腰为肾府。肾与膀胱为表里。在经属太阳。在脏属肾气。诸脉皆贯于肾。而络于腰脊。故腰
痛悠悠不止乏力酸软者肾虚也。遇阴雨久坐。则冷痛沉重者。湿也。遇寒而痛。足冷背强者
。寒也。遇热而痛者热也。郁怒而痛者气滞也。忧愁思虑而痛者气虚也。劳动则痛者肝肾衰
也。风痛则牵连左右。脚膝强急。挫闪痛者。举身不能俯仰转侧。瘀血作痛。昼轻夜重。便
黑溺清。(刺委中)。肾着腰痛身重。腰冷如冰。亦由湿也。
跌扑伤而腰痛者此伤在筋骨。而血脉凝滞也。用酒糟葱姜捣烂罨之最效。
俗以身痛呼为箭风者。因其人卫气虚腠理不密。贼风乘虚而入客于经络营卫不通。则痛
处按之用针挑出形如羊毛。此即闭塞结硬之络脉也而挑时暂快。过则依然。治法或燃麻油灯
淬之或用艾叶温散或用白芥子为末调敷。或用金银花内服取效。
五脏之滞。皆为心痛。肾心痛者。多由阴邪上冲。故善螈如从后触其心。胃心痛者。多由停
滞。故胸腹胀满。脾心痛者。多由寒逆中焦。故其痛甚。肝心痛者。多由木火之郁。病在血
分。故色苍苍如死状。肺心痛者。多由上焦不清。病在气分。故动作则病益甚。(以上刺法
见灵枢厥病篇)知其在气则顺之。在血则行之。郁则开之滞则逐之。火多实则或散或清之。
寒多虚。则或温或补之。得其本。可随手而应也。真心痛者。不可治。(金匮要略心痛章沈
氏注曰五脏胃府心痛并痰虫食积即为九痛)外台九种心痛之名一虫二注。三气四悸。五食六
饮七冷。八热。九去来痛。
心痛有上中下三焦之别上焦痛者。在膈上。内经所谓胃脘当心而痛。时人以此为心痛非
也。中焦痛者。在中脘。脾胃间病也。下焦痛者。在脐下肝肾大小肠病也。
腰部是肾脏的外府。肾与膀胱互为表里关系。在经络归属上,属于太阳经;在脏腑归属上,属于肾气。所有的经脉都贯穿肾脏,并联络于腰脊部位。因此,腰痛绵绵不止、伴有乏力酸软症状的,是肾虚所致;遇到阴雨天或久坐后,出现冷痛且身体沉重的,是湿邪所致;遇寒冷则疼痛加剧,伴有足部发冷、背部僵硬的,是寒邪所致;遇热则疼痛的,是热邪所致;因愤怒郁结而疼痛的,是气机阻滞所致;因忧愁思虑而疼痛的,是气虚所致;劳动后疼痛加重的,是肝肾衰退所致;风邪引起的疼痛,会牵连左右两侧,导致脚膝僵硬紧急;挫伤闪失引起的疼痛,表现为全身不能俯仰和转侧;瘀血引起的疼痛,特点是白天轻晚上重,大便色黑但小便清亮。(治疗可针刺委中穴)。肾着病引起的腰痛,感觉身体沉重,腰部冰冷如冰,也是由湿邪所致。
因跌打损伤导致的腰痛,这是伤势在筋骨,导致血脉凝滞。用酒糟、生姜、大葱捣烂后外敷,效果最好。
民间将身痛称为“箭风”,这是因为患者卫气虚弱,腠理(皮肤毛孔)不紧密,贼风乘虚而入,客居于经络,导致营卫运行不通畅。此时在疼痛处按压,用针挑出形似羊毛的异物,这就是闭塞结硬的络脉。挑治时暂时感到爽快,过后依然如故。治疗方法有的用燃着的麻油灯淬刺患处,或用艾叶温散寒邪,或用白芥子研末调敷,或者内服金银花以取效。
五脏的气机滞涩,都会引起心痛。肾心痛,多由阴邪上冲所致,所以患者善惊抽搐,感觉像从背后撞击心脏一样;胃心痛,多由食物停滞所致,所以胸腹胀满;脾心痛,多由寒邪逆犯中焦所致,所以疼痛剧烈;肝心痛,多由木火之气郁结所致,病在血分,所以面色青苍,如同死状;肺心痛,多由上焦不清爽所致,病在气分,所以活动时病情加重。(以上刺法详见《灵枢·厥病》篇)。知道病在气分就顺其气机,病在血分就行其血液,气郁就开泄它,气滞就驱逐它,火邪多属实证就用发散或清热的方法,寒邪多属虚证就用温补的方法。抓住疾病的根本,就能随手应验。真心痛,是不可治愈的。(《金匮要略·心痛》章沈氏注解说:五脏及胃腑的心痛,并伴有痰、虫、食积的,即为九种痛)。《外台秘要》记载了九种心痛的名字:一为虫痛,二为注痛,三为气痛,四为悸痛,五为食痛,六为饮痛,七为冷痛,八为热痛,九为往来痛。
心痛有上、中、下三焦的区别。上焦痛,位置在膈肌之上,《内经》称之为“胃脘当心而痛”。当时的人将此误认为是心痛,其实不对。中焦痛,位置在中脘穴附近,是脾胃之间的疾病。下焦痛,位置在脐下,是肝肾及大小肠的疾病。
The waist is the mansion of the Kidney. The Kidney and Bladder are exterior-interiorly related. In terms of meridian affiliation, it belongs to the Taiyang (Greater Yang) channel; in terms of zang-organ affiliation, it pertains to Kidney Qi. All meridians penetrate the Kidney and connect with the lumbar spine. Therefore, lingering lower back pain accompanied by fatigue, soreness, and weakness indicates Kidney deficiency. Cold pain and heaviness occurring after exposure to rainy weather or prolonged sitting indicate Dampness. Pain exacerbated by cold, accompanied by cold feet and a stiff back, indicates Cold. Pain exacerbated by heat indicates Heat. Pain caused by anger and depression indicates Qi stagnation. Pain caused by worry and overthinking indicates Qi deficiency. Pain aggravated by labor indicates decline of the Liver and Kidney. Wind-induced pain radiates to both sides, causing stiffness and urgency in the legs and knees. Sprain or contusion pain manifests as an inability to bend, extend, or turn the body. Blood stasis pain is characterized by being lighter during the day and heavier at night, with dark stools but clear urine. (Treatment: puncture Weizhong [BL-40]). Lower back pain due to "Kidney Fixation" (Shenzhuo), characterized by heavy body sensation and a waist feeling cold as ice, is also caused by Dampness.
