《治法纲》曰∶腰者肾之外候，一身所恃，赖转移者也。盖诸经皆贯于肾而络于腰脊，肾气一虚，腰必
痛矣。有肾虚而腰痛者，有淤血而痛者，有挫闪而痛者，有痰而痛者，有湿热而痛者，有风寒而痛者，有气
滞而痛者。
腰者肾之府，不能转摇，肾将惫矣。戴氏曰∶腰痛而不已者，是肾虚也，宜补肾。淤血作痛，日轻夜重
是也，宜行血顺气。有暑热动作必有痰，或一块作痛，遇天阴而发也，宜燥湿行气豁痰，使痰随气运化也。
腰枢因拗 忽然不可俯仰，此淤血为患，以桃仁、大黄、苏木、当归、红花之类。若痛转侧如锥刺者，尤
是也。肾冷如冰，饮食如故。小便自利，腰间如带五千钱，治宜去湿之药，兼用温散之剂。
又曰∶肾虚腰痛者，其脉必大，不能转侧，如疲弱嗜卧，痛而不已，宜用加味虎潜丸之类。风伤肾腰
痛者，其脉必浮，或左或右，痛无常处，牵引两足，宜用独活寄生汤。感寒而痛，其脉必紧，见热则减，
见寒则增，宜用五积散去桔梗，加吴茱萸。气滞而作痛者，其脉必沉，宜乌药顺气散，可加木香。腰软而
不能强者，是肝肾二经受病，宜消息用药。凡腰痛之症，多因肾脏真阴虚损，外被风寒之郁遏，内有湿热之
流注，以致营卫不通，故作痛也。
《千金》云所感不同，腰痛有五∶一曰阳气不足，少阴肾衰之故；二曰风痹，风寒湿着之故；三曰肾
虚，劳役伤肾之故；四曰坠堕伤腰之故；五曰湿地寝卧之故。此皆各有所因而致之，治宜审症用药。
大抵腰之作痛，亦不宜补气之药，又不宜峻用寒凉。因
而气虚作痛者，非补不可，不能不用补气之药，当监制之，又何执一论哉。
背痛有静坐久而痛者，属虚，补中益气汤、八物汤。肥人多痰，年高必用人捶而痛快者，属痰与虚，
除湿化痰，兼补肾脾。醉饱后多痛欲捶，是脾不运而湿热作禁也，须节饮。瘦人多是血少阴虚，亦不禁酒及
浓味而然，养血清火为要。又有素虚后，及病后、产后、经行后心痛，或牵引乳胁，或走注背肩，此元气上
逆，当引使归元，不可复下疏利，愈利愈虚。发汗后患此者众，惟宜温补。拘于痛无补法，谬矣。汗
者心之液，阳受气于胸中，汁过多则心液耗，阳气不足，故致痛也。
柯柏斋曰∶腰痛之证，多因肾虚所致。盖肾虚则精血之真气不足，寒湿之气乘虚而入，久则结滞不通，
真气与之相攻，故痛。先泻其邪，后补其气，此治法也。未泻而补，则补而不效；泻而不补，则痛必复作，
盖邪乘其虚而再入也。腰痛亦有因闪挫而得者，闪挫之初，必有凝滞之处，亦宜先泻而后补也。疝痛与腰痛皆
起于肾虚寒湿，由前而入则为疝，由后而入则为腰痛。
张景岳曰∶腰痛之虚症，十居八九。但察既无表邪，又无湿热，而或年衰劳苦，或酒色斫丧，或七情忧
郁所致者，悉属真阴虚症。凡虚证之候，形色必青白，间或见黧黑；脉息必和缓，而或细微；或行立劳动
更甚，而卧息少可。盖积而渐至者皆不足，暴而痛甚者多有余，治宜辨之。凡肾水真阴虚，宜当归地黄饮，
及左右归丸；若病稍轻，或痛不甚，虚不甚者，青蛾丸、煨肾丸、补髓丹、通气散。
丹溪云∶诸腰痛，不可用参补气，亦不可峻用寒凉。此言未当。盖凡劳伤虚损而阳不足者，多有气虚之
症，何为参
不可用？又如火聚下焦，痛极不可忍者，速宜清火。而热不甚，不宜过用寒凉者有之；或虚中挟实，不宜
参者亦有之。概谓不可用寒凉，岂其然乎？
《治法纲》说：腰部是肾脏的外在表现，是人体所依赖的、负责转动的器官。因为各条经脉都贯穿肾脏并联络腰脊，肾气一旦虚弱，腰部必然疼痛。有因肾虚而腰痛者，有因瘀血而痛者，有因挫伤闪失而痛者，有因痰湿而痛者，有因湿热而痛者，有因风寒而痛者，有因气滞而痛者。
腰部是肾脏的府邸，如果腰部不能转动摇晃，说明肾脏即将衰败。戴氏说：腰痛久治不愈的，是肾虚所致，应当补肾。瘀血引起的疼痛，特点是白天轻晚上重，应当活血行气。暑热时节活动后往往生痰，或者局部结块作痛，遇阴天发作，应当燥湿行气、豁痰，使痰随气机运化。腰部枢轴突然扭伤，导致忽然不能俯仰，这是瘀血为患，可用桃仁、大黄、苏木、当归、红花等药治疗。如果疼痛如针刺般剧烈，更是如此。肾冷如冰，但饮食正常，小便通畅，腰间感觉像束着五千枚铜钱（沉重感），治疗宜用祛湿药，兼用温散剂。
又说：肾虚腰痛的人，脉象必定大，身体不能转侧，疲弱嗜睡，疼痛不止，宜用加味虎潜丸之类。风邪伤及肾脏引起腰痛的人，脉象必定浮，疼痛部位或左或右，没有固定位置，牵引两足疼痛，宜用独活寄生汤。感受寒邪而痛，脉象必定紧，遇热减轻，遇寒加重，宜用五积散去掉桔梗，加入吴茱萸。气滞引起的疼痛，脉象必定沉，宜用乌药顺气散，可加入木香。腰部软弱无力，不能强直，是肝肾二经受病，应斟酌用药。凡是腰痛的症状，多因肾脏真阴虚损，外受风寒郁遏，内有湿热流注，导致营卫不通畅，所以发生疼痛。
《千金方》说：感受不同，腰痛有五种：一是阳气不足，是少阴肾衰的缘故；二是风痹，是风寒湿邪留着体内的缘故；三是肾虚，是劳役损伤肾脏的缘故；四是坠堕损伤腰部的缘故；五是卧于湿地的缘故。这些都各有病因导致，治疗应当审察症状用药。
大体上腰部作痛，也不宜使用补气药，又不宜峻烈地使用寒凉药。但如果确实是气虚作痛，非补不可，不能不用补气药，只要加以监制即可，何必拘泥于一论呢？
