论
《内经》曰∶足太阳脉令人腰痛，引项脊尻背如重状。少阳腰痛，如以针刺其皮中，循循然不可以俯仰，不可以顾。
阳明腰痛，不可以顾，顾如有见者，善悲。足少阴腰痛，痛引脊内廉。厥阴腰痛，腰中如张弓弩弦。太阴腰痛，热甚生
烦，腰下如有横木居其中，甚则遗溲。又曰∶太阳所至为腰痛。巨阳虚则腰背颈项痛，是动则病项如拔，脊痛腰似折，
髀不可以曲。又曰∶腰者肾之腑，转摇不能，肾将惫矣。脉经曰∶凡有所用力举重，若入房过度，汗出如浴水，则伤肾。
肾胀者，腹满引背央央然，腰髀痛。又有肾着之病，从腰以下冷，腰重如带五千钱。若夫腰痛之证，虽有六经见候之不
同，锉闪肾着之或异，或瘀血，或风寒，或湿痰流注，种种不一，原其所由，未必不因房室过度、负重劳伤之所致也，
经曰邪之所凑、其气必虚是也。治法，虚者补之，杜仲、黄柏、肉桂、当归、五味、菟丝子、天门冬、熟地黄之类。风
者散之，麻黄、防风、羌活、独活之类。寒者温之，肉桂、附子、干姜之类。挫闪者行之，当归、苏木、乳香、没药、
桃仁、红花之类。瘀血者逐之，大黄、牵牛、桃仁、水蛭、虻虫之类。湿痰流注者消导之，苍术、抚芎、香附、白芷、
枳实、橘红、半夏、茯苓之类。宜各类推而治之，不可执一论也。
脉法
《脉经》曰∶尺脉沉，腰背痛。凡腰痛时时失精，饮食减少，其脉沉滑而迟，此为可治。
腰痛之脉皆沉弦，沉弦而紧者为寒，沉弦而浮者为风，沉弦而濡细者为湿，沉弦而实者为锉闪。
丹溪曰∶脉必沉而弦，沉为滞，弦为虚，涩者是瘀血，缓者是湿，滑者伏者是痰，大者是肾虚也。
方法
丹溪曰∶有肾虚，有瘀血，有湿热，有锉闪，有痰。诸腰痛不可用补气药，亦不宜峻用寒凉药。
肾虚腰痛，用杜仲、黄柏、龟板、知母、枸杞子、五味子，猪脊骨髓丸服。
瘀血宜行血顺气，用补阴丸加桃仁、红花，外用三梭针于委中穴出血，以其血滞于下也。
湿宜燥湿行气，用黄柏、杜仲、苍术、川芎之类。
戴氏曰∶疼之不已，为肾虚也。日轻夜重者，是瘀血也。遇天阴及久坐而发者，是湿也。
痰宜南星、半夏，加快气药佐之，使痰随气运。
腰曲不能伸者，针委中立愈。
肾着为病，其体重，腰冷如冰，饮食如故，小便自利，腰以下冷痛而重治宜流湿兼用温药。
（以上丹溪方法凡七条）
肾着汤（三因方）治肾着腰痛。
干姜（炮） 茯苓（各一钱五分） 甘草（炙，五分） 白术（二钱五分）
上每服四钱，水煎服。
青娥丸（三因） 治肾虚腰痛，常服壮筋补虚。
杜仲（一斤，炒） 生姜（十两，炒） 破故纸（一斤，炒）
上为细末，用胡桃肉一百二十个，汤浸去皮膜，研为膏，炼蜜些少，丸如梧桐子大，每服五十丸，盐汤下或姜汤下。
立安丸（三因） 治五种腰痛。常服温补肾元，壮健腰脚。
破故纸（炒） 干木瓜（各一两五钱） 牛膝（酒洗，一两） 萆 （二两） 杜仲（姜汁炒丝断） 续断（各一
两）
上为细末，炼蜜丸如梧桐子大，每服五十丸，温酒下。
补骨脂丸（局方） 治肾虚及寒湿一切腰痛。
萆 （四两，一两用童便浸，一两用米泔浸，一两用盐汤浸，一两用酒浸，各浸一昼夜） 杜仲（四两，炒丝断） 补
骨脂（三两，炒香） 胡桃肉（八两，浸去油腻，另研如泥）
上以前三味共研为细末，不犯铁器，入胡桃肉，用木杵捣千余下，以糯米糊为丸，秋冬以炼蜜为丸，如梧桐子大，
每服五十丸空心温酒下，干物压之。
独活汤（东垣） 治劳役腰痛如折。
羌活（去芦） 防风（去芦） 独活（去芦） 泽泻（去毛） 肉桂（各三钱，去粗皮） 大黄（酒浸煨熟） 甘
草（各二钱） 川归（五钱） 连翘（五钱） 防己（酒炒） 黄柏（酒炒，各二钱） 桃仁（三十个，研）
每服一两，酒水煎服。
摩腰丹 治寒热腰痛。
附子尖 乌头尖 天南星（各二钱五分） 朱砂 干姜（各一钱） 雄黄 樟脑 丁香（各一钱五分） 麝香（当
门子，五粒）
上为末，蜜丸如龙眼大，每用一丸，生姜汁化开，如浓粥样，烘热置掌中，摩腰上，冷尽粘着肉，烘绵衣缚定，腰
热如火，间三日用一丸妙。或加吴茱萸、桂皮。
煨肾丸（局方） 治肾虚腰痛。
杜仲（三钱，炒丝断）
上为细末，以猪腰子一只，薄批作五、七块，以椒、盐腌去腥水，掺药末在内，以荷叶包裹，更加湿纸二、三重外
包，慢火煨熟食之，无灰酒送下。
补肾丸（丹溪） 治肾虚腰痛。（方见虚损门。）
苍术汤（丹溪） 治湿热腰腿疼痛。
防风 黄柏（各一钱） 柴胡（二钱） 苍术（三钱）
上细切，作一服，水一盏半，煎至一盏，去渣温服。
川芎肉桂汤（东垣） 治瘀血在足太阳、足少阴、足少阳三经腰痛。
汉防己 防风（去芦，各三钱） 神曲（炒） 独活（各五分） 川芎 柴胡 肉桂 当归梢 甘草（炙） 苍术
（各一钱） 羌活（一钱五分） 桃仁（五个，去皮尖，另研细）
上细切，作一服，好酒三盏，煎至一盏，去渣稍热服，食远。
地龙散（东垣） 治腰脊痛，或打扑损伤，或从高坠下，恶血在太阳经，令人腰脊痛，或髀股胫 中痛不可忍。
当归梢（二分） 中桂 地龙（各四分，盐水拌炒） 麻黄（五分） 苏木（六分） 独活 黄柏（盐酒炒） 甘
草（各八分） 羌活（一钱二分） 桃仁（六个，去皮尖，研如泥）
上细切，作一服水二盏，煎至一盏，去渣温服。
拈痛汤（东垣） 治湿热为病，肩背沉重，肢节腰胁疼痛，胸膈不利。
白术（四分） 人参（去芦） 升麻 苦参（酒炒） 葛根 苍术（各五分） 防风（去芦） 知母（去毛，酒洗）
泽泻 黄芩 猪苓（去皮） 当归（各六分） 甘草（炙） 生黄芩（酒洗） 茵 （酒炒） 羌活（各八分）
上细切，作一服，水二盏，煎至一盏，去渣温服。
苍术复煎散（东垣） 治寒湿相合，脑后痛，恶寒，项筋脊骨强，肩背膝眼痛，腰痛，膝膑痛无力，行步沉重。
红花（一分） 黄柏（三分） 柴胡（去芦） 本 泽泻 白术 升麻（各五分） 羌活（一钱） 苍术（四两）
上细切，先以苍术一味，用水三大盏，煎至二盏，去渣入前药，复煎至一盏，去渣空心稍热服，取微汗为效，忌酒
及湿面。
一粒金丹（河间） 治腰膝走注疼痛，如虎咬之，状不可忍者。
