Suwen: Discourse on Needling Lumbar Pain, Chapter 41

Vernacular Translation and Interpretation of Suwen·Discourse on Needling Lumbar Pain, Chapter 41

Overall Paraphrase

This chapter is a dedicated treatise in the Suwen focusing on the channel-pattern differentiation of lumbar pain and its needling methods. The ancients classified lumbar pain into multiple types according to different channels and collaterals, selecting different needling techniques based on the location of pain, its radiating direction, and accompanying symptoms.

Lumbar Pain of the Foot-Taiyang Channel
When the Foot-Taiyang Bladder channel is affected and causes lumbar pain, the pain radiates to the nape, spine, buttocks, and back, as if carrying a heavy load. One may needle the Xizhong (center of the popliteal fossa behind the knee) to draw blood from the proper Foot-Taiyang channel; in spring, do not draw blood.

Lumbar Pain of the Shaoyang Channel
Lumbar pain due to the Foot-Shaoyang Gallbladder channel feels like needles piercing the skin, gradually worsening, preventing bending forward, leaning backward, or turning the head. One may needle the prominent high bone on the lateral side of the knee to draw blood from the Shaoyang channel; in summer, do not draw blood.

Lumbar Pain of the Yangming Channel
Lumbar pain due to the Foot-Yangming Stomach channel prevents turning the head; when turning, it seems as if seeing a foreign object; there is a tendency to grieve easily. One may needle three points on the anterior aspect of the shin bone, regulating above and below to cause bleeding; in autumn, do not draw blood.

Lumbar Pain of the Foot-Shaoyin Channel
Lumbar pain due to the Foot-Shaoyin Kidney channel radiates along the inner side of the spine. One may needle two points above the medial malleolus; in spring, do not draw blood; if too much blood is drawn, the upright qi is not easily restored.

Lumbar Pain of the Jueyin Channel
Lumbar pain due to the Foot-Jueyin Liver channel makes the lower back feel taut like a drawn bowstring. One may palpate rope-like nodules at the junction between the calf and heel, along the outer edge of the gastrocnemius muscle, and needle three points. The patient may sometimes be talkative, sometimes silent and listless.

Lumbar Pain of the Jie Channel
Lumbar pain due to the Jie channel radiates to the shoulders, causes blurred vision, and sometimes enuresis. One may draw blood from the sinew-flesh boundary at the knee and the transverse collaterals on the lateral side of the popliteal fossa, until the blood color changes.
Another type of Jie channel lumbar pain feels like being pulled by a belt around the waist, often seeming about to break, with a tendency to fear easily. One may needle grain-sized nodular collaterals in the popliteal fossa, from which the ancients observed black blood shooting out, stopping only when fresh red blood appears.

Lumbar Pain of the Tongyin Channel
Lumbar pain due to the Tongyin channel feels like a small hammer striking inside, with local swelling. One may needle three points at the superior end of the Juegu (the margin of the fibula) above the lateral malleolus.

Lumbar Pain of the Yangwei Channel
Lumbar pain due to the Yangwei channel manifests with swelling at the painful site. One may needle the meeting point of the Yangwei channel and the Foot-Taiyang channel, about one chi below the calf, near the lower leg.

Lumbar Pain of the Hengluo Channel
Lumbar pain due to the Hengluo channel prevents bending and extending; leaning backward causes fear of falling, often from heavy lifting injuring the lower back, obstruction of the Hengluo, and blood stasis. One may draw blood from two points horizontally along the sinew spaces on the lateral side of the popliteal fossa, several cun above.

Lumbar Pain of the Huiyin Channel
Lumbar pain due to the Huiyin channel causes sweating at the painful site; after sweating stops, the patient desires to drink water, and after drinking, wants to move around. One may needle three points on the Zhiyang channel, located five cun below the popliteal fossa above the Qiao region, bleeding where blood collaterals are full.

Lumbar Pain of the Feiyang Channel
Lumbar pain due to the Feiyang channel causes discomfort and restlessness at the painful site; in severe cases, there is grief and fear. One may needle the point five cun above the medial malleolus, in front of the Shaoyin channel where it meets the Yinwei channel.

Lumbar Pain of the Changyang Channel
Lumbar pain due to the Changyang channel radiates to the chest, causes blurred vision; in severe cases, the back extends backward in a reversed arch and the tongue curls, preventing speech. One may needle two points about two cun behind the large sinew above the medial malleolus and behind the Taiyin channel.

Lumbar Pain of the San Channel
Lumbar pain due to the San channel causes heat in the lower back; severe heat leads to vexation and restlessness; below the waist feels like a horizontal piece of wood; in severe cases, there is enuresis. One may needle three points at the bone-flesh boundary in front of the knee and along the lateral binding vessels.

Lumbar Pain of the Rouli Channel
Lumbar pain due to the Rouli channel prevents coughing, as coughing causes spasms and pulling of the sinews. One may needle two points lateral to the Taiyang channel and behind the Juegu of the Shaoyang channel.

Comprehensive Channel Differentiation for Treatment
If lumbar pain travels along both sides of the spine up to the head, with tightness and discomfort in the neck and back, blurred vision, and a feeling of falling, one may needle the popliteal fossa of the Foot-Taiyang channel to draw blood.
If lumbar pain is accompanied by cold in the upper body, take Foot-Taiyang and Foot-Yangming; if heat in the upper body, take Foot-Jueyin; if unable to bend or stretch, take Foot-Shaoyang; if internal heat with wheezing, take Foot-Shaoyin, and needle the popliteal fossa to draw blood.
If lumbar pain is accompanied by cold in the upper body and inability to turn the head, take Foot-Yangming; if heat in the upper body, take Foot-Taiyin; if internal heat with wheezing, take Foot-Shaoyin.
For difficulty with defecation, take Foot-Shaoyin; for distension and fullness in the lower abdomen, take Foot-Jueyin.
If lumbar pain feels like breaking, with inability to bend, stretch, or lift, take Foot-Taiyang; if pain radiates to the inner side of the spine, take Foot-Shaoyin.

