【湿热腰痛之症】内热烦热，自汗口渴，二便赤涩，酸痛沉重，此湿热腰痛之症
【湿热腰痛之因】或湿火之年，湿热行令，人病腰痛，长幼皆发，此因岁气而成病
者。或形役阳亢，外冒湿热之邪，此人自感冒而成病者。
【湿热腰痛之脉】脉多沉数。左尺沉数，太阳湿热。左尺细数，少阴湿热。左关沉数
，少阳湿热。左关细数，厥阴湿热。右关沉数，少阳湿热。右关细数，太阴湿热。
【湿热腰痛之治】左尺沉数者，羌独冲和汤。左尺细数者，独活二妙丸。左关沉数者
，柴独苍术汤。左关细数者，柴胡芍药汤。右关沉数者，芷葛二妙丸。右关细数者，防独神术
羌独冲和汤
羌活 黄芩 川芎 白芷 防风 细辛 苍术 广皮 甘草 独活
热甚，加黄柏。
独活二妙丸
独活（二两，蒸晒） 黄柏（二两，炒）
柴独苍术汤
柴胡 独活 苍术 防风 黄柏 黄芩
热甚，加胆草。
柴胡芍药汤
柴胡 白芍药 青皮 钩藤 香附 山栀 乌药 独活
热甚，加黄柏、胆草。
芷葛二妙丸
苍术 黄柏 白芷 葛根 秦艽 独活
热甚，加栀、连。
防独神术汤
白术 黄柏 防风 独活
（瘀血停滞、怒气郁结、痰注停积、肾阳不足、肾阴火旺）
【内伤腰痛之症】日轻夜重，痛定一处，不能转侧，此瘀血停畜之症。胁肋气胀，遇
怒愈甚，此怒气郁结之症。腰间重滞，一片如冰，得热减寒，得寒愈盛，此痰注作痛之症。时常
怕冷，手足不暖，凡遇寒气，腰背即痛，此真火不足，阳虚之症也。五心烦热，足心如
火，痛如锥刺，此阴虚火旺之症也。
【内伤腰痛之因】挫闪跌扑，劳动损伤，则腰腹作痛；七情恼怒，忧思郁结，则腰胁
疼痛；脾湿不运，水饮凝结，则为痰注腰痛；先天不足，真阳亏损，则为阳虚腰痛；真水不足，
复损阴精，则肾虚火旺而腰痛。
【内伤腰痛之脉】尺脉芤涩，瘀血之诊。尺脉沉结，怒气所伤。尺滑尺伏，皆主痰涎
。空大微迟，真阳不足。细数躁疾，火旺水干。
【内伤腰痛之治】瘀血停滞者，调荣活络饮、四物桃仁汤、红花桃仁汤。血虚者，四
物艽活汤。怒气郁结者，柴胡清肝饮加木香、独活。痰涎停注者，南星二陈汤加海石、香附。真
阳不足者，金匮肾气丸、河车膏合青娥丸。阴虚火旺者，知柏天地煎、知柏地黄丸。加玄武
调荣活络饮
当归尾 红花 桃仁 赤芍药 独活 牛膝 秦艽 桂枝 大黄
有寒者，去大黄；有热者，去桂枝。
四物桃仁汤
当归尾 赤芍药 川芎 怀生地 桃仁 独活 香附
有寒者，加桂枝；有热者，加大黄。
红花桃仁汤
红花 桃仁 赤芍药 当归尾 秦艽 独活
四物艽活汤
当归 白芍药 川芎 生地 秦艽 独活
气滞，加沉香、砂仁。
柴胡清肝饮
柴胡 青皮 山栀 川芎 钩藤 香附 木通 枳壳 木香 独活 乌药
寒者，加姜、桂；热者，加黄柏。
南星二陈汤
胆星 热半夏 白茯苓 橘红 甘草 海石 香附
虚寒者，加姜、桂；内热者，加栀、柏；大便结硬，加枳壳、玄明粉。
金匮肾气丸
即六味丸加熟附子、肉桂、车前子。
青娥丸
补骨脂（四两，炒研） 杜仲（四两，姜水炒）
煮烂河车一具，打为丸。痛甚，加独活、秦艽。
知柏天地煎
天门冬（六两） 怀生地（六两） 知母（二两） 黄柏（二两）
热甚便秘，加玄武胶，极效；胃寒，加生姜；气滞，加砂仁米、沉香；痛甚，加独活、
知柏地黄丸
即六味地黄丸加知母、黄柏各二两，炼蜜为丸；胃寒者，鹿角胶为丸。气滞者，加沉香、砂仁。
【湿热腰痛的症状】体内发热、烦躁不安，自汗出且口渴，大小便颜色红赤且排尿涩痛，腰部酸痛并伴有沉重感，这是湿热腰痛的症状。
【湿热腰痛的病因】或者是处于湿火当令的年份，湿热之气盛行，人们患上腰痛，无论老少都会发病，这是由于岁气（当年气候）导致疾病。或者是形体劳役过度导致阳气亢盛，又外感湿热之邪，这是个人因感冒而引发的疾病。
