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The Bladder meridian descends to the waist, and the Kidney meridian enters the waist. Furthermore, the classics state: "The waist is the mansion of the Kidney; if turning and shaking are difficult, the Kidney Qi is about to fail." Therefore, low back pain is a disease of the Kidney and Bladder. When the Taiyang meridian (Greater Yang) is deficient, pathogenic factors such as wind, cold, and dampness can easily invade and cause illness, with deficiency of the Kidney leading to particularly frequent occurrences.

Symptoms include flaccidity and weakness of the waist and limbs, bodily fatigue, soreness and weakness of the feet and knees, pulse either surging or fine but always forceless, and pain that is dull, hidden, and not severe. These are its characteristic signs. It is divided into two syndromes: cold and heat. A fine and forceless pulse, timid Qi, and clear, free urination indicate Yang deficiency. Suitable formulas include Shenqi Wan (Kidney Qi Pill, see Deficiency Damage), Juxiang Wan (Citrus Fragrance Pill), and Shengliao Lurong Wan (Raw Material Deer Antler Pill, see Blood Disorders). Additionally, use Fennel seeds stir-fried and powdered, sliced pig kidneys (not cut through), sprinkle the powder inside, wrap in paper, and bake until hot; take with yellow wine. A surging yet forceless pulse, yellow-red urine, and occasional flare-ups of deficient fire indicate Yin deficiency. Dongyuan stated that indulgence in alcohol and sexual intercourse damages true Yin, causing Heat in the Kidney Qi. Heat leads to pain in the lower back and spine preventing lifting, and over time, depletion of marrow and withering of bones, developing into Bone Wei (Bone Flaccidity). Suitable formulas include Liuwei Wan (Six-Ingredient Pill, see Deficiency Damage), Zishen Wan (Nourish Kidney Pill, see Difficulty in Urination), and Fengsui Dan (Seal Marrow Elixir, see Spermatorrhea). Pain occurring after malaria/dysentery or menstruation mostly belongs to deficiency; add Eucommia Bark (Duzhong) and Biota Leaf (Cebaiye) to Qi- and Blood-tonifying herbs. Danxi said: For chronic low back pain, Guigui (Cinnamon Bark) must be used to open the pathways for the pain to cease. The same applies to hypochondriac and abdominal pain. Causes include Wind, Cold, Dampness, Heat, sprain/strain, Blood stasis, Qi stagnation, and Phlegm accumulation.

Wind injury results in a floating pulse, pain on either the left or right side, pain without fixed location, radiating to both legs; Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root), and Qinjiao (Gentiana Macrophylla Root) are essential. Cold injury causes pain with the waist feeling cold as ice, a tight pulse, relief with heat, and aggravation with cold; treat with Jiangfu Tang (Ginger and Aconite Decoction, see Middle Cold) plus Lagui (Spicy Cinnamon) and Duzhong, externally apply Moyao Gao (Waist Rubbing Plaster). Dampness injury feels like sitting in water, a slow pulse, onset during cloudy weather or prolonged sitting (prolonged sitting condenses dampness), bodily swelling; treat with Shenshi Tang (Leach Dampness Decoction) or Shen Zhuo Tang (Kidney Fixation Decoction) (both see Injury by Dampness). Heavy body, cold waist, normal diet, and free urination are named Shen Zhuo (Kidney Fixation), where Cold-Damp Qi condenses and adheres without moving. Treatment should dispel dampness while warming and dispersing. For Wind-Damp, use Duhuo Jisheng Tang (Angelica Pubescens and Hosta Root Decoction). For Damp-Heat, use Cangzhu Tang (Atractylodes Rhizome Decoction), Duhuo Tang, or Qianghuo Tang.

Pain from sprains or falls: Use Ruxiang Tong San (Frankincense Pain Powder), or Wuji San (Five Accumulations Powder, see Middle Cold) plus Taoren (Peach Kernel), Dahuang (Rhubarb Root), and Sumu (Sappan Wood) each 1 qian, double the dose of Danggui (Angelica Sinensis). Alternatively, pound Fennel root with Red Yeast Rice, mix with hot wine, and take. Pain from labor and heavy lifting: Use Heqi Yin (Harmonize Qi Drink) or Puxian Zhengqi San.

Blood stasis presents with a choppy pulse, pain upon turning like knife or awl piercing, black stool, lighter by day and heavier by night; treat with Tao Ren Jiu Tiao Heishen San (Black God Powder mixed with Peach Kernel Wine) or Siwu Tang (Four Substances Decoction, see Blood Disorders), adding Taoren (Peach Kernel) and Honghua (Safflower). Qi stagnation presents with a deep pulse; treat with Wuyao Shunqi San (Lindera Smooth Qi Powder) or Renshen Shunqi San (Ginseng Smooth Qi Powder). Phlegm accumulation presents with a slippery or deep-wiry pulse; treat with Erchen Tang (Two Aged Herbs Decoction, see Phlegm) plus Nanxing (Arisaema Rhizome), Xiangfu (Cyperus Rhizome), Wuyao (Lindera Root), Zhike (Bitter Orange Fruit), and Weilingxian (Syneilesis Aconitifolia Root), an important herb for pain. Grind to powder, use 2 qian per dose, sprinkle inside pig kidney, bake and eat, take with hot wine, stopping when mild diarrhea occurs.

Prepare Duzhong (stir-fried with Ginger Juice until fibers break), Heiqiu (Black Morning Glory Seed), Poguzhi (Cistanche Stem), Taoren (Peach Kernel, stir-fried, skin and tip removed), and Yuanhusuo (Corydalis Rhizome) in equal parts. Grind to powder, make pills using wine-boiled wheat paste and Walnut Meat, size of paulownia seeds. Take 50-70 pills on an empty stomach with warm wine or plain water; suitable for patients requiring purgation.

Although low back pain belongs to the Kidney and Bladder, there are cases where the child disease affects the mother; thus, Liver injury from depression and anger also causes low back pain, treat with Tiaogan San (Regulate Liver Powder). There are cases where Earth disease affects Water; thus, Spleen injury from worry and overthinking also causes low back pain, treat with Chenxiang Jiangqi Tang (Agarwood Descend Qi Decoction) combined with Tiaoqi San (Regulate Qi Powder). Low back pain accompanied by sudden redness or blackness of the face indicates contention between Heart and Kidney, a difficult-to-treat syndrome.