腿痛亦属六经。前廉为阳明。白芷、升麻、干葛为引经。后廉太阳。羌活、防风。外廉少阳。
柴胡、羌活。内廉厥阴。青皮、吴茱萸。内前廉太阴。苍术、白芍。内后廉少阴。独活、泽泻。
痛有血虚血寒。寒湿风湿。湿热流注。阴虚阳虚。肾虚风袭之殊。
血虚者。足不任地。行则振掉。脉细弱。六味丸加巴戟、续断、杜仲、鹿茸。血寒者。经急。脉
沉。喜汤火。严冬尤甚。舒筋三圣散。湿者两腿隐隐痛。或麻瞀作肿身沉重。肢节疼痛。恶风不
欲去衣。脉浮涩。或浮细。除风湿羌活汤。脉沉。白术附子汤。肥人。导痰汤加减。湿热者。痛
自腰胯以至足胫。或上或下。或红或肿。小便赤涩。脉濡大而数。当归拈痛汤。流注者。郁痰留
于腰胁有块。互换作痛。恶心头眩。脉沉滑或弦。二陈汤加羌活、白术。阴虚者。肌体羸瘦。足
心及胫热痛。左尺细数。或两尺数盛。虎潜丸去橘皮加肉桂。阳虚者。两足浮肿无力。大便泻。
小便短少。痛不能动。左尺虚大。或两尺浮迟。脾与命门俱虚。先用补中益气加桂、附。后用八
味丸。肾虚风袭。则下体痿弱。骨节疼痛。喘咳失精。腰腹腿胫俱痛。尺中浮大而数。安肾丸。
大股痛 痛而喜按者。肝肾虚寒而湿气痹着也。四斤丸二方选用。痛不可按者。败血也。川
芎肉桂汤。或舒筋三圣散。酒调服。妇人产后多有此证。宜加穿山甲、桃仁。虚人。十全大补汤
加附子、穿山甲。有湿热者。痛虚心肿。而沉重不能转侧。二妙散加羌、防、升、柴、术、草之
类。或除湿汤、渗湿汤选用。寒热而胆痛者。须防发痈。
腿痛也归属于六经辨证体系。大腿前侧疼痛属于阳明经，常用白芷、升麻、干葛作为引经药。大腿后侧疼痛属于太阳经，常用羌活、防风。大腿外侧疼痛属于少阳经，常用柴胡、羌活。大腿内侧疼痛属于厥阴经，常用青皮、吴茱萸。大腿内前侧疼痛属于太阴经，常用苍术、白芍。大腿内后侧疼痛属于少阴经，常用独活、泽泻。
腿痛的病因病机有血虚、血寒、寒湿、风湿、湿热流注、阴虚、阳虚、肾虚受风袭等不同区别。
血虚引起的腿痛，表现为双脚无法承受体重，行走时身体震颤摇晃，脉象细弱，治疗用六味丸（Liuwei Wan, Six-Ingredient Pill with Rehmannia）加巴戟天、续断、杜仲、鹿茸。血寒引起的腿痛，表现为经脉拘急，脉象沉，喜欢热敷或火烤，严冬时节症状尤为严重，治疗用舒筋三圣散（Shujin Sansheng San, Three-Saint Decoction for Relaxing Tendons）。湿气重引起的腿痛，表现为双腿隐隐作痛，或者麻木昏沉并伴有肿胀，身体沉重，肢节疼痛，怕风不想脱衣，脉象浮涩或浮细，治疗用除风湿羌活汤（Chufengshi Qianghuo Tang, Decoction to Remove Wind-Dampness with Notopterygium），若脉象沉则用白术附子汤（Baizhu Fuzi Tang, Atractylodes and Aconite Decoction），体型肥胖者用导痰汤（Daotan Tang, Phlegm-Guiding Decoction）加减。湿热引起的腿痛，疼痛从腰胯一直延伸到足胫，位置上下不定，患处发红或肿胀，小便赤红涩痛，脉象濡大而数，治疗用当归拈痛汤（Danggui Niantong Tang, Angelica Decoction to Relieve Pain）。流注（Flowing Abscess/Phlegm-Nodule accumulation）引起的腿痛，郁结的痰浊停留在腰胁部形成肿块，疼痛部位互换，恶心头晕，脉象沉滑或弦，治疗用二陈汤（Erchen Tang, Two-Aged Decoction）加羌活、白术。阴虚引起的腿痛，表现为形体消瘦，足心及小腿发热疼痛，左尺脉细数，或两尺脉数盛，治疗用虎潜丸（Hujian Wan, Tiger-Hiding Pill）去掉橘皮加入肉桂。阳虚引起的腿痛，表现为双足浮肿无力，大便泄泻，小便短少，疼痛剧烈无法活动，左尺脉虚大，或两尺脉浮迟，这是脾与命门（Mingmen Gate of Vitality）俱虚，先用补中益气汤（Buzhong Yiqi Tang, Decoction to Supplement the Middle and Augment Qi）加肉桂、附子，后用八味丸（Bawei Wan, Eight-Ingredient Pill）。肾虚受风邪侵袭，表现为下肢痿弱，骨节疼痛，气喘咳嗽，遗精，腰腹腿胫全部疼痛，尺脉浮大而数，治疗用安肾丸（Anshen Wan, Kidney-Calming Pill）。
