swelling
10. If there is generalised body pain, add BL-12 to dispel the Wind, relieve the External symptoms and relieve the body pain
11. If there is a headache, add GB-20 to dispel Wind and relieve the headache
12. If there is redness, swelling and a hot sensation in the knee joint, add ST-44 and GB-43, the Spring points of the Stomach and Gallbladder channel respectively, to clear the Heat and reduce the swelling.
A 40-year-old male had been suffering from severe pain in both knee joints with a cold sensation for 2 months. To begin with, he had caught a cold, and had generalised body pain, a headache, an aversion to cold and a slight fever. He did not feel too bad so did not visit his doctor. One week later, his general symptoms had improved, but he had started to suffer from knee pain. He also felt a weakness in the lower back region and aggravation of the knee pain in cold weather. He was given no clear diagnosis for his knee pain despite all kinds of investigations. Over the previous 2 months, he often took painkillers when the knee pain was severe.
When he arrived at the clinic, he still had pain in his knees with a cold feeling. The pain was mainly along the Spleen channel, with a slight swelling on the knees, and tenderness at both SP-8 and SP-9. His pulse was superficial and tight, and he had a thin and white tongue coating.
Knee pain due to incomplete elimination of Wind, Cold and Damp.
Dispel Wind, warm Cold, eliminate Damp and relieve the pain.
TE-5, LI-4, SP-3, SP-4, SP-6, SP-8, SP-9 and SP-10. Reducing method was applied on these points except for SP-3, on which tonifying method was used. Moxibustion was used on TE-5, LI-4 and SP-3. Treatment was given once every 3 days.
▪ TE-5 and LI-4 dispel External pathogenic Wind, and eliminate Cold and Damp
▪ SP-3, the Source point, with moxibustion warms the channels and dispels Cold
▪ SP-6 and SP-10 activate the circulation of Blood, eliminate its stasis and relieve knee pain
▪ SP-4, the Connecting point, SP-8, the Accumulation point, and SP-9, the Sea point, harmonise the collateral, promote circulation in the channels and reduce knee pain
▪ Moxibustion was applied to warm the channels, dispel Cold and relieve the pain.
The patient was cured after 6 treatments, and he reported no relapse at the 1 month follow-up.
The main symptoms are gradual occurrence of swelling and painful knee joint, which gets worse on touching, with a burning sensation in the knees, redness and limited joint movement. Accompanying symptoms include irritability, restlessness, a poor appetite, a bitter taste in the mouth, scanty and yellow urination, occasional fever, a yellow and greasy tongue coating and slippery and rapid pulse.
Clear the Heat, eliminate the Damp, subside the swelling and sedate the pain.
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Four-Marvel Powder. This formula is mainly indicated in Downward flow of Damp-Heat. Jiang Huang Rhizoma Curcumae Longae 15g, Hai Tong Pi Cortex Erythrinae 15g, Fang Ji Radix Stephaniae Tetrandrae 10g, Dang Gui Radix Angelicae Sinensis 10g and Ren Dong Teng Ramus Lonicerae Japonicae 15g, etc., should be added to eliminate Damp-Heat and relieve the pain.
White Tiger plus Ramulus Cinnamon Decoction and Three-Marvel Pill. When these two formulas are used together, their effectiveness at clearing the Heat, eliminating the Damp and relieving the pain will be much stronger. The same modifications as for the above formula can be applied.
Although these two formulas can be used to treat knee pain due to downward flow of Damp-Heat, the former has the stronger effect on eliminating Damp, and the latter is better for clearing the Heat.
1. If there is a fever, add Jin Yin Hua Flos Lonicerae 10g and Lian Qiao Fructus Forsythiae 10g to clear the Heat and reduce the fever
2. If the knees are swollen and red, add Tu Fu Ling Rhizoma Smilacis 10g and Sheng Di Huang Radix Rehmanniae 15g to clear the Heat, remove the Toxin, reduce the swelling and relieve the pain
3. If there is pus in the knee joint, add Di Fu Zi Fructus Kochiae 10g and Chi Shao Radix Paeoniae Rubra 10g to eliminate Damp-Heat and cool the Blood
4. If there is severe knee pain, add San Leng Rhizoma Sparganii 10g to promote the circulation of Blood and stop the pain
5. If the appetite is poor, add Ban Xia Rhizoma Pinelliae 10g and Chen Pi Pericarpium Citri Reticulatae 10g to regulate the Qi and improve the appetite
