Back Pain So Bad You Can’t Stand Straight — and You Can’t Urinate? Doctor Zhang Jingyue’s Da Fen Qing Yin (Major Clearing-Divide Drink) for Damp-Heat Low Back Pain: One Dose Unblocks the Urine and the Pain Vanishes
Patient search terms: back pain / low back pain / back pain so bad I can’t stand straight / can’t urinate / urine won’t come out / bladder distension / sore back / back pain in the morning / back sore and weak
Medical terms for this condition: damp-heat low back pain · damp-heat accumulated in the lower burner · kidney-deficiency back pain · cold-damp back pain · blood-stasis back pain · urinary blockage
Opening: a gentleman in his sixties, in so much pain he wanted to die
The physician in today’s story is the great Ming-dynasty doctor Zhang Jingyue — the master of the warming-and-tonifying school, author of the Jingyue Quan Shu (The Complete Works of Jingyue), nicknamed "Zhang the Rehmannia Man." The illness he treats today is one everyone knows all too well: back pain.
💬 Note from Doctor Luo: Back pain — who hasn’t been through it in this life? I’d say basically everyone has had it at some point. But ordinary back pain is "uncomfortable." Today’s patient’s back pain was life-threatening.
The patient was an elderly gentleman surnamed Dong, over sixty — in his sixties. You might think, hearing that age, that his body was frail — but not at all: he had a naturally robust constitution (zi bing su zhuang), strong and sturdy. So why did he suddenly fall ill? Doctor Zhang Jingyue pointed straight at the root cause in one sentence:
💬 Note from Doctor Luo: He loved to drink hot strong liquor — fiery spirits, taken piping hot, cup after scalding cup. Drink too much liquor and the damp-heat gradually collects in the body, until finally it gathered in the Bladder meridian of Foot-Taiyang (Pang Guang Jing). This channel runs up the back and passes right through the lower back. When damp-heat blocks the channel, the lower back pays the price.
That day, Elder Dong suddenly suffered back pain beyond endurance (hu bing yao tong bu ke ren). How bad was it? So bad he wanted to end his own life (yi zhi qiu zi jin): the pain was so unbearable he actually began to think of suicide.
A surging, slippery pulse — but not a single drop of urine
The moment Doctor Zhang Jingyue took his pulse, he understood most of the picture: all six pulses surging and slippery with overwhelming force (liu mai hong hua zhi sheng) — every position jumping hard and fast, frighteningly strong. The other symptoms confirmed the diagnosis: his urine was completely blocked (xiao shui bu tong), and his bladder was swollen and urgent (pang guang zhang ji).
💬 Note from Doctor Luo: A surging, slippery pulse is the pulse of excess heat with dampness; when the urine is blocked and the bladder is swollen and urgent, it means damp-heat is stored up inside, clogging everything solidly. This is not a deficiency pattern — it is a genuine excess damp-heat pattern. Why was Doctor Zhang Jingyue so accurate? Because his pattern-differentiation skill was superb — pulse, symptoms, tongue, complexion all clicked together, and the disease mechanism was crystal clear.
Why was Doctor Zhang Jingyue so accurate? First he copied out every line the Huangdi Neijing ever wrote about back pain
Before formally discussing treatment, Doctor Zhang Jingyue did something well worth learning from: he hunted down every single passage about back pain in the Huangdi Neijing (The Yellow Emperor’s Classic of Internal Medicine), organized them one by one.
💬 Note from Doctor Luo: This is exactly why I recommend everyone read the Jingyue Quan Shu — Doctor Zhang Jingyue explains every illness in painstaking detail. When he treated a patient, he first went back to the Neijing, looked at how the ancients understood the disease, digested the classics thoroughly, and only then turned to the bedside. This habit of "establishing the roots first, then building on them" is enormously helpful for anyone studying any disease.
For example, the chapter Mai Yao Jing Wei Lun (Essential Subtleties of the Pulse) of the Su Wen (Plain Questions) says: "The lower back is the mansion of the kidneys; when it cannot turn or bend, the kidneys are about to fail" — the lower back is the kidneys’ residence, and when it cannot turn, the kidneys are exhausted and weakened. It also says: "When the kidney pulse is firm and strong yet long, and the complexion is yellow tinged with red, the person will suffer back pain as if it were snapped" — a kidney pulse that is firm and long, with a yellowish-red face, means the person will get back pain like a broken back. The chapter Re Lun (Treatise on Heat) likewise says: "On the first day of cold damage, the Greater Yang (Taiyang) channel is attacked; hence pain in the head and neck, and stiffness of the back and spine" — on the first day of an externally contracted febrile disease, the Taiyang channel is invaded, giving headache, neck pain and a stiff lower back.
