经义
腰者肾之府，转摇不能，肾将惫矣。（《素问》）
肝，足厥阴也；是动则病腰痛，不可以俯仰。○膀胱，足太
阳也；是动则病冲，头痛，目似脱，项似拔，脊痛，腰似折。（《灵枢》）
哲言
腰痛∶有肾虚、有痰饮、有食积、有挫闪、有瘀血、有风、有寒、有湿、有热、有气，凡十种。（《东医宝鉴》）
两腰眼横过处痛，乃足少阴；连腿痛，乃足太阳；连脊及项痛，亦足太阳，连胯痛，乃足少阳；连膝痛，
乃足少阴、厥阴。（《医阶辨证》）
腰痛∶悠悠不止，乏力酸软者，房欲伤肾也。HT 骨如脱，四肢倦怠者，劳力伤气也。面黧腰胀，不能久立
者，失志伤心，血脉不舒也。腹满肉痹，不能饮食者，忧思伤脾，胃气不行也。胁腰胀闷，筋弛白淫者，郁怒
伤肝，肾肝同系也。冷痛沉重，阴雨则发者，湿也。足冷背强，洒淅拘急者，寒也。牵连左右，脚膝强急者，
风也。举身不能俯仰，动摇不能转侧者，挫也。有形作痛，皮肉青白者，痰也。无形作痛，胀满连腹者，气也。
便闭溺赤，烦躁口渴者，膏粱积热也。昼轻夜重，便黑溺清者，跌损血瘀也。（《证治汇补》）
腰者，肉之要处也，筋骨皆远，惟带脉为之收束。带脉坠则腰重，带脉纵则腰肿，带脉敝则腰如折矣。腰
者肾之府，一点痛为真腰痛，不可忽视。（《医参》）
肾者，作强之官，技巧出焉。束骨而利机关，从腰膝始。腰胯痛者，知技巧无所施，而强者自弱。若寒、
若湿，皆得击我之弱而客之。彼客我主，只须强下焦之阳，胜之以主。主者，肾也。（程郊倩）
补编
虚劳腰痛，少腹拘急，小便不利者，八味肾气丸主之。○肾着之病，其人身体重，腰中冷，如坐水中，形
如水状；反不渴，小便自利，饮食如故；病属下焦，身劳汗出，衣被冷湿，久久得
之。腰以下冷痛，腹重如带五千钱，甘姜苓术汤主之。（《金匮》）
腰为肾之府，肾与膀胱为表里。在经属太阳，在脏属少阴，又为冲、任、督、带之要会。凡病腰痛者，
多由真阴不足，最宜培补肾气为主。○腰痛，虚证十居八九。察其既无表邪，又无湿热，或以年衰，或以劳苦，
或酒色斫丧，或七情忧郁所致者，则悉属虚证。其候∶色必淡白，脉必细微，或行立不支而卧息少可，或疲倦
无力而劳动益甚。凡积而渐至者皆不足；暴而痛甚者多有余。内伤禀弱者皆不足；外感邪实者多有余。治当辨
其所因。○丹溪云∶诸腰痛不可用人参补气，补气则痛愈甚；不可峻用寒凉，得寒则闭遏而痛亦甚。此言皆未
当也。盖凡劳伤虚损而阳不足者，多有气虚之证，何为人参不可用？又如火聚下焦痛剧而不可忍者，速宜清火，
何为寒凉不可用？但虚中挟实，不宜用参者有之；虽有火而热不甚，不宜过用寒凉者亦有之。若谓概不可用，
岂其然乎？（《景岳全书》）
腰痛以肾为主，然有内因、外因、不内外因之别。旧有五辨∶一曰阳虚不足，少阴肾衰；二曰风痹；三
曰劳役伤肾；四曰坠堕损伤；五曰寝卧湿地。景岳更增表、里、虚、实、寒、热之论，尤为详悉。夫内因治法∶
肾阳有亏，则益火以消阴翳；肾阴内夺，则壮水以制阳光。外因治法∶寒湿伤阳者，用苦辛温以通阳泄浊；
湿郁生热者，用苦辛以胜湿通腑。不内外因治法∶劳役伤肾者，以先天后天同治；坠堕损伤者，辨伤之轻重与
瘀之有无，或通或补。若夫腿足痛，外感者惟寒湿、湿热、湿痰之流经入络。《经》云∶伤于湿者，下先受之。
故当以治湿为主，其间佐温、佐清、佐散，随证制方。内伤则不外肝、脾、肾三者之虚，或补中，或填下，或
养肝，随证施治。（《临证指南》）
死血腰痛，转动若锥刀之刺，大便色黑，日轻夜重，宜调营活络汤。肾虚腰痛，不能反侧者，宜羊肾丸。（朱丹溪）
腰痛有寒湿、伤损之异。腰酸悉属肾虚，惟有峻补。男子用
青娥丸或八味丸加补骨脂、杜仲，有热去附子加五味子；妇人用六味加杜仲、续断。（《张氏医通》）
腿痛∶有属湿者，脉沉濡或伏，两膝隐隐作痛，或麻木作肿，遍身沉重，天阴益甚。初宜微表，后兼分利。
有属湿热者，脉濡细而数，痛自腰胯至足，或上或下，或肿、或红，小便赤涩。宜渗湿清热，当归拈痛汤。有
属湿痰流注者，脉沉滑或弦，腰腿一块互换作痛，恶心头眩。宜豁痰行气，羌独、二术、二陈，或加减豁痰汤。
有属阴虚者，脉细而数，或两尺洪盛，肌体羸瘦，足心及胫俱痛，不能任地。宜滋阴降火，四物汤加知、柏、
牛膝、杜仲。有属阳虚者，脉沉而弱，或虚大，两足浮肿，大便不实，小便短少，痛不能动，乃命门火衰，真
阳虚极，宜金匮肾气丸。盖下部道远，非乌附不能达；湿痰郁久，非乌附不能开。（《冯氏锦囊》）
环跳穴及腿根彻痛不已，外皮如故，脉沉数或滑，防生附骨疽。乃毒瓦斯附着于骨而成。人多误为湿热，及
至脓成，气血大亏，不可救矣！不知此证肾虚者多患之，因真气虚弱，邪气得以深袭。前人用附子温补肾气，
又能行药势、散寒邪也。（薛立斋）
脉候
肾脉搏坚而长。其色黄而赤者，当病折腰。（《素问》）
腰病之脉∶大为肾虚，涩为瘀血，缓为湿，滑为痰，沉紧为寒，浮弦为风，沉实为闪肭。（《证治准绳》）
选案
一人体浓，酒色内伤，腰忽拘挛疼痛，口渴多汗，诊脉弦洪，两尺更甚。治用黄柏、元参，服之立愈。人
问何故？曰∶此相火上炎，冲于腰臀，黄柏去相火也。拘挛疼痛，则气逆不舒，火盛，温之不可；脉洪，补之
非宜；汗多，风药又不可用。元参性寒走肾，退六经之火，枢机上下通行，拘挛自舒矣。○一人患腰痛，医作肾
虚治，用山萸、杜仲、破故纸等药，益甚。予以为风湿致病，改用羌活、苍术、木通、防己、威灵仙、萆 、
牛膝而愈。（程星海）
一人因堕马后腰痛不止，日轻夜重，瘀血谛矣。与四物汤去生地，加肉桂、桃仁、红花、苏木，四服便下
黑瘀而痊。（《医学六要》）
一老年腰膝久痛，牵引少腹，两足不能步履。此奇经二脉为病，方用鹿角霜、当归、苁蓉、官桂、小茴香、
柏子仁。（叶天士）
[Scriptural Principles]
The waist is the mansion of the Kidney. If turning and shaking becomes difficult, it indicates that the Kidney function is about to decline. (From *Suwen*)
The Liver belongs to the Foot Jueyin Meridian; when this meridian is disturbed, it causes lower back pain, making the body unable to bend forward or backward. ○ The Bladder belongs to the Foot Taiyang Meridian; when this meridian is disturbed, it causes Qi rushing upward with headache, eyes feeling as if they are popping out, the neck feeling as if being pulled, spinal pain, and the waist feeling as if broken. (From *Lingshu*)
