督脉主脊。经云∶督脉之别，名曰长强，别走太阳，实则脊强，取之所别
也。（刺灸之。）大肠筋挟脊。心脉与脊里细筋相连贯，故心痛有连背者。脾筋着脊。
肾筋脉贯脊，脊髓空则痛。膀胱筋脉挟脊，上项，为风寒湿所袭，则倔强不能屈伸，
取本经 中血络。背上两角为肩解，小肠脉出之，肩解下成片肉为肩胛，大小肠筋
脉俱绕之。又肩背属肺部分。太阳中风湿，经脉不行，脊痛项强，不可回顾，羌活
胜湿汤（见伤湿）。兼气实郁滞者，则常常作痛，加木香、陈皮、香附。气虚郁滞者，
则时止时痛，加升、柴、参、 。血虚郁痛者，则夜甚时止，加归、芍。血瘀郁痛
者，则夜痛不止，加姜黄、灵脂、红花。风盛项背强，加威灵仙。湿盛肩背重，
加二术。痰气凝滞则呕眩，本汤送青州白丸子（见中风）。看书封弈，久坐而脊背痛者，
补中益气汤（见气），或八珍（见虚损）加黄 。喘咳气逆，肩背痛，汗出，肺实也，热也。肺
虚亦痛，觉寒，少气不足以息，当补气。肾气上逆，先背痛，后及肩，和气饮（见肿胀）
加炒盐、小茴。当肩背一片冷痛，而用神保丸者（见伤饮食），此有积气故也。素虚人，
或病后，或发汗过多，心隔间痛引乳胁或肩背，此气上逆，当引使归元。有患肩胛
缝一线痛起，上跨肩，（肩背属小肠经。）至胸前侧胁止，（胆经。）昼夜不息。
丹溪谓因思虑伤心，
（心血虚而火动。）移于小肠，及虑不能决，又归之胆，（胆火亦动。）子来乘母，为实邪，以人
参四钱，（思虑则气结不行，故补其气以行之。）木通二钱（引火从小肠出）煎汤，
下龙荟丸（见胁肋痛。除肝胆火）而愈。
The Du Mai (Governor Vessel) governs the spine. The classics state: "The collateral branch of the Du Mai is named Changqiang (Long Strength, GV1), which diverges to run to the Taiyang (Greater Yang) channel. When there is excess, the spine becomes stiff; treat by selecting its collateral branch." (Acupuncture and moxibustion.) The sinews of the Large Intestine flank the spine. The heart's meridians are connected and continuous with the fine sinews inside the spine; therefore, heart pain may radiate to the back. The sinews of the Spleen attach to the spine. The sinews and vessels of the Kidney penetrate the spine; when the spinal marrow is empty, pain occurs. The sinews and vessels of the Bladder flank the spine and ascend to the nape; if attacked by wind-cold-dampness, rigidity and inability to flex or extend occur; treat by selecting the blood collaterals of this channel. The two corners of the back are called Jianjie (Shoulder Resolution), where the Small Intestine meridian emerges. Below the Jianjie, the fleshy mass is called Jianjia (Shoulder Blade); the sinews and vessels of both the Large and Small Intestines surround it. Furthermore, the shoulder and back belong to the region governed by the Lung. If the Taiyang channel is affected by wind-dampness, causing stagnation of the meridians, symptoms include back pain, neck stiffness, and inability to turn the head; Qianghuo Shengshi Tang (Notopterygium Decoction for Overcoming Dampness) [see Injury by Dampness] can be used. In cases complicated by Qi excess and stagnation, pain is frequent; add Muxiang (Aucklandiae Radix), Chenpi (Citri Reticulatae Pericarpium), and Xiangfu (Cyperi Rhizoma). In cases of Qi deficiency with stagnation, pain comes and goes intermittently; add Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix), Renshen (Ginseng Radix et Rhizoma), and [character missing in original text, likely a tonifying herb]. In cases of Blood deficiency with stagnation-pain, pain is worse at night and ceases during the day; add Danggui (Angelicae Sinensis Radix) and Shaoyao (Paeoniae Radix Alba). In cases of Blood stasis with stagnation-pain, pain persists throughout the night; add Jianghuang (Curcumae Longae Rhizoma), Lingzhi (Trogopterori Faeces), and Honghua (Carthami Flos). If wind is predominant causing neck and back rigidity, add Weilingxian (Sinomenii Caulis). If dampness is predominant causing heavy shoulders and back, add Baizhu (Atractylodis Macrocephalae Rhizoma) and Cangzhu (Atractylodis Rhizoma). If phlegm-Qi stagnation causes vomiting and dizziness, administer Qingzhou Baiwanzi (Qingzhou White Pill) [see Stroke] with the above decoction. For back pain caused by prolonged sitting while reading or playing chess, Buyi Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) [see Qi] or Bazhen Tang (Eight Treasures Decoction) [see Deficiency and Damage] plus Huangqi (Astragali Radix) can be used. For wheezing, coughing, rebellious Qi, shoulder and back pain, and sweating, this indicates Lung excess and heat. Lung deficiency also causes pain, accompanied by a sensation of cold and shortness of breath insufficient for respiration; tonify Qi. When Kidney Qi rebels upward, back pain appears first, then spreads to the shoulders; Heqi Yin (Harmonizing Qi Decoction) [see Swelling] plus stir-fried salt and Xiaohui (Foeniculi Fructus) can be used. When there is a patch of cold pain across the shoulder and back, treated with Shenbao Wan (Divine Preservation Pill) [see Food Injury], this is due to accumulated stagnant Qi. In individuals with constitutional deficiency, or after illness, or after excessive sweating, if pain in the heart and diaphragm radiates to the breasts, hypochondrium, or shoulder and back, this is rebellious Qi; guide the Qi back to its origin. Some patients experience a linear pain starting from the gap between the scapulae, crossing over the shoulder ([shoulder and back belong to the Small Intestine meridian]), and stopping at the lateral chest and hypochondrium ([Gallbladder meridian]), unceasing day and night. Danxi stated that this is caused by excessive thinking injuring the Heart, (Heart Blood deficiency leading to Fire agitation,) transferring to the Small Intestine, and because indecisiveness affects the Gallbladder, (Gallbladder Fire also agitates.) The child organ overacting on the mother organ constitutes an Excess pathogen. Treat with Renshen (Ginseng Radix et Rhizoma) 4 qian, (Thinking causes Qi knotting and stagnation, thus tonify Qi to promote movement,) and Mutong (Akebiae Caulis) 2 qian (to guide Fire out through the Small Intestine), decocted in water, followed by Longhui Wan (Dragon Bile Pill) [see Hypochondriac Pain. Clears Liver and Gallbladder Fire], resulting in cure.