【外感肩背痛之症】背痛肩痛，发热不恶寒，反恶热，烦躁不宁，便闭便赤，口渴唇
焦，此火邪伤肺之症也。若背痛肩痛，头痛发热，内虽烦躁，外反恶寒，此风寒伤肺之症也。
【外感肩背痛之因】《内经》云∶岁火太过，民病肩背热痛。又云∶少阴司天，热淫
所胜，民病肩背缺盆痛，此火邪伤肺也。又有肺素有热，风寒外束皮毛，肺热不得泄越，而肩
背肺俞作痛，此寒邪伤肺也。
【外感肩背痛之脉】右寸洪数，肺经热壅，火邪所伤；脉浮而紧，表有寒邪，风寒
【外感肩背痛之治】若火邪伤肺，当用家秘泻白汤、清燥清肺饮。肺素有热，风寒束于
家秘泻白汤
桑白皮 地骨皮 粉甘草 黄芩 石膏 黄连
清肺饮
桔梗 黄芩 山栀 连翘 天花粉 玄参 薄荷 甘草
羌防泻白散 即泻白散加羌活、防风。
【内伤肩背痛之症】气怯神离，精神不足，痛势不急，仍能睡卧。此肺气不足之症也
。若
焦，二便赤涩，烦躁不宁，此积热作痛之症也。
【内伤肩背痛之因】元气素亏，又复伤损，则肺气不足而作痛；肺热叶焦，复有触发
，则肺气怫郁而作痛；劳碌举重，损伤筋膜，则肺窍有损而作痛；膏粱酒客，肠胃积热，上熏肺
金，则土中之火刑金，而肩背痛缺盆肺俞，每每作痛。此皆内伤肩背痛也。
【内伤肩背痛之脉】右脉浮大，按之无根，肺气不足。寸口脉盛，按之数实，气壅肺
实。六脉弦大，按之促结，伤损之诊。右关沉数，肠胃积热；左关弦数，肝胆之火。
【内伤肩背痛之治】气怯神清，脉大而虚，四君子汤、补中益气汤。喘急气逆，不得
安卧，六脉躁盛，重则葶苈泻肺汤，轻则家秘泻白散。久痛不愈，气血有伤者，四物汤、八珍汤
，加秦艽、续断、钩藤、羌活。膏粱积热，口燥唇焦，六脉沉数者，家秘泻白散。木火刑金
四君子汤 治气虚作痛。
人参 白术 茯苓 甘草
补中益气汤 治气血两虚，肩背作痛。
人参 白术 黄 当归 陈皮 甘草 升麻 柴胡
葶苈泻肺汤 治痰饮壅塞肺窍，肩背缺盆牵引作痛。
葶苈子 大枣肉
家秘泻白散 治实火刑金，肺热喘咳，唇焦便赤。
桑白皮 地骨皮 甘草 黄芩 石膏 川黄连
家秘加葛根清胃火，加白芍药清脾火，加柴胡清肝胆之火，加辰砂清心火，加黄柏清肾
火，加枳壳清大肠之火，加木通清小肠之火。
四物汤 治血虚肩背作痛。
熟地黄 白芍药 当归 川芎
家秘加秦艽、续断、钩藤、羌活，治诸凡身痛。
八珍汤 治气血两亏，肩背作痛。
即四君子、四物汤，家秘加秦艽、续断、钩藤、羌活。
泻白各半汤
桑白皮 地骨皮 甘草 胆草 山栀 黄芩
加青黛冲服。
【外感肩背痛的症状】背部和肩部疼痛，发热但不怕冷，反而怕热，烦躁不安，大便闭塞、小便短赤，口渴且嘴唇焦枯，这是火邪损伤肺脏的症状。如果背部和肩部疼痛，伴有头痛发热，体内虽然烦躁，体表却反而怕冷，这是风寒损伤肺脏的症状。
【外感肩背痛的病因】《黄帝内经》说：岁运火气太过，百姓容易患肩背热痛。又说：少阴君天之气主事时，热气过盛，百姓易患肩背及缺盆穴部位疼痛，这是火邪损伤肺脏所致。又有肺脏原本有热，风寒从外部束缚皮毛，导致肺热无法宣泄发散，从而引起肩背部肺俞穴疼痛，这是寒邪损伤肺脏（郁而化热）的情况。
【外感肩背痛的脉象】右寸脉洪大且数，表示肺经热邪壅滞，为火邪所伤；脉象浮而紧，表示表证有寒邪，属风寒致病。
【外感肩背痛的治疗】如果是火邪损伤肺脏，应当使用家传秘方的泻白汤、清燥清肺饮。如果是肺脏素来有热，又被风寒束表，可用羌防泻白散。
清肺饮
组成：桔梗、黄芩、山栀、连翘、天花粉、玄参、薄荷、甘草。
【内伤肩背痛的症状】气息怯弱，精神涣散，精力不足，疼痛程度不剧烈，仍能睡眠躺卧。这是肺气不足的症状。如果出现口唇焦枯，大小便赤涩不通，烦躁不安，这是积热引起的疼痛。
【内伤肩背痛的病因】元气素来亏虚，又再次受到损伤，导致肺气不足而作痛；肺热导致肺叶焦枯，又有诱因触发，导致肺气郁结不畅而作痛；劳累过度或举重物，损伤筋膜，导致肺窍受损而作痛；嗜食肥甘厚味及饮酒之人，肠胃积热，向上熏蒸肺金，导致脾土中的火热刑克肺金，从而引起肩背痛、缺盆穴及肺俞穴经常疼痛。这些都属于内伤引起的肩背痛。
【内伤肩背痛的脉象】右脉浮大，重按无根，是肺气不足的表现。寸口脉盛大，重按数而有力，是气机壅滞、肺实热的表现。六脉弦大，重按出现急促或间歇停顿，是伤损的脉象。右关脉沉数，表示肠胃积热；左关脉弦数，表示肝胆之火。
【内伤肩背痛的治疗】如果气息怯弱但神志清醒，脉象大而虚弱，使用四君子汤、补中益气汤。如果喘急气逆，不能安卧，六脉躁动盛大，重症用葶苈泻肺汤，轻症用家传秘方泻白散。久病不愈，气血受损的，使用四物汤、八珍汤，并加入秦艽、续断、钩藤、羌活。如果是膏粱积热，口燥唇焦，六脉沉数的，使用家传秘方泻白散。木火刑金者需辨证施治。
