称绝对。然服附子至百枚。以每次用三分计之。功程毋乃太远乎。
东垣治一人。露宿寒湿之地。腰痛不能转侧。胁搐急。作痛月余。腰痛论云。皆足太阳
足少阴。血络有凝血作痛。间有一二证属少阳胆经。外络脉病。皆去血络之凝。乃愈。经
云。冬三月禁针。只宜服药通其经络。破血络中败血。以汉防己、防风各三分。炒曲、独活
各五分。川芎、柴胡、肉桂、当归、炙草、苍术各一钱。羌活一钱五分。桃仁五粒。酒煎服
愈。
震按此条虽云去血络中瘀血。其实温寒胜湿之药为多。治其得病之因也。
丹溪治徐质夫。年六十余。因坠马。腰疼不可转侧。六脉散大。重取则弦小而长。稍坚
朱以为恶血虽有。未可驱逐。且以补接为先。遂令煎苏木、人参、黄 、芎、归、陈皮、
甘草。服至半月后。散大渐敛。食亦进。遂与熟大黄汤调下自然铜等药。一月而安。
震按跌伤有瘀。似宜先逐瘀而后补。丹溪则以年之老。脉之散大。反先补而后逐瘀。是
其学问之高也。昧者必以为补住恶血。惧不敢补。则尽力逐之。瘀终不去而变端起矣。损伤
且然。况内病乎。观此案及治叶先生痢疾案。而知补住邪气。补住恶血之为谬谈也。大抵元
气果虚。则补药惟元气受之。而或邪或瘀。不相干涉。若元气不虚。则补药为邪助长。为瘀
增痛。诚非所宜。要在能辨其虚与不虚耳。
刘立之治一妇人。患腰痛已历年。诸药不效。刘诊之曰。病虽危殆。然一夕可安。主人
讶焉。乃请其药。答曰。不须药。但用铅粉二三十两。壮士五人。大铃五七枚足矣。于是主
家悉备。刘命撤去床帐幔。移置屋中。以米饮和铅粉置病妇腰周回。令其舒卧。壮士一人。
摇
铃绕床急走。使其声不绝。人倦即易之。至夜半后。其妇稍能自起立。既而腰痛顿释。举家
拜云。师、神医也。愿闻其意。刘云。此病因服水银所致。水银客腰 间。不能出。故疼不
已。今用铅粉。粉乃水银所化。为金之母。取金音以母呼子。母子合德。出投粉中。则病愈
矣。
震按此法异想天开。较之葛可久浴以银汤。坐以川椒者。各臻神化。并绝跻攀。
李士材曰。徽州太学方鲁儒。精神困倦。腰膝异痛不可忍。皆曰肾主腰膝而用桂、附。
绵延两月。愈觉四肢痿软。腰膝寒冷。遂恣服热药。了无疑惧。比予视之。脉伏于下。极重
按之。振指有力。因思阳证似阴。乃火热过极。反兼胜己之化。小盒饭赤。必畏沸汤。询之
果然。乃以黄柏三钱。龙胆草二钱。芩、连、栀子各一钱五分。加生姜七片为向导。乘热顿
饮。移时便觉腰间畅快。三剂而痛若失矣。用人参固本丸。日服二两。一月而痊安。
震按此与景岳治董翁腰痛相同。但张案则脉洪滑而小水不通。故用大厘清饮倍加黄柏、
胆草。小水通而腰痛顿止。
祝茹穹治张修甫。腰痛重坠。如负千金。惟行房时不见重。服补肾等丸总不效。祝曰。
腰者肾之府。肾气虚。斯病腰。然何以行房时不见重。必瘀血滞之也。故行房时肾摇而血行
行即不瘀。遂不见其重也。以黄柏、知母、乌药、青皮、桃仁、红花、苏木、穿山甲、木
通各一钱。甘草五分。姜、枣煎。二剂而愈。
震按瘀血腰痛。古人原有治法。而想到行房时肾摇血即不瘀。岂非明哲乎。然行瘀多用
肉桂。此反用知、柏者。岂于脉中见相火之强耶。
孙东宿曰。吴东星冒暑应试。落第而怏怏。因成疟。自中秋延至十月。疟虽止而腰痛甚
且白浊咳嗽。肌肉大削。药剂乱投。如大羌活汤、地黄汤、及连、柏、桂、附、参、茸等
皆用过。痛剧欲死。叫撼四邻。予脉之。左弦细。右滑大。俱六至。口渴眼赤。予知其昔患
杨梅疮。余毒尚伏经络。适因疟后。气血不足。旧毒感动。故痛而暴也。以归、芍、甘草、
