Knee & Ankle (AC) ™
* Acute knee and ankle injuries: sprain and strain, pain with swelling and inflammation
* Acute leg injuries: damages to the soft tissues, including muscles, ligaments, tendons, cartilages and bones
* Soreness of the knee from repeated pressure and use of the knees, tendonitis, bursitis, sprain and strain, patellar tendonitis
WESTERN THERAPEUTIC ACTIONS
* Analgesic effect to relieve pain
* Anti-inflammatory effect to reduce swelling and inflammation
* Antiarthritic effect to suppress pro-inflammatory cytokines
* Antirheumatic effect to protect against joint destruction
CHINESE THERAPEUTIC ACTIONS
* Clears heat
* Activates blood circulation
* Eliminates blood stasis
* Drains fluids
Take 3 to 4 capsules three times daily. Dosage may be increased up to 5 to 6 capsules every four to six hours as needed. For quick and maximum effectiveness, take the herbs on an empty stomach with warm water.
Chi Shao (Radix Paeoniae Rubrae)
Chuan Mu Xiang (Radix Vladimiriae)
Chuan Niu Xi (Radix Cyathulae)
Chuan Xiong (Rhizoma Chuanxiong)
Da Huang (Radix et Rhizoma Rhei)
Dang Gui (Radix Angelicae Sinensis)
Di Huang (Radix Rehmanniae)
Du Huo (Radix Angelicae Pubescentis)
Gan Cao (Radix et Rhizoma Glycyrrhizae)
Hong Hua (Flos Carthami)
Mo Yao (Myrrha)
Mu Gua (Fructus Chaenomelis)
Ru Xiang (Gummi Olibanum)
San Qi (Radix et Rhizoma Notoginseng)
Su Mu (Lignum Sappan)
Tao Ren (Semen Persicae)
Wu Yao (Radix Linderae)
Xu Duan (Radix Dipsaci)
Ze Lan (Herba Lycopi)
Musculoskeletal and connective tissue injuries lead to over 10 million clinic visits per year in the United States. Causes of these injuries may be external (sports injuries, car accidents, trauma), internal (chronic wear and tear of muscles, ligaments and tendons; bones weakened by osteoporosis), or both. Acute injuries are characterized by severe pain, swelling and inflammation, and in some cases, internal bleeding. Treatment of acute injuries should focus on relieving pain, reducing swelling and inflammation, and stopping bleeding. Chronic injuries are characterized by dull pain, stiffness and numbness, and decreased muscle mass and strength. Treatment of chronic injuries includes relief of pain and restoration of physical and physiological functions.
Knee & Ankle (AC) is designed to treat disorders of the knee and ankle characterized by swelling, inflammation, and pain. It contains herbs that activate qi and blood circulation, eliminate qi and blood stasis, clear heat, and reduce swelling and inflammation.
In this formula, many herbs are used to activate qi and blood circulation. Dang Gui (Radix Angelicae Sinensis), Di Huang (Radix Rehmanniae) and Chuan Xiong (Rhizoma Chuanxiong) are used to tonify blood and activate blood circulation. Gan Cao (Radix et Rhizoma Glycyrrhizae), Chuan Mu Xiang (Radix Vladimiriae) and Wu Yao (Radix Linderae) tonify qi and activate qi circulation. Furthermore, San Qi (Radix et Rhizoma Notoginseng), Ze Lan (Herba Lycopi), Tao Ren (Semen Persicae), Chi Shao (Radix Paeoniae Rubrae) and Hong Hua (Flos Carthami) activate blood circulation and eliminate blood stasis to treat pain. Ze Lan (Herba Lycopi) also has the ability to drain swelling associated with the inflammatory stage in acute pain conditions. Su Mu (Lignum Sappan), Xu Duan (Radix Dipsaci) and Du Huo (Radix Angelicae Pubescentis) open peripheral channels and collaterals to relieve pain. Mu Gua (Fructus Chaenomelis) relaxes the muscles to treat cramps, spasms, and stiffness. It helps repair damaged tendons and ligaments. Da Huang (Radix et Rhizoma Rhei) drains swelling and inflammation that often occur with acute physical injuries. It is one of the most commonly used herbs for acute trauma. Together, Ru Xiang (Gummi Olibanum) and Mo Yao (Myrrha) are used as a pair to dramatically reduce pain associated with external and trauma injuries. Chuan Niu Xi (Radix Cyathulae) and Du Huo (Radix Angelicae Pubescentis) act as channel-guiding herbs to direct the effect of the formula to the lower extremities and increase blood circulation to the area of the knees. Lastly, Gan Cao (Radix et Rhizoma Glycyrrhizae) tonifies qi and harmonizes the formula.