[Philosophical Remarks]
Lower back pain: It can be caused by Kidney deficiency, Phlegm-fluid retention, Food stagnation, Sprain/Contusion, Blood stasis, Wind pathogen, Cold pathogen, Dampness pathogen, Heat pathogen, and Qi stagnation, totaling ten types. (From *Dongui Bogam*)
Pain across the horizontal area of both lumbar eye points belongs to the Foot Shaoyin Meridian; pain radiating to the legs belongs to the Foot Taiyang Meridian; pain radiating to the spine and neck also belongs to the Foot Taiyang Meridian; pain radiating to the hips belongs to the Foot Shaoyang Meridian; pain radiating to the knees belongs to the Foot Shaoyin and Foot Jueyin Meridians. (From *Yijie Bianzheng*)
Lower back pain: Lingering without cessation, accompanied by fatigue, soreness, and softness, is due to sexual excess damaging the Kidney. Bones feeling as if dislocated, with four limbs listlessness, is due to labor damaging Qi. Dark complexion, abdominal distension, and inability to stand for long periods indicate Heart damage from frustration, leading to unsmooth blood vessels. Abdominal fullness, muscle numbness, and inability to eat indicate Spleen damage from overthinking, causing Stomach Qi obstruction. Hypochondriac and lumbar distension, flaccid tendons, and leukorrhea indicate Liver damage from anger, as the Liver and Kidney are interconnected. Cold pain and heaviness, occurring on rainy days, is Dampness. Cold feet, stiff back, shivering, and spasms are Cold. Pain radiating to both sides, with stiff and cramped feet and knees, is Wind. Inability to bend or twist the whole body is Sprain. Pain with visible form and blue-white skin discoloration is Phlegm. Formless pain with fullness extending to the abdomen is Qi. Constipation, red urine, irritability, and thirst are Heat accumulation from rich food. Lighter pain during the day and heavier at night, with black stool and clear urine, is Blood stasis from trauma. (From *Zhengzhi Huibu*)
The waist is a crucial area for flesh, where muscles and bones are distant, bound only by the Dai Mai (Girdle Vessel). If the Dai Mai sinks, the waist feels heavy; if it relaxes, the waist swells; if it fails, the waist feels broken. The waist is the mansion of the Kidney; point-specific pain constitutes true lower back pain and should not be ignored. (From *Yican*)
The Kidney is the official of strength, from which skills emerge. It binds bones and facilitates joints, starting from the waist and knees. Those with waist-hip pain know their skills cannot be applied, and strength turns to weakness. Whether Cold or Dampness, they attack our weakness and become pathogens. When the pathogen attacks the host, one must strengthen the Yang of the Lower Jiao to overcome the pathogen with the host. The "Host" refers to the Kidney. (Cheng Jiaoqian)
[Supplementary Compilation]
