大意
腰为肾府。乃精气所藏。有生之根蒂也。假令作强伎巧之官。谨其闭蛰封藏之本。则州都之地。真气布护。
虽六气苛毒。勿之能害。惟以欲竭其精。以耗散其真。则肾气虚伤。膀胱之府安能独足。所以作痛。（必读）
内因
诸经皆贯于肾。而络于腰脊。肾气一虚。凡冲风冒湿。伤冷蓄热。血涩气滞。水积堕伤。与夫失志作劳。并能
患此。（心法）
外候
悠悠不止。乏力酸软者。房欲伤肾也。体骨如脱。四肢倦怠者。劳力伤气也。面黧腰胀。不能久立者。失志伤
心。血脉不舒也。腹满肉痹。不能饮食者。忧思伤脾。胃气不行也。胁腰胀闷。筋弛白淫者。郁怒伤肝。肾肝同
系也。冷痛沉重。阴雨则发者。湿也。足冷背强。洒淅拘急者。寒也。牵连左右无常。脚膝强急难舒者。风也。举
身不能俯仰。动摇不能转侧者。挫也。有形作痛。皮肉青白者。痰也。无形作痛。胀满连腹者。气也。便闭溺赤。
烦躁口渴者。膏粱积热也。昼轻夜重。便黑溺清者。跌损血瘀也。（汇补）
死候
腰者。肾之外候。转摇不能。肾将惫矣。（内经） 痛甚。面上忽见红点。人中黑者死。（丹溪）
脉法
腰痛之脉。必沉而弦。沉弦而紧者寒。沉弦而浮者风。沉弦而濡细者湿。沉弦而急实为闪肭。（刘三点）芤涩者
瘀血。滑伏者痰气。虚豁者肾虚。（汇补）
治法
治惟补肾为先。而后随邪之所见者以施治。标急则治标。本急则治本。初痛宜疏邪滞。理经隧。久痛宜补
真元。养血气。（汇补）
治禁
凡诸痛本虚标热。寒凉不可峻用。必用温散之药。又不可纯用参、 大补。大补则气旺不通而痛愈甚。（心法）
用药
主以归芎汤。加桑寄生、杜仲、续断等。肾虚。加生熟地、枸杞、牛膝。虚火。加黄柏、知母。瘀血。加桃仁、红
花。痰涎。
加苍术、半夏。跌损。加猴姜、玄胡索。气滞。加香附、枳壳。风寒。加威灵仙、羌活。风湿。加五加皮、海桐皮。
湿热。加
苍术、黄柏。风加独活、防风。寒加干姜、肉桂。湿加萆 、防己。凡腰痛久不愈。古方多用肉桂者。取其性达下
焦。辛温开导也。又虚腰痛多用磁石者。取其引肺金之气下达肾中。可使大气周流也。（汇补）
【附肾着】
肾着腰痛。腰冷如冰。身重不渴。小便自利。饮食如故。腰以下冷重如带五千钱。多因作劳汗出。衣裳湿冷。
久久得之。治宜流湿为主。兼以温暖之药散之。肾着汤。（医统）
腰痛选方
芎归汤 统治腰痛。
当归 川芎
独活寄生汤（宝鉴） 养荣血。祛外邪。
独活 桑寄生 杜仲 牛膝 细辛 秦艽
茯苓 桂心 防风 川芎 人参（各一钱五分） 甘草
当归 熟地（各一钱） 生姜（五片）
水煎服。
调荣活络散 治瘀血腰痛。通经络。
大黄 当归梢 牛膝 杏仁（各二钱） 赤芍 红花
羌活 桃仁（各一钱） 川芎 桂枝（各三分） 香附（一钱半）
水煎服。
无比山药丸（子和） 补肾气。益诸虚。
熟地 赤石脂（ ） 山萸肉 白茯苓 泽泻 巴戟肉
牛膝（各一两） 杜仲（姜炒） 山药 肉苁蓉（酒浸） 菟丝子（各三两）
加萆 、骨碎补、续断、木瓜、破故纸、桂心、鹿角、青盐等。炼蜜为丸。空心。温酒盐汤任下。
青娥丸（直指） 补肾强腰。乌须壮脚。
杜仲（四两生姜片炒） 破故纸（四两炒）
末之。以胡桃三十枚。取肉捣和。入蜜为丸。梧子大。每服五十丸。调气散下。
补阴丸（丹溪）
黄柏（酒炒） 龟板（酒炙） 知母 侧柏叶 枸杞子 五味子
杜仲（姜炒） 砂仁（各等分） 甘草（减半）
为末。猪脊髓加地黄膏为丸。
立安散（奇效） 暖肾添精。治五积腰痛。健脚膝。
牛膝（酒浸） 杜仲（姜炒） 木瓜 破故纸 川续断（各一两） 萆 （二两）
炼蜜丸。盐汤下。
牛膝酒（三因） 治湿热腰痛。
地骨皮 五加皮 薏苡仁（各一两） 海桐皮（二两） 川芎（一两） 生地（十两）
甘草 牛膝 羌活（各一两）
以好酒一斗。浸二七日。夏七日。每服一杯。日三四次。令酒气不绝为佳。一方。入炒杜仲一两。
二妙丸
黄柏 苍术
摩腰膏（丹溪） 治寒湿腰痛。虚者亦宜。
乌头尖 附子尖 南星（各二钱半） 樟脑 丁香 干姜
吴茱萸（各一钱半） 雄砂（一钱） 麝（五粒）
为末。蜜丸。龙眼大。用时。以姜汁化开如粥。布上。火烘热。摩腰上。外用绵衣缚定。二日一丸。十丸即效。
肾着汤
干姜 茯苓（各四两） 甘草 白术（或苍术各二两）
凡腰痛不能立者。须刺人中穴。又瘀血作痛者。刺委中穴以行血滞。如肾虚作痛。药中加猪脊髓。丸服。
又法。用猪腰子一具剖开。入青盐三钱、杜仲末五钱。煮烂。空心服。
[General Principle]
The lower back is the mansion of the Kidney (Shen). It is the repository of essence and qi, serving as the root of life. It functions like an official responsible for strength and dexterity; one must carefully guard its fundamental mechanism of closure and storage. If this is maintained, the true qi in the lower jiao (Zhou Du) will be well-distributed and protected. Even if exposed to pathogenic factors from the six climatic conditions or toxins, harm can be avoided. However, if desires exhaust the essence and dissipate the true qi, the Kidney qi becomes deficient and injured. How can the Bladder (Pang Guang), as the exterior-interior partner of the Kidney, remain sufficient? Thus, pain arises. (From *Bi Du*)
[Etiology: Internal Factors]
