针灸 肩痛有三法∶
其一取手阳明。经云∶大肠手阳明之脉所生病者，肩前 痛，视盛虚热寒陷下取之也。
其二取手太阳。经云∶小肠手太阳之脉是动，则病肩似拔， 似折，视盛虚热寒陷下取之也。
其三取筋，经云∶手太阳之筋病，绕肩胛引颈而痛，应耳中鸣痛，手阳明足太阳之筋皆病，肩不举，
皆治在燔针劫刺，以知为数，以痛为 也。
〔《东》〕肩不可动，臂不可举∶肩 （二寸半。） 巨骨（五分。） 清泠渊（一寸。） 关冲（五分。）
〔《玉》〕肩端肿∶肩 （二寸半，泻九吸。） 腕骨（七分，先泻后补。） 两胛痛∶肩井（二寸半，
不宜久停针。） 支沟
〔《甲》〕肩肿不能顾，气舍主之。肩中热，指臂痛，肩 主之。肩肘中痛难屈伸，手不可举，腕重急，
曲池主之。肩肘节酸重，臂痛不可屈伸，肘 主之。肩痛不能自举，汗不出，头痛，阳池主之。肩重，肘臂
痛不可举，天宗主之。肩胛周痹，曲垣主之。肩胛中痛而寒至肘，肩外 主之。肩膊闭急，凄厥恶寒，魄户
主之。肩痛不可举，天 、秉风主之。肩重不举，臂痛，肩 主之。肩不可举，不能带衣，清泠渊主之。肩
痛不可举，引缺盆云门主之。
〔《素》〕黄帝问曰∶余闻皮有分部，脉有经纪，筋有结络，骨有度量，其所生病各异，别其分部，左右
上下，阴阳所在，病之始终，愿闻其道。岐伯对曰∶欲知皮部以经脉为记者，诸经皆然。阳明之阳，名曰害蜚，
上下同法，视其部中有浮络者，皆阳明之络也，其色多青则痛，多黑则痹，黄赤则热，多白则寒，五色皆见，
则寒热也。络盛则入客于经。阳主外，阴主内。少阳之阳，名曰枢持，上下同法，视其部中有浮络者，皆少阳
之络也，络盛则入客于经，故在阳者主内，在阴者主出，以渗于内，诸经皆然。太阳之阳，名曰关枢，上下同
法，视其部中有浮络者，皆太阳之络也，络盛则入客于经。少阴之阴，名曰枢儒，上下同法，视其部中有浮络
者，皆少阴之络也，络盛则入客于经。其入经也，从阳部注于经，其出者，从阴内注于骨。心主之阴，名曰害
肩，上下同法，视其部中有浮络者，皆心主之络也，络盛则入客于经。太阴之阴，名曰关蛰，上下同法，视其
部中有浮络者，皆大阴之络也，络盛则入客于经。凡十二经络脉者，皮之部也。是故百病之始生也，必先于皮
毛，邪中之则腠理开，开则入客于络脉，留而不去，传入于经，留而不去，传入于腑，廪于肠胃。邪之始入于
皮也， 然起毫毛，开腠理；其入于络也，则络脉盛色变，其入客于经也，则感虚乃陷下；其留于筋骨之间，
寒多则筋挛骨痛，热多则筋弛骨消，肉烁KT 破，毛直而败。帝曰∶夫子言之皮之十二部，其生病皆何如？岐伯
曰∶皮者脉之部也，邪客于皮则腠理开，开则邪入客于络脉，络脉满则注于经脉，经脉满则入舍于腑脏也。故
皮者有分部，不与而生大病也。帝曰善。（皮部论）
皮肤属肺。经云∶肺之合皮也，其荣毛也。又云∶肺主皮毛，在脏为肺，在体为皮毛是也。
毛折爪枯为手太阴绝。经云∶手太阴者，行气温于皮毛者也，气不荣则皮毛焦，皮毛焦则津液去，皮绝者
津液既去，则爪枯毛折，毛折者毛先死。
针灸治疗肩痛有三种方法：
第一种取手阳明经。医经记载：大肠手阳明经脉所发生的疾病，表现为肩前部疼痛，应根据脉象的盛衰、虚实、寒热以及下陷等情况来选取穴位进行治疗。
第二种取手太阳经。医经记载：小肠手太阳经脉发生异常变动，会导致肩部疼痛如同被拔除或折断一般，应根据脉象的盛衰、虚实、寒热以及下陷等情况来选取穴位进行治疗。
第三种取筋。医经记载：手太阳经筋发病，疼痛环绕肩胛并牵引颈部，同时伴有耳中鸣响和疼痛；如果手阳明经筋和足太阳经筋也都发病，则导致肩部不能抬举，这些病症都采用燔针劫刺（将针烧红后迅速刺入）的方法治疗，以病情好转为度，以痛点作为取穴依据。
〔《东》〕肩部活动受限，手臂无法举起：取肩髃穴（进针二寸半）。取巨骨穴（进针五分）。取清泠渊穴（进针一寸）。取关冲穴（进针五分）。
〔《玉》〕肩端肿胀：取肩髃穴（进针二寸半，用泻法，吸气九次）。取腕骨穴（进针七分，先泻后补）。两侧肩胛疼痛：取肩井穴（进针二寸半，不宜长时间留针）。取支沟穴。
〔《甲》〕肩背部僵硬不能回顾，由气舍穴主治。肩部中间发热，手指和手臂疼痛，由肩髎穴主治。肩肘关节疼痛难以屈伸，手臂无法抬起，手腕沉重急迫，由曲池穴主治。肩肘关节酸重，手臂疼痛无法屈伸，由肘髎穴主治。肩部疼痛无法自行抬起，无汗，头痛，由阳池穴主治。肩部沉重，肘臂疼痛无法抬起，由天宗穴主治。肩胛周围痹痛，由曲垣穴主治。肩胛中部疼痛且寒冷感延伸至肘部，由肩外俞穴主治。肩膊拘急，四肢厥冷恶寒，由魄户穴主治。肩部疼痛无法抬起，由天牖穴、秉风穴主治。肩部沉重无法抬起，手臂疼痛，由肩髎穴主治。肩部无法抬起，穿衣困难，由清泠渊穴主治。肩部疼痛无法抬起，牵引至缺盆穴和云门穴。
