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The *Huangdi Neijing* (Yellow Emperor's Inner Canon) describes three methods for acupuncture and moxibustion treatment of spinal pain and stiffness: The first method involves selecting the Du Meridian (Governing Vessel). The classic states: "The collateral branch of the Du Meridian is named Changqiang (DU-1), which diverges to run to the Taiyang Meridian. In excess conditions presenting with spinal stiffness, treat its divergent point." The second method involves selecting the Foot-Taiyang Bladder Meridian. The classic states: "Jueyin qi causes pain along the spine extending to the vertex, accompanied by a heavy and dull head, blurred vision, and stiff waist and spine; this is treated by selecting the blood collaterals of the Foot-Taiyang Meridian." The third method involves selecting the Small Intestine Meridian. The classic states: "Lower abdominal pain radiating to the testicles, pulling into the waist and spine, with qi rushing up to the heart; if the pathogen is in the Small Intestine, treat the Hanyuan area to dissipate it, needle the Hand-Taiyin Lung Meridian to support it, select the Foot-Jueyin Liver Meridian to descend it, and select Julixia (ST-39) to eliminate it." Spinal pain with neck stiffness, waist feeling as if broken, neck feeling as if pulled, and throbbing headache indicate dysfunction of the Foot-Taiyang Meridian. It is primarily treated with Qianghuo Shengshi Tang (Notopterygium Decoction to Overcome Dampness). For traumatic injuries or falls from height, where evil blood stagnates in the Foot-Taiyang Meridian causing unbearable lower back and spinal pain, Dilong Tang (Earthworm Decoction) is indicated.

The shoulder and back region corresponds to the Lung organ. The classic states: "West wind arises in autumn, disease affects the Lung, manifesting in the shoulders and back; thus, autumn diseases often affect the shoulders and back." It further states: "Lung disease presents with wheezing, coughing, reverse qi, shoulder and back pain, and sweating." Also: "Excessive Lung Qi in autumn causes disease; externally it leads to reverse qi and aching back pain." Additionally: "When the Hand-Taiyin Lung Meridian has excess qi, it causes shoulder and back pain with cold wind and sweating; when deficient, it causes shoulder and back pain with cold sensation, shortness of breath, and inability to take a full breath." This represents self-disease of Metal-Lung. The classic states: "In years of excessive Fire, people suffer from hot shoulder and back." Also: "When Shaoyin governs the year and heat dominates excessively, symptoms include pain in the shoulders, back, and supraclavicular fossa; this is Lung Metal suffering from Fire pathogen." The classic states: "If pathogen is in the Kidney, it causes pain in the shoulders, back, neck, and nape; select Yongquan (KI-1) and Kunlun (BL-60), and if blood stasis is visible, drain all of it." This is pain caused by rebellious Kidney Qi. Li Dongyuan stated: "Shoulder and back pain preventing turning the head is due to stagnation and non-circulation of Hand-Taiyang Qi; disperse it with Wind-dispelling herbs." The *Maijing* (Pulse Classic) states: "Wind-cold causing sweating, shoulder and back pain, stroke, frequent urination, and yawning indicates wind-heat attacking the Lung, causing severe Lung Qi stagnation. One should drain wind-heat to unblock Qi, primarily using Fangfeng Tang (Saposhnikovia Decoction)." Regarding cases of wind-cold with sweating, shoulder/back pain, and frequent urination, since wind-heat draining herbs are used to unblock Lung Qi obstruction, for cases involving alternating chills and fever, shortness of breath, shoulder/back pain, and urinary incontinence, one should use herbs like Renshen (Ginseng Root) and Huangqi (Astragalus Root) to tonify Lung Qi deficiency, which is self-evident. When damp-heat clump together causing heavy and painful shoulders and back, Danggui Niangong Tang (Angelica Ligustolactone Pain-Relieving Decoction) is used. For widespread cold pain in the shoulder and back, and pain in the back muscles, ancient formulas used Shenbao Wan (Divine Treasure Pill) for cure, indicating the presence of stagnant Qi. If a person has chronic phlegm-fluid retention flowing into the shoulders and back causing pain, Xingxiang San (Star and Fragrance Powder) or Daotan Tang (Phlegm-Resolving Decoction) administered with Wutao Wan (Five-Sleeve Pill) is appropriate. If Kidney Qi does not follow its normal pathway, but rebels upward along the spine causing shoulder and back pain, Heqi Yin (Harmonizing Qi Infusion) added with salt-fried Huixiang (Fennel Fruit) and stir-fried Chuanjiao (Sichuan Pepper) is suitable. For back pain caused by prolonged sitting while reading or playing chess, Buzhong Yiqi Tang (Middle-Warmer Boosting Qi-Tonifying Decoction) or Bawu Tang (Eight-Ingredient Decoction) added with Huangqi is indicated. For constitutionally weak individuals or those post-illness experiencing pain between the heart and diaphragm, radiating to the breasts and hypochondrium, or wandering to the shoulders and back, this is rebellious Yuan Qi (Primal Qi); it should be guided back to its root. Do not use purgative or dispersing agents, as they will increase pain. This condition is common among those who sweat excessively; only warm-tonification is suitable. Adhering strictly to the theory that "Qi disorders do not require tonification" is erroneous. Sweat is the fluid of the Heart; Yang Qi receives Qi in the chest. Excessive sweating depletes Heart fluids and weakens Yang Qi, leading to pain. Zhu Danxi treated a man who suddenly developed a linear pain starting from the scapular seam, crossing over the shoulder to the lateral chest, lasting day and night without relief, unbearable. His pulse was wiry and rapid, large upon heavy pressure, with the left pulse larger than the right. The scapula belongs to the Small Intestine Meridian; the chest and hypochondrium belong to the Gallbladder Meridian. This must be due to mental worry injuring the Heart; although the Heart itself was not diseased, its Fu-organ was affected first, so pain started at the scapula. When worry led to indecision, it shifted to the Gallbladder, so pain stopped at the chest/hypochondrium. This is Small Intestine Fire assaulting Gallbladder Wood, with the child assaulting the mother, constituting an Excess pathogen. Inquiry revealed the illness stemmed from unsuccessful planning. He prescribed Renshen (4 qian) and Mutong (2 qian) decocted in water, taken with Longhui Wan (Dragon Ash Pill). After several doses, he recovered.

[Diagnosis] A Hongda (Surging and Large) pulse indicates Heat (Hong) and Wind (Da). A Cu (Rapid/Interrupted) pulse striking upwards indicates shoulder and back pain. A Chen (Deep) and Hua (Slippery) pulse indicates pain in the back muscles.