汪石山治一人。年逾三十。季夏日午行房。多汗。晚浴又近女色。因患白浊。医用胃苓
汤。加右眼作痛。用四物汤入三黄服之。睡醒口愈加苦。又加左膝肿痛。仲冬不药。浊止。
渐次延至背痛。不能转侧。日轻夜重。嚏则如绳索撮腰胁。痛楚不堪。呵气亦应背痛。时或
梦遗。次年正月。汪诊之。脉皆缓弱无力。脾虚可知。左脉滑者。血热也。遂以参、 各二
钱。苓、术、归身、麦冬各一钱。牛膝、神曲、陈皮、黄柏各七分。甘草、五味各八分。煎
服三十余帖。仍以龟板、参、 、黄柏各二两。熟地、萸肉、枸杞、杜仲、归、茯、牛膝各
一两丸服。寻愈。
卢不远治浦江张二如。病脊膂痛。难于起拜。形伛偻。楚甚。卢诊之。谓曰。此房后风
入髓中。骨气不精。故屈伸不利。用龟鹿四仙胶。服三月以填骨髓。佐透冰丹二十粒。以祛
肾风。遂全愈。
祝茹穹治一人。患心重如千斤下坠。背弯不能直。每发时疼痛难忍。眼珠直出。舌俱咬
啐。无药可疗。祝曰。此必打铜锡生理。终日用力。伤于饥饱。间以欲事。或因偷情为人所
惊。精不得泄。用槌则弯背。惊则心血走。不泄则肾气逆。以气裹血。渗留胞络。遂成兹证
究之。果打铜匠也。乃以麻黄、羌活各一钱。茯神、香附、归尾、赤芍各八分。甘草四分
两剂发汗而心轻。再以熟大黄三钱。赤芍、槟榔、枳实、黄柏、黄芩各一钱。两剂便通而
背直。服八味地黄丸一料。而用力生理如常时矣。
震按汪案养阴益气。卢案补精搜风。祝案汗下以通经。温纳以固肾。俱真实学问。非肤
浅伎俩。尚有未备者。背属太阳。若暴痛则审其脉浮紧为伤寒。脉沉缓为寒湿。麻黄汤、羌
活胜湿汤。可酌用也。脊系督脉。若久痛。则审其热而痛为阴虚。冷而痛为阳虚。麋茸六味
鹿茸八味。可分用也。若肩背痛则兼肺经。腰背痛则兼肾经。又当各求其因而治之。更有
胸与背互换作痛。项与背牵连作痛。背痛彻心。心痛彻背。散在诸书。均宜博览。
汪石山治疗一名患者。年龄超过三十岁。在夏季末日的中午进行房事，出汗很多。晚上洗澡后又亲近女色。因此患上白浊（尿道口流出白色分泌物）。医生使用胃苓汤治疗。后来出现右眼疼痛的症状，医生使用四物汤加入三黄（黄连、黄芩、黄柏）服用。睡醒后口苦更加严重。又加上左膝肿痛。到了仲冬时节未服药，白浊停止。症状逐渐蔓延至背痛，身体不能转动侧身，白天轻晚上重，打喷嚏时感觉像绳索勒住腰胁，痛苦不堪，呵气也会引发背痛。有时发生梦遗。次年正月，汪石山诊脉，脉象都缓弱无力，可知是脾虚。左脉滑，说明有血热。于是用人参、黄芪各二钱，茯苓、白术、当归身、麦冬各一钱，牛膝、神曲、陈皮、黄柏各七分，甘草、五味子各八分，煎服三十多帖。随后仍以龟板、人参、黄芪、黄柏各二两，熟地黄、山茱萸、枸杞子、杜仲、当归、茯苓、牛膝各一两，制成丸药服用。不久痊愈。
卢不远治疗浦江人张二如。病症为脊背疼痛，难以起身行礼，身体弯曲驼背，非常痛苦。卢不远诊察后说：这是房事后风邪侵入髓中，骨气不精固，所以屈伸不利。使用龟鹿四仙胶，服用三个月以填补骨髓。辅助服用透冰丹二十粒，以祛除肾风。于是完全痊愈。
祝茹穹治疗一名患者。患有心沉重感如千斤下坠，背部弯曲不能伸直。每次发作时疼痛难忍，眼球突出，舌头被咬破。无药可治。祝茹穹说：这一定是从事打铜锡工作的人，整日用力，饮食饥饱不均，偶尔行房事。或者因为偷情被人惊吓，精气不得泄出。用槌敲打则弯腰，惊吓则心血涣散，精气不泄则肾气上逆。以气包裹血液，渗漏停留在胞络，于是形成这种病症。探究结果，果然是打铜匠。于是使用麻黄、羌活各一钱，茯神、香附、当归尾、赤芍各八分，甘草四分，两剂发汗后心沉重感减轻。再用熟大黄三钱，赤芍、槟榔、枳实、黄柏、黄芩各一钱，两剂大便通畅后背部能伸直。服用八味地黄丸一料，恢复体力劳动如常。
俞震按语：汪石山的医案注重养阴益气，卢不远的医案注重补精搜风，祝茹穹的医案通过汗法和下法疏通经络，温补收纳以固护肾脏。都是真实的学问，不是肤浅的技巧。还有不完善的地方。背部属于太阳经，如果是突发疼痛，则审查其脉象浮紧为伤寒，脉象沉缓为寒湿，麻黄汤、羌活胜湿汤可以酌情使用。脊柱系属督脉，如果是久痛，则审查其热而痛为阴虚，冷而痛为阳虚，麋茸六味丸、鹿茸八味丸可以分别使用。如果肩背痛则兼涉肺经，腰背痛则兼涉肾经，又应当各自探求病因进行治疗。更有胸部与背部互换作痛，颈部与背部牵连作痛，背痛放射至心脏，心痛放射至背部，散见于各种医书中，都应当广泛阅读。
