脉候 尺脉牢而长，关上无有，此为阴干阳，其人苦两胫重，少腹引腰痛。寸口脉壮大，尺中无有，
此为阳干阴，其人苦腰背痛，阴中伤，足胫寒。（《脉经》）
尺脉沉，腰背痛，宜服肾气丸，针京门补之。（同上）
尺脉粗常热者，谓之热中（按∶此《平人气象论》文），腰胯疼，小便赤热。（同上）
诊其尺脉沉，主腰背痛。寸口脉弱，腰背痛。尺寸俱浮直下，此为督脉腰强痛。（《病源论》）
大抵腰痛之脉，脉皆沉弦。沉弦而紧者寒腰痛，沉弦而浮者风腰痛，沉弦而濡细者湿腰痛。坠堕闪肭，以致
气凝血滞而痛者，脉多沉弦而实也（按∶此脉法，《微义》引刘三点。又《崔氏脉诀》，其意
相同）。当推其所因，合其脉以治，无不效者矣。（《济生》）
脉必沉而弦，沉为滞，弦为虚。涩者是瘀血，缓者是湿，滑者或伏者是痰，大者是肾虚。（《丹溪》）
病由肾虚（不能俯仰） 肾主腰脚，肾经虚损，风冷乘
之，故腰痛也。又邪客于足少阴之络，令人腰痛引少腹，不可以仰息。（《病源论》）
肾主腰脚，而三阴三阳十二经八脉，有贯肾络于腰脊者。劳损于肾，动伤经络，又为风冷所侵，血
气击搏，故腰痛也。阳病者不能俯，阴病者不能仰，阴阳俱受邪气者，故令腰痛
而不能俯仰。（同上）
大抵因于房室过伤而肾虚者为多。盖肾虚则火旺，火旺则阴愈消而不能荣养，故作痛也。久而不治，则
成骨痿。（《医学集成》）（按∶此说本于东垣，东垣说见后。）
源由证治总说 凡腰痛病有五∶一曰少阴，少阴肾也，十月万物阳气伤，是以腰痛。二曰风痹，风
寒着腰，是以痛。三曰肾虚，役用伤肾，是以痛。四曰 腰，坠堕伤肾（按∶《医心》 作概，肾作腰），
是以痛。五曰寝卧湿地，是以痛。（《病源论》）
腰者肾之外候，足少阴经之所流注。若痛连小腹，不得俯仰， 短气，此由肾气虚弱，劳伤过度，有所
不荣，宜服杜仲散（用杜仲、官桂、丹皮）。若其状阴阴而痛，以热物熨痛处即少宽，此由久处卑湿，复为
风邪伤于足太阳之经，与血气相搏，诊其脉缓涩，宜服白术散。若痛不可转侧，转侧痛极，此由役用，动
伤经络，或从高堕下，气滞于足少阴之经，留而不行，为正气冲击而痛，诊其脉沉，大小不常，谓之肾腰痛，
宜服趁痛丸。若痛而转侧，转侧则如锥刀所刺，大便涩，小便赤，甚或黑，此留血滞于腰间，谓之血沥腰痛，
诊其脉涩，宜服当归丸。（《方氏》）（按∶原更有肾着证，全据经文，仍不录。又白术散，《是斋》引史
氏《指南方》，主治亦同，然则此五证论方皆出于史氏欤。）
夫腰痛虽属肾经，亦涉三因所致。在外则脏腑经络受邪，在内则忧思恐怒，以至房劳坠堕，皆能致之。方
书五种之说，未为详论云云。庶几后学以类推寻，为治疗之典据耳。（《三因》）
《素问》云∶腰者肾之府，转摇不能，肾将惫矣。审如
是说，则知肾系于腰，多因嗜欲过度，劳伤肾经，肾脏既虚，
喜怒忧思，风寒湿毒，得以伤之，遂致腰痛。又有坠堕内肭。气凝血滞，亦致腰痛。（《济生》）
腰者肾之外候，一身所恃以转移阖辟者也。盖诸经皆贯于肾而络于腰脊，肾气一虚，凡冲风受湿，伤
冷蓄热，血沥气滞，水积堕伤，与夫失志作劳，种种腰疼，迭见而层出矣。冲风者，汗出乘风，风邪风毒之
胚胎也。受湿者，践雨卧湿，重着肿滞之萌柏也。腰间如水为伤冷，发渴便闭为蓄热。血沥则转侧如锥
之所刺，气滞则郁郁闷闷而不伸。积水沉重，则小肠不得宣通；坠堕损伤，则瘀血为之凝结。沮锉失志者
肾之蠹，疲精劳力者肾之戕。举是数证，肾家之感受如此，腰安得而不为痛乎。《内经》曰∶腰者肾之府，转
摇不能，肾将惫矣。审如是则痛在少阴，必究其受病之原而处之为得。虽然，宗筋聚于阴器，肝者肾之
同系也。五脏皆取气于谷，脾者肾之仓廪也。郁怒伤肝则诸筋纵弛，忧思伤脾则胃气不
行。二者又能为腰痛之寇，故并及之。（《直指》）
大抵寒湿多而风热少。（《试效》）
腰痛主湿热，肾虚，瘀血，挫闪，有痰积。（《丹溪》）
湿热腰疼者，遇天阴或久坐而发者是也。肾虚者，疼之不已者是也。瘀血者，日轻夜重者是也。（《钩玄》）
腰者肾之所附，皆属肾，有寒有湿，有风有虚，皆能作痛。腰痛如锯刀所刺，大便黑，小便赤黄或黑，
由血滞腰间，名沥血腰痛，桃仁酒调黑神散。若寒腰痛，见热则减，见寒
则增，宜五积散，每服加吴茱萸半钱。（《要诀》）
腰痛证旧有五辨，虽其大约如此，然而犹未悉也。盖此证有表里虚实寒热之异，
知斯六者，庶乎尽矣，而治之亦无难也。（《景岳》）
腰痛证，凡悠悠戚戚、屡发不已者，肾之虚也。遇阴雨
或久坐而重者，湿也。遇诸寒而痛，或喜暖而恶寒者，寒也。遇诸热而痛，及喜寒而恶热者，热也。郁怒而痛
者，气之滞也。忧愁思虑而痛者，气之虚也。劳动即痛者，肝肾之衰也。当辨其所因而治之。（同上）
凡积而渐至者皆不足，暴而痛甚者多有余。内伤禀赋者皆不足，外感邪实者多有余。故治者当辨其所因。
（同上）
其为痛也，或引于项脊，傍及两胁，不可俯仰，或腰下如有横木，如坐水中，多令人面目黧黑，腹胁
胀满。感邪气者驱散之，凝滞者顺其气而调其血，如此治之，病无不愈。（《集成》）
