（附腰胯肿痛、腰软）
【脉】 尺脉粗常热，谓之热中。腰胯痛，脉大者，肾虚；脉涩者，痰血。
【因】 肾虚而致。有湿热，有瘀血，有外感。
肾虚，皆起于内。盖失志伤肾，郁怒伤肝，忧思伤脾，皆致腰痛。故使气结不行，血停
不禁，遂成虚损，血气去之。又有房劳过者多矣。
湿热，亦因肾虚而生焉。肾者，水也。气不利而成湿热者，因肾水涸，相火炽，无所荣
制，故湿热相搏而成痛。亦有虚劳，外感湿气，内热不行而成党锢。
瘀血，因用力过多，堕坠折纳，瘀血不行。
外感，因虚袭之。
外有肾风、肾热、肾疟、厥阴疟，皆腰痛。
【证】 失志者虚，云不足。面黑，远行久立不能住。郁怒者，腹急胁胀，目视
KTKT ，所祈不能，意浮于外。忧思者，肌肉濡渍，痹而不仁，饮食不化，肠胃胀满。房劳者
，精血不足，无所荣养。经曰∶转摇不得，肾将惫矣，名骨痿。
湿热者，四肢缓，足寒逆，腰冷如冰，冷汗，精滑，扇痛。外感，如太阳腰痛引项，尻
重；阳明腰痛，不可以顾，善悲；少阳如刺其皮，不可俯仰；太阴烦热，如有横木居中，遗
溺；少阴引脊内；厥阴如张弓弦。大抵太阳、少阴多中寒，阳明、太阴多燥湿，少阳、厥阴
多风热。
【治】羌活汤 治腰痛。
羌活 独活 柴胡 防风 肉桂 当归
如卧寒湿地，足太阳、少阴血络中有凝血，加归尾、苍术、桃仁、防己。如湿热痛，加
黄柏
、苍术、杜仲、川芎。如虚，加杜仲、五味、 、归、知母、龟板。如坠扑瘀血，加桃仁、
麝香、苏木、水蛭。
肾气丸、茴香丸、鹿茸丸、此三方补阳之不足也，劳伤、房室之人有之。
六味地黄丸、封髓丹，此二方补阴之不足也，膏粱之人有之。
煨肾丸 治腰痛虚。
杜仲（炒去丝，三钱）
上一味，末之。以猪肾一枚，薄批五七片，以盐椒淹去腥水，糁药在内，包在荷叶，用
湿纸数重煨熟，酒下。
立效散 玄胡索 当归 肉桂（等分）
为末，酒下。
挫气丹 治挫气腰痛。
山楂子（四两，去核） 北茴香（炒，一两）
为末，酒下。
腰胯重痛
【因】 风、寒、湿流注经络，结凝骨节，气血不和而痛。痰积趁逐经络，流注
搏于血内，亦然。
【治】 宜流湿，散风寒，逐痰积，气血自然湍流也。
除湿丹 槟榔 甘遂 赤芍药 威灵仙 泽泻 葶苈（各二两） 乳香（研） 没药
（各一两） 大戟（炒，三钱） 陈皮（四两）
面糊丸，加牵牛末丸。
禹功散 治同。
腰软
【因】 肾肝伏热。
【治】 宜黄柏、防己。
论余 解 证，少气不欲言，寒不寒，热不热，壮不壮，停不停，乃精气虚而肾
邪实矣。治以泽、茯疏肾实，地黄、牛膝、麦门冬补精气。
（附腰胯肿痛、腰部软弱无力）
【脉象】
尺部脉搏动粗大且常伴有热感，称为“热中”。腰痛伴见脉象洪大者，为肾虚；脉象涩滞者，为痰湿或瘀血阻滞。
【病因】
多因肾虚所致。具体包括湿热、瘀血和外感邪气三种情况。
肾虚引起的腰痛，皆源于内部损伤。如意志消沉伤肾，郁怒伤肝，忧思伤脾，都会导致腰痛。这使得气机结滞不行，血液停滞不禁，从而形成虚损，气血耗散。此外，房事过度也是常见原因。
湿热之邪，也往往因肾虚而生。肾属水。若气机不利而生成湿热，是因为肾水枯竭，相火（寄居于肝肾的命门之火）炽盛，失去制约，故湿热相互搏结而致痛。也有因虚劳过度，外感湿气，内热不得宣通，形成闭塞不通的情况。
瘀血，多因用力过猛，或从高处坠落、跌打损伤，导致瘀血停滞不行。
外感，是因正气虚弱，外邪乘虚侵袭。
此外，还有肾风、肾热、肾疟、厥阴疟等病证，均表现为腰痛。
【证候】
意志消沉所致者属虚证，表现为元气不足。面色发黑，远行或久立后无法支撑。