Back pain comes in five kinds — which one are you?
After combing through the Neijing, Doctor Zhang Jingyue summarized back pain into roughly five major types:
- Insufficient yang — kidney yang deficiency, kidney deficiency;
- Wind, cold and damp turbidity — external pathogens (wind, cold, damp) invading the body;
- Overwork and exhaustion — working too hard, injuring the kidneys;
- Falls and injuries — a fall, a knock, an old wound;
- Excess in the bedroom — sexual indulgence injuring the kidneys.
💬 Note from Doctor Luo: These are the broad categories of the root cause. How do you tell them apart in practice? Doctor Zhang Jingyue wrote it out very finely: pain that is dull, lingering, clinging, recurring endlessly is generally kidney deficiency; pain that gets heavier on rainy or overcast days, or after sitting too long, where the back feels heavy and weighed down, is dampness; pain that comes with cold, eases with warmth, and fears cold is cold; pain that comes with heat, likes coolness, and fears heat is heat; pain that flares up when you get angry is qi stagnation (the qi mechanism blocked); pain that comes with worry and anxious brooding is qi deficiency. Work through this checklist and you can basically figure out which category you fall into.
Eighty or ninety percent is deficiency — how to spot kidney-deficiency back pain at a glance
Before discussing treatment, Doctor Zhang Jingyue set down a line of hard-won clinical experience: "Of back pain that is deficiency pattern, eight or nine cases out of ten."
💬 Note from Doctor Luo: That is real experience. Out of ten people with back pain, eight or nine have deficiency — kidney deficiency. But note: he said "eight or nine out of ten," not "ten out of ten." The remaining one or two cases are the kind we see today — excess damp-heat. If you only recognize deficiency and dare not use cold, cooling herbs, you will equally ruin the treatment. Doctor Zhang Jingyue always left himself that "one or two cases out of ten" of leeway.
How do you tell it’s deficiency? Doctor Zhang Jingyue said: as long as there is no exterior pathogen and no damp-heat, and on top of that the person shows — advanced age (nian shuai), hard labor (lao ku), liquor and lust (jiu se, drinking and dissipation), or depressed emotions (qing zhi yu yu) — these people usually have true yin deficiency, that is, kidney essence depletion.
💬 Note from Doctor Luo: For kidney deficiency, look at appearance and complexion: the face is certainly pale-white or dark, sooty black (black tinged with gloom), never that rosy, moist look; look at the pulse: weak; look at their state: their strength fails when standing or walking (xing li li bu zhi) — they can’t stand up straight, always want to lean on something, the back always bent; a bit of labor and they’re exhausted, and the back pain worsens. An old practitioner walks into the clinic, sweeps his eyes over a patient who is holding his back, hunched over, face dull and dark — eight or nine times out of ten it’s deficiency. Kidney-deficiency back pain is that sore-and-weak kind of ache, a slow, grinding torment.
How is deficiency treated? Doctor Zhang Jingyue’s direction was clear: for kidney yin deficiency use Zuo Gui Wan (Left-Restoring Pill); for kidney yang deficiency use You Gui Wan (Right-Restoring Pill); for milder cases there is also a whole shelf of gentler formulas — Qing E Wan (Green Maidens Pill), Wei Shen San (Roasted Kidney Powder), Bu Sui Dan (Marrow-Replenishing Elixir), Er Zhi Wan (Two Ultimates Pill), Tong Qi San (Qi-Freeing Powder) — taken slowly to nurse the body back.
Exogenous and cold-damp back pain: the air-conditioning backache
Besides deficiency, there is also back pain caused by external contraction. The Neijing explains it: when the Taiyang channel is invaded, the channels go wrong, and back pain appears — during a cold, plenty of people wake up with a sore, aching back.
