Knee Pain

photo of person showing silver-colored ring
Knee pain
  • 5 main types of knee pain, and various subcategories. The Chinese have had knee pain too, and for thousands of years!
  • Recognize your type of knee pain by its symptoms and what makes it worse
  • Most people with knee pain come when they’ve  had it a long time when earlier treatment might have stopped it becoming chronic
  • Read what improves it and Discover what you can do about it

Knee pain affects apparently 25% of us … so drug manufacturers love it!

Every drug you take must be metabolised by your body, slowing it down. Some drugs have unpleasant side-effects for which you may be taking additional drugs!

You have two knees and they’re built strong but hard to repair when one goes wrong. Look after them carefully! However, Chinese medicine and acupuncture have lots to offer.

This page looks at knee pain from the point of view of Chinese medicine: I’ve simplified a complicated subject, so please don’t think that what you read here is all there is to say!

Mention knee pain to acupuncturists and most will instantly think of one particular cause even though it’s not usually the most common except in old people. And not everyone is old! So let’s get that one out of the way!

1. Kidney Deficiency and Knee pain

Older people have walked further than younger people. Age uses up their jing essence. They notice age-related deficiencies in their backs and knees. What kind of knee pain is this?

  • Nearly always occurs in both knees, though one knee may be worse than the other
  • Pain develops over time: at first you hardly notice it, but it recurs more frequently as time goes on
  • Nearly always a bit painful: this is a chronic condition and won’t easily disappear
  • Not swollen (swelling occurs when caused by other factors than age alone)
  • A good sleep or rest temporarily eases the pain
  • Worsens with exercise or use, especially if you are carrying something heavy or walking upstairs or uphill – or just standing for too long!
  • It’s not just pain, but weakness and unreliability too
two person talking while standing near wall
Legs and knees become unreliable with age
  • Knees may feel cold, and like warmth – otherwise not much affected by the weather, though you yourself may prefer warmth to cold
  • Usually comes with other signs of Kidney deficiency such as lumbar backache, loss of hearing, ear noises (tinnitus) and dizziness (meaning a sense of disorientation in space, often with light-headedness). For more on a common form of Kidney deficiency (there are several kinds, see Kidney Syndromes), click on Kidney Yang Deficiency.
  • Kidney deficiency pain doesn’t begin suddenly and it does gradually worsen as you age, though there’s lots you can do about it
  • Your kidney pulses will probably be weaker than your other pulses.


Treatment of Kidney Deficiency Knee pain

I treat many people in their 70s and 80s, and a few into their 90s. Many have knee pain, and acupuncture is often highly effective, preventing recurrence of the pain for some months unless the patient gets over-exhausted (by which I mean that, after strain or stress, their energy doesn’t improve even after several nights of good sleep).

However, the patient usually needs an acupuncture treatment every few months to maintain improvement. They are usually happy with this arrangement because treatment helps them feel better in many other ways – not just in their knees!

For kidney deficiency, there are also Chinese herbal formulae. The exact formula depends on your symptoms, not least on whether you are more Kidney Yin or Kidney Yang deficient, but all the formulae start with then adapt to your particular circumstances liu di huang wan.

What can you do to help?

  • Starting 30 years ago …
  • … get fit, not least by strengthening your legs and knees BUT! be careful not to overstrain yourself. (Overstrain? For example, over-lifting weights or damaging them. How do you know if you are over-lifting, putting too much strain on your knees? If you recover after a good night’s sleep, you probably haven’t overstrained them. But if pain or stiffness or weakness takes two or three days to get back to normal health, you are probably overstraining them. When young, you can do this occasionally, and not much harm is done. But as you age into your thirties, forties and later, beware! It is easy to let pride, arrogance and the desire to keep up with others cloud your judgement and …)