郁怒所致者，腹部拘急，胁肋胀满，目光呆滞无神，性欲减退，心神浮越不宁。
忧思所致者，肌肉浸渍濡软，肢体麻木不仁，饮食不化，肠胃胀满。
房劳所致者，精血不足，无法滋养身体。《内经》说：“转侧摇动困难，说明肾脏即将衰败”，这被称为骨痿。
湿热所致者，四肢弛缓无力，足部寒冷逆冷，腰部冰冷如冰，出冷汗，遗精滑泄，扇风时疼痛加剧。
外感所致者，如太阳经腰痛牵引项部，尾骶部沉重；阳明经腰痛，不能回顾，容易悲伤；少阳经腰痛如针刺皮肤，不能俯仰；太阴经腰痛烦热，感觉如有横木堵在中间，小便失禁；少阴经腰痛牵引脊柱内部；厥阴经腰痛如弓弦紧绷。大体而言，太阳、少阴经多兼夹寒邪，阳明、太阴经多兼夹燥湿，少阳、厥阴经多兼夹风热。
【治法】
羌活汤：治疗腰痛。
组成：羌活、独活、柴胡、防风、肉桂、当归。
如果因睡卧在寒冷潮湿之地，导致足太阳、足少阴经络中有凝血，加入归尾、苍术、桃仁、防己。如果是湿热疼痛，加入黄柏、苍术、杜仲、川芎。如果是虚证，加入杜仲、五味子、（原文缺字，推测为续断或类似补益药）、当归、知母、龟板。如果是坠扑导致的瘀血，加入桃仁、麝香、苏木、水蛭。
肾气丸、茴香丸、鹿茸丸：这三个方剂用于补阳气之不足，适用于劳伤、房室过度之人。
六味地黄丸、封髓丹：这两个方剂用于补阴液之不足，适用于饮食肥甘厚味之人。
煨肾丸：治疗肾虚腰痛。
组成：杜仲（炒去丝，三钱）。
用法：将上述一味药研成末。取猪肾一枚，切成五七薄片，用盐和花椒浸泡以去除腥水，将药粉撒入肾片中，用荷叶包裹，外面包多层湿纸，煨熟后，用酒送服。
立效散：玄胡索、当归、肉桂（等分）。
用法：研成细末，用酒送服。
挫气丹：治疗因气机受阻导致的腰痛。
组成：山楂子（四两，去核）、北茴香（炒，一两）。
用法：研成细末，用酒送服。
【腰胯重痛】
【病因】
风、寒、湿邪流注于经络，凝结于骨节，导致气血不和而疼痛。痰积顺着经络流注，搏结于血脉之中，也会引起同样的疼痛。
【治法】
应当利湿，散风寒，逐痰积，气血自然流畅。
除湿丹：槟榔、甘遂、赤芍药、威灵仙、泽泻、葶苈子（各二两），乳香（研，一两），没药（一两），大戟（炒，三钱），陈皮（四两）。
用法：用面糊制成丸药，也可加入牵牛子末制成丸药。
禹功散：功效同上。
【论述余义】
解除了证候分析，若出现少气懒言，似寒非寒，似热非热，似壮实非壮实，似停聚非停聚等症状，这是精气亏虚而肾邪实证的表现。治疗应用泽泻、茯苓疏泄肾中实邪，用地黄、牛膝、麦门冬补益精气。
(Attached: Swelling and pain of the waist and hips, weakness of the lower back)
[Pulse]
The pulse at the Chi position (Cun Kou method, corresponding to Kidney/Lower Jiao) is coarse and often feels hot; this is termed "Heat in the Middle" (Re Zhong). Lower back pain with a large (Hong) pulse indicates Kidney Deficiency (Shen Xu); a choppy (Se) pulse indicates Phlegm (Tan) or Blood Stasis (Yu Xue).
