Knee & Ankle (CR) ™
* Chronic knee and ankle disorders with atrophy and degeneration of the soft tissues (muscles, tendons and ligaments)
* Chronic leg disorders with weakness, stiffness, decreased range of motion and mobility of the joints
* Sprain, partial rupture, stretch or tear of ankle ligaments leading to instability and frequent re-injuries.
WESTERN THERAPEUTIC ACTIONS
* Chondroprotective function to protect joints and cartilages
* Osteogenic function to promote generation of new bones
* Anti-inflammatory effect to reduce swelling and inflammation
* Analgesic effect to relieve pain
* Muscle-relaxant effect to relieve spasms and cramps
CHINESE THERAPEUTIC ACTIONS
* Tonifies qi, blood and yin
* Activates qi and blood circulation
* Opens channels and collaterals of the lower limb to relieve pain
Take 3 to 4 capsules three times daily. Depending on the nature and severity of the illness, the dosage may be increased up to 8 capsules three times daily for three or four days to relieve pain. For maximum effectiveness, take the herbs on an empty stomach with warm water. This formula should not be taken during the acute phases of injuries, where there is still bleeding, inflammation, and bruising.
Bai Shao (Radix Paeoniae Alba)
Bai Zhu (Rhizoma Atractylodis Macrocephalae)
Chuan Niu Xi (Radix Cyathulae)
Da Zao (Fructus Jujubae)
Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae)
Dang Gui (Radix Angelicae Sinensis)
Dang Shen (Radix Codonopsis)
Di Huang (Radix Rehmanniae)
Du Zhong (Cortex Eucommiae)
Fu Ling (Poria)
Gan Cao (Radix et Rhizoma Glycyrrhizae)
Huang Bo (Cortex Phellodendri Chinensis)
Ji Xue Teng (Caulis Spatholobi)
Mu Dan Pi (Cortex Moutan)
Qian Nian Jian (Rhizoma Homalomenae)
Shan Yao (Rhizoma Dioscoreae)
Shen Jin Cao (Herba Lycopodii)
Sheng Jiang (Rhizoma Zingiberis Recens)
Shu Di Huang (Radix Rehmanniae Praeparata)
Wu Jia Pi (Cortex Acanthopanacis)
Ze Xie (Rhizoma Alismatis)
Zhi Mu (Rhizoma Anemarrhenae)
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 (CR) is designed to treat chronic degenerative knee disorders with swelling, inflammation, and pain. This formula incorporates tonic herbs to address the chronic and degenerative nature of illness. Furthermore, it contains herbs that activate qi and blood stagnation, clear heat to reduce swelling and inflammation, and open the channels and collaterals to relieve pain.
Dang Gui (Radix Angelicae Sinensis), Di Huang (Radix Rehmanniae), Shu Di Huang (Radix Rehmanniae Praeparata), and Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) tonify blood, activate blood circulation, and disperse blood stagnation. Dang Shen (Radix Codonopsis), Bai Zhu (Rhizoma Atractylodis Macrocephalae), and Gan Cao (Radix et Rhizoma Glycyrrhizae) tonify qi. Bai Shao (Radix Paeoniae Alba)and Shan Yao (Rhizoma Dioscoreae) nourish yin to relieve chronic bi zheng (painful obstruction syndrome) with underlying Kidney deficiencies. Mu Dan Pi (Cortex Moutan), Zhi Mu (Rhizoma Anemarrhenae), and Huang Bo (Cortex Phellodendri Chinensis) clear deficiency heat to reduce chronic swelling and inflammation. Ze Xie (Rhizoma Alismatis) and Fu Ling (Poria) eliminate water accumulation and reduce swelling. Chuan Niu Xi (Radix Cyathulae) dispels stagnation and opens the channels and collaterals.
