脊者。督脉之经。与膀胱之经。皆取道于脊也。故项脊常热而痛者。阴虚也。六味丸加麋茸。
常寒而痛者。阳虚也。八味丸加鹿茸。有肾气攻背。而项筋痛连脊髀。不可转移者。此地气从背
而上入也。椒附散。太阳经脊痛项强。腰似折。
项似拔。羌活胜湿汤。脉浮紧为伤寒。麻黄汤。沉缓为风湿。五苓散换苍术、桂枝。加羌活。打
扑伤损。从高坠下。恶血在太阳经中。腰脊痛不可忍。地龙汤。
尻痛 尻乃足少阴与督脉所过之处。兼属厥阴。若肾虚者。六味丸加肉桂。不愈。加鹿茸。
肥人属湿痰。二陈合二妙。有因死血作痛者。当归、赤芍、牡丹、桃仁、延胡索、生牛膝、穿山
甲、肉桂之类清理之。不应。加地龙、生附子。
经云。背者胸中之府。背曲肩随。府将坏矣。肺病者。喘咳逆气。肩背痛汗出。肺盛有余。
则肩背痛。风寒汗出中风。
小便数而欠。气虚则肩背寒。少气不足以息。溺色变。邪在肾。则肩背痛。是肾气上逆也。
东垣云。肩背痛不可回顾。此手太阳气郁不行也。以风药散之。通气防风汤。若面白脱色。
短气者勿服。宜逍遥散加人参。火郁热盛。东垣升阳散火汤。形气虚甚。十全大补汤。肩背痛。
脊强。腰似折。项似拔。此足太阳经气不行也。羌活胜湿汤。风寒汗出中风。肩背痛。小便数而
欠者。风热乘其肺而肺气郁甚也。当泻风热。消风散去僵蚕、蝉蜕加枳、桔。寒热少气不足以息
而肩痛。小便遗失者。补中益气加门冬、五味。湿热相搏。肩背沉重而痛。当归拈痛汤。
当肩背一片冷痛。背膂疼痛。古方用神保丸愈者。此有寒积也。有因寒饮伏结者。近效白术
附子汤。亦有因痰气留伏者。指迷茯苓丸。素有痰饮流注。肩背作痛。导痰汤。有肾气不循故道。
气逆挟脊而上。致肩背痛。沉香、肉桂、茯苓、牛膝、茴香、川椒、青盐。或观书对奕久坐而至
脊背痛者。补中益气加羌、防。肥人喜捶而痛快者属痰。宜除湿
化痰。兼补脾胃。六君子加木香。瘦人多是血少气虚。宜养血清火。圣愈汤。背痛须加羌、防引
经。肥人少佐附子。瘦人须佐芩、连、丹皮。有素虚人及病后房劳后。妇人产后。经行后。心膈
间痛。或牵引乳胁。或走注肩背痛。并宜十全大补随证加减。
〔诊〕寸口脉促上击者。肩背痛。洪大为热。浮大为风。沉而滑者背膂痛。必有寒饮伏结也。
丹溪治一人。忽患肩胛缝有一线疼起。上循肩至胸前侧胁而止。昼夜不息。其脉弦而数。重
按豁大。左大于右。夫胛小肠经也。胸胁胆经也。此因谋事不遂。思虑烦心。心不病而小肠之火
乘胆所致。以人参四钱、木通二钱煎汤。下龙荟丸。数服而愈。
李士材治俞元济。背心一点痛。久而渐大。服行气和血药不效。其脉濡滑。遇天阴痛辄甚。
其为湿痰无疑。以胃苓汤加半夏三钱。数剂而痛消。
脊骨，是督脉循行的部位，与足太阳膀胱经的经脉，都经过脊柱区域。因此，如果颈项和脊背经常发热且疼痛，属于阴虚证，可用六味地黄丸加麋鹿茸治疗；经常发冷且疼痛的，属于阳虚证，可用金匮肾气丸（八味丸）加鹿茸治疗。若有肾气攻冲背部，导致颈项筋脉疼痛并牵连至脊背和大腿，身体无法转动的，这是地气从背部向上侵入所致，用椒附散治疗。
足太阳膀胱经受邪引起的脊痛、颈项强直，腰部感觉像要折断一样，颈项感觉像被拔起一样，用羌活胜湿汤治疗。脉象浮紧的是伤寒证，用麻黄汤治疗；脉象沉缓的是风湿证，用五苓散替换苍术、桂枝，再加羌活治疗。因跌打损伤，从高处置坠落，恶血停滞在足太阳经中，导致腰脊剧痛难以忍受的，用地龙汤治疗。
尻部（尾骶骨区域）疼痛：尻部是足少阴肾经与督脉经过的地方，同时也归属于足厥阴肝经。如果是肾虚引起的，用六味地黄丸加肉桂治疗；若无效，再加鹿茸。体型肥胖者多属湿痰证，用二陈汤合二妙散治疗。有因瘀血作痛的，用当归、赤芍、牡丹皮、桃仁、延胡索、生牛膝、穿山甲、肉桂等药物清理瘀血；若无效，再加地龙、生附子。
《内经》说：“背部是胸中脏腑的外府。”如果背部弯曲、肩膀下垂，说明脏腑功能即将败坏。肺病的人，会出现气喘、咳嗽、气逆，肩背疼痛、出汗。肺气盛有余时，会导致肩背疼痛。风寒袭表导致汗出中风，会出现小便频数但排尿不畅、气短不足以呼吸、尿液颜色改变等症状。邪气在肾脏，也会导致肩背疼痛，这是肾气上逆的表现。
