秦子曰∶《内经》论腰痛,诸条不一。其曰太阳所至为腰痛,少阳腰痛如针刺,阳明腰
痛不可顾。此数者,乃论外感腰痛也。其曰用力举重,入房过度,转摇不能,肾将惫矣,此
论内伤腰痛也。今立外感三条,以该六气;内伤五条,以该七情。
(风湿)
【风湿腰痛之症】发热恶风,自汗身重,腰背重痛,不能转侧,此风湿腰痛之症也。
【风湿腰痛之因】或雨湿之年,风湿袭入肌表,则时行腰痛,此因岁气而致病者;或
冲风冒雨,风湿感人;或以水为事,水舍皮肤,一人独病,此人自感冒而致病者也。
【风湿腰痛之脉】脉多浮涩。左尺浮涩,太阳风湿。左尺细涩,少阴风湿。左关浮涩
,少阳风湿。左关细涩,厥阴风湿。右关浮涩,阳明风湿。右关细涩,太阴风湿。
【风湿痛之治】《内经》云∶腰痛引项脊尻背,太阳经也,宜羌独败毒散,加白芷、
苍术。腰痛引脊内廉,少阴经痛也,宜独活秦艽汤。腰痛如锥刺皮中,少阳经痛也,宜柴胡独
活汤。腰痛如张弓弦,厥阴痛也,宜柴胡芍药汤。腰痛不可顾,如有见,善悲者,阳明经痛
也,白芷独活汤。腰以下如横木居其中,太阴经痛也,苍独肾着汤。
羌独败毒散
羌活 独活 防风 荆芥 川芎 柴胡 前胡 甘草 苍术 白芷
独活秦艽汤
独活 秦艽 防风 川芎 苍术
柴胡独活汤
柴胡 独活 防风 川芎 苍术 青皮 甘草
芍药柴胡汤
白芍药 独活 防风 川芎 苍术 青皮 钩藤
白芷独活汤
白芷 独活 防风 苍术 秦艽 干葛
苍独肾着汤
白术 白茯苓 干葛 苍术 独活 防风
秦子说:《黄帝内经》中论述腰痛的条文有很多。其中提到“太阳经受邪所致腰痛”,“少阳经受邪所致腰痛如针刺感”,“阳明经受邪所致腰痛导致头部无法回顾”。这几条,是论述外感引起的腰痛。其中提到“用力举重,房事过度,腰部转动困难,这是肾脏功能即将衰败的表现”,这是论述内伤引起的腰痛。现在我设立外感腰痛三条,以概括六淫(风、寒、暑、湿、燥、火)致病;内伤腰痛五条,以概括七情(喜、怒、忧、思、悲、恐、惊)致病。
【风湿腰痛的症状】发热、怕风、自汗、身体沉重,腰背部沉重疼痛,不能翻身侧卧,这是风湿腰痛的症状。
【风湿腰痛的病因】或者是多雨潮湿之年,风湿之邪侵入肌表,导致流行性腰痛,这是因岁气(当年气候特点)而致病的;或者是迎风冒雨,风湿侵袭人体;或者是从事涉水工作,水湿之气滞留皮肤,只有一个人单独患病,这是人自身感受外邪而致病的。
【风湿腰痛的脉象】脉象多表现为浮涩。左尺部脉浮涩,为太阳经风湿;左尺部脉细涩,为少阴经风湿;左关部脉浮涩,为少阳经风湿;左关部脉细涩,为厥阴经风湿;右关部脉浮涩,为阳明经风湿;右关部脉细涩,为太阴经风湿。
【风湿腰痛的治法】《黄帝内经》说:腰痛牵引颈部、脊柱、尾骶部和背部,属于太阳经病变,适宜使用羌活胜湿汤(注:原文为羌独败毒散),加白芷、苍术。腰痛牵引脊柱内侧,属于少阴经疼痛,适宜使用独活秦艽汤。腰痛像锥子刺入皮肉中,属于少阳经疼痛,适宜使用柴胡独活汤。腰痛像拉紧的弓弦一样拘急,属于厥阴经疼痛,适宜使用柴胡芍药汤(注:原文方名列表中有误,此处对应芍药柴胡汤)。腰痛头部无法回顾,如有幻觉,容易悲伤,属于阳明经疼痛,使用白芷独活汤。腰部以下感觉像有横木堵在其中,属于太阴经疼痛,使用苍术干姜肾着汤(注:原文为苍独肾着汤)。
Qin Zi said: The *Huangdi Neijing* (Yellow Emperor's Inner Canon) contains numerous passages discussing low back pain. It states that "wind-cold-dampness affecting the Taiyang channel causes low back pain," "Shaoyang channel involvement causes low back pain feeling like needle pricks," and "Yangming channel involvement causes low back pain preventing the head from turning." These few cases discuss exogenous low back pain. It also states, "Lifting heavy weights with excessive force, or excessive sexual intercourse, leading to an inability to twist or turn the waist, indicates that the Kidney is about to fail." This discusses endogenous low back pain. I now establish three categories for exogenous low back pain to encompass the Six Excesses (Wind, Cold, Summerheat, Dampness, Dryness, Fire), and five categories for endogenous low back pain to encompass the Seven Emotions (Joy, Anger, Worry, Pensive, Sorrow, Fear, Fright).
