Coccyx pain 34

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Pain in the coccyx, according to TCM theory, is often caused by invasion of pathogenic Cold and
Damp or Damp-Heat, deficiency of Kidney-Qi or stagnation of Qi and Blood. Coccyx pain may
be attributed to any of the following disorders in Western medicine: rheumatism, rheumatoid
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arthritis, muscle strain or traumatic injury in the coccyx region, and deformation or injury to the
spinal column and coccyx.

Aetiology and pathology

Invasion by Cold-Damp
In this situation coccyx pain is caused by an obstruction of the circulation of Qi in the channels
and collaterals. Cold and Damp are the Yin pathogenic factors: Cold is characterised by con-
traction and stagnation; Damp is characterised by heaviness and stagnation. When Cold-Damp
invades the coccyx, it may impede the functions of the Qi, and specifically impair the Yang-Qi,
which leads to stagnation of the Qi and Blood in the locality and disturbance of the channels,
causing coccyx pain with a cold sensation and feeling of heaviness to occur.
Invasion of Cold-Damp usually happens to people who live in a cold and damp place for too
long, or frequently go out in the rain without waterproof clothing, or wade through or work in
water, or who remain in clothes drenched from sweating, or consume too much cold or
uncooked food. If in addition there is a deficiency of Qi or Yang of the Spleen or Kidney, such
people will be particularly vulnerable to attack by Cold-Damp.

Invasion by Damp-Heat
Since Damp is characterised by heaviness and stagnation, and Heat is characterised by burning
and consumption of Yin, if Damp-Heat invades the Lower Burner and the coccyx, it obstructs
the circulation of Qi in the channels and collateral and impairs the Yin and Blood, causing
coccyx pain.
Damp-Heat usually invades people who fail to maintain personal hygiene in their genital and
anal regions, who walk and live in a damp and dirty place, or who remain in clothes drenched
from sweating in summer or after work or sport. Moreover, if Cold-Damp persists for a long
time in the body it will gradually transform into Damp-Heat. .
Invasion of Damp-Heat to the coccyx can also be caused by the downward flow of Damp-
Heat to the Lower Burner and coccyx, leading to coccyx pain. Internal Damp-Heat is usually
caused by bad diets, such as frequent eating of pungent, sweet, or fatty or greasy food, or milk

409
41() BACK PAIN
products, or drinking too much alcohol, which result
in poor transportation and transformation by the
Spleen and Stomach.
Deficiency of the Kidney-Essence
The Kidney dominates the Bones and produces the
Marrow. Congenital weakness, excessive strain, pro-
longed sickness, a poor diet, excessive sexual activity
or senility, may cause the Kidney to function poorly,
leading to deficiency of the Kidney-Essence. When the
coccyx is not properly nourished by the Kidney-
Essence then coccyx pain follows.
Stagnation of Qi and Blood
The Qi and Blood should circulate freely in the body
and channels. If they stagnate in the region of the
coccyx because of various causes, they block the chan-
nels, causing coccyx pain. Stagnation of the Qi and
Blood may be caused by emotional disturbance,
trauma or congenital deformity.
Treatment based on
differentiation
Differentiation
Differentiation of External or Internal origin
Coccyx pain can be caused either by invasion of Exter-
nal pathogenic factors or by Internal disorders.
In case it is caused by invasion of External
pathogenic factors, it is usually acute, and
accompanied by External symptoms such as
headache, fever, an aversion to cold, runny nose
or coughing.
If it is caused by disorders of Internal organs, it is
chronic and has no External symptoms.
Differentiation of character of the pain
Acute onset of coccyx pain after exposure to
cold and damp, aggravation of the coccyx pain
on rainy days, with a heavy sensation and
stiffness of the muscles in the coccyx region and
a cold feeling, limitation of extension and
flexion of the back, lower back pain radiating to
the buttocks and lower limbs, cold feeling in the
lower back, an aversion to cold, or a slight fever,
is usually caused by invasion of Cold-Damp.
Acute onset of coccyx pain, lower back pain and
pain in the coccyx region with a heavy and warm
or hot sensation, or even swelling of the coccyx,
sticky sweating, thirst but with no desire to drink,
fever, or painful urination, is often caused by
invasion of Damp-Heat.
