脉
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
而涩者，为闪挫。涩者恶血，大者肾虚，滑者、浮者是痰也。
病
夫腰者，肾之外候，一身所恃以转移阖辟者。盖诸经皆贯于肾而络于腰脊，肾气一虚，腰必痛矣。腰
痛有五，所感不同∶一曰阳气不足，少阴肾衰，是以腰痛；二曰风痹，风寒湿着腰而痛；三曰
肾虚，劳役伤肾而痛；四曰坠堕险地，伤腰而痛；五曰寝卧湿地而痛。又有三因而分之，盖太阳、少阴多
中寒，少阳、厥阴多中风，阳明、太阴多中湿，此六经腰痛者，为外因也；若失志伤肾，郁怒伤肝，忧思
伤脾，若此腰痛，为内因也；坠堕险地，伤腰而痛，为不内不外。当以五种三因而推之。不过从其所由，汗
下补泻之法以疗之，风则散之，寒则温之，湿则燥之，热则清之，气则顺之，血则和之，此治之法也。
治
因寒而痛，见热则减，遇寒愈增，宜五积散，每服加茱萸五分。
一、因风伤肾而痛者，或左或右，痛无常处，引两足，五积散加防风、全蝎。
一、因湿而痛者，遇天阴，或久坐而发，盖肾属水，久坐湿地，或为雨露所着，湿流入肾，
以致腰痛，宜渗湿汤，或肾着汤。
一、因湿热，宜操湿行气，用苍术，黄柏、杜仲、川芎之类，或当归拈痛汤。
一、因挫闪劳役而痛者，五积散加黑牵牛一钱，桃仁炒九枚，陈酒煎服，神效。
一、因瘀血而痛者，日轻夜重，宜行血顺气，丹溪补阴丸加桃仁、红花，外用三
棱针于委中穴出血，以其血滞于下也。
一、瘀血在足太阳、足太阴、足少阳三经腰痛，宜川芎肉桂汤。
一、瘀血腰痛，以四物汤加桃仁、红花、酒苏木。
一、因痰而痛者，宜南星、半夏，加快气之药佐之，使痰随气运。
一、因肾虚者，痛之不已，用安肾主之。
一、肾着为病，体重，腰冷如水，饮食如故，小便自利，腰以下冷痛如带五千钱，治宜流湿兼温散，肾
着汤主之。
一、腰软者，肾肝伏热，治用黄柏、防己。
一、因气滞而痛，或俯仰挫闪，宜乌药顺气散加炒桃仁，酒煎服。
一、因肾气虚弱，为湿所乘，流注腰膝，或挛拳掣痛，不可屈
伸，或缓弱冷痹，行步无力，以独活寄生汤主之。
方
补肾汤（西园公制） 治一切腰痛。
破故纸（酒炒） 小茴（盐酒炒） 玄胡索 牛膝（去芦，酒洗） 当归 杜仲
（酒炒） 黄柏（酒炒） 知母（酒炒）
上锉一剂，生姜煎服。
屠尚书方 治腰痛。
破故纸（五钱） 杜仲（酒炒，一两） 巴戟（五钱，净） 葫巴戟（五钱） 当归
（五钱） 桃仁（四十九个）
上锉一剂，酒煎，入乳香、没药各三钱，调热服。
壮本丹（秘方） 治肾虚腰痛，久则寒冷，此药壮筋骨，补元阳，利大小，养丹田，治腰痛之妙剂。
杜仲（酒炒，一两） 肉苁蓉（酒洗，五钱） 巴戟（酒浸，去骨，五钱） 破故纸
（盐水炒，一两） 茴香（一两） 青盐（五钱）
上为末，将猪腰子分开，入药在内，缝住，纸包煨熟。每一个一服，用黄酒送下。
加味青莪丸〔批〕（按此方治肾虚腰痛之剂） 治肾虚腰痛或风寒乘之，血
气相搏为痛。
杜仲（姜汁浸炒，十二个） 破故纸（水淘，十二两，芝麻同炒变色，去芝麻，瓦上
焙干，为末） 沉香（六两） 胡桃（去皮膈，另研，六两黄） 没药（另研） 乳香（另研，各六两）
上为末，用肉苁蓉十二两，酒浸成膏，和剂捣千余杵，丸如梧桐子大。每服三十丸，空心温酒，或盐汤任下。
立安散〔批〕（按此方治闪挫腰痛之剂） 治气滞腰痛，并闪挫腰痛，肾虚腰痛。
当归（一两） 官桂（一两） 玄胡索（炒，一两） 杜仲（姜炒，一两） 小茴（炒，
一两） 木香（五钱） 牵牛（一钱，半生半熟）
上为末，每服二匙，空心陈酒调下。一方去牵牛，以酒煎服。
川芎肉桂汤〔批〕（按此方治寒湿腰痛之剂） 治露宿寒湿之地，腰痛不能转侧，两胁搐急作痛。
当归尾（一钱） 川芎（一钱） 桃仁（五个，去皮尖，研） 肉桂（一钱） 防己（三分）
苍术（一钱） 羌活（一钱半） 独活（五分） 柴胡（一钱） 防风（三分） 神曲（五分，炒）
甘草（炙，一钱）
上锉一剂，陈酒煎，食远稍热服。
追风通气散（方见痈疽） 治经年腰痛，以本方加川萆 、玄胡索，陈酒煎服。
脉象
腰痛的脉象，多表现为沉弦。脉象沉弦而紧的，属于寒邪；沉弦而浮的，属于风邪；沉弦而濡细的，属于湿邪；沉弦而涩的，属于闪挫损伤。脉涩提示有瘀血（恶血），脉大提示肾虚，脉滑或浮提示有痰饮。
病因病机
