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The waist is the area where the Kidney resides. When Kidney Qi is deficient and pathogenic factors invade, pain occurs. The so-called pathogenic factors refer to Wind, Heat, Dampness, Dryness, and Cold. Generally, Cold-Dampness is more common than Wind-Heat. Etiologies include presence of Wind, Dampness, Cold, Heat, sprain/strain (traumatic injury), blood stasis, Qi stagnation, and Phlegm accumulation.

If Wind pathogen injures the Kidney causing lumbar pain, the pulse must be floating. The pain may be on the left or right, has no fixed location, and radiates to both legs. Wuji San (Cinnamon Twig and Atractylodes Macrocephala Decoction) is suitable. Add Fangfeng (Saposhnikovia Root) 5 fen per dose, or add Quanxie (Scorpion) 3 pieces for better effect. Xiaoxuming Tang (Minor Xu-Bi Decoction) and Duhuo Jisheng Tang (Angelica Pubescens and Sangjisheng Decoction) are also selectable options, used in conjunction with Sanxian Dan (Three Immortals Pill). Chuzhong (Eucommia Bark) stir-fried with ginger juice and ground into powder, taken as 1 qian per dose with warm wine on an empty stomach, named Chuzhong Wine, treats Kidney Qi lumbar pain and concomitant Wind-Cold conditions.

Pain caused by Dampness injury feels like sitting in water. Since the Kidney belongs to Water, long-term sitting in damp places or exposure to morning/evening dew allows Dampness to flow into the Foot-Taiyang Bladder Meridian, causing lumbar pain. The pulse must be slow. It triggers on cloudy days or after prolonged sitting, accompanied by a heavy and sluggish body sensation. Shenshi Tang (Dampness-Penetrating Decoction) is the primary treatment. If ineffective, use Shen Zhuo Tang (Kidney Fixation Decoction) or Shengfu Tang (Raw Aconite Decoction).

Pain from Cold invasion feels like water in the waist. The pulse must be tight. Pain decreases with heat and increases with cold. Use Wuji San removing Jiegeng (Platycodon Root), adding Wuzhuyu (Evodia Fruit) 5 fen. Alternatively, use Jiangfu Tang (Ginger and Aconite Decoction) with Lagui (Cassia Twig/Eucommia) and Chuzhong (Eucommia Bark).

Pain from Heat invasion presents with a surging, rapid, and slippery pulse, thirst, and constipation. Gandou Tang (Mung Bean Decoction) added with Xuduan (Dipsacus Root) and Tianma (Gastrodia Rhizome) is suitable. Intermittently use Baidu San (Defeat Toxin Powder). For pain due to sprains or falls, Ruxiang Chen Tong San (Frankincense Pain-Alleviating Powder), Heishen San (Black Divine Powder), and Fuyuan Tongqi San (Restore Origin and Unblock Qi Powder) mixed with wine are appropriate. If ineffective, there is likely stagnant evil blood. First, take Suhexiang Wan (Styrax Pill) with wine. Then use Wuji San with Dahuang (Rhubarb Root) 5 fen, Sumu (Sappan Wood) 5 fen, and Danggui (Angelica Sinensis) doubled.

For pain due to labor and heavy lifting, Heqi San (Harmonize Qi Powder) or Puxian Zhengqi San (Pu Xian Healthy Qi Powder) is suitable. Yang Renzhai stated: For pain from physical exertion, Shibu Tang (Ten Tonics Decoction) with Qing'e Wan (Green Youth Pill) is appropriate.

Pain from blood stasis presents with a choppy pulse. Turning or side-lying feels like stabbing with awls or knives. Stool is black, urine is red or black. Pain is lighter during the day and heavier at night, named Lixue Lumbar Pain. Suschen Muxiang Wan (Su Chen Musk Fragrance Pill) or Taoren (Peach Kernel) wine-mixed Heishen San is suitable. Or Siwu Tang (Four Substances Decoction) added with Tao Ren (Peach Kernel), Honghua (Safflower), Zhike (Bitter Orange), and Wuyao (Lindera Root). Zhu Danxi treated it with Buyin Wan (Tonify Yin Pill) added with Tao Ren and Honghua.

Pain from Qi stagnation presents with a deep pulse, feeling depressed and unrelieved. Renshen Shunqi San (Ginseng Smooth Qi Powder) or Wuyao Shunqi San (Lindera Smooth Qi Powder) added with Wujia Pi (Acanthopanax Bark), Muxiang (Costus Root), and Gancao (Licorice Root) in small amounts, decocted and taken as soup, is suitable.

