（腰酸 腰偻废 腰软 尻 膝 跟附）
经云∶腰者肾之腑。又云∶太阳所至为腰痛，惟肾与膀胱相表里，故腰在经则属太阳，在脏则属肾。
经言太阳腰痛者，外感六气也。经言肾经腰痛者，内伤房劳也。而又为冲任督带之要会，
其所由致痛者，以肾气本虚，而风寒湿热之邪，皆可乘虚而入，即诸奇经亦多统系焉。凡腰脊酸痿，绵绵作痛，
并腿足酸软者，肾虚也。遇阴雨则隐痛，或久坐觉重者，湿也。得寒则痛，喜近温暖者，寒也。得热则痛，喜
近清凉者，热也。闪挫痛，或跌扑损伤者，血瘀也。肝脾伤，由忧思郁怒者，气滞也。负重致痛者，劳力也。
凡此皆属标，而肾虚为本，详其治法。肾虚痛者，多由房欲，但察其既无表邪，又非湿热；或年力衰颓，
或情志怫郁；或行立不支，而坐卧少可；或疲倦无力，而动劳益甚；或面色惨晦，脉候虚微，皆肾经不足也。
但肾阳虚者，脉微无力，小便清利，神疲气短，宜益火之源。肾气丸、鹿茸丸。肾阴虚者，脉洪而数，虚火
时炎，小便黄赤，宜壮水之主。地黄汤、大补丸。肾阴阳俱虚者，脉虚而大，宜水火平调。无比山药丸。其
六气乘虚，侵犯太阳，如伤风腰痛，症必寒热，脉必浮，痛连背脊，牵引两足。小续命汤加减。伤寒腰冷如冰，
脉必紧，得热则减。姜附汤加肉桂、杜仲，外用摩腰膏。伤湿，由坐卧湿地，或伤雨露，身重，脉缓，天阴更
甚，腰溶溶如坐水中。宜茯苓皮、木防己、晚蚕砂、滑石、浓朴、萆 、薏苡、渗湿汤、肾着汤。湿兼风，
一身尽痛，羌活胜湿汤、独活寄生汤。湿兼寒，腹痛自利，姜附汤。湿兼热，郁久化火，当归拈痛汤。风
寒湿痹痛，川乌头三个，生捣为末，少加盐水，调摊帛上，贴痛处立止。热痛脉必洪数、口渴便秘，甘豆汤加
续断、天麻。如阴虚火盛，当滋阴降火，滋阴八味丸。闪挫跌扑诸痛，肝脉搏坚而长，两尺实，不可俯仰，复
元通气散酒调下。若血瘀痛，转动如刺，大便黑，或秘结，四物汤加红花、桃仁、穿山甲、延胡索、大黄。
外用酒糟、葱白、生姜捣烂罨之，尤效。气滞腰痛，脉沉弦，或结伏，乌药顺气散，不应，八味顺气散。
肝气失畅，卧觉腰痛，频欲转侧，晓起则止，柴胡舒肝散。痰注痛，脉滑或沉，痛在一块，导痰汤加香附、乌
药、枳壳。伤力腰痛，大补汤下青娥丸。腰肋如带束引痛，此带脉为病，宜辛散其结，甘缓其急。用延胡、
归须、桑寄生、杞子、小茴、沙苑子、或调肝散。痛久络虚，宜调补奇脉。用核桃、当归、杜仲、羊腰、鹿角、
杞子、牛膝、补骨脂。老人虚人肾亏腰
痛，不能转侧。宜二至丸，或立安丸。腰酸属房劳肾虚，宜峻补。青娥丸。若走精，六味丸去泽泻，加鱼鳔、
沙苑子、五味子。妇女腰酸，六味丸加杜仲、续断。腰偻废，乃热邪深入，血脉久闭。桃仁承气汤、多用肉桂，
少用熟附子行经。痛者可治，不痛久废者，不可治。腰软湿袭经络者，肾着汤。风袭腰背者，牛膝酒。斫丧太
过者，八味丸、补髓丹。脊者，督脉及太阳经所过，项脊常热而痛者，阴虚也。六味丸加麋茸。常寒而痛者，
阳虚也。八味丸加鹿茸。太阳经脊痛项强，腰似折，项似拔，羌活胜湿汤。脉浮紧为伤寒，麻黄汤。沉缓为风
湿，柴胡汤加减。尻乃足少阴及督脉所经，兼属厥阴，尻痛属肾虚者，七味丸，不应，加鹿茸。肥人属湿痰，
二陈汤合二妙散。腿足为足六经所至，痛有阴虚、阳虚、血虚、血寒、肾虚、风袭、寒湿、风湿、湿热之症。阴
虚者体羸，足心及股胫热痛，左尺细数，或两尺数盛。虎潜丸去陈皮，加肉桂。阳虚者足浮肿无力，大便泻，
右尺虚大，或两尺浮迟，脾与命火俱衰。先用补中益气汤加炮姜，再用八味丸。血虚者足不任地，行则振掉，
脉细弱。六味汤加续断、鹿茸、杜仲。血寒者，筋急脉沉，喜近汤火，舒筋三圣散。肾虚风袭，则下体痿弱，
骨节疼痛，尺中浮大而数。安肾汤。寒湿者，两腿隐痛，或麻顽作肿，身重，肢节痛，脉沉者，白术附子汤。
脉浮涩者，除风湿羌活汤。风湿者，肿痛走注，独活寄生汤。湿热者，或上或下，或红或肿，溺赤，脉濡数。
当归拈痛汤。更有腿转筋，上冲入腹，宜瓜萸散，详香港脚门。膝者筋之腑，屈伸不利，行则偻俯，筋将惫矣。
其膝痛在筋，则屈不能伸而肿，多挟风热，二妙散加羌、防、升、柴。兼阴虚则热而不肿，虎潜丸。若膝胫痹
弱重痛，多挟风湿，独活寄生汤。夏月湿热肿痛，当归拈痛汤。屈伸不利，活络丹。虚寒兼挟风湿作痛，虎
骨四斤丸。虚热筋痿，颤掉作痛，鹿茸四斤丸。足跟痛，属肾阴虚者，胫热跟痛，六味丸加肉桂、龟板。
肾阳虚者，不能久立，八味丸。挟湿者，必重着而肿，换骨丹。足心为少阴肾经涌泉穴所注，足心及踝骨热痛
者，为肾虚湿着，肾着汤下六味丸。或用二至丸、立安丸。
(Soreness of the lower back, lumbar curvature and disability, weakness of the waist, sacrum, knees, heels, and surrounding areas)