大腿剧痛（大股痛）：疼痛且喜欢按压的，是肝肾虚寒且湿气痹阻所致，选用四斤丸（Sijin Wan, Four-Jin Pill）的两个方剂之一。疼痛且不可按压的，是瘀血阻滞，用川芎肉桂汤（Chuanxiong Rougui Tang, Ligusticum and Cinnamon Twig Decoction），或者舒筋三圣散，用酒调服。妇女产后多有此证，宜加穿山甲、桃仁。体虚者，用十全大补汤（Shiquan Dabu Tang, Perfect Ten Great Tonifying Decoction）加附子、穿山甲。若有湿热者，疼痛伴有心胸烦闷、局部肿胀，且沉重不能翻身转动，选用二妙散（Ermiao San, Two-Marvel Powder）加羌活、防风、升麻、柴胡、白术、甘草之类，或者选用除湿汤（Chushi Tang, Dampness-Removing Decoction）、渗湿汤（Shenshi Tang, Dampness-Seeping Decoction）。若出现寒热往来且胆区疼痛，须防止发生痈肿。
Leg pain is also categorized within the framework of the Six Channels (Liujing). Pain on the anterior aspect of the thigh belongs to the Yangming Channel; Bai Zhi (Angelicae Dahuricae Radix), Sheng Ma (Cimicifugae Rhizoma), and Gan Ge (Puerariae Radix) are used as guiding herbs. Pain on the posterior aspect belongs to the Taiyang Channel, treated with Qiang Huo (Notopterygii Rhizoma et Radix) and Fang Feng (Saposhnikoviae Radix). Pain on the lateral aspect belongs to the Shaoyang Channel, treated with Chai Hu (Bupleuri Radix) and Qiang Huo. Pain on the medial aspect belongs to the Jueyin Channel, treated with Qing Pi (Citri Reticulatae Pericarpium Viride) and Wu Zhu Yu (Evodiae Fructus). Pain on the anteromedial aspect belongs to the Taiyin Channel, treated with Cang Zhu (Atractylodis Rhizoma) and Bai Shao (Paeoniae Radix Alba). Pain on the posteromedial aspect belongs to the Shaoyin Channel, treated with Du Huo (Angelicae Pubescentis Radix) and Ze Xie (Alismatis Rhizoma).
The etiologies and pathogenesis of leg pain vary, including Blood Deficiency (Xue Xu), Blood Cold (Xue Han), Cold-Dampness (Han Shi), Wind-Dampness (Feng Shi), Damp-Heat Flowing Accumulation (Shi Re Liu Zhu), Yin Deficiency (Yin Xu), Yang Deficiency (Yang Xu), and Kidney Deficiency with Wind Invasion (Shen Xu Feng Xi).
