子和云腰者肾之腑为大关节血气不行则沉痛不能转侧世人多服补肾药鲜有效者惟用牵牛
甘遂等药大泻其湿其痛自可
按此论治只是谓气郁气挫经壅血瘀及湿热甚者宜行此法至于气血不足肾虚之类皆未宜轻
举宜以脉体别之丹溪有曰腰痛脉大者肾虚脉涩者瘀血有湿热成痰者不可不辨
陈无择云六经腰痛皆外因大抵太阳少阴多中寒少阳厥阴多中风热太阴阳明多燥湿以类推
之失
志伤肾郁怒伤肝忧思伤脾皆致腰痛者以肝肾同系脾胃表里脾滞胃闭最致腰痛其证虚羸不足面
目黧黑远行久立力不能尽失志所为也腹急胁胀目视KT KT 所祈不得意淫于外宗筋弛纵及为白淫
郁怒所为也肌肉濡渍痹而不仁饮食不化肠胃胀满闭坠腰胁忧思所为也此属内因肾着腰痛腰冷
如水身重不渴小便自利饮食如故腰以下冷重如带五千钱因作劳汗出衣里冷湿久久得之肾腰
伛偻肿重引季胁痛因于坠堕恶血流滞及房劳疲力耗竭精气致腰疼痛此属不内外因补泻施治
按此所论病机甚详惜乎方治所略今聊具其例一二于下学人自宜推格
小续命汤治因风腰痛(方见中风门三因方加槐仁炒)
三因独活寄生汤治肾虚卧冷湿当风所得
独活(三两) 桑寄生 杜仲(炒) 细辛 牛膝 秦艽 茯苓 白芍 桂心 川芎 防风
甘草(炙) 人参 熟地黄 当归(各等分)
上 咀每四钱水煎空心服
按此足少阴厥阴药也
牛膝酒治伤风毒腰痛
牛膝 川芎 羌活 地骨皮 五加皮 薏苡仁(各一两) 生地黄 甘草(各十两) 海桐
皮(二两) 杜仲(一两)
上 咀帛裹入无灰酒浸各二七日夏三五日每服一杯日三五次
按此足太阳少阴药也
子和说：腰部是肾脏的外腑，也是人体最大的关节。如果气血运行不畅，就会导致沉重疼痛，身体无法转动。世人大多服用补肾的药物，很少见效。只有使用牵牛子、甘遂等药物大力泻除体内的湿气，疼痛自然可以消除。
按语：这种论述的治疗方法，只是针对气机郁滞、气机挫伤、经络壅塞、血瘀以及湿热严重的情况，适宜采用这种方法。至于气血不足、肾虚等情况，都不宜轻易使用此法，应当通过脉象和体质来辨别。丹溪曾说：腰痛脉象大的，属于肾虚；脉象涩的，属于瘀血；有湿热或形成痰浊的，不可不加以辨别。
陈无择说：六经腰痛都属于外感病因，大抵太阳经和少阴经多感受寒邪，少阳经和厥阴经多感受风热，太阴经和阳明经多感受燥湿，依此类推即可。
（内因方面）志意损伤肾脏，郁怒损伤肝脏，忧思损伤脾脏，都会导致腰痛。这是因为肝肾相互关联，脾胃互为表里，脾脏停滞、胃气闭塞最容易导致腰痛。其症状表现为身体虚弱消瘦、面色黧黑，这是远行久立、体力耗尽所致，属于“失志”引起的。腹部拘急、胁肋胀满、视物模糊、欲望无法满足、淫欲外泄导致宗筋弛纵，以及出现白淫（滑精或白带过多），这些属于“郁怒”引起的。肌肉浸渍湿邪，麻木不仁，饮食不化，肠胃胀满，二便闭结坠痛，腰胁部不适，这些属于“忧思”引起的。
（肾着病）腰部寒冷，像水浇在身上一样，身体沉重但不口渴，小便正常，饮食如常，腰部以下冷重，感觉像带着五千枚铜钱一样沉重，这是因为劳作出汗后，衣服里面冷湿，久而久之形成的。
（其他原因）腰部弯曲肿胀沉重，牵引季胁疼痛，这是由于跌坠受伤，恶血停滞所致；以及房劳过度，精力耗竭，精气亏损导致的腰痛疼痛，这些属于“不内外因”。补法和泻法的治疗方案，在此论述中虽然详细，可惜方剂治疗部分有所简略。现在姑且列举其中的一两个例子如下，学习的人应当自行推究格律。
小续命汤：治疗因风邪引起的腰痛。（方剂见中风门，《三因方》中加入炒槐仁）
三因独活寄生汤：治疗肾虚，睡卧于冷湿之处，当风受邪所致的腰痛。
独活（三两）、桑寄生、杜仲（炒）、细辛、牛膝、秦艽、茯苓、白芍、桂心、川芎、防风、甘草（炙）、人参、熟地黄、当归（各等分）。
以上药材切碎，每次取四钱，用水煎煮，空腹服用。
按语：这是足少阴肾经和足厥阴肝经的药物。
牛膝酒：治疗伤风毒引起的腰痛。
牛膝、川芎、羌活、地骨皮、五加皮、薏苡仁（各一两）、生地黄、甘草（各十两）、海桐皮（二两）、杜仲（一两）。
以上药材切碎，用布包裹，放入无灰酒中浸泡，夏季三五天，冬季二七天。每次服用一杯，每日三到五次。
按语：这是足太阳膀胱经和足少阴肾经的药物。
He Zi said: The waist is the external mansion of the Kidney and constitutes the largest joint in the body. If Qi and Blood fail to circulate, it results in heavy pain and an inability to turn or move the body. People mostly take Kidney-tonifying medicines with little effect. Only by using strong purgatives such as Qian Niu (Pharbitis Seed) and Gan Sui (Kansui Root) to vigorously drain Dampness can the pain be relieved.