四君子汤：治疗气虚引起的疼痛。
组成：人参、白术、茯苓、甘草。
补中益气汤：治疗气血两虚引起的肩背疼痛。
组成：人参、白术、黄芪、当归、陈皮、甘草、升麻、柴胡。
葶苈泻肺汤：治疗痰饮壅塞肺窍，引起肩背及缺盆穴牵引性疼痛。
组成：葶苈子、大枣肉。
家秘泻白散：治疗实火刑金，肺热喘咳，嘴唇焦枯，小便赤涩。
组成：桑白皮、地骨皮、甘草、黄芩、石膏、川黄连。
家传秘方加减法：加葛根清胃火，加白芍药清脾火，加柴胡清肝胆之火，加辰砂清心火，加黄柏清肾火，加枳壳清大肠之火，加木通清小肠之火。
四物汤：治疗血虚引起的肩背疼痛。
组成：熟地黄、白芍药、当归、川芎。
家传秘方加减法：加入秦艽、续断、钩藤、羌活，治疗各种身体疼痛。
[Symptoms of Shoulder and Back Pain due to External Contraction]
Pain in the back and shoulders, fever without aversion to cold but with aversion to heat, restlessness and agitation, constipation with dark urine, thirst with parched lips. This is a condition where Fire Pathogen (Huoxie) injures the Lung. If there is pain in the back and shoulders accompanied by headache and fever, with internal restlessness but external aversion to cold, this is a condition where Wind-Cold Pathogen (Fenghan) injures the Lung.
[Etiology of Shoulder and Back Pain due to External Contraction]
The *Neijing* states: "When the annual fire qi is excessive, people suffer from hot pain in the shoulders and back." It also states: "When Shaoyin governs the year, and heat prevails excessively, people suffer from pain in the shoulders, back, and Key-Well points (Quepen)." This indicates injury to the Lung by Fire Pathogen. Additionally, if the Lung has pre-existing heat, and Wind-Cold binds the exterior skin and hair, the Lung heat cannot vent or disperse, causing pain at the Bladder 13 (Feishu) acupoint on the shoulder and back; this is considered injury to the Lung by Cold Pathogen (leading to heat retention).
[Pulse Signs of Shoulder and Back Pain due to External Contraction]
A surging and rapid pulse at the Right Cun position indicates Heat obstruction in the Lung meridian, injured by Fire Pathogen. A floating and tight pulse indicates Exterior Cold Pathogen, characteristic of Wind-Cold.
