腰痛之脉，多沉而弦。兼浮者风，兼紧者寒。
弦滑痰饮，濡细肾着。大乃肾虚，沉实闪肭。
腰痛者，足之六经病也。足三阳从头走足，足三阴从足入腹。各经受邪，则随
各经之所过者为痛，与头心为痛之义略同，而手之六经不与焉，以手经不至于腰也。
其因有三，曰外因、内因、曰不内外因。外因者，风、热、寒、湿也。木化风，火
化热，水化寒，土化湿。风多伤厥阴，火多伤少阳，寒多伤太阳、少阴，湿多伤太
阴、阳明。此言邪伤足三阴、三阳之经也，亦各从其类也。厥阴腰痛，腰中如张弓
弩弦（宜调肝散、加味逍遥散之类。）少阳腰痛，如以针刺其皮中，循循然不可以俯仰，不可以
顾。（宜逍遥散倍白芍加枳壳、木香之类。）太阳腰痛，则引项脊尻背如重状（宜东垣羌活胜湿汤、川芎肉桂
汤、九味羌活汤之类。）足少阴腰痛，痛引脊内廉。（宜金匮八味丸、六味丸、青娥丸之类。）太阴散脉
腰痛，腰下如有横木居其中，甚则遗溲。（宜东垣苍术汤、统旨清湿散之类。）阳明腰痛，不可以
顾，顾如有见者，善悲（宜四物汤、平胃散、导痰汤之类。）内因者，恐惧失志、恚怒忿恨、抑郁
忧思也。恐惧失志则伤肾，恚怒忿恨则伤肝，抑郁忧思则伤脾。此言情志不得其所，
三阴脏气自伤也。亦各从其类也。肾伤腰痛，虚羸不足，面目黧黑，远行久立，力
不能尽。（宜六味丸、煨肾丸、黑地黄丸之类。）肝伤腰痛，腹急胁胀，目视KT KT ，所祈不得，意
淫于外，宗筋弛纵，及为白淫。（宜六味丸加知柏之类。）脾伤腰痛，肌肉濡渍，痹而不仁，
饮食不化，肠胃胀满，闭坠腰胁。（宜平胃散、局方普贤正气散之类。）不内外因者，房室过度，
烦劳不节，以致精力耗竭，腰膂空虚，发为腰痛。盖精藏于肾，而腰者肾之府。力
出于膂，而腰者膂所系。其痛转侧屈伸不得，膝酸胫冷，腰中冷，面黑，伛偻不能
久立。（宜二至丸、子和无比山药丸、六味丸之类。）一种腰痛，因作劳多汗，衣里冷湿，久久得之。
其证身重不渴，小便自利，食饮如常，腰以下冷重，如带五千钱者。（名曰肾着。肾着者，
因劳极，肾膂之气张散，汗湿乘之，乘其已所胜也。湿因注渗腰膂之间，着而不行，犹邪有着落，无
碍他处，故但腰痛而重，更无他证。如上所云，宜仲景肾着汤、子和禹功散、统旨清湿散、渗湿汤之类。
）一种因搏击、堕坠、闪肭，气血凝滞，或只气滞而血未至于瘀，或血瘀结而气久方行，令人伛偻肿痛
而重，牵引胁脊。气滞者，呼吸亦痛，不能转侧，鼻塞。身不动，则痛亦定。（宜良方人参顺气散、
乌药顺气散之类。）血瘀者，亦转侧不能，腰下重痛，若锥刀之刺，大便黑，面目黄，日
轻夜重。（宜调荣活络饮、仲景桃核承气汤之类。）一种积痰停饮，阻滞于腰胁之间，有碍气道，
亦能作痛。其痛或作或止，或移易不定，或不仁，或麻木，或痛处如冰，腰脊重坠。
（宜导痰汤、王隐君滚痰丸之类。）以上诸证，大抵外因，寒湿多而风热少；内因，肾多，肝次
之，而脾脏少。不内外因，感亦明显。若谨慎善摄之人，自不多罹，并可终身不一
遇也。诸腰痛，脉多沉弦者，沉为在里，在下，弦则为痛，故多沉弦也。兼浮者，
沉弦中有泛泛欲浮之势，所谓如水漂木，举之有余，是状风邪虚浮之性，非言在表
之浮也。兼紧者寒，寒紧敛也。兼滑者痰饮，痰饮滑利也。兼濡细者肾着，肾着者
湿，濡细渗着也。兼大者肾虚，肾虚不敛藏，而反空松虚大也。兼实者闪肭，闪肭
非血瘀，则气滞。皆成凝滞，故沉实也。
The pulse of lower back pain (Yao Tong) is mostly deep and wiry. If accompanied by a floating pulse, it indicates wind; if accompanied by a tight pulse, it indicates cold.