李东垣说：肩背痛且不能回顾转头，这是手太阳小肠经气机郁滞不通所致，应用风药疏散，用通气防风汤治疗。如果面色苍白无华、气短的，不要服用此方，宜用逍遥散加人参治疗。若是火郁热盛，用李东垣的升阳散火汤。若形体元气非常虚弱，用十全大补汤。
肩背疼痛，脊背强直，腰部感觉像要折断，颈项感觉像被拔起，这是足太阳膀胱经气机运行不畅所致，用羌活胜湿汤治疗。风寒袭表导致汗出中风，出现肩背疼痛，小便频数但排尿不畅的，是风热侵袭肺部导致肺气郁滞严重，应当泻除风热，用消风散去僵蚕、蝉蜕，加枳壳、桔梗治疗。伴有寒热往来、气短不足以呼吸且肩痛，小便失禁的，用补中益气汤加麦冬、五味子治疗。湿热相搏结，导致肩背沉重而疼痛的，用当归拈痛汤治疗。
当肩背出现一片冷痛，背部脊柱肌肉疼痛，古方使用神保丸治愈的，这是因为体内有寒积。有因寒饮潜伏结聚的，用近效白术附子汤。也有因痰气留滞伏结的，用指迷茯苓丸。素有痰饮流注于经络，导致肩背作痛的，用导痰汤治疗。有因肾气不循常道，气逆挟带脊背而上行，导致肩背疼痛的，用沉香、肉桂、茯苓、牛膝、小茴香、川椒、青盐治疗。或者因为读书、下棋久坐而导致脊背疼痛的，用补中益气汤加羌活、防风。体型肥胖的人喜欢捶打而感到痛快，这属于痰证，宜除湿化痰，兼补脾胃，用六君子汤加木香。体型瘦弱的人多是血少气虚，宜养血清热，用圣愈汤。治疗背痛必须加羌活、防风作为引经药。体型肥胖者可稍佐以附子；体型瘦弱者须佐以黄芩、黄连、牡丹皮。对于素体虚弱的人，以及病后、房劳之后、妇女产后、月经后的患者，出现心膈间疼痛，或牵引至乳房胁肋，或游走性肩背疼痛的，均宜用十全大补汤随证加减。
【诊法】寸口脉搏动急促且向上冲击手指的，主肩背疼痛。脉象洪大主热证，浮大主风证，沉而滑主背部脊柱肌肉疼痛，必定是有寒饮潜伏结聚。
朱丹溪治疗一人，忽然患肩胛缝处有一线疼痛，向上沿肩部至胸前侧胁部为止，昼夜不停息。其脉象弦而数，重按豁然宽大，左侧大于右侧。肩胛部属于小肠经，胸胁部属于胆经。这是由于谋事不成，思虑烦心，心虽未病但小肠之火乘袭胆经所致。用人参四钱、木通二钱煎汤，送服龙荟丸，数服后痊愈。
李士材治疗俞元济，背心有一点疼痛，日久逐渐扩大，服用行气和血的药物无效。其脉象濡滑，遇到阴天疼痛就加重，这无疑是湿痰所致。用胃苓汤加半夏三钱，数剂后疼痛消除。
The spine is the meridian of the Du vessel (Governor Vessel), and it, along with the Bladder meridian (Bladder Channel), both traverse the spinal region. Therefore, if the neck and spine are frequently hot and painful, it indicates Yin deficiency; Liuwei Wan (Six-Ingredient Rehmannia Pill) added with Cervus Elaphus Antler (Milurong) should be used. If it is frequently cold and painful, it indicates Yang deficiency; Bawei Wan (Eight-Ingredient Pill, i.e., Jin Gui Shen Qi Wan) added with Cervus Nippon Antler (Lurong) should be used. If Kidney Qi attacks the back, causing pain in the neck tendons that radiates to the spine and thighs, making movement impossible, this is due to Earth Qi entering from the back upwards; Jiaofu San (Pepper and Aconite Powder) should be used.
