Lumbago is pain in the lumbar region, which is that part of the body between the lower ribs and the pelvis. The term usually refers to pain in the lumbar back or the flanks.
Etiology and Pathology
Lumbago is due to disturbance in Qi and blood movement in the meridians and channels in the lumbar region, so that the channels go into spasm or the region loses adequate nourishment. This may result from attack by exogenous pathogenic evil, from traumatic injury or from insufficiency of the kidney. Among the external evils, Dampness most readily impedes or obstructs the lumbar meridians and channels because of its turbid nature. Traumatic injury acts primarily through blood stasis. The lumbar region is the home of the kidney. All six of the Foot-Meridians and all eight of the Irregular Meridians are connected with the kidney and the lumbar vertebrae. Because of this, all internal injuries causing lumbago do so through the mechanism of kidney insufficiency.
Thus, the location of illness in lumbago is the kidney and the meridians and channels of the lumbar region.
Cold-Dampness. Residence in a damp or humid locale, sitting or sleeping on damp ground, exposure to the wind while sweating profusely from physical exertion, wading in water or walking in the rain all risk Cold and Dampness lodging in the meridians and channels of the lumbar region. When this impedes the movement of Qi and blood, lumbago may result.
Dampness-Heat. Invasion by Dampness and Heat occurs most commonly in summer. Also, persistent Cold-Dampness can transform into Heat. In either case, Dampness and Heat also impede or obstruct the lumbar meridians and channels.
Qi Stagnation and Blood Stasis. Blunt trauma to the lumbar region can precipitate impedance of Qi and blood circulation, which in turn can lead to blood stasis. This also gives rise to lumbago.
Depletion of Kidney-Essence. Depleted kidney-essence is unable to nourish the tendons and channels in the lumbar region and can lead to lumbago. Depletion of kidney-essence may result from inadequate innate endowment complicated by overstrain, weakening by protracted illness, senescence, or unrestrained sexual indulgence.
Clinical Manifestation
Lumbar pain may be one-sided or both-sided. It also presents a variety of patterns and quality. The pain may be lingering with intermittent aggravation by overstrain. It may be fixed in location and distending in quality. It may be stabbing in quality and worsened by pressure. It may be cold in quality, with amelioration by pressure and warmth. It may be tearing in quality, with aggravation by warmth.
Uneasy sleep, restlessness and anxiety may accompany severe lumbago.
Key Points of Analysis
Deficiency versus Strength. Lumbago due to attack by exogenous pathogenic evil or trauma develops rapidly and is often manifested as blood stasis obstructing the channels. It is a condition of strength. Lumbago due to senescence, overstrain or internal injury mainly manifests as kidney insufficiency with loss of nourishment of the lumbar region. It is a condition of deficiency. Most cases of chronic lumbago are a mixture of strength and deficiency, with deficiency of kidney-essence or Qi and blood as the root and blockage of channels by evil Qi as the appearance.
Quality of Pain. Intermittent aching weakness of the waist that is aggravated by strain is mostly due to depletion of kidney-essence and poor nourishment of the lumbar region. Stabbing pain in a fixed location, accompanied by a gray complexion and a bluish tongue, is mostly due to Qi stagnation and blood stasis. Lumbago that is burning in quality and aggravated by warmth, accompanied by a yellow and greasy tongue coating and a rapid pulse, is mostly due to Dampness-Heat gelling and impeding Qi movement. Lumbago that is cold in quality and is worse on rainy or overcast days is mostly due to Cold-Dampness attacking the lumbar region and blocking the meridians and channels.
Herbal Treatment
Cold-Dampness
Main Symptoms. Lumbar coldness and heaviness, difficulty turning over; gradual worsening, especially on rainy or overcast days or following exposure to cold; preference for warmth; and lassitude. The tongue coating is white and greasy, and the pulse deep and tight or deep and slow.
Therapeutic Principle. Dispel Cold, eliminate Dampness, warm and unblock the meridians and channels.