Stabbing pain in the coccyx, with rigidity at the
lower back, aggravation of the coccyx pain by
pressure and at night, or a history of physical
trauma to the coccyx or adjacent region, is often
caused by stagnation of Blood.
Insidious onset of protracted coccyx pain with
soreness, weakness of the lower back, legs and
knees, aggravation of the coccyx pain by tiredness
and alleviation of pain by rest, is often caused by
deficiency of Kidney-Essence.
Treatment
INVASION OF COLD-DAMP
Symptoms and signs
Coccyx pain usually occurring after exposure to cold
and damp, which worsens on rainy days, with a heavy
sensation and stiffness of the muscles in the coccyx
region, and a cold feeling, accompanied by symptoms
such as limitation of extension and flexion of the back,
lower back pain radiating to the buttocks and lower
limbs, a cold feeling in the lower back, an aversion to
cold, a slight fever, slight generalised body pain, a
white and greasy tongue coating and a superficial and
slippery pulse.
Principle of treatment
Dispel Cold, dry Damp and relieve the pain.
HERBAL TREATMENT
Prescription
YI YI KEN TANG
Coix Decoction
YiYi Ken Semen Coicis 15 g
Chuan Xiong Rhizoma Ligustici C1ll1anxiong 10 g
Ma Huang Herba Ephedrae 10 g
Gui Zhi Ramulus Cinnamomi 6 g
Qiang Huo Rhizoma seu Radix Notopterygii 10 g
Du Huo Radix Angelicae Pubescentis 10 g
Chuan Wu Radix Aconiti Lateralis Praeparaia 6 g.
decocted for more than 2 hours
Cang Zhu Rhizoma Atractylodis 10 g

Gan Cao Radix Glycyrrhizae 6 g
Sheng Jiang Rhizome Zingiberis 5 g
Chuan Niu Xi Radix Cyathulae 5 g
Explanations
• YiYi Ren and Cang Zhu eliminate Damp in the
Lower Burner and coccyx.
• Qiang Huo and Du Huo dispel Wind, Cold and
Damp, relieve External symptoms and stop the
coccyx pain.
• Chuan Wu and Sheng Jiang warm the Yang-Qi of
the body, eliminate Cold-Damp and promote the
circulation of Qi and Blood.
• Ma Huang and Gui Zhi open the skin pores and
promote sweating so as to dispel Wind and Cold
and relieve External symptoms.
• Chuan Niu Xi and Chuan Xiong promote the
circulation of Blood and relieve the coccyx pain.
Chuan Niu Xi also dispels Cold-Damp and leads
the treatment to the Lower Burner and coccyx.
• Gan Cao harmonises the actions of the other herbs
in the prescription.
Modifications
1. If there is an aversion to cold and general body
pain, add Fang Feng Radix Ledebouriellae 10 g and
Sang Zhi Ramulus Mori 10 g to dispel Wind-Cold
and relieve External symptoms.
2. If there is lower back pain with a feeling of
heaviness, add Bu Gu Zhi Fructus Psoraleae 10 g
and Du Zhong Cortex Eucommiae 10 g to tonify the
Kidney, strengthen the lower back and relieve the
pain.
3. [f the coccyx pain worsens at night, add Pu Huang
Pollen Typhae 10 g and San Qi RadixNotoginseng
10 g to promote the circulation of Blood and
relieve the pain.
4. If there is a poor appetite and fullness in the
abdomen, add Bai Zhu Rhizoma Atractylodis
Macrocephalae 10 g and Sha Ren Fructus Amomi 5 g
to activate the Spleen and dry Damp.
5. If there is generalised tiredness, shortness of
breath and a pale complexion due to deficiency of
Qi, add Huang Qi RadixAstragali seu Hedysari 12 g
and Dang Shen RadixCodonopsis Pilosulae 10 g to
activate the Spleen and Spleen-Qt.
