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[Background Information]
Book: Youke Zhengzhi Zhunsheng (Standard for Diagnosis and Treatment of Pediatric Diseases)
Author: Wang Kentang
Dynasty: Ming
Chapter: Lower Back Pain
Category: Comprehensive

[English Translation]
In the course of eruptive diseases such as smallpox or measles, if lower back pain appears first during fever, it is most taboo. The Classics state: "The waist is the mansion of the Kidney." It also states: "When the Taiyang channel is affected, it results in lower back pain." The Foot-Taiyang Bladder Channel is the head of the twelve channels; its vessel runs alongside the spine, enters along the paravertebral muscles, and connects with the Kidney. The toxin of eruptive diseases originates below the right Kidney, spreads along the Foot-Taiyang Bladder Channel to various other channels, representing the transmission of pathogenic factors from the interior to the exterior. If lower back pain occurs immediately upon the initial onset of fever, this indicates that the pathogen has entered the Kidney directly from the Bladder, causing joint stiffness and lower back pain. In this situation, one must urgently resolve toxicity to drain the pathogenic factors of the Shaoyin (Kidney) channel, and release the exterior to unblock the Taiyang (Bladder) channel, preventing the pathogen from penetrating deeper. Even if the eruptions are dense, recovery may still be possible. If treatment is delayed even slightly, the pathogen of the Taiyang channel will transmit from the exterior to the Yang aspect, and the pathogen of the Shaoyin channel will transmit from the interior to the Yin aspect. This leads to disease in both the interior and exterior, injury to both Yin and Yang, stagnation of Ying (Nutritive) and Wei (Defensive) vessels, and exhaustion of Qi in all Zang-Fu organs. This may result in black depression of the eruptions or itching and collapse, ultimately becoming incurable.

For patients who experience lower back pain concurrent with fever, initially administer Renshen Baidu San (Ginseng Detoxification Powder) [for early-stage fever], followed by Wuling San (Five-Ingredient Poria Pill) modified with Du Huo (Notopterygii Rhizoma et Radix) and Xi Xin (Asari Radix).

[Xue Ji's Commentary] Cases of smallpox presenting with lower back pain are due to deficiency and weakness of the Kidney Channel, with Ministerial Fire stirring internally and dryness arising, such that True Yin cannot overcome the pathogen, resulting in lower back pain. One should urgently administer Dihuang Wan (Rehmannia Pill) to prevent progression to the severe condition known as "Black Return to the Kidney," thereby ensuring efficacy. Generally, these cases of smallpox arise from congenital insufficiency of Essence and Qi in the Kidney system; thus, the whites of the eyes are often prominent, a condition colloquially called "Broken-Waist Smallpox." Children who typically have pale complexions, prominent whites in the eyes, delayed walking, and delayed speech will likely have their smallpox pathology return to the Kidney Channel. One should preemptively regulate and tonify Kidney Qi to avoid such complications.

One thirteen-year-old child had prominent whites in the eyes, occasional facial redness, frequent neck pain, and a洪数 (surging and rapid) Chi pulse. My father diagnosed this as congenital Kidney Qi deficiency. The patient was cured using the ingredients of Dihuang Wan decocted and taken orally. When this child developed smallpox at age fifteen, my father advised continuing the previous medication, using Dihuang Wan and Yiqi Tang (Qi-Supplementing Decoction). As the child became increasingly fatigued, large doses of Dihuang Wan were decocted for free consumption, along with large doses of Bazhen Tang (Eight-Treasure Decoction). The eruptions gradually appeared according to the normal pattern. Strict adherence to the previous medications led to recovery after consuming over seventeen jin (approx. 8.5 kg) of the two medicines combined by the end of the first year. Whenever my father observed infants with prominent whites in the eyes, pale or reddish complexions, he would advise preemptive tonification of the Spleen and Kidney to prevent complications during smallpox eruption, though few believed him.

