经云∶东风生于春，病在肝， 在颈项。诸痉项强，皆属于湿。缺盆之中，任脉也，名曰天突。
（当缺盆中央动脉是。）一次任脉侧之动脉，足阳明也，名曰人迎。（挟喉两旁动脉。）二次脉，手
阳明也，名曰扶突。（挟喉动脉之后，曲颊之前一寸后是。）三次脉，手太阳也，名曰天 。（手阳
明之后，当曲颊之下。）四次脉，足少阳也，名曰天容。（曲颊之后，当耳之下。）五次脉，手少阳
也，名曰天牖。（耳后当完骨上。）六次脉，足太阳也，名曰天柱。（挟项大筋中。）七次脉，颈中
央之脉，督脉也，名曰风府。足阳明，挟喉之动脉也，其 在膺中。手阳明次在其 外，不至曲颊一
寸。太阳当曲颊。足少阳在耳下曲颊之后。手少阳出耳后上，加完骨之上。足太阳挟项大筋之中。然
则颈项强急之证，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。颈项强急，发热恶寒，脉浮而紧，此风寒客三
阳经也。宜驱邪汤。颈项强急，动则微痛，脉弦而数实、右为甚，作痰热客三阳经治，宜消风豁痰汤。
颈项强急，动则微痛，脉弦而涩，左为甚，作血虚邪客太阳、阳明经治，宜疏风滋血汤。颈项强急，
寒热往来，或呕吐，或胁痛，宜小柴胡汤、升麻防荆汤。颈项强急，腰似折，项似拔，加味胜湿汤。
精神短少，不得睡，项筋肿急难伸，禁甘温，宜苦寒，养神汤主之。《本事方》椒附散，治肾气上攻，
项背不能转侧，于虚寒者为宜。丹溪治一男子。项强不能回顾，动则微痛，其脉弦而数实，右手为甚，
作痰客太阳经治之，用二陈汤加酒洗黄芩、羌活、红花，服后二日愈。许学士治一人患筋急项不得转
侧，自午后发至黄昏时定，此患必从足起。经言十二经络各有筋，惟足太阳之筋，自足至项。大抵筋
者，肝之合也。日中至黄昏，天之阳，阳中之阴也。又曰∶阳中之阴，肺也。自离至兑，阴旺阳弱之
时，故《灵宝毕法》云∶离至干，肾气绝而肝气弱，肝肾二脏受阴气，故发于是时。授以木瓜煎方，
三服而愈。戴云∶颈痛，非是风邪，即是气挫，亦有落枕而成痛者，并宜和气饮，食后服。按人多有
挫闪，及久坐失枕，而致项强不可转移者，皆由肾
虚不能生肝，肝虚无以养筋，故机关不利，宜六味地黄丸常服。《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
痛不可俯仰，刺足太阳。不可以顾，刺手太阳。又云∶大风项颈痛，刺风府。风府在上椎。又云∶邪
客于足太阳之络，令人头项肩痛，刺足小指爪甲上与肉交者各一 ，立已。不已则刺外踝下三 ，左
取右，右取左，如食顷是也。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、陷下取之也。
《黄帝内经》说：东风生于春季，病变在肝，症状表现在颈项。各种痉挛、项部强直的症状，都归属于湿邪。缺盆中央的经脉是任脉，名为天突穴。（位于缺盆中央的动脉处。）第一次提到的任脉侧旁的动脉，是足阳明胃经，名为人迎穴。（位于喉结两旁动脉处。）第二次提到的脉，是手阳明大肠经，名为扶突穴。（位于喉结动脉之后，下颌角前一寸处。）第三次提到的脉，是手太阳小肠经，名为天窗穴。（位于手阳明大肠经之后，下颌角下方。）第四次提到的脉，是足少阳胆经，名为天容穴。（位于下颌角之后，耳垂下方。）第五次提到的脉，是手少阳三焦经，名为天牖穴。（位于耳后完骨穴上方。）第六次提到的脉，是足太阳膀胱经，名为天柱穴。（位于项部大筋中间。）第七次提到的脉，是颈部正中的经脉，督脉，名为风府穴。足阳明胃经，是挟持喉部的动脉，其循行在胸膺中。手阳明大肠经其次在其外侧，不到达下颌角前一寸。足太阳膀胱经正当下颌角处。足少阳胆经在耳下、下颌角之后。手少阳三焦经出于耳后向上，加于完骨穴之上。足太阳膀胱经挟持项部大筋之中。既然这样，那么颈项强急的病证，多由邪气客居于三阳经所致。寒邪搏结则筋脉拘急，风邪搏结则筋脉弛缓，左侧病重多属血分问题，右侧病重多属痰饮问题。
颈项强急，伴有发热恶寒，脉象浮而紧，这是风寒邪气客居三阳经的表现。宜用驱邪汤。颈项强急，活动时轻微疼痛，脉象弦而数实，右侧更为明显，按痰热客居三阳经治疗，宜用消风豁痰汤。颈项强急，活动时轻微疼痛，脉象弦而涩，左侧更为明显，按血虚兼邪气客居太阳、阳明经治疗，宜用疏风滋血汤。颈项强急，伴有寒热往来，或呕吐，或胁痛，宜用小柴胡汤、升麻防己荆芥汤（注：原文为“升麻防荆汤”，通常指含升麻、防风、荆芥等药的方剂，此处保留原名）。颈项强急，腰部像要折断，项部像被拔起，宜用加味胜湿汤。精神短少，无法入睡，项部筋脉肿胀强急难以伸展，禁止使用甘温药物，宜用苦寒药物，以养神汤为主治。《济生方》中的椒附散，治疗肾气上攻导致的项背不能转侧，对于虚寒体质者适宜。丹溪治疗一名男子，项强不能回头回顾，活动时轻微疼痛，脉象弦而数实，右手脉更甚，按痰邪客居太阳经治疗，使用二陈汤加酒洗黄芩、羌活、红花，服药两天后痊愈。许学士治疗一人患筋急项强不能转侧，从午后发病至黄昏时缓解，这种病必定从足部发起。经文说十二经络各有筋，只有足太阳之筋，从足部直达项部。大抵筋与肝相合。中午到黄昏，是天的阳气，也是阳中之阴。又说：阳中之阴，对应肺脏。从午时（离）到酉时（兑），是阴气旺盛阳气衰弱的时候，所以《灵宝毕法》说：从离卦到干卦，肾气绝而肝气弱，肝肾两脏受阴气影响，所以在此时发作。授予木瓜煎方，服用三次后痊愈。戴云说：颈痛，不是风邪，就是气机挫伤，也有因落枕而成痛的，都宜用和气饮，饭后服用。按：人们多有挫闪，以及久坐失枕，导致项强不可转移的情况，这都是由于肾虚不能生肝，肝虚无以养筋，所以关节机关不利，宜常服六味地黄丸。《黄帝内经》关于刺灸治疗项颈痛有两种情况：其一取手足太阳经，治疗项后痛。经文说：足太阳经脉，发生变动就会病项如拔，视其虚、盛、寒、热、陷下的情况选取穴位。又说：项痛不可俯仰，刺足太阳经。不可以回顾，刺手太阳经。又说：大风引起的项颈痛，刺风府穴。风府穴在上椎骨间。又说：邪气客居足太阳之络，使人头项肩痛，刺足小趾爪甲上与肉交界处各一穴，立即见效。不见效则刺外踝下三穴，左病取右，右病取左，大约一顿饭的时间即可。其二取足、手阳明经，治疗颈前痛。经文说：足阳明经脉，所生的疾病有颈肿。又说：手阳明经脉，发生变动就会病颈肿。都是视其盛、虚、寒、热、陷下的情况选取穴位。