[Treatment of Shoulder and Back Pain due to External Contraction]
If the Lung is injured by Fire Pathogen, use Jiamixiebai Decoction (Secret Formula Xiebai Tang) or Qingzao Qingfei Yin. If the Lung has inherent heat bound by Wind-Cold externally, use Qiangfang Xiebai San.
Jiamixiebai Decoction (Secret Formula Xiebai Tang)
Ingredients: Sangbaipi (Morus Albae Cortex), Digupi (Lycii Cortex), Fen Gancao (Prepared Glycyrrhizae Radix et Rhizoma), Huangqin (Scutellariae Radix), Shigao (Gypsum Fibrosum), Huanglian (Coptidis Rhizoma).
Qingfei Yin (Clear the Lung Drink)
Ingredients: Jiegeng (Platycodonis Radix), Huangqin (Scutellariae Radix), Shanzhi (Gardeniae Fructus), Lianqiao (Forsythiae Fructus), Tianhuafen (Trichosanthis Radix), Xuanshen (Scrophulariae Radix), Bohe (Menthae Haplocalycis Herba), Gancao (Glycyrrhizae Radix et Rhizoma).
Qiangfang Xiebai San: Xiebai San added with Qianghuo (Notopterygii Rhizoma et Radix) and Fangfeng (Saposhnikoviae Radix).
[Symptoms of Shoulder and Back Pain due to Internal Injury]
Weakness of Qi, scattered spirit, lack of mental energy, pain that is not severe, ability to sleep and lie down. This is a symptom of Lung Qi Deficiency. If there are parched lips, dark and scanty urination and defecation, and restlessness, this is pain caused by Accumulated Heat.
[Etiology of Shoulder and Back Pain due to Internal Injury]
Constitutional deficiency of Yuanqi (Primordial Qi) compounded by further damage leads to Lung Qi Deficiency causing pain; Lung Heat causing scorching of Lung leaves, triggered by aggravating factors, leads to Lung Qi Stagnation causing pain; overexertion or lifting heavy weights damages tendons and fascia, injuring the Lung orifice causing pain; individuals consuming rich foods and alcohol have Accumulated Heat in the Intestines and Stomach, which steams upward to insult Metal (Lung), causing Earth-Fire to punish Metal, resulting in frequent pain in the shoulders, back, Quepen point, and Feishu acupoint. These are all cases of shoulder and back pain due to Internal Injury.
[Pulse Signs of Shoulder and Back Pain due to Internal Injury]
A floating and large right pulse, empty upon deep pressure, indicates Lung Qi Deficiency. A full pulse at the Cunkou position, rapid and solid upon deep pressure, indicates Qi Obstruction and Lung Excess. String-taut and large pulses in all six positions, with choppy or intermittent beats upon deep pressure, indicate Injury/Damage. A deep and rapid pulse at the Right Guan position indicates Accumulated Heat in the Intestines and Stomach; a string-taut and rapid pulse at the Left Guan position indicates Fire of the Liver and Gallbladder.
[Treatment of Shoulder and Back Pain due to Internal Injury]
For weak Qi but clear consciousness, with a large and deficient pulse, use Sijunzi Tang or Buzhong Yiqi Tang. For panting,急促 Qi reversal, inability to lie flat, and restless/full pulses, use Tingli Xiefei Tang for severe cases, or Jiamixiebai San for mild cases. For chronic pain not resolving, indicating Qi and Blood injury, use Siwu Tang or Bazhen Tang, added with Qinjiao (Gentianae Macrophyllae Radix), Xuduan (Dipsaci Radix), Gouteng (Uncariae Ramulus cum Uncis), and Qianghuo (Notopterygii Rhizoma et Radix). For Accumulated Heat from rich diet, dry mouth and parched lips, with deep and rapid pulses, use Jiamixiebai San. For Wood-Fire punishing Metal, treat accordingly.
Sijunzi Tang: Treats pain due to Qi Deficiency.
Ingredients: Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Gancao (Glycyrrhizae Radix et Rhizoma).
Buzhong Yiqi Tang: Treats shoulder and back pain due to dual deficiency of Qi and Blood.
Ingredients: Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix).
Tingli Xiefei Tang: Treats shoulder and back pain radiating to the Quepen point due to Phlegm-Fluid obstructing the Lung orifice.
Ingredients: Tinglizi (Descurainiae Semen seu Lepidii Semen), Dazao Rou (Ziziphus Jujubae Mesocarp).
Jiamixiebai San (Secret Formula Xiebai San): Treats Real Fire punishing Metal, Lung Heat with panting/cough, parched lips, and red urine.