草乌头（炮制） 五灵脂（各四两） 木鳖子（一两，去壳） 白胶香（二两） 乳香（二钱五分） 当归（五钱）
京墨（二钱五分） 没药（五钱） 麝香（二分半） 地龙（去泥土净，一两）
上为细末，再研千余下，糯米糊丸，如梧桐子大，每服一丸或二丸，多至三丸，温酒下。服药后微汗，神验。
加味四物汤（元戎） 治瘀血腰痛。
本方加桃仁泥、酒红花二味，煎服。
安肾丸（三因） 治肾虚腰痛。
破故纸（炒） 胡芦芭（炒） 茴香（炒） 川苦楝（炒） 续断（炒，各三两） 桃仁（炒） 杏仁（炒） 山
药茯苓（各二两）
上为细末，炼蜜为丸，如梧桐子大，每服五十丸，盐汤下。
如神散（三因） 治挫闪腰痛，甚者不过三服平安。
川归 肉桂 玄胡索（各等分，杵碎，炒）
上为细末，每服二钱，热酒调下。或细切，酒煎亦可。
独活寄生汤（三因） 治因肾虚，坐卧冷湿，当风所得。
独活（一钱） 桑寄生 杜仲（炒） 细辛 牛膝 秦艽 茯苓 白芍药 桂心 川芎 防风 甘草（炙） 人参 熟
地黄 当归（各五分）
上细切，作一服，水二盏，煎至一盏，去渣，空心温服。
五积散（局方） 治寒湿及清痰流注经络，腰膝背胁疼痛。
白芷 川芎 桔梗 芍药 陈皮 浓朴（姜制，炒） 茯苓（去皮） 甘草 麻黄 干姜（炮） 官桂 川归 半
夏（汤泡七次，去皮脐） 苍术（米泔浸五、七日） 枳壳（各五分）
上细切，作一服，加生姜三片，水二盏，煎至一盏，温服。
（丹溪活套）云∶凡因房劳辛苦而腰痛者，四物汤加知母、黄柏、五味子、杜仲之类，吞补肾丸或大补阴丸。因风
寒湿流注经络而作痛者，二陈汤加麻黄、苍术、川芎、白芷、防风、羌活、独活之类。因挫闪跌扑，致死血流于本经而
作痛者，四物汤加桃仁、红花、苏木之类。脉实人壮盛者，大承气汤加桂下之安。有因醉饱入房太甚，而酒食之积乘虚
流入于本经，致腰痛难以俯仰，四物汤合二陈汤加麦 、神曲、杜仲、黄柏、官桂、砂仁、葛花、桔梗之类。
论
《黄帝内经》说：足太阳膀胱经的经脉病变使人腰痛，疼痛牵引项部、脊柱和臀部背部，感觉沉重。少阳胆经腰痛，像针刺在皮肤中，行动迟缓不便，不能前后俯仰，也不能左右回顾。阳明胃经腰痛，不能回头，回头时好像看见异物，容易悲伤。足少阴肾经腰痛，疼痛牵引脊柱内侧。足厥阴肝经腰痛，腰部僵硬如同拉满弓弩的弦。足太阴脾经腰痛，热邪严重导致烦躁，腰部下方好像横放着一块木头，严重时会出现大小便失禁。又说：太阳经气异常会导致腰痛。巨阳（即太阳经）虚弱则腰背颈项疼痛，一经变动发病则出现颈部像被拔起、脊痛腰痛像要折断、大腿不能弯曲的症状。又说：腰是肾脏的外府，如果转动摇动困难，说明肾脏即将衰败。《脉经》说：凡是用力举重，或者房事过度，出汗像洗澡一样，就会损伤肾脏。肾胀病，腹部胀满牵引背部，心中不适，腰和大腿疼痛。又有肾着病，从腰部以下发冷，腰部沉重得像挂着五千枚铜钱。至于腰痛的证候，虽然有六经表现的不同，挫闪伤和肾着病的差异，或者是瘀血，或者是风寒，或者是湿痰流注，情况多种多样，追溯其根源，未必不是因为房事过度、负重劳损所导致的，正如经文所说“邪气聚集的地方，正气必然虚弱”。治疗方法，虚证用补法，选用杜仲、黄柏、肉桂、当归、五味子、菟丝子、天门冬、熟地黄等药物。风邪用散法，选用麻黄、防风、羌活、独活等药物。寒邪用温法，选用肉桂、附子、干姜等药物。挫闪伤者用行气活血法，选用当归、苏木、乳香、没药、桃仁、红花等药物。瘀血者用逐瘀法，选用大黄、牵牛子、桃仁、水蛭、虻虫等药物。湿痰流注者用消导法，选用苍术、抚芎、香附、白芷、枳实、橘红、半夏、茯苓等药物。应当根据各类情况进行推演治疗，不可拘泥于一种说法。
脉法
《脉经》说：尺脉沉，主腰背痛。凡是腰痛且时常遗精，饮食减少，脉象沉滑而迟，这是可以治疗的。
腰痛的脉象大多为沉弦脉，沉弦而紧的是寒证，沉弦而浮的是风证，沉弦而濡细的是湿证，沉弦而实的是挫闪伤。
朱丹溪说：脉象必定沉而弦，沉代表气滞，弦代表虚，涩脉代表瘀血，缓脉代表湿，滑脉伏匿代表痰，大脉代表肾虚。
方法
朱丹溪说：腰痛有肾虚、瘀血、湿热、挫闪、痰饮几种类型。各种腰痛都不可使用补气药，也不宜峻烈地使用寒凉药。
肾虚腰痛，使用杜仲、黄柏、龟板、知母、枸杞子、五味子，配合猪脊骨髓丸服用。
瘀血腰痛宜行血顺气，使用补阴丸加桃仁、红花，外用三棱针在委中穴刺出血，因为瘀血停滞在下焦。
戴氏说：疼痛不止，是肾虚。白天轻晚上重，是瘀血。遇到阴天及久坐后发作，是湿邪。
腰部弯曲不能伸直者，针刺委中穴可立即痊愈。
肾着病，身体沉重，腰部冷如冰，饮食正常，小便自利，腰部以下冷痛且沉重，治疗宜祛湿兼用温药。
（以上朱丹溪的方法共七条）
肾着汤（出自《三因极一病证方论》）治疗肾着腰痛。
干姜（炮制） 茯苓（各一钱五分） 甘草（炙，五分） 白术（二钱五分）
以上每服四钱，加水煎服。
青娥丸（出自《三因极一病证方论》）治疗肾虚腰痛，常服可强壮筋骨补虚。
杜仲（一斤，炒） 生姜（十两，炒） 破故纸（即补骨脂，一斤，炒）
以上研为细末，用胡桃肉一百二十个，热水浸泡去皮膜，研磨成膏，加入少许炼蜜，制成梧桐子大小的丸药，每次服用五十丸，盐汤或姜汤送下。
立安丸（出自《三因极一病证方论》）治疗五种腰痛。常服可温补肾元，强壮腰脚。
破故纸（炒） 干木瓜（各一两五钱） 牛膝（酒洗，一两） 萆薢（二两） 杜仲（姜汁炒至丝断） 续断（各一两）
以上研为细末，炼蜜制成梧桐子大小的丸药，每次服用五十丸，温酒送下。
补骨脂丸（出自《太平惠民和剂局方》）治疗肾虚及寒湿引起的各种腰痛。
萆薢（四两，其中一两用童便浸，一两用米泔水浸，一两用盐汤浸，一两用酒浸，各浸泡一昼夜） 杜仲（四两，炒至丝断） 补骨脂（三两，炒香） 胡桃肉（八两，浸泡去油腻，另研如泥状）
以上前三味共同研为细末，不接触铁器，加入胡桃肉，用木杵捣一千多下，以糯米糊为丸，秋冬季节用炼蜜为丸，梧桐子大小，每次空腹服用五十丸，温酒送下，并用干食物压住药力。
