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The meridians of the Foot-Taiyang Bladder cause lower back pain. The pain radiates to the nape, spine, buttocks, and back, feeling as if bearing a heavy burden. Puncture the Xi-cleft point (Weizhong BL60) and Jing-River point (Kunlun BL60) of this meridian to bleed the Foot-Taiyang regular meridian. (Commentary: Refers to puncturing Weizhong BL60 and Kunlun BL60.) Do not allow bleeding in Spring. (Because Kidney Water Qi is deficient in Spring.)

The meridians of the Foot-Shaoyang Gallbladder cause lower back pain. The pain feels as if needles are pricking the skin, with a sensation of sluggishness. One cannot flex or extend the waist, nor can one turn the head to look back. Puncture the end of the Chenggu bone of the Foot-Shaoyang (Yangguan EX-B9) to bleed. (Commentary: Yangguan EX-B9 is located on the lateral side of the knee.) Do not allow bleeding in Summer. (Because Liver Wood Qi is deficient in Summer.)

The meridians of the Foot-Yangming Stomach cause lower back pain. One cannot turn the head to look back; when turning, one may see hallucinations. (Commentary: Seeing ghosts or monsters.) One tends to feel sorrowful. (Commentary: Divine spirit is insufficient. Yangming Qi is deficient and Yin pathogens invade, hence these symptoms appear.) Puncture the aforementioned three points (Zusanli ST36, Shanglianquan ST34, and Xialianquan ST35), harmonize the upper and lower, and bleed. (Commentary: Refers to Zusanli ST36, combined with Shanglianquan ST34 and Xialianquan ST35.) Do not allow bleeding in Autumn. (Because Spleen Earth Qi is deficient in Autumn.)

The meridians of the Foot-Shaoyin Kidney cause lower back pain. The pain radiates to the medial aspect of the spine. Puncture the Foot-Shaoyin meridian two cun above the medial malleolus (Fuliu KI7). Do not allow bleeding in Spring. (Because Kidney Water Qi is deficient in Spring.) If too much blood is lost, it cannot be restored.

The meridians of the Foot-Jueyin Liver cause lower back pain. The waist feels stiff like the string of a drawn bow. Puncture the Luo-connecting vessel of the Foot-Jueyin meridian. (Old texts erroneously read "meridian".) This point is located outside the fleshy part of the calf near the heel (Ligou LR5). This disease causes excessive talking but with low, dull speech. (Commentary: Believing oneself to be eloquent, yet unable to produce normal sound.) Puncture three times (should be punctured three times; same for subsequent locations).

Jie Mai (Resolving Vessel) causes lower back pain. The pain radiates to the shoulder. The eyes are dim and unclear, and there is occasional enuresis. Puncture Jie Mai at the space between muscles and tendons behind the knee, specifically the transverse collateral on the lateral margin of the popliteal fossa. (Old texts erroneously read "meridian".) Bleed until the blood changes color. (Commentary: Jie Mai is a divergent branch of the Foot-Taiyang Bladder meridian. It should be punctured at the high muscular area between the two tendons at the popliteal crease. If transverse collaterals are visible laterally, full and purple-black, puncture to release black blood. Stop only when the blood turns red.)

Jie Mai also causes lower back pain, feeling as if pulled by a belt, often as if the waist is broken (pronounced 'she'). One easily becomes frightened. Puncture Jie Mai in the center of the popliteal fossa (Weizhong BL60). The knotted collaterals resemble millet grains; upon puncture, blood shoots out black. Stop when red blood appears. (Commentary: Reiterating Jie Mai refers to the Taiyang branch descending from the waist, passing along the spine into the center of the popliteal fossa. Hence the pain is thus. The Taiyang meridian connects with the Kidney, hence fear.)

Tongyin Mai (Same Yin Vessel) causes lower back pain. The pain feels as if a small hammer is lodged in the middle of the waist. (Commentary: Painful and heavy.) There is sudden swelling. (Commentary: Swelling protrudes as if angry.) Puncture Tongyin Mai at the end of the fibular head above the lateral malleolus (Yangfu GB38), puncturing three times. (Commentary: Yangfu GB38 is a Luo-connecting vessel of the Foot-Shaoyang Gallbladder, connecting with the Foot-Jueyin Liver meridian and descending to connect with the dorsum of the foot, hence called Tongyin Mai.)

Yangwei Mai (Yang Linking Vessel) causes lower back pain. The painful area is swollen and protruding. Puncture the Yangwei Mai where it joins with the Taiyang meridian below the popliteal fossa, about one chi from the ground (Chengshan BL57).

Hengluo Mai (Transverse Collateral Vessel) causes lower back pain. One cannot flex or extend the waist; lying supine, one fears falling. This results from lifting heavy objects and injuring the waist, causing Hengluo to rupture and evil blood to accumulate. Puncture at the space between tendons and muscles on the lateral side of the popliteal fossa, several cun upward, horizontally distributed (Weiyang BL39 and Yinmen BL37, both located here). (Commentary: Heng means transverse. A collateral of the Foot-Taiyang Bladder emerges horizontally from the waist to the posterior-lateral thigh, merging into the popliteal fossa, hence called Hengluo.) Puncture twice to bleed.

Huiyin Mai (Meeting Yin Vessel) causes lower back pain. The painful area sweats profusely. (Commentary: Pathogen in the Yin division.) When sweat dries, one desires to drink. (Commentary: Body fluids are depleted.) After drinking, one desires to move about. (Commentary: Excessive drinking causes Yin Qi to overflow downward, hence the desire to move.) Puncture Zhiyang Mai (Straight Yang Vessel) three times above, located five cun above the popliteal fossa on the Yangqiao vessel, horizontally distributed. Observe the prominent collaterals and bleed. (Commentary: Huiyin is an Renmai point; Du Mai runs along the back from here, causing lower back pain. Zhiyang refers to the Foot-Taiyang Bladder meridian running straight along the spine. Its point is above Yangqiao and below the popliteal fossa, about five cun apart and horizontally distributed. Observe prominent collaterals for accuracy.)

