《黃帝內經素問補註釋文》Vol. 25

The chapter is titled “On Needling for Lower Back Pain.” It describes how to select points and apply acupuncture for lower back pain according to the particular channel involved. The main text in this section comes from the Suwen. Its commentary was written by Wang Bing of the Tang dynasty, who used the title Qixuanzi, and was later collated by Lin Yi and others during the Song dynasty.

Lower back pain of the Foot Taiyang channel: Pain associated with the Foot Taiyang Bladder channel may pull into the neck, back, and buttocks, while the person feels heaviness in the back, as though something were pressing down on it. The commentary explains that a branch of the Foot Taiyang channel descends through the neck, runs along the inner side of the shoulder blade, follows the spine to the lower back, and then passes through the buttocks. When the channel is obstructed, it can therefore cause pain that pulls into the neck, spine, buttocks, and back. The collators add that in the Jiayi jing, “passes through the buttocks” is written as “passes through the muscles beside the spine”; the commentary to the chapter “On Needling for Malaria” also uses “muscles beside the spine,” while the commentary to “On the Three Regions and Nine Indicators” has “buttocks.”

The treatment is to needle the hollow at the back of the knee, known as Xizhong, or Weizhong, and to bleed the main Taiyang channel. Do not bleed it in spring. Weizhong lies in the middle of the hollow behind the knee, where a pulse can be felt. It is the point where the channel’s Qi enters. The needling depth is about five fen, measured in proportional body inches, and the needle is retained for seven breaths. If moxibustion is used, apply three cones of moxa; one moxa cone is counted as one treatment unit. The reason for avoiding bloodletting in spring is that the Taiyang channel is associated with the Kidneys. Kidney Qi is vigorous in winter and wanes in spring, so bleeding at that time may further deplete it.

Lower back pain of the Foot Shaoyang channel: Pain associated with the Foot Shaoyang Gallbladder channel feels like needles pricking the skin and comes in intermittent waves. The phrase xunxun ran describes a gradual, on-and-off sensation. The person cannot bend forward or backward, or turn to look around. The commentary says that the Foot Shaoyang channel circles the hairline and runs across the hip joint, where the thighbone meets the pelvis. This accounts for the needle-like pain and difficulty bending. The channel begins at the outer corner of the eye, rises to the temple, then descends behind the ear and travels around the head. It passes in front of the Hand Yangming channel and emerges on the shoulder behind the Hand Shaoyang channel. A branch descends from the outer corner of the eye to the Daying point, joins the Hand Shaoyang channel below the cheek, then runs down by the jaw to the neck and converges at the clavicular hollow. Because the channel runs through the neck, the person cannot turn the head. The collators note that in the Jiayi jing, “passes in front of the Hand Yangming channel” reads “passes in front of the Hand Shaoyang channel.”

The treatment is to needle the end of the “forming bone” on the Shaoyang channel and let it bleed. Do not bleed it in summer. “Forming bone” refers to the prominent bone on the outer side of the knee. More precisely, it is the area below the outer knee where the two raised parts at the upper end of the shinbone lie alongside one another, with a hollow between them that can hold a fingertip. The bone supports and connects the knee to the thighbone, hence the name “forming bone.” The reason for avoiding bloodletting in summer is that the Shaoyang channel is associated with the Liver, which governs spring. The Wood phase wanes as summer arrives, so bleeding then is inadvisable.

When the Foot Yangming Stomach Channel becomes diseased, it causes lower back pain and prevents the person from turning around. When they do turn, they seem to catch sight of something and are prone to sadness.

The Foot Yangming channel begins where the channels meet beside the nose. It descends along the outer sides of the nose, enters the upper gums, then turns back, passes beside the mouth, and circles the lips before meeting at the Chengjiang point beneath the chin. From there it runs down the back of the jaw to the Daying point. One branch descends from the front of Daying, passes through the Renying point, follows the throat, and enters the supraclavicular fossa. Another branch begins at the lower opening of the Stomach, descends along the inner side of the abdominal cavity, joins the channel at Qijie, and then continues down through the thigh. Thus, disease in the Foot Yangming channel causes lower back pain and prevents the person from turning around. The sensation of seeming to see something when turning is due to weakness of Yang Qi, which makes the person prone to sadness.

Needle three points along the front of the lower leg on the Yangming channel, and regulate the Qi of the channels above and below. Bloodletting may be used, but do not bleed in autumn.

According to the diagrams and explanations of channel flow in the Neijing, this type of lower back pain treated through Yangming channel points should be treated by needling three points on the front of the lower leg: namely, Zusanli. Zusanli is three cun below the knee, between two muscles at the outer edge of the shinbone. The needle may be inserted one cun and retained for seven breaths; alternatively, apply three moxa cones. The Yangming channel joins the Spleen, which belongs to Earth. Earth Qi is vigorous in late summer and weakens in autumn, so bloodletting is unsuitable in autumn.

The collator’s note says: According to the Jiayi Jing, the character heng here should read gan.

When the Foot Shaoyin Kidney Channel becomes diseased, it causes lower back pain that pulls toward the inner side of the spine.

The Foot Shaoyin channel runs upward along the back edge of the inner thigh, passes through the spine, and connects with the Kidney. Thus, disease in this channel causes lower back pain that pulls toward the inner side of the spine. The collator’s note says: In the Quan Yuanqi recension, “inner edge of the spine” should read “pain within the spine”; the Taisu has the same reading. The passage lacks the description of the Foot Taiyin pattern of lower back pain and the method for needling the Foot Taiyin channel. A short section was probably omitted during the copying of the ancient text.

Needle two points on the Foot Shaoyin channel above the inner ankle, and do not bleed in spring. If too much blood is drawn, the condition cannot be restored.

According to the diagrams and explanations of channel flow in the Neijing, this type of lower back pain treated through Shaoyin channel points should be treated by needling Fuliu above the inner ankle. Fuliu lies two cun above and behind the inner ankle, in a hollow where a pulse can be felt. The needle may be inserted three fen and retained for three breaths; alternatively, apply five moxa cones.

When the Foot Jueyin Liver Channel becomes diseased, it causes lower back pain, with the waist feeling as though it were taut like a bowstring.

