Knee pain for a month

Date: 06/03/08 Gender: F

Age: 47

Chief Complaints: Knee pain for a month

Descriptions (4 diagnostic methods)

A) Asking

She has been suffering from knee pain for a month. She first encountered

pain when standing, and felt sudden onset of pain. When standing for a

short time she feels little pain, and as the duration of standing lengthens,

the pain increases. Also, when going down the stairs, she feels “dull”pain.

Sometimes a company with lower back pain. She feels easy to tired.

When applying warmth the pain is relieved. No fever and chill, No thirsty,

normal sleep, no sweating, good appetite, normal urination and defecation.

Past illness history : Neck & Intervertebral disc , cauple tunnel

Life style : Normal, housekeeper

Family history : NAD

B) Inspection

General : Normal complexion (7/10)

Tongue: Pale, teeth mark, white thin coating

C) auscultation/ olfaction

sound : Nothing abnormal detected

Odours : Nothing abnormal detected

D) Palpation

Pulse : Deep & weak pulse especially weak on the chi

Case Summary

Definition:

Knee pain refers to any aching or burning pain in the knee joint. Knee pain can be a symptom of numerous conditions and diseases, including knee stress, osteoarthritis, injury, gout, infection, and bursitis.

WMS:

Knee pain usually results from overuse, poor form during physical activity, not warming up or cooling down, or inadequate stretching. Simple causes of knee pain often clear up on their own with self care. Knee pain can be caused by:

1. Arthritis -- including rheumatoid, osteoarthritis, and gout

2. Baker's cyst -- a fluid-filled swelling behind the knee that may accompany inflammation from other causes, like arthritis

3. Bursitis -- inflammation from repeated pressure on the knee, such as kneeling for long periods of time, overuse, or injury

4. Connective tissue disorders such as lupus

5. Dislocation of the kneecap

6. Iliotibial band syndrome -- a hip disorder related to injury of the thick band that runs from your hip to the outside of your knee

7. Infection in the joint

8. Knee injuries -- may cause bleeding into your knee, which worsens the pain

9. Tendinitis -- a pain in the front of your knee that gets worse when going up and down stairs or inclines

10. Torn cartilage (a meniscus tear) -- pain felt on the inside or outside of the knee joint

11. Torn ligament (ACL tear) -- leads to pain and instability of the knee

12. Strain or sprain -- minor injuries to the ligaments caused by sudden or unnatural twisting

TCM Aetiology and Pathology:

1) Qi stagnation & blood stasis: severe pain & swelling, limitation in movement, ecchymoses on the tongue, wiry / choppy pulse

2) Disharmony of collaterals: aching & dull pain, rigidity & weakness, pale tongue, thready pulse

3) Obstruction of cold-dampness: cold pain & heavy sensation, impaired walking, mild swelling, pale tongue with thin white/greasy coating, wiry/slippery pulse

4) Deficiency of liver & kidney: on and off dull pain/aching, weakness & soreness of waist and knee, pale tongue with little coating, thready pulse

TCM Diagnosis: Knee pain

Syndrome Differentiation: Kidney qi deficiency

Explanation:

The kidney governs the bone and produces the marrow which supplies the brain. When patient is old, kidney’s function will get weak, and then leads to kidney qi deficiency. The kidney qi deficiency gives rise to fatigue, weakness, and sore lumbar and, knee. So the patient has knee pain. Weak chi pulse indicate kidney deficiency.

Treatment principles:

Tonify kidney

Points and Therapies:

Xiyan, Yanglingquan, Xuehai, liangqiu, yinlingquan reducing method

Explanation:

Xiyan is activate the channel.

Liangqiu is activate the channel and alleviates pain

Yanglingquan is benefits the sinews and joint.

Yinlingquan is benefits the lower jiao

Lifestyle advice:

Don’t over work. Take enough rest of long time standing or walking

Follow up consultation

NO. 2

Patient name: Lee

TCM disease: Knee pain

TCM type/pattern: Kidney qi deficiency

Date: 13/03/08

Current condition/changes: She has a little getting better. Still painful.

Treatment principle: Tonify kidney

Prescription: Same as last treatment

NO. 3

Patient name: Lee

TCM disease: Knee pain

TCM type/pattern: Kidney qi deficiency

Date: 13/03/08

Current condition/changes: The symptom same as before.

Treatment principle: Tonify kidney

Treatment adjustment: Jingqu(+), FUliu(+), Taixi(-), Taibai(-)

Explanation: Jingqu(經) lung, Fuliu(復) kidney Lung generate kidney in the five elements. So first treatment is tonify. Kidney. Taibai(兪) Spleen, Taixi(兪) Kidney ). Spleen restrain Kidney. Second treatment is reduce. It is eliminate evil qi.

Case Conclusion

This patient was suffering knee pain. The first and second treatment was the local points but his symptom was not improved. As a result, I used Tonify KI points and his knee pain was significantly improved. Therefore, I realised that when patients have no external injury but have joint pain, it is important to consider patients' age and kidney function,