经曰∶太阳所致为腰痛。巨阳虚，则腰背头项疼，是动则项如拔，夹脊痛；腰似折，髀不可
以曲。盖腰者肾之府，为一身之大关节，所恃以转移阖辟者也。且诸脉皆贯于肾，而络于腰脊，
肾气一虚，腰必痛矣。《内经》推足三阴三阳，皆令人腰脊痛。书叙五种三因致痛。曰阳气不足
；曰风痹寒湿；曰肾虚劳役；曰坠堕险地；曰寝卧卑湿五也。如六淫气浸，皆属外因。用力举重
，因于坠堕，恶血留滞，闪肭挫气，房劳疲力，耗竭精气；及肾着腰痛，腰冷如水，身重不渴，
如带五千钱；因作劳汗出，衣里冷湿，久久得之，臀腰伛偻，腰重引季胁痛，属不内外因。失志
伤肾，郁怒伤肝，忧思伤脾，皆致腰痛。其证虚羸不足，面色黧黑，两耳热痛，精气不固，齿疼
龈肿，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，皆属内因。感
受虽有种种，无出肾虚一门。脉沉而弦涩，血；滑，痰。治虽祛邪，必以补肾为主。
主方 杜仲（姜炒断丝） 破故纸（盐酒炒） 牛膝 当归 生地 白芍 黄柏 知母（
俱盐炒） 熟地（各一钱） 茴香（盐
炒） 肉桂（各二分） 怀山药（七分） 枣（二枚） 煎成，入盐一分，服。多食胡桃肉，饮
好酒送药。
痛甚加玄胡，另磨沉香，研乳香、砂仁末服。去白芍药、生地。虚加人参、黄 、龟胶、枸
杞、山萸之类。
煨肾散 治肾虚，日夜悠悠痛不已，与主方兼用。
杜仲（姜炒，二钱） 破故纸（盐酒炒，一钱）
上研细，先以猪腰子一个，切七片，盐腌拭净；将仲、纸入茴香末，盐少许掺，挟湿纸包煨
，酒下。
青娥丸 治肾虚腰痛。
杜仲（四两） 破故纸（二两，一方加牛膝、熟地黄尤可）
上为末，胡桃肉四十九个捣细，入山药糊和，丸如桐子大，每服七、八十丸，酒下。
补肾丸 治肾虚腰痛。
熟地 当归 杜仲（各钱半） 白芍 破故纸 枸杞子 黄柏（酒炒） 川楝肉 茴香（盐
酒炒） 川芎（各七分） 桃仁（一钱，炒）
上为末，蜜丸桐子大。每服七十丸，盐汤下。
肾着丸 治肾虚为病，身重腰冷如冰，不渴，小便自利，饮食如故，腰下重痛如带五千
钱。渗湿汤亦可服。
白术 茯苓（各四两） 干姜 甘草（炙。各一两） 上咀，每四钱，空心煎服。
川芎肉桂汤 治冬月因感寒湿腰痛，兼行瘀血。
羌活（钱半） 柴胡 肉桂 桃仁 当归尾 苍术 甘草（炙） 川芎（各八分） 独活
神曲 防风 防己（酒。各三分）
上酒三盏，煎至一盏，食前暖室温服。
牛膝酒 治肾受风毒，攻刺腰痛不可忍者。
牛膝 地骨皮 五味子 薏苡仁 川芎 羌活 甘草（炙。各一两） 海桐皮 生地黄（二
两）
上咀，用绵包药，入无灰酒，装入坛内浸，春五、夏三、秋七、冬十日。每服一盏，一日三
、四次，常令酒气不绝。
摩腰膏 治寒湿腰痛。
附子（一两） 天南星 川乌（各二钱半） 肉桂（一钱） 雄黄 樟脑 丁香（各一钱半）
麝香（五分）
上为末，蜜丸龙眼大，每用二丸，姜汁化开，顿热涂腰间，绵纸覆，外烘热，绵衣缚定，内
火热。三日一次。
风湿寒热痛，宜当归拈痛汤（方见身痛）。瘀血夜痛甚，四物汤加桃仁、红花。闪挫痛，当
归、玄胡、肉桂为末，每二钱酒下。
大便秘，三花神佑丸（方见痰门）。痛甚者，经曰∶腰痛不可俯仰，肾将惫矣。宜参、 配
补肾药大剂服，忌寒凉药。
简便方（治腰痛） 用大胡桃二个炮焦，取肉烧，酒送下。
又方（治风冷寒湿痛） 川乌一两为末，盐酒调，敷痛处，绵纸软帛束之。
又方（治卒痛） 杜仲一两，制；次以韭白七茎，盐、花椒、姜、醋、酱，作羹食。
又方（腰肿痛）槟榔末一钱，酒下。
又 鳖甲炙为末，酒下。
又方（腰痛无力） 风栗子每早吃十枚，再以猪腰子煮粥食。
又 白蒺藜为末，蜜丸桐子大。每服七、八十丸，一日三服。
又 杜仲一两，川萆 二两，为末，每三钱，酒调下。
又 红曲一钱，（炒研），酒下。或炒盐熨；或橘核（炒，去壳），茴香酒下。
《黄帝内经》说：太阳经受邪会导致腰痛。足太阳膀胱经气虚弱，就会出现腰、背、头、项部的疼痛；经脉发生变动时，颈部像被拔起一样僵硬疼痛，夹脊部位疼痛；腰部好像要折断一样，大腿无法弯曲。大概腰部是肾脏的外府，也是全身最大的关节，依靠它来支撑身体的转动和开合。况且所有的经脉都贯通于肾，并联络于腰脊，肾气一旦虚弱，腰部必然疼痛。《内经》论述足三阴经和足三阳经的病变，都会导致腰脊疼痛。书中叙述了五种因内因、外因及不内外因而致痛的病因。一是阳气不足；二是风、痹、寒、湿侵袭；三是肾虚和过度劳累；四是坠落或身处险地受伤；五是睡卧在低洼潮湿之处。如六淫邪气浸渍，都属于外因。用力举重，或因坠落受伤，导致恶血留滞，闪挫扭伤导致气机阻滞，房事过度耗竭精气；以及肾着病引起的腰痛，腰部冷得像水浇一样，身体沉重但不口渴，感觉像腰间系着五千枚铜钱；因为劳作出汗后，内衣寒冷潮湿，久而久之得此病，臀部腰部弯曲，腰部沉重牵引季胁部疼痛，属于不内外因。意志消沉损伤肾脏，郁怒损伤肝脏，忧思损伤脾脏，都会导致腰痛。其症状表现为形体消瘦虚弱，面色黧黑，两耳发热疼痛，精气不固，牙齿疼痛牙龈肿胀，这是由意志消沉（情志抑郁）所致；腹部拘急胁肋胀满，视物模糊不清，所求不得意淫于外，宗筋弛缓纵弛，以及出现白淫（滑精或白带过多），这是由郁怒所致；肌肉濡渍腐烂，麻木不仁，饮食不化，肠胃胀满，二便闭结或下坠感牵连腰胁，这是由忧思所致，这些都属于内因。感受邪气虽然有种种不同，但无不出于肾虚这一根本。脉象沉而弦涩，主血瘀；脉滑，主痰饮。治疗虽然以祛除邪气为主，但必须以补肾为根本。
