腰者，肾之所附，肾气虚而邪客之，则能作痛。邪者，风热湿燥寒也，大抵寒湿多而风
热少，有
风有湿，有寒有热，有挫闪，有瘀血，有滞气，有痰积。风伤肾而痛，其脉必带浮，或左或
右，痛无常处
，牵引两足，宜五积散。每服加防风五分，或加全蝎三个尤好，小续命汤、独活寄生汤，皆
可选用
，仍合三仙丹。杜仲姜汁炒研末，每一钱空心温酒调服，名杜仲酒，治肾气腰痛，兼治风冷
为患。
伤湿而痛，如坐水中，盖肾属水，久坐水湿处，或为两露所着，湿流入足太阳经，以致腰痛
，其
脉必带缓，遇天阴或久坐必发，身体必带迟重，宜渗湿汤主之。不效。宜肾着汤，或生附汤
。
感寒而痛者，腰间如水，其脉必紧，见热则减，见寒则增，宜五积散去桔梗，加吴茱萸五分
，
或姜附汤
加辣桂、杜仲主之。伤热而痛者，脉必洪数而滑，发渴便闭，宜甘豆汤加续断、天麻。间服
败毒散
，若因挫闪，或 扑伤损而痛者，宜乳香趁痛散，及黑神散，和复元通气散，酒调下。不效
，则必有恶
血停滞，宜先用酒调服苏合香丸，以五积散加大黄五分，苏木五分，当归倍元散。若因劳役
负重
而痛，宜用和气散，或普贤正气散。杨仁斋云∶劳力而痛，宜十补汤下青娥丸。瘀血为痛，
其脉必
涩，转侧若锥刀之刺，大便黑，小便赤或黑，日轻夜重，名沥血腰痛。宜苏沉麝香丸，及桃
仁酒调
黑神散，或四物汤加桃仁、红花、枳壳、乌药之属。丹溪用补阴丸中加桃仁、红花主之。气
滞而痛，其脉
必沉，若郁闷而不伸，宜人参顺气散，乌药顺气散加五加皮、木香、甘草少许，煎汤调下
。痰注而痛，其脉必滑或伏，宜二陈汤加南星、香附、枳壳主之。大抵诸腰痛皆起于肾
虚，既挟邪气，则须除其邪，如无外邪积滞而自痛，则惟补肾而已
。腰肢
痿弱，身体疲倦，脚膝酸软，脉或洪或细而皆无力。(脉细便清为阳虚，重按必沉而无力。)
是其候也。亦分寒热二症。脉细而无力，怯怯短气，小便清利，是为阳虚。宜肾气丸、
茴香丸，并戴复庵法，以大
建中汤加
川椒十粒，下腰肾丸，及生料鹿茸丸之类，仍以猪腰切作薄片，勿令断，层层掺炒茴香末，
湿纸
裹煨熟，细嚼酒下，此所以补阳之不足也。脉洪大而无力，(脉洪大无力为阴虚。其小便必
黄赤。)
小便黄赤，虚火时炎，是为阴虚。东垣所谓膏粱之人，久服汤药，醉以入房，损其真气，则
肾气
热，肾气热则腰脊痛不能举，久则髓减骨枯，发为骨痿。宜六味地黄丸、滋肾丸、封髓丹之
类，治阴之不足也。
杨仁斋云∶经曰，腰者肾之府，转摇不能，肾将惫矣。审如是，则病在少阴，
必究其受病之源而处之为得。虽然，宗筋聚于阴器，胀者肾之同系也。五脏皆取气于谷，脾
者，肾之仓廪也。郁怒伤肝，则诸经纵弛，忧思伤脾，则胃气不行，二者皆能为腰痛之寇，
故并
及之。郁怒伤肝，发为腰痛，宜调肝散主之。忧思伤脾，发为腰痛，宜沉香降气汤，和调气
散，姜枣煎主
之。又有沮挫失志伤肾而痛者，和剂七气汤，多加白茯苓，少加沉香、乳香主之。《保命集
》云∶煨
肾丸，治肝肾损及脾损，谷不化，腰痛不起者，神效。疟痢后腰痛，及妇人月经行后腰痛，
俱属虚，宜补
之，于气血药加杜仲、侧柏叶主之。丹溪云∶久腰痛必用官桂开之方止，腹胁痛亦然。
橘香丸治腰痛，经久不瘥，用官桂，亦开之意也。
腰为肾府，若肾气虚，随六淫之邪为转移则痛作，调其荣卫，损有余，补不足，究其致
痛之由，而治之为得也。
腰部是肾脏所依附的部位，肾气虚弱而邪气侵袭，就会导致疼痛。所谓的邪气，是指风、热、湿、燥、寒五种外邪，大体上寒湿多见而风热少见。病因包括有风、有湿、有寒、有热、有挫闪（外力扭伤）、有瘀血、有滞气、有痰积。
