经义
东风生于春，病在肝，俞在颈项。○诸痉项强，皆属于湿。（《素问》）
哲言
太阳病，项背强KT KT 。（张仲景）
颈项强急之证，多由邪客三阳经也。寒搏则筋急，风搏则筋弛。左多属血，右多属痰。○《内经》刺灸项
颈痛有二∶其一取足、手太阳，治项后痛。《经》云∶足太阳之脉，是动则病项如拔。视虚、盛、寒、热，陷
下取之。又云∶项痛不可仰俯，刺足太阳；不可以顾，刺手太阳。又云∶大风项颈痛，刺风府。又云∶邪容于
足太阳之络，令人头、项、肩痛，刺足小指爪甲上与肉交者各一 ，立已。其二取足、手阳明，治颈前痛。
《经》云∶足阳明之脉，所生病者颈肿。又云∶手阳明之脉，是动则病颈肿。皆视盛、虚、寒、热，陷下取之。（《证治准绳》）
头痛非是风邪，即是气挫，亦有落枕而致者，并宜用和气饮。○有由肾虚不能生肝，肝虚无以养筋，故机
关不利者，宜用六味地黄丸。（戴元礼）
经义
西风生于秋，病在肺，俞在肩背。○故秋气者，病在肩背。○肺病者，喘咳逆气，肩背痛，汗出。○秋脉
太过，为病在外，则令人逆气，背痛愠愠然。○肺手太阴之脉，气盛有余则肩背痛。○风寒，汗出气虚则肩背痛、
恶寒、少气不足以息。○岁火太过，民病肩背痛。○少阴司天，热淫所胜，民病肩、背、 、缺盆中痛。○邪在
肾，则病肩、背、颈、项痛。（《素问》）
哲言
肘痛引肩，不可屈伸，寒热，颈项、肩背痛，臂痛，痹不仁，
天井主之。○肩不可举，不能带衣，清冷渊主之。○肘、臂、腕中痛，颈肿不可以顾，头项急痛眩，淫泺肩胛小
指痛，前谷主之。○肩痛，不可自带衣，臂腕外侧痛不举，阳谷主之。○臂不可举，头项痛，咽肿不可咽，前谷
主之。○肩痛欲折， 如拔，手不能自上下，养老主之。○肩背头痛，时眩，涌泉主之。（《甲乙经》）
病患常以手指臂肿动，身体 者，藜芦甘草汤主之。（《金匮》）
肺朝百脉。肺病则不能管摄一身，故肺俞为病，即肩背作痛。又背为阳明之府，阳明有亏，不能束筋骨、
利机关，即肩垂背曲。至于臂，经络交会不一，而阳明为十二经络之长，臂痛赤当责之阳明。但痛有内外两因，
虚实迥异；治分气血二致，通补攸殊。如营虚脉络失养，风动筋急者，不受辛寒，当仿东垣舒筋汤之意，佐以
活络丹。劳倦伤阳，脉络凝塞，肩臂作痛者，以辛甘为君，佐以循经入络之品。阳明气衰，厥阴风动，右肩痛
麻者，用枸杞、归身、黄 、羚角、桑枝，为阳明、厥阴营气两虚主治。血虚风动者，因阳明络虚，受肝脏风
阳之扰，用首乌、枸杞、归身、胡麻、柏子仁、蒺藜等味，以柔甘为温养。失血背痛者，其虚亦在阳明之络，
用人参、归身、枣仁、白芍、炙草、茯神，以填补阳明。若肾气上逆，则督虚为主病，宜用奇经之药以峻补其
阳。至于口鼻吸受寒冷，阻郁气隧，痛自胸引及背者，宗《内经》诸痛皆寒之义，以温药两通气血。更有古法，
如防风汤散肺俞之风，指迷丸治痰流臂痛，控涎丹治流痹牵引，此皆从实证而治，所谓通则不痛也。（《临证指南》）
臂痛有六道经络。究其痛在何经络，以行本经药行其气血，血气通则愈矣。以两手伸直，贴身垂下，大指
居前，小指居后而定之。其臂 之前 痛者，属阳明经，以升麻、白芷、干葛行之。后 痛者，属太阳经，以
本、羌活行之。外 痛者，属少阳经，
以柴胡行之。内 痛者，属厥阴经，以柴胡青、皮行之。内前 痛者，属太阴经，以升麻、白芷、葱白行之。
内后 痛者，属少阴经，以细辛、独活行之。并用针灸法，视其何经而取之。（李东垣）
肩背痛，不可回顾者，此太阳气郁而不行。或脊痛项强，腰似折、项似拔者，宜通气防风汤。有因湿热肩
背沉重而痛者，宜当归拈痛汤。有因汗出小便数而痛者，风热乘脾，脾气郁而肩背痛也，当泻风热则愈，宜升
麻柴胡汤。有因痰饮流注肩背作痛者，宜星香散，或导痰汤。有因肾气不循故道，气逆挟背而上，致肩背作痛，
宜和气饮，加盐炒小茴香。有因劳力或看书、着棋久坐而致脊背痛者，宜补中益气汤，或八味汤加黄 。背者
胸之府，肺主气居胸中，肺气滞则血脉泣，肺气虚则不能营运阳道，肺中有痰，流注肩背皆作胀疼。○臂为风
寒湿所搏，或痰流气滞，或因提挈重物，皆致臂痛。有肿者，有不肿者。因于风寒，宜五积散加羌活。因于湿，
蠲痹汤加苍术。因于痰，导痰汤。因于气，乌药顺气散。因提重伤筋，劫劳散或和气饮加姜黄，盖姜黄能入臂
故也。（《赤水玄珠》）
脉候
寸口脉中手促上击者，曰肩背痛。（《素问》）
【经文要义】
东风生于春季，人体易患肝病，其经气输注于颈项部位。○各种痉病出现的颈项强直，多归属于湿邪致病。（出自《素问》）
颈项强急的病症，多由邪气侵犯三阳经所致。寒邪搏结则筋脉拘急，风邪搏结则筋脉弛缓。左侧病变多与血有关，右侧病变多与痰有关。○《内经》记载针刺灸疗颈项痛有两种取穴方法：其一选取足太阳膀胱经和手太阳小肠经，治疗颈后疼痛。《经脉》篇说：足太阳膀胱经发生变动，就会引起颈项疼痛，感觉像被拔扯一样。需根据虚、实、寒、热的不同情况，采用陷下取穴法（补法）。又说：颈项疼痛不能前后仰俯，应刺足太阳经；不能左右回顾，应刺手太阳经。又说：大风引起的颈项疼痛，应刺风府穴。又说：邪气客居在足太阳膀胱经的络脉，会导致头、颈、肩疼痛，应刺足小趾爪甲角上方与肉交接处各一针，疼痛立即停止。其二选取足阳明胃经和手阳明大肠经，治疗颈前疼痛。《经脉》篇说：足阳明胃经所生的疾病包括颈部肿胀。又说：手阳明大肠经发生变动，就会引起颈部肿胀。均需根据盛、虚、寒、热的不同情况，采用陷下取穴法。（出自《证治准绳》）
头痛如果不是风邪所致，就是气机挫伤，也有因落枕引起的，都适宜使用和气饮。○有的因为肾虚不能滋养肝木，导致肝血不足无法濡养筋脉，从而关节活动不利，适宜使用六味地黄丸。（戴元礼）
【经文要义】
西风生于秋季，人体易患肺病，其经气输注于肩背部位。○所以秋季的气候特点，容易导致肩背发病。○肺病患者，会出现气喘咳嗽、气逆、肩背痛、出汗等症状。○秋季脉象太过，病邪在外，会导致人气逆、背部隐隐作痛。○手太阴肺经，如果气盛有余，就会导致肩背痛。○感受风寒，汗出且气虚，就会导致肩背痛、恶寒、气短不足以呼吸。○岁运火气太过，百姓容易患肩背痛。○少阴君天之气主事，热气过胜，百姓容易患肩、背、腋下、缺盆中疼痛。○邪气在肾，就会引起肩、背、颈、项疼痛。（出自《素问》）
【哲人言论】
