right loin, how do we know that this is simply a channel problem causing backache and not a
condition of the kidney itself?

In acute cases, the differentiation is relatively easy as an actual kidney problem such as acute
nephritis would manifest itself with obvious symptoms and signs such as a fever, oedema of the
face, scanty-dark urine, malaise and a head-ache. If the problem were due to kidney stones, this
would be very obvious from the severity of the colicky pain and from its gradual migration from
the loin to the groin.

In chronic cases, an affection of the kidney itself, such as chronic nephritis, would be manifest
from the general malaise, slight oedema of the ankles, exhaustion and the presence of protein in
the urine. This can be quickly and easily tested with the diagnostic strips.

Apart from the differentiation according to accompanying symptoms, a backache from an actual
kidney problem is located higher than one from a channel problem only (Figure 24.6(485)).
However, this is not an absolutely reliable guide as the higher location of the back pain may also
be seen in channel problems.

Of course, a chronic backache may be associated not with a kidney disease in a Western sense
but with a Kidney disharmony in a Chinese sense. This is quite frequent. Thus the patient will
complain of chronic backache, dizziness, some tinnitus, frequent and pale urination, etc.
However, it is not unusual for chronic backache to be the only symptom of a Kidney deficiency
especially in young or middle-aged people.

Differentiation and Treatment

The treatment of backache is based on a differentiation between acute and chronic cases rather
than a differentiation of patterns. The most important aspects for a successful treatment are not
so much a differentiation of patterns but a proper selection of distal and local points with the
appropriate manipulation and radiation of the needling sensation. The choice of points is guided
not so much by an identification of patterns as by the location and nature of the pain.

However, there are some differences in approach which depend on the pattern. These are as
follows.

Invasion of Cold and Dampness

Use the reducing method in acute cases and the even method in chronic cases. Moxa should be
used.