独活汤（李东垣方）治疗劳累过度腰痛如折断感。
羌活（去芦头） 防风（去芦头） 独活（去芦头） 泽泻（去毛） 肉桂（各三钱，去粗皮） 大黄（酒浸煨熟） 甘草（各二钱） 川归（五钱） 连翘（五钱） 防己（酒炒） 黄柏（酒炒，各二钱） 桃仁（三十个，研碎）
每服一两，酒水混合煎服。
摩腰丹 治疗寒热腰痛。
附子尖 乌头尖 天南星（各二钱五分） 朱砂 干姜（各一钱） 雄黄 樟脑 丁香（各一钱五分） 麝香（当门子，五粒）
以上研为细末，蜂蜜制成龙眼大小的丸药，每次取一丸，用生姜汁化开，调成浓粥状，加热后置于掌心，摩擦腰部，直到冷却粘着皮肤，再用烘热的绵衣绑紧固定，腰部感到火热，每隔三天使用一丸效果奇妙。也可以加吴茱萸、桂皮。
煨肾丸（出自《太平惠民和剂局方》）治疗肾虚腰痛。
杜仲（三钱，炒至丝断）
以上研为细末，取猪腰子一只，薄切成五、七块，用花椒、盐腌制去腥水，将药末掺入其中，用荷叶包裹，外面再加两层湿纸包裹，用慢火煨熟食之，无灰酒送下。
苍术汤（朱丹溪方）治疗湿热腰腿疼痛。
防风 黄柏（各一钱） 柴胡（二钱） 苍术（三钱）
以上细切，作一服，加水一盏半，煎至一盏，去渣温服。
川芎肉桂汤（李东垣方）治疗瘀血在足太阳、足少阴、足少阳三条经络引起的腰痛。
汉防己 防风（去芦头，各三钱） 神曲（炒） 独活（各五分） 川芎 柴胡 肉桂 当归梢 甘草（炙） 苍术（各一钱） 羌活（一钱五分） 桃仁（五个，去皮尖，另研细）
以上细切，作一服，用好酒三盏，煎至一盏，去渣稍热服用，饭后远时服用。
地龙散（李东垣方）治疗腰脊痛，或因打扑损伤，或从高坠落，恶血停留在太阳经，导致人腰脊痛，或大腿、小腿中间疼痛难以忍受。
当归梢（二分） 中桂 地龙（各四分，盐水拌炒） 麻黄（五分） 苏木（六分） 独活 黄柏（盐酒炒） 甘草（各八分） 羌活（一钱二分） 桃仁（六个，去皮尖，研如泥状）
以上细切，作一服，加水二盏，煎至一盏，去渣温服。
拈痛汤（李东垣方）治疗湿热为病，肩背沉重，肢节腰胁疼痛，胸膈不利。
白术（四分） 人参（去芦头） 升麻 苦参（酒炒） 葛根 苍术（各五分） 防风（去芦头） 知母（去毛，酒洗） 泽泻 黄芩 猪苓（去皮） 当归（各六分） 甘草（炙） 生黄芩（酒洗） 茵陈（酒炒） 羌活（各八分）
以上细切，作一服，加水二盏，煎至一盏，去渣温服。
苍术复煎散（李东垣方）治疗寒湿相合，脑后痛，恶寒，项筋脊骨强直，肩背膝眼痛，腰痛，膝盖髌骨痛无力，行走步态沉重。
红花（一分） 黄柏（三分） 柴胡（去芦头） 藁本 泽泻 白术 升麻（各五分） 羌活（一钱） 苍术（四两）
以上细切，先用苍术一味，用水三大盏，煎至二盏，去渣加入前药，再煎至一盏，去渣空腹稍热服用，以微微出汗为有效，忌酒及湿面。
一粒金丹（刘河间方）治疗腰膝走注疼痛，如虎咬一般，痛苦难以忍受。
草乌头（炮制） 五灵脂（各四两） 木鳖子（一两，去壳） 白胶香（二两） 乳香（二钱五分） 当归（五钱） 京墨（二钱五分） 没药（五钱） 麝香（二分半） 地龙（去泥土净，一两）
以上研为细末，再研磨一千多下，糯米糊丸，梧桐子大小，每次服用一丸或二丸，多至三丸，温酒送下。服药后微微出汗，神效。
加味四物汤（张元素方）治疗瘀血腰痛。
本方加桃仁泥、酒红花两味，煎服。
安肾丸（出自《三因极一病证方论》）治疗肾虚腰痛。
破故纸（炒） 胡芦芭（炒） 茴香（炒） 川苦楝（炒） 续断（炒，各三两） 桃仁（炒） 杏仁（炒） 山药 茯苓（各二两）
以上研为细末，炼蜜为丸，梧桐子大小，每次服用五十丸，盐汤送下。
如神散（出自《三因极一病证方论》）治疗挫闪腰痛，严重者不过三服即可平安。
川归 肉桂 玄胡索（各等分，捣碎，炒）
以上研为细末，每次服用二钱，热酒调下。或者细切，酒煎也可。
独活寄生汤（出自《三因极一病证方论》）治疗因肾虚，坐卧冷湿，当风所得。
独活（一钱） 桑寄生 杜仲（炒） 细辛 牛膝 秦艽 茯苓 白芍药 桂心 川芎 防风 甘草（炙） 人参 熟地黄 当归（各五分）
以上细切，作一服，加水二盏，煎至一盏，去渣，空腹温服。
五积散（出自《太平惠民和剂局方》）治疗寒湿及清痰流注经络，腰膝背胁疼痛。
白芷 川芎 桔梗 芍药 陈皮 浓朴（姜制，炒） 茯苓（去皮） 甘草 麻黄 干姜（炮） 官桂 川归 半夏（汤泡七次，去皮脐） 苍术（米泔浸五、七日） 枳壳（各五分）
以上细切，作一服，加生姜三片，加水二盏，煎至一盏，温服。
（朱丹溪的灵活变通之法）说：凡是因房劳辛苦而腰痛者，用四物汤加知母、黄柏、五味子、杜仲等，吞服补肾丸或大补阴丸。因风寒湿流注经络而作痛者，用二陈汤加麻黄、苍术、川芎、白芷、防风、羌活、独活等。因挫闪跌扑，致死血流于本经而作痛者，用四物汤加桃仁、红花、苏木等。脉实人体壮盛者，用大承气汤加桂枝攻下安正。有因醉饱入房太甚，而酒食之积乘虚流入于本经，致腰痛难以俯仰，用四物汤合二陈汤加麦蘖、神曲、杜仲、黄柏、官桂、砂仁、葛花、桔梗等。
Treatise