若风邪伤肾引起腰痛，脉象必然带浮，疼痛部位或左或右，没有固定位置，并牵引至两足，适宜使用五积散（一种解表温里、养血祛风的方剂）。每服加防风五分，或者加全蝎三个效果更好，小续命汤（治疗中风及风湿痹痛的方剂）、独活寄生汤（祛风湿、止痹痛、益肝肾、补气血的方剂）也都可选用，同时配合服用三仙丹（一种成药）。杜仲用姜汁炒后研成粉末，每次一钱，空腹时用温酒调服，名为杜仲酒，治疗肾气腰痛，兼治风冷为患。
因湿邪受伤而痛，感觉像坐在水中一样，因为肾属水，久坐在水湿之处，或被两露（早晚露水）所侵，湿气流入足太阳膀胱经，导致腰痛，其脉象必然带缓，遇到阴天或久坐必定发作，身体必然感觉沉重迟缓，适宜用渗湿汤（利水渗湿的方剂）主治。如果无效，宜用肾着汤（温脾胜湿的方剂），或者生附汤（温阳散寒的方剂）。
感受寒邪而痛者，腰部感觉像有水一样冷，其脉象必然紧，遇热则减轻，遇寒则加重，适宜用五积散去桔梗，加吴茱萸五分，或者用姜附汤（温中散寒的方剂）加辣桂（肉桂）、杜仲主治。
感受热邪而痛者，脉象必然洪数而滑，伴有口渴、大便闭塞，适宜用甘豆汤（清热解毒的方剂）加续断、天麻。间服败毒散（益气解表、散风祛湿的方剂）。如果是因挫闪或扑跌损伤而痛，适宜用乳香趁痛散（活血止痛的方剂），以及黑神散（化瘀生新的方剂），和复元通气散（行气活血的方剂），用酒调服。如果无效，则必有恶血停滞，适宜先用酒调服苏合香丸（开窍醒神的方剂），再用五积散加大黄五分、苏木五分、当归倍于原方用量。
如果是因劳役负重而痛，适宜用和气散（调和气机的方剂），或者普贤正气散（理气化痰的方剂）。杨仁斋说：劳力而痛，适宜用十补汤送服青娥丸（补肾强腰的方剂）。
瘀血引起的疼痛，其脉象必然涩，转身侧卧时像锥刀刺入一样疼痛，大便色黑，小便色赤或黑，白天轻晚上重，名为沥血腰痛。适宜用苏沉麝香丸（行气活血开窍的方剂），以及桃仁酒调服黑神散，或者四物汤（补血调血的方剂）加桃仁、红花、枳壳、乌药之类。朱丹溪用补阴丸（滋阴降火的方剂）中加桃仁、红花主治。
气滞引起的疼痛，其脉象必然沉，表现为郁闷而不舒展，适宜用人参顺气散（益气顺气的方剂），乌药顺气散加五加皮、木香、甘草少许，煎汤调服。
痰注引起的疼痛，其脉象必然滑或伏，适宜用二陈汤（燥湿化痰的方剂）加南星、香附、枳壳主治。
大体上各种腰痛都起因于肾虚，既然夹杂了邪气，就必须祛除邪气；如果没有外邪积滞而自行疼痛，那就只需补肾而已。
腰肢痿弱，身体疲倦，脚膝酸软，脉象或洪大或细弱但都无力。（脉细且小便清长为阳虚，重按必沉而无力。）这是其征候。也分为寒热两种证型。
脉细而无力，怯懦短气，小便清利，这是阳虚。适宜用肾气丸（温补肾阳的方剂）、茴香丸，并参考戴复庵的方法，以大建中汤（温中补虚的方剂）加川椒十粒，送服腰肾丸，以及生料鹿茸丸（温补肾阳的方剂）之类。仍然将猪腰切成薄片，不要切断，层层撒上炒过的茴香末，用湿纸包裹煨熟，细细咀嚼后用酒送下，这就是用来补充阳气不足的方法。
脉洪大而无力（脉洪大无力为阴虚。其小便必然黄赤），小便黄赤，虚火时常炎上，这是阴虚。李东垣所说的那些吃精细食物的人，长期服药，醉酒后行房事，损伤真气，导致肾气热，肾气热则腰脊疼痛不能举动，时间久了则髓减骨枯，发为骨痿。适宜用六味地黄丸（滋补肾阴的方剂）、滋肾丸（泻火坚阴的方剂）、封髓丹（降火固精的方剂）之类，治疗阴液的不足。
杨仁斋说：《内经》记载，腰是肾的府邸，转动摇晃不能自如，说明肾即将衰惫了。确实如此，那么病在少阴经，必须追究受病的根源来处方用药才算得当。虽然如此，宗筋聚集于阴器，胀满也是肾的同系病症。五脏都从谷物中摄取精气，脾是肾的仓廪。郁怒伤肝，则诸经纵弛；忧思伤脾，则胃气不行，这两者都能成为导致腰痛的祸害，所以一并提及。
