足太阳脉。令人腰痛。引项脊。尻背如重状。（按此篇承上章而复记病在形身之外。经络之间。令人腰痛者。有刺取
之法也。夫身半之中。在内为腹。在外为腰。腹中之血气。不循经而灌于膜原郛郭之间。是以为病则胸满腹胀。为治所
不宜灸砭。至于阴阳经脉。皆从腰而循转。是以为病则痛于有形。为治皆所当刺取。此形身外内之各有别也。所谓经脉
者。足之三阴三阳。及奇经之八脉。皆循腰而上。惟足太阴之脉。从膝股内廉。入腹属脾。以主腹中。故不论于外也。
张
兆璜问曰。足之三阴三阳。及奇经八脉。有从腰脊而上循于头项。有从胸腹而上属于膺喉。今独主腰痛者。何也。曰。
腰以上为天。腰以下为地。而带脉横束于其间。是以无病则天地交而经脉调。病则经气阻滞于其间而为痛。故诸脉皆令
人腰痛也。）刺其 中。太阳正经出血。春无见血。（足太阳之脉。从巅别下项。挟脊抵腰中。经脉阻滞于其间则腰痛。
上下不能疏通。故引项脊。尻背如重状也。王冰以委中为 中。在膝后屈处。出血者。泻而疏之也。春无见血者。正月
太阳寅。故不宜出血。以泄太阳方盛之气。按此篇记经脉为病。而痛于腰之实证。与内伤肝肾外病筋骨之虚痛者不同也。）
少阳令人腰痛。如以针刺其皮中。循循然不可以俯仰。不可以顾。（少阳之气主夏。而夏气在皮肤。故皮中如针刺。循循、
渐次也。少阳主枢。循循不可以俯仰者。经脉病而枢折也。足少阳之脉。从目锐 。循颈至肩。故不可以回顾。）刺少阳
成骨之端出血。成骨在膝外廉之骨独起者。夏无见血。（膝外廉。阳陵泉之下。有独起之骨为成骨。盖足少阳主骨。至此
筋骨交会之处。为成骨也。少阳为心之表。主夏之三气。故夏无见血。莫仲超曰。太阳之气。生于水中。故主正月寅
而始盛。少阳为君火之相。故为心之所表。夫少阳主初生之气者。少阳先天之所生也。少阳为心之表者。少阳之上。相
火主之也。太阳正月寅者。太阳从水中之所生也。太阳主夏火之气者。太阳之后天也。阴阳之道。推散无穷。学人当详
究其妙。）阳明令人腰痛。不可以顾。顾如有见者。善悲。（顾、回视也。足阳明之脉。循喉咙。入缺盆。经脉强急于前。
故不可回顾于后。夫血脉荣卫。阳明之所生也。血脉和则精神乃居。故神者。水谷之精气也。阳明脉病则神气乃虚。精
神虚乱。卒然见非常物。神不足则悲也。）刺阳明于 前三 。上下和之出血。秋无见血。（ 前三 者。足之三里。及
上廉下廉也。阳明居中土。故当上下以和之。阳明主秋令。故秋无见血。杨元如曰。少阳太阳之气。生于下焦水中。
而合于上焦君相之火。故有先后天之分。阳明之气。生于中焦水谷而居中土。故独主于秋令也。）足少阴令人腰痛。痛引
脊内廉。（足少阴之脉。上股内廉。贯脊属肾。故痛引脊内廉也。）刺少阴于内踝上二 。春无见血。出血太多。不可复
也。（内踝上二 。取左右之太溪也。夫血乃精水之所生。肾主闭藏。以奉春生之气。春时出血。则泄其所藏。是以多则
不可复矣。）厥阴之脉。令人腰痛。腰中如张弓弩弦。（足厥阴之脉。抵少腹。布胁肋。故腰痛如张弓弦。盖 弱端长。
肝之平脉也。肝脉病。故强急如弓弩弦。）刺厥阴之脉。在 踵鱼腹之外。循之累累然。乃刺之。（ 、腿肚也。踵、足
跟也。鱼腹、谓 之形如鱼腹也。视 踵之间。鱼腹之外。循之有脉累累然者。乃刺之。）其病令人善言。默默然不慧。
刺之三 。（肝主语。故其病令人善言。默默、安静貌。谓虽善言而不狂妄也。不慧、语言之不明爽也。其病若此者。于
踵之外。刺之三 。三 者。取经外穴也。按腰中如弓弦者。所病在经也。善言不慧者。病厥阴之气而有是证也。三
阴三阳之主腰痛。有单病在经者。有病经而及于气者。故以此筋分而论之。）解脉令人腰痛。痛引肩。目KT KT 然。
时遗溲。（KT 音荒。解脉者。散行横解之络脉也。盖经脉为里。浮而横者为络。络脉横散于皮肤之间。故名曰解脉。
诸络脉者。在皮之部。皮主太阳之气分。故痛引肩目。时遗溲。而宜取太阳之 也。散上声。）刺解脉在膝筋肉分间。
外廉之横脉出血。血变而止。（膝后筋肉分间。太阳之委中穴也。 外廉之横脉。穴外之横络也。针经云。支而横者为
络。络之别者为孙。盛而血者疾诛之。故宜泻出其血。黑变赤而止。倪冲之曰。邪在横解之络脉。故亦取横脉以泻之。）
解脉令人
腰痛如引带。常如折腰状。善恐。（此复论横络盛加于大经。令之不通。是以令人腰痛如引带。腰似折者。太阳之气病也。
横盛于中。则上虚下实。下实则气并于阴。故善恐也。）刺解脉在 中。结络如黍米。刺之血射以黑。见赤血而已。（有
结络如黍米。视而泻之。此所谓解结也。）同阴之脉。令人腰痛。痛如小锤居其中。怫然肿。（此论阳跷之脉而令人腰痛
也。跷脉有阴阳。男子数其阳。女子数其阴。当数者为经。不当数者为络。是男女阴阳。经络交并。故为同阴之脉。其
脉行健。故名曰跷。有阻于中。则不上行。故痛如小锤居其中。怫然、怒意。言肿突如怒起也。按跷脉为病。少腹痛里
急。腰及髋 下相连阴中痛。阴疝。本经言痛如小锤居其中。即里急阴疝之证也。）刺同阴之脉。在外踝上绝骨之端为三
。（阳跷者。足太阳之别脉。起于跟中。出于外踝。下足太阳申脉穴。当踝后绕跟。以仆参为本。上外踝三寸。以附阳
为。直上循役外廉。故宜取外踝绝骨之处。）阳维之脉。令人腰痛。痛上怫然肿。（此论阳维之脉而令人腰痛也。阳维、
总维一身之阳。阳气盛。故痛上怫然肿。）刺阳维之脉。脉与太阳合 下间。去地一尺所。（阳维起于诸阳之会。其脉发
于足太阳金门穴。在足外踝下一寸五分。上外踝七寸。会足少阳于阳交。为阳维之 。故当与太阳合 下间而取之。