牛膝、苡仁、木通、白藓皮、钩藤。用土茯苓四两。煎汤代水煎药。数服而痛止嗽缓。乃以
酒后犯房。次日腰如束缚。足面亦疼。左眼赤。小水短。足底有火。从两胯直冲其上。痛不
可言。予于方去木通、白藓、土茯苓。加石斛、红花、生地、黄柏。调理三日。证无进退。
时值祁寒。因大便燥结。误听人用元明粉。一日夜服至两许。便仍不行。而腰痛愈猛。两足
挛缩。气息奄奄。面色青惨。自觉危急。诊之。六脉俱伏。痛使然也。予曰。君证虽热。便
虽燥。但病不在肠胃。而在经络筋骨间。徒泻肠胃何益。且闭藏之月。误泻则阳气亏乏。来
春无发生根本矣。今四肢拘缩。腰胯痛极者。由天寒而经络凝涩也。寒主收敛。法当温散寒
邪之标。使痛定。然后复治其本。乃用桂心、杜仲、炙甘草、苍术、破故纸、五加皮。连与
二剂。痛定而四肢柔和。饮食始进。予曰。标病已去。顾今严寒。不可治本。须俟春和。为
君拔去病根。渠不信。任他医用滋阴降火。久而无效。至次年三月。予乃以煨肾散进。大泻
五六度。四肢冰冷。举家大恐。予曰。病从此去矣。改进理脾药数帖。神气始转。腰胯柔和
可下床举步矣。盖此系杨梅疮余毒伏于经络。岂补剂所能去哉。予故先为疏通湿热。方用
补剂收功也。后仍以威灵仙末子二钱。入猪腰子内煨熟食之。又泻一二度。病根尽拔。改用
熟地、归、芍、苡仁、牛膝、黄柏、丹参、龟板。调理全安。
震按此案病情反复。孙公能随其病机曲折以赴之。就所录者已有七次。治法惟始终汇载
方知其中间有效有不效。而终底于效。乃可垂为模范。苟逸其半而存其半。则不知来路之
渊源。未明结局之成败。何以评 其是非乎。因不禁慨然于临证指南矣。
喻嘉言治张令施之弟。伤寒坏证。两腰偻废。卧床彻夜痛叫。百治不效。喻诊其脉亦平
顺。痛则比前大减。乃曰。病非死证。但恐成废人矣。此证之可以转移处。全在痛如刀刺。
尚有邪正互争之象。若全然不痛。则邪正混为一家。相安于无事矣。今痛觉大减。实有可忧
因谛思病情。必由热邪深入两腰。血脉久闭。不能复出。止有攻散一法。而邪入既久。正
气全虚。攻之必不应。乃以桃仁承气汤。多加肉桂、附子。二大剂与服。服后即能强起。再
为丸服。至旬余全安。此仿仲景治结胸证附子泻心汤法。结胸者在上之证。气多。故附子与
大黄
同用以泻心。腰偻者在下之症。血多。故合桃仁肉桂以散腰间之血结也。后用此法治江生。
二剂而愈。
震按此人无火象见。故可多加桂、附。若不受热药则奈何。试为西昌广其义。如大黄
虫丸、复元活血汤。或可为桂、附分途之法乎。再如黎峒丸、山羊血、石羊胆。与针砭法。
皆可一致思也。
称绝对。然而服用附子达到一百枚。如果按每次使用三分计算。疗程未免太长了吧。
李东垣治疗一个人。在寒冷潮湿的地方露天睡觉。腰痛不能翻身。胁肋抽搐拘急。疼痛持续一个多月。《腰痛论》说。都是足太阳膀胱经和足少阴肾经的血络中有瘀血导致疼痛。偶尔有一两个病例属于足少阳胆经的外络脉病变。都是去除血络中的瘀血后痊愈的。《内经》说。冬季三个月禁止针刺。只适合服药疏通经络。破除血络中的败血。用汉防己、防风各三分。炒神曲、独活各五分。川芎、柴胡、肉桂、当归、炙甘草、苍术各一钱。羌活一钱五分。桃仁五粒。酒煎服后痊愈。
俞震按：这条医案虽然说是去除血络中的瘀血。其实温寒胜湿的药物居多。这是治疗得病的病因。
朱丹溪治疗徐质夫。六十多岁。因为坠马。腰疼不能翻身。六脉散大。重按时则弦小而长。稍微坚硬。
