【歌】腰痛多缘肾气虚，冲风郁热总因之。天阴痛作知归湿，寒湿疼时见热除。闪挫板疼难俯仰，日轻夜
重血多瘀。或因肾着并劳役，水积仍兼气不舒。
【论】夫腰者，肾之府，身之大关节也。血气不行，风、寒、暑、湿之气相干，则沉痛不能转侧。然老人
肾虚多腰痛，亦有寒湿者，挫闪者，气滞者，血瘀者，肾着者，冲风蓄热者，水积者，劳伤者之不同也。
【脉】腰痛之脉，必沉而弦。沉微气滞，弦损肾元。或浮而紧，风寒所缠。湿伤濡细，实挫闪然。涩必瘀
血，滑痰火煎。或引背痛，沉滑易痊。
肾虚腰痛
腰痛悠悠不已，肾虚也，青娥丸或摩腰膏、独活寄生汤、丹溪补阴丸、安肾丸、立安丸选而用之。
青娥丸
治肾虚腰痛。
杜仲（姜炒，一斤） 破故纸（炒，半斤） 胡桃肉（二十个）
末之，大蒜四两，捣为膏，和丸如梧桐子大，每三十丸，空心温酒送下，或用酒糊为丸。
摩腰膏
治腰痛虚寒证。
附尖（二钱五分） 乌头（二钱五分） 天南星（二钱五分） 朱砂（一钱） 干姜（一钱） 雄
黄（一钱五分） 樟脑（一钱五分） 丁香（一钱五分） 麝香（半分）
末之，姜汁调，烘热，摩腰上。
独活寄生汤
独活（一钱） 桑寄生（一钱） 杜仲（盐水炒，去丝，一钱半） 细辛（一钱） 牛膝（去
芦，一钱） 秦艽（去芦，一钱） 白茯苓（去皮，八分） 桂心（六分） 川芎（八分） 防风（去芦，八
分） 白芍药（酒炒，八分） 甘草（炙，七分） 人参（一钱二分） 当归（酒洗，钱半） 熟地黄（酒洗，二钱）
上锉，一剂，水二钟，煎至八分，空心热服。
丹溪补阴丸
黄柏（酒炒，四两） 龟板（酥炙，四两） 知母（酒炒，四两） 熟地黄（酒浸，六两）
末之，蜜丸梧子大，空心淡盐汤下。
安肾丸
治肾虚腰痛。
茴香（三两，炒） 川楝（炒，三两） 破故子（炒，三两） 续断（三两） 胡芦巴（三两）
桃仁（二两） 杏仁（炒，二两） 干山药（二两） 白茯苓（二两）
末之，蜜丸桐子大，盐汤下。
立安丸
补肾止腰疼。
牛膝（去芦，四两） 杜仲（盐炒，四两） 破故子（炒，四两） 黄柏（二两，酒炒） 大茴香（炒，二两）
末之，蜜丸，淡盐汤送下。
肾着腰痛
肾着者，腰冷重痛，如带五千钱者，其饮食如故是也，直流湿热则自已，肾着汤。不已，服牛膝酒最妙。
三因肾着汤
白茯苓（四两） 白术（四两） 干姜（二两） 甘草（炙，二两）
每锉四钱，水二盏，空心煎服。
牛膝酒
治肾着腰痛。
地骨皮（一两） 五加皮（一两） 薏苡仁（一两） 川芎（一两） 甘草（一两） 生地黄（一
两） 海桐皮（一两） 川牛膝（一两） 羌活（一两）
锉一大剂，浸酒，日饮三次。
寒湿腰痛
寒湿腰痛者，遇阴寒即作，或久雨阴湿所得，晴暖即减，五积散加吴茱萸、杜仲。（方见中寒。）
湿热腰痛
湿热腰痛，板疼不能俯仰，小便赤、大便泄，或走注痛，二妙丸或健步丸。
二妙丸
治湿热腰痛。
川黄柏（酒炒，四两） 苍术（米泔浸，炒，四两）
末之，酒调下，或为丸，白汤送下二、三钱。
健步丸
治湿热腰痛。
羌活（半两，去芦） 柴胡（半两） 滑石（炒，半两） 甘草（炙，半两） 栝蒌根（半两）
防风（去芦，三钱） 泽泻（三钱，去毛） 防己（酒洗，一两） 川乌（三钱） 苦参（酒洗，
五钱） 肉桂（一钱）
末之，酒糊丸如桐子大，每七十丸，煎愈风汤吞下。
闪挫腰痛
闪挫腰痛者，板疼，复元通气散，（方见胁痛。）或五积散加牵牛头末、桃仁，（方见中寒。）或济生
丸。
济生 丸
子（半两） 没药（二钱五分） 乳香（二钱五分） 补骨脂（五钱） 威灵仙（半两） 杜仲
（炒，半两） 当归（半两，酒洗）
末之，酒糊丸如梧子大，每七十丸，空心淡盐汤下。
劳役腰痛
腰痛因劳役而得者，独活寄生汤。（方见前。）瘀血腰痛，四物汤加桃仁、红花、苏木。（方见血证。）
风热腰痛
因风腰痛，小续命汤；（方见中风。）或独活寄生汤。（方见前。）风湿腰痛，牛膝酒。（方见前。）
气滞腰痛
气滞腰痛，木香调气散。（见胁痛证后。）因郁怒忧思，气不舒而痛，枳壳汤或小七香丸。
枳壳汤
顺气解郁止痛。
枳壳（五两，炒） 甘草（二两，生用）
末之，葱白汤下。
小七香丸
气滞腰痛
丁香（一两二钱） 香附（炒，一两） 甘草（一两） 蓬莪术（二钱） 砂仁（二钱，炒） 甘
松（八钱） 益智仁（六钱）
末之，蒸饼糊丸如绿豆大，每二、三十丸，米饮下。
[Song] Low back pain often stems from deficiency of Kidney Qi (Shen Qi, Kidney Energy); external wind invasion and internal stagnant heat are also caused by this. Pain occurring on cloudy days indicates dampness; when pain is due to cold-dampness, it resolves upon exposure to heat. Stiff, painful low back pain due to sprain or strain makes bending and extending difficult; being lighter during the day and heavier at night suggests blood stasis (Xue Yu, Stagnant Blood). There are also cases due to Kidney Fixation disease (Shen Zhuo Bing) and overexertion, accompanied by fluid accumulation and constrained Qi movement.