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: Pathology of the Foot-Taiyang bladder meridian causes lower back pain, radiating to the neck, spine, buttocks, and back, with a sensation of heaviness. Shaoyang gallbladder meridian lower back pain feels like needles pricking the skin; movement is sluggish and difficult, unable to bend forward or backward, nor turn the head left or right. Yangming stomach meridian lower back pain prevents turning the head; when attempting to turn, one may see hallucinations and feel prone to sadness. Foot-Shaoyin kidney meridian lower back pain radiates inward along the spine. Foot-Jueyin liver meridian lower back pain makes the waist stiff as if strung like a bowstring. Foot-Taiyin spleen meridian lower back pain involves severe heat causing irritability, a sensation of a horizontal block in the lower waist, and in severe cases, urinary or fecal incontinence. It also says: Abnormal Qi of the Taiyang leads to lower back pain. Deficiency of Juyang (Taiyang) causes pain in the lower back, back, neck, and head; upon disease manifestation, the neck feels as if being pulled out, the spine and waist hurt as if breaking, and the thighs cannot be bent. It also says: The waist is the mansion of the Kidney; inability to twist or rotate indicates the Kidney is about to fail. The *Maijing* (Pulse Classic) states: Any exertion from lifting heavy weights, or excessive sexual intercourse leading to sweating profusely as if bathing, damages the Kidney. Kidney distension presents with abdominal fullness radiating to the back, discomfort, and pain in the waist and thighs. There is also a condition called "Kidney Fixation" (Shenzhuo), characterized by coldness below the waist and a heavy sensation in the waist as if carrying five thousand coins. Regarding lower back pain syndromes, although manifestations differ among the Six Meridians, and injuries from sprains/bruises or Kidney Fixation vary, whether due to blood stasis, wind-cold, or damp-phlegm flowing and depositing, the causes are numerous. Tracing their origin, they are not necessarily unrelated to excessive sexual activity or strain from carrying heavy loads, as the classics state: "Where pathogenic factors gather, Zheng Qi (Upright Qi) must be deficient." Treatment methods: For deficiency, use tonification, selecting herbs such as Duzhong (Eucommia Bark), Huangbai (Phellodendron Bark), Rougui (Cinnamon Bark), Danggui (Angelica Sinensis), Wuweizi (Schisandra Fruit), Tusizi (Cuscuta Seed), Tiandong (Asparagus Tuber), and Shudihuang (Rehmannia Root). For wind, use dispersal, selecting Mahuang (Ephedra Herb), Fangfeng (Saposhnikovia Root), Qianghuo (Notopterygium Rhizome), and Duhuo (Angelica Pubescens Root). For cold, use warming, selecting