Knee synovitis

　　1, Knee synovitis, in the elderly, is often secondary to knee osteoarthritis, mainly due to mechanical and biochemical stimulation caused by cartilage degeneration and bone spur formation, leading to secondary knee synovitis, edema, and effusion. In young adults, it is often caused by acute trauma and chronic injury. Acute trauma includes: knee sprain, meniscus injury, collateral ligament or cruciate ligament injury, joint effusion or sometimes hemorrhage, manifested as acute traumatic synovitis of the knee joint. Sometimes, it can also be caused by simple knee synovial injury, such as minor trauma or long-term chronic knee joint fatigue. In addition, invasion by wind, cold, and dampness can lead to gradual swelling and dysfunction of the knee joint, forming chronic knee synovitis.

　　2, Swelling-type joint synovitis is mainly characterized by swelling after excessive exercise, with varying degrees of pain. Non-swelling type, mainly characterized by joint pain, often accompanied by mild swelling. Research has confirmed that the two types are essentially the same, but differ in the degree of pathological changes in the synovium. Researchers have found that after prolonged single-action excessive exercise of the knee joint, the synovial tissue becomes congested and edematous, and the red and white blood cells and fibrin exudation are positively correlated with the increase in intra-articular pressure and the decrease in oxygen partial pressure. Moreover, when the exudation rate exceeds the compensatory absorption rate of the synovium, joint effusion occurs, leading to a continuous increase in intra-articular pressure and a continuous decrease in oxygen partial pressure in a恶性循环, eventually leading to the formation of chronic aseptic inflammation such as synovial atrophy and fatty metaplasia. Therefore, the occurrence of traumatic synovitis after excessive exercise is not only related to the repetitive impact on the joint surface and the injury of the joint capsule but also plays an important role in the development and prognosis of the disease course.

　　1, The synovium is mainly distributed around the joint and communicates with the joint cavity, secreting lubricating fluid to lubricate the joint. It responds to various causes of stimulation (such as osteophytes, arthritis, joint tuberculosis, rheumatism, and traumatic injuries, bone injuries, intra-articular injuries, peripheral soft tissue injuries, and surgery) or direct stimulation of the synovium by producing inflammatory reactions. The response of the synovium to inflammation is the secretion of exudate. Pain occurs, strictly speaking, as long as there is effusion in the joint, it proves the existence of synovitis. Its main manifestations are joint congestion and swelling, pain, increased exudation, joint effusion, difficulty in bending and squatting, and limited function.

　　2, Synovitis is an aseptic inflammation caused by poor microcirculation, the main symptoms being the formation of effusion. The synovium is a membranous tissue surrounding the joint, which not only serves as a protective tissue for the joint but also produces synovial fluid, providing 'lubricating fluid' for joint movement. The production and absorption of synovial fluid is a 'dynamic balance', and when there is a barrier to the reabsorption of synovial fluid, the dynamic balance between production and absorption is disrupted, leading to an excess of production over reabsorption, and the occurrence of 'joint effusion'.

　　1. Chronic strain or traumatic knee synovitis. Improper treatment of acute knee synovitis can lead to chronic synovitis, which is more common in the elderly, those with damp constitution, or patients with genu varum, genu valgum, or other knee deformities, or those with knee osteoarthritis. The main complaints are discomfort and沉重 in the legs, difficulty in extending and flexing the knee, but passive movement has no obvious obstacles, the pain is not severe, the local area is not red or hot, and the knee function examination generally has no obvious positive signs. Common phenomena include: swelling and fullness at the patellar ligament and knee eyes, which are soft to the touch, and may even have a cystic sensation. If the joint effusion exceeds 10 milliliters, the floating patella test is positive.

　　2. Acute injury, knee hematoma. Knee hematoma usually occurs immediately or within 1-2 hours after the injury, with extensive ecchymosis on the knee and lower leg. Palpation reveals tension in the skin or swelling, and the floating patella test is positive. There are often systemic symptoms, such as fever caused by ecchymosis, and the local area is warmer. This condition is often a complication of other injuries. A careful clinical examination is necessary to prevent missed diagnosis.

　　3. Long-term heavy loads and chronic strain, as well as other factors such as direct violent blows to the knee, long-term heavy loads and chronic strain, indirect knee sprains, injuries during surgery, intense sports activities or excessive training, incorrect movements, joint degeneration, knee overextension, and even improper shoe wearing can all lead to injury to the synovium, synovial congestion, swelling, and active synovial cells producing a large amount of effusion, which contains plasma, leukocytes, and phagocytes. The fluid aspirated from the joint is usually yellow and clear, or pink due to blood, and bacterial culture is negative. X-ray examination shows no bone abnormalities in synovitis, or there may be degenerative changes, or there may be loose bodies within the joint, or osteophytes at the margins of the bone and joint.

