经曰足太阳脉令人腰痛引项脊尻背如重状 少阳令人腰痛如以针刺其皮中循循然不可以
俯仰
不可以顾 阳明令人腰痛不可以顾顾如有见者善悲 足少阴令人腰痛痛引脊内廉 厥阴之脉
令人腰痛腰中如张弓弩弦 太阴腰痛下如有横木居其中甚则遗溲
按本论备言诸经及奇经同阴解脉等为痛并刺法甚详宜玩本文
又曰太阳所至为腰痛巨阳虚则腰背头项痛是动则项如拔挟脊痛腰似折髀不可以曲 腰者
肾之腑转摇不能肾将败矣
脉经曰凡有所用力举重若入房过度汗出如浴水则伤肾肾胀者腹满引背央央然腰髀痛 肾
着之为病从腰以下冷腰重如带五千钱
按此云用力以下为内伤肾着是外困也
脉经曰尺脉沉腰背痛腰痛时时失精饮食减少其脉洪滑而迟此为可治
刘三点曰腰痛之脉皆沉而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实
者为闪肭
东垣曰太阳气虚则邪客之痛病生矣夫邪者是风热寒湿燥皆能为病大抵寒湿多而风热少然
有房
室劳伤肾虚腰痛者是阳气虚弱不能运动故也阳之不足宜补阳如膏粱之人久服阳药醉以入房损
其真阴肾气热则腰脊痛而不能举久则髓减骨枯骨枯发为骨痿阴之不足宜补阴
经云腰痛上寒不可顾取足太阳阳明 腰痛上热取足厥阴不可以俯仰取足少阳东垣云盖足
之三
阳从头走足足三阴从足入腹经所过处皆能为痛治之者当审其何经所过分野循其空穴而刺之审
其寒热而药之假令足太阳令人腰痛引项脊尻背如重状刺其 中太阳二经出血余皆仿此
按本篇论刺法甚详宜玩本文然太阳腰痛刺委中出血效速王注经中更言灸疑误灸者宜肾俞
腰俞穴
《内经》说：足太阳经脉使人腰痛，疼痛牵引项部、脊背和臀部，感觉身体沉重。足少阳经脉使人腰痛，痛感如同针刺在皮肤中，活动受限，不能前后俯仰，也不能左右回顾。足阳明经脉使人腰痛，不能回头，回头时好像看到了什么幻象，且容易悲伤。足少阴经脉使人腰痛，疼痛牵引脊柱内侧。足厥阴经脉使人腰痛，腰部僵硬紧绷，如同拉满的弓弩弦。足太阴经脉使人腰痛，感觉腰部下方像有一根横木卡在中间，严重时会出现小便失禁。
查阅本论，详细论述了各条经脉以及奇经八脉中的同阴脉、解脉等引起的腰痛及其刺法，内容非常详尽，值得仔细研读原文。
又说：太阳经气异常导致腰痛；巨阳（太阳）虚损则出现腰、背、头、项疼痛；若为“是动病”，则颈部僵硬如被拔起，夹脊部位疼痛，腰部似要折断，大腿无法弯曲。腰是肾的外府，如果腰部转动困难，说明肾气即将败绝。
《脉经》说：凡是用力过度、举重，或者房事不节、出汗如洗澡般，都会损伤肾脏。肾胀的病证表现为腹部胀满并牵引背部，心中郁闷不适，腰部和大腿疼痛。肾着病的表现是从腰部以下寒冷，腰部沉重，如同带着五千枚铜钱。
查阅此处记载，用力过度属于内伤肾气，而肾着病则是外邪困阻所致。
《脉经》说：尺脉沉取，伴有腰背痛，腰痛时常伴有遗精，饮食减少。若脉象洪大滑利但兼迟，这是可以治疗的。
刘三点说：腰痛的脉象大多呈现沉而弦的特征。沉弦而紧的是寒证；沉弦而浮的是风证；沉弦而濡细的是湿证；沉弦而实的是闪挫瘀滞证。
李东垣说：太阳经气虚损，邪气就会客居其中，从而产生痛病。所谓邪气，是指风、热、寒、湿、燥都能致病，大致上是寒湿多见而风热少见。然而，也有因房劳过度导致肾虚腰痛的情况，这是因为阳气虚弱，不能温煦运动所致。阳气不足应当补阳，例如膏粱厚味之人长期服用温热药物，醉酒后行房，会损伤真阴。肾气受热则腰脊疼痛，不能抬举，时间久了会导致髓减骨枯，骨枯进而发展为骨痿。阴液不足应当补阴。
经文说：腰痛伴上半身寒冷、不能回头的，取足太阳、足阳明经穴治疗；腰痛伴上半身发热的，取足厥阴经穴治疗；不能俯仰的，取足少阳经穴治疗。李东垣说：足三阳经从头走足，足三阴经从足入腹，经络经过的部位都可能发生疼痛。治疗时应当审察是哪条经脉受病，沿着该经所属的分野，寻找相应的穴位进行针刺，并根据寒热性质用药。假设足太阳经脉使人腰痛，疼痛牵引项部、脊背和臀部，感觉身体沉重，应针刺委中穴，使足太阳、足少阳二经出血，其余情况都仿照此法。
查阅本篇关于刺法的论述非常详尽，值得仔细研读原文。然而，对于太阳腰痛，针刺委中出血疗效迅速。王冰在注释中提到的灸法，可能是误传。如果要使用灸法，适宜选取肾俞、腰俞穴。
The *Neijing* states: The Foot-Taiyang meridian causes lower back pain that radiates to the nape, spine, buttocks, and back, with a sensation of heaviness. The Shaoyang meridian causes lower back pain as if pricked by needles in the skin, accompanied by stiffness preventing flexion, extension, or turning the head. The Yangming meridian causes lower back pain where one cannot turn the head; when attempting to do so, visual hallucinations may occur, along with a tendency toward sorrow. The Foot-Shaoyin meridian causes lower back pain radiating inward along the spine. The Jueyin meridian causes lower back pain where the waist feels stiff and tense, like the string of a drawn bow. The Taiyin meridian causes lower back pain with a sensation of a horizontal blockage in the lower waist, which may lead to urinary incontinence in severe cases.
