夏氏 当脐 痛，触寒屡发，痛来饮食都废，神色清减，脉虚弦。据述服和肝调气不应，数年前曾以
鸦片烟脚为丸，服下痛止。夫鸦片能行下体经络，此症明系血络阻滞为患，况痛久入络，宜辛温以通之。若但
如四七汤、四磨饮仅开气分。昔贤谓经主气，络主血，不分经络，安能应手。用当归须（酒拌）、延胡、
小茴（酒焙）、新绛、桃仁（研）、旋复花（绢包煨），服效。
薛 寒热咳嗽，数日后小腹掣痛，疑为肠痈。诊脉浮弦，全不沉数，乃络虚气聚，非肠痈也。用杏仁、
栝蒌、茴香、橘核、当归、延胡（俱酒焙）、木瓜，二服全瘳。
沈氏 冬寒小腹瘕聚，左胁撑痛，上攻胸背，大小便不通，胀闷欲绝，汤饮不下，兼发寒热，脉短涩，宜
先导其瘀滞，古云痛则不通也。枳壳、桃仁（各二钱）、浓朴（姜制）、青皮（麸炒各七分）、
延胡（酒炒）、归尾（酒润。各钱半）、苏梗、郁李仁（各二钱）、沉香（磨汁三分），二服痛定，二便通调，
惟左胁偶一隐痛。原方去桃仁、归尾、苏梗、延胡，加郁金、香附，沉香改木香，仍磨汁冲服。又将煎剂挫
为细末，服愈。
经曰∶背者胸中之腑，背曲肩随，腑将坏矣。又曰∶肺病者、喘咳逆气，肩背痛汗出。又曰∶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。又曰∶邪在肾，则肩背痛，
是肾气上逆也。盖肩背为太阳经所循，又为肺脏分域，凡太阳经及肺俞为病，固足致痛，而肾气逆攻，亦足致
痛焉。故肩背痛，不可回顾，此手太阳经气郁不行，宜风药散之。防风通气散。肩背痛、脊强，腰似折，项似
拔，此足太阳经气郁不行。羌活胜湿汤。如肺受风热，而肩背痛，羌活散。肺气虚而肩背寒，补中益气汤加麦
冬、五味。肾气逆冲，挟脊而上攻背痛者，系督脉主病，治在少阴。宜川椒、桂枝、茯苓、附子、牛膝、远志、
沉香、小茴香。亦有肝浊逆冲，从腹而上攻背
痛者，系冲任主病，治在厥阴。宜干姜、川椒、桂枝、乌梅、川连、白芍、细辛、川楝肉。伤湿而肩背重痛者，
当归拈痛汤。寒饮伏结，肩背冷痛者，白术附子汤。素有痰饮，流注肩背手臂作痛者，导痰汤。因于气滞者，
乌药顺气散。因于血虚者，四物汤加秦艽、姜黄。因营虚络脉失养，风动筋急者，舒筋汤。阳明脉衰，肩胛筋
缓不举而痛，宜调补络脉。生 、于术、当归、防风根、姜黄、桑枝、甘杞子、橘络。督脉虚，背痛脊高突，
鹿角霜、杞子、归身、杜仲、茯苓、沙苑子。劳力或坐久而致脊背痛者，补中益气汤，或八珍汤加黄 。
凡背痛，通用姜黄散，更须加防风、羌活引经。肥人喜捶而痛减者，属痰，宜除湿运痰，兼补脾气。六君子汤
加木香。瘦人多由营弱卫衰，宜调气养血。圣愈汤加桂枝、白芍。手臂为手六经交会，或为风寒湿所搏，或
因饮液流入，或因提挚重物，皆能致痛。因风湿者，除湿蠲痛汤加姜黄、当归、桂枝。因风热者，秦艽地黄汤。
因寒湿者，五积散加减。湿痹经络者，蠲痹汤。肢节痛，臂不能举者，舒筋汤加油松节、威灵仙。骨痛筋挛，
血脉凝涩者，透经解挛汤。痰饮流入四肢，肩背手臂酸痛软痹者，导痰汤加姜、炒白术、姜黄、木香。中脘
停痰伏饮，脾不能运，臂战不举，脉来沉细者，指迷茯苓丸。挈重伤筋臂痛，宜和气调血，十全大补汤。血
不荣筋者，四物秦艽汤加玉竹。手屈而不能伸者，病在筋，薏苡仁汤。伸而不能屈者，病在骨，白术附子汤。
手肿痛连臂，蠲痹汤加桑枝。凡用薄桂，能横行手臂。片子姜黄，能引至手臂，油松节，能透入骨节。丹
溪治臂痛，以二陈汤加酒炒黄芩、苍术、羌活。是风痰湿热兼治也。
夏姓患者，肚脐周围疼痛，因受寒而屡次发作，疼痛发作时饮食完全无法进用，神色憔悴减退，脉象虚弦。据述服用调和肝气、疏理气机的药物无效，数年前曾将鸦片烟脚制成丸药服用，服药后疼痛停止。鸦片能够通行下部的经络，此症明确属于血络阻滞为患，况且疼痛日久已深入络脉，应当使用辛温药物来疏通它。如果仅仅像四七汤、四磨饮那样只开通气分。古代贤者说经脉主气，络脉主血，如果不区分经络，怎么能随手应效。处方用当归须（酒拌）、延胡索、小茴香（酒焙）、新绛、桃仁（研碎）、旋覆花（绢包煨），服用后见效。
薛姓患者，恶寒发热咳嗽，几天后小腹牵引疼痛，怀疑是肠痈。诊察脉象浮弦，完全不沉数，这是络脉虚弱、气机聚结，不是肠痈。处方用杏仁、瓜蒌、茴香、橘核、当归、延胡索（均酒焙）、木瓜，服用两剂后痊愈。
沈姓患者，冬季寒冷导致小腹瘕聚（腹内结块），左胁部撑胀疼痛，向上攻冲胸背，大小便不通，胀闷欲绝，汤水饮食都无法咽下，兼有恶寒发热，脉象短涩，应当先引导瘀滞排出，古语说痛则不通。枳壳、桃仁（各二钱）、厚朴（姜制）、青皮（麸炒各七分）、延胡索（酒炒）、当归尾（酒润，各钱半）、苏梗、郁李仁（各二钱）、沉香（磨汁三分），服用两剂后疼痛安定，大小便通畅，只有左胁偶尔隐痛。原方去掉桃仁、当归尾、苏梗、延胡索，加入郁金、香附，沉香改为木香，仍磨汁冲服。又将煎剂挫成细末，服用后痊愈。
