Back Pain Isn’t One Disease: Kidney Deficiency, Cold-Damp, Blood Stasis, Damp-Heat, or External Contraction — Which One Is Yours? The Ming Master Doctor Zhang Jingyue on Low Back Pain (The Old Mr. Dong Damp-Heat Case)
What people search for: low back pain won’t go away / why does my lower back hurt in the morning / kidney deficiency back pain / cold-damp back pain from air conditioning / blood stasis back pain / damp-heat back pain / sudden severe back pain with urine retention / back pain after catching a cold / Zhu Danxi back pain treatment / Zhang Jingyue back pain / Da Fen Qing Yin / Zuo Gui Wan vs You Gui Wan / lower back pain when angry / back pain worse on rainy days / traditional Chinese medicine for back pain
Medical terms for this condition: low back pain (yao tong) · the lumbar region is the mansion of the kidneys (yao zhe, shen zhi fu) · kidney essence deficiency (shen jing kui) · Greater Yang channel / Foot Taiyang Bladder channel (zu taiyang pangguang jing) · wind-cold-damp (feng han shi) · damp-heat (shi re) · qi stagnation (qi zhi) · qi deficiency (qi xu) · nine out of ten cases of low back pain are deficiency (yao tong xu zheng shi ju ba jiu) · Da Fen Qing Yin (Major Clear-and-Separate Decoction) · Zuo Gui Wan (Restore the Left [Kidney] Pill) · You Gui Wan (Restore the Right [Kidney] Pill) · treating the external contraction per the Treatise on Cold Damage · do not cling to one rigid rule (bu ke zhi yi er lun)
💬 Note from Doctor Luo: Dear friends, good morning everyone. Today we continue with the stories of the famous Ming-dynasty doctor Zhang Jingyue. And what are we talking about today? Low back pain. This is such a common complaint — who in this life has never had a sore back? Practically everyone has been through it. So what exactly is going on with back pain? Today we start with one case, and then, using Zhang Jingyue’s discussion, we’ll go through the whole subject of back pain from beginning to end.
Opening: this old gentleman hurt so badly he wanted to die
The first case Zhang Jingyue recorded: the patient’s surname was Dong — Old Mr. Dong — over sixty years old.
💬 Note from Doctor Luo: This old gentleman was past sixty, no longer young. But he was naturally strong and robust (zi bing su zhuang) — an excellent constitution, a sturdy body. He had one hobby: he loved drinking strong hot liquor (hao yin huo jiu) — fiery, warming spirits. Drink too much, and damp-heat collects in the Greater Yang channel — the Foot Taiyang Bladder channel, which runs along the back and passes through the lumbar region — and suddenly he collapsed into illness: unbearable low back pain. How bad was it? So bad he wanted to die (yi zhi yu qiu si) — the pain was so severe he no longer wished to live. You can imagine how serious this was!
Then Doctor Zhang Jingyue was called in. Taking the pulse: all six positions were full and slippery (liu mai hong hua zhi sheng) — beating violently. Looking at the symptoms: xiaoshui bu tong — the urine was blocked, and the bladder was swollen and urgent (pang guang zhang ji).
💬 Note from Doctor Luo: What is this? This is damp-heat accumulated inside. The damp-heat is stuck in the Greater Yang channel and the bladder; the channels and networks are blocked, the urine is shut off — how could the lower back not hurt? When pain reaches its extreme, a person wants to die. This is a very typical, critical presentation of damp-heat low back pain.
When Zhang Jingyue discussed back pain, he first brought out the Yellow Emperor’s Inner Classic
Zhang Jingyue had a habit when treating illness: for every single disease, he collected and organized everything the Inner Classic said about it and everything the previous masters said — this is exactly why the Complete Works of Jingyue is worth reading.
