龟背乃先天肾亏，冷风入脊，或痰饮攻注，或闪挫折伤，或肾肝虚热，婴儿脊骨柔脆，
强坐太早，皆能致之。背之中行属于督脉，旁开则足太阳膀胱，与肾为表里。腰为肾之外
廓，肾脏亏虚，膀胱之府焉能自足。督脉为阳脉之海，其为病也，腰似折，髀不可以曲，督脉
与膀胱之经皆取道于脊，一着风寒湿邪，则经气不行，腰脊板强，渐至脊庀成为龟背庀。于
脊之第三椎者，肺脏受病已评于前，庀于第五椎以下者，厥阴肝经受病，十椎十一椎者，属
太阴脾经，十二椎以下者，足少阴肾。其在肝者，脊背强痛，牵引胁肋，肝脉布于两胁也。疏
肝流气饮。若兼咳嗽气粗，必兼治肺，在脾经者始悠悠腹痛，始所不觉，三日五日一作，三
五月后腰背渐强，脊渐凸，行则伛偻，温脾饮主之。亦有腹不痛者，和脾通络散。在肾者，
腰脊强痛，痛引股腿，日久精血衰夺，筋骨不荣，两足瘫软，独活汤、安肾丸主之。若痰饮攻
注，兼于经隧而脊凸者，久之必发陈痰，脊两旁作肿，或串腰腿，漫肿不痛，脉象双弦，或兼
缓滑，二陈竹茹汤。虚羸食少发热者，六君子汤合何首乌鳖甲煎。若肝肾虚热，阴精被耗，
骨枯髓减，宜以地黄汤合二至丸。闪挫折伤，必瘀血凝滞经络，当活血通经络。但此症治之
贵早，用药得宜，犹可保全，若成痰外溃，十无一愈。今之治者见脊庀腰背作强，总属虚寒，
不分何脏，不究所因，一概温补。邪留不去，痰湿不行，变成残废，枉致夭亡者多多矣。有嗜
欲伤肾之人，精衰血惫，腰痛脊庀者，非温补三阴不可。然宜辨阴中水亏、火亏，盖为水脏，
在卦为坎，而真阳寓焉。水亏者，补元煎、左归丸之类，火亏者，归肾丸、赞化血余丹之类。
填精养血，俾精来生气，气来生阴，精血充旺，庶无痿废之虞。
一方疏肝流气饮 治风冷着于肝俞五六椎，两旁作痛，牵引胁肋。
当归（二钱） 丹参（二钱） 白蒺藜（三钱） 乌药（八分） 茯苓（二钱） 秦艽（钱半） 川断
肉（五钱） 红花（钱半） 橘络（八分） 老姜（一片）
清肺和肝饮
杏仁（二钱） 橘络（八分） 云茯苓（二钱） 枳壳（八分） 佛手（钱半） 栝蒌皮（二钱） 丹参
（钱半） 蒺藜（钱半） 当归（钱半） 秦艽（钱半） 川楝子（切，钱半）
温脾饮 治寒客太或痰滞于脾，肚腹悠悠作痛，腰瘀伛偻。
当归（钱半） 焦白术（一钱） 茯苓（二钱） 乌药（八分） 小茴香（八分） 延胡（钱半） 姜半
夏（一钱） 白芍（钱半） 炙草（四分） 川浓朴（一两） 川续断（钱半） 煨生姜（二片）
和脾通经汤 治脾俞脊庀，两旁作痛，行则伛偻，腰脊板强。
当归 木香 丹参 秦艽 焦白术 独活 川续断 红花 淮牛膝 桑枝 姜
独活汤 治寒客肾与膀胱之经，腰脊痛引股腿。
独活（一钱） 秦艽（五钱） 炙没药（八分） 怀牛膝（钱半） 五加皮（钱半） 当归（钱半）
丹参（钱半） 巴戟肉（钱半） 川续断（钱半） 狗脊（三钱） 广木香（四分） 红枣（三个） 桑枝（三钱）
安肾丸 治肾虚脊庀，足痿疼痛。
鹿角霜（三钱） 焦白术（钱半） 肉桂（三分） 当归（二钱） 川续断（钱半） 独活（八分）
怀牛膝（五钱） 大生地（三钱） 菟丝子（五钱） 巴戟肉（钱半） 红枣（三个） 桑枝（三钱）
导痰汤 治湿痰攻注，背俞脊庀作痛，脉小滑者。
制半夏（钱半） 陈皮（一钱） 木香（四分） 当归（二钱） 独活（一钱） 五加皮（钱半）
生白术（钱半） 淮牛膝（钱半） 川芎（八分） 竹茹（八分） 生姜（一片）
首乌鳖甲煎 治龟背虚羸，食少发热者。
生首乌（三钱） 焦冬术（钱半） 茯苓（二钱） 炙鳖甲（四分） 生姜（二片） 甘草（四分）
东洋参（钱半） 姜半夏（钱半） 陈皮（一钱） 红枣（三枚）
活血通经汤 治闪挫折伤，腰痛脊庀者。
当归（二钱） 延胡（钱半） 生地（二钱） 丹参（二钱） 木香（四分） 独活（一钱） 桃仁（钱半）
炙没药（一钱） 红花（五分） 淮牛膝（五钱） 桑枝（三钱）
地黄二至丸 治肝肾阴虚生热，背庀足弱，小溲不利者。
大生地（二钱） 女贞子（三钱） 泽泻（钱半） 怀山药（二钱） 当归（钱半） 怀牛膝（钱半）
旱莲草（钱半） 丹皮（一钱） 川断（钱半） 桑枝（三钱）
加减左归饮 治真阴不足，不能滋养荣卫，腰酸痛。
大熟地（四钱） 龟板胶（钱半） 山萸肉（钱半） 云茯苓（二钱） 菟丝子（三钱） 鹿角胶（钱半）
怀山药（二钱）
加减右归饮 治三阳不足，腰腿冷，足弱。
熟地黄（四钱） 杞子（二钱） 肉桂（三分） 杜仲（三钱） 当归（二钱） 菟丝子（三钱） 萸肉
（钱半） 怀牛膝（五钱）
赞化血余丹 此丹大补气血，壮筋养骨，有培元赞育之功。
血余（三钱） 熟地黄（四钱） 鹿角胶（五钱） 桃肉（二枚） 小茴香（八分） 杜仲（三钱） 柑子
（二钱） 老台人参（三钱） 云茯苓（二钱） 巴戟肉（二钱） 苁蓉（三钱） 菟丝子（二钱） 生首乌
（三钱） 当归（二钱）
Gui Bei (Tortoise Back) is caused by congenital Kidney deficiency, cold wind invading the spine, or phlegm-fluids attacking and pouring into the body, or due to sprain and fracture injuries, or Liver-Kidney deficient heat. Infants' spinal bones are soft and fragile; forcing them to sit too early can all lead to this condition. The midline of the back belongs to the Du Mai (Conception Vessel of the Back), while the lateral aspect corresponds to the Foot-Taiyang Bladder Meridian, which has a interior-exterior relationship with the Kidneys. The waist is the outer shell of the Kidneys; if the Kidneys are deficient, how can the Bladder Fu organ be sufficient? The Du Mai is the sea of Yang meridians. When diseased, it presents with a sensation that the waist is about to break, and the thighs cannot bend. Both the Du Mai and the Bladder Meridian pass through the spine. Once affected by wind-cold-damp pathogens, the Qi of the meridians fails to circulate, leading to stiffness and rigidity in the waist and spine, gradually developing into spinal curvature, forming Gui Bei (Tortoise Back).