[Discussion] The waist is the mansion of the Kidneys and a major joint of the body. When Blood and Qi do not circulate freely, and Wind, Cold, Summerheat, and Dampness interfere with each other, heavy pain results, making turning and side-bending impossible. However, while elderly people with Kidney deficiency often suffer from low back pain, there are differences among those caused by cold-dampness, sprain/strain, Qi stagnation, blood stasis, Kidney fixation, wind-stagnant heat, fluid accumulation, and labor injury.
[Pulse Diagnosis] The pulse in low back pain must be deep (Chen) and wiry (Xian). A deep-thin pulse indicates Qi stagnation; a wiry pulse indicates damage to the Kidney Yuan Qi. Alternatively, a floating-tight pulse indicates entanglement by Wind-Cold. Dampness injuring the body yields a soggy-fine pulse; excess patterns indicate sprain/strain. A choppy pulse necessarily indicates blood stasis; a slippery pulse indicates Phlegm-Fire simmering. If pain radiates to the back, a deep-slippery pulse indicates easy recovery.
Kidney Deficiency Low Back Pain
Low back pain that is lingering and unceasing belongs to Kidney deficiency. Select one of Qing'e Wan (Qing'e Pill), Moyao Gao (Waist-Massaging Ointment), Duhuo Jisheng Tang (Duhuo Decoction for Nourishing the Living), Danxi Buyin Wan (Danxi Yin-Nourishing Pill), Anshen Wan (Anshen Pill), or Li'an Wan (Li'an Pill) for use.
Qing'e Wan
Treats Kidney deficiency low back pain.
Du Zhong (Stir-fried with ginger juice, 1 jin) Pugu Zhi (Fried, 0.5 jin) Hetao Rou (Walnut meat, 20 pieces)
Grind into powder. Take 4 liang of garlic, pound into a paste, mix with the powder, and form pills the size of paulownia seeds. Take 30 pills per dose, swallowing with warm wine on an empty stomach, or form pills using wine paste.
Moyao Gao
Treats deficiency-cold syndrome of low back pain.
Fu Jian (Aconite tip, 2.5 qian) Wutou (Aconite root, 2.5 qian) Tiannanxing (Arisaema rhizome, 2.5 qian) Zhusha (Cinnabar, 1 qian) Ganjiang (Dried ginger, 1 qian) Xionghuang (Realgar, 1.5 qian) Zhangnao (Borneol, 1.5 qian) Dingxiang (Clove, 1.5 qian) Shexiang (Musk, 0.5 fen)
Grind into powder, mix with ginger juice, heat until warm, and massage onto the waist.