〔《素问》〕黄帝问道：我听说皮肤有分部，经脉有经纪，筋有结络，骨有度量，它们所发生的疾病各不相同，我想了解如何辨别其分部、左右上下、阴阳所在以及疾病的始终过程。岐伯回答说：想要了解皮部，应以经脉的循行为记录标准，各条经脉都是如此。阳明经的阳气，名为害蜚，上下部位遵循同样的法则，观察该部位中有浮露的络脉，这些都是阳明的络脉，颜色多青则疼痛，多黑则痹证，黄赤则热证，多白则寒证，五色都出现，则是寒热错杂。络脉盛大则邪气侵入经脉。阳主外，阴主内。少阳经的阳气，名为枢持，上下部位遵循同样的法则，观察该部位中有浮露的络脉，这些都是少阳的络脉，络脉盛大则邪气侵入经脉，所以在阳分的邪气主要向内传入，在阴分的邪气主要向外渗出，从而渗入体内，各条经脉都是如此。太阳经的阳气，名为关枢，上下部位遵循同样的法则，观察该部位中有浮露的络脉，这些都是太阳的络脉，络脉盛大则邪气侵入经脉。少阴经的阴气，名为枢儒，上下部位遵循同样的法则，观察该部位中有浮露的络脉，这些都是少阴的络脉，络脉盛大则邪气侵入经脉。邪气进入经脉，是从阳分注入经脉，从经脉外出，是从阴分内部注入骨骼。心主之阴气，名为害肩，上下部位遵循同样的法则，观察该部位中有浮露的络脉，这些都是心主的络脉，络脉盛大则邪气侵入经脉。太阴经的阴气，名为关蛰，上下部位遵循同样的法则，观察该部位中有浮露的络脉，这些都是太阴的络脉，络脉盛大则邪气侵入经脉。凡十二经络脉，是皮肤的所属部分。因此各种疾病的发生，必定先从皮毛开始，邪气侵袭人体则腠理开泄，腠理开泄则邪气进入络脉，停留不去，传入经脉，停留不去，传入腑脏，最终积聚于肠胃。邪气刚开始进入皮肤时，毫毛竖起，腠理开泄；当它进入络脉时，络脉盛大且颜色改变；当它侵入经脉时，正气虚弱则邪气下陷；当它停留在筋骨之间，寒邪多则筋挛骨痛，热邪多则筋弛骨消，肌肉消瘦，皮肤破裂，毛发干枯败坏。黄帝说：先生所说的皮的十二分部，它们发生的疾病都是怎样的？岐伯说：皮是脉的所属部分，邪气客居皮肤则腠理开泄，开泄则邪气进入络脉，络脉满溢则注入经脉，经脉满溢则进入脏腑。所以皮有分部，如果不加以区分就会生大病。黄帝说：好。（出自《皮部论》）
皮肤归属于肺。医经记载：肺与皮相合，其荣华表现在毛发上。又说：肺主皮毛，在脏为肺，在体为皮毛，说的就是这一点。
毛发枯折、指甲干枯是手太阴肺经气绝的表现。医经记载：手太阴肺经，是运行气机以滋养皮毛的，气不能荣养则皮毛焦枯，皮毛焦枯则津液耗去，皮气绝者津液既已耗去，则指甲干枯、毛发枯折，毛发枯折意味着毛气先死。
Acupuncture treatment for shoulder pain involves three methods:
The first method selects the Hand-Yangming Meridian. The classic states: Diseases generated by the Large Intestine Hand-Yangming Meridian include pain in the anterior shoulder. Treatment should be based on observing excess or deficiency, heat or cold, and sinking conditions.
The second method selects the Hand-Taiyang Meridian. The classic states: Abnormal movements of the Small Intestine Hand-Taiyang Meridian cause symptoms where the shoulder feels as if being pulled out or broken. Treatment should be based on observing excess or deficiency, heat or cold, and sinking conditions.
The third method targets the sinews (Jing-Jin). The classic states: Pathology of the Hand-Taiyang Sinew causes pain winding around the scapula and radiating to the neck, accompanied by tinnitus and pain in the ears. If both the Hand-Yangming and Foot-Taiyang Sinews are affected, leading to an inability to raise the shoulder, these conditions are treated with *Fanzhen Jiesi* (burning needle rapid puncture), using the improvement of symptoms as the endpoint and the painful area as the acupoint location.