肘部疼痛牵引至肩部，不能屈伸，伴有寒热，颈项、肩背疼痛，手臂疼痛，麻木不仁，由天井穴主治。○肩膀不能上举，穿衣困难，由清冷渊穴主治。○肘部、手臂、手腕疼痛，颈部肿胀不能回顾，头项紧急疼痛眩晕，大腿无力酸痛，肩胛及小指疼痛，由前谷穴主治。○肩痛，穿衣困难，手臂手腕外侧疼痛不能上举，由阳谷穴主治。○手臂不能上举，头项疼痛，咽喉肿痛吞咽困难，由前谷穴主治。○肩痛欲折断，腋下疼痛如被拔扯，手不能上下活动，由养老穴主治。○肩背头痛，时常眩晕，由涌泉穴主治。（出自《针灸甲乙经》）
病人经常用手指指向手臂肿胀跳动，身体颤抖者，由藜芦甘草汤主治。（出自《金匮要略》）
肺朝百脉。肺病则不能统摄全身，所以肺俞穴区域发病，就会出现肩背疼痛。另外，背部是阳明经的府库，如果阳明经气亏损，不能约束筋骨、利关节，就会导致肩膀下垂、背部弯曲。至于手臂，经络交会复杂，而阳明经是十二经络之长，手臂疼痛发红应当责之于阳明经。但是疼痛有内外两种原因，虚实截然不同；治疗分为调理气血两个方面，通补的方法也有所不同。如营血虚弱脉络失养，风动筋急者，不耐受辛寒药物，应当仿照李东垣舒筋汤的意思，配合活络丹使用。劳倦损伤阳气，脉络凝塞，导致肩臂疼痛者，以辛甘药物为主药，配合循经入络的药物。阳明经气衰弱，厥阴肝风内动，右肩疼痛麻木者，使用枸杞、当归身、黄芪、羚羊角、桑枝，作为阳明、厥阴营气两虚的主治方。血虚风动者，因为阳明络脉虚弱，受到肝脏风阳的干扰，使用何首乌、枸杞、当归身、胡麻、柏子仁、蒺藜等药物，以柔甘药物进行温养。失血导致背痛者，其虚也在阳明之络，使用人参、当归身、酸枣仁、白芍、炙甘草、茯神，以填补阳明经气。如果肾气上逆，则以督脉虚损为主病，适宜使用奇经药物来峻补阳气。至于口鼻吸入寒冷，阻滞郁遏气机通道，疼痛从胸部牵引到背部者，遵循《内经》诸痛皆属寒的理论，使用温药来疏通气血。更有古法，如防风汤疏散肺俞之风，指迷丸治疗痰流导致的臂痛，控涎丹治疗流痹牵引疼痛，这些都是从实证角度治疗，即所谓“通则不痛”。（出自《临证指南医案》）
手臂疼痛涉及六道经络。探究疼痛在哪条经络，就使用本经药物来运行该经的气血，气血通畅则痊愈。将两手伸直，贴身垂下，大拇指在前，小拇指在后来确定经络位置。其手臂内侧前方疼痛者，属于阳明经，使用升麻、白芷、干葛（葛根）来引导药力。内侧后方疼痛者，属于太阳经，使用羌活来引导药力。外侧疼痛者，属于少阳经，使用柴胡来引导药力。内侧深处疼痛者，属于厥阴经，使用柴胡、青皮来引导药力。内侧前侧疼痛者，属于太阴经，使用升麻、白芷、葱白来引导药力。内侧后侧疼痛者，属于少阴经，使用细辛、独活来引导药力。并配合针灸疗法，视哪条经络有病就取哪条经络的穴位。（李东垣）
肩背痛，不能回头，这是太阳经气郁滞而不运行。或者脊痛项强，腰部像折断、颈项像被拔扯一样，适宜使用通气防风汤。有的因为湿热导致肩背沉重而疼痛，适宜使用当归拈痛汤。有的因为出汗多、小便频数而疼痛，这是风热乘袭脾土，脾气郁滞导致肩背痛，应当泻除风热即可痊愈，适宜使用升麻柴胡汤。有的因为痰饮流注肩背导致疼痛，适宜使用星香散，或导痰汤。有的因为肾气不循常道，气逆挟带背部向上，导致肩背疼痛，适宜使用和气饮，加盐炒小茴香。有的因为劳累用力，或看书、下棋久坐而导致脊背疼痛，适宜使用补中益气汤，或八味汤加黄芪。背部是胸部的府库，肺主气居于胸中，肺气滞涩则血脉凝泣，肺气虚弱则不能营运阳气之道，肺中有痰，流注肩背都会产生胀疼。○手臂被风寒湿邪搏结，或痰气流注气机滞涩，或因提举重物，都会导致臂痛。有的肿胀，有的不肿胀。因于风寒，适宜五积散加羌活。因于湿，适宜蠲痹汤加苍术。因于痰，适宜导痰汤。因于气，适宜乌药顺气散。因提举重物损伤筋脉，适宜劫劳散或和气饮加姜黄，因为姜黄能进入手臂经络的缘故。（出自《赤水玄珠》）
【脉象候诊】
寸口脉搏动急促，手指触按感到向上冲击的，称为肩背痛。（出自《素问》）
[Scriptural Principles]
The east wind arises in spring, causing liver diseases, with its acupoint transmission located at the neck and nape. ○ Various spasmodic conditions presenting with neck stiffness are attributed to dampness. (Su Wen)
[Philosophical Discourses]
Taiyang disease presents with stiffness and discomfort in the neck and back. (Zhang Zhongjing)
Conditions of neck stiffness and urgency are mostly caused by pathogenic factors invading the three Yang meridians. Cold binding causes tendon contraction, while wind binding causes tendon flaccidity. Left-sided pathology is mostly related to blood, and right-sided pathology is mostly related to phlegm. ○ The Nei Jing records two methods for acupuncture and moxibustion treating neck pain: First, select the Foot-Taiyang and Hand-Taiyang meridians to treat posterior neck pain. The Jing Mai chapter states: When the Foot-Taiyang bladder meridian undergoes change, it causes neck pain as if being pulled out. Treatment should be based on deficiency, excess, cold, or heat, using the "depression point" method (tonification). It further states: For neck pain preventing flexion and extension, needle