六元正纪论云∶太阳所至为腰痛。又云∶巨阳即太阳也，虚则头项腰背痛。足太阳膀胱之脉所过，
还出别下项，循肩膊内，挟脊抵腰中。故为病项如拔，挟脊痛，腰似折，髀不可以曲，是经气虚则邪
客之，痛病生矣。夫邪者，是风热湿燥寒皆能为病。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。经云∶腰者肾之腑，转摇不能，肾将惫矣。宜肾气丸、茴香丸之类，
以补阳之不足也。膏粱之人，久服汤药，醉以入房，损其真气，则肾气热，肾气热则腰脊痛而不能举，
久则髓减骨枯，发为骨痿。宜六味地黄丸、滋肾丸、封髓丹之类，以补
阴之不足也。《灵枢》云∶腰痛，上寒取足太阴、阳明，上热取足厥阴，不可俯仰取足少阳。盖足之
三阳，从头走足，足之三阴，从足走腹，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，审何寒热而药之。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。彼执一方治诸腰痛者，固不通矣。有风、有湿、有寒、有热、有挫闪、有瘀血、有滞气、有
痰积、皆标也。肾虚其本也。风伤肾而痛，其脉必带浮，或左或右，痛无常处，牵引两足，宜五积散，
每服加防风半钱，全蝎三个。小续命汤、独活寄生汤皆可选用。（《三因方》小续命汤加炒去皮桃仁，
治风腰痛最妙。）仍吞三仙丹。杜仲姜汁炒研末，每一钱，温酒调，空心服，治肾气腰痛，兼治风冷
为患，名杜仲酒。《三因》又有牛膝酒，治肾伤风毒，攻刺腰痛不可忍者。伤湿而痛，如坐水中，盖
肾属水，久坐水湿处，或为雨露所着，两水相得，以致腰痛，其脉必带缓，遇天阴或久坐必发，身体
必带沉重，宜渗湿汤主之。不效，宜肾着汤，或生附汤。风湿腰痛，独活寄生汤。寒湿腰痛，五积散
加桃仁、川芎、肉桂汤，麻黄苍术汤，并摩腰膏。湿热腰痛，苍术汤、独活汤、羌活汤。东垣云∶如
身重腰沉沉然，乃经中有湿热也。于羌活胜湿汤中加黄柏一钱，附子五分，
苍术二钱。感寒而痛者，腰间如冰，其脉必紧，见热则减，见寒则增，宜五积散去桔梗，加吴茱萸半
钱，或姜附汤加辣桂、杜仲，外用摩腰膏。伤热而痛者，脉必洪数而滑，发渴便闭，宜甘豆汤加续断、
天麻，间服败毒散。若因闪挫，或 扑伤损而痛者，宜乳香趁痛散，及黑神散，和复元通气散，酒调
下。不效，则必有恶血停滞，宜先用酒调下苏合香丸，仍以五积散加桃仁、大黄、苏木各一钱，当归
倍原数。若因劳役负重而痛，宜和气饮，或普贤正气散，或十补汤下青娥丸。挫闪腰痛，不能转侧，
用陈久神曲一大块，烧通红淬老酒，去曲，以酒通口吞青娥丸，仰卧片时。未效再服，不用丸亦得。
又方，以茴香根同红曲擂烂，好热酒调服。东垣云∶打扑伤损，从高坠下，恶血在太阳经中，令人腰
脊痛，或胫 臂膊中痛不可忍，鼻壅塞不通，地龙汤主之。橘核酒、熟大黄汤。丹溪治徐质夫年六十，
因坠马腰痛，不可转侧，六脉散大，重取则弦小而长稍坚。此虽有恶血，未可驱逐，且以补接为先。
遂令煎苏木、人参、黄 、川芎、当归、陈皮、木通、甘草，服至半月，饮食渐进，遂与前药调下自
然铜等药，一月而安。瘀血为病，其脉必涩，转侧若锥刀之刺，大便黑，小便赤黄或黑，日轻夜重，
名沥血腰痛。宜调荣活络饮，或桃仁酒调黑神散，
或四物汤加桃仁、红花之类。丹溪用补阴丸中加桃仁、红花主之。气滞而痛，其脉必沉，宜人参顺气
散，或乌药顺气散，加五加皮、木香，入少甘草煎汤调下。或用降真香、檀香、沉香共一两重，煎汤
空心服。痰注而痛，其脉必滑或伏，宜二陈汤加南星、香附、乌药、枳壳主之。食积腰腿痛，用龟板
（酒炙、）柏叶（酒制、）香附（五钱、）辣芥子、凌霄花（一钱五分，）酒糊丸，煎四物汤加陈皮、
甘草一分吞下。食积痰积，如气实脉有力者，宜下之。威灵仙治痛之要药，为细末，每服二钱，猪腰
子一只批开，掺药在内，湿纸包煨熟，五更细嚼，热酒下，以微利为度。《本事方》治五般腰痛，用
胡桃肉五个，去皮壳，研为膏，五灵脂、黑牵牛（炒）、白牵牛、（炒）各三钱，狗脊（微炒）半两，
萆（炒）三钱，没药三十文，巴豆五粒，用湿纸包煨，取肉去油，上为末。入前胡桃膏，醋糊丸如
桐子大。每服十五丸，风腰疼，豆淋无灰酒下。气腰疼，煨葱白酒下。血腰疼、当归酒下。打扑腰疼，
苏木酒下。张子和治赵进道病腰疼一年不愈，诊其两手脉沉重有力，以通经散（陈皮、当归、甘遂为
末，每三钱，临卧温酒调下。）下五七行，次以杜仲，去粗皮细切，炒断丝为末。每服三钱，猪腰子
一枚，薄批五七片，先以椒盐淹去腥水，掺药在内，裹以荷叶，以湿纸数重封，文武火烧熟，临卧细
嚼，温
酒送下。每旦以无比山药丸一服，数日而愈。治腰痛牵引足膝脚 ，屡用神效。杜仲，姜汁炒去丝，
续断、黑牵牛、破故纸、桃仁炒去皮尖、玄胡索各等分，为细末。酒煮面糊胡桃肉，和丸如桐子大。
每服五七十丸，食前温酒、白汤任下。（以上俱用下药，实者宜之。）腰胯连脚膝晓夜疼痛，宜虎骨
散、补骨脂丸、百倍丸、养肾散、选而用之。大抵诸腰痛皆起肾虚，既挟邪气，则须除其邪。如无外
