（腰酸 腰软 腰胯痛）
经云。腰者肾之府。转摇不能。肾将惫矣。巨阳虚则头项腰背痛。（此二条言证之虚。）膀
胱之脉。挟脊抵腰。故挟脊痛。腰似折。（此一条言邪之实。）
按内经言太阳腰痛者。外感六气也。言肾经腰痛者。内伤房劳也。假令肾脏真气布护。六气
焉能为害。惟肾脏虚伤。膀胱之府安能独足。又有膏粱之人。久服热剂。醉以入房。损其真气。
则肾脏热。腰脊痛。久则髓减骨枯。发为骨痿。此为本病。其有风寒湿热闪挫瘀血滞气痰积。皆
为标病。而肾虚则其本也。风痛者。脉浮。或左或右。痛无定处。牵引两足。小续命加减。寒痛
者。其腰如冰。其脉必紧。得热则减。得寒则增。干姜附子汤加肉桂、杜仲。外用摩腰膏。兼风
寒者。五积散热服微汗之。内蓄风热痛者。脉必洪数。口渴便闭。小柴胡去半夏。加羌活、续断、
黑豆。若大便闭者。先用大柴胡微利之。湿痛者。如坐水中。肾属水。久坐水湿。或着雨露。以
致腰下冷痛。脉必弦缓。小便自利。饮食如故。
天阴头必重。体必沉重。渗湿汤。肾虚由卧湿地。流入腰脚。偏枯冷痹疼重。千金独活寄生汤。
兼风湿者。改定三痹汤。如挟寒湿。并用摩腰膏。虚寒甚而挟湿者。术附汤。挟湿热者。羌活胜
湿汤合二妙散。肾气虚寒而受寒湿。腰疼不得立。用烧羊肾主之。此千金法也。闪挫痛者。跌扑
损伤。肝脉搏坚而长。两尺实。忽然不可俯仰。复元通气散。不效。必有恶血。复元活血汤。气
滞而痛。脉沉弦或结伏。初起乌药顺气散。不应。八味顺气散。痰注而痛。脉滑或沉伏。动作便
有痰。或一块作痛。导痰汤加香附、乌药、枳壳。脉实。加大黄。肝气不条达。睡至黎明。觉则
腰痛。频欲转侧。晓起则止。宜柴胡疏肝散。或二妙散加柴胡、防风。即东垣苍术汤。腰痛如以
带束引痛。此属带脉为病。用辛味横行而散带脉之结。甘味舒缓带脉之急。调肝散。腰痛牵引足
膝。青娥丸加蝎尾最妙。以补肾兼补肝也。两腰偻废。乃热邪深入。血脉久闭之故。桃核承气多
用肉桂。少加熟附行经。但痛者可治。偻废而不痛者。不可治也。诸般腰痛。皆由肾虚。若兼六
淫。须除其邪。如无他证而腰肢痿弱。隐隐作痛。身体疲倦。脚膝酸软者。总属肾虚。然须分寒
热主治。脉细而软。或虚浮。力怯短气。小便清利。属阳虚火衰。肾气丸加肉苁蓉、补骨脂、巴
戟、鹿茸之类。脉大而软。或细数。小便黄。属阴虚火炎。六味丸加龟板、当归、杜仲、续断之类。
腰酸 腰痛尚有寒湿伤损之异。腰酸悉属房劳肾虚。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。走精。用六味丸去泽泻。加鳔胶、沙苑蒺藜、五味子。大
便不实。加肉果、补骨脂。山药粉糊代蜜。妇人用六味加杜仲、续断。有带。去熟地加艾、附。
经候不调。加当归、阿胶。
腰软 湿气袭于少阳经络之中。则为肾着。金匮用甘姜苓术汤。后世更名为肾着汤。或渗湿
汤选用。斫丧太过
者。八味丸。肾虚风袭。腰背软痛。安肾丸。
腰胯痛 寒湿流注于足少阳之经络。则为腰胯痛。盖腰乃胆经之所过。因受寒湿。结滞于骨
节而痛。渗湿汤去橘红加肉桂。有痰滞经络。导痰汤加减。若肾肝伏热。用姜汁炒黄柏、酒防己。
少加肉桂。若腰胯连脚膝晓夜疼痛者。肾虚风毒乘之也。用虎骨散加补骨脂。老人肾虚腰痛连膝
痛者。二至丸。
〔诊〕脉大为肝肾阴虚。尺沉为肾脏阳虚。浮缓为虚风。弦细为寒湿。或弦或涩为瘀血。或滑
或伏为痰饮。沉弦而紧为寒。沉弦而细为湿。沉弦而实为闪肭。若肾惫及盛怒伤志。则腰失强。
不能转摇者死。
石顽治沈云步媳。常有腰疼带下之疾。或时劳动。日晡便有微热。诊其两尺皆弦。而右寸关
虚濡少力。此手足太阴气衰。敷化之令不及也。合用异功散加当归、丹皮调补胃中营气。兼杜仲
以壮关节。泽泻以利州都。则腰疼带下受其益矣。
江苏总藩张公。严冬腰腹疼重。甲夜延石顽诊候。脉得沉滑而快。遂取导痰兼五苓之制。一
剂而腹痛止。三啜而腰 弛纵自如。未尝用腰腹痛之药也。
(Soreness of the waist, flaccidity of the waist, pain in the waist and hips)
The *Neijing* (Classic of Internal Medicine) states: "The waist is the mansion of the Kidney." If one cannot turn or sway the body, it indicates that the Kidney function is about to fail. (These two passages describe the manifestations of deficiency syndromes.) The meridian of the Foot-Taiyang Bladder runs alongside the spine and reaches the waist; therefore, pain along the sides of the spine and a sensation as if the waist were broken occur. (This passage describes the manifestation of excess pathogens.)