The Foot Jueyin channel curves around the genitals along the inner thigh and reaches the lower abdomen. One of its branches…

One kind of low back pain arises from the Foot Jueyin channel (Liver channel) as it passes through the lower back and beneath the hip, running alongside the spine near the third and fourth sacral foramina. These areas correspond to the Zhongliao and Xialiao points. When the pain strikes, the lower back becomes stiff and cramped, like a bowstring pulled taut.

For treatment, look for the vessels along the posterolateral side of the lower leg, near the heel, on the Foot Jueyin channel. “Fish belly” describes the way the calf muscle resembles a fish’s belly. Feel along the divisions between the muscles for distinct blood vessels, then needle them to let blood. This location roughly corresponds to the Ligou point, the connecting point of the Foot Jueyin Liver channel, five cun above the inner ankle. Its connecting channel branches off here and links to the Foot Shaoyang Gallbladder channel. The needle may be inserted two fen and retained for three breaths; alternatively, apply three moxa cones. In the classical text, “Juyin” is likely a copying error for “Jueyin,” the two characters having similar written forms.

If a person with low back pain speaks abnormally and is dazed or unclear-minded, needle the relevant area of the Foot Jueyin channel three times. The channel passes behind the throat, rises to the nasopharynx, and connects with the root of the tongue. For this reason, classical commentators held that illness in the channel could affect speech; an excess of pathogenic wind, meanwhile, could make a person dazed and confused. After three needling treatments, the low back pain may be relieved.

Textual editors point out that “speaks readily” seems to contradict “silent, dazed, and uncomprehending,” making it difficult for both descriptions to apply at once. The Quan Yuanqi edition omits the word “readily,” which makes the passage read more smoothly. According to the Jia Yi Jing, moreover, the Jueyin channel does not connect with the root of the tongue. In his commentaries on other chapters of the Suwen, Wang Bing sometimes says that the channel “connects with the root of the tongue” and sometimes does not, perhaps reflecting his own uncertainty on this point.

When low back pain is caused by a dispersed vessel—a vessel that runs separately and does not join the main channel—the pain pulls toward the shoulder and is accompanied by blurred vision and occasional involuntary urination. The channel described here is the Foot Taiyang channel (Bladder channel). It begins at the inner corner of the eye, rises to the forehead and meets at the crown, then runs over the shoulder blades and down alongside the spine to the lower back. It enters the muscles on either side of the spine, connects with the kidneys, and pertains to the bladder; from there it descends into the hollow behind the knee…

Because the disorder lies in the middle of the lumbar region, these symptoms occur. Another branch vessel separates from the inner side of the shoulder blade, descends through the back muscles, and runs along the outer rear edge of the thigh to join the hollow behind the knee. The two vessels separate like strands of a rope and then come together again, so they are called the “Branching Vessel.”

To needle the Branching Vessel, prick the vessels for bleeding in the gaps on the inner side of the knee tendons, where a horizontal vessel runs along the outer edge of the hollow behind the knee. Stop the bleeding when the blood, initially its original color, turns red.

On either side behind the knee are large tendons that extend upward along the back of the thigh. The transverse crease between these tendons, where the muscles bulge, marks the boundary of the hollow behind the knee. The Ancient Proclamation says that the hollow behind the knee is the Xi point of the Foot Taiyang channel, where the channel’s Qi and blood gather deeply. When needling, select the visible horizontal vessel along the outer edge of the hollow. If it is clearly purple-black and engorged, prick it for bleeding. The blood released should be black; wait until it turns red before stopping. If its color does not turn red, continue bleeding until it does. This is one form of lower-back pain caused by a disorder of the Foot Taiyang channel.

Disorder of the Branching Vessel causes lower-back pain, as if a belt were pulling on it. The person often feels that the back is about to snap and is prone to fright. A collateral branch of the Foot Taiyang channel separates at the shoulder, descends along the spine to the lower back, then runs sideways to the outer rear edge of the thigh and descends to join the hollow behind the knee. This is why the back feels as if pulled by a belt and about to snap. The New Collation notes that the Jia Yi Jing reads “as if torn” instead of “as if pulled by a belt,” and “prone to anger” instead of “prone to fright.”

To needle the Branching Vessel, prick the spots in the hollow behind the knee where vessels have gathered into collaterals the size of millet grains. If black blood spurts out like an arrow, wait until red blood appears before stopping.

The hollow behind the knee refers to the Weizhong point, the He point of the Foot Taiyang channel. It lies at the center of the hollow behind the bent knee, near the artery in the crease. The channel text says to needle to a depth of five fen, retain the needle for seven breaths, or apply three moxa cones; these are the needling methods recorded for this channel. The method described here, however, targets vessels gathered into collaterals the size of millet grains. If black blood spurts out like an arrow, wait until it turns red before stopping. The New Collation notes that, according to Quan Yuanqi, there are two kinds of Branching Vessel, each with a different cause of illness. There may be an error here, though the precise issue is unclear.

Disorder of the Same-Yin Vessel causes lower-back pain, as if a small hammer were lodged inside, followed by sudden swelling. The “Same-Yin Vessel” is a collateral branch of the Foot Shaoyang channel. It travels upward along the Foot Shaoyang channel to a point five cun above the outer ankle, where it branches off toward the Foot Jueyin channel and then descends along that channel to connect with the top of the foot. Hence it is called the “Same-Yin Vessel.” The word fu means anger; here it describes pain and swelling as if the area had been provoked. The New Collation notes that the Suwen Taishu reads “small needle” instead of “small hammer.”

(The text is incomplete, so its meaning cannot yet be determined.)

To treat the Ci Tong Yin vessel, insert three needles at the point above the outer ankle, at the end of Juegu.

As mentioned earlier, the end of Juegu is about three tenths of a body-inch away, at Yangfu, a point on the Foot Shaoyang Gallbladder Channel. The Foot Shaoyang Channel passes through here. The needle may be inserted three fen and retained for seven breaths. If using moxibustion, apply three cones.

A disorder of the Yangwei vessel, one of the Eight Extraordinary Vessels, causes lower back pain, with swelling and a raised area extending upward from the painful spot.

The Yangwei vessel begins in the yang aspect and is generated by the Taiyang Channel. It is one of the Eight Extraordinary Vessels.