经文说：背部是胸中脏腑的外府，背部弯曲肩膀随之塌陷，说明腑气将要败坏。又说：肺病的人，气喘咳嗽逆气，肩背疼痛出汗。又说：肺气盛有余，就会肩背疼痛，风寒出汗，中风，小便频数且量少，气虚则肩背寒冷，少气不足以呼吸，尿液颜色改变。又说：邪气在肾，就会肩背疼痛，这是肾气上逆的缘故。大概肩背是太阳经循行的部位，又是肺脏的分野，凡是太阳经及肺俞发生病变，固然足以导致疼痛，而肾气逆乱攻冲，也足以导致疼痛。所以肩背痛，不能回顾，这是手太阳经气郁结不行，宜用风药疏散。防风通气散。肩背痛、脊柱僵硬，腰部像要折断，颈部像被拔起，这是足太阳经气郁结不行。羌活胜湿汤。如肺受风热，而肩背疼痛，用羌活散。肺气虚而肩背寒冷，用补中益气汤加麦冬、五味子。肾气逆冲，挟持脊柱向上攻冲背痛，属于督脉主病，治疗在少阴。宜用川椒、桂枝、茯苓、附子、牛膝、远志、沉香、小茴香。也有肝浊气逆冲，从腹部向上攻冲背痛的，属于冲任主病，治疗在厥阴。宜用干姜、川椒、桂枝、乌梅、黄连、白芍、细辛、川楝肉。伤湿而肩背沉重疼痛的，用当归拈痛汤。寒饮伏结，肩背冷痛的，用白术附子汤。素有痰饮，流注肩背手臂作痛的，用导痰汤。因于气滞的，用乌药顺气散。因于血虚的，用四物汤加秦艽、姜黄。因营虚络脉失养，风动筋急的，用舒筋汤。阳明脉衰，肩胛筋缓不能举起而疼痛，宜调补络脉。生黄芪、白术、当归、防风根、姜黄、桑枝、甘枸杞、橘络。督脉虚，背痛脊骨高突，用鹿角霜、枸杞、归身、杜仲、茯苓、沙苑子。劳力或久坐导致脊背痛的，用补中益气汤，或八珍汤加黄芪。凡背痛，通用姜黄散，更须加防风、羌活作为引经药。肥胖之人喜欢捶打而疼痛减轻的，属于痰，宜除湿运痰，兼补脾气。六君子汤加木香。瘦人多由营弱卫衰，宜调气养血。圣愈汤加桂枝、白芍。手臂为手六经交会之处，或被风寒湿所搏结，或因饮液流入，或因提举重物，都能导致疼痛。因风湿的，用除湿蠲痛汤加姜黄、当归、桂枝。因风热的，用秦艽地黄汤。因寒湿的，用五积散加减。湿痹经络的，用蠲痹汤。肢节痛，手臂不能举起的，用舒筋汤加油松节、威灵仙。骨痛筋挛，血脉凝涩的，用透经解挛汤。痰饮流入四肢，肩背手臂酸痛软痹的，用导痰汤加姜、炒白术、姜黄、木香。中脘停痰伏饮，脾不能运化，手臂颤抖不能举起，脉来沉细的，用指迷茯苓丸。提举重伤筋臂痛，宜和气调血，用十全大补汤。血不荣养筋的，用四物秦艽汤加玉竹。手屈而不能伸的，病在筋，用薏苡仁汤。伸而不能屈的，病在骨，用白术附子汤。手肿痛连及手臂，用蠲痹汤加桑枝。凡用薄桂，能横行手臂。片子姜黄，能引药至手臂，油松节，能透入骨节。丹溪治疗臂痛，用二陈汤加酒炒黄芩、苍术、羌活。这是风痰湿热兼治。
Patient Xia experienced pain around the umbilicus, recurring frequently upon exposure to cold. During attacks, food and drink were completely rejected, with a sallow complexion and diminished spirit. The pulse was deficient and wiry (Xu Xian). It was reported that formulas harmonizing the Liver and regulating Qi were ineffective. Years ago, pills made from opium residue stopped the pain. Opium can circulate the meridians of the lower body; this case clearly involves obstruction in the blood collaterals. Moreover, chronic pain penetrates into the collaterals, so acrid-warm herbs should be used to unblock it. If one merely uses Siqi Tang (Seven-Character Decoction) or Simo Yin (Four-Mortar Drink) to open only the Qi aspect, it is insufficient. Ancient sages stated that the main meridians govern Qi, while the collateral vessels govern Blood. Without distinguishing between meridians and collaterals, how can treatment be effective? Prescription: Danggui Xu (Radix Angelicae Sinensis Root Tip, stir-fried with wine), Yanhu Suo (Rhizoma Corydalis), Xiaohui (Fructus Foeniculi, baked with wine), Xinjiang (Safflower-infused silk), Taoren (Semen Persicae, crushed), Xuanfuhua (Flos Inulae, wrapped in silk and roasted). Effective after administration.