Treatment. Ganjiang Ling Zhu Tang (Ginger-Poria-Atractylodes Decoction). It has a simple composition: ganjiang (Zingiber) 10 g, baizhu (Atractylodes) 10 g, fuling (Poria) 10 g, and gancao (Glycyrrhiza) 6 g.
If the aching waist is weak, add duzhong (Eucommia), xuduan (Dipsacus) and sangjisheng (Loranthus) to nourish the kidney and strengthen the waist.
If pain is severe and the limbs are cold, add fuzi (Aconitum) and xixin (Asarum) to warm the kidney and dispel Cold.
If Dampness is especially severe and the pain is characterized by heaviness, add cangzhu (Atractylodes lancea), yiyiren (Coix) and chuanwu (Aconitum carmichaeli) to dry Dampness.
If lumbago is protracted and has affected kidney-Yang, add tusizi (Cuscuta) and buguzhi (Psoralea), or use the formula Duhuo Jisheng Tang (Angelica-Loranthus Decoction) instead.
Dampness-Heat
Main Symptoms. Lumbar heaviness and hotness, spastic pain, aggravated in warm weather or by warmth; thirst without desire to drink; and dark urine. The tongue is red, with yellow and greasy coating, and the pulse is rapid and either soft or taut.
Therapeutic Principle. Cool Heat, eliminate Dampness, soothe tendons and unblock channels.
Treatment. Jia Wei Er Miao Tang (Augmented Two-Wonders Decoction). It has the following basic composition: huangbai (Phellodendron) 15 g, fangji (Stephania) 10 g, beixie (Dioscorea hypoglauca) 10 g, cangzhu (Atractylodes) 15 g, danggui (Angelica) 10 g, niuxi (Achyranthes) 6g, and guiban (Chinemys) 10 g.
To enhance the formula’s ability to drain Dampness, soothe the tendons and unblock the channels, add tufuling (Smilax glabra), mugua (Chaenomeles) and luoshiteng (Trachelospermum jasminioides).
For strong Heat with thirst and dark urine, add zhizi (Gardenia jasminoides), zexie (Alisma) and mutong (Akebia quinata) to purge Dampness-Heat.
For protracted Dampness-Heat with damage to Yin, add Er Zhi Wan (Two Seasons-End Pill) to nourish Yin and strengthen the kidney. Er Zhi Wan contains nuzhenzi (Ligustrum) 15 g and moliancao (Eclipta) 15 g.
Qi Stagnation and Blood Stasis
Main Symptoms. Prickling lumbago in fixed location, mild during the day and worse at night; inability to turn about; aggravation by pressure; and gray complexion and dark lips. The tongue is bluish or has purpuric spots. The pulse is taut and impeded or threadlike and rapid.
Therapeutic Principle. Mobilize blood, remove stasis, regulate Qi and stop pain.
Treatment. Modified Shen Tong Zhu Yu Tang (Decoction for Relieving Stasis and Pain). It has the following basic composition: chuanxiong (Ligusticum) 6g, taoren (Prunus persica) 10 g, honghua (Carthamus) 10 g, moyao (Commiphora) 6g, xiangfu (Cyperus) 3g, niuxi (Achyranthes) 10 g, dilong (Pheretima) 6g, and danggui (Angelica) 10 g. Note that Shen Tong Zhu Yu Tang also contains Qianghuo (Notopterygium) and Qinjiao (Gentiana), but these are omitted in the absence of generalized pain.
If lumbago extends to the subcostal region, add chaihu (Bupleurum) and yujin (Curcuma) to enhance Qi regulation and analgesia.
If the symptoms of blood stasis are severe and worse at night, add quanxie (Buthus), wugong (Scolopendra), baihuashe (Agkistrodon acutus) to enhance the unblocking of meridians and channels and analgesia.
Depletion of Kidney-Essence
Main Symptoms. Recurrent aching lumbago, with preference for pressure and warmth, and weakness in the knees and legs, both aggravated by strain. If depletion affects Yang more, then there are a pallid complexion, cold hands and feet, spasm in the lower abdomen, a pale tongue and a deep and threadlike pulse. If it affects Yin more, then there are restlessness, insomnia, dry mouth and throat, a flushed face, hotness in the palms and soles, a red tongue with slight coating and a taut, threadlike and rapid pulse.