For lower back pain due to consumptive disease, with hypogastric tension and difficulty urinating, Bawei Shenqi Wan (Eight-Ingredient Rehmannia Pill) is indicated. ○ For Renzhe Disease (Kidney Fixation), the patient feels heavy in the body, cold in the waist, as if sitting in water, resembling edema; yet there is no thirst, urination is normal, and appetite is good. This disease belongs to the Lower Jiao, caused by sweating from labor and cold dampness from clothing over time. Cold pain below the waist and heaviness in the abdomen like carrying 5,000 coins are treated with Ganjiang Lingzhu Tang (Ginger, Poria, Atractylodes Decoction). (From *Jingui Yaolue*)
The waist is the mansion of the Kidney; the Kidney and Bladder are exterior-interior pairs. In the meridians, it belongs to Taiyang; in the zang-fu, it belongs to Shaoyin. It is also the key convergence of the Chong, Ren, Du, and Dai Mai. Most cases of lower back pain stem from insufficiency of True Yin, so nourishing and tonifying Kidney Qi is primary. ○ In lower back pain, deficiency patterns account for 80-90%. If there are no exterior pathogens or Damp-Heat, and it is caused by old age, labor, excessive sex/alcohol, or emotional depression, it belongs to deficiency patterns. Symptoms include pale complexion, fine and weak pulse, inability to stand/walk but relief upon lying down, and worsening fatigue with activity. Gradual onset indicates insufficiency; sudden severe pain indicates excess. Internal injury with weak constitution indicates insufficiency; external pathogenic excess indicates excess. Treatment must distinguish the cause. ○ Zhu Danxi said: Do not use Ginseng to tonify Qi for all lower back pains, as it worsens pain; do not use harsh cold-cooling herbs, as they cause obstruction and worsen pain. These statements are inaccurate. Generally, those with consumptive injury and Yang insufficiency have Qi deficiency symptoms; why is Ginseng contraindicated? Also, for severe pain due to Fire gathering in the Lower Jiao, clearing Fire is urgent; why is cold-cooling herb contraindicated? There are cases of deficiency mixed with excess where Ginseng is unsuitable, and cases of mild heat where excessive cold-cooling is unsuitable. But saying it is universally contraindicated is incorrect. (From *Jingyue Quanshu*)
Lower back pain primarily involves the Kidney, but distinguishes between internal, external, and neither-internal-nor-external causes. Old classifications include five: 1. Yang insufficiency and Shaoyin Kidney decline; 2. Wind Bi; 3. Labor damaging the Kidney; 4. Falling/Trauma; 5. Sleeping on damp ground. Zhang Jingyue added discussions on Exterior, Interior, Deficiency, Excess, Cold, and Heat, which are more detailed. Treatment for internal causes: For Kidney Yang deficiency, benefit Fire to dispel Yin shadows; for Kidney Yin depletion, strengthen Water to control Sunlight. Treatment for external causes: For Cold-Damp damaging Yang, use bitter-pungent-warm herbs to unblock