盖取阳维之 也。 上去踝七寸。是离地一尺所矣。）衡络之脉。令人腰痛不可以俯仰。仰则恐仆。得之举重伤腰。衡络
绝。恶血归之。（此论带脉为病而令人腰痛也。衡、横也。带脉横络于腰间。故曰横络之脉。夫足之三阳。循腰而下。足
之三阴。及奇经之脉。皆循腰而上。病则上下不通。阴阳间阻。而为腰痛之证。惟带脉横束于其间。无上下之相贯。故
必因举重伤腰。以致横络之脉绝伤。而恶血归之。令人腰痛不可以俯仰也。）刺之在 阳筋之间。上 数寸。横居为二
出血。（ 阳谓足太阳之浮 。在臀下腿筋之间。上 数寸。是在腰尻之下矣。横居二 者。盖随带脉之横形而取之。按
灵枢经曰。足少阳之正主 中。别走太阳而合。上至肾。当十四椎。出属带脉是带脉。之下连于足少阴太阳。故当从浮
而上。循太阳之络以取之。）会阴之脉。令人腰痛。痛上漯漯然汗出。汗干令人欲饮。饮已欲走。（此论任脉为病而令
人腰痛也。任脉起于至阴。与督脉交会。分而上行。故名曰会阴。任脉统任一身之阴。汗乃阴液。故漯漯然汗出也。汗
干则液竭。故令人欲饮。走者阳象也。任与督脉。上下相交。饮已欲走者。阴液周而交于阳也。）刺直阳之脉上三 。
在跷上 下五寸。横居视其盛者出血。（直阳之脉。督脉也。督脉总督一身之阳。贯脊直上。故曰直阳。其原起于肾下胞
中。循阴器。绕臀至少阴。与太阳中络者合。故取跷上 下者。循足太阳之络以泻之也。按会阴节后。当有刺条。刺直
阳前。宜有腰痛。或简脱与。抑督与任交病在阴而取之阳耶。滑伯仁曰。任督二脉。一源而二歧。一在于身之前。一行
于身之后。又督脉别络。自长强走任脉者。由小腹直上。贯脐中央。入喉上颐。会太阳于晴明穴。是任督二脉。阴阳合
并。分而上行。然其间又有交会之处。张兆璜曰。饮已欲走。是阴入于阳。故当从督以泻任。且任脉循于腹。而其痛
在腰。是所病之因在任。而所成之证在督也。）飞阳之脉。令人腰痛。痛上怫怫然。甚则悲以恐。（此论阴维之脉而令人
腰痛也。足太阳之别。名曰飞阳。去踝七寸。别走少阴。阴维之脉。起于足少阴筑宾穴。为阴维之 。故名飞阳者。谓
阴维之原。从太阳之脉。走少阴而起者也。怫怫、郁怒貌。肾病者。意不乐。气并于肾则恐也。朱永年曰。任督二脉。
与阳维阴维阳跷阴跷。皆阴阳互相交会而起。）刺飞阳之脉。在内踝上五寸。少阴之前。与阴维之会。（阴维之脉。在
内踝上五寸。 肉分中。上循股内廉。上行入腹。故于此取之。盖内踝上五寸。少阴之前。乃足少阴与阴维交会之处。）
昌阳之脉。令人腰痛。痛引膺。目KT KT 然。甚则反折。舌卷不能言。（此论阴跷之脉而令人腰痛也。阴跷者。足少
阴之别。其脉起于跟中。同足少阴。上内踝之上二寸。以交信为 。直上循阴股。入阴。上循胸里。出人迎之前。至咽
喉。交目内 。合于太阳阳跷。是以痛引膺。目KT KT 然。交足太阳。故甚则反折。循咽喉。故舌卷不能言也。马
莳曰。昌阳、即足少阳穴名。一名复溜。又名伏白。）刺内筋为二 。在内踝上大筋前。太阴后上踝二寸所。（内筋谓大
筋之前分肉也。太阴后。大筋前。上踝二寸所。即阴跷之 。交信穴也。）散脉令人腰痛而热。热甚生烦。腰下如有横
木居其中。甚则遗溲。（此论冲脉为病而令人腰痛也。冲脉者。起于胞中。上循背里。为经络之海。其浮而外者。循腹右
上行。至胸中而散。灌于皮肤。渗于脉外。故名散脉也。冲脉为十二经脉之原。心主血脉。故痛而热。热甚生烦。其循
于腹者。出于气街。挟脐下两旁各五分。至横骨一寸。经脉阻滞于其间。故腰下如有横木居其中。起于胞中。故甚则遗
溺。）刺散脉在膝前骨肉分间。络外廉束脉为三 。（冲脉者。其输上在于大杼。下出于巨虚之上下廉。故取膝前外廉者。
取冲脉之下俞也。以上论奇经之八脉。皆循腰而上。故并主腰痛。）肉里之脉。令人腰痛。不可以咳。咳则筋缩急。（此
论肉里之脉而令人腰痛也。肉者分肉。里者肌肉之纹理也。经云。肉之大会为谷。肉之小会为溪。分肉之间。溪谷之会。
以行荣卫。以会大气。其小痹淫溢。循脉往来。微针所及。与法相同。盖谓溪谷分肉之间。亦有穴会。循脉往来。邪气
淫溢。用微针取之。与取络脉之法相同。夫分肉起于筋骨。属于气分。咳则动气。故不可以咳。咳则筋缩急也。）刺肉里
之脉为二 。在太阳之外。少阳绝骨之后。（为二 者。取左右二足穴也。足少阳阳辅穴。又名分肉穴。在太阳膀胱经之
外。少阳绝骨穴之后。去足外踝四寸。乃其脉也。夫肌肉之纹理。属骨而生。从筋而起。足少阳属骨主筋。故取少阳之
分肉穴也。按分肉之间。溪谷之会。小痹淫溢。循脉往来。能令人腰痛也。孙络之脉别经者。其血盛而当泻者。亦令人
腰痛。是以首论横解之络脉为痛。末论肉里之间。亦循脉而为腰痛也。）腰痛挟脊而痛。至头KT KT 然。目KT KT
欲僵仆。刺足太阳 中出血。（KT 音除。此论经俞为病。而令人腰痛也。夫五脏六腑之俞。皆在太阳之经。而足太
阳之脉。挟脊抵腰。上至于头目。是以腰痛挟脊。而上及于头目者。邪入于经俞也。KT KT 短羽之鸟。背强欲舒之象。
阳盛者不能俯。故欲僵仆也。夫邪之伤于人也。先客于皮肤。传入于孙络。孙络满则传入于络脉。留而不去。传舍于经
脉。留而不去。传入于经俞。邪中于人。虽有浅深。然皆在于形身上下之间。故并主腰痛。是以论肉里之肤腠。解脉之
横络。足之三阴三阳。及奇经之经脉。以至于太阳挟脊之经俞。为痛之见证。各有不同。而取刺亦各有法也。）腰痛上
寒。刺足太阳阳明。上热刺足厥阴。不可以俯仰。刺足少阳。中热而喘。刺足少阴。刺 中出血。（此论阴阳之气不和而
