Knee & Ankle (CR)™

TCM herbal formula for chronic knee and ankle disorders with atrophy, degeneration, stiffness, weakness, and decreased range of motion — chondroprotective; osteogenic; anti-inflammatory; analgesic; muscle-relaxant; adaptogenic; tonifies qi, blood, and yin; activates qi and blood circulation; opens channels and collaterals of the lower limb; dispels wind-damp; treats bi zheng (painful obstruction syndrome)

⚠️ Do NOT use alone during the acute phase of injuries where there is still bleeding, inflammation, and bruising — use Knee & Ankle (AC), Flex (TMX), or Herbal ANG instead. Do NOT use alone for inflammatory knee disorders such as rheumatoid arthritis, bursitis, synovitis, or tenosynovitis — use Flex (Heat), Flex (CD), or others based on TCM diagnosis. Contains Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae) and Dang Gui (Radix Angelicae Sinensis) — patients on anticoagulant or antiplatelet therapies such as Coumadin (warfarin) should use with caution or not at all. Optimal results occur when herbs are combined with acupuncture, electro-stimulation, and tui-na. Patients with arthritis should avoid vigorous exercise — mild exercise such as tai chi chuan and walking are recommended.

Clinical distinction — Knee & Ankle (CR) vs. Knee & Ankle (AC): Knee & Ankle (AC) is for the acute phase — swelling, inflammation, and pain from recent injury or trauma. Knee & Ankle (CR) is for the chronic and rehabilitation phase — repetitive wear and tear, atrophy, degeneration, decreased mobility, and ligament instability. Use Knee & Ankle (AC) first for acute injuries; transition to Knee & Ankle (CR) + Flex (MLT) for chronic recovery and rehabilitation. Note: untreated acute sprains and strains lead to ligament and joint instability and more frequent re-injury — Knee & Ankle (CR) ensures repair of minor ligament tears and facilitates complete recovery to prevent future re-injury.

CLINICAL APPLICATIONS

* Chronic knee and ankle disorders with atrophy and degeneration of soft tissues (muscles, tendons, and ligaments)

* Chronic leg disorders with weakness, stiffness, decreased range of motion, and decreased mobility of the joints

* Sprain, partial rupture, stretch, or tear of ankle ligaments leading to instability and frequent re-injuries

* Rehabilitation and recovery phase following acute knee and ankle injuries

* Muscle wasting and atrophy from lack of exercise and physical movement in late-stage musculoskeletal injuries

Background: Musculoskeletal and connective tissue injuries lead to over 10 million clinic visits per year in the United States. Chronic injuries are characterized by dull pain, stiffness, numbness, and decreased muscle mass and strength. Treatment of chronic injuries includes relief of pain and restoration of physical and physiological functions. Degeneration of soft tissues (muscles, tendons, and ligaments) is often seen in chronic knee and ankle disorders, leading to decreased range of motion and mobility. Many patients experience pain or worsening of their condition prior to rainy days — antirheumatic herbs that dispel wind-damp are essential in these cases.

Key herb-level clinical data:

— Chuan Niu Xi (Radix Cyathulae / Cyathula Root): chondroprotective — potently inhibits MMP-13, an important enzyme for degradation of the cartilage collagen matrix especially under arthritic conditions; by down-regulating MMP-13 activity, shows great chondroprotective benefit against cartilage-degrading disorders; dispels stagnation; opens channels and collaterals; channel-guiding herb to the lower extremities

— Dang Gui (Radix Angelicae Sinensis / Angelica Sinensis / Dong Quai): osteogenic — stimulates proliferation, alkaline phosphatase activity, protein secretion, and type I collagen synthesis of human osteoprecursor cells in a dose-dependent manner; analgesic — potency similar to or stronger than acetylsalicylic acid; anti-inflammatory — potency similar to or stronger than acetylsalicylic acid; tonifies blood; activates blood circulation; disperses blood stagnation; caution with anticoagulants

— Du Zhong (Cortex Eucommiae / Eucommia Bark): osteogenic and antiosteoporotic — increases proliferation and differentiation of osteoblasts without affecting osteoclast activity; effectively increases rate of tissue regeneration of damaged bones; strong anti-inflammatory action; dispels wind-damp; treats bi zheng

— Shu Di Huang (Radix Rehmanniae Praeparata / Prepared Rehmannia): antiosteoporotic — stimulates proliferation and activities of osteoblasts while inhibiting generation and resorptive activities of osteoclasts; prevents osteoporotic bone loss; tonifies blood; nourishes yin

— Zhi Mu (Rhizoma Anemarrhenae / Anemarrhena Rhizome): osteoprotective — prevents bone loss through promotion of bone formation (not inhibition of bone resorption); clears deficiency heat; reduces chronic swelling and inflammation