Rougui (Cinnamon Bark), Fuzi (Aconite Lateral Root), and Ganjiang (Dried Ginger). For sprains/bruises, use promoting circulation and resolving stasis, selecting Danggui (Angelica Sinensis), Sumu (Sappan Wood), Ruxiang (Frankincense), Moyao (Myrrh), Taoren (Peach Seed), and Honghua (Carthamus Flower). For blood stasis, use purging stasis, selecting Dahuang (Rhubarb Root), Qianniu (Morning Glory Seed), Taoren (Peach Seed), Shuizhi (Leech), and Mengchong (Buckwheat Beetle). For damp-phlegm flowing and depositing, use resolving and guiding out, selecting Cangzhu (Atractylodes Rhizome), Fuxiong (Ligusticum Chuanxiong), Xiangfu (Cyperus Rhizome), Baizhi (Angelica Dahurica Root), Zhishi (Immature Bitter Orange), Juhong (Citrus Peel), Banxia (Pinellia Tuber), and Fuling (Poria). Treatments should be deduced according to categories; one must not adhere rigidly to a single theory.
Pulse Diagnosis
The *Maijing* (Pulse Classic) states: A deep Chi pulse indicates lower back and back pain. In cases of lower back pain accompanied by frequent seminal emission and reduced appetite, if the pulse is deep, slippery, and slow, it is treatable.
Pulses associated with lower back pain are generally deep and wiry. Deep, wiry, and tight indicates cold; deep, wiry, and floating indicates wind; deep, wiry, moist, and fine indicates dampness; deep, wiry, and excess/solid indicates sprain/bruise injury.
Zhu Danxi states: The pulse must be deep and wiry. Deep indicates stagnation; wiry indicates deficiency. Choppy indicates blood stasis; moderate/slow indicates dampness; slippery and hidden indicates phlegm; large indicates Kidney deficiency.
Methods
Zhu Danxi states: Lower back pain arises from Kidney deficiency, blood stasis, damp-heat, sprain/bruise, or phlegm. None of these types of lower back pain should be treated with Qi-tonifying herbs, nor should harsh cold-clearing herbs be used aggressively.
For Kidney deficiency lower back pain, use Duzhong (Eucommia Bark), Huangbai (Phellodendron Bark), Guiban (Tortoise Shell), Zhimu (Anemarrhena Rhizome), Gouqizi (Goji Berry), Wuweizi (Schisandra Fruit), taken with Pig Spinal Marrow Pills.
For blood stasis, promote blood circulation and regulate Qi using Buyin Wan (Nourish Yin Pill) plus Taoren (Peach Seed) and Honghua (Carthamus Flower). Externally, bleed at the Weizhong (BL40) acupoint using a three-edged needle, because blood stasis resides in the lower jiao.