　　1. Reduce the intake of dairy products such as milk and goat milk, as well as foods containing tyrosine, phenylalanine, and tryptophan such as peanuts, chocolate, millet, cheese, and sugar, as they can produce prostaglandins, leukotrienes, tyrosine kinase autoantibodies, and anti-milk IgE antibodies that can cause arthritis, leading to exacerbation, recurrence, or worsening of the condition.

　　2. Reduce the consumption of fatty meats, high animal fat, and high cholesterol foods, as the ketone bodies, acids, arachidonic acid metabolites, and inflammatory mediators they produce can inhibit the function of T lymphocytes, and are likely to cause and worsen joint pain, swelling, bone decalcification, and joint destruction.

　　3. Reduce the intake of sweets, as the sugars are prone to cause allergies, which can worsen the development of synovitis, and are likely to cause increased joint swelling and pain.

　　4. Reduce alcohol and coffee, tea, and other beverages, and avoid passive smoking, as all of them can exacerbate the progression of arthritis.

　　5. It is recommended to eat in moderation foods rich in histidine, arginine, nucleic acids, and collagen, such as animal blood, eggs, fish, shrimp, soy products, potatoes, beef, chicken, and beef tendons.

　　The examination found that the knee joint flexion and extension movement is limited, squatting is difficult and accompanied by pain in the joint. There may be localized tenderness points around, and the floating patella test is positive for chronic traumatic synovitis, which may not have a history of obvious trauma. The main manifestations are weakness and limited movement of the knee joint, swelling that does not subside, and the inability to squat. The pain increases with increased activity and decreases after rest. Long-standing patients may feel the thickening of the knee joint capsule, and for patients with a large amount of joint effusion or those who repeatedly appear effusion, joint effusion examination can be performed, which can reflect the nature and severity of synovitis. Therefore, joint puncture and synovial fluid examination are of great reference value for the diagnosis and differential diagnosis of knee joint synovitis.

　　From the perspective of laboratory examination: the floating patella test is positive in patients with synovitis. For patients with a large amount of joint effusion or those who repeatedly appear effusion, joint effusion examination can be performed, which can reflect the nature and severity of synovitis.

　　1.食疗方乌豆粥：Black soybeans 20 grams, glutinous rice 60 grams, with appropriate amount of brown sugar. Soak the black soybeans in warm water overnight, wash them clean, and boil them in a pot for a few minutes, then add glutinous rice and brown sugar and cook until the congee is thick, to be eaten with meals.

　　2. It is necessary to avoid drinking alcohol and coffee, tea, and other beverages as much as possible, and to avoid passive smoking, as all of these can exacerbate the progression of arthritis. Patients should eat less fatty meat, high animal fat, and high cholesterol foods, as the ketone bodies, acids, arachidonic acid metabolites, and inflammatory mediators produced by these can inhibit the function of lymphocytes, causing and exacerbating joint pain, swelling, bone decalcification, and joint destruction. Moreover, patients should also eat less sweets, as the sugars can cause allergies and exacerbate the development of synovitis, leading to increased joint swelling and pain.

　　3. Suggestions: Eat less milk, sheep milk, and other dairy products, peanuts, chocolate, millet, cheese, sugar, and other foods containing tyrosine, phenylalanine, and tryptophan, as they can produce prostaglandins, leukotrienes, tyrosine kinase autoantibodies, and anti-milk antibodies that can cause arthritis, and are prone to allergic reactions, leading to the aggravation, recurrence, or worsening of arthritis.

　　1. External application therapy in traditional Chinese medicine

　　According to traditional Chinese medicine, synovitis belongs to the category of 'Bi syndrome'. Joint synovitis is divided into two aspects: trauma and chronic strain. After the knee joint is injured due to fractures, dislocations, ligament ruptures, cartilage injuries, etc., the synovium of the joint can also be damaged at the same time. Post-injury blood stasis and fluid retention, combined with damp-heat, cause the knee joint to become hot, swollen, painful, and the muscles to become rigid, leading to difficulty in joint flexion and extension, forming acute synovitis; if the injury is slight, or if there is long-term chronic strain, along with the invasion of wind, cold, and dampness, the knee can gradually become swollen, causing functional impairment, leading to chronic synovitis.

