bubble_chart Concept

The waist connects the back above and the coccyx below, with the spine in the middle. The area on both sides at the level of the navel is the waist, serving as the pivotal point for the body's rotation and movement.

If pain occurs in the lumbar spine due to certain reasons, it is called lumbar spine pain. Since the waist and spine are adjacent, the pain may be more severe in the central spine or on both sides of the waist, hence it is generally referred to as lumbar spine pain or collectively as lumbago. Therefore, Neijing sometimes calls it "lumbar spine pain" ( Maijie Pian ), and sometimes as "lumbago" ("On Pricking Lumbago").

Pain caused by lumbago affecting adjacent areas is commonly seen in clinical practice: if lumbago affects the back, it is called lumbago with back pain; if it affects the coccyx, it is called lumbago with coccyx pain or lumbosacral pain; if it affects the lower limbs, it is called lumbago with leg pain.

In the book Neijing , based on the location of lumbar spine pain, severe lumbago is called "broken waist," while pain mainly in the spine is called "broken spine," and when both the waist and spine are severely painful, it is called "spine pain with waist as if broken." According to the symptoms of lumbago, it is divided into "lumbago that cannot bend forward or backward," "lumbago that cannot rotate or shake," "lumbago that cannot turn the head," "lumbago with the waist feeling like a drawn bowstring," "stiffness of the waist and spine," etc. Based on the areas affected by lumbago, it can also be divided into "spine pain with waist as if broken, thigh unable to bend, popliteal fossa as if tied, calf as if splitting," "head and neck pain, stiffness of the waist and spine," "lumbago, pulling the neck, spine, coccyx, and back," "lumbago, pain pulling the inner side of the spine," "lumbago, pain pulling the shoulder," "lumbago with pain along the spine to the head," "lumbago pulling the lower abdomen," "lumbago with back pain and soreness of the shin," etc.

Since Neijing , later physicians such as Zhubing Yuanhou Lun often classified lumbago by its course into "sudden lumbago" (acute lumbago) and "chronic lumbago." Also, Sanyin Fang classified lumbago by its cause into external contraction lumbago, internal damage lumbago, and lumbago caused by falls or internal twists.

Clinically, many diseases are accompanied by lumbago symptoms, covering a wide range, such as the stiff and painful waist and spine in tetanus, stranguria lumbago, menstrual lumbago in women, postpartum lumbago, lumbago caused by bone and tendon injuries, as mentioned in Suwen ． Shengqi Tongtian Lun : "Thus, excessive force injures kidney qi, and the protruding bone is damaged," leading to lumbago, etc. These should be discussed in the context of the respective diseases. This section focuses on lumbago as the main clinical symptom without obvious organic sexually transmitted disease changes.

bubble_chart Modern Research

Lumbago can occur in diseases of internal, external, orthopedic, and gynecological departments. It is generally divided into four categories: the first category is spinal diseases, such as wind-dampness spondylitis, subcutaneous node or suppurative spondylitis, etc.; the second category is paravertebral soft tissue diseases, such as lumbar muscle strain, fibrositis, etc.; the third category is lumbago caused by irritation of the spinal nerve roots, such as spinal cord compression, acute myelitis, etc. The fourth category is visceral diseases, such as kidney disease, pancreatitis, biliary system diseases, adnexitis, etc.

The so-called lumbago in Western medicine mainly refers to Orthopedics and Traumatology diseases. In addition to the patient's complaints, medical history, and physical examination, modern technological methods are used to provide greater convenience for the clinical diagnosis of lumbago, while also improving the accuracy of the diagnosis. For example, lumbago caused by spinal nerve root compression can be diagnosed by magnetic resonance imaging (MRI). Familiarity with the so-called lumbago in Western medicine, and combining the differentiation of syndromes and diseases in Chinese and Western medicine, is very helpful for mastering the indications of Chinese medicine treatment, excluding non-indications, and improving the level of Chinese medicine treatment for lumbago diseases.

Severe lumbago, such as renal colic pain, can lead to painful shock.