Patent remedy
Du Huo [i Sheng Tang Angelica Pubescens and Loranihus
Decoction
COCCYX PAIN 411
ACUPUNCTURE TREATMENT
LU-7 Lieque, LI-4 Hegu, GB-20 Fengchi, BL-12
Fengmen, BL-35 Huiyang, BL-58 Feiyang, BL-62
Shenmai, GV-3 Yaoyangguan and 5[-3 Houxi. Reducing
method is used on these points.
Explanations
• LI-4, the Source point of the Large Intestine channel,
and LU-7, the Connecting point of the Lung
channel, are a pair of points from Externally and
Internally related channels. Together they dispel
Wind, eliminate Cold, relieve External symptoms
and stop generalised body pain. LI-4is also a very
good point for sedating the coccyx pain.
• GB-20 and BL-12 dispel Wind, Cold and Damp in
the Bladder channel and Governing Vessel, and
relieve the coccyx pain.
• BL-20, the Back Transporting point of the Spleen,
activates the Spleen and Stomach, eliminates
Damp and relieves the diarrhoea.
• BL-58, the Connecting point, harmonises the
collateral, dispels Wind-Cold and relieves the pain.
• BL-35 and GV-3, the local points, harmonise the
collateral in the coccyx region and relieve the pain.
• BL-62 and SI-3 in combination dispel Wind, Cold
and Damp, remove blockage in the Governing
Vessel and relieve the coccyx pain.
Modifications
1. If there is severe heaviness of the back, add SP-9 to
eliminate Damp and relieve the feeling of heaviness.
2. If there is lower back pain with an obvious cold
sensation, add moxibustion on BL-12, BL-58 and
Ll-4 to warm the channels, dispel Cold and relieve
the cold sensation.
3. If there is worsening of the back pain at night and
waking at night due to severe pain, add SP-6 and
HT-7 to promote the circulation of Blood, calm the
Mind and relieve the severe pain.
4. If there is nausea with a feeling of heaviness in the
Stomach, add BL-21, the Back Transporting point
of the Stomach, to harmonise the Stomach, help
the Stomach-Qi to descend, resolve Damp and
relieve the nausea.
5. If there is a poor appetite and a feeling of fullness
in the Stomach, add SP-4 to help the Stomach-Qi
to descend, dry Damp, improve the appetite and
relieve the fullness.
6. If there is diarrhoea, add SP-3, the Source point, to
dry Damp, activate the Spleen and relieve the
diarrhoea.
412 BACK PAIN
Case history
A 36-year-old man had been suffering from coccyxpain,
with a heavy and cold sensation for 3 weeks. Three
weeks previously he had caught a cold after walking in
the rain, when he had an aversion to cold, a slight fever,
and headache and coccyx pain. He did not take too
much care over these complaints, and the coccyxpain
became worse and worse.
When he arrived at the clinic, he stated that when it
rained his coccyx pain usually worsened and he
sometimes woke up at night. Also, he still had a slight
aversion to cold and a fever (37.4°0, a sensation of
heaviness in the coccyx,limitation of extension and
flexion in the lower back with pain radiating to the
buttocks, a white and greasy tongue coating, and a
superficial and slippery pulse.
Diagnosis
Coccyx pain due to invasion of Cold-Damp.
Principle of treatment
Dispel Wind and Cold, dry Damp and relieve the pain.
Acupuncture treatment
Ll-4, BL-12, BL-3S, BL-S8, BL-62, BL-64, SP-6,GV-3 and
51-3. Reducing method was used on these points.
Treatment was given once a day.
Explanations
• Ll-4,the Source point, and BL-12 dispel Wind,
eliminate Cold, relieve External symptoms and stop
generalised body pain. Ll-4 can also sedate the coccyx
pain.
• 5P-6, the crossing point of the three Yinchannels of
the foot, activates the Spleen and Stomach, eliminates
Damp, promotes the circulation of Blood and relieves
the coccyxpain.
• BL-58, the Connecting point, and BL-64, the Source
point, harmonise the channel and collateral, dispel
Wind-Cold and relieve the coccyx pain.
• BL-35 and GV-3, the local points, harmonise the
collateral in the coccyxregion and relieve the pain.
• BL-62 and 51-3 in combination dispel Wind, Cold and
Damp, remove blockage in the Governing Vessel and
relieve the coccyxpain.