背痛有因久坐而痛的，属于虚证，用补中益气汤、八物汤。肥胖人多痰，年高且必须用人捶打才痛快感的，属于痰与虚，宜除湿化痰，兼补肾脾。醉饱之后多痛欲捶打的，是脾不运化而湿热作祟，须节制饮酒。瘦人多是血少阴虚，也是不禁酒及浓味食物导致的，以养血清火为要。又有素体虚弱后，以及病后、产后、月经后出现心痛，或牵引乳胁，或游走至背肩，这是元气上逆，应当引导其回归本源，不可再用下法疏利，越疏利越虚。发汗后患此病的很多，只宜温补。拘泥于“痛无补法”的观点，是错误的。汗是心之液，阳气受气于胸中，汗出过多则心液耗损，阳气不足，所以导致疼痛。
柯柏斋说：腰痛的病症，多因肾虚所致。因为肾虚则精血真气不足，寒湿之气乘虚而入，久了则结滞不通，真气与邪气相争，所以疼痛。先泻除邪气，后补益真气，这是治疗方法。未泻邪而先补，则补而不效；只泻不补，则疼痛必复发，因为邪气会乘虚再入。腰痛也有因闪挫而得的，闪挫之初，必有凝滞之处，也宜先泻后补。疝痛与腰痛都起于肾虚寒湿，由前阴而入则为疝，由后腰而入则为腰痛。
张景岳说：腰痛的虚证，十占八九。只要观察既无表邪，又无湿热，而或因年老劳累，或因酒色过度，或因七情忧郁所致的，都属于真阴虚证。凡是虚证的征候，面色必定青白，间或见黧黑；脉息必定和缓，或细微；或行走站立劳动时更甚，卧床休息时稍好。积累而逐渐形成的都是不足，突然发作且疼痛剧烈的多有余邪，治疗应当辨别清楚。凡是肾水真阴虚，宜用当归地黄饮，以及左归丸、右归丸；若病情稍轻，或疼痛不甚，虚损不重的，可用青蛾丸、煨肾丸、补髓丹、通气散。
朱丹溪说：各种腰痛，不可用参补气，也不可峻用寒凉。这种说法是不恰当的。因为凡是劳伤虚损而阳气不足的，多有气虚的症状，为什么不能用参？另外如火聚在下焦，疼痛极度难以忍受的，速宜清火。而热势不盛，不宜过用寒凉的确实存在；或虚中挟实，不宜用参的也确实存在。一概说不可用寒凉，难道是这样吗？
The *Zhi Fa Gang* states: The waist is the external manifestation of the Kidney, relied upon by the whole body for movement and rotation. Since all meridians pass through the Kidney and connect to the lumbar spine, once Kidney Qi becomes deficient, the waist will inevitably hurt. There are cases of lumbar pain due to Kidney deficiency, blood stasis, sprain or strain, phlegm-dampness, damp-heat, wind-cold, and qi stagnation.
The waist is the mansion of the Kidney; if it cannot rotate or sway, the Kidney is on the verge of exhaustion. Dai Shi said: Lumbar pain that persists and does not heal indicates Kidney deficiency, which should be treated by tonifying the Kidney. Pain caused by blood stasis is characterized by being lighter during the day and heavier at night; it should be treated by promoting blood circulation and regulating qi. After physical activity in summer heat, phlegm often arises, causing localized lump-like pain that worsens on cloudy days; treatment should involve drying dampness, moving qi, and resolving phlegm, allowing the phlegm to be transformed and transported with qi. Sudden twisting of the lumbar pivot resulting in inability to bend forward or backward is caused by blood stasis; herbs such as Tao Ren (Peach Kernel), Da Huang (Rhubarb Root and Rhizome), Su Mu (Sappan Wood), Dang Gui (Angelica