Chronic low back pain is often caused by the lumbar muscles being in a state of sustained or recurrent high tension over a short period of time, exceeding their physiological limits, which leads to chronic aseptic inflammation of the lumbar muscle fibers. The primary symptom is pain on one or both sides of the lower back. In modern medicine, conditions such as kidney disease, rheumatic diseases, rheumatoid arthritis, lumbar muscle strain, and lumbar spinal hypertrophy can all be treated with reference to this syndrome.
Traditional Chinese Medicine prescribes different treatment plans based on the specific cause:
Cold-Dampness Low Back Pain: This condition arises from exposure to cold and damp environments—such as sitting or lying on cold, damp surfaces, wading through water, or being caught in the rain—as well as from physical exertion followed by sweating and wearing cold, damp clothing. This leads to the invasion of cold and damp pathogenic factors, which obstruct the meridians and impede the smooth flow of qi and blood, resulting in low back pain. Symptoms include cold pain in the lower back, difficulty turning over, and pain that gradually worsens; the pain does not subside even with rest and may even intensify. The pain worsens on overcast or rainy days, accompanied by a white, greasy tongue coating and a deep, slow pulse. The formula used is Glycyrrhiza, Poria, and Atractylodes Decoction, with modifications based on the specific symptoms. For example, if the pain is severe and the limbs are cold, add Aconite; if the pain has persisted for a long time without resolution, add Dipsacus and Dogspine; if the pain is wandering or accompanied by joint pain, indicating a concomitant wind pathogen, use Duhuo Jisheng Decoction.
Damp-Heat Low Back Pain: During the long summer months, when dampness and heat intermingle and intensify, exposure to these pathogenic factors obstructs the meridians, leading to low back pain. Symptoms include distending pain in the lower back, with the affected area feeling hot to the touch; the pain worsens on hot or rainy days; urine is reddish and scant; the tongue coating is yellow and greasy; and the pulse is soft and rapid. The treatment principle is to clear heat, drain dampness, relax the tendons, and relieve pain. The herbal formula used is Jiawei Ermiao San. If the pain is severe, add Frankincense and Myrrh to promote blood circulation and relieve pain.
Kidney Deficiency-Induced Low Back Pain: This is often caused by congenital insufficiency, prolonged illness leading to physical debility, advanced age and physical decline, or excessive overwork, resulting in a deficiency of kidney essence that fails to nourish the tendons and vessels, thereby causing low back pain. Symptoms include a dull, aching pain in the lower back that is relieved by pressure or massage; weakness in the legs and knees; worsening with overexertion and improvement when lying down; and recurrent episodes. The tongue is pale, and the pulse is deep, fine, and weak. Treatment Principles: Tonify the kidneys and strengthen the lower back; for yang deficiency, combine with warming the yang; for yin deficiency, combine with nourishing the yin. For cases predominantly involving yang deficiency, use You Gui Wan; for cases predominantly involving yin deficiency, use Zuo Gui Wan; for general kidney deficiency, Qing E Wan may be used to tonify the kidneys and treat low back pain.
Lumbar Pain Due to Blood Stasis: This condition results from falls, blows, sprains, or strains that damage the meridians and impair the flow of qi and blood, or from chronic illness leading to impaired circulation of qi and blood, resulting in qi stagnation and blood stasis, which obstructs the meridians and causes lumbar pain. Patients present with stabbing pain in the lower back at a specific location; the affected area is tender to pressure; pain is milder during the day and worse at night; in mild cases, bending forward or backward is difficult; in severe cases, the pain is so intense that the patient cannot turn over in bed; the tongue is dark purple or has ecchymotic spots; and the pulse is涩 (thready). Treatment Principles: Promote blood circulation and resolve stasis; regulate qi and relieve pain. The formula used is Huoluo Xiaoling Dan with appropriate modifications. For cases with rheumatoid symptoms, add Duhuo, Weilingxian, and Qin Jiao; for cases complicated by kidney deficiency, add Huai Niuxi, Duzhong, and Xuduan.
Other Therapies for Chronic Low Back Pain:
Acupuncture Therapy
(1) Body Acupuncture: Select the following points: Shen Shu (BL23), Wei Zhong (BL40), Yang Ling Quan (GB34), and Ashi points in the lumbar region. Add supplementary points based on the specific pattern: for cold-damp low back pain, add Feng Fu (GB20); for kidney deficiency low back pain, add Tai Xi (KI3) and Ming Men (GV4); for blood stasis low back pain, add Ge Shu (BL17), Shen Shu (BL23), and Ci Liao (BL31). Perform once daily using a balanced tonification and dispersion technique, retaining the needles for 30 minutes.
(2) Auricular Acupuncture: Treat low back pain using ear needles or the ear acupressure bean method. Select points such as Sacral Vertebra, Kidney, Subcortical, Shenque, and Adrenal. Apply moderate to strong stimulation; retain needles for 30 minutes. For the acupressure bean method, leave the beans in place for 1–3 days.
(3) Acupoint Electrical Pulse Stimulation: This method is based on the theory of meridians in Traditional Chinese Medicine. Acupoints are selected along the meridians, corresponding to those used in body acupuncture. After locating the acupoints, rubber electrodes are placed on them, and alligator clips are attached to deliver electrical stimulation. The intensity and frequency are adjusted according to the patient’s tolerance. This therapy provides analgesia, reduces inflammation, relieves spasms, and regulates functional disorders of the cerebral cortex and subcutaneous autonomic nervous system centers. It is used to treat sciatica, facial nerve paralysis, low back pain, insomnia, and other conditions.
(4) Field Effect Therapy: This method helps activate meridians, warm the meridians to dispel cold, reduce inflammation, relieve spasms, and alleviate pain. It is highly effective for rheumatoid arthritis, lumbar muscle strain, sprains and contusions, phlebitis, gastrointestinal dysfunction, and frozen shoulder.
Massage and Tuina Therapy: Press and knead the Spleen Shu (SP21), Kidney Shu (KI23), Zhi Shi (BL28), and Large Intestine Shu (BL27) points 30 times each; tap the lumbar region 10 times; rub the “lumbar eyes” 20 times; rub the lumbosacral region horizontally until warmth is felt; and press and knead the Weizhong (BL40) and Chengshan (BL57) points 30 times each. Combine with lumbar exercises such as forward bending, backward extension, lateral flexion, and rotation.
Select additional acupoints based on symptoms: For severe lower back pain, a preference for warmth and aversion to cold, or symptoms that worsen during rainy or overcast weather, add 30 presses each to Fengchi (GB20), Fengmen (BL12), and Waiguan (TE5), and 20 kneads each to Yinlingquan (SP9) and Yanglingquan (SP3). For lower back pain accompanied by soreness, weakness, persistent discomfort, fatigue, and cold extremities, add pressing and tapping the Qihai and Guanyuan acupoints 30 times each, rubbing the Dantian in both clockwise and counterclockwise directions 30 times each, and pressing and rubbing the Sanyinjiao acupoint 30 times. For stiffness and soreness in the lower back that prevents prolonged sitting or standing, or for cases of lumbar spondylosis, add pressing and rubbing the Mingmen, Yaoyangguan, and Yanglingquan acupoints 30 times each, and rubbing the Shenque acupoint in both clockwise and counterclockwise directions 30 times each.