Duhuo Jisheng Tang
Duhuo (Radix Angelicae Pubescentis, 1 qian) Sangjisheng (Herba Taxilli, 1 qian) Du Zhong (Stir-fried with salt water, remove silk fibers, 1.5 qian) Xixin (Rhizoma Asari, 1 qian) Niuxi (Radix Achyranthis Bidentatae, remove radicle, 1 qian) Qinjiao (Radix Gentianae Macrophyllae, remove radicle, 1 qian) Baifuling (Poria, peel off, 8 fen) Guixin (Cortex Cinnamomi, 6 fen) Chuanxiong (Rhizoma Chuanxiong, 8 fen) Fangfeng (Radix Saposhnikoviae, remove radicle, 8 fen) Baishaoyao (Radix Paeoniae Albae, stir-fried with wine, 8 fen) Gancao (Honey-fried Licorice Root, 7 fen) Renshen (Radix Ginseng, 1.2 qian) Danggui (Radix Angelicae Sinensis, washed with wine, 1.5 qian) Shudihuang (Prepared Rehmannia Root, washed with wine, 2 qian)
Cut all ingredients coarsely. For one dose, add two zhong of water, decoct until eight parts remain. Take hot on an empty stomach.
Danxi Buyin Wan
Huangbai (Phellodendron Bark, stir-fried with wine, 4 liang) Guiban (Turtle Shell, roasted with butter, 4 liang) Zhimu (Anemarrhena Rhizome, stir-fried with wine, 4 liang) Shudihuang (Prepared Rehmannia Root, soaked in wine, 6 liang)
Grind into powder, form pills with honey the size of paulownia seeds. Take on an empty stomach with light salt water soup.
Anshen Wan
Treats Kidney deficiency low back pain.
Huixiang (Fennel Fruit, 3 liang, fried) Chuanlian (Fructus Toosendan, fried, 3 liang) Puguzi (Seed of Psoralea, fried, 3 liang) Xuduan (Radix Dipsaci, 3 liang) Huluba (Seed of Trigonellae, 3 liang) Taoren (Seed Pruni Persicae, 2 liang) Xingren (Seed Armeniacae Amarum, fried, 2 liang) Gansanyao (Dried Rhizoma Dioscoreae, 2 liang) Baifuling (Poria, 2 liang)
Grind into powder, form pills with honey the size of paulownia seeds. Take with salt water soup.
Li'an Wan
Tonifies the Kidney and stops low back pain.
Niuxi (Radix Achyranthis Bidentatae, remove radicle, 4 liang) Du Zhong (Stir-fried with salt, 4 liang) Puguzi (Seed of Psoralea, fried, 4 liang) Huangbai (Phellodendron Bark, 2 liang, stir-fried with wine) Da Huixiang (Large Fennel Fruit, fried, 2 liang)
Grind into powder, form pills with honey. Take with light salt water soup.
Kidney Fixation Low Back Pain
Kidney Fixation refers to cold, heavy, painful sensation in the waist, as if wearing five thousand coins, while appetite and digestion remain normal. If damp-heat flows down, it will resolve itself; otherwise, use Shen Zhuo Tang (Kidney Fixation Decoction). If ineffective, drinking Niuxi Jiu (Achyranthes Wine) is best.
Sanyin Shen Zhuo Tang
Baifuling (Poria, 4 liang) Baizhu (Rhizoma Atractylodis Macrocephalae, 4 liang) Ganjiang (Dried Ginger, 2 liang) Gancao (Honey-fried Licorice Root, 2 liang)
Cut four qian per dose, add two zhan of water, decoct and take on an empty stomach.
Niuxi Jiu
Treats Kidney Fixation low back pain.
Digupi (Cortex Lycii, 1 liang) Wujia Pi (Cortex Acanthopanacis, 1 liang) Yiyiren (Semen Coicis, 1 liang) Chuanxiong (Rhizoma Chuanxiong, 1 liang) Gancao (Licorice Root, 1 liang) Shengdihuang (Raw Rehmannia Root, 1 liang) Haitongpi (Cortex Erythrinae, 1 liang) Chuan Niuxi (Radix Achyranthis Bidentatae, 1 liang) Qianghuo (Rhizoma et Radix Notopterygii, 1 liang)
Cut into a large dose, soak in wine. Drink three times daily.
Cold-Damp Low Back Pain
Cold-damp low back pain occurs upon exposure to cold or after prolonged rainy/damp weather, and alleviates when sunny and warm. Use Wuji San (Wuji Powder) plus Wuzhuyu (Fructus Evodiae) and Du Zhong. (Formula see "Middle Cold" section.)
