Lower Back Pain So Bad You Can’t Turn Your Head to Look in the Rear-View Mirror? Back Wrenched Lifting Something Heavy? Your Waist Feels Broken in Two? — Doctor Ni Haixia’s Forty-Ninth Lecture on the Huang Di Nei Jing: the Ci Yao Tong Pian (Low Back Pain Treatise) — Jue Ni: Chest and Belly Fullness Where Moxa Silences the Voice and Needles Drive One Mad; Thin Congee with Ginger Is the Best Medicine; the Pregnancy Pulse Sign; the Renying Pulse Copying Error; Taiyang, Shaoyang, Yangming, Shaoyin and Jueyin Back Pain; Weizhong BL40 for All Back Pain; the Dai Mai Belt; Chong Luo Back Pain from Lifting Heavy Things; Hui Yin, Feiyang and Chang Yang Back Pain; and the Bloodletting Principle — Stop When the Blood Turns Red

Patient search words: lower back pain / back pain / wrenched back / back injury from lifting something heavy / cannot turn the head to look in the rear-view mirror / neck pain when reversing and looking back / back pain that reaches the head / waist feels broken in two / waist feels like a belt strapped around it / tailbone injury / back pain with urinary incontinence / sciatica / yao bei wei zhong qiu — for back pain seek Weizhong / Weizhong bloodletting / bloodletting therapy / pregnant / how to tell you are pregnant / missed period / chest fullness and belly distension / bloated belly / can eat in the morning but not at night / congee to nourish the stomach / ginger congee / renying pulse / cun kou pulse / Fuliu / Taichong / Yanglingquan / Zusanli / Chengshan / Zhubin / Dai Mai / Governor Vessel / Conception Vessel / varicose vein / bleeding the engorged blue-green veins

Corresponding topics (medical terms): Su Wen · Fu Zhong Lun (Abdominal Treatise, chapter 40) concluded — chest fullness and belly fullness, jue ni (reversed flow: yang does not descend, yin does not ascend, affecting the twelve channels and the sea of qi; moxibustion silences the voice, needle and stone drive one mad; wait for yin and yang to harmonize before treating; thin congee with ginger nourishes the stomach qi — the stomach is the root from which all five zang and six fu receive qi) · pregnancy pulse sign (shen you bing er wu xie mai — the body ails but the pulse is normal: pregnant and a smooth birth; gynecological differentiation foundations of the Jin Gui come from this chapter) · renying and cun kou pulse method (in fever the yang vessels move with the three yang; renying one-fold excess is shaoyang, two-fold yangming, three-fold taiyang — Doctor Ni corrects a copying error in the Nei Jing here; taiyang three-fold excess: yang at its extreme enters yin, causing headache and abdominal distension) · Su Wen · Ci Yao Tong Pian (Low Back Pain Treatise, chapter 41): taiyang back pain needles Weizhong BL40 with bleeding, no bleeding in spring; shaoyang back pain at the end of the bone (Yanglingquan GB34), cannot bend or turn the head; yangming back pain — turning the head blurs the eyes, needle Zusanli ST36; shaoyin back pain draws along the inner spine, needle Fuliu KI7 at the inner ankle; jueyin back pain — the back tightly drawn, needle the tender point near Taichong LR3, patient talks a great deal; jie mai (separating vessel) pain draws to the shoulder with urinary incontinence; the jie mai/dai mai form feels like a belt, often like the waist broken in two; tong yin zhi mai (same-yin vessel) — like a small scale-weight in the middle, sudden swelling, bleed the end of the outer ankle; yang wei mai (Yang Linking Vessel) — swelling and pain encircling the whole chest, needle Waiguan TE5 and Feiyang BL58; chong luo zhi mai (Thoroughfare collateral) — cannot bend or lean back, from lifting heavy weights wrenching the back with stagnant blood, bleed Weizhong, Yanglingquan and the outer knee; hui yin zhi mai (Conception Vessel) — sweating, thirst, wants to pace, hurts sitting but not walking, needle three wei on the straight yang vessel; feiyang zhi mai — Yin Linking Vessel and kidney channel together, five cun above the inner ankle near Zhubin KI9; chang yang zhi mai (Governor Vessel with the kidney channel) — pain draws to the chest, dim eyes, severe cases bend backward with a curled tongue and lost voice (Jinjin and Yuye belong to the kidney), needle two wei on the inner sinew; san mai (scattered vessel) — pain with heat, like a horizontal log across the lower back, severe cases urinary incontinence; rou li zhi mai (flesh-interior vessel) — cannot cough, a cough cramps the sinews (the liver governs the sinews); cold above needles the taiyang and yangming, heat above needles the jueyin; yang disease treated in the yin, yin disease in the yang, left in the right, right in the left; yao bei wei zhong qiu — for back pain seek Weizhong BL40, Weiyang BL39 and Yingu KI10) · bloodletting principles (bleed what is engorged with stagnant blood, stop the moment the blood turns red, never needle a varicose vein) · anatomical characters (kao — sacrum, ke — hip bone, pi — beside the spine)