weight lifting, good for health unless overdone

  • … learn to sleep well, and to get enough sleep, regularly and …
  • … if possible, ask an acupuncturist to advise you about your constitutional needs, for instance what kinds of food to avoid and then help you with good nutritional advice. Eating food appropriate to your type is very important in the long run. Also, learn to chew well: chewing helps your digestion extract more nourishment from food.
  • What if you forgot, 30 years ago? Start now, with the same advice. And go for regular walks, gradually increasing distances, but not to the point where you get exhausted.
  • If in pain from kidney deficiency (knee pain, back pain, nagging head pain etc, see Kidney Yin deficiency for example), get some good acupuncture for a start!
  • Don’t overwork.
  • Remain active physically and mentally. Continue to work if congenial: having to adapt to circumstances everyday keeps your yang energy circulating.
  • Be careful not to get too cold … and wrap up well against the damp too! These are the subjects of the next category below, to which ageing makes you more vulnerable.


2. Knee pain from Cold and Damp

This knee pain is common, at least in cold, wet climates. Modern advice for ice for knee (and other) trauma is, well … wrong! Ice helps pain and inflammation short term but is poor advice for long-term knee health because ice is cold, and damp easily ‘invades’. What are the symptoms?

  • More usually affects one knee only, or one knee is much worse than the other
  • Starts fairly quickly – even, it might seem, suddenly
  • Symptoms are worse when exposed to Cold and/or Damp. ‘Cold’ is pretty obvious, but ‘damp’ is not necessarily what you’d expect: it can mean rain, but for some it means humidity. For others it means the build-up to a thunderstorm (though this usually means they are susceptible to ‘Wind‘ as well.) It can certainly mean exposure to water as in swimming pools. Some very damp-forming foods can worsen it too (that page also lists foods that fight damp.)
  • This kind of knee pain often makes the knee very stiff, even rigid, or difficult to bend.
  • Damp frequently causes swelling, and your legs or knees may feel heavy.
  • This kind of knee pain improves, at least temporarily, from application of warmth, whether it be a warm shower, a warm bath, a warm beanbag, or warm, dry weather, as found in warm countries.
  • If you keep moving the pain usually ameliorates somewhat until you sit to rest when it returns. Movement and warmth, and the warmth generated by movement usually helps while you keep moving.
  • Your pulse, if affected by Cold, is slower than normal.
  • Remember the symptoms, because they can happen to anyone of any age, for instance if you fall heavily on your knee without actually breaking it. Even more so if you fall on ice (‘cold’ and ‘damp’) without taking immediate action to treat it.

Treatment for Knee pain caused by Cold and Damp

  • If you’ve got the chronic condition of this, keep your knees warm and away from damp … but you’ve probably worked that out for yourself!
  • Avoid foods that may weaken your resistance to Damp and Cold. Read our pages on Damp-forming foods, then our page on Cold foods.
  • Whatever you eat, chew well. Damp arises in your body partly from weakness in your digestion (your ‘Spleen‘ energy). The wrong foods can weaken how well your Spleen resists and mends your problem.
  • Acupuncture early on may reduce the time you take to heal. Moxa would be used, almost certainly.
Moxa for health!
Moxibustion on needle near the knee.
  • There are several well-used herbal formulae for knee pain from Cold and Damp. Bu zhong yi qi tong is more appropriate if the main problem is damp, but it could be adapted for Cold-type knee pain by adding other herbs.
  • Try not to take NSAIDs like paracetemol which does reduce acute pain and inflammation but also prevents neutrophils triggering repairs, so your condition becomes chronic. You won’t realise this until later, when, still taking your medications, you’ll count the months since your problems began. For more on this click Suppression. The longer you’ve been taking such painkillers, the longer you’ll take to get better.
  • Gentle walks? Certainly!
  • If you want to know more about how Chinese medicine understands the invasion of external pathogenic influences like Cold and Damp, about 2000 years ago a Chinese doctor wrote a major thesis on it, in the process founding a hugely important ‘school’ and sytem of treatment, used to this day. It’s quite different from Western medicine so comes with very different solutions! Read about it! It’s called the ‘Six Stages of Disease caused by invasion of Cold’. (But it applies to Damp too.)

3. Knee pain from Cold

Knee pain from Cold is more common as you age, because with age comes poorer circulation so you get cold more easily. (Especially if you are Kidney yang deficient.) Lacking internally generated warmth your body is less good at repelling external ‘evils’ like Cold.

