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Kidney deficiency (Shen Xu), blood stasis (Yu Xue), damp-heat (Shi Re), phlegm accumulation (Tan Ji), and sprain/trauma (Shan Cuo) are common causes of lower back pain. The pulse in lower back pain must be wiry (Xian) and deep (Chen). A wiry pulse indicates deficiency; a deep pulse indicates stagnation. If the pulse is large, it indicates kidney deficiency; if the pulse is choppy (Se), it is due to blood stasis; if the pulse is slow (Huan), it indicates dampness; if the pulse is slippery (Hua) or hidden (Fu), it indicates phlegm.

For lower back pain caused by kidney deficiency, use Eucommiae Cortex (Duzhong), Testudinis et Chelonis Carapax et Plastrum (Guiban), Phellodendri Cortex (Huangbai), Anemarrhenae Rhizoma (Zhimu), Lycii Fructus (Gouqi), and Schisandrae Fructus (Wuweizi). If necessary, add Psoraleae Fructus (Buguzhi) and Porcine Spinal Cord (Zhujisuji), and take them as pills. For pain caused by blood stasis, it is appropriate to use Xingxue Shunqi Buyin Wan (Blood-Invigorating and Qi-Smoothying Yin-Nourishing Pill) and add Persicae Semen (Taoren) and Carthami Flos (Honghua). Additionally, prick the Weizhong (BL40) acupoint to bleed, as blood stasis often stagnates in the lower jiao. For pain caused by damp-heat, one should dry dampness and move qi, using Atractylodis Rhizoma (Cangzhu), Eucommiae Cortex (Duzhong), Chuanxiong Rhizome (Chuanxiong), and Phellodendri Cortex (Huangbai); Zhang Hezi's Wei Shen San (Kidney-Baking Powder) is suitable. For pain caused by phlegm, use Erchen Tang (Two-Cured Decoction) with Arisaematis Rhizoma (Nanxing), assisted by qi-moving medicines, so that phlegm dissipates with the movement of qi. For various excess pains caused by sprain/trauma, use Danggui Chengqi Tang (Angelica Sinensis and Da Huang Decoction) or similar purgatives to drain downward.

The condition known as "Shen Zhuo" (Kidney Fixation) presents with coldness in the waist as if immersed in water, heaviness of the body without thirst, normal urination, normal diet, and a sensation of heaviness in the abdomen as if there were an object in the waist. Treatment should focus on draining dampness while using warm medicines to disperse cold. For pain caused by cold-dampness, Moyao Gao (Waist-Massaging Ointment) is used. For lower back pain so severe that one cannot stand, needle the Renzhong (GV26) acupoint. For chronic lower back pain, Guigui (Cinnamomi Ramulus) must be used to open the meridians to stop thigh pain; this can also be applied to hypochondriac pain. For all types of pain, do not use Ginseng Radix (Renshen) to tonify qi, because if qi flow is obstructed, the pain will worsen. Generally, most pains belong to fire syndromes; one should not severely use cold-cooling medicines, but rather use warm-dispersing methods.

Lower back pain with damp-phlegm leading to diarrhea: Roasted Testudinis et Chelonis Carapax et Plastrum (1 liang), stir-fried Broussonetiae Cortex (Chupi), Atractylodis Rhizoma (Cangzhu), Talcum (Huashi) (each 5 qian), stir-fried Paeoniae Radix Alba (Shaoyao), Cyperi Rhizoma (Xiangfu) (each 4 qian). Grind the above into powder, make pills with rice porridge paste, and swallow like Neishang Baizhu Tang (Internal Injury Atractylodes Macrocephala Decoction) or Shanzha Tang (Hawthorn Decoction).

Damp-pain in waist and legs: Wine-processed Testudinis et Chelonis Carapax et Plastrum (Guiban), wine-processed Phellodendri Cortex (Baibo) (each 5 qian), Citri Reticulatae Pericarpium (Qingpi) (3 qian), raw Glycyrrhizae Radix et Rhizoma (Gancao) (1.5 qian). Grind the above into powder. Take one slice of fresh Zingiberis Rhizoma (Shengjiang), add 2 qian of the medicine powder, grind finely, mix with juice from Xanthii Fructus (Canger), boil until bubbling, and take orally.