Opening: what the last lecture left unfinished — chest fullness and belly fullness, why you may neither moxa nor needle

The forty-eighth lecture finished the Fu Zhong Lun (Abdominal Treatise) with great animation: Ji Shi Li (Chicken Droppings Wine) for drum distension, cuttlefish bone and madder root pills for blood depletion. At the start of this lecture Doctor Ni closes the tail of the Abdominal Treatise — the very last disease is chest fullness and belly fullness.

💬 Note from Doctor Ni: The tight pain means the sea of qi (qi hai) is affected. Chest and belly fullness: chest fullness is a problem of yang, belly fullness is a problem of yin — when the yang aspect is disturbed, the qi is disturbed; when the yin aspect is disturbed, the yin is disturbed; both yin and yang are sick. Bo Qi says: this is jue ni — reversed flow — yin and yang are separated. The chest itself is yang, and yang is supposed to descend; the belly itself is yin, and yin is supposed to ascend — that is the normal state. Now the yang cannot come down and the yin cannot go up: the chest is full and the belly is full too, and this affects the channels of the twelve meridians and our sea of qi. In simple terms, jue ni means the flow is going backward.

So how is this disease treated? The Yellow Emperor asks Bo Qi, and Bo Qi’s answer is one Doctor Ni repeats over and over — do not move rashly.

💬 Note from Doctor Ni: If we use moxibustion, the moment we moxa him his voice disappears; if we open it with needle and stone, he is sure to go mad. Why? Because his qi is already separated. What do we do then? Bo Qi says: wait only until his yin and yang are harmonized, then treat him slowly. When yin and yang harmonize — he had chest fullness and belly fullness, and now the chest fullness gradually recedes; you wait until the qi has slowly come down, then you begin the treatment.

Why must you neither moxa nor needle? Doctor Ni breaks the reasoning down piece by piece.

💬 Note from Doctor Ni: The yang qi is heavy in the upper body — the yang is supposed to be above, but now the yang cannot descend, yang added to yang, an extremely heavy yang sits in the chest cavity. If you moxa it, the yang rises even more and the voice in the throat is gone; if you break it open with needle and stone, the yang is suddenly emptied — in one instant it collapses, like a balloon suddenly losing its air, and at that moment the patient goes mad. We must wait and treat the qi disease — when yin and yang merge, when the qi is a little calmer — and only then make our move.

When the disease qi is at its height, a bowl of thin congee is the best medicine

So before making any move, do we just wait? Doctor Ni says there is a method to the waiting — and hidden inside it is a great principle of the Huang Di Nei Jing.

💬 Note from Doctor Ni: The principle of the Huang Di Nei Jing: when the disease qi is very strong, if you attack it you will empty him — the disease qi is still there, and the upright qi will be depleted. In this situation we can nourish him a little with food: the stomach qi is the place where all five zang and six fu receive qi from the stomach. At this point use some white rice boiled into a congee, boiled very thin, let it go into the stomach to strengthen the stomach qi — all the qi of the five zang and six fu is governed by it; let it store up and generate the ten thousand things. This is a very good method.

