Pain in the coccyx, according to TCM theory, is often caused by invasion of pathogenic Cold and Damp or Damp-Heat, deficiency of Kidney-Qi or stagnation of Qi and Blood. Coccyx pain may be attributed to any of the following disorders in Western medicine: rheumatism, rheumatoid arthritis, muscle strain or traumatic injury in the coccyx region, and deformation or injury to the spinal column and coccyx.
Aetiology and pathology
Invasion by Cold-Damp
In this situation coccyx pain is caused by an obstruction of the circulation of Qi in the channels and collaterals. Cold and Damp are the Yin pathogenic factors: Cold is characterised by contraction and stagnation; Damp is characterised by heaviness and stagnation. When Cold-Damp invades the coccyx, it may impede the functions of the Qi, and specifically impair the Yang-Qi, which leads to stagnation of the Qi and Blood in the locality and disturbance of the channels, causing coccyx pain with a cold sensation and feeling of heaviness to occur.
Invasion of Cold-Damp usually happens to people who live in a cold and damp place for too long, or frequently go out in the rain without waterproof clothing, or wade through or work in water, or who remain in clothes drenched from sweating, or consume too much cold or uncooked food. If in addition there is a deficiency of Qi or Yang of the Spleen or Kidney, such people will be particularly vulnerable to attack by Cold-Damp.
Invasion by Damp-Heat
Since Damp is characterised by heaviness and stagnation, and Heat is characterised by burning and consumption of Yin, if Damp-Heat invades the Lower Burner and the coccyx, it obstructs the circulation of Qi in the channels and collateral and impairs the Yin and Blood, causing coccyx pain.
Damp-Heat usually invades people who fail to maintain personal hygiene in their genital and anal regions, who walk and live in a damp and dirty place, or who remain in clothes drenched from sweating in summer or after work or sport. Moreover, if Cold-Damp persists for a long time in the body it will gradually transform into Damp-Heat.
Invasion of Damp-Heat to the coccyx can also be caused by the downward flow of Damp-Heat to the Lower Burner and coccyx, leading to coccyx pain. Internal Damp-Heat is usually caused by bad diets, such as frequent eating of pungent, sweet, or fatty or greasy food, or milk products, or drinking too much alcohol, which result in poor transportation and transformation by the Spleen and Stomach.
Deficiency of the Kidney-Essence
The Kidney dominates the Bones and produces the Marrow. Congenital weakness, excessive strain, prolonged sickness, a poor diet, excessive sexual activity or senility, may cause the Kidney to function poorly, leading to deficiency of the Kidney-Essence. When the coccyx is not properly nourished by the Kidney-Essence then coccyx pain follows.
Stagnation of Qi and Blood
The Qi and Blood should circulate freely in the body and channels. If they stagnate in the region of the coccyx because of various causes, they block the channels, causing coccyx pain. Stagnation of the Qi and Blood may be caused by emotional disturbance, trauma or congenital deformity.
Treatment based on differentiation
Differentiation
Differentiation of External or Internal origin
Coccyx pain can be caused either by invasion of External pathogenic factors or by Internal disorders.
— In case it is caused by invasion of External pathogenic factors, it is usually acute, and accompanied by External symptoms such as headache, fever, an aversion to cold, runny nose or coughing.
— If it is caused by disorders of Internal organs, it is chronic and has no External symptoms.
Differentiation of character of the pain
— Acute onset of coccyx pain after exposure to cold and damp, aggravation of the coccyx pain on rainy days, with a heavy sensation and stiffness of the muscles in the coccyx region and a cold feeling, limitation of extension and flexion of the back, lower back pain radiating to the buttocks and lower limbs, cold feeling in the lower back, an aversion to cold, or a slight fever, is usually caused by invasion of Cold-Damp.
— Acute onset of coccyx pain, lower back pain and pain in the coccyx region with a heavy and warm or hot sensation, or even swelling of the coccyx, sticky sweating, thirst but with no desire to drink, fever, or painful urination, is often caused by invasion of Damp-Heat.
— Stabbing pain in the coccyx, with rigidity at the lower back, aggravation of the coccyx pain by pressure and at night, or a history of physical trauma to the coccyx or adjacent region, is often caused by stagnation of Blood.
— Insidious onset of protracted coccyx pain with soreness, weakness of the lower back, legs and knees, aggravation of the coccyx pain by tiredness and alleviation of pain by rest, is often caused by deficiency of Kidney-Essence.
Treatment
INVASION OF COLD-DAMP
Symptoms and signs
Coccyx pain usually occurring after exposure to cold and damp, which worsens on rainy days, with a heavy sensation and stiffness of the muscles in the coccyx region, and a cold feeling, accompanied by symptoms such as limitation of extension and flexion of the back, lower back pain radiating to the buttocks and lower limbs, a cold feeling in the lower back, an aversion to cold, a slight fever, slight generalised body pain, a white and greasy tongue coating and a superficial and slippery pulse.
Principle of treatment
Dispel Cold, dry Damp and relieve the pain.