郁怒伤肝，引发腰痛，适宜用调肝散主治。忧思伤脾，引发腰痛，适宜用沉香降气汤，和调气散，加姜枣煎煮主治。又有因沮丧失意伤肾而痛者，用和剂七气汤（行气散结的方剂），多加白茯苓，少加沉香、乳香主治。《保命集》说：煨肾丸，治疗肝肾亏损波及脾脏亏损，食物不消化，腰痛起不来的人，效果神奇。疟疾痢疾后的腰痛，以及妇女月经行经后的腰痛，都属于虚证，适宜补益，在气血药中加入杜仲、侧柏叶主治。
朱丹溪说：久腰痛必须用官桂（肉桂）开通气机才能停止，腹胁痛也是如此。橘香丸治疗腰痛，经久不愈，使用官桂，也是开通的意思。
腰是肾的府邸，如果肾气虚弱，随着六淫（风、寒、暑、湿、燥、火六种外感病邪）之邪的变化而转移，就会发作疼痛，调理其营卫，损有余而补不足，探究导致疼痛的原因，从而进行治疗才算得当。
The waist is the area where the Kidney resides. When Kidney Qi is deficient and pathogenic factors invade, pain occurs. The so-called pathogenic factors refer to Wind, Heat, Dampness, Dryness, and Cold. Generally, Cold-Dampness is more common than Wind-Heat. Etiologies include presence of Wind, Dampness, Cold, Heat, sprain/strain (traumatic injury), blood stasis, Qi stagnation, and Phlegm accumulation.
If Wind pathogen injures the Kidney causing lumbar pain, the pulse must be floating. The pain may be on the left or right, has no fixed location, and radiates to both legs. Wuji San (Cinnamon Twig and Atractylodes Macrocephala Decoction) is suitable. Add Fangfeng (Saposhnikovia Root) 5 fen per dose, or add Quanxie (Scorpion) 3 pieces for better effect. Xiaoxuming Tang (Minor Xu-Bi Decoction) and Duhuo Jisheng Tang (Angelica Pubescens and Sangjisheng Decoction) are also selectable options, used in conjunction with Sanxian Dan (Three Immortals Pill). Chuzhong (Eucommia Bark) stir-fried with ginger juice and ground into powder, taken as 1 qian per dose with warm wine on an empty stomach, named Chuzhong Wine, treats Kidney Qi lumbar pain and concomitant Wind-Cold conditions.