After three treatment sessions, his general symptoms
were much better, and his coccyx pain had also
improved somewhat. He could also sleep without
waking up at night. After another week of treatment the
coccyxpain was under control. He was followed up 2
months afterwards and he reported that he had
experienced no coccyxpain since the treatment.
INVASION OF DAMP-HEAT
Symptoms and signs
Coccyx pain that is usually worse on rainy and hot
days, or lower back pain and pain in the coccyx region
with a heavy and warm or hot sensation, or even
swelling at the coccyx. Other symptoms include sticky
sweating, thirst with no desire to drink, fever, deep
yellow urine, a red tongue with a yellow and greasy
coating and a slippery and rapid pulse.
Principle of treatment
Clear Heat, eliminate Damp and relieve the pain.
HERBAL TREATMENT
Prescription
SIMIAOSAN
Four-Maroel Powder
Huang Bai Cortex Phellodendri 12 g
Cang Zhu Rhizoma Atractylodis 10 g
Chuan Niu Xi RadixCyathulae 6 g
Yi Yi Ren Semen Coicis 15 g
Jin Qian Cao Herba Lysimachiae 20 g
Explanations
• Huang Bai and Cang Zhu clear Heat, reduce fever
and dry Damp in the Lower Burner.
• Yi Yi Ren clears Heat and promotes urination so as
to eliminate Damp in the Lower Burner.
• Chuan Niu Xi guides all herbs downward to the
coccyx region, invigorates the circulation of
Blood, eliminates Blood stasis and reinforces the
Kidney.
• [in Qian Cao promotes urination and eliminates
Damp-Heat in the Lower Burner.
Modifications
1. If there is swelling, pain and ulceration around
the coccyx, add Sheng Di Huang Radix
Rehmanniae Recens 10 g and Pu Gong Ying Herba
Taraxaci 15 g to clear Heat, eliminate Toxin,
reduce the swelling and promote healing of the
ulceration.
2. If the coccyx pain worsens at night, add Pu Huang
Pollen Typhae 10 g and San Qi RadixNotoginseng
10 g to promote the circulation of Blood and
relieve the pain.
3. If there is a fever and thirst, add Zhi Zi Fructus
Gardeniae 10 g to clear Heat, reduce the fever,
eliminate Damp and relieve the pain.
4. If there is lassitude in the loins, a dry throat and
feverish sensations in the palms and sales of the
feet, add Zhi Mu Rhizoma Anemarrhenae 12 g to
clear Heat and nourish the Yin.

5. If there is a bitter taste in the mouth and insomnia,
add Huang Lian Rhizoma Coptidis 5 g to clear Heat,
eliminate Damp and calm the Mind.
6. If there is frequent and urgent painful urination,
add Mu Tong Caulis Aristolochiae 6 g and Che Qian
Zi Semen Planiaginis 12 g to eliminate Damp-Heat,
promote urination and relieve the urination pain.
7. If there is bloody urine, add Xiao [i Herba
Ceplialanopioris 12 g to cool the Blood and stop the
bleeding.
8. If there is urethral calculus, add Hai [in Sha Spora
Lygodii 10 g to promote urination and dissolve the
stone.
Patent remedy
San Miao Wan Three-Marne! Pill
ACUPUNCTURE TREATMENT
Ll-4 Hegu, TE-6 Zhigou, BL-35 Huiyang, BL-40
Weizhong, BL-58 Feiyang, BL-62 Shenmai, BL-66
Zutonggu, GV-3 Yaoyangguan and 51-3 Houxi.
Reducing method is used on these points.
Explanations
• LI-4, the Source point, and TE-6 dispel External
factors, clear Heat and eliminate Damp.
• BL-40, a commanding point for the back, and
BL-58,the Connecting point, promote the free flow
of Qi in the channels and harmonise the collateral in
order to treat the lower back pain and coccyx pain.
• BL-66, the Spring point, clears Heat and eliminates
Damp in the Lower Burner.
• BL-35 and GV-3, the local points, harmonise the
collateral in the coccyx region and relieve the pain.
• BL-62 and SI-3 in combination dispel Wind, Cold
and Damp, remove blockage in the Governing
Vessel and relieve the coccyx pain.