All meridians pass through the Kidney and connect to the lumbar spine. Once Kidney qi is deficient, any exposure to wind, dampness, cold accumulation, heat retention, blood stasis, qi stagnation, water accumulation, traumatic injury, emotional frustration, or overexertion can lead to this condition. (From *Xin Fa*)
[Clinical Manifestations]
Continuous dull pain accompanied by fatigue, soreness, and weakness indicates Kidney injury due to excessive sexual activity. A sensation that bones are dislocating, with limb fatigue, indicates Qi injury due to physical labor. Dark complexion, lumbar distension, and inability to stand for long periods indicate Heart injury due to emotional frustration, leading to unsmooth blood vessels. Abdominal fullness, muscle numbness, and loss of appetite indicate Spleen injury due to worry and overthinking, resulting in stagnant Stomach qi. Distension and stuffiness in the hypochondrium and waist, along with flaccid tendons and leukorrhea, indicate Liver injury due to repressed anger, given the close connection between the Liver and Kidney. Cold pain with a heavy sensation, worsening on rainy days, indicates Dampness. Cold feet, stiff back, shivering, and spasms indicate Cold. Pain radiating irregularly to both sides, with stiff and difficult-to-relax ankles and knees, indicates Wind. Inability to bend or extend the whole body, and difficulty turning sideways when moving, indicates trauma/contusion. Pain with a fixed form and bluish-white skin/muscle color indicates Phlegm. Pain without a fixed form, with distension extending to the abdomen, indicates Qi stagnation. Constipation, dark red urine, irritability, and thirst indicate internal heat accumulation from rich food. Lighter pain during the day and heavier at night, with black stool and clear urine, indicates blood stasis from traumatic injury. (From *Hui Bu*)
[Mortality Signs]
The lower back reflects the state of the Kidney. If the waist cannot turn or sway, the Kidney is nearing exhaustion. (From *Nei Jing*) Severe pain accompanied by sudden red spots on the face and blackening of the Ren Zhong point indicates death. (From Zhu Danxi)
[Pulse Diagnosis]
The pulse for lower back pain is invariably deep and wiry. Deep, wiry, and tight indicates Cold. Deep, wiry, and floating indicates Wind. Deep, wiry, moist, and fine indicates Dampness. Deep, wiry, rapid, and excess indicates sprain/twist. (From Liu Sandian) Knotted or choppy pulses indicate Blood stasis. Slippery and hidden pulses indicate Phlegm-Qi. Empty and wide pulses indicate Kidney deficiency. (From *Hui Bu*)
