《内经》刺灸脊痛脊强有三法∶其一取督脉。经云∶督脉之别，名曰长强，别走太阳。实则脊强，
取之所别也。其二取足太阳。经曰∶厥挟脊而痛至顶，头沉
沉然，目KT KT 然，腰脊强，取足太阳 中血络是也。其三取小肠。经云∶小腹控睾，引腰脊，上
冲心，邪在小肠，取之肓原以散之，刺太阴以予之，取厥阴以下之，取巨虚下廉以去之
是也。脊痛项强，腰似折，项似拔，冲头痛，乃足太阳经不行也。羌活胜湿汤主之。打扑伤损，从高
坠下，恶血在太阳经中，腰脊痛不可忍，地龙汤主之。
肩背分野属肺。经云∶西风生于秋，病在肺， 在肩背，故秋气者病在肩背。又云∶肺病者喘咳
逆气，肩背痛汗出。又云∶秋肺太过为病，在外则令人逆气，背痛愠愠然。又云∶肺手太阴之脉，气
盛有余则肩背痛，风寒汗出；气虚则肩背痛寒，少气不足以息。此肺金自病也。经云∶岁火太过，民
病肩背热。又云∶少阴司天，热淫所胜，病肩背 缺盆中痛，此肺金受火邪而病也。经云∶邪在肾，
则病肩背颈项痛，取之涌泉、昆仑，视有血者尽取之。是肾气逆上而痛也。东垣云∶肩背痛不
可回顾，此手太阳气郁而不行，以风药散之。《脉经》云∶风寒汗出肩背痛中风，小便数而欠者，风
热乘其肺，使肺气郁甚也。当泻风热以通气，防风汤主之。按风寒汗出而肩背痛，小便数者，既以泻
风热之药，通肺气之壅，则寒热气不足以息而肩背痛，小便遗失者，当以人参、黄 之属，补肺气之
虚，不言可知也。湿热相搏，肩背沉重而疼者，当归拈痛汤。当肩背一片冷痛，背膂疼痛，古方用神
保丸愈者，此有积气故也。其人素有痰饮，流注肩背作痛，宜星香散，或导痰汤下五套丸。有肾气不
循故道，气逆挟脊而上，致肩背作痛，宜和气饮加盐炒小茴香半钱，炒川椒十粒。或看书对奕久坐而
致脊背疼者，补中益气汤，或八物汤加黄 。有素虚人及病后心膈间痛，或牵引乳胁，或走注肩背，
此乃元气上逆，当引使归元，不可复下疏刷之剂，愈刷愈痛，发汗人患此者众，惟宜温补。拘于气无
补法之说误矣。汗者心之液，阳受气于胸中，汗过多则心液耗，阳气不足，故致疼也。丹溪治一男子
忽患背胛缝有一线疼起，上跨肩至胸前侧胁而止，其痛昼夜不息，不可忍。其脉弦而数，重取豁大，
左大于右。夫胛、小肠经也，胸胁、胆经也。此必思虑伤心，心脏未病而腑先病，故痛从背胛起，及
虑不能决，又归之胆，故痛至胸胁而止。乃小肠
火乘胆木，子来乘母，是为实邪。询之果因谋事不遂而病。以人参四钱，木通二钱，煎汤下龙荟丸，
数服而愈。
【诊】脉洪大，洪为热，大为风。脉促上击者，肩背痛。脉沉而滑者，背膂痛。
《黄帝内经》中关于针刺和艾灸治疗脊痛、脊强有三种方法：第一种是取督脉。经文说：督脉的别络，名叫长强，别行走向太阳经。如果实证出现脊背强直，就取它的别络来治疗。第二种是取足太阳膀胱经。经文说：厥阴之气夹着脊柱向上疼痛直到头顶，头部沉重昏沉，眼睛视物模糊不清，腰脊强直，这是取足太阳经的血络（瘀血之处）进行治疗。第三种是取小肠经。经文说：小腹部牵引睾丸，牵连腰脊，气上冲心胸，邪气在小肠，要取肓原穴以消散邪气，针刺手太阴肺经以给予正气，取足厥阴肝经以降逆气，取巨虚下廉穴以祛除病邪，这就是治疗方法。脊痛项强，腰部像要折断一样，颈部像被拔起一样，冲击性头痛，这是足太阳膀胱经气血运行不畅所致。用羌活胜湿汤主治。跌打损伤，从高处坠落，恶血停滞在足太阳经中，导致腰脊疼痛难以忍受，用地龙汤主治。
肩背部所属的区域对应肺脏。经文说：西风生于秋季，病变在肺，表现在肩背，所以秋季的疾病多在肩背。又说：肺病患者会出现气喘咳嗽、气逆、肩背痛、出汗。又说：秋季肺气太过致病，在体表则使人气逆，背部隐隐作痛。又说：手太阴肺经的气盛有余，则出现肩背痛、风寒汗出；气虚则出现肩背痛怕冷、气短不足以呼吸。这是肺金自身的病变。经文说：岁火太过之年，百姓易患肩背发热之病。又说：少阴君天主管岁时，热气过盛，病症表现为肩背及缺盆中疼痛，这是肺金受到火邪侵害而发病。经文说：邪气在肾，则导致肩背颈项疼痛，取涌泉穴、昆仑穴，观察是否有瘀血，若有则全部刺破放血。这是肾气上逆导致的疼痛。李东垣说：肩背痛不能回头，这是手太阳小肠经气机郁滞而不运行，用风药发散治疗。《脉经》说：风寒导致汗出、肩背痛且中风，小便频数且频繁欠伸，这是风热侵袭肺部，使肺气郁滞严重。应当泻除风热以通畅气机，用防风汤主治。按照风寒汗出而肩背痛、小便频数的情况，既然用泻风热的药物通利肺气的壅滞，那么对于寒热交替、气短不足以呼吸以及肩背痛、小便失禁的情况，应当用人参、黄芪之类的药物，补益肺气的虚弱，这不言自明。湿热相互搏结，导致肩背沉重而疼痛的，用当归拈痛汤。当肩背一片冷痛，背部脊柱疼痛，古方使用神保丸治愈的，这是因为有积滞之气。那人平时素有痰饮，流注到肩背引起疼痛，宜用星香散，或者用导痰汤送服五套丸。有肾气不循常道，气逆挟带脊柱而上，导致肩背疼痛的，宜用和气饮加盐炒小茴香半钱，炒川椒十粒。