令人腰痛也。痛上寒者。腰以上寒也。痛上热者。腰以上热也。夫阴阳二气。皆出于下焦。阳气不能上升。则腰痛而上
寒。阴气不能上升。则腰痛而上热。盖气阻于阴阳上下之间。故腰痛也。太阳、巨阳也。为诸阳主气。阳明间于二阳之
间。为阳盛之经。故上寒者。当取此二经。以疏三阳之气。少阳主枢。故不可俯仰者。当取足少阳也。厥阴主一阴初生
之气。故上热者取足厥阴。少阴之气。中合于阳明。上合于肺脏。阴气逆于下。故中热而喘也。 、隙也。谓经穴之空
隙为 。阴 者。足少阴之筑宾穴也。）腰痛上寒。不可顾。刺足阳明。（按此以下至引脊内廉。刺足少阴。系衍文。
谨照王氏原注。王冰曰。上寒。阴市主之。在膝下三寸。伏兔下陷者中。足阳明脉气所发。不可顾。三里主之。在膝下
三寸 外廉。两筋肉分间。足阳明脉之所入也。）上热刺足太阴。（王冰曰。地机主之。在膝下五寸。足太阴之 也。）中
足太阳经脉，使人腰痛，疼痛牵引项部和脊背，臀部及背部感觉沉重。（按：此篇承接上一章，再次记载病位在形体之外、经络之间的腰痛，有针刺取穴的方法。身体半腰之中，在内为腹部，在外为腰部。腹中的血气，如果不循行经脉而灌注在膜原和体表之间，因此生病会出现胸满腹胀，这是治疗时不适宜用灸法和砭法治疗的。至于阴阳经脉，都从腰部循行回转，因此生病则疼痛在形体上，治疗都应当针刺取穴。这是形体内外各有区别的说法。所谓经脉，足部的三阴经和三阳经，以及奇经八脉，都循行腰部向上。只有足太阴脾经，从膝股内侧，进入腹部属脾，以主管腹部，所以不讨论在外的情况。
张兆璜问道：足部的三阴三阳经，以及奇经八脉，有的从腰脊向上循行至头项，有的从胸腹向上属于膺喉。现在唯独主治腰痛，为什么呢？回答说：腰以上为天，腰以下为地，而带脉横束于其间。所以没有病时，天地之气相交而经脉调和；有病时，经气阻滞于其间而产生疼痛。所以各条经脉都会使人腰痛。）针刺委中穴（腘窝中央），使足太阳正经出血，春季不宜放血。（足太阳经脉，从头顶别行向下至项部，挟脊抵于腰中。经脉阻滞于其间则腰痛，上下不能疏通，所以牵引项脊，臀部背部如重状。王冰认为委中即郄中，位于膝后屈曲处。出血是为了泻除并疏通经气。春季不宜放血，因为正月对应太阳经寅位，所以不宜出血，以免泄去太阳方盛的气。按：此篇记载经脉为病，且痛在腰部的实证，与内伤肝肾、外病筋骨的虚痛不同。）
少阳经使人腰痛，像针扎皮肤一样，渐渐不能俯仰，不能回顾。（少阳之气主夏季，而夏气在皮肤，所以皮中如针刺。循循，意为渐次。少阳主枢机，渐渐不能俯仰，是因为经脉病而枢机折损。足少阳经脉，从目锐眦，循颈至肩，所以不能回顾。）刺少阳成骨之端出血。成骨位于膝外侧独起的骨头处，夏季不宜放血。（膝外侧，阳陵泉之下，有独起的骨头称为成骨。大概足少阳主骨，至此筋骨交会之处，称为成骨。少阳是心的表里关系，主夏季的三气，所以夏季不宜放血。莫仲超说：太阳之气生于水中，所以主正月寅而始盛。少阳是君火的相火，所以为心之所表。夫少阳主初生之气，是少阳先天所生的。少阳为心之表，是因为少阳之上，相火主事。太阳正月寅，是因为太阳从水中所生。太阳主夏火之气，是太阳的后天。阴阳之道，推散无穷，学人应当详细探究其妙理。）
阳明经使人腰痛，不能回顾，回顾时好像看见什么东西，容易悲伤。（顾，回视。足阳明经脉，循喉咙，入缺盆。经脉强急于前，所以不能回顾于后。夫血脉营卫，是阳明所生的。血脉和则精神乃居，所以神是水谷的精气。阳明脉病则神气乃虚，精神虚乱，突然看见非常之物，神不足则悲伤。）刺阳明经在足三里等三个穴位上下调和出血，秋季不宜放血。（足三里等三个穴位，指足三里及上廉、下廉。阳明居中土，所以应当上下调和。阳明主秋令，所以秋季不宜放血。杨元如说：少阳太阳之气，生于下焦水中，而合于上焦君相之火，所以有先后天之分。阳明之气，生于中焦水谷而居中土，所以独主于秋令。）
足少阴经使人腰痛，疼痛牵引脊骨内侧。（足少阴经脉，上股内侧，贯脊属肾，所以疼痛牵引脊骨内侧。）刺足少阴在内踝上二寸处，春季不宜放血。如果出血太多，就无法恢复了。（内踝上二寸，取左右两侧的太溪穴。夫血是精水所生，肾主闭藏，以奉春生之气。春时出血，则泄其所藏，所以多了就无法恢复。）
厥阴经脉，使人腰痛，腰部中间像张开的弓弩弦一样。（足厥阴经脉，抵少腹，布胁肋，所以腰痛如张弓弦。大概软弱端长，是肝的正常脉象。肝脉病，所以强急如弓弩弦。）刺厥阴经脉，在跟腱鱼腹之外的地方，循摸到有累累跳动的脉搏，才针刺。（腨，腿肚也。踵，脚跟也。鱼腹，谓腨之形如鱼腹也。视腨踵之间，鱼腹之外，循摸到有脉累累跳动者，才针刺。）这种病使人喜欢说话，默默然不明智。（肝主语，所以其病使人喜欢说话。默默，安静貌。谓虽然喜欢说话但不狂妄。不慧，语言的不明爽。其病若此者，于踵之外，刺三次。三次，取经外穴位。按：腰中如弓弦者，病在经脉。善言不慧者，病厥阴之气而有这些证候。三阴三阳主要治腰痛，有单病在经脉的，有病经脉而波及到气的，所以以此筋脉区分来论述。）
解脉使人腰痛，疼痛牵引肩部，眼睛昏花看不清，时常遗尿。（KT音荒。解脉，是散行横解的络脉。大概经脉为里，浮而横行的为络。络脉横散于皮肤之间，所以名叫解脉。诸络脉，在皮之部。皮主太阳之气分，所以痛引肩目，时常遗尿，而宜取太阳的郄穴。散上声。）刺解脉在膝后筋肉分间，外侧的横脉出血，血色变红就停止。（膝后筋肉分间，是太阳的委中穴。外侧的横脉，是穴外的横络。《针经》说：支而横者为络，络之别者为孙。盛而血者疾诛之，所以宜泻出其血，黑变赤而止。倪冲之说：邪在横解之络脉，所以也取横脉以泻之。）