新痛宜疏外邪，清湿热。久则补肾，兼理气血。（《入门》）
肾虚（诸般虚证） 有房室劳伤，肾虚腰痛者，是阳气虚弱，不能运动故也。经言腰者肾之府，转摇
不能，肾将败矣。宜肾气丸、鹿茸、茴香之类，以补阳之不足也。如膏粱之人，久服阳药，醉以入房，损
其真阴，肾气热，肾气热则腰脊痛而不能举，久则髓减骨枯，骨枯发为骨痿，宜六味地
黄丸、温肾丸、封髓丹（二方当考）之类，以补阴之不足也。（《试效》）
若肾虚腰痛，转侧不能，嗜卧瘦弱者，大建中汤，加川椒十粒，吞下腰肾丸（方阙）及生料鹿茸丸（出
《济生》，系补肾大方）之类。（《要诀》）
大抵诸腰痛皆起肾虚，既挟邪气，则须除其邪。如无外邪积滞而自痛，则惟补肾而已。腰肢痿弱，身
体疲倦，脚膝 软，脉或洪或细而皆无力，痛亦悠悠隐隐而不甚，是其候也。亦分寒热二证∶脉细而无力，
怯怯短气，小便清利，是谓阳虚；其脉洪而无力，小便黄赤，虚火时炎，是谓阴虚。（《准绳》）
腰痛之虚证十居八九，但察其既无表邪，又无湿热，而或以年衰，或以劳苦，或以酒色斫丧，或七情忧郁
所致者，则悉属真阴虚证。凡虚证之候，形色必清白，而或见黧黑，脉息必和缓，而或见细微，或以行立不支
而卧息少可，或以疲倦无力而劳动益甚。（《景岳》）
老年精力自衰，背驼腰曲，疲软无力，行动艰难，其脉涩而微弱，以精血之属慎补可也。又有久病之体，
或病后虚人，及房劳多欲者，腰膝无力，悠悠隐隐，疲软而痛，嗜卧懒行，步履不胜，两腰喜暖，六脉涩
弱而无神，或空大而搏指者，以温补之药主治。（《百问》）
肾着 肾主腰脚，肾经虚则受风冷，内有积水，风水相搏，浸积于肾，肾气内着，不能宣通，
故令腰痛。其病状，身重腰冷，腹重如带五千钱，如坐于水，形状如水，不渴，小便自
利，饮食如故，久久变为水病，肾湿故也。（《病源论》）
若湿腰痛，如坐水中。盖肾属水，久坐水湿处，或为雨露所着，湿流入肾经，以致腰痛，
宜渗湿汤（方见《中湿》）。不效，宜肾着汤。（《要诀》）
如为湿寒湿热外袭，其痛微缓，转输重着，阴寒天气尤甚，其脉微滑而濡软，以升阳
除湿为主。（《百问》）
风湿 劳伤肾气，经络既虚，或因卧湿当风，而风湿乘
虚搏于肾，肾经与血气相击而腰痛，故云风湿腰痛。（《病源论》）
风寒 若风伤而腰疼者，或左或右，痛无常处，牵引两足，宜五积散，每服加防风半钱，
或加全蝎三个尤好，小续命汤、独活寄生汤皆可选用。（《要诀》）
若风寒在经，其证必有寒热，其脉必见紧数，其来必骤，
其痛必拘急兼酸而多连脊背，此当辨其阴阳，治从解散。
（《景岳》）
如为风寒所感，肢体酸软，绵绵而痛，肾腰无力，畏寒就热，其脉弦紧浮，以温散为先。（《百问》）
腰（闪肭） 腰者，犹如反腰，忽转而 之。（《肘
后》）（按∶《医心》引葛氏方作“概腰者，是反腰，忽动转而挽之。”）
腰者，谓卒然伤损于腰而致痛也。此由损血搏于背脊所为，久不已，令人气息乏少，
面无颜色，损肾故也。（《病源论》）
腰痛者，偻伛肿重，引季胁痛，因于坠堕，恶血流
滞，及房劳疲力，耗竭精气，致腰疼痛。惟此，从不内外因补泻施治。（《三因》）
若因闪肭或 扑伤损而痛，宜黑神散和复元通气散（方见《寒疝》），酒调下。不效则恐有恶血停滞，
宜先用酒调下苏合香丸，仍以五积散，每服加大黄半钱，苏木半钱，当归倍元数。（《要诀》）（按∶
《丹溪心法·附录》作五积散，加牵牛头末一钱，或桃仁七枚。）
腰痛亦有因闪挫而得者，闪挫之初，血气必有凝滞之处，亦宜先泄而后补也。（《医学管见》）
如挫闪跌扑，以致死血流于本经而作痛，宜四物加桃仁、红花、苏木行之。若脉壮盛者，用桃仁承气汤。（《原理》）
食积 食积腰痛者，食滞于脾而气传于肾也。夫肾受脾之精而脏焉者也，若食不消，则所输于肾者，
非精微之气，为陈腐之气矣。而肾受之，乱气伤精，能无痛乎。亦有醉饱入房太甚，酒食之积，乘虚流入少
阴，腰痛难以俯仰者，疏瀹其源，澄清其流，此大法也。（《金匮翼》）
妇人 妇人（按∶此似脱去字）血过多，及素患血虚致
腰痛者，当益其血。（《要诀》）
妇人腰痛者分二∶一则经不调而有热，一则浊气下坠而多带，腰痛一阵，下白一阵是也。（《六要》）
女人腰痛，少壮者多血滞，衰老者多血虚。（《玉案》）
腰酸 腰痛尚有寒湿伤损之异，腰酸悉属房劳肾虚，惟有峻补，男子用青蛾丸，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、沙菀蒺藜、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。（《医通》）
环跳痛 所示近来腰复微痛，坐久屈伸不便，右侧腰腿相接处曰环跳穴，旁多酸痛。夫腰者肾之
外候，盖由肾水衰虚于内，以致肾之外候，或微痛，或屈伸不便，或环跳穴旁酸痛也。环跳虽属膀胱，膀胱亦
肾之府，未有脏病而腑不病也。（《石山》）（按∶丹溪治环跳穴痛不已，防生附骨疽，以苍术、黄柏、青
