肾虚、瘀血、湿热、痰积、闪挫。腰痛之脉必弦而沉。弦者，为虚；沉者，为滞。若脉大者，肾虚涩者，是瘀
血；缓者，是湿；滑与伏者，是痰。肾虚者，用杜仲、龟板、黄柏、知母、枸杞、五味，一加补骨脂、猪脊髓，丸
服。瘀血作痛者，宜行血顺气补阴丸加桃仁、红花之类。更刺委中穴出血，以其血滞于下也。湿热作痛者，宜燥湿
行气，用苍术、杜仲、川芎、黄柏之类，宜子和煨肾散。因痰作痛者，二陈加南星，佐以快气药，使痰随气运。闪
挫诸实痛者，当归承气等下之。肾着为病，腰冷如水，身重不渴，小便自利，饮食如故，腹重如有物在腰，治宜流湿
兼用温暖药以散之。寒湿作痛者，摩腰膏治之。腰痛不能立者，针人中穴。久患腰痛，必官桂以开之，方止股痛，
胁痛亦可用。诸痛，勿用参补气，气不通则愈痛。凡诸痛多属火，不可峻用寒凉药，以温散之可也。湿痰腰痛作
泄∶龟板（炙一两） 樗皮（炒） 苍术 滑石（各五钱） 炒芍、香附（各四钱） 上粥丸，如内伤白术、山楂汤
下。腰腿湿痛∶酒炙龟板 酒炙柏（各五钱） 青皮（三钱） 生甘草（一钱半） 上末之，捣姜
一片，入药末二钱重，研细，以苍耳汁调，荡起令沸服之。
腰脚湿痛∶龟板末（二两酒炙） 酒炙柏 苍耳 苍术 威灵（酒洗各一两） 扁柏（半两）上末之，以黑豆汁
煎四物汤、陈皮、甘草、生姜，去渣调服前药二钱。摩腰膏治老人虚人腰痛，并治白带∶乌附 南星（各二钱半
）雄、砂（各一钱） 樟脑 丁香 干姜 吴茱（各钱半） 麝（五粒） 上为末，蜜丸，如龙眼大，每一丸
姜汁化开，如粥，浓火烘热放掌中摩腰上，候药尽粘腰上为度，烘绵衣缚定，腰热如火，间二日用一丸。治湿热腰
腿疼痛，两胁搐急，露卧湿地，不能转侧苍术汤∶苍术、黄柏、柴胡、防风、附子、杜仲、川芎、肉桂作汤服之。若
寒湿气客身，体沉重肿痛，面色痿黄加麻黄。一人年六十，因坠马腰疼不可忍，六脉散大，重取则弦小而长稍坚，此
有恶血未可逐之，且以补接为先，以苏木煎参、归、芎、陈皮、甘草服之。半月后，脉渐敛，食渐进，遂以前药调
下自然铜等药，一旦而安。治腰痛并筋骨冷痛∶当归、赤芍药、羌活、酒炒黄柏、酒炒杜仲各一钱、白术、川芎、木
香、槟榔、防风、白芷、苍术、八角茴香各半钱、甘草三分，作汤，调乳香一钱，食前服。外用摩腰膏亦好。
肾虚、瘀血、湿热、痰积、闪挫，是引起腰痛的常见病因。腰痛患者的脉象必然呈现弦而沉的特点。脉弦，代表正气虚弱；脉沉，代表邪气阻滞。如果脉象宏大，多属肾虚；脉象涩滞，则是瘀血所致；脉象缓弱，说明有湿邪；脉象滑利或伏匿，则是痰饮作祟。
对于肾虚引起的腰痛，使用杜仲、龟板、黄柏、知母、枸杞、五味子等药物，若情况需要可加入补骨脂、猪脊髓，制成丸药服用。由瘀血引起的疼痛，适宜使用行血顺气补阴丸，并加入桃仁、红花等药物。同时可以针刺委中穴使其出血，因为瘀血往往停滞在下焦。湿热引起的疼痛，应当燥湿行气，使用苍术、杜仲、川芎、黄柏等药物，适宜采用张子和的煨肾散。因痰饮引起的疼痛，使用二陈汤加天南星，辅以理气药物，使痰随气机运行而消散。因闪挫导致的各种实证疼痛，使用当归承气汤等攻下剂治疗。
