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[Symptoms of Shoulder and Back Pain due to External Contraction]
Pain in the back and shoulders, fever without aversion to cold but with aversion to heat, restlessness and agitation, constipation with dark urine, thirst with parched lips. This is a condition where Fire Pathogen (Huoxie) injures the Lung. If there is pain in the back and shoulders accompanied by headache and fever, with internal restlessness but external aversion to cold, this is a condition where Wind-Cold Pathogen (Fenghan) injures the Lung.

[Etiology of Shoulder and Back Pain due to External Contraction]
The *Neijing* states: "When the annual fire qi is excessive, people suffer from hot pain in the shoulders and back." It also states: "When Shaoyin governs the year, and heat prevails excessively, people suffer from pain in the shoulders, back, and Key-Well points (Quepen)." This indicates injury to the Lung by Fire Pathogen. Additionally, if the Lung has pre-existing heat, and Wind-Cold binds the exterior skin and hair, the Lung heat cannot vent or disperse, causing pain at the Bladder 13 (Feishu) acupoint on the shoulder and back; this is considered injury to the Lung by Cold Pathogen (leading to heat retention).

[Pulse Signs of Shoulder and Back Pain due to External Contraction]
A surging and rapid pulse at the Right Cun position indicates Heat obstruction in the Lung meridian, injured by Fire Pathogen. A floating and tight pulse indicates Exterior Cold Pathogen, characteristic of Wind-Cold.

[Treatment of Shoulder and Back Pain due to External Contraction]
If the Lung is injured by Fire Pathogen, use Jiamixiebai Decoction (Secret Formula Xiebai Tang) or Qingzao Qingfei Yin. If the Lung has inherent heat bound by Wind-Cold externally, use Qiangfang Xiebai San.

Jiamixiebai Decoction (Secret Formula Xiebai Tang)
Ingredients: Sangbaipi (Morus Albae Cortex), Digupi (Lycii Cortex), Fen Gancao (Prepared Glycyrrhizae Radix et Rhizoma), Huangqin (Scutellariae Radix), Shigao (Gypsum Fibrosum), Huanglian (Coptidis Rhizoma).

Qingfei Yin (Clear the Lung Drink)
Ingredients: Jiegeng (Platycodonis Radix), Huangqin (Scutellariae Radix), Shanzhi (Gardeniae Fructus), Lianqiao (Forsythiae Fructus), Tianhuafen (Trichosanthis Radix), Xuanshen (Scrophulariae Radix), Bohe (Menthae Haplocalycis Herba), Gancao (Glycyrrhizae Radix et Rhizoma).

Qiangfang Xiebai San: Xiebai San added with Qianghuo (Notopterygii Rhizoma et Radix) and Fangfeng (Saposhnikoviae Radix).

[Symptoms of Shoulder and Back Pain due to Internal Injury]
Weakness of Qi, scattered spirit, lack of mental energy, pain that is not severe, ability to sleep and lie down. This is a symptom of Lung Qi Deficiency. If there are parched lips, dark and scanty urination and defecation, and restlessness, this is pain caused by Accumulated Heat.

[Etiology of Shoulder and Back Pain due to Internal Injury]
Constitutional deficiency of Yuanqi (Primordial Qi) compounded by further damage leads to Lung Qi Deficiency causing pain; Lung Heat causing scorching of Lung leaves, triggered by aggravating factors, leads to Lung Qi Stagnation causing pain; overexertion or lifting heavy weights damages tendons and fascia, injuring the Lung orifice causing pain; individuals consuming rich foods and alcohol have Accumulated Heat in the Intestines and Stomach, which steams upward to insult Metal (Lung), causing Earth-Fire to punish Metal, resulting in frequent pain in the shoulders, back, Quepen point, and Feishu acupoint. These are all cases of shoulder and back pain due to Internal Injury.

[Pulse Signs of Shoulder and Back Pain due to Internal Injury]
A floating and large right pulse, empty upon deep pressure, indicates Lung Qi Deficiency. A full pulse at the Cunkou position, rapid and solid upon deep pressure, indicates Qi Obstruction and Lung Excess. String-taut and large pulses in all six positions, with choppy or intermittent beats upon deep pressure, indicate Injury/Damage. A deep and rapid pulse at the Right Guan position indicates Accumulated Heat in the Intestines and Stomach; a string-taut and rapid pulse at the Left Guan position indicates Fire of the Liver and Gallbladder.

[Treatment of Shoulder and Back Pain due to Internal Injury]
For weak Qi but clear consciousness, with a large and deficient pulse, use Sijunzi Tang or Buzhong Yiqi Tang. For panting,急促 Qi reversal, inability to lie flat, and restless/full pulses, use Tingli Xiefei Tang for severe cases, or Jiamixiebai San for mild cases. For chronic pain not resolving, indicating Qi and Blood injury, use Siwu Tang or Bazhen Tang, added with Qinjiao (Gentianae Macrophyllae Radix), Xuduan (Dipsaci Radix), Gouteng (Uncariae Ramulus cum Uncis), and Qianghuo (Notopterygii Rhizoma et Radix). For Accumulated Heat from rich diet, dry mouth and parched lips, with deep and rapid pulses, use Jiamixiebai San. For Wood-Fire punishing Metal, treat accordingly.

Sijunzi Tang: Treats pain due to Qi Deficiency.
Ingredients: Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Fuling (Poria), Gancao (Glycyrrhizae Radix et Rhizoma).

