bubble_chart Concept

The coccyx, Lingshu, Gudu chapter refers to it as "tail sacrum". Suwen, Ci Yaotong Pian and others refer to it as "buttocks" or "tail buttocks". The sacrum (sacrum, buttocks) connects to the lumbar spine and extends down to the tailbone. Pain in the coccyx area due to certain reasons is called coccyx pain or tail sacrum pain. Tail sacrum pain is closely related to lumbago, as lumbago can cause coccyx pain, or coccyx pain can lead to lumbago, clinically referred to as lumbar buttocks pain or lumbar sacrum pain.

bubble_chart Pattern Analysis

1. Contusion︰There is a clear history of contusion, and the severity of pain symptoms varies depending on the degree of contusion. Most patients exhibit obvious symptoms, including severe pain in the coccyx region, which radiates to the lower back. Functional activities are impaired, with difficulty bending, turning, walking, lying flat, or rolling over freely. Some may even avoid coughing, sneezing, or speaking loudly due to pain, often accompanied by severe constipation and loss of appetite. However, other systemic symptoms are rare. Also known as sacrococcygeal contusion, it is commonly seen in middle-aged, overweight women with a clear history of traumatic falls. The onset is sudden, with intense pain. Apart from localized pain, obvious hematomas or bruises are seldom observed, but tenderness in the coccyx region, especially the tailbone, is pronounced. It is often difficult to distinguish from a coccygeal fracture (particularly non-displaced fractures). In the acute phase, contusion coccyx pain resembles the "static blood accumulation" described in general traumatic injuries—where "a fall leads to malignant blood retention internally." However, this condition manifests more prominently, with not only severe pain but also prolonged duration. Although no obvious external swelling or signs of static blood are visible, the internal accumulation persists, clinically referred to as "dead blood." This is because the coccyx often sustains varying degrees of injury or even fracture during contusion, yet clinical diagnosis is challenging. Once a coccyx contusion occurs, it is often accompanied by severe constipation. Treatment generally focuses on invigorating blood, resolving stasis, relieving pain, and promoting bowel movements. Cock Crow Powder may be used, while severe cases may require Peach Kernel Chengqi Decoction or Dacheng Decoction. After the acute phase, grade I pain in the coccyx region often persists, worsening with fatigue or cold exposure. Kanli Coarse Powder can be applied as a hot compress. This grade I pain may take months or even years to fully resolve.
2. Congenital Deficiency︰The pain symptoms are mild and do not affect functional activities, often accompanied by a dull discomfort in the coccyx area. If triggered by injury, the symptoms are usually more pronounced, with the pain being most severe in the sacral region. Some patients may have symptoms of enuresis from childhood that persist into adulthood. Apart from coccygeal pain, there are rarely other systemic symptoms. This condition is often caused by congenital insufficiency, where the sacrum fails to fully close (some individuals may have an unclosed sacrum congenitally but experience no discomfort throughout their lives). The onset of symptoms is usually triggered by fatigue or injury. The onset is relatively slow, and the pain symptoms are not very severe. Some cases may be accompanied by symptoms of enuresis due to kidney qi deficiency. Treatment may involve general formulas that mildly tonify kidney qi, such as "Tiangu Wanjin Decoction."

Pain in the coccyx due to insufficient kidney qi, contusion coccyx dysmenorrheal that has not healed for a long time and is further affected by wind-cold dampness, often occurs clinically along with lumbago, referred to as lumbosacral pain or lumbococcygeal pain. For more information, see the sections on strain-induced kidney-deficiency lumbago and wind-cold-dampness impediment lumbago in the lumbago section.

bubble_chart Documentation

1. Zhangshi Yitong．Chapter on Various Pains: "The coccyx is where the Foot Shaoyin and the Governor Vessel pass through, and it is also related to the Jueyin. If it is due to kidney deficiency, use the Six-Ingredient Pill with Cassia Bark, and if it does not improve, add Pilose Antler. For obese people, it is due to damp phlegm, use the Two-Cured Decoction combined with the Two-Marvel Decoction. For pain caused by stagnant blood, use Chinese Angelica, Red Peony Root, Tree Peony Bark, Peach Kernel, Corydalis Tuber, Raw Achyranthes Root, Pangolin Scales, Cassia Bark, and similar herbs to clear and regulate. If there is no improvement, add Earthworm and Raw Aconite Lateral Root."