腰部是肾脏的外候表现，是人体依靠它来转动开合的关键部位。因为各条经脉都贯穿肾脏并联络腰脊，一旦肾气虚弱，腰部必然疼痛。腰痛主要有五种，致病原因各不相同：一是阳气不足，少阴肾经衰败，导致腰痛；二是风痹，风寒湿邪侵袭腰部导致疼痛；三是肾虚，因劳累过度损伤肾脏导致疼痛；四是坠落高处或身处险地，损伤腰部导致疼痛；五是睡卧在潮湿之地导致疼痛。又有根据三种病因进行分类的说法：太阳经和少阴经容易感受寒邪，少阳经和厥阴经容易感受风邪，阳明经和太阴经容易感受湿邪，这六经腰痛属于外因；若是因失意伤肾、郁怒伤肝、忧思伤脾等原因引起的腰痛，属于内因；若是因坠落险地损伤腰部导致的疼痛，属于不内不外之因。应当根据这五种类型和三种病因来推究治疗。不过是根据其发病原因，采用发汗、攻下、补益、泻实等治疗方法来调理，风邪则用疏散法，寒邪则用温散法，湿邪则用燥湿法，热邪则用清热法，气滞则用理气顺气法，血瘀则用活血和血法，这就是治疗的法则。
治法与方药
因寒邪引起的腰痛，遇热则减轻，遇冷则加重，宜用五积散，每次服用时加吴茱萸五分。
第一种，因风邪伤肾引起的腰痛，疼痛位置或在左或在右，痛无定处，牵引至双腿，可用五积散加防风、全蝎。
第二种，因湿邪引起的腰痛，遇到阴天发作，或久坐后发作，因为肾属水，久坐湿地，或被雨露淋湿，湿气流入肾脏，导致腰痛，宜用渗湿汤，或肾着汤。
第三种，因湿热引起的腰痛，宜操除湿行气，使用苍术、黄柏、杜仲、川芎等药物，或用当归拈痛汤。
第四种，因挫闪劳役引起的腰痛，用五积散加黑牵牛一钱，桃仁炒九枚，陈酒煎服，效果显著。
第五种，因瘀血引起的腰痛，白天轻晚上重，宜行血顺气，用丹溪补阴丸加桃仁、红花，外用三棱针在委中穴刺络出血，因为血液停滞在下部。
第六种，瘀血阻滞在足太阳膀胱经、足太阴脾经、足少阳胆经引起的腰痛，宜用川芎肉桂汤。
第七种，瘀血腰痛，用四物汤加桃仁、红花、酒苏木。
第八种，因痰饮引起的腰痛，宜用天南星、半夏，配合快气药物辅助，使痰随气运行消散。
第九种，因肾虚引起的腰痛，疼痛不止，用安肾主方治疗。
第十种，肾着病，身体沉重，腰部寒冷如水浸，饮食正常，小便通畅，腰部以下冷痛如同束着五千铜钱，治疗宜祛湿兼温散，用肾着汤主治。
第十一种，腰部软弱无力者，是肝肾伏热，治疗用黄柏、防己。
第十二种，因气滞引起的腰痛，或因俯仰动作挫闪引起，宜用乌药顺气散加炒桃仁，酒煎服。
第十三种，因肾气虚弱，被湿邪乘虚而入，流注于腰膝，出现拘挛拳曲掣痛，不能屈伸，或弛缓软弱冷痹，行走无力，用独活寄生汤主治。
方剂
补肾汤（西园公制） 治疗各种腰痛。
破故纸（酒炒） 小茴香（盐酒炒） 玄胡索 牛膝（去芦头，酒洗） 当归 杜仲（酒炒） 黄柏（酒炒） 知母（酒炒）
以上药材锉碎为一剂，加生姜煎服。
屠尚书方 治疗腰痛。
破故纸（五钱） 杜仲（酒炒，一两） 巴戟天（五钱，净选） 葫芦巴（五钱） 当归（五钱） 桃仁（四十九个）
以上药材锉碎为一剂，用酒煎，加入乳香、没药各三钱，调匀后热服。
壮本丹（秘方） 治疗肾虚腰痛，日久则感到寒冷，此药能强壮筋骨，补益元阳，利大小便，滋养丹田，是治疗腰痛的妙方。
杜仲（酒炒，一两） 肉苁蓉（酒洗，五钱） 巴戟天（酒浸，去骨心，五钱） 破故纸（盐水炒，一两） 茴香（一两） 青盐（五钱）
以上研为末，将猪腰子剖开，放入药粉，缝合，用纸包裹煨熟。每个猪腰子作为一服，用黄酒送下。
加味青莪丸〔批注〕（按：此方是治疗肾虚腰痛的药剂） 治疗肾虚腰痛或风寒侵袭，气血相搏结引起的疼痛。
杜仲（姜汁浸炒，十二个） 破故纸（水淘洗，十二两，与芝麻同炒至变色，去掉芝麻，在瓦上焙干，研为末） 沉香（六两） 胡桃（去皮膜，另研，六两黄肉） 没药（另研） 乳香（另研，各六两）
以上研为末，用肉苁蓉十二两，酒浸成膏，调和药粉捣千余杵，制成梧桐子大小的丸药。每次服用三十丸，空腹时用温酒或盐汤送服均可。
立安散〔批注〕（按：此方是治疗闪挫腰痛的药剂） 治疗气滞腰痛，以及闪挫腰痛、肾虚腰痛。
当归（一两） 官桂（一两） 玄胡索（炒，一两） 杜仲（姜炒，一两） 小茴香（炒，一两） 木香（五钱） 牵牛子（一钱，半生半熟）
以上研为末，每次服用两匙，空腹时用陈年米酒调服。另一用法是去掉牵牛子，用酒煎服。
川芎肉桂汤〔批注〕（按：此方是治疗寒湿腰痛的药剂） 治疗露宿寒湿之地，腰痛不能转侧，两胁抽搐紧急作痛。
当归尾（一钱） 川芎（一钱） 桃仁（五个，去皮尖，研碎） 肉桂（一钱） 防己（三分） 苍术（一钱） 羌活（一钱半） 独活（五分） 柴胡（一钱） 防风（三分） 神曲（五分，炒） 甘草（炙，一钱）
以上药材锉碎为一剂，用陈酒煎，饭后稍热时服用。
Pulse Diagnosis
