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Absolute certainty is claimed. However, consuming Aconiti Lateralis Radix Preparata (Fuzi, 附子) up to one hundred pills—if calculated at three fen per dose—the treatment course would be excessively long.

Li Dongyuan treated a patient who slept outdoors in cold and damp conditions, suffering from lower back pain that prevented turning over, with spasmodic and painful contraction of the flanks lasting for over a month. The *Treatise on Lower Back Pain* states: "All cases belong to the Foot-Taiyang Bladder Channel and Foot-Shaoyin Kidney Channel, where blood stasis in the collateral vessels causes pain. Occasionally, one or two cases belong to the external collateral vessels of the Foot-Shaoyang Gallbladder Channel." In all these instances, removing the blood stasis from the collateral vessels led to recovery. The *Classic of Internal Medicine* states: "Needling is prohibited during the three months of winter." Therefore, only medication should be used to unblock the meridians and break down the degenerated blood in the collateral vessels. The prescription consisted of Stephaniae Tetrandrae Radix (Han Fangji, 汉防己) and Saposhnikoviae Radix (Fangfeng, 防风), each 3 fen; Fermented Medicament (Chao Qu, 炒曲) and Angelicae Pubescentis Radix (Duhuo, 独活), each 5 fen; Chuanxiong Rhizome (Chuanxiong, 川芎), Bupleuri Radix (Chaihu, 柴胡), Cinnamon Twig (Guizhi, 桂枝), Angelicae Sinensis Radix (Danggui, 当归), Prepared Licorice Root (Zhigancao, 炙甘草), and Atractodis Rhizoma (Cangzhu, 苍术), each 1 qian; Notopterygii Rhizoma et Radix (Qianghuo, 羌活), 1.5 qian; and Peach Kernel (Taoren, 桃仁), five grains. Decocted in wine, the patient recovered.
Yu Zhen commented: Although this case claims to remove blood stasis from the collateral vessels, the majority of the herbs are warming and drying to overcome dampness. This treats the cause of the disease.

Zhu Danxi treated Xu Zhifu, who was over sixty years old. After falling from a horse, he suffered from severe lower back pain preventing turning over. His six pulses were scattered and large; upon heavy pressure, they became wiry, small, long, and slightly firm.
Zhu Danxi reasoned that although there was bad blood (blood stasis), it could not be driven out immediately. He prioritized tonification and connection first. He prescribed a decoction of Sappan Wood (Sumu, 苏木), Ginseng Radix et Rhizoma (Renshen, 人参), Astragali Membranacei Radix (Huangqi, 黄芪), Chuanxiong Rhizome (Xiong, 芎), Angelicae Sinensis Radix (Gui, 归), Tangerine Peel (Chenpi, 陈皮), and Licorice Root (Gancao, 甘草). After half a month of consumption, the scattered pulse gradually converged, and appetite returned. Then, he administered Natural Pyrite (Ziran Tong, 自然铜) and other herbs mixed with a decoction of Prepared Rhubarb (Shudahuang, 熟大黄). The patient stabilized after one month.
Yu Zhen commented: For traumatic injuries with blood stasis, it seems appropriate to expel stasis first and then tonify. Zhu Danxi, however, due to the patient's advanced age and scattered pulse, reversed this order, tonifying first and then expelling stasis. This demonstrates his profound medical knowledge. Ignorant practitioners might fear that tonics will retain bad blood and dare not use them, instead striving to expel stasis aggressively. Consequently, the stasis remains, and complications arise. If this applies to trauma, how much more so for internal diseases? Observing this case and the case of treating Mr. Ye's dysentery reveals that the notion of "tonics retaining pathogenic factors" or "tonics retaining bad blood" is fallacious. Generally, if Yuan Qi (Original Qi) is truly deficient, only the Yuan Qi can receive the benefits of tonics, while pathogens or stasis remain unaffected. If Yuan Qi is not deficient, tonics may aid pathogens or increase pain due to stasis, which is indeed inappropriate. The key lies in accurately distinguishing between deficiency and non-deficiency.

