药隐老人论曰∶夫肾主于腰，女人肾脏系于胞络，若肾气虚弱，外感六淫，内伤七
情，皆致腰痛。古方亦有五种之说，如风腰痛，宜小续命汤加桃仁。杜仲煎服。脾胃气
痞，及寒湿腰痛，宜五积散（杂病中寒。）加桃仁。如虚损及五种腰痛，服青娥丸、（杂病腰痛。）神
应丸，（同上。）皆可用也。如气滞腰痛，服如神汤必效。
〔薛〕陈无择先生云∶若形体虚羸，面色黧黑，腿足痿软，不能行立，此失志所为
也。腹急胁胀，目视KT KT ，宗筋弛纵，白淫下注，此郁结所为也。肌肉不仁，饮食不化，
肠胃胀满，闭坠腰胁，此忧思所为也。皆属内，若腰冷作痛，身重不渴，小便自利，饮
食如故，因劳汗出，腰酸胁痛，或坠堕血滞，或房劳精竭，皆属不内外因也。窃谓前证失
志，肾虚热者，六味丸。（杂病虚劳。）肾虚寒者，八味丸。（杂病虚劳。）郁怒伤肝，实用龙胆泻肝
汤；（杂病淋。）虚用六味丸。补肝散。（杂病腰痛。）忧虑伤脾者，归脾汤、（杂病健忘。）逍遥散。（调
经。）肾着者，寒则术附汤；（杂病伤湿。）虚则肾着汤。（同上。）腰膝痛者，寄生汤、养肾散。（杂
病腰痛。）瘀血滞者，如神汤、舒筋散。房劳腰痛者，青娥丸、十补丸。（见前虚劳。）一妇人
腰痛三年矣，每痛必面青头晕目紧。余以为肝脾气虚，用补肝散而愈。三年后，因劳役，
患头痛兼恶心，用补中益气汤。（杂病伤劳倦。）加茯苓、半夏、蔓荆子而愈。一妇人苦腰痛，数
年不愈，余用白术一味大剂服，不三月而痊。乃胃气虚闭之证，故用白术也。
如神汤 治男子妇人气虚腰痛。（一方有杜仲，无当归。）
玄胡索 当归（去芦） 桂心（等分）
上为细末，每服三钱，温酒调下，甚者不过数服。
独活寄生汤 夫腰痛者，皆由肾气虚弱，卧冷湿地当风所得，不时速治，喜流入脚膝，
为偏枯冷痹，缓弱疼重，或腰痛拘挛，脚膝重痹，宜急服之。
独活（三两） 桑寄生 续断 杜仲（炒去丝） 北细辛 川牛膝 秦艽 茯苓 白芍药
桂心 川芎 防风 人参 熟地黄 当归（各二两）
上 咀，每服三钱，水一盏，煎至七分，去滓温服，空心。气虚下利，除地黄。
并治新产腹痛不得转动，及腰脚挛痛痹弱，不得屈伸。此药最能除风消血。《肘后》
有附子，故无寄生、人参、当归、粉草。近人将治历节风、香港脚流注亦效。
舒筋散 治腰痛神效，闪挫亦良。
玄胡索（炒） 杜仲（姜汁炒） 官桂（去粗皮） 羌活 芍药（各等分）
上为末，酒调下二钱。
又方 橘核炒香，研酒，去渣，下青木香丸。（方见。）
又方 天罗布瓜子仁炒焦，擂酒热服，留渣炒热封痛处效。
Old Man Yao Yin stated: The Kidneys govern the waist. In women, the Kidneys are connected to the Bao Mai (uterine vessels). If Kidney Qi is deficient, external invasion by the Six Excesses (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) or internal injury by the Seven Emotions will all lead to lower back pain. Ancient prescriptions also describe five types of lower back pain. For example, for Wind-induced lower back pain, Xiao Xuming Tang (Minor Continuation Decoction) with added Tao Ren (Peach Seed) is suitable, taken along with a decoction of Du Zhong (Eucommia Bark). For Spleen and Stomach Qi stagnation and Cold-Damp induced lower back pain, Wuji San (Five Accumulations Powder) (for Cold patterns in miscellaneous diseases) with added Tao Ren is suitable. For deficiency injuries and the five types of lower back pain, Qing'e Wan (Green Youth Pill) (for lower back pain in miscellaneous diseases) and Shenying Wan (Miraculous Response Pill) (same as above) can be used. For Qi stagnation-induced lower back pain, Rushen Tang (Divine Efficacy Decoction) is highly effective.