The *Classic of Internal Medicine* states: The waist is the external mansion of the Kidney. It also states: Abnormalities of the Taiyang (Greater Yang) channel lead to low back pain. Since the Kidney and Bladder are exteriorly-interiorly related, the waist belongs to the Taiyang channel at the meridian level, and to the Kidney organ at the zang-fu level.
Low back pain described in the classics as belonging to the Taiyang channel is caused by the exogenous invasion of the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire). Low back pain described as belonging to the Kidney channel is caused by internal injury from excessive sexual activity. The waist is also a crucial convergence point for the Chong (Penetrating), Ren (Conception), Du (Governing), and Dai (Belt) vessels. The causes of pain arise because the Kidney Qi is originally deficient, allowing Wind, Cold, Dampness, and Heat pathogens to invade when defenses are weak; thus, the Extraordinary Vessels are largely associated with this region. Any soreness, weakness, and chronic pain in the lower back and spine, accompanied by soreness and weakness in the legs and feet, indicates Kidney Deficiency. Pain that becomes dull during cloudy or rainy weather, or heaviness felt after prolonged sitting, indicates Dampness. Pain exacerbated by cold and relieved by warmth indicates Cold. Pain exacerbated by heat and relieved by coolness indicates Heat. Pain resulting from sprains or falls indicates Blood Stasis. Liver and Spleen injury due to worry, overthinking, depression, or anger leads to Qi Stagnation. Pain caused by carrying heavy loads indicates Labor Injury. All these are manifest symptoms (Biao), while Kidney Deficiency is the root cause (Ben). The treatment methods are detailed below:
Pain due to Kidney Deficiency often stems from excessive sexual desire. If it is observed that there are no exterior pathogenic factors and no Damp-Heat, or if the patient is elderly and physically declining, or emotionally depressed, or unable to stand/walk without support but finds relief in lying down/sitting, or feels fatigued and weak with worsening symptoms upon exertion, or has a sallow/dull complexion and a faint, minute pulse, these all indicate insufficiency of the Kidney channel.