💬 Note from Doctor Luo: In the Plain Questions · Discourse on the Subtleties of the Pulse (Su Wen · Mai Yao Jing Wei Lun) it says: “The lumbar region is the mansion of the kidneys; when one can no longer turn and twist, the kidneys are about to fail (yao zhe, shen zhi fu, zhuan yao bu neng, shen jiang bei yi).” — The lower back is the home of the kidneys; if the back can no longer turn, the kidney qi is exhausted. It also says: “When the kidney pulse is hard and long, and the complexion is yellow with a touch of red, the person will suffer ‘waist-snapping’ disease (dang bing zhe yao).” — the kidney pulse hard and long, the face yellow tinged with red, and the person will get this “broken waist” disease — meaning violent low back pain. The Plain Questions · Discourse on Heat (Su Wen · Re Lun) discusses external contraction: “On the first day of cold damage, the Greater Yang channel receives it, therefore the head and nape ache and the lumbar spine is stiff (shang han yi ri, ju yang shou zhi, gu tou xiang tong, yao ji qiang).” — When the Greater Yang channel is invaded, the head and nape hurt and the back feels stiff and rigid. You see — everything the Inner Classic says about back pain, Zhang Jingyue dug out for you and organized it crystal clear.
Five kinds of back pain: Zhang Jingyue’s classification
Zhang Jingyue roughly divided the causes of low back pain into five categories:
💬 Note from Doctor Luo: First, yang deficiency and insufficiency (yang xu bu zu) — kidney yang insufficient, the kidneys weakened; second, wind-cold-damp settling in (feng han shi zhuo) — external wind, cold, and damp invading the body; third, overwork injuring the kidneys (lao yi shang shen) — exhaustion damaging the kidneys; fourth, falls and injuries (zhui duo sun shang) — traumatic injury; fifth, sleeping on damp ground (qin wo shi di). Roughly these five.
How to differentiate them? Zhang Jingyue also wrote it out clearly:
- Pain that is lingering, nagging, never quite resolving, and keeps recurring — usually kidney deficiency;
- Pain that comes on in rainy weather, or after sitting a long time (heavy, dragging pain) — damp evil is inside;
- Pain that is worse with cold and relieved by warmth — cold invasion;
- Pain that is worse with heat and likes coolness — a heat pattern;
- Pain that flares up when angry — qi stagnation — the qi mechanism is blocked;
- Pain that comes on with worry and brooding — qi deficiency — worry injures the spleen, qi deficiency means it cannot transport and transform.
Nine out of ten back pain cases are deficiency: Zhang Jingyue’s hard-won experience
On treatment, Zhang Jingyue offered one especially important piece of experience: “For low back pain, nine out of ten cases are deficiency (yao tong, xu zheng shi ju ba jiu).”
💬 Note from Doctor Luo: This is experiential wisdom, and it is true — out of ten people with back pain, eight or nine have deficiency. How do you recognize it? No exterior evil (no external contraction), no damp-heat — then look at age: elderly people; or even if young and strong, those who ordinarily toil hard, indulge in wine and sex, or are depressed and stifled in their emotions — these people are usually suffering true yin deficiency, that is, kidney essence depletion. Look at their complexion and form: it is always pale-white or sooty-black, never rosy and moist; the pulse is weak; standing they can hardly stay upright, walking a few steps exhausts them, and working makes the back pain worse. An old practitioner walks in and sees at once: this person holds his lower back with his hand, his waist always bent — that is deficiency. After kidney deficiency, the back aches with a sour, soft pain — this is the most common kind.
How to treat kidney-deficiency back pain? If kidney yin is depleted, use Zuo Gui Wan (Restore the Left [Kidney] Pill); if kidney yang is depleted, use You Gui Wan (Restore the Right [Kidney] Pill); for milder cases there are Qing E Wan (Green Maiden Pill), Wei Shen San (Roasted Kidney Powder), Bu Sui Dan (Marrow-Filling Elixir), Er Zhi Wan (Two Solstices Pill), Tong Qi San (Qi-Coursing Powder) and so on — all tonifying formulas.
External-contraction back pain: catch a cold, and the back hurts first
There is another kind of back pain — back pain caused by external contraction. The Inner Classic’s “on the first day of cold damage the Greater Yang channel receives it, therefore the head and nape ache and the lumbar spine is stiff” refers to exactly this.