In cases of Blood Deficiency, the feet cannot bear weight, trembling occurs upon walking, and the pulse is fine and weak. Treatment uses Liuwei Wan (Six-Ingredient Pill with Rehmannia) added with Ba Ji Tian (Morindae Officinalis Radix), Xu Duan (Dipsaci Radix), Du Zhong (Eucommiae Cortex), and Lu Rong (Cervi Cornu Pantotrichum). In cases of Blood Cold, the meridians feel tight, the pulse is deep, and the patient prefers heat from hot water or fire; symptoms worsen in severe winter. Treatment uses Shujin Sansheng San (Three-Saint Decoction for Relaxing Tendons). In cases of Dampness, there is a dull pain in both legs, or numbness, dizziness, swelling, heaviness of the body, and joint pain. The patient fears wind and dislikes removing clothes; the pulse is floating and choppy, or floating and fine. Treatment uses Chufengshi Qianghuo Tang (Decoction to Remove Wind-Dampness with Notopterygium); if the pulse is deep, use Baizhu Fuzi Tang (Atractylodes and Aconite Decoction). For obese individuals, Daotan Tang (Phlegm-Guiding Decoction) is modified. In cases of Damp-Heat, pain extends from the waist and hips to the shins, moving up or down, with redness or swelling, and dark, scanty urination. The pulse is soggy, large, and rapid. Treatment uses Danggui Niantong Tang (Angelica Decoction to Relieve Pain). In cases of Flowing Accumulation (phlegm-nodules), stagnant phlegm remains in the waist and hypochondrium forming masses, causing shifting pain, nausea, and dizziness. The pulse is deep and slippery, or wiry. Treatment uses Erchen Tang (Two-Aged Decoction) added with Qiang Huo and Bai Zhu. In cases of Yin Deficiency, the body is emaciated, with hot pain in the soles and shins. The left Chi position pulse is fine and rapid, or both Chi positions are rapidly full. Treatment uses Hujian Wan (Tiger-Hiding Pill) with Ju Pi (Citri Reticulatae Pericarpium) removed and Rou Gui (Cinnamomi Cortex) added. In cases of Yang Deficiency, both feet are swollen and weak, stool is loose, urine is short, and pain prevents movement. The left Chi position pulse is deficient and large, or both Chi positions are floating and slow. This indicates deficiency of both the Spleen and Mingmen (Gate of Vitality). Initially, Buzhong Yiqi Tang (Decoction to Supplement the Middle and Augment Qi) is used with Rou Gui and Fu Zi; subsequently, Bawei Wan (Eight-Ingredient Pill) is administered. When Kidney Deficiency is complicated by Wind Invasion, there is flaccidity of the lower body, bone and joint pain, asthma and cough, seminal emission, and pain throughout the waist, abdomen, thighs, and shins. The Chi pulse is floating, large, and rapid. Treatment uses Anshen Wan (Kidney-Calming Pill).
Severe Thigh Pain: Pain that is relieved by pressure indicates Liver and Kidney deficiency-cold with Bi obstruction due to dampness. One of the two formulas of Sijin Wan (Four-Jin Pill) is selected. Pain that cannot be pressed indicates blood stasis. Treatment uses Chuanxiong Rougui Tang (Ligusticum and Cinnamon Twig Decoction) or Shujin Sansheng San, taken with wine. This condition is common in postpartum women; Shan Zha (Manis Squama) and Tao Ren (Persicae Semen) should be added. For deficient patients, Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction) is used with Fu Zi and Shan Zha. If damp-heat is present, accompanied by chest vexation, local swelling, and heaviness preventing turning over, Ermiao San (Two-Marvel Powder) is added with Qiang Huo, Fang Feng, Sheng Ma, Chai Hu, Bai Zhu, and Gan Cao, or Chushi Tang (Dampness-Removing Decoction) and Shenshi Tang (Dampness-Seeping Decoction) are selected. If chills and fever occur with gallbladder area pain, one must guard against the development of an abscess (Yong).