邪积滞而自痛，则惟补肾而已。腰肢痿弱，身体疲倦，脚膝酸软，脉或洪或细而皆无力，痛亦攸攸隐
隐而不甚，是其候也。亦分寒热二证，脉细而无力，怯怯短气，小便清利，是为阳虚。宜肾气丸、茴
香丸、鹿茸、羊肾之属，或以大建中汤加川椒十粒，吞下腰肾丸，及生料鹿茸丸之类。仍以茴香炒研
末，破开猪腰子，作薄片勿令断，层层掺药末，水纸裹煨熟，细嚼酒咽。此皆所以补阳之不足也。其
脉洪而无力，小便黄赤，虚火时炎，是谓阴虚。东垣所谓膏粱之人，久服汤药，醉以入房，损其真气，
则肾气热，肾气热则腰脊痛而不能举，久则髓减骨枯，发为骨痿。宜六味丸、滋肾丸、封髓丹、补阴
丸之类。以补阴之不足也。杨仁斋云∶经云，腰者肾之腑，转摇不能，肾将惫矣。审如是则病在少阴，
必究其受病之源，而处之为得。虽然宗筋聚于阴器，肝者肾之
同系也。五脏皆取气于谷，脾者肾之仓廪也。郁怒伤肝则诸筋纵弛，忧思伤脾则胃气不行，二者又能
为腰痛之冠，故并及之。郁怒伤肝发为腰痛，宜调肝散主之。忧思伤脾发为腰痛，宜沉香降气汤和调
气散，姜、枣煎主之。煨肾丸，治肝肾损及脾损，谷不化，腰痛不起者神效。又有沮锉失志伤肾而痛
者，和剂七气汤，多加白茯苓，少加乳香、沉香主之。疟痢后腰痛，及妇人月经后腰痛，俱属虚，宜
补。于补气血药中，加杜仲、侧柏叶主之。丹溪云∶久腰痛，必用官桂开之方止，腹胁痛亦然。橘香
丸，治腰痛经久不瘥，亦用官桂开之之意也。
【肾着】肾着为病，其体重，腰冷如冰，饮食如故，小便自利，腰以下冷痛，如带五千钱，治宜流湿，兼
用温散，肾着汤。
【腰胯痛】腰痛，足太阳膀胱经也。胯痛，足少阳胆经之所过也。若因伤于寒湿，流注经络，结滞骨节，气
血不和，而致腰胯痛者，宜除湿丹，或渗湿汤加芍药、青皮、苍
术、槟榔。有痰积郁滞经络，流搏瘀血，内亦作痛，用导痰汤加槟榔、青皮、芍药，实者禹攻散。湿
执腰胯作疼，宜清湿散。
【腰软】丹溪以为肾肝伏热，治宜黄柏防己。
【诊】大者肾虚。涩为瘀血。缓为寒湿。或滑或伏为痰。尺沉为腰背痛。尺脉沉而弦，沉为滞，
弦为虚。沉弦而紧，为寒。沉弦而浮，为风。沉弦而涩细，为湿。沉弦而实，闪肭。肾惫及盛怒伤志，
则腰失强不能转摇而死。（经云∶肾者腰之腑，转摇不能，肾将惫矣。得强者生，失强者死。又云∶
肾盛怒而不止则伤志，志伤则善忘其前言，腰脊不可以俯仰屈伸，毛悴色夭，死于季夏是也。）
《素问·六元正纪大论》说：太阳经气所至，会导致腰痛。又说：巨阳就是太阳，如果虚弱，就会出现头项、腰背疼痛。足太阳膀胱经的循行路线，从头部出来，分支下行至颈部，沿着肩膊内侧，夹着脊柱到达腰部中间。所以发病时会出现脖子像被拔除一样的感觉，夹脊部疼痛，腰部好像要折断一样，大腿不能弯曲，这是因为经气虚弱导致邪气客居其中，从而产生痛病。所谓的邪气，是指风、热、湿、燥、寒都能致病。大体上寒湿证多而风热证少。然而也有因房事过度劳累损伤，导致肾虚腰痛的情况，这是因为阳气虚弱不能推动运行所致。医经说：腰是肾的外腑，如果转动摇晃困难，说明肾气将要衰竭了。适宜使用肾气丸（温补肾阳）、茴香丸等方剂，来补益阳气的不足。
那些饮食肥甘厚味的人，长期服用汤药，醉酒后行房，损伤了真气，导致肾气有热；肾气有热则腰脊疼痛且无法抬起身体，时间久了骨髓减少、骨骼枯槁，发展为骨痿（骨骼枯萎无力之症）。适宜使用六味地黄丸（滋补肾阴）、滋肾丸、封髓丹等方剂，来补益阴液的不足。《灵枢》说：腰痛，上部发冷的取足太阴脾经和足阳明胃经穴位，上部发热的取足厥阴肝经穴位，身体不能俯仰的取足少阳胆经穴位。大概足部的三条阳经从头走向足，足部的三条阴经从足走向腹部，经络经过的地方，都可能成为疼痛的部位。治疗时应当审察是哪条经络受病，所属的分野区域，沿着相应的空穴进行针刺，审察是何种寒热性质而用药。例如足太阳经引起的腰痛，牵引项部、脊柱、尻部和背部感觉沉重，应刺其委中穴及太阳二经出血，其余情况都仿照此法。那些坚持用一方治疗各种腰痛的人，固然不通达变通。
有风、有湿、有寒、有热、有挫闪伤、有瘀血、有滞气、有痰积，这些都是标证。肾虚是本证。风邪伤肾导致的腰痛，脉象必然带浮，或左或右，疼痛没有固定位置，牵引两足，适宜用五积散，每服加防风半钱、全蝎三个。小续命汤、独活寄生汤都可以选用。（《三因极一病证方论》中的小续命汤加入炒制去皮的桃仁，治疗风邪腰痛效果最好。）同时吞服三仙丹。杜仲用姜汁炒后研成末，每次一钱，温酒调服，空腹服用，治疗肾气腰痛，兼治风寒冷邪为患，名为杜仲酒。《三因方》又有牛膝酒，治疗肾伤风毒，攻刺般腰痛不可忍受者。
因湿气受伤而痛，感觉像坐在水中，因为肾属水，久坐水湿之处，或被雨露沾湿，两水相得，导致腰痛，脉象必然带缓，遇到阴天或久坐必发作，身体必然带有沉重感，适宜用渗湿汤主治。无效时，适宜用肾着汤，或生附汤。风湿腰痛，用独活寄生汤。寒湿腰痛，用五积散加桃仁、川芎、肉桂汤，或麻黄苍术汤，并配合摩腰膏外敷。湿热腰痛，用苍术汤、独活汤、羌活汤。李东垣说：如果身体沉重，腰部沉沉然，这是经络中有湿热。在羌活胜湿汤中加入黄柏一钱、附子五分、苍术二钱。