the Foot-Taiyang meridian; for inability to turn the head, needle the Hand-Taiyang meridian. It also states: For neck pain caused by severe wind, needle the Fengfu (GV16) point. It also states: When pathogenic factors lodge in the collateral of the Foot-Taiyang bladder meridian, causing head, neck, and shoulder pain, needle one point at each junction of the nail and flesh on the little toe, and the pain will cease immediately. Second, select the Foot-Yangming and Hand-Yangming meridians to treat anterior neck pain. The Jing Mai chapter states: Diseases generated by the Foot-Yangming stomach meridian include neck swelling. It also states: When the Hand-Yangming large intestine meridian undergoes change, it causes neck swelling. Treatment should be based on excess, deficiency, cold, or heat, using the "depression point" method. (Zhengzhi Zhunsheng)
Headache, if not caused by wind pathogen, is due to qi injury, or may result from stiff neck (luozhen); all are suitable for Heqi Yin. ○ Some cases arise from kidney deficiency failing to nourish liver wood, leading to liver blood deficiency unable to moisten tendons, resulting in joint dysfunction; Liuwei Dihuang Wan is suitable. (Dai Yuanli)
[Scriptural Principles]
The west wind arises in autumn, causing lung diseases, with its acupoint transmission located at the shoulders and back. ○ Thus, autumn qi tends to cause shoulder and back disorders. ○ Lung disease patients present with wheezing, coughing, qi rebellion, shoulder and back pain, and sweating. ○ An excessive autumn pulse indicates external pathogen, causing qi rebellion and dull back pain. ○ The Hand-Taiyin lung meridian, when qi is abundant and excessive, causes shoulder and back pain. ○ Exposure to wind-cold with sweating and qi deficiency causes shoulder and back pain, aversion to cold, and shortness of breath. ○ Excessive fire year运 leads to public suffering of shoulder and back pain. ○ When Shaoyin governs the sky and heat dominates excessively, the public suffers pain in shoulders, back, axilla, and supraclavicular fossa. ○ Pathogens in the kidney cause pain in shoulders, back, neck, and nape. (Su Wen)
[Philosophical Discourses]
Elbow pain radiating to the shoulder, with inability to flex or extend, accompanied by chills and fever, neck and shoulder pain, arm pain, numbness, and bi-syndrome, is primarily treated by Tianjing (SI10). ○ Inability to raise the shoulder or dress oneself is primarily treated by Qinglengyuan (SI9). ○ Pain in elbow, arm, and wrist, neck swelling preventing turning of the head, urgent head and neck pain with dizziness, weakness in thighs, and pain in scapula and little finger is primarily treated