[Therapeutic Principles]
Treatment prioritizes tonifying the Kidney, followed by addressing specific pathogens. Treat the branch (symptoms) if acute; treat the root (cause) if chronic. Initial pain should be treated by dispersing pathogenic stagnation and regulating the meridians. Chronic pain requires tonifying true Yuan qi and nourishing blood and qi. (From *Hui Bu*)
[Contraindications]
For pain characterized by underlying deficiency and superficial heat, harsh cooling agents must not be used. Warm dispersing herbs are necessary. However, pure use of Ginseng or other strong tonics is also contraindicated, as excessive tonification can cause Qi abundance without flow, exacerbating pain. (From *Xin Fa*)
[Prescription Usage]
The primary formula is Gui Xiong Tang, added with Sang Ji Sheng (Taxillus), Du Zhong (Eucommia), and Xu Duan (Dipsacus). For Kidney deficiency, add Shu Di Huang (Rehmannia), Gou Qi Zi (Goji berry), and Niu Xi (Achyranthes). For deficient fire, add Huang Bo (Phellodendron) and Zhi Mu (Anemarrhena). For blood stasis, add Tao Ren (Peach seed) and Hong Hua (Safflower). For phlegm-saliva, add Cang Zhu (Atractylodes) and Ban Xia (Pinellia). For traumatic injury, add Hou Jiang (Bonebreaker) and Xuan Hu Suo (Corydalis). For Qi stagnation, add Xiang Fu (Cyperus) and Zhi Ke (Bitter orange). For Wind-Cold, add Wei Ling Xian (Clematis) and Qiang Huo (Notopterygium). For Wind-Damp, add Wu Jia Pi (Acanthopanax) and Hai Tong Pi (Sarcandra). For Damp-Heat, add Cang Zhu and Huang Bo. For Wind, add Du Huo (Angelica pubescens) and Fang Feng (Saposhnikovia). For Cold, add Gan Jiang (Dried ginger) and Rou Gui (Cinnamon bark). For Damp, add Bi Xie (Dioscorea hypoglauca) and Fang Ji (Stephania). Ancient formulas often use Rou Gui for chronic lower back pain because its acrid-warm nature guides qi to the lower jiao. Additionally, Ci Shi (Magnetite) is often used for deficient lower back pain to guide Lung Metal qi down to the Kidney, promoting the circulation of great qi. (From *Hui Bu*)
[Appendix: Shen Zhuo Disease]
Lower back pain due to Shen Zhuo presents with a waist cold as ice, heavy body but no thirst, normal urination, and normal diet. The area below the waist feels cold and heavy, as if bound by five thousand coins. This is often caused by sweating during labor while wearing wet, cold clothes, developing over time. Treatment focuses on draining dampness combined with warming herbs. Use Shen Zhuo Tang. (From *Yi Tong*)
[Selected Formulas for Lower Back Pain]
Xiong Gui Tang: General treatment for lower back pain.