皮、甘草，冬加桂枝，夏加条芩，体虚加牛膝，大料煎，入姜汁，食前饮之云云。又《赤水》有
治验二则，文繁不录。）
尻痛 臀尖尽处，又有所谓尻骨痛，有痰、有血虚、死血不同。（《玉案》）
尻乃足少阴与督脉所过之处，兼属厥阴。若肾虚者，六味丸加肉桂。不愈，加鹿茸。肥人属湿痰，二
陈合二炒（用苍术、黄柏）。有因死血作痛者，当归、赤芍、牡丹、桃仁、延胡索、
生牛膝、穿山甲、肉桂之类清理之。不应，加地龙、生附子。（《医通》）
死证 人有痛，面上忽见红点者，多死。（《丹溪》）
腰痛，面忽红忽黑，为心肾交争，难治。（《医碥》）
杂治例 今之人每患腰痛，不问虚实，多进牵牛之药。
殊不知牵牛之为性，能伤肾气，服之未见作效，肾气先有所损矣。倘的是气，（原书此下有缺漏）
香茸元，治肾脏虚寒，腰膝沉重，补益。
麝香（一钱） 破故纸（四两） 牛膝 鹿茸（各二两） 附子 苁蓉（各四两）
上为细末，酒煮稀面糊和丸，如梧子大，每服五十丸，食前盐汤或温酒下。（《鸡峰》）
鹿角丸，治肾虚伤冷，冷气入肾，其痛如掣。
鹿角屑（一两酥炙黄） 附子（炮二两） 桂心（三分）
上为末，酒糊丸，如梧桐子大，盐酒下三、五十丸，空心服。（《三因》）
青娥丸，治肝肾虚，腰腿重痛。常服壮筋补虚，填精益髓。
杜仲（一斤炒） 生姜（十两炒） 破故纸（一斤炒）
上为末，用胡桃肉一百二十个，汤浸去皮，研成膏，入少熟蜜，丸如梧子大，每服五十丸，盐酒、盐
汤任下。（同上）（按∶《简易》魏将使青娥丸，有丸和十二年岭南节度使郑□序，其方无杜仲。又按∶
此本出《本草图经》，无杜仲、生姜，蜜和如饴糖，以暖酒二合，调药一匙服，不饮人以暖熟水调。）《和
剂·诸局秘方》补骨脂用脂麻同于银器内炒熟。《是斋》补髓丹，于本方去生姜（杜仲、补骨脂各十两，
用芝麻五两同炒，候芝麻黑色无声为度，筛去芝麻），加鹿茸（二两，燎去毛，酒炙）、没药（一两，别
Pulse Diagnosis A firm and long pulse at the Chi (Cun-Chi) position, with a weak or absent pulse at the Guan (Cun-Guan) position, indicates Yin pathogen invading Yang meridians. The patient suffers from heaviness in both calves and pain in the lower abdomen radiating to the waist. A strong and large pulse at the Cun (Cun-Kou) position, with a weak or absent pulse at the Chi position, indicates Yang pathogen invading Yin meridians. The patient suffers from pain in the lower back and back, injury to the genitalia, and coldness in the feet and shins. (From *Mai Jing*)
A deep pulse at the Chi position accompanied by lower back pain is suitable for treatment with Shengqi Wan (Kidney Qi Pill), and acupuncture at Jingmen (GB25) using the tonification method. (Ibid.)
A coarse and frequently hot pulse at the Chi position is called Re Zhong (Heat in the Middle). According to this description from *Ping Ren Qi Xiang Lun*, symptoms include pain in the lower back and hips, and red, hot urination. (Ibid.)
Diagnosing a deep pulse at the Chi position indicates lower back pain. A weak pulse at the Cun position indicates lower back pain. Floating and straight-downward pulses at both Cun and Chi positions indicate stiffness and pain in the waist due to pathology of the Du Mai (Governing Vessel). (From *Bing Yuan Lun*)
