腰痛外邪五积宜，内虚六味（汤，八味汤）化裁之，若还瘀血寻鹿角，肾着（病，即用肾着汤
沉沉不转移。
不寐证。经文外，《金匮》主肝魂不守宅，用酸枣仁汤。余以阳不归阴，用干百合一两半
，紫苏叶三钱，龙骨、牡蛎、茯神、枣仁之类，随宜加入。
（经义）《邪客篇》“伯高曰∶厥气客于五脏六腑，则卫气独行其外，行于阳而不得入于阴
。行于阳则阳气盛，阳气盛则阳跷陷（按∶此“陷”字即陷阱之陷，阳气阻而不行也，）不得入
于
阴，阴虚故目不瞑。帝曰∶善，治之奈何。伯高曰∶补其不足，泻其有余，调其虚实，以通其
道，而去其邪，饮以半夏汤一剂，阴阳已调，其卧立至。”《大惑论》∶“帝曰∶病不得卧
者，何气使然。岐伯曰∶卫气不得入于阴，常留于阳，留于阳则阳气满，阳气满则阳跷盛
，不得入于阴，则阴气虚，故目不瞑矣。”
不寐《内经》论最详，肝魂招纳（酸）枣仁汤，紫苏百合归阴分（《侣山堂类辨》云∶“余植
百合，其花朝开暮合，紫苏之叶，朝挺暮垂，俱能引阳气而归阴分”，）龙牡茯神佐使良。
不能食者，胃中元气虚也。然有虚冷虚热之异。虚冷者，面黄白，身常怕寒，所食不能
克化，懒不欲食，大便溏秘无常，病在上、中二焦，宜用消食丸。若病在下焦，命门乏火化
之职，宜用《本事》二神丸。虚热者，面黄中带赤，身常恶热，胸膈饱闷，不欲食，间或吐
酸，小便短，大便不通，病在上、下二焦，轻者用资生丸，重者用凝神散。若病在下焦，高
鼓峰谓∶“肾乃胃之关，关门不利，升降息矣。”关门，即气交之中，天之枢也。关故肾旺则
胃阴足，胃阴足则思食，当急以六味加归芍养之。若血燥大肠干枯，有黑粪叠积胃底，则当
以熟地五钱，当归、麻仁各三钱，白芍、桃仁各二钱，微微润之。视其形体如常，气血尚足
，可加大黄三钱助血药，大肠一顺利，胃自开矣。江苏顾西畴最得意之秘法，其徒徐炳南刻
《金匮翼》，谓为尤在泾所着，余未敢信。然此法余用少年亦之多效，似不必爱古而薄今也
。又此证有谷劳一证，其人怠惰好卧，肢体烦重，腹满善饥而不能食，食已则发，谷气不行
使然也。《金匮翼》用沉香汤。《肘后》云∶饥食便卧得“谷劳”病，令人四肢烦重，默默
欲卧食毕辄甚，用大麦芽一升，川椒一两，并炒干姜三两，捣末，每服方寸匕，日三服。
腰痛若由外邪及五积所致，宜用相应方法治疗；若因内虚引起，则应对六味地黄汤或八味肾气丸进行加减化裁。若是瘀血阻滞，可寻找鹿角（入药）治疗；若是肾着病，可用肾着汤治疗，其症状表现为身体沉重、痛处固定不移。
关于不寐（失眠）的证候，除了《内经》经文论述外，《金匮要略》主要认为是肝魂不能安居于舍，使用酸枣仁汤治疗。我则认为若不寐是由于阳气不能归入阴分所致，可使用干百合一两半、紫苏叶三钱，并酌情加入龙骨、牡蛎、茯神、酸枣仁等药物。
（经义阐释）《灵枢·邪客篇》记载：“伯高说：厥逆之气侵犯五脏六腑，卫气就只能独自在体表运行，行于阳分而不能进入阴分。行于阳分则阳气偏盛，阳气偏盛则阳跷脉陷滞（按：此处的‘陷’字意为陷阱之陷，指阳气受阻而不能通行），导致阳气无法进入阴分，阴分因此虚弱，所以眼睛不能闭合而失眠。黄帝说：讲得好，如何治疗？伯高说：补益不足，泻除有余，调节虚实，以疏通其道，祛除邪气，服用半夏汤一剂，待阴阳调和，睡眠立刻就能恢复。”《灵枢·大惑论》记载：“黄帝问：患病不能卧睡，是什么气造成的？岐伯回答：卫气不能进入阴分，常停留在阳分。停留在阳分则阳气满盛，阳气满盛则阳跷脉旺盛，不能进入阴分，则阴气虚弱，所以眼睛不能闭合而失眠。”
关于不寐，《内经》论述最为详尽。招纳肝魂可用酸枣仁汤，紫苏和百合能引导阳气回归阴分（《侣山堂类辨》云：“我种植百合，其花朵早晨开放傍晚闭合；紫苏的叶子，早晨挺立傍晚下垂，二者都能引导阳气回归阴分”），龙骨、牡蛎、茯神作为辅助佐使药物效果良好。
不能进食的情况，是因为胃中元气虚弱。然而有虚冷和虚热之分。虚冷者，面色黄白，身体常怕寒冷，食物难以消化，懒惰不想吃东西，大便时而溏泄时而秘结，病位在上焦和中焦，宜用消食丸。如果病位在下焦，是命门之火缺乏温化功能，宜用《济生方》中的二神丸。虚热者，面色黄中带红，身体常厌恶炎热，胸膈部饱闷，不想吃东西，偶尔吐酸水，小便短少，大便不通，病位在上焦和下焦，轻症用资生丸，重症用凝神散。如果病位在下焦，高鼓峰认为：“肾是胃的关口，关口不利，升降之气就停止了。”所谓关口，就是气交之中，天之枢纽所在。如果肾气旺盛，则胃阴充足，胃阴充足就会想吃饭，此时应当紧急用六味地黄丸加当归、白芍来滋养。如果血燥导致大肠干枯，有黑色粪便堆积在胃底，则应当用熟地黄五钱、当归和三钱、火麻仁三钱、白芍和二钱、桃仁二钱，微微润肠通便。观察患者形体如常，气血尚且充足，可以加大黄三钱以协助活血药，一旦大肠通畅，胃气自然开通。江苏顾西畴最得意的秘密疗法，他的徒弟徐炳南刻印《金匮翼》时，称这是尤在泾所著，我不敢轻信。然而此法我在年轻时也常用且多有效，似乎不必因为崇古而轻视今人。另外，此证还有一种叫“谷劳”的病，患者怠惰嗜卧，肢体烦重，腹部胀满且容易饥饿但不能进食，吃完饭后病情发作，这是因为谷气运行不畅导致的。《金匮翼》使用沉香汤。《肘后备急方》云：饥饿时进食后立即躺卧会得“谷劳”病，使人四肢烦重，默默想睡觉，吃完饭后症状加重，可用大麦芽一升、川椒一两、炒干姜三两，捣成末，每次服用一方寸匕，每日三次。
