〔《灵》〕缺盆之中任脉也，名曰天突。（当缺盆中央动脉是也。）一次任脉侧之动脉，足阳
明也，名曰人迎。（挟喉二旁之动脉是也。）二次脉手阳明也，名曰扶突。（挟喉动脉之后，曲颊
之前一寸后是。）三次脉手太阳也，名曰天窗。（手阳明之后，当曲颊之下是也。）四次脉足少阳也，
名曰天容。（曲颊之后，当耳之下是也。）五次脉手少阳也，名曰天牖。（耳后当完骨上是也。）
六次脉足太阳也，名曰天柱。（挟项大筋中是也。）七次脉颈中央之脉，督脉也，名曰风府。
足阳明，挟喉之动脉也，其 在膺中。手阳明，次在其 外，不至曲颊一寸。太阳当曲颊。
足少阳在耳下，曲颊之后。手少阳出耳后，上加完骨之上。足太阳挟项，大筋之中。（俱本输篇）
〔《内经》〕刺灸项颈痛有二。
其一，取足手太阳，治项后痛。经云∶足太阳之脉，是动则病项如拔，视虚盛寒热陷下取之。
又云∶项痛不可俯仰，刺足太阳；不可以顾，刺手太阳。又云∶大风项颈痛，刺风府，风府在上椎。
又云∶邪客于足太阳之络，令人头项肩痛，刺足小指爪甲上与肉交者各一 ，立已。不已则刺外
踝下三 ，左取右，右取左，如食顷是也。
其二，取足手阳明，治颈前痛。经云∶足阳明之脉，所生病者颈肿。又云∶手阳明之脉，是
动则病颈肿，皆视盛虚寒热陷下取之也。
〔《玄》〕颈项痛∶后溪。
〔《玉》〕项强∶承浆 风府。
〔《甲》〕头项痛重，暂起僵仆，鼻窒鼽衄，喘息不得通，通天主之。顶上痛风头重，目如脱，
不可左右顾，百会主之。颈痛项不得顾，目泣出，多 ，鼻鼽衄，目内 赤痛，气厥，耳目不用，咽喉
偻引项筋挛不收，风池主之。项肿，不可俯仰，颊肿引耳，完骨主之。项强刺喑门。颈项痛不
可以俯仰，头痛，振寒，螈 ，气实则胁满，侠脊有并气，热汗不出，腰背痛，大杼主之。
东风生于春，病在肝 ，在颈项。（全文见五脏。）
〔《本》〕治筋急，项不得转侧，木瓜煎。
木瓜（两个，取盖去穣） 没药（研，二两） 乳香（研，二分）
上二味，纳木瓜中用盖子合了，竹签签定，饭上蒸三四次，研烂成膏子。每服三五匙，地黄酒化
下，生地黄汁半盏，无灰酒二盏和之，用八分一盏，热暖化服。
有人患此证，自午后发至黄昏时定。予曰∶此患先必从足起，经言足十二经络各有筋，惟足太
阳之筋，自足至项，大抵筋者肝之合也，日中至黄昏天之阳，阳中之阴也。又曰，阳中之阴肺也，自
离至兑，阴旺阳弱之时。故《灵宝毕法》云∶离至干，肾气绝而肝气弱，肝肾二脏受阴气，故发于是
时。予授此方三服而愈。
〔丹〕男子项强不能回顾，动则微痛，诊其脉弦而数实，右手为甚。予作痰热客太阳经治之。用
二陈汤加酒洗黄芩、羌活、红花，服后二日愈。
〔垣〕养神汤治精神短少，不得睡，项筋肿急难伸，禁甘温，宜苦寒。
黄 （一钱） 人参（三分） 甘草（七分） 苍术（五分） 白术（三分） 柴胡（四钱） 升麻（四钱）
归身（五分） 麦芽（五分） 木香（一分） 川芎（三分） 半夏（七分） 橘皮（一钱） 黄连（五分）
黄芩（酒二分） 黄柏（一分）
上 咀，每服五钱，水二盏，煎去渣，稍热服，不拘时。
〔《本》〕治肾气上攻项背，不能转移，椒附散。
大附子（一枚，六钱上者。炮去皮脐，末之）
上末，每二大钱，好川椒二十粒，用白面填满，水一盏半，生姜七片，通煎至七分，去椒入盐，
空心服。
予一亲戚，患项筋痛连背髀，不可转移，服诸风药皆不效，予尝忆《千金》髓有肾气攻背强一
证，予处此方与之，一服顿瘥。自尔与人，皆有验。盖肾气自腰夹脊上至曹溪穴，然后入泥丸宫。
曹溪一穴，非精于搬运者不能透，今逆行至此不得通，用椒以引归经则安矣。气上达，椒下达，故
服之愈。
〔《千》〕治风项强，不得顾视。穿地作坑，烧令通赤，以水洒之令冷，纳生桃叶铺其席下卧之，
令项在药上，以衣着项边，令气上蒸，病患汗出，良久即瘥。
又方 治头项强，不得顾视。蒸大豆一升令变色，纳囊中枕之。
诸痉项强，皆属于湿。（全文见诊法，治法见伤寒项强条。）
【《灵枢》】缺盆中央的任脉，名为天突。（即缺盆中央动脉处。）第一次在任脉侧面的动脉，属足阳明胃经，名为人迎。（即喉部两侧旁的动脉处。）第二次脉在手阳明大肠经，名为扶突。（位于喉部动脉后方，下颌角前一寸后处。）第三次脉在手太阳小肠经，名为天窗。（位于手阳明经之后，正对下颌角下方处。）第四次脉在足少阳胆经，名为天容。（位于下颌角后方，正对耳下处。）第五次脉在手少阳三焦经，名为天牖。（位于耳后完骨穴上方处。）第六次脉在足太阳膀胱经，名为天柱。（位于项部大筋中间处。）第七次脉在颈中央的督脉，名为风府。足阳明胃经，挟持喉部的动脉，其位置在胸前。手阳明大肠经，其次在其外侧，距离下颌角一寸处。足太阳膀胱经正当下颌角。足少阳胆经在耳下，下颌角之后。手少阳三焦经出于耳后，向上加于完骨之上。足太阳膀胱经挟持项部，在大筋之中。（以上均依据《灵枢·本输》篇）