Wang Shishan treated a patient over thirty years old. In late summer, he engaged in sexual intercourse at noon, sweating profusely. That evening, after bathing, he again indulged in sexual activity. Consequently, he developed Bai Zhuo (leukorrhea or urethral discharge). The physician prescribed Weiling Tang (Stomach and Lingzhi Decoction). Later, right eye pain occurred, so the physician administered Siwu Tang (Four Substances Decoction) with Sanhuang (Three Yellows: Coptidis Rhizoma, Scutellariae Radix, Phellodendri Cortex). Upon waking, bitter taste in the mouth worsened. Left knee swelling and pain were added. By mid-winter, without medication, the discharge ceased. Symptoms gradually extended to back pain, with inability to turn or side-bend. Pain was lighter during the day and heavier at night; sneezing felt like ropes tightening the waist and hypochondrium, unbearable in pain; sighing also triggered back pain. Occasional nocturnal emission occurred. In January of the following year, Wang examined the pulse: all pulses were slow, weak, and powerless, indicating Spleen Qi deficiency. The left pulse was slippery, indicating Blood heat. Thus, he used Renshen (Ginseng Radix et Rhizoma) and Huangqi (Astragali Radix), each 2 qian; Fuling (Poria), Baizhu (Atractylodis Macrocephalae Rhizoma), Danggui Shen (Radix Angelicae Sinensis Root End), Maidong (Ophiopogonis Radix), each 1 qian; Niuxi (Achyranthis Bidentatae Radix), Shenqu (Massa Medicata Fermentata), Chenpi (Citri Reticulatae Pericarpium), Huangbai (Phellodendri Cortex), each 7 fen; Gancao (Glycyrrhizae Radix et Rhizoma) and Wuweizi (Schisandrae Chinensis Fructus), each 8 fen. These were decocted and taken for over thirty doses. Subsequently, he prepared pills using Guiban (Testudinis Carapax et Plastrum), Renshen, Huangqi, and Huangbai, each 2 liang; Shudi (Rehmanniae Radix Praeparata), Yurou (Corni Fructus), Gouqi (Lycii Fructus), Duzhong (Eucommiae Cortex), Danggui, Fuling, and Niuxi, each 1 liang. He recovered soon after.