Lesions at the third vertebral level involve the Lung Zang, as discussed previously. Lesions below the fifth vertebral level belong to the Jueyin Liver Meridian. The tenth and eleventh vertebral levels belong to the Taiyin Spleen Meridian. Below the twelfth vertebral level belongs to the Foot-Shaoyin Kidney Meridian. If the pathology involves the Liver, there is stiffness and pain in the back and spine, radiating to the hypochondrium, because the Liver Meridian distributes along both flanks. Treatment uses Shugan Liqi Yin (Liver-Soothing Qi-Flowing Decoction). If accompanied by cough and coarse breathing, the Lungs must also be treated simultaneously. For pathologies involving the Spleen Meridian, initially there is lingering abdominal pain, which may not seem serious at first, occurring once every three to five days. After three to five months, the waist and back gradually become stiff, the spine protrudes, and walking requires stooping. This is primarily treated with Wenspi Yin (Spleen-Warming Decoction). In cases without abdominal pain, Heping Tongluo San (Spleen-Harmonizing Collateral-Unblocking Powder) is used. For pathologies involving the Kidneys, there is stiffness and pain in the waist and spine, radiating to the thighs and legs. Over time, essence and blood decline, and sinews and bones lose nourishment, resulting in weak and flaccid feet. This is treated with Duhuo Tang (Angelica Pubescens Decoction) or Anshen Wan (Kidney-Anchoring Pill). If phlegm-fluids attack and pour, combined with meridian obstruction causing spinal convexity, old phlegm will eventually manifest, with swelling on both sides of the spine, or spreading to the waist and legs. The swelling is diffuse and painless, with a double-wiry pulse, or possibly slow and slippery. This is treated with Erchen Zhuru Tang (Two-Aged Bamboo-Rusk Decoction). For those who are emaciated, have poor appetite, and fever, Liu Junzi Tang (Six-Gentlemen Decoction) combined with Heshouwu Biejia Jian (Polygonum Multiflorum and Turtle Shell Decoction) is used. If there is Liver-Kidney deficient heat, with consumption of Yin essence leading to dry bones and reduced marrow, Dihuang Tang (Rehmannia Decoction) combined with Erzhi Wan (Two Solstices Pill) is appropriate. For sprain and fracture injuries, blood stasis stagnates in the meridians, requiring methods to invigorate blood and unblock the meridians. However, treatment for this condition is most effective when initiated early; with appropriate medication, recovery is possible. If it progresses to external ulceration of phlegm, ten out of ten cases will not survive. Current practitioners often see spinal curvature and back stiffness and assume it is always deficiency-cold, without distinguishing the involved Zang organs or investigating the