If Kidney Yang is deficient, the pulse is faint and powerless, urination is clear and profuse, spirit is tired, and breath is short. The treatment should be to "benefit the source of fire" (warm and tonify Kidney Yang). Formulas include Shengji Wan (Kidney Qi Pill) and Lurong Wan (Deer Antler Pill). If Kidney Yin is deficient, the pulse is surging and rapid, deficiency fire flares up intermittently, and urine is yellow and red. The treatment should be to "strengthen the master of water" (nourish and tonify Kidney Yin). Formulas include Dihuang Tang (Rehmannia Decoction) and Dabu Wan (Great Tonifying Pill). If both Kidney Yin and Yang are deficient, the pulse is deficient and large. The treatment should balance water and fire (tonify both Yin and Yang). Formula: Wubi Shanyao Wan (Incomparable Chinese Yam Pill).
When the Six Evils invade the Taiyang channel due to deficiency, such as wind-cold causing low back pain, symptoms must include aversion to cold and fever, the pulse must be floating, pain radiates to the spine and pulls into both legs. Formula: Xiao Xuming Tang (Minor Continuation of Life Decoction) modified. For cold like ice in the waist due to Cold Damage (Shanghan), the pulse is tight, and pain decreases with heat. Formula: Jiangfu Tang (Ginger and Aconite Decoction) added with Rougui (Cinnamon Bark) and Duzhong (Eucommia Bark); externally apply Moyao Gao (Waist Massage Paste). For Dampness injury from sitting/lying on damp ground or exposure to rain/dew, the body feels heavy, the pulse is slow, worsens on cloudy days, and the waist feels soggy as if sitting in water. Ingredients: Fuling Pi (Poria Peel), Mufangji (Stephania Tetrandra), Wancansha (Silkworm Frass), Huashi (Talcum), Houpo (Magnolia Bark), Bibing (Dioscorea Hypoglauca), Yiyiren (Coix Seed). Formulas: Shenshi Tang (Damp-Draining Decoction) or Shen Zhuo Tang (Sinking Dampness Decoction). If Dampness combines with Wind, causing whole-body pain, use Qianghuo Shengshi Tang (Notopterygium Decoction to Overcome Dampness) or Duhuo Jisheng Tang (Angelica Pubescens and Porcine Spine Decoction). If Dampness combines with Cold, causing abdominal pain and spontaneous diarrhea, use Jiangfu Tang. If Dampness combines with Heat, stagnating and transforming into Fire, use Danggui Niangong Tang (Angelica Ligustici Decoction to Relieve Pain). For Bi-syndrome pain due to Wind-Cold-Dampness, use San Chuantou (Aconitum Carmichaelii Radix Preparata) three units, raw and pounded into powder, mixed with a little salt water, spread on cloth, and applied to the painful area for immediate relief. For Heat pain, the pulse is surging and rapid, with thirst and constipation. Formula: Gandou Tang (Mung Bean Decoction) added with Xuduan (Dipsacus Root) and Tianma (Gastrodia Rhizome). If Yin deficiency with flourishing fire, nourish Yin and descend fire using Ziyin Bawei Wan (Yin-Nourishing Eight-Ingredient Pill).