Modifications
1. If there is a fever, add GV-14 to clear Heat and
reduce the fever.
2. If there is sacral pain, add some local Ah Shi points
to harmonise the collateral and arrest the pain.
3. If there is a severe burning sensation and aversion
to heat in the lower back, add BL-67 to clear Heat
and relieve the burning sensation.
4. If there is scanty and painful urination, add BL-32
and KI-4 to promote urination and relieve the
urination pain.
COCCYX PAIN 413
5. If there is a feeling of heaviness in the body, add
SP-6 to resolve Damp and eliminate Phlegm from
the body.
6. If the appetite is poor, add BL-20, the Back
Transporting point of the Spleen, to activate the
Spleen and improve the appetite.
7. If there is diarrhoea, add SP-3, the Source point, to
activate the Spleen, eliminate Damp and relieve
the diarrhoea.
8. If there is profuse leucorrhoea, add GB-27 and
GB-41 to eliminate Damp and relieve the
leucorrhoea.
DEFICIENCY OF KIDNEY-ESSENCE
Symptoms and signs
Insidious onset of protracted coccyx pain with sore-
ness, which worsens when tired and is alleviated by
rest, accompanied by weakness in the lower back, legs
and knees.
If the deficiency is of Kidney-Yang, there is also a
cold feeling in the lower back, pallor, cold limbs, a
normal taste in the mouth, polyuria, a pale tongue
and a deep and feeble, or faint, or deep and slow
pulse.
If the deficiency is of Kidney-Yin, there is also a dry
mouth and throat, a flushed face, a feverish sensation
in the chest, palms and soles of the feet, irritability,
insomnia, a red tongue with a scanty coating and a
thready and weak or thready and rapid pulse.
Principle of treatment
Tonify the Kidney, benefit the Essence and relieve the
pain.
HERBAL TREATMENT
Prescription a: for deficiency of Kidney-Yang
JIN GUI SHEN QI WAN
Kidney Qi Pill
Shu Di Huang Radix Rehmanniac Pmcparota 12 g
Shan Yao Rhizoma Dioscoreae 15 g
Shan Zhu Yu Fructus Corni 10 g
Ze Xie Rhizoma Alismaiis 10 g
Fu Ling Poria 10 g
Gui Zhi Ramulus Cinnamomi 6 g
Fu Zi Radix Aconiti Carmichaeii Pracpamta h g,
decocted first
Tu Si Zi Semen CUSClItllC 10 g
Du Zhong Cortex Eucommiac 10 g
414 BACK PAIN
Prescription b: for deficiency of Kidney-Yin
ZUOGUIWAN
Restoring the Left Pill
Shu Di Huang Rhizoma Rehmanniae Pracparata 12 g
Shan Yao Rhizoma Dioscoreae 15 g
Shan Zhu Yu Fructus Corni 6 g
Tu Si Zi Semen Cuscutae 10 g
Gou Qi Zi Fructus Lycii 12 g
Chuan Niu Xi RadixCyatJlUlae 6 g
Lu Jiao Jiao Colla CerviComus 6 g
Gui Ban Jiao Colla Plastri Testudinis 10 g
Explanations
• In [in Gui Shen Qi Wan, Shu Di Huang tonifies the
Kidney, benefits the Essence and consolidates the
bones.
• Shan Yao and Shan Zhu Yu strengthen the Liver and
Spleen to help Shu Di Huang tonify the Kidney.
• Gui Zhi and Fu Zi tonify the Kidney-Yang and
dispel Cold.
• Ze Xie and Fu Ling remove Damp and promote
urination.
• Tu Si Zi and Du Zhong tonify the Kidney, benefit
the Essence and strengthen the back and bones.
• In Zuo Gui Wan, Shu Di Huang tonifies the
Kidney and benefits the Essence.
• Shan Yao and Shan Zhu Yu strengthen the Liver and
Spleen to help Shu Di Huang tonify the Kidney.
• Gou Qi Zi nourishes the Yin of the Liver and
Kidney and benefits the eyes.
• Gui Ban [iao, Tu Si Zi and Lu [iao [iao tonify the
Kidney and strengthen the bones.