Sinensis), and Hong Hua (Carthamus Flower) may be used. If the pain feels like needle pricks, this confirms the diagnosis. Coldness in the Kidney region like ice, yet normal diet and urination, accompanied by a sensation of heaviness in the waist as if bound by five thousand coins, should be treated with damp-resolving herbs combined with warming and dispersing agents.
It is also stated: For lumbar pain due to Kidney deficiency, the pulse must be large, the body unable to turn sideways, accompanied by fatigue, weakness, desire to lie down, and unceasing pain; Jia Wei Hu Qian Wan (Modified Tiger-Hiding Pill) should be used. For lumbar pain caused by Wind injuring the Kidney, the pulse must be floating, pain occurring alternatively on the left or right without fixed location, radiating to both legs; Du Huo Ji Sheng Tang (Notopterygium and Sangjisheng Decoction) should be used. For pain caused by Cold invasion, the pulse must be tight, alleviated by heat and aggravated by cold; Wu Ji San (Five Accumulations Powder) with Jing Jie removed and Wu Zhu Yu (Evodia Fruit) added should be used. For pain caused by qi stagnation, the pulse must be deep; Wu Yao Shun Qi San (Lindera Regulating Qi Powder) with Mu Xiang (Aucklandia Root) added may be used. Weakness and inability to straighten the waist indicate disease in the Liver and Kidney meridians; medication should be adjusted according to circumstances. Generally, lumbar pain is caused by deficiency of True Yin in the Kidney, external constraint by wind-cold, internal accumulation of damp-heat, leading to obstruction of Ying and Wei (Nutritive and Defensive Qi), thus causing pain.
The *Qian Jin Fang* states: Due to different pathogenic factors, there are five types of lumbar pain: 1. Insufficiency of Yang Qi, due to decline of Shaoyin Kidney; 2. Feng Bi (Wind Bi Syndrome), due to lingering of wind, cold, and dampness; 3. Kidney deficiency, due to overwork damaging the Kidney; 4. Trauma from falling, damaging the waist; 5. Lying on damp ground. All these arise from specific causes, and treatment must be based on syndrome differentiation.
