Treating pain in the right knee

Name: Marja M.
Date of birth: 8/11/50.
Reason for consultation: Pain in the right knee.

Clinical background: nothing relevant to the case
Finnish lady, widowed,  with a robust constitution, with a happy character, outgoing, sporty history, with a history of pain in the knees during the last ten years.
Last year she had a knee protests implant in the left leg for lack of cartilage and unbearable pain.
The operation has been a succes with successful recovery.
For reasons of compensation during the recovery, but probably already before the operation, the pain has passed to the right knee.

The last ten years, after the death of her husband, she has stopped to practice sport and subsequently has gained weight. Around 40 kilos. One thinks about a state of anxiety.
She is mother of two daughters , already grown up, with one (of 28) with a large and severe history of bulimia and anorexia, now in successful recovery.
Complexion: pink with a flushed face, shining eyes, tendency to sweat with a slow and painful mobility.
Palpation shows serious tension in the shoulder and neck area as well in the lumbar region.
Pulse is fast and big, but empty and slipping as well, tense as well in the liver area as in the heart zone. Indicating an emptiness of yin of the kidneys and the liver with a condition of heat combined with ‘dampness’ (tan).
The tongue is red without cover even redder in the sides and the tip.

The syndrome of ‘Bi’ from Traditional Oriental Medicine means: Painful Obstruction Syndrome has its cause in the invasion of cold humid ‘wind’. In the case of invasion of wind one sees painful inhibition of movement in the muscles and articulations moving from one articulation to the other. Combined with ‘dampness’ it gives way to swelling in one articulation with the feeling of numbness and heaviness, made worse by humid climatological circumstances.
Combined with cold it produces acute pain with limitation of mobility, normally only on one side.
The combination of wind with ‘dampness’ and cold can on a long turn produce, as in the case of this lady a situation of ‘Bi’ syndrome with heat.
Especially when there is a background of emptiness of ‘yin’ (‘cool’ substance, interior, liquids, nutrition) it gives rise to intense pain combined with heat in the articulations, painful at though, swelling, redness and limitation of mobility.
Diagnostic in this case is heat combined with ‘humidity’, but the main pathological factor is ‘dampness’.
On the long term this situation of heat humidity will develop into ‘Bi’ syndrome in the bones.
If this process will go on during a long period of time it will produce local blood stasis that will produce muscular atrophy, swelling and bone deformation, a extreme form of what is called ‘Phlegm’ in TOM.
In every case of ‘Bi’ syndrome one has to consider that the three invasive factors (wind, cold and humidity) are at the base of the problem.
The other important factor to consider is  that the invasion of what T.O.M. calls pernicious energies (wind, cold, dampness) is related to a weakness off the kidney energy  and the Du Mai or governor function/meridian who is seen as the ‘backbone’ of the bodily functions (Du Mai is considered ‘The sea of Yang energy, related to the nervous system and all bodily activity) and together with the kidney energy  stands as the basis of ‘Wei Qi’ or defensive energy, meaning the immunity to penetrating pernicious energies.
In this case any treatment should be combined with an effort to lose weight.

Treatment: mobilise Qi-Xue (energy and blood), expulse heat-dampness, tonify Qi and Yin of the kidneys and liver, strengthen Du Mai, calm anxiety and ease the pain.

The first step was to put her on a diet. Her knees literary could not handle her lack of movement and her weight. Also she had to start moving, therefor she bought a static bike to start exercising at home.
According to T.O.M., internal dampness is  related to a malfunctioning of the spleen-pancreas function. Therefore elimination of blood sugar rising food was required. The diet that should be most helpful in this case is the Paleo-diet, the diet that Fred Flintstone was eating before the cultivation of grains and pulses etc. No carbohydrates, only food that originally was not cultivated. Meat, fish, shellfish, algae,  ‘wild’ green leafs like salad, spinach, broccoli, asparagus etc. mushrooms, fruit, nuts etc. No lactic products.

She has a house in the ‘Costa Brava’ in Spain, with a swimming pool that she had to use more often to tonify her muscles without stressing the knee-joints and gradually bring up her pulsations as a ‘light’ cardio.
Shiatsu treatment and Qi-Kung exercises should complement her whole program to liberate her muscular tension and induce deeper breathing, strengthening her Du Mai, kidney and ‘Wei Qi’  or defensive energy.
She started a program to specifically tonify her quadriceps and adductors to give more stability to the knees and alleviate the pain.

Used acupuncture points:

To Tonify Du Mai: Ming Men (Du Mai 4), and Da Zhui (D.M. 14)
Basic points to strengthen bones and bone marrow: Da Shu (Bladder 11), Xuang Zong (Gallbladder 39).
For Damp-Heat: Quchi (Large intestine 11), Fenglong (stomach 40), Xiangu (St. 43), Hegu (L.I. 4), Yinlingquang (Spleen-Pancreas 9). San Yin Jiao (S.-P. 6), Pi Shu (Bladder 20), Zhongwan (Ren Mai 12) Shui Fen ( R.M. 9) and Xing Jian (Liver 2).
To eliminate blood stasis: Xue Hai (S.P. 10), Ge Shu (B. 17), Nei Guan (Pericardium 6).
To strengthen Liver and Kidneys: Shen Shu (B. 23), Taixi (Kidney 3), Fu Liu (K. 7), Gan Shu (B. 18), Ququan (liver 8), Guan Yuan (Ren Mai/conception vessel 4), Yanglingquan (G.B. 34), Zu San Li (s. 36), San Yin jiao (S.-P-6)
To calm anxiety: Tai Chong (L.3), with Nei Guan (P. 6), Shen Men (Heart 7) with Tan Zhong (R.M. 17) and Pa Hui (D.M. 20)
To calm the pain: distant points: Shangqiu (S.-P- 5) and Qiuxu (G.B. 40)
local points: Yinlinquan (S.-P. 9), Yanglinquan (G.B. 34) Zu San Li (S.36), Xiguan (L. 7), Weizhong (B. 40) and extra points Xiyan (the ‘eyes of the knee of which the exterior corresponds to Du Bi (S. 35).
To calm anxiety auricular acupuncture was used. Points used: Shen Men, Thyroid and Para-renals.
To help clean the liver and blood western herb combination was used with: Cardo Mariano, Artichoke, Gentianum.

In 12 sessions her mobility improved significantly, pain still persists but at a much more manageable level (At home she already walked without crutches, outside with one, ‘just to feel more secure’). Although the goal is to lose 25% of her weight in two years, she has not been strict on this part until now.

She is on the waiting-list for another knee prosthesis operation but the surgeon has told her that she might avoid the need for it.