Dang Gui (Angelica sinensis), Chuan Xiong (Ligusticum chuanxiong).
Du Huo Ji Sheng Tang (From *Bao Jian*): Nourishes Ying-Blood, expels external pathogens.
Du Huo (Angelica pubescens), Sang Ji Sheng (Taxillus), Du Zhong (Eucommia ulmoides), Niu Xi (Achyranthes bidentata), Xi Xin (Asarum), Qin Jiao (Gentiana macrophylla), Fu Ling (Poria cocos), Gui Xin (Cinnamomi Cortex), Fang Feng (Saposhnikovia divaricata), Chuan Xiong (Ligusticum chuanxiong), Ren Shen (Panax ginseng) [1.5 qian each], Gan Cao (Glycyrrhiza uralensis), Dang Gui (Angelica sinensis), Shu Di Huang (Rehmannia glutinosa) [1 qian each], Sheng Jiang (Fresh ginger) [5 slices].
Decoct in water and take orally.
Tiao Rong Huo Luo San: Treats blood stasis lower back pain, unblocks meridians.
Da Huang (Rheum palmatum), Dang Gui Shao (tip of Angelica sinensis), Niu Xi (Achyranthes bidentata), Xing Ren (Prunus armeniaca) [2 qian each], Chi Shao (Paeonia lactiflora), Hong Hua (Carthamus tinctorius), Qiang Huo (Notopterygium incisum), Tao Ren (Prunus persica) [1 qian each], Chuan Xiong (Ligusticum chuanxiong), Gui Zhi (Cinnamomi Ramulus) [0.3 qian each], Xiang Fu (Cyperus rotundus) [1.5 qian].
Decoct in water and take orally.
Wu Bi Shan Yao Wan (From Zhang Hezi): Tonifies Kidney qi, benefits various deficiencies.
Shu Di Huang (Rehmannia glutinosa), Chi Shi Zhi (Halloysitum rubrum), Shan Yu Rou (Cornus officinalis), Bai Fu Ling (Poria cocos), Ze Xie (Alisma orientale), Ba Ji Tian (Morinda officinalis), Niu Xi (Achyranthes bidentata) [1 liang each], Du Zhong (Eucommia ulmoides, stir-fried with ginger juice), Shan Yao (Dioscorea opposita), Rou Cong Rong (Cistanche deserticola, soaked in wine), Tu Si Zi (Cuscuta chinensis) [3 liang each].
Add Bi Xie (Dioscorea hypoglauca), Gu Sui Bu (Drynaria fortunei), Xu Duan (Dipsacus asper), Mu Gua (Chaenomelis fructus), Po Gu Zhi (Psoralea corylifolia), Gui Xin (Cinnamomi Cortex), Lu Jiao (Cervi cornus pantotrichum), Qing Yan (Rock salt). Process with refined honey into pills. Take on an empty stomach with warm wine or salt water.
Qing E Wan (From *Zhi Zhi Fang*): Tonifies Kidney, strengthens waist, darkens hair, strengthens legs.
Du Zhong (Eucommia ulmoides, 4 liang, stir-fried with ginger slices), Po Gu Zhi (Psoralea corylifolia, 4 liang, stir-fried).
Grind into powder. Take flesh from 30 walnuts, mash and mix with the powder. Add honey to form pills the size of wutong seeds. Take 50 pills per dose with Tiao Qi San.