Patient Xue suffered from aversion to cold, fever, and cough. Several days later, pulling pain occurred in the lower abdomen, raising suspicion of Changyong (Intestinal Abscess). The pulse was floating and wiry, not deep and rapid at all. This indicated deficiency in the collaterals and aggregation of Qi, not Intestinal Abscess. Prescription: Xingren (Semen Armeniacae Amarum), Gualou (Fructus Trichosanthis), Huixiang (Fructus Foeniculi), Juhe (Pericarpium Citri Reticulatae), Danggui (Radix Angelicae Sinensis), Yanhusuo (Rhizoma Corydalis, all baked with wine), Mugua (Fructus Chaenomelis). Cured after two doses.
Patient Shen developed Jiaju (abdominal mass) in the lower abdomen due to winter cold. There was distending pain in the left hypochondrium attacking upwards to the chest and back, with obstruction of urination and defecation, severe bloating and stifling sensation nearly causing death, inability to swallow fluids, accompanied by aversion to cold and fever. The pulse was short and choppy. Stasis and obstruction should first be guided out, as the ancients said: "Pain indicates obstruction." Prescription: Zhike (Fructus Aurantii), Taoren (Semen Persicae, each 2 qian), Houpo (Cortex Magnoliae Officinalis, processed with ginger), Qingpi (Pericarpium Citri Reticulatae Viride, bran-fried, each 7 fen), Yanhusuo (Rhizoma Corydalis, stir-fried with wine), Guiwei (Radix Angelicae Sinensis Tail, moistened with wine, each 1.5 qian), Sugeng (Herba Perillae), Yuliren (Semen Pruni), Chenxiang (Lignum Aquilariae Resinatum, ground into juice, 3 fen). Pain subsided and bowel/bladder functions regulated after two doses, except for occasional dull pain in the left hypochondrium. From the original formula, remove Taoren, Guiwei, Sugeng, and Yanhusuo; add Yujin (Radix Curcumae Longae) and Xiangfu (Rhizoma Cyperi Rotundi); replace Chenxiang with Muxiang (Radix Aucklandiae), still grinding into juice for mixing. The decoction was then powdered and administered, leading to recovery.