For lower back pain caused by external pathogens and the five accumulations, appropriate treatments should be applied; if caused by internal deficiency, Liuwei Dihuang Decoction (Six-Ingredient Rehmannia Decoction) or Bawei Shengqi Wan (Eight-Ingredient Kidney Qi Pill) should be modified. If due to blood stasis, Lu Jiao (Deer Antler) can be used; if it is Shen Zhuo Bing (Kidney-Dampness Disease), Shen Zhuo Tang (Kidney-Dampness Decoction) should be used, characterized by a heavy sensation in the body and fixed pain.
Regarding Bu Mei (Insomnia), besides the discussions in the *Neijing*, the *Jingui Yaolue* primarily attributes it to the Liver Hun (Liver Ethereal Soul) failing to reside in its abode, treating it with Suanzaoren Tang (Sour Jujube Seed Decoction). I believe that if insomnia is due to Yang Qi failing to return to Yin, one may use Gan Baihe (Dried Lily Bulb) 1.5 liang, Zi Su Ye (Perilla Leaf) 3 qian, and appropriately add Long Gu (Dragon Bone), Mu Li (Oyster Shell), Fushen (Poria with Hostwood), and Suanzaoren (Sour Jujube Seed).
(Exegesis of Classics) The *Lingshu · Xieke Pian* states: "Bo Gao said: When Jue Qi (Rebellious Qi) invades the five zang and six fu organs, Wei Qi (Defensive Qi) can only circulate independently on the exterior, moving through the Yang aspects without entering the Yin. Moving through Yang leads to an excess of Yang Qi; when Yang Qi is excessive, the Yang Qiao vessel becomes obstructed (Note: The character 'Xian' here implies a trap, meaning Yang Qi is blocked and cannot flow), preventing entry into Yin, resulting in Yin deficiency and thus inability to close the eyes for sleep. The Emperor said: Excellent. How should it be treated? Bo Gao said: Tonify the deficiency, drain the excess, regulate the true and false, unblock the pathways, and eliminate the pathogen. Administer one dose of Banxia Tang (Pinellia Decoction); once Yin and Yang are harmonized, sleep will resume immediately." The *Lingshu · Daguo Lun* states: "The Emperor asked: What qi causes the inability to lie down? Qibo answered: Wei Qi fails to enter Yin and often remains in Yang. Remaining in Yang makes Yang Qi full; full Yang Qi makes the Yang Qiao vessel vigorous. Failure to enter Yin results in Yin Qi deficiency, hence the inability to close the eyes."