[Xue Ji's Commentary] Mr. Chen Wuyue said: If the body is emaciated and weak, the complexion is dark, and the legs and feet are flaccid and weak, unable to stand or walk, this is caused by "Shi Zhi" (loss of will/spiritual trauma). If there is abdominal urgency and hypochondriac distension, blurred vision, relaxation of the Zong Jin (tendons of the genitalia), and downward leakage of white turbidity, this is caused by "Yu Jie" (emotional depression/stagnation). If muscles are numb, food is not digested, the intestines and stomach are full and bloated, and there is a bearing-down sensation and pain in the lower back and hypochondrium, this is caused by excessive worry and overthinking. All these belong to Internal Causes. If the lower back feels cold and painful, the body is heavy without thirst, urination is normal, and appetite remains unchanged, but it occurs after sweating from labor, causing soreness and pain in the lower back and hypochondrium, or results from blood stasis due to falling from a height, or essence depletion due to sexual excess, these belong to Non-Internal/External Causes. I believe that for the aforementioned conditions: if Shi Zhi leads to Kidney Deficiency with Heat, Liuwei Wan (Six-Ingredient Pill with Rehmannia) should be used (for deficiency consumptive disease in miscellaneous diseases); if Kidney Deficiency with Cold exists, Bawei Wan (Eight-Ingredient Pill with Rehmannia) should be used (same category). If anger injures the Liver, excess patterns require Longdan Xiogan Tang (Gentian Liver-Draining Decoction) (for strangury in miscellaneous diseases); deficiency patterns require Liuwei Wan combined with Bugan San (Liver-Nourishing Powder) (for lower back pain in miscellaneous diseases). If worry injures the Spleen, Guipi Tang (Spleen-Tonifying Decoction) (for forgetfulness in miscellaneous diseases) and Xiaoyao San (Free and Easy Wanderer Powder) (for regulating menstruation) are indicated. For Shen Zhuo (Kidney Fixation/Damp-Cold fixed in the lumbar region), cold patterns require Shu Fu Tang (Atractylodes and Aconite Decoction) (for damp-cold injury in miscellaneous diseases); deficiency patterns require Shen Zhuo Tang (same category). For lower back and knee pain, Sangsheng Tang (Mulberry Root Bark and Parasite Decoction) and Yangshen San (Kidney-Nourishing Powder) (for lower back pain in miscellaneous diseases) are used. For blood stasis stagnation, Rushen Tang and Shujin San (Tendon-Relaxing Powder) are used. For lower back pain due to sexual exhaustion, Qing'e Wan and Shibu Wan (Ten-Tonification Pill) (see previous deficiency consumptive section) are used.
One woman suffered from lower back pain for three years; every time she had pain, her face turned blue, she felt dizzy, and her eyes felt tight. I diagnosed it as Liver and Spleen Qi deficiency and treated her with Bugan San, resulting in a cure. Three years later, due to overwork, she developed headache accompanied by nausea. She was treated with Buzhong Yiqi Tang (Middle-Journey-Boosting and Qi-Supplementing Decoction) (for fatigue and overwork in miscellaneous diseases) plus Fuling (Poria), Banxia (Pinellia Tuber), and Manjingzi (Buddleja Fruit), which cured her. Another woman suffered from persistent lower back pain for many years without relief. I prescribed a large dose of a single herb, Baizhu (Atractylodes Macrocephala Rhizome), which resulted in recovery within three months. This was a pattern of Stomach Qi deficiency and closure, hence the use of Baizhu.
Rushen Tang: Treats Qi deficiency-induced lower back pain in men and women. (One variation includes Du Zhong and excludes Dang Gui.)
Yanhusuo (Corydalis Rhizome), Dang Gui (Angelica Sinensis Root, remove radicle), Guixin (Cinnamon Twig Heart) (equal parts).
Grind into fine powder. Take 3 qian per dose, mixed with warm wine. Severe cases may resolve in just a few doses.
Duhuo Jisheng Tang: Lower back pain is generally caused by Kidney Qi deficiency, sleeping on cold and damp ground while exposed to wind. If not treated promptly, the pathogen tends to flow into the legs and knees, leading to hemiplegia, cold bi-syndrome, limb weakness, severe pain, or lumbar spasms and pain, and heavy numbness in the legs and knees. It should be taken immediately.
Duhuo (Radix Angelicae Pubescentis, 3 liang), Sangjisheng (Taxilli Herba), Xuduan (Dipsaci Radix), Duzhong (Eucommiae Cortex, stir-fried to remove silk fibers), Beixixin (Asari Radix et Rhizoma), Chuan Niuxi (Achyranthis Bidentatae Radix), Qinjiao (Gentianae Macrophyllae Radix), Fuling (Poria), Baishaoyao (Paeoniae Radix Alba), Guixin (Cinnamomi Ramulus), Chuanxiong (Ligustici Chuanxiong Rhizoma), Fangfeng (Saposhnikoviae Radix), Renshen (Ginseng Radix et Rhizoma), Shudihuang (Rehmanniae Radix Preparata), Dang Gui (Angelicae Sinensis Radix) (2 liang each).
Cut into pieces. Take 3 qian per dose, with one cup of water, decoct until reduced to 0.7 cups. Strain and take warm on an empty stomach. If there is Qi deficiency with diarrhea, omit Dihuang.
It also treats postpartum abdominal pain preventing movement, and spasmodic pain, numbness, and weakness in the lower back and legs, preventing flexion and extension. This medicine is most effective at dispelling wind and resolving blood stasis. The *Zhouhou* (Emergency Prescriptions Kept Up One's Sleeve) version contains Fuzi (Aconiti Lateralis Radix Preparata), thus excluding Sangjisheng, Renshen, Dang Gui, and Gancao (Licorice Root). Modern practitioners find it effective for treating Li Jie Feng (Rheumatoid Arthritis/Gout) and Hong Kong Foot (Charcot Joint/Diabetic Foot) with flowing accumulation.
Shujin San: Highly effective for lower back pain; also good for sprains and contusions.
Yanhusuo (stir-fried), Duzhong (stir-fried with ginger juice), Guanzi Gui (Cortex Cinnamomi Cassiae, remove coarse bark), Qianghuo (Notopterygii Rhizoma et Radix), Shaoyao (Paeoniae Radix) (equal parts).
Grind into powder. Take 2 qian mixed with wine.
Another prescription: Stir-fry Juhe (Citri Reticulatae Pericarpium Viride) until fragrant, grind with wine, strain, and take with Qingmuxiang Wan (Blue Musk Fragrance Pill) (formula see previous section).
Another prescription: Stir-fry Tianluobu Gua Zi Ren (Seeds of Luffa Cylinrica) until scorched, grind with wine, and take hot. Retain the dregs, stir-fry them until hot, and apply as a compress to the painful area for efficacy.