或者是看书、下棋久坐而导致的脊背疼痛，用补中益气汤，或者八物汤加黄芪。有素体虚弱的人及病后心膈间疼痛，或者牵引乳房胁肋，或者游走至肩背，这是元气上逆，应当引导使其回归本源，不可再用下法疏刷的药物，越疏刷疼痛越厉害，出汗多的人患此病较多，只适宜温补。拘泥于“气病无补法”的说法是错误的。汗是心之液，阳气受气于胸中，出汗过多则心液耗损，阳气不足，所以导致疼痛。朱丹溪治疗一名男子忽然患背胛缝有一线疼痛，向上跨过肩膀到胸前侧胁为止，疼痛昼夜不停，难以忍受。其脉弦而数，重按豁大，左脉大于右脉。夫胛部属小肠经，胸胁属胆经。这必定是因思虑伤心，心脏尚未发病而腑先发病，所以疼痛从背胛开始，等到思虑不能决断时，又归咎于胆，所以疼痛止于胸胁。这是小肠火乘袭胆木，子来乘母，属于实邪。询问得知果然因谋划事情不顺遂而生病。用人参四钱，木通二钱，煎汤送服龙荟丸，服用几剂后痊愈。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) describes three methods for acupuncture and moxibustion treatment of spinal pain and stiffness: The first method involves selecting the Du Meridian (Governing Vessel). The classic states: "The collateral branch of the Du Meridian is named Changqiang (DU-1), which diverges to run to the Taiyang Meridian. In excess conditions presenting with spinal stiffness, treat its divergent point." The second method involves selecting the Foot-Taiyang Bladder Meridian. The classic states: "Jueyin qi causes pain along the spine extending to the vertex, accompanied by a heavy and dull head, blurred vision, and stiff waist and spine; this is treated by selecting the blood collaterals of the Foot-Taiyang Meridian." The third method involves selecting the Small Intestine Meridian. The classic states: "Lower abdominal pain radiating to the testicles, pulling into the waist and spine, with qi rushing up to the heart; if the pathogen is in the Small Intestine, treat the Hanyuan area to dissipate it, needle the Hand-Taiyin Lung Meridian to support it, select the Foot-Jueyin Liver Meridian to descend it, and select Julixia (ST-39) to eliminate it." Spinal pain with neck stiffness, waist feeling as if broken, neck feeling as if pulled, and throbbing headache indicate dysfunction of the Foot-Taiyang Meridian. It is primarily treated with Qianghuo Shengshi Tang (Notopterygium Decoction to Overcome Dampness). For traumatic injuries or falls from height, where evil blood stagnates in the Foot-Taiyang Meridian causing unbearable lower back and spinal pain, Dilong Tang (Earthworm Decoction) is indicated.