As many patients experience pain or worsening of their condition prior to rainy days, antirheumatic herbs should be used. Wu Jia Pi (Cortex Acanthopanacis), Qian Nian Jian (Rhizoma Homalomenae), Du Zhong (Cortex Eucommiae) and Shen Jin Cao (Herba Lycopodii) dispel wind-damp to treat bi zheng (painful obstruction syndrome). Shen Jin Cao (Herba Lycopodii) also has the effect to relieve stiffness. Sheng Jiang (Rhizoma Zingiberis Recens), Da Zao (Fructus Jujubae) and Gan Cao (Radix et Rhizoma Glycyrrhizae) harmonize all the herbs in the formula. Ji Xue Teng (Caulis Spatholobi) moves blood, opens channels and collaterals, and enhances flexibility. Lastly, Chuan Niu Xi (Radix Cyathulae) also acts as a channel-guiding herb to direct the therapeutic qualities of the formula to the affected area in the lower extremities.
Overall, Knee & Ankle (CR) is a well-balanced formula that addresses chronic and degenerative aspects of chronic knee disorders.
CAUTIONS & CONTRAINDICATIONS
* This formula should not be used alone in patients with acute physical injuries of the knees, such as external injuries or trauma with actual damage to the soft tissues (muscles, tendons, and ligaments). Patients with acute physical injuries of the knees or ankles, such as external injuries or trauma with actual damage to the soft tissues (muscles, tendons, and ligaments), should be treated with Flex (TMX), Knee & Ankle (AC) or Herbal ANG.
* This formula should not be used alone in patients with inflammatory knee disorders, such as rheumatoid arthritis, bursitis, synovitis and tenosynovitis. Patients with such conditions should be treated with Flex (Heat), Flex (CD) or others depending on the TCM diagnosis.
* This herbal formula contains herbs that invigorate blood circulation, such as Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) and 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.,,
* This formula is an excellent adjunct formula to acupuncture treatment. Optimal results will occur when acupuncture, electro-stimulation, and herbs are all included in the treatment regimen.
* Patients with arthritis should avoid vigorous exercise of the knee. Mild exercise, such as tai chi chuan [tai ji chuan] and walking, are recommended.
* This formula is most effective when taken during the recovery and rehabilitation phases of treatment. Strengthening exercises help to ensure recovery of the integrity of the knee and ankle ligaments.
* In cases where acute sprain and strain of the knees and ankles are not treated properly, the ligaments and joints will become unstable and re-injury may occur more frequently. Knee & Ankle (CR) can ensure the repair of minor tears of the ligaments and can facilitate complete recovery to prevent the future possibility of re-injury.
* For ligament injuries or degeneration of soft tissue, add Flex (MLT).
* For knee disorders with manifestations of heat or re bi (heat painful obstruction), combine with Flex (Heat).
* For knee disorders with manifestations of cold and damp or zhuo bi (fixed painful obstruction), combine with Flex (CD).
* For bone spurs, add Flex (SPR).
* For osteoarthritis of the knee, add Osteo 8.
* For acute pain in the lower back, combine with Back Support (AC).
* For chronic pain in the lower back, combine with Back Support (CR).
* For spasms and cramps in the legs, combine with Flex (SC).
* Xiyan, Liangqiu (ST 34), Xiyangguan (GB 33), Jiexi (ST 41), Kunlun (BL 60), Qiuxu (GB 40), relevant 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 contralaterally Jianzhong (T 44.06). Bleed Chize (LU 5) or Quchi (LI 11) area if acute.
* Ankle pain: Needle contralaterally 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 in 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.
* Glucosamine sulfate and chondroitin sulfate are well recognized for their nutritional support, as they are important for the formation of bones, tendons, ligaments, and cartilages.
* Sea cucumber is very beneficial, as it contains a rich source of compounds that are needed in all connective tissues, especially synovial joints and joint fluids.
* It is important to consume an adequate amount of various vitamins and minerals, as they are essential to prevent bone loss and promote bone growth.
* It is important to engage in gentle exercises daily. This will not only facilitate recovery, but will also prevent muscle atrophy and muscle wasting.
* Avoid activities with high impact or high risk of injury.
* K.L., a 42-year-old male, presented with right hip and leg pain and numbness. He was using crutches with decreased and impaired mobility for the previous three months. Symptoms of stiff neck, frozen ankle, and pain affecting his sleep were present. The patient had a tendency to get injuries due to his poor balance. The practitioner diagnosed the condition as bi zheng (painful obstruction syndrome) with blood deficiency and blood stasis with qi constraint. His Western diagnosis was muscle atrophy. The patient was given Flex (MLT) for eight weeks with the addition of Knee & Ankle (CR) for four weeks. With both formulas and receiving acupuncture treatment for eight weeks, the patient regained 100% of his leg use, moving from crutches to a cane. The patient resumed sleeping flat after three weeks and riding a bicycle after eight weeks. Pain reduced from 10 to 0 on a 1-10 scale. The patient was very pleased with the herbs, has started a yoga practice and has become more enthusiastic about life. Submitted by K.F., Honolulu, Hawaii.