In summary, Knee & Ankle (AC) is an excellent formula to treat acute injuries of the knees and ankles with accompanying swelling, inflammation, and pain.
CAUTIONS & CONTRAINDICATIONS
* This formula is contraindicated during pregnancy and nursing.
* This herbal formula contains herbs that invigorate blood circulation, such as Dang Gui (Radix Angelicae Sinensis). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.,,
* The following warning statement is required by the State of California: “This product contains Da Huang (Radix et Rhizoma Rhei). Read and follow directions carefully. Do not use if you have or develop diarrhea, loose stools, or abdominal pain because Da Huang (Radix et Rhizoma Rhei) may worsen these conditions and be harmful to your health. Consult your physician if you have frequent diarrhea or if you are pregnant, nursing, taking medication, or have a medical condition.”
* Knee & Ankle (AC) is most effective for knee disorders due to acute external or trauma injuries with swelling, inflammation and pain. These types of acute physical injury often affect both the bones and the soft tissues. Clinical applications of this formula include disorders of the bones (bone fracture, dislocation, or meniscus injury of the knees) and surrounding soft tissue damage [anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL)]. Anterior drawer test and posterior drawer test can also be performed to determine whether the ACL or the PCL is damaged.
* According to Dr. Jun-Qing Luo, a tui-na master from China, 70 to 80% of MCL and LCL damages involve a posterior shift of those ligaments. Treatment involves resetting the soft tissue in an upward motion towards the patella. The MCL/LCL should never be stroked downwards toward the popliteal fossa. Treating ACL and PCL injuries does not require excessive force, twisting or pulling motion. He also does not recommend using tui-na treatment during the acute inflammation stage of knee disorders. However, if left untreated, tendons and ligaments may adhere and make treatment more difficult and painful. According to Dr. Luo, ligament and meniscus injuries are better treated with tui na and herbs instead of surgery.
Furthermore, Dr. Luo’s said that patients will often seek your help after their medical doctor confirmed that there is nothing wrong. However, patients still feel knee pain or discomfort. In such cases, the cause is likely just a minor ligament injury. In some cases, knee pain may not reflect where the problem is. It may be caused by problems elsewhere, such as in the greater trochanter causing radiating pain to the knee, the tensor fasciae latae and the iliotibial band, with physical structural changes to compensate for these imbalances that leads to the knee pain. Accurate diagnosis is essential to prescribing the correct formula.
* This formula is not the most suitable formula for knee disorders due to osteoarthritis or rheumatoid arthritis. Osteoarthritis should be treated with Osteo 8 and Knee & Ankle (CR). Rheumatoid arthritis of the knees is more effectively treated with Flex (Heat).
* Because the meniscus is a cartilage and receives very little blood supply, it is important to increase blood supply to the knees so that the surrounding soft tissues receive an adequate supply of fresh blood and oxygen to facilitate healing. If blood stagnation is not removed, recovery time will be prolonged and adhesion is more likely to develop. Following this principle, blood-invigorating herbs are used extensively in this formula.