Lu Buyuan treated Zhang Eru from Pujiang. His illness involved spinal pain, difficulty in rising and bowing, a stooped posture, and severe suffering. Lu diagnosed him, saying: "This is wind entering the marrow after sexual intercourse, causing bone Qi to be deficient and unconsolidated, hence limited flexion and extension." He prescribed Guilu Sixian Jiao (Tortoise-Deer Four Immortals Gelatin), taken for three months to fill the marrow. He supplemented it with Toubing Dan (Ice-Penetrating Pill), twenty grains, to dispel Kidney wind. The patient fully recovered.
Zhu Ruqiong treated a patient suffering from a sensation of heaviness in the heart as if weighed down by a thousand jin, with a bent back unable to straighten. Each attack brought unbearable pain, protruding eyeballs, and bitten tongue. No medicine seemed effective. Zhu said: "This must be someone who works with copper and tin, exerting force all day, suffering from irregular meals, and occasionally engaging in sexual activity. Or perhaps startled while illicitly meeting a lover, preventing ejaculation. Hammering causes the back to bend; startling scatters Heart Blood; non-ejaculation causes Kidney Qi to rebel. Qi envelops Blood, which leaks and stagnates in the Bao Luo (uterine collaterals), thus forming this syndrome." Investigation confirmed he was a coppersmith. Zhu prescribed Mahuang (Ephedrae Herba) and Qianghuo (Notopterygii Rhizoma et Radix), each 1 qian; Fushen (Poria cum Radix), Xiangfu (Cyperi Rhizoma), Danggui Wei (Radix Angelicae Sinensis Tail), Chishao (Paeoniae Radix Rubra), each 8 fen; Gancao, 4 fen. After two doses inducing sweating, the heaviness in the chest lightened. Then he used ShuDahuang (Rhei Radix et Rhizoma Praeparated), 3 qian; Chishao, Binglang (Arecae Semen), Zhishi (Aurantii Fructus Immaturus), Huangbai, Huangqin (Scutellariae Radix), each 1 qian. After two doses promoting bowel movement, the back straightened. One dose of Bawei Dihuang Wan (Eight-Ingredient Rehmannia Pill) restored his ability to work with physical effort as usual.
Yu Zhen commented: Wang's case focuses on nourishing Yin and tonifying Qi; Lu's case focuses on tonifying Essence and searching out Wind; Zhu's case uses sweating and purging methods to unblock meridians, and warming/consolidating methods to secure the Kidney. All represent genuine scholarship, not superficial tricks. There are still incomplete aspects. The back belongs to the Taiyang (Greater Yang) channel. If pain is sudden, examine if the pulse is floating and tight, indicating Cold Damage (Shanghan); if sinking and slow, indicating Cold-Dampness. Mahuang Tang (Ephedra Decoction) and Qianghuo Shengshi Tang (Notopterygium Decoction for Overcoming Dampness) can be considered. The spine is governed by the Du Mai (Governor Vessel). If pain is chronic, examine if hot pain indicates Yin deficiency, and cold pain indicates Yang deficiency. Milu Rong Liuwei Wan (Deer Antler Six-Ingredient Pill) and Luru Bawei Wan (Deer Horn Eight-Ingredient Pill) can be used respectively. Shoulder and back pain involves the Lung channel; lower back and back pain involves the Kidney channel. One should seek the specific cause for treatment in each case. Furthermore, alternating pain between chest and back,牵连 pain between neck and back, back pain radiating to the heart, and heart pain radiating to the back are scattered across various medical texts and should be studied extensively.