The waist feels heavy and cold, hence it is called lumbar cold heaviness. Jingui Yaolue records "cold in the waist, as if sitting in water," "heavy abdomen as if carrying five thousand coins"; Zhubing Yuanhou Lun refers to it as "heavy body, cold waist." This condition is mostly accompanied by grade I lumbago.

bubble_chart Pattern Analysis

1. Kidney Affliction︰The patient feels heaviness in the body, with coldness in the waist and areas below, sometimes as cold as ice, as if sitting in cold water. It is accompanied by lumbago, a frequent sensation of heaviness and distension in the lower abdomen, a pale or swollen tongue with teeth marks, a white and moist or slippery tongue coating, and a deep, thin, or slow pulse. The term "著" implies attachment; "cold-dampness lumbago" refers to the cold and heavy sensation in the waist caused by cold-dampness pathogenic qi lodging in the waist, which is the external residence of the kidneys, rather than cold-dampness evils internally attaching to the kidneys themselves. "Cold-dampness lumbago" describes the disease cause, resulting from prolonged exposure to cold-damp environments, getting drenched in rain, bathing in cold water after sweating from labor, or failing to change out of wet clothes promptly. Cold-dampness invades the lower energizer, and its damp nature causes body heaviness. Cold-dampness, as a yin pathogen, obstructs yang qi, often leading to lumbago. Zhubing Yuanhou Lun states that this condition often occurs in individuals with internal water-dampness excess and, if prolonged, may "transform into water disease." As mentioned in the section on "cold-dampness lumbago syndrome": "The kidneys govern the waist and legs. When kidney channels are deficient, they are susceptible to wind-cold, leading to accumulated water internally. Wind-edema interacts, soaking and accumulating in the kidneys, causing kidney qi to lodge internally and fail to disperse freely, resulting in lumbago... heavy body and cold waist... Over time, it transforms into water disease due to kidney dampness." In summary, this syndrome arises from external contraction of cold-dampness pathogenic qi. When dampness predominates, the waist and body feel heavy; when cold predominates, the waist feels cold and painful (see wind-cold-dampness obstruction lumbago in the section on waist and spine pain). Treatment focuses on dispelling water-dampness, warming the middle, and dissipating cold. Mild cases may use Coix Seed porridge, while severe cases may require dampness-eliminating decoction or Licorice, Dried Ginger, Poria and White Atractylodes Decoction (also known as cold-dampness lumbago decoction). For those with kidney yang deficiency, Aconite Lateral Root may be added. You Zai-jing's "Jingui Yaolue Xindian" states: "The disease does not lie in the kidneys' apoplexy involving zang-organs but in their external residence. Thus, the treatment does not aim to warm the kidneys to disperse cold but to warm the earth to overcome water." $Cold-dampness lumbago with cold, heavy waist vs. wind-edema with cold, heavy waist! Both conditions involve internal water-dampness excess and external contraction of dampness pathogens. As Jingui Yaolue Xindian states: "When earth virtue is deficient, dampness stirs internally, leading to sluggish qi transformation and external dampness soaking." However, cold-dampness lumbago with cold, heavy waist involves mild internal dampness combined with cold-dampness pathogenic qi, manifesting only as "cold, heavy waist, as if sitting in water," without edema symptoms. Wind-edema with cold, heavy waist involves inherent internal dampness excess combined with wind-dampness evils, causing swelling in the waist, legs, and even the yin region. Cold-dampness lumbago with cold, heavy waist presents with a deep pulse and no exterior pattern symptoms, while wind-edema with cold, heavy waist may show a floating pulse, sweating, aversion to wind, and obvious exterior deficiency signs. Cold-dampness lumbago with cold, heavy waist involves cold-dampness lodging in the waist's channels and muscle layers, often accompanied by lumbago. Wind-edema with cold, heavy waist involves water-dampness flooding the lower energizer, rarely accompanied by lumbago. Treatment for cold-dampness lumbago with cold, heavy waist focuses on warming the spleen to eliminate dampness, using formulas like cold-dampness lumbago decoction. Wind-edema with cold, heavy waist requires replenishing qi and consolidating the exterior, promoting dampness movement and diuresis, using formulas like Stephania Tetrandra and Astragalus Decoction. In summary, cold-dampness lumbago with cold, heavy waist is milder. If prolonged, it may "transform into water disease" or develop into wind-edema with cold, heavy waist.
2. Yang Deficiency︰The waist feels cold, as if cold wind is blowing in. Accompanied by soreness in the waist or grade I pain, cold limbs, fear of cold, weak knees, heel pain, alopecia areata, loose teeth, diarrhea, clear and copious urine; in severe cases, impotence, seminal emission, and in women, menstrual irregularities. The tongue is pale, and the pulse is deep and thin, especially at the chi position. $cold-dampness lumbago (cold and heavy waist) and yang deficiency (cold and heavy waist)!cold-dampness lumbago (cold and heavy waist), where "heavy" implies attachment, refers to the cold and heavy waist caused by cold-dampness pathogenic qi affecting the waist as the external residence of the kidney, rather than cold-dampness evils internally attaching to the kidney itself. cold-dampness lumbago refers to the disease cause, resulting from prolonged lying in cold-dampness environments, exposure to rain and dampness, bathing in cold water after sweating from labor, or failing to change wet clothes promptly. cold-dampness invades the lower energizer, and its damp nature causes heaviness in the body. cold-dampness, as a yin pathogen, obstructs yang qi, often leading to lumbago. Zhubing Yuanhou Lun states: This condition often occurs in individuals with internal water-dampness excess and, if prolonged, may "transform into water disease." As mentioned in the section on "cold-dampness lumbago syndrome": "The kidney governs the waist and feet. When the kidney meridian is deficient, it is susceptible to wind-cold, leading to internal water