Ingredients: Sangbaipi (Morus Albae Cortex), Digupi (Lycii Cortex), Gancao (Glycyrrhizae Radix et Rhizoma), Huangqin (Scutellariae Radix), Shigao (Gypsum Fibrosum), Chuan Huanglian (Coptidis Rhizoma).
Secret Formula Modifications: Add Gegen (Puerariae Lobatae Radix) to clear Stomach Fire; add Baishaoyao (Paeoniae Radix Alba) to clear Spleen Fire; add Chaihu (Bupleuri Radix) to clear Liver/Gallbladder Fire; add Chencha (Cinnabaris) to clear Heart Fire; add Huangbai (Phellodendri Cortex) to clear Kidney Fire; add Zhike (Aurantii Fructus Immaturus) to clear Large Intestine Fire; add Mutong (Akebiae Caulis) to clear Small Intestine Fire.
Siwu Tang: Treats shoulder and back pain due to Blood Deficiency.
Ingredients: Shudihuang (Rehmanniae Radix Preparata), Baishaoyao (Paeoniae Radix Alba), Danggui (Angelicae Sinensis Radix), Chuanxiong (Chuanxiong Rhizoma).
Secret Formula Modification: Add Qinjiao (Gentianae Macrophyllae Radix), Xuduan (Dipsaci Radix), Gouteng (Uncariae Ramulus cum Uncis), and Qianghuo (Notopterygii Rhizoma et Radix) to treat general body pain.
Bazhen Tang: Treats shoulder and back pain due to dual deficiency of Qi and Blood.
Composition: Combination of Sijunzi Tang and Siwu Tang, with Secret Formula additions of Qinjiao (Gentianae Macrophyllae Radix), Xuduan (Dipsaci Radix), Gouteng (Uncariae Ramulus cum Uncis), and Qianghuo (Notopterygii Rhizoma et Radix).
Xiebai Banban Tang (Half-and-Half Xiebai Decoction)
Ingredients: Sangbaipi (Morus Albae Cortex), Digupi (Lycii Cortex), Gancao (Glycyrrhizae Radix et Rhizoma), Danshen/Caoshen (Artemisiae Scopariae Herba - Note: 'Dancao' here likely refers to Qingdanchi or similar bitter cold herb, often interpreted as Gentian or Artemisia in context of clearing heat, strictly 'Dancao' usually means Licorice but here distinct from Gancao, likely Qingdanchi/Indigo Naturalis precursor or Gentiana. Given context of clearing liver/gallbladder fire, Qingdanchi or Longdancao is implied. Text says 'Dancao', likely shorthand for Qingdanchi or similar. WHO term for Qingdanchi is Indigo Naturalis. However, 'Dancao' literally is Licorice. But Gancao is listed separately. In some contexts Dancao refers to Gentiana Scabra (Longdancao). Let's assume Longdancao/Gentian based on 'clearing liver fire' context later. Actually, standard 'Dancao' is not a standard single herb name distinct from Gancao unless it's a typo for Longdancao or Qingdanchi. Given 'clearing liver fire' in modifications, Longdancao is probable. I will translate as Gentianae Radix (Longdancao) assuming textual convention for clearing heat/fire). *Correction*: In many ancient texts, 'Dancao' might refer to *Qingdanchi* (Indigo Naturalis) or be a variant. However, looking at the list, it clears heat. Let's stick to literal 'Dancao' if ambiguous, but functionally it acts as a heat-clearing herb. Wait, 'Dancao' is often used for *Gentiana Scabra* (Longdancao) in abbreviated forms in some lineages, or *Artemisia*. Given the pairing with Zhi and Huangqin, it is a bitter-cold herb. I will use Gentianae Radix (Longdancao) as the most clinically consistent interpretation for 'Dancao' in a heat-clearing formula alongside Huangqin/Shanzhi, or note it as 'Dancao'. To be safe and accurate to WHO, if the source is ambiguous, I will use the pinyin or common equivalent. Let's use Gentianae Radix (Longdancao) as it fits the 'Liver/Gallbladder fire' theme often associated with such combinations, or simply 'Dancao (Herb)' if unsure. Actually, 'Dancao' is frequently a typo or abbreviation for *Longdancao*. I will translate as Gentianae Radix (Longdancao).
Shanzhi (Gardeniae Fructus), Huangqin (Scutellariae Radix).
Administration: Mix with Qingdai (Indigo Naturalis) and take orally.