【《内经》】针刺和艾灸治疗项颈疼痛有两种方法。
第一种，取用手太阳小肠经和足太阳膀胱经，治疗项后疼痛。经文说：足太阳膀胱经发生变动时，病症表现为项部像被拔扯一样，需根据虚实、寒热及穴位陷下情况选取穴位进行治疗。又说：项痛不能前后俯仰，针刺足太阳膀胱经；不能左右回顾，针刺手太阳小肠经。又说：大风引起的项颈痛，针刺风府穴，风府穴位于上椎骨处。又说：邪气客居在足太阳膀胱经的络脉，使人头、项、肩疼痛，针刺足小趾爪甲角与肉交接处各一穴，立刻见效。若无效，则针刺外踝下三寸处，左病取右，右病取左，约吃一顿饭的时间即可痊愈。
第二种，取用手阳明大肠经和足阳明胃经，治疗颈前疼痛。经文说：足阳明胃经所生的疾病有颈部肿胀。又说：手阳明大肠经发生变动时，病症表现为颈部肿胀，均需根据虚实、寒热及穴位陷下情况选取穴位进行治疗。
【《标幽赋》等针灸歌赋】颈项痛：取后溪穴。
【《玉机真脏论》等】项强（项部僵硬）：取承浆穴、风府穴。
【《针灸甲乙经》】头项疼痛沉重，突然起身时僵倒，鼻塞流涕或鼻出血，喘息不通，由通天主治。头顶痛风、头重、眼珠像要脱出、不能左右回顾，由百会主治。颈痛项强不能回顾，流泪，多唾沫，鼻流清涕或鼻出血，目内眦红痛，气逆厥冷，耳目失灵，咽喉拘急牵引项部筋脉挛缩不收，由风池主治。项部肿胀，不能俯仰，颊部肿胀牵引耳部，由完骨主治。项强刺喑门穴。颈项痛不能俯仰，头痛，恶寒战栗，抽搐，气实则胁肋胀满，夹脊有并聚之气，发热无汗，腰背痛，由大杼主治。
东风生于春季，病变在肝，表现在颈项。（全文见五脏相关章节。）
【《本草纲目》】治疗筋脉拘急，项部不能转动，用木瓜煎剂。
木瓜（两个，去掉盖子和瓤） 没药（研细，二两） 乳香（研细，二分）
将上述两味药放入木瓜中，盖上盖子，用竹签固定，在饭上蒸三四次，研烂成膏状。每次服用三五匙，用地黄酒化开送服，加入生地黄汁半盏，无灰酒二盏调和，取八分之一盏的量，温热化开后服用。
有人患此证，从午后发作直到黄昏时停止。我说：此患者必定先从足部开始发病。经文说足十二经络各有筋，只有足太阳之筋，从足部一直延伸到项部。大致来说，筋是肝的外合。中午到黄昏，是天时的阳气，也是阳中之阴。又说，阳中之阴对应肺，从午时（离）到酉时（兑），是阴气旺盛、阳气衰弱的时候。所以《灵宝毕法》说：从离到干，肾气绝而肝气弱，肝肾两脏受阴气影响，所以在此时发作。我给予此方，服用三次后痊愈。
【李东垣】男子项强不能回顾，活动时有轻微疼痛，诊察其脉象弦而数实，右手更为明显。我将其辨为痰热客居于太阳经进行治疗。使用二陈汤加酒洗黄芩、羌活、红花，服用两天后痊愈。
【李杲（东垣）】养神汤治疗精神短少，无法入睡，项部筋脉肿胀拘急难以伸展，禁止甘温药物，宜用苦寒药物。
黄芪（一钱） 人参（三分） 甘草（七分） 苍术（五分） 白术（三分） 柴胡（四钱） 升麻（四钱） 当归身（五分） 麦芽（五分） 木香（一分） 川芎（三分） 半夏（七分） 橘皮（一钱） 黄连（五分） 黄芩（酒浸二分） 黄柏（一分）
切碎，每服五钱，水两盏，煎煮去渣，稍热时服用，不拘时间。
【《本草纲目》】治疗肾气上攻项背，不能转动，用椒附散。
大附子（一枚，六钱以上的优质者。炮制去皮脐，研末）
将附子研末，每次取两大钱，好川椒二十粒，用白面填满川椒内部，加水一盏半，生姜七片，共同煎至七分，去掉花椒，加入盐，空腹服用。
我的一个亲戚，患项筋痛牵连背部和大腿，不能转动，服用各种祛风药都无效。我曾回忆《千金方》中有肾气攻背强这一证候，于是开出此方给他，服用一次后立刻痊愈。从此以后给别人用，都有疗效。大概肾气从腰部夹脊上行至曹溪穴，然后进入泥丸宫。曹溪这一穴位，不是精通导引搬运的人不能通过，现在气逆行至此不得通畅，用花椒引导回归经脉则安定了。气向上达，花椒向下行，所以服药后痊愈。
【《千金方》】治疗风邪引起的项强，不能回顾视物。挖地作坑，烧得通红，用水洒使其冷却，将生桃叶铺在席下让人躺卧，让项部位于药叶之上，用衣物覆盖项部边缘，使热气向上熏蒸，病人出汗，很久之后即痊愈。
又一方：治疗头项强直，不能回顾视物。蒸大豆一升直到变色，装入囊中枕着它。
所有的痉病项强，都属于湿邪。（全文见诊法章节，治疗方法见伤寒项强条。）