— Dang Shen (Radix Codonopsis / Codonopsis / Dang Shen): promotes neuron regeneration in a dose-dependent manner — activates IGF-I and FGF-2 pathways to induce proliferation and migration effects in RSC96 Schwann cells; adaptogenic — regulatory effect on the central nervous system to help with adaptation to various stressful environments; tonifies qi

— Wu Jia Pi (Cortex Acanthopanacis / Acanthopanax Bark / Siberian Ginseng Bark): analgesic and anti-inflammatory — duration of action up to 5 hours; adaptogenic — enhances physical adaptation by increasing endurance and performance; dispels wind-damp; treats bi zheng

— Bai Shao (Radix Paeoniae Alba / White Peony Root): muscle-relaxant — excellent effect to relieve spasms, cramps, and muscle stiffness in both smooth and skeletal muscles; anti-inflammatory and antipyretic — reduces inflammation, swelling, and burning sensations; treats neuralgia; Bai Shao + Gan Cao pair — marked effectiveness for pain of the entire body, especially lower back and legs; nourishes yin

— Gan Cao (Radix et Rhizoma Glycyrrhizae / Licorice Root): anti-inflammatory — enhances glucocorticoid effect; treats neuralgia; Bai Shao + Gan Cao pair — marked effectiveness for lower back and leg pain; tonifies qi; harmonizes the formula

— Di Huang (Radix Rehmanniae / Rehmannia): anti-inflammatory and antipyretic — reduces inflammation, swelling, and burning sensations through influence on the endocrine system; increases plasma levels of adrenocortical hormones; tonifies blood; nourishes yin

— Mu Dan Pi (Cortex Moutan / Moutan Bark / Tree Peony Root Bark): strong anti-inflammatory action — inhibits prostaglandin synthesis and decreases blood vessel permeability; clears deficiency heat; reduces chronic swelling and inflammation

— Huang Bo (Cortex Phellodendri Chinensis / Phellodendron / Amur Cork Tree Bark): clears deficiency heat; reduces chronic swelling and inflammation

— Ji Xue Teng (Caulis Spatholobi / Spatholobus Stem / Millettia): moves blood; opens channels and collaterals; enhances flexibility

— Qian Nian Jian (Rhizoma Homalomenae / Homalomena Rhizome): dispels wind-damp; treats bi zheng (painful obstruction syndrome)

— Shen Jin Cao (Herba Lycopodii / Lycopodium / Club Moss): dispels wind-damp; treats bi zheng; relieves stiffness

— Ze Xie (Rhizoma Alismatis / Alisma Rhizome): eliminates water accumulation; reduces swelling

— Fu Ling (Poria / Poria Cocos / Hoelen): eliminates water accumulation; reduces swelling; tonifies qi

— Bai Zhu (Rhizoma Atractylodis Macrocephalae / White Atractylodes): tonifies qi; strengthens Spleen

— Shan Yao (Rhizoma Dioscoreae / Chinese Yam / Dioscorea): nourishes yin; addresses Kidney deficiency underlying bi zheng

— Dan Shen (Radix et Rhizoma Salviae Miltiorrhizae / Salvia / Red Sage Root): tonifies blood; activates blood circulation; disperses blood stagnation; caution with anticoagulants

— Sheng Jiang (Rhizoma Zingiberis Recens / Fresh Ginger): harmonizes the formula

— Da Zao (Fructus Jujubae / Jujube Date): harmonizes the formula; tonifies qi and blood

WESTERN THERAPEUTIC ACTIONS

* Chondroprotective — Chuan Niu Xi (MMP-13↓; cartilage collagen matrix protection; arthritic conditions)

* Osteogenic / antiosteoporotic — Dang Gui (osteoblast proliferation↑, alkaline phosphatase↑, type I collagen synthesis↑); Du Zhong (osteoblast proliferation↑, bone tissue regeneration↑); Shu Di Huang (osteoblasts↑, osteoclasts↓, osteoporotic bone loss↓); Zhi Mu (bone formation↑, bone loss↓)

* Analgesic — Dang Gui (≥ acetylsalicylic acid potency); Wu Jia Pi (up to 5 hours duration); Bai Shao + Gan Cao (lower back and leg pain)

* Anti-inflammatory — Dang Gui (≥ acetylsalicylic acid potency); Wu Jia Pi (up to 5 hours duration); Bai Shao + Di Huang (antipyretic, reduces swelling and burning); Mu Dan Pi + Du Zhong (prostaglandin synthesis↓, blood vessel permeability↓); Huang Bo + Zhi Mu (deficiency heat↓)

* Muscle-relaxant — Bai Shao (smooth and skeletal muscle spasms, cramps, stiffness; neuralgia)

* Neuron regeneration — Dang Shen (IGF-I + FGF-2 pathways; RSC96 Schwann cell proliferation and migration)

* Adaptogenic — Dang Shen (CNS regulatory effect; stress adaptation); Wu Jia Pi (endurance↑, performance↑)

