"It's my age, doctor. Nothing to be done about it." Knees are among the parts of the body most readily written off as ageing — after which nobody asks any further questions.

But age is not a diagnosis. A sore knee at sixty might be wear, or inflammation, or an old injury, or years of walking in a way that compensated for something else — and sometimes it is not the knee at all. This article is about what a practitioner asks — set out as 5 things.

I. First: when it hurts tells you more than how much it hurts

In a consultation, "how bad is it" ranks surprisingly low. When it hurts is where the sorting starts:

• Going up stairs, or coming down — two different movements that load the joint differently.
• Squatting down, or standing back up.
• Only after walking a while, or sore at the first step and easier once you get going.
• Stiffest for the first few steps after sitting a long time, easing as you move.
• Aching at night while lying still, unrelated to activity.

That last one matters — pain unrelated to activity, particularly at night, is a sign to have assessed first. See section IV.

As for how this is categorised within TCM theory, that belongs to the framework of channels and qi-blood, which is not the same as the modern medical description of knee structures.

II. The 5 things a practitioner asks about

• Exactly where — front, inner side, outer side, behind the knee, or nowhere you can point to.
• What brings it on — stairs, squatting, kneeling, standing after sitting, walking a slope.
• Swelling, heat, locking, or giving way — these four are different things, and each matters.
• One knee or both — the answer leads the consultation in different directions.
• Past injuries and work history — a twist in your twenties, an old accident, years of kneeling work, how many flights of stairs a day.

The fifth often gets left out as "too long ago to matter". The opposite is true. A sprain decades back can be the start of how you walk today.

III. How to describe it usefully

This table deliberately does not say what any answer "means". TCM is not a self-matching exercise — the assessment is the practitioner's, after the consultation.

IV. When to see a doctor first

• A red, swollen, hot knee — particularly with a fever — call 999 or go to the nearest emergency department immediately. An acute joint infection needs prompt attention.
• Unable to bear weight or walk after a clear injury — seek medical attention immediately; imaging may be needed.
• The knee suddenly locking so it will not straighten, or repeatedly giving way and causing falls — see a doctor for assessment first.
• Swelling that comes up quickly — see a doctor first.
• Pain that wakes you at night, does not ease with rest, or comes with unexplained weight loss — see a doctor first.
• A swollen, warm, painful calf on one side — go to the nearest emergency department today, and do not massage or manipulate it. If breathlessness or chest pain develops, call 999 or go to the nearest emergency department — this can move quickly, so do not wait to see whether it settles.

A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.

V. Fitting it into life in Malaysia

• Stairs — living above a shop or in a walk-up flat, lifts that are often out, how many trips a day. That is concrete information, and far more useful than "I don't exercise much".
• Squatting and kneeling — prayers, washing floors, crouching to stock shelves in the kedai, traditional squat toilets. Years of accumulated posture is worth describing.
• Footwear — slippers all day, hard-soled work shoes, whether long walking days feel different.
• Weight changes — this is not a judgement. The knee carries body weight directly, so recent gain or loss is relevant either way.
• Don't rush to have someone give it a good pull — where there is swelling, locking or giving way, any manual technique should follow an assessment. For the difference between tui na and relaxation massage, see tui na or massage?

For how pain is approached in a consultation generally, see how TCM approaches pain. Backs and knees influence each other — see also back pain, acute or chronic?

In closing

✅ Worth remembering:

1. Age is not a diagnosis — "getting old" should not be where the questions stop.
2. When it hurts says more than how much: stairs up, stairs down, squatting, standing after sitting.
3. A practitioner asks about location, triggering movements, swelling/heat/locking/giving way, one knee or both, and old injuries and work history.
4. A red, hot, swollen knee — call 999 or go to an emergency department; unable to bear weight after injury, sudden locking or giving way — see a doctor first.
5. An injury from decades ago is worth mentioning — it may be where today's pattern started.

❌ What not to do:

1. Do not stop asking questions because "it's my age".
2. Do not have any manual technique done on a swollen or locking knee before it is assessed.
3. Do not treat pain that wakes you at night as ordinary aching to be endured.

👉 If you would like to set out your knee properly for a practitioner, you are welcome to book an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it with you. In-person consultations are coming soon.

Sit with a licensed TCM practitioner from wherever you are.