According to the *Neijing*, pain in the Taiyang meridian is caused by external contraction of the Six Qi (pathogenic factors); pain in the Kidney meridian is caused by internal injury from excessive sexual activity. If the true Qi of the Kidney is abundant and protects the body, how can the Six Qi cause harm? Only when the Kidney is deficient can its paired organ, the Bladder, not remain strong. Furthermore, those who consume rich and sweet foods, long-term use of hot-natured medicines, and engage in sexual intercourse after intoxication damage their true Qi, leading to Heat in the Kidney and pain in the waist and spine. Over time, this results in decreased marrow and withered bones, developing into Bone萎 (Bone Atrophy). This constitutes the root disease. Those caused by Wind, Cold, Damp-Heat, sprain/trauma, Blood stasis, Qi stagnation, and Phlegm accumulation are all branch diseases, while Kidney deficiency is the root.
Pain caused by Wind: The pulse is floating; pain may be on the left or right, without a fixed location, radiating to both legs. Treat with modified *Xiao Xuming Tang* (Minor Continuation of Life Decoction). Pain caused by Cold: The waist feels like ice; the pulse must be tight; pain decreases with heat and increases with cold. Treat with *Ganjiang Fuzi Tang* (Dried Ginger and Aconite Decoction) plus Rougui (Cinnamon Twig) and Duzhong (Eucommia Bark). Apply external Moyao Gao (Waist Rubbing Plaster). For combined Wind-Cold, take *Wuji San* (Five Accumulations Powder) warm to induce slight sweating. Pain caused by internal accumulation of Wind-Heat: The pulse must be surging and rapid; there is thirst and constipation. Use *Xiao Chaihu Tang* (Minor Bupleurum Decoction) removing Banxia (Pinellia Tuber), adding Qianghuo (Notopterygium Rhizome), Xuduan (Dipsacus Root), and Heidou (Black Soybean). If constipated, first use *Da Chaihu Tang* (Major Bupleurum Decoction) to mildly purge.