Liu Lizhi treated a woman who had suffered from lower back pain for several years without effect from various medicines. Liu diagnosed her and said, "Although the condition appears critical, she can be relieved overnight." The host was surprised and requested medicine. Liu replied, "No medicine is needed. Only 20-30 taels of Lead Powder (Qianfen, 铅粉), five strong men, and five to seven large bells are sufficient." The host prepared everything. Liu ordered the bed curtains to be removed and the bed moved into the room. He mixed the lead powder with rice water and placed it around the woman's waist, instructing her to lie comfortably. One strong man shook a bell and walked quickly around the bed to keep the sound continuous, rotating men when tired. By midnight, the woman could stand up slightly, and soon her lower back pain vanished completely. The family bowed and thanked him, calling him a divine physician, and asked for the rationale. Liu explained, "This illness was caused by ingesting Mercury (Shuiyin, 水银). The mercury lodged in the waist and could not exit, causing persistent pain. Now, using lead powder, which is derived from mercury. In Five Elements theory, Metal is the mother of Water (Mercury is associated with Water/Metal alchemy concepts here, specifically 'Metal is the mother' implying generative cycle or elemental relationship). Taking the sound of Metal to call the son (Mercury), mother and son harmonize. The mercury exits and enters the lead powder, curing the disease."
Yu Zhen commented: This method is imaginative and unconventional. Compared to Ge Kejiu’s method of bathing in silver water and sitting on Sichuan pepper, each achieves its own miraculous transformation, reaching heights that are hard to surpass.

Li Shicai stated: Fang Luru, a Taixue student from Huizhou, suffered from mental fatigue and unbearable, abnormal pain in the lower back and knees. Everyone attributed it to the Kidney governing the lower back and knees and prescribed Cinnamon Twig (Guizhi, 桂枝) and Prepared Aconite Root (Fuzi, 附子). After two months, his limbs became increasingly flaccid, and his lower back and knees felt cold. He recklessly consumed hot-natured medicines without hesitation. Upon my examination, his pulse was deep and hidden; upon extreme pressure, it was vigorous and forceful. I recalled that Yang syndromes can mimic Yin syndromes; excessive heat may manifest as cold due to the counteracting influence of the overcoming element. Urine should be red, and the patient should fear boiling water. Inquiry confirmed this. I prescribed Phellodendri Cortex (Huangbai, 黄柏), 3 qian; Gentiana Scabra Radix (Longdancao, 龙胆草), 2 qian; Scutellariae Radix (Huangqin, 芩), Coptidis Rhizoma (Huanglian, 连), and Gardenia Jasminoidis Fructus (Zhizi, 栀子), each 1.5 qian; plus seven slices of Ginger (Shengjiang, 生姜) as a guide. Taken hot in one dose, he felt relief in his waist shortly after. After three doses, the pain disappeared. He took Ren Shen Gu Ben Wan (Ginseng Root Solidifying the Root Pill), 2 liang daily, and recovered fully in one month.
Yu Zhen commented: This is similar to Zhang Jingyue’s treatment of Old Man Dong’s lower back pain. However, Zhang’s case featured a surging and slippery pulse with urinary obstruction, so he used Da Li Qing Yin (Great Clearing Decoction) with increased Huangbai and Longdancao. Once urination was restored, the lower back pain ceased instantly.