by Qian Gu (SI3). ○ Shoulder pain preventing dressing, lateral arm and wrist pain with inability to raise, is primarily treated by Yanggu (SI5). ○ Inability to raise arm, head and neck pain, swollen throat with difficulty swallowing, is primarily treated by Qian Gu (SI3). ○ Shoulder pain feeling like breaking, armpit pain feeling like pulling, inability to move hands up and down, is primarily treated by Yanglao (SI2). ○ Shoulder, back, and head pain with frequent dizziness is primarily treated by Yongquan (KI1). (Jia Yi Jing)
Patients who frequently point to swollen and trembling arms, with body tremors, are treated with Licorice and Veratrum Decoction (Lilu Gancao Tang). (Jin Gui Yao Lue)
The Lung directs all vessels. Lung disease impairs the control over the whole body; thus, pathology at Fei Shu manifests as shoulder and back pain. Furthermore, the back is the residence of the Yangming meridians. If Yangming qi is deficient, failing to bind sinews and bones and facilitate joints, it results in drooping shoulders and curved back. As for the arms, where meridians intersect complexly, Yangming is the leader of the twelve meridians; red arm pain should be attributed to Yangming. However, pain has internal and external causes, with distinct deficiency and excess patterns; treatment distinguishes between qi and blood, requiring different approaches of unblocking and tonifying. For example, in case of ying-blood deficiency with malnourished collaterals and wind-moving tendon stiffness, pungent-cold herbs are contraindicated; one should emulate Dongyuan's Jin Tendon Decoction (Shujin Tang) combined with Huoluo Dan. For fatigue damaging yang qi, causing collateral blockage and shoulder-arm pain, use pungent-sweet herbs as sovereign, assisted by channel-entering collaterals. For declining Yangming qi and stirring Jueyin wind causing right shoulder pain and numbness, use Gouqi, Danggui Shen, Huangqi, Lingjiao, Sangzhi to treat dual deficiency of Yangming and Jueyin ying-qi. For blood deficiency with wind movement due to weak Yangming collaterals disturbed by Liver wind-yang, use Shouwu, Gouqi, Danggui Shen, Huma, Baiziren, Jili, employing sweet-soft herbs for warming and nourishing. For back pain after blood loss, the deficiency lies in Yangming collaterals; use Renshen, Danggui Shen, Zaoren, Baishao, Zhi Cao, Fushen to fill Yangming. If Kidney qi rebels upward, Du vessel deficiency is primary; use extraordinary vessel herbs to strongly tonify yang. For cold inhaled via mouth and nose, obstructing qi channels, causing pain radiating from chest to back, follow the Nei Jing principle that all pains are cold-related; use warm herbs to unblock qi and blood. Ancient methods include Fangfeng Tang dispersing wind at Fei Shu, Zhimi Wan treating arm pain from flowing phlegm, Kongyan Dan treating migrating bi-pain; these treat excess syndromes, embodying "if unblocked, there is no pain." (Linzheng Zhinan Yian)