Pain from Phlegm infiltration presents with a slippery or hidden pulse. Erchen Tang (Two Aged Ingredients Decoction) added with Nanxing (Arisaema Rhizome), Xiangfu (Cyperus Rhizome), and Zhike is suitable.

Generally, all lumbar pains originate from Kidney deficiency. Since they involve pathogens, the pathogens must be removed. If there is no external pathogen or accumulation and pain occurs spontaneously, only tonifying the Kidney is required.

Symptoms include weak waist and limbs, body fatigue, sore and weak knees and feet. The pulse may be surging or fine but always powerless. (A fine pulse with clear urination indicates Yang deficiency; heavy pressing reveals a deep and powerless pulse.) These are its signs. It is divided into Cold and Heat syndromes.

A fine, powerless pulse, timidity, shortness of breath, and clear urination indicate Yang deficiency. Shenyang Wan (Kidney Yang Pill), Huixiang Wan (Fennel Pill), following Dai Fu'an's method using Da Jianzhong Tang (Major Construct the Middle Decoction) with Chuanjiao (Sichuan Pepper) 10 grains, followed by Yao Shen Wan (Waist-Kidney Pill) and Shenglu Rong Wan (Fresh Deer Antler Pill) are suitable. Also, slice pig kidneys thinly without cutting through, layer with stir-fried Huixiang (Fennel) powder, wrap in wet paper, bake until cooked, chew thoroughly, and swallow with wine. This supplements insufficient Yang.

A surging, large, yet powerless pulse (indicates Yin deficiency; urine must be yellow/red) with yellow/red urine and intermittent deflagration of deficient fire indicates Yin deficiency. Li Dongyuan described that those who consume rich foods, take medicines long-term, and engage in intercourse while drunk damage their True Qi, causing Kidney Heat. Kidney Heat leads to lumbar and spinal pain preventing movement. Long-term results in marrow depletion and bone withering, manifesting as Bone Wei (Atrophy Syndrome). Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), Zishen Wan (Nourish Kidney Pill), and Fengsui Dan (Seal Marrow Pill) are suitable to treat insufficient Yin.

Yang Renzhai said: The Classic states, "The waist is the mansion of the Kidney. Inability to turn or shake indicates the Kidney is failing." Indeed, the disease is in the Shaoyin channel. One must investigate the source of the disease to prescribe appropriately. Although, the Zongjin (Tendons) gather at the genitalia, distension is also related to the Kidney system. The Five Zang organs derive Qi from grain; the Spleen is the granary of the Kidney. Anger injures the Liver, causing meridians to relax; worry/sorrow injures the Spleen, causing Stomach Qi to stagnate. Both can cause lumbar pain, hence mentioned together.

Anger injuring the Liver causing lumbar pain is treated with Tiaogan San (Regulate Liver Powder). Worry/Sorrow injuring the Spleen causing lumbar pain is treated with Chenxiang Jiangqi Tang (Aquilaria Descending Qi Decoction) and Tiaoqi San (Regulate Qi Powder), decocted with Ginger and Jujube. Pain from frustration/injury to the Kidney is treated with Heji Qi Qi Tang (Formula Seven Qi Decoction) with increased Baifuling (Poria) and decreased Chenxiang (Aquilaria Wood) and Ruxiang (Frankincense). Baoming Ji states: Weishen Wan (Baked Kidney Pill) is miraculous for treating Liver/Kidney damage affecting the Spleen, indigestion, and inability to rise from lumbar pain. Lumbar pain after malaria/dysentery or post-menstrual lumbar pain in women belong to deficiency and should be tonified. Add Chuzhong (Eucommia Bark) and Cebaiye (Biota Top Leaf) to Qi and Blood formulas.

Zhu Danxi said: Chronic lumbar pain requires Guanzi Gui (Cassia Twig) to open the pathway to stop pain; abdominal/flank pain is similar. Ju Xiang Wan (Citrus Fragrance Pill) treats chronic lumbar pain not healing, using Guanzi Gui, which implies opening the pathway.

The waist is the mansion of the Kidney. If Kidney Qi is deficient, it shifts with the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire), causing pain. Regulate Ying and Wei, reduce excess, tonify deficiency, investigate the cause of pain, and treat accordingly for optimal results.