The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: East wind arises in spring, the disease affects the Liver (*Gan*), and the symptoms manifest in the neck and nape. Various spasms and stiffness of the neck all belong to Dampness (*Shi*). The Ren Mai (Conception Vessel) at the center of the Quepen (Supraclavicular Fossa) is named Tiantu (CV22). (Located at the arterial pulse in the center of the supraclavicular fossa.) The first artery mentioned on the side of the Ren Mai is the Foot-Yangming Stomach Channel, named Yingjing (ST9). (Located at the arterial pulse on both sides of the larynx.) The second pulse mentioned is the Hand-Yangming Large Intestine Channel, named Futu (LI18). (Located behind the arterial pulse of the larynx, one cun anterior to the angle of the mandible.) The third pulse mentioned is the Hand-Taiyang Small Intestine Channel, named Tianchuang (SI16). (Behind the Hand-Yangming channel, below the angle of the mandible.) The fourth pulse mentioned is the Foot-Shaoyang Gallbladder Channel, named Tianrong (SI17). (Behind the angle of the mandible, below the ear.) The fifth pulse mentioned is the Hand-Shaoyang Sanjiao Channel, named Tianyou (TE16). (Above the Wanggu bone behind the ear.) The sixth pulse mentioned is the Foot-Taiyang Bladder Channel, named Tianzhu (BL10). (In the middle of the large tendons of the nape.) The seventh pulse mentioned is the central vessel of the neck, the Du Mai (Governor Vessel), named Fengfu (GV16). The Foot-Yangming Stomach Channel is the arterial pulse flanking the throat, its course is in the chest and epigastrium. The Hand-Yangming Large Intestine Channel lies next outside it, not reaching one cun before the angle of the mandible. The Foot-Taiyang Bladder Channel corresponds to the angle of the mandible. The Foot-Shaoyang Gallbladder Channel is behind the ear and below the angle of the mandible. The Hand-Shaoyang Sanjiao Channel emerges from behind the ear and goes upward, adding above the Wanggu bone. The Foot-Taiyang Bladder Channel runs between the large tendons of the nape. Therefore, syndromes of neck and nape stiffness and urgency are mostly caused by pathogenic factors lodging in the Three Yang Channels. Cold binding causes tendon contraction; Wind binding causes tendon relaxation. Left-sided predominance often relates to Blood issues; right-sided predominance often relates to Phlegm.