For dampness, dry dampness and move Qi using Huangbai (Phellodendron Bark), Duzhong (Eucommia Bark), Cangzhu (Atractylodes Rhizome), and Chuanxiong (Ligusticum Chuanxiong).
Master Dai states: Unrelenting pain indicates Kidney deficiency. Pain lighter during the day and heavier at night indicates blood stasis. Pain triggered by cloudy weather or prolonged sitting indicates dampness.
For phlegm, use Nanxing (Arisaema Rhizome) and Banxia (Pinellia Tuber), assisted by Qi-moving herbs to ensure phlegm moves with Qi.
For inability to straighten the waist curvature, needling Weizhong (BL40) cures immediately.
In Kidney Fixation disease, the body feels heavy, the waist is cold as ice, diet remains normal, urination is spontaneous, and there is cold pain and heaviness below the waist. Treatment should focus on draining dampness combined with warming herbs.
(Above are seven methods from Zhu Danxi.)
Shenzhuo Tang (from *San Yin Fang*) treats Kidney Fixation lower back pain.
Ganjiang (Paeoniae Radix Alba processed/Ginger processed) 1.5 qian, Fuling (Poria) 1.5 qian, Gancao (Licorice Root roasted) 0.5 qian, Baizhu (Atractylodes Macrocephala Rhizome) 2.5 qian.
Take 4 qian per dose, decoct in water and take orally.
Qing'e Wan (from *San Yin Fang*) treats Kidney deficiency lower back pain; regular use strengthens sinews and tonifies deficiency.
Duzhong (Eucommia Bark) 1 jin (roasted), Shengjiang (Fresh Ginger) 10 liang (roasted), Poguzhi (Psoralea Fruit/Cuscuta Seed alias) 1 jin (roasted).
Grind into fine powder. Use 120 walnut meats, soak in hot water to remove skins/membranes, grind into paste. Add a little refined honey to form pills the size of mulberry seeds. Take 50 pills per dose, washed down with salt water or ginger water.
Li'an Wan (from *San Yin Fang*) treats five types of lower back pain. Regular use warms and tonifies Kidney Yuan, strengthening the waist and legs.
Poguzhi (Psoralea Fruit) (roasted), Gan Mugua (Dried Chaenomelis Fructus) 1.5 liang each, Niuxi (Achyranthes Root) (wine-washed) 1 liang, Bibi (Dioscorea Hypoglauca Rhizome) 2 liang, Duzhong (Eucommia Bark) (fried with ginger juice until fibers break), Xuduan (Dipsacus Root) 1 liang each.
Grind into fine powder, refine honey to form pills the size of mulberry seeds. Take 50 pills per dose with warm wine.
Buguzhi Wan (from *Ju Fang*) treats Kidney deficiency and all lower back pain caused by cold-dampness.
Bibi (Dioscorea Hypoglauca Rhizome) 4 liang (one liang soaked in child's urine, one liang in rice wash water, one liang in salt water, one liang in wine, each for one day and night), Duzhong (Eucommia Bark) 4 liang (roasted until fibers break), Buguzhi (Psoralea Fruit) 3 liang (roasted until fragrant), Hetaorou (Walnut Meat) 8 liang (soaked to remove grease, ground separately into mud).
Grind the first three ingredients into fine powder without touching iron. Add walnut meat and pound with a wooden pestle over a thousand times. Form pills with glutinous rice paste; in autumn/winter, use refined honey. Size of mulberry seeds. Take 50 pills on an empty stomach with warm wine, followed by dry food to settle the medicine.
Duhuo Decoction (by Li Dongyuan) treats labor-induced lower back pain feeling like breaking.
Qianghuo (Notopterygium Rhizome) (remove root crown), Fangfeng (Saposhnikovia Root) (remove root crown), Duhuo (Angelica Pubescens Root) (remove root crown), Zexie (Alisma Rhizome) (remove hairs), Rougui (Cinnamon Bark) (remove rough bark) 3 qian each, Dahuang (Rhubarb Root) (wine-soaked and baked), Gancao (Licorice Root) 2 qian each, Chuangui (Angelica Sinensis) 5 qian, Lianqiao (Forsythia Fruit) 5 qian, Fangji (Stephania Root) (wine-fried), Huangbai (Phellodendron Bark) (wine-fried) 2 qian each, Taoren (Peach Seed) 30 pieces (ground).
Take 1 liang per dose, decoct in a mixture of wine and water.
Moyao Dan (Waist Rubbing Pill) treats cold-heat lower back pain.
Fuzijian (Tip of Aconite Lateral Root), Wutoujian (Tip of Aconite Root), Tian Nanxing (Arisaema Rhizome) 2.5 qian each, Zhusha (Cinnabar), Ganjiang (Dried Ginger) 1 qian each, Xionghuang (Realgar), Zhangnao (Camphor), Dingxiang (Clove) 1.5 qian each, Shexiang (Musk) (5 grains).
Grind into powder, form pills the size of longan fruits with honey. Use one pill per application, dissolve in fresh ginger juice to a thick porridge consistency, heat, place in palm, and rub onto the waist. When cool and sticking to the skin, bind with heated cotton clothing. The waist will feel fiery hot. Apply once every three days for excellent results. Can add Wuzhuyu (Evodia Fruit) or Guipi (Cinnamon Bark).
Wei Shen Wan (Stewed Kidney Pill) (from *Ju Fang*) treats Kidney deficiency lower back pain.
Duzhong (Eucommia Bark) 3 qian (roasted until fibers break).