朱丹溪认为恶血虽然有。但不可急于驱逐。暂且以补益接续为先。于是让他煎煮苏木、人参、黄芪、川芎、当归、陈皮、甘草。服用半个月后。散大的脉象逐渐收敛。饮食也进来了。于是用熟大黄汤调下自然铜等药。一个月后安稳。
俞震按：跌打损伤有瘀血。似乎应该先逐瘀而后补益。朱丹溪却因为他年老。脉象散大。反而先补益而后逐瘀。这是他的学问高深之处。愚昧的人一定认为补药会留住恶血。害怕不敢补。就会尽力逐瘀。瘀血最终不去而变证丛生。损伤尚且如此。何况内伤病呢？看这个医案以及治疗叶先生痢疾的医案。就知道所谓“补住邪气”、“补住恶血”是谬论。大致元气如果真的虚弱。那么补药只有元气能接受。而邪气或瘀血。互不干涉。如果元气不虚。那么补药就会为邪气助长。为瘀血增加疼痛。确实不合适。关键在于能辨别其虚与不虚罢了。
刘立之治疗一个妇人。患腰痛已经好几年。各种药物无效。刘立之诊断说。病虽然危重。但一晚就能安愈。主人感到惊讶。于是请求开药。回答说。不需要药。只需要铅粉二三十两。壮士五人。大铃五七个就够了。于是主人全部准备妥当。刘立之命令撤去床帐幔。移到屋中。用米饮调和铅粉放在生病妇人的腰部周围。让她舒展躺卧。壮士一人。摇着铃绕床快走。使铃声不断。人累了就换人。到半夜后。那个妇人稍微能自己起立。不久腰痛顿时缓解。全家拜谢说。老师真是神医啊。希望听听您的意思。刘立之说。这个病因是服用水银导致的。水银停留在腰间。不能排出。所以疼痛不止。现在用铅粉。铅粉是水银所化。金之母。取金的音韵以母亲呼唤儿子。母子合德。出来投入铅粉中。病就好了。
俞震按：这种方法异想天开。比起葛可久用银汤洗澡。坐花椒的方法。各有各的神妙变化。并绝了攀登（指难以企及）。
李士材说。徽州太学方鲁儒。精神困倦。腰膝异常疼痛无法忍受。大家都说肾主腰膝而用桂枝、附子。延续两个月。越发觉得四肢痿软。腰膝寒冷。于是肆意服用热药。毫无顾忌。到我诊视时。脉伏于下。极重按下去。振指有力。因而想到阳证似阴。是火热过极。反而兼有克制自己的五行之气所化的表现。小便应当发红。一定怕喝滚烫的水。询问果然如此。于是用黄柏三钱。龙胆草二钱。黄芩、黄连、栀子各一钱五分。加生姜七片作为向导。趁热顿饮。过了一会儿就觉得腰间畅快。三剂药后疼痛消失。用人参固本丸。每天服用二两。一个月痊愈。
俞震按：这和张景岳治疗董翁腰痛相同。但张案的脉象洪滑且小便不通。所以用大厘清饮加倍黄柏、胆草。小便通利而腰痛顿时停止。
祝茹穹治疗张修甫。腰痛沉重下坠。像背负千斤。只有在行房事时不见沉重。服用补肾等丸药总无效。祝茹穹说。腰是肾的府邸。肾气虚。才会病腰。但是为什么行房事时不见沉重。一定是瘀血阻滞的缘故。所以在行房事时肾摇动而血液运行。运行了就不瘀滞。所以就不见沉重了。用黄柏、知母、乌药、青皮、桃仁、红花、苏木、穿山甲、木通各一钱。甘草五分。姜、枣煎服。两剂后痊愈。
俞震按：瘀血腰痛。古人原本就有治法。而想到行房事时肾摇动血液就不瘀滞。岂不是明智吗？然而行瘀多用肉桂。这里反而用知母、黄柏。难道是在脉象中看到相火旺盛吗？