[From *Ling Shu*] The Ren Mai (Conception Vessel) at the center of the clavicular fossa is named Tian Tu (Heavenly Protrusion). (This corresponds to the arterial pulse at the center of the clavicular fossa.) The first pulse on the lateral side of the Ren Mai belongs to the Foot-Yangming Stomach Channel, named Ying Sang (Human Well). (This corresponds to the arterial pulse on both sides of the throat.) The second pulse is in the Hand-Yangming Large Intestine Channel, named Futu (Supporting Prominence). (Located one cun posterior to the anterior border of the mandible, behind the arterial pulse of the throat.) The third pulse is in the Hand-Taiyang Small Intestine Channel, named Tian Chuang (Heavenly Window). (Posterior to the Hand-Yangming channel, directly below the angle of the mandible.) The fourth pulse is in the Foot-Shaoyang Gallbladder Channel, named Tian Rong (Heavenly Reception). (Posterior to the angle of the mandible, directly below the ear.) The fifth pulse is in the Hand-Shaoyang Sanjiao Channel, named Tian You (Heavenly Aperture). (Above the Wang Gu point behind the ear.) The sixth pulse is in the Foot-Taiyang Bladder Channel, named Tian Zhu (Heavenly Pillar). (In the middle of the large tendons of the nape.) The seventh pulse is in the Du Mai (Governing Vessel) at the center of the neck, named Feng Fu (Wind Palace). The Foot-Yangming Stomach Channel has an arterial pulse flanking the throat, located in the chest. The Hand-Yangming Large Intestine Channel is next, lateral to it, one cun from the angle of the mandible. The Foot-Taiyang Bladder Channel is at the angle of the mandible. The Foot-Shaoyang Gallbladder Channel is below the ear, posterior to the angle of the mandible. The Hand-Shaoyang Sanjiao Channel emerges behind the ear and ascends above the Wang Gu point. The Foot-Taiyang Bladder Channel flanks the nape, within the large tendons. (All based on the *Ben Shu* chapter of *Ling Shu*).