💬 Note from Doctor Luo: Just like during the pandemic, many people had terrible back pain — that’s external evil entering the body and blocking the channels. The evil qi can sometimes invade the Shaoyin (kidney channel) directly and cause back pain; when it sits in the Taiyang channel, the back hurts too, because the Taiyang channel runs along the back and through the lower back. How do you treat exogenous back pain? Treat the external contraction along the lines of the Shang Han Lun (Treatise on Cold Damage) — once the cold is cured, the back pain clears up by itself. This one is easy to tell apart: when your back hurts in the middle of a cold, nobody treats it as a back problem.
The hard one to distinguish is the second kind — back pain from dampness stagnating in the channels, especially cold-damp. This is extremely common. Doctor Luo put his finger on one very familiar scenario:
💬 Note from Doctor Luo: In summer, when it’s hot, lots of people sleep under the air conditioner, the blanket slips off, the lower back is left exposed, and the next morning they can’t straighten up — that’s cold-damp! Summer is hot and humid; maybe you also ate a big slice of watermelon, then lay down to sleep, and the cold-damp crept in. Any back pain that isn’t the deficiency kind — the kidney-deficiency kind — and that suddenly flares up over a day or two, most of the time it’s this: you were blown by cold wind, especially when you know it yourself: "I slept with the AC on last night." You have to watch for it. In winter everyone is bundled up in a down jacket and never gets blown on; it’s usually summer when the cool draft catches you. This is the "summer air-conditioning illness."
And blood-stasis back pain: Doctor Luo’s own bout
The third easily overlooked kind is blood-stasis back pain — from a fall, an old injury, a twist, or qi and blood stasis. This one is the most hidden, and it’s tied to your whole-body state: you got angry recently, the qi mechanism stagnated, qi stasis led to blood stasis, and the back pain arrived — you may not even know why.
💬 Note from Doctor Luo: Blood-stasis back pain is especially hard to identify — sometimes you can see bruise-like spots on the tongue, sometimes you really can’t see them at all; it all comes down to experience. I had a bout myself: out of nowhere I woke up every morning with terrible back pain, scary pain. I figured there might be some blood stasis in my kidney channel, so I prescribed myself the formula that Professor Zhao Shaoqin (the renowned kidney-disease specialist at Beijing University of Chinese Medicine) used for kidney disease — all cooling-blood, quickening-blood herbs, and I remember he included Sang Zhi (mulberry twig) and Si Gua Luo (luffa gourd fiber) — when Professor Zhao treated kidney patients, he’d ask whether their back was sore or painful; the moment they said yes, he’d add Sang Zhi and Si Gua Luo to open up the damp-heat in the kidney channel. I drank it, and the effect was immediate — one dose and the back pain was finished! It had nothing to do with any injury; the qi and blood had slowly stagnated into stasis. So this blood-stasis pattern must never be ignored — but it truly is hard to distinguish.
Back to Elder Dong: one dose of Da Fen Qing Yin — the urine flowed, the pain was gone
Now back to Elder Dong. He loved hot strong liquor, and damp-heat was clogged up inside — this was not cold invasion, it was heat.
💬 Note from Doctor Luo: Of the back pain I see with an external pathogen, eight out of ten cases are cold invasion — but two out of ten are heat — you must know this exists. Elder Dong was one of those: a fiercely surging, slippery pulse, urine blocked, bladder swollen and urgent — this is damp-heat accumulated within, compressed into excess heat.
Doctor Zhang Jingyue used a formula of his own creation — Da Fen Qing Yin (Major Clearing-Divide Drink). This formula specializes in accumulated heat closing and binding, urinary blockage (urine blocked and unable to come out), scanty urine, as well as pain below the lower back and legs, damp-heat diarrhea, jaundice, blood in the urine, pathogenic heat with stagnant blood, abdominal pain, and dribbling urinary block (lin bi).