主方：杜仲（姜炒至断丝）、破故纸（即补骨脂，盐酒炒）、牛膝、当归、生地、白芍、黄柏、知母（均用盐炒）、熟地（各一钱）、茴香（盐炒）、肉桂（各二分）、怀山药（七分）、大枣（二枚）。煎煮成汤后，加入盐一分，服用。多吃胡桃肉，用好酒送服药物。
疼痛剧烈者，加玄胡索，另磨沉香，研碎乳香、砂仁末服用。去掉白芍药、生地。虚证明显者，加人参、黄芪、龟胶、枸杞、山茱萸之类。
煨肾散：治疗肾虚，日夜悠悠作痛不止，可与主方兼用。
杜仲（姜炒，二钱）、破故纸（盐酒炒，一钱）。
以上研细。先用猪腰子一个，切七片，用盐腌制洗净；将杜仲、破故纸放入茴香末中，加少许盐拌匀，夹在猪腰片中，用湿纸包裹后煨熟，用酒送下。
青娥丸：治疗肾虚腰痛。
杜仲（四两）、破故纸（二两，另一版本加牛膝、熟地黄更好）。
以上研为细末，胡桃肉四十九个捣细，加入山药糊调和，制成梧桐子大小的丸剂。每次服用七八十丸，用酒送下。
补肾丸：治疗肾虚腰痛。
熟地、当归、杜仲（各钱半）、白芍、破故纸、枸杞子、黄柏（酒炒）、川楝肉、茴香（盐酒炒）、川芎（各七分）、桃仁（一钱，炒）。
以上研为细末，蜂蜜炼蜜为丸，如梧桐子大。每次服用七十丸，淡盐汤送下。
肾着丸：治疗肾虚致病，身体沉重腰部冷如冰，口不渴，小便自利，饮食正常，腰部以下沉重疼痛像带着五千枚铜钱。渗湿汤也可以服用。
白术、茯苓（各四两）、干姜、甘草（炙，各一两）。以上切碎，每次取四钱，空腹煎服。
川芎肉桂汤：治疗冬季因感受寒湿导致的腰痛，兼能行散瘀血。
羌活（钱半）、柴胡、肉桂、桃仁、当归尾、苍术、甘草（炙）、川芎（各八分）、独活、神曲、防风、防己（酒制，各三分）。
以上用酒三盏，煎至一盏，饭前温服。
牛膝酒：治疗肾受风毒，攻刺腰痛不可忍受。
牛膝、地骨皮、五味子、薏苡仁、川芎、羌活、甘草（炙，各一两）、海桐皮、生地黄（二两）。
以上切碎，用棉布包好药，放入无灰酒中，装入坛内浸泡，春季五、夏季三、秋季七、冬季十日。每次服用一盏，一日三、四次，常令酒气不绝于口。
摩腰膏：治疗寒湿腰痛。
附子（一两）、天南星、川乌（各二钱半）、肉桂（一钱）、雄黄、樟脑、丁香（各一钱半）、麝香（五分）。
以上研为细末，蜂蜜炼蜜为丸，如龙眼大小。每次用二丸，用姜汁化开，顿热后涂于腰部，用绵纸覆盖，外部烘烤加热，再用绵衣缚紧，使内部火热。每三日一次。
风湿寒热痛，宜用当归拈痛汤（方见身痛篇）。瘀血夜间疼痛加剧者，用四物汤加桃仁、红花。闪挫疼痛，用当归、玄胡索、肉桂研为细末，每次二钱，用酒送下。
大便秘结者，用三花神佑丸（方见痰门篇）。疼痛严重者，《内经》说：“腰痛不能俯仰，说明肾气即将衰竭。”宜用人参、黄芪配合补肾药大剂量服用，忌用寒凉药。
简便方（治腰痛）：用大胡桃两个炮焦，取肉烧熟，用酒送下。
又方（治风冷寒湿痛）：川乌一两研为细末，用盐酒调匀，敷于痛处，用绵纸软帛束紧。
又方（治卒然剧痛）：杜仲一两，炮制；其次用韭白七茎，加盐、花椒、姜、醋、酱，做成羹食用。
又方（治腰肿痛）：槟榔末一钱，用酒送下。
又方：鳖甲炙后研为细末，用酒送下。
又方（治腰痛无力）：风栗子每天早晨吃十枚，再用猪腰子煮粥食用。
又方：白蒺藜研为细末，蜂蜜炼蜜为丸，如梧桐子大。每次服用七八十丸，一日三次。
又方：杜仲一两，川萆薢二两，研为细末，每次三钱，用酒调下。
又方：红曲一钱（炒研），用酒送下。或者炒盐熨烫；或者橘核（炒，去壳），茴香酒送下。
According to the *Huangdi Neijing* (Yellow Emperor's Inner Canon), pathogenic factors affecting the Taiyang (Greater Yang) channel cause lower back pain. When the Qi of the Foot-Taiyang Bladder channel is deficient, pain occurs in the lower back, back, head, and nape; if the channel undergoes pathological changes, the neck feels as if being pulled out, with pain along the spine; the lower back feels as if it is about to break, and the thighs cannot be flexed. The lower back is considered the mansion of the Kidney and serves as the largest joint of the body, relying on it for movement and rotation. Furthermore, all meridians