Buzhong Yiqi Tang: Treats shoulder and back pain due to dual deficiency of Qi and Blood.
Ingredients: Renshen (Ginseng Radix et Rhizoma), Baizhu (Atractylodis Macrocephalae Rhizoma), Huangqi (Astragali Radix), Danggui (Angelicae Sinensis Radix), Chenpi (Citri Reticulatae Pericarpium), Gancao (Glycyrrhizae Radix et Rhizoma), Shengma (Cimicifugae Rhizoma), Chaihu (Bupleuri Radix).

Tingli Xiefei Tang: Treats shoulder and back pain radiating to the Quepen point due to Phlegm-Fluid obstructing the Lung orifice.
Ingredients: Tinglizi (Descurainiae Semen seu Lepidii Semen), Dazao Rou (Ziziphus Jujubae Mesocarp).

Jiamixiebai San (Secret Formula Xiebai San): Treats Real Fire punishing Metal, Lung Heat with panting/cough, parched lips, and red urine.
Ingredients: Sangbaipi (Morus Albae Cortex), Digupi (Lycii Cortex), Gancao (Glycyrrhizae Radix et Rhizoma), Huangqin (Scutellariae Radix), Shigao (Gypsum Fibrosum), Chuan Huanglian (Coptidis Rhizoma).

Secret Formula Modifications: Add Gegen (Puerariae Lobatae Radix) to clear Stomach Fire; add Baishaoyao (Paeoniae Radix Alba) to clear Spleen Fire; add Chaihu (Bupleuri Radix) to clear Liver/Gallbladder Fire; add Chencha (Cinnabaris) to clear Heart Fire; add Huangbai (Phellodendri Cortex) to clear Kidney Fire; add Zhike (Aurantii Fructus Immaturus) to clear Large Intestine Fire; add Mutong (Akebiae Caulis) to clear Small Intestine Fire.

Siwu Tang: Treats shoulder and back pain due to Blood Deficiency.
Ingredients: Shudihuang (Rehmanniae Radix Preparata), Baishaoyao (Paeoniae Radix Alba), Danggui (Angelicae Sinensis Radix), Chuanxiong (Chuanxiong Rhizoma).

Secret Formula Modification: Add Qinjiao (Gentianae Macrophyllae Radix), Xuduan (Dipsaci Radix), Gouteng (Uncariae Ramulus cum Uncis), and Qianghuo (Notopterygii Rhizoma et Radix) to treat general body pain.

Bazhen Tang: Treats shoulder and back pain due to dual deficiency of Qi and Blood.
Composition: Combination of Sijunzi Tang and Siwu Tang, with Secret Formula additions of Qinjiao (Gentianae Macrophyllae Radix), Xuduan (Dipsaci Radix), Gouteng (Uncariae Ramulus cum Uncis), and Qianghuo (Notopterygii Rhizoma et Radix).

Xiebai Banban Tang (Half-and-Half Xiebai Decoction)
Ingredients: Sangbaipi (Morus Albae Cortex), Digupi (Lycii Cortex), Gancao (Glycyrrhizae Radix et Rhizoma), Danshen/Caoshen (Artemisiae Scopariae Herba - Note: 'Dancao' here likely refers to Qingdanchi or similar bitter cold herb, often interpreted as Gentian or Artemisia in context of clearing heat, strictly 'Dancao' usually means Licorice but here distinct from Gancao, likely Qingdanchi/Indigo Naturalis precursor or Gentiana. Given context of clearing liver/gallbladder fire, Qingdanchi or Longdancao is implied. Text says 'Dancao', likely shorthand for Qingdanchi or similar. WHO term for Qingdanchi is Indigo Naturalis. However, 'Dancao' literally is Licorice. But Gancao is listed separately. In some contexts Dancao refers to Gentiana Scabra (Longdancao). Let's assume Longdancao/Gentian based on 'clearing liver fire' context later. Actually, standard 'Dancao' is not a standard single herb name distinct from Gancao unless it's a typo for Longdancao or Qingdanchi. Given 'clearing liver fire' in modifications, Longdancao is probable. I will translate as Gentianae Radix (Longdancao) assuming textual convention for clearing heat/fire). *Correction*: In many ancient texts, 'Dancao' might refer to *Qingdanchi* (Indigo Naturalis) or be a variant. However, looking at the list, it clears heat. Let's stick to literal 'Dancao' if ambiguous, but functionally it acts as a heat-clearing herb. Wait, 'Dancao' is often used for *Gentiana Scabra* (Longdancao) in abbreviated forms in some lineages, or *Artemisia*. Given the pairing with Zhi and Huangqin, it is a bitter-cold herb. I will use Gentianae Radix (Longdancao) as the most clinically consistent interpretation for 'Dancao' in a heat-clearing formula alongside Huangqin/Shanzhi, or note it as 'Dancao'. To be safe and accurate to WHO, if the source is ambiguous, I will use the pinyin or common equivalent. Let's use Gentianae Radix (Longdancao) as it fits the 'Liver/Gallbladder fire' theme often associated with such combinations, or simply 'Dancao (Herb)' if unsure. Actually, 'Dancao' is frequently a typo or abbreviation for *Longdancao*. I will translate as Gentianae Radix (Longdancao).
Shanzhi (Gardeniae Fructus), Huangqin (Scutellariae Radix).
Administration: Mix with Qingdai (Indigo Naturalis) and take orally.