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[Danxi] Discussion on the Blackening of the Face and Nose upon Exposure to Cold: All Yang meridians converge at the head; therefore, the face is "Yang within Yang." The nose resides in the center of the face, where the Yangming meridians originate. The blood circulating to the face and nose, which are Yang regions, consists of extremely pure and refined Qi and Blood. Wine has a nature that promotes movement and ascending, possessing intense heat and severe toxicity. In individuals who consume excessive wine, the fumes of wine steam the face and nose. The Blood becomes extremely hot due to the wine; when this hot Blood encounters cold, it is constrained by Yin pathogens, leading to turbid coagulation and stagnation without flow. Hence, the complexion first turns purple and subsequently black. It is necessary to employ methods to resolve stagnant Blood, allowing it to circulate freely, generate new Blood, and restore metabolic function, so that the disease may be cured. I once used Siwu Tang (Four Substances Decoction) processed with wine, adding Huangqin (Scutellariae Radix) stir-fried with wine, Chenpi (Citri Reticulatae Pericarpium), Sheng Gancao (Raw Glycyrrhizae Radix), Honghua (Carthami Flos) processed with wine, and Shengjiang (Zingiberis Rhizoma Recens). After decocting, Wu Lingzhi powder (Trogopteri Dung) was mixed in for oral administration. For patients with weak Qi and obese physique, Huangqi (Astragali Radix) processed with wine was added, yielding consistent results. (A few drops of good-quality wine were added as a guiding agent.)

Shoulder and back pain belongs to the pathological domain of the Lung. The Classics state: "West wind arises in autumn, the disease is in the Lung, manifesting in the shoulder and back." Thus, autumnal pathogens often affect the shoulder and back. It is also stated: "Excessive Lung Qi in autumn causes disease; externally, it leads to rebellious Qi and a lingering sensation of pain in the back."

[Yuan] The *Mai Jing* (Pulse Classic) states: "Wind-cold with sweating, shoulder and back pain, and wind-stroke with frequent urination and scanty voids indicate that Wind-Heat has invaded the Lung, causing severe Qi stagnation. One should drain Wind-Heat to unblock Qi, using Fangfeng Tang (Saposhnikoviae Decoction)."
Chaihu (Bupleuri Radix), Shengma (Cimicifugae Rhizoma), Mahuang (Ephedrae Herba) (each 1 qian); Fangfeng (Saposhnikoviae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Chenpi (Citri Reticulatae Pericarpium), Renshen (Ginseng Radix), Gancao (Glycyrrhizae Radix) (each 0.5 qian); Gaoben (Ligustici Rhizoma et Radix), Qingpi (Aurantii Fructus Immaturus) (each 0.3 qian); Huangbai (Phellodendri Cortex) (0.1 qian); Baokouren (Amomi Fructus Rotundus) (0.2 qian).
Crush the above herbs into coarse pieces. Prepare one dose, decoct in water, and take warm after meals. Suitable for those with robust Qi; contraindicated for those with pale complexion, loss of luster, and shortness of breath.

Inability to turn the head due to shoulder and back pain indicates Qi stagnation in the Hand-Taiyang meridian; disperse it with Wind-dispelling herbs.

[Danxi] Treated a male patient who suddenly experienced a linear pain starting from the interscapular region, extending upward to the shoulder and crossing to the lateral chest and hypochondrium. The pain persisted day and night, unbearable. His pulse was wiry and rapid; deep palpation revealed a hollow and large quality, with the left pulse larger than the right. I surmised that the interscapular region corresponds to the Small Intestine meridian. This must have resulted from overthinking damaging the Heart; although the Heart itself was not diseased, its paired Fu organ, the Small Intestine, was affected first, hence the pain originated in the interscapular area. Further analysis led me to consider the Gallbladder, explaining why the pain stopped at the chest and hypochondrium. This represents Small Intestine Fire attacking Gallbladder Wood, where the child (Fire) attacks the mother (Wood), constituting an Excess pathogen. Inquiry confirmed the illness stemmed from unsuccessful planning. Therefore, I prescribed Renshen (Ginseng Radix) 4 fen and Mutong (Akebiae Caulis) 2 fen decocted in water, used to swallow Longdan Wan (Gentian Pills) several times, resulting in recovery.