Yang and drain turbidity; for Dampness stagnating into Heat, use bitter-pungent herbs to overcome Dampness and unblock bowels. Treatment for neither-internal-nor-external causes: For labor damaging the Kidney, treat both congenital and acquired sources; for trauma, assess severity and presence of stasis, using either purgation or tonification. For leg/foot pain from external causes, only Cold-Damp, Damp-Heat, or Damp-Phlegm flow into collaterals. The Classics state: "When injured by Dampness, the lower part receives it first." Thus, treating Dampness is primary, supplemented by warming, clearing, or dispersing methods as needed. For internal causes, it involves deficiency of the Liver, Spleen, or Kidney; treat by tonifying Middle Jiao, filling Lower Jiao, or nourishing the Liver, according to symptoms. (From *Linzheng Zhinan*)
Blood stasis lower back pain, with movement feeling like needle/stabbing pain, black stool, lighter by day and heavier by night, is treated with Tiaoying Huoluo Tang (Regulate Ying and Activate Collaterals Decoction). Kidney deficiency lower back pain, with inability to turn sideways, is treated with Yangshen Wan (Sheep Kidney Pill). (Zhu Danxi)
Lower back pain differs between Cold-Damp and Trauma. Waist soreness generally indicates Kidney deficiency, requiring strong tonification. Men use Qing'e Wan or Bawei Wan plus Gubuzhi (Psoralea Fructus) and Duzhong (Eucommia Cortex); if Heat, remove Fuzi (Aconite Radix Preparata) and add Wuweizi (Schisandra Fructus). Women use Liuwei Dihuang Wan plus Duzhong and Xuduan (Dipsacus Radix). (From *Zhangshi Yitong*)
Leg pain: Due to Dampness, pulse is deep-soft or hidden, knees ache faintly or feel numb/swollen, body feels heavy, worse on cloudy days. Initially use mild diaphoresis, later combine with draining dampness. Due to Damp-Heat, pulse is soft-thin-rapid, pain extends from waist-hip to foot, varying up/down, with swelling/redness, red/scanty urine. Use damp-draining and heat-clearing, Danggui Niangong Tang (Angelica Ligustaci Pain-Relieving Decoction). Due to Damp-Phlegm flowing, pulse is deep-slippery or wiry, alternating waist-leg pain, nausea/dizziness. Use phlegm-resolving and Qi-moving, Qianghuo, Duhuo, Erzhu, Erchen Tang, or Jiajian Huotan Tang. Due to Yin deficiency, pulse is thin-rapid or Chi pulse surging, emaciated body, pain in soles and calves, unable to bear weight. Use Yin-nourishing and fire-descending, Siwu Tang plus Zhimu (Anemarrhena Rhizome), Huangbai (Phellodendron Cortex), Niuxi (Achyranthes Radix), Duzhong. Due to Yang deficiency, pulse is deep-weak or empty-large, bilateral foot edema, loose stools, scanty urine, immobility due to pain. This is Mingmen Fire decline and extreme True Yang deficiency; use Jingui Shenqi Wan. Because the lower body is distant, only Wutou (Aconitum Carmichaelii Radix) and Fuzi are effective; for long-standing Damp-Phlegm stagnation, only Wutou and Fuzi can open it. (From *Fengshi Jin nang*)