Pain caused by Dampness: It feels like sitting in water. Since the Kidney belongs to Water, prolonged sitting in damp places or exposure to rain and dew causes cold pain below the waist. The pulse must be wiry and moderate; urination is normal, and appetite remains good. On cloudy days, the head feels heavy, and the body feels heavy. Treat with *Shenshi Tang* (Damp-Draining Decoction). If Kidney deficiency allows dampness from sleeping on wet ground to flow into the waist and feet, causing hemiplegia, cold bi-syndrome, pain, and heaviness, treat with *Qianjin Duhuo Jisheng Tang* (Thousand Gold Angelica Pubescens and Dorstenia Decoction). For combined Wind-Damp, use *Gaiding Sanbi Tang* (Modified Three Bi Decoction). If combined with Cold-Damp, also apply Moyao Gao. For severe deficiency-cold with Dampness, use *Zhufu Tang* (Atractylodes and Aconite Decoction). For combined Damp-Heat, combine *Qianghuo Shengshi Tang* (Notopterygium Damp-Vanquishing Decoction) with *Ermi San* (Two Miracles Powder). For Kidney Qi deficiency-cold suffering from Cold-Damp, where waist pain prevents standing, roast Sheep Kidneys as the main treatment. This is a method from *Qianjin Fang*.
Pain caused by sprain/trauma: Due to falls or injuries, the Liver pulse is firm and long, and both Chi pulses are excess. Sudden inability to bend or extend. Treat with *Fuyuan Tongqi San* (Restoring Origin and Circulating Qi Powder). If ineffective, there must be evil blood; treat with *Fuyuan Huoxue Tang* (Restoring Origin and Invigorating Blood Decoction). Pain caused by Qi stagnation: The pulse is deep, wiry, or knotted/fixed. In the early stage, use *Wuyao Shunqi San* (Lindera Regulating Qi Powder); if ineffective, use *Bawei Shunqi San* (Eight Ingredients Regulating Qi Powder). Pain caused by Phlegm deposition: The pulse is slippery or fixed; movement induces phlegm sensations, or pain occurs in a specific lump. Treat with *Daotan Tang* (Great Phlegm-Resolving Decoction) adding Xiangfu (Cyperus Rhizome), Wuyao (Lindera Root), and Zhike (Aurantii Fructus). If the pulse is excess, add Dahuang (Rhubarb Root). When Liver Qi is not flowing smoothly, one feels waist pain upon waking at dawn, frequently wanting to turn over, which stops upon rising in the morning. Use *Chaihu Shugan San* (Bupleurum Soothing Liver Powder) or *Ermi San* adding Chaihu (Bupleurum Root) and Fangfeng (Saposhnikovia Root), which is Dongyuan's *Cangzhu Tang* (Atractylodes Macrocephala Decoction). Waist pain feeling like being bound by a belt and radiating pain belongs to Dai Mai (Girdle Vessel) pathology. Use pungent flavors to disperse horizontally and resolve Dai Mai knots, and sweet flavors to relax and relieve Dai Mai tension. Use *Tiaogan San* (Regulate Liver Powder). Waist pain radiating to the feet and knees: *Qing'e Wan* (Blue Robe Pill) added with Scorpion tails is best, as it tonifies both Kidney and Liver.
Flaccidity and dysfunction of both waists result from Heat pathogens penetrating deeply and long-term closure of blood vessels. Use *Taohhe Chengqi Tang* (Peach Kernel and Magnolia Bark Purging Decoction) with more Rougui (Cinnamon Twig) and a little Shufu (Prepared Aconite Root) to unblock collaterals. However, if there is only pain, it is treatable; if there is flaccidity without pain, it is untreatable. All types of waist pain originate from Kidney deficiency. If combined with the Six Exogenous Pathogens, one must eliminate the pathogens. If there are no other symptoms, but the waist and limbs are weak, with dull pain, physical fatigue, and soreness/weakness in the feet and knees, it generally belongs to Kidney deficiency. One must distinguish between Cold and Heat for treatment. A fine and soft pulse, or floating and empty, with weakness and shortness of breath, and clear urination, indicates Yang deficiency and Fire decline. Use *Shenqi Wan* (Kidney Qi Pill) adding Rongrong (Cistanche Stem), Buguzhi (Psoralea Fruit), Bajitian (Morinda Root), and Lurong (Deer Antler Glue), etc. A large and soft pulse, or fine and rapid, with yellow urine, indicates Yin deficiency and Fire flaming upward. Use *Liujun Wan* (Six-Ingredient Rehmannia Pill) adding Guiban (Tortoise Shell), Danggui (Angelica Sinensis Root), Duzhong (Eucommia Bark), and Xuduan (Dipsacus Root), etc.
