疮疹发热，先腰痛者最忌。经曰∶腰者，肾之府也。又曰∶太阳所至为腰痛。盖足太阳膀胱经为十二经之首，
其脉侠脊，入循膂，络肾，疮疹之毒起于右肾之下，循足太阳膀胱散于诸经，乃邪由里传表也，如初发热其腰即痛，
此邪由膀胱直入于肾，故关节不利而腰痛，亟解毒以泻少阴之邪，发表以通太阳之经，使邪气不得以
深入，疮虽稠密，或可愈也。治若少缓，则太阳之邪由表以传于阳，少阴之邪由里
以传于阴，表里受病，阴阳俱伤，荣卫之脉不行，脏腑之气皆绝，或为黑陷，或为
痒塌，终莫能救矣。
凡发热便腰痛者，先服人参败毒散（初热），次服五苓散加独活、细辛主之。
〔薛〕痘疮而见腰痛证者，皆因肾经虚怯，相火内燥，真阴不能胜邪，故腰作痛也，急服地黄丸以防变黑归肾，
乃克有济。大抵此痘因禀赋肾家精气不足，故目睛多白，俗谓之折腰痘是也，若平素面白，眼白睛多，行迟语迟者，
出痘必归肾经，预为调补肾气，庶免此患。一小儿十三岁，眼睛多白，或时面赤，常患颈痛，尺脉洪数。先君谓禀肾
气虚。用地黄丸料煎服而愈。至十五岁出痘，先君云须多服前药，仍用地黄丸、益气汤，更加倦怠，乃以地黄丸大剂
煎与恣饮，又用大剂八珍汤，痘渐出如式，恪服前药，至期岁，二药计十七斤余而愈。先君每见婴儿白睛多，面
色白，或色赤，令其预补脾肾，以防出痘，但信者少耳。一小儿出痘，腰痛、足热、发渴。此禀肾虚火动也。先君用
大剂加减八味丸料煎与恣饮，诸证渐退，佐以大剂八珍加紫草、糯米数剂，脓渐灌，仍用前药而结痂，用八珍汤而靥。
一小儿出痘将愈，因停食泄泻，作渴腰痛。此脾肾虚弱也。先君用加减八味丸料及五味
异功散，渴泻顿止，又与六味丸料及八珍汤而靥。一小儿面色常白，目睛多白，
时常腰痛，两足时热，冬不衣绵，年九岁。先君谓禀肾虚。令每日服地黄丸，至十岁出痘，腰痛发渴，面赤饮冷，用
地黄丸每剂加肉桂半钱，煎与恣饮，数剂之后，热渴顿止，腰痛顿愈，却去肉桂，仍与服之，至五十余剂而靥。
加味地黄丸
熟地黄（酒浸，蒸透，晒干、八两，酒拌，杵膏） 山茱萸肉 干山药 五味子（炒。各四两） 泽泻
白茯苓 牡丹皮 鹿茸（炙。各三两） 肉桂（浓者，去皮取肉一两，发热者，以此加之，引虚火归肾经，
而热自止也）
上，各另为末，入地黄和匀，量入米糊丸服。煎服更好。
羌活当归汤 治腰背痛，初发热时便宜服之。
羌活 当归 独活 防风 川芎 黄柏（各一钱） 柴胡（一钱五分） 桂枝（七分） 栀仁 红花（各八分）
酒水各半，煎服。又方，治腰痛，有苍术、汉防己。
如神汤 治腰痛。
当归 桂皮 玄胡索
各等分，为末。酒下二三钱。
【背景信息】
书名：幼科证治准绳 作者：王肯堂 朝代：明 章节：腰痛 类别：综合
【原文翻译】
在疮疹（天花、麻疹等出疹性疾病）发热过程中，如果首先出现腰痛症状，这是最忌讳的。医经说：“腰是肾的外府。”又说：“太阳经受邪会导致腰痛。”足太阳膀胱经是十二经脉之首，其经脉夹行于脊柱两侧，深入循行于脊背肌肉，联络肾脏。疮疹的毒气起始于右肾之下，沿着足太阳膀胱经散布到各条经脉，这是病邪由体内向体表传变的过程。如果在刚开始发热时腰部就疼痛，这说明邪气从膀胱直接侵入肾脏，导致关节活动不利而引发腰痛。此时必须紧急解毒以泻除少阴肾经的邪气，同时发表以疏通太阳膀胱经，使邪气无法进一步深入。即使疮疹长得稠密，或许还可以治愈。如果治疗稍有迟缓，那么太阳经的邪气会从表传入阳分，少阴经的邪气会从里传入阴分，导致表里两经都受病，阴阳俱伤，营卫之气运行停滞，脏腑之气全部衰竭，可能出现痘疮黑陷或瘙痒塌陷的症状，最终就无法救治了。
凡是发热时就伴有腰痛的患者，应先服用人参败毒散（用于初期发热阶段），接着服用五苓散加独活、细辛来主治。
〔薛己按〕患痘疮而出现腰痛症状的，都是因为肾经虚弱怯懦，相火在内燥动，真阴不能制约邪气，所以腰部作痛。应当紧急服用地黄丸以防止病情恶化转为“黑归肾”重症，这样才能取得疗效。大抵这类痘疮是因为先天禀赋中肾的精气不足，所以患者眼睛白色部分较多，俗称“折腰痘”。如果平时面色苍白，眼白多，走路晚、说话晚的孩子，出痘时必然归于肾经。应预先调理补益肾气，才可以避免这种祸患。有一个十三岁的儿童，眼睛白色部分多，有时面色发红，经常患颈部疼痛，尺脉洪大数急。我的父亲认为这是禀受肾气虚弱的表现。使用地黄丸的药料煎服而痊愈。到了十五岁出痘时，父亲说必须多服用前面的药物，仍然用地黄丸、益气汤，孩子更加倦怠乏力，于是用大剂量的地黄丸煎汤让他随意饮用，又用大剂量的八珍汤，痘疮逐渐按照正常规律发出，严格服用前面的药物，到满周岁时，两种药合计服用十七斤多才痊愈。父亲每次见到婴儿眼白多、面色白或色赤，都会嘱咐预先补益脾肾，以防出痘时发生变故，但相信的人很少。
另一个小儿出痘时，出现腰痛、脚热、口渴的症状。这是禀受肾虚导致虚火妄动的表现。父亲用大剂量的加减八味丸药料煎汤让他随意饮用，各种症状逐渐消退，辅助以大剂量八珍汤加紫草、糯米几剂，脓液逐渐充盈，仍然用前面的药物结痂，最后用八珍汤收靥（脱痂愈合）。
还有一个小儿出痘即将痊愈时，因为停食导致泄泻，出现口渴和腰痛。这是脾肾虚弱所致。父亲用加减八味丸药料及五味异功散，口渴和腹泻立刻停止，又给予六味丸药料及八珍汤使其收靥。
还有一个小儿面色常白，眼白多，时常腰痛，两脚时常发热，冬天不穿棉衣，九岁时。父亲认为是禀受肾气虚弱。命令每天服用地黄丸，到十岁出痘时，出现腰痛、口渴、面色红、想喝冷水的情况，用地黄丸每剂加入肉桂半钱，煎汤让他随意饮用，几剂之后，热象和口渴立刻停止，腰痛立刻痊愈，随后去掉肉桂，继续服用前面的药物，服用了五十多剂后收靥。
