郭心鸽 姚欣艳 刘侃 杨志松 卓丹 史德禄

〔摘要〕 多种疾病均可以导致腰痛。腰痛常见于脊椎疾病、脊椎旁软组织疾病、神经系统疾病和某些内脏疾病，如腰肌劳损、腰椎间盘突出症、肾脏疾病、妇科疾病等。国医大师熊继柏辨病辨证相结合治疗腰痛，临证细辨虚实、寒热、气血，将腰痛病分为5种证型，寒湿腰痛常用羌活胜湿汤或肾着汤;湿热腰痛常用加味二妙散或四妙散;气滞腰痛常用复元通气散;血瘀腰痛常用身痛逐瘀汤;肾虚腰痛常用青娥丸，阴虚者合用左归饮或知柏地黄丸，阳虚者合用右归饮或肾气丸。

〔关键词〕 熊继柏;腰痛;腰椎管狭窄;肾炎;腰椎间盘突出症;四妙散;通气散;身痛逐瘀汤

〔中图分类号〕R274.9       〔文献标志码〕B       〔文章编号〕doi：10.3969/j.issn.1674-070X.2021.07.002

〔Abstract〕 Many diseases can cause low back pain. Low back pain is common in spine diseases， paravertebral soft tissue diseases， neurological diseases and certain internal organ diseases， such as lumbar muscle strain， lumbar disc herniation， kidney disease， gynecological diseases， etc. The master of traditional Chinese medicine Xiong Jibo treats low back pain by combining disease differentiation and syndrome differentiation. The low back pain is divided into five types of syndromes acording to deficiency and excess， cold and heat， Qi and blood. Cold-damp low back pain usually uses Qianghuo Shengshi Decoction or Shenzho Decoction; damp-heat low back pain commonly uses Supplemented ErMiao Powder or Simiao Powder; Fuyuan Tongqi Powder for low back pain with stagnation of Qi; Shentong Zhuyu Decoction for low back pain with blood stasis; Qing'e Pill for low back pain with kidney deficiency， Zuogui Yin or Zhibai Dihuang Pill for Yin deficiency， Yougui Yin or Shenqi Pills for Yang deficiency.

〔Keywords〕 Xiong Jibo; low back pain; lumbar spinal stenosis; nephritis; lumbar intervertebral disc herniation; Simiao Powder; Tongqi Powder; Shentong Zhuyu Decoction

腰痛是因感受外邪或跌仆閃挫引起的腰部气血运行不畅，或因肾虚引起腰部失于濡养所致的以腰部一侧或两侧疼痛为主要症状的一类病证[1]。腰痛常见于脊椎疾病、脊椎旁软组织疾病、神经系统疾病和某些内脏疾病，如腰肌劳损、腰椎间盘突出症、肾脏疾病、妇科疾病等。国医大师熊继柏是湖南中医药大学教授，主任医师，博士研究生导师，湖南中医药大学第一附属医院特聘中医学术顾问、终身教授。熊教授行医六十余载，并从事中医教学三十余年，临证经验丰富，德艺双馨。他通晓中医经典，善于辨证施治，因证选方，因方用药，理法方药丝丝入扣。笔者兹将熊继柏教授关于腰痛的证治经验整理成文，以飨读者。

1 病因病机