When Er-Yang (Yang Ming and Tai Yang) and Yi-Yin (Jue Yin) are involved in disease onset, the main manifestations are fright and terror, back pain, and frequent belching. (See full text in the section on Disease Transmission.)

According to the Theory of Five Movements and Six Qi: Shoulder and back pain all belong to diseases where Fire attacks the Lung. The Classics state: "When Year Fire is excessive, the people suffer from heat in the shoulder and back." It also states: "When Shaoyin governs the year, excessive Heat causes disease manifesting as pain in the shoulder, back, and clavicular fossa." Furthermore: "When Year Metal is deficient, internal disease involves the chest, hypochondrium, shoulder, and back, while external disease affects the skin and hair; treatment employs cold agents."

Acupuncture offers two approaches for shoulder and back pain:
First, treat the Lung. The Classics state: "For Lung disease presenting with wheezing, cough, rebellious Qi, shoulder and back pain, and sweating, select points on the meridians, specifically bleeding points located outside the Foot-Taiyin, outside the Foot-Taiyang, and inside the Jueyin." It also states: "Regarding the Hand-Taiyin Lung meridian, if Qi is excessive, there is shoulder and back pain with wind-cold sweating; if Qi is deficient, there is shoulder and back pain, aversion to cold, and shortness of breath. Treat according to excess, deficiency, heat, cold, or sinking conditions."
Second, treat the Kidney. The Classics state: "When pathogens reside in the Kidney, disease manifests as pain in the shoulder, back, neck, and nape, with occasional dizziness. Select Yongquan (KI1) and Kunlun (BL60). If blood stasis is present, bleed them completely."

[From *Yu Shu*]: Shoulder and back pain radiating to the scapula: Select Jianxia (interscapular gap) (located below the vertebral bone, directly opposite the tip of the axillary fold and arm, depth 2.5 cun, reduce method, six inhalations). Wushu (GB29) (depth 2.5 cun, reduce method, eight inhalations).

[Worldly Physicians]: Shoulder, back, and scapular pain: Select Kunlun (BL60), Xuanzhong (GB39), Jianjing (GB21).

[From *Dong Yuan*]: Pain in the shoulder, back, neck, nape, anterior axilla, radiating to the chest: Select Yongquan (KI1) (depth 1 fen, until blood appears, excellent effect). Qianye (Anterior Axilla point) (depth 1 cun).
Another method: Select Qishe (ST11) (depth 5 fen), Tiantu (CV22) (moxibustion), Quchi (LI11) (depth 1.5 cun), Tianjing (SJ10) (depth 5 fen).

[From *Jia Yi Jing*]: Bi-pain in the shoulder and back with inability to move, blood stasis in the shoulder preventing motion, is primarily treated by Jugu (SI1). Inability to dress oneself due to shoulder and back pain, pain on the lateral aspect of the forearm and wrist with inability to lift, is primarily treated by Yanggu (SI03). Sensation of the shoulder and back wanting to break, pain like pulling out hairs, inability to move hands up and down, is primarily treated by Yanglao (SI05). Neck and back pain radiating to the neck is primarily treated by Pohu (BL42). Shoulder pain with chest fullness, cold extremities, and stiffness of the spine and back is primarily treated by Shentang (BL44). Pain in the shoulder, back, and thigh, with inability to raise the arm, accompanied by chills and fever, is primarily treated by Jianjing (GB21).

[From *Tong Xuan Zhi Yao*]: Shoulder and back pain is primarily treated by Shousanli (LI10).

[From *Su Wen*]: When the Cun Kou pulse feels hurried and strikes upward upon palpation, it is termed shoulder and back pain. (From the chapter "Imaging of Healthy Persons").