孙东宿说。吴东星冒暑考试。落第后郁郁寡欢。因此患上疟疾。从中秋延续到十月。疟疾虽然停止但腰痛严重。且有白浊咳嗽。肌肉大幅消瘦。药剂乱投。如大羌活汤、地黄汤。以及黄连、黄柏、桂枝、附子、人参、鹿茸等都曾用过。疼痛剧烈想要死。叫喊撼动四邻。我诊脉。左脉弦细。右脉滑大。都达到六至（每息六次）。口渴眼红。我知道他以前患过杨梅疮。余毒还潜伏在经络。恰逢疟疾后。气血不足。旧毒被感动。所以疼痛暴烈。用当归、白芍、甘草、牛膝、薏苡仁、木通、白鲜皮、钩藤。用土茯苓四两。煎汤代替水煎药。几服后疼痛停止咳嗽缓解。后来因为酒后犯房事。第二天腰像被束缚。足面也疼。左眼红。小便短。足底有火。从两胯直冲向上。疼痛无法形容。我在方中去掉木通、白鲜皮、土茯苓。加石斛、红花、生地、黄柏。调理三天。症状没有进退。正值严寒。因为大便燥结。误听人话用元明粉。一天一夜服用到二两左右。大便仍然不行。而腰痛更猛烈。两足挛缩。气息奄奄。面色青惨。自觉危急。诊脉。六脉俱伏。是因为疼痛造成的。我说。您证候虽然是热。大便虽然燥。但病不在肠胃。而在经络筋骨间。徒然泻肠胃有什么益处。而且闭藏之月。误泻则阳气亏乏。来年春天就没有发生生长的根本了。现在四肢拘缩。腰胯痛极。是由天寒导致经络凝涩。寒主收敛。法当温散寒邪的标症。使疼痛安定。然后恢复治疗其本。于是用桂心、杜仲、炙甘草、苍术、破故纸、五加皮。连续给两剂。疼痛安定而四肢柔和。饮食才开始进食。我说。标病已去。但现在严寒。不可治本。必须等到春和。为您拔去病根。他不相信。任由其他医生用滋阴降火。久而无效。到次年三月。我才用煨肾散进服。大泻五六次。四肢冰冷。全家大惊恐惧。我说。病从此去了。改进理脾药几帖。神气才转过来。腰胯柔和可以下床举步了。因为这系杨梅疮余毒伏于经络。岂是补剂所能去除的呢？所以我先为疏通湿热。方用补剂收功。后来仍以威灵仙末子二钱。放入猪腰子内煨熟食之。又泻一二度。病根尽拔。改用熟地、当归、白芍、薏苡仁、牛膝、黄柏、丹参、龟板。调理全安。
俞震按：这个医案病情反复。孙公能随着病机曲折去应对。就所记录的已有七次。治疗方法只有始终汇总记载才知道中间有效有不效。而最终达到疗效。才可以流传作为模范。如果遗漏一半而保留一半。就不知道来路的渊源。不明白结局的成败。凭什么评价其是非呢？因此不禁感慨于《临证指南》了。
喻嘉言治疗张令施的弟弟。伤寒坏证。两腰偻废。卧床整夜痛叫。百治无效。喻嘉言诊脉也平顺。疼痛比以前大减。于是说。病不是死证。但恐怕成为废人了。这个证候可以转移的地方。全在于疼痛如刀刺。还有邪正互相争斗的现象。如果全然不痛。则邪正混为一体。相安无事。现在疼痛大减。实在令人担忧。仔细思考病情。必定是由热邪深入两腰。血脉久闭。不能复出。只有攻散一法。而邪入既久。正气全虚。攻之必然不应。于是用桃仁承气汤。多加肉桂、附子。两大剂服用。服用后就能强起。再做成丸药服用。到十几天完全安康。这是仿照张仲景治疗结胸证附子泻心汤的法子。结胸是在上的证候。气多。所以附子与大黄同用以泻心。腰偻是在下的症候。血多。所以合桃仁肉桂以散腰间之血结。后用此法治江生。两剂而愈。
俞震按：此人没有火象显现。所以可以多加桂、附。如果不受热药怎么办？试着为西昌推广其义。如大黄䗪虫丸、复元活血汤。或许可以作为桂、附分途的方法吗？再如黎峒丸、山羊血、石羊胆。与针砭法。都可以一致思考。
Absolute certainty is claimed. However, consuming Aconiti Lateralis Radix Preparata (Fuzi, 附子) up to one hundred pills—if calculated at three fen per dose—the treatment course would be excessively long.