Generally, the pulse in cases of lower back pain is Chen-Xian (Deep and String-taut). A Chen-Xian-Jin (Deep, String-taut, and Tight) pulse indicates Cold Lower Back Pain; a Chen-Xian-Fu (Deep, String-taut, and Floating) pulse indicates Wind Lower Back Pain; a Chen-Xian-Ru-Xi (Deep, String-taut, Soft, and Fine) pulse indicates Dampness Lower Back Pain. Pain caused by falling or spraining, leading to Qi stagnation and Blood stasis, typically presents with a Chen-Xian-Shi (Deep, String-taut, and Excess) pulse. One must investigate the cause and treat according to the pulse pattern, which will invariably be effective. (From *Ji Sheng Fang*)
The pulse must be Deep and String-taut. Deep indicates stagnation; String-taut indicates deficiency. Se (Choppy) pulse indicates Blood Stasis; Huan (Slow) pulse indicates Dampness; Hua (Slippery) or Fu (Hidden) pulse indicates Phlegm; Da (Large) pulse indicates Kidney Deficiency. (From Zhu Danxi)
Etiology stems from Kidney Deficiency (manifesting as inability to bend forward or extend backward). The Kidneys govern the waist and legs. When the Kidney Meridian is deficient, Wind-Cold-Dampness pathogens invade, causing lower back pain. Additionally, pathogens lodging in the collaterals of the Foot Shaoyin Kidney Meridian cause lower back pain radiating to the lower abdomen, making it difficult to breathe while extending backward. (From *Bing Yuan Lun*)
The Kidneys govern the waist and legs. Among the Twelve Regular Meridians of Yin and Yang and the Eight Extraordinary Vessels, some penetrate the Kidneys and connect to the lumbar spine. Labor damages the Kidneys, disturbing the meridians, and invasion by Wind-Cold-Dampness causes Qi and Blood to clash, resulting in lower back pain. Pathogens affecting the Yang aspect prevent bending forward; those affecting the Yin aspect prevent extending backward. When both Yin and Yang are affected by pathogens, the result is lower back pain with inability to bend or extend. (Ibid.)