Neck and nape stiffness with fever and aversion to cold, floating and tight pulse, indicates Wind-Cold lodging in the Three Yang Channels. Quxie Decoction (*Quxie Tang*) is indicated. Neck and nape stiffness with slight pain upon movement, wiry, rapid, full, and solid pulse, more pronounced on the right, should be treated as Phlegm-Heat lodging in the Three Yang Channels. Xiaofeng Huotan Decoction (*Xiaofeng Huotan Tang*) is indicated. Neck and nape stiffness with slight pain upon movement, wiry and choppy pulse, more pronounced on the left, should be treated as Blood Deficiency with pathogenic factors lodging in the Taiyang and Yangming Channels. Shufeng Zixue Decoction (*Shufeng Zixue Tang*) is indicated. Neck and nape stiffness with alternating chills and fever, or vomiting, or hypochondriac pain, Xiao Chaihu Decoction (*Xiaochaihu Tang*) and Shengma Fangjing Decoction (*Shengma Fangjing Tang*) are indicated. Neck and nape stiffness, waist feeling like breaking, neck feeling like being pulled, Jiawei Shengshi Decoction (*Jiawei Shengshi Tang*) is indicated. Shortage of spirit, inability to sleep, swelling and stiffness of neck tendons making extension difficult: avoid sweet-warm substances; use bitter-cold substances. Yangshen Decoction (*Yangshen Tang*) is the primary treatment. Jiaofu Powder (*Jiaofu San*) from *Ben Shi Fang* treats kidney Qi attacking upward, causing inability to turn the head and back, suitable for deficiency-cold patterns. Danxi treated a male patient with neck stiffness unable to look back, slight pain upon movement, wiry, rapid, full, and solid pulse, more pronounced on the right hand. He was treated as Phlegm lodging in the Taiyang Channel using Erchen Decoction (*Erchen Tang*) plus wine-washed Huangqin (*Scutellariae Radix*), Qianghuo (*Notopterygii Rhizoma et Radix*), and Honghua (*Carthami Flos*), cured after two days. Scholar Xu treated a person suffering from tendon stiffness and neck inability to turn, starting in the afternoon and resolving at dusk. This illness must originate from the feet. The classics state that each of the twelve channels has associated tendons; only the Foot-Taiyang tendon extends from the foot to the neck. Generally, tendons correspond to the Liver. From noon to dusk is Heaven's Yang, specifically Yin within Yang. It is also said: Yin within Yang corresponds to the Lung. From Li (Wu hour/noon) to Dui (You hour/evening) is the time when Yin flourishes and Yang weakens. Thus, *Lingbao Bifa* states: From Li to Qian, Kidney Qi is exhausted and Liver Qi is weak; the Liver and Kidney organs receive Yin Qi, hence the onset occurs at this time. Mu Gua Jian Decoction (*Mu Gua Jian Fang*) was prescribed, cured after three doses. Dai Yun stated: Neck pain is either due to Wind pathogen or Qi injury; there are also cases of pain resulting from sleeping awkwardly (Luozhen). All these should be treated with Heqi Yin (*Heqi Yin*), taken after meals. Note: Many people suffer from sprains or sleeping awkwardly for long periods, leading to stiff necks that cannot move. These are all due to Kidney Deficiency failing to generate Liver, and Liver Deficiency failing to nourish tendons, thus causing joint dysfunction. Liuwei Dihuang Wan (*Liuwei Dihuang Wan*) should be taken regularly.
The *Neijing* describes two acupuncture/moxibustion approaches for neck and nape pain: First, select the Hand and Foot Taiyang channels to treat posterior neck pain. The classics state: When the Foot-Taiyang channel moves abnormally, it causes disease where the neck feels like being pulled; select points based on excess, deficiency, cold, heat, or sinking conditions. It also states: For neck pain with inability to bend or extend, puncture the Foot-Taiyang channel. For inability to look back, puncture the Hand-Taiyang channel. It also states: For severe Wind causing neck and nape pain, puncture Fengfu (GV16). Fengfu is located in the upper vertebrae. It also states: When pathogenic factors lodge in the collaterals of the Foot-Taiyang channel, causing head, neck, and shoulder pain, puncture the point at the junction of the nail and flesh on the little toe, one on each side, for immediate effect. If ineffective, puncture three points below the lateral malleolus, treating the left side for right-side symptoms and vice versa, within the time it takes to eat a meal. Second, select the Foot and Hand Yangming channels to treat anterior neck pain. The classics state: Diseases generated by the Foot-Yangming channel include neck swelling. It also states: When the Hand-Yangming channel moves abnormally, it causes disease with neck swelling. In both cases, select points based on excess, deficiency, cold, heat, or sinking conditions.