肾着病表现为腰部寒冷如浸水，身体沉重但不口渴，小便正常，饮食如常，腹部沉重感觉腰间有重物，治疗宜祛湿兼用温性药物以散寒。寒湿引起的疼痛，使用摩腰膏治疗。腰痛严重到无法站立者，针刺人中穴。长期患有腰痛的人，必须使用官桂来开通经络，这样才能停止股部疼痛，胁痛也可以使用此法。各种疼痛，不要用人参补气，因为气机不通畅反而会使疼痛加剧。凡是各种疼痛大多属于火证，不可猛烈使用寒凉药物，用温散的方法即可。
湿痰腰痛导致腹泻：炙龟板一两，樗白皮炒制，苍术，滑石（各五钱），炒白芍、香附（各四钱）。以上药物研末，用米粥糊丸，像内伤白术汤、山楂汤那样送服。腰腿湿痛：酒炙龟板、酒炙黄柏（各五钱），青皮（三钱），生甘草（一钱半）。以上药物研成细末，取生姜一片，加入两钱重的药末，研磨细腻，用苍耳汁调匀，煮沸后服用。
腰脚湿痛：酒炙龟板末二两，酒炙黄柏，苍耳，苍术，威灵仙（酒洗各一两），侧柏叶（半两）。以上药物研成细末，用黑豆汁煎煮四物汤，加入陈皮、甘草、生姜，去渣后调服前药二钱。
摩腰膏用于治疗老人及体虚者的腰痛，也可治疗白带：乌头、天南星（各二钱半），雄黄、朱砂（各一钱），樟脑，丁香，干姜，吴茱萸（各一钱半），麝香（五粒）。以上药物研成细末，用蜂蜜制成如龙眼大小的丸药。每次取一丸，用姜汁化开成粥状，在旺火上烘热后放在手掌中，摩擦腰部，直到药尽粘在腰部为止，再用烘热的棉衣绑紧固定，腰部感觉如火般发热，每隔两天使用一丸。
治疗湿热腰腿疼痛，两侧胁肋抽搐紧急，因露宿湿地导致不能转侧，使用苍术汤：苍术、黄柏、柴胡、防风、附子、杜仲、川芎、肉桂，煎汤服用。如果是寒湿之气客居身体，导致身体沉重肿痛，面色萎黄，可加入麻黄。
有一位六十岁的患者，因坠马导致腰痛难忍，六脉散大，重按则脉象弦小而长且稍坚，这是体内有恶血（瘀血）但不可立即攻逐，应当先以补益接续为主，用苏木煎人参、当归、川芎、陈皮、甘草服用。半个月后，脉象逐渐收敛，饮食逐渐恢复，于是以前药调服自然铜等药物，一天之内便痊愈了。
治疗腰痛以及筋骨冷痛：当归、赤芍药、羌活、酒炒黄柏、酒炒杜仲各一钱，白术、川芎、木香、槟榔、防风、白芷、苍术、八角茴香各半钱，甘草三分，煎汤，调服乳香一钱，饭前服用。外用摩腰膏也很好。
Kidney deficiency (Shen Xu), blood stasis (Yu Xue), damp-heat (Shi Re), phlegm accumulation (Tan Ji), and sprain/trauma (Shan Cuo) are common causes of lower back pain. The pulse in lower back pain must be wiry (Xian) and deep (Chen). A wiry pulse indicates deficiency; a deep pulse indicates stagnation. If the pulse is large, it indicates kidney deficiency; if the pulse is choppy (Se), it is due to blood stasis; if the pulse is slow (Huan), it indicates dampness; if the pulse is slippery (Hua) or hidden (Fu), it indicates phlegm.