connect to the Kidney and network through the lumbar spine; once Kidney Qi becomes deficient, lower back pain inevitably ensues. The *Neijing* discusses that disorders of the three Yin and three Yang channels of the foot can all lead to lumbar and spinal pain. The text describes five causes of pain due to internal, external, and non-internal/external factors: first, deficiency of Yang Qi; second, invasion by Wind, Bi syndrome, Cold, and Dampness; third, Kidney deficiency and overexertion; fourth, trauma from falls or dangerous situations; fifth, sleeping in low-lying damp places. Invasion by the six Exogenous pathogens belongs to external causes. Heavy lifting, trauma from falls leading to stagnation of evil blood, sprains causing Qi stagnation, excessive sexual activity depleting essence and Qi, and "Kidney-Damp" lower back pain characterized by coldness in the waist like water pouring, heaviness without thirst, and a sensation of carrying five thousand coins—all these, especially when caused by sweating during labor followed by cold, damp clothing leading to chronic curvature of the hips and waist and heavy pain radiating to the hypochondrium—belong to non-internal/external causes. Loss of will injures the Kidney, suppressed anger injures the Liver, and worry/thought injures the Spleen, all leading to lower back pain. Symptoms include emaciation and weakness, dark complexion, hot and painful ears, insecure essence, toothache, and swollen gums, caused by loss of will; abdominal urgency, hypochondriac distension, blurred vision, unfulfilled desires, flaccid sinews, and white discharge (seminal emission or leukorrhea), caused by suppressed anger; muscle maceration, numbness, indigestion, intestinal and gastric distension, and constipation or tenesmus radiating to the waist and hypochondrium, caused by worry/thought; these belong to internal causes. Although the nature of pathogenic invasion varies, it ultimately stems from Kidney deficiency. A deep, wiry, and choppy pulse indicates Blood stasis; a slippery pulse indicates Phlegm. Treatment should focus on dispelling pathogens but must prioritize tonifying the Kidney.