HansMed Modern TCM

「医师，我这个膝盖，年纪到了嘛，没办法的。」膝盖是最常被归给「老化」然后就不再追问的部位之一。

但年龄不是一个诊断。六十岁的膝盖痛可能是磨损，也可能是发炎、是旧伤、是走路姿势代偿了很多年，甚至可能根本不是膝盖本身的问题。这篇讲的是医师在问诊时会了解哪些事，整理成 5 件事。

一、先分清楚：痛的时机，比痛的程度更能说明问题

问诊时，「多痛」其实排在很后面。什么时候痛才是分辨的起点：

• 上楼梯痛，还是下楼梯痛——这两个是不同的动作，负担的方式不一样。
• 蹲下去痛，还是站起来痛。
• 走一段路之后才痛，还是一开始动就痛、走开了反而松。
• 坐久了站起来那几步最僵，走一走就好一些。
• 晚上躺着也痛，与活动无关。

最后一项要特别注意——与活动无关的疼痛，尤其是夜间痛，是需要先就医评估的信号，见第四节。

至于这些在中医里怎么归类，属于经络与气血的理论框架，与现代医学对膝关节结构的描述不是同一回事。

二、医师会了解的 5 件事

• 确切位置：膝盖前面、内侧、外侧、后面（膝窝），还是说不出确切的点。
• 诱发动作：上下楼梯、蹲、跪、久坐后起身、走斜坡。
• 有没有肿、热、卡住、软脚：这四个字各自代表不同的情况。
• 两边还是单边：这一题会带出不同的问诊方向。
• 过去的伤与工作史：年轻时的扭伤、旧车祸、长年蹲着或跪着工作、爬楼梯的频率。

第五项常被认为「太久以前了不用讲」——恰恰相反。几十年前的一次扭伤，可能是今天走路姿势的起点。

三、一张表看懂：怎么描述才有用

这张表刻意不写「哪一个答案代表什么」。中医不做自我对号入座——分辨是医师问诊后的判断。

四、这些情况请先就医

• 膝盖红、肿、发热，尤其伴随发烧时——请立刻拨打 999 或前往最近的急诊部。关节的急性感染需要尽快处理。
• 明显外伤之后无法承重、走不了路——请立刻就医，可能需要影像检查。
• 膝盖突然「卡住」伸不直，或反覆软脚跌倒——请先就医评估。
• 短时间内明显肿起来——请先就医。
• 夜间痛醒、休息也不缓解，或伴随不明原因的体重下降——请先就医。
• 单侧小腿肿胀、发热、疼痛——请立刻前往最近的急诊部，并不要按摩或推拿该部位。若同时出现气促或胸痛，请立刻拨打 999 或前往最近的急诊部，这类情况可能进展得很快，不要等它自己缓解。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

五、大马生活里怎么安排

• 楼梯：住组屋或店屋楼上、电梯常坏、一天上下几趟——这些是具体资讯，比「我很少运动」有用。
• 蹲跪的习惯：拜拜、洗地、在 kedai 里蹲着理货、传统蹲厕——长年累积的姿势值得说明。
• 鞋子：整天穿拖鞋、工作穿硬底鞋、走路多的日子有没有差别。
• 体重变化：这不是评价，是因为膝盖承重与体重直接相关，近期的增减都值得讲。
• 别急着请人「拉一拉」：膝盖出现肿、卡住或软脚时，任何手法都应该先经过评估。想了解推拿与放松性按摩的差别，可参考：推拿和按摩有什么不同。

关于疼痛问诊的整体顺序，可参考：中医怎么看疼痛。腰与膝常互相影响，腰痛的部分可参考：腰痛：急性和慢性有什么不同。

结语

✅ 记住这几点：

1. 年龄不是诊断——「老化」不该是追问的终点。
2. 什么时候痛，比多痛更能说明问题：上楼梯、下楼梯、蹲、久坐后起身。
3. 医师会了解位置、诱发动作、肿热卡软、单双边、旧伤与工作史。
4. 膝盖红肿发热——立刻拨 999 或前往急诊部；外伤后无法承重、突然卡住或软脚——先就医。
5. 几十年前的旧伤值得讲，它可能是今天的起点。

❌ 不要这样做：

1. 不要因为「年纪到了」就不再追问。
2. 不要在膝盖肿胀或卡住时先接受任何手法，应先经过评估。
3. 不要把夜间痛醒当成一般的酸痛忍着。

👉 如果您想把膝盖的情况完整说给医师听，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估。亲诊服务即将推出。

无论身在何处，与持证中医师对坐。

汉方现代中医