[Etiology]
It is primarily caused by Kidney Deficiency. There are three types: Damp-Heat (Shi Re), Blood Stasis (Yu Xue), and External Contraction (Wai Gan).
Kidney Deficiency-induced pain originates internally. Loss of will injures the Kidneys, depression and anger injure the Liver, and worry and overthinking injure the Spleen, all leading to lower back pain. This causes Qi stagnation and inability to control Blood stasis, resulting in deficiency damage and depletion of Qi and Blood. Additionally, excessive sexual activity is a common cause.
Damp-Heat also arises due to Kidney Deficiency. The Kidney belongs to Water. If Qi mechanism fails and Damp-Heat forms, it is because Kidney Water is depleted, Ministerial Fire (Xiang Huo) blazes without restraint, so Damp-Heat binds together causing pain. There are also cases of chronic exhaustion where external Dampness is contracted, and internal Heat cannot circulate, leading to blockage.
Blood Stasis results from excessive physical exertion, falling, or trauma, causing Blood stasis to stagnate and not flow.
External Contraction occurs when pathogenic factors invade due to deficiency.
Furthermore, conditions such as Wind-Kidney (Shen Feng), Heat-Kidney (Shen Re), Malaria-Kidney (Shen Nüe), and Jueyin Malaria all manifest as lower back pain.
[Symptoms]
Those caused by loss of will are deficient, characterized by insufficiency of Yuan Qi. The complexion is dark, and one cannot endure long walks or standing.
Those caused by depression and anger present with abdominal tension and hypochondriac distension, fixed gaze, diminished libido, and floating/restless mind.
Those caused by worry and overthinking present with sodden muscles, numbness and anesthesia, indigestion, and abdominal fullness.
Those caused by sexual exhaustion present with insufficient Essence and Blood, failing to nourish the body. The Classic states: "Inability to turn or sway indicates the Kidney is about to fail," known as Bone Atrophy (Gu Wei).
Those caused by Damp-Heat present with flaccid limbs, cold feet, icy cold lower back, cold sweats, seminal emission, and pain exacerbated by fanning.
Those caused by external contraction: Taiyang lower back pain radiates to the neck with heaviness in the sacrum; Yangming lower back pain prevents looking back and is associated with sadness; Shaoyang lower back pain feels like skin puncture, preventing bending forward or backward; Taiyin lower back pain involves烦热 (restlessness and heat), feeling like a horizontal log in the center, and urinary incontinence; Shaoyin lower back pain radiates inward along the spine; Jueyin lower back pain feels like a taut bowstring. Generally, Taiyang and Shaoyin channels often involve Cold; Yangming and Taiyin often involve Dryness-Dampness; Shaoyang and Jueyin often involve Wind-Heat.
[Treatment]
Qianghuo Decoction (Qianghuo Tang): Treats lower back pain.
Ingredients: Notopterygii Rhizoma et Radix (Qianghuo), Angelicae Pubescentis Radix (Duhuo), Bupleuri Radix (Chaihu), Saposhnikoviae Radix (Fangfeng), Cinnamomi Ramulus (Rougui), Angelicae Sinensis Radix (Danggui).