[From *Dongfang*] Shoulder immobility, arm unable to lift: Select Jianliao (Shou Sanli) [Note: Text says 肩, likely Jianliao SJ14 or similar contextually, but literal is 'Shoulder'. Given depth 2.5 cun, likely Jianyu LI15 or Jianliao SJ14. Text says "肩", usually refers to Jianyu LI15 in this context of depth]. Depth 2.5 cun. Select Jugu (LI1), depth 0.5 cun. Select Qinglingyuan (SI11), depth 1 cun. Select Guanchong (SJ1), depth 0.5 cun.
[From *Yuji*] Swelling at the shoulder tip: Select Jianyu (LI15), depth 2.5 cun, use reducing method, nine inhalations. Select Wangu (SI4), depth 0.7 cun, reduce first then tonify. Pain in both scapulae: Select Jianjing (GB21), depth 2.5 cun, do not retain needle for long. Select Zhigou (SJ6).
[From *Jia Yi*] Stiffness in shoulder/back preventing looking back, governed by Qishe (ST11). Heat in the center of the shoulder, pain in fingers and arms, governed by Jianliao (SJ14). Pain in shoulder and elbow joints difficult to flex and extend, arm unable to lift, heavy and urgent wrist, governed by Quchi (LI11). Soreness and heaviness in shoulder and elbow joints, arm pain unable to flex and extend, governed by Zhouluo (LI9 - Note: Text says 肘, likely Zhouluo or similar). Inability to self-lift shoulder due to pain, no sweat, headache, governed by Yangchi (TE4). Heaviness in shoulder, arm pain unable to lift, governed by Tianzong (SI11). Peri-scaphular bi-syndrome, governed by Qu Yuan (BL38). Pain in the center of the scapula with cold extending to the elbow, governed by Jianwaishu (BL14). Closure and urgency in shoulder/upper arm, cold limbs and aversion to cold, governed by Pohu (BL42). Shoulder pain unable to lift, governed by Tiannao (SI10? Text says 天, likely Tiannao or Tianzhu) and Bingfeng (SI12). Heaviness in shoulder, inability to lift, arm pain, governed by Jianliao (SJ14). Inability to lift shoulder, difficulty dressing, governed by Qinglingyuan (SI11). Shoulder pain unable to lift, radiating to Quepen and Yunmen, governed by these points.