For various pains from sprains and falls, if the Liver pulse is firm and long, and both Chi pulses are excess, and the body cannot bend or extend, use Fuyuan Tongqi San (Revive the Origin Qi-Promoting Powder) taken with wine. If Blood Stasis pain, movement feels like stabbing, stool is black or constipated, use Siwu Tang (Four Substances Decoction) added with Honghua (Carthamus Flower), Taoren (Peach Kernel), Shanjia (Pangolin Scale), Yanhusuo (Corydalis Rhizome), and Dahuang (Rhubarb Root). Externally, apply a paste of Jiuzao (Wine Lees), Congbai (Scallion White), and Shengjiang (Fresh Ginger) for superior effect. For Qi Stagnation low back pain, the pulse is deep and wiry, or knotted and hidden. Formula: Wuyao Shunqi San (Lindera Qi-Smooth Powder). If ineffective, use Bawei Shunqi San (Eight-Ingredient Qi-Smooth Powder). If Liver Qi is not smooth, feeling low back pain while sleeping, frequently turning over, stopping upon waking, use Chaishu Ganhe San (Bupleurum Liver-Soothing Powder). For Phlegm-Obstruction pain, the pulse is slippery or deep, pain is localized to one spot, use Daotan Tang (Major Phlegm-Resolving Decoction) added with Xiangfu (Cyperus Rhizome), Wuyao (Lindera Root), and Zhike (Aurantii Fructus). For Labor Injury low back pain, use Dabu Tang (Great Tonifying Decoction) to swallow Qing'e Wan (Green Pellet Pill). For waist and ribs feeling bound and pulling pain, this is a Dai Mai (Belt Vessel) disorder. Use acrid herbs to disperse knots and sweet herbs to relieve urgency. Use Yanhusuo, Guixu (Angelica Sinensis Tail), Sangjisheng (Taxillus Chinensis), Gouqi (Goji Berry), Xiaohui (Fennel Fruit), Shayuanzi (Astragalus Complanatus Seed), or Tiaogan San (Liver-Calming Powder). For long-standing pain with empty collaterals, regulate and tonify the Extraordinary Vessels. Use Hetao (Walnut), Danggui (Angelica Sinensis), Duzhong (Eucommia Bark), Yangyao (Sheep Kidney), Lujiao (Deer Horn), Gouqi (Goji Berry), Niuxi (Achyranthes Root), Buguzhi (Psoralea Fruit). For elderly or debilitated patients with Kidney Deficiency low back pain unable to turn, use Erzhi Wan (Two Solstice Pill) or Li'an Wan (Instant Peace Pill). Soreness of the waist due to sexual fatigue and Kidney Deficiency requires strong tonification. Use Qing'e Wan. If seminal emission occurs, use Liuwei Wan (Six-Ingredient Pill) removing Zexie (Alisma Rhizome), adding Yubiao (Fish Swim Bladder), Shayuanzi (Astragalus Complanatus Seed), and Wuweizi (Schisandra Berry). For women's waist soreness, use Liuwei Wan added with Duzhong (Eucommia Bark) and Xuduan (Dipsacus Root). Lumbar curvature and disability result from Deep Penetration of Heat Pathogens and long-term closure of blood vessels. Use Taocheng Tang (Peach Kernel Cathartic Decoction), using more Rougui (Cinnamon Bark) and less Shufuzi (Prepared Aconite Root) to unblock channels. Painful cases are treatable; non-painful, long-term disabled cases are untreatable. For soft waist due to Dampness invading collaterals, use Shen Zhuo Tang. For Wind invading waist and back, use Niuxi Jiu (Achyranthes Wine). For excessive depletion (sexual exhaustion), use Bawei Wan (Eight-Ingredient Pill) or Busui Dan (Marrow-Tonifying Pellet).
The spine is traversed by the Du Mai (Governing Vessel) and Taiyang channel. Constant heat and pain in the neck and spine indicates Yin Deficiency. Formula: Liuwei Wan (Six-Ingredient Pill) added with Mirong (Elk Antler). Constant cold and pain indicates Yang Deficiency. Formula: Bawei Wan (Eight-Ingredient Pill) added with Lurong (Deer Antler Glue). Taiyang channel spine pain with neck stiffness, waist feeling like breaking, neck feeling like pulling, use Qianghuo Shengshi Tang (Notopterygium Decoction to Overcome Dampness). Floating-tight pulse indicates Shanghan (Cold Damage), use Mahuang Tang (Ephedra Decoction). Deep-slow pulse indicates Fengshi (Wind-Dampness), use Chaihu Tang (Bupleurum Decoction) modified.
The sacrum (Kao) is traversed by the Foot-Shaoyin channel and Du Mai, also relating to Jueyin. Sacral pain due to Kidney Deficiency uses Qiwei Wan (Seven-Ingredient Pill); if ineffective, add Lurong (Deer Antler Glue). In obese individuals, it is due to Damp-Phlegm, use Erchen Tang (Two-Aged Decoction) combined with Ermiao San (Two-Marvels Powder).
Legs and feet are reached by the six Foot channels. Pains may present as Yin Deficiency, Yang Deficiency, Blood Deficiency, Blood Cold, Kidney Deficiency, Wind Invasion, Cold-Dampness, Wind-Dampness, or Damp-Heat.
