寶鑑Bogam

Formulas · Text · Donguibogam 東醫寶鑑

The Lumbus

Yo

한글 요문  ·  Pinyin Yao

Ten kinds of low back pain, and the single claim that the kidney stands behind them all

腰門

The Lumbus chapter is the most immediately practical in the whole book. It divides low back pain into ten kinds and gives each its own signs, causes, and formulas — and the distinguishing features are ones a clinician still asks about today: whether the pain moves or stays fixed, whether it worsens at night or after sitting, whether warmth relieves it, and whether it began with lifting. Underneath the ten sits a single organizing claim, stated at the outset: however the pain arrives, the Kidney must first be vacuous before anything can settle there.

The measurements of the lumbar circumference 腰圍度數

腰圍四尺二寸. 《靈樞》 ○腰脊者, 身之大關節也. 《靈樞》

The circumference of the lumbus is four cheok two chon (Yeongchu 靈樞). — The lumbus and spine are the great joint of the body. (Yeongchu 靈樞)
Clinical note Two lines, and the second is the one that matters: the lumbus and spine named as *the great joint* — not one joint among many but the hinge on which the body turns. Everything the chapter says afterward follows from treating the low back as a structure that bears and pivots rather than as a place where pain happens to occur.

Yeongchu 靈樞

The lumbus is the palace of the Kidney 腰爲腎府

腰者, 腎之府, 轉搖不能, 腎將憊矣. 《內經》 ○腰者, 腎之外候, 一身所恃, 以轉移開闔者也. 然諸經貫於腎, 絡於腰脊, 雖外感內傷, 種種不同, 必腎虛而後, 邪能湊之. 故不可純用涼藥, 亦不可純用參芪補氣也. 《入門》

The lumbus is the palace of the Kidney; when it can no longer turn and sway, the Kidney is about to give out (Naegyeong 內經). — The lumbus is the Kidney's outward sign, that on which the whole body relies for turning, shifting, opening, and closing. Now all the channels thread through the Kidney and net the lumbus and spine; and though external contraction and internal damage differ in a hundred ways, **the Kidney must first be vacuous, and only then can an evil gather there.** Therefore one must not use cooling medicines alone, nor supplement the Qi with ginseng and astragalus alone. (Immun 入門)
Clinical note The chapter's governing principle, and it is a claim about susceptibility rather than about cause: cold, damp, strain, and stasis can all produce back pain, but none of them settle in a lumbus that is sound. Hence the closing caution, which is really a warning against two opposite errors — treating every back pain by clearing heat, or treating every back pain by supplementing Qi. Neither addresses the ground the pain is standing on.

Naegyeong 內經 · Immun 入門

Pulse patterns 脉法

按之至骨, 脉氣少者, 腰脊痛而身有痺也. 《內經》 ○尺脉沈, 腰背痛. ○腰痛之脉, 皆沈弦. 沈弦而緊者爲寒, 沈弦而浮者爲風, 沈弦而濡細者爲濕, 沈弦而實者爲挫閃. 《脉經》 ○腰痛脉必沈而弦. 沈爲滯, 弦爲虛. 澁是瘀血, 緩者是濕, 滑者伏者是痰, 大者是腎虛也. 《丹心》

Pressing down to the bone, where the pulse Qi is scant, there is pain of the lumbus and spine and the body has impediment (Naegyeong 內經). — Where the cubit pulse is sunken, there is pain of the lumbus and back. — The pulse in lumbar pain is in every case sunken and wiry. Sunken and wiry with tightness is cold; sunken and wiry with floating is wind; sunken and wiry with sogginess and fineness is damp; sunken and wiry with repletion is wrenching strain (Maekgyeong 脉經). — In lumbar pain the pulse must be sunken and wiry: sunken means stagnation, wiry means vacuity. Rough is static blood; moderate is damp; slippery or hidden is phlegm; large is Kidney vacuity. (Dansim 丹心)
Clinical note A working table rather than a theory. Sunken and wiry is the baseline for all lumbar pain; what is added to it names the kind. The two sources overlap but do not entirely agree — the Pulse Classic reads repletion as strain, while Danxi reads roughness as stasis and largeness as Kidney vacuity — and the chapter prints both without reconciling them, which is honest.

Naegyeong 內經 · Maekgyeong 脉經 · Dansim 丹心

Lumbar pain is of ten kinds 腰痛有十

有腎虛, 有痰飮, 有食積, 有挫閃, 有瘀血, 有風, 有寒, 有濕, 有濕熱, 有氣, 凡十種.