💬 Note from Doctor Luo: With external contraction, many people have experienced it: as soon as a cold comes on, the back feels sore and painful. During the recent pandemic, huge numbers of people had terrible back pain — the ancients summarized this situation very clearly. When external evil enters the body, cold and heat evils gather there; some invade the Shaoyin kidney channel, some stay in the Greater Yang channel (the Greater Yang channel runs along the back and passes through the lower back), and back pain results. How do you treat this kind? Treat the external contraction according to the thinking of the Treatise on Cold Damage (Shang Han Lun) — once the external contraction resolves, the back pain resolves too. Everyone should note: back pain from a cold is generally not treated as a back-pain problem.
Cold-damp back pain: summer air conditioning is worse than winter wind
Apart from deficiency, the “sudden back pain” Doctor Luo sees most in his own clinical work is cold-damp back pain.
💬 Note from Doctor Luo: Especially cold-damp. In this season, the weather gradually turns hot, and many people sleep with the air conditioner blowing on them and the lower back uncovered — one night’s sleep, and the next morning the back hurts so much you cannot straighten up. Why? The cold air from the AC blows straight on the lower back; summer is hot and damp, and maybe you also ate a big watermelon before lying down to sleep — the cold-damp gets in. Of the sudden back pains I see, whenever it is not the kidney-deficiency kind, most are this type — everyone must remember this. In winter, with padded coats and down jackets wrapped tight, you rarely get blown on; precisely in summer, when cool wind hits you, this happens very often. If the person has been exposed to cold wind — especially if they know they slept with the AC on — then be on guard.
Blood-stasis back pain: Doctor Luo’s own back pain, cured by one dose
As for blood-stasis back pain, Zhang Jingyue spoke of back pain from falls and injuries — sometimes you do not even know when you were hurt; it is an old injury. Or it is caused by qi and blood stagnation — qi stuck, blood static, and the back hurts.
💬 Note from Doctor Luo: This kind of back pain is hidden and especially hard to diagnose — I experienced it myself. For a period I would wake up every morning with inexplicable severe back pain; it hurt as soon as I got up. I judged that there might be some blood stasis in the kidney channel, so I prescribed the formula Doctor Zhao Shaoqin (the kidney-disease specialist at Beijing University of Chinese Medicine) uses for kidney disease — a formula built on cooling the blood and activating the blood: Fangfeng (Saposhnikovia root), Jingjiesui (Schizonepeta spike), Danshen (Salvia miltiorrhiza root), Qiancao (Rubia root), Lugen (reed rhizome), Baimaogen (Imperata cylindrica root), Sheng Diyu (raw Sanguisorba root), and such. I remember I added sangzhi (mulberry twig) and siguacao (luffa vine) — because old Master Zhao had a diagnostic habit: he would ask the patient “is your back sore? does it hurt?” and the moment the patient said yes, he would add mulberry twig and luffa vine to open up the damp-heat in the kidney channel. And what happened? I drank one dose — immediate effect, the back pain was cured. My back pain had nothing to do with falls or injuries; it was blood stasis that had slowly formed from stagnant qi and blood. This pattern is genuinely hard to recognize — sometimes you can see stasis spots on the tongue, sometimes you cannot, and you have to rely on experience and analysis.
Back to Old Mr. Dong: damp-heat back pain, cured by one dose of Da Fen Qing Yin
Having covered all the types, let’s return to the old gentleman in the opening who hurt so badly he wanted to die. Zhang Jingyue’s judgment was clear: damp-heat is blocked inside.
💬 Note from Doctor Luo: For external-evil back pain, eight out of ten cases I encounter are from cold, but two out of ten are heat — damp-heat pent up inside: full slippery pulse, urine blocked, bladder swollen and urgent — this is damp-heat accumulation. The formula Zhang Jingyue used is called Da Fen Qing Yin (Major Clear-and-Separate Decoction), a formula he created himself, used for accumulated heat with constipation, blocked urine, severe pain in the lower back and legs, damp-heat dysentery, jaundice, blood in the urine, heat evil with blood stasis, abdominal pain, and strangury with dribbling urine — and so on.