Generally, most cases arise from excessive sexual activity leading to Kidney Deficiency. Kidney Deficiency leads to Hyperactive Fire, which further consumes Yin Essence, preventing nourishment and causing pain. If untreated for a long time, it develops into Gu Wei (Bone萎/Atrophy). (From *Yi Xue Ji Cheng*)
General Discussion on Etiology, Symptoms, and Treatment There are five types of lower back pain: First, Shaoyin Lower Back Pain; Shaoyin refers to the Kidneys. In the tenth lunar month, the Yang Qi of all things is damaged, hence lower back pain. Second, Feng Bi (Wind Obstruction) Lower Back Pain; Wind, Cold, and Dampness adhere to the waist, causing pain. Third, Kidney Deficiency Lower Back Pain; overexertion damages the Kidneys, causing pain. Fourth, Zhe Yao (Broken Waist) Lower Back Pain; falling or trauma damages the Kidneys, causing pain. Fifth, Sleeping on Damp Ground Lower Back Pain; sleeping on damp ground causes pain. (From *Bing Yuan Lun*)
The waist is the external manifestation of the Kidneys and the flow path of the Foot Shaoyin Kidney Meridian. If pain radiates to the lower abdomen, accompanied by inability to bend/extend and shortness of breath, it is due to Kidney Qi Deficiency and excessive labor leading to lack of nourishment. Treat with Duzhong San (containing Duzhong, Guigui, Mudanpi). If the pain is dull and relieved by heat application, it is due to prolonged exposure to low-lying dampness and Wind pathogen invading the Foot Taiyang Bladder Meridian, clashing with Qi and Blood. With a Huan-Se (Slow and Choppy) pulse, treat with Baizhu San. If pain prevents turning sideways and is severe upon movement, it is due to overexertion damaging meridians or falling from height, causing Qi stagnation in the Foot Shaoyin Kidney Meridian. Striking against healthy Qi causes pain. With a Deep pulse of varying magnitude, it is called Kidney Lower Back Pain; treat with Chentong Wan. If pain feels like needle/stabbing upon turning, with dry stool and dark/red urine, it is Blood Stasis in the waist, called Xue Li Lower Back Pain. With a Se (Choppy) pulse, treat with Danggui Wan. (From *Fang Shi*)
Although lower back pain belongs to the Kidney Meridian, it involves three categories of etiology. Externally, it is due to pathogens invading organs, fu-organs, meridians, and collaterals; internally, it is due to worry, fear, anger, sexual exhaustion, or trauma. The five types mentioned in medical texts are not exhaustive. Let future scholars use this for analogy and as a basis for treatment. (From *San Yin Ji Yi Bing Zheng Fang Lun*)
*Susu Wen* states: "The waist is the mansion of the Kidneys. Inability to turn or shake indicates the Kidneys are failing." This confirms the close relationship between Kidneys and waist. Excessive desires and labor damage the Kidney Meridian. Once Kidney Qi is deficient, emotions (joy, anger, worry, thought) and pathogens (Wind, Cold, Damp, Toxic) can harm it, causing lower back pain. Falling or internal trauma causing Qi stagnation and Blood stasis also cause lower back pain. (From *Ji Sheng Fang*)
The waist is the external manifestation of the Kidneys and the body's pivot for movement. All meridians pass through the Kidneys and connect to the lumbar spine. Once Kidney Qi is deficient, various factors such as Wind-Cold-Dampness, Cold-Heat accumulation, Blood Stasis, Qi stagnation, Water retention, trauma, emotional distress, and labor can cause recurrent lower back pain. "Chong Feng" (Rushing Wind) refers to wind entering during sweating, the embryo of Wind pathogens. "Shou Shi" (Receiving Dampness) refers to walking in rain or lying on wet ground, the萌芽 of heavy/swollen stagnation. Water-like sensation in the waist indicates Cold; thirst and constipation indicate Heat accumulation. Xue Li (Blood Dripping/Stasis) causes stabbing pain upon turning; Qi stagnation causes depression and lack of expansion. Heavy water accumulation obstructs the Small Intestine; trauma causes Blood