徐 迩日天令骤冷。诊左脉忽现芤涩。痛时筋挛。绕掣耳后。此营虚脉络失养。风动筋急。前法
清络。凉剂不应。营虚不受辛寒。仿东垣舒筋汤意。（痛绕耳后）
当归 生黄 片姜黄 桂枝 防风 生于术 煎药化活络丹一丸。
某 劳倦。肩臂疼。（肩臂痛）
川桂枝木 木防己 五加皮 茯苓 生苡仁 炒白蒺
涂（六二） 痛起肩胛。渐入环跳髀膝。是为络虚。
黄 （五钱） 于术（三钱） 当归（三钱） 茯苓（二钱） 防己（八分） 防风根（五分）
羌活（五分）
又 照前方去防风羌活加杞子沙苑。
邹 五旬又四。阳明脉衰。肩胛筋缓。不举而痛。治当通补脉络。莫进攻风。
生黄 于术 当归 防风根 姜黄 桑枝
王（四二） 阳明气衰。厥阴风动头眩目昏。右肩痛麻。胁下有聚气。足厥阴主治。
枸杞子（四两） 归身（三两） 羚羊角（生研二两） 制白蒺（去刺三两） 嫩黄 皮（四两）
胡天麻（二两煨）
菊花二两熬汁桑枝四两熬汁丸。
徐（五二） 左指胀痛引肩。男子血虚风动。病在肝。形脉不足。以柔药温养。
制首乌 枸杞子 归身 三角胡麻 菊花炭 柏子仁 刺蒺藜 桑枝膏丸。
俞（妪） 高年阳明气乏。肩胛痛难屈伸。法当理卫阳通补。
黄 桂枝 归身 片姜黄 海桐皮 夏枯草
孙（二四） 肾气攻背项强。溺频且多。督脉不摄。腰重头疼。难以转侧。先与通阳。宗许学士法。（背痛）
川椒（炒出汗三分） 川桂枝（一钱） 川附子（一钱） 茯苓（一钱半） 生白术（一钱）
生远志（一钱）
凡冲气攻痛。从背而上者。系督脉主病。治在少阴。从腹而上者。治在厥阴。系冲任主病。或
填补阳明。此治病之宗旨也。
汪（十二） 肝浊逆攻。痛至背。
淡干姜（八分） 炒黑川椒（三分） 炒焦乌梅肉（五分） 小川连（三分） 川桂枝木（五分）
北细辛（二分） 黄柏（五分） 川楝子肉（一钱） 生白芍（二钱）
陈（氏） 内经论诸痛皆寒。时当冬腊。口鼻吸受寒冷。阻气隧之流行。痛自胸引及背。甚则手足厥
冷。只宜两通气血主治。
川楝子 延胡 生香附 橘红 吴萸 乌药 红花
沈（氏） 脉芤汗出失血。背痛。此为络虚。
人参 炒归身 枣仁 炒白芍 炙草 茯神
庄（三四） 督虚背疼。脊高突。
生毛鹿角（切片三钱） 鹿角霜（一钱半） 杞子（三钱） 归身（一钱） 生杜仲（一钱半）
沙苑（一钱） 茯苓（一钱半） 青盐（调入三分）
张（三八） 督虚背痛。遗泄。
生毛鹿角 鹿角霜 生菟丝子 生杜仲 沙苑子 白龙骨
茯苓 当归
肺朝百脉。肺病则不能管摄一身。故肺俞为病。即肩背作痛。又背为阳明之府。阳明有
亏。不能束筋骨。利机关。即肩垂背曲。至于臂。经络交会不一。而阳明为十二经络之长。臂
痛亦当责之阳明。但痛有内外两因。虚实迥。异治分气血二致。通补攸殊。如营虚脉络失
养。风动筋急者。不受辛寒。当仿东垣舒筋汤之意。佐以活络丹。劳倦伤阳。脉络凝塞。肩臂
作痛者。以辛甘为君。佐以循经入络之品。阳明气衰。厥阴风动。右肩痛麻者。用枸杞归身
黄羚羊桑枝膏。为阳明厥阴营气两虚主治。血虚风动者。因阳明络虚。受肝脏风阳之
扰。用首乌枸杞归身胡麻柏子仁刺蒺藜药等味。以柔甘为温养。失血背痛者。其虚亦在阳
明之络。用人参归身枣仁白芍炙草茯神。以填补阳明。若肾气上逆。则督虚为主病。宜用
奇经之药以峻补真阳。至于口鼻吸受寒冷。阻郁气隧。痛自胸引及背者。宗内经诸痛
皆寒之义。以温药两通气血。更有古法。如防风汤散肺俞之风。指迷丸治痰流臂痛。控涎
丹治流痹牵引。此皆从实症而治。所谓通则不痛也。医者不拘守一法。洞悉病源。运巧思
以制方。而技于是进。（龚商年）
徐评 痛定于肩背。此着痹之类。必用外治之药。以攻之提之。煎药不能取效也。
Xu Recently, the weather has turned suddenly cold. Palpation of the left pulse reveals a sudden appearance of Kou (hollow) and Se (choppy) qualities. During pain episodes, the sinews spasm, radiating to behind the ear. This indicates Ying Blood deficiency leading to malnourishment of the collaterals, with internal Wind movement causing sinew tension. Previous methods using clearing collaterals and cooling agents were ineffective. The deficient Ying Blood cannot tolerate acrid-cold herbs. Following the intent of Li Dongyuan's Shujin Decoction. (Pain circles behind the ear)
Danggui (Radix Angelicae Sinensis), Sheng Huangqi (Astragali Radix), Pian Jianghuang (Curcumae Longae Rhizoma), Guizhi (Ramulus Cinnamomi), Fangfeng (Radix Saposhnikoviae), Chao Baizhu (Atractylodis Macrocephalae Rhizoma). Decoct these herbs and dissolve one pill of Huoluo Dan (Living Collateral Pill) in the liquid.