Bu Yin Wan (From Zhu Danxi):
Huang Bo (Phellodendron amurense, wine-fried), Gui Ban (Testudinis et Plastrum Carapacis et Plastrum Testudinis, wine-baked), Zhi Mu (Anemarrhena asphodeloides), Ce Bai Ye (Platycladi Cacumen), Gou Qi Zi (Lycium barbarum), Wu Wei Zi (Schisandra chinensis), Du Zhong (Eucommia ulmoides, stir-fried with ginger juice), Sha Ren (Amomi fructus) [equal parts each], Gan Cao (Glycyrrhiza uralensis) [half amount].
Grind into powder. Mix with pig spinal cord and Di Huang Gao (Rehmannia paste) to form pills.
Li An San (From *Qi Xiao Liang Fang*): Warms Kidney, adds essence, treats five accumulations lower back pain, strengthens legs and knees.
Niu Xi (Achyranthes bidentata, soaked in wine), Du Zhong (Eucommia ulmoides, stir-fried with ginger juice), Mu Gua (Chaenomelis fructus), Po Gu Zhi (Psoralea corylifolia), Chuan Xu Duan (Dipsacus asper) [1 liang each], Bi Xie (Dioscorea hypoglauca) [2 liang].
Process with refined honey into pills. Take with salt water.
Niu Xi Jiu (From *San Yin Fang*): Treats Damp-Heat lower back pain.
Di Gu Pi (Lycii cortex), Wu Jia Pi (Acanthopanacis cortex), Yi Yi Ren (Coicis semen) [1 liang each], Hai Tong Pi (Sarcandraglabrae cortex), Chuan Xiong (Ligusticum chuanxiong) [1 liang], Sheng Di Huang (Rehmannia glutinosa) [10 liang], Gan Cao (Glycyrrhiza uralensis), Niu Xi (Achyranthes bidentata), Qiang Huo (Notopterygium incisum) [1 liang each].
Soak in 1 dou of good wine for 14 days (7 days in summer). Take one cup per dose, 3-4 times daily. Ideally, maintain a continuous effect of alcohol. Another method: add 1 liang of stir-fried Du Zhong.
Er Miao Wan:
Huang Bo (Phellodendron amurense), Cang Zhu (Atractylodes lancea).
Mo Yao Gao (From Zhu Danxi): Treats Cold-Damp lower back pain, suitable for deficiency patterns.
Wu Tou Jian (Aconiti Lateralis Radix Praeparata tip), Fu Zi Jian (Aconiti Lateralis Radix Praeparata tip), Nan Xing (Arisaema erubescens) [2.5 qian each], Zhang Nao (Borneolum Syntheticum), Ding Xiang (Eugeniae flos), Gan Jiang (Zingiberis rhizoma), Wu Zhu Yu (Evodiae fructus) [1.5 qian each], Xiong Dan (Realgar), She Xiang (Moschus) [5 grains].
Grind into powder. Make pills with honey, size of a longan. When using, dissolve in ginger juice to a porridge-like consistency, apply to cloth, heat over fire, and massage onto the waist. Bind tightly with cotton clothing. Use one pill every two days; ten pills yield efficacy.
Shen Zhuo Tang:
Gan Jiang (Zingiberis rhizoma), Fu Ling (Poria cocos) [4 liang each], Gan Cao (Glycyrrhiza uralensis), Bai Zhu (Atractylodis macrocephalae rhizoma) or Cang Zhu (Atractylodis lanceae rhizoma) [2 liang each].
For those unable to stand due to lower back pain, needle Ren Zhong (GV26). For pain due to blood stasis, needle Wei Zhong (BL40) to move blood stagnation. For Kidney deficiency pain, add pig spinal cord to medicine and take as pills.
Another method: Cut open one pig kidney, insert 3 qian of Qing Yan (Rock salt) and 5 qian of Du Zhong powder. Cook until soft. Take on an empty stomach.