cause, applying warming tonification indiscriminately. This leaves pathogens lingering, prevents the transformation of phlegm-dampness, leads to disability, and causes premature death in many cases. For individuals whose kidneys are damaged by excessive desires, with depleted essence and exhausted blood, presenting with waist pain and spinal curvature, warming and tonifying the Three Yin is necessary. However, one must distinguish between Water deficiency and Fire deficiency within the Yin. Since the Kidney is the Water Organ, corresponding to the Kan Trigram in the Bagua, True Yang resides within it. For Water deficiency, Buyuan Jian (Origin-Replenishing Decoction) or Zuogui Wan (Left Restoring Pill) are suitable. For Fire deficiency, Guishen Wan (Kidney-Nourishing Pill) or Zanhua Xuyudan (Nurturing Transformation Hair-Residue Pill) are suitable. By filling essence and nourishing blood, allowing essence to generate Qi, and Qi to generate Yin, when essence and blood are abundant, there will be no fear of flaccidity and paralysis.
Formula 1: Shugan Liqi Yin (Liver-Soothing Qi-Flowing Decoction) treats wind-cold attaching to Ganshu (BL18, located at the 5th and 6th thoracic vertebrae), causing pain on both sides radiating to the hypochondrium.
Danggui (Radix Angelicae Sinensis, 2 qian), Danshen (Radix Salviae Miltiorrhizae, 2 qian), Baijili (Fructus Tribuli, 3 qian), Wuyao (Rhizoma Linderae, 0.8 fen), Fuling (Poria, 2 qian), Qinjiao (Radix Gentianae Macrophyllae, 1.5 qian), Chuanduanrou (Radix Dipsaci, 5 qian), Honghua (Flos Carthami, 1.5 qian), Jieluo (Retinervus Citri Reticulatae Pericarpium, 0.8 fen), Laojiang (Zingiberis Rhizoma Recens, 1 slice).
Qingfei He Gan Yin (Lung-Clearing Liver-Harmonizing Decoction)
Xingren (Semen Armeniacae Amarum, 2 qian), Jieluo (Retinervus Citri Reticulatae Pericarpium, 0.8 fen), Yunfuling (Poria, 2 qian), Zhiqiao (Fructus Aurantii, 0.8 fen), Foshou (Fructus Citri Sarcodactylis, 1.5 qian), Gualoupi (Pericarpium Benincasae, 2 qian), Danshen (Radix Salviae Miltiorrhizae, 1.5 qian), Jili (Fructus Tribuli, 1.5 qian), Danggui (Radix Angelicae Sinensis, 1.5 qian), Qinjiao (Radix Gentianae Macrophyllae, 1.5 qian), Chuanlianzi (Fructus Toosendan, sliced, 1.5 qian).
Wenspi Yin (Spleen-Warming Decoction) treats cold invading the Taiyin or phlegm stagnating in the Spleen, causing lingering abdominal pain and stiff, stooped posture.
Danggui (Radix Angelicae Sinensis, 1.5 qian), Jiaobaizhu (Rhizoma Atractylodis Macrocephalae, stir-fried, 1 qian), Fuling (Poria, 2 qian), Wuyao (Rhizoma Linderae, 0.8 fen), Xiaohuixiang (Fructus Foeniculi, 0.8 fen), Yanhusu (Rhizoma Corydalis, 1.5 qian), Jiangbanxia (Rhizoma Pinelliae Preparatum, 1 qian), Baishao (Radix Paeoniae Alba, 1.5 qian), Zhigancao (Radix Glycyrrhizae Preparata, 0.4 fen), Chuanhoupo (Cortex Magnoliae Officinalis, 1 liang), Chuaxuduan (Radix Dipsaci, 1.5 qian), Weishengjiang (Zingiberis Rhizoma Praeparatum, 2 slices).