Li Dongyuan treated a patient who slept outdoors in cold and damp conditions, suffering from lower back pain that prevented turning over, with spasmodic and painful contraction of the flanks lasting for over a month. The *Treatise on Lower Back Pain* states: "All cases belong to the Foot-Taiyang Bladder Channel and Foot-Shaoyin Kidney Channel, where blood stasis in the collateral vessels causes pain. Occasionally, one or two cases belong to the external collateral vessels of the Foot-Shaoyang Gallbladder Channel." In all these instances, removing the blood stasis from the collateral vessels led to recovery. The *Classic of Internal Medicine* states: "Needling is prohibited during the three months of winter." Therefore, only medication should be used to unblock the meridians and break down the degenerated blood in the collateral vessels. The prescription consisted of Stephaniae Tetrandrae Radix (Han Fangji, 汉防己) and Saposhnikoviae Radix (Fangfeng, 防风), each 3 fen; Fermented Medicament (Chao Qu, 炒曲) and Angelicae Pubescentis Radix (Duhuo, 独活), each 5 fen; Chuanxiong Rhizome (Chuanxiong, 川芎), Bupleuri Radix (Chaihu, 柴胡), Cinnamon Twig (Guizhi, 桂枝), Angelicae Sinensis Radix (Danggui, 当归), Prepared Licorice Root (Zhigancao, 炙甘草), and Atractodis Rhizoma (Cangzhu, 苍术), each 1 qian; Notopterygii Rhizoma et Radix (Qianghuo, 羌活), 1.5 qian; and Peach Kernel (Taoren, 桃仁), five grains. Decocted in wine, the patient recovered.
Yu Zhen commented: Although this case claims to remove blood stasis from the collateral vessels, the majority of the herbs are warming and drying to overcome dampness. This treats the cause of the disease.
Zhu Danxi treated Xu Zhifu, who was over sixty years old. After falling from a horse, he suffered from severe lower back pain preventing turning over. His six pulses were scattered and large; upon heavy pressure, they became wiry, small, long, and slightly firm.
Zhu Danxi reasoned that although there was bad blood (blood stasis), it could not be driven out immediately. He prioritized tonification and connection first. He prescribed a decoction of Sappan Wood (Sumu, 苏木), Ginseng Radix et Rhizoma (Renshen, 人参), Astragali Membranacei Radix (Huangqi, 黄芪), Chuanxiong Rhizome (Xiong, 芎), Angelicae Sinensis Radix (Gui, 归), Tangerine Peel (Chenpi, 陈皮), and Licorice Root (Gancao, 甘草). After half a month of consumption, the scattered pulse gradually converged, and appetite returned. Then, he administered Natural Pyrite (Ziran Tong, 自然铜) and other herbs mixed with a decoction of Prepared Rhubarb (Shudahuang, 熟大黄). The patient stabilized after one month.
Yu Zhen commented: For traumatic injuries with blood stasis, it seems appropriate to expel stasis first and then tonify. Zhu Danxi, however, due to the patient's advanced age and scattered pulse, reversed this order, tonifying first and then expelling stasis. This demonstrates his profound medical knowledge. Ignorant practitioners might fear that tonics will retain bad blood and dare not use them, instead striving to expel stasis aggressively. Consequently, the stasis remains, and complications arise. If this applies to trauma, how much more so for internal diseases? Observing this case and the case of treating Mr. Ye's dysentery reveals that the notion of "tonics retaining pathogenic factors" or "tonics retaining bad blood" is fallacious. Generally, if Yuan Qi (Original Qi) is truly deficient, only the Yuan Qi can receive the benefits of tonics, while pathogens or stasis remain unaffected. If Yuan Qi is not deficient, tonics may aid pathogens or increase pain due to stasis, which is indeed inappropriate. The key lies in accurately distinguishing between deficiency and non-deficiency.