The Classic states: "The back is the outer mansion of the organs in the chest. If the back is curved and shoulders collapse, the organ Qi is about to fail." It also states: "In Lung disease, there is wheezing, coughing, and reverse Qi flow, with shoulder and back pain and sweating." Furthermore: "If Lung Qi is excessive, shoulder and back pain occur; with wind-cold and sweating, stroke may ensue, frequent urination with scantiness, Qi deficiency leads to coldness in the shoulder and back, shortness of breath, and changes in urine color." Again: "When pathogenic factors are in the Kidney, shoulder and back pain result, which is due to rebellious Kidney Qi." Generally, the shoulder and back are traversed by the Taiyang Meridian and belong to the Lung's domain. Pathologies of the Taiyang Meridian and Feishu (BL13) certainly cause pain, as does rebellious Kidney Qi attacking upwards. Therefore, shoulder and back pain with inability to look back indicates stagnation of Hand-Taiyang Qi, best treated with wind-dispersing herbs. Fangfeng Tongqi San (Windproof Qi-Circulating Powder). Shoulder and back pain with spinal stiffness, waist feeling like breaking, neck feeling like pulling, indicates stagnation of Foot-Taiyang Qi. Qianghuo Shengshi Tang (Notopterygium Decoction for Overcoming Dampness). If the Lung is affected by wind-heat causing shoulder and back pain, use Qianghuo San (Notopterygium Powder). If Lung Qi is deficient causing cold in the shoulder and back, use Buzhong Yiqi Tang (Center-Supplementing Qi-Uplifting Decoction) plus Maidong (Radix Ophiopogonis) and Wuweizi (Fructus Schisandrae). If Kidney Qi rebels and attacks the back along the spine, it is a Du Mai (Governing Vessel) disorder, treated via Shaoyin. Use Chuanjiao (Pericarpium Zanthoxyli), Guizhi (Ramulus Cinnamomi), Fuling (Poria), Fuzi (Radix Aconiti Lateralis Preparata), Niuxi (Radix Achyranthis Bidentatae), Yuanzhi (Radix Polygalae), Chenxiang (Lignum Aquilariae Resinatum), Xiaohuixiang (Fructus Foeniculi). If Liver turbidity rebels and attacks the back from the abdomen, it is a Chong-Ren Mai (Penetrating and Conception Vessels) disorder, treated via Jueyin. Use Ganjiang (Rhizoma Zingiberis), Chuanjiao (Pericarpium Zanthoxyli), Guizhi (Ramulus Cinnamomi), Wumei (Fructus Mume), Chuanlian Rou (Endocarpium Toosendan), Baishao (Radix Paeoniae Alba), Xixin (Herba Asari), Chuanlourou (Endocarpium Toosendan). For dampness injuring the shoulder and back causing heavy pain, use Danggui Niantong Tang (Angelica Decoction for Relieving Pain). For cold-fluid retention causing cold pain in the shoulder and back, use Baizhu Fuzi Tang (Atractylodes and Prepared Aconite Decoction). For pre-existing phlegm-fluid flowing into the shoulder, back, and arms causing pain, use Daotan Tang (Phlegm-Guiding Decoction). For Qi stagnation, use Wuyao Shunqi San (Tso-Wu Spice Powder for Smoothing Qi). For Blood deficiency, use Siwu Tang (Four Substances Decoction) plus Qinjiao (Radix Gentianae Macrophyllae) and Jianghuang (Rhizoma Curcumae Longae). For Ying (Nutritive) deficiency with collateral malnourishment and wind stirring causing tendon tension, use Shujin Tang (Tendon-Relaxing Decoction). When Yangming Meridian Qi declines, scapular tendons become lax, unable to lift, causing pain; regulate and tonify collaterals using Sheng Huangqi (Radix Astragali), Baizhu (Rhizoma Atractylodis Macrocephalae), Danggui (Radix Angelicae Sinensis), Fangfeng Gen (Radix Saposhnikoviae), Jianghuang (Rhizoma Curcumae