To needle the Yangwei vessel, select the point where it joins the Taiyang Channel: below the calf, at a point one chi above the ground.

The channel governed by the Taiyang runs upward alongside the regular channels and joins the Taiyang again below the calf. This point is one chi above the ground, measured in body-inches. The original text identifies it as Chengguang, located on the outer side of the calf, in the hollow between the muscles. The needle may be inserted seven fen; if using moxibustion, apply five cones. Since the point is taken at the division between the muscles below the calf, the text says that it joins the channel there.

The New Critical Edition notes that, judging by the point’s location, this should be Chengshan, not Chengguang; the character “shan” was mistakenly written as “guang.”

A disorder of the Hengluo vessels, the transversely distributed collateral vessels, causes lower back pain and an inability to bend forward or backward, sometimes making a person feel as though they are about to fall. This condition often results from injuring the lower back while lifting a heavy object: the transverse collaterals are torn, and stagnant blood collects within them.

“Heng” means “transverse.” Here it refers to the collateral vessels on the outer side of the Taiyang Channel. They run transversely from the lower back into the outer rear of the thigh, then descend to meet the channel in the hollow behind the knee. After the lower back is injured while lifting a heavy object, the transverse collaterals are damaged and the regular channels become full on their own, causing lower back pain and making it impossible to bend forward or backward. One transmitted version gives the phrase as “the vessels of the Xingluo,” but this is a copying error. If “Xingmai” were the intended reading, the points Weiyang and Yinmen on the Taiyang Channel would not be appropriate.

Needle several inches above the hollow behind the knee, between the two tendons; take two points across the same level and bleed them.

“Heng ju er xue” means that Weiyang and Yinmen lie at roughly the same level. “Xiyang” refers to Weiyang, above Fuxi and toward the outer side; “between the tendons” refers to Yinmen, between the two tendons above the hollow behind the knee. Both points are six cun below the gluteal crease, which is why the text places them several inches above the hollow behind the knee. At Weiyang, the needle may be inserted seven fen and retained for five breaths. The original text is incomplete at this point regarding moxibustion.

When moxibustion is appropriate, apply three cones of moxa (burning three moxa cones). The Yimen point may be needled to a depth of five fen (measured according to the patient’s own bodily proportions), with the needle retained for seven breaths. If moxibustion is used, three cones may also be applied. Thus, walking and dwelling together make two sites of treatment.

The New Critical Edition says: A close examination of Wang Bing’s commentary shows that the Fuxi point lies above the Weiyang point. But according to the Jiayi Jing, the Weiyang point is one cun below the Fuxi point, so it cannot be said to lie above it.

When the meridian associated with the perineum becomes diseased, a person develops lower back pain, and the area above the painful spot sweats profusely. After the sweat dries, the person wants to drink water, and after drinking, wants to walk around. This is a disease of the Foot Taiyang meridian. The Foot Taiyang meridian descends along the lower back and joins at the anus, which is why it is called the “meridian of the perineum.” Its course runs from the lower back down to the feet. At this time, Yang Qi is extremely abundant, so sweat rises above the painful area. As sweat flows out, the Kidneys become dry and Yin Qi is depleted, causing the person to want water to nourish the Kidneys. After drinking, Kidney Qi recovers and Yin Qi begins to circulate; the Yang Qi of the Foot Taiyang meridian then becomes abundant again, so the person wants to walk after drinking.

Needle three points along the upper portion of the meridian that runs straight down the back of the body, located five cun below the hollow behind the knee and above the Yang Qiao meridian’s Shenmai point; take the points transversely. Observe which side has a fuller meridian, and prick it to let blood.

The meridian that runs straight down the back is the Foot Taiyang meridian. It descends alongside the spine, passes through the buttocks, reaches the hollow behind the knee, then continues down the calf and passes behind the outer ankle. Because its course is straight, it is called the “straight Yang meridian.” “Qiao” refers to the Yang Qiao meridian, which begins at the Shenmai point; Shenmai lies below the outer ankle. “Below the hollow” means below the hollow behind the knee. The needling location described here, five cun below that hollow and above Shenmai, is the Chengjin point, at the shallow depression slightly to the outside of the center of the calf. Chengjin is where the Qi of the Foot Taiyang meridian emerges. Needling is prohibited there, but three cones of moxa may be applied. “Needling” here means piercing the blood vessels that are congested and swollen. The Foot Taiyang meridian’s Qi descends through the calves on both sides. Examine the center of each calf, and prick the side where the blood vessels are congested and swollen to let blood.

The New Critical Edition says: The earlier passage states, “The meridian of the perineum causes lower back pain,” while this passage says, “Prick the straight Yang meridian.” This suggests that the straight Yang meridian is the meridian of the perineum: although the names differ, they refer to the same meridian and condition. Also, the commentary on the Chengjin point describes it as “the shallow depression slightly to the outside of the center of the calf,” but neither the Jiayi Jing nor the commentary on “Gu Kong Lun” includes the words “slightly to the outside.”

The “Flying Yang vessel” causes lower back pain that spreads upward, with a feeling of tightness and fullness in the chest. In severe cases, it brings sadness and fear. This refers to the Yin Linking Vessel. The Yin Linking Vessel begins five cun above the inner ankle and ascends alongside the Foot Shaoyin channel through the middle of the calf. Wherever the Foot Shaoyin channel passes in front, the Yin Linking Vessel follows as well.

The Foot Shaoyin channel rises from the kidneys, passes through the liver and diaphragm, enters the lungs, and runs along both sides of the throat to the root of the tongue. A branch separates from the lungs, connects with the heart, and then flows into the chest. This is why severe illness brings sadness and fear: fear is associated with the kidneys, and sadness with the heart.

To needle the “Flying Yang vessel,” take the point five cun above the inner ankle. The New Collation notes that the Jia Yi Jing gives the distance as two cun.

Where the Foot Shaoyin channel meets the Yin Linking Vessel in front, five cun above and behind the inner ankle, is Fuliu, a point on the Foot Shaoyin channel. The needle may be inserted three fen. Zhubin, behind the inner ankle, is the Xi-Cleft point of the Yin Linking Vessel, where the channel’s Qi and blood gather deeply; the needle may also be inserted three fen, and the point may be moxibusted for five cones. At the meeting point in front of the Foot Shaoyin channel and the Yin Linking Vessel, three channels converge, so the needle may be inserted three fen and the point moxibusted for five cones. The wording in the current edition of the Zhonggao Jing is the same.

