〔丹〕面鼻得冷则黑论 诸阳聚于头，则面为阳中之阳，鼻居面中央，而阳明起于 中，一身之血
运到面鼻阳部，皆为至清至精之气矣。酒性善行而喜升，大热而有峻急之毒，多酒之人，酒气熏蒸面鼻，
血得酒为极热，热血得冷为阴气所搏，污浊凝结，滞而不行，宜其先为紫而后为黑色也。须用融化滞血，
使得流通，滋生新血，可以运化，病乃可愈。予尝以酒制四物汤加酒炒片芩、陈皮、生甘草、酒红花、
生姜，煎，调下五灵脂末饮之。气弱形肥者加酒黄 ，无有不应。（入好酒数滴为引使。）
肩背痛属肺分野病。经云∶西风生于秋，病在肺 ，在肩背，故秋气者病在肩背。又云∶秋肺太过为病，
在外则令人逆气，背痛愠愠然是也。
〔垣〕《脉经》云∶风寒汗出，肩背痛，中风小便数而欠者，风热乘其肺，使肺气郁甚也，当泻风热以
通气，防风汤主之。
柴胡 升麻 黄 （各一钱） 防风 羌活 陈皮 人参 甘草（各五分） 本 青皮（各三分）
黄柏（一分） 白蔻仁（二分）
上 咀，作一服，水煎，温服食后。气盛者宜服，面白脱色气短者勿服。
肩背痛不可回顾，此手太阳气郁而不行，以风药散之。
〔丹〕治一男子忽患背胛缝有一线痛起，上肩跨至胸前侧胁而止，其痛昼夜不歇，不可忍，诊其脉弦而数，
重取豁大，左大于右。予意背胛小肠经也，此必思虑伤心，心脏未病而腑小肠先病，故痛从背胛起。及虑不能
决，又归之胆，故痛至胸胁而止。乃小肠火乘胆木，子来乘母，是为实邪。询之，果因谋事不遂而病。故用人
参四分，木通二分煎汤，使吞龙胆丸数服而愈。
二阳一阴发病，主惊骇，背痛善噫。（全文见诊病传变。）
运气 肩背痛皆属火攻肺病。经云∶岁火太过，民病肩背热。又云∶少阴司天，热淫所胜，病肩背 缺盆
中痛。又云∶岁金不及，其病内舍膺胁肩背，外在皮毛，治以寒剂是也。
针灸 肩背有二法∶
其一取肺。经云∶肺病者喘咳逆气，肩背痛，汗出，取其经太阴足太阳之外厥阴内血者。又云∶肺手太阴
之脉，气盛有余，则肩背痛，风寒汗出，气虚则肩背痛，寒少气不足以息，视盛虚热寒陷下取之是也。
其二取肾。经云∶邪在肾则病肩背颈项痛，时眩，取之涌泉、昆仑，视有血者尽取之是也。
〔《玉》〕肩背痛连胛∶胛缝（在背 骨下，直腋缝尖及臂，取二寸半，泻六吸。） 五枢（二寸半，
泻八吸。）
〔世〕肩背胛痛∶昆仑 悬钟 肩井
〔《东》〕肩背颈项腋前痛，与胸相引者∶涌泉（一分，见血，妙。） 前腋（刺面上一寸。）
又法∶气舍（五分） 天 （灸） 曲池（一寸半。） 天井（五分）
〔《甲》〕肩背痹痛不举，血瘀肩中，不能动摇，巨骨主之。肩背不可自带衣，臂腕外侧痛不举，阳谷
主之。肩背欲折， 如拔，手不能自上下，养老主之。项背痛引颈，魄户主之。肩痛胸满凄厥，脊背急强，神
堂主之。肩背髀痛，臂不举，寒热凄索，肩井主之。
〔通玄〕肩背痛，手三里主之。
〔《素》〕寸口脉中手促上击者，曰肩背痛。（平人气象论）