💬 Note from Doctor Ni: Drink the congee down — and if this person dies after drinking congee, you cannot be blamed: have you ever heard of anyone dying from congee? This is the most easily digested thing that goes into the stomach. If you want to strengthen the stomach qi a little more, put some ginger in the congee — ginger disperses and makes absorption stronger. This is not a medicine; it is a way of using food, something very easy to digest. A newborn baby — what rice water, what rice juice can it not digest, right? Or you quietly wait, let his qi settle a little, and then begin to act.

A bonus diagnostic gem: the body feels sick, but the pulse is completely normal — she is pregnant

Doctor Ni then turns to page 345 and teaches a diagnostic method that perks up the whole room — how do you know a woman is pregnant?

💬 Note from Doctor Ni: The Yellow Emperor asks: can you know that she is carrying a child, and that the child will be born smoothly? Bo Qi says: shen you bing er wu xie mai — the body has an ailment but no evil pulse. Feel the pulse and it is entirely normal, the body feels uncomfortable, but every pulse you feel is normal — she is pregnant, and the birth will be smooth. Because this chapter is about the belly (fu zhong), the problems inside the belly — and pregnancy is also inside the belly — so they are all discussed together. Of course there is much more gynecology, but the basic principles all come from this chapter. When we read the Jin Gui (Essentials from the Golden Cabinet), many of the gynecological differentiation foundations come from this chapter.

The renying pulse against the cun kou pulse — Doctor Ni says: here the Nei Jing made a copying error

After pregnancy, Doctor Ni teaches a passage of pulse method: in fever, it is the yang pulse that moves, with the motion of the three yang. Renying one-fold excess, shaoyang two-fold excess, taiyang three-fold excess, yangming entering yin — this compares the renying pulse with the cun kou (wrist) pulse for diagnosis.

💬 Note from Doctor Ni: Often in diagnosis we look at the cun kou pulse against the renying pulse. The renying is where the foot yangming stomach channel passes: on the neck there are three steps — the renying takes two steps, and the other two steps are shaoyang; only one step is yangming, and that is the renying pulse. Renying one-fold excess (yi sheng) means the renying pulse is one time larger than the cun kou pulse — that is called one-fold. I believe the Huang Di Nei Jing has an error here too — according to what we taught earlier, shaoyang is the one-yang disease, yangming is the two-yang disease, taiyang is the three-yang disease. So renying one-fold excess should be shaoyang, two-fold should be yangming, and three-fold should be taiyang. Please all of you quietly make that correction.

💬 Note from Doctor Ni: If the taiyang pulse is three-fold, at the extreme of yang the yang returns into yin — yang enters yin — so the disease shows in sweating of the head and in the middle of the belly, the body distends and the head aches. Why is taiyang the three-fold pulse? Because taiyang is the great yang (ju yang); the three yang gathered together make taiyang, so taiyang is the triple pulse. The belly belongs to a purely yin place; normally inside there is only a little shaoyang fire — taiyang grows below, the small intestine is taiyang and generates fire — that is the normal state. Now yang enters yin, yang on top of yang; and when yang is entering yin, the moment the yang above moves away, the yin rises. Yin and yang always take over from each other: when yang leaves, yin fills the vacancy; when yin leaves, yang fills the vacancy — it is always like this. That is our law of yin and yang: yin rises and yang descends, yang rises and yin descends. Headache: you all know the upper part is yang and the lower part is yin — when the head hurts, it is either double yang (yang multiplied), or yang deficiency with yin qi rising up to cause the headache. Yang enters yin, and on top of that the head hurts and the belly distends — the head is yang; this is the reverse, the phenomenon of yang at its extreme entering yin. When our fever rises up to the head, the head hurts badly, and then the belly begins to ache too, because the yang turns back.

💬 Note from Doctor Ni: So abdominal pain has several kinds: some are the cold inside from our Abdominal Treatise, some are heat inside, some are food blocking the inside, some are childbirth, and some are the phenomenon of yang at its extreme generating yin. Pattern differentiation is not very difficult.

The main event: back pain — beginning with the taiyang channel: yao bei wei zhong qiu

After the pulse lesson, Doctor Ni turns to page 347, and the centerpiece of this lecture arrives: the Low Back Pain Treatise (Yao Tong Lun). How do you treat back pain? First memorize the master verse — yao bei wei zhong qiu: for back pain, seek Weizhong.