There is Kidney vacuity, there is phlegm-rheum, there is food accumulation, there is wrenching strain, there is static blood, there is wind, there is cold, there is damp, there is damp heat, and there is Qi — ten kinds in all.
Clinical note The ten kinds, and their order is not arbitrary: Kidney vacuity comes first because the chapter has just argued that it underlies the rest. What follows in the sections below is a differential built almost entirely on the history — when the pain started, what makes it worse, whether it moves — which is exactly how a modern clinician sorts back pain before imaging. The classical categories translate more directly than one might expect: wrenching strain is a lifting injury, static blood is the pain that worsens at night, damp heat is the pain that comes on from sitting.

Donguibogam · Yo

Kidney vacuity lumbar pain 腎虛腰痛

脉大者, 腎虛腰痛也. ○腎虛者, 疼之不已者是也. 《丹心》 ○房慾傷腎, 精血不足養筋, 陰虛悠悠痛, 不能擧者, 六味地黃元, 或八味元 方幷見虛勞, 加鹿茸ㆍ當歸ㆍ木瓜ㆍ續斷. 《東垣》 ○腎虛腰痛, 宜靑娥元ㆍ加味靑娥元ㆍ壯本丹ㆍ局方安腎元ㆍ補髓丹. ○陽虛腰軟不能運用, 宜九味安腎丸ㆍ百倍丸ㆍ杜沖丸ㆍ補腎湯. ○腰軟者, 肝腎伏熱, 治用黃柏ㆍ防己. 《醫鑑》

Where the pulse is large, it is Kidney vacuity lumbar pain. — Kidney vacuity is where the aching does not let up (Dansim 丹心). — Where bedroom desire has damaged the Kidney and the essence and Blood are insufficient to nourish the sinews, the Yin being vacuous there is a long drawn-out ache and one cannot lift oneself: Yukmijihwang-won, or Palmi-won — both formulas in the Taxation chapter — with deer antler, Korean angelica, chaenomeles, and teasel root added (Dongwon 東垣). — For Kidney vacuity lumbar pain: Cheongah-won 靑娥元, Gamicheongah-won 加味靑娥元, Jangbon-dan 壯本丹, Gukbangansin-won 局方安腎元, and Bosu-dan 補髓丹. — Where the Yang is vacuous and the lumbus is soft and cannot be put to use: Gumiansin-hwan 九味安腎丸, Baekbae-hwan 百倍丸, Ducheung-hwan 杜沖丸, and Bosin-tang 補腎湯. — Where the lumbus is soft, there is hidden heat in Liver and Kidney; treat with phellodendron and stephania. (Uigam 醫鑑)
Clinical note The signature of this kind is *the aching does not let up* — no flare and no remission, a background ache that has been there for months. It is distinguished from the others less by what makes it worse than by what does not make it better. Note the sub-division that follows: pain is one thing, and a lumbus gone **soft** — unable to be put to use — is another, and gets a different shelf of formulas. That distinction between painful and merely weak is one the classical texts make more consistently than modern back-pain language does.

Dansim 丹心 · Dongwon 東垣 · Uigam 醫鑑

Phlegm-rheum lumbar pain 痰飮腰痛

脉滑者伏者是痰飮痛也. 《丹心》 ○痰飮流注經絡, 腰背疼痛, 二陳湯, 或芎夏湯 幷見痰飮, 加南星ㆍ蒼朮ㆍ黃柏, 或用控涎丹 方見痰飮. ○痰飮腰痛, 宜南星ㆍ半夏, 加快氣藥佐之. 《丹心》

Where the pulse is slippery or hidden, it is phlegm-rheum pain (Dansim 丹心). — Where phlegm-rheum flows and pours into the channels and network vessels, there is aching pain of the lumbus and back: Ijin-tang, or Gunghha-tang — both in the Phlegm chapter — with arisaema, atractylodes, and phellodendron added; or use Gongyeon-dan — formula in the Phlegm chapter —. — In phlegm-rheum lumbar pain, arisaema and pinellia are appropriate, with Qi-quickening medicines added to assist them. (Dansim 丹心)
Clinical note The one kind identified almost entirely by pulse rather than by history, which makes it the hardest to recognize without training. What the category picks out clinically is back pain in the heavy, damp-constitution patient — often with a sense of fullness rather than sharpness, and frequently in someone whose other complaints are also phlegm-type. The instruction to add Qi-quickening herbs is the practical part: phlegm does not move unless the Qi moves it.