Lower back pain resulting from falls or blows indicates injury to the sinews and bones, leading to coagulation and stagnation of blood vessels. Applying a paste made of fermented rice wine lees, fresh ginger, and scallions is most effective.
Commonly, generalized body pain is referred to as "Arrow Wind." This occurs because the patient's Defensive Qi (Wei Qi) is deficient and the interstices (cou li) are not tight, allowing pathogenic winds to enter vacuously and lodge in the meridians, obstructing the flow of Ying (Nutritive) and Wei (Defensive) Qi. Pressing on the painful area and picking with a needle may extract wool-like filaments, which represent blocked and hardened collateral vessels. Although relief is temporary after picking, the condition returns. Treatment methods include cauterization with a burning sesame oil lamp, warming and dispersing with mugwort (Ai Ye), applying a poultice of white mustard seed powder, or internally administering Honeysuckle Flower (Jinyinhua).
Stagnation in any of the Five Zang organs can cause Heart pain. Kidney Heart pain is often caused by Yin pathogens rushing upward, manifesting as spasms and a sensation as if being struck from behind. Stomach Heart pain is often caused by food stagnation, manifesting as chest and abdominal fullness. Spleen Heart pain is often caused by Cold rebellion in the Middle Jiao, manifesting as severe pain. Liver Heart pain is often caused by the depression of Wood and Fire, affecting the Blood level, manifesting as a pale cyan complexion resembling death. Lung Heart pain is often caused by turbidity in the Upper Jiao, affecting the Qi level, manifesting as worsening symptoms upon movement. (The above needling methods are detailed in the *Ling Shu: Jue Bing* chapter). If the disease is in the Qi, regulate its flow; if in the Blood, invigorate it; if depressed, open it; if stagnant, expel it. For excess Fire patterns, use dispersing or clearing methods; for deficiency Cold patterns, use warming or tonifying methods. Grasping the root allows for immediate efficacy. True Heart pain is incurable. (Shen’s commentary on the *Heart Pain* chapter of the *Jin Gui Yao Lue* states that heart pain involving the five zang organs and stomach fu, accompanied by phlegm, parasites, or food accumulation, constitutes the nine types of pain. The *Wai Tai Mi Yao* lists nine names for heart pain: 1. Parasite, 2. Impression/Transmission, 3. Qi, 4. Palpitation, 5. Food, 6. Drink, 7. Cold, 8. Heat, 9. Wandering).
Heart pain is distinguished by the Upper, Middle, and Lower Jiao. Upper Jiao pain is located above the diaphragm; the *Nei Jing* refers to this as "epigastric pain striking the heart center." It is incorrect for contemporary people to label this simply as heart pain. Middle Jiao pain is located at the Zhongwan region, indicating pathology between the Spleen and Stomach. Lower Jiao pain is located below the umbilicus, indicating pathology of the Liver, Kidney, Large Intestine, and Small Intestine.