Therapeutic Principle. Stronger Yang depletion: warm restoration of kidney-Yang. Stronger Yin depletion: nourishing restoration of kidney-Yin.
Treatment. Stronger Yang depletion: You Gui Wan (kidney-Yang-Augmenting Pill). Stronger Yin depletion: Zuo Gui Wan (kidney-Yin-Augmenting Pill).
If there is spleen insufficiency with sinking of Qi, manifested by shortness of breath, weakness, diminished appetite, loose feces, add as appropriate dangshen (Codonopsis), huangqi (Astragalus), baizhu (Atractylodes), shengma (Cimicifuga) and chaihu (Bupleurum) to strengthen the spleen, augment Qi and raise pure Yang.
Acupuncture Treatment
(1) Select the acupoints Shenshu (BL-23), Yaoyan (BA-7) and Weizhong (BL-40). For severe Cold-Dampness, add the acupoint Yaoyangguan (GV-3). For blood stasis, add the acupoint Shuigou (GV-26). For kidney insufficiency, add the acupoints Mingmen (GV-4) and Sanyinjiao (SP-6).
Use filiform needles. Apply the reducing method if the condition is strength, and the reinforcing method if the condition is deficiency.
Moxibustion or cupping may be applied as appropriate.
Ear Acupuncture. Select Acupoint Lumbosacral Vertebrae, Acupoint Shenmen and Acupoint Kidney on the affected side. Retain the needles for 30 min, and treat daily. After each treatment, advise the patient to move the waist cautiously.
Case Study
The patient was a 48-year old married male laborer. He presented with lumbago of 4 days’ duration. Just prior to the onset of lumbago, the patient played basketball with friends and sweated profusely. He took a bath in cold water. That night he slept with an open window and did not cover himself with a blanket. The following morning he woke up with lumbago. He had difficulty turning prone or supine, arising, walking or sitting. He had a history of similar episodes.
Examination showed significantly limited mobility of the lumbar spine. There was marked spasm and pain of the muscles along the right side of the fourth lumbar vertebra. Pressure aggravated the spasm and pain. His tongue coating was white and greasy, and his pulse was indistinct. X-ray study of the lumbar spine was normal.
Diagnosis. Lumbago due to kidney insufficiency and blockage of meridians by Cold-Dampness.
Therapeutic Principle. Warm and strengthen the kidney and the meridians.
Treatment and Course. The patient was treated with both an medicinal herbs and acupuncture. The prescribed formula had the following composition: processed fuzi slices (Aconitum) 9 g, rougui (Cinnamomum) 3g, gouji (Cibotium barometz) 6g, raw huangqi (Astragalus) 18 g, danggui (Angelica sinensis) 9g, Qianghuo (Notopterygium) 4.5 g, duhuo (Angelica pubescens) 4.5 g, prepared ruxiang (Boswellia) 4.5 g, prepared moyao (Commiphora) 4.5 g, chenpi (Citrus tangerina) 6 g, gancao (Glycyrrhiza) 3 g, sangjisheng (Loranthus) 9 g, and shengjiang (Zingiber) 6g. Note: the fuzi slices were decocted for 30 min prior to adding the other ingredients. Each daily dose was taken in two portions.
Acupuncture was applied to the acupoints Yaoyangguan (GV-3) and Dachangshu (BL-25) on the right side with filiform needles and retention for 30 min.
After two daily doses and one treatment with acupuncture lumbago was markedly reduced. The patient was able to turn over and walk without pain, but still had mild pain on bending over. Other activities were unaffected. The formula was modified as follows: ruxiang and moyao were removed, and duzhong (Eucommia) 9 g and shenjincao (Lycopodium japonicum) 9 g added. After four doses of the modified formula, the patient recovered completely. To consolidate the clinical response, the patient was instructed to take Xiao Huo Luo Dan (Minor Channel-Stimulating Pill), one pill daily, for 7 days.