Dansim 丹心

Food accumulation lumbar pain 食積腰痛

因醉飽入房, 濕熱乘虛入腎, 腰痛難以俛仰. 四物湯 方見血門, 合二陳湯 方見痰飮, 加麥芽ㆍ神麴ㆍ葛花ㆍ縮砂ㆍ杜沖ㆍ黃柏ㆍ官桂ㆍ枳殼ㆍ桔梗煎服. 痛甚者, 宜速效散. 《入門》

From entering the bedchamber while drunk and full, damp heat takes advantage of the vacuity and enters the Kidney, and the lumbar pain makes it hard to bend forward or lean back. Samul-tang — formula in the Blood chapter — combined with Ijin-tang — formula in the Phlegm chapter —, with barley sprout, medicated leaven, kudzu flower, amomum, eucommia, phellodendron, cassia, bitter orange husk, and platycodon added, decocted and taken. Where the pain is severe, Sokhyo-san 速效散 is appropriate. (Immun 入門)
Clinical note A category that looks strange until you read the etiology: not food accumulation in general, but the specific combination of drink, a heavy meal, and sex — after which damp heat sinks into a Kidney left open by exhaustion. What the presentation describes is back pain that arrived overnight after a night out, with difficulty bending in either direction. The kudzu flower in the formula list is the giveaway; it is the chapter's standing herb for alcohol.

Immun 入門

Wrenching strain lumbar pain 挫閃腰痛

擧重勞傷, 或挫閃墜落以作痛, 亦謂之䐴腰痛. 宜獨活湯ㆍ乳香趁痛散ㆍ如神湯ㆍ舒筋散ㆍ立安散ㆍ神麴酒.

From lifting something heavy and straining, or from a wrench or a fall producing pain — this is also called wrenched lumbar pain. Appropriate are Dokhwal-tang 獨活湯, Yuhyangjintong-san 乳香趁痛散, Yeosin-tang 如神湯, Seogeun-san 舒筋散, Ipan-san 立安散, and Singuk-ju 神麴酒.
Clinical note The acute mechanical injury, and the chapter gives it six formulas — more than any other kind except Kidney vacuity. That proportion tells you how common it was. Three of the six share the same small core of corydalis, angelica, and cinnamon heart, differing only in what is added; the tradition evidently found that combination reliable for a fresh strain, and it remains a reasonable starting point today. **Note on modern practice: back pain following a fall, or with leg weakness, numbness, or bladder or bowel changes, requires prompt medical evaluation.**

Donguibogam · Yo

Static blood lumbar pain 瘀血腰痛

跌撲墜墮, 以致血瘀腰痛. 《入門》 ○晝輕夜重者是瘀血痛也. 《丹心》 ○血瀝則腰痛, 轉側如錐之所刺. 《直指》 ○瘀血腰痛, 宜破血散疼湯ㆍ川芎肉桂湯ㆍ地龍散. 實者, 桃仁承氣湯 方見寒門. 久者, 五積散 方見寒門, 去麻黃, 加桃仁ㆍ紅花ㆍ木香ㆍ檳榔ㆍ茴香(炒). 或四物湯 方見血門, 加桃仁ㆍ蘇木ㆍ紅花(酒). ○腰連脇痛者, 復元通氣散 方見氣門, 加木香服之. 《入門》

From a stumble, a blow, or a fall, so that the blood becomes static and the lumbus pains (Immun 入門). — **Where it is light by day and heavy by night, it is static blood pain** (Dansim 丹心). — Where the blood drips and pools, the lumbus pains, and on turning to either side it is as though pierced by an awl (Jikji 直指). — For static blood lumbar pain: Pahyeolsandong-tang 破血散疼湯, Cheongungyukgye-tang 川芎肉桂湯, and Jiryong-san 地龍散. Where it is replete, Doinseunggi-tang — formula in the Cold Damage chapter —. Where it is long-standing, Ojeok-san — formula in the Cold Damage chapter — with the ephedra removed and peach kernel, safflower, aucklandia, areca nut, and dry-fried fennel added. Or Samul-tang — formula in the Blood chapter — with peach kernel, sappan wood, and wine-processed safflower added. — Where the lumbar pain extends into the flank: Bogwontonggi-san — formula in the Qi chapter — with aucklandia added. (Immun 入門)
Clinical note **Light by day and heavy by night** — six characters that do more diagnostic work than anything else in the chapter. Night-worse pain is still one of the first questions asked about a back, and the classical reading of it as stasis rather than as inflammation is different in vocabulary but not in what it selects for. The awl image is the other useful piece: pain that stabs specifically on turning, rather than aching throughout. **Note on modern practice: back pain that is worse at night, or that wakes a person from sleep, is also a red flag in modern practice for infection and malignancy, and warrants evaluation — particularly with fever, weight loss, or a history of cancer.**

Immun 入門 · Dansim 丹心 · Jikji 直指

Wind lumbar pain 風腰痛

風傷腎而腰痛者, 或左或右, 痛無常所, 引兩足强急. 五積散 方見寒門, 加防風ㆍ全蝎, 或烏藥順氣散 方見風門, 加五加皮. 痛勢甚者, 加味龍虎散. 《入門》 ○風熱腰痛, 敗毒散 方見寒門, 加續斷ㆍ天麻ㆍ木瓜ㆍ薄荷. 《得效》