accumulation. Wind and edema interact, soaking and accumulating in the kidney. Kidney qi becomes internally obstructed and cannot circulate freely, resulting in lumbago... heavy body and cold waist... Over time, this transforms into water disease due to kidney dampness." In summary, this syndrome is caused by external contraction of cold-dampness pathogenic qi. When dampness predominates, the waist and body feel heavy; when cold predominates, the waist feels cold and painful (see also wind-cold-dampness bi syndrome lumbago in the section on waist and spine pain). Treatment focuses on dispelling water-dampness, warming the middle, and dissipating cold. Mild cases may use Coix Seed porridge, while severe cases may require eliminating dampness decoction or Licorice, Dried Ginger, Poria and White Atractylodes Decoction (also known as cold-dampness lumbago decoction). For cases with kidney yang deficiency, Aconite Lateral Root may be added. You Zai-jing's "Synopsis of the Golden Chamber" states: "The disease does not lie in the kidney's apoplexy involving zang-organs but in the kidney's external residence. Thus, the treatment does not involve warming the kidney to disperse cold but rather warming the earth to overcome water." There is often a persistent sensation of cold and heaviness in the waist, as if cold wind is blowing in, unrelenting. In severe cases, the waist feels as cold as ice, relieved by heat and aggravated by cold. It is often accompanied by lumbago, weak knees, heel pain, alopecia areata, loose teeth; or diarrhea, clear and copious urine; or seminal emission, impotence, and in women, menstrual irregularities. The tongue is pale, and the pulse is deep and thin. These symptoms all indicate insufficiency of the kidney's original qi, decline of life gate fire, and internal excess of pudendal coldness. Treatment should strengthen the source of fire, warming and tonifying kidney yang, using Ginger and Aconite Decoction with Eucommia Bark and Cassia Bark, or Kidney Qi Pill, Right-Restoring Pill, etc.
3. Wind-Water︰Cold and heavy sensation in the lower back, edema in the lower back and feet, free movement above the waist but limited flexion and extension below the waist. Additionally, there is weakness in the limbs, heaviness throughout the body, or joint pain and discomfort; occasional sweating, or head sweating, aversion to wind, and reluctance to remove clothing. The tongue is pale with a white coating, and the pulse is floating. $The key points to differentiate between cold-dampness lumbago (cold and heavy sensation in the lower back) and yang deficiency lumbago (cold and heavy sensation in the lower back) are as follows: one is caused by external contraction of cold-dampness pathogens, where water-dampness lodges in the lower back, and excessive dampness leads to heaviness, treated primarily by eliminating dampness pathogens, focusing on the spleen; the other is due to kidney yang deficiency, where yang deficiency leads to cold, and the treatment should focus on supporting the body's vital energy, targeting the kidneys. However, individuals with kidney yang deficiency are also prone to contracting cold-dampness pathogens, as the saying goes, "invasion of pathogen must be due to deficiency of essential qi"; conversely, prolonged exposure to cold-dampness can also lead to kidney yang deficiency. Therefore, warming and tonifying the yang of the spleen and kidneys is the key to treating this condition.
4. Cold-dampness lumbago (cold and heavy sensation in the lower back) and wind edema lumbago (cold and heavy sensation in the lower back)! Both have internal factors of excessive water-dampness and are further affected by external dampness pathogens. As stated in Jingui Yaolue Xindian: "When the earth's virtue is deficient, dampness moves internally, leading to sluggish qi transformation and dampness spreading externally." However, in cold-dampness lumbago (cold and heavy sensation in the lower back), the internal dampness is not severe, and the symptoms are only "cold and heavy sensation in the lower back, as if sitting in water," without edema symptoms; in wind edema lumbago (cold and heavy sensation in the lower back), internal dampness is inherently excessive, and the condition is further aggravated by wind-dampness pathogens, causing swelling in the lower back, feet, and even the genital area. Cold-dampness lumbago (cold and heavy sensation in the lower back) presents with a deep pulse and no exterior pattern symptoms; wind edema lumbago (cold and heavy sensation in the lower back) may show a floating pulse, sweating, aversion to wind, and obvious signs of exterior deficiency. In cold-dampness lumbago (cold and heavy sensation in the lower back), cold-dampness lodges in the Jingmai and the muscles of the lower back, often accompanied by lumbago symptoms; in wind edema lumbago (cold and heavy sensation in the lower back), water-dampness floods the lower energizer, rarely accompanied by lumbago. For treatment, cold-dampness lumbago (cold and heavy sensation in the lower back) focuses on warming the spleen to eliminate dampness, using formulas such as cold-dampness lumbago decoction; wind edema lumbago (cold and heavy sensation in the lower back) requires replenishing qi and consolidating the exterior, as well as promoting dampness elimination and diuresis, using formulas like Stephania Tetrandra Astragalus Decoction. In summary, cold-dampness lumbago (cold and heavy sensation in the lower back) is a milder condition, but if it persists, it may develop into "water disease" or even wind edema lumbago (cold and heavy sensation in the lower back).

bubble_chart Documentation

1. Gujin Yian AnVolume 7 records: "Zhu Ruqiong treated Zhang Xiufu, who suffered from severe lumbago as if carrying a thousand gold, but did not feel the weight during intercourse. Taking kidney-tonifying pills had no effect. Zhu said, the waist is the house of the kidney, and kidney qi deficiency causes this illness of the waist. However, why is the weight not felt during intercourse? It must be due to static blood stagnation. ... Using Phelloendron Bark, Anemarrhena, Lindera, green tangerine peel, Peach Kernel, Carthamus, Sappan Wood, Pangolin Scales, Akebia Stem, each one qian, and Liquorice Root five fen, with ginger and jujube, decocted, two doses cured him.