The pulse in lumbar pain is predominantly Chen-Xian (Deep and Wiry). If the pulse is Deep, Wiry, and Tight, it indicates Cold; if Deep, Wiry, and Floating, it indicates Wind; if Deep, Wiry, and Soft-Fine, it indicates Dampness; if Deep, Wiry, and Choppy, it indicates Sprain/Trauma. A Choppy pulse suggests Blood Stasis (Evil Blood); a Large pulse suggests Kidney Deficiency; a Slippery or Floating pulse suggests Phlegm.
Pathogenesis
The waist is the external manifestation of the Kidneys and is crucial for the body's movement and flexibility. Since all meridians pass through the Kidneys and connect to the lumbar spine, once Kidney Qi becomes deficient, lumbar pain inevitably occurs. There are five types of lumbar pain with different etiologies: First, insufficient Yang Qi and decline of the Shaoyin Kidney meridian cause lumbar pain; Second, Wind-Bi syndrome, where Wind-Cold-Dampness adheres to the waist causing pain; Third, Kidney deficiency due to overexertion damaging the Kidneys; Fourth, injury from falling from heights or dangerous places damaging the waist; Fifth, sleeping on damp ground causing pain. Additionally, there is a classification based on three causes: The Taiyang and Shaoyin meridians are prone to Cold invasion; the Shaoyang and Jueyin meridians are prone to Wind invasion; the Yangming and Taiyin meridians are prone to Dampness invasion. These six-meridian lumbar pains are considered external causes. Lumbar pain resulting from emotional distress damaging the Kidneys, anger damaging the Liver, or worry damaging the Spleen is considered an internal cause. Lumbar pain from falling and injuring the waist is considered neither internal nor external. Treatment should be deduced based on these five types and three causes. Generally, one employs sweating, purging, tonifying, or draining methods according to the etiology: disperse Wind, warm Cold, dry Dampness, clear Heat, regulate Qi, and harmonize Blood. This constitutes the therapeutic principles.