Grind into fine powder. Take one pig kidney, slice thinly into 5-7 pieces, marinate with pepper and salt to remove fishy smell. Stuff with powder, wrap in lotus leaf, then wrap externally with two to three layers of wet paper. Slow-fire stew until cooked. Take with non-intoxicating wine.
Bushen Wan (Tonify Kidney Pill) (by Zhu Danxi) treats Kidney deficiency lower back pain. (Formula see Deficiency Damage Section.)
Cangzhu Tang (Atractylodes Decoction) (by Zhu Danxi) treats damp-heat lower back and leg pain.
Fangfeng (Saposhnikovia Root), Huangbai (Phellodendron Bark) 1 qian each, Chaihu (Bupleurum Root) 2 qian, Cangzhu (Atractylodes Rhizome) 3 qian.
Cut finely, make one dose. Decoct in 1.5 cups of water until 1 cup remains. Strain and take warm.
Chuanxiong Rougui Tang (Ligusticum and Cinnamon Decoction) (by Li Dongyuan) treats lower back pain due to blood stasis in the Foot-Taiyang, Foot-Shaoyin, and Foot-Shaoyang meridians.
Han Fangji (Stephania Tetrandra Root), Fangfeng (Saposhnikovia Root) (remove root crown) 3 qian each, Shenqu (Medicated Leaven) (roasted), Duhuo (Angelica Pubescens Root) 0.5 qian each, Chuanxiong (Ligusticum Chuanxiong Rhizome), Chaihu (Bupleurum Root), Rougui (Cinnamon Bark), Danggui Shao (Tip of Angelica Sinensis Root), Gancao (Licorice Root) (roasted), Cangzhu (Atractylodes Rhizome) 1 qian each, Qianghuo (Notopterygium Rhizome) 1.5 qian, Taoren (Peach Seed) 5 pieces (remove skin/tip, grind separately).
Cut finely, make one dose. Decoct in 3 cups of good wine until 1 cup remains. Strain and take slightly warm, far from meals.
Dilong San (Earthworm Powder) (by Li Dongyuan) treats lumbar spine pain, or pain from blows/falls, or falling from heights, where evil blood stays in the Taiyang meridian causing lumbar spine pain, or unbearable pain in the thighs/calves.
Danggui Shao (Tip of Angelica Sinensis Root) 2 fen, Zhonggui (Cinnamon Twig), Dilong (Pheretima Earthworm) 4 fen each (stir-fry with salt water), Mahuang (Ephedra Herb) 5 fen, Sumu (Sappan Wood) 6 fen, Duhuo (Angelica Pubescens Root), Huangbai (Phellodendron Bark) (salt-wine fry), Gancao (Licorice Root) 8 fen each, Qianghuo (Notopterygium Rhizome) 1.2 qian, Taoren (Peach Seed) 6 pieces (remove skin/tip, grind to mud).
Cut finely, make one dose. Decoct in 2 cups of water until 1 cup remains. Strain and take warm.
Niantong Tang (Relieve Pain Decoction) (by Li Dongyuan) treats diseases caused by damp-heat: heavy shoulders/back, pain in joints/waist/flanks, and chest/diaphragm discomfort.
Baizhu (Atractylodes Macrocephala Rhizome) 4 fen, Renshen (Ginseng Root) (remove crown), Shengma (Cimicifuga Rhizome), Kushen (Sophora Root) (wine-fried), Gegen (Pueraria Root), Cangzhu (Atractylodes Rhizome) 5 fen each, Fangfeng (Saposhnikovia Root) (remove crown), Zhimu (Anemarrhena Rhizome) (remove hairs, wine-wash), Zexie (Alisma Rhizome), Huangqin (Scutellaria Root), Zhuling (Polyporus) (remove skin), Danggui (Angelica Sinensis) 6 fen each, Gancao (Licorice Root) (roasted), Sheng Huangqin (Scutellaria Root) (wine-wash), Yichen (Artemisia Capillaris), Qianghuo (Notopterygium Rhizome) 8 fen each.
Cut finely, make one dose. Decoct in 2 cups of water until 1 cup remains. Strain and take warm.
Cangzhu Fujian San (Atractylodes Re-decoction Powder) (by Li Dongyuan) treats combination of cold-dampness: occipital pain, aversion to cold, stiffness of neck tendons/spine, shoulder/back/knee pain, lower back pain, weak knee cap pain, heavy gait.
Honghua (Carthamus Flower) 1 fen, Huangbai (Phellodendron Bark) 3 fen, Chaihu (Bupleurum Root) (remove crown), Gaoben (Ligusticum Wallichii Rhizome), Zexie (Alisma Rhizome), Baizhu (Atractylodes Macrocephala Rhizome), Shengma (Cimicifuga Rhizome) 5 fen each, Qianghuo (Notopterygium Rhizome) 1 qian, Cangzhu (Atractylodes Rhizome) 4 liang.
Cut finely. First decoct Cangzhu alone in 3 large cups of water until 2 cups remain. Strain, add remaining herbs, re-decoct until 1 cup remains. Strain and take slightly warm on an empty stomach. Effect indicated by slight sweating. Avoid alcohol and damp wheat products.
Yili Jin Dan (One Pill Golden Elixir) (by Liu Hejian) treats wandering pain in waist/knees, like tiger bites, unbearable.
Caowutou (Processed Aconitum Carmichaelii Lateral Root) (processed), Wulingzhi (Trogopterus Dung) 4 liang each, Mubiezi (Momordica Seed) (shell removed) 1 liang, Baijiaoxiang (Elemi Resin) 2 liang, Ruxiang (Frankincense) 2.5 qian, Danggui (Angelica Sinensis) 5 qian, Jingmo (Beijing Ink) 2.5 qian, Moyao (Myrrh) 5 qian, Shexiang (Musk) 2.5 fen, Dilong (Pheretima Earthworm) (cleaned) 1 liang.
