Foreword by Heiko Lade: This article appeared in the Newsletter of the Australian Chinese Medicine Education and Research Council Ltd Vol 2:1 1996 and reprinted here with the kind permission of Steve Clavey, the former editor of the newsletter. The article itself is by Dr Zhao Fu-Guo, of the Sichuan Province, Xichang City People’s Hospital and was originally in the Zhong Yi Za Zhi (Journal of Chinese Medicine , 1995, 36 (11) pp. 694-695.)
Please note: the following article is intended for qualified practitioners of Traditional Chinese Medicine.
Not all cases of lower backache are from Kidney deficiency, but when Kidney deficiency is clearly the cause, the standard treatment is with Kidney tonics; Zuo Gui Wan (Left-returning Pill for Kidney yin deficiency, You Gui Wan (Right-returning Pill) for Kidney yang deficiency; usually each will have several specific “lumbar pain” herbs added such as Xu Duan (Dipsaci, Radix) or Du Zhong (Eucommiae Ulmoidis, Cortex).
But what happens if this standard approach does not work? Dr. Zhao discusses the directions to take, and the logic behind each, in the following short article.
Kidney is a Water and Fire organ which stores True Yin and True Yang. The lower back is the Palace of the Kidneys which is criss-crossed with important channels. Foot Tai Yang Urinary Bladder has four branches crossing the area, the Dai Channel encircles the area, and the Foot Shao Yang Gall Bladder Channel even has a branch which traverses the sacrum, connected to the point Huan Tiao (GB 30)
When Kidneys are weak, the local muscles, tissues, channels and collaterals lose the warming nourishment due to them, and this lack of nourishment causes pain. When these types of case are treated with Kidney tonics, the pain reduces or disappears, but when the herbs stop the pain gradually returns. What has happened?
In long term cases of lower back pain, the continual lack of flow can lead to obstruction of the collaterals – very much like small rivulets would become obstructed by refuse after a drought – which is referred to in the saying “long term conditions enter the collaterals”. When this happens the movement of warmth and nourishment by Kidney yin and yang is disturbed and this becomes combined xu/deficiency and shi/excess.
Kidney, while storing congenital Primal Heaven jing/essence, also receives and stores supplemental essence produced by other organs – especially the Spleen which is the source of our everyday energy. If Spleen is weak however the often greasy hard-to-digest Kidney tonics may not be well-absorbed or digested. This fact was well appreciated by the ancients, who allowed for this problem in the design of many Kidney tonic formulas by adding herbs to assist Spleen transportation and transformation. Even in the quintessential tonic Liu Wei Di Huang Wan, three of the six herbs ensure that Spleen is not overwhelmed by damp: Fu Ling (Poriae Cocos, Sclerotium), Shan Yao (Dioscoreae oppositae, Radix) and Ze Xie (Alismatis Plantago-aquaticae, Rhizoma). It was in this context that Li Dong-Yuan stated: “Tonifying Kidney is not as good as tonifying the Spleen”.
Because of all the foregoing reasons, when Kidney tonics surprisingly do not work or stop lower backache, one must check the duration of the problem, and the status of the spleen. If long-term, add herbs which will remove stagnation and clear collaterals. If the spleen transport is weak, add herbs to help this and assist that crucial source of nourishment. At the same time the selection and matching of herbs can be very important.
Specifically, the following are strong kidney yin tonics and several can be used together:
Shou Di (Rehmanniae Glutinosae Conquitae, Radix)
Gou Qi Zi (Lycii Chinensis, Fructus)
Tu Si Zi (Cuscutae, Semen)
Xuan Shen (Scrophulariae Ningpoensis, Radix)
The following are strong kidney yang tonics which are not however too drying and so do not damage yin:
Yin Yang Huo (Epimedii, Herba)
Xian Mao (Curculiginus Orchioidis, Rhizoma)
Ba Ji Tian (Morindae Officianalis, Radix)
Rou cong Rong (Cistanches, Herba)
There are three herbs which are gentle and harmonious, benefit the kidneys, relax the tendons and open the collaterals to stop pain. When these are added to the chosen formula the effect goes straight to the site of the problem and the result is good. They are:
Xu Duan (Dipsaci, Radix)
Du Zhong (Eucommiae Ulmoidis, Cortex)
San Ji Sheng (Loranthi seu Visci, Ranus)
Used together, these treat both the root and the branch.
Examples of herbs which promote free flow of blood and open the collaterals are:
Yan Hu Suo (Corydalis Yanhusuo, Rhizoma)
Tao Ren (Persicae, Semen)
Hong Hua (Carthami Tinctorii, Flos)
Si Gua Luo (Vascularis Luffae, Fasciculus)
Ji Xue Teng (Jixueteng, Radix et Caulis)
These herbs also have excellent pain stopping effects.
Herbs which promote Spleen transportation and transformation are:
Fu Ling (Poriae Cocos, Sclerotium
Bai Zhu (Atractylodis Macrocephalae, Rhizoma)
Yi Yi Ren (Coicis Lachryma-jobi, Semen)
Shan Yao (Dioscroreae Oppositae, Radix)
Sha Ren (Amomi, Fructus et Semen)
Shen Qu (Massa Fermentata)
Shan Zho (Crataegi, Fructus)
These herbs parch damp or allow it to drain away through the urine, and also prevent the sticky greasiness of many kidney tonics from affecting the spleen.
Some principles of treatment, and when to choose them
When a patient with lower backache also has loose stool, it is best use Spleen transport strengthening herbs as the primary approach, coupled with some Kidney tonics and lumbar pain stopping herbs. Once the loose stool has firmed up, then the emphasis can be shifted to tonifying Kidney, coupled with auxiliary Spleen tonics and damp removers.
Even if the stool is not loose and there are no signs of weak spleen, it is still a good idea to add some Spleen assisting herbs in order to assist absorption of the other herbs through the digestion.
When the lumbar pain is long-standing and chronic, there is sure to be blood stagnation and obstruction existing stubbornly in the area. If there is little relief – or only very short-term relief – after using the herbs mentioned above to promote blood flow and open the collaterals, certain stronger “blood-busters” can be added to the herbs for Kidney tonification, such as:
Di Bie Chong (Eupolyphagae seu Opisthoplatiae)
Shui Zhi (Hirudo seu Whitmaniae)
Used for a short time, these are stronger to remove stagnation, open the collaterals and restore new blood flow through the area which has been blocked by old stagnating blood.
When the Kidney is weak, the body’s defences will also suffer. This is especially true for those already weakened channels and collaterals of the lower back which will be deficient and easily invaded by wind, cold and damp. These pathogens further impede the functioning of the local channels and collaterals, tissues and muscles. This of course is a Bi-syndrome overlaying the Kidney deficiency, and these cases will have the familiar signs of such an invasion. In this situation herbs to expel wind, damp and cold should be added to the formula chosen, herbs such as:
Fang Feng (Ledebouriellae Sesloidis, Radix)
Qin Jiao (Gentianae Macrophyllae, Radix)
Wu Jia Pi (Acanthopanacis Radicis, Cortex)
Gui Zhi (Cinnamomi Cassiae, Ramulus)
Xi Xin (Asari cum Radixe, Herba)
Gao Ben (Ligustici Sinensis, Radix)
Yi Yi Ren (Coicis Lachryma-jobi, Semen)
Qiang Huo (Notopterygii, Rhizoma et Radix)
Du Huo (Duhuo, Radix)
The foregoing is an exposition of common changes to the standard approach for treating Kidney deficiency lumbar pain.