A wiry and slippery pulse indicates phlegm-fluid retention (Tan Yin); a soft and thin pulse indicates Kidney Fixation (Shen Zhuo). A large pulse suggests Kidney deficiency (Shen Xu); a deep and excess pulse suggests sprain/strain (Shan Na).
Lower back pain is a disease of the six meridians of the foot. The three Yang meridians of the foot run from head to foot, and the three Yin meridians of the foot run from foot to abdomen. When each meridian is invaded by pathogenic factors, the pain occurs along the pathway of that meridian, which is roughly similar in principle to pain in the head or heart. The six meridians of the hand are not involved because they do not reach the waist.
There are three causes: external causes, internal causes, and causes neither internal nor external. External causes include wind, heat, cold, and dampness. Wood transforms into wind, fire transforms into heat, water transforms into cold, and earth transforms into dampness. Wind often injures the Jueyin meridian, fire often injures the Shaoyang meridian, cold often injures the Taiyang and Shaoyin meridians, and dampness often injures the Taiyin and Yangming meridians. This describes how pathogens injure the six meridians of the foot (three Yin and three Yang), following their respective categories.
Jueyin lower back pain feels like a drawn bowstring in the waist (suitable for Tiao Gan San [Liver Regulating Powder] or Jiawei Xiaoyao San [Modified Free and Easy Wanderer Powder]). Shaoyang lower back pain feels like needles pricking the skin, with gradual inability to bend forward or backward, or to look back (suitable for Xiaoyao San [Free and Easy Wanderer Powder] doubled with Baishao [White Peony Root], plus Zhike [Bitter Orange] and Muxiang [Aucklandia Root]). Taiyang lower back pain draws the neck, spine, buttocks, and back as if heavy (suitable for Dong Yuan Qiang Huo Sheng Shi Tang [Dong Yuan's Notopterygium Decoction to Overcome Dampness], Chuanxiong Rougui Tang [Ligusticum and Cinnamon Twig Decoction], or Jiuwei Qiang Huo Tang [Nine-Ingredient Notopterygium Decoction]). Foot Shaoyin lower back pain draws pain to the inner aspect of the spine (suitable for Jin Gui Ba Wei Wan [Eight-Ingredient Pill from the Golden Cabinet], Liu Wei Wan [Six-Ingredient Pill], or Qing E Wan [Green Quiver Pill]). Taiyin lower back pain feels as if a horizontal log is lodged in the lower waist, and in severe cases, leads to urinary incontinence (suitable for Dong Yuan Cang Zhu Tang [Dong Yuan's Atractylodes Decoction] or Tong Zhi Qing Shi San [Tong Zhi Clearing Dampness Powder]). Yangming lower back pain prevents looking back; when attempting to look back, there may be visual hallucinations, and the patient is prone to sadness (suitable for Si Wu Tang [Four Substance Decoction], Ping Wei San [Calm the Stomach Powder], or Dao Tan Tang [Phlegm-Guiding Decoction]).
Internal causes include fear causing loss of will, anger causing resentment, and depression causing worry/thought. Fear injuring the will damages the Kidney; anger and resentment damage the Liver; depression and worry damage the Spleen. This is because emotions are out of place, leading to self-injury of the Qi of the three Yin organs. It also follows their respective categories.
Kidney injury causing lower back pain presents with emaciation and insufficiency, dark complexion, and inability to exert strength after long walks or standing (suitable for Liu Wei Wan [Six-Ingredient Pill], Wei Shen Wan [Roasted Kidney Pill], or Hei Di Huang Wan [Black Rehmannia Pill]). Liver injury causing lower back pain presents with abdominal urgency and hypochondriac distension, blurred vision (KT KT), unfulfilled desires, scattered attention, flaccidity of the genital tendons (Zong Jin), and white discharge (Bai Yin) (suitable for Liu Wei Wan [Six-Ingredient Pill] added with Zhimu [Anemarrhena Rhizome] and Huangbai [Phellodendron Bark]). Spleen injury causing lower back pain presents with moistened muscles, numbness and insensitivity, undigested food, gastrointestinal distension, and bearing-down pain affecting the waist and hypochondrium (suitable for Ping Wei San [Calm the Stomach Powder] or Ju Fang Pu Xian Zheng Qi San [Formulary Standard Pu Xian Upright Qi Powder]).