Damp-pain in waist and feet: Two liang of wine-processed Testudinis et Chelonis Carapax et Plastrum powder (Guiban), wine-processed Phellodendri Cortex (Baibo), Xanthii Fructus (Canger), Atractylodis Rhizoma (Cangzhu), Syneilesis Rhizoma (Weilingxian) (wine-washed, each 1 liang), Platycladi Cacumen (Bianbo) (half liang). Grind the above into powder. Decoct Sijunzi Tang (Four Substances Decoction) with black bean juice, add Citri Reticulatae Pericarpium (Chenpi), Glycyrrhizae Radix et Rhizoma (Gancao), and Zingiberis Rhizoma (Shengjiang), remove dregs, and mix with 2 qian of the aforementioned powder for oral administration.

Moyao Gao (Waist-Massaging Ointment) treats lower back pain in the elderly and those with deficiency, and also treats leukorrhea: Aconiti Lateralis Radix Praeparata (Wutou), Arisaematis Rhizoma (Nanxing) (each 2.5 qian), Realgar (Xionghuang), Cinnabar (Zhusha) (each 1 qian), Camphora (Zhangnao), Eugeniae Flos (Dingxiang), Zingiberis Rhizoma Recens (Ganjiang), Evodiae Fructus (Wuzhuyu) (each 1.5 qian), Moschus (She) (5 grains). Grind the above into powder, make pills with honey the size of a longan. Each time, dissolve one pill in Ginger Juice (Jiangzhi) to form a porridge-like consistency. Heat it strongly over fire, place in the palm, and massage the waist until the medicine adheres completely. Bind tightly with heated cotton clothing. The waist will feel hot like fire. Use one pill every two days.

Cangzhu Tang (Atractylodis Rhizoma Decoction) treats damp-heat pain in the waist and legs, spasms and tightness in both hypochondria, inability to turn over after sleeping exposed to damp ground: Atractylodis Rhizoma (Cangzhu), Phellodendri Cortex (Huangbai), Bupleuri Radix (Chaihu), Saposhnikoviae Radix (Fangfeng), Aconiti Lateralis Radix Praeparata (Fuzi), Eucommiae Cortex (Duzhong), Chuanxiong Rhizome (Chuanxiong), Cinnamomi Ramulus (Rougui). Decoct and take orally. If cold-damp pathogen invades the body causing heaviness, swelling, pain, and sallow complexion, add Ephedrae Herba (Mahuang).

A sixty-year-old patient suffered unbearable lower back pain after falling from a horse. The six pulses were scattered and large; upon heavy pressure, they became wiry, small, long, and slightly firm. This indicated the presence of evil blood (blood stasis) that could not yet be purged. Therefore, tonification and connection should be prioritized first. Decoct Suomu (Lignum Dalbergiae Odoriferae) with Ginseng Radix (Renshen), Angelicae Sinensis Radix (Danggui), Chuanxiong Rhizome (Chuanxiong), Citri Reticulatae Pericarpium (Chenpi), and Glycyrrhizae Radix et Rhizoma (Gancao) for oral administration. Half a month later, the pulse gradually converged, and appetite improved. Then, the previous medicine was used to administer Zi Ran Tong (Natural Pyrite) and other drugs, resulting in recovery within one day.

Treatment for lower back pain and cold pain of sinews and bones: Angelicae Sinensis Radix (Danggui), Rubia Cordifoliae Radix (Chishaoyao), Notopterygii Rhizoma et Radix (Qianghuo), wine-fried Phellodendri Cortex (Huangbai), wine-fried Eucommiae Cortex (Duzhong) (each 1 qian), Atractylodis Macrocephalae Rhizoma (Baizhu), Chuanxiong Rhizome (Chuanxiong), Aquilariae Lignum Resinatum (Muxiang), Arecae Semen (Binglang), Saposhnikoviae Radix (Fangfeng), Angelicae Dahuricae Radix (Baizhi), Atractylodis Rhizoma (Cangzhu), Illicii Fructus (Bajiaohuixiang) (each half qian), Glycyrrhizae Radix et Rhizoma (Gancao) (3 fen). Decoct and take orally, mixing with 1 qian of Boswelliae Resina (Ruxiang) before meals. Applying Moyao Gao externally is also good.