Core Viewpoint - Knee osteoarthritis, commonly referred to as "old cold legs," is a prevalent condition among the elderly, characterized by knee pain, swelling, and limited mobility, with traditional treatments often leading to gastrointestinal or liver-kidney burdens. Traditional Chinese medicine (TCM) external treatment methods are gaining popularity as a safe and convenient conservative treatment option [1]. Summary by Sections Symptoms of Knee Osteoarthritis - TCM categorizes knee osteoarthritis as "bone bi" or "knee bi," attributing its root cause to liver and kidney deficiency, along with invasion by wind, cold, and dampness, leading to poor circulation of qi and blood, and malnourishment of muscles and bones [2]. TCM External Treatment Methods - TCM external treatment methods intervene in knee osteoarthritis through various approaches, including topical herbal applications, acupuncture, and massage, which improve blood circulation and reduce inflammation. These methods are characterized by their multi-faceted and holistic approach, making them less invasive and more suitable for elderly patients or those with liver and kidney dysfunction [3]. Common TCM External Treatment Methods 1. **Warm Therapy**: - **Moxibustion**: Involves using ignited moxa sticks near knee joint acupuncture points to provide warmth and stimulate qi, effectively alleviating cold pain and stiffness [4]. - **Fire Cupping**: Combines the warming effects of moxibustion with negative pressure suction to enhance blood circulation and reduce inflammation, particularly beneficial for patients with cold-damp obstruction [5]. 2. **Manual Therapy**: - **Massage**: Utilizes techniques such as pressing and kneading to relieve muscle stiffness around the knee joint, promoting blood flow and improving joint mobility [6]. - **Needle Knife Therapy**: A minimally invasive technique that releases adhesions in soft tissues around the knee, restoring mechanical balance and alleviating deep pain [7]. 3. **Topical Herbal Applications**: - **Fumigation and Soaking**: Involves using herbal decoctions to steam or wet the knee joint, promoting absorption of medicinal properties through the skin, effectively reducing swelling and inflammation [9]. - **Plaster Application**: Directly applying herbal plasters to the painful areas of the knee, allowing for sustained local action and avoiding gastrointestinal irritation from oral medications [10]. Considerations for TCM External Treatments - While TCM external treatments are beneficial, they should be administered under professional guidance, especially during acute inflammatory phases. Caution is advised for patients with severe osteoporosis or skin lesions. Emphasis is placed on preventive measures, including regular exercise and maintaining a healthy lifestyle to delay knee degeneration and improve quality of life [11].