解脉使人腰痛，像牵引腰带一样，常常像腰折断一样，容易恐惧。（这是再论横络盛大加于大经，使之不通，所以使人腰痛如牵引带，腰似折断，这是太阳之气病。横盛于中，则上虚下实，下实则气并于阴，所以容易恐惧。）刺解脉在腨中，结络如黍米大小，针刺时血液射出呈黑色，见到赤血就停止。（有结络如黍米，视而泻之，这叫做解结。）
同阴之脉，使人腰痛，痛如小锤居其中，怫然肿胀。（这是论阳跷之脉而使人腰痛。跷脉有阴阳，男子数其阳，女子数其阴。当数为经，不当数为络。是男女阴阳，经络交并，所以叫同阴之脉。其脉行健，所以名叫跷。有阻于中，则不上行，所以痛如小锤居其中。怫然，怒意。言肿突如怒起也。按跷脉为病，少腹痛里急，腰及髋下相连阴中痛，阴疝。本经言痛如小锤居其中，即是里急阴疝的证候。）刺同阴之脉，在外踝上绝骨之端为三寸。（阳跷，是足太阳的别脉，起于跟中，出于外踝，下足太阳申脉穴。当踝后绕跟，以仆参为本，上外踝三寸，以附阳为郄。直上循役外廉，所以宜取外踝绝骨之处。）
阳维之脉，使人腰痛，痛处怫然肿胀。（这是论阳维之脉而使人腰痛。阳维，总维一身之阳，阳气盛，所以痛处怫然肿胀。）刺阳维之脉，脉与太阳合腨下间，去地一尺左右。（阳维起于诸阳之会，其脉发于足太阳金门穴，在足外踝下一寸五分，上外踝七寸，会足少阳于阳交，为阳维之郄。所以当与太阳合腨下间而取之。大概取阳维之郄。郄上去踝七寸，是离地一尺左右了。）
衡络之脉，使人腰痛不可以俯仰，仰则恐跌倒，得自举重伤腰。衡络绝，恶血归之。（这是论带脉为病而使人腰痛。衡，横也。带脉横络于腰间，所以叫横络之脉。夫足之三阳，循腰而下。足之三阴，及奇经之脉，皆循腰而上。病则上下不通，阴阳间阻，而为腰痛之证。惟带脉横束于其间，无上下之相贯，所以必因举重伤腰，以致横络之脉绝伤，而恶血归之，使人腰痛不可以俯仰。）刺之在腨阳筋之间，上腨数寸，横居为二出血。（腨阳谓足太阳之浮郄，在臀下腿筋之间。上腨数寸，是在腰尻之下矣。横居二郄者，盖随带脉之横形而取之。按《灵枢经》曰：足少阳之正主腨中，别走太阳而合，上至肾，当十四椎，出属带脉。是带脉之下连于足少阴太阳，故当从浮郄而上，循太阳之络以取之。）
会阴之脉，使人腰痛，痛处漯漯然汗出，汗干令人想喝水，喝完后想走动。（这是论任脉为病而使人腰痛。任脉起于至阴，与督脉交会，分而上行，所以名叫会阴。任脉统任一身之阴，汗乃阴液，所以漯漯然汗出也。汗干则液竭，所以令人想喝水。走者是阳象。任与督脉，上下相交，饮已欲走者，阴液周而交于阳也。）刺直阳之脉上三寸，在跷上腨下五寸，横居视其盛者出血。（直阳之脉，是督脉。督脉总督一身之阳，贯脊直上，所以叫直阳。其原起于肾下胞中，循阴器，绕臀至少阴，与太阳中络者合。所以取跷上腨下者，循足太阳之络以泻之。按会阴节后，应有刺条。刺直阳前，宜有腰痛。或是简脱与？抑督与任交病在阴而取之阳耶？滑伯仁说：任督二脉，一源而二歧，一在于身之前，一行于身之后。又督脉别络，自长强走任脉者，由小腹直上，贯脐中央，入喉上颐，会太阳于晴明穴。是任督二脉，阴阳合并，分而上行。然其间又有交会之处。张兆璜说：饮已欲走，是阴入于阳，故当从督以泻任。且任脉循于腹，而其痛在腰，是所病之因在任，而所成之证在督也。）
飞阳之脉，使人腰痛，痛处怫怫然，甚至悲伤恐惧。（这是论阴维之脉而使人腰痛。足太阳的别脉，名叫飞阳，去踝七寸，别走少阴。阴维之脉，起于足少阴筑宾穴，为阴维之郄，所以名叫飞阳者，谓阴维之原，从太阳之脉，走少阴而起者也。怫怫，郁怒貌。肾病者，意不乐，气并于肾则恐也。朱永年说：任督二脉，与阳维阴维阳跷阴跷，皆阴阳互相交会而起。）刺飞阳之脉，在内踝上五寸，少阴之前，与阴维之会。（阴维之脉，在内踝上五寸，腨肉分中，上循股内廉，上行入腹，所以于此取之。盖内踝上五寸，少阴之前，乃是足少阴与阴维交会之处。）
昌阳之脉，使人腰痛，疼痛牵引胸部，眼睛昏花看不清，严重时反折，舌卷不能说话。（这是论阴跷之脉而使人腰痛。阴跷，是足少阴的别脉。其脉起于跟中，同足少阴，上内踝之上二寸，以交信为郄，直上循阴股，入阴，上循胸里，出人迎之前，至咽喉，交目内眦，合于太阳阳跷。是以痛引膺，目KT KT然。交足太阳，所以严重时反折。循咽喉，所以舌卷不能言。马莳说：昌阳，即足少阳穴名，一名复溜，又名伏白。）刺内筋为二郄，在内踝上大筋前，太阴后上踝二寸处。（内筋谓大筋之前分肉也。太阴后，大筋前，上踝二寸处，即阴跷之郄，交信穴也。）
散脉使人腰痛而热，热甚生烦，腰下如有横木居其中，严重时遗尿。（这是论冲脉为病而使人腰痛。冲脉者，起于胞中，上循背里，为经络之海。其浮而外者，循腹右上行，至胸中而散，灌于皮肤，渗于脉外，所以名叫散脉。冲脉为十二经脉之原，心主血脉，所以痛而热。热甚生烦。其循于腹者，出于气街，挟脐下两旁各五分，至横骨一寸。经脉阻滞于其间，所以腰下如有横木居其中。起于胞中，所以严重时遗溺。）刺散脉在膝前骨肉分间，络外廉束脉为三郄。（冲脉者，其输上在于大杼，下出于巨虚之上下廉。所以取膝前外廉者，取冲脉之下俞也。以上论奇经之八脉，皆循腰而上，所以并主腰痛。）