The New Collation also says that, according to the Jia Yi Jing, a collateral vessel branches from the Foot Taiyang channel and runs toward the Foot Shaoyin channel. It is called Feiyang and lies seven cun above the outer ankle. The text also places Zhubin above the inner ankle, in the middle of the calf, and identifies it as the Xi-Cleft point of the Yin Linking Vessel; Fuliu is two cun above the inner ankle. The commentary on this passage does not agree with the Jia Yi Jing. It is suspected that “five cun” in the commentary should read “two cun,” which would bring the Suwen into agreement with the Jia Yi Jing.

The “Flourishing Yang vessel” causes lower back pain that pulls toward the chest, with blurred vision. In severe cases, the body arches backward, the tongue curls, and the person cannot speak.

This refers to the Yin Heel Vessel. The Yin Heel Vessel is a branch of the Foot Shaoyin channel. It begins behind Rangu, passes upward over the inner ankle, and continues along the inner thigh. It enters the genital region, ascends through the abdomen into the chest, then enters the supraclavicular fossa. From there it rises past the front of Renying, enters the inner side of the throat, connects with the inner canthus, and joins the Foot Taiyang channel and the Yang Heel Vessel before continuing upward. This explains why lower back pain can produce the symptoms described above.

Needle the medial sinew at two points. The points lie above the inner ankle, in front of the large tendon and behind the Taiyin channel, about two cun above the ankle.

This passage explains the relationship between meridian points and lumbar pain conditions in the human body, focusing on three key locations:

First is the Jiaoxin point on the Yin Heel Vessel (Yinqiao, one of the Eight Extraordinary Meridians), located approximately two cun above the inner ankle in the depression between bones and tendons, posterior to the Taiyin meridian and anterior to the Shaoyin meridian. Needling here should reach a depth of four fen with retention for five breaths; moxibustion can be applied with three cones. This point primarily treats lumbar pain with fever, restlessness, and in severe cases, urinary incontinence.

Next is the Sanmai (a branch of the Foot Taiyin meridian), which runs along the inner thigh into the abdomen, intersecting with the Shaoyin and Shaoyang meridians in the lumbosacral region. When this meridian malfunctions, patients experience a sensation of "a wooden beam pressing against the lower back," with severe cases also showing urinary incontinence. Treatment involves needling three times at the boundary between bone and muscle on the inner knee, near the outer collateral vessels—this location corresponds to the Diji point.

Finally, the Rouli meridian (originating from the Shaoyang meridian, where Yang Linking Vessel Qi emerges) causes lumbar pain that worsens with coughing, triggering tendon spasms. The correct needling position lies lateral to the Taiyang meridian, posterior to the Juegu point (the fibula on the outer calf). Here lies the Fenrou point, located at the muscular boundary about two fen posterior to the upper end of the fibula directly above the outer ankle—where Yang Linking Vessel Qi emerges. Needling depth should be five fen with retention for ten breaths, or moxibustion with three cones.

The text specifically notes that some records mistakenly describe this point as "anterior to the Shaoyang Juegu," when it should actually be posterior. These observations from ancient physicians demonstrate precise correlations between specific acupoints and lumbar pain symptoms, along with their therapeutic approaches.

The Jiayi Jing does not include this passage. The acupoint annotations differ between versions, with two readings in each case, and the measurements are inconsistent: some versions give two fen, others three fen; some give five fen, others three fen. The number of breaths also varies, with some versions giving ten breaths and others seven.

For pain in the lower back that travels upward along both sides of the spine to the head, accompanied by a heavy, clouded feeling in the head, dimming vision, and a sense of being about to stiffen and collapse, needle the Xizhong point on the Foot Taiyang channel—that is, Weizhong—and release the stagnant blood. The New Critical Edition notes that the Taisu reads “the head feels heavy, the vision dim, as if about to stiffen and fall” in place of “the head feels unsteady, the vision dim, as if about to stiffen and fall.”

For cold and pain in the lower back, needle the Foot Taiyang channel; for heat above the lower back, needle the Foot Jueyin channel. If pain makes the body unable to bend or straighten, needle the Foot Shaoyang channel. If there is internal heat and panting, needle the Foot Shaoyin channel and also bleed the Xizhong point.

These methods are profoundly subtle, and other medical texts give different accounts, so their full meaning is difficult to grasp. During treatment, observe the results. If the expected effect does not occur, first prick the stagnant blood vessels to release blood, then continue treatment.

If there is cold above the lower back and the patient cannot turn the head, needle the Foot Yangming channel. The Yinshi point treats this condition. It lies three cun above the knee, in the hollow beneath the rectus femoris muscle, where the Qi of the Foot Yangming channel emerges. Needle to a depth of three fen and retain the needle for seven breaths; apply three moxa cones. If the patient cannot turn the head, Zusanli may also be selected. Zusanli lies three cun below the knee, on the outer side of the tibia between two muscles, where the channel Qi of the Foot Yangming channel converges. Needle to a depth of three cun and retain the needle for seven breaths; apply three moxa cones.

For heat above the lower back, needle the Foot Taiyin channel. The Diji point treats this condition. It lies five cun below the knee and is the Xi-cleft point of the Foot Taiyin channel, where the channel’s Qi and blood gather deeply. Needle to a depth of three fen; apply three moxa cones. The New Critical Edition notes that the Jiayi Jing gives five cones.

For internal heat and panting, needle the Foot Shaoyin channel. Both Yongquan and Taizhong can treat this condition. Yongquan lies in the hollow in the sole of the foot: when the foot is flexed and the toes curled, a depression appears at the center of the sole. This is where the channel Qi of the Foot Shaoyin channel emerges. Needle to a depth of three fen and retain the needle for three breaths; apply three moxa cones. Taizhong lies at the artery behind the heel and is the Luo point of the Foot Shaoyin channel. Needle to a depth of two fen and retain the needle for seven breaths; apply three moxa cones. The New Critical Edition notes that the annotations in the relevant chapter give different locations for Taizhong: some place it behind the medial malleolus, others behind the heel.

