方书谓∶“腰者肾之府，腰疼则肾将惫矣。”夫谓腰疼则肾将惫，诚为确论。至谓腰为肾之府，则尚
欠研究。何者？凡人之腰疼，皆脊梁处作疼，此实督脉主之。督脉者，即脊梁中之脊髓袋，下连命门穴处，
为人之副肾脏（是以不可名为肾之府）。肾虚者，其督脉必虚，是以腰疼。治斯证者，当用补肾之剂，而引
以入督之品。曾拟益督丸一方，徐徐服之，果系肾虚腰疼，服至月余自愈。
【益督丸】杜仲四两酒浸炮黄，菟丝子三两酒浸蒸熟，续断二两酒浸蒸熟，鹿角胶二两，将前三味为
细末，水化鹿角胶为丸，黄豆粒大。每服三钱，日两次。服药后，嚼服熟胡桃肉一枚。
诸家本草皆谓，杜仲宜炒断丝用，究之将杜仲炒成炭而丝仍不断，如此制法殊非所宜。是以此方中惟用
生杜仲炮黄为度。胡桃仁原补肾良药，因其含油质过多，不宜为丸，故于服药之后单服之。
若证兼气虚者，可用黄 、人参煎汤送服此丸。若证兼血虚者，可用熟地、当归煎汤送服此丸。
有因瘀血腰疼者，其人或过于任重，或自高坠下，或失足闪跌，其脊梁之中存有瘀血作疼。宜治以
活络效灵丹，加 虫三钱，煎汤服，或用葱白作引更佳。
李××，腰疼数年不愈，为之延医。其疼剧时心中恒觉满闷，轻时则似疼非疼，绵绵不已；亦恒数
日不疼。其脉左部沉弦，右部沉牢。自言得此病已三年，服药数百剂，其疼卒未轻
减。观从前所服诸方，虽不一致，大抵不外补肝肾强筋骨诸药，
间有杂以祛风药者。因思《内经》谓通则不痛，而此则痛则不通也。且即其脉象之沉弦、沉牢，心中恒
觉满闷，其关节经络必有瘀而不通之处可知也。爰为拟利关节通络之剂，而兼用补正之品以辅助之。
生怀山药（一两） 大甘枸杞（八钱） 当归（四钱） 丹参（四钱） 生明没药（四钱） 生
五灵脂（四钱） 穿山甲（二钱炒捣） 桃仁（二钱） 红花（钱半） 虫（五枚） 广三七（二钱捣细）
药共十一味。先将前十味煎汤一大盅，送服三七细末一半。至煎渣再服时，仍送服其余一半。
此药服至三剂，腰已不疼，心中亦不发闷，脉较前缓和，不专在沉分。遂即原方去山甲，加胡桃肉四钱。
连服十剂，自觉身体轻爽。再诊其脉，六部调匀，腰疼遂从此除根矣。就此证观之，凡其人身形不羸弱而
腰疼者，大抵系关节经络不通；其人显然羸弱而腰疼者，或肝肾有所亏损而然也。
在妇女又恒有行经时腰疼者，曾治一人，年过三旬，居恒呼吸觉短气，饮食似畏寒凉。当行经时觉腰
际下坠作疼。其脉象无力，至数稍迟。知其胸中大气虚而欲陷，是以呼吸气短，至行经时因气血下注大气亦随
之下陷，是以腰际觉下坠作疼也。为疏方用生箭 一两，桂枝尖、当归、生明没药各三钱。连服七八剂，
其病遂愈。
又治一妇人行经腰疼且兼腹疼，其脉有涩象，知其血分瘀也。治以当归、生鸡内金各三钱，
生明没药、生五灵脂、生箭 、天花粉各四钱，连服数剂全愈。
医书说：“腰是肾的府邸，腰痛则说明肾气将要衰竭了。”说腰痛意味着肾气将衰，这确实是确切的论断。至于说腰是肾的府邸，则还需要进一步研究。为什么呢？凡是人的腰痛，都是在脊梁处疼痛，这实际上是由督脉所主司的。督脉，就是脊梁中的脊髓袋，下端连接命门穴，是人体的副肾脏（因此不能称之为肾的府邸）。肾虚的人，其督脉必然也虚，所以导致腰痛。治疗这种证候，应当使用补肾的药物，并引导药物进入督脉。我曾拟定益督丸一方，慢慢服用，如果是肾虚引起的腰痛，服用一个月左右即可自愈。
【益督丸】杜仲四两，用酒浸泡后炮制变黄；菟丝子三两，用酒浸泡后蒸熟；续断二两，用酒浸泡后蒸熟；鹿角胶二两。将前三味药研成细末，用水化开鹿角胶制成丸药，大小如黄豆粒。每次服用三钱，每日两次。服药后，嚼服一枚熟胡桃肉。
各家本草书籍都说，杜仲宜炒至断丝使用，但究其实际，将杜仲炒成炭状而丝线仍然不断，这样的炮制方法非常不适宜。因此本方中只使用生杜仲，炮制到变黄的程度即可。胡桃仁原本是补肾的良药，但因为其含油量过多，不适合做成药丸，所以在服药之后单独服用。
如果证候兼有气虚的，可以用黄芪、人参煎汤送服此丸。如果证候兼有血虚的，可以用熟地黄、当归煎汤送服此丸。
有因瘀血引起腰痛的患者，这些人或许是因为过度负重，或者从高处坠落，或者失足扭伤跌扑，导致脊梁之中存有瘀血而疼痛。适宜用活络效灵丹治疗，加入土鳖虫三钱，煎汤服用，或者用葱白作为引经药效果更佳。
李某某，腰痛数年不愈，我为他延请医生诊治。疼痛剧烈时，心中常常觉得满闷；疼痛轻微时，则似痛非痛，绵绵不绝；但也常常几天不疼。其脉象左部沉弦，右部沉牢。他自己说得此病已有三年，服用了数百剂药，疼痛始终没有减轻。观察之前所服用的各方，虽然不一致，但大抵不外乎补肝肾、强筋骨的药物，偶尔夹杂一些祛风药。我想到《内经》说“通则不痛”，而此症则是“痛则不通”。况且从其脉象的沉弦、沉牢，以及心中常觉满闷来看，可知其关节经络必有瘀滞不通之处。于是为他拟定利关节、通经络的药剂，并兼用补益正气的药物以辅助治疗。