肉里之脉，使人腰痛，不可以咳嗽，咳则筋缩急。（这是论肉里之脉而使人腰痛。肉者分肉，里者肌肉之纹理也。经云：肉之大会为谷，肉之小会为溪。分肉之间，溪谷之会，以行荣卫，以会大气。其小痹淫溢，循脉往来，微针所及，与法相同。盖谓溪谷分肉之间，亦有穴会，循脉往来，邪气淫溢，用微针取之，与取络脉之法相同。夫分肉起于筋骨，属于气分，咳则动气，所以不可以咳，咳则筋缩急也。）刺肉里之脉为二郄，在太阳之外，少阳绝骨之后。（为二郄者，取左右二足穴也。足少阳阳辅穴，又名分肉穴，在太阳膀胱经之外，少阳绝骨穴之后，去足外踝四寸，乃是其脉也。夫肌肉之纹理，属骨而生，从筋而起。足少阳属骨主筋，故取少阳之分肉穴也。按分肉之间，溪谷之会，小痹淫溢，循脉往来，能令人腰痛。孙络之脉别经者，其血盛而当泻者，亦令人腰痛，是以首论横解之络脉为痛，末论肉里之间，亦循脉而为腰痛也。）
腰痛挟脊而痛，至头KT KT然，目KT KT然欲僵仆，刺足太阳郄中出血。（KT音除。这是论经俞为病，而使人腰痛。夫五脏六腑之俞，皆在太阳之经，而足太阳之脉，挟脊抵腰，上至于头目。是以腰痛挟脊，而上及于头目者，邪入于经俞也。KT KT短羽之鸟，背强欲舒之象。阳盛者不能俯，故欲僵仆也。夫邪之伤于人，先客于皮肤，传入于孙络。孙络满则传入于络脉，留而不去，传舍于经脉，留而不去，传入于经俞。邪中于人，虽有浅深，然皆在于形身上下之间，故并主腰痛。是以论肉里之肤腠，解脉之横络，足之三阴三阳，及奇经之经脉，以至于太阳挟脊之经俞，为痛之见证，各有不同，而取刺亦各有法也。）
腰痛上寒，刺足太阳阳明，上热刺足厥阴，不可以俯仰，刺足少阳，中热而喘，刺足少阴，刺郄中出血。（这是论阴阳之气不和而使人腰痛。痛上寒者，腰以上寒也。痛上热者，腰以上热也。夫阴阳二气，皆出于下焦。阳气不能上升，则腰痛而上寒。阴气不能上升，则腰痛而上热。盖气阻于阴阳上下之间，故腰痛也。太阳，巨阳也，为诸阳主气。阳明间于二阳之间，为阳盛之经，所以上寒者，当取此二经，以疏三阳之气。少阳主枢，所以不可俯仰者，当取足少阳也。厥阴主一阴初生之气，所以上热者取足厥阴。少阴之气，中合于阳明，上合于肺脏。阴气逆于下，所以中热而喘也。郄，隙也。谓经穴之空隙为郄。阴郄者，足少阴之筑宾穴也。）
腰痛上寒，不可顾，刺足阳明。（按此以下至引脊内廉，刺足少阴，系衍文。谨照王氏原注。王冰说：上寒，阴市主之，在膝下三寸，伏兔下陷者中，足阳明脉气所发。不可顾，三里主之，在膝下三寸胻外廉，两筋肉分间，足阳明脉之所入也。）上热刺足太阴。（王冰说：地机主之，在膝下五寸，足太阴之郄也。）
The Foot-Taiyang channel causes lower back pain, with pain radiating to the neck and spine, and a heavy sensation in the buttocks and back. (Note: This chapter follows the previous one, reiterating that for lower back pain located outside the body and within the meridians, there are specific acupuncture methods. The waist is the midpoint of the body; internally it is the abdomen, externally it is the waist. If the qi and blood in the abdomen do not follow the channels but instead irrigate the membrane source and superficial layers, disease manifests as chest fullness and abdominal distension, which should not be treated with moxibustion or bian stones. However, the yin and yang channels all circulate from the waist; thus, when diseased, pain occurs in the有形 (tangible/form) structures, and treatment requires acupuncture. This distinguishes the internal and external aspects of the body. The so-called "channels" refer to the three yin and three yang channels of the foot, as well as the eight extraordinary vessels, all of which ascend along the waist. Only the Foot-Taiyin Spleen channel enters the abdomen from the medial aspect of the knee and thigh to connect with the spleen, governing the abdomen, and is therefore excluded from this discussion on external conditions.