Yin Deficiency: Emaciated body, hot/painful soles and calves/thighs, left Chi pulse fine and rapid, or both Chi pulses rapid and abundant. Formula: Huyian Wan (Tiger-Kneeling Pill) removing Chenpi (Citrus Peel), adding Rougui (Cinnamon Bark).
Yang Deficiency: Swollen and powerless feet, loose stools, right Chi pulse deficient and large, or both Chi pulses floating and slow, indicating decline of Spleen and Mingmen (Gate of Vitality) fire. First use Buzhong Yiqi Tang (Middle-Boosting Qi-Enriching Decoction) with Paojiang (Roasted Ginger), then Bawei Wan (Eight-Ingredient Pill).
Blood Deficiency: Feet cannot bear weight, trembling while walking, pulse fine and weak. Formula: Liuwei Tang (Six-Ingredient Decoction) added with Xuduan (Dipsacus Root), Lurong (Deer Antler Glue), Duzhong (Eucommia Bark).
Blood Cold: Tendon tension, deep pulse, preference for hot baths/fire, use Shujin Sansheng San (Three-Sages Decoction to Soothe Tendons).
Kidney Deficiency with Wind Invasion: Lower body flaccidity, bone/joint pain, Chi pulse floating, large, and rapid. Formula: Anshen Tang (Spirit-Calming Decoction).
Cold-Dampness: Dull pain in both legs, or numbness/heaviness/swelling, heavy body, joint pain, deep pulse. Formula: Baizhu Fuzi Tang (Atractylodes and Aconite Decoction). Floating-choppy pulse: Chufengshi Qianghuo Tang (Remove Wind-Dampness Notopterygium Decoction).
Wind-Dampness: Swelling, pain, and wandering sensations. Formula: Duhuo Jisheng Tang (Angelica Pubescens and Porcine Spine Decoction).
Damp-Heat: Pain above or below, redness or swelling, dark urine, soggy-rapid pulse. Formula: Danggui Niangong Tang (Angelica Ligustici Decoction to Relieve Pain).
For leg cramps shooting up into the abdomen, use Guayu San (Melon and Cornus Powder), see section on Hongjiaojiao (Hongjiao Disease/Gout).
The knee is the mansion of tendons. Inability to flex/extend, stooping while walking, indicates tendons are failing. Knee pain in tendons involves inability to extend and swelling, often mixed with Wind-Heat. Formula: Ermiao San (Two-Marvels Powder) added with Qianghuo (Notopterygium Rhizome), Fangfeng (Saposhnikovia Root), Shengma (Cimicifuga Rhizome), Chaihu (Bupleurum Root). If mixed with Yin Deficiency, heat without swelling, use Huyian Wan (Tiger-Kneeling Pill). If knee/shin Bi-syndrome with weakness and heavy pain, mixed with Wind-Dampness, use Duhuo Jisheng Tang (Angelica Pubescens and Porcine Spine Decoction). Summer Damp-Heat swelling/pain: Danggui Niangong Tang (Angelica Ligustici Decoction to Relieve Pain). Inability to flex/extend: Huoluo Dan (Collateral-Unblocking Pellet). Deficient-Cold mixed with Wind-Dampness pain: Hubu Sijin Wan (Tiger Bone Four-Jin Pill). Deficient-Heat tendon flaccidity, tremors/pain: Lurong Sijin Wan (Deer Antler Four-Jin Pill).
Heel pain: Kidney Yin Deficiency presents with calf heat and heel pain. Formula: Liuwei Wan (Six-Ingredient Pill) added with Rougui (Cinnamon Bark) and Guiban (Turtle Shell). Kidney Yang Deficiency presents with inability to stand long. Formula: Bawei Wan (Eight-Ingredient Pill). Mixed with Dampness: Heavy sensation and swelling. Formula: Huangu Dan (Bone-Changing Pellet).
The sole is where the Shaoyin Kidney channel's Yongquan (Spring Underfoot) acupoint irrigates. Heat/pain in soles and ankles indicates Kidney Deficiency with Dampness adherence. Formula: Shen Zhuo Tang (Sinking Dampness Decoction) swallowing Liuwei Wan (Six-Ingredient Pill). Or use Erzhi Wan (Two Solstice Pill) or Li'an Wan (Instant Peace Pill).