Zhu Ruqiong treated Zhang Xiufu, who suffered from heavy, dragging lower back pain, as if carrying a thousand jin. The heaviness disappeared only during sexual intercourse. Tonifying Kidney pills were ineffective. Zhu said, "The waist is the residence of the Kidney. Kidney Qi deficiency causes lower back pain. But why is there no heaviness during intercourse? It must be due to blood stasis blocking the flow. During intercourse, the Kidney moves, causing blood to circulate. Once circulating, there is no stasis, hence no heaviness." He prescribed Phellodendri Cortex (Huangbai, 黄柏), Anemarrhenae Rhizome (Zhimu, 知母), Linderae Radix (Wuyao), Green Tangerine Peel (Qingpi, 青皮), Peach Kernel (Taoren, 桃仁), Safflower (Honghua, 红花), Sappan Wood (Sumu, 苏木), Pangolin Scales (Chanshanjia, 穿山甲), and Akebia Caulis (Mutong, 木通), each 1 qian; Licorice Root (Gancao, 甘草), 5 fen. Decocted with Ginger and Jujube, the patient recovered after two doses.
Yu Zhen commented: Ancient texts already have treatments for lower back pain due to blood stasis. To realize that Kidney movement during intercourse prevents blood stasis is indeed wise. However, moving stasis usually involves Cinnamon Twig (Guizhi, 肉桂); here, Anemarrhenae Rhizome (Zhimu, 知母) and Phellodendri Cortex (Huangbai, 黄柏) are used instead. Does this indicate observing strong Ministerial Fire (Xianghuo, 相火) in the pulse?

Sun Dongsu stated: Wu Dongxing took an exam in summer heat, failed, and became depressed, subsequently developing malaria. It lasted from Mid-Autumn to October. Although the malaria stopped, severe lower back pain persisted, accompanied by white turbidity in urine and coughing, with significant muscle wasting. Various medicines were indiscriminately used, including Da Qianghuo Tang (Major Notopterygium Decoction), Dihuang Tang (Rehmannia Decoction), and herbs like Coptis, Phellodendron, Cinnamon, Aconite, Ginseng, and Deer Antler. The pain was excruciating, causing him to scream and disturb neighbors. My pulse diagnosis showed a wiry and fine left pulse and a slippery and large right pulse, both beating six times per breath. He had thirst and red eyes. I knew he had previously suffered from Syphilis (Yangmei Chuang, 杨梅疮), and residual toxins remained latent in the collaterals. Following the malaria, his Qi and Blood were deficient, agitating the old toxins, causing violent pain. I prescribed Angelicae Sinensis Radix (Gui, 归), Paeoniae Radix Alba (Shaoyao, 芍), Licorice Root (Gancao, 甘草), Achyranthis Bidentatae Radix (Niuxi, 牛膝), Coicis Semen (Yiren, 苡仁), Akebia Caulis (Mutong, 木通), Dictamni Cortex (Baixianpi, 白藓皮), and Uncaria Ramulus cum Uncis (Gouteng, 钩藤). Decocted with 4 liang of Smilacis Glabrae Rhizoma (Tufuling, 土茯苓) as water substitute. After several doses, pain stopped and cough eased. Later, due to sexual activity after drinking alcohol, his waist felt bound the next day, with foot surface pain, left eye redness, short urination, and burning sensation in the soles shooting up from the hips. The pain was unbearable. I removed Mutong, Baixianpi, and Tufuling from the formula, adding Dendrobii Caulis (Shihu, 石斛), Safflower (Honghua, 红花), Rehmanniae Radix Preparata (Shengdi, 生地), and Phellodendri Cortex (Huangbai, 黄柏). After three days of regulation, symptoms stagnated. During severe cold, due to dry stool, he mistakenly followed advice to use Mirabilite (Yuanmingfen, 元明粉), consuming about 2 liang in a day and night. Stool remained impacted, lower back pain intensified, legs contracted, breathing was faint, complexion was dark blue, and he felt critically ill. Pulse was hidden in all six positions due to pain. I said, "Your syndrome is heat, and stool is dry, but the disease is not in the Intestines and Stomach, but in the collaterals, sinews, bones, and joints. Purging the intestines is useless. Moreover, in the season of closure, purging depletes Yang Qi, destroying the root of spring growth. Your current limb contracture and severe hip/waist pain are due to cold congealing the collaterals. Cold governs contraction. We must warm and disperse the cold pathogen as the branch symptom to stabilize pain, then treat the root." I prescribed Cinnamon Heart (Guixin, 桂心), Eucommiae Cortex (Duzhong, 杜仲), Prepared Licorice Root (Zhigancao, 炙甘草), Atractodis Rhizoma (Cangzhu, 苍术), Psoraleae Fructus (Poguzhi, 破故纸), and Acanthopanacis Cortex (Wujiaopi, 五加皮). Two doses stabilized pain and relaxed limbs, allowing food intake. I said, "Branch symptoms are gone. But given the severe cold, we cannot treat the root now. We must wait for spring warmth to eradicate the root." He did not believe me and allowed other doctors to use Yin-nourishing and Fire-descending methods, which failed over time. In March of the following year, I administered Wei Shen San (Kidney Roasting Powder). He had five or six large bowel movements, becoming cold-limbed, terrifying his family. I said, "The disease is leaving." I switched to Spleen-regulating herbs. His spirit recovered, and he could walk. This case involved residual toxins from Syphilis latent in collaterals, which tonics cannot remove. Thus, I first cleared damp-heat, then used tonics to conclude treatment. Later, I gave 2 qian of Clematis Root Powder (Weilingxian, 威灵仙) stuffed inside a roasted pig kidney. He had one or two more bowel movements, eradicating the root. Finally, he was regulated with Prepared Rehmannia Root (Shudi, 熟地), Angelicae Sinensis Radix (Gui, 归), Paeoniae Radix Alba (Shaoyao, 芍), Coicis Semen (Yiren, 苡仁), Achyranthis Bidentatae Radix (Niuxi, 牛膝), Phellodendri Cortex (Huangbai, 黄柏), Salviae Miltiorrhizae Radix (Danshen, 丹参), and Tortoise Carapax and Plastron (Guiban, 龟板), achieving full recovery.
Yu Zhen commented: This case showed repeated fluctuations. Dr. Sun adapted to the complex pathogenesis. As recorded, there were seven stages. Only by recording the entire process can we see what worked and what didn't, leading to ultimate efficacy, setting a model. If half were omitted, the origin and outcome would be unclear, making judgment impossible. This evokes sighs regarding *Lin Zheng Zhi Nan* (Guide to Clinical Practice).