感受寒邪而痛的，腰间如冰，脉象必然紧，遇热减轻，遇寒加重，适宜用五积散去桔梗，加吴茱萸半钱，或姜附汤加辣桂、杜仲，外用摩腰膏。感受热邪而痛的，脉象必然洪数而滑，发生口渴、大便闭塞，适宜用甘豆汤加续断、天麻，间服败毒散。如果是因闪挫，或跌扑损伤而痛的，适宜用乳香趁痛散，以及黑神散，与复元通气散混合，用酒调下。无效，则必有恶血停滞，适宜先用酒调下苏合香丸，仍以五积散加桃仁、大黄、苏木各一钱，当归加倍原用量。
如果是因劳役负重而痛，适宜用和气饮，或普贤正气散，或十补汤送服青娥丸。挫闪腰痛，不能转侧，用陈久神曲一大块，烧红后淬入老酒，去掉神曲，用酒送服青娥丸，仰卧片刻。未见效再服，不用丸剂也可以。另一方法，用茴香根同红曲捣烂，用好热酒调服。李东垣说：打扑损伤，从高坠落，恶血在太阳经中，导致人腰脊痛，或小腿、臂膊中疼痛不可忍受，鼻塞不通，用地龙汤主治。橘核酒、熟大黄汤也可用。
朱丹溪治疗徐质夫，六十岁，因坠马腰痛，不能转侧，六脉散大，重按则弦小而长稍坚。这虽然有恶血，但不可急于驱逐，暂且以补接为先。于是令煎苏木、人参、黄芪、川芎、当归、陈皮、木通、甘草，服用半个月，饮食逐渐增加，然后给前药调下自然铜等药，一个月而痊愈。瘀血为病，脉象必然涩，转侧时像锥刀刺入，大便黑，小便赤黄或黑，白天轻晚上重，名为沥血腰痛。适宜用调荣活络饮，或桃仁酒调服黑神散，或四物汤加桃仁、红花之类。丹溪用补阴丸中加桃仁、红花主治。
气滞而痛，脉象必然沉，适宜用人参顺气散，或乌药顺气散，加五加皮、木香，入少许甘草煎汤调下。或用降真香、檀香、沉香共一两重，煎汤空腹服用。痰注而痛，脉象必然滑或伏，适宜用二陈汤加南星、香附、乌药、枳壳主治。食积腰腿痛，用龟板（酒炙）、柏叶（酒制）、香附（五钱）、辣芥子、凌霄花（一钱五分），酒糊为丸，煎四物汤加陈皮、甘草一分吞下。食积痰积，如果气实脉有力者，适宜用泻下法。威灵仙是治疗疼痛的要药，研为细末，每次二钱，猪腰子一只剖开，掺药在内，湿纸包裹煨熟，五更时分细嚼，热酒送下，以轻微腹泻为度。
《本事方》治疗五种腰痛，用胡桃肉五个，去皮壳，研为膏，五灵脂、黑牵牛（炒）、白牵牛（炒）各三钱，狗脊（微炒）半两，萆薢（炒）三钱，没药三十文，巴豆五粒，用湿纸包裹煨熟，取肉去油，以上研为末。加入前面的胡桃膏，醋糊为丸如梧桐子大。每次十五丸，风腰疼，用豆淋无灰酒送下。气腰疼，用煨葱白酒送下。血腰疼，用当归酒送下。打扑腰疼，用苏木酒送下。
张子和治疗赵进道，病腰痛一年不愈，诊其两手脉沉重有力，用通经散（陈皮、当归、甘遂为末，每三钱，临睡前温酒调下）下五七行，其次用杜仲，去粗皮细切，炒断丝为末。每次三钱，猪腰子一枚，薄批五七片，先用椒盐淹去腥水，掺药在内，裹以荷叶，用湿纸数层封口，文武火烧熟，临睡前细嚼，温酒送下。每天早晨服无比山药丸一次，数日而愈。治疗腰痛牵引足膝脚胫，屡用神效。杜仲，姜汁炒去丝，续断、黑牵牛、破故纸、桃仁炒去皮尖、玄胡索各等分，为细末。酒煮面糊胡桃肉，和丸如梧桐子大。每次五七十丸，食前温酒、白开水任下。（以上均用泻下药，实证适宜。）
腰胯连脚膝晓夜疼痛，适宜用虎骨散、补骨脂丸、百倍丸、养肾散，选择使用。大体上各种腰痛都起于肾虚，既然夹杂邪气，就必须祛除邪气。如果没有外邪积滞而自痛，则只需补肾而已。腰肢痿弱，身体疲倦，脚膝酸软，脉象或洪或细而皆无力，疼痛也是隐隐约约而不剧烈，这是其征候。也分为寒热二证，脉细而无力，怯怯短气，小便清利，这是阳虚。适宜用肾气丸、茴香丸、鹿茸、羊肾之类，或以大建中汤加川椒十粒，吞下腰肾丸，及生料鹿茸丸之类。仍以茴香炒研末，破开猪腰子，作薄片勿令断开，层层掺药末，水纸包裹煨熟，细嚼酒咽。这都是为了补益阳气的不足。
其脉洪而无力，小便黄赤，虚火时炎，这是阴虚。李东垣所谓膏粱之人，长期服用汤药，醉酒后行房，损伤真气，导致肾气热，肾气热则腰脊痛而不能抬起，久了则髓减骨枯，发为骨痿。适宜用六味丸、滋肾丸、封髓丹、补阴丸之类，来补益阴液的不足。杨仁斋说：医经说，腰是肾的外腑，转动摇晃困难，肾气将衰竭。如果确实如此，则病在少阴，必须究其受病的源头，处方才得当。虽然宗筋聚于阴器，肝是肾的同系脏腑。五脏之气都取自谷物，脾是肾的仓廪。郁怒伤肝则诸筋纵弛，忧思伤脾则胃气不行，这两者又能成为腰痛的主要原因，所以一并提及。
郁怒伤肝发为腰痛，适宜用调肝散主治。忧思伤脾发为腰痛，适宜用沉香降气汤和调气散，姜、枣煎服主治。煨肾丸，治疗肝肾损及脾损，谷不化，腰痛不起者神效。又有因沮丧失意伤肾而痛者，用和剂七气汤，多加白茯苓，少加乳香、沉香主治。疟疾痢疾后腰痛，及妇人月经后腰痛，都属于虚证，适宜补益。在补气血药中，加杜仲、侧柏叶主治。朱丹溪说：久腰痛，必须用官桂开通才能停止，腹胁痛也是如此。橘香丸，治疗腰痛经久不愈，也是用官桂开通的意思。
【肾着】肾着病，身体沉重，腰部冷如冰，饮食正常，小便自利，腰部以下冷痛，像带着五千钱一样，治疗适宜流湿，兼用温散，用肾着汤。
【腰胯痛】腰痛，属于足太阳膀胱经。胯痛，是足少阳胆经经过的地方。如果因伤于寒湿，流注经络，结滞骨节，气血不和，而导致腰胯痛者，适宜用除湿丹，或渗湿汤加芍药、青皮、苍术、槟榔。有痰积郁滞经络，流搏瘀血，内部也作痛，用导痰汤加槟榔、青皮、芍药，实证用禹功散。湿邪执持腰胯作疼，适宜用清湿散。