Heping Tongjing Tang (Spleen-Harmonizing Meridian-Unblocking Decoction) treats Gui Bei at Shupi (BL20), pain on both sides, stooping while walking, and stiff waist and spine.
Danggui (Radix Angelicae Sinensis), Muxiang (Radix Aucklandiae), Danshen (Radix Salviae Miltiorrhizae), Qinjiao (Radix Gentianae Macrophyllae), Jiaobaizhu (Rhizoma Atractylodis Macrocephalae, stir-fried), Duhuo (Radix Angelicae Pubescentis), Chuaxuduan (Radix Dipsaci), Honghua (Flos Carthami), Huainiuxi (Radix Achyranthis Bidentatae), Sangzhi (Ramulus Mori), Jiang (Zingiberis Rhizoma Recens).
Duhuo Tang (Angelica Pubescens Decoction) treats cold invading the Kidney and Bladder meridians, with waist and spine pain radiating to the thighs and legs.
Duhuo (Radix Angelicae Pubescentis, 1 qian), Qinjiao (Radix Gentianae Macrophyllae, 5 qian), Zhimoyao (Resina Myrrhae Preparata, 0.8 fen), Huainiuxi (Radix Achyranthis Bidentatae, 1.5 qian), Wujiapi (Cortex Acanthopanacis Senticosi, 1.5 qian), Danggui (Radix Angelicae Sinensis, 1.5 qian), Danshen (Radix Salviae Miltiorrhizae, 1.5 qian), Bajirou (Radix Morindae Officinalis, 1.5 qian), Chuaxuduan (Radix Dipsaci, 1.5 qian), Gouji (Caulis Cibotii, 3 qian), Guangmuxiang (Radix Aucklandiae, 0.4 fen), Hongzao (Fructus Jujubae, 3 pieces), Sangzhi (Ramulus Mori, 3 qian).
Anshen Wan (Kidney-Anchoring Pill) treats Kidney deficiency with spinal curvature and weak, painful feet.
Lujiaoshuang (Cornu Cervi Degelatinatum, 3 qian), Jiaobaizhu (Rhizoma Atractylodis Macrocephalae, stir-fried, 1.5 qian), Rougui (Cortex Cinnamomi, 0.3 fen), Danggui (Radix Angelicae Sinensis, 2 qian), Chuaxuduan (Radix Dipsaci, 1.5 qian), Duhuo (Radix Angelicae Pubescentis, 0.8 fen), Huainiuxi (Radix Achyranthis Bidentatae, 5 qian), Dashengdi (Radix Rehmanniae Preparata, 3 qian), Tusizi (Semen Cuscutae, 5 qian), Bajirou (Radix Morindae Officinalis, 1.5 qian), Hongzao (Fructus Jujubae, 3 pieces), Sangzhi (Ramulus Mori, 3 qian).
Daotan Tang (Phlegm-Expelling Decoction) treats wet-phlegm attacking and pouring, causing pain at the Back-Shu points and spinal curvature, with a small-slippery pulse.
Zhibanxia (Rhizoma Pinelliae Preparata, 1.5 qian), Chenpi (Pericarpium Citri Reticulatae, 1 qian), Muxiang (Radix Aucklandiae, 0.4 fen), Danggui (Radix Angelicae Sinensis, 2 qian), Duhuo (Radix Angelicae Pubescentis, 1 qian), Wujiapi (Cortex Acanthopanacis Senticosi, 1.5 qian), Shengbaizhu (Rhizoma Atractylodis Macrocephalae, raw, 1.5 qian), Huainiuxi (Radix Achyranthis Bidentatae, 1.5 qian), Chuanxiong (Rhizoma Chuanxiong, 0.8 fen), Zhuru (Succus Bambusae in Taenia, 0.8 fen), Shengjiang (Zingiberis Rhizoma Recens, 1 slice).
Shouwu Biejia Jian (Polygonum Multiflorum and Turtle Shell Decoction) treats Gui Bei with emaciation, poor appetite, and fever.