* Knee & Ankle (AC) is an adjunct formula to acupuncture treatment. Optimal results will occur with acupuncture, electro-stimulation and herbs are all included in the treatment regime.
* For severe pain, combine with Herbal ANG.
* For severe inflammation and swelling, add Astringent Complex.
* For knee and ankle disorder with heat manifestations or re bi (heat painful obstruction), combine with Flex (Heat).
* For knee and ankle disorder with cold and damp manifestations or zhuo bi (fixed painful obstruction), combine with Flex (CD).
* For knee and ankle disorders caused by acute injury or trauma or fracture of bones, use Flex (TMX).
* For ligament injury of the knee and ankle, add Flex (MLT).
* For knee and ankle disorders characterized by atrophy and degeneration, use Osteo 8.
* For bone spurs, add Flex (SPR).
* Xiyan, Liangqiu (ST 34), Xiyangguan (GB 33), Jiexi (ST 41), Kunlun(BL 60), Qiuxu (GB 40), ah shi points.
Classic Master Tung’s Points:
* Needle contralateral to the pain. If the pain is in the center, needle bilaterally or the side with the more ah shi points. If the pain is bilateral, needle bilaterally.
* General knee pain: Xiyan, Jianzhong (T 44.06), Xinxi (T 11.09). Bleed around Gaohuangshu (BL 43) with cupping. Bleed before needling for best result.
* Lateral knee pain: Xinxi (T 11.09), Jianzhong (T 44.06)
* Knee (coldness): Tongguan (T 88.01), Tongtian (T 88.03), Xiyan. Use plum-blossom needle to bleed on and around the knee. Bleed before needling for best result.
* Knee (ligament pain): Shenjian (T 44.19), Jianfeng (T 44.31)*, Shangqu (T 44.16), Jianzhong (T 44.06), Yunbai (T 44.11), Renzong (T 44.08), Quchi (LI 11), Xinling (T 33.17)*
* Chondromalacia patella: Jianfeng (T 44.31)*, Jianzhong (T 44.06), Huofuhai (T 33.07), Tianhuang (T 77.17), Dihuang (T 77.19), Renhuang (T 77.21)
* Knee arthritis: Linggu (T 22.05), Jianzhong (T 44.06), Shangqu (T 44.16), Xiaqu (T 44.15), Libai (T 44.12), Yunbai (T 44.11)
* Medial ankle pain: Xiabai (T 22.07), Minghuang (T 88.12), Tianhuang (T 88.13), Qihuang (T 88.14), Wuhu (T 11.27), ah shi points around the MCP joint of the thumb, Xiaojie (T 22.13)*. Bleed the sprained ankle. Bleed before needling for best result.
* Lateral ankle pain: Linggu (T 22.05), Qimen (T 33.01), Qihu (T 77.26), ah shi points around the MCP joint of the thumb, Xiaojie (T 22.13)*. Bleed the sprained ankle. Bleed before needling for best result.
Master Tung’s Points by Dr. Chuan-Min Wang:
* Knee pain: Needle contra-laterally Jianzhong (T 44.06). Bleed Chize (LU 5) or Quchi (LI 11) area if acute.
* Ankle pain: Needle contra-laterally Zhongbai (T 22.06), Xiabai (T 22.07), Wuhu 4, 5 (T 11.27).
Balance Method by Dr. Richard Tan:
* Ah shi points around Quchi (LI 11), Chize (LU 5) and Shaohai (HT 3). Needle the side that is more tender upon palpation. If the pain is deep on the knee, needle the elbow for up to 1.5 to 2 cun if necessary.
* Select the respective points on the ear for the pain in addition to Subcortex, Shenmen, and Adrenals.
Auricular Medicine by Dr. Li-Chun Huang:
* Knee pain: Knee Joint. Bleed Ear Apex.
§ For external knee joint pain, add External Knee.
§ For internal knee joint pain, add Internal Knee Joint.