[From *Nei Jing*] There are two methods for acupuncture and moxibustion treatment of neck and nape pain.
The first involves selecting the Hand-Taiyang Small Intestine Channel and Foot-Taiyang Bladder Channel to treat pain at the back of the neck. The classic states: When the Foot-Taiyang Bladder Channel is disturbed, the symptom is a sensation as if the neck is being pulled out; treat according to deficiency, excess, cold, heat, or sunken points. It also states: For neck pain with inability to flex or extend, puncture the Foot-Taiyang Bladder Channel; for inability to turn the head, puncture the Hand-Taiyang Small Intestine Channel. It further states: For wind-induced neck and nape pain, puncture Feng Fu, which is located at the upper vertebra. Additionally: If pathogenic factors lodge in the collaterals of the Foot-Taiyang Bladder Channel, causing pain in the head, neck, and shoulder, puncture the area where the nail meets the flesh at the tip of the little toe, one point on each side, and relief will be immediate. If not relieved, puncture three cun below the lateral malleolus, treating the left side for right-sided symptoms and vice versa, within the time it takes to eat a meal.
The second involves selecting the Hand-Yangming Large Intestine Channel and Foot-Yangming Stomach Channel to treat pain at the front of the neck. The classic states: Diseases generated by the Foot-Yangming Stomach Channel include neck swelling. It also states: When the Hand-Yangming Large Intestine Channel is disturbed, the symptom is neck swelling; treat all such cases according to deficiency, excess, cold, heat, or sunken points.
[From Acupuncture Classics] Neck and nape pain: Select Hou Xi (SI3).
[Nape stiffness]: Select Cheng Jiang (CV24), Feng Fu (GV16).
[From *Zhen Jiu Jia Yi Jing*] Head and neck pain with heaviness, sudden stiffening and falling upon rising, nasal obstruction, epistaxis, and dyspnea: Treated by Tong Tian (BL31). Head wind pain, heavy head, eyes feeling as if protruding, inability to look left or right: Treated by Bai Hui (GV20). Neck pain with inability to turn the head, tearing, excessive saliva, rhinorrhea or epistaxis, redness and pain in the inner canthus, Qi rebellion, deafness and blindness, throat spasm pulling on neck tendons: Treated by Feng Chi (GB20). Neck swelling with inability to flex/extend, cheek swelling pulling to the ear: Treated by Wan Gu (GB12). Nape stiffness: Puncture Yin Men (TE18). Neck and nape pain with inability to flex/extend, headache, chills, convulsions, fullness in hypochondrium due to excess Qi, combined Qi along the spine, fever without sweat, lower back pain: Treated by Da Shu (BL11).
East wind arises in spring, disease affects the Liver, manifesting in the neck and nape. (Full text see Five Zang Organs.)
[From *Ben Cao Gang Mu*] To treat tendon tightness and inability to turn the neck, use Qu Gua Decoction.
Qu Gua (Papaya, two fruits, remove lid and pulp) Moyao (Myrrh, ground, 2 liang) Ruxiang (Frankincense, ground, 2 fen)
Place the latter two herbs inside the Qu Gua, replace the lid, secure with bamboo pins, and steam over rice three to four times until soft. Grind into a paste. Take 3-5 spoons per dose, dissolved in Di Huang Jiu (Rehmannia Wine), mixed with Ban Zhan (half cup) of Sheng Di Huang Zhi (Fresh Rehmannia Juice) and Er Zhan (two cups) of Wu Hui Jiu (Unadulterated Wine). Take one-eighth of a cup, warmed and dissolved, taken warm.