Soreness and pain in the waist also differ due to Cold-Damp injury. Soreness entirely belongs to Kidney deficiency from sexual exhaustion, requiring vigorous tonification. For men, use *Qing'e Wan* or *Bawei Wan* (Eight-Ingredient Pill) adding Buguzhi and Duzhong. If there is Heat, remove Fuzi and add Wuweizi (Schisandra Berry). For seminal emission, use *Liujun Wan* removing Zexie (Alisma Rhizome), adding Biaojiao (Fish Maw), Shayuanjili (Astragalus Complanatus Seed), and Wuweizi. For loose stools, add Rouguou (Nutmeg) and Buguzhi, using Yam powder paste instead of honey for pills. For women, use *Liujun Wan* adding Duzhong and Xuduan. For leukorrhea, remove Shudi (Prepared Rehmannia Root) and add Aiye (Mugwort Leaf) and Fuzi. For irregular menstruation, add Danggui and Ejiao (Donkey-hide Gelatin).
Flaccidity of the waist: Dampness invading the Shaoyang meridians leads to Shen Zhuo (Kidney Fixation). *Jinkui Yaolue* uses *Ganjiang Lingzhu Tang* (Ginger, Poria, Atractylodes, and Licorice Decoction). Later generations renamed it *Shenzhuo Tang*. Alternatively, select *Shenshi Tang*. For excessive depletion, use *Bawei Wan*. For Kidney deficiency with Wind invasion causing soft and painful back/waist, use *Anshen Wan* (Peaceful Kidney Pill).
Pain in the waist and hips: Cold-Damp flowing into the Foot-Shaoyang Gallbladder meridian leads to pain in the waist and hips. The waist is traversed by the Gallbladder meridian; receiving Cold-Damp causes stagnation in the bone joints leading to pain. Use *Shenshi Tang* removing Juhong (Citrus Peel) and adding Rougui. For Phlegm stagnation in collaterals, modify *Daotan Tang*. For latent Heat in Liver and Kidney, use Huangbai (Phellodendron Bark) stir-fried with Ginger juice and Fangji (Stephania Root) treated with wine, adding a little Rougui. If waist and hip pain radiates to the feet and knees day and night, it is due to Wind-Toxin attacking Kidney deficiency. Use *Hugu San* (Tiger Bone Powder) adding Buguzhi. For elderly people with Kidney deficiency causing waist pain radiating to knees, use *Ersi Wan* (Two Winter Pills).
[Diagnosis] A large pulse indicates Liver-Kidney Yin deficiency. A deep Chi pulse indicates Kidney Yang deficiency. A floating and moderate pulse indicates Deficient Wind. A wiry and fine pulse indicates Cold-Damp. A wiry or choppy pulse indicates Blood Stasis. A slippery or fixed pulse indicates Phlegm-Fluid. A deep, wiry, and tight pulse indicates Cold. A deep, wiry, and fine pulse indicates Dampness. A deep, wiry, and excess pulse indicates Sprain/Trauma. If the Kidney is exhausted and anger injures the Will (Zhi), the waist loses strength and cannot turn or sway; this is fatal.
Shiwan treated the daughter-in-law of Shen Yunbu, who often suffered from waist pain and leukorrhea. Sometimes after labor, she had slight fever in the late afternoon. Her Chi pulses on both sides were wiry, while the Right Cun and Guan pulses were deficient, soggy, and weak. This indicated deficiency of the Hand and Foot Taiyin Qi, insufficient distribution and transformation functions. She should have been treated with *Yigong San* (Beneficial Merit Powder) adding Danggui and Danpi (Moutan Cortex) to tonify the Stomach's Ying (Nutritive) Qi, combined with Duzhong to strengthen joints, and Zexie to benefit the Zhou Du (Bladder), thereby benefiting the waist pain and leukorrhea.
Lord Zhang, the Provincial Administrator of Jiangsu, suffered from heavy pain in the waist and abdomen during the severe winter. Shiwan was summoned at night to diagnose him. The pulse was deep, slippery, and rapid. Thus, a formulation combining *Daotan Tang* and *Wuling San* (Five-Ling Powder) was taken. After one dose, abdominal pain stopped; after three doses, the waist became flexible and free. No specific medicine for waist or abdominal pain was used.