Feiyang Mai (Flying Yang Vessel) causes lower back pain. The painful area feels uncomfortable and distended; severely, one experiences grief and fear. Puncture Feiyang Mai at its intersection with the Yinwei Mai. (Commentary: Feiyang BL58 is the Luo-connecting point of the Foot-Taiyang Bladder, diverging to the Shaoyin. The intersection with Yinwei Mai is anterior to Shaoyin, five cun above the medial malleolus, Zhubin KI7.)

Changyang Mai (Bright Yang Vessel) causes lower back pain. The pain radiates to the chest. The eyes are dim and unclear; severely, the body arches backward (opisthotonos), the tongue curls, and speech is impossible. (Commentary: Puncture Fuliu KI7. Yinqiao merges with the Foot-Taiyang Bladder meridian, hence called Changyang.)

San Mai (Scattered Vessel) causes lower back pain accompanied by heat. Severe heat causes irritability. Below the waist, it feels as if a horizontal piece of wood is lodged there; severely, there is enuresis. Puncture San Mai between the bone and muscle anterior to the knee, at the outer margin of the collateral vessels binding the meridians, puncturing three times. (Commentary: Wang Bing notes San Mai is a branch of the Foot-Taiyin Spleen meridian, scattering into the thigh and abdomen, joining with Shaoyin and Shaoyang under the iliac bone. Large tendons bind the tibial bones. Taking these tendon-bone binding meridians treats the disease, which is Diji SP8. Three punctures mean three needle insertions. Wu Qian notes San Mai is a scattered branch of the Foot-Yangming Stomach meridian's Luo vessel. Leijing notes that "between bone and muscle anterior to the knee, outer margin of collateral binding meridians" seems to refer to the Yangming meridian as San Mai, but this chapter lacks Taoyin puncture methods. However, later text mentions "upper heat puncture Foot-Taiyin," which corresponds. Note: Diji SP8 treats lower back pain, consistent with Wang Bing's note.)

Rouli Mai (Muscle Interior Vessel) causes lower back pain. One cannot cough; coughing causes muscle spasms and tightness. (Commentary: Rouli refers to the interior of muscle compartments, traversed by the Foot-Shaoyang Gallbladder meridian, governing fascia and tendons.) Puncture Rouli Mai twice, located lateral to the Taiyang meridian and posterior to the Shaoyang meridian's fibular head (Yangfu GB38).

Lower back pain flanking the spine radiating to the head, eyes dim and unclear (looking down posture), eyes blurry, desire to collapse and fall. Puncture the center of the popliteal fossa of the Foot-Taiyang Bladder meridian to bleed.

Upper back coldness: Puncture Foot-Taiyang (Jinggu BL64) and Foot-Yangming (Chongyang ST42).

Upper back heat: Puncture Foot-Jueyin Liver (Dachong LR3). (Commentary: Upper cold/heat refers to the upper body. Cold is treated by puncturing Yang meridians to expel Yin pathogens from Yang divisions; heat is treated by puncturing Jueyin to expel wind-heat from Yin.)

Inability to flex or extend: Puncture Foot-Shaoyang Gallbladder (Qiuxu GB40).

Mid-body heat with panting: Puncture Foot-Shaoyin Kidney (Taixi KI3). (Commentary: Puncture the center of the popliteal fossa to bleed [Weizhong BL60]. Note: The Shaoyin meridian passes through the liver and diaphragm into the lungs. Insufficient Kidney Water fails to control Fire, causing mid-heat and panting; thus puncture the Shu-stream of Foot-Shaoyin. Taixi KI3 is correct. Puncturing the popliteal center refers to Foot-Taiyang Weizhong BL60. Wu Qian's note suggesting Shuiquan KI6 of Shaoyin is incorrect.)

Upper back coldness with inability to look around: Puncture Foot-Yangming Stomach. Upper back heat: Puncture Foot-Taiyin Spleen. (Wang Bing note: Upper cold treated by Yinshi ST8; inability to look treated by Zusanli ST36; upper heat treated by Diji SP8. ○ Both Yangming and Taiyin meridians cannot look left or right.)

Difficulty defecating: Puncture Foot-Shaoyin Kidney (Yongquan KI1).

Fullness in the lower abdomen: Puncture Foot-Jueyin Liver (Taichong LR3).

Lower back pain as if broken, unable to flex/extend or lift: Puncture Foot-Taiyang Bladder. (Wang Bing note: As if broken, treat with Shugu BL65; inability to flex/extend, treat with Jinggu BL64 and Kunlun BL60; inability to lift, treat with Shenmai BL62 and Pucan BL59.)

Pain radiating to the medial spine: Puncture Foot-Shaoyin Kidney. (Wang Bing note: Fuliu KI7. ○ Wu Qian note: Having symptoms of breaking, inability to flex/extend/lift, with pain radiating to the medial spine, this is pain of the Foot-Taiyang Bladder meridian connecting to the Kidney.)

Lower back pain radiating to the hypochondrium/groin, unable to lie supine: Puncture the crossing points of the lumbar and sacral regions, above the gluteal muscles on both sides. Release the needle immediately for cure. (Wang Bing note: This refers to the Xiagao BL34 point, where Foot-Taiyin Spleen, Foot-Jueyin Liver, and Foot-Shaoyang Gallbladder meridians cross. The "two knees" refer to the firm flesh below the iliac crest. There are four bony depressions on either side of the sacrum below the iliac crest, eight points total, all treating lower back pain.)