* Diuretic / anti-edema — Ze Xie + Fu Ling (water accumulation↓, swelling↓)

CHINESE THERAPEUTIC ACTIONS

* Tonifies qi, blood, and yin (Dang Shen, Bai Zhu, Gan Cao, Da Zao, Dang Gui, Di Huang, Dan Shen, Shu Di Huang, Bai Shao, Shan Yao, Fu Ling)

* Activates qi and blood circulation; disperses blood stagnation (Dang Gui, Dan Shen, Ji Xue Teng, Chuan Niu Xi)

* Clears deficiency heat; reduces chronic swelling and inflammation (Mu Dan Pi, Zhi Mu, Huang Bo)

* Eliminates water accumulation; reduces swelling (Ze Xie, Fu Ling)

* Dispels wind-damp; treats bi zheng (painful obstruction syndrome) (Wu Jia Pi, Qian Nian Jian, Du Zhong, Shen Jin Cao)

* Opens channels and collaterals; relieves stiffness; enhances flexibility (Ji Xue Teng, Shen Jin Cao, Chuan Niu Xi)

* Directs formula to lower extremities (Chuan Niu Xi)

* Harmonizes the formula (Sheng Jiang, Da Zao, Gan Cao)

DOSAGE

Standard: 3–4 capsules three times daily on an empty stomach with warm water. For acute pain flare-ups, increase to 8 capsules three times daily for 3–4 days. Do not use during the acute phase of injuries where there is still bleeding, inflammation, and bruising.

Supplementary formulas: Acute injuries with severe pain — add Knee & Ankle (AC) or Herbal ANG. Ligament injuries or soft tissue degeneration — add Flex (MLT). Heat manifestations or re bi (heat painful obstruction) — add Flex (Heat). Cold and damp manifestations or zhuo bi (fixed painful obstruction) — add Flex (CD). Bone spurs — add Flex (SPR). Osteoarthritis of the knee — add Osteo 8. Acute lower back pain — add Back Support (AC). Chronic lower back pain — add Back Support (CR). Leg spasms and cramps — add Flex (SC).

Nutrition: Glucosamine sulfate and chondroitin sulfate provide important nutritional support for formation of bones, tendons, ligaments, and cartilage. Sea cucumber is very beneficial — contains a rich source of compounds needed in all connective tissues, especially synovial joints and joint fluids. Consume adequate vitamins and minerals — essential to prevent bone loss and promote bone growth.

Lifestyle: Engage in gentle daily exercise — facilitates recovery and prevents muscle atrophy and wasting. Avoid activities with high impact or high risk of injury. Patients with arthritis should avoid vigorous exercise — mild exercise such as tai chi chuan and walking are recommended. Strengthening exercises help ensure recovery of the integrity of knee and ankle ligaments. This formula is most effective during the recovery and rehabilitation phases of treatment.

CASE STUDIES

— K.L., 42-year-old male: Right hip and leg pain and numbness; on crutches with decreased and impaired mobility for 3 months; stiff neck, frozen ankle, pain affecting sleep; tendency to get injuries due to poor balance; bi zheng with blood deficiency, blood stasis, and qi constraint / muscle atrophy. Flex (MLT) for 8 weeks + Knee & Ankle (CR) for 4 weeks + acupuncture for 8 weeks. Result: 100% leg use regained — moved from crutches to a cane. Sleeping flat resumed at 3 weeks; riding a bicycle at 8 weeks. Pain reduced from 10 to 0/10. Patient started yoga practice and became more enthusiastic about life.

— L.K., 58-year-old female: Left knee pain; limited range of motion; pain with movement; limping; pain level 7/10 only slightly alleviated with elevation or rest; qi and blood stagnation with Liver and Kidney yin deficiencies. Knee & Ankle (CR) + Herbal ANG + acupuncture. Result: greater ROM and reduced pain level.

— A.S., 45-year-old female: Right lateral ankle sprain 3 days prior — purplish color and swelling; local blood stagnation. Flex (TMX) + Knee & Ankle (AC) first. Result at 3 days: 50% better. Flex (TMX) discontinued at 8 days (90% better). Continued Knee & Ankle (CR) for 1 additional week — 100% better.

Related Reading

Also see: Knee & Ankle (AC) – for acute knee and ankle injuries with swelling and pain | Flex (MLT) – for ligament injuries and soft tissue degeneration | Flex (Heat) – for heat painful obstruction and rheumatoid arthritis | Flex (CD) – for cold and damp painful obstruction | Flex (SPR) – for bone spurs | Flex (SC) – for leg spasms and cramps | Flex (TMX) – for acute trauma and bone fracture | Osteo 8 – for osteoarthritis | Herbal ANG – for severe pain | Back Support (AC) – for acute lower back pain | Back Support (CR) – for chronic lower back pain | Pain Relief & Musculoskeletal Support Collection.