Where wind has damaged the Kidney and the lumbus pains: now on the left, now on the right, **the pain keeping to no fixed place**, and drawing both legs into tension and urgency. Ojeok-san — formula in the Cold Damage chapter — with saposhnikovia and scorpion added; or Oyaksungi-san — formula in the Wind chapter — with acanthopanax added. Where the force of the pain is severe, Gamiyongho-san 加味龍虎散 (Immun 入門). — For wind-heat lumbar pain, Paedok-san — formula in the Cold Damage chapter — with teasel root, gastrodia, chaenomeles, and mint added. (Deukhyo 得效)
Clinical note Wind is identified by movement: the pain shifts sides and keeps to no fixed place. That single feature is what separates it from stasis, which stays exactly where it is. The added detail — both legs drawn tight — suggests the presentations that would now be described as radicular or as involving muscle guarding. Note that the chapter reaches for wind-dispelling formulas from other chapters rather than building its own, which is characteristic: wind is treated as wind wherever it lands.

Immun 入門 · Deukhyo 得效

Cold lumbar pain 寒腰痛

寒傷腎經, 腰痛不能轉側, 見熱則減, 遇寒則發, 脉沈弦急. 五積散, 加吳茱萸ㆍ杜沖ㆍ桃仁. 痛甚, 加黑丑頭末一錢調服. 《入門》 ○痛甚, 服加味龍虎散. 《入門》 ○代灸膏, 貼腰眼穴 方見寒門.

Where cold has damaged the Kidney channel, the lumbus pains and one cannot turn to either side; **meeting warmth it lessens, encountering cold it breaks out**, and the pulse is sunken, wiry, and urgent. Ojeok-san with evodia, eucommia, and peach kernel added. Where the pain is severe, add 1 don of the first-ground powder of black morning glory seed and take it stirred in (Immun 入門). — Where the pain is severe, take Gamiyongho-san 加味龍虎散. — Daegu-go, applied to the Yaoyan points — formula in the Cold Damage chapter —.
Clinical note The plainest of the ten to identify, and the one patients report themselves: warmth helps, cold brings it on. What the chapter adds is the pulse — sunken, wiry, and urgent — and the treatment principle, which is to warm rather than to move. The last line is worth noticing: a medicated plaster applied to the Yaoyan points, which is a heat patch on the low back by another name, and among the oldest continuously used remedies for this complaint.

Immun 入門

Damp lumbar pain 濕腰痛

久處卑濕, 雨露浸淫, 腰重痛如石, 冷如氷. 五積散, 加桃仁ㆍ吳茱萸最效. 《得效》 ○濕腰痛, 宜朮附湯ㆍ通經散. ○川芎肉桂湯 方見上, 治露宿寒濕之地, 腰痛不能轉側. 《醫鑑》 ○腎着證, 同參治之.

From long dwelling in low damp places, soaked and steeped by rain and dew, the lumbus is heavy and **pains like a stone, cold as ice**. Ojeok-san with peach kernel and evodia added is most effective (Deukhyo 得效). — For damp lumbar pain: Chulbu-tang 朮附湯 and Tonggyeong-san 通經散. — Cheongungyukgye-tang — formula above — treats lodging out overnight in a cold damp place, with lumbar pain and inability to turn to either side (Uigam 醫鑑). — Consider the Kidney Fixity pattern alongside this in treating it.
Clinical note Heavy like a stone, cold as ice — the two similes do the identifying, and they describe weight rather than sharpness. The etiology is environmental and specific: living in a low damp place, or sleeping out in one. Modern equivalents are not hard to find. The cross-reference at the end is the useful part: damp lumbar pain and the Kidney Fixity pattern in the next section overlap heavily, and the chapter says so rather than pretending they are separate.

Deukhyo 得效 · Uigam 醫鑑

Damp heat lumbar pain 濕熱腰痛

坐臥濕地, 濕入腎經, 外腎腫, 腰背曲, 痛楚甚. 用五苓散煎水 方見寒門, 入少許, 呑下靑木香元 三五十粒, 數服, 藏府微動, 腫消腰直, 其痛立止. 《得效》 ○平日膏粱厚味之人腰痛, 皆是濕熱陰虛. 《綱目》 ○濕熱腰痛者, **遇天陰, 或久坐而發者是也**. 《丹心》 ○脉緩或沈, 是濕腰痛. 《丹心》 ○濕熱腰痛, 實者, 二炒蒼柏散 方見足部, 虛者, 七味蒼柏散, 或當歸拈痛湯 方見足部. 如諸藥不效, 用三花神祐丸 方見下門, 或煨腎散下之. 《入門》