Pain caused by Dampness injury feels like sitting in water. Since the Kidney belongs to Water, long-term sitting in damp places or exposure to morning/evening dew allows Dampness to flow into the Foot-Taiyang Bladder Meridian, causing lumbar pain. The pulse must be slow. It triggers on cloudy days or after prolonged sitting, accompanied by a heavy and sluggish body sensation. Shenshi Tang (Dampness-Penetrating Decoction) is the primary treatment. If ineffective, use Shen Zhuo Tang (Kidney Fixation Decoction) or Shengfu Tang (Raw Aconite Decoction).
Pain from Cold invasion feels like water in the waist. The pulse must be tight. Pain decreases with heat and increases with cold. Use Wuji San removing Jiegeng (Platycodon Root), adding Wuzhuyu (Evodia Fruit) 5 fen. Alternatively, use Jiangfu Tang (Ginger and Aconite Decoction) with Lagui (Cassia Twig/Eucommia) and Chuzhong (Eucommia Bark).
Pain from Heat invasion presents with a surging, rapid, and slippery pulse, thirst, and constipation. Gandou Tang (Mung Bean Decoction) added with Xuduan (Dipsacus Root) and Tianma (Gastrodia Rhizome) is suitable. Intermittently use Baidu San (Defeat Toxin Powder). For pain due to sprains or falls, Ruxiang Chen Tong San (Frankincense Pain-Alleviating Powder), Heishen San (Black Divine Powder), and Fuyuan Tongqi San (Restore Origin and Unblock Qi Powder) mixed with wine are appropriate. If ineffective, there is likely stagnant evil blood. First, take Suhexiang Wan (Styrax Pill) with wine. Then use Wuji San with Dahuang (Rhubarb Root) 5 fen, Sumu (Sappan Wood) 5 fen, and Danggui (Angelica Sinensis) doubled.
For pain due to labor and heavy lifting, Heqi San (Harmonize Qi Powder) or Puxian Zhengqi San (Pu Xian Healthy Qi Powder) is suitable. Yang Renzhai stated: For pain from physical exertion, Shibu Tang (Ten Tonics Decoction) with Qing'e Wan (Green Youth Pill) is appropriate.
Pain from blood stasis presents with a choppy pulse. Turning or side-lying feels like stabbing with awls or knives. Stool is black, urine is red or black. Pain is lighter during the day and heavier at night, named Lixue Lumbar Pain. Suschen Muxiang Wan (Su Chen Musk Fragrance Pill) or Taoren (Peach Kernel) wine-mixed Heishen San is suitable. Or Siwu Tang (Four Substances Decoction) added with Tao Ren (Peach Kernel), Honghua (Safflower), Zhike (Bitter Orange), and Wuyao (Lindera Root). Zhu Danxi treated it with Buyin Wan (Tonify Yin Pill) added with Tao Ren and Honghua.
Pain from Qi stagnation presents with a deep pulse, feeling depressed and unrelieved. Renshen Shunqi San (Ginseng Smooth Qi Powder) or Wuyao Shunqi San (Lindera Smooth Qi Powder) added with Wujia Pi (Acanthopanax Bark), Muxiang (Costus Root), and Gancao (Licorice Root) in small amounts, decocted and taken as soup, is suitable.
Pain from Phlegm infiltration presents with a slippery or hidden pulse. Erchen Tang (Two Aged Ingredients Decoction) added with Nanxing (Arisaema Rhizome), Xiangfu (Cyperus Rhizome), and Zhike is suitable.