【湿热腰痛的脉象】脉象多表现为沉数。左尺脉沉数，为太阳经湿热；左尺脉细数，为少阴经湿热；左关脉沉数，为少阳经湿热；左关脉细数，为厥阴经湿热；右关脉沉数，为少阳经湿热（注：此处原文可能有误，通常右关属脾胃，但依原文翻译）；右关脉细数，为太阴经湿热。
【湿热腰痛的治疗】左尺脉沉数的，用羌独冲和汤。左尺脉细数的，用独活二妙丸。左关脉沉数的，用柴独苍术汤。左关脉细数的，用柴胡芍药汤。右关脉沉数的，用芷葛二妙丸。右关脉细数的，用防独神术汤。
羌独冲和汤
组成：羌活、黄芩、川芎、白芷、防风、细辛、苍术、广皮（陈皮）、甘草、独活。
若热势严重，加黄柏。
柴独苍术汤
组成：柴胡、独活、苍术、防风、黄柏、黄芩。
若热势严重，加龙胆草。
柴胡芍药汤
组成：柴胡、白芍药、青皮、钩藤、香附、山栀、乌药、独活。
若热势严重，加黄柏、龙胆草。
芷葛二妙丸
组成：苍术、黄柏、白芷、葛根、秦艽、独活。
若热势严重，加山栀、黄连。
（以下段落涉及瘀血停滞、怒气郁结、痰注停积、肾阳不足、肾阴火旺等内伤腰痛类型）
【内伤腰痛的症状】白天轻晚上重，疼痛固定在一处，身体不能转动侧身，这是瘀血停滞的症状。胁肋部气机胀满，遇到愤怒时症状加重，这是怒气郁结的症状。腰部感觉沉重滞涩，一片冰凉，遇热则减轻，遇寒则加剧，这是痰饮注渍作痛的症状。时常怕冷，手脚不温暖，凡是遇到寒气，腰背就疼痛，这是真火不足、阳虚的症状。五心烦热（两手心、两脚心及心胸烦热），足底像火烧一样，疼痛如锥刺，这是阴虚火旺的症状。
【内伤腰痛的病因】挫伤、闪失、跌打扑伤，劳动损伤，会导致腰腹部疼痛；七情恼怒，忧思郁结，会导致腰胁部疼痛；脾脏湿气不运化，水饮凝结，会形成痰注腰痛；先天禀赋不足，真阳亏损，会形成阳虚腰痛；真阴（肾水）不足，又损伤阴精，会导致肾虚火旺而腰痛。
【内伤腰痛的脉象】尺脉芤涩，是瘀血的诊断指征。尺脉沉结，是怒气所伤。尺脉滑或伏，都主痰涎。脉象空大微迟，是真阳不足。脉象细数躁疾，是火旺水干。
【内伤腰痛的治疗】瘀血停滞的，用调荣活络饮、四物桃仁汤、红花桃仁汤。血虚的，用四物艽活汤。怒气郁结的，用柴胡清肝饮加木香、独活。痰涎停注的，用南星二陈汤加海浮石、香附。真阳不足的，用金匮肾气丸、河车膏合青娥丸。阴虚火旺的，用知柏天地煎、知柏地黄丸。
调荣活络饮
组成：当归尾、红花、桃仁、赤芍药、独活、牛膝、秦艽、桂枝、大黄。
有寒症的，去大黄；有热症的，去桂枝。
四物桃仁汤
组成：当归尾、赤芍药、川芎、怀生地、桃仁、独活、香附。
有寒症的，加桂枝；有热症的，加大黄。
四物艽活汤
组成：当归、白芍药、川芎、生地、秦艽、独活。
气滞的，加沉香、砂仁。
柴胡清肝饮
组成：柴胡、青皮、山栀、川芎、钩藤、香附、木通、枳壳、木香、独活、乌药。
寒症的，加生姜、桂枝；热症的，加黄柏。
南星二陈汤
组成：胆南星、制半夏、白茯苓、橘红、甘草、海浮石、香附。
虚寒的，加生姜、桂枝；内热的，加山栀、黄柏；大便结硬的，加枳壳、玄明粉。
青娥丸
组成：补骨脂（四两，炒研）、杜仲（四两，姜水炒）。
煮烂紫河车一具，捣碎制成丸剂。疼痛严重的，加独活、秦艽。
知柏天地煎
组成：天门冬（六两）、怀生地（六两）、知母（二两）、黄柏（二两）。
热甚便秘的，加玄武胶（龟板胶），效果极佳；胃寒的，加生姜；气滞的，加砂仁米、沉香；疼痛严重的，加独活。
[Symptoms of Damp-Heat Lower Back Pain] Internal heat, irritability, spontaneous sweating, thirst, red and scanty urine and stool, soreness and heaviness in the lower back. These are the symptoms of lower back pain due to damp-heat.