From sitting and lying on damp ground, damp enters the Kidney channel: the external kidney swells, the lumbus and back bend, and the pain is severe. Use Oryeong-san decocted in water — formula in the Cold Damage chapter —, add a little, and swallow down 30–50 pellets of Cheongmokhyang-won; after several doses the bowels stir slightly, the swelling resolves and the lumbus straightens, and the pain stops at once (Deukhyo 得效). — In one whose daily fare is rich and fatty, lumbar pain is in every case damp heat with Yin vacuity (Gangmok 綱目). — **Damp heat lumbar pain is that which breaks out in overcast weather, or after sitting a long while** (Dansim 丹心). — Where the pulse is moderate or sunken, it is damp lumbar pain (Dansim 丹心). — For damp heat lumbar pain: where replete, Ichochangbaek-san — formula in the Feet section —; where vacuous, Chilmichangbaek-san 七味蒼柏散, or Danggwiyeomtong-tang — formula in the Feet section —. Where none of the medicines take effect, use Samhwasinu-hwan — formula in the Purgation chapter —, or Oesin-san 煨腎散 to bring it down. (Immun 入門)
Clinical note Two identifying features, and both are still asked about: **worse in overcast weather, and worse after sitting a long time.** The second is the most common presentation in any modern clinic, and finding it named as its own category in 1613 is striking. The remark about rich food is the chapter's version of a metabolic observation — that back pain in the well-fed and sedentary is a different animal from back pain in the labourer — which is a distinction worth keeping.

Deukhyo 得效 · Gangmok 綱目 · Dansim 丹心 · Immun 入門

Qi lumbar pain 氣腰痛

凡人失志, 則心血不旺, 不養筋脉, 氣滯腰痛, 不能久立遠行. 七氣湯 方見氣門, 倍加茯苓, 加沈香ㆍ乳香 各少許, 煎服. 《入門》 ○憂思傷脾則腰痛, 忿怒傷肝亦作腰痛, 俱宜沈香降氣湯 方見氣門, 合調氣散, 入薑三片ㆍ棗二枚煎服. 《直指》

Whenever a person **loses their purpose**, the Heart Blood is not exuberant and does not nourish the sinews and vessels; the Qi stagnates and the lumbus pains, and one cannot stand long or walk far. Chilgi-tang — formula in the Qi chapter — with the poria doubled and a little aquilaria and frankincense added, decocted and taken (Immun 入門). — Where worry and thought have damaged the Spleen there is lumbar pain, and where indignation and anger have damaged the Liver there is likewise lumbar pain: for both, Chimhyanggangi-tang — formula in the Qi chapter — combined with Jogi-san 調氣散, with 3 slices of ginger and 2 jujubes, decocted and taken. (Jikji 直指)
Clinical note The tenth kind, and the reason to read the whole list: back pain from **losing one's purpose**. Not stress in general but a specific state — 失志, the will gone out of a person — producing Heart Blood that no longer nourishes the sinews, and a back that cannot stand long or walk far. The second passage adds worry and anger as separate routes to the same complaint. This is the same etiological move the Spirit and Womb chapters make, applied here to a musculoskeletal symptom, and it is why this chapter belongs in a discussion of stress as much as of injury.

Immun 入門 · Jikji 直指

The Kidney Fixity pattern 腎着證

病人身體重, 腰中冷如坐水, 形如水狀, 反不渴, 小便自利, 飮食如故, 腰以下冷痛, **腰重如帶五千錢**, 腎着湯主之. 《仲景》 ○大抵與濕同治.

The sick person's body is heavy; the lumbus is cold within as though sitting in water, and the form is as though waterlogged — yet on the contrary there is no thirst, the urine passes freely, and eating and drinking are as usual; below the lumbus there is cold pain, and **the lumbus is as heavy as though five thousand cash were strung about it**. Sinchak-tang 腎着湯 governs it (Jungyeong 仲景). — In the main, treat it as damp.
Clinical note One of the most quoted lines in East Asian medicine, and deservedly: *as heavy as though five thousand cash were strung about the waist.* Zhang Zhongjing's description is a complete differential in three clauses — heavy and cold below, but no thirst, normal urine, and normal appetite, which excludes the interior patterns it might otherwise resemble. What he is describing is cold damp lodged in the lumbar tissues rather than in the organ, and the formula that follows warms and dries without touching the Kidney at all.

Jungyeong 仲景 · Donguibogam · Yo

General treatment of lumbar pain 腰痛通治

六氣皆能爲痛, 大抵寒濕多而風熱少. 又有房室勞傷, 腎虛腰痛者居多, 是陽氣虛弱, 不能運動故也. 《入門》 ○久腰痛, 必用官桂以開之, 腹脇痛皆然. 《丹心》 ○諸腰痛, 不可用補氣藥, 亦不宜峻用寒涼藥. 《丹心》 ○補腎湯, 治一切腰痛 方見上.

