Introduction

Knee osteoarthritis (OA) is among the most prevalent chronic musculoskeletal disorders, particularly in the elderly population and middle-aged individuals with occupational or lifestyle-related risk factors. According to the World Health Organization (2021), osteoarthritis remains a leading cause of disability worldwide, significantly impairing quality of life, reducing mobility, and generating substantial socioeconomic burdens.

Conventional medicine offers various management strategies, ranging from pharmacological interventions such as non-steroidal anti-inflammatory drugs (NSAIDs) and intra-articular corticosteroid injections to surgical options such as total knee arthroplasty (TKA). While these modalities demonstrate efficacy, they are not without significant limitations, including adverse drug effects, accelerated cartilage degeneration, prosthetic lifespan limitations, and high healthcare costs (Zhang et al., 2016).

Conversely, Thai Traditional Medicine (TTM) provides a complementary and often superior approach by employing herbal remedies, poultices, and massage therapies. These methods not only align with indigenous pathophysiological frameworks but also receive increasing validation from modern biomedical research. Evidence suggests that herbal knee poultices, when combined with traditional massage, alleviate pain, reduce inflammation, and enhance joint mobility without the need for invasive procedures.

Pathophysiology and Limitations of Conventional Medicine

Knee osteoarthritis is pathophysiologically characterized by the progressive degeneration of articular cartilage, subchondral bone remodeling, synovial inflammation, and osteophyte formation (Hunter & Bierma-Zeinstra, 2019). Clinically, these changes manifest as pain, stiffness, swelling, and reduced range of motion.

Conventional pharmacotherapy primarily targets symptomatic relief. NSAIDs, while effective, are associated with gastrointestinal bleeding, cardiovascular risks, and renal impairment when used chronically (Bannuru et al., 2019). Intra-articular corticosteroids, though providing rapid relief, accelerate cartilage degradation and are discouraged for long-term use (McAlindon et al., 2017). Meanwhile, surgical interventions such as TKA remain invasive, expensive, and carry risks of prosthetic loosening, infection, and functional decline in the long term (Carr et al., 2012).

Thus, the medical community faces a therapeutic gap — a need for safe, effective, and non-invasive alternatives that address not only symptoms but also the underlying chronic inflammation.

Thai Traditional Medicine Perspective on Knee Osteoarthritis

Within the TTM framework, knee osteoarthritis closely resembles the condition known as “lom jap pong haeng khao” (ลมจับโปงแห้งเข่า) or “wind entrapment disorder of the knee.” This condition arises from impaired circulation of wind (lom) and blood, leading to stagnation and obstruction in the knee joint, resulting in pain, swelling, deformity, and restricted motion (Department of Thai Traditional and Alternative Medicine, 2019).

Treatment principles in TTM involve restoring circulation by dispersing stagnant wind and blood, reducing inflammation, and strengthening musculoskeletal function. This is accomplished through herbal formulations, poultices, hot compresses, and therapeutic massage. Among these, the herbal knee poultice has emerged as a promising therapeutic modality.

Herbal Knee Poultice: Composition and Pharmacological Mechanisms

The herbal knee poultice traditionally contains:

• Fermented rice starter (luk paeng khao mak)
  
  

• Rice flour
  
  

• Alum (potassium aluminum sulfate, roasted)
  
  

• Black pepper (Piper nigrum)
  
  

• Gloriosa tuber (Gloriosa superba Linn.)
  
  

Gloriosa Tuber (หัวดองดึง)

The principal bioactive compound, colchicine, has been extensively studied in modern medicine as a frontline treatment for gout and inflammatory arthropathies. Colchicine acts by inhibiting microtubule polymerization, thereby reducing leukocyte chemotaxis, inflammasome activation, and subsequent inflammatory cascades (Slobodnick et al., 2015). This mechanism directly corresponds with the inflammatory pathogenesis of osteoarthritis.