This passage first corrects a textual detail: the three commentaries differ about the artery previously described as being “in the middle of the street,” while the Jia Yi Jing also says it lies behind the heel. Here, “Chongzhong” should be corrected in accordance with the Jia Yi Jing.

Difficulty passing stool: Needle the Foot Shaoyin Kidney Channel and use Yongquan.

Distension and fullness in the lower abdomen: Needle the Foot Jueyin Liver Channel and use Taichong. Taichong lies in the hollow two body inches behind the base of the big toe, on its inner side. When pressed, a pulse can be felt beneath the finger. It is where the channel Qi of the Foot Jueyin is poured into the body (“poured into” refers to the Shu-Stream point among the Five Shu points). The needle may be inserted three fen and retained for ten breaths; alternatively, apply three moxa cones.

Pain in the lower back as if it were breaking, with inability to bend forward or backward, lean back, or raise the body: Needle the Foot Taiyang Bladder Channel.

• For lower back pain as if it were breaking, use Shugu.
• For inability to bend forward and backward, either Jinggu or Kunlun may be used.
• For inability to move, either Shenmai or Pucan may be used.

The locations and procedures for each point are as follows:

• Shugu: In the hollow behind the base of the little toe, on the outer side, at the border between the red and white skin—the boundary between the skin of the top and sole of the foot. It is where the channel Qi of the Foot Taiyang is poured into the body. Insert the needle three fen and retain it for three breaths; apply three moxa cones.
• Jinggu: In the hollow below the large bone on the outer side of the foot, at the border between the red and white skin; the point can be found by pressing. It is where the channel Qi of the Foot Taiyang passes through. Insert the needle three fen and retain it for seven breaths; apply three moxa cones.
• Kunlun: In the hollow behind the outer ankle, above the heel bone; a fine pulse can be felt beneath the finger when pressed. It is where the channel Qi of the Foot Taiyang moves. Insert the needle five fen and retain it for ten breaths; apply three moxa cones.
• Shenmai: Five fen below the outer ankle, in a hollow large enough to accommodate a fingernail. It is where the Yang Qiao vessel, one of the Eight Extraordinary Vessels, originates. Insert the needle six fen and retain it for ten breaths; apply three moxa cones.
• Pucan: In the hollow below the heel bone, where the Foot Taiyang Channel and the Yang Qiao vessel meet. Insert the needle three fen and retain it for seven breaths; apply three moxa cones.

Note from the new textual collation: According to the Jia Yi Jing, Shenmai is “in the hollow below the outer ankle,” without the words “five fen.” The needle depth is given as three fen, not six, and the retention time as six breaths, not ten. The commentary to the “Qixue Lun” gives seven breaths. For Pucan, the stated retention time is seven breaths, while the Jia Yi Jing gives six. These are differences among textual versions.

Lower back pain that draws along the inner side of the spine: Needle the Foot Shaoyin Kidney Channel and use Fuliu. Feiyang may also be used when the pain begins in the lower back and surges upward, accompanied by coldness that prevents bending forward or backward.

This passage of the Jing, up to this point, is written entirely in red ink, except for the commentary. ○ Newly collated:

According to the Quan Yuanqi edition, the Jia Yi Jing, and the Tai Su, this passage is absent from “pain in the lower back with cold above” to this point. It may have been added by Wang. The present commentary says, “from ‘pain in the lower back with cold above’ to this point,” counting nineteen characters. These are not Wang Bing’s original words and were probably added by later readers.

The lower back pain pulls down toward the lower abdomen and tightens the soft area beneath the ribs, making it impossible to bend backward.

The newly collated text says: “According to the Jia Yi Jing, this reads ‘unable to bend forward or backward.’” The character miao is pronounced like chao.

Needle the point where the lower back meets the sacrum, the bone at the base of the spine: below the lumbar prominences on either side, on the raised muscle beneath them. Determine the number of needling sessions according to the moon’s cycle from fullness to waning. After needling, the pain will soon stop.

This is caused by pathogenic Qi entering the Foot Taiyin channel. Kong is interchangeable with tong and means “to pull.” Miao refers to the soft, hollow area beneath the lowest ribs.

“Where the lower back meets the buttocks” refers to the eight bony openings beside the sacrum, four on each side beneath the lumbar prominences. They are commonly called the “Eight Liao.” To treat this kind of lower back pain, select the fourth liao point below the lumbar prominence, known as the Lower Liao. The Foot Taiyin, Foot Jueyin, and Foot Shaoyang channels converge here, hence the name “where the lower back meets the buttocks.”

“Above the muscle beneath the two lumbar prominences” does not mean the tops of the prominences, but the raised muscle beneath them. The needle should be inserted straight into this muscle, that is, “above the muscle.” The lumbar prominences are the bones projecting on either side of the lower spine. On each side of the spine, below the lumbar prominence, is a raised muscle that slopes behind and supports it; these are the “muscles beneath the two lumbar prominences.” Beneath each muscle are four bony openings, called in order the Upper Liao, Second Liao, Middle Liao, and Lower Liao. The Upper Liao lies in the hollow below the lumbar prominence; the other three liao points angle slightly downward and can be located by pressing into the hollows.

All four openings can treat lower back pain. The indications for the Lower Liao correspond to the description in the Jing: it is where the Foot Taiyin, Foot Jueyin, and Foot Shaoyang channels converge. The needle can be inserted to a depth of three body inches, a measurement taken from the patient’s own body, and retained for ten breaths. If using moxibustion, apply three cones.

“Determine the number of needling sessions according to the moon’s cycle from fullness to waning” means that the moon gradually waxes at the beginning of the month, a phase called “moon waxing,” and gradually wanes after the middle of the month, a phase called “moon waning.” Needle less when the moon is waning and more as it waxes. The Treatise on Needle Techniques says: “On the first day of the waxing moon…”

For pain in the lower back, each needled spot is counted as one “wei” (a mark left by a single needle insertion). On the first day, needle one spot; on the second, two; then gradually increase the number, until fifteen spots are needled on the fifteenth day. Beginning on the sixteenth day, gradually reduce the number. Each day’s number of spots should be set according to this method.