Lumbar Pain Radiating to the Lower Abdomen and Hypochondriac Region
Lumbar pain radiates to the lower abdomen and hypochondriac region, preventing backward bending. One may needle the lumbosacral junction and the fleshy, thick areas on both sides of the hip bones. The ancients determined the number of needling according to the waxing and waning of the moon, believing that relief would come immediately after needling. For left-sided disorders, needle the right side; for right-sided disorders, needle the left side.

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🧠 Deep Understanding

Core Principles 💡

• Distinguishing Lumbar Pain by Channels: This chapter does not treat lumbar pain as a single disease name but, based on the location, radiating direction, and accompanying emotional and physical symptoms, attributes it to the Foot-Taiyang, Shaoyang, Yangming, Shaoyin, Jueyin, as well as specific channels such as Jie, Hengluo, and Feiyang. This reflects the diagnostic logic of "where the channel passes, there its treatment reaches".
• Blood-Letting at the Collaterals as the Core: The chapter is replete with phrases like "to bleed," "stop when red blood appears," and "bleed where blood collaterals are full," indicating that the ancients believed these types of lumbar pain were mostly related to blood stasis obstructing the collaterals, and collaterals being blocked. The change of blood color from black to red was seen as evidence of stasis gradually dissipating and collaterals becoming unobstructed.
• Four Seasons and Needling Contraindications: The repeated occurrences of "in spring do not see blood," "in summer do not see blood," and "in autumn do not see blood" reflect the ancients' adaptation of needling methods according to the floating and sinking of qi and blood in different seasons, to avoid excessive depletion of upright qi.
• Correspondence Between Heaven and Humanity: The final statement of "using the waxing and waning of the moon to determine the number of needling" reflects the application of ancient numerological concepts in acupuncture.
• Cross-Over Point Selection on Left and Right: "Take left for right, take right for left" resembles the later "Miu needling" method, indicating early recognition of left-right correspondence regulation.

Modern Perspectives 🌟

• Modern medicine understands lumbar pain as having complex causes, often including muscle fascia injuries, lumbar disc herniation, joint degeneration, and nerve compression. The symptoms described under different channel-types of lumbar pain in this chapter, such as "radiating to the nape and spine," "inability to turn the head," and "pain radiating to the inner of the spine," share some phenomenological similarities with different nerve distribution areas and referred pain patterns—but channels cannot be directly equated to anatomical neural or vascular structures.
• Blood-letting at the collaterals has its historical context in antiquity, but modern high-quality evidence does not support it as a routine treatment for lumbar pain, and it carries risks of infection, vascular and nerve injury, and bleeding. In particular, descriptions such as "back reversed arch, tongue curled, inability to speak," or "blurred vision, as if about to collapse," may indicate the need for urgent evaluation of neurological or systemic diseases—one must not self-operate based on ancient texts.
• Statements like "using the waxing and waning of the moon to determine needling frequency" and "seasonal contraindications" lack supporting modern scientific evidence and should be understood as medical-historical and philosophical concepts.
• The value of this chapter lies in its systematic observation of symptoms and its channel-based classification logic, which holds literary significance for understanding Chinese medical reasoning, but it should not be used directly as a foundation for modern diagnosis and treatment.

Wellness Insights ⚡

• Protect the Lower Back from Injury: Avoid sudden bending while lifting heavy objects, reduce prolonged sitting or standing, keep the lower back warm, and prevent external sprains.
• Move Gently: Sensitivity to bending, extending, turning, or coughing suggests daily activities should be smooth and avoid sudden twisting or excessive backward extension.
• Steady the Emotions: The chapter repeatedly mentions "tendency to grieve" and "tendency to fear," as emotional fluctuations can intensify bodily tension. Maintaining a balanced mindset and engaging in moderate stretching can help reduce lower back discomfort.
• Do Not Self-Carry Out Blood-Letting: If lumbar pain persists, or is accompanied by lower limb numbness, bowel or bladder abnormalities, fever, severe pain, visual abnormalities, or speech difficulties, seek medical evaluation promptly, and do not attempt needling or blood-letting based on the ancient text.

📚 Related Knowledge

• Associated Concepts: Foot-Taiyang Bladder channel, Foot-Shaoyang Gallbladder channel, Foot-Yangming Stomach channel, Foot-Shaoyin Kidney channel, Foot-Jueyin Liver channel; Yangwei channel, Yinwei channel; collateral blood-letting; Shu number; Miu needling; four-season needling methods; correspondence between heaven and humanity.
• Further Reading: Lingshu·Jingmai on pathologies of the twelve channels; Suwen·Miuci Lun; Lingshu·Guanzhen; Suwen·Ciyao Lun; and the commentaries of successive annotators on specific channel names such as "Jie Channel," "Hengluo," and "Huiyin Channel."

—— Bu Gua

This content is based on classical Chinese medical texts and is provided solely for the study and exchange of traditional culture. It does not constitute any form of medical diagnosis, medication, or treatment advice; in case of discomfort, please consult a qualified healthcare professional promptly.