Symptoms of knee pain from Cold

  • One knee is more affected than the other, or sometimes only one knee is sore.
  • Pain is severe, tight, constricting. Cold makes it very stiff to move.
  • You’ll want to stay still and apply warmth to it. For instance a hot water bottle or warm bean bag round the knee feels good. So does a warm bath and, somewhat less so, a warm shower.
  • Actually, your condition doesn’t improve with rest and may get worse when resting. (That’s because rest is a yin state, and cold is a yin pathogenic factor, so rest increases the amount of yin, of which you’ve already enough, being the cold!)
  • Movement reduces the pain, if you keep going but the first movements are very sore, until you get going.
  • Cold makes it worse: wrap up well!
  • Your pulse may be slower than usual.

Treatment of Knee pain from Cold

person holding lighted lighter with fire, lighting moxa punk
Moxa for yang – Photo by Katherine Hanlon
  • The right herbs, over time, will help. There are many formulae: one such is dang gui si ni tang which is also good for warming your circulation generally.
  • Massage from someone with warm hands may help
  • Movement, once you get going, improves the pain until, at least, you get tired
  • Time spent in warm, dry climates may improve the pain
  • Keep off painkillers if you can: they are usually anti-inflammatory, so stop your body producing any warming healing reactions. Hence your condition persists indefinitely (that’s why it’s called ‘chronic’!) Read our page on Suppression!


4. Knee pain from Qi Stagnation and Blood stasis

This comes from what Chinese medicine calls ‘stagnation’, or ‘stasis’. (Stagnation refers to Qi, Stasis to Blood.) Although there’s much more to it than this, Blood stasis often follows Qi stagnation, which itself has many causes, the main one being emotional tension from Stress and Frustration.

Pain occurs because of what Chinese medicine calls a blockage in the flow of energy and blood through the joint.

Accidents and sudden trauma initially block the flow of Qi, then because Qi stagnates, you get soon get Blood stasis: the shock leads to bruising. Repeated movements of any joint can also cause this syndrome.

Examples of repetitive strain

Examples include:

  • typists,
  • wrists and fingers using computer mice,
  • cleaners,
  • joggers,
  • some forms of cooking like coffee baristas,
  • bricklayers,
  • even car drivers: for some, an early sign is cramp of the fingers holding the driving wheel,
  • but for knee pain, joggers and weight-lifters are among those susceptible.


jogging often causes knee pain from qi stagnation and blood stasis: woman in black sports bra and black pants running on water during sunset

Symptoms when due to Qi stagnation and Blood Stasis

  • Pain is often sharp and boring; and/or aching felt deep inside
  • Pain is often worse when pressed
  • Pain is usually worse for movement
  • Pain is usually better when resting
  • Skin around the painful area is often darker than elsewhere
  • Pain is unaffected by weather, hot or cold.
  • However, most people with this prefer warm applications rather than cold or ice.
  • Unless Damp is also involved, there is no swelling
  • The cause is usually from repeated movements (ie repetitive strain) or from overstrain (for example, over-lifting) or accident
  • Theoretically strong emotions like anger make it worse
  • I haven’t seen enough cases to be sure but suspect that people on high levels of deep-acting medication may be more liable to this
  • Affects one or both knees

Treatment of pain in knees from Qi Stagnation and Blood stasis

This kind of pain comes from trauma, overstrain or repetitive strain, so

  • Rest is important, to allow time for the tissues to mend. Anything which encourages fresh blood to the area will help.
  • Deep massage on the knees will be painful, but massaging the thigh above the painful knee and, to some extent the leg below it, may help.
  • Elevating the leg is good:


