Library

Cao (39 years old): Dampness stagnation. Lower abdominal pain radiating to the waist. Soreness in the right foot. (Lumbago)
Stephania tetrandra (Mufangji), Morus alba silkworm sand (Wancansha), Calcined talcum powder (Feihuashi), Poria cocos skin (Fulingpi), Apricot seed (Xingren), Magnolia bark (Nongpu), Tsaoko cardamom (Caoguo), Dioscorea hypoglauca rhizome (Bixie).

Yu (55 years old): Fatigue and exhaustion complicated by dampness. Lumbar pain.
Cinnamon twig tip (Chuanguijijian), Stephania tetrandra (Mufangji), Raw Coix seed (Shengyiren), Poria cocos skin (Fulingpi), Morus alba silkworm sand (Wancansha), Dioscorea hypoglauca rhizome (Bixie).

He (47 years old): Lumbar pain. Painful bi syndrome at the Huantiao acupoint (GB30).
Astragalus complanatus seed (Shayuan), Cinnamon twig wood (Guizhimu), Fennel seed (Xiaohui), Poria cocos (Fuling), Eucommia bark (Sangjisheng), Stir-fried Goji berry (Chaoqizi).

Weng (35 years old): Lumbar pain caused by strenuous effort.
Raw Eucommia bark (Shengdudzhong), Angelica sinensis (Danggui), Five-leaf acanthopanax bark (Wujapi), Stir-fried Achyranthes root (Chaoniuxi), Goji berry (Gouqizi), Poria cocos (Fuling), Green salt (Qingyan), Raw sheep kidney (Shengyangyaozi).

Mrs. Wu: Weak pulse, feverish body, pain in both lumbar region and thighs. Distinct mass in lower abdomen with attacking tenderness. Visceral yin and extraordinary vessels are simultaneously injured. It should not be treated as an external contraction.
Angelica sinensis (Danggui), Stir-fried White Peony Root (Chaobaishao), Cinnamon twig (Guizhi), Poria cocos (Fuling), Honey-fried Licorice root (Zhigancao), Roasted Ginger (Weijiang), Jujube (Dazao).

Wang (23 years old): Choppy pulse. Pain throughout the lumbar region, thighs, and Huantiao acupoint (GB30), triggered by fatigue. Deficiency of the Lower Jiao, obstruction of collaterals. This is what is meant by "collateral deficiency leads to pain."
Angelica sinensis root body (Guishen), Cinnamon twig wood (Guizhimu), Raw Eucommia bark (Shengdudzhong), Stephania tetrandra (Mufangji), Astragalus complanatus seed (Shayuan), Achyranthes root (Niuxi), Dioscorea hypoglauca rhizome (Bixie), Fennel seed (Xiaohui).

Certain patient: Loose stools, lumbar pain with weakness. Prescription: Shu Tu Wan formula.

Zhu: Fine pulse, sallow complexion. Liver and Kidney deficiency, lumbar pain. Treatment method for collateral diseases.
Raw sheep internal kidney (Shengyangneishen), Angelica sinensis (Danggui), Goji berry (Gouqizi), Fennel seed (Xiaohui), Walnut kernel with purple skin (Ziyihetao), Spirit of Poria (Fushen).

Wang (Elderly woman): Long-term pain in waist and knees in the elderly, radiating to the lower abdomen and both legs, unable to walk. The extraordinary vessels mostly belong to the Liver and Kidney. (Waist and knee pain)
Deer horn frost (Lujiaoshuang), Angelica sinensis (Danggui), Cistanche stem (Roucongrong), Thin Cinnamon bark (Baogui), Fennel seed (Xiaohui), Biota seed (Baiziren).

Wang (35 years old): Slow and delayed pulse. Loose stools after drinking alcohol, seminal emission for several years without cessation. Recently, heavy dragging pain and numbness in the lumbar-thigh region and knee-feet. This is dampness coagulation injuring the Spleen and Kidney Yang. Tonifying and astringent methods will certainly not match the disease. First, propose using Ling Jiang Zhu Gui Tang to dispel dampness and warm the earth (Spleen/Stomach). Then discuss subsequent methods.