Another child developing smallpox presented with lower back pain, heat in the feet, and thirst. This indicated congenital Kidney deficiency with stirring of deficient fire. My father prescribed large doses of Jiajian Bawei Wan (Modified Eight-Ingredient Rehmannia Pill) decocted for free consumption, which gradually alleviated the symptoms. This was supplemented with large doses of Bazhen Tang plus Zi Cao (Arnebiae Radix seu Rubra) and Nuomi (Glutinous Rice) for several doses. Pus gradually filled the lesions. The previous medication was continued until scabbing occurred, followed by Bazhen Tang until the scabs fell off (jieye).

Another child, nearing recovery from smallpox, suffered from food stagnation-induced diarrhea, thirst, and lower back pain. This was attributed to Spleen and Kidney deficiency. My father used Jiajian Bawei Wan and Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder), which instantly stopped the thirst and diarrhea. Liuwei Wan (Six-Ingredient Rehmannia Pill) and Bazhen Tang were then administered until the scabs fell off.

Another child, aged nine, had a constant pale complexion, prominent whites in the eyes, frequent lower back pain, intermittent heat in both feet, and refused to wear cotton in winter. My father diagnosed congenital Kidney deficiency and ordered daily intake of Dihuang Wan. At age ten, when smallpox erupted, the child experienced lower back pain, thirst, facial redness, and desire for cold drinks. Dihuang Wan was modified with Ban Qian (half qian, approx. 1.875g) of Rou Gui (Cinnamomi Cortex) per dose, decocted for free consumption. After several doses, the heat and thirst ceased instantly, and the lower back pain resolved completely. Rou Gui was then discontinued, and the original formula was continued. Recovery occurred after more than fifty doses.

Jiawei Dihuang Wan (Additive Rehmannia Pill)
Shu Dihuang (Prepared Rehmanniae Radix, soaked in wine, steamed through, sun-dried, 8 liang, mixed with wine, pounded into paste)
Shanzhuyu (Corni Fructus)
Gan Shanyao (Dioscoreae Rhizoma)
Wuweizi (Schisandrae Fructus, stir-fried, 4 liang each)
Zexie (Alismatis Rhizoma)
Baifuling (Poria with Hostwood)
Mudanpi (Moutan Cortex)
Lurong (Cervi Cornus Pantotrichum, roasted, 3 liang each)
Rougui (Cinnamomi Cortex, thick bark, peeled to obtain flesh, 1 liang; add this when fever is present to guide deficient fire back to the Kidney channel, thereby stopping the heat.)
All ingredients are separately ground into fine powder, mixed evenly with the Rehmannia paste, and formed into pills using rice paste as a binder. Taking them as a decoction is preferable.

Qianghuo Danggui Tang (Notopterygium and Angelica Decoction)
Indicated for lower back and back pain; suitable for administration during the initial fever stage.
Qianghuo (Notopterygii Rhizoma et Radix)
Danggui (Angelicae Sinensis Radix)
Du Huo (Notopterygii Rhizoma et Radix)
Fangfeng (Saposhnikoviae Radix)
Chuanxiong (Ligustici Chuanxiong Rhizoma)
Huangbai (Phellodendri Cortex, 1 qian each)
Chaihu (Bupleuri Radix, 1.5 qian)
Guizhi (Cinnamomi Ramulus, 0.7 qian)
Zhiren (Gardeniae Semen)
Honghua (Carthami Flos, 0.8 fen each)
Decoct with half wine and half water. Another prescription for lower back pain includes Cangzhu (Atractylodis Rhizoma) and Han Fangji (Stephaniae Tetrandrae Radix).

Rushen Tang (Miraculous Divine Decoction)
Indicated for lower back pain.
Danggui (Angelicae Sinensis Radix)
Guipi (Cinnamomi Cortex)
Yanhusuo (Corydalis Rhizoma)
Equal parts, ground into powder. Take 2-3 qian with wine.