• Chuan Niu Xi has the effect of strengthening the
waist and knees and reinforcing the muscles and
joints.
Modifications
1. If there is shortness of breath, lassitude, a low
voice, a poor appetite and diarrhoea due to
deficiency of the Spleen-Qi, add Dang Shen Radix
Codonopsis Pilosulac 10 g and Huang Qi Radix
Astragali Pilosulae 12 g to tonify the Spleen-Qi.
2. If there is diarrhoea before dawn with cold in the
lower abdomen due to deficiency of Kidney-Yang,
add Bu Gu Zhi Fructus Psoraleae 10 g and Wu Wei
Zi Fructus Schisandrae 10 g to tonify the Kidney-
Yang and stop the diarrhoea.
3. If there is seminal emission, enuresis and frequent
nocturnal urination due to deficiency of the
Kidney-Qi, add Yi Zhi Ren Fructus Alpiniae
Oxyplzyllae 6 g to tonify the Kidney-Qi and arrest
the seminal emission.
4. If there is insomnia due to disharmony between
the Heart and Kidney, add Huang Lian Rhizome
Coptidis 5 g and E [iao Colla Corii Asini 10 g to clear
Deficient-Fire, balance the Heart and Kidney and
improve sleep.
5. If there is headache and vertigo due to
hyperactivity of Liver-Yang caused by deficiency
of the Yin of the Liver and Kidney, add Tian Ma
Rhizoma Gastrodiae 10 g and Gou Teng Uncariae
cum Uncis 15 g to subdue the Liver-Yang and
relieve the vertigo.
6. If there is a tidal fever or feverish sensation in the
palms and soles of the feet due to deficiency of
Yin, add Di Gu Pi Cortex Lycii Radicis 12 g to clear
Deficient-Heat.
Patent remedies
[in Gui Shen Qi Wan Kidney Qi Pill for deficiency of
Kidney-Yang
Liu Wei Di Huang Wan Six-Flavour Rehmanniae Pill for
deficiency of Kidney-Yin
ACUPUNCTURE TREATMENT
BL-23 Shenshu, BL-35 Huiyang, BL-40 Weizhong,
BL-58 Feiyang, GB-39 Xuanzhong, KI-3 Taixi, KI-lO
Yingu, GV-3 Yaoyangguan and SP-6 Sanyinjiao.
Reinforcing method is used on these points.
Explanations
• BL-23,the Back Transporting point of the Kidney,
KI-3, the Source point, and KI-lO, the Sea point,
tonify the Kidney, and strengthen the back and
bones so as to treat the root cause.
• BL-40,a commanding point for the back, and
BL-58, the Connecting point, promote the free flow
of Qi in the channels and harmonise the collateral
in order to treat pain in the lower back and coccyx.
• GB-39, the Gathering point for the Marrow,
strengthens the tendons and bones so as to
consolidate the back and coccyx.
• SP-6, the crossing point of the three Yin channels
of the foot, nourishes the Liver, Spleen and Kidney
so as to promote the production of Qi and Blood.
• BL-35 and GV-3, the local points, harmonise the
collateral in the coccyx region and relieve pain.
Modifications
1. If there is a cold sensation in the lower back,
add GV-4 with moxibustion and a moxa box on

the lower back to warm the lower back and
dispel Cold.
2. If there is weakness in the knees, add GB-34, the
Cathering point for the tendons, to strengthen the
knees.
3. If there is impotency, add CV-4 and CV-6 to
reinforce the Kidney and improve the potency.
4. If there is insomnia, add HT-3 and rC-6 to calm
the Mind and improve the sleep.
5. If there is dizziness, add GB-20 to regulate the Qi
and Blood in the head and relieve the dizziness.
6. If there is generalised tiredness, add ST-36 and
CV-20 to lift up the energy and relieve the tiredness.
7. If there is diarrhoea, add BL-20 and BL-25 to
strengthen the Spleen and stop the diarrhoea.
8. If there is constipation, add LI-4 to promote
defecation.
q If there is profuse night sweating, add HT-6 and
KI-2 to clear Deficient-Heat and stop the sweating.