Zhang Zhaohuang asked: Among the three yin and three yang channels of the foot, and the eight extraordinary vessels, some ascend from the waist and spine to the head and neck, while others ascend from the chest and abdomen to the chest and throat. Why is this section specifically focused on lower back pain? The answer is: Above the waist is Heaven, below the waist is Earth, and the Dai Mai (Girdle Vessel) binds them horizontally. When healthy, Heaven and Earth interact, and the channels are harmonious. When diseased, channel qi becomes obstructed, causing pain. Thus, all these channels can cause lower back pain.) Acupuncture at Weizhong (BL-40, center of the popliteal fossa) of the Foot-Taiyang regular channel to induce bleeding; however, bleeding should be avoided in spring. (The Foot-Taiyang channel descends from the vertex to the nape, flanking the spine to the waist. Obstruction here causes lower back pain and inability to move freely, leading to radiation to the neck and spine and heaviness in the buttocks. Wang Bing identified Weizhong as Xi-Zhong, located behind the knee. Bleeding serves to drain and unblock the qi. Spring bleeding is contraindicated because the first lunar month corresponds to the Yin position of the Taiyang channel; bleeding would deplete the vigorous qi of Taiyang. Note: This chapter describes excess patterns of lower back pain due to channel pathology, distinct from deficiency patterns caused by internal injury to the Liver and Kidney or external damage to sinews and bones.)
Shaoyang channel pathology causes lower back pain, feeling like a needle prick in the skin, gradually preventing flexion and extension, and turning the head. (Shaoyang qi governs summer, and summer qi resides in the skin, hence the pricking sensation. Xun-xun means gradual. Shaoyang governs the pivot; inability to flex/extend indicates pivot failure due to channel disease. The Foot-Shaoyang Gallbladder channel runs from the lateral canthus down the neck to the shoulder, hence difficulty looking back.) Acupuncture at the end of the Chenggu bone of the Shaoyang channel to induce bleeding. The Chenggu bone is the prominent bone on the lateral side of the knee; bleeding is contraindicated in summer. (Below Yanglingquan (GB-34) on the lateral knee, the prominent bone is called Chenggu. Foot-Shaoyang governs bones, and this junction of bone and sinew is Chenggu. Shaoyang is the exterior of the Heart and governs the three qi of summer; thus, bleeding is contraindicated in summer. Mo Zhongchao stated: Taiyang qi is born from water, governing the first month (Yin), and begins to flourish. Shaoyang is the ministerial fire of the sovereign fire, thus exterior to the Heart. Shaoyang governs the initial generating qi, born from the pre-heaven. Shaoyang being exterior to the Heart is because superior Shaoyang is governed by ministerial fire. Taiyang in the first month is born from water. Taiyang governing summer fire qi is its post-heaven aspect. The way of yin and yang is infinite; students must investigate its subtleties.)
Yangming channel pathology causes lower back pain, inability to look back, visual hallucinations upon looking back, and propensity for sorrow. (Gu means looking back. The Foot-Yangming Stomach channel runs along the throat and enters the supraclavicular fossa. Channel stiffness anteriorly prevents looking posteriorly. Blood vessels and Ying-Wei are generated by Yangming. When blood vessels are harmonious, spirit resides. Spirit is the essence of food and water. Yangming channel disease leads to deficient spirit qi, chaotic spirit, sudden perception of unusual objects, and sorrow due to spirit deficiency.) Acupuncture at the three points of Yangming (Zusanli ST-36, Shanglian, and Xialian) to harmonize and induce bleeding; bleeding is contraindicated in autumn. (These three points refer to Zusanli, Shanglian, and Xialian. Yangming occupies central Earth, requiring upper-lower harmonization. Yangming governs autumn regulations; thus, bleeding is contraindicated in autumn. Yuan Ru said: Shaoyang and Taiyang qi are born from lower jiao water and combine with upper jiao sovereign/ministerial fire, having pre- and post-heaven distinctions. Yangming qi is born from middle jiao food/water, occupying central Earth, thus uniquely governing autumn.)
Foot-Shaoyin channel pathology causes lower back pain, with pain radiating to the medial aspect of the spine. (The Foot-Shaoyin Kidney channel ascends the medial thigh, pierces the spine, and connects to the Kidney, hence pain radiating to the medial spine.) Acupuncture two cun above the medial malleolus of the Foot-Shaoyin; bleeding is contraindicated in spring. Excessive bleeding cannot be replenished. (Two cun above the medial malleolus refers to Taixi (KI-3). Blood is generated from essence/water; the Kidney stores essence to support spring generation. Bleeding in spring depletes stored essence; excessive loss is irreversible.)
Jueyin channel pathology causes lower back pain, with the waist feeling tight like a drawn bowstring. (The Foot-Jueyin Liver channel reaches the lower abdomen and spreads over the hypochondrium, causing waist pain like a bowstring. A soft, long pulse is the normal Liver pulse. Pathological Liver pulses become stiff and tense like a bowstring.) Acupuncture the Jueyin channel where the tendon meets the fish-belly muscle belly laterally; palpate for pulsating vessels before needling. (Shuan refers to the calf muscle belly. Zhong is the heel. Fish-belly describes the shape of the calf. Between the calf and heel, laterally, if pulsating vessels are felt, then needle.) This condition causes excessive talking, silence, and mental dullness. (The Liver governs speech; thus, the disease causes talking. Momo implies quietness, not madness. Bu-hui means unclear speech. For such symptoms, needle three times outside the heel. These are extra-channel points. Note: Waist stiffness like a bowstring indicates channel pathology. Excessive talking/dullness indicates Jueyin qi pathology. The three yin and three yang channels primarily treat lower back pain; some involve only the channel, others involve channel and qi. Thus, differentiation by sinew/channel is used.)