Regarding Bu Mei (Insomnia), the *Neijing* provides the most detailed discussion. To attract and settle the Liver Hun, Suanzaoren Tang (Sour Jujube Seed Decoction) is used; Zi Su Ye (Perilla Leaf) and Bai He (Lily Bulb) guide Yang Qi back to the Yin aspect (*Lushantang Leibian* notes: "I planted lilies, whose flowers open in the morning and close at dusk; perilla leaves stand upright in the morning and droop at dusk; both can guide Yang Qi to return to Yin"). Long Gu (Dragon Bone), Mu Li (Oyster Shell), and Fushen (Poria with Hostwood) serve as effective adjuvants.
Inability to eat is due to deficiency of Yuan Qi (Primal Qi) in the Stomach. However, there are distinctions between Cold Deficiency and Heat Deficiency. In Cold Deficiency, the complexion is yellowish-white, the body constantly fears cold, food is difficult to digest, there is laziness and lack of appetite, and bowel movements alternate between loose and constipated. The disease is located in the Upper and Middle Jiao, and Xiaoshi Wan (Digestion-Promoting Pill) is indicated. If the disease is in the Lower Jiao, it is due to the Mingmen Fire (Gate of Life Fire) lacking the function of transformation and digestion, and Ershen Wan (Two-Gentlemen Pill) from *Jisheng Fang* is indicated. In Heat Deficiency, the complexion is yellow with red hues, the body constantly dislikes heat, there is fullness and oppression in the chest and diaphragm, lack of appetite, occasional acid regurgitation, short urine, and constipation. The disease is located in the Upper and Lower Jiao; mild cases use Zisheng Wan (Nourishing Life Pill), and severe cases use Ninghen San (Calming Spirit Powder). If the disease is in the Lower Jiao, Gao Gufeng stated: "The Kidney is the gate of the Stomach; if the gate is not functional, ascending and descending cease." This gate refers to the intersection of Qi, the pivot of Heaven. If Kidney Qi is prosperous, Stomach Yin is sufficient; if Stomach Yin is sufficient, there is desire to eat. At this point, Liuwei Dihuang Decoction (Six-Ingredient Rehmannia Decoction) added with Dang Gui (Angelica Sinensis) and Bai Shao (White Peony Root) should be urgently used to nourish. If Blood Dryness causes dryness of the Large Intestine, with black feces accumulating at the bottom of the stomach, one should use Shu Di Huang (Prepared Rehmannia Root) 5 qian, Dang Gui (Angelica Sinensis) 3 qian, Huo Ma Ren (Hemp Seed) 3 qian, Bai Shao (White Peony Root) 2 qian, and Tao Ren (Peach Kernel) 2 qian to gently moisten. Observing that the patient's physique is normal and Qi and Blood are still sufficient, Da Huang (Rhubarb Root) 3 qian can be added to assist the blood-nourishing herbs; once the Large Intestine is unblocked, Stomach Qi will naturally open. This secret method was most favored by Gu Xichou of Jiangsu. His disciple Xu Bingnan, in printing *Jingui Yi* (Wings to the Essentials of the Golden Cabinet), attributed it to You Zaijing, which I dare not fully trust. However, I have used this method frequently in my youth with good results, so it seems unnecessary to revere the ancients while despising the moderns. Additionally, this condition includes a syndrome called Gu Lao (Grain Exhaustion/Labor). Patients are lethargic and prone to lying down, limbs feel heavy and vexed, abdomen is full yet they feel hungry but cannot eat; symptoms flare after eating because Grain Qi fails to circulate. *Jingui Yi* uses Chenxiang Tang (Agarwood Decoction). *Zhouhou Beiji Fang* states: Eating when hungry and then lying down immediately causes "Gu Lao" disease, making limbs heavy and vexed, causing silence and desire to sleep, worsening after eating. It can be treated with Damai Ya (Sprouted Barley) 1 sheng, Chuan Jiao (Sichuan Pepper) 1 liang, and fried Gan Jiang (Dried Ginger) 3 liang, pounded into powder, taken as one fang cun bi (square-inch spoonful) per dose, three times daily.