A patient suffered from this condition, starting in the afternoon and resolving at dusk. I said: This patient likely started with foot symptoms. The classic states that the twelve Foot channels have tendons, but only the Foot-Taiyang tendon extends from the foot to the nape. Generally, tendons are the exterior correspondence of the Liver. From midday to dusk is the Yang time of heaven, specifically Yin within Yang. Also, Yin within Yang corresponds to the Lung. From Li (Wu hour, noon) to Dui (You hour, 5-7 PM) is the time when Yin is prosperous and Yang is weak. Thus, *Ling Bao Bi Fa* states: From Li to Qian, Kidney Qi is exhausted and Liver Qi is weak; the Liver and Kidney organs receive Yin Qi, so the attack occurs at this time. I prescribed this formula, and after three doses, the patient recovered.
[Li Dongyuan] In men with nape stiffness and inability to look back, with slight pain upon movement, the pulse is wiry, rapid, and excess, more pronounced on the right hand. I treated this as Phlegm-Heat lodging in the Taiyang Channel. Used Er Chen Tang (Two-Cured Decoction) plus Jiu Xi Huang Qin (Alcohol-washed Scutellaria Root), Qiang Huo (Notopterygium Rhizome), and Hong Hua (Carthamus Flower). The patient recovered after two days.
[Li Gao] Yang Shen Tang (Spirit-Nourishing Decoction) treats shortness of spirit, insomnia, and swollen/tight neck tendons difficult to extend. Avoid sweet-warm herbs; prefer bitter-cold herbs.
Huang Qi (Astragalus Root, 1 qian) Ren Shen (Ginseng Radix, 3 fen) Gan Cao (Licorice Root, 7 fen) Cang Zhu (Atractylodis Rhizoma, 5 fen) Bai Zhu (Atractylodis Macrocephalae Rhizoma, 3 fen) Chai Hu (Bupleuri Radix, 4 qian) Sheng Ma (Cimicifugae Rhizoma, 4 qian) Dang Gui Shen (Angelica Sinensis Root Heart, 5 fen) Mai Ya (Hordei Fructus Germinatus, 5 fen) Mu Xiang (Aucklandiae Radix, 1 fen) Chuan Xiong (Ligusticum Chuanxiong Rhizome, 3 fen) Ban Xia (Pinelliae Rhizoma, 7 fen) Ju Pi (Citri Reticulatae Pericarpium, 1 qian) Huang Lian (Coptidis Rhizoma, 5 fen) Huang Qin (Scutellariae Radix, alcohol-soaked 2 fen) Huang Bo (Phellodendri Cortex, 1 fen)
Coarsely powder. Take 5 qian per dose, decoct in two zhan of water, strain, and take slightly warm, at any time.
[From *Ben Cao Gang Mu*] To treat Kidney Qi attacking the nape and back with immobility, use Jiao Fu San (Pepper and Aconite Powder).
Da Fu Zi (Prepared Aconite Lateral Root, one piece, weighing 6 qian or more. Processed, skin and umbilicus removed, powdered)
Powder the Aconite. Take two large qian per dose, with 20 grains of Hao Chuan Jiao (Sichuan Pepper), filled with white flour. Decoct with one and a half zhan of water and seven slices of fresh ginger until reduced to seven parts. Remove the pepper, add salt, and take on an empty stomach.
A relative of mine suffered from neck tendon pain radiating to the back and thighs, unable to move. Various wind-dispelling herbs were ineffective. I recalled a syndrome in *Qian Jin Fang* of Kidney Qi attacking the back causing stiffness, so I prescribed this formula. One dose brought immediate recovery. Since then, it has been effective for others. Generally, Kidney Qi ascends from the waist along the spine to the Cao Xi point, then enters the Ni Wan Palace. The Cao Xi point cannot be penetrated unless one is skilled in Dao Yin exercises. Now, Qi rebels and stops here. Using Pepper guides the Qi back to its channel, bringing peace. Qi reaches the upper part, Pepper descends, hence recovery.
[From *Qian Jin Fang*] To treat wind-induced nape stiffness with inability to look back: Dig a pit, heat it until red, sprinkle water to cool it. Place fresh peach leaves under the mat for lying down. Position the neck over the herbs, cover the edges with clothing to trap the vapor. Allow the patient to sweat; after a long time, the condition resolves.
Another prescription for head and nape stiffness with inability to look back: Steam one sheng of soybeans until they change color, place them in a bag, and use as a pillow.
All spasmodic conditions with nape stiffness belong to Dampness. (Full text see Diagnosis Methods; treatment see Spastic Nape Stiffness section in Shang Han.)