For spinal pain and neck stiffness caused by the Taiyang meridian (Greater Yang Channel), where the waist feels as if it will break and the neck feels as if it will be pulled out, Qianghuo Shengshi Tang (Notopterygium Decoction for Overcoming Dampness) should be used. A floating and tight pulse indicates Cold Damage (Shanghan); Mahuang Tang (Ephedra Decoction) should be used. A deep and slow pulse indicates Wind-Dampness; Wuling San (Five-Ingredient Powder with Poria) with Cangzhu (Atractylodis Rhizoma) and Guizhi (Cinnamon Twig) substituted, plus Qianghuo (Notopterygii Rhizoma et Radix), should be used. For traumatic injuries from falling from heights, where evil blood stagnates in the Taiyang meridian causing unbearable lower back and spinal pain, Dilong Tang (Earthworm Decoction) should be used.
Kao Pain (Pain in the Sacrococcygeal Region): The kao area is where the Shaoyin meridian (Lesser Yin Channel of the Foot-Kidney) and the Du vessel pass, and it also belongs to the Jueyin meridian (Terminal Yin Channel). If caused by Kidney deficiency, Liuwei Wan (Six-Ingredient Rehmannia Pill) added with Rougui (Cinnamon Bark) should be used; if ineffective, add Lurong (Cervus Nippon Antler). In obese individuals, it belongs to Phlegm-Dampness; Erchen Tang (Two-Aged Decoction) combined with Ermiao San (Two-Marvel Powder) should be used. If caused by fixed blood (stasis), drugs such as Danggui (Angelicae Sinensis Radix), Chishao (Paeoniae Radix Rubra), Mudanpi (Moutan Cortex), Taoren (Persicae Semen), Yanhusuo (Corydalis Rhizoma), Sheng Niuxi (Achyranthis Bidentatae Radix fresh), Chuanshanjia (Manis Squama), and Rougui (Cinnamon Bark) should be used to clear it; if ineffective, add Dilong (Pheretima) and Sheng Fuzi (Aconiti Lateralis Radix Preparata fresh).
The Classic states: "The back is the mansion of the chest organs." If the back is curved and the shoulders droop, the mansion is about to collapse. Patients with Lung disease suffer from panting, coughing, rebellious Qi, shoulder and back pain, and sweating. When Lung Qi is excessive, it causes shoulder and back pain. Wind-Cold with sweating and wind-strike cause frequent urination but incomplete voiding, shortness of breath insufficient for respiration, and changes in urine color. Pathogenic factors in the Kidney also cause shoulder and back pain, which is rebellious Kidney Qi.
Li Dongyuan said: Shoulder and back pain with inability to look back is due to Qi stagnation in the Hand-Taiyang meridian (Small Intestine Channel); it should be dispersed using wind-dispersing herbs, specifically Tongqi Fangfeng Tang (Qi-Ventilating Saposhnikovia Decoction). If the face is pale and lacking luster, with shortness of breath, do not use this formula; instead, Xiaoyao San (Free and Easy Wanderer Powder) added with Renshen (Ginseng Radix et Rhizoma) should be used. For Fire Stagnation with intense heat, Li Dongyuan's Shengyang Sanhuo Tang (Raising Yang and Dispersing Fire Decoction) should be used. If physical Qi is extremely deficient, Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction) should be used.