Wu: White and dry tongue coating, no hunger sensation in the epigastrium, pulling pain in the tendons of both knees and dorsum of feet. Although there is a chronic condition, the recent onset of pain must involve seasonal warm-heat and damp-steaming qi obstructing the pathways of flow. Reasonably advance promoting unblocking methods; do not use wind-dispelling drugs. (Knee, leg, and foot pain)
Calcined talcum powder (Feihuashi), Gypsum fibrosum (Shigao), Arsenolite (Han shuishishi), Apricot seed (Xingren), Stepheania root (Fangji), Coix seed (Yiren), Spirit pepper (Weilingxian).

Jiang (7 years old): Swelling of feet and knees, prolonged pain, internal heat.
Raw Tiger bone (Shenghugu), Stir-fried Achyranthes root (Chaoniuxi), Dioscorea hypoglauca rhizome (Bixie), Gold-haired Dogwood spine (Jinmaogouji), Angelica sinensis (Danggui), Epimedium leaf (Xianlingpi).
Again: Add Raw Deer Horn and Phellodendron bark (Huangbai) to the previous prescription.

Zhang (42 years old): Injury from labor, numbness and pain in the left leg bones.
Raw Tiger bone (4 liang), Angelica sinensis (2 liang), Five-leaf acanthopanax bark (2 liang), Epimedium leaf (2 liang), Achyranthes root (2 liang), Notopterygium root (Duhuo), White Eggplant root (Baiqiegen), Oil Pine joint (Yousongjie), Gold-haired Dogwood spine (8 liang).

Zhu: Pain fixed on the front of the right leg, muscles not swollen. The pathology must be in the sinews and bones. Moreover, the condition worsens at night, pathogen lingering in Yin, occasionally accompanied by hernia. Treatment follows the Liver meridian.
Raw Eucommia bark (1 liang), Angelica sinensis tail (Dangguixu), Pangolin scale (2 qian, fried), Fennel seed (1 qian, fried), Northern Asarum (Beixixin), Dried Earthworm (Gan dilong, fried 1 qian).

Certain patient: Vomiting and regurgitation of saliva, Chong Qi attacking the Heart. Hardness and pain in the big toe of the foot. (Foot pain)
Light Evodia fruit (Dan wuyu), Prepared Aconite root (Shu fuzi), Notopterygium root (Duhuo), Northern Asarum (Beixixin), Angelica sinensis (Danggui), Han Fangji (Huanfangji).

Certain patient: Pain upon touching the skin membrane of both feet. Caused by Jueyin invading Yangming, resulting in Stomach rebellion. Pulse is wiry and rapid. Treatment should be draining and dispersing.
Toosendan fruit (Chuannianzi), Corydalis rhizome (Yanhu), Tangerine green peel (Qingpi), Black Gardenia fruit (Heishanzhi), Angelica sinensis tail (Guixu), Peach kernel (Taoren), Tangerine peel (Juhong), Stir-fried black Hawthorn flesh (Chaohei zharonr).

Lu (24 years old): Hiccups after full meals, indicating Stomach disease. Pain in all joints of both feet. The Yangming Stomach meridian fails to bind sinews and bones, causing attacking pain. Propose the method of rotating Yang Qi.
Ling Jiang Zhu Gui Tang.

Certain patient: Numbness, stiff sinews, and slight swelling in the affected area of the right foot. In the elderly, Qi and Blood cannot circulate freely. Disease starting in Winter extends to Late Summer, food intake decreases. Pulse is small and weak. Main treatment with warming and nourishing.
Tiger shin bone (Sanqian, raw pounded), Huai Achyranthes root (Yiqian), Angelica sinensis root body (Yiqian, fried), Goji berry (Sanqian, fried), Raw Eucommia bark (Sanqian), Dendrobium stem (Sanqian), Dioscorea hypoglauca rhizome (Yiqian), Tribulus fruit (Yiqian, stir-fried, thorns removed, ground).

