Most Americans have some back discomfort in their lifetime. Back pain is most often caused by a muscle or ligament strain or spasm; a disk problem; spondylosis; or stenosis. Stress can also be a factor.

A prolapsed disc, also known as a herniated disc, can produce severe back pain. Most prolapsed discs will repair themselves with adequate time and rest. In addition to medications and surgery, physicians sometimes inject chymopapain, an enzyme derived from the papaya tree, to shrink the disc. (Herbalists often use proteolytic enzymes in oral form for this purpose).

Spondylosis is sometimes referred to as degenerative joint disease or osteoarthritis of the spine. It produces back pain and tenderness caused by overuse, injury or aging.

Lumbar stenosis, a constriction or narrowing of the spine caused by arthritic changes or genetics, results in pain in the buttock, thigh and calf associated with movement. Sciatica (nerve inflammation or compression of a nerve root in the lower back) leads to radiating sensation from the back through the buttock and leg. Tingling, numbness or muscle weakness may be present.

Good posture while sitting, lying down, lifting or exercising is often the best way to prevent back problems. Exercise, stretching and strength training can make your arms, legs and back stronger, thus relieving back pain. Weight loss is important, as extra pounds stored in the abdomen put stress on your lower back. Physicians typically recommend medications such as aspirin, acetaminophen, ibuprofen, steroids, physical therapy and surgery.

It is thought in traditional Chinese medicine (TCM) that trauma, overwork, and exposure to wind, cold, heat and dampness cause back pain. Weak kidney energetic function and impaired circulation can result. To get the best results using Chinese herbs, one must assess how much of the problem is caused by weakness and how much is caused by stagnation.

The most useful formulas for long-term use often contain herbs that will have both tonifying and circulating properties. One of the most valuable herbs is dipsacus (xu duan). Dipsacus is traditionally used for painful lower back, stiffness, and weakness in the lower body due to deficient kidneys. Dipsacus also increases blood circulation and reduces pain; it can be used topically and internally. It is often combined with eucommia (du zhong), which is traditionally used to treat backache. Laboratory experiments have shown eucommia to have anti-inflammatory and diuretic effects. In a study conducted at Chongqing Hospital, a pill made of eucommia and psoralea was administered to 40 patients with low back pain, fatigue and weakness of the extremities. Symptomatic improvement was seen in most cases.

Other herbs to consider are psoralea and cibotium. Psoralea (bu gu zhi) tonifies the kidneys and treats painful and cold lower back, impotence and premature ejaculation. Cibotium (gou ji) is traditionally used for weakness in the low back and extremities, and expels wind and dampness.

The next step to treat the lower back pain in TCM is to use blood circulating herbs. Myrrh (mo yao) is one of the premier pain relieving plants in many parts of the world. The ancient Greeks and Romans used this resinous plant to treat wounds. Today it is employed in clinics in the U.S. and China to treat pain associated with trauma.

Achyranthes (niu xi) is said to strengthen the sinews and lower back. It belongs to the invigorate blood section of the materia medica. Laboratory experiments have shown it to have analgesic effects. Sichuan achyranthes (chuan niu xi) is considered stronger than the standard variety for relieving low back pain.

Carthamus (hong hua), also known as safflower, is a bright red flower used topically as well as internally for traumatic injury. In a study of 775 cases sprain, bleeding and swelling were reduced in almost all cases of those applying carthamus tincture. It is also commonly administered in tea and tablet form.

Acathopanax (wu jian pi), a relative of the widely used eleuthero ginseng, is traditionally used to strengthen the sinews and bones. Experienced herbalists will often add herbs to enrich the blood such as rehmannia (shu di huang) and tang kuei (dang gui).

Many of these herbs may be combined into a formula to treat low back pain and weakness of the back and knees due to kidney yang deficiency. It is not indicated for acute sprain or strain, or for those with digestive weakness. For acute injury, formulas based on the ancient formula qi li san can be applied. For patients who have frequent sprains and strains, the low back pain formula mentioned above can be employed after short-term administration of the qi li san-derived formulas.

For low back and weak digestion, I would consider a formula of clematis (wei ling xian), ginseng (ren shen), siler (fang feng), saussurea (mu xiang), ho-shou-wu (he shou wu), rehmannia (shu di huang), lindera (wu yao), chiang-huo (qiang huo), tang-kuei (dang gui), gastrodia (tian ma), cinnamon bark (rou gui), aquilaria (chen xiang), frankincense (ru xiang), coptis (huang lian), blue citrus (qing pi), cloves (ding xiang), gentiana (qin jiao), achyranthes (niu xi), loranthus (sang ji sheng), borneol (bing pian) and asarum (xi xin), which has a larger percentage of blood circulating ingredients and less tonifying herbs.

For sciatica, I usually employ shu jing huo xue tang, a formula consisting of red peony (chi shao), tang kuei (dang gui), ligusticum (chuan xiong), rehmannia (shu di huang), persica (tao ren), atractylodes (bai zhu), poria (fu ling), siler (fang feng), citrus (chen pi), stephania (fang ji), gentiana (qin jiao), achyranthes (niu xi), chinaghuo (qiang huo), clematis (wei ling xian), ginger (gan jiang), angelica (bai zhi) and licorice (gan cao).

Case Studies

Jake, a 42-year old chiropractor and runner, was having lower back pain and fatigue. His pulse was weak in the kidney position and normal in the other positions. His tongue was normal. I recommended three tablets TID of the back pain and weakness formula on an empty stomach with ginger tea. I also recommended application of a red tiger balm (menthol, camphor, cajeput oil, dementholized mint oil, clove oil and cassia oil) topically over his lower back. Within one week, he saw a substantial reduction in back pain. I recommended he continue on the formula for another month, then use it on an as needed basis.

Aaron was a 33-year old professional mover and weight lifter. When I saw him, he had chronic low back pain. He was talking ibuprofen every four hours and drinking alcohol every night for the pain. His pulse was weak and slightly irregular. His tongue was purple. Initially, we recommended two tablets QID of a formula called da huo lo dan consisting of aquilaria root-alowswood (chen xiang), angelicae sinensis (dang gui-a), ledebouriella (fang feng), polygonum root (he shou wu), coptis rhizome (huang lian), saussurea root (mu xiang), acyhranthes (niu xi), notopterygium root (qiang huo), gentianamacrophylla root (qin jiao), green tangerine peel (qing pi), white ginseng root (ren shen), cinnamon bark (rou gui), frankincense (ru xiang), mulberry mistletoe stem (sang ji sheng), cooked rehmannia root (shu di huang), gastrodia rhizome (tian ma), roasted Chinese clematis root (wei ling xian), lindera root (wu yao) and asarum (xi xin) to move qi and blood, and two tablets QID of the low back pain and weakness formula to strengthen his kidneys and increase blood circulation. We also recommended posumon oil applied topically twice per day, massaged into his lower back by his wife. After two weeks, Aaron saw a reduction in pain; his pulse was slightly stronger. After one month, he eliminated the da huo lo dan and was able to reduce his ibuprofen and alcohol usage. He continued on the low back pain and weakness formula for three months with a total resolution of pain.

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