* Heel pain: Heel (front and back). Bleed Ear Apex.
* Sulfur helps the absorption of calcium. Adequate intake and absorption of calcium is essential for the repair and the rebuilding of bones, tendons, cartilage, and connective tissues. Consume foods high in sulfur such as asparagus, eggs, fresh garlic, and onions.
* Histidine, an amino acid, is responsible for removing the high levels of copper and iron found in arthritic patients. Consume foods high in histidine, such as rice, wheat and rye.
* Fresh pineapples are recommended as they contain bromelain, an enzyme that is excellent in reducing inflammation.
* Fish oil may help alleviate pain associated with rheumatoid arthritis. It can be taken in conjunction with the herbs.
* Avoid spicy food, caffeine, citrus fruits, sugar, milk, dairy products and red meat.
* Decrease the intake of sour foods, drinks or fruits (citrus), as their nature constricts and may contribute to further stagnation in the channels and collaterals.
* For obese patients, weight loss is suggested as it lessens the pressure on the joints, which can then help in relieving pain.
* Patients who are active in sports should take time off to rest the knee in order to gain full recovery.
* Patients with meniscus and ligament injuries are encouraged to rest and move the knee as little as possible to prevent recurrent injuries. Full movement or sports should not be performed until the knee is completely healed. Jumping or sudden landing are contraindicated.
* The above principles also apply to the ankles as well.
* A 35-year-old male patient presented with acute ankle sprains due to sliding into second base at his softball game. Objective findings included swelling and bruising around both ankles. It was noted that he had iced and taken NSAIDs the night before. The practitioner diagnosed this condition as qi and blood stagnation. Knee & Ankle (AC) was prescribed at 5 capsules three times per day, along with rest and ice. Patient responded well with a full recovery after taking the herbs and receiving acupuncture for three weeks. Recommendation of stretching and warming up before games was also suggested to him for future prevention. Submitted by L.W., Arroyo Grande, California.
* S.V., a 30-year-old female, presented with knee pain, which had produced loss of range of motion and build up of scar tissue. It was noted that she had recently had surgery two weeks before coming in. Her blood pressure was 108/64 mmHg and her heart rate was 64 beats per minute. The practitioner diagnosed this condition as qi and blood stagnation. For treatment, Knee & Ankle (AC) was prescribed at 4 capsules four times per day. After taking the herbs for one week, the patient had reported the pain was less severe beginning after two days. The dosage was decreased after one week to 4 capsules twice per day, which she had continued taking for an additional week. Submitted by M.P., Muskego, Wisconsin.
* A.S., a 45-year-old female, presented with a right lateral ankle sprain that had occurred three days prior. Objective findings included purplish color and swelling around the ankle. The practitioner diagnosed this condition as local blood stagnation. For treatment, Flex (TMX) and Knee & Ankle (AC) were prescribed. After taking the herbs for three days, the patient reported her ankle was feeling 50% better. She discontinued taking the Flex (TMX) after 8 days since her ankle was then 90% better. For an additional week she continued to take the Knee & Ankle (CR) and her ankle was 100% better. Submitted by S.L., Yuma, Arizona.
* E.F., a 60-year-old male, presented with knee pain located above the right patella, beginning two days prior. X-rays had confirmed there was a bone spur present. It was noted that it became aggravated by any weight bearing or change of position. Objective findings included slight swelling and warm temperature. There was no trauma preceding the condition. The practitioner diagnosed this condition as qi and blood stagnation. Knee & Ankle (AC) and Flex (SPR) were prescribed at 2 capsules each three times per day. After taking the herbs for six weeks the condition had resolved. Submitted by L.L., Greenwich, Connecticut.
PHARMACOLOGICAL AND CLINICAL RESEARCH
Knee & Ankle (AC) is most effective for knee and ankle disorders due to acute trauma or external injuries with swelling, inflammation, and pain. Pharmacological effects of this formula include analgesic effect to relieve pain, anti-inflammatory action to reduce swelling, antiarthritic activity to suppress pro-inflammatory cytokines, and antirheumatic function to protect against joint destruction.
