Low Back Pain
Ten kinds, not one
Most people who come in with back pain have already been told what it is. A strain. Arthritis. A disc. Sometimes that's right and useful. Often the label doesn't quite explain why this back hurts in this particular way — worse at night, or only after sitting, or shifting from side to side, or heavy rather than sharp.
Korean medicine starts from those details rather than arriving at them. The Donguibogam, the 1613 master text, divides low back pain into ten distinct kinds, each with its own history, its own signs, and its own treatment. We translated that chapter in full.
→ The Lumbus — full translated chapter
The questions that sort it
Here is the differential, in the order the text gives it, translated into the questions we actually ask:
Does it ache constantly, without flaring or easing? — read as depletion. The classical phrase is that the aching does not let up. Often with fatigue, and often in someone who has been running on empty for a long time.
Is it worse at night, and better during the day? — read as stasis. The text is exact: light by day and heavy by night, and on turning to either side, as though pierced by an awl. Frequently follows an old injury.
Does it come on after sitting a long while, or in overcast weather? — read as damp heat. This is the most common presentation in a modern clinic, and finding it named as its own category in 1613 is striking.
Does warmth help and cold bring it on? — read as cold. Straightforward, and patients usually report it themselves.
Is it heavy rather than sharp? — read as damp. The text's images are hard to improve on: heavy as a stone, cold as ice.
Does the sore spot move from side to side? — read as wind. Pain that keeps to no fixed place, often drawing tension down both legs.
Did it start with lifting something? — the acute strain, which gets more formulas in this chapter than any other kind except depletion.
Does it hurt more when you're stressed, and can you not stand or walk for long? — read as Qi. More on this below, because it's the one people don't expect.
The remaining kinds — phlegm, food accumulation, and the Kidney Fixity pattern — are identified more by pulse and constitution than by history.
The idea underneath all ten
One claim organizes the whole chapter, stated at the start:
> Though external contraction and internal damage differ in a hundred ways, the Kidney must first be vacuous, and only then can an evil gather there.
In other words: cold, damp, strain, and stasis can all produce back pain — but none of them settle in a back that is sound. Whatever brought the pain on, there is usually a reason it stayed.
That has a practical consequence, and the text spells it out: do not treat every back pain by clearing, and do not treat every back pain by supplementing Qi. Both are named as errors. The ground needs rebuilding, but Qi tonics don't do it; and clearing what has settled must not be done hard enough to empty the ground further.
The tenth kind
Nine of the ten are what you'd expect from a back chapter. The tenth is not:
> Whenever a person **loses their purpose**, the Heart Blood is not exuberant and does not nourish the sinews and vessels; the Qi stagnates and the lumbus pains, and one cannot stand long or walk far.
Not stress in general — a specific state, 失志, the will having gone out of someone. And the passage continues: worry and overthinking damage the Spleen and produce back pain; anger and indignation damage the Liver and produce back pain.
This is the same reasoning Korean medicine applies to abnormal bleeding after a reversal of fortune, and to anxiety that follows lost status. Applied here to a musculoskeletal complaint, it explains something patients often sense but rarely hear confirmed: that a back can hurt more in a bad season of life, and that this isn't imagination.
The formula given for it contains no back herbs at all — only aromatics that move the Qi. The reading is that in this kind, the back is where the problem is felt, not where it is.
The line worth quoting
The chapter's description of one particular pattern — cold damp settled in the lumbar tissues — has been quoted for eighteen centuries:
> The lumbus is as heavy as though **five thousand cash were strung about it**.
What makes it clinically sharp is what the same passage says is normal in this patient: no thirst, urine passing freely, appetite unchanged. Only the low back is heavy and cold. That combination tells you the damp is lodged in the tissue around the organ rather than in the organ itself — and the formula for it, four herbs, doesn't touch the Kidney at all.
What treatment looks like here
Acupuncture is the main tool for back pain and the one most people come for. Points the chapter names are still the ones used daily — BL40 Weizhong for a back that won't straighten, BL23 Shenshu for the depleted ache, and the ankle points for acute strain. Moxibustion is used where cold or damp dominates.
Herbal formulas do the slower work, and which one depends entirely on which of the ten you have. A few from the chapter:
Cheongah-won 靑娥元 — three ingredients, the standard for the chronic depleted ache
Chilmichangbaek-san 七味蒼柏散 — for the damp heat kind: worse sitting, worse in bad weather
Yeosin-tang 如神湯 — for the fresh lifting strain
Sinchak-tang 腎着湯 — the five-thousand-cash formula, for heavy and cold
Bosin-tang 補腎湯 — the chapter's general decoction, named as treating every kind
Most people notice change within four to six sessions. Chronic patterns take longer, and the chapter says as much — its Kidney vacuity formulas are all pills meant to be taken for months.
If you have sciatica read more about it here -https://www.raahacupuncture.com/sciatica
Please read this part
Some back pain needs a physician first, and not later.
Get urgent evaluation if you have: numbness in the groin or inner thighs, loss of bladder or bowel control, progressive leg weakness, or new severe pain after a fall. These can indicate cauda equina syndrome or fracture, and both are time-sensitive.
Get evaluated before starting here if you have: fever with back pain, unexplained weight loss, night pain that wakes you from sleep, a history of cancer, or pain that has been steadily worsening over weeks. Spinal infection and malignancy present as back pain first.
The 1613 chapter has its own version of this. Its section on inauspicious signs exists precisely to mark the boundary — the point at which back pain is no longer the illness but a symptom of something else. That instinct is right, even where the specific signs belong to their era.
This approach may help if you're dealing with: chronic low back ache · pain after lifting · stiffness that's worse in the morning or after sitting · sciatica-type pain into the leg · pain that worsens in cold or damp weather · recurring strain in the same spot · back pain that flares with stress · lumbar weakness with fatigue.
The Donguibogam translation project at formulas.raahacupuncture.com is researched and translated by Eui Young (Justin) Chung, L.Ac., Dipl. O.M. — the same clinician you'll see in the treatment room.