Elevating the leg often helps knee pain

  • For short periods, compression is acceptable, eg during a tennis match if the joint is overstrained, for support: afterwards remove the compression and elevate the limb.
  • Alternating hot and cold bathing may help to push new blood to the area.
  • Acupuncture with electro-stimulation can work well, but any kind of good acupuncture should help. NB acupuncture on the painful joint is not always the best policy. Acupuncture elsewhere may be more effective. (See our pages on the Tan balance method for more.)
  • A Chinese herbal formula often used, though it may be adapted in particular circumstances, is shen tong zhu yu tang
  • Warm applications (hot water bottle, or warm beanbag) and warm bathing help to draw new blood to the area
  • Conversely, cold and ice freeze the nerves, reducing pain, but also delay the healing response.
  • Do your best to clear your knee of this syndrome because if it hangs around in the background it makes your knee(s) more prone to the other syndromes or problems listed on this page
  • Painkillers and anti-inflammatory medicines of course reduce the acute pain, but also obstruct your body’s genetically inherited ability to heal the joint. (Read our page on Suppression for more on this.) Long-term use of medicines like aspirin and paracetemol therefore tend to make the problem chronic. (What is long-term? Probably not much more than one week, certainly no more than two weeks – so, not long!)
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5. Knee pain from Damp-Heat

Damp-Heat symptoms often look infected, and they may be. But in Chinese medicine, the symptoms you get might NOT be due to infection.

You can probably understand that if there is both damp and heat, infection readily finds a welcome. There are benefits from living in cold climates – not so many bugs and bacteria! As you approach warmer climates you get more of both. So when your body harbours Damp-Heat it may become more vulnerable to infection.

Damp-Heat is a big subject – we’ve got a page on it, worth reading if you think your knee pain comes from it there may be things you can do to reduce your predisposition to it.

  • Joint is swollen


swollen with knee pain as from Damp-Heat

  • Looks and feels hot
  • Hot to the touch
  • Red and inflamed
  • Pain is severe
  • Pain often starts suddenly
  • Averse moving it, either bending or stretching fully, though you feel restless and may want to keep trying to move it


If the Damp-Heat penetrates further into your system you get more general symptoms, such as

  • Rapid pulse
  • Tongue has a yellow coating
  • Irritability and averse contradiction
  • You feel heavy and tired
  • Fever
  • Dislike cold
  • Thirst but, if Damp predominates, you even may dislike drinking or find even a little is enough
  • Urine is darker than usual
  • Perspiration but if feverish, sweating may not help the fever (just as perspiring in hot humid environments doesn’t cool you)

Treatment of pain in knees from Damp-Heat

  • Acupuncture should deal with both the Damp-Heat syndrome and the channels most involved (see below)
  • Herbal formula for the chronic form is often yi yi ren tang
  • Although what you eat may seem unimportant, Chinese medical experience suggests otherwise. Please avoid foods that increase Damp-Heat in your system: we’ve got a page about Damp-Heat foods here. (Can’t be bothered to avoid such foods? Then please expect your pain etc to last longer!) Eating right helps whatever treatment for damp-heat that you’re getting.
  • As the symptoms of Damp-Heat reduce, begin gentle movement. You may find professional advice helpful.


Which Acupuncture Channels are affected by knee pain?

If you or your acupuncturist can identify which acupuncture channels are affected, treatment will be more effective and work faster.

  • Medial (on the inside of your knee) at the front is the Spleen channel (foot tai-yin channel)
  • Medial (on the inside of your knee) at the back is your Kidney channel (foot shao-yin channel)
  • Medial (on the inside of your knee) between the front and back is your Liver channel (foot juey-yin channel)
  • Lateral (on the outside of your knee) at the front is your Stomach channel (foot yang-ming channel)
  • Lateral (on the outside of your knee) at the back if your Bladder channel (foot tai-yang channel)
  • Lateral (on the outside of your knee), between the front and back on the side, is your Gallbladder channel (foot shao-yang channel)


Channel theory is a big subject and it seems simple when you start! Treating the affected channel is important, but your acupuncturist will get even better results if, when treating the actual channel identified, s/he also treats points on the same name channel on the arm. For example, if your pain is on the Spleen channel, the foot tai-yin channel, consider points on the arm tai-yin channel, the Lung channel. For knee pain, such points might be around the elbow.

Also use, of course, acupuncture points for the particular syndrome diagnosed. For Damp, for example, consider Spleen 9.

Other Pages on Pain to read



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