Kidney-deficiency lumbago is roughly equivalent to lumbar hyperosteogeny, prolapse of lumbar intervertebral disc, and osteoporosis in Western medicine, and the affected population is mostly middle-aged and elderly people. Western medicine commonly uses oral analgesics, calcium supplements, hormones, as well as postural traction, surgical therapy, etc. The wind-evil-induced lumbago with pulling pain in the legs mentioned in the original text is similar to the symptoms of prolapse of lumbar intervertebral disc in Western medicine. After degenerative changes in the lumbar intervertebral disc, under external force, the fibrous ring ruptures, and the nucleus pulposus protrudes, irritating or compressing the nerve roots, blood vessels, or spinal cord, causing lumbago, and the pain can extend to the legs. Western medicine mostly uses physical therapies such as infrared, microwave, and traction for this type of lumbago, local use of closed drugs, oral non-steroidal anti-inflammatory analgesics, and surgical therapy, etc. Blood-stasis lumbago is mostly seen in soft tissue injury diseases of the waist, such as acute lumbar muscle membrane sprain, acute lumbar ligament injury, etc. It is often caused by improper posture during heavy labor or falls. Treatment mostly involves oral administration of aspirin, ibuprofen, and other antispasmodic and analgesic drugs, as well as local closure, physiotherapy, and other therapies.

Dampness-heat lumbago and damp-phlegm lumbago, from the perspective of Western medicine, are mostly caused by inflammation. Dampness-heat lumbago is equivalent to lumbar suppurative myelitis, chronic prostatitis in men, chronic pelvic inflammation in women, adnexitis, etc., causing lumbago. Damp-phlegm lumbago is equivalent to lumbar subcutaneous node, wind-dampness or wind-dampness-like spinal lumbago, etc. The treatment is mostly anti-inflammatory, anti-tuberculosis, and symptomatic treatment.