Xie Mai (Loose/Splayed Vessels) pathology causes lower back pain radiating to the shoulder, blurred vision, and occasional urinary incontinence. (Xie Mai refers to collateral vessels running transversely and loosely. Channels are interior; floating/transverse vessels are collaterals. Collaterals scatter in the skin. Skin governs Taiyang qi distribution; thus, pain radiates to shoulder/eyes, and incontinence occurs, requiring needling of the Taiyang Xi point.) Acupuncture the transverse vessel laterally between the muscle divisions of the knee to induce bleeding; stop when blood color changes. (Between the muscles behind the knee is Weizhong (BL-40). The transverse vessel outside the acupoint is an external collateral. The *Classic of Acupuncture* states: Branching and transverse vessels are collaterals; distinct collaterals are Sun collaterals. Full and bloody collaterals should be rapidly purged. Drain blood until it turns from black to red.)
Xie Mai pathology also causes lower back pain feeling like a pulling belt, often like a broken waist, with fearfulness. (This discusses excessive horizontal collaterals obstructing major channels, causing pulling/breaking sensations, indicative of Taiyang qi pathology. Horizontal excess creates upper deficiency and lower excess; lower excess pushes qi into Yin, causing fear.) Acupuncture the Xi point in the calf where collaterals knot like millet grains; needle until black blood射 (shoots) out, stopping when red blood appears. (Knot-like collaterals resembling millet grains should be viewed and drained. This is called "untying knots.")
Tongyin Mai pathology causes lower back pain, feeling like a small hammer lodged inside, with swelling. (This discusses the Yang Qiao Mai. Qiao vessels have yin/yang aspects; men count Yang, women count Yin. The counted one is the channel, the other is the collateral. Male/female yin/yang interweave, hence "Tongyin" (Same Yin). The vessel moves vigorously, hence "Qiao" (Leap). Obstruction prevents ascent, causing pain like a hammer and swelling. Swelling feels like anger rising. Qiao vessel diseases include lower abdominal urgency, pain connecting waist/hip/genitals, and yin hernia. Pain like a hammer corresponds to urgency/hernia.) Acupuncture three cun above the end of the fibula on the lateral ankle. (Yang Qiao is a branch of Foot-Taiyang, starting in the heel, exiting the lateral ankle, passing Shenmai (BL-62), wrapping around the heel via Pucan (BL-63), ascending 3 cun above the lateral ankle to Fuyang (BL-59), the Xi point. Ascend along the lateral leg; thus, select the fibular end.)
Yang Wei Mai pathology causes lower back pain with swelling at the painful site. (Yang Wei gathers all Yang qi. Excess Yang causes swelling.) Acupuncture the Yang Wei Mai where it joins the Taiyang channel in the calf depression, about one chi from the ground. (Yang Wei originates from the meeting of Yang channels, emerging from Jinmen (BL-63) below the lateral ankle, ascending 7 cun to meet Shaoyang at Yangjiao (GB-35), forming the Xi point. Select where it joins Taiyang in the calf. The Xi point is 7 cun above the ankle, approx. one chi from the ground.)
Heng Luo Mai pathology causes lower back pain preventing flexion/extension; leaning back causes fear of falling. Caused by lifting heavy weights injuring the waist, severing Heng Luo, causing evil blood accumulation. (This discusses Dai Mai pathology. Heng means transverse. Dai Mai binds horizontally at the waist. Three Yang descend the waist; Three Yin and Extraordinary vessels ascend. Disease blocks ascent/descent, causing obstruction. Dai Mai binds horizontally without vertical connection. Heavy lifting injures the waist, severing Heng Luo and accumulating blood, causing immobility.) Acupuncture between the Shu-yang sinew, several cun above the calf, horizontally at two points to bleed. (Shu-yang refers to the floating Xi of Foot-Taiyang, between the gluteal and leg tendons. Several cun above the calf is below the lumbosacral region. Two horizontal Xi points follow the transverse Dai Mai. *Ling Shu* states: Foot-Shaoyang connects to Taiyang, ascends to the Kidney, exits at T14 to belong to Dai Mai. Dai Mai connects to Foot-Shaoyin/Taiyang; thus, ascend from the floating Xi along Taiyang collaterals.)
Huiyin Mai pathology causes lower back pain with profuse sweating, thirst after sweat dries, and urge to walk. (This discusses Ren Mai pathology. Ren Mai starts at Huiyin, intersects Du Mai, and ascends. Ren governs all Yin. Sweat is Yin fluid; thus, profuse sweating. Dry sweat depletes fluids, causing thirst. Walking is Yang movement. Ren/Du intersect; drinking then walking represents Yin fluid circulating to interact with Yang.) Acupuncture the Zhiyang Mai three cun upward, five cun below the calf on the Qiao, horizontally at full vessels to bleed. (Zhiyang Mai is the Du Mai, commanding all Yang, piercing the spine vertically. Originating below the Kidney/bladder, circling genitals, passing the hip to Shaoyin, merging with Taiyang collaterals. Select Qiao/calf points to drain via Taiyang collaterals. Note: There may be missing text regarding Huiyin. Before needling Zhiyang, there should be lower back pain. Is this a textual omission? Or does Du/Ren intersection pathology in Yin require treating Yang? Hua Boren said: Ren/Du share a source but diverge; one anterior, one posterior. Du collateral from Changqiang goes to Ren, up through umbilicus/throat to Jingming, meeting Taiyang. Ren/Du merge yin/yang and ascend separately, yet intersect. Zhang Zhaohuang said: Thirst/walking indicates Yin entering Yang; thus, drain Ren via Du. Ren runs on the abdomen, but pain is in the waist; the cause is Ren, the manifestation is Du.)