Liu Lizhi treated a woman who had suffered from lower back pain for several years without effect from various medicines. Liu diagnosed her and said, "Although the condition appears critical, she can be relieved overnight." The host was surprised and requested medicine. Liu replied, "No medicine is needed. Only 20-30 taels of Lead Powder (Qianfen, 铅粉), five strong men, and five to seven large bells are sufficient." The host prepared everything. Liu ordered the bed curtains to be removed and the bed moved into the room. He mixed the lead powder with rice water and placed it around the woman's waist, instructing her to lie comfortably. One strong man shook a bell and walked quickly around the bed to keep the sound continuous, rotating men when tired. By midnight, the woman could stand up slightly, and soon her lower back pain vanished completely. The family bowed and thanked him, calling him a divine physician, and asked for the rationale. Liu explained, "This illness was caused by ingesting Mercury (Shuiyin, 水银). The mercury lodged in the waist and could not exit, causing persistent pain. Now, using lead powder, which is derived from mercury. In Five Elements theory, Metal is the mother of Water (Mercury is associated with Water/Metal alchemy concepts here, specifically 'Metal is the mother' implying generative cycle or elemental relationship). Taking the sound of Metal to call the son (Mercury), mother and son harmonize. The mercury exits and enters the lead powder, curing the disease."
Yu Zhen commented: This method is imaginative and unconventional. Compared to Ge Kejiu’s method of bathing in silver water and sitting on Sichuan pepper, each achieves its own miraculous transformation, reaching heights that are hard to surpass.
Li Shicai stated: Fang Luru, a Taixue student from Huizhou, suffered from mental fatigue and unbearable, abnormal pain in the lower back and knees. Everyone attributed it to the Kidney governing the lower back and knees and prescribed Cinnamon Twig (Guizhi, 桂枝) and Prepared Aconite Root (Fuzi, 附子). After two months, his limbs became increasingly flaccid, and his lower back and knees felt cold. He recklessly consumed hot-natured medicines without hesitation. Upon my examination, his pulse was deep and hidden; upon extreme pressure, it was vigorous and forceful. I recalled that Yang syndromes can mimic Yin syndromes; excessive heat may manifest as cold due to the counteracting influence of the overcoming element. Urine should be red, and the patient should fear boiling water. Inquiry confirmed this. I prescribed Phellodendri Cortex (Huangbai, 黄柏), 3 qian; Gentiana Scabra Radix (Longdancao, 龙胆草), 2 qian; Scutellariae Radix (Huangqin, 芩), Coptidis Rhizoma (Huanglian, 连), and Gardenia Jasminoidis Fructus (Zhizi, 栀子), each 1.5 qian; plus seven slices of Ginger (Shengjiang, 生姜) as a guide. Taken hot in one dose, he felt relief in his waist shortly after. After three doses, the pain disappeared. He took Ren Shen Gu Ben Wan (Ginseng Root Solidifying the Root Pill), 2 liang daily, and recovered fully in one month.
Yu Zhen commented: This is similar to Zhang Jingyue’s treatment of Old Man Dong’s lower back pain. However, Zhang’s case featured a surging and slippery pulse with urinary obstruction, so he used Da Li Qing Yin (Great Clearing Decoction) with increased Huangbai and Longdancao. Once urination was restored, the lower back pain ceased instantly.