Main Formula: Du Zhong (Eucommiae Cortex, stir-fried with ginger until fibers break), Po Gu Zhi (Psoraleae Fructus, stir-fried with salt and wine), Niu Xi (Achyranthis Bidentatae Radix), Dang Gui (Angelicae Sinensis Radix), Sheng Di Huang (Rehmanniae Radix), Bai Shao (Paeoniae Radix Alba), Huang Bo (Phellodendri Cortex), Zhi Mu (Anemarrhenae Rhizoma)—all stir-fried with salt; Shu Di Huang (Rehmanniae Radix Preparata), each 1 qian; Hui Xiang (Foeniculi Fructus, stir-fried with salt); Rou Gui (Cinnamomi Cortex), each 2 fen; Huai Shan Yao (Dioscoreae Rhizoma), 7 fen; Jujubae Fructus (Jujube), 2 pieces. Decoct in water, add 1 fen of salt, and take orally. Eat more walnuts and take the medicine with good wine.
If pain is severe, add Yuan Hu Suo (Corydalis Rhizoma). Grind Chen Xiang (Aquilariae Lignum Resinatum) separately, and mix with powder of Ru Xiang (Boswelliae Resin) and Sha Ren (Amomi Fructus Rotundus) to take orally. Remove Bai Shao and Sheng Di Huang. For significant deficiency, add Ren Shen (Ginseng Radix), Huang Qi (Astragali Radix), Gui Jiao (Colla Corii Asini), Gou Qi Zi (Lycii Fructus), and Shan Yu Zhu (Corni Fructus).
Wei Shen San (Roasted Kidney Powder): Treats Kidney deficiency causing continuous day-and-night dull pain. Can be used concurrently with the Main Formula.
Du Zhong (stir-fried with ginger, 2 qian), Po Gu Zhi (stir-fried with salt and wine, 1 qian).
Grind into fine powder. Take one pig kidney, slice into seven pieces, marinate with salt, and wash clean. Mix Du Zhong and Po Gu Zhi with Fennel powder and a little salt, sandwich between kidney slices, wrap in wet paper, and roast until cooked. Take with wine.
Qing E Wan (Green Youth Pill): Treats Kidney deficiency lower back pain.
Du Zhong (4 liang), Po Gu Zhi (2 liang; another version adds Niu Xi and Shu Di Huang, which is also effective).
Grind into powder. Mash 49 walnut kernels finely, mix with Yam paste to form pills the size of mulberry seeds. Take 70–80 pills per dose with wine.
Bu Shen Wan (Tonify Kidney Pill): Treats Kidney deficiency lower back pain.
Shu Di Huang, Dang Gui, Du Zhong (each 1.5 qian), Bai Shao, Po Gu Zhi, Gou Qi Zi, Huang Bo (stir-fried with wine), Chuan Lian Rou (Toosendan Fructus), Hui Xiang (stir-fried with salt and wine), Chuan Xiong (each 7 fen), Tao Ren (Persicae Semen, 1 qian, stir-fried).
Grind into powder, make honey pills the size of mulberry seeds. Take 70 pills per dose with light salt water.
Shen Zhuo Wan (Kidney-Damp Pill): Treats disease caused by Kidney deficiency, characterized by body heaviness, cold waist like ice, no thirst, normal urination, normal diet, and heavy pain below the waist as if carrying five thousand coins. Shen Shi Tang (Drain Dampness Decoction) may also be taken.
Bai Zhu (Atractylodis Macrocephalae Rhizoma), Fu Ling (Poria), each 4 liang; Gan Jiang (Zingiberis Rhizoma), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma), each 1 liang. Cut into small pieces. Decoct 4 qian per dose, take on an empty stomach.
Chuan Xiong Rou Gui Tang (Ligusticum and Cinnamon Twig Decoction): Treats winter lower back pain due to Cold-Damp invasion, also promoting blood circulation.