💬 Note from Doctor Luo: Look at the design of this formula and you see Doctor Zhang Jingyue’s skill at composing prescriptions. Fu Ling (Poria) removes dampness; Ze Xie (Alisma) drains the dampness of the kidneys; Mu Tong (Akebia stem) conducts heat out through the urine; Zhu Ling (Polyporus) drains dampness like Ze Xie; Zhi Zi (Gardenia fruit) clears the heat of the Triple Burner; Zhi Ke (Bitter orange peel) regulates the qi; Che Qian Zi (Plantago seed) promotes urination — Fu Ling, Ze Xie and Mu Tong at two qian (about 6 g) each, Zhu Ling, Zhi Zi, Zhi Ke and Che Qian Zi at one qian (about 3 g) each, decocted in one cup of water down to eight-tenths, taken warm away from meals (on an empty stomach, well separated from eating). Doctor Zhang Jingyue also deliberately added Huang Bai (Phellodendron bark) and Long Dan Cao (Chinese gentian root) — two powerful heat-draining herbs — because he could see it crystal clear: this is heat stored up inside.
What was the result? One dose, and the urine flowed freely all at once (yi ji er xiao shui dun tong) — with the first dose, the urine came "whoosh," unobstructed; and as the urine passed, the back pain vanished as if it had never been (xiao shui tong er yao tong ruo shi).
Doctor Zhang Jingyue "argues" with Doctor Zhu Danxi: can you ever use cold, cooling herbs for back pain?
With the patient cured, Doctor Zhang Jingyue still wanted to debate the logic with his predecessor Doctor Zhu Danxi. Doctor Zhu had said: in treating back pain one must not use ginseng (ren shen) — don’t use qi-tonifying herbs, because tonifying qi makes the pain worse; nor should one exhaustively use cold, cooling herbs — try to avoid cooling herbs, because cold makes the pain worse still.
💬 Note from Doctor Luo: Doctor Zhang Jingyue took a debating stance toward Doctor Zhu Danxi — he said it outright: this statement is not comprehensive. If out of fear you never dare use cold, cooling herbs at all, then you are ruining the treatment! Whether back pain calls for warming or cooling can never be fixed by one rigid rule (bu ke zhi yi er lun) — you cannot have a set frame. Elder Dong’s case today is a living example: with damp-heat stored inside, if you don’t use cold, cooling herbs like Huang Bai and Long Dan Cao to drain the heat, the urine will never flow and the back pain will never heal. My own back pain was the same — Professor Zhao Shaoqin’s formula was cooling-blood and quickening-blood (Fang Feng, Jing Jie Sui, Dan Shen, Qian Cao, Lu Gen, Mao Gen, Sheng Di Yu — all cooling-blood herbs, paired with Dan Shen and Qian Cao to quicken the blood), also on the "cool" track, because damp-heat was stagnating in the kidney channel. So when cooling is called for, use it — this is the value of pattern differentiation.
The full map of back pain
With Elder Dong’s story told, Doctor Luo drew the complete map of back pain for everyone:
💬 Note from Doctor Luo: First, deficiency is extremely common — kidney deficiency! Especially pain that strikes in the morning, or in the small hours — in men this is very often kidney yang deficiency, lingering and never quite resolving. These really do need tonifying: the Zuo Gui Wan / You Gui Wan family, nursed along little by little. Chinese medicine is remarkably effective for this — the pain soon stops, and your whole mental state improves. Second, cold-damp is extremely common — blown by wind, blown by the AC; this very season a wave of people will come in with back pain. Third, blood stasis — after injuries, falls and knocks; quicken the blood, dissolve the stasis bit by bit — definitely beneficial. Fourth, damp-heat — not common, but everyone should know it exists. Doctor Zhang Jingyue’s case tells it most vividly: pain beyond bearing, urine won’t come out at all — reach quickly for Da Fen Qing Yin, drain the heat and promote urination at the same time, and the illness is cured.
By the end of this lesson, everyone should have a good sense of back pain: how many kinds there are, roughly which one you belong to — you can analyze it yourself with eight or nine parts confidence. And if you want to go deeper, pull out the Jingyue Quan Shu — Doctor Zhang Jingyue patiently lists the formulas after every single disease section, like a table of contents; a quick search and you’ve found them.
💬 Note from Doctor Luo: This is the meaning of chatting about Chinese medicine stories every day — as we talk, you become more and more familiar with your body and the problems it develops. Only once you understand can you speak of nurturing and treatment. And if you have a Chinese-medicine practitioner around you to help analyze, that’s even better.
Compiled from Doctor Luo Dalun’s commentary on Doctor Zhang Jingyue’s medical cases; the case is from the Jingyue Quan Shu (The Complete Works of Jingyue, Ming dynasty, by Doctor Zhang Jingyue, published 1624).