Commentary: This therapeutic approach applies only to cases of Qi stagnation, Qi injury, meridian obstruction, Blood stasis, and severe Damp-Heat. For conditions involving Qi and Blood deficiency or Kidney deficiency, this method should not be used lightly; differentiation must be made based on pulse and constitution. Dan Xi stated: A large pulse in lower back pain indicates Kidney deficiency; a choppy pulse indicates Blood stasis; one must distinguish between cases caused by Damp-Heat or Phlegm.
Chen Wuze said: Lower back pain involving the Six Channels is generally due to external causes. Generally, the Taiyang and Shaoyin channels are prone to Cold invasion; the Shaoyang and Jueyin channels are prone to Wind-Heat; the Taiyin and Yangming channels are prone to Dryness-Dampness. One may infer other cases by analogy.
(Internal Causes): Injury to willpower damages the Kidney; anger and frustration damage the Liver; worry and overthinking damage the Spleen. All these can lead to lower back pain because the Liver and Kidney are closely related, and the Spleen and Stomach are exterior-interior pairs. Spleen stagnation and Stomach closure most easily cause lower back pain. Symptoms include emaciation and weakness, dark complexion, resulting from long-distance walking or prolonged standing leading to exhaustion; this is caused by "loss of will." Abdominal tightness, hypochondriac distension, blurred vision, unfulfilled desires, excessive sexual activity leading to flaccidity of the Sinews (Zong Jin), and discharge of white fluid (Bai Yin) are caused by "anger and frustration." Muscle immersion in dampness, numbness, indigestion, intestinal and gastric distension, constipation or tenesmus, and discomfort in the waist and hypochondrium are caused by "worry and overthinking."
(Kidney Fixation Disease): Coldness in the waist, feeling like water pouring on the body, heaviness without thirst, normal urination, normal appetite, coldness and heaviness below the waist feeling like wearing five thousand copper coins. This arises from sweating during labor, with cold-dampness remaining inside the clothes for a long time.
(Other Causes): Curvature, swelling, and heaviness of the waist radiating to the lateral costal region, caused by falls or trauma leading to stagnation of evil blood; or pain in the waist caused by excessive sexual exertion, depletion of essence and Qi. These belong to "non-external, non-internal causes." Although the pathogenesis discussed here is detailed, the specific formulas are omitted. Here, I briefly list one or two examples for students to study and deduce.
Xiao Xuming Tang: Treats lower back pain caused by Wind pathogens. (Formula see Stroke Section; add fried Huai Ren [Sophora Flower] as per San Yin Fang).
San Yin Duhuo Jisheng Tang: Treats lower back pain due to Kidney deficiency, sleeping in cold-damp places, and exposure to wind.
Duhuo (3 liang), Sangjisheng (Mulberry Mistletoe Stem), Duzhong (Stir-fried Eucommia Bark), Xixin (Asarum), Niuxi (Achyranthes Root), Qinjiao (Gentiana Macrophylla Root), Fuling (Poria), Baishao (White Peony Root), Guixin (Cinnamon Twig), Chuanxiong (Ligusticum Rhizome), Fangfeng (Saposhnikovia Root), Zhigancao (Honey-fried Licorice Root), Renshen (Ginseng), Shudihuang (Prepared Rehmannia Root), Danggui (Angelica Sinensis Root) (all in equal proportions).
Crush the herbs. Take 4 qian per dose, decoct in water, and take on an empty stomach.
Commentary: These are herbs for the Foot-Shaoyin and Foot-Jueyin channels.
Niuxi Jiu: Treats lower back pain caused by Wind-toxin.
Niuxi (1 liang), Chuanxiong (1 liang), Qianghuo (Notopterygium Rhizome), Digupi (Dogwood Root Bark), Wujia Pi (Acanthopanax Bark), Yiyiren (Coix Seed) (each 1 liang); Shengdihuang (Rehmannia Root), Gancao (Licorice Root) (each 10 liang); Haitongpi (Trematocarpus Bark) (2 liang); Duzhong (Eucommia Bark) (1 liang).
Crush the herbs, wrap in cloth, and soak in pure wine (without ash additives). Soak for 2-7 days in summer, 5-7 days in winter. Take one cup per dose, 3-5 times daily.
Commentary: These are herbs for the Foot-Taiyang and Foot-Shaoyin channels.