Shengshouwu (Radix Polygoni Multiflori Preparata, 3 qian), Jiaodongzhu (Rhizoma Atractylodis Macrocephalae, stir-fried, 1.5 qian), Fuling (Poria, 2 qian), Zhiebjia (Carapax et Plastrum Testudinis Preparata, 0.4 fen), Shengjiang (Zingiberis Rhizoma Recens, 2 slices), Gancao (Radix Glycyrrhizae, 0.4 fen), Dongyangshen (Radix Ginseng Orientalis, 1.5 qian), Jiangbanxia (Rhizoma Pinelliae Preparatum, 1.5 qian), Chenpi (Pericarpium Citri Reticulatae, 1 qian), Hongzao (Fructus Jujubae, 3 pieces).
Huoxue Tongjing Tang (Blood-Invigorating Meridian-Unblocking Decoction) treats sprain/fracture injuries with waist pain and spinal curvature.
Danggui (Radix Angelicae Sinensis, 2 qian), Yanhusu (Rhizoma Corydalis, 1.5 qian), Shengdi (Radix Rehmanniae Recens, 2 qian), Danshen (Radix Salviae Miltiorrhizae, 2 qian), Muxiang (Radix Aucklandiae, 0.4 fen), Duhuo (Radix Angelicae Pubescentis, 1 qian), Taoren (Semen Persicae, 1.5 qian), Zhimoyao (Resina Myrrhae Preparata, 1 qian), Honghua (Flos Carthami, 0.5 fen), Huainiuxi (Radix Achyranthis Bidentatae, 5 qian), Sangzhi (Ramulus Mori, 3 qian).
Dihuang Erzhi Wan (Rehmannia and Two Solstices Pill) treats Liver-Kidney Yin deficiency generating heat, with spinal curvature, weak feet, and difficult urination.
Dashengdi (Radix Rehmanniae Preparata, 2 qian), Nvzhenzi (Fructus Ligustri Lucidi, 3 qian), Zexie (Rhizoma Alismatis, 1.5 qian), Huaishanyao (Rhizoma Dioscoreae, 2 qian), Danggui (Radix Angelicae Sinensis, 1.5 qian), Huainiuxi (Radix Achyranthis Bidentatae, 1.5 qian), Hanliancao (Herba Ecliptae, 1.5 qian), Danpi (Cortex Moutan, 1 qian), Chuanchuan (Radix Dipsaci, 1.5 qian), Sangzhi (Ramulus Mori, 3 qian).
Jiajian Zuogui Yin (Modified Left Restoring Decoction) treats insufficiency of True Yin, inability to nourish Ying and Wei, with sore and painful waist.
Da Shudi (Radix Rehmanniae Preparata, 4 qian), Guibanjiao (Colla Testudinis, 1.5 qian), Shanzhuyu (Fructus Corni, 1.5 qian), Yunfuling (Poria, 2 qian), Tusizi (Semen Cuscutae, 3 qian), Lu jiaojiao (Colla Cornus Cervi, 1.5 qian), Huaishanyao (Rhizoma Dioscoreae, 2 qian).
Jiajian Yougui Yin (Modified Right Restoring Decoction) treats insufficiency of the Three Yang, with cold waist and legs, and weak feet.
Shudihuang (Radix Rehmanniae Preparata, 4 qian), Qizi (Fructus Lycii, 2 qian), Rougui (Cortex Cinnamomi, 0.3 fen), Duzhong (Cortex Eucommiae, 3 qian), Danggui (Radix Angelicae Sinensis, 2 qian), Tusizi (Semen Cuscutae, 3 qian), Yurou (Fructus Corni, 1.5 qian), Huainiuxi (Radix Achyranthis Bidentatae, 5 qian).
Zanhua Xuyudan (Nurturing Transformation Hair-Residue Pill) greatly tonifies Qi and Blood, strengthens sinews and nourishes bones, possessing the function of replenishing the Origin and assisting reproduction.
Xuyutan (Crisp Hair Carbon, 3 qian), Shudihuang (Radix Rehmanniae Preparata, 4 qian), Lu jiaojiao (Colla Cornus Cervi, 5 qian), Taorou (Semen Prunus Persicae, 2 pieces), Xiaohuixiang (Fructus Foeniculi, 0.8 fen), Duzhong (Cortex Eucommiae, 3 qian), Ganzi (Exocarpus Citri Grandis, 2 qian), Laotairenshen (Radix Ginseng, Old Taiwan variety, 3 qian), Yunfuling (Poria, 2 qian), Bajirou (Radix Morindae Officinalis, 2 qian), Congrong (Herba Cistanche, 3 qian), Tusizi (Semen Cuscutae, 2 qian), Shengshouwu (Radix Polygoni Multiflori Preparata, 3 qian), Danggui (Radix Angelicae Sinensis, 2 qian).