Stasis. Frustration and loss of will are parasites of the Kidneys; exhausting essence and strength are killers of the Kidneys. Given these conditions affecting the Kidneys, how can the waist not hurt? *Neijing* says: "The waist is the mansion of the Kidneys. Inability to turn/shake indicates Kidney failure." Thus, pain is in Shaoyin; one must trace the root cause to treat effectively. Although Zong Jin (Tendon Convergence) gathers at the genitalia, and Liver is related to Kidney, and Spleen is the granary of Kidney, emotional injuries to Liver (causing tendon flaccidity) and Spleen (stopping Stomach Qi) can also cause lower back pain. (From *Zhi Zhi Fang*)
Generally, Cold-Dampness is more common than Wind-Heat. (From *Shi Xiao Fang*)
Lower back pain is mainly caused by Damp-Heat, Kidney Deficiency, Blood Stasis, Trauma/Sprain, and Phlegm Accumulation. (From Zhu Danxi)
Damp-Heat Lower Back Pain occurs on cloudy days or after prolonged sitting. Kidney Deficiency Lower Back Pain is persistent/chronic. Blood Stasis Lower Back Pain is lighter during the day and heavier at night. (From *Gou Xuan*)
The waist is attached to the Kidneys. Causes include Cold, Dampness, Wind, and Deficiency. Stabbing pain like a saw, with black stool and dark/red/black urine, indicates Blood Stasis in the waist, named Li Xue Lower Back Pain. Treat with Heishen San mixed with Peach Kernel wine. Cold Lower Back Pain improves with heat and worsens with cold; treat with Wuji San, adding Wuzhuyu half a qian per dose. (From *Yao Jue*)
Old classifications of lower back pain had five types, but this is incomplete. One must distinguish between Exterior/Interior, Excess/Deficiency, Cold/Heat. Understanding these six aspects allows for comprehensive treatment. (From Zhang Jingyue)
Lower back pain that is lingering, frequent, and unceasing indicates Kidney Deficiency. Worsening with rain or prolonged sitting indicates Dampness. Worsening with cold or preferring warmth indicates Cold. Worsening with heat or preferring coolness indicates Heat. Pain from anger indicates Qi Stagnation. Pain from sorrow/worry indicates Qi Deficiency. Pain upon exertion indicates decline of Liver and Kidney. Treat based on the cause. (Ibid.)
Gradual onset indicates Deficiency; sudden severe onset indicates Excess. Internal injury/congenital weakness indicates Deficiency; external pathogenic excess indicates Excess. Therefore, treatment must identify the cause. (Ibid.)
Pain may radiate to the neck/spine, involve the hypochondrium, prevent bending/extending, feel like a horizontal log or sitting in water, cause dark complexion, and abdominal/flank distension. Expel pathogens if invaded; regulate Qi and Blood if stagnant. Such treatment ensures recovery. (From *Yi Xue Ji Cheng*)
New pain should be treated by dispersing external pathogens and clearing Damp-Heat. Chronic pain requires tonifying the Kidney and regulating Qi and Blood. (From *Ru Men*)
Kidney Deficiency (Various Deficiency Syndromes) Sexual exhaustion causing Kidney Deficiency lower back pain is due to Yang Qi deficiency failing to move. Classics say: "Waist is Kidney's mansion; inability to turn means Kidney is failing." Treat with Shengqi Wan, Lurong (Deer Antler), Huixiang (Fennel) to tonify Yang. For those consuming rich food who take Yang-tonics excessively and engage in sex while drunk, damaging True Yin, causing Kidney Heat and lower back pain unable to lift, leading to Marrow depletion and Bone Atrophy, treat with Liuwei Dihuang Wan, Wen Shen Wan, Fengsui Dan to tonify Yin. (From *Shi Xiao Fang*)
For Kidney Deficiency lower back pain with inability to turn, lethargy, and emaciation, use Dajianzhong Tang plus Sichuan Pepper, swallowing Yaoshen Wan (formula missing) and Shengliao Lurong Wan. (From *Yao Jue*)