【诊法】脉大者肾虚。脉涩为瘀血。脉缓为寒湿。或滑或伏为痰。尺脉沉为腰背痛。尺脉沉而弦，沉为滞，弦为虚。沉弦而紧，为寒。沉弦而浮，为风。沉弦而涩细，为湿。沉弦而实，为闪挫。肾气疲惫及盛怒伤志，则腰失强不能转摇而死。（医经说：肾是腰的外腑，转摇不能，肾将衰竭。得强者生，失强者死。又说：肾盛怒而不止则伤志，志伤则善忘其前言，腰脊不可以俯仰屈伸，毛发憔悴颜色枯夭，死于季夏是也。）
The *Suwen: Liuyuan Zhengji Dalun* states: When the Taiyang qi arrives, it leads to lower back pain. It also states: Juyang is synonymous with Taiyang; when deficient, it causes pain in the head, nape, lower back, and spine. The pathway of the Foot-Taiyang Bladder Meridian emerges from the head, branches down to the nape, runs along the medial aspect of the shoulder blades, flanks the spine, and reaches the middle of the waist. Therefore, pathology manifests as a sensation of the neck being pulled out, pain flanking the spine, the waist feeling as if broken, and the thighs being unable to flex. This occurs because deficiency of meridian qi allows pathogenic factors to lodge within, generating pain diseases. These pathogenic factors include wind, heat, dampness, dryness, and cold, all of which can cause disease. Generally, cold-damp patterns are more common than wind-heat patterns. However, there are cases of kidney-deficiency lower back pain caused by sexual exhaustion, due to the weakness of yang qi failing to move and transform. The classics state: "The waist is the mansion of the Kidney; if turning and rocking become impossible, the Kidney Qi is about to fail." Suitable formulas include Shenqi Wan (Kidney Qi Pill) and Huixiang Wan (Fennel Pill) to tonify insufficient yang.
Those who consume rich and greasy foods, take decoctions for a long time, and engage in intercourse while intoxicated damage their true qi, leading to Heat in the Kidney Qi. Heat in the Kidney Qi causes pain in the lower back and spine that prevents lifting the body; over time, marrow decreases and bones wither, developing into Guwei (Bone Atrophy). Suitable formulas include Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), Zishen Wan (Nourish Kidney Pill), and Fengsui Dan (Seal Marrow Elixir) to tonify insufficient yin. The *Ling Shu* states: For lower back pain, if the upper part is cold, select points on the Foot-Taiyin Spleen and Foot-Yangming Stomach meridians; if the upper part is hot, select points on the Foot-Jueyin Liver meridian; if the body cannot bend or extend, select points on the Foot-Shaoyang Gallbladder meridian. Generally, the three Yang meridities of the foot run from head to foot, and the three Yin meridities of the foot run from foot to abdomen; pain can occur wherever these meridians pass. Treatment requires determining which meridian is affected and its corresponding territory, needling the appropriate empty acupoints, and prescribing herbs based on the nature of cold or heat. For example, if Foot-Taiyang causes lower back pain radiating to the nape, spine, sacrum, and back with a heavy sensation, bleed the Weizhong point (BL40) and the two Taiyang meridians. Other cases follow this pattern. Those who insist on using a single formula for all types of lower back pain are certainly inflexible.
Wind, dampness, cold, heat, sprain/strain, blood stasis, qi stagnation, and phlegm accumulation are all branch manifestations. Kidney deficiency is the root manifestation. Wind injuring the Kidney causing pain presents with a floating pulse, pain shifting left or right without fixed location, radiating to both legs; Wujisan (Five Accumulations Powder) is suitable, adding Fangfeng (Saposhnikovia Root) half qian and Quanxie (Scorpion) three pieces per dose. Xiaoxuming Tang (Minor Rescue Decoction) and Duhuo Jisheng Tang (Angelica Pubescens and Poria Decoction) are also selectable. (Adding Chao Qutao Ren (Stir-fried Peach Kernel) to Xiaoxuming Tang from *San Yin Fang* is excellent for wind-induced lower back pain.) Swallow Sanxian Dan simultaneously. Zhuyu (Eucommia Bark) stir-fried with ginger juice and powdered, one qian per dose, taken with warm wine on an empty stomach, treats Kidney Qi lower back pain and wind-cold pathogens, named Zhuyu Jiu (Eucommia Wine). *San Yin Fang* also has Niuxi Jiu (Achyranthes Wine) for unbearable stabbing lower back pain caused by Kidney injury from wind-toxin.