　　The methods for treating synovitis, in Western medicine, it is generally believed that there is currently no ability to reverse the pathological changes of synovitis, and patients can only use painkillers, analgesic injections, and fluid aspiration to relieve symptoms. However, traditional Chinese medicine, which always emphasizes holistic treatment and treating the root cause of the disease, has long studied this condition and achieved very ideal clinical therapeutic effects with traditional black ointments that are good at promoting blood circulation, removing blood stasis, dispelling wind and cold, reducing swelling and pain, and strengthening tendons and bones. Among them, the most effective is the famous Chinese medicine formula for synovitis, the swelling reduction plaster.

　　2. Massage Therapy

　　Wash both hands with warm water, dry them, and rub them together until warm; find a quiet environment, best on the bed; wear shorts and expose the legs.

　　1. Pressing six acupoints: Stand or sit flat on the bed, with both legs flat or naturally curved. Rub both hands warm, and press the 6 acupoints on the leg with synovitis with the thumb. The force should start light and gradually increase to a point where there is a numb and painful sensation. The order of the 6 acupoints is as follows: the Shangjiao point, the Fufu point, the Fengshi point, the Kelinesi point, the Weizhong point, and the Xuehai point. Press each acupoint for 2 minutes.

　　2. Pushing on the thigh: Sit flat on the bed, with both legs flat or naturally curved. Rub both hands warm, place the leg with synovitis flat, and push from the root of the thigh to the knee with both hands, gradually increasing the force. While doing this step, focus the mind on the area pushed by the hands, and the intention of Qi and blood is pushed towards the knee. Push for 3 minutes.

　　3. Pressing the knee: Sit flat on the bed, with the affected leg flat or naturally curved. Rub both hands warm, and press the affected knee with both hands: first press on the opposite sides for 1 minute (the left hand on the left side of the knee, the right hand on the right side of the knee), then press up and down for 1 minute (one hand on the upper part of the knee, the other hand on the lower part of the knee), then press the knee joint all around (use the palm of both hands to rub the knee from all angles until the knee is warm) for 2 minutes. While doing this step, focus the mind on the area where the hands and knees touch. Note: When pressing, use the palm of the hand with a force similar to kneading dough.

　　4. Foot and Leg Guiding: Sit flat on the bed. Taking the knee synovitis of the left leg as an example:

　　The first step, bend the left knee, hold the toes with the left hand, and hold the heel with the right hand;

　　The second step, pull the toes of the left foot to the left, and pull the heel of the right foot to the right, slowly pull to the point of immobility, with gentle force, while coordinating with exhalation;

　　The third step, while still holding the toes and heels with both hands, slowly pull to let the foot naturally return to its position, while coordinating with inhalation. Repeat the second and third steps 10 times. If the right leg is affected, do the opposite.

　　Apply Tongmoyao Xiatong plaster every evening. After rubbing the skin with ginger, directly apply the plaster to the affected area, one on the left and one on the right. Note: The force of traction must be gentle, the movement must be slow, and the range must reach the point of immobility.

　　3. Puncture Therapy

　　When there is a large amount of synovial fluid and high tension, joint puncture can be performed to completely remove the synovial fluid and blood clots, and then sodium hyaluronate is injected into the joint cavity. It is the main component of synovial fluid. Studies have shown that various pathological changes in arthritis are closely related to its reduction and changes in physical and chemical properties. The injection of sodium hyaluronate has the following effects: covering the surface of the articular cartilage, which can protect the articular cartilage and prevent or delay further degeneration; protecting the synovial membrane, clearing pain-causing substances, and significantly reducing pain; improving the contracture state of the joint, increasing the range of motion of the joint; and improving the synovial fluid of degenerated joints.

　　Four, Drug Therapy

　　During the acute stage of synovial injury, with blood stasis and effusion retention, the treatment is mainly to disperse blood stasis and promote the production of new tissue to reduce swelling, with the oral administration of Sanqi powder, etc. In the chronic stage with dampness and cold retention, muscle and tendons are weak, the treatment is to dispel wind-dampness and strengthen the muscles and tendons, with the internal administration of modified羌活胜湿汤, and external application of the membrane-dissolving pain plaster; if there is an excess of cold evil, it can also disperse coldness and wind-dampness, with the use of the Cimicifuga Decoction.

　　Five, Traditional Chinese Medicine Plaster

　　The synovium is mainly distributed around the joint and communicates with the joint cavity, secreting lubricating fluid to lubricate the joint. Under the stimulation or direct stimulation of various causes (such as bone hyperplasia, arthritis, joint tuberculosis, rheumatism, and traumatic injuries, bone injuries, intra-articular injuries, surrounding soft tissue injuries, surgery, etc.), the synovium produces an inflammatory response, and the response of the synovium to inflammation is the secretion of exudate. Pain occurs, strictly speaking, if there is effusion inside the joint, it proves that there is synovial inflammation. The main manifestations are joint congestion, swelling, pain, increased exudation, joint effusion, difficulty in squatting, and functional limitation.