bubble_chart Pattern Analysis

1. Taiyang Wind-Cold︰The patient had no history of lumbago, but due to external contraction of wind-cold, the onset was sudden, with severe stiffness and pain in the lumbar spine accompanied by a sense of tightness, along with headache, neck stiffness, and shoulder and back pain. In severe cases, there may also be pain in the sacrum, popliteal fossa, calf, and joints throughout the body. Symptoms include fever, aversion to cold, with or without sweating, a thin white tongue coating, and a floating, tight pulse. This is the pattern of lumbago caused by wind-cold common cold, resulting from exposure to wind-cold pathogens, which externally bind the muscle surface and invade the Jingmai of the Foot taiyang Bladder and the Governor Vessel. The Foot taiyang Bladder Channel originates from the inner canthus, connects to the brain, descends along the neck, runs alongside the spine, reaches the lumbar region, follows the paravertebral muscles, enters the popliteal fossa, and penetrates the calf. When wind-cold pathogens invade the taiyang Channel, mild cases present with stiffness and pain in the lumbar spine and neck, while severe cases manifest as a sensation of the neck being pulled, spinal pain, the waist feeling broken, the popliteal fossa knotted, and the calf splitting—essentially pain in the neck, back, lumbar region, sacrum, popliteal fossa, and calf. The Governor Vessel originates at the tip of the coccyx, ascends through the spine to the neck and enters the Fengfu point, governing all yang in the body. The taiyang is the exterior of the three yang channels, the convergence of all yang, and is interconnected with the Governor Vessel. Therefore, when wind-cold invades, it first attacks the taiyang and Governor Vessel, presenting as "headache, neck stiffness, and lumbar spine pain." As described in the Treatise on Cold Damage, Taiyang disease, in addition to headache, neck stiffness, lumbago, joint pain, and body pain, must also include fever, aversion to cold, and a floating, tight pulse. Treatment should focus on releasing the exterior with pungent-warm herbs, such as Ephedra Decoction or {|106|}Nine-Ingredient Notopterygium Decoction{|107|}, with modifications as needed. If improperly treated, the wind-cold pathogens on the muscle surface may persist, eventually transforming into chronic wind-cold lumbar spine bi pain.
2. Wind-cold Dampness Obstruction︰Lumbago, often accompanied by pain in the coccyx and lower limbs, varies in intensity, relieved by warmth and aggravated by cold, damp weather, or during autumn and winter. The onset can be sudden or gradual, with generally normal or slightly limited lumbar mobility. The pain is mostly dull or {|###|}dull pain{|###|}, often accompanied by stiffness or a "wooden" sensation. If caused by severe cold pathogens, the pain is usually fixed and intense, even preventing bending or turning, with a deep and forceful pulse. If dampness predominates, the pain is less severe but accompanied by heaviness and soreness, worsening in cold, damp weather, with a slow pulse. If wind pathogens are the main cause, the pain is migratory and fluctuates in intensity. Wind-cold-dampness obstruction dysmenorrheal, if prolonged, is often accompanied by numbness in the lumbosacral region or lower limbs, and even muscle atrophy. Wind-cold-dampness lumbago occurs when wind-cold-dampness Xieke invades the lumbar region, stagnating in the taiyang meridians, leading to obstruction of qi and blood flow, resulting in obstruction pain. If wind is the dominant pathogen, the pain is milder and migratory, and Notopterygium Decoction may be prescribed. However, wind often accompanies cold and dampness, so clinically, wind-cold obstruction pain or wind-dampness obstruction pain is common. If cold is the dominant pathogen, lumbago symptoms are severe, with fixed pain, temporarily relieved by warmth and aggravated by cold, presenting with a deep, wiry, or tight pulse. Treatment should focus on warming the meridians and dissipating cold, using modified Ginger and Aconite Decoction. If dampness is the dominant pathogen, the lumbago is heavy and sore, with a deep, slow pulse, as described in Jingui Yaolue as "cold-dampness lumbago." For details, refer to the section on cold, heavy lumbar pain. Chronic wind-cold-dampness lumbago with deficiency and insufficient qi and blood requires kidney tonification, dual {|###|}tonifying qi{|###|} and blood, reinforcing healthy qi and eliminating pathogenic factors. Pubescent Angelica and Taxillus Decoction may be used.
3. Consumptive Kidney Deficiency︰The lumbago persists incessantly, temporarily alleviating with rest but worsening with slight exertion, often accompanied by varying degrees of shortness of breath, heavy body, dizziness, tinnitus, alopecia areata, loose teeth, weak knees, heel pain, nocturnal emission, spermatorrhea, impotence, or in women, menstrual irregularities. Those with kidney yang deficiency exhibit cold intolerance, cold limbs, preference for warmth, pale or swollen tender tongue texture, and deep thin pulse. Those with kidney yin deficiency present with low-grade fever, vexing heat in the chest, palms, and soles, facial flushing, night sweats, dark urine, dry mouth, red tongue, and thin rapid pulse. The waist is the external manifestation of the kidneys, as all meridians pass through the kidneys and connect to the waist. When kidney qi is deficient, lumbago inevitably occurs. Suwen. Maiyao Jingwei Lun states, "The waist is the house of the kidneys; if it cannot turn or sway, the kidneys will be exhausted," referring specifically to kidney-deficiency lumbago. Kidney deficiency signifies insufficient essential qi of the kidneys. The reasons for this insufficiency may include the natural decline of kidney qi with aging (Suwen. Shanggu Tianzhen Lun states, "When the kidney storage declines, the body and form reach exhaustion"), which is a normal phenomenon of physiological decline. Hence, the elderly often experience lumbago due to kidney qi deficiency. If kidney qi deficiency leading to lumbago occurs prematurely, unrelated to aging, it is mostly caused by overstrain. So-called overstrain kidney-deficiency lumbago refers to either prolonged physical overexertion or extended periods of labor beyond one's capacity, particularly work that fixes the waist in the same posture for long durations (such as prolonged sitting, standing, or bending), which injures kidney qi and results in kidney-deficiency lumbago. More commonly, however, it refers to overstrain kidney-deficiency lumbago caused by irregular daily routines or excessive sexual activity. Suwen. Shanggu Tianzhen Lun states, "Taking recklessness as normal, entering the bedchamber while intoxicated, exhausting one's essence through desire, and dissipating one's true qi" (true qi refers to vital qi, i.e., kidney qi). Zhang Jing-yue's remark, "Desire must not be indulged, for indulgence exhausts the essence," both refer to sexual overstrain injuring the kidney's essential qi, with lumbago being its primary manifestation. Kidney qi is further divided into kidney yin and kidney yang. Kidney yang deficiency lumbago invariably manifests as cold signs (fear of cold, cold limbs, preference for warmth, loose stools or even diarrhea before dawn, clear and copious or frequent urination, pale tongue, deep thin pulse), the so-called "yang deficiency leading to cold." This cold pattern is not due to excess cold pathogens but rather to insufficient kidney yang, thus requiring warming and tonifying kidney yang. In cases of kidney yin deficiency lumbago, signs of deficient heat invariably appear (low-grade fever, vexing heat in the chest, palms, and soles, night sweats, dark urine, dry mouth, red tongue, thin rapid pulse), the so-called "yin deficiency leading to heat." This heat pattern is also not due to excess yang heat but rather to insufficient kidney yin, typically treated by nourishing kidney yin. For lumbago due to kidney qi deficiency or kidney qi deficiency in the elderly, Megalosaurus Pill may be used. For kidney yang deficiency lumbago, Jingui Yaolue states, "For deficiency fatigue lumbago with lower abdominal tension and dysuria, the Eight-Ingredient Kidney Qi Pill is prescribed." Alternatively, Right-Restoring Pill may be used. For kidney yin deficiency lumbago, Six-Ingredient Rehmannia Pill or Left-Restoring Pill may be employed.
4. Static Blood Due to Sudden Sprain︰The onset is sudden, with a clear history of trauma and severe pain. Depending on the site of the sprain or contusion, the pain may manifest as back pain, lumbago, or lumbocrural pain, affecting lumbar movement and making it difficult to bend, stretch, or turn, with aggravated pain upon exertion. If caused by a sprain, there may be no visible swelling externally; if due to contusion, localized static blood swelling and pain may be present. The condition arises abruptly from a sprain or contusion, with a distinct history of trauma. If caused by a sprain, it is termed acute lumbar sprain lumbago, as mentioned in Suwen·"On Treating Lumbago": "Lifting heavy objects injures the waist,... leading to the accumulation of stagnant blood." There is no obvious swelling in the lumbar region, but severe stabbing pain occurs during positional changes, deep breathing, coughing, or sneezing, resulting from qi stagnation in the Jingmai after the sprain. Treatment should focus on moving qi to relieve pain, using Immediate Effect Powder. For contusion lumbago caused by falls or blunt force trauma, the injured area often exhibits varying degrees of static blood swelling or bruising, with marked localized tenderness and impaired functional movement. Treatment should prioritize invigorating blood and resolving stasis to alleviate pain, using modified Taohong Siwu Decoction or Chengtong Powder.