All six Qi can produce pain, but in the main cold and damp are many while wind and heat are few. There are also those damaged by bedroom taxation, and Kidney vacuity lumbar pain is the most numerous of all — this being that the Yang Qi is vacuous and weak and cannot move things along (Immun 入門). — In long-standing lumbar pain one must use cassia to open it; the same holds for pain of the abdomen and flanks (Dansim 丹心). — **In all lumbar pain one must not use Qi-supplementing medicines, nor is it appropriate to use cold and cooling medicines aggressively** (Dansim 丹心). — Bosin-tang 補腎湯 treats every kind of lumbar pain — formula above —.
Clinical note Danxi's prohibition is the line to carry: neither supplement the Qi nor cool aggressively. Read against the chapter's opening — that the Kidney must be vacuous before an evil can settle — the two together describe a narrow path: the ground needs filling, but filling with Qi tonics does not do it, and clearing what has settled must not be done hard enough to empty the ground further. The note about cassia in chronic cases is a practical addition most practitioners end up rediscovering.

Immun 入門 · Dansim 丹心

Inauspicious signs in lumbar pain 腰痛凶證

腰痛, 面上忽見紅點, 人中黑者, 死. 《入門》

In lumbar pain, where red points suddenly appear on the face and the philtrum is black — death.
Clinical note A single line, and its function is to mark the boundary of the chapter. Red points appearing on the face with a darkened philtrum, in a patient whose complaint is back pain, told the physician that something else entirely was underway. **Note on modern practice: back pain with fever, unexplained weight loss, night pain that wakes from sleep, leg weakness, numbness in the saddle region, or loss of bladder or bowel control requires urgent evaluation — spinal infection, malignancy, and cauda equina syndrome all present as back pain first.**

Immun 入門

Guiding and pulling exercises 導引法

理腰背痛. 病人正東坐, 手抱心, 一人於前據躡其兩膝, 一人後捧其頭, 徐牽令偃臥, 頭到地, 三起三臥便差. 《得效》

To put right pain of the lumbus and back: the patient sits facing due east with the hands clasped over the heart; one person kneels in front and holds down both knees, another supports the head from behind and slowly draws the patient back to lie down until the head reaches the ground. Three risings and three lyings, and it is put right.
Clinical note A two-assistant passive extension, described precisely enough to reconstruct: knees pinned, head supported, the trunk drawn slowly backward into extension and returned, three times. Modern manual therapy does something recognizably similar for the same complaint, though usually with one clinician and a table. The instruction to face east belongs to its era; the mechanics do not.

Deukhyo 得效

Simple medicinals 單方

凡二十二種, 有固陽丹ㆍ煨腎丸. ○磁石, 補腎治腰痛. 火煆醋淬九次爲末, 水飛作丸服. 或入補腎藥皆佳. ○兎絲子, 治腰痛膝冷. 酒煮作末, 溫酒下二錢. 又兎絲子ㆍ牛膝 各一兩, 酒浸五日曝乾爲末, 酒糊丸服. 又兎絲子末二兩, 杜沖蜜灸末一兩, 山藥末酒煮爲糊作丸, 酒下五七十丸, 名固陽丹. ○牛膝, 除腰脊痛. 煮汁飮, 或酒浸服幷良. 又取嫩葉和米醬, 空心作粥服. ○石斛, 治腰痛脚弱. 煮服末服浸酒服皆佳. ○蒺藜子, 治腰脊痛. 爲末蜜丸服, 或作末和酒服幷佳. ○肉蓯蓉, 主腰痛. 作丸服之. ○續斷, 主腰痛. 煮服末服幷佳. 《本草》

Twenty-two kinds in all, including Goyang-dan and Oesin-hwan. — Loadstone supplements the Kidney and treats lumbar pain: calcine in fire and quench in vinegar nine times, powder, levigate in water and take as pills; or added to Kidney-supplementing medicines it is excellent in every case. — Cuscuta treats lumbar pain and cold knees: boil in wine and powder, take 2 don with warm wine. Also cuscuta and achyranthes, 1 nyang each, steeped in wine five days, sun-dried and powdered, bound with a wine paste into pills. Also powdered cuscuta 2 nyang with honey-roasted eucommia powder 1 nyang, bound with a paste of dioscorea powder boiled in wine; 50–70 pills with wine — this is called Goyang-dan. — Achyranthes removes pain of the lumbus and spine: boil and drink the liquid, or steep in wine; both are good. Also take the tender leaves with rice paste and eat as gruel on an empty stomach. — Dendrobium treats lumbar pain and weak legs. — Tribulus treats pain of the lumbus and spine. — Cistanche governs lumbar pain. — Teasel root governs lumbar pain.
Clinical note The first eight of the twenty-two, and the list is worth reading for what recurs rather than for any single entry. Eucommia, psoralea, cuscuta, achyranthes, cistanche, and teasel root appear again and again — through the simples, through the formulas, and through the whole chapter. Those six are the working core of classical low back treatment, and a practitioner who knows only them can build most of what this chapter contains.