Certain Patient Fatigue and overwork. Pain in the shoulder and arm. (Shoulder and arm pain)
Chuan Guizhimu (Cinnamomi Ramulus et Cortex), Mufangji (Stephaniae Tetrandrae Radix), Wujiapi (Acanthopanacis Cortex), Fuling (Poria), Sheng Yiyiren (Coicis Semen), Chao Baijili (Tribuli Fructus).
Tu (62 years old) Pain originates in the scapula, gradually extending to the Huantiao point and thigh/knee. This is due to collateral deficiency.
Huangqi (5 qian), Baizhu (3 qian), Danggui (3 qian), Fuling (2 qian), Fangji (8 fen), Fangfenggen (5 fen), Qianghuo (5 fen).
Second visit Follow the previous prescription, remove Fangfeng and Qianghuo, add Gouqizi (Fructus Lycii) and Shayuanzi (Astragali Complanati Semen).
Zou 54 years old. Yangming pulse qi declines. Scapular sinews become flaccid. Inability to raise the arm accompanied by pain. Treatment should focus on unblocking and tonifying the collaterals. Do not use attacking wind-dispersing methods.
Sheng Huangqi, Baizhu, Danggui, Fangfenggen, Jianghuang, Sangzhi (Ramulus Mori).
Wang (42 years old) Yangming qi declines. Jueyin Wind moves, causing dizziness and blurred vision. Right shoulder pain and numbness. Qi accumulation under the ribs. Managed via Foot Jueyin Liver Meridian.
Gouqizi (4 liang), Guishen (Radix Angelicae Sinensis, 3 liang), Lingyangjiao (Cornu Saigae Tataricae, raw ground, 2 liang), Zhi Baijili (Tribuli Fructus, thorns removed, 3 liang), Nen Huangqipi (Astragali Cortex, 4 liang), Hutianma (Gastrodiae Rhizoma, baked, 2 liang).
Jujuhua (Chrysanthemi Flos, 2 liang) decocted juice, Sangzhi (4 liang) decocted juice, made into pills.
Xu (52 years old) Left finger distending pain radiating to the shoulder. Men with Blood deficiency experience Wind movement. Disease location is in the Liver. Physical form and pulse indicate insufficiency. Use soft/moistening herbs for warm nourishment.
Zhi Shouwu (Polygoni Multiflori Preparata Radix), Gouqizi, Guishen, Sanjiao Huma (Sesami Semini Nigrum), Jujuhtan (Chrysanthemi Flos carbonized), Baiziren (Biota Semen), Cijili (Tribuli Fructus), Sangzhigao (Mori Ramulus Extract) pills.
Yu (Elderly Woman) Advanced age, Yangming qi deficiency. Scapular pain difficult to flex/extend. Method: Regulate Wei Yang and tonify through unblocking.
Huangqi, Guizhi, Guishen, Pian Jianghuang, Haitongpi (Saposhnikoviae Radix? No, likely Celastrus or similar bark contextually, but literally Haitongpi), Xiakucao (Prunellae Spica).
Sun (24 years old) Kidney qi attacks upward, back stiffness. Frequent and abundant urination. Du Mai (Governor Vessel) fails to secure. Heavy waist, headache, difficulty turning. First apply unblocking Yang method. Follow Scholar Xu's method. (Back pain)
Chuanjiao (Zanthoxyli Pericarpium, fried until sweat appears, 3 fen), Chuan Guizhi (1 qian), Chuan Fuzi (Aconiti Lateralis Radix Preparata, 1 qian), Fuling (1.5 qian), Sheng Baizhu (1 qian), Sheng Yuanzhi (Polygalae Radix, 1 qian).
Generally, when rushing Qi attacks pain moving upward from the back, it is a disease of the Du Mai, treated in Shaoyin (Kidney). When moving upward from the abdomen, it is treated in Jueyin, belonging to Chong and Ren vessels. Or tonify Yangming. This is the fundamental principle of treatment.
Wang (12 years old) Liver turbid Qi rebels and attacks. Pain extends to the back.