Shoulder and back pain, spinal stiffness, waist feeling as if breaking, and neck feeling as if being pulled out indicate non-circulation of Qi in the Foot-Taiyang meridian (Bladder Channel); Qianghuo Shengshi Tang (Notopterygium Decoction for Overcoming Dampness) should be used. Wind-Cold with sweating and wind-strike causing shoulder and back pain, frequent urination but incomplete voiding, indicate Wind-Heat attacking the Lung causing severe Lung Qi stagnation; Wind-Heat should be purged using Xiaofeng San (Wind-Extinguishing Powder) with Jiangcan (Bombyx Batryticatus) and Chantui (Cicadae Periostracum) removed, plus Zhike (Aurantii Fructus Immaturus) and Jiegeng (Platycodonis Radix). Accompanied by alternating chills and fever, shortness of breath insufficient for respiration, and shoulder pain, with urinary incontinence, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Maidong (Ophiopogonis Radix) and Wuweizi (Schisandrae Chinensis Fructus) should be used. Damp-Heat clashing causing heavy and painful shoulders and backs requires Dangni Tongtong Tang (Angelica Joint-Pain Relieving Decoction).
When there is a patch of cold pain in the shoulder and back, and pain in the dorsal muscles, ancient formulas cured this with Shenbao Wan (Divine Treasure Pill), indicating Cold Accumulation. For cases due to latent Cold Fluids knotting, Jinxiao Baizhu Fuzi Tang (Recently Effective Atractylodes and Aconite Decoction) should be used. For cases due to Phlegm-Qi retention, Zhimi Fu Ling Wan (Point-Mistaking Poria Pill) should be used. For chronic Phlegm-Fluids flowing into collaterals causing shoulder and back pain, Daotan Tang (Great Phlegm-Resolving Decoction) should be used. For Kidney Qi not following its proper path, with Qi rebelling upwards along the spine causing shoulder and back pain, Chenxiang (Aquilariae Lignum Resinatum), Rougui (Cinnamon Bark), Fuling (Poria), Niuxi (Achyranthis Bidentatae Radix), Huixiang (Foeniculi Fructus), Chuanjiao (Zanthoxyli Pericarpium), and Qingyan (Halitum) should be used. Or, for spinal and back pain caused by prolonged sitting while reading or playing chess, Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) added with Qianghuo (Notopterygii Rhizoma et Radix) and Fangfeng (Saposhnikoviae Radix) should be used. Obese individuals who find relief from pounding belong to Phlegm; Dampness should be removed, Phlegm resolved, and Spleen and Stomach supplemented with Liujunzi Tang (Six-Gentlemen Decoction) added with Muxiang (Aucklandiae Radix). Thin individuals mostly have Blood deficiency and Qi deficiency; Blood should be nourished and Heat cleared with Shengyu Tang (Life-Sustaining Decoction). Treating back pain requires adding Qianghuo (Notopterygii Rhizoma et Radix) and Fangfeng (Saposhnikoviae Radix) as guiding herbs. Obese individuals may take a small dose of Fuzi (Aconiti Lateralis Radix Preparata); thin individuals must take Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), and Mudanpi (Moutan Cortex). For constitutionally weak individuals, and those after illness, sexual exertion, postpartum women, or after menstruation, experiencing pain between the heart and diaphragm, radiating to breasts and flanks, or wandering shoulder and back pain, all should use Shiquan Dabu Tang (Perfect Ten Great Tonifying Decoction) modified according to symptoms.
[Diagnosis] A Cun Kou (Radial Pulse) that is rapid and strikes upward indicates shoulder and back pain. A洪大 (Hongda, Surging and Large) pulse indicates Heat; a 浮大 (Fuda, Floating and Large) pulse indicates Wind; a 沉而滑 (Chen er Hua, Deep and Slippery) pulse indicates dorsal muscle pain, necessarily due to latent Cold Fluids knotting.
Zhu Danxi treated a patient who suddenly suffered from a line of pain starting in the scapular seam, running up the shoulder to the lateral side of the chest, ceaselessly day and night. His pulse was wiry and rapid, hollow and large upon heavy pressure, larger on the left than the right. The scapula belongs to the Small Intestine meridian, and the chest/flank belongs to the Gallbladder meridian. This was caused by unsuccessful schemes and anxious thinking; although the Heart was not diseased, Fire from the Small Intestine attacked the Gallbladder. Ren Shen (Ginseng Radix et Rhizoma) 4 qian and Mutong (Akebiae Caulis) 2 qian were decocted in water to administer Longhui Wan (Dragon Liver Pill), curing him after several doses.
Li Shicai treated Yu Yuanji, who had a single point of pain in his back that gradually enlarged over time. Medications regulating Qi and invigorating Blood were ineffective. His pulse was soggy and slippery, and pain worsened on cloudy days. This was undoubtedly Damp-Phlegm. Weiling Tang (Gastrodia and Poria Decoction, here referring to Ping Wei San combined with Wuling San) added with Banxia (Pinelliae Tuber) 3 qian eliminated the pain after several doses.