Bonchō 本草

萆薢, 主䐴腰痛. 酒浸服之. 又萆薢三兩ㆍ杜沖一兩擣爲末, 空心酒服二錢, 禁食牛肉. ○威靈仙, 治腰痛. 生爲末, 酒調二錢服. 又細末二錢, 猪腰子一隻, 批藥在內, 濕紙裹煨熟, 早晨細嚼熱酒下. ○牽牛子, 治腰痛下冷膿. 半生半炒, 取頭末一兩, 入硫黃一分同硏, 分三服. ○破故紙, 治腰痛神妙. 炒爲末, 酒下二錢. ○五加皮, 治腰脊痛及䐴腰痛. 細剉酒浸服之. ○杜沖, 治腰脊痛, 又治腎勞腰脊攣. 薑汁炒爲末, 空心酒下一錢. ○橘核, 治腰痛. 微炒去殼爲末, 空心酒下二錢. ○胡桃, 治虛損腰痛. 取肉, 和杜沖ㆍ茴香浸酒, 空心服. ○芡仁, 主腰脊痛. 爲末煮粥, 空心服. ○胡麻, 治腰痛. 熬令香爲末, 以酒飮ㆍ蜜湯ㆍ薑湯調下三錢, 日三服, 卽永差. 《本草》

Dioscorea hypoglauca governs wrenched lumbar pain: steep in wine and take. Also 3 nyang with 1 nyang of eucommia, pounded and powdered, 2 don with wine on an empty stomach — beef is to be avoided. — Clematis treats lumbar pain: powder raw and take 2 don stirred into wine. Also finely powdered 2 don packed inside a pig's kidney, wrapped in damp paper and roasted through, chewed fine in the early morning and washed down with hot wine. — Morning glory seed treats lumbar pain with cold pus descending. — Psoralea treats lumbar pain with divine efficacy: dry-fry, powder, and take 2 don with wine. — Acanthopanax treats pain of the lumbus and spine, and wrenched lumbar pain. — Eucommia treats pain of the lumbus and spine, and also Kidney taxation with the lumbus and spine drawn tight: ginger-juice-fried and powdered, 1 don with wine on an empty stomach. — Tangerine seed treats lumbar pain. — Walnut treats vacuity detriment lumbar pain: take the flesh and steep in wine with eucommia and fennel. — Euryale seed governs pain of the lumbus and spine. — Sesame treats lumbar pain: roast until fragrant, powder, and take 3 don stirred into wine, honey water, or ginger decoction, three times daily — and it is permanently cured.
Clinical note The middle group, and two things stand out. The pig's kidney appears again as a delivery vehicle — the herb packed inside it, wrapped and roasted — which is the chapter's favorite preparation and rests on the doctrine that like reaches like. And psoralea gets the chapter's strongest endorsement, *divine efficacy*, for a preparation that could hardly be simpler: dry-fry, powder, take with wine.

Bonchō 本草

鹿茸, 主腰脊痛. 酥灸紫色去毛爲末, 每日空心溫酒下一錢. ○鹿角, 除腰脊痛. 熬黃爲末, 溫酒一盃調一錢, 日二服. ○羊脊骨, 治腰痛轉搖不得. 脊骨一具, 槌碎爛煮, 和五味食之, 因飮酒少許. ○黃狗肉, 煖腰膝止痛. 取淨肉, 和五味煮熟, 空心食之. ○猪腎, 治腎虛腰痛. 取腰子一枚薄批, 以椒鹽末淹過, 糝杜沖末三錢在內, 包以荷葉, 或濕紙慢火煨熟, 以酒嚼下, 名曰煨腎丸. ○又方, 童便二盞ㆍ好酒一盞ㆍ腰子一對, 盛磁缸, 黃泥封口. 日晚以慢火養熟至中夜, 待五更初以火溫之, 發甁飮酒食腰子. **此以血養血, 絶勝金石草木之藥.** 《本草》

Deer antler governs pain of the lumbus and spine. — Deer horn removes pain of the lumbus and spine. — Sheep spine treats lumbar pain with inability to turn and sway: take one whole spine, break it up and boil until tender, season with the five flavors and eat it, drinking a little wine with it. — Yellow dog meat warms the lumbus and knees and stops pain. — Pig's kidney treats Kidney vacuity lumbar pain: take one kidney, slice it thin, salt it through with pepper-salt powder, sprinkle 3 don of powdered eucommia inside, wrap in a lotus leaf or damp paper and roast through over a slow fire; chew it down with wine — this is called Oesin-hwan. — Another method: two cups of child's urine, one cup of good wine, and a pair of kidneys, put into a porcelain crock sealed at the mouth with yellow clay; from evening cook slowly through to midnight, and at the first watch before dawn warm it with fire, open the vessel, drink the wine and eat the kidneys. **This nourishes blood with blood, and far surpasses medicines of metal, stone, herb, or tree.**
Clinical note The animal simples, and they close with the chapter's boldest claim: *this nourishes blood with blood, and far surpasses medicines of metal, stone, herb, or tree.* The reasoning is the sympathetic one that runs through this whole chapter — kidney treats kidney, spine treats spine — and here it is stated as a ranking, with food-medicine placed above the entire mineral and botanical pharmacy. Whatever one makes of the theory, the practical instruction is familiar enough: a person with a worn-out back should eat well, and eat the sort of food that rebuilds.