Treatment Methods
For lumbar pain caused by Cold, which alleviates with heat and worsens with cold, use Wuji San (Five Accumulations Powder), adding 5 fen of Zhuyu (Evodia Fruit) per dose.
1. For lumbar pain caused by Wind damaging the Kidneys, characterized by alternating left or right pain without fixed location, radiating to both legs, use Wuji San with Fangfeng (Saposhnikovia Root) and Quanxie (Scorpion).
2. For lumbar pain caused by Dampness, occurring on cloudy days or after prolonged sitting, as the Kidney belongs to Water, prolonged sitting on damp ground or exposure to rain/dew allows Dampness to flow into the Kidneys, causing pain. Use Shen Shi Tang (Dampness Percolation Decoction) or Shen Zhuo Tang (Kidney Fixation Decoction).
3. For lumbar pain caused by Damp-Heat, employ damp-draining and Qi-regulating herbs such as Cangzhu (Atractylodes Rhizome), Huangbai (Phellodendron Bark), Duzhong (Eucommia Bark), and Chuanxiong (Ligusticum Rhizome), or Danggui Nian Tong Tang (Angelica Joint-Pain Relieving Decoction).
4. For lumbar pain caused by sprain/trauma and overexertion, use Wuji San with 1 qian of Hei Qianniu (Black Morning Glory Seed), nine fried Taoren (Peach Kernel), decocted in aged wine for miraculous effect.
5. For lumbar pain caused by Blood Stasis, which is lighter during the day and heavier at night, promote blood circulation and regulate Qi using Danxi Buyin Wan (Danxi Yin-Nourishing Pill) with added Taoren and Honghua (Carthamus Flower). Externally, bleed at Weizhong (BL-40) acupoint using a three-edged needle, as blood stagnates in the lower body.
6. For lumbar pain due to Blood Stasis in the Foot-Taiyang Bladder Meridian, Foot-Taiyin Spleen Meridian, and Foot-Shaoyang Gallbladder Meridian, use Chuanxiong Rougui Tang (Ligusticum and Cinnamon Twig Decoction).
7. For lumbar pain due to Blood Stasis, use Siwu Tang (Four Substances Decoction) with added Taoren, Honghua, and Jiusumu (Arbor Vitae Wood soaked in wine).
8. For lumbar pain caused by Phlegm, use Nanxing (Arisaema Rhizome) and Banxia (Pinellia Tuber), assisted by Qi-moving herbs to facilitate the transport and dispersion of Phlegm with Qi.
9. For lumbar pain due to Kidney Deficiency that persists, use Anshen Zhu (Kidney Calming Main Formula).
10. For Shen Zhuo disease (Kidney Fixation), characterized by heavy body, cold sensation in the waist like water immersion, normal diet, free urination, and cold pain below the waist resembling being bound by five thousand coins, treat with damp-draining and warming-dispersing methods using Shen Zhuo Tang.
11. For softness of the waist indicating latent Heat in the Liver and Kidneys, treat with Huangbai and Fangji (Stephania Root).
12. For lumbar pain due to Qi Stagnation, or caused by bending/stretching sprains, use Wuyao Shunqi San (Lindera Regulating Qi Powder) with fried Taoren, decocted in wine.
13. For lumbar pain due to weak Kidney Qi allowing Dampness to invade and flow into the waist and knees, causing spasmodic cramping pain preventing flexion/extension, or flaccid weakness and cold bi-syndrome with inability to walk strongly, use Duhuo Jisheng Tang (Angelica Pubescens and Poria Decoction).
Formulas
Bushen Tang (Kidney Tonifying Decoction - Xiyuan Gong System) Treats all types of lumbar pain.
Pogu Zhi (Fructus Psoraleae, stir-fried with wine) Xiaohui (Fructus Foeniculi, stir-fried with salt and wine) Yansu (Rhizoma Corydalis) Niuxi (Radix Achyranthis Bidentatae, de-radicle, washed with wine) Danggui (Radix Angelicae Sinensis) Duzhong (Cortex Eucommiae, stir-fried with wine) Huangbai (Cortex Phellodendri, stir-fried with wine) Zhimu (Rhizoma Anemarrhenae, stir-fried with wine)
Crush these ingredients for one dose, decoct with fresh ginger, and take orally.