Da Fen Qing Yin ingredients: Fuling (Poria), Zexie (Alisma), Mutong (Akebia stem), Zhuling (Polyporus), Zhizi (Gardenia fruit), Zhiqiao (bitter orange), Cheqianzi (Plantago seed) — Poria drains water-damp, Zexie drains dampness from the kidneys, Mutong guides heat out through the urine, Zhuling drains water downward, Zhizi clears the heat of the three burners, Zhiqiao regulates qi, and Cheqianzi promotes urination. The doses were all modest — about one qian (3 g) each — simmered in one cup of water down to eight-tenths, and taken warm, well away from meals (shi yuan wen fu). Zhang Jingyue also doubled the dose and added huangbai (Phellodendron bark) and longdancao (Gentian root) — to drain the heat. And the result? One dose, and the urine flowed; the back pain vanished as if it had never been (yi ji er xiao shui tong, yao tong ruo shi) — one dose, urine passed, and the lower back pain was instantly better!
Zhu Danxi said you cannot use cold herbs for back pain — Zhang Jingyue said: do not cling to one rigid rule
Here is a famous anecdote from the medical world: long ago Zhu Danxi (one of the four great masters of the Jin-Yuan period, founder of the yin-nourishing school) said that in treating back pain you must not use ginseng to tonify qi — tonify qi and the pain worsens; and you must not boldly use cold and cooling herbs (bu ke jun yong han liang) — getting cold will block and suppress the channels, and the pain worsens.
💬 Note from Doctor Luo: Zhang Jingyue took a debating stance toward this claim — he thought Zhu Danxi was not telling the whole story. If you refuse all cold herbs out of fear, you will make mistakes. When damp-heat is genuinely present inside, if you do not use cold herbs to drain the heat, how will the illness ever improve? Just like his own back pain, which in fact also had damp-heat — Master Zhao Shaoqin’s formula was a cooling-blood, activating-blood one. So do not cling to one rigid rule (bu ke zhi yi er lun) — you cannot say fixedly that back pain must be treated with warming herbs, nor that cold herbs can never be used; you must make distinctions. Damp-heat also easily settles in the kidney channel: rich, fatty, sweet food; some stagnation; too much wine; rising fire — all of these can bring it on. But damp-heat severe enough to block the urine, urgent and unable to pass, is a minority of cases — yet when you meet it, Da Fen Qing Yin drains the heat on one side and promotes urination on the other, and the illness is cured.
Doctor Luo’s summary: four kinds of back pain — which one is yours?
Having gone through the whole subject, Doctor Luo gives everyone a general sorting-out:
💬 Note from Doctor Luo: First, deficiency is the most common — kidney deficiency. Especially pain in the early morning or in the small hours of the night; in men, kidney-yang deficiency is very common. This kind is always lingering and unresolved, and it truly needs tonifying: Zuo Gui Wan, You Gui Wan and similar foundational formulas, adjusted slowly over time. Chinese medicine is especially effective for this — the pain stops quickly, and your whole mental state improves. Second, cold-damp is very common — catching cold, being blown by wind, most often from summer air conditioning. Third, blood stasis — from old injuries, or pain caused by qi-and-blood stagnation; activate the blood and transform stasis (huo xue hua yu) gradually — it definitely helps. Fourth, damp-heat — not common, but everyone should know it exists: sudden violent pain, urine can no longer come out — quickly use Da Fen Qing Yin, drain heat on one side and promote urination on the other, and the illness resolves.
💬 Note from Doctor Luo: If you have back pain, after listening you can probably analyze it yourself: which kind am I? Zhang Jingyue’s book — the Complete Works of Jingyue (Jing Yue Quan Shu), which you can find with a quick internet search — takes every disease, explains how it is discussed, how it is differentiated, and then lists the formulas one after another, patiently, like a table of contents — extremely clear, and helpful for our own analysis; and if you have a Chinese-medicine practitioner around you to help analyze it, so much the better. Every day we chat a little about the stories of Chinese medicine; as we keep chatting, we grow more and more familiar with the body and the problems that arise — only by understanding can we talk about regulation and treatment. That is the starting point of our lectures on the ancient medical cases.
💬 Compiled from Doctor Luo Dalun’s commentary on Doctor Zhang Jingyue’s case studies; the case is from the Complete Works of Jingyue · Treatise on Miscellaneous Patterns · Low Back Pain (Jing Yue Quan Shu · Za Zheng Mo · Yao Tong), first published in 1624.