Lumbago, as a condition, is often an excess pattern in its early stages and a deficiency pattern in its chronic phase. Lumbago caused by exposure to wind-cold dampness or injury, if not healed over time, often accompanies kidney deficiency; conversely, if kidney qi is insufficient, it is also prone to wind-cold dampness or susceptible to sprain injuries. The main manifestation of kidney-deficiency lumbago is "lingering and recurrent pain, frequently occurring without cessation." Jingyue Quanshu states: "Deficiency pattern account for eighty to ninety percent of lumbago cases," and "those with excess pathogens causing lumbago are no more than twenty to thirty percent." Lumbago is predominantly associated with kidney yang deficiency. When yang qi is deficient, wind-cold dampness pathogens take advantage of the deficiency to invade the Jingmai, inevitably leading to obstruction of qi and blood, hence chronic lumbago often also involves qi and blood stasis. Therefore, warming and tonifying kidney yang, regulating qi and resolving stasis are the major principles in treating lumbago. The "Shen's Book of Life Preservation" says: "All types of lumbago originate from kidney deficiency. If external pathogens are present, they must be eliminated; if not, the focus should solely be on tonifying the kidney."

bubble_chart Documentation

1. Jingyue Quanshu-Lumbar Pain states: "Danxi mentioned that all types of lumbar pain... should not be aggressively treated with cold and cooling herbs, as exposure to cold may lead to obstruction and exacerbate the pain. These remarks are not entirely accurate... I once treated an elderly gentleman named Dong, over sixty years old, who had always been robust in constitution. Due to his fondness for strong liquor, damp-heat accumulated in the Taiyang meridian, suddenly causing unbearable lumbar pain—so severe that he sought to end his own life. Upon examination, I found his six pulses extremely full and slippery, with blocked urination and acute distension of the bladder. I prescribed a large dose of Da Fen Qing Yin, doubling the amounts of Phelloendron Bark and Gentian. A single dose restored urination, and with it, the lumbar pain vanished as if it had never existed. Had I followed Danxi’s advice, the outcome would surely have been disastrous."
2. Shenshi Zunsheng Shu lists the Bushen Tang (Kidney-Tonifying Decoction) with modifications: "For wind, add processed Kusnezoff Monkshood Root and Gastrodia Tuber; for cold, double the amount of Eucommia Bark and add Cinnamon Twig and processed Aconite Lateral Root; for dampness, add Atractylodes Rhizome, White Atractylodes Rhizome, and Peach Kernel; for heat, remove Notopterygium and add Malaytea Scurfpea Fruit and Black Soybean; for phlegm, reduce Anemarrhena and Phellodendron by half and add processed Arisaema, processed Pinellia, and Poria; for food stagnation, double the amount of Psoralea Fruit and add Medicated Leaven, Germinated Barley, and Immature Orange Fruit; for qi stagnation, reduce Anemarrhena and Phellodendron by half and add White Cardamom, White Sandalwood, Lindera, and Green Tangerine Peel; for blood stasis, remove Anemarrhena and Phellodendron, double the amount of Corydalis Tuber, replace Angelica Root with Angelica Tail, and add Cassia Bark, Bupleurum, and Peach Kernel—in severe cases, add Trogopterus Dung; for traumatic injuries, remove Anemarrhena and Phellodendron, double the amount of Corydalis Tuber and Angelica Root, and add Notopterygium, Pubescent Angelica, Frankincense, Myrrh, and Peach Kernel, or alternatively add Cassia Bark and Red Peony Root."