💬 Note from Doctor Ni: Everyone knows the foot taiyang channel — it runs from Jingming BL1 all the way down the back. It causes back pain, the pain drawing into the nape, spine, sacrum and back, the back as if carrying something heavy. Needle Weizhong BL40 and let blood — but do not let blood in spring. Just remember: whenever it is the taiyang channel, we needle at Weizhong; this is the taiyang-pattern back pain. No blood in spring, because spring is shaoyang, the one-yang just being born — when a single yang is just starting to rise and you let blood, the yang is wounded, making the person yang-deficient, so in spring try not to let blood. In summer the yang is abundant, a little better than spring.

Three back pains, three memory hooks: taiyang at the spine, shaoyang cannot turn the head, yangming goes dizzy when turning

The three yang channels’ back pains each carry their own signature, and Doctor Ni teaches three simple ways to remember them.

💬 Note from Doctor Ni: Taiyang back pain is pain right on the spine — on the vertebral column. Shaoyang back pain: the pain is such that you cannot bend, and the symptom is that you cannot look back — when you are driving and cannot turn your head to check the rear-view mirror or reverse, that is shaoyang. The taiyang patient can turn his head to look back; only the shaoyang cannot look back. The yangming pattern also causes back pain and also cannot look back — why? Because with yangming, the moment you turn your head your eyes go blurry. The yangming channel runs through the Zusanli position; needle Zusanli ST36 and the back pain will heal very quickly. The three yang channels: taiyang — back pain on the spine; shaoyang — cannot turn the head; yangming — cannot turn the head, and turning makes the eyes blur. Three different symptoms, easily remembered.

How do you needle shaoyang back pain?

💬 Note from Doctor Ni: Shaoyang back pain — we needle the xi-cleft point and bleed at the end of the bone, which is the Yanglingquan GB34 position, the end of the outer ankle bone. In summer our blood is fuller and the yang qi is stronger, so letting a little blood does no harm. One reminder: in the old days the needles were thicker and often the bleeding went too far. Generally when we speak of bloodletting, it is not deep needling to let blood; it is around the Yanglingquan point — you see some blood vessels on the skin and let a few drops. So even in spring and summer it does no harm — we are not letting a lot.

Clinical honesty: I still let blood even in winter — a real case of a tailbone injury

Speaking of bloodletting, Doctor Ni cannot help telling a story from his own clinic — a clinical demonstration of bloodletting therapy.

💬 Note from Doctor Ni: Actually in clinical practice, even in winter I still let a little blood. For example, a patient with back pain: if the pain is on the bladder channel, we use Weizhong; if the pain is on the tailbone — women wearing high heels injure that spot most easily; coming down the stairs carelessly, a bump, and the tailbone hits squarely on the concrete step, and it hurts terribly — what do we do then? Weizhong is not right — Weizhong is beside the bladder channel; for tailbone pain you go from Weizhong down to Chengshan, and around the Chengshan BL57 point you can see engorged blue-green veins. What about winter? What about spring? We still bleed it, because the pain is killing him. Prick the skin on those engorged veins, apply the cupping jar, and a lot of the pain is gone.

The three yin channels’ back pain: shaoyin needles Fuliu, jueyin needles Taichong — and a curious sign: the patient talks a lot

With the three yang done, on to the three yin. The foot shaoyin and foot jueyin back pains each have their own needling method and their own strange symptoms.

💬 Note from Doctor Ni: Foot shaoyin back pain — it also causes back pain, but this pain draws into the inner spine, drawing toward our abdomen. Then we know it is the shaoyin pattern: needle above the inner ankle, above Fuliu KI7. If it is jueyin, the back is drawn very tight in the pain — needle the jueyin channel, between the big toe and the second toe, find the tender point near Taichong LR3 and needle there; that is jueyin back pain. As for symptoms: the patient likes to talk — he talks and talks.

Why do jueyin back pain patients talk so much? This leads to a great secret of the pericardium.

