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He Zi said: The waist is the external mansion of the Kidney and constitutes the largest joint in the body. If Qi and Blood fail to circulate, it results in heavy pain and an inability to turn or move the body. People mostly take Kidney-tonifying medicines with little effect. Only by using strong purgatives such as Qian Niu (Pharbitis Seed) and Gan Sui (Kansui Root) to vigorously drain Dampness can the pain be relieved.

Commentary: This therapeutic approach applies only to cases of Qi stagnation, Qi injury, meridian obstruction, Blood stasis, and severe Damp-Heat. For conditions involving Qi and Blood deficiency or Kidney deficiency, this method should not be used lightly; differentiation must be made based on pulse and constitution. Dan Xi stated: A large pulse in lower back pain indicates Kidney deficiency; a choppy pulse indicates Blood stasis; one must distinguish between cases caused by Damp-Heat or Phlegm.

Chen Wuze said: Lower back pain involving the Six Channels is generally due to external causes. Generally, the Taiyang and Shaoyin channels are prone to Cold invasion; the Shaoyang and Jueyin channels are prone to Wind-Heat; the Taiyin and Yangming channels are prone to Dryness-Dampness. One may infer other cases by analogy.

(Internal Causes): Injury to willpower damages the Kidney; anger and frustration damage the Liver; worry and overthinking damage the Spleen. All these can lead to lower back pain because the Liver and Kidney are closely related, and the Spleen and Stomach are exterior-interior pairs. Spleen stagnation and Stomach closure most easily cause lower back pain. Symptoms include emaciation and weakness, dark complexion, resulting from long-distance walking or prolonged standing leading to exhaustion; this is caused by "loss of will." Abdominal tightness, hypochondriac distension, blurred vision, unfulfilled desires, excessive sexual activity leading to flaccidity of the Sinews (Zong Jin), and discharge of white fluid (Bai Yin) are caused by "anger and frustration." Muscle immersion in dampness, numbness, indigestion, intestinal and gastric distension, constipation or tenesmus, and discomfort in the waist and hypochondrium are caused by "worry and overthinking."

(Kidney Fixation Disease): Coldness in the waist, feeling like water pouring on the body, heaviness without thirst, normal urination, normal appetite, coldness and heaviness below the waist feeling like wearing five thousand copper coins. This arises from sweating during labor, with cold-dampness remaining inside the clothes for a long time.

(Other Causes): Curvature, swelling, and heaviness of the waist radiating to the lateral costal region, caused by falls or trauma leading to stagnation of evil blood; or pain in the waist caused by excessive sexual exertion, depletion of essence and Qi. These belong to "non-external, non-internal causes." Although the pathogenesis discussed here is detailed, the specific formulas are omitted. Here, I briefly list one or two examples for students to study and deduce.

Xiao Xuming Tang: Treats lower back pain caused by Wind pathogens. (Formula see Stroke Section; add fried Huai Ren [Sophora Flower] as per San Yin Fang).

San Yin Duhuo Jisheng Tang: Treats lower back pain due to Kidney deficiency, sleeping in cold-damp places, and exposure to wind.
Duhuo (3 liang), Sangjisheng (Mulberry Mistletoe Stem), Duzhong (Stir-fried Eucommia Bark), Xixin (Asarum), Niuxi (Achyranthes Root), Qinjiao (Gentiana Macrophylla Root), Fuling (Poria), Baishao (White Peony Root), Guixin (Cinnamon Twig), Chuanxiong (Ligusticum Rhizome), Fangfeng (Saposhnikovia Root), Zhigancao (Honey-fried Licorice Root), Renshen (Ginseng), Shudihuang (Prepared Rehmannia Root), Danggui (Angelica Sinensis Root) (all in equal proportions).
Crush the herbs. Take 4 qian per dose, decoct in water, and take on an empty stomach.
Commentary: These are herbs for the Foot-Shaoyin and Foot-Jueyin channels.

Niuxi Jiu: Treats lower back pain caused by Wind-toxin.
Niuxi (1 liang), Chuanxiong (1 liang), Qianghuo (Notopterygium Rhizome), Digupi (Dogwood Root Bark), Wujia Pi (Acanthopanax Bark), Yiyiren (Coix Seed) (each 1 liang); Shengdihuang (Rehmannia Root), Gancao (Licorice Root) (each 10 liang); Haitongpi (Trematocarpus Bark) (2 liang); Duzhong (Eucommia Bark) (1 liang).
Crush the herbs, wrap in cloth, and soak in pure wine (without ash additives). Soak for 2-7 days in summer, 5-7 days in winter. Take one cup per dose, 3-5 times daily.
Commentary: These are herbs for the Foot-Taiyang and Foot-Shaoyin channels.