Generally, lumbar pain should not be treated with Qi-tonifying herbs, nor with harshly cooling herbs. However, if the pain is indeed due to Qi deficiency, tonification is necessary; one simply needs to monitor and control the dosage, rather than adhering rigidly to a single theory.
Back pain caused by prolonged sitting belongs to deficiency; Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) and Ba Wu Tang (Eight Substance Decoction) are indicated. Obese people often have phlegm; those who are elderly and find relief only after being beaten by hand have conditions involving phlegm and deficiency; treatment should focus on removing dampness, resolving phlegm, and simultaneously tonifying the Spleen and Kidney. Pain after excessive drinking and eating that desires percussion indicates Spleen failure to transform and damp-heat acting up; alcohol intake must be restricted. Thin people mostly suffer from blood deficiency and Yin deficiency, often exacerbated by indulgence in alcohol and rich flavors; nourishing blood and clearing fire is essential. Additionally, heart pain occurring after constitutional weakness, illness, postpartum, or menstruation, which may radiate to the breasts and hypochondrium or travel to the back and shoulders, is due to Yuan Qi (Original Qi) rebelling upward. It should be guided back to its origin; purgative and draining methods should not be repeated, as they further deplete the body. This condition is common after sweating therapies; only warming and tonifying are appropriate. Adhering to the fallacy that "pain has no tonification method" is erroneous. Sweat is the fluid of the Heart; Yang Qi receives its energy from the chest. Excessive sweating consumes Heart fluids and depletes Yang Qi, thereby causing pain.
Ke Bozhai stated: Lumbar pain syndromes are mostly caused by Kidney deficiency. When the Kidney is deficient, the true qi of essence and blood is insufficient, allowing cold-damp pathogens to enter vacuously. Over time, stagnation occurs, and true qi battles the pathogen, causing pain. The treatment method is to first drain the pathogen, then tonify the qi. Tonifying before draining results in ineffective tonification; draining without tonifying leads to recurrence of pain because pathogens re-enter due to deficiency. Lumbar pain can also result from sprains or strains. Initially, there is stagnation; thus, draining followed by tonification is also appropriate here. Hernia pain and lumbar pain both originate from Kidney deficiency and cold-dampness. Entering from the anterior results in hernia; entering from the posterior results in lumbar pain.
Zhang Jingyue stated: Deficient syndromes account for eight or nine out of ten cases of lumbar pain. If there are no exterior pathogens and no damp-heat, but the cause is aging and labor, excess of wine and sexual activity, or emotional depression, all belong to True Yin deficiency. Signs of deficiency syndromes include a bluish-white complexion, occasionally dark/blackish; the pulse is harmonious and slow, or fine and minute; symptoms worsen with walking, standing, and exertion, and improve slightly with rest. Conditions developing gradually through accumulation are always deficiencies; sudden onset with severe pain is mostly excess. Treatment requires careful differentiation. For True Yin deficiency of Kidney Water, Dang Gui Di Huang Yin (Angelica and Rehmannia Drink), Zuo Gui Wan (Left Restoring Pill), and You Gui Wan (Right Restoring Pill) are indicated. For milder cases, less severe pain, or mild deficiency, Qing E Wan (Green Parrot Pill), Wei Shen Wan (Roasted Kidney Pill), Bu Sui Dan (Marrow-Nourishing Pill), and Tong Qi San (Moving Qi Powder) may be used.
Zhu Danxi stated: Various lumbar pains should not be treated with Ginseng to tonify Qi, nor with harshly cooling herbs. This statement is inappropriate. For cases of labor injury and deficiency where Yang is insufficient, Qi deficiency symptoms are common; why is Ginseng inadvisable? Furthermore, when Fire accumulates in the Lower Jiao, causing unbearable pain, rapid clearance of Fire is required. While it is true that for mild heat, harsh cooling is unnecessary, and for deficiency mixed with excess, Ginseng may be contraindicated, it is incorrect to generalize that cooling herbs should never be used.