💬 Note from Doctor Ni: Because jueyin is the liver, and the liver connects with the pericardium. What is the pericardium’s definition in the Huang Di Nei Jing? It wraps the fire of the heart and the yang of the heart — that is the pericardium. If the heart had no pericardium, the heart and the spirit would run away; the yang would have nothing guarding it in the body — that is the pericardium’s main function. The pericardium membrane itself also falls to the gallbladder, and also falls to the uterus (nu zi bao) — the place that protects a woman’s womb; the pericardium falls there too. The heart itself does not receive disease; the pericardium receives disease. Because jueyin is the pericardium and the liver, at this time the patient is shan yan — fond of talking — or silent; it affects the spirit and the emotions. So with back pain, some people’s back pain is nothing — they are still cheerful; some people with back pain are prone to sorrow; some with back pain are gloomy and depressed; and some with back pain keep repeating themselves as they talk.

💬 Note from Doctor Ni: If you cannot remember all these signs, it does not matter at all — why? Because if you know the channels well, when he hurts, you ask him where it hurts; he points, and you already know which channel it is. You do not need to worry about whether he is prone to sorrow, talks a lot, or is gloomy. You only need to know that back pain hurts badly — has anyone ever come to you cheerful and delighted to be treated for back pain, right? So if you know the channels, you will never make a differentiation error.

Jie mai: back pain reaching the shoulder with urinary incontinence — find the transverse engorged veins at Weizhong and Weiyang

💬 Note from Doctor Ni: The jie mai passage speaks of the foot taiyang: it causes back pain, the pain drawing up to the shoulder; at this time the bladder channel is often injured, and the urine is often hard to control. We needle at Weizhong BL40, Weiyang BL39 and such places on the foot taiyang channel. Whenever you see the transverse vein — the popliteal fossa, the strip behind the knee, that is the transverse vein — with engorged blue-green places on it, the light-engorged places, avoid the artery, find the stagnant blood above it and let it out.

One kind of back pain is like the waist broken in two — the Dai Mai (belt vessel) disease

Next Doctor Ni describes a back pain patients describe very vividly.

💬 Note from Doctor Ni: This jie mai passage speaks of the dai mai (belt vessel) disease, belt vessel pain. The back pain is like being strapped by a belt — ru yin dai, like a belt pulled around you — and often ru chang zhe yao zhuang, like the waist folded in two: the patient will tell you, my waist has become two halves, a line in the center has split it into two halves, the upper and lower do not communicate — that is dai mai disease. To treat the dai mai, you can see congested blood between Weizhong and the outer knee — let the congested blood there. In real acupuncture we can also needle on the dai mai — Daimai GB26, Wushu GB27, Weidao GB28, right? Needling the dai mai works too. In the Huang Di Nei Jing there are very many places — including malaria (nüe ji) — where we treat with bloodletting, because the scope of acupuncture is extremely wide. We must be certain: whenever you see congested veins, let them out; on the leg you can see them very clearly.

💬 Note from Doctor Ni: Treating back pain — in my practice almost every day someone comes to me complaining of back pain. When the trouser leg is rolled up, from Weizhong down on the calf there are congested veins in many places. I often let them out — put on the gloves, let a few drops, no problem, spring, summer, autumn or winter, I do not care. When it is done his back is very comfortable. He says, hey, I hurt along the belt vessel, below the dai mai, I hurt above and below Weizhong — and I do it for him just like that.

Tong yin zhi mai: back pain as if a little scale-weight sits in the middle — stop bleeding the moment it turns red

💬 Note from Doctor Ni: The tong yin zhi mai (same-yin vessel) is the shaoyang vessel. It causes back pain — the pain feels as if a small scale-weight sits in the middle of the back; right in the middle it suddenly swells up, that kind of feeling. At the end of the outer ankle bone — the outer ankle is the shaoyang place — let a little blood, prick three wei (three marks); you only need to draw a few drops. How do you gauge how much to let? At first you see black blood coming out and coming out — do not stop; the moment you see it turn red, stop. You cannot just keep letting and letting until the person’s face turns pale — that is too much. So when I let blood I keep my eyes on the blood in the cupping jar: the instant it becomes very fresh, bright, new blood, I stop — do not overdo it; let out the stagnant blood and that is enough.