The waist is the mansion of the Kidney. The Kidney and Bladder are interior-exterior pairs. Externally, it belongs to the Taiyang; internally, it belongs to Shaoyin. It is also the crucial meeting point of the Chong, Ren, Du, and Dai vessels. Therefore, for the symptom of lumbar pain, one must take the Kidney as the primary disease site. However, there are distinctions among internal causes, external causes, and non-internal/external causes. There are five traditional discriminations: 1. Yang deficiency insufficiency, Shaoyin Kidney decline; 2. Wind-bi Cold-Wind, Dampness adhering to cause lumbar pain; 3. Labor injury damaging the Kidney; 4. Falling or trauma injury; 5. Sleeping on wet ground. These theories are already detailed. Zhang Jingyue further added discussions on exterior-interior, deficiency-excess, cold-heat, which are particularly comprehensive. For internal cause treatments: If Kidney Yang is deficient, benefit the root of Fire to eliminate Yin shadows; if Kidney Yin is depleted, strengthen the source of Water to control Yang brightness. For external cause treatments: For Cold-Damp injuring Yang, use bitter-pungent-warm herbs to unblock Yang and drain turbidity; for Dampness stagnation generating Heat, use bitter-pungent herbs to overcome dampness and promote Qi flow. For non-internal/external cause treatments: For labor injury damaging the Kidney, treat both Pre-heaven and Post-heaven sources; for falling trauma, discriminate the severity of injury and presence of blood stasis, adopting either unblocking or tonifying methods. Regarding leg and foot pain, external contractions involve only Cold-Damp, Damp-Heat, or Wind-Damp pathogens entering the meridians and collaterals. The Classic states: "Those injured by Dampness, the lower part receives it first." Thus, treatment should focus primarily on resolving dampness, assisting with warming, clearing, or dispersing methods according to symptoms. Internal injuries mainly involve deficiencies of the Liver, Spleen, and Kidney, treating by tonifying the Middle, filling the Lower, or nourishing the Liver, according to the disease. Ancient methods for treating lumbar, leg, and foot pain are generally as described. However, diagnosing symptoms must be thorough like illuminating monsters with a fire-rhinoceros horn; prescribing medicine requires precision like dropping a mustard seed onto a needle. Reviewing these cases: for a patient with loose stools after drinking, persistent seminal emission, and lumbar numbness, others would use tonifying and astringent drugs, but Mr. Ye diagnosed dampness coagulation injuring Spleen-Kidney Yang, using Ling Gui Zhu Gan Tang to dispel dampness and warm the spleen. For an elderly patient with lumbar pain, others merely used generic Kidney-tonifying herbs, but Mr. Ye considered that extraordinary vessels belong to the Liver and Kidney, using animal-derived substances like Deer Horn, Angelica, Cistanche, Thin Cinnamon, and Fennel to warm and nourish the Lower Jiao. For pain fixed in the right leg, muscle not swollen, worsening at night, Mr. Ye determined the pathology was in sinews and bones, pathogen flowing into Yin, using Angelica tail, Earthworm, Pangolin scale, and Asarum to enter collaterals with pungent-aromatic-bitter-warm properties to search out pathogens. For patients with pain upon touching the skin of both feet, seemingly Wind-Damp, Mr. Ye diagnosed Jueyin invading Yangming, using Toosendan, Corydalis, Angelica tail, Peach kernel, Green Peel, and Gardenia to drain the Liver. For hiccups after eating and joint pain in both feet, people usually use dispersing and purging methods, but Mr. Ye followed the idea that Yangming deficiency cannot bind sinews and bones, using Ling Jiang Zhu Gui Tang to rotate Yang Qi. Such treatments exceed ordinary capabilities. In summary, treating disease requires examining deficiency and excess, and further observing deficiency within excess and excess within deficiency. Merely knowing to tonify deficiency and attack excess is common knowledge. Deeply studying these cases suffices to supplement the wisdom of future generations. Is it trivial? (Commented by Gong Shangnian)

Xu's Commentary: Any pathogen that lingers and adheres should generally be attacked externally. The Inner Canon has a chapter on lumbar pain, also implying that medication alone may not suffice to cure the disease.