腰痛有肾虚，有气滞，有血瘀，有痰饮，有闪挫。有寒湿，有湿热之不同，宜分别施治。经曰∶腰
者、肾之府，
转摇不能，肾将惫矣。故腰痛虽有多端，其原皆本于肾虚。所谓邪之所凑，其气必虚是也。然标急先
治标，而后治其本，标本不失，此谓良工矣。
保阴煎 六味汤丸 左归丸饮〔俱见虚劳。〕腰痛攸攸隐隐，痛而不甚，无已时者，属肾虚选
而用之。
如用六味，宜加牛膝、杜仲、枸杞、玉竹、猪肾，脊髓煎汤煎药更佳。
此皆壮水之剂，肾水不足者，宜常饮之。
青蛾丸 八味丸〔见不能食。〕肾虚火衰，腰痛，小水清利，脉沉小迟者宜之。
杜仲〔醋炙。〕破故纸〔胡桃油炒。〕胡桃肉〔俱温补肾脏。各四两。〕或加鹿茸 羊
肾〔胡桃内研膏，蜜丸桐子大。陈酒下三四、钱。〕此皆益火之剂，果属肾中诸阳衰弱者可用，内有热
者大忌。
聚宝丹〔见胃脘痛。〕
此方气血兼理，治诸痛颇效者，以凡痛必因气滞血凝故也。
五磨饮〔见胃脘痛。〕治气滞腰痛、脉沉者。〔外用檀香末。涂痛处。〕
宜加当归、续断、玄胡、砂仁。
黑牛续地饮〔自制。〕治瘀血腰痛，痛有定处，转动若锥刀之刺，日轻夜重，小便利大便黑，
脉涩者。
黑豆 牛膝〔生用。〕续断 生地〔均主补肾，又能行瘀。〕当归 玄胡〔活血利
气。〕丹皮 赤芍〔凉血行
瘀。〕如因闪挫跌扑，转舒不便，呼吸作痛者，可加乳香、没药。如不效，脉沉有力痛甚者，或再加
桃仁、大黄。〔韭菜汁炒。〕
二陈汤〔见中风。〕
四苓散〔见湿。〕治痰饮流入肾经，往来走痛，或心下悸，胍滑者。
二方合用，〔宜去甘草。〕当君茯苓。〔渗痰利饮，安神定悸。〕加沉香、砂仁，〔芳而
下达，气利则痰自行。〕
杜仲、续断。〔补而不滞，正旺则邪自除。〕如人壮实，脉有力痛甚者，可用礞石丸〔痰去，
方以补药滋阴。〕
肾着汤〔见湿。〕治寒湿着肾，身重腰冷疼痛。〔外用艾热熨之，或再用草乌末，姜汁涂之。〕
可加破故纸、杜仲、续断。
三妙散 治湿热腰痛，或作或止。
苍术〔燥湿。〕黄柏〔清热。〕牛膝〔最利腰膝。〕宜加生地、茯苓、杜仲、续断。
此六方皆治标之剂，宜各审明致病之因，而采用之。
Lower back pain may be caused by Kidney deficiency (Kidney Xu), Qi stagnation (Qi Zhi), blood stasis (Xue Yu), phlegm-fluid retention (Tan Yin), or sprain/trauma. There are also differences between cold-dampness and damp-heat, requiring differentiated treatment. The Classics state: "The waist is the mansion of the Kidney; if turning and shaking become difficult, the Kidney Qi is about to fail." Therefore, although lower back pain has many causes, its root always lies in Kidney deficiency. This is what is meant by "where pathogenic factors gather, the healthy Qi must be deficient." However, if the branch symptoms are urgent, treat the branch first, then treat the root. Balancing both branch and root constitutes the work of a skilled physician.
Baoyin Decoction (Preserve Yin Decoction), Liuwei Dihuang Wan/Tang (Six-Ingredient Pill with Rehmannia), Zuogui Wan/Yin (Left Restoring Pill/Decoction) [see Consumption Disease]. Lower back pain that is dull and lingering, not severe but ceaseless, belongs to Kidney deficiency; select these formulas for use.
If using Liuwei Dihuang, it is advisable to add Achyranthes Root (Niuxi), Eucommia Bark (Duzhong), Goji Berry (Gouqi), Polygonatum Rhizome (Yuzhu), and pig kidney. Decocting spinal cord to make a soup for decocting the herbs is even better.