If sleeping in cold/damp places causes blood stasis in the Foot-Taiyang and Foot-Shaoyin collaterals, add Angelicae Sinensis Radix Tail (Guiwei), Atractylodis Rhizoma (Cangzhu), Persicae Semen (Taoren), and Stephaniae Tetrandrae Radix (Fangji). If Damp-Heat pain, add Phellodendri Cortex (Huangbai), Atractylodis Rhizoma (Cangzhu), Eucommiae Cortex (Duzhong), and Chuanxiong Rhizome (Chuanxiong). If deficiency, add Eucommiae Cortex (Duzhong), Schisandrae Fructus (Wuweizi), [missing text], Angelicae Sinensis Radix (Danggui), Anemarrhenae Rhizoma (Zhimu), and Testudinis Carapax et Plastrum (Guiban). If trauma-induced blood stasis, add Persicae Semen (Taoren), Moschus (Shexiang), Sappan Lignum (Sumu), and Hirudo (Shuizhi).
Shenqi Pill (Kidney Qi Pill), Huixiang Pill, and Lurong Pill: These three formulas tonify Yang deficiency, suitable for those with labor injuries or excessive sexual activity.
Liujun Diwan Pill (Six-Ingredient Rehmannia Pill) and Fengsui Dan: These two formulas tonify Yin deficiency, suitable for those consuming rich/greasy foods.
Wei Shen Wan (Baked Kidney Pill): Treats deficiency-type lower back pain.
Ingredients: Eucommiae Cortex (Duzhong) (stir-fried to remove silk fibers, 3 qian).
Preparation: Grind the above herb into powder. Take one pig kidney, slice thinly (5-7 slices), soak in salt and pepper water to remove fishy odor, sprinkle the powder inside, wrap in lotus leaf, wrap in several layers of wet paper, bake until cooked, and take with wine.
Lixiao San (Instant Efficacy Powder): Corydalis Rhizome (Yanhusuo), Angelicae Sinensis Radix (Danggui), Cinnamomi Ramulus (Rougui) (equal parts).
Preparation: Grind into powder, take with wine.
Cuqi Dan: Treats lower back pain due to Qi constraint.
Ingredients: Crataegi Fructus (Shanzhazhi) (4 liang, pitted), Foeniculi Fructus (Beihuixiang) (stir-fried, 1 liang).
Preparation: Grind into powder, take with wine.
[Heavy Pain in Waist and Hips]
[Etiology]
Wind, Cold, and Dampness flow into the meridians, condense in the joints, causing Qi and Blood disharmony and pain. Phlegm accumulation follows the meridians, flowing and binding within the blood vessels, causing similar pain.
[Treatment]
One should promote diuresis to drain dampness, disperse Wind-Cold, expel phlegm accumulation, allowing Qi and Blood to flow naturally.
Chushi Dan (Dampness-Expelling Pill): Areca Seed (Binglang), Kansui Root (Gansui), Red Peony Root (Chishaoyao), Spirit Flower Root (Weilingxian), Alisma Rhizome (Zexie), Lepidium Seed (Tingli), Frankincense (Ruxiang) (ground), Myrrh (Moyao) (each 1 liang), Great Thistle Root (Daji) (stir-fried, 3 qian), Tangerine Peel (Chenpi) (4 liang).
Preparation: Make pills with wheat paste, optionally adding Nigella Seed (Qianniu) powder.
Yugong San: Same indications.
[Lumbar Weakness]
[Etiology]
Latent Heat in the Liver and Kidneys.
[Treatment]
Use Phellodendri Cortex (Huangbai) and Stephaniae Tetrandrae Radix (Fangji).
[Additional Discussion]
Regarding symptom differentiation: Shortness of breath, reluctance to speak, feeling neither truly cold nor hot, neither truly strong nor weak, neither truly stagnant nor moving—these indicate Essence and Qi deficiency with Excess of Kidney Pathogens. Treatment should use Alisma Rhizome (Zexie) and Poria (Fuling) to drain Kidney excess, and Rehmanniae Radix (Dihuang), Achyranthis Bidentatae Radix (Niuxi), and Ophiopogonis Tuber (Maidong) to tonify Essence and Qi.