HERBAL TREATMENT
Prescription
YI YI REN TANG
Coix Decoction
Yi Yi Ren Semen Coicis 15 g
Chuan Xiong Rhizoma Ligustici Chtianxiong 10 g
Ma Huang Herba Ephedrae 10 g
Gui Zhi Ramulus Cinnamomi 6 g
Qiang Huo Rhizoma seu Radix Notopterygii IOg
Du Huo Radix Angelicae Pubescentis 10 g
Chuan Wu Radix Aconiti Lateralis Praeparata 6 g,
decocted for more than 2 hours
Cang Zhu Rhizoma Atractylodis 10 g
Gan Cao Radix Giycyrrhizae 6 g
Sheng Jiang Rhizoma Zingiberis 5 g
Chuan Niu Xi Radix Cyathulae 5 g
Explanations
• Yi Yi Ren and Cang Zhu eliminate Damp in the Lower Burner and coccyx.
• Qiang Huo and Du Huo dispel Wind, Cold and Damp, relieve External symptoms and stop the coccyx pain.
• Chuan Wu and Sheng Jiang warm the Yang-Qi of the body, eliminate Cold-Damp and promote the circulation of Qi and Blood.
• Ma Huang and Gui Zhi open the skin pores and promote sweating so as to dispel Wind and Cold and relieve External symptoms.
• Chuan Niu Xi and Chuan Xiong promote the circulation of Blood and relieve the coccyx pain. Chuan Niu Xi also dispels Cold-Damp and leads the treatment to the Lower Burner and coccyx.
• Gan Cao harmonises the actions of the other herbs in the prescription.
Modifications
1. If there is an aversion to cold and general body pain, add Fang Feng Radix Ledcbouriellae 10 g and Sang Zhi Ramulus Mori 10 g to dispel Wind-Cold and relieve External symptoms.
2. If there is lower back pain with a feeling of heaviness, add Bu Gu Zhi Fructus Psoraleae 10 g and Du Zhong Cortex Eucommiae 10 g to tonify the Kidney, strengthen the lower back and relieve the pain.
3. If the coccyx pain worsens at night, add Pu Huang Pollen Typhae 10 g and San Qi Radix Notoginseng 10 g to promote the circulation of Blood and relieve the pain.
4. If there is a poor appetite and fullness in the abdomen, add Bai Zhu Rhizoma Atractylodis Macrocephalae 10 g and Sha Ren Fruetus Amomi 5 g to activate the Spleen and dry Damp.
5. If there is generalised tiredness, shortness of breath and a pale complexion due to deficiency of Qi, add Huang Qi Radix Astragali seu Hedysari 12 g and Dang Shen Radix Codonopsis Pilosulae 10 g to activate the Spleen and Spleen-Qi.
Patent remedy
Du Huo Ji Sheng Tang Angelica Pubescens and Loranthus
Decoction
ACUPUNCTURE TREATMENT
LU-7 Lieque, LI-4 Hegu, GB-20 Fengchi, BL-12
Fengmen, BL-35 Huiyang, BL-58 Feiyang, BL-62
Shenmai, GV-3 Yaoyangguan and SI-3 Houxi. Reducing method is used on these points.
Explanations
• LI-4, the Source point of the Large Intestine channel, and LU-7, the Connecting point of the Lung channel, are a pair of points from Externally and Internally related channels. Together they dispel Wind, eliminate Cold, relieve External symptoms and stop generalised body pain. LI-4 is also a very good point for sedating the coccyx pain.
• GB-20 and BL-12 dispel Wind, Cold and Damp in the Bladder channel and Governing Vessel, and relieve the coccyx pain.
• BL-20, the Back Transporting point of the Spleen, activates the Spleen and Stomach, eliminates Damp and relieves the diarrhoea.
• BL-58, the Connecting point, harmonises the collateral, dispels Wind-Cold and relieves the pain.
• BL-35 and GV-3, the local points, harmonise the collateral in the coccyx region and relieve the pain.
• BL-62 and SI-3 in combination dispel Wind, Cold and Damp, remove blockage in the Governing Vessel and relieve the coccyx pain.
Modifications
1. If there is severe heaviness of the back, add SP-9 to eliminate Damp and relieve the feeling of heaviness.
2. If there is lower back pain with an obvious cold sensation, add moxibustion on BL-12, BL-58 and LI-4 to warm the channels, dispel Cold and relieve the cold sensation.
3. If there is worsening of the back pain at night and waking at night due to severe pain, add SP-6 and HT-7 to promote the circulation of Blood, calm the Mind and relieve the severe pain.
4. If there is nausea with a feeling of heaviness in the Stomach, add BL-21, the Back Transporting point of the Stomach, to harmonise the Stomach, help the Stomach-Qi to descend, resolve Damp and relieve the nausea.
5. If there is a poor appetite and a feeling of fullness in the Stomach, add SP-4 to help the Stomach-Qi to descend, dry Damp, improve the appetite and relieve the fullness.