* L.K., a 58-year-old female, presented with pain located on her left knee. Objective findings included limited range of motion, pain with movement, and limping. It was noted that her pain level was 7 out of 10, and the pain was only slightly alleviated with elevation or rest. The practitioner diagnosed this condition as qi and blood stagnation along with Liver and Kidney yin deficiencies. Knee & Ankle (CR) and Herbal ANG were prescribed upon diagnosis. After taking the herbs and receiving acupuncture, the patient’s ROM was greater and her pain level had reduced. Submitted by J.C., Rosemead, California.
* 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 eight 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.
PHARMACOLOGICAL AND CLINICAL RESEARCH
Knee & Ankle (CR) is an excellent formula for rehabilitation from chronic knee or ankle disorders, such as repetitive knee injuries or long-term wear and tear of the joint. As a result, the chronic nature of this condition may eventually contribute to atrophy and degeneration of the knee joints, accompanied by decreased mobility of the joints, and generalized weakness and pain. This formula is designed specifically to treat this condition, as it contains herbs with chondroprotective functions to protect joint destruction and cartilage erosion, osteogenic functions to promote generation of new bones, anti-inflammatory effects to reduce swelling and inflammation, analgesic effects to relieve pain, and muscle-relaxant effects to relieve spasms and cramps.
To facilitate healing and recovery from chronic leg injuries, many herbs are used to promote healing of cartilages, nerves, and bones. Chuan Niu Xi (Radix Cyathulae) is an excellent herb to protect the cartilage from repetitive and stress-induced injuries. According to one study, the extract of Chuan Niu Xi (Radix Cyathulae) has a potent effect to inhibit the induction of MMP-13, an important enzyme for the degradation of the cartilage collagen matrix, especially under arthritic conditions. By down-regulating the MMP-13 activity, Chuan Niu Xi (Radix Cyathulae) shows great chondroprotective benefit against cartilage degrading disorders. Dang Shen (Radix Codonopsis) promotes neuron regeneration in a dose-dependent manner. Specifically, it activates IGF-I and FGF-2 pathways to induce proliferation and migration effects in RSC96 Schwann cells. Dang Gui (Radix Angelicae Sinensis), Du Zhong (Cortex Eucommiae), Shu Di Huang (Radix Rehmanniae Praeparata) and Zhi Mu (Rhizoma Anemarrhenae) all have beneficial effects on the bones. Dang Gui (Radix Angelicae Sinensis) is an effective herb to promote the generation of bones. According to one study, the water extract of Dang Gui (Radix Angelicae Sinensis) has been found to contribute to the formation of bones and treatment of bone injuries. It directly stimulates the proliferation, alkaline phosphatase activity, protein secretion and particularly type I collagen synthesis of human osteoprecursor cells in a dose-dependent manner. Du Zhong (Cortex Eucommiae) has significant osteogenic and antiosteoporotic effects that promote generation of new bones and prevent osteoporosis. According to a bone cells culture experiment, administration of Du Zhong (Cortex Eucommiae) shows a potential effect to increase the proliferation and differentiation of the osteoblasts without affecting osteoclasts activities. The researchers conclude that these herbs can effectively increase the rate of tissue regeneration of damaged bones. Shu Di Huang (Radix Rehmanniae Praeparata) has an antiosteoporotic effect to prevent osteoporotic bone loss. This herb stimulates the proliferation and activities of osteoblasts, while inhibiting the generation and resorptive activities of osteoclasts. Lastly, Zhi Mu (Rhizoma Anemarrhenae) has an osteoprotective effect. It is effective to prevent bone loss through the promotion of bone formation but not the inhibition of bone resorption.