Yang wei mai: this back pain makes the whole ring of the chest ache — needle Waiguan and Feiyang

💬 Note from Doctor Ni: The yang wei mai (Yang Linking Vessel) causes back pain, the pain with sudden swelling (fu ran zhong). Needle the yang wei vessel — the vessel joins with the taiyang, its endpoint is one chi below the lower space, that is the Feiyang BL58 point. In fact when the yang wei vessel hurts, remember it runs horizontally across the chest and diaphragm: the back pain is there too, but he does not say back pain — the pain surrounds and affects this whole ring of the chest, the whole chest hurts — that is the yang wei vessel. You can needle Waiguan TE5 — Waiguan links to the yang wei vessel, right? The yang wei of the extraordinary vessels — or needle Feiyang.

Chong luo zhi mai: you wrenched your back lifting something heavy — stagnant blood inside

💬 Note from Doctor Ni: The chong luo zhi mai (Thoroughfare collateral vessel) causes back pain so that you cannot bend forward or lean back — neither bowing nor arching is possible — this is an injury to the chong mai (Thoroughfare Vessel). When the chong mai is injured, most often it comes from lifting something heavy — moving house, lifting a heavy object, wrenching the back, causing back pain — and this has stagnant blood (e xue). Generally there is always congested blood inside, because the chong mai governs blood. At this time we needle the congested places at Weizhong and so on, and also the lower outer side of the knee — wherever you see congested blood, mostly in the Weizhong BL40, Yanglingquan GB34, outer-knee region — the yang-channel region — you can let blood there.

💬 Note from Doctor Ni: If the body has congested blood, look at the side of the leg — this is your left leg seen from outside: the gallbladder channel runs on the outside, and all through this outer region down to Weizhong and Weiyang you can see many engorged blue-green veins; very often these people almost all have back pain. Whatever kind of back pain it is, if we let blood here it will work. So you do not need to memorize one channel or two channels — everyone’s pain is different; whenever you see congested blood, let it all out. That is the simple way to close the case.

Hui yin zhi mai: sitting hurts terribly, but walking does not — a strange disease of the Conception Vessel

💬 Note from Doctor Ni: The hui yin zhi mai (Conception Vessel, ren mai) causes back pain: pain and swelling, sweat pouring down, then dry, making one want to drink; after drinking he wants to pace, and pacing hurts less. Ren mai pain is very strange: sitting there hurts badly, but walking hurts less; walking makes him sweat a great deal, and after drinking he wants to walk around. At this time we needle three wei on the straight yang vessel (zhi yang zhi mai), five cun above the calf gap (qiao shang xi xia wu cun heng ju) — that describes the area at the outer side of the knee.

Feiyang zhi mai: five cun above the inner ankle, the Yin Linking Vessel and the kidney channel fall ill together

💬 Note from Doctor Ni: The feiyang zhi mai causes back pain — is this not the yin wei mai (Yin Linking Vessel)? The Yin Linking Vessel and the kidney channel are two channels that fall ill together, connected. The feiyang vessel is five cun above the inner ankle, roughly in the area of Zhubin KI9. Because the channels that hurt differ — for example, dai mai pain: some people’s dai mai pain is at the back, some not at the front — Daimai, Wushu and Weidao belong to the dai mai, only three points, but the pain may be here or at the back. On the same channel, when you let blood on the foot, it is perfectly normal for the spot to differ. It is like Chengshan BL57 above — above it is the tailbone; this person bumped his tailbone, sometimes the pain is here, sometimes there — you cannot predict where — so we look at where the blue-green veins pop out and let blood there.

Chang yang zhi mai: pain so severe the body bends backward, the tongue curls, and speech is lost — back pain of the kidney channel and Governor Vessel combined

💬 Note from Doctor Ni: The chang yang zhi mai is the du mai (Governor Vessel). The Governor Vessel causes back pain, the pain drawing into the chest (ying), the eyes seeing dimly (mu shi huang huang), blurred vision; in severe cases the person bends backward like a bow, and the tongue curls so he cannot speak — this speaks of the kidney. Under the root of the tongue, the sinews below the tongue — Jinjin and Yuye (EX-HN12/EX-HN13) fall to the kidney. So the chang yang zhi mai here describes a back pain of the kidney and the Governor Vessel combined. At this time we needle the inner sinew for two wei — that is, let a little blood in two places, above the inner ankle in front of the big sinew and behind the taiyin, up on the inner ankle.