Pain in Huantiao (GB30) and root of thigh persisting, with normal skin surface, deep-rapid or slippery pulse, warns of Fusgu Ju (Bone-abscess). This is toxin attaching to bone. Often mistaken for Damp-Heat; by the time pus forms, Qi and Blood are severely depleted, making it incurable! This condition often affects those with Kidney deficiency, as weak True Qi allows pathogens to invade deeply. Ancients used Fuzi to warm and tonify Kidney Qi, while also promoting drug action and dispersing Cold. (Xue Lizhai)
[Pulse Diagnosis]
If the Kidney pulse is firm and long, and the complexion is yellow-red, the patient will suffer from broken-waist pain. (From *Suwen*)
Pulses for waist diseases: Large indicates Kidney deficiency; Choppy indicates Blood stasis; Slow indicates Dampness; Slippery indicates Phlegm; Deep-tight indicates Cold; Floating-wiry indicates Wind; Deep-solid indicates sprain/contusion. (From *Zhengzhi Zhunsheng*)
[Selected Cases]
Case 1: A corpulent man, injured internally by alcohol and sex, suddenly developed cramping lower back pain, thirst, and profuse sweating. Pulse was wiry-surging, stronger at Chi positions. Treated with Huangbai (Phellodendron Cortex) and Xuanshen (Scrophularia Radix), cured immediately. Questioned why? Answer: This was Ministerial Fire flaming upward, attacking the waist/buttocks. Huangbai clears Ministerial Fire. Cramping/pain indicates rebellious Qi and excessive Fire; warming is contraindicated. Surging pulse means tonification is inappropriate. Profuse sweating means wind-dispersing herbs are contraindicated. Xuanshen is cold, enters Kidney, clears Six Meridian Fire, regulates pivot mechanism allowing free flow above and below, relieving cramps. ○ Case 2: A patient had lower back pain; the doctor treated it as Kidney deficiency using Shanzhuyu (Cornus Fructus), Duzhong, Pogostemon, etc., worsening the condition. I diagnosed Wind-Damp, treated with Qianghuo (Notopterygium Rhizome), Cangzhu (Atractylodes Lancea Rhizoma), Mutong (Akebia Caulis), Fangji (Stephania Root), Weilingxian (Clematis Radix), Bibi (Dioscorea Hypoglauca Rhizome), Niuxi, cured. (Cheng Xinghai)
Case 3: A man suffered continuous lower back pain after falling from a horse, lighter by day, heavier by night, confirming Blood stasis. Given Siwu Tang minus Shengdi (Rehmannia Radix), plus Rougui (Cinnamon Bark), Taoren (Prunus Persica Seed), Honghua (Carthamus Flower), Sumu (Pterocarpus Santalinus Lignum). After four doses, black stasis was discharged, and he recovered. (From *Yixue Liuyao*)
Case 4: An elderly man had chronic waist-knee pain radiating to the hypogastrium, unable to walk. This is a disease of the Extraordinary Vessels. Formula: Lu jiao shuang (Deer Antler Glue), Danggui (Angelica Sinensis Radix), Rongrong (Cynomorium Herba), Guigui (Cinnamon Twig), Xiaohuixiang (Foeniculum Fructus), Baiziren (Biota Seed). (Ye Tianshi)