加味地黄丸
熟地黄（酒浸，蒸透，晒干，八两，酒拌，捣成膏状） 山茱萸肉 干山药 五味子（炒，各四两） 泽泻 白茯苓 牡丹皮 鹿茸（炙，各三两） 肉桂（浓者，去皮取肉一两，发热者，以此加之，引虚火归肾经，而热自止也）
以上各药分别研为细末，加入地黄和匀，适量加入米糊制成丸剂服用。煎汤服用效果更好。
羌活当归汤 治疗腰背痛，初发热时适宜服用。
羌活 当归 独活 防风 川芎 黄柏（各一钱） 柴胡（一钱五分） 桂枝（七分） 栀仁 红花（各八分）
酒水各半，煎汤服用。另一个方子，治疗腰痛，含有苍术、汉防己。
[Background Information]
Book: Youke Zhengzhi Zhunsheng (Standard for Diagnosis and Treatment of Pediatric Diseases)
Author: Wang Kentang
Dynasty: Ming
Chapter: Lower Back Pain
Category: Comprehensive
[English Translation]
In the course of eruptive diseases such as smallpox or measles, if lower back pain appears first during fever, it is most taboo. The Classics state: "The waist is the mansion of the Kidney." It also states: "When the Taiyang channel is affected, it results in lower back pain." The Foot-Taiyang Bladder Channel is the head of the twelve channels; its vessel runs alongside the spine, enters along the paravertebral muscles, and connects with the Kidney. The toxin of eruptive diseases originates below the right Kidney, spreads along the Foot-Taiyang Bladder Channel to various other channels, representing the transmission of pathogenic factors from the interior to the exterior. If lower back pain occurs immediately upon the initial onset of fever, this indicates that the pathogen has entered the Kidney directly from the Bladder, causing joint stiffness and lower back pain. In this situation, one must urgently resolve toxicity to drain the pathogenic factors of the Shaoyin (Kidney) channel, and release the exterior to unblock the Taiyang (Bladder) channel, preventing the pathogen from penetrating deeper. Even if the eruptions are dense, recovery may still be possible. If treatment is delayed even slightly, the pathogen of the Taiyang channel will transmit from the exterior to the Yang aspect, and the pathogen of the Shaoyin channel will transmit from the interior to the Yin aspect. This leads to disease in both the interior and exterior, injury to both Yin and Yang, stagnation of Ying (Nutritive) and Wei (Defensive) vessels, and exhaustion of Qi in all Zang-Fu organs. This may result in black depression of the eruptions or itching and collapse, ultimately becoming incurable.