10. If there is nervousness and headache, add LR-2,
the Spring point, to clear Heat in the Liver and
calm it.
Case history
A 75-yeilf-old woman had been suffering from coccyx
pain for 5 years. The onset was gradual, and the pain
mostly occurred when she was tired and resolved after
she had rested. Sometimes she suffered from coccyx pain
when she walked too much. Other symptoms were heat
in the body, a thirst, a dry throat, dry stools, slight night
sweating, lower back pain and soreness, weakness in the
knees, a poor memory, dizziness, tinnitus in the left ear,
irritability, nervousness, occasional headaches, a red
tongue with a scanty coating, and one small area of
peeled coating on the left edge, and a thready, weak and
slightly rapid pulse.
Diagnosis
Coccyx pain due to deficiency of Yin of Liver and Kidney.
Principle of treatment
Nourish Yin, tonify the Kidney and relieve the pain.
Acupuncturetreatment
BL-23, BL-35, BL-58, GB-20, GB-39, KI-3, KI-7, KI-lO,
GV-3 and SP-6. Reinforcing method was used on these
points. Treatment was given once every 3 days.
Explanations
• BL-23, the Back Transporting point of the Kidney,
KI-3, the Source point, and KI-lO, the Sea point, tonify
the Kidney, and strengthen the back and bones so as
to treat the root cause.
• KI-7, the Metal point, and SP-6, the crossing point of
the three Yin channels of the foot, nourish the Yin of
the Liver and Kidney and clear Deficient-Heat.
• BL-58, the Connecting point, harmonises the collateral
and relieves the coccyx pain.
COCCYX PAIN 415
• GB-39, the Gathering point for the Marrow,
strengthens the tendons and bones so as to
consolidate the back and coccyx.
• BL-35 and GV-3, the local points, harmonise the
collateral in the coccyx region and relieve the pain.
• GB-20 calms the Mind, smoothes the Liver and
tranquillises the Mind.
Herbal treatment
Liu Wei Di Huang Wan Six-Flavour Rchmanninc Pill, three
times per day, 12 pills each time.
After treatment for 1 month, her coccyx pain was almost
under control. After this, acupuncture was given once
every week for another 2 months, by which time her
coccyx pain had disappeared. She was followed lip a
year later and she replied she had experienced no
further coccyx pain since the treatment.
STAGNATION OF QI AND BLOOD
Symptoms and signs
A stabbing pain in the coccyx that is aggravated by
pressure and worsens at night, with a history of phys-
ical trauma to the coccyx or adjacent region, accompil-
nied by rigidity in the lower back, restlessness or
insomnia due to the coccyx pain, a dark purplish
tongue and a thready or choppy pulse.
Principle of treatment
Promote Qi and Blood circulation, eliminate Blood
stasis and relieve the pain.
HERBAL TREATMENT
Prescription
SHEN TONG ZHU YU TANG
Meridian Passage
Dang Gui RadixAngelicae Sinensis 10 g
Chuan Xiong Rhizome Ligustici ClllIallx!cmg 12 g
Tao Ren Semen Persicac 10 g
Hong Hua Flas Carthami 6 g
Mo Yao Resina Myrrhae 6 g
Xiang Fu Rhizoma Cyperi 10 g
Wu Ling Zhi Faeces Trogoptcrorum 6 g
Chuan Niu Xi Radix Cyathulae 6 g
Di Long Lumbricus 10 g
Gan Cao Radix Glycyrrhizae 6 g
Explanations
• Dang Cui, Chuang Xiong, Tao Ren and Hong Hua
promote the circulation of Blood and eliminate
Blood stasis.
416 BACK PAIN
• Mo Yao and Wu Ling Zhi eliminate Blood stasis
and sedate coccyx pain.
• Xiang Fu promotes the circulation of Qi to
reinforce the effect of the circulation of Blood.
• Chuan Niu Xi and Di Long promote the circulation
of Blood in the channels and relieve coccyx pain.
• Chuan Niu Xi guides Blood stasis down and
tonifies the back and coccyx.
• Gan Cao harmonises the actions of the other herbs
in the prescription.
Modifications
1. If there is swelling around the coccyx, add San Qi
Radix Notoginseng 10 g to promote the circulation
of Blood, eliminate Blood stasis and reduce the
swelling.