For pain on the left side, needle the right side; for pain on the right, needle the left. In other words, when the left side hurts, needle the right, and when the right side hurts, needle the left. This is because the channels on the two sides cross and connect within the coccyx (sacrum). The editors of the revised text say to consult the section “Lower Back Pain Extending into the Lower Abdomen” in the “Treatise on Contralateral Needling.”

“Treatise on Wind”

The Yellow Emperor asked: When wind pathogen harms people, sometimes it causes alternating chills and fever; sometimes it produces internal heat; sometimes internal cold; sometimes lì wind (a severe wind-related disorder); sometimes hemiplegia (paralysis on one side of the body); and sometimes it appears as an ordinary wind illness. These disorders differ from one another and have different names. Some also invade the five Zang organs and six Fu organs. I do not understand the reason for this, and hope you will explain it.

Here, “harms” means that a person has been invaded by wind pathogen.

Qibo replied: Wind pathogen lodges between the skin and flesh. It cannot penetrate inward, nor can it disperse outward.

When the interstices—the skin’s texture and sweat pores—are loose and open, wind pathogen enters. Once it has entered, the sweat pores close, so the pathogen can neither move inward nor escape outward.

Wind pathogen readily moves and changes quickly. When the interstices open, a person feels sudden bouts of cold; when they close, the person develops fever and a stuffy, oppressive feeling in the chest.

“Sa ran” describes the sensation of cold, while “oppressive” means uncomfortable. When the interstices open, wind pathogen surges through and makes the person feel cold; when they close, it becomes trapped and causes distress.

When a person is cold, they eat less; when feverish, their flesh grows thin. Alternating cold and heat can also make a person suddenly shiver and unable to eat. This illness is called “cold and heat.”

Cold wind entering the stomach reduces appetite and food intake; heat pathogen trapped within the body causes the flesh to grow thin. When cold and heat combine, a person shivers and cannot eat, hence the name “cold and heat.” “Tu li” describes a sudden chill. The editors of the revised text note that the Quan Yuanqi edition reads “loss of taste,” while the Jiayi Jing reads “weakness and fatigue.”

Wind pathogen enters the stomach together with the Qi of Yangming (the Stomach channel), then travels upward along the channel to the inner corner of the eye. If the patient is corpulent, the wind pathogen is less able to disperse outward, producing internal heat and yellowing of the eyes. If the patient is lean, the wind pathogen disperses outward more easily, but the person is thereby exposed to cold; this produces internal cold and tears.

Yangming is the Stomach channel. It begins at the nose, meets at the root of the nose, and runs downward along the sides of the nose. It enters the upper teeth, then curves out around the cheeks and circles the lips, meeting at the Chengjiang point. From there it runs along the back of the lower jaw, passes through the throat, and enters the supraclavicular fossa—the hollow above the collarbone. It then descends through the diaphragm and connects with the stomach.

Therefore, Wind-pathogen enters the stomach together with the Yangming channel (Stomach channel), then travels upward along the channels until it reaches the inner canthus, the corner of the eye nearest the nose. In a person who is overweight, the interstices between the skin and muscles are dense, making it difficult for Wind-pathogen to disperse outward. This produces internal heat, and the eyes turn yellow. In a person who is thin, the interstices are loose, allowing Wind-pathogen to disperse outward easily. This produces internal cold and causes tears to flow.

Wind-pathogen invades together with the Qi of the Taiyang channel. It travels along the channels and acupoints, spreading among the muscles, where it interacts with Defensive Qi, the Qi that protects the body. When the pathways through which Qi moves are obstructed, the muscles swell and sores form. Wherever Defensive Qi stagnates and cannot circulate, the muscles become numb and insensible.

Defensive Qi circulates among the muscles. When Wind-pathogen clashes with Defensive Qi and the two remain lodged between the muscles, the pathways of Qi become impeded and sluggish. Once the pathways are blocked, Wind-pathogen attacks inward and Defensive Qi resists it; the muscles then swell and develop sores. “Yang” means a sore. If Wind-pathogen affects Defensive Qi and prevents it from circulating smoothly, Qi gathers and stagnates in one area, leaving parts of the muscles numb. Here, “insensible” means numbness and an inability to feel cold, heat, pain, or itching.

Li, or leprosy (an ancient term for a kind of skin disease), results when heat and swelling arise in Nutritive Qi and Defensive Qi and the movement of Qi becomes disordered. The bridge of the nose may be damaged, the complexion may deteriorate, and sores may form on the skin and break down into ulcers.

This describes Wind-pathogen entering the interior of the channels. Nutritive Qi circulates within the vessels. Once Wind-pathogen enters them, it disturbs the blood and combines with Nutritive Qi. The two become congested with heat, causing the blood to swell and deteriorate. “Qi is unclear” means that the movement of Qi is disordered. After the vessels become disrupted, Nutritive Qi carries Wind-pathogen upward. The channels of the Yang traverse the head, and the nose is where breath enters and leaves; therefore, the bridge of the nose may be damaged, the complexion may become unsightly, and the skin may be broken and ulcerated. The “Treatise on the Essential Subtleties of the Pulse” says, “When Wind-pathogen is abundant in the vessels, it produces Li, with ulceration.” An old commentary gives the pronunciation of “Kui” in “ulceration” as “Hu-dui.”

When Wind and Cold remain lodged in the vessels and do not depart for a long time, the condition is called “Li-feng,” or sometimes “Cold and Heat.” At first, it appears as alternating bouts of cold and heat. Once the heat develops, the condition is called Li-feng. (The New Critical Edition notes that other versions have “flourishes” in place of “develops.”)

Being afflicted by Wind-pathogen on a Jia or Yi day in spring is called Liver Wind; on a Bing or Ding day in summer, Heart Wind; on a Wu or Ji day in late summer, Spleen Wind; on a Geng or Xin day in autumn, Lung Wind; and on a Ren or Gui day in winter, Kidney Wind.

These names follow the correspondences among the Five Phases (Wood, Fire, Earth, Metal, and Water), the seasons, the Heavenly Stems, and the five viscera: spring corresponds to Wood and the Liver; summer to Fire and the Heart; late summer to Earth and the Spleen; autumn to Metal and the Lung; and winter to Water and the Kidney.