Generally, all lumbar pains originate from Kidney deficiency. Since they involve pathogens, the pathogens must be removed. If there is no external pathogen or accumulation and pain occurs spontaneously, only tonifying the Kidney is required.
Symptoms include weak waist and limbs, body fatigue, sore and weak knees and feet. The pulse may be surging or fine but always powerless. (A fine pulse with clear urination indicates Yang deficiency; heavy pressing reveals a deep and powerless pulse.) These are its signs. It is divided into Cold and Heat syndromes.
A fine, powerless pulse, timidity, shortness of breath, and clear urination indicate Yang deficiency. Shenyang Wan (Kidney Yang Pill), Huixiang Wan (Fennel Pill), following Dai Fu'an's method using Da Jianzhong Tang (Major Construct the Middle Decoction) with Chuanjiao (Sichuan Pepper) 10 grains, followed by Yao Shen Wan (Waist-Kidney Pill) and Shenglu Rong Wan (Fresh Deer Antler Pill) are suitable. Also, slice pig kidneys thinly without cutting through, layer with stir-fried Huixiang (Fennel) powder, wrap in wet paper, bake until cooked, chew thoroughly, and swallow with wine. This supplements insufficient Yang.
A surging, large, yet powerless pulse (indicates Yin deficiency; urine must be yellow/red) with yellow/red urine and intermittent deflagration of deficient fire indicates Yin deficiency. Li Dongyuan described that those who consume rich foods, take medicines long-term, and engage in intercourse while drunk damage their True Qi, causing Kidney Heat. Kidney Heat leads to lumbar and spinal pain preventing movement. Long-term results in marrow depletion and bone withering, manifesting as Bone Wei (Atrophy Syndrome). Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), Zishen Wan (Nourish Kidney Pill), and Fengsui Dan (Seal Marrow Pill) are suitable to treat insufficient Yin.
Yang Renzhai said: The Classic states, "The waist is the mansion of the Kidney. Inability to turn or shake indicates the Kidney is failing." Indeed, the disease is in the Shaoyin channel. One must investigate the source of the disease to prescribe appropriately. Although, the Zongjin (Tendons) gather at the genitalia, distension is also related to the Kidney system. The Five Zang organs derive Qi from grain; the Spleen is the granary of the Kidney. Anger injures the Liver, causing meridians to relax; worry/sorrow injures the Spleen, causing Stomach Qi to stagnate. Both can cause lumbar pain, hence mentioned together.
Anger injuring the Liver causing lumbar pain is treated with Tiaogan San (Regulate Liver Powder). Worry/Sorrow injuring the Spleen causing lumbar pain is treated with Chenxiang Jiangqi Tang (Aquilaria Descending Qi Decoction) and Tiaoqi San (Regulate Qi Powder), decocted with Ginger and Jujube. Pain from frustration/injury to the Kidney is treated with Heji Qi Qi Tang (Formula Seven Qi Decoction) with increased Baifuling (Poria) and decreased Chenxiang (Aquilaria Wood) and Ruxiang (Frankincense). Baoming Ji states: Weishen Wan (Baked Kidney Pill) is miraculous for treating Liver/Kidney damage affecting the Spleen, indigestion, and inability to rise from lumbar pain. Lumbar pain after malaria/dysentery or post-menstrual lumbar pain in women belong to deficiency and should be tonified. Add Chuzhong (Eucommia Bark) and Cebaiye (Biota Top Leaf) to Qi and Blood formulas.
Zhu Danxi said: Chronic lumbar pain requires Guanzi Gui (Cassia Twig) to open the pathway to stop pain; abdominal/flank pain is similar. Ju Xiang Wan (Citrus Fragrance Pill) treats chronic lumbar pain not healing, using Guanzi Gui, which implies opening the pathway.
The waist is the mansion of the Kidney. If Kidney Qi is deficient, it shifts with the Six Evils (Wind, Cold, Summer-heat, Dampness, Dryness, Fire), causing pain. Regulate Ying and Wei, reduce excess, tonify deficiency, investigate the cause of pain, and treat accordingly for optimal results.