Several herbs in Knee & Ankle (AC) have significant analgesic effect to alleviate pain. Ru Xiang (Gummi Olibanum) and Mo Yao (Myrrha) have an analgesic effect to relieve pain and anti-inflammatory to reduce swelling and inflammation., These two herbs also show an antiarthritic effect by reducing edema and decreasing arthritic scores in subjects with adjuvant-induced arthritis. The mechanism of action is attributed to the suppression of pro-inflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin-1beta (IL-1β). Furthermore, use of Ru Xiang (Gummi Olibanum) and Mo Yao (Myrrha) is also beneficial to facilitate wound healing by stimulating maturation and differentiation of white blood cells. Clinically, these two herbs have been used effectively to treat pain associated with various types of trauma and external injuries.
Knee & Ankle (AC) contains many herbs with both analgesic and anti-inflammatory effects. Dang Gui (Radix Angelicae Sinensis) alleviates pain and reduces inflammation through the inhibition of pro-inflammatory mediators, including nitric oxide and prostaglandin E2 in peritoneal macrophages., In comparison with acetylsalicylic acid, the anti-inflammatory effect of Dang Gui (Radix Angelicae Sinensis) is approximately 1.1 times stronger, and its analgesic effect is approximately 1.7 times stronger.In addition, Du Huo (Radix Angelicae Pubescentis) has a mild sedative effect and marked analgesic and anti-inflammatory activities. Lastly, Da Huang (Radix et Rhizoma Rhei) has both analgesic and anti-inflammatory effects. Emodin and rhein, two compounds from Da Huang (Radix et Rhizoma Rhei), exert their anti-inflammatory effect via inhibition of inducible nitric oxide synthase.
Many herbs in Knee & Ankle (AC) have strong effects to reduce swelling and inflammation. Chuan Xiong (Rhizoma Chuanxiong) exerts its anti-inflammatory effect via an inhibitory activity on TNF-α production and bioactivity, and shows promising effect to treat inflammation and related diseases. Chuan Mu Xiang (Radix Vladimiriae) exhibits an anti-inflammatory effect through significant inhibitory effects on INF-γ-induced nitric oxide production. San Qi (Radix et Rhizoma Notoginseng) suppresses inflammation by inhibiting lipopolysaccharide-induced production of proinflammatory mediators, such as TNF-α, COX-2, IL-1, and IL-6. Su Mu (Lignum Sappan) has both anti-inflammatory and antiarthritic effects. It suppresses inflammation through the inhibition of nitric oxide activity, and attenuates collagen-induced arthritis by decreasing the levels of IL-1β, IL-6, TNF-α and PGE2 in serum and the expression of COX-2 and transcription factor NF-κB. Wu Yao (Radix Linderae) has both anti-inflammatory and antirheumatic effects. It reduces inflammation via its inhibitory effects on the production of inflammatory mediators from macrophages by blocking NF-kappaB and MAPKs signaling pathways. It treats rheumatism by protecting against joint destruction in type II collagen-induced model of rheumatoid arthritis.