Causes neither internal nor external include excessive sexual activity and overexertion without regulation, leading to exhaustion of essence and energy, emptiness of the waist and lumbar region, resulting in lower back pain. Essence is stored in the Kidney, and the waist is the mansion of the Kidney. Strength comes from the Lv (muscles between the shoulders), and the waist is connected to the Lv. The pain manifests as inability to turn, side-bend, flex, or extend, sour knees, cold calves, cold waist, dark face, and kyphosis preventing prolonged standing (suitable for Er Zhi Wan [Two Solstices Pill], He Zi Wu Bi Shan Yao Wan [He Zi's Matchless Yam Pill], or Liu Wei Wan [Six-Ingredient Pill]).
Another type of lower back pain arises from labor with excessive sweating, cold dampness in clothing, developing over time. Symptoms include heavy body but no thirst, free urination, normal appetite, coldness and heaviness below the waist, as if wearing five thousand coins (named Kidney Fixation/Shen Zhuo). Kidney Fixation occurs due to extreme labor causing dispersion of Kidney and Lv Qi, allowing sweat-dampness to invade what it overcomes. Dampness infiltrates the waist and Lv, adhering and not moving, like a pathogen finding a foothold without affecting other areas. Thus, only lower back pain and heaviness occur, with no other symptoms. As mentioned above, suitable for Zhong Jing Shen Zhuo Tang [Zhong Jing's Kidney Fixation Decoction], He Zi Yu Gong San [He Zi's Yu Gong Powder], Tong Zhi Qing Shi San [Tong Zhi Clearing Dampness Powder], or Shen Shi Tang [Dampness-Oozing Decoction].
Another type results from blows, falls, or sprains, causing stagnation of Qi and Blood. It may be only Qi stagnation without Blood stasis, or Blood stasis with delayed Qi movement, causing kyphosis, swelling, pain, heaviness, and traction on the hypochondrium and spine. In Qi stagnation, breathing is painful, turning is impossible, and nasal congestion occurs. Without body movement, the pain location is fixed (suitable for Liang Fang Ren Shen Shun Qi San [Good Formula Ginseng Smooth Qi Powder] or Wu Yao Shun Qi San [Litsea Smooth Qi Powder]). In Blood stasis, turning is also impossible, with heavy pain below the waist like needle or knife stabbing, black stool, yellowish face, lighter during the day and heavier at night (suitable for Tiao Rong Huo Luo Yin [Regulate Nutrient and Unblock Collaterals Decoction] or Zhong Jing Tao He Cheng Qi Tang [Zhong Jing's Peach Kernel and Cathartic Decoction]).
Another type involves accumulated phlegm and retained fluids obstructing the space between the waist and hypochondrium, hindering the Qi pathway, also causing pain. The pain may come and go, shift unpredictably, cause numbness or insensitivity, feel like ice at the painful site, and involve heavy sinking of the waist and spine (suitable for Dao Tan Tang [Phlegm-Guiding Decoction] or Wang Yinjun Gun Tan Wan [Wang Yinjun's Rolling Phlegm Pill]).
Generally, among these syndromes, external causes are mostly cold-damp and less wind-heat; internal causes are mostly Kidney,其次 Liver, and least Spleen. Causes neither internal nor external are also obvious. Those who are cautious and good at self-care will rarely suffer from this and may never encounter it in their lifetime.
Regarding the pulse of various lower back pains being mostly deep and wiry: Deep indicates interior and lower body; Wiry indicates pain. Hence, deep and wiry pulses are common. If accompanied by floating, it is a tendency within the deep-wiry pulse to float superficially, described as "wood floating on water," with excess upon light palpation. This describes the vacuous-floating nature of wind pathogens, not a floating pulse indicating exterior syndrome. Accompanied by tight indicates cold, as cold causes contraction and tightening. Accompanied by slippery indicates phlegm-fluids, as phlegm-fluids are slippery. Accompanied by soft and thin indicates Kidney Fixation, which is dampness; soft and thin reflects the penetrating and adhering nature of dampness. Accompanied by large indicates Kidney deficiency, where deficiency fails to consolidate and instead becomes empty and loose/large. Accompanied by excess indicates sprain; sprain is either blood stasis or Qi stagnation, both forming stagnation, hence deep and excess.