Longae), Sangzhi (Ramulus Mori), Gouqi (Fructus Lycii), Juluo (Medulla Tetrapanacis). For Du Mai deficiency with painful high protrusion of the spine, use Lujiaoshuang (Cornu Cervi Pantotrichum Preparatum), Gouqi (Fructus Lycii), Guishen (Radix Angelicae Sinensis Head), Duzhong (Cortex Eucommiae), Fuling (Poria), Shayuanzi (Semen Astragali Complanati). For back pain due to labor or prolonged sitting, use Buzhong Yiqi Tang (Center-Supplementing Qi-Uplifting Decoction) or Bazhen Tang (Eight Treasures Decoction) plus Huangqi (Radix Astragali). For general back pain, Jianghuang San (Curcuma Powder) is commonly used, preferably added with Fangfeng (Radix Saposhnikoviae) and Qianghuo (Rhizoma Notopterygii) as guiding herbs. For obese individuals whose pain decreases with pounding, it belongs to Phlegm; resolve dampness, transport phlegm, and supplement Spleen Qi using Liujunzi Tang (Six Gentlemen Decoction) plus Muxiang (Radix Aucklandiae). For thin individuals, often due to weak Ying and declining Wei, regulate Qi and nourish Blood using Shengyu Tang (Sage Renewal Decoction) plus Guizhi (Ramulus Cinnamomi) and Baishao (Radix Paeoniae Alba). The arms are the intersection of the six Hand Meridians. Pain may result from wind-cold-damp binding, fluid accumulation, or lifting heavy objects. For wind-damp, use Chushi Juanbi Tang (Dampness-Removing Bi-Relieving Decoction) plus Jianghuang (Rhizoma Curcumae Longae), Danggui (Radix Angelicae Sinensis), Guizhi (Ramulus Cinnamomi). For wind-heat, use Qinjiadihuang Tang (Gentian Rehmannia Decoction). For cold-damp, modify Wuji San (Five Accumulations Powder). For damp-bi in collaterals, use Juanbi Tang (Bi-Relieving Decoction). For joint pain with inability to raise arms, use Shujin Tang (Tendon-Relaxing Decoction) plus Yousongjie (Node Pinus Massoniana) and Weilingxian (Herba Clematidis). For bone pain, tendon spasm, and stagnant blood, use Toujing Jielluan Tang (Meridian-Penetrating Spasm-Relieving Decoction). For phlegm-fluid flowing into limbs causing sore, soft, bi-sensation in shoulder/back/arms, use Daotan Tang (Phlegm-Guiding Decoction) plus Ginger, Chao Baizhu (Rhizoma Atractylodis Macrocephalae, stir-fried), Jianghuang (Rhizoma Curcumae Longae), Muxiang (Radix Aucklandiae). For phlegm-fluid retention in Zhongwan (CV12) with Spleen failure to transport, trembling arms unable to lift, and deep-thin pulse, use Zhimi Fuling Wan (Mysteries-Revealing Poria Pill). For trauma-induced tendon injury and arm pain, harmonize Qi and regulate Blood using Shiquan Dabu Tang (Ten Great Tonifying Decoction). For Blood failing to nourish tendons, use Siwu Qinjiao Tang (Four Substances and Gentian Decoction) plus Yuzhu (Rhizoma Polygonati Odorati). For hands unable to flex but able to extend, pathology is in tendons; use Yiyiren Tang (Coix Seed Decoction). For hands unable to extend but able to flex, pathology is in bones; use Baizhu Fuzi Tang (Atractylodes and Prepared Aconite Decoction). For hand swelling/pain extending to arms, use Juanbi Tang (Bi-Relieving Decoction) plus Sangzhi (Ramulus Mori). Thin Cinnamon Twig (Bo Gui) travels horizontally through arms. Pianzi Jianghuang (Slice-shaped Curcuma Rhizome) guides to arms. You Songjie (Pinus Node) penetrates joints. Danxi treated arm pain with Erchen Tang (Two Aged Herbs Decoction) plus Jiu Chao Huangqin (Scutellaria Root, wine-stir-fried), Cangzhu (Rhizoma Atractylodis Lanceae), Qianghuo (Rhizoma Notopterygii), treating wind-phlegm, heat, and dampness simultaneously.