[Symptoms of Wind-Damp Low Back Pain] Fever, aversion to wind, spontaneous sweating, heaviness of the body, heavy and painful sensation in the lower back and back, inability to turn or side-roll; these are the symptoms of Wind-Damp low back pain.
[Etiology of Wind-Damp Low Back Pain] During years of rain and dampness, Wind-Damp pathogens invade the muscle and surface, causing epidemic low back pain; this is illness caused by the annual climate qi. Or, one goes out into strong winds and rain, allowing Wind-Damp to affect the person. Or, one engages in work involving water, where water-dampness lodges in the skin, and only one person becomes ill; this is illness caused by personal exposure to external pathogens.
[Pulse Patterns of Wind-Damp Low Back Pain] The pulse is mostly floating and choppy (Se). A floating and choppy pulse at the left Chi position indicates Wind-Damp in the Taiyang channel. A fine and choppy pulse at the left Chi position indicates Wind-Damp in the Shaoyin channel. A floating and choppy pulse at the left Guan position indicates Wind-Damp in the Shaoyang channel. A fine and choppy pulse at the left Guan position indicates Wind-Damp in the Jueyin channel. A floating and choppy pulse at the right Guan position indicates Wind-Damp in the Yangming channel. A fine and choppy pulse at the right Guan position indicates Wind-Damp in the Taiyin channel.
[Therapeutic Methods for Wind-Damp Low Back Pain] The *Huangdi Neijing* states: "Low back pain radiating to the neck, spine, sacrum, and back belongs to the Taiyang channel." It is appropriate to use Qianghuo Shengshi Tang (Qiangdu Baidu San), adding Bai Zhi (Angelicae Dahuricae Radix) and Cang Zhu (Atractylodis Rhizoma). "Low back pain radiating to the inner aspect of the spine belongs to Shaoyin channel pain." It is appropriate to use Duhuo Qinjiao Tang. "Low back pain feeling like a awl piercing the skin belongs to Shaoyang channel pain." It is appropriate to use Chaihu Duhuo Tang. "Low back pain feeling like a drawn bowstring belongs to Jueyin channel pain." It is appropriate to use Shaoyao Chaihu Tang. "Low back pain preventing the head from turning, accompanied by visual hallucinations and frequent sadness, belongs to Yangming channel pain." Use Baizhi Duhuo Tang. "A sensation of a horizontal log lodged in the lower part of the waist belongs to Taiyin channel pain." Use Cangdu Shen Zhuo Tang.
Qianghuo Shengshi Tang (Qiangdu Baidu San)
Qiang Huo (Notopterygii Rhizoma et Radix), Du Huo (Angelicae Pubescentis Radix), Fang Feng (Saposhnikoviae Radix), Jing Jie (Schizonepetae Herba), Chuan Xiong (Chuanxiong Rhizoma), Chai Hu (Bupleuri Radix), Qian Hu (Peucedani Radix), Gan Cao (Glycyrrhizae Radix et Rhizoma), Cang Zhu (Atractylodis Rhizoma), Bai Zhi (Angelicae Dahuricae Radix).
Duhuo Qinjiao Tang
Du Huo (Angelicae Pubescentis Radix), Qin Jiao (Gentianae Macrophyllae Radix), Fang Feng (Saposhnikoviae Radix), Chuan Xiong (Chuanxiong Rhizoma), Cang Zhu (Atractylodis Rhizoma).
Chaihu Duhuo Tang
Chai Hu (Bupleuri Radix), Du Huo (Angelicae Pubescentis Radix), Fang Feng (Saposhnikoviae Radix), Chuan Xiong (Chuanxiong Rhizoma), Cang Zhu (Atractylodis Rhizoma), Qing Pi (Citri Reticulatae Pericarpium Viride), Gan Cao (Glycyrrhizae Radix et Rhizoma).
Shaoyao Chaihu Tang
Bai Shao Yao (Paeoniae Radix Alba), Du Huo (Angelicae Pubescentis Radix), Fang Feng (Saposhnikoviae Radix), Chuan Xiong (Chuanxiong Rhizoma), Cang Zhu (Atractylodis Rhizoma), Qing Pi (Citri Reticulatae Pericarpium Viride), Gou Teng (Uncariae Ramulus cum Uncis).
Baizhi Duhuo Tang
Bai Zhi (Angelicae Dahuricae Radix), Du Huo (Angelicae Pubescentis Radix), Fang Feng (Saposhnikoviae Radix), Cang Zhu (Atractylodis Rhizoma), Qin Jiao (Gentianae Macrophyllae Radix), Ge Gen (Puerariae Lobatae Radix).
Cangdu Shen Zhuo Tang
Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), Ge Gen (Puerariae Lobatae Radix), Cang Zhu (Atractylodis Rhizoma), Du Huo (Angelicae Pubescentis Radix), Fang Feng (Saposhnikoviae Radix).