Generally, all lower back pain originates from Kidney Deficiency. If accompanied by pathogens, expel them. If spontaneous pain without external pathogens/stagnation, only tonify the Kidney. Symptoms include weak waist/limbs, fatigue, soft knees, weak pulse (either Large or Fine but powerless), and dull, hidden pain. Differentiate Cold vs. Heat: Fine/powerless pulse, timidity, shortness of breath, clear urine indicates Yang Deficiency. Large/powerless pulse, yellow/red urine, intermittent deficiency fire indicates Yin Deficiency. (From *Zhun Sheng*)
Eight or nine out of ten lower back pain cases are deficiency. If no exterior pathogens or Damp-Heat, and caused by aging, labor, alcohol/sex excess, or emotional depression, it is True Yin Deficiency. Deficiency signs include clear/pale complexion or darkening, harmonious/slow or fine/small pulse, relief upon lying down, and worsening with labor. (From Zhang Jingyue)
Elderly people naturally decline, with hunched backs, curved waists, weakness, and difficulty walking. Pulse is Choppy and weak; cautiously tonify with essence/blood substances. Chronic patients, post-illness weakness, or excessive sexual desire causing weak waist/knees, dull pain, lethargy, preference for warmth, and weak/empty pulses require warm tonification. (From *Bai Wen*)
Shen Zhuo (Kidney Fixation) Kidneys govern waist/legs. Kidney deficiency invites Wind-Cold. Internal water accumulation clashes with Wind-Water, accumulating in Kidneys. Kidney Qi becomes fixed and cannot circulate, causing lower back pain. Symptoms: heavy body, cold waist, heavy abdomen like carrying 5000 coins, feeling like sitting in water, no thirst, normal urination/diet. Long-term leads to Water Disease due to Kidney Dampness. (From *Bing Yuan Lun*)
Damp Lower Back Pain feels like sitting in water. Kidneys belong to Water. Prolonged sitting in dampness or exposure to rain/dew allows Dampness to enter Kidney Meridian, causing pain. Treat with Shen Shi Tang. If ineffective, use Shen Zhuo Tang. (From *Yao Jue*)
If attacked by Cold-Damp or Damp-Heat, pain is mild but heavy, worse in cold weather. Pulse is slightly Slippery and Soft. Primary treatment is Ascending Yang and Dispersing Dampness. (From *Bai Wen*)
Feng Shi (Wind-Damp) Labor damages Kidney Qi and meridians. Lying in dampness/exposure to wind allows Wind-Damp to invade deficient Kidneys, clashing with Qi/Blood, causing lower back pain. (From *Bing Yuan Lun*)
Feng Han (Wind-Cold) Wind injury causing lower back pain varies in location, radiating to legs. Treat with Wuji San plus Fangfeng half a qian, or Quanxie (Scorpion) three pieces. Xiaoxuming Tang or Duhuo Jisheng Tang are also options. (From *Yao Jue*)
If Wind-Cold is in the meridians, symptoms include chills/fever, Tight-Rapid pulse, sudden onset, spasmodic/aching pain connecting to spine/back. Differentiate Yin/Yang and treat by dispersing. (From Zhang Jingyue)
If infected by Wind-Cold, limbs are sore/weak, pain is continuous, Kidney/Waist is weak, fear of cold/seeking heat. Pulse is String-Taut/Tight/Floating. Primary treatment is Warm Dispersion. (From *Bai Wen*)
Zhe Yao (Sprain/Twist) "Zhe Yao" is like breaking the waist, suddenly twisting and snapping. (From *Zhou Hou Bei Ji Fang*)
Zhe Yao refers to sudden waist injury causing pain. Due to damaged blood clashing in the back/spine. If chronic, leads to shortness of breath and pale face, damaging Kidneys. (From *Bing Yuan Lun*)
Lower back pain with stooping, swelling/heaviness, radiating to hypochondrium, caused by falling, evil blood stasis, or sexual exhaustion depleting essence/Qi. This type is treated by tonifying/venting regardless of internal/external origin. (From *San Yin Ji Yi Bing Zheng Fang Lun*)
For pain from sprains or falls, use Heishen San and Fuyuan Tongqi San mixed with wine. If ineffective, suspect evil blood stasis; first use Suhexiang Wan with wine, then Wuji San plus Dahuang half a qian, Sumu half a qian, and double Danggui. (From *Yao Jue*)
Initial stage of sprain involves Qi/Blood stagnation; treat by draining first, then tonifying. (From *Yi Xue Guan Jian*)