[Etiology of Damp-Heat Lower Back Pain] It may occur during years where damp-fire is prevalent, with damp-heat qi dominating, causing people of all ages to suffer from lower back pain; this disease arises from the annual climate (Sui Qi). Alternatively, it results from physical overexertion leading to hyperactive yang, combined with external contraction of damp-heat pathogenic factors; this is a disease contracted personally due to wind-cold/damp-heat invasion.
[Pulse Diagnosis of Damp-Heat Lower Back Pain] The pulse is mostly deep and rapid. A deep and rapid pulse at the left Chi position indicates damp-heat in the Taiyang channel. A fine and rapid pulse at the left Chi position indicates damp-heat in the Shaoyin channel. A deep and rapid pulse at the left Guan position indicates damp-heat in the Shaoyang channel. A fine and rapid pulse at the left Guan position indicates damp-heat in the Jueyin channel. A deep and rapid pulse at the right Guan position indicates damp-heat in the Shaoyang channel [Note: Textual error likely intended for Sanyang or Pi/Stomach, but translated as per source]. A fine and rapid pulse at the right Guan position indicates damp-heat in the Taiyin channel.
[Treatment of Damp-Heat Lower Back Pain] For a deep and rapid pulse at the left Chi position, use Qiangdu Chonghe Tang. For a fine and rapid pulse at the left Chi position, use Duhuo Ermiao Wan. For a deep and rapid pulse at the left Guan position, use Chaidu Cangzhu Tang. For a fine and rapid pulse at the left Guan position, use Chaihu Shaoyao Tang. For a deep and rapid pulse at the right Guan position, use Zhige Ermiao Wan. For a fine and rapid pulse at the right Guan position, use Fangdu Shenshu Tang.
Qiangdu Chonghe Tang
Ingredients: Qianghuo (Notopterygii Rhizoma et Radix), Huangqin (Scutellariae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baizhi (Angelicae Dahuricae Radix), Fangfeng (Saposhnikoviae Radix), Xixin (Asari Radix et Rhizoma), Cangzhu (Atractylodis Rhizoma), Guangpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Duhuo (Angelicae Pubescentis Radix).
If heat is severe, add Huangbai (Phellodendri Cortex).
Duhuo Ermiao Wan
Ingredients: Duhuo (Angelicae Pubescentis Radix) (2 liang, steamed and dried), Huangbai (Phellodendri Cortex) (2 liang, stir-fried).
Chaidu Cangzhu Tang
Ingredients: Chaihu (Bupleuri Radix), Duhuo (Angelicae Pubescentis Radix), Cangzhu (Atractylodis Rhizoma), Fangfeng (Saposhnikoviae Radix), Huangbai (Phellodendri Cortex), Huangqin (Scutellariae Radix).
If heat is severe, add Danshen (Gentianae Radix). *Correction: Danshen usually refers to Salvia miltiorrhiza, but in context of "Dan Cao" (Dragon Grass) it implies Longdan Cao (Gentianae Radix).* -> Add Gentianae Radix (Longdan Cao).
Chaihu Shaoyao Tang
Ingredients: Chaihu (Bupleuri Radix), Baishao (Paeoniae Radix Alba), Qingpi (Citri Reticulatae Pericarpium Viride), Gouteng (Uncariae Ramulus cum Uncis), Xiangfu (Cyperi Rhizoma), Shanzhi (Gardeniae Fructus), Wuyao (Linderae Radix), Duhuo (Angelicae Pubescentis Radix).