6. If there is diarrhoea, add SP-3, the Source point, to dry Damp, activate the Spleen and relieve the diarrhoea.
Case history
A 36-year-old man had been suffering from coccyx pain, with a heavy and cold sensation for 3 weeks. Three weeks previously he had caught a cold after walking in the rain, when he had an aversion to cold, a slight fever, and headache and coccyx pain. He did not take too much care over these complaints, and the coccyx pain became worse and worse.
When he arrived at the clinic, he stated that when it rained his coccyx pain usually worsened and he sometimes woke up at night. Also, he still had a slight aversion to cold and a fever (37.4°C), a sensation of heaviness in the coccyx, limitation of extension and flexion in the lower back with pain radiating to the buttocks, a white and greasy tongue coating, and a superficial and slippery pulse.
Diagnosis
Coccyx pain due to invasion of Cold-Damp.
Principle of treatment
Dispel Wind and Cold, dry Damp and relieve the pain.
Acupuncture treatment
LI-4, BL-12, BL-35, BL-58, BL-62, BL-64, SP-6, GV-3 and SI-3. Reducing method was used on these points. Treatment was given once a day.
Explanations
• LI-4, the Source point, and BL-12 dispel Wind, eliminate Cold, relieve External symptoms and stop generalised body pain. LI-4 can also sedate the coccyx pain.
• SP-6, the crossing point of the three Yin channels of the foot, activates the Spleen and Stomach, eliminates Damp, promotes the circulation of Blood and relieves the coccyx pain.
• BL-58, the Connecting point, and BL-64, the Source point, harmonise the channel and collateral, dispel Wind-Cold and relieve the coccyx pain.
• BL-35 and GV-3, the local points, harmonise the collateral in the coccyx region and relieve the pain.
• BL-62 and SI-3 in combination dispel Wind, Cold and Damp, remove blockage in the Governing Vessel and relieve the coccyx pain.
After three treatment sessions, his general symptoms were much better, and his coccyx pain had also improved somewhat. He could also sleep without waking up at night. After another week of treatment the coccyx pain was under control. He was followed up 2 months afterwards and he reported that he had experienced no coccyx pain since the treatment.
INVASION OF DAMP-HEAT
Symptoms and signs
Coccyx pain that is usually worse on rainy and hot days, or lower back pain and pain in the coccyx region with a heavy and warm or hot sensation, or even swelling at the coccyx. Other symptoms include sticky sweating, thirst with no desire to drink, fever, deep yellow urine, a red tongue with a yellow and greasy coating and a slippery and rapid pulse.
Principle of treatment
Clear Heat, eliminate Damp and relieve the pain.
HERBAL TREATMENT
Prescription
SI MIAO SAN
Four-Marvel Powder
Huang Bai Cortex Phellodendri 12 g
Cang Zhu Rhizoma Atractylodis 10 g
Chuan Niu Xi Radix Cyathulae 6 g
Yl Yl Ren Semen Coicis 15 g
Jin Qian Cao Herba Lysimachiae 20 g
Explanations
• Huang Bai and Cang Zhu clear Heat, reduce fever and dry Damp in the Lower Burner.
• Yi Yi Ren clears Heat and promotes urination so as to eliminate Damp in the Lower Burner.
• Chuan Niu Xi guides all herbs downward to the coccyx region, invigorates the circulation of Blood, eliminates Blood stasis and reinforces the Kidney.
• Jin Qian Cao promotes urination and eliminates Damp-Heat in the Lower Burner.
Modifications
1. If there is swelling, pain and ulceration around the coccyx, add Sheng Di Huang Radix Rehmanniae Recens 10 g and Pu Gong Ying Herba Taraxaci 15 g to clear Heat, eliminate Toxin, reduce the swelling and promote healing of the ulceration.
2. If the coccyx pain worsens at night, add Pu Huang Pollen Typhae 10 g and San Qi Radix Notoginseng 10 g to promote the circulation of Blood and relieve the pain.
3. If there is a fever and thirst, add Zhi Zi Fructus Gardeniae 10 g to clear Heat, reduce the fever, eliminate Damp and relieve the pain.
4. If there is lassitude in the loins, a dry throat and feverish sensations in the palms and soles of the feet, add Zhi Mu Rhizoma Anemarrhenae 12 g to clear Heat and nourish the Yin.
5. If there is a bitter taste in the mouth and insomnia, add Huang Lian Rhizoma Coptidis 5 g to clear Heat, eliminate Damp and calm the Mind.
6. If there is frequent and urgent painful urination, add Mu Tong Caulis Aristolochiae 6 g and Che Qian Zi Semen Plantaginis 12 g to eliminate Damp-Heat, promote urination and relieve the urination pain.
7. If there is bloody urine, add Xiao Ji Herba Cephalanoploris 12 g to cool the Blood and stop the bleeding.
8. If there is urethral calculus, add Hai Jin Sha Spora Lygodii 10 g to promote urination and dissolve the stone.
Patent remedy
San Miao Wan Three-Marvel Pill