For lower back pain caused by kidney deficiency, use Eucommiae Cortex (Duzhong), Testudinis et Chelonis Carapax et Plastrum (Guiban), Phellodendri Cortex (Huangbai), Anemarrhenae Rhizoma (Zhimu), Lycii Fructus (Gouqi), and Schisandrae Fructus (Wuweizi). If necessary, add Psoraleae Fructus (Buguzhi) and Porcine Spinal Cord (Zhujisuji), and take them as pills. For pain caused by blood stasis, it is appropriate to use Xingxue Shunqi Buyin Wan (Blood-Invigorating and Qi-Smoothying Yin-Nourishing Pill) and add Persicae Semen (Taoren) and Carthami Flos (Honghua). Additionally, prick the Weizhong (BL40) acupoint to bleed, as blood stasis often stagnates in the lower jiao. For pain caused by damp-heat, one should dry dampness and move qi, using Atractylodis Rhizoma (Cangzhu), Eucommiae Cortex (Duzhong), Chuanxiong Rhizome (Chuanxiong), and Phellodendri Cortex (Huangbai); Zhang Hezi's Wei Shen San (Kidney-Baking Powder) is suitable. For pain caused by phlegm, use Erchen Tang (Two-Cured Decoction) with Arisaematis Rhizoma (Nanxing), assisted by qi-moving medicines, so that phlegm dissipates with the movement of qi. For various excess pains caused by sprain/trauma, use Danggui Chengqi Tang (Angelica Sinensis and Da Huang Decoction) or similar purgatives to drain downward.
The condition known as "Shen Zhuo" (Kidney Fixation) presents with coldness in the waist as if immersed in water, heaviness of the body without thirst, normal urination, normal diet, and a sensation of heaviness in the abdomen as if there were an object in the waist. Treatment should focus on draining dampness while using warm medicines to disperse cold. For pain caused by cold-dampness, Moyao Gao (Waist-Massaging Ointment) is used. For lower back pain so severe that one cannot stand, needle the Renzhong (GV26) acupoint. For chronic lower back pain, Guigui (Cinnamomi Ramulus) must be used to open the meridians to stop thigh pain; this can also be applied to hypochondriac pain. For all types of pain, do not use Ginseng Radix (Renshen) to tonify qi, because if qi flow is obstructed, the pain will worsen. Generally, most pains belong to fire syndromes; one should not severely use cold-cooling medicines, but rather use warm-dispersing methods.
Lower back pain with damp-phlegm leading to diarrhea: Roasted Testudinis et Chelonis Carapax et Plastrum (1 liang), stir-fried Broussonetiae Cortex (Chupi), Atractylodis Rhizoma (Cangzhu), Talcum (Huashi) (each 5 qian), stir-fried Paeoniae Radix Alba (Shaoyao), Cyperi Rhizoma (Xiangfu) (each 4 qian). Grind the above into powder, make pills with rice porridge paste, and swallow like Neishang Baizhu Tang (Internal Injury Atractylodes Macrocephala Decoction) or Shanzha Tang (Hawthorn Decoction).
Damp-pain in waist and legs: Wine-processed Testudinis et Chelonis Carapax et Plastrum (Guiban), wine-processed Phellodendri Cortex (Baibo) (each 5 qian), Citri Reticulatae Pericarpium (Qingpi) (3 qian), raw Glycyrrhizae Radix et Rhizoma (Gancao) (1.5 qian). Grind the above into powder. Take one slice of fresh Zingiberis Rhizoma (Shengjiang), add 2 qian of the medicine powder, grind finely, mix with juice from Xanthii Fructus (Canger), boil until bubbling, and take orally.