Yu Jiayan treated the younger brother of Zhanglingshi, suffering from a complicated stage of Cold Damage (Shanghan, 伤寒). Both lower backs were flexed and paralyzed, lying in bed screaming in pain all night. Treatments failed. Yu’s pulse diagnosis was smooth and regular. Pain had decreased significantly compared to before. He said, "This is not a fatal syndrome, but he risks becoming disabled. The point of potential reversal lies in the stabbing pain, indicating struggle between Pathogen and Righteous Qi. If there were no pain, Pathogen and Righteous Qi would merge in peace. The significant reduction in pain is worrying." After careful thought, he deduced that Heat Pathogen had deeply entered the lower backs, closing blood vessels for a long time, unable to reopen. The only method was to attack and disperse. However, the pathogen had been present long, and Righteous Qi was exhausted; attacking would fail. He used Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction) with added Cinnamon Twig (Guizhi, 肉桂) and Prepared Aconite Root (Fuzi, 附子). Two large doses allowed him to rise strongly. Pills were taken subsequently. Full recovery occurred in over ten days. This imitates Zhang Zhongjing’s method for Chest Binding (Jie Xiong, 结胸) using Fuzi Xie Xin Tang (Aconite Draining the Epigastrium Decoction). Chest binding is an upper syndrome dominated by Qi, so Aconite and Rhubarb are combined to drain the Heart. Lower back flexion is a lower syndrome dominated by Blood, so Peach Kernel and Cinnamon are combined to disperse blood clumps in the waist. This method cured Jiang Sheng in two doses.
Yu Zhen commented: This patient showed no signs of fire, so adding Guizhi and Fuzi was acceptable. What if he could not tolerate hot medicines? Expanding on this for Xichang: Could Da Huang Zhe Chong Wan (Rhubarb and Ground Beetle Pill) or Fu Yuan Huo Xue Tang (Restore Vitality and Move Blood Decoction) serve as alternative paths to Guizhi and Fuzi? Additionally, Litong Wan, Goat Blood, and Sheep Gallbladder, along with acupuncture and cupping, could be considered similarly.