Damp-Heat Low Back Pain
Damp-heat low back pain presents with stiff pain preventing bending/extending, red urine, loose stools, or wandering pain. Use Ermiao Wan (Ermiao Pill) or Jianbu Wan (Jianbu Pill).
Ermiao Wan
Treats damp-heat low back pain.
Chuan Huangbai (Phellodendron Bark, stir-fried with wine, 4 liang) Cangzhu (Rhizoma Atractylodis Lanceae, soaked in rice wash water, fried, 4 liang)
Grind into powder, take mixed with wine, or form pills and take 2-3 qian with plain boiled water.
Jianbu Wan
Treats damp-heat low back pain.
Qianghuo (Rhizoma et Radix Notopterygii, half liang, remove radicle) Chaihu (Radix Bupleuri, half liang) Huashi (Talcum, fried, half liang) Gancao (Honey-fried Licorice Root, half liang) Gualougen (Radix Trichosanthis, half liang) Fangfeng (Radix Saposhnikoviae, remove radicle, 3 qian) Zexie (Rhizoma Alismatis, remove hairs, 3 qian) Fangji (Radix Stephaniae Tetrandrae, washed with wine, 1 liang) Chuanwu (Radix Aconiti Carminativae, 3 qian) Kushen (Cortex Sophorae Flavescentis, washed with wine, 5 qian) Rougui (Cortex Cinnamomi, 1 qian)
Grind into powder, form pills with wine paste the size of paulownia seeds. Take 70 pills per dose, swallowed with decoction of Yufeng Tang (Yufeng Decoction).
Sprain/Strain Low Back Pain
Sprain/strain low back pain presents with stiffness and pain. Use Fuyuan Tongqi San (Fuyuan Circulating-Qi Powder). (Formula see "Hypochondriac Pain" section.) Or Wuji San plus Qian Niu Tou Mo (Powder of Morning Glory Seed head) and Taoren. (Formula see "Middle Cold" section.) Or Jisheng Wan (Jisheng Pill).
Jisheng Wan
Zi (Seed name missing in original text, likely referring to a preceding herb or generic seed, 0.5 liang) Moyao (Resina Myrrhae, 2.5 qian) Ruxiang (Resina Olibani, 2.5 qian) Buguzhi (Fructus Psoraleae, 5 qian) Weilingxian (Herba Clematidis, 0.5 liang) Du Zhong (Stir-fried, 0.5 liang) Danggui (Radix Angelicae Sinensis, 0.5 liang, washed with wine)
Grind into powder, form pills with wine paste the size of paulownia seeds. Take 70 pills per dose, swallowing with light salt water soup on an empty stomach.
Labor Injury Low Back Pain
Low back pain caused by overexertion uses Duhuo Jisheng Tang. (Formula see above.) Blood Stasis Low Back Pain uses Siwu Tang (Siwu Decoction) plus Taoren, Honghua, and Sumu. (Formula see "Blood Disease" section.)
Wind-Heat Low Back Pain
Low back pain due to Wind uses Xiao Xuming Tang (Minor Xuming Decoction). (Formula see "Wind-Stroke" section.) Or Duhuo Jisheng Tang. (Formula see above.) Wind-Damp Low Back Pain uses Niuxi Jiu. (Formula see above.)
Qi Stagnation Low Back Pain
Qi stagnation low back pain uses Muxiang Tiaoqi San (Muxiang Regulating-Qi Powder). (See post-Hypochondriac Pain Syndrome section.) Pain due to depression, anger, worry, and thought causing constrained Qi uses Zhike Tang (Zhike Decoction) or Xiaoqixiang Wan (Small Qixiang Pill).
Zhike Tang
Regulates Qi, resolves stagnation, and stops pain.
Zhike (Fructus Aurantii, fried, 5 liang) Gancao (Licorice Root, raw, 2 liang)
Grind into powder, take with scallion white soup.
Xiaoqixiang Wan
Qi Stagnation Low Back Pain
Dingxiang (Clove, 1.2 liang) Xiangfu (Rhizoma Cyperi, fried, 1 liang) Gancao (Licorice Root, 1 liang) Peng'ezhu (Rhizoma Curcumae, 2 qian) Sharen (Fructus Amomi Rotundus, fried, 2 qian) Gangsong (Rhizoma Nardostachyos, 8 qian) Yizhiren (Semen Alpiniae Oxyphyllae, 6 qian)
Grind into powder, form pills with steamed bread paste the size of mung beans. Take 20-30 pills per dose, swallowing with rice drink.