Zhu Ruqiong treated Zhang Xiufu, who suffered from heavy, dragging lower back pain, as if carrying a thousand jin. The heaviness disappeared only during sexual intercourse. Tonifying Kidney pills were ineffective. Zhu said, "The waist is the residence of the Kidney. Kidney Qi deficiency causes lower back pain. But why is there no heaviness during intercourse? It must be due to blood stasis blocking the flow. During intercourse, the Kidney moves, causing blood to circulate. Once circulating, there is no stasis, hence no heaviness." He prescribed Phellodendri Cortex (Huangbai, 黄柏), Anemarrhenae Rhizome (Zhimu, 知母), Linderae Radix (Wuyao), Green Tangerine Peel (Qingpi, 青皮), Peach Kernel (Taoren, 桃仁), Safflower (Honghua, 红花), Sappan Wood (Sumu, 苏木), Pangolin Scales (Chanshanjia, 穿山甲), and Akebia Caulis (Mutong, 木通), each 1 qian; Licorice Root (Gancao, 甘草), 5 fen. Decocted with Ginger and Jujube, the patient recovered after two doses.
Yu Zhen commented: Ancient texts already have treatments for lower back pain due to blood stasis. To realize that Kidney movement during intercourse prevents blood stasis is indeed wise. However, moving stasis usually involves Cinnamon Twig (Guizhi, 肉桂); here, Anemarrhenae Rhizome (Zhimu, 知母) and Phellodendri Cortex (Huangbai, 黄柏) are used instead. Does this indicate observing strong Ministerial Fire (Xianghuo, 相火) in the pulse?
Sun Dongsu stated: Wu Dongxing took an exam in summer heat, failed, and became depressed, subsequently developing malaria. It lasted from Mid-Autumn to October. Although the malaria stopped, severe lower back pain persisted, accompanied by white turbidity in urine and coughing, with significant muscle wasting. Various medicines were indiscriminately used, including Da Qianghuo Tang (Major Notopterygium Decoction), Dihuang Tang (Rehmannia Decoction), and herbs like Coptis, Phellodendron, Cinnamon, Aconite, Ginseng, and Deer Antler. The pain was excruciating, causing him to scream and disturb neighbors. My pulse diagnosis showed a wiry and fine left pulse and a slippery and large right pulse, both beating six times per breath. He had thirst and red eyes. I knew he had previously suffered from Syphilis (Yangmei Chuang, 杨梅疮), and residual toxins remained latent in the collaterals. Following the malaria, his Qi and Blood were deficient, agitating the old toxins, causing violent pain. I prescribed Angelicae Sinensis Radix (Gui, 归), Paeoniae Radix Alba (Shaoyao, 芍), Licorice Root (Gancao, 甘草), Achyranthis Bidentatae Radix (Niuxi, 牛膝), Coicis Semen (Yiren, 苡仁), Akebia Caulis (Mutong, 木通), Dictamni Cortex (Baixianpi, 白藓皮), and Uncaria Ramulus cum Uncis (Gouteng, 钩藤). Decocted with 4 liang of Smilacis Glabrae Rhizoma (Tufuling, 土茯苓) as water substitute. After several doses, pain stopped and cough eased. Later, due to sexual activity after drinking alcohol, his waist felt bound the next day, with foot surface pain, left eye redness, short urination, and burning sensation in the soles shooting up from the hips. The pain was unbearable. I removed Mutong, Baixianpi, and Tufuling from the formula, adding Dendrobii Caulis (Shihu, 石斛), Safflower (Honghua, 红花), Rehmanniae Radix Preparata (Shengdi, 生地), and Phellodendri Cortex (Huangbai, 黄柏). After three days of regulation, symptoms stagnated. During severe cold, due to dry stool, he mistakenly followed advice to use Mirabilite (Yuanmingfen, 元明粉), consuming about 2 liang in a day and night. Stool remained impacted, lower back pain intensified, legs contracted, breathing was faint, complexion was dark blue, and he felt critically ill. Pulse was hidden in all six positions due to pain. I said, "Your syndrome is heat, and stool is dry, but the disease is not in the Intestines and Stomach, but in the collaterals, sinews, bones, and joints. Purging the intestines is useless. Moreover, in the season of closure, purging depletes Yang Qi, destroying the root of spring growth. Your current limb contracture and severe hip/waist pain are due to cold congealing the collaterals. Cold governs contraction. We must warm and disperse the cold pathogen as the branch symptom