The shoulder and back region corresponds to the Lung organ. The classic states: "West wind arises in autumn, disease affects the Lung, manifesting in the shoulders and back; thus, autumn diseases often affect the shoulders and back." It further states: "Lung disease presents with wheezing, coughing, reverse qi, shoulder and back pain, and sweating." Also: "Excessive Lung Qi in autumn causes disease; externally it leads to reverse qi and aching back pain." Additionally: "When the Hand-Taiyin Lung Meridian has excess qi, it causes shoulder and back pain with cold wind and sweating; when deficient, it causes shoulder and back pain with cold sensation, shortness of breath, and inability to take a full breath." This represents self-disease of Metal-Lung. The classic states: "In years of excessive Fire, people suffer from hot shoulder and back." Also: "When Shaoyin governs the year and heat dominates excessively, symptoms include pain in the shoulders, back, and supraclavicular fossa; this is Lung Metal suffering from Fire pathogen." The classic states: "If pathogen is in the Kidney, it causes pain in the shoulders, back, neck, and nape; select Yongquan (KI-1) and Kunlun (BL-60), and if blood stasis is visible, drain all of it." This is pain caused by rebellious Kidney Qi. Li Dongyuan stated: "Shoulder and back pain preventing turning the head is due to stagnation and non-circulation of Hand-Taiyang Qi; disperse it with Wind-dispelling herbs." The *Maijing* (Pulse Classic) states: "Wind-cold causing sweating, shoulder and back pain, stroke, frequent urination, and yawning indicates wind-heat attacking the Lung, causing severe Lung Qi stagnation. One should drain wind-heat to unblock Qi, primarily using Fangfeng Tang (Saposhnikovia Decoction)." Regarding cases of wind-cold with sweating, shoulder/back pain, and frequent urination, since wind-heat draining herbs are used to unblock Lung Qi obstruction, for cases involving alternating chills and fever, shortness of breath, shoulder/back pain, and urinary incontinence, one should use herbs like Renshen (Ginseng Root) and Huangqi (Astragalus Root) to tonify Lung Qi deficiency, which is self-evident. When damp-heat clump together causing heavy and painful shoulders and back, Danggui Niangong Tang (Angelica Ligustolactone Pain-Relieving Decoction) is used. For widespread cold pain in the shoulder and back, and pain in the back muscles, ancient formulas used Shenbao Wan (Divine Treasure Pill) for cure, indicating the presence of stagnant Qi. If a person has chronic phlegm-fluid retention flowing into the shoulders and back causing pain, Xingxiang San (Star and Fragrance Powder) or Daotan Tang (Phlegm-Resolving Decoction) administered with Wutao Wan (Five-Sleeve Pill) is appropriate. If Kidney Qi does not follow its normal pathway, but rebels upward along the spine causing shoulder and back pain, Heqi Yin (Harmonizing Qi Infusion) added with salt-fried Huixiang (Fennel Fruit) and stir-fried Chuanjiao (Sichuan Pepper) is suitable. For back pain caused by prolonged sitting while reading or playing chess, Buzhong Yiqi Tang (Middle-Warmer Boosting Qi-Tonifying Decoction) or Bawu Tang (Eight-Ingredient Decoction) added with Huangqi is indicated. For constitutionally weak individuals or those post-illness experiencing pain between the heart and diaphragm, radiating to the breasts and hypochondrium, or wandering to the shoulders and back, this is rebellious Yuan Qi (Primal Qi); it should be guided back to its root. Do not use purgative or dispersing agents, as they will increase pain. This condition is common among those who sweat excessively; only warm-tonification is suitable. Adhering strictly to the theory that "Qi disorders do not require tonification" is erroneous. Sweat is the fluid of the Heart; Yang Qi receives Qi in the chest. Excessive sweating depletes Heart fluids and weakens Yang Qi, leading to pain. Zhu Danxi treated a man who suddenly developed a linear pain starting from the scapular seam, crossing over the shoulder to the lateral chest, lasting day and night without relief, unbearable. His pulse was wiry and rapid, large upon heavy pressure, with the left pulse larger than the right. The scapula belongs to the Small Intestine Meridian; the chest and hypochondrium belong to the Gallbladder Meridian. This must be due to mental worry injuring the Heart; although the Heart itself was not diseased, its Fu-organ was affected first, so pain started at the scapula. When worry led to indecision, it shifted to the Gallbladder, so pain stopped at the chest/hypochondrium. This is Small Intestine Fire assaulting Gallbladder Wood, with the child assaulting the mother, constituting an Excess pathogen. Inquiry revealed the illness stemmed from unsuccessful planning. He prescribed Renshen (4 qian) and Mutong (2 qian) decocted in water, taken with Longhui Wan (Dragon Ash Pill). After several doses, he recovered.
[Diagnosis] A Hongda (Surging and Large) pulse indicates Heat (Hong) and Wind (Da). A Cu (Rapid/Interrupted) pulse striking upwards indicates shoulder and back pain. A Chen (Deep) and Hua (Slippery) pulse indicates pain in the back muscles.