Tu Shangshu Fang (Minister Tu's Formula) Treats lumbar pain.
Pogu Zhi (5 qian) Duzhong (stir-fried with wine, 1 liang) Bajiji (Radix Morinda Officinalis, cleaned, 5 qian) Hubaji (Herba Halophilae, 5 qian) Danggui (5 qian) Taoren (49 seeds)
Crush these ingredients for one dose, decoct in wine, add Ruxiang (Olibanum) and Moyao (Myrrha), each 3 qian, mix well, and take hot.
Zhuangben Dan (Strengthening Root Pill - Secret Recipe) Treats Kidney-deficiency lumbar pain, which becomes cold over time. This pill strengthens sinews and bones, tonifies Primordial Yang, benefits urination and defecation, nourishes the Dantian, and is an excellent remedy for lumbar pain.
Duzhong (stir-fried with wine, 1 liang) Rongzhrong (Cistanche Stem, washed with wine, 5 qian) Bajiji (soaked in wine, de-boned, 5 qian) Poguzhi (stir-fried with salt water, 1 liang) Huixiang (Fennel Fruit, 1 liang) Qingyan (Blue Salt, 5 qian)
Grind into powder. Split pig kidneys, insert the medicine inside, sew up, wrap in paper, and bake until cooked. Take one kidney per dose, swallowed with yellow wine.
Jiawei Qing'e Wan [Commentary] (Note: This formula treats Kidney-deficiency lumbar pain) Treats Kidney-deficiency lumbar pain or pain caused by Wind-Cold invasion where Qi and Blood clash.
Duzhong (soaked in ginger juice and stir-fried, 12 pieces) Poguzhi (washed with water, 12 liang, stir-fried with sesame until color changes, remove sesame, bake on tile, grind to powder) Chenxiang (Aquilaria Wood, 6 liang) Hetao (Walnut Kernel, peeled and de-membraned, separately ground, 6 liang yellow meat) Moyao (Myrrha, separately ground) Ruxiang (Olibanum, separately ground, each 6 liang)
Grind into powder. Soak 12 liang of Rongzhrong in wine to form a paste, mix with the powder, and pound for over a thousand strokes to make pills the size of paulownia seeds. Take 30 pills per dose, swallowed with warm wine or salt water on an empty stomach.
Li'an San [Commentary] (Note: This formula treats sprain-induced lumbar pain) Treats Qi-stagnation lumbar pain, as well as sprain-induced and Kidney-deficiency lumbar pain.
Danggui (1 liang) Guanzi Gui (Cinnamomi Cortex, 1 liang) Yansu (stir-fried, 1 liang) Duzhong (stir-fried with ginger, 1 liang) Xiaohui (stir-fried, 1 liang) Muxiang (Aucklandiae Radix, 5 qian) Qianniu (Morning Glory Seed, 1 qian, half raw half fried)
Grind into powder. Take two teaspoons per dose, mixed with aged rice wine on an empty stomach. Another method removes Qianniu and decocts in wine.
Chuanxiong Rougui Tang [Commentary] (Note: This formula treats Cold-Damp lumbar pain) Treats lumbar pain from sleeping exposed to cold and dampness, preventing turning/side-bending, with spasmodic pain in the hypochondrium.
Dangguiwei (Tail of Angelica, 1 qian) Chuanxiong (1 qian) Taoren (5 seeds, peeled and de-pitted, ground) Rougui (Cinnamon Twig, 1 qian) Fangji (Stephania Root, 3 fen) Cangzhu (Atractylodes Rhizome, 1 qian) Qianghuo (Notopterygium Rhizome, 1.5 qian) Duhuo (Angelica Pubescens Root, 5 fen) Chaihu (Bupleurum Root, 1 qian) Fangfeng (Saposhnikovia Root, 3 fen) Shenqu (Medicated Leaven, 5 fen, fried) Gancao (Licorice Root, honey-fried, 1 qian)
Crush for one dose, decoct in aged wine, and take slightly warm after meals.
Zhuifeng Tongqi San (See Chapter on Carbuncles and Ulcers) Treats chronic lumbar pain lasting years. Add Chuanbixie (Dioscorea Hypoglauca Rhizome) and Yansu to this base formula, decoct in aged wine, and take.