2. If there is lower back pain with an aversion to
Wind-Damp, add Du Huo Radix Angelicae
Pubescentis 10 g to dispel the Wind and relieve the
pain.
3. If there is lower back pain with weakness of the
lower back, add Du Zhong Cortex Eucommiae
10 g and Shu Di Huang RadixRehmanniae
Praeparata 12 g to tonify the Kidney and relieve
the pain.
4. If there is irregular menstruation due to stagnant
Blood, add Yi Mu Cao Herba Leonuri 10 g to
regulate the menstruation.
5. If there are cold limbs, a pale complexion, a deep
and slow pulse and a pale tongue, add Gui Zhi
Ramulus Cinnamomi 6 g and Gan Jiang Rhizoma
Zingiberis 6 g to warm the Kidney-Yang and
relieve the pain.
Patent remedy
Te Xiao Yao Tong Ling Special Efficacy Lower Back Pain
Pill
ACUPUNCTURE TREATMENT
BL-17 Geshu, BL-35 Huiyang, BL-40 Weizhong, BL-58
Feiyang, BL-62 Shenmai, BL-63 [inmen, 51-3 Houxi,
GV-2 Yaoshu and 5P-6Sanyinjiao. Reducing method is
used on these points.
Explanations
• BL-17,the Gathering point for the Blood, and 5P-6,
the crossing point of the three Yin channels of the
foot, promote the circulation of Blood and
eliminate Blood stasis.
• BL-40, a commanding point for the back, BL-58,
the Connecting point, and BL-63, the
Accumulation point, promote the free flow of Qi
in the channels and harmonise the collateral to
relieve the pain in the lower back and coccyx.
• BL-62and 51-3in combination open the Governing
Vessel and relieve coccyx pain.
• BL-35and GV-2, the local points, harmonise the
collateral in the coccyx region and relieve pain.
Modifications
1. If there is a severe coccyx pain, add LI-4 and LR-3
to promote the circulation of Qi and Blood and
relieve the pain.
2. If there is swelling around the coccyx, add some
local Ah 5hi points to promote the circulation of
Qi and Blood and reduce the swelling.
3. If there is restlessness due to pain, add GB-20 to
calm the Mind.
4. If there is insomnia, add HT-3 and HT-7 to calm
the Heart and tranquillise the Mind.
5. If there is aversion to cold in the lower back, add
moxibustion to warm the channel and dispel
Cold.
Case history
A 20-year-old man had been suffering from coccyx pain
after falling down whilst horse riding 5 days previously.
He visited his doctor and was given some painkillers;
however, the pain did not improve much.
When he arrived at the clinic, he still had some
swelling around the coccyx, together with a big blue
spot, which was about 10 x 10 em, worsening of the
pain at night and frequent waking due to pain,
restlessness, an inability to sit and lie down and,
because of the coccyx pain, he could not easily defecate
as usual. His appetite, tongue coating and pulse were
normal.
Diagnosis
Coccyx due to stagnation of Blood.
Principle of treatment
Promote circulation of Qi and Blood, eliminate Blood
stasis and relieve the pain.
Acupuncture treatment
GV-2, GV-26, BL-17, BL-40, BL-3S, BL-S8 and SP-6.
Reinforcing method was applied for all these points.
Treatment was given two times per week.
Explanations
• GV-2 and BL-3S are the local points to promote the
circulation of Qi and Blood, harmonise the collateral
and relieve the coccyx pain.
• Needling at GV-26 with reducing method conducts

the circulation of Qi and Blood in the Governing
Vessel, which passes through the sacral region.
• BL-40, the commanding point for the back, and BL-58,
the Connecting point, disperse the stagnation of
Blood from the collateral and relieve the pain.
• BL·17, the Gathering point for the Blood, and SP-6,
the crossing point of the three Yin channels of the
COCCYX PAIN 417
foot, were used to promote the circulation of Blood,
eliminate Blood stasis and relieve the pain.
After 1 month of treatment, his coccyx pain had
disappeared. Two months later, he was followed up by
telephone and he replied he had experienced no pain
since the treatment.