生怀山药一两，大甘枸杞八钱，当归四钱，丹参四钱，生明没药四钱，生五灵脂四钱，穿山甲二钱（炒后捣碎），桃仁二钱，红花一钱半，土鳖虫五枚，广三七二钱（捣细）。
药物共十一味。先将前十味药煎取一大盅汤，送服一半三七细末。等到煎煮药渣再次服用时，仍送服剩余的一半三七细末。
此药服用至三剂，腰部已不疼痛，心中也不发闷，脉象较前缓和，不再专门表现为沉脉。随即在原方中去掉穿山甲，加入胡桃肉四钱。连续服用十剂，自觉身体轻快爽利。再诊其脉，六部调匀，腰痛从此除根了。就这个证候来看，凡是身形不羸弱而腰痛的人，大抵是关节经络不通；身形明显羸弱而腰痛的人，可能是肝肾有所亏损所致。
在妇女中，又常有行经时腰痛的情况。曾治疗一人，年过三十，平时呼吸觉得短气，饮食似乎畏惧寒凉。当行经时感觉腰际下坠作痛。其脉象无力，至数稍迟。我知道她是胸中大气虚而下陷，所以呼吸气短；到了行经时，因为气血下注，大气也随之陷下，所以腰际感觉下坠作痛。于是为她开具处方：用生黄芪一两，桂枝尖、当归、生明没药各三钱。连续服用七八剂，病情遂愈。
又治疗一位妇人行经时腰痛且兼有腹痛，其脉有涩象，知道她是血分有瘀。治疗用当归、生鸡内金各三钱，生明没药、生五灵脂、生黄芪、天花粉各四钱，连续服用数剂后完全痊愈。
Medical texts state: "The waist is the mansion of the Kidney; if the waist aches, the Kidney Qi is about to fail." To say that waist pain indicates failing Kidney Qi is indeed an accurate assertion. However, regarding the statement that the waist is the mansion of the Kidney, further research is needed. Why? In all cases of human waist pain, the pain occurs at the spine, which is actually governed by the Du Mai (Governing Vessel). The Du Mai is the spinal canal within the spine, connecting inferiorly to the Mingmen acupoint (Gate of Life), serving as the body's accessory kidney (therefore, it cannot be called the mansion of the Kidney). When the Kidney is deficient, the Du Mai must also be deficient, leading to waist pain. To treat this syndrome, one should use formulas that tonify the Kidney and guide them into the Du Mai. I once formulated the Yidu Wan (Benefit the Du Pill), which, when taken slowly, cures waist pain caused by Kidney deficiency after about a month.
[Yidu Wan]: Duzhong Cortex Eucommiae (4 liang), soaked in wine and stir-fried until yellow; Tusizi Semen Cuscutae (3 liang), soaked in wine and steamed until cooked; Xuduan Radix Dipsaci (2 liang), soaked in wine and steamed until cooked; Lujiaojiao Colla Cornu Cervi (2 liang). Grind the first three herbs into fine powder, dissolve the Lujiaojiao in water, and form pills the size of soybeans. Take 3 qian per dose, twice daily. After taking the medicine, chew and swallow one ripe Juglans regia kernel (walnut).