Pain from dampness injury feels like sitting in water; since the Kidney belongs to Water, prolonged sitting in damp places or exposure to rain/dew causes two Waters to combine, leading to lower back pain. The pulse is typically slow, exacerbating on cloudy days or after prolonged sitting, accompanied by bodily heaviness; Shenshi Tang (Damp-Percolating Decoction) is primary. If ineffective, use Shen Zhuo Tang (Kidney-Lodging Decoction) or Sheng Fu Tang (Raw Aconite Decoction). For wind-damp lower back pain, use Duhuo Jisheng Tang. For cold-damp lower back pain, use Wujisan plus Taoren (Peach Kernel), Chuanxiong (Sichuan Lovage Rhizome), Rougui (Cinnamon Bark) decoction, or Mahuang Cangzhu Tang (Ephedra and Atractylodes Decoction), combined with Moyao Gao (Lower Back Rubbing Ointment). For damp-heat lower back pain, use Cangzhu Tang, Duhuo Tang, or Qianghuo Tang. Li Dongyuan stated: If the body feels heavy and the lower back feels sinking, it indicates damp-heat in the meridians. Add Huangbai (Phellodendron Bark) one qian, Fuzi (Prepared Aconite) five fen, and Cangzhu (Atractylodes Macrocephala Rhizome) two qian to Qianghuo Shengshi Tang (Notopterygium Decoction for Overcoming Damp-Heat).
Pain from cold invasion feels icy in the waist, with a tight pulse, alleviated by heat and aggravated by cold; Wujisan minus Jiegeng (Platycodon Root), plus Wuzhuyu (Evodia Fruit) half qian, or Jiangfu Tang (Ginger and Aconite Decoction) plus LAGui (Spicy Cinnamon) and Zhuyu, applied externally with Moyao Gao. Pain from heat invasion presents with a surging, rapid, and slippery pulse, thirst, and constipation; Gandou Tang (Sweet Bean Decoction) plus Xuduan (Dipsacus Root) and Tianma (Gastrodia Rhizome), alternating with Baidu San (Defecate Toxins Powder). If pain results from sprain/strain or falls/blows, use Ruxiang Chen Tong San (Frankincense Relieving Pain Powder) and Heishen San (Black Divine Powder), mixed with Fuyuan Tongqi San (Restore Origin Promoting Qi Circulation Powder), taken with wine. If ineffective, stagnant evil blood is likely present; first take Suhexiang Wan (Liquid Amber Pill) with wine, then use Wujisan plus Taoren, Dahuang (Rhubarb), Sumu (Dragon's Blood Wood) each one qian, and double the amount of Danggui (Angelica Sinensis).
If pain results from labor/overburdening, use Heqi Yin (Harmonizing Qi Drink) or Puxian Zhengqi San (Puxian Rectifying Qi Powder), or Shibu Tang (Ten Tonics Decoction) swallowing Qing'e Wan (Green Youth Pill). For sprain-strain lower back pain preventing turning/side-bending, take a large piece of aged Shenqu (Medicated Leaven), heat until red, quench in Laojiu (Old Wine), remove the Qu, and swallow Qing'e Wan with the wine, lying supine for a moment. Repeat if ineffective; pills may be omitted. Another method: mash Huixiang Gen (Fennel Root) with Hongqu (Red Yeast Rice), mix with good hot wine. Li Dongyuan stated: Blows/falls causing evil blood in the Taiyang meridian lead to lower back/spine pain or unbearable pain in calves/arms, with nasal congestion; Dilong Tang (Earthworm Decoction) is primary. Juhe Jiu (Walnut Seed Wine) and Shu Dahuang Tang (Cooked Rhubarb Decoction) are also options.
Zhu Danxi treated Xu Zhifu, age 60, with lower back pain from a horse fall, unable to turn/side-bend. His six pulses were scattered and large; deep pressure revealed wiry, small, long, and slightly firm qualities. Although evil blood was present, aggressive expulsion was contraindicated initially; tonification and connection were prioritized. He prescribed decoctions of Sumu, Renshen (Ginseng), Huangqi (Astragalus), Chuanxiong, Danggui, Chenpi (Tangerine Peel), Mutong (Akebia Stem), and Gancao (Licorice). After half a month, diet improved, then he administered natural copper powder mixed with the previous medicine. Recovery occurred in one month. Blood stasis pathology presents with a choppy pulse, stabbing pain upon turning, black stool, yellow-black urine, worse at night, named Lixue Yao Tong (Dripping Blood Lower Back Pain). Use Tuirong Huoluo Yin (Regulate Nutrient Activate Collaterals Drink), or Tao Ren Jiu Tiao Heishen San (Peach Kernel Wine-Mixed Black Divine Powder), or Siwu Tang (Four Substances Decoction) plus Taoren and Honghua (Safflower). Danxi used Buyin Wan (Tonify Yin Pill) plus Taoren and Honghua.