For patients who experience lower back pain concurrent with fever, initially administer Renshen Baidu San (Ginseng Detoxification Powder) [for early-stage fever], followed by Wuling San (Five-Ingredient Poria Pill) modified with Du Huo (Notopterygii Rhizoma et Radix) and Xi Xin (Asari Radix).
[Xue Ji's Commentary] Cases of smallpox presenting with lower back pain are due to deficiency and weakness of the Kidney Channel, with Ministerial Fire stirring internally and dryness arising, such that True Yin cannot overcome the pathogen, resulting in lower back pain. One should urgently administer Dihuang Wan (Rehmannia Pill) to prevent progression to the severe condition known as "Black Return to the Kidney," thereby ensuring efficacy. Generally, these cases of smallpox arise from congenital insufficiency of Essence and Qi in the Kidney system; thus, the whites of the eyes are often prominent, a condition colloquially called "Broken-Waist Smallpox." Children who typically have pale complexions, prominent whites in the eyes, delayed walking, and delayed speech will likely have their smallpox pathology return to the Kidney Channel. One should preemptively regulate and tonify Kidney Qi to avoid such complications.
One thirteen-year-old child had prominent whites in the eyes, occasional facial redness, frequent neck pain, and a洪数 (surging and rapid) Chi pulse. My father diagnosed this as congenital Kidney Qi deficiency. The patient was cured using the ingredients of Dihuang Wan decocted and taken orally. When this child developed smallpox at age fifteen, my father advised continuing the previous medication, using Dihuang Wan and Yiqi Tang (Qi-Supplementing Decoction). As the child became increasingly fatigued, large doses of Dihuang Wan were decocted for free consumption, along with large doses of Bazhen Tang (Eight-Treasure Decoction). The eruptions gradually appeared according to the normal pattern. Strict adherence to the previous medications led to recovery after consuming over seventeen jin (approx. 8.5 kg) of the two medicines combined by the end of the first year. Whenever my father observed infants with prominent whites in the eyes, pale or reddish complexions, he would advise preemptive tonification of the Spleen and Kidney to prevent complications during smallpox eruption, though few believed him.