Damp-pain in waist and feet: Two liang of wine-processed Testudinis et Chelonis Carapax et Plastrum powder (Guiban), wine-processed Phellodendri Cortex (Baibo), Xanthii Fructus (Canger), Atractylodis Rhizoma (Cangzhu), Syneilesis Rhizoma (Weilingxian) (wine-washed, each 1 liang), Platycladi Cacumen (Bianbo) (half liang). Grind the above into powder. Decoct Sijunzi Tang (Four Substances Decoction) with black bean juice, add Citri Reticulatae Pericarpium (Chenpi), Glycyrrhizae Radix et Rhizoma (Gancao), and Zingiberis Rhizoma (Shengjiang), remove dregs, and mix with 2 qian of the aforementioned powder for oral administration.
Moyao Gao (Waist-Massaging Ointment) treats lower back pain in the elderly and those with deficiency, and also treats leukorrhea: Aconiti Lateralis Radix Praeparata (Wutou), Arisaematis Rhizoma (Nanxing) (each 2.5 qian), Realgar (Xionghuang), Cinnabar (Zhusha) (each 1 qian), Camphora (Zhangnao), Eugeniae Flos (Dingxiang), Zingiberis Rhizoma Recens (Ganjiang), Evodiae Fructus (Wuzhuyu) (each 1.5 qian), Moschus (She) (5 grains). Grind the above into powder, make pills with honey the size of a longan. Each time, dissolve one pill in Ginger Juice (Jiangzhi) to form a porridge-like consistency. Heat it strongly over fire, place in the palm, and massage the waist until the medicine adheres completely. Bind tightly with heated cotton clothing. The waist will feel hot like fire. Use one pill every two days.
Cangzhu Tang (Atractylodis Rhizoma Decoction) treats damp-heat pain in the waist and legs, spasms and tightness in both hypochondria, inability to turn over after sleeping exposed to damp ground: Atractylodis Rhizoma (Cangzhu), Phellodendri Cortex (Huangbai), Bupleuri Radix (Chaihu), Saposhnikoviae Radix (Fangfeng), Aconiti Lateralis Radix Praeparata (Fuzi), Eucommiae Cortex (Duzhong), Chuanxiong Rhizome (Chuanxiong), Cinnamomi Ramulus (Rougui). Decoct and take orally. If cold-damp pathogen invades the body causing heaviness, swelling, pain, and sallow complexion, add Ephedrae Herba (Mahuang).
A sixty-year-old patient suffered unbearable lower back pain after falling from a horse. The six pulses were scattered and large; upon heavy pressure, they became wiry, small, long, and slightly firm. This indicated the presence of evil blood (blood stasis) that could not yet be purged. Therefore, tonification and connection should be prioritized first. Decoct Suomu (Lignum Dalbergiae Odoriferae) with Ginseng Radix (Renshen), Angelicae Sinensis Radix (Danggui), Chuanxiong Rhizome (Chuanxiong), Citri Reticulatae Pericarpium (Chenpi), and Glycyrrhizae Radix et Rhizoma (Gancao) for oral administration. Half a month later, the pulse gradually converged, and appetite improved. Then, the previous medicine was used to administer Zi Ran Tong (Natural Pyrite) and other drugs, resulting in recovery within one day.
Treatment for lower back pain and cold pain of sinews and bones: Angelicae Sinensis Radix (Danggui), Rubia Cordifoliae Radix (Chishaoyao), Notopterygii Rhizoma et Radix (Qianghuo), wine-fried Phellodendri Cortex (Huangbai), wine-fried Eucommiae Cortex (Duzhong) (each 1 qian), Atractylodis Macrocephalae Rhizoma (Baizhu), Chuanxiong Rhizome (Chuanxiong), Aquilariae Lignum Resinatum (Muxiang), Arecae Semen (Binglang), Saposhnikoviae Radix (Fangfeng), Angelicae Dahuricae Radix (Baizhi), Atractylodis Rhizoma (Cangzhu), Illicii Fructus (Bajiaohuixiang) (each half qian), Glycyrrhizae Radix et Rhizoma (Gancao) (3 fen). Decoct and take orally, mixing with 1 qian of Boswelliae Resina (Ruxiang) before meals. Applying Moyao Gao externally is also good.