Qi stagnation pain presents with a deep pulse; Renshen Shunqi San (Ginseng Smooth Qi Powder) or Wuyao Shunqi San (Lindera Smooth Qi Powder) plus Wujia Pi (Acanthopanax Bark) and Muxiang (Costus Root), with little Gancao, decocted in water. Alternatively, Jiangzhen Xiang (Dalbergia Odorifera), Tanxiang (Sandalwood), and Chenxiang (Agarwood) totaling one liang, decocted and taken on an empty stomach. Phlegm lodging pain presents with a slippery or hidden pulse; Erchen Tang (Two Aged Herbs Decoction) plus Nanting (Pinellia) and Xiangfu (Cyperus Rhizome), Wuyao, and Zhike (Bitter Orange) is primary. Food-stagnation lower back/leg pain uses Guiban (Turtle Shell, wine-processed), Baiye (Cypress Leaf, wine-processed), Xiangfu (5 qian), La Jiezi (Hot Mustard Seed), Lingxiaohua (Lagerstroemia Flower, 1.5 qian), pill-formulated with wine paste, swallowed with Siwu Tang plus Chenpi and Gancao (one fen). For food/phlegm stagnation with excess qi and strong pulse, purgatives are indicated. Weilinxian (Syneilesis Aconitifolia) is a key herb for pain; powder two qian per dose, inserted into a sliced pig kidney, wrapped in wet paper, roasted, chewed thoroughly at dawn, washed down with hot wine, stopping at mild laxation.
*Benshi Fang* treats five types of lower back pain: five Walnut Kernels (peeled, pounded to paste), Wulingzhi (Trogopterus Dung) three qian, Hei Qianniu (Black Morning Glory Seed, stir-fried) three qian, Bai Qianniu (White Morning Glory Seed, stir-fried) three qian, Gouji (Cibotium Rhizome, lightly stir-fried) half liang, Bibi (Dioscorea Hypoglauca Rhizome, stir-fried) three qian, Moyao (Myrrh) thirty wen, Badou (Croton Seed) five grains (wrapped in wet paper, roasted, flesh taken, oil removed). All powdered, mixed with walnut paste, pill-formulated with vinegar paste to wu-tong seed size. Fifteen pills per dose: Wind lower back pain with Doulin Wu Hui Jiu (Bean-Drip Non-Wine Alcohol); Qi lower back pain with Wei Cong Bai Jiu (Roasted Scallion White Wine); Blood lower back pain with Danggui Jiu (Angelica Wine); Blow/Fall lower back pain with Sumu Jiu (Dragon's Blood Wine).
Zhang Zihe treated Zhao Jindao with one-year persistent lower back pain. Both hands had heavy, strong pulses. Tongjing San (Meridian-Penetrating Powder: Chenpi, Danggui, Gansui powder, three qian, taken with warm wine before bed) induced five to seven bowel movements. Then, Duzhu (Eucommia Bark, peeled, cut fine, stir-fried until silk breaks, powdered), three qian per dose. One pig kidney, thinly sliced five to seven pieces, soaked in pepper-salt to remove fishy water, stuffed with powder, wrapped in lotus leaf, sealed with multiple layers of wet paper, cooked over moderate fire, chewed before bed, washed down with warm wine. Each morning, Wubi Shanyao Wan (Matchless Yam Pill) once daily. Cured in several days. Effective for lower back pain radiating to knees/feet. Formula: Duzhu (ginger-processed, silk removed), Xuduan (Teasel Root), Hei Qianniu, Poguzhi (Cistanche/Broomseed - note: context implies Cistanche or Broomseed, usually Cistanche in tonics but here paired with purgatives? Text says Po Gu Zhi usually Cistanche, but often paired with Du Zhong for kidney. Here listed with purgatives? Actually "Po Gu Zhi" usually refers to Cistanche or sometimes Broomseed depending on region, but standard is Cistanche. However, listed with Qian Niu/Tao Ren suggests a complex formula. Let's stick to literal translation), Taoren (stir-fried, skin/hilum removed), Yanshusuo (Corydalis Rhizome) equal parts. Powdered. Walnut meat boiled in wine with wheat paste, pill-formulated. 50-70 pills per dose, warm wine or plain water before meals. (These use purgatives, suitable for excess patterns.)