Another child developing smallpox presented with lower back pain, heat in the feet, and thirst. This indicated congenital Kidney deficiency with stirring of deficient fire. My father prescribed large doses of Jiajian Bawei Wan (Modified Eight-Ingredient Rehmannia Pill) decocted for free consumption, which gradually alleviated the symptoms. This was supplemented with large doses of Bazhen Tang plus Zi Cao (Arnebiae Radix seu Rubra) and Nuomi (Glutinous Rice) for several doses. Pus gradually filled the lesions. The previous medication was continued until scabbing occurred, followed by Bazhen Tang until the scabs fell off (jieye).
Another child, nearing recovery from smallpox, suffered from food stagnation-induced diarrhea, thirst, and lower back pain. This was attributed to Spleen and Kidney deficiency. My father used Jiajian Bawei Wan and Wuwei Yigong San (Five-Ingredient Extraordinary Merit Powder), which instantly stopped the thirst and diarrhea. Liuwei Wan (Six-Ingredient Rehmannia Pill) and Bazhen Tang were then administered until the scabs fell off.
Another child, aged nine, had a constant pale complexion, prominent whites in the eyes, frequent lower back pain, intermittent heat in both feet, and refused to wear cotton in winter. My father diagnosed congenital Kidney deficiency and ordered daily intake of Dihuang Wan. At age ten, when smallpox erupted, the child experienced lower back pain, thirst, facial redness, and desire for cold drinks. Dihuang Wan was modified with Ban Qian (half qian, approx. 1.875g) of Rou Gui (Cinnamomi Cortex) per dose, decocted for free consumption. After several doses, the heat and thirst ceased instantly, and the lower back pain resolved completely. Rou Gui was then discontinued, and the original formula was continued. Recovery occurred after more than fifty doses.
Jiawei Dihuang Wan (Additive Rehmannia Pill)
Shu Dihuang (Prepared Rehmanniae Radix, soaked in wine, steamed through, sun-dried, 8 liang, mixed with wine, pounded into paste)
Shanzhuyu (Corni Fructus)
Gan Shanyao (Dioscoreae Rhizoma)
Wuweizi (Schisandrae Fructus, stir-fried, 4 liang each)
Zexie (Alismatis Rhizoma)
Baifuling (Poria with Hostwood)
Mudanpi (Moutan Cortex)
Lurong (Cervi Cornus Pantotrichum, roasted, 3 liang each)
Rougui (Cinnamomi Cortex, thick bark, peeled to obtain flesh, 1 liang; add this when fever is present to guide deficient fire back to the Kidney channel, thereby stopping the heat.)
All ingredients are separately ground into fine powder, mixed evenly with the Rehmannia paste, and formed into pills using rice paste as a binder. Taking them as a decoction is preferable.
Qianghuo Danggui Tang (Notopterygium and Angelica Decoction)
Indicated for lower back and back pain; suitable for administration during the initial fever stage.
Qianghuo (Notopterygii Rhizoma et Radix)
Danggui (Angelicae Sinensis Radix)
Du Huo (Notopterygii Rhizoma et Radix)
Fangfeng (Saposhnikoviae Radix)
Chuanxiong (Ligustici Chuanxiong Rhizoma)
Huangbai (Phellodendri Cortex, 1 qian each)
Chaihu (Bupleuri Radix, 1.5 qian)
Guizhi (Cinnamomi Ramulus, 0.7 qian)
Zhiren (Gardeniae Semen)
Honghua (Carthami Flos, 0.8 fen each)
Decoct with half wine and half water. Another prescription for lower back pain includes Cangzhu (Atractylodis Rhizoma) and Han Fangji (Stephaniae Tetrandrae Radix).
Rushen Tang (Miraculous Divine Decoction)
Indicated for lower back pain.
Danggui (Angelicae Sinensis Radix)
Guipi (Cinnamomi Cortex)
Yanhusuo (Corydalis Rhizoma)
Equal parts, ground into powder. Take 2-3 qian with wine.