If trauma causes dead blood to flow into the meridian causing pain, use Siwu Tang plus Taoren, Honghua, Sumu. If pulse is strong, use Taoren Chengqi Tang. (From *Yuan Li*)
Shi Ji (Food Accumulation) Food accumulation lower back pain: Food stagnates in Spleen, Qi transmits to Kidneys. Kidneys store Spleen's essence. Undigested food sends turbid Qi instead of essence to Kidneys, disturbing Qi and damaging Essence, causing pain. Drunken eating/drinking followed by sex allows food/alcohol accumulation to enter Shaoyin, causing lower back pain with inability to bend/extend. Clear the source and clarify the flow. (From *Jin Kui Yi*)
Fu Ren (Women) Women with excessive blood loss or chronic Blood Deficiency causing lower back pain should tonify Blood. (From *Yao Jue*)
Female lower back pain has two types: Irregular menstruation with Heat; or Turbid Qi sinking with leukorrhea, alternating lower back pain and discharge. (From *Liu Yao*)
Young women's lower back pain is mostly Blood Stasis; elderly women's is mostly Blood Deficiency. (From *Yu An*)
Suan Yao (Sore Waist) Lower back pain differs from sore waist. Sore waist is entirely due to sexual exhaustion and Kidney Deficiency, requiring strong tonification. Men use Qing'e Wan or Bawei Wan plus Buguzhi, Duzhong. If Heat, remove Fuzi, add Wuweizi. For seminal emission, use Liuwei Wan minus Zexie, plus Biaojiao, Shayuanjili, Wuweizi. For loose stools, add Rouguo, Buguzhi, Shanyao paste instead of honey. Women use Liuwei Wan plus Duzhong, Xuduan. With leukorrhea, remove Shudi, add Aiye, Fuzi. With irregular menses, add Danggui, Ejiao. (From *Yi Tong*)
Huantiao Tong Pain in the Huantiao point (GB30) area. Recent slight lower back pain, difficulty bending/extending after sitting, sour pain near Huantiao on the right. Waist is Kidney's external manifestation. Internal Kidney Water deficiency affects the external manifestation, causing pain or stiffness. Huantiao belongs to Bladder, which is the Fu-organ of Kidney. Zang disease always affects Fu disease. (From *Shi Shan Yi An*)
Kao Tong (Sacral/Coccygeal Pain) Pain at the tip of the buttocks (Kao bone). Causes include Phlegm, Blood Deficiency, and Dead Blood. (From *Yu An*)
Kao is passed by Foot Shaoyin and Du Mai, also related to Jueyin. For Kidney Deficiency, use Liuwei Wan plus Rougui. If ineffective, add Lurong. For obese patients with Damp-Phlegm, use Erchen Tang combined with Erchao (Cangzhu, Huangbai). For Dead Blood pain, use Danggui, Chishao, Mudan, Taoren, Yanhusuo, Sheng Niuxi, Shanjiajia, Rougui to clear. If ineffective, add Dilong, Sheng Fuzi. (From *Yi Tong*)
Si Zheng (Death Signs) Patients with pain who suddenly develop red spots on the face often die. (From Zhu Danxi)
Lower back pain with face suddenly turning red or black indicates Heart-Kidney conflict; difficult to treat. (From *Yi Que*)
Miscellaneous Treatment Examples Modern patients often take Qianniu (Mercurialis) for lower back pain regardless of deficiency/excess. Qianniu damages Kidney Qi; efficacy is rarely seen before Kidney Qi is harmed. ... Xiangrong Yuan treats Kidney Cold-Deficiency, heavy waist/knees. Musk (1 qian), Pogostemon (4 liang), Niuxi, Lurong (2 liang each), Fuzi, Rongrong (4 liang each). Powdered, mixed with wine-boiled wheat paste, pill size of wutong seeds. 50 pills per dose, taken before meals with salt water or warm wine. (From *Ji Feng Pu Ji Fang*)
Lujiao Wan treats Kidney Deficiency Cold Injury, Cold Qi entering Kidneys, pulling pain. Deer Horn Scrapings (1 liang, fried in butter until yellow), Prepared Fuzi (2 liang), Guixin (3 fen). Powdered, mixed with wine paste, pill size of wutong seeds. 30-50 pills with salt wine on empty stomach. (From *San Yin Ji Yi Bing Zheng Fang Lun*)
Qing'e Wan treats Liver/Kidney Deficiency, heavy/aching waist/legs. Strengthens tendons, tonifies deficiency, fills marrow. Duzhong (1 jin, fried), Ginger (10 liang, fried), Pogostemon (1 jin, fried). Powdered. 120 Walnuts, peeled, pounded into paste with honey. Pill size of wutong seeds. 50 pills per dose with salt wine/water. (Ibid.)