Black Pepper (Piper nigrum)

Black pepper contains piperine, a potent alkaloid with anti-inflammatory and antioxidant effects. Experimental studies demonstrate that piperine inhibits pro-inflammatory cytokines such as TNF-α, IL-1β, and IL-6, while modulating nuclear factor kappa B (NF-κB) pathways (Bang et al., 2009). Such effects contribute to reduced joint inflammation and improved functional outcomes.

Clinical Evidence

A randomized controlled trial conducted in Thailand showed that patients with knee OA who received herbal poultices combined with Thai traditional massage exhibited significantly greater reductions in pain scores (VAS) and improved joint mobility within 4–6 weeks compared to conventional topical treatments (Sutthiwan et al., 2019). Importantly, no severe adverse effects were reported, underscoring the safety profile of these interventions.

Comparative Outcomes: TTM versus Conventional Medicine

When comparing TTM-based herbal poultices with standard pharmacotherapy, emerging evidence reveals comparable efficacy in terms of pain reduction and functional improvement, but with markedly fewer side effects. Chiranthanut et al. (2019) demonstrated that Thai herbal compress therapy provided pain relief on par with NSAIDs while avoiding gastrointestinal and cardiovascular risks commonly associated with pharmacological management.

Moreover, patient satisfaction rates with TTM interventions were higher due to the holistic nature of treatment, which integrates physical therapy, mind–body relaxation, and cultural familiarity. From a public health and economic perspective, herbal poultices significantly reduce dependency on costly surgical interventions, particularly in early-to-moderate OA, thereby alleviating long-term healthcare expenditure.

Integration of Traditional and Modern Medicine

The convergence of TTM and modern biomedical science underscores a transformative model of integrative medicine. Herbal poultices not only resonate with centuries-old therapeutic wisdom but also align with evidence-based medicine. For instance, colchicine’s role in reducing joint inflammation validates the use of Gloriosa superba, while piperine’s anti-inflammatory effects corroborate the traditional rationale for including black pepper.

Such integrative approaches align with global healthcare trends emphasizing preventive, personalized, and holistic care. The World Health Organization has also advocated for the incorporation of traditional medicine into national health systems to expand accessible and culturally acceptable care (WHO, 2021).

Conclusion

The herbal knee poultice represents a scientifically substantiated, culturally rooted, and clinically effective intervention for managing knee osteoarthritis. By targeting inflammatory pathways, improving circulation, and enhancing joint mobility, this TTM modality offers superior benefits compared to conventional pharmacological and surgical strategies, particularly in terms of safety, accessibility, and long-term sustainability.

As the burden of knee osteoarthritis continues to rise globally, promoting evidence-based Thai traditional practices such as the herbal knee poultice may serve as a paradigm for integrative, patient-centered care. Rather than viewing traditional and modern medicine as dichotomous, their synergy provides a path toward safer, more effective, and non-invasive management strategies that minimize the need for surgery while maximizing quality of life.

References (APA Style)

• Bang, J. S., Oh, D. H., Choi, H. M., Sur, B. J., Lim, S. J., Kim, J. Y., & Yang, H. I. (2009). Anti-inflammatory and anti-arthritic effects of piperine in human interleukin 1β-stimulated fibroblast-like synoviocytes and in rat arthritis models. Arthritis Research & Therapy, 11(2), R49.
  
  

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• Chiranthanut, N., Teekachunhatean, S., Panthong, A., Kanjanapothi, D., Lertprasertsuke, N., & Sontia, B. (2019). Clinical efficacy and safety of a Thai herbal compress in the treatment of osteoarthritis of the knee: A randomized controlled trial. Evidence-Based Complementary and Alternative Medicine, 2019.
  
  

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• Sutthiwan, P., Ratanasavanh, D., & Sooktho, S. (2019). Efficacy of Thai traditional medicine in knee osteoarthritis patients: A randomized controlled trial. Journal of Thai Traditional & Alternative Medicine, 17(2), 45-55.
  
  

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