When wind pathogens enter the transport points of the five Zang organs and six Fu organs—the points through which the Qi of the channels flows and passes in and out—they can also give rise to wind in the organs. The point of entry determines which part is affected. When wind attacks more strongly on one side along the transport points, it is called one-sided wind.

When a wind pathogen enters upward along Fengfu (a point located one inch inside the hairline at the back of the neck, in the hollow between the large tendons, where the Governor Vessel meets the Yang Linking Vessel), it gives rise to brain wind. If the wind pathogen enters and affects the head, it can cause eye wind and coldness of the eyes—that is, the eyes become chilled and uncomfortable from exposure to wind.

Above Fengfu is Naohu (a point where the Governor Vessel meets the Foot Taiyang channel). The Foot Taiyang channel begins at the inner corner of the eye, rises across the forehead, meets at the crown, then enters and connects with the brain before turning back and emerging. Thus, when a wind pathogen travels upward from Fengfu, it gives rise to brain wind; when it enters and affects the head, it causes eye wind and coldness of the eyes.

Exposure to wind after drinking alcohol is called leaking wind. Heat accumulates, the pores and interstices of the skin loosen, and wind then enters, causing profuse sweating as though fluid were leaking out. Hence the name leaking wind. The Jing specifically calls this “alcohol wind.”

Sweating after sexual activity and then being exposed to wind is called internal wind. The body’s Jing and Qi have been depleted, while the pores and interstices at the body’s surface have opened, leaving the body vulnerable to wind. Hence the name internal wind. The Jing specifically calls this “taxation wind.”

Exposure to wind immediately after washing the hair is called head wind. After the hair is washed, the wind pathogen lodges in the head, hence the name head wind.

When a wind pathogen remains for a long time and enters the body, it can give rise to intestinal wind and undigested-food diarrhea. The wind pathogen lodges in the intestines and affects the stomach above, preventing food from being digested; it is then expelled from below. Undigested-food diarrhea is a condition in which food is passed before it has been digested. The New Editorial Commentary notes that, according to the Quan Yuanqi edition, this term refers to diarrhea in which fluids and grains are not properly separated.

When a wind pathogen lodges in the pores and interstices at the body’s surface, it gives rise to leaking wind. The pathogen settles in the interstices and opens the sweat pores, also called the mysterious portals. It drives fluids outward, causing sweating; hence the name leaking wind.

Thus, wind is the forerunner of the hundred diseases. As it changes, it can bring about other illnesses. Their symptoms have no fixed form, but their cause lies in wind. Here, “leader” means “first”: wind precedes the hundred diseases. The New Editorial Commentary notes that the Quan Yuanqi edition and the Jia Yi Jing read “cause” where this text has “bring about.”

The Yellow Emperor asked: “When the five Zang organs are affected by wind, each shows different signs. Why is this? I would like to hear how they can be diagnosed and what conditions each one produces.”

“Diagnosis” refers to the signs that can be stated; “produces” refers to the manifestations a disease takes inside the body.

Qibo replied: “The signs of lung wind are profuse sweating, aversion to wind, and a pale white complexion. At times there is coughing and shortness of breath. The symptoms are milder during the day and worse toward evening. On examination, look above the eyebrows: the area appears white.”

When Wind Qi is excessive within the body, it causes fever. Excess heat opens the skin’s pores and interstices, making it easy to sweat. When Wind Qi invades the body, a person becomes sensitive to drafts. Here, “pale” refers to a light whitish color.

Among the five colors, white corresponds to the Lungs; when they are diseased, coughing is common. Wind Pathogen invades the Lung Qi from within, causing a pale complexion, frequent coughing, and shortness of breath. During the day, Yang Qi moves along the body’s surface, so the symptoms lessen. In the evening, Yang Qi enters the body, and the Wind Pathogen responds, causing the symptoms to worsen. Que Ting, the area above the eyebrows between them, is where Lung health is assessed by observing the face, so it should be examined. White is the color of the Lungs.

When the Heart is affected by Wind Pathogen, common signs include excessive sweating, sensitivity to drafts, dry, scorched lips, irritability, and a red complexion. In severe cases, speech becomes impaired. The mouth can be examined; red is the color of the Heart. “Scorched and cracked” describes lips that are dry and scorched, with lines that look as though they have broken apart. This results from intense heat drying and cracking the skin. When Wind Pathogen disturbs the Heart spirit, a person becomes unsettled and irritable, and may even startle others. Branches of the Heart vessels ascend from the Heart network, pass alongside the throat, and connect with the tongue; therefore, speech becomes impaired when the condition is severe. Since the lips and mouth turn red, the mouth can be examined to assess Heart disease. The New Collation states that the Jia Yi Jing does not contain the character “startle.”

When the Liver is affected by Wind Pathogen, common signs include excessive sweating, sensitivity to drafts, a tendency toward sadness, a slightly bluish-green complexion, dryness of the throat, irritability, and sometimes aversion to women. The area beneath the eyes can be examined; blue-green is the color of the Liver. Liver disease can affect the Heart. When the Heart Qi is not properly nourished, it becomes weak, making a person prone to sadness. The Liver corresponds to Wood, and Wood corresponds to a bluish-green color, so the complexion takes on a slight bluish-green hue. According to the course of the meridians, the Liver meridian ascends from the lower limbs, passes through the genitals, abdomen, and stomach, connects with the Liver and Gallbladder, then passes through the diaphragm, ribs, and throat before reaching the head and face. One of its branches descends from the eye network. According to this account, when Wind Pathogen affects the Liver, symptoms such as throat dryness and irritability arise, and the area beneath the eyes can also be examined.

When the Spleen is affected by Wind Pathogen, common signs include excessive sweating, sensitivity to drafts, bodily fatigue and weakness, and reluctance to move the limbs. The complexion becomes a faint yellow, and the person loses their appetite. The area above the nose can be examined; yellow is the color of the Spleen. The Spleen meridian begins at the foot and ascends along the lower leg, passing the knee and inner thigh before entering the abdomen and connecting with the Spleen and Stomach. It then ascends through the diaphragm and throat, reaches the base of the tongue, and spreads beneath it. Another branch separates from the Stomach, ascends through the diaphragm, and flows into the Heart. The original text ends at this point, and the following content is missing.