San mai and rou li zhi mai: one back pain burns hot, the other cramps with every cough

💬 Note from Doctor Ni: The san mai (scattered vessel) — these are the collateral vessels, grandchild vessels of the foot taiyang channel; the san mai also causes back pain with heat — because it is not on the main channel; the heat makes the body restless (shen fan), and below the waist it is ru heng — like a horizontal log stuck across. In severe cases, urinary incontinence. You see, it is also on this Weizhong side, the outer side of the knee — look for congested blood and let it. The rou li zhi mai (flesh-interior vessel) causes back pain so that you cannot cough — a single cough makes the sinews cramp and twitch. The sinews are governed by the liver — the liver governs the sinews (gan zhu jin). This one is also outside the taiyang, up past the cheekbone — you see, they are all in this outer region. The yin wei vessel is on the inner side.

The most important principle: cold above needles the yang channels, heat above needles the yin channels — yang disease treated in the yin, yin disease in the yang

The needling methods for back pain change endlessly, but a thousand changes never leave one master principle — Doctor Ni says this is the principle of yin and yang communicating with each other.

💬 Note from Doctor Ni: When the back pain is cold above, it is the foot taiyang and yangming; when hot above, needle the foot jueyin. When a cold pattern appears we needle the yang channels; when a hot pattern appears we needle the yin channels — this is the phenomenon of yin and yang communicating. So we treat yang disease in the yin, yin disease in the yang, left disease in the right, right disease in the left — all these are acupuncture principles. When it is a cold pattern we needle the yang channels; when the pain is hot — the patient will tell you, this place is very cold, an icy pain — then you must think: cold pattern, needle the yang channels; some people have hot pain, as if scalded by boiling water — then we call for needling the yin channels. Both can be found behind Weizhong. That is why we often say in the acupuncture verses: yao bei wei zhong qiu — for back pain seek Weizhong: most back pain finds its congested blood around Weizhong BL40, Weiyang BL39 and Yingu KI10; find the stagnant blood on it and let it out.

The character lesson: kao, ke, pi — three rare characters from page 352

At the end, Doctor Ni turns to page 352 and teaches three rare characters — and explains the anatomy of the sitting bones along the way.

💬 Note from Doctor Ni: This character kao (尻) is the sacrum — the sitting-bone area; the waist and sacrum meet at the junction of the sitting bones, on top of the two ke bones — ke (髁), we pronounce ke, meaning the bones of the buttocks. And pi (肶) is jia ji — gripping the spine — clamped on both sides of the vertebral column; that is called pi. There is also the phrase yi yue sheng si wei shu — in addition to bloodletting, you also determine the number of times to let blood by the waxing and waning of the moon.

Closing: see engorged veins, let them; blood turns red, stop — the final principle of bloodletting

This whole lecture was bloodletting, and Doctor Ni closes with a clinical master principle — the fruit of his many years practicing in America.

💬 Note from Doctor Ni: This is clinical practice: I go to my American clinic every day, and below the knees many people have engorged blue-green veins and congested blood; the patients all have different back pains — almost all of them do. Let it out; letting it out does no harm. This is different from a venous aneurysm (jing mai liu, varicose vein): with a varicose vein the whole vessel wall is like an earthworm, very thick — never let blood on it; we have very good medicines for that. But if it is a blood vessel — you can see the skin is pale and suddenly one blue-green vein bulges out — that is a blood vessel and can be let; let it out.

In this back pain chapter there are many needling methods and many points — but remembering three things is enough: see engorged veins and let them, stop when the blood turns red, and yao bei wei zhong qiu — for back pain, seek Weizhong.

Based on Doctor Ni Haixia’s Ren Ji (Human Records) Huang Di Nei Jing lecture series (Lecture 49), presented by Doctor Luo Dalun.