Di Huang (Radix Rehmanniae) and Gan Cao (Radix et Rhizoma Glycyrrhizae) also have anti-inflammatory effects, with different mechanism of action. Di Huang (Radix Rehmanniae) reduces swelling and inflammation through its influence on the endocrine system. It has been shown that the use of Di Huang (Radix Rehmanniae) increases the plasma levels of adrenocortical hormones, even in the presence of dexamethasone. Gan Cao (Radix et Rhizoma Glycyrrhizae) demonstrates marked anti-inflammatory effects by enhancing the effect of glucocorticoid through increased production and secretion as well as decreased metabolism by the liver. In terms of anti-inflammatory actions, the comparison of cortisone to glycyrrhizin and glycyrrhetinic acid, two compounds from Gan Cao (Radix et Rhizoma Glycyrrhizae), is approximately 10:1. Clinically, Di Huang (Radix Rehmanniae) has been used in an herbal formula to successfully treat 12 patients with rheumatoid arthritis. Gan Cao (Radix et Rhizoma Glycyrrhizae) has been used with success to treat pain, inflammation, edema, arthritis, spasms, cramps and other related symptoms.,
Finally, many herbs are used in Knee & Ankle (AC) to facilitate healing and recovery from acute knee and ankle injuries. San Qi (Radix et Rhizoma Notoginseng) has an excellent osteogenic effect to treat bone fractures. San Qi (Radix et Rhizoma Notoginseng) promotes osteogenesis of bone marrow stromal cells by targeting osteogenesis-associated genes, which could be mediated by their actions on gap junction intercellular communication. By improving the osteogenic differentiation of bone marrow stromal cells, San Qi (Radix et Rhizoma Notoginseng) is able to enhance bone mineral density and bone strength. Xu Duan (Radix Dipsaci) has significant osteogenic and antiosteoporotic effects that promote generation of new bones and prevent osteoporosis. According to a bone cells culture experiment, administration of Xu Duan (Radix Dipsaci) shows potential effect to increase the proliferation and differentiation of the osteoblasts without affecting osteoclast activity. The researchers conclude that Xu Duan (Radix Dipsaci) can effectively increase the rate of tissue regeneration of damaged bones.
In summary, Knee & Ankle (AC) is an excellent formula to use during the first days and weeks of leg injury to relieve pain, reduce swelling and inflammation, and facilitate recovery.
Pain is a basic bodily sensation induced by a noxious stimulus that causes physical discomfort (such as pricking, throbbing, or aching). Pain may be of acute or chronic states. For acute pain of the legs (including knees and ankles), two classes of drugs commonly used for treatment include non-steroidal anti-inflammatory agents (NSAID) and opioid analgesics. NSAIDs [such as Motrin (ibuprofen) and Voltaren (diclofenac)] are generally used for mild to moderate pain, and are most effective to reduce inflammation and swelling. Though effective, they may cause such serious side effects as gastric ulcer, duodenal ulcer, gastrointestinal bleeding, tinnitus, blurred vision, dizziness and headache. Furthermore, the newer NSAIDs, also known as COX-2 inhibitors [such as Celebrex (celecoxib)], are associated with significantly higher risk of cardiovascular events, including heart attack and stroke. Opioid analgesics [such as Vicodin (APAP/hydrocodone) and morphine] are usually used for severe to excruciating pain. While they may be the most potent agents for pain, they also have the most serious risks and side effects, including but not limited to dizziness, lightheadedness, drowsiness, upset stomach, vomiting, constipation, stomach pain, rash, difficult urination, and respiratory depression resulting in difficult breathing. Furthermore, long-term use of these drugs leads to tolerance and addiction. In brief, it is important to remember that while drugs offer reliable and potent symptomatic pain relief, they should be used only if and when needed. Frequent use and abuse leads to unnecessary side effects and complications.
In TCM, treatment of pain is a sophisticated balance of art and science. Proper treatment of pain requires a careful evaluation of the type of disharmony (excess or deficiency, cold or heat, exterior or interior), characteristics (qi and/or blood stagnations), and location (upper body, lower body, extremities, or internal organs). Furthermore, optimal treatment requires integrative use of herbs, acupuncture, and tui-na therapies. All these therapies work together to tonify the underlying deficiencies, strengthen the body, and facilitate recovery from chronic pain. TCM pain management targets both the symptoms and causes of pain, and as such, often achieves immediate and long-term success. Furthermore, TCM pain management is often associated with few or no side effects.
For treatment of mild to severe pain due to various causes, TCM pain management offers similar treatment effects with significantly fewer side effects.
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