　　Synovitis is an aseptic inflammation caused by poor microcirculation, the main symptoms are the production of effusion. The synovium is a membranous tissue surrounding the joint, which is not only a protective tissue for the joint but also produces synovial fluid, providing 'lubricating fluid' for joint movement. The production and absorption of synovial fluid is a 'dynamic balance'. When there is a barrier to the reabsorption of synovial fluid, due to the disruption of the dynamic balance of production and absorption of synovial fluid, the production of synovial fluid exceeds reabsorption, resulting in 'joint effusion'. Therefore, the treatment of synovitis mainly focuses on regulating the microcirculatory system. Once the microcirculation is unobstructed, the effusion will circulate and disappear, and the inflammation will also be relieved. During the effusion period, try to avoid fatigue and reduce the frequency of fluid aspiration injections. Excessive fluid aspiration injections will stimulate the subsynovial connective tissue fibrosis and aging of the synovial tissue, significantly reducing the regeneration and repair capacity of the synovial tissue, making further treatment more difficult.

　　Traditional Chinese Medicine Plaster Therapy. Principle: The plaster applied externally stimulates the nerve endings, through reflexes, dilates blood vessels, promotes local blood circulation, improves the nutrition of surrounding tissues, promotes the absorption of the fluid inside the bursa, so that it returns to a dynamic balance of production and absorption, achieving the purpose of eliminating the synovial inflammation inside the bursa and curing the disease. 'Disease originates internally and manifests externally'. When a part of the human body shows symptoms, treatment should be carried out according to the meridian pathways, simultaneously at the 'Ashi acupoint' and its corresponding acupoints, and in accordance with the corresponding course of treatment for the disease, to achieve the purpose of treating both the symptoms and the root cause, and completely cutting off the source of recurrence. External application of membrane-dissolving pain plaster; the plaster stimulates the acupoints, promotes microcirculation, dilates blood vessels, promotes local blood circulation, improves the nutrition of surrounding tissues, promotes the absorption of the fluid inside the bursa, so that it returns to a dynamic balance of production and absorption, achieving the purpose of eliminating the synovial inflammation inside the bursa and curing the disease.

　　The methods of treating synovitis, Western medicine believes that there is currently no ability to reverse the pathological changes of synovitis, and patients can only use painkillers, analgesic injections, and aspiration of effusion to relieve symptoms. However, our country's traditional medicine, which always emphasizes holistic treatment and treating the root of the disease, has already had research on this disease and has achieved very ideal clinical treatment effects with the traditional black plaster medicine known for its ability to activate blood circulation, remove blood stasis, and strengthen the tendons and bones. The most significant efficacy is achieved by the famous traditional Chinese medicine formula Tongmian Xiaotong plaster.

　　Applying a permeable membrane pain-relieving plaster on the corresponding acupoints can increase the efficacy of the medicine by 3-5 times. Plastering the acupoints for a course is the key to external application of traditional Chinese medicine. This has been confirmed in practice over hundreds of years. It is not easy to relapse after recovery.

　　Chapter 6: Application of Knee Osteoarthritis (Synovitis) Plaster

　　One plaster can be pasted on each side of the knee 'knee eye acupoint' to wrap the entire knee joint. For leg cramps, the 'Weizhong acupoint' must be plastered, the 'Hejing acupoint' for patellar softening, the 'Chengshan acupoint' for numbness and pain in the lower leg, and the 'Xuehai acupoint' can be added to treat lower limb pain very effectively.

　　Chapter 7: Nanotherapy

　　Emi is a unit that is 1/10 smaller than nanometers. The significance of emi drugs is that how each drug works needs to be looked at from the atomic scale, where the 'receiver' of the drug in the human body is located. This technology completely solves the problems of dissolution performance, toxic and side effects, bioavailability, efficacy, and timeliness, as well as the accuracy of the action site of traditional Chinese medicine, and is a breakthrough and original platform technology for the modernization of traditional Chinese medicine.

　　Emi traditional Chinese medicine can not only improve the bioavailability of drugs, effectively reduce the toxic and side effects of traditional Chinese medicine, enhance clinical efficacy, but also more convenient and economical. If the drugs that are not easily absorbed by the human body are made into emi powder, they are easier to be fully absorbed; the effective components of the plaster made from emi drugs can not only directly pass through the skin tissue without obstacles, but also penetrate deeply into the synovial cells.