Feiyang Mai pathology causes lower back pain with oppression, severe cases involving sadness and fear. (This discusses Yin Wei Mai pathology. Feiyang is a branch of Foot-Taiyang, 7 cun above the ankle, branching to Shaoyin. Yin Wei starts at Zhubin (KI-9), its Xi point. Named Feiyang because Yin Wei's origin travels from Taiyang to Shaoyin. Fu-fu implies depression/anger. Kidney disease causes displeasure; qi combining with Kidney causes fear. Zhu Yongnian said: Ren/Du and Yang/Yin Wei/Qiao all interconnect yin/yang.) Acupuncture Feiyang Mai 5 cun above the medial malleolus, anterior to Shaoyin, at the Yin Wei intersection. (Yin Wei runs 5 cun above medial malleolus in the calf muscle, ascending medial thigh to abdomen. Select here. 5 cun above medial malleolus, anterior to Shaoyin, is the intersection of Foot-Shaoyin and Yin Wei.)
Changyang Mai pathology causes lower back pain radiating to the chest, blurred vision, severe opisthotonos, tongue rolling, and inability to speak. (This discusses Yin Qiao Mai pathology. Yin Qiao is a branch of Foot-Shaoyin, starting in the heel, ascending 2 cun above the medial malleolus to Jiaoxin (KI-8), its Xi point. Ascending medial thigh, genitals, chest, anterior to Renying, to throat, crossing medial canthus, joining Taiyang Yang Qiao. Hence chest radiation/blurred vision. Joining Taiyang causes opisthotonos. Passing throat causes tongue rolling/speech issues. Ma Shi said: Changyang is a Foot-Shaoyang acupoint, also known as Fuliu or Fubai.) Acupuncture two Xi points in the inner sinew, anterior to the large sinew, posterior to Taiyin, 2 cun above the ankle. (Inner sinew refers to the muscle gap anterior to the large sinew. Posterior to Taiyin, anterior to large sinew, 2 cun above ankle is Jiaoxin (KI-8), the Yin Qiao Xi point.)
San Mai pathology causes lower back pain with heat, severe heat causing irritability, sensation of a horizontal log in the lower waist, and severe urinary incontinence. (This discusses Chong Mai pathology. Chong Mai originates in the uterus, ascends the back interior, serving as the Sea of Channels. Its superficial part ascends right abdomen to the chest, scattering into skin/vessels, hence "San" (Scattered). Chong is the origin of the twelve channels; Heart governs blood vessels, hence pain/heat. Heat causes irritability. Ascending part runs from Qichuan, 0.5 cun lateral to umbilicus to Henggu. Obstruction causes the log sensation. Originating in uterus causes incontinence.) Acupuncture San Mai between the bone and flesh of the knee anteriorly, binding three vessels laterally on the collateral. (Chong Mai output points are Dazhu (BL-11) superiorly and Shang/Xia Juxu inferiorly. Selecting lateral knee accesses the lower Shu of Chong. Above discussed how all eight extraordinary vessels ascend the waist, thus governing lower back pain.)
Rouli Mai pathology causes lower back pain preventing coughing; coughing causes sinew contraction/spasm. (This discusses Rouli Mai pathology. Rou means muscle separation; Li means muscle texture. Classics state: Large muscle gatherings are Gu, small are Xi. Muscle gaps and Xi/Gu meetings conduct Ying-Wei and gather Great Qi. Minor bi pathogens overflow here, moving along channels. Fine needles apply same methods as collateral needling. Muscle gaps have acupoints; pathogens overflow, treatable by fine needles. Muscles originate from sinew/bone, belong to Qi. Cough moves Qi, causing spasm.) Acupuncture two Xi points of Rouli Mai, lateral to Taiyang, posterior to Shaoyang Fibula (Guanggu). (Two Xi points refer to bilateral acupoints. Yangfu (GB-38), also Fenrou, is lateral to Taiyang, posterior to Guanggu, 4 cun above lateral ankle. Muscle texture relates to bone/sinew. Foot-Shaoyang governs bone/sinew; thus, select Shaoyang Fenrou. Note: Muscle gaps/Xi meetings with minor bi can cause lower back pain. Sun collaterals with excess blood also cause lower back pain. Hence, the chapter begins with transverse collaterals and ends with Rouli/muscle gaps, both causing pain via channel circulation.)
Lower back pain flanking the spine, radiating to the head with stiffness, blurred vision, and desire to fall. Acupuncture Xi-Zhong of Foot-Taiyang to bleed. (KT sounds like Chu. This discusses Jing-Shu pathology. All Zang-Fu Shu points are on Taiyang. Foot-Taiyang flanks the spine to the head/eyes. Lower back pain radiating upward indicates pathogen entering Jing-Shu. KT-KT resembles short-winged birds stretching stiff backs. Yang excess prevents flexion, causing desire to fall. Pathogens enter skin, then Sun collaterals, then Luo, then Jing, then Jing-Shu. Depth varies, but all affect form/body, causing lower back pain. Thus, discussions on Rouli skin, Xie Mai collaterals, Three Yin/Yang channels, Extraordinary vessels, and Taiyang spinal Shu points show different manifestations and needling methods.)
Upper lower back cold: Acupuncture Foot-Taiyang and Yangming. Upper lower back heat: Acupuncture Foot-Jueyin. Inability to flex/extend: Acupuncture Foot-Shaoyang. Middle heat with panting: Acupuncture Foot-Shaoyin. Bleed at Xi-Zhong. (This discusses yin/yang disharmony causing lower back pain. Upper cold means upper back cold. Upper heat means upper back heat. Both yin/yang qi originate in lower jiao. Yang failing to ascend causes upper back cold. Yin failing to ascend causes upper back heat. Qi obstruction between upper/lower causes pain. Taiyang (Ju-Yang) commands Yang. Yangming lies between two Yang, representing Yang excess. Thus, upper cold requires these two to disperse Three Yang qi. Shaoyang governs pivot; immobility requires Foot-Shaoyang. Jueyin governs initial Yin generation; upper heat requires Foot-Jueyin. Shaoyin qi combines with Yangming/Lungs. Yin reversing downward causes middle heat/panting. Xi means gap. Yin Xi is Zhubin (KI-9).)
Upper lower back cold, inability to look back: Acupuncture Foot-Yangming. (Note: Text from here to "radiating to spine, acupuncture Foot-Shaoyin" is likely a duplication/error. Following Wang Bing's annotation: Upper cold is treated by Yinshi (ST-33), 3 cun below knee. Inability to look back is treated by Zusanli (ST-36), 3 cun below knee, lateral to shin. Upper heat is treated by Dijji (SP-8), 5 cun below knee, the Xi point of Foot-Taiyin.)