Arm pain involves six meridians. Determine which meridian is affected and use its specific herbs to circulate qi and blood; once unblocked, recovery occurs. Extend both arms straight down along the body, thumb forward, little finger backward to identify. Pain in the anterior medial aspect belongs to Yangming; use Shengma, Baizhi, Ge Gen. Pain in the posterior medial aspect belongs to Taiyang; use Qianghuo. Pain in the lateral aspect belongs to Shaoyang; use Chaihu. Pain in the deep medial aspect belongs to Jueyin; use Chaihu, Qingpi. Pain in the anterior medial aspect (repeated/variant description) belongs to Taiyin; use Shengma, Baizhi, Congbai. Pain in the posterior medial aspect belongs to Shaoyin; use Xixin, Duhuo. Combine with acupuncture, selecting points according to the affected meridian. (Li Dongyuan)
Shoulder and back pain with inability to look back indicates stagnation of Taiyang qi. Or spinal pain with neck stiffness, waist feeling like breaking, neck feeling like pulling, suggests Tongqi Fangfeng Tang. Shoulder and back heaviness and pain due to damp-heat suggests Danggui Niantong Tang. Pain due to sweating and frequent urination, where wind-heat attacks Spleen causing Spleen qi stagnation and shoulder pain, requires draining wind-heat; Shengma Chaihu Tang is suitable. Shoulder and back pain due to phlegm-fluid accumulation suggests Xingxiang San or Daotan Tang. Shoulder and back pain due to Kidney qi deviating from its path and rising with the back suggests Heqi Yin with salt-fried Huixiang. Back pain due to labor, prolonged reading, or chess-playing suggests Buzhong Yiqi Tang or Bawei Tang with Huangqi. The back is the mansion of the chest; Lung governs qi in the chest. Lung qi stagnation causes blood stasis; Lung qi deficiency fails to circulate yang pathways; phlegm in Lung flowing to shoulder/back causes distension and pain. ○ Arm pain caused by wind-cold-damp binding, phlegm flow, qi stagnation, or lifting heavy objects, with or without swelling. Due to wind-cold, Wuji San plus Qianghuo. Due to dampness, Juanbi Tang plus Cangzhu. Due to phlegm, Daotan Tang. Due to qi, Wuyao Shunqi San. Due to heavy lifting injuring sinews, Jie Lao San or Heqi Yin plus Jianghuang, as Jianghuang enters arm meridians. (Chishui Xuanzhu)
[Pulse Diagnosis]
A cunkou pulse that is rapid and strikes upward upon palpation indicates shoulder and back pain. (Su Wen)