to stabilize pain, then treat the root." I prescribed Cinnamon Heart (Guixin, 桂心), Eucommiae Cortex (Duzhong, 杜仲), Prepared Licorice Root (Zhigancao, 炙甘草), Atractodis Rhizoma (Cangzhu, 苍术), Psoraleae Fructus (Poguzhi, 破故纸), and Acanthopanacis Cortex (Wujiaopi, 五加皮). Two doses stabilized pain and relaxed limbs, allowing food intake. I said, "Branch symptoms are gone. But given the severe cold, we cannot treat the root now. We must wait for spring warmth to eradicate the root." He did not believe me and allowed other doctors to use Yin-nourishing and Fire-descending methods, which failed over time. In March of the following year, I administered Wei Shen San (Kidney Roasting Powder). He had five or six large bowel movements, becoming cold-limbed, terrifying his family. I said, "The disease is leaving." I switched to Spleen-regulating herbs. His spirit recovered, and he could walk. This case involved residual toxins from Syphilis latent in collaterals, which tonics cannot remove. Thus, I first cleared damp-heat, then used tonics to conclude treatment. Later, I gave 2 qian of Clematis Root Powder (Weilingxian, 威灵仙) stuffed inside a roasted pig kidney. He had one or two more bowel movements, eradicating the root. Finally, he was regulated with Prepared Rehmannia Root (Shudi, 熟地), Angelicae Sinensis Radix (Gui, 归), Paeoniae Radix Alba (Shaoyao, 芍), Coicis Semen (Yiren, 苡仁), Achyranthis Bidentatae Radix (Niuxi, 牛膝), Phellodendri Cortex (Huangbai, 黄柏), Salviae Miltiorrhizae Radix (Danshen, 丹参), and Tortoise Carapax and Plastron (Guiban, 龟板), achieving full recovery.
Yu Zhen commented: This case showed repeated fluctuations. Dr. Sun adapted to the complex pathogenesis. As recorded, there were seven stages. Only by recording the entire process can we see what worked and what didn't, leading to ultimate efficacy, setting a model. If half were omitted, the origin and outcome would be unclear, making judgment impossible. This evokes sighs regarding *Lin Zheng Zhi Nan* (Guide to Clinical Practice).
Yu Jiayan treated the younger brother of Zhanglingshi, suffering from a complicated stage of Cold Damage (Shanghan, 伤寒). Both lower backs were flexed and paralyzed, lying in bed screaming in pain all night. Treatments failed. Yu’s pulse diagnosis was smooth and regular. Pain had decreased significantly compared to before. He said, "This is not a fatal syndrome, but he risks becoming disabled. The point of potential reversal lies in the stabbing pain, indicating struggle between Pathogen and Righteous Qi. If there were no pain, Pathogen and Righteous Qi would merge in peace. The significant reduction in pain is worrying." After careful thought, he deduced that Heat Pathogen had deeply entered the lower backs, closing blood vessels for a long time, unable to reopen. The only method was to attack and disperse. However, the pathogen had been present long, and Righteous Qi was exhausted; attacking would fail. He used Tao Ren Cheng Qi Tang (Peach Kernel Order the Qi Decoction) with added Cinnamon Twig (Guizhi, 肉桂) and Prepared Aconite Root (Fuzi, 附子). Two large doses allowed him to rise strongly. Pills were taken subsequently. Full recovery occurred in over ten days. This imitates Zhang Zhongjing’s method for Chest Binding (Jie Xiong, 结胸) using Fuzi Xie Xin Tang (Aconite Draining the Epigastrium Decoction). Chest binding is an upper syndrome dominated by Qi, so Aconite and Rhubarb are combined to drain the Heart. Lower back flexion is a lower syndrome dominated by Blood, so Peach Kernel and Cinnamon are combined to disperse blood clumps in the waist. This method cured Jiang Sheng in two doses.
Yu Zhen commented: This patient showed no signs of fire, so adding Guizhi and Fuzi was acceptable. What if he could not tolerate hot medicines? Expanding on this for Xichang: Could Da Huang Zhe Chong Wan (Rhubarb and Ground Beetle Pill) or Fu Yuan Huo Xue Tang (Restore Vitality and Move Blood Decoction) serve as alternative paths to Guizhi and Fuzi? Additionally, Litong Wan, Goat Blood, and Sheep Gallbladder, along with acupuncture and cupping, could be considered similarly.