Consulting this treatise, it elaborately details the lower back pain caused by various meridians and the extraordinary vessels (such as Tongyin and Xie Mai), including their acupuncture methods, which is worth careful study of the original text.
It further states: Abnormalities in the Taiyang qi manifest as lower back pain; deficiency of Ju Yang (Taiyang) leads to pain in the waist, back, head, and nape. If it is a "meridian movement disease" (Shi Dong Bing), the neck feels rigid as if pulled out, there is pain flanking the spine, the waist feels as if it will break, and the thighs cannot be bent. The waist is the external residence of the Kidney; if rotation becomes difficult, it indicates impending failure of Kidney Qi.
The *Mai Jing* (Pulse Classic) states: Excessive physical exertion, heavy lifting, excessive sexual activity, or profuse sweating akin to bathing can damage the Kidneys. In cases of Kidney distension (Shen Zhang), there is abdominal fullness radiating to the back, a sense of oppression, and pain in the waist and thighs. In Kidney-dampness (Shen Zhuo), the area below the waist feels cold, and the waist feels heavy, as if burdened by five thousand coins.
Reviewing this passage, excessive effort constitutes internal injury to the Kidney, whereas Shen Zhuo represents external constraint.
The *Mai Jing* states: A deep pulse at the Chi position, accompanied by lower back pain, frequent seminal emission during lower back pain episodes, and reduced appetite, is curable if the pulse is surging, slippery, yet slow.
Liu Sandian stated: Pulses associated with lower back pain are generally deep and wiry. Deep, wiry, and tight indicates Cold; deep, wiry, and floating indicates Wind; deep, wiry, moist, and fine indicates Dampness; deep, wiry, and excess/solid indicates sprain or stasis.
Li Dongyuan stated: When Taiyang Qi is deficient, pathogenic factors invade, causing pain. Pathogens such as Wind, Heat, Cold, Dampness, and Dryness can all cause disease, though Cold and Dampness are more common than Wind and Heat. However, lower back pain due to Kidney deficiency from sexual exhaustion occurs because Yang Qi is weak and unable to move/warm. Deficiency of Yang should be treated by tonifying Yang. For instance, individuals consuming rich foods who long-term use warming herbs and engage in intercourse while intoxicated may damage True Yin. If Kidney Qi is heated, it causes lower back and spinal pain with inability to lift the body; over time, marrow decreases and bones wither, leading to Bone Withering Disease (Gu Wei). Deficiency of Yin should be treated by tonifying Yin.
The classic states: For lower back pain with upper-body coldness and inability to turn the head, treat the Foot-Taiyang and Foot-Yangming meridians. For lower back pain with upper-body heat, treat the Foot-Jueyin meridian. For inability to flex or extend, treat the Foot-Shaoyang meridian. Li Dongyuan stated: The three Foot-Yang meridians run from head to foot, and the three Foot-Yin meridians run from foot to abdomen; pain can occur anywhere along these pathways. Treatment requires identifying the affected meridian, locating the corresponding acupoints for needling, and prescribing herbs based on Cold or Heat patterns. For example, if Foot-Taiyang causes lower back pain radiating to the nape, spine, and buttocks with heaviness, needle Weizhong (BL40) to bleed both the Taiyang and Shaoyang meridians. Other cases follow this pattern.
This chapter details acupuncture methods extensively, warranting careful study. However, for Taiyang lower back pain, bleeding at Weizhong (BL40) yields rapid results. Wang Bing’s mention of moxibustion in his commentary may be an error. If moxibustion is indicated, Shenshu (BL23) and Yaoshu (DU2) are appropriate points.