Grind into fine powder, grind again over a thousand times. Form pills with glutinous rice paste, size of mulberry seeds. Take 1-2 pills, up to 3, with warm wine. Slight sweating after taking is effective.
Jiawei Siwu Tang (Modified Four Substances Decoction) (by Zhang Yuansu) treats blood stasis lower back pain.
Add Taoren Mud (Peach Seed Paste) and Jiuhonghua (Wine-processed Carthamus Flower) to this formula, decoct and take.
Anshen Wan (Peace Kidney Pill) (from *San Yin Fang*) treats Kidney deficiency lower back pain.
Poguzhi (Psoralea Fruit) (roasted), Huluba (Trigonella Foenum-graecum Seed) (roasted), Huixiang (Fennel Fruit) (roasted), Chuan Koulou (Melia Toosendan Fruit) (roasted), Xuduan (Dipsacus Root) (roasted) 3 liang each, Taoren (Peach Seed) (roasted), Xingren (Apricot Seed) (roasted), Shanyao (Dioscorea Rhizome), Fuling (Poria) 2 liang each.
Grind into fine powder, refine honey to form pills size of mulberry seeds. Take 50 pills per dose with salt water.
Rushen San (Miraculous Powder) (from *San Yin Fang*) treats sprain/bruise lower back pain; severe cases resolve within three doses.
Chuangui (Angelica Sinensis), Rougui (Cinnamon Bark), Yanhusuo (Corydalis Rhizome) equal parts (crushed, roasted).
Grind into fine powder. Take 2 qian per dose, mixed with hot wine. Or cut finely and decoct in wine.
Duhuo Jisheng Tang (Angelica Pubescens and Taxillus Decoction) (from *San Yin Fang*) treats lower back pain due to Kidney deficiency, sitting/lying in cold dampness, exposure to wind.
Duhuo (Angelica Pubescens Root) 1 qian, Sangjisheng (Taxillus Branch), Duzhong (Eucommia Bark) (roasted), Xixin (Asarum Root), Niuxi (Achyranthes Root), Qinjiao (Gentiana Macrophylla Root), Fuling (Poria), Baishao (White Peony Root), Guixin (Cinnamon Twig), Chuanxiong (Ligusticum Chuanxiong Rhizome), Fangfeng (Saposhnikovia Root), Gancao (Licorice Root) (roasted), Renshen (Ginseng Root), Shudihuang (Rehmannia Root), Danggui (Angelica Sinensis) 0.5 qian each.
Cut finely, make one dose. Decoct in 2 cups of water until 1 cup remains. Strain and take warm on an empty stomach.
Wuji San (Five Accumulations Powder) (from *Ju Fang*) treats cold-dampness and clear phlegm flowing into meridians, causing pain in waist/knees/back/flanks.
Baizhi (Angelica Dahurica Root), Chuanxiong (Ligusticum Chuanxiong Rhizome), Jiegeng (Platycodon Root), Shaoyao (Peony Root), Chenpi (Citrus Peel), Houpo (Magnolia Bark) (ginger-processed, roasted), Fuling (Poria) (skin removed), Gancao (Licorice Root), Mahuang (Ephedra Herb), Ganjiang (Dried Ginger) (roasted), Guanyi (Official Cinnamon), Chuangui (Angelica Sinensis), Banxia (Pinellia Tuber) (boiled 7 times, skin/navel removed), Cangzhu (Atractylodes Rhizome) (soaked in rice wash water 5-7 days), Zhike (Immature Bitter Orange) 0.5 qian each.
Cut finely, make one dose. Add 3 slices of fresh ginger, 2 cups of water. Decoct until 1 cup remains. Take warm.
(Zhu Danxi's Flexible Methods) states: For lower back pain due to sexual fatigue and hard work, use Siwu Tang (Four Substances Decoction) plus Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Bark), Wuweizi (Schisandra Fruit), Duzhong (Eucommia Bark), etc., swallowing Bushen Wan (Tonify Kidney Pill) or Dabu Yin Wan (Great Tonify Yin Pill). For pain due to wind-cold-damp flowing into meridians, use Erchen Tang (Two Aged Herbs Decoction) plus Mahuang (Ephedra Herb), Cangzhu (Atractylodes Rhizome), Chuanxiong (Ligusticum Chuanxiong Rhizome), Baizhi (Angelica Dahurica Root), Fangfeng (Saposhnikovia Root), Qianghuo (Notopterygium Rhizome), Duhuo (Angelica Pubescens Root), etc. For pain due to sprains/falls causing death-blood in the meridian, use Siwu Tang plus Taoren (Peach Seed), Honghua (Carthamus Flower), Sumu (Sappan Wood), etc. For patients with excess pulses and robust constitution, use Dachengqi Tang (Major Order the Qi Decoction) plus Guizhi (Cinnamon Twig) to purge and stabilize. For pain due to excessive drinking/eating followed by sex, where food/alcohol accumulation enters the meridian via deficiency causing inability to bend/extend, use Siwu Tang combined with Erchen Tang plus Maiya (Germinated Hordeen Grain), Shenqu (Medicated Leaven), Duzhong (Eucommia Bark), Huangbai (Phellodendron Bark), Guanyi (Official Cinnamon), Sharen (Amomum Fruit), Gegua (Pueraria Flower), Jiegeng (Platycodon Root), etc.