Various materia medica texts claim that Duzhong should be stir-fried until the fibers break. However, upon investigation, even when stir-fried to charcoal, the fibers remain intact, making such processing inappropriate. Therefore, this formula uses raw Duzhong processed only until it turns yellow. Walnut kernels are originally excellent medicines for tonifying the Kidney, but due to their high oil content, they are unsuitable for pill formation; thus, they are taken separately after taking the pills.
If the syndrome is accompanied by Qi deficiency, Huangqi Radix Astragali and Renshen Radix Ginseng decoction can be used to send down the pills. If accompanied by Blood deficiency, Shudihuang Rhizoma Rehmanniae Praeparata and Danggui Radix Angelicae Sinensis decoction can be used.
For those with waist pain due to blood stasis, the patient may have overburdened themselves with heavy loads, fallen from a height, or suffered a sprain or fall, resulting in blood stasis within the spine causing pain. It is appropriate to treat with Huoluo Xiaoling Dan (Activate the Collaterals and Relieve Pain Elixir), adding 3 qian of Banchong (Eupolyphaga/Swallowtail), decocted in water for oral administration; using Congbai Scallion Stem as a guiding herb yields better results.
Patient Li XX suffered from waist pain for several years without cure. During severe pain episodes, he constantly felt chest fullness and oppression; during mild episodes, the pain was vague and lingering; yet there were also periods of several days without pain. His pulse was deep and wiry on the left, and deep and firm on the right. He stated he had suffered for three years, taking hundreds of prescriptions, yet the pain never lessened. Observing his previous prescriptions, although varied, they largely consisted of herbs that tonify the Liver and Kidney and strengthen sinews and bones, occasionally mixed with wind-dispelling herbs. Recalling the *Neijing* stating "patency leads to no pain," this case demonstrates "pain implies lack of patency." Furthermore, given the deep/wiry and deep/firm pulses, along with constant chest fullness, it is evident that his joints and collaterals have stagnation and obstruction. Thus, I prescribed a formula to benefit the joints and unblock the collaterals, supplemented with herbs to tonify healthy Qi.
Sheng Huai Shanyao Rhizoma Dioscoreae (1 liang), Da Gan Gouqizi Fructus Lycii (8 qian), Danggui Radix Angelicae Sinensis (4 qian), Danshen Radix Salviae Miltiorrhizae (4 qian), Sheng Ming Moyao Resina Mastichis (4 qian), Sheng Wulingzi Faeces Trogopterori (4 qian), Chanshanjia Squama Manis (2 liang, stir-fried and crushed), Taoren Semen Persicae (2 qian), Honghua Flos Carthami (1.5 qian), Banchong Insectus Eupolyphagae (5 specimens), Guang Sanqi Radix Notoginseng (2 qian, finely crushed).
Total eleven ingredients. First, decoct the initial ten ingredients in a large cup of water, and take half of the finely crushed Sanqi powder with the decoction. When decocting the dregs for the second dose, take the remaining half of the Sanqi powder.
After taking three doses, the waist pain ceased, chest fullness disappeared, and the pulse became more relaxed, no longer exclusively deep. Subsequently, remove Chanshanjia from the original formula and add 4 qian of walnut kernels. After continuously taking ten doses, he felt physically light and refreshed. Upon re-examination, the pulses in all six positions were balanced, and the waist pain was eradicated. From this case, we observe that for individuals who are not emaciated but suffer from waist pain, it is largely due to obstruction in the joints and collaterals; for those who are obviously emaciated with waist pain, it is likely due to depletion of the Liver and Kidney.
In women, waist pain often occurs during menstruation. I once treated a woman over thirty years old who habitually experienced shortness of breath and seemed to fear cold foods/drinks. During menstruation, she felt a bearing-down sensation and pain in the waist. Her pulse was forceless and slightly slow. I determined that her Upper Jiao Great Qi was deficient and sinking, causing shortness of breath; during menstruation, as Qi and Blood descended, the Great Qi sank with it, causing the bearing-down pain in the waist. I prescribed: Sheng Jian Huangqi Radix Astragali (1 liang), Guizhi Ramulus Cinnamomi Acuminati Apices, Danggui Radix Angelicae Sinensis, and Sheng Ming Moyao Resina Mastichis, each 3 qian. After seven to eight doses, the illness was cured.
I also treated a woman who suffered from waist pain and abdominal pain during menstruation. Her pulse exhibited a choppy quality, indicating Blood stasis in the Blood aspect. Treatment used Danggui Radix Angelicae Sinensis and Sheng Jineijin Gizzard Membrane Gallus Galli Jasmatis, each 3 qian; Sheng Ming Moyao Resina Mastichis, Sheng Wulingzi Faeces Trogopterori, Sheng Jian Huangqi Radix Astragali, and Tianhuafen Radix Trichosanthis, each 4 qian. After several doses, she was completely cured.