Qiang Huo (Notopterygii Rhizoma et Radix, 1.5 qian), Chai Hu (Bupleuri Radix), Rou Gui, Tao Ren, Dang Gui Wei (Angelicae Sinensis Radix Tail), Cang Zhu (Atractylodis Rhizoma), Zhi Gan Cao, Chuan Xiong (each 8 fen), Du Huo (Angelicae Pubescentis Radix), Shen Qu (Massa Medicata Fermentata), Fang Feng (Saposhnikoviae Radix), Fang Ji (Stephaniae Tetrandrae Radix, wine-treated, each 3 fen).
Decoct in 3 bowls of wine until reduced to 1 bowl. Take warm before meals.
Niu Xi Jiu (Achyranthes Wine): Treats Kidney affected by Wind-Toxin, causing unbearable stabbing lower back pain.
Niu Xi, Di Gu Pi (Lycii Cortex), Wu Wei Zi (Schisandrae Fructus), Yi Yi Ren (Coicis Semen), Chuan Xiong, Qiang Huo, Zhi Gan Cao (each 1 liang), Hai Tong Pi (Cryptocaryae Cortex), Sheng Di Huang (2 liang).
Cut into pieces, wrap in cotton, soak in pure wine in a jar. Soak for 5 days in spring, 3 in summer, 7 in autumn, 10 in winter. Take 1 bowl per dose, 3–4 times daily, maintaining a constant mild intoxication.
Mo Yao Gao (Waist Rubbing Ointment): Treats Cold-Damp lower back pain.
Fu Zi (Aconiti Lateralis Radix Preparata, 1 liang), Tian Nan Xing (Arisaematis Rhizoma), Chuan Wu (Aconiti Radix), each 2.5 qian; Rou Gui (1 qian); Xiong Huang (Realgar), Zhang Nao (Camphora), Ding Xiang (Eugeniae Flos), each 1.5 qian; She Xiang (Moschus), 5 fen.
Grind into powder, make honey pills the size of a longan. Use 2 pills per application, dissolve in Ginger Juice, heat thoroughly, apply to the waist, cover with cotton paper, externally heat, and bind tightly with cotton cloth to generate internal heat. Apply once every three days.
For Wind-Damp-Cold-Heat pain, use Dang Gui Nian Tong Tang (Angelica Ligustici Chuanxiong Pain-Relieving Decoction; see Body Pain section). For Blood Stasis with worse night pain, use Si Wu Tang (Four Substances Decoction) plus Tao Ren and Hong Hua. For sprain/trauma pain, use Dang Gui, Yuan Hu Suo, and Rou Gui ground into powder, take 2 qian with wine.
For severe constipation, use San Hua Shen You Wan (Three Flowers Shenyou Pill; see Phlegm section). If pain is severe, the *Neijing* states: "Lower back pain preventing bending forward or backward indicates impending Kidney exhaustion." Use large doses of Ren Shen and Huang Qi combined with Kidney-tonifying herbs. Avoid cold-natured medicines.
Simple Prescription (for Lower Back Pain): Roast two large walnuts until charred, take the meat, burn it slightly, and take with wine.
Another Prescription (for Wind-Cold-Damp pain): Grind 1 liang of Chuan Wu into powder, mix with salt wine, apply to the painful area, and bind with soft cotton cloth.
Another Prescription (for sudden acute pain): Use 1 liang of prepared Du Zhong. Also, cook 7 stalks of leek whites with salt, Sichuan pepper, ginger, vinegar, and soy sauce into a soup and eat.
Another Prescription (for swollen/painful waist): Take 1 qian of Bin Lang (Arecae Semen) powder with wine.
Another Prescription: Roast Bie Jia (Testudinis Carapax et Plastrum), grind into powder, take with wine.
Another Prescription (for weak lower back pain): Eat 10 Feng Li Zi (Castanea mollissima) every morning, and eat porridge made with pig kidneys.
Another Prescription: Grind Bai Ji Li (Tribuli Fructus) into powder, make honey pills the size of mulberry seeds. Take 70–80 pills, three times daily.
Another Prescription: Use 1 liang of Du Zhong and 2 liang of Chuan Bi Xie (Dioscoreae Hypoglaucae Rhizoma), grind into powder, take 3 qian mixed with wine.
Another Prescription: Take 1 qian of Hong Qu (Red Yeast Rice) (stir-fried and ground) with wine. Alternatively, stir-fry salt and apply as a compress; or take roasted Jue He (Citri Reticulatae Pericarpium Viride) with Fennel wine.