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Huangdi asked: From which meridian does lower back pain originate? How should it be needled? Qibo replied: Pathogenic factors in the Foot-Taiyang Meridian cause lower back pain, with pain radiating to the nape of the neck, spine, buttocks, and back, accompanied by a sensation of heaviness; one should needle the Xi-cleft point (Jinmen, BL63) of the Foot-Taiyang Meridian to bleed, but bleeding is contraindicated in spring. Pathogenic factors in the Foot-Shaoyang Meridian cause lower back pain, with a sensation as if needles are pricking the skin, slow movement, inability to flex or extend the waist, and inability to look back; one should needle the end of the "Chenggu" (formed bone) of the Foot-Shaoyang Meridian to bleed. The Chenggu refers to the solitary bone protruding laterally at the knee; bleeding is contraindicated in summer. Pathogenic factors in the Foot-Yangming Meridian cause lower back pain, with inability to look back, visual hallucinations when looking back, and predisposition to sadness; one should needle the Zusanli (ST36) point, three cun below the knee on the Foot-Yangming Meridian, combining upper and lower points to bleed, but bleeding is contraindicated in autumn. Pathogenic factors in the Foot-Shaoyin Meridian cause lower back pain, with pain radiating to the medial aspect of the spine; one should needle the Fuliu (KI7) point, two cun above the medial malleolus on the Foot-Shaoyin Meridian, but bleeding is contraindicated in winter. Excessive bleeding may lead to irreversible conditions. Pathogenic factors in the Jueyin Meridian cause lower back pain, with stiffness in the waist resembling a drawn bowstring; one should needle the Jueyin Meridian at the lateral aspect of the calf muscle belly near the heel, where nodules can be felt upon palpation, then proceed with needling (Ligou, LR5: needle 2 fen, moxa 3 zhuang). If the patient exhibits taciturnity and mental confusion, needle the meridian three times (some texts omit the character "shan").

Pathogenic factors in the Jie Meridian cause lower back pain, with pain radiating to the shoulder, blurred vision, and occasional urinary incontinence; one should needle the Jie Meridian at the transverse vessels lateral to the separation between muscles and tendons at the knee, bleeding until the blood changes from dark to bright red. Pathogenic factors in the Jie Meridian cause lower back pain, with a sensation of being pulled by a belt, often feeling like the waist is broken, and predisposition to fear; one should needle the collateral vessels at the popliteal fossa that are clustered like millet grains, bleeding until black blood stops flowing and only bright red blood remains. Pathogenic factors in the Tongyin Meridian cause lower back pain, with a sensation as if a small hammer is striking inside, accompanied by local swelling (small hammer refers to a small needle); one should needle the Tongyin Meridian at the end of the fibula above the lateral malleolus, applying three needle insertions. Pathogenic factors in the Yangwei Vessel cause lower back pain, with local swelling at the painful site; one should needle the Yangwei Vessel where it joins the Foot-Taiyang Meridian in the depression below the calf, approximately one chi from the ground (Chengshan, BL57: needle 7 fen, moxa 5 zhuang). Pathogenic factors in the Hengluo Meridian cause lower back pain, with inability to flex or extend the waist, and fear of falling when extending, caused by heavy lifting injuring the waist, severing the transverse collaterals, and causing stasis to accumulate; one should needle between the yang tendons, horizontally several cun upward, bleeding from two sites (Weiyang, BL39: needle 7 fen; Yinmen, BL37: needle 5 fen; moxa 3 zhuang each).

Pathogenic factors in the Huiyin Meridian cause lower back pain, with profuse sweating at the painful site, thirst after sweat dries, and restlessness after drinking; one should needle the Shuyang Meridian three cun above, located five cun above the Qi Mai on a horizontal line, bleeding where vessels are full (some texts state Chengjin, BL56 is contraindicated for needling). Pathogenic factors in the Feiyang Meridian cause lower back pain, with heat sensation at the painful site, and severe cases involving fear and sorrow; one should needle the Feiyang Meridian five cun above the medial malleolus (or seven cun), anterior to the Foot-Shaoyin Meridian, at its intersection with the Yinwei Vessel (Fuliu, KI7 and Zubin, SP9: both needle 3 fen, moxa 5 zhuang). Pathogenic factors in the Changyang Meridian cause lower back pain, with pain radiating to the chest, blurred vision, severe cases involving opisthotonos, tongue retraction, and inability to speak; one should needle the inner tendons twice. The location is anterior to the large tendon above the medial malleolus, posterior to the Foot-Taiyin Meridian, two cun above the ankle joint (Jiaoxin, KI6). Pathogenic factors in the San Meridian cause lower back pain with heat, irritability due to excessive heat, a sensation of a horizontal block in the lower waist, and severe cases involving urinary incontinence; one should needle the San Meridian at the separation between bone and flesh anterior to the knee, at the lateral aspect of the collateral vessels, applying three needle insertions (Diji, SP8). Pathogenic factors in the Rouli Meridian cause lower back pain, exacerbated by coughing leading to tendon spasm; one should needle the Rouli Meridian twice, located lateral to the Foot-Taiyang Meridian and posterior to the fibula of the Foot-Shaoyang Meridian.

Lower back pain along the sides of the spine radiating to the head, with blurred vision and a desire to collapse; needle the Xi-cleft point (Jinmen, BL63) of the Foot-Taiyang Meridian to bleed. [Note: The original text contains a list of symptoms and corresponding treatments here, which seems to be a separate section or commentary inserted into the main narrative. I will translate the specific symptom-treatment pairs listed in the source text]: For upper back coldness and inability to look back, needle the Foot-Yangming Meridian (Yinshi, ST31; Zusanli, ST36). For upper heat, needle the Foot-Taiyin Meridian (Diji, SP8). For middle heat and panting, needle... (Kongzui, LU6; Dazhong, KI4). For difficulty defecating, needle the Foot-Shaoyin Meridian (Kongzui, LU6). For fullness in the lower abdomen, needle the Foot-Jueyin Meridian (Taichong, LR3). For stiffness like a break, inability to flex/extend or lift, needle the Foot-Taiyang Meridian (Shugu, BL65; Jinggu, BL64; Kunlun, BL60; Shenmai, BL62; Pucan, BL61). For pain radiating to the medial spine, needle the Foot-Shaoyin Meridian (Fuliu, KI7; Feiyang, BL58). For lower back pain radiating to the hypochondrium and groin, with inability to extend, needle the intersection of the lumbar and sacral regions, above the gluteal muscles on both condyles. Use the waxing and waning of the moon to determine the number of needle insertions; the effect is immediate upon insertion (the fourth vertebra below the iliac crest, i.e., Shenshu, BL23: needle 2 cun, moxa 3 zhuang). Treat left pain by needling the right side, and right pain by needling the left side (because the meridians cross at the sacrum).