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Loss of will injures the Kidney (Shen), depression and anger injure the Liver (Gan), worry and overthinking injure the Spleen (Pi); all these can lead to lower back pain. This is because the Liver and Kidney are closely related, and the Spleen and Stomach are exterior-interior partners. When Spleen transport stagnates and Stomach closure occurs, it most easily causes lower back pain. The symptoms include emaciation and deficiency, dark complexion, inability to exert full strength after long walks or standing for a long time; this is caused by loss of will. Abdominal urgency and hypochondriac distension, blurred vision, unfulfilled desires, external wandering of thoughts and lust, flaccidity of the sinews (Zongjin), and occurrence of white discharge (Baiyin, referring to seminal emission in men or clear vaginal discharge in women); this is caused by depression and anger. Muscle infiltration with dampness, numbness and insensitivity, failure of food digestion, abdominal and intestinal distension, and lower back and hypochondriac pain due to sprains or falls; this is caused by worry and overthinking. Based on this, treatment should be regulated according to internal causes.

Kidney-attaching lower back pain presents with coldness in the waist like ice, heaviness in the body without thirst, normal urination, and normal appetite. The area below the waist feels cold and heavy as if bound with five thousand coins. It arises from sweating during labor, with cold and damp clothes remaining against the skin for a long time. Lower back pain accompanied by stooping, swelling, and heaviness, radiating pain to the lateral costal margin, is caused by falls or trauma leading to stasis of evil blood. Also, exhaustion from sexual activity depletes essence and qi, causing lower back pain. Based on this, treatment should employ tonification and purgation methods according to non-internal and non-external causes.

Generally, lower back pain is caused by weakness of Kidney Qi, lying on cold and damp ground, and contracting wind pathogens. If not treated promptly, the pathogen tends to flow into the feet and knees, causing hemiplegia (Pianku), cold bi-syndrome, weakness, and heavy pain, or lower back pain with spasms, heavy and numb feet. One should immediately take this prescription:
Du Huo (Radix Angelicae Pubescentis, 3 liang) Sang Sheng Ji (Herba Taxilli, note: *Gu Jin Lu Yan* uses Xu Duan, which is also a name for Sang Ji Sheng, but is not the true Xu Duan) Du Zhong (Cortex Eucommiae, processed, stir-fried until fibers break) Xi Xin (Radix et Rhizoma Asari, remove seedlings) Niu Xi (Radix Achyranthis Bidentatae, soaked in wine) Qin Jiao (Radix Gentianae Macrophyllae, remove soil) Fu Ling (Poria) Bai Shao Yao (Radix Paeoniae Alba) Gui Xin (Cortex Cinnamomi, do not expose to fire) Xiong (Radix Chuanxiong) Fang Feng (Radix Saposhnikoviae, remove rhizome head) Gan Cao (Radix Glycyrrhizae, honey-fried) Ren Shen (Radix Ginseng) Shu Di Huang (Radix Rehmanniae Preparata) Dang Gui (Radix Angelicae Sinensis) (each 2 liang).
Grind the above into a coarse powder. Take four large qian-bi per dose, add two zhan of water, decoct to seven-tenths, remove dregs, and take on an empty stomach. For qi deficiency with downward diarrhea, remove Di Huang. It also treats postpartum abdominal pain preventing movement, as well as lower back and leg spasmodic pain, numbness, weakness, and inability to flex or extend. This decoction is best at dispelling wind and resolving blood stasis. *Zhou Hou Bei Ji Fang* includes one Fu Zi (Radix Aconiti Lateralis Preparata), but lacks Sang Ji Sheng, Ren Shen, Gan Cao, and Dang Gui. Modern practitioners use it to treat Li Jie Feng (rheumatoid arthritis-like conditions) and Hong Kong Jiao Liu Zhu (gouty arthritis with flowing obstruction) with great efficacy.
Xiao Xu Ming Tang (Minor Decoction that Preserves Life) is excellent for treating wind-induced lower back pain. (See formula in Stroke chapter, add Tao Ren [Semen Persicae], stir-fried, peeled, and crushed.)