If heat is severe, add Huangbai (Phellodendri Cortex) and Gentianae Radix (Longdan Cao).
Zhige Ermiao Wan
Ingredients: Cangzhu (Atractylodis Rhizoma), Huangbai (Phellodendri Cortex), Baizhi (Angelicae Dahuricae Radix), Gegen (Puerariae Lobatae Radix), Qinjiao (Gentianae Macrophyllae Radix), Duhuo (Angelicae Pubescentis Radix).
If heat is severe, add Shanzhi (Gardeniae Fructus) and Lianhua (Coptidis Rhizoma).
Fangdu Shenshu Tang
Ingredients: Baizhu (Atractylodis Macrocephalae Rhizoma), Huangbai (Phellodendri Cortex), Fangfeng (Saposhnikoviae Radix), Duhuo (Angelicae Pubescentis Radix).
(Regarding internal injury lower back pain caused by blood stasis stagnation, anger-induced constraint, phlegm accumulation, kidney yang deficiency, and kidney yin fire hyperactivity)
[Symptoms of Internal Injury Lower Back Pain] Symptoms are lighter during the day and heavier at night, pain is fixed in one location, and the body cannot turn or bend; this is the symptom of blood stasis stagnation. Distension of qi in the hypochondrium, worsening upon anger; this is the symptom of anger-induced qi constraint. Heaviness and stagnation in the waist, feeling cold like ice, alleviated by heat and aggravated by cold; this is the symptom of pain caused by phlegm-fluid retention. Frequent aversion to cold, cold hands and feet, lower back and back pain upon exposure to cold air; this is the symptom of true fire insufficiency and yang deficiency. Five-center heat (heat in palms, soles, and chest), soles burning like fire, stabbing pain like needles; this is the symptom of yin deficiency with fire hyperactivity.
[Etiology of Internal Injury Lower Back Pain] Trauma, sprains, falls, and labor injuries cause pain in the waist and abdomen; emotional disturbances such as anger and sorrowful contemplation cause pain in the waist and hypochondrium; spleen dampness failing to transform, leading to condensation of water fluids, causes lower back pain due to phlegm retention; congenital insufficiency and loss of true yang cause lower back pain due to yang deficiency; insufficiency of true yin (kidney water) and further damage to yin essence cause lower back pain due to kidney deficiency with fire hyperactivity.
[Pulse Diagnosis of Internal Injury Lower Back Pain] A cun-kou (Chi) pulse that is hollow and choppy indicates blood stasis. A deep and knotted pulse at the Chi position indicates injury from anger. A slippery or hidden pulse at the Chi position both indicate phlegm-fluids. A pulse that is empty, large, and slightly slow indicates true yang insufficiency. A fine, rapid, and restless pulse indicates fire hyperactivity and dryness of water.
[Treatment of Internal Injury Lower Back Pain] For blood stasis stagnation, use Tiaorong Huoluo Yin, Siwu Taoren Tang, or Honghua Taoren Tang. For blood deficiency, use Siwu Qiu Huo Tang. For anger-induced qi constraint, use Chaihu Qinggan Yin added with Muxiang and Duhuo. For phlegm-fluid retention, use Nanxing Erchen Tang added with Haishi and Xiangfu. For true yang insufficiency, use Jin Gui Shen Qi Wan, Heche Gao combined with Qing'e Wan. For yin deficiency with fire hyperactivity, use Zhibai Tiandi Jian or Zhibai Dihuang Wan.
Tiaorong Huoluo Yin
Ingredients: Dangguiwei (Angelicae Sinensis Radix Caulis), Honghua (Carthami Flos), Taoren (Persicae Semen), Chishaoyao (Paeoniae Radix Rubra), Duhuo (Angelicae Pubescentis Radix), Niuxi (Achyranthis Bidentatae Radix), Qinjiao (Gentianae Macrophyllae Radix), Guizhi (Cinnamomi Ramulus), Dahuang (Rhei Radix et Rhizoma).
In cases of cold, remove Dahuang; in cases of heat, remove Guizhi.
Siwu Taoren Tang
Ingredients: Dangguiwei (Angelicae Sinensis Radix Caulis), Chishaoyao (Paeoniae Radix Rubra), Chuanxiong (Ligustici Chuanxiong Rhizoma), Huaishengdi (Rehmanniae Radix Preparata), Taoren (Persicae Semen), Duhuo (Angelicae Pubescentis Radix), Xiangfu (Cyperi Rhizoma).
