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(See the section on "Stagnant Fluid and Hidden Phlegm in Various Coughs")

Pain in the shoulder and back. If the specific syndrome has not yet been differentiated, Heqi Yin (Harmonizing Qi Decoction) is generally suitable. Add Ban Qian (half a qian, approx. 2.5g) of Wuyao (Lindera Root) to each dose.
When there is a patch of cold pain across the shoulder and back, and pain in the dorsal spine, ancient formulas used Shenbao Wan (Divine Preservation Pill) for cure; this is due to accumulated stagnant Qi.
The patient habitually suffers from phlegm-fluid retention, which flows and pours into the shoulder and back causing pain. Xingxiang San (Star and Fragrance Powder) is suitable, or it can be taken with Daotan Tang (Phlegm-Expelling Decoction) followed by Wu Tao Wan (Five Rounds Pill). Further selection of herbs can be made from the Stagnant Fluid Syndrome section under Vomiting.
If Kidney Qi does not follow its normal pathway, Qi rebels upward, carrying along the back and ascending, resulting in shoulder and back pain. Heqi Yin (Harmonizing Qi Decoction) is suitable. Add Chao Huixiang (Stir-fried Fennel Fruit), half a qian, and Chao Shuijiao (Stir-fried Zanthoxylum Bungeanum), ten grains, to each dose.
If the constitution is deficient, or if there is pain between the heart and diaphragm after illness, radiating to the breasts and hypochondrium, or wandering to the shoulder and back, this is due to Yuan Qi (Primal Qi) rebelling upward. It should be guided to return to its origin. One must not again use purgative or draining agents; the more one drains, the worse the pain becomes. Many people suffer from this condition after excessive sweating. Only warming and tonifying methods are appropriate. Adhering to the theory that "Qi cannot be tonified" is erroneous.
The Classics state: "Sweat is the fluid of the Heart." It also says: "Yang receives Qi from the chest center." Excessive sweating depletes the Heart's fluids and causes Yang Qi deficiency, thus leading to pain.

Recently, some patients have fallen ill; some have had the disease for a long time with intermittent attacks. Regardless of various symptoms, Yigong San (Different Attack Powder), Xiangling Tang (Fragrant and Spirit Decoction) are suitable, assisted by Zhuapi Tang (Beating Spleen Decoction).
If the pain is due to accumulated cold, Shounian San (Hand-Sticking Powder) is suitable, mixed with wine for administration. Add Guanzi Gui (Cinnamon Bark) in equal proportion, still assisted by Zhuapi Tang (Beating Spleen Decoction) and Tieshua Tang (Iron Brush Decoction). Or use Suhexiang Wan (White Musk Pill), mixed with ginger juice and wine, taken warm. This can also be used for anterior and posterior heart pain.
If warming medicines are ineffective and pain worsens, slight purgation of the large intestine is suitable. Assess deficiency and excess; first administer Shenbao Wan (Divine Preservation Pill), stopping when bowel movement is achieved. Then administer Jiawei Qi Qi Tang (Modified Seven Qi Decoction). If the pain is caused by consuming cold food, Tiaoqi San (Regulating Qi Powder) combined with Zhuapi Tang (Beating Spleen Decoction) is suitable.
If the pain is caused by roundworms, with roundworms attacking and biting the heart region, pain having intervals, and the patient vomiting roundworms, or if administering decoctions or medicines leads to further vomiting, it is because food entry agitates the worms, and worm agitation causes nausea and vomiting. Use ten-plus grains of Chuanjiao (Sichuan Pepper), decocted in water, to send down Wumei Wan (Mume Pill).
If Kidney Qi rebels upward attacking the Heart, causing heart pain, fresh Chinese chive juice is ground and mixed with Wuling San (Five-Ingredient Powder with Poria) to make pills. Taken on an empty stomach with Huixiang Tang (Fennel Decoction).