Knee & Ankle (CR) also contains herbs with marked analgesic and anti-inflammatory effects to relieve pain, and reduce swelling and inflammation. For example, Dang Gui (Radix Angelicae Sinensis) has marked analgesic and anti-inflammatory effects, with potency similar or stronger than that of acetylsalicylic acid., Wu Jia Pi (Cortex Acanthopanacis) also has excellent analgesic and anti-inflammatory effects with the duration of action lasting up to five hours., Bai Shao (Radix Paeoniae Alba) and Di Huang (Radix Rehmanniae) have anti-inflammatory and antipyretic effects, and are helpful to reduce inflammation and swelling, as well as relieve burning sensations in affected areas., Mu Dan Pi (Cortex Moutan) and Du Zhong (Cortex Eucommiae) have strong anti-inflammatory actions. Pharmacologically, the mechanisms behind the anti-inflammatory effects of these herbs vary, but most have been attributed primarily to the inhibition of prostaglandin synthesis and decreased permeability of the blood vessels. Alternatively, some anti-inflammatory mechanisms involve stimulation of the endocrine system and consequent secretion of steroids from the adrenal cortex. Clinically, these herbs have been used with great success to treat a wide variety of musculoskeletal conditions, including but not limited to muscle wasting, muscle atrophy, chronic soft tissue injuries, and various types of pain.,
Bai Shao (Radix Paeoniae Alba) has excellent muscle-relaxant effect to relieve spasms, cramps, and muscle stiffness. This efficacy has been demonstrated in both smooth and skeletal muscles. In addition, Bai Shao (Radix Paeoniae Alba) and Gan Cao (Radix et Rhizoma Glycyrrhizae) are effective in treating neuralgia. Furthermore, Bai Shao (Radix Paeoniae Alba) and Gan Cao (Radix et Rhizoma Glycyrrhizae) have shown marked effectiveness to treat pain of the entire body, especially in the lower back and legs.
Lastly, Knee & Ankle (CR) uses many herbs with adaptogenic effects to facilitate both mental and physical aspects of rehabilitation. Dang Shen (Radix Codonopsis) has a regulatory effect on the central nervous system to help with adaptation to various stressful environments. Wu Jia Pi (Cortex Acanthopanacis) enhances physical adaptation by increasing endurance and performance.
In summary, Knee & Ankle (CR) is an excellent formula for chronic knee and ankle disorders. Degeneration of soft tissues (muscles, tendons, and ligaments) is often seen in chronic knee and ankle disorders that lead to decreased range of motion and mobility of the joints. With late-stage musculoskeletal injuries, muscle wasting and atrophy are present due to lack of exercise and physical movement. Knee & Ankle (CR) is developed specifically to address all of these conditions by using herbs that compliment the rehabilitation process and complete the recovery from these injuries.
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 state, and may be of nociceptive, neuropathic, or psychogenic origin. For acute pain, use of non-steroidal anti-inflammatory agents (NSAID) and opioid analgesics offer immediate and reliable effects to relieve pain. Though these drugs have serious side effects, short-term use can be justified because the benefits often outweigh the risks. For chronic pain, on the other hand, use of NSAIDs and opioid analgesics are usually not the desired treatment options, as they symptomatically relieve pain, but do not change the underlying course of illness. Unfortunately, the convenience of these drugs contributes to the vicious cycle of pain, followed by continuous and repetitive use of drugs to symptomatically relieve pain. When the effect of the drugs dissipates, patients are often left with nothing but more pain and more complications from side effects. Therefore, it is important to understand that while these drugs may be beneficial for acute pain, they do not adequately address most cases of chronic pain. Additional treatment modalities must be incorporated to ensure effective and complete recovery from chronic pain conditions. [Note: Common side effects of NSAIDs include gastric ulcer, duodenal ulcer, gastrointestinal bleeding, tinnitus, blurred vision, dizziness and headache. Serious side effects of newer NSAIDs, also known as COX-2 inhibitors [such as Celebrex (celecoxib)], include significantly higher risk of cardiovascular events, including heart attack and stroke. Side effects of opioid analgesics [such as Vicodin (APAP/hydrocodone) and morphine] include 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.]
Treatment of chronic 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 symptom and the cause 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. Though TCM therapies may not be as potent as drugs for acute pain management, they are often superior [better effects with fewer side effects] for chronic pain management.
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