Bonchō 本草

Acupuncture and moxibustion 鍼灸法

腰痛, 灸腎兪三七壯卽差. 《綱目》 ○腰曲不能伸, 鍼委中出血立愈. 《丹心》 ○腰背痛, 以鍼決膝腰句畫中靑赤絡脉出血便差. 《得效》 ○腰痛不得俛仰, 令患人正立, 以竹拄地度至臍斷竹, 乃以度背脊, 灸竹上頭盡處, 隨年壯. 灸訖, 藏竹勿令人知. 《資生》

For lumbar pain, moxa BL23 Sinsu twenty-one cones and it is put right (Gangmok 綱目). — Where the lumbus is bent and cannot be straightened, needle BL40 Wijung to let blood and it is cured at once (Dansim 丹心). — For pain of lumbus and back, open with a needle the blue and red network vessels within the crease at the knee and lumbus, let blood, and it is put right (Deukhyo 得效). — For lumbar pain with inability to bend forward or lean back: have the patient stand upright, set a bamboo rod on the ground and measure up to the navel, cut the bamboo there, then measure that length up the spine from below and moxa at the point where the top of the bamboo ends, as many cones as the patient's years. When the moxa is done, hide the bamboo and let no one know of it. (Jasaeng 資生)
Clinical note BL40 Wijung for a back that will not straighten is among the most-used points in all of acupuncture, and here it is with the classic instruction — needle to let blood. The bamboo measurement is the chapter's most charming entry: the patient's own navel height, transferred to the spine, locates the point. Measuring by the body rather than by a ruler is the standard classical method, and the final instruction to hide the bamboo afterward is pure folk practice and preserved here as such.

Gangmok 綱目 · Dansim 丹心 · Deukhyo 得效 · Jasaeng 資生

神仙灸法, 治腰痛, 灸曲䐐兩文頭左右脚四處各三壯. 每灸一脚, 二火齊下, 艾炷纔燒至肉, 初覺痛, 便用二人兩邊齊吹至火滅. 午時着灸, 至人定已來, 藏府自動一二行, 或轉動如雷聲, 其疾立愈. 此法神效. 《綱目》 ○腎虛腰痛, 取腎兪ㆍ人中ㆍ委中ㆍ肩井. ○挫閃腰痛, 取尺澤(勿灸)ㆍ委中ㆍ人中ㆍ陽陵泉ㆍ束骨ㆍ崑崙ㆍ下髎ㆍ氣海. ○腰痛, 崑崙ㆍ委中出血. 又取腎兪ㆍ中膂兪ㆍ腰兪. ○腰强痛, 命門ㆍ崑崙ㆍ志室ㆍ行間ㆍ復溜. 《綱目》

The Divine Immortal moxa method treats lumbar pain: moxa three cones at each of four places, at the two ends of the crease behind the knee, left leg and right. For each leg the two fires are set down together; as soon as the moxa cone burns down to the flesh and pain is first felt, two people blow from either side together until the fire is out. Apply the moxa at midday, and by the time people have settled for the night the bowels stir of themselves once or twice, or turn over with a sound like thunder — and the illness is cured at once. This method has divine efficacy (Gangmok 綱目). — For Kidney vacuity lumbar pain: BL23 Sinsu, GV26 Insu, BL40 Wijung, GB21 Gyeonjeong. — For wrenching strain lumbar pain: LU5 Cheokdaek (do not moxa), BL40 Wijung, GV26 Insu, GB34 Yangneungcheon, BL65 Sokgol, BL60 Gonryun, BL34 Haryo, CV6 Gihae. — For lumbar pain: bleed BL60 Gonryun and BL40 Wijung; also BL23 Sinsu, BL29 Jungnyeosu, GV2 Yosu. — For lumbar rigidity and pain: GV4 Myeongmun, BL60 Gonryun, BL52 Jisil, LR2 Haenggan, KI7 Bongnyu.
Clinical note The point prescriptions at the end are the practical core, and they are still teachable: Sinsu and Wijung for the deficient back, Wijung and Insu with the ankle points for the acute wrench, and the note **do not moxa LU5** — one of the chapter's few explicit contraindications. The Divine Immortal method above is worth reading for the choreography alone: two fires lit together, two people blowing them out in unison the moment pain is felt, applied at noon so that the effect arrives by nightfall.

Gangmok 綱目