These are all formulas that strengthen water (nourish Kidney Yin). They are suitable for frequent consumption by those with insufficient Kidney Yin.
Qinge Wan (Blue Hawk Pill), Bawei Wan (Eight-Ingredient Pill) [see Inability to Eat]. For Kidney deficiency with declining fire, lower back pain, clear and profuse urination, and a deep, small, and slow pulse, these are suitable.
Eucommia Bark (prepared with vinegar), Psoralea Fruit (Pogu Zhi, stir-fried with walnut oil), Walnut Meat (all warm and tonify the Kidney, 4 liang each). Alternatively, add Deer Antler (Lurong) and sheep kidney. Grind walnut meat into a paste, mix with honey to form pills the size of paulownia seeds. Take 3-4 qian with aged wine. These are all formulas that benefit fire (warm and tonify Kidney Yang). They can be used only if there is indeed a decline of various Yang energies in the Kidney; they are strictly contraindicated for those with internal heat.
Jubao Dan (Treasure Gathering Pill) [see Epigastric Pain].
This formula regulates both Qi and blood and is quite effective for treating various pains, because pain invariably arises from Qi stagnation and blood coagulation.
Wumo Yin (Five-Fragment Decoction) [see Epigastric Pain]. Treats lower back pain due to Qi stagnation with a deep pulse. [Externally apply Sandalwood Powder to the painful area.]
It is advisable to add Angelica Sinensis Root (Danggui), Dipsacus Root (Xuduan), Corydalis Rhizome (Yanhusuo), and Amomum Fruit (Sharen).
Heiniu Xudi Yin (Black Bean, Achyranthes, Dipsacus, and Rehmannia Decoction) [Self-made]. Treats lower back pain due to blood stasis, where pain is fixed in location, feels like stabbing with an awl or knife upon movement, is lighter during the day and heavier at night, accompanied by free urination and black stools, and a choppy pulse.
Black Soybean, Achyranthes Root (used raw), Dipsacus Root, Rehmannia Root (both primarily tonify the Kidney and promote blood circulation), Angelica Sinensis Root, Corydalis Rhizome (invigorate blood and regulate Qi), Moutan Cortex, Red Peony Root (cool blood and resolve stasis). If caused by sprain or fall, resulting in difficulty turning and pain upon breathing, Frankincense (Ruxiang) and Myrrh (Moyao) can be added. If ineffective, and the pulse is deep and forceful with severe pain, Peach Kernel (Taoren) and Rhubarb (Dahuang) [stir-fried with chive juice] may be added.
Erchen Tang (Two-Aged Decoction) [see Stroke].
Siling San (Four-Ling Powder) [see Dampness]. Treats phlegm-fluid entering the Kidney meridian, causing wandering pain, or palpitations below the heart, with a slippery pulse.
Combine the two formulas [remove Licorice Root], making Poria (Fuling) the sovereign herb [drains phlegm and fluid, calms the spirit and stops palpitations]. Add Agarwood (Chenxiang) and Amomum Fruit (Sharen) [aromatic and descending, promotes Qi flow so phlegm moves naturally].
Add Eucommia Bark (Duzhong) and Dipsacus Root (Xuduan) [tonify without stagnation; when healthy Qi is strong, pathogenic factors are naturally eliminated]. If the patient is robust, with a forceful pulse and severe pain, Mengshi Wan (Lapis Martis Pill) can be used [after phlegm is removed, subsequently use tonifying herbs to nourish Yin].
Shenzhe Tang (Kidney-Attaching Decoction) [see Dampness]. Treats cold-dampness attaching to the Kidney, characterized by heavy body, cold and painful waist. [Externally apply moxibustion heat or apply Aconite Root (Caowu) powder mixed with ginger juice to the area.]
Can add Psoralea Fruit (Pogu Zhi), Eucommia Bark (Duzhong), and Dipsacus Root (Xuduan).
Sanmiao San (Three-Superior Powder). Treats damp-heat lower back pain, which comes and goes intermittently.
Atractylodes Macrocephala Rhizome (Cangzhu) [dries dampness], Phellodendron Bark (Huangbai) [clears heat], Achyranthes Root (Niuxi) [most beneficial for waist and knees]. It is advisable to add Rehmannia Root (Shengdi), Poria (Fuling), Eucommia Bark (Duzhong), and Dipsacus Root (Xuduan).
These six formulas are all for treating the branch symptoms. One should carefully examine the cause of the disease and adopt the appropriate formula accordingly.