Overeating can damage the Spleen Qi. The Spleen corresponds to Earth and governs the center of the body. Since the nose lies at the center of the face, the nose can also be examined when diagnosing Spleen disorders.

The Spleen’s color is yellow. The New Collation says that the seven characters in Wang’s commentary—“In Spleen Wind, there is no reason to draw the Heart pulse out through the hand and along the arm”—do not fit the argument here and should be deleted. The Spleen governs the limbs. When it is affected by pathogenic Wind, the limbs become reluctant to move.

The symptoms of Kidney Wind are easy sweating, aversion to Wind, swelling of the face, back pain, and an inability to stand upright. The complexion turns dark, and the functions of the hidden parts become impaired. On examination, the skin may appear dark.

“mangran” describes a raised swelling, while “tai” means black. The Kidney belongs to Yin, as does the area below the eyes. Thus, when the Kidney is affected by pathogenic Wind, the face swells. The Kidney channel begins at the sole of the foot, ascends along the inner side of the lower leg, passes through the inner knee and the back of the inner thigh, and runs through the spine. This accounts for the back pain and inability to stand upright. “Yinqu” refers to hidden, curved parts of the body and to the functions associated with them. The Kidney stores Jing and is associated with sexual intercourse between men and women. When pathogenic Wind assails the Kidney, Jing and Qi weaken, and the functions of the hidden parts become impaired. The “Treatise on the Correspondence of Yin and Yang” says that Qi returns to Jing, and Jing can nourish Qi. Here, the explanation is that when Jing is insufficient, Qi gathers inward and cannot nourish the skin, so the skin turns dark. Black is the Kidney’s color.

The symptoms of Stomach Wind are easy sweating around the neck, aversion to Wind, difficulty swallowing food, a blocked feeling in the chest and diaphragm, and frequent abdominal distension. Wearing too little clothing and becoming chilled causes abdominal distension; eating cold foods causes diarrhea. Examination may reveal a thin body and a distended abdomen.

A branch of the Stomach channel runs from behind the lower jaw along its underside, passes the Renying point, follows the throat into the supraclavicular hollow, then descends through the diaphragm to connect with the Stomach and link with the Spleen. The channel’s main course descends from the supraclavicular hollow, follows the inner side of the breast and passes through the abdomen to Qijie. Another branch begins at the Stomach’s lower opening, follows the inner side of the abdominal cavity to Qijie, and joins the channel there. Therefore, when the Stomach is affected by pathogenic Wind, the neck sweats easily, food is difficult to swallow, the chest and diaphragm feel blocked, and the abdomen tends to distend. When too little clothing is worn, external Cold enters while heat remains inside, causing abdominal distension. When cold foods are eaten, Cold invades the Stomach, whose Yang cannot digest them within the body, and diarrhea follows. The Stomach works together with the Spleen and governs the muscles. When Stomach Qi is insufficient, the muscles are not nourished, so the body becomes thin. When Wind Qi gathers in the Stomach, the abdomen becomes distended. The New Collation cites Sun Simiao as saying that exposure to Wind immediately after eating causes Stomach Wind.

The symptoms of Head Wind are easy sweating of the head and face and aversion to Wind. On the day before an attack of pathogenic Wind, the condition begins to appear…

When the headache is severe, the person may even be unable to leave the house. On the day when the wind pathogen that triggered the illness was encountered, the condition improves slightly.

The head is where all the Yang channels converge. When a wind pathogen invades the head, it loosens the skin’s pores and texture, so the face and head tend to sweat easily. The body’s Yang Qi responds to wind by moving outward; therefore, exposure to wind often makes the illness worse that same day. Since the condition worsens first, it also begins to subside first. Thus, on the day the person encounters wind, the illness improves somewhat. Here, “inside” means indoors. The patient cannot leave the house because the headache is severe and they are afraid of being exposed to the wind outside.

The New Corrected Edition says: Sun Simiao noted that going out into the wind just after washing one’s hair can cause “head wind,” an illness caused by wind affecting the head.

The symptoms of “leaking wind” are these: sometimes there is heavy sweating, and the person often cannot wear only a single layer of clothing. They sweat while eating; in severe cases, they sweat all over and experience shortness of breath and fear of wind. Their clothes become soaked with sweat, their mouth is dry and they are easily thirsty, and they cannot do strenuous work.

This is a sign of wind-heat in the Lung and Stomach, which is why the person cannot wear only a single layer of clothing. When the pores are loose, eating causes sweating. If the wind pathogen is severe, it invades the Lung, causing sweating over the whole body, shortness of breath, and fear of wind. The clothes are soaked with sweat, and the mouth is dry and easily thirsty. Any physical exertion brings on shortness of breath, so the person cannot do strenuous work.

The New Corrected Edition says: Sun Simiao noted that exposure to wind after drinking alcohol can cause “leaking wind.” Its symptoms include fear of wind, heavy sweating, shortness of breath, dry mouth, and easy thirst. When the person puts on clothes, their body feels as hot as fire. As mealtime approaches, sweat pours down like rain. Their joints are slack and weak, and they do not want to move on their own.

The symptoms of “discharging wind” are these: heavy sweating that soaks the clothes; a dry mouth; and skin that is wet as if soaked in water. The person cannot work, has pain throughout the body, and feels cold.

The phrase “the skin is wet as if soaked in water” refers to heavy sweating, which makes the skin seem waterlogged. Excessive sweating depletes bodily fluids, causing a dry mouth. Physical exertion makes the sweating worse, so the person cannot work. The pain throughout the body results from excessive sweating; this also damages Yang Qi, which is why the person feels cold.

The New Corrected Edition says: Sun Simiao noted that exposure to wind after sexual activity can cause “internal wind,” whose symptoms include fear of wind and sweating so heavily that the clothes become soaked. He suspected that the “discharging wind” mentioned here is the same as “internal wind.” In the earlier passage of this chapter, the text first discusses “leaking wind,” “internal wind,” and “head wind.” It then explains that wind pathogens entering the interior become “intestinal wind,” while those remaining on the body’s surface become “discharging wind.” This passage mentions “discharging wind” but not “internal wind”; yet the symptoms of the “internal wind” described by Sun Simiao are the same as those given here. Therefore, “discharging” may be a corruption of “internal.”

The Yellow Emperor said, “Good.”