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  • Writer's picturePhysician Lim Chen Sing | 林晨欣

TCM treat lower back pain

How does TCM treat lower back pain?

Lower back pain is a disease that caused by external pathogens, internal injury, or traumatic injury, leads to poor circulation of Qi and blood in the lower back meridian, or loss of essence and blood nourishment in the lower back, resulting in pain on one or both sides of the lower back area. Diseases such as osteoporosis, rheumatoid spondylitis, spinal cord compression, pyelonephritis, prostatitis, lumbar muscle strain and other diseases with lower back pain as the main manifestation can be treated according to the TCM syndrome differentiation.



Classification of lower back pain in TCM

In TCM, the diagnosis of lower back pain is made by combining medical history, clinical syndromes, physical and laboratory test results and X-rays, and etc, in order to give corresponding treatment. The main points of clinical diagnosis in TCM can be divided into the following:

1. Identify the deficiency or excess: The sudden onset of lower back pain and refusal to press on the pain area are mostly excess syndromes; dull pain with recurrent attacks, and fondness to press on the pain area are mostly deficiency syndromes; those caused by wind, cold, dampness, heat, and blood stasis are mostly excess syndromes; while those with deficiency of kidney essence are mostly deficiency syndromes.

2. Identify the nature of pain: Lower back pain with cold sensation is mostly caused by cold; pain with burning sensation is mostly caused by heat; dull pain that aggravated on cloudy and rainy days is mostly caused by dampness; while local stabbing pain with pain when pressed are mostly caused by blood stasis.

3. Examine the cause: If the lower back pain is severe, movement is limited, and local skin is bruised, it is more likely to be sprains and contusions; if lower back pain is comfortable when pressed, it is more likely to be rheumatism; If the pain is aggravated after exertion, it is more likely to be lumbar muscle strain. If the pain is severe, it is mostly due to blood stasis, which is common in traumatic injury, dislocation, lumbar spine injury, intervertebral disc prolapse, and etc; if the pain is dull, it is mostly due to blood stasis with kidney deficiency, which is common in urinary tract infection, chronic nephritis, prostatitis, lumbar rheumatism, functional uterine bleeding, and etc; and in case of soreness on lower back, it is mostly due to kidney deficiency, which is common in neurasthenia, tuberculosis, and etc; if the pain is cold and heavy, it is common in general weakness, after a long illness, impotence, enuresis, chronic nephritis, asthma, functional uterine bleeding, male and female infertility, and etc.


The etiology, pathogenesis and treatment principles of lower back pain in TCM

The pathogenesis, clinical manifestations and treatment methods of lower back pain can be divided into the following four main types of syndromes:

1. Cold-damp syndrome

Pathogenesis: Cold and dampness are caused by living in a cold and humid environment for a long time, wearing wet and cold clothes, or wading in the rain. The evil of cold and dampness invades, leads to blockage of meridians and poor circulation of Qi and blood, resulting in lower back pain.

Clinical manifestations: Cold pain in the lower back is severe, and it is reduced when there is heat. The pain gets worse on cloudy and rainy days, and does not decrease or worsens when lying down. The tongue coating is white and greasy, and the pulse is deep and slow or tight.

Treatment method: Dispel cold and remove dampness to warm the meridians.


2. Damp-heat syndrome

Pathogenesis: During long summer, the damp and heat intermingle together, or the cold and dampness accumulate for a long time turns into heat, could block the meridians, resulting in lower back pain.

Clinical manifestations: Pain in the lumbar region with heat sensation, aggravated by heat or rain, has short urination, and constipation in severe cases. The tongue coating is yellow and greasy, and the pulse is fast and stringy.

Treatment method: Clear heat and remove dampness to activate the collaterals.


3. Kidney deficiency syndrome

Pathogenesis: Overwork, or prolonged illness, or deficiency of essence and blood due to old age, or excessive sexual intercourse, resulting in a deficiency of the essence and Qi of the kidneys, unable to nourish the meridians, leading to lower back pain.

Clinical manifestations: Soreness and tenderness of the lower back, and the pain is relieved when lying down. Weakness of the waist and knees, or lack of warmth in the hands and feet, insomnia, sleeplessness, dryness of mouth and throat. People with Yang deficiency have pale tongue with deep and weak pulse, while people with Yin deficiency have red tongue with rapid and thin pulse.

Treatment method: For those with Yang deficiency, warm the kidney-Yang; For those with Yin deficiency, nourish the kidney-Yin.


4. Blood stasis syndrome

Pathogenesis: Long-term illness with kidney deficiency damages the Qi and blood of the meridians, or traumatic injury, resulting in poor circulation of Qi and blood, the blood stasis stagnation in the waist region leading to pain.

Clinical manifestations: Stabbing pain, fixed pain area and refusing to be pressed at lower back area. In mild cases, it is uncomfortable to lie down, and in severe cases, the pain is severe and unable to turn the body from side to side, and usually there is a history of injury or exertion. The tongue is dark in colour or purple, or with petechiae, uneven pulse.

Treatment method: Promote blood circulation and remove blood stasis, regulate Qi and relieve pain.



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