Lower back/hip pain radiating to knees day and night: Tiger Bone San, Buguzhi Wan, Baibei Wan, Yangshen San, choose as needed. Generally, all lower back pain originates from Kidney deficiency. If complicated by pathogens, expel them. If spontaneous pain without external pathogens/stagnation, only tonify the Kidney. Symptoms of lower back/limb flaccidity, bodily fatigue, sore weak knees, pulse surging or fine but powerless, dull vague pain indicate this condition. Differentiate Cold vs. Heat: Fine, powerless pulse, timidity, shortness of breath, clear urination indicate Yang Deficiency. Use Shenqi Wan, Huixiang Wan, Lurong (Deer Antler), Yangshen (Sheep Kidney), or Dajianzhong Tang (Great Build the Middle Decoction) plus ten Sichuan Peppercorns, swallowing Yaoshen Wan and Shengliao Lurong Wan. Also, stir-fry Huixiang powder, stuff into sliced pig kidney, wrap in water/paper, roast, chew with wine. This tonifies insufficient Yang.
Surging, powerless pulse, yellow-red urine, intermittent deficiency-fire flare-ups indicate Yin Deficiency. As Li Dongyuan stated: Rich-food consumers taking long-term meds, intoxication-sex damaging true qi lead to Kidney Heat... resulting in Guwei. Use Liuwei Wan, Zishen Wan, Fengsui Dan, Buyin Wan to tonify insufficient Yin. Yang Renzhai said: The classics state "Waist is Kidney's mansion... if turning impossible, Kidney fails." If so, the disease is in Shaoyin; investigate the source to prescribe correctly. Although Zongjin gathers at the genitalia, and Liver is the same system as Kidney. Five Zang organs derive qi from grain; Spleen is the Kidney's granary. Depressive anger injures Liver causing tendon laxity; worry/thought injures Spleen causing Stomach Qi stagnation. Both can be primary causes of lower back pain, hence mentioned.
Depressive anger injuring Liver causing lower back pain: Tiaogan San (Regulate Liver Powder). Worry/thought injuring Spleen causing lower back pain: Chenxiang Jiangqi Tang (Aquilaria Descending Qi Decoction) and Tiaoqi San (Regulate Qi Powder), decocted with Ginger/Jujube. Weishen Wan (Roasted Kidney Pill) is miraculous for Liver/Kidney/Spleen damage, indigestion, and inability to rise from lower back pain. Frustration/frustrated will injuring Kidney causing pain: Heji Qiqi Tang (Harmonizer Seven Qi Decoction), add much Baifuling (Poria), little Rushen (Frankincense) and Chenxiang. Post-malaria/dysentery lower back pain, and post-menstrual lower back pain in women, belong to deficiency; tonify. In blood/qi tonics, add Duzhu and Cebeiye (Biota Leaf). Zhu Danxi said: Chronic lower back pain must be opened with Guigui (Cassia Twig) to stop; abdominal/flank pain similarly. JuXiang Wan (Citrus Fragrant Pill) treats chronic lower back pain not healing, employing the intent of opening with Guigui.
[Shenzhuo] Shenzhuo disease: Body heavy, waist cold as ice, normal diet, free urination, cold pain below waist like carrying 5,000 coins. Treatment: Percolate dampness, warm-disperse, use Shen Zhuo Tang.
[Yao Ku Tong] Lower back pain belongs to Foot-Taiyang Bladder Meridian. Hip pain belongs to Foot-Shaoyang Gallbladder Meridian. If caused by cold-damp invading meridians, stagnating in bones/joints, disrupting qi/blood: Chushi Dan (Remove Dampness Pill) or Shenshi Tang plus Shaoyao (Peony), Qingpi (Green Tangerine Peel), Cangzhu, Binglang (Areca Seed). Phlegm stagnation in meridians, clashing with blood stasis, internal pain: Daotan Tang (Guide Phlegm Decoction) plus Binglang, Qingpi, Shaoyao; Excess patterns use Yugong San. Dampness holding hip/waist pain: Qing Shi San (Clear Dampness Powder).
[Yao Ruan] Zhu Danxi attributes to latent heat in Kidney/Liver; treat with Huangbai (Phellodendron) and Fangji (Stephania Root).
[Diagnosis] Large pulse: Kidney deficiency. Choppy pulse: Blood stasis. Slow pulse: Cold-damp. Slippery or hidden pulse: Phlegm. Chi (Cun-Guan-Chi) deep pulse: Lower back/spine pain. Chi deep and wiry: Deep indicates stagnation, wiry indicates deficiency. Deep-wiry-tight: Cold. Deep-wiry-floating: Wind. Deep-wiry-choppy-fine: Dampness. Deep-wiry-excess: Sprain/strain. Kidney exhaustion and excessive anger injuring Zhi (Will) lead to loss of waist strength, inability to turn/rock, and death. (Classics: "Kidney is waist's mansion... gain strength live, lose strength die." Also: "Excessive anger injures Zhi... forgetfulness, inability to bend/extend waist/spine, hair withered, color faded, dies in late summer.")