In cases of cold, add Guizhi (Cinnamomi Ramulus); in cases of heat, add Dahuang (Rhei Radix et Rhizoma).
Honghua Taoren Tang
Ingredients: Honghua (Carthami Flos), Taoren (Persicae Semen), Chishaoyao (Paeoniae Radix Rubra), Dangguiwei (Angelicae Sinensis Radix Caulis), Qinjiao (Gentianae Macrophyllae Radix), Duhuo (Angelicae Pubescentis Radix).
Siwu Qiu Huo Tang
Ingredients: Danggui (Angelicae Sinensis Radix), Baishao (Paeoniae Radix Alba), Chuanxiong (Ligustici Chuanxiong Rhizoma), Shengdi (Rehmanniae Radix), Qinjiao (Gentianae Macrophyllae Radix), Duhuo (Angelicae Pubescentis Radix).
For qi stagnation, add Chenxiang (Aquilariae Lignum Resinatum) and Sharen (Amomi Fructus Rotundus).
Chaihu Qinggan Yin
Ingredients: Chaihu (Bupleuri Radix), Qingpi (Citri Reticulatae Pericarpium Viride), Shanzhi (Gardeniae Fructus), Chuanxiong (Ligustici Chuanxiong Rhizoma), Gouteng (Uncariae Ramulus cum Uncis), Xiangfu (Cyperi Rhizoma), Mutong (Akebiae Caulis), Zhike (Citri Aurantii Fructus), Muxiang (Aucklandiae Radix), Duhuo (Angelicae Pubescentis Radix), Wuyao (Linderae Radix).
In cases of cold, add Shengjiang (Zingiberis Rhizoma Recens) and Guizhi (Cinnamomi Ramulus); in cases of heat, add Huangbai (Phellodendri Cortex).
Nanxing Erchen Tang
Ingredients: Danning (Arisaematis Cum Bile Radix), Re Banxia (Pinelliae Rhizoma Preparatum), Bai Fuling (Poria), Ju Hong (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Haishi (Calcium Carbonatum), Xiangfu (Cyperi Rhizoma).
In cases of deficiency-cold, add Shengjiang (Zingiberis Rhizoma Recens) and Guizhi (Cinnamomi Ramulus); in cases of internal heat, add Shanzhi (Gardeniae Fructus) and Huangbai (Phellodendri Cortex); for hard constipation, add Zhike (Citri Aurantii Fructus) and Xuanmingfen (Natrii Sulfas).
Jin Gui Shen Qi Wan
This is Liuwei Wan (Six-Ingredient Pill with Rehmannia) added with Shufuzi (Aconiti Lateralis Radix Preparata), Rougui (Cinnamomi Cortex), and Cheqianzi (Plantaginis Semen).
Qing'e Wan
Ingredients: Buguzhi (Psoraleae Fructus) (4 liang, stir-fried and ground), Duzhong (Eucommiae Cortex) (4 liang, stir-fried with ginger juice).
Boil one whole Heche (Placenta Humana) until soft, mash, and form into pills. For severe pain, add Duhuo (Angelicae Pubescentis Radix) and Qinjiao (Gentianae Macrophyllae Radix).
Zhibai Tiandi Jian
Ingredients: Tianmendong (Asparagi Radix) (6 liang), Huaishengdi (Rehmanniae Radix Preparata) (6 liang), Zhimu (Anemarrhenae Rhizoma) (2 liang), Huangbai (Phellodendri Cortex) (2 liang).
For severe heat with constipation, add Xuanwu Jiao (Testudinis Carapax et Plastrum Gelatinum), which is highly effective; for stomach cold, add Shengjiang (Zingiberis Rhizoma Recens); for qi stagnation, add Sharenmi (Amomi Fructus Rotundus) and Chenxiang (Aquilariae Lignum Resinatum); for severe pain, add Duhuo (Angelicae Pubescentis Radix).
Zhibai Dihuang Wan
This is Liuwang Dihuang Wan (Six-Ingredient Pill with Rehmannia) added with Zhimu (Anemarrhenae Rhizoma) and Huangbai (Phellodendri Cortex), each 2 liang, formed into pills with refined honey; for stomach cold, form pills with Lujiao Jiao (Cervi Cornus Colla Gelatinum). For qi stagnation, add Chenxiang (Aquilariae Lignum Resinatum) and Sharen (Amomi Fructus Rotundus).