activity. If it is caused by a deficiency of Kidney-Yang there may be a cold sensation in the
back; this may show a slight but not a significant improvement with the application of heat.

A Kidney deficiency is a cause of chronic backache by itself but it also forms the background
which facilitates both invasions of Cold-Damp and repeated sprains. Any Kidney deficiency can
give rise to backache, although that from Kidney-Yang deficiency is more common.

Obviously a backache from Kidney deficiency is more common in middle-aged or elderly
people. However, young people may also suffer from this type of backache and, if they do, it is
usually from a hereditary Kidney deficiency. An exception to this is when a child does a lot of
physical work (such as children who need to help their parents on a farm) or exercise (such as
ballet) around the time of puberty. This is a vulnerable time from an energetic point of view and
excessive exercise at this time of life may seriously weaken the Kidneys and the back.

Some doctors consider a Kidney deficiency to be always the underlying condition in any type of
back pain. The "Standards of Diagnosis and Treatment" (1602), for example, says:

"[In backache], Wind, Dampness, Cold, Heat, sprain, stasis of Blood, stagnation

of Qi, accumulations are all the Manifestation; the Root is always Kidney

deficiency."6(482)

There is considerable interaction among the above three conditions which influence one another.
For example, repeated invasions of Cold-Dampness lead to permanent retention of Damp-Cold
in the back muscles. This on the one hand weakens the Kidneys as Damp-Cold interferes with
the Kidney's transformation of Water and leads to Kidney deficiency, and on the other hand it
obstructs the circulation of Qi and Blood in the area and gives rise to stagnation of Qi and Blood.

Diagnosis

This will be discussed under the following headings:

• observation


• interrogation


• palpation


• pulse.

Observation

Face Colour