Dan Ganjiang (Zingiberis Rhizoma, 8 fen), Chaohei Chuanjiao (Zanthoxyli Pericarpium, charred black, 3 fen), Chaojiao Wumeirou (Mume Fructus, charred, 5 fen), Xiao Chuanlian (Corydalis Rhizoma, 3 fen), Chuan Guizhimu (5 fen), Beixixin (Asari Radix et Rhizoma, 2 fen), Huangbai (Phellodendri Cortex, 5 fen), Chuanlianzi Rou (Toosendan Fructus, 1 qian), Sheng Baishao (Paeoniae Radix Alba, 2 qian).
Chen (Family) Nei Jing states all pains are due to Cold. It is winter. Cold inhaled via mouth/nose obstructs the flow of Qi tunnels. Pain radiates from chest to back. Severe cases have cold extremities. Only appropriate to treat by unblocking both Qi and Blood.
Chuanlianzi, Yanhusuo (Corydalisis Rhizoma), Sheng Xiangfu (Cyperi Rhizoma), Juhong (Citri Reticulatae Pericarpium Rubrum), Wuyu (Evodiae Fructus), Wuyao (Linderae Radix), Honghua (Carthami Flos).
Shen (Family) Pulse is Kou, sweating, blood loss. Back pain. This is collateral deficiency.
Renshen (Ginseng Radix), Chao Guishen (Angelicae Sinensis Radix, stir-fried), Zaoren (Ziziphi Spinosae Semen), Chao Baishao (Paeoniae Radix Alba, stir-fried), Zhigancao (Glycyrrhizae Radix et Rhizoma Preparata), Fushen (Poria with Hostwood).
Zhuang (34 years old) Du Mai deficiency causes back pain. Spine protrudes high.
Sheng Mao Lu jiao (Cervi Cornus Pantotrichum, sliced, 3 qian), Lu jiaoshuang (Cervi Cornus Degelatinatum), Gouqi (3 qian), Guishen (1 qian), Sheng Duzhong (Eucommiae Cortex, 1.5 qian), Shayuanzi (1 qian), Fuling (1.5 qian), Qingyan (Halitum, mixed in 3 fen).
Zhang (38 years old) Du Mai deficiency causes back pain. Spermatorrhea/emission.
Sheng Mao Lu jiao, Lu jiaoshuang, Sheng Tusizi (Cuscutae Semen), Sheng Duzhong, Shayuanzi, Bailonggu (Ossis Femoris), Fuling, Danggui.
The Lung governs all collaterals. Lung disease prevents control over the whole body. Thus, when Feishu (Bladder 13) is diseased, shoulder and back pain occur. Furthermore, the back is the domain of the Yangming. If Yangming is deficient, it cannot bind sinews and bones or facilitate joints, leading to drooping shoulders and curved back. Regarding the arm, meridians intersect variously, but Yangming is the chief of the twelve meridians. Arm pain should also be attributed to Yangming. However, pain has external and internal causes; deficiency and excess differ greatly, requiring distinct treatments for Qi and Blood, with specific approaches for unblocking and tonifying. For example, if Ying Blood deficiency leads to collateral malnourishment and Wind-induced sinew tension, acrid-cold herbs are contraindicated; follow Li Dongyuan's Shujin Decoction intent, assisted by Huoluo Dan. If fatigue damages Yang, causing collateral stagnation and shoulder/arm pain, use acrid-sweet herbs as sovereign, assisted by channel-entering collaterals. If Yangming qi declines and Jueyin Wind moves, causing right shoulder pain/numbness, use Gouqi, Guishen, Huangqi, Lingyangjiao, Sangzhigao. This treats dual deficiency of Ying Qi in Yangming and Jueyin. If Blood deficiency causes Wind movement, due to Yangming collateral weakness disturbed by Liver Wind-Yang, use Shouwu, Gouqi, Guishen, Huma, Baiziren, Cijili. Use soft-sweet herbs for warm nourishment. If back pain follows blood loss, the deficiency lies in Yangming collaterals; use Renshen, Guishen, Zaoren, Baishao, Zhigancao, Fushen to tonify Yangming. If Kidney Qi rebels, Du Mai deficiency is primary; use extraordinary vessel herbs to vigorously tonify True Yang. If cold inhaled obstructs Qi tunnels causing chest-to-back pain, follow Nei Jing's "all pains are cold" principle, use warming herbs to unblock Qi and Blood. Ancient methods include: Fengfang Tang dispersing Wind at Feishu; Zhimi Wan treating phlegm-flow arm pain; Kongxian Dan treating flowing bi traction. These treat excess syndromes, embodying "if unblocked, no pain." Physicians must not stick rigidly to one method, must understand the disease source, apply ingenuity in prescribing, and thus advance their skills. (Commentary by Gong Shangnian)
Xu's Commentary: Pain fixed in shoulder/back belongs to Zhuo Bi (Heavy Bi Syndrome). External treatments must be used to attack and lift. Internal decoctions cannot achieve efficacy.