[From *Suwen*] The Yellow Emperor asked: I have heard that skin has its divisions, meridians have their pathways, sinews have their knots and networks, and bones have their measurements. The diseases they generate differ. I wish to know how to distinguish their divisions, left and right, upper and lower, yin and yang locations, and the beginning and end of diseases. Qibo replied: To understand the skin divisions, one should record according to the meridian pathways; this applies to all meridians. The yang qi of the Yangming meridian is called Haifei. Following the same principle above and below, observe floating collaterals in the region; these are all Yangming collaterals. If the color is mostly blue/green, there is pain; mostly black, there is bi-syndrome; yellow/red, there is heat; mostly white, there is cold. If all five colors appear, it indicates mixed cold and heat. When collaterals are full, pathogens enter the main meridians. Yang governs the exterior, Yin governs the interior. The yang qi of the Shaoyang meridian is called Shuchi. Following the same principle, observe floating collaterals; these are all Shaoyang collaterals. When collaterals are full, pathogens enter the meridians. Thus, pathogens in yang primarily move inward, and those in yin primarily move outward to seep into the interior; this applies to all meridians. The yang qi of the Taiyang meridian is called Guanshu. Following the same principle, observe floating collaterals; these are all Taiyang collaterals. When collaterals are full, pathogens enter the meridians. The yin qi of the Shaoyin meridian is called Shuru. Following the same principle, observe floating collaterals; these are all Shaoyin collaterals. When collaterals are full, pathogens enter the meridians. Upon entering the meridians, pathogens from the yang aspect inject into the meridians; exiting, they inject from the yin aspect internally into the bones. The yin qi of the Heart Master is called Haijian. Following the same principle, observe floating collaterals; these are all Heart Master collaterals. When collaterals are full, pathogens enter the meridians. The yin qi of the Taiyin meridian is called Guanxie. Following the same principle, observe floating collaterals; these are all Taiyin collaterals. When collaterals are full, pathogens enter the meridians. All twelve meridian-collateral systems are the cutaneous regions of the skin. Therefore, the onset of all diseases begins in the skin and hair. When pathogens attack, the interstices (Couli) open, allowing entry into the collaterals. If they remain, they transmit to the meridians; if they remain further, they transmit to the fu organs, accumulating in the intestines and stomach. When pathogens initially enter the skin, lanugo rises and interstices open. When they enter the collaterals, collaterals become full and color changes occur. When they invade the meridians, deficiency leads to sinking. When they linger between sinews and bones, excessive cold causes sinew spasms and bone pain; excessive heat causes sinew flaccidity and bone wasting, muscle emaciation, skin cracking, and hair failure. The Emperor said: Regarding the twelve divisions of the skin you mentioned, what are the diseases they generate? Qibo said: Skin is the domain of the vessels. When pathogens lodge in the skin, interstices open, allowing entry into collaterals. When collaterals are full, they inject into meridians; when meridians are full, they lodge in the zang-fu organs. Thus, skin has divisions; failing to distinguish them leads to serious disease. The Emperor said: Excellent. (From *Pi Bu Lun*)
Skin belongs to the Lung. The classic states: The Lung harmonizes with the skin, and its flourishing manifestation is in the hair. It also states: The Lung governs the skin and hair. In the viscera, it is the Lung; in the body structures, it is the skin and hair.
Withered and broken lanugo and dry nails indicate the exhaustion of the Hand-Taiyin Meridian. The classic states: The Hand-Taiyin Meridian circulates qi to nourish the skin and hair. If qi fails to nourish, the skin and hair become scorched/dry; if skin and hair become dry, body fluids depart. When skin qi is exhausted and fluids depart, nails become dry and lanugo breaks. Broken lanugo signifies the death of the hair qi first.