【丹溪】面鼻遇冷变黑论：诸阳经汇聚于头部，因此面部是阳中之阳。鼻子位于面部中央，而阳明经起始于此，运行至面鼻这一阳气部位的血液，都是极其清纯精微的气血。酒性善于行走且喜好上升，性质大热且具有猛烈急迫的毒性。长期饮酒的人，酒气熏蒸面鼻，血液因酒的作用变得极热；热血遇到寒冷，被阴气所遏制，导致污浊凝结，气血滞涩不行，所以面色先变为紫色，继而变为黑色。必须使用化解瘀滞之血的方法，使气血流通，滋生新血，从而恢复运化功能，疾病才能痊愈。我曾以酒制的四物汤为基础，加入酒炒的黄芩、陈皮、生甘草、酒制红花、生姜，煎煮后，调服五灵脂粉末饮用。对于气弱形体肥胖者，加用酒制的黄芪，没有不奏效的。（加入几滴好酒作为引经药。）
肩背痛属于肺经分野的疾病。《内经》说：西风生于秋季，病位在肺，表现在肩背，所以秋季的病邪多侵犯肩背。又说：秋季肺气太过致病，在体表则使人气逆，背部隐隐作痛，正是此意。
【垣】《脉经》说：风寒感冒出汗，肩背痛，中风伴小便频数且尿量少者，这是风热侵袭肺部，致使肺气郁闭严重，应当泻除风热以通畅气机，用防风汤主治。
柴胡、升麻、麻黄（各一钱），防风、羌活、陈皮、人参、甘草（各五分），藁本、青皮（各三分），黄柏（一分），白蔻仁（二分）。
以上药物捣碎，为一剂，加水煎煮，饭后温服。正气盛者适宜服用，面色苍白、脱色、气短者禁止服用。
肩背痛不能回顾，这是手太阳经气机郁滞而不运行，需用风药发散。
【丹溪】治疗一名男子突然患背胛缝处有一线疼痛，向上延伸至肩部跨越至胸前侧胁部停止，疼痛昼夜不停，难以忍受。诊察其脉象弦而数，重按豁然宽大，左脉大于右脉。我推测背胛部位属小肠经，这必定是因为思虑过度损伤心脏，心脏尚未发病而腑脏小肠先受病，所以疼痛从背胛开始。进而考虑无法决断，又归结于胆经，所以疼痛止于胸胁。这是小肠火邪乘袭胆木，子盗母气，属于实邪。询问病情，果然因为谋划事情不顺遂而致病。于是用人参四分，木通二分煎汤，送服龙胆丸数次而痊愈。
二阳一阴发病，主要表现为惊骇，背痛且容易嗳气。（全文见诊病传变章节。）
运气学说认为：肩背痛皆属于火邪攻肺的病证。《内经》说：岁火太过，民众易患肩背发热。又说：少阴司天，热气淫胜，病见肩背及缺盆中疼痛。又说：岁金不及，其病在内则舍于膺胁肩背，在外则涉及皮毛，治疗应用寒凉药剂。
针灸治疗肩背有两种方法：
其一取肺经。《内经》说：肺病患者喘咳气逆，肩背痛，出汗，应取其经脉，即足太阴之外、足太阳之外、厥阴之内出血处。又说：手太阴肺经，气盛有余，则肩背痛，风寒出汗；气虚则肩背痛，恶寒，气短不足以息，视其虚实寒热陷下情况取穴治疗。
其二取肾经。《内经》说：邪气在肾则病见肩背颈项痛，时常眩晕，取涌泉、昆仑穴，视有瘀血者尽刺之。
【《玉枢》】肩背痛连及背胛：取胛缝（在背骨下，直对腋缝尖及手臂，取二寸半，泻法六吸。）五枢穴（二寸半，泻法八吸。）
【《东垣》】肩背颈项腋前痛，牵引胸部者：取涌泉穴（一分，见血，效果妙。）前腋穴（刺入深一寸。）
另一法：取气舍穴（五分）、天突穴（灸法）、曲池穴（一寸半）、天井穴（五分）。
【《甲乙经》】肩背痹痛不能举动，血瘀于肩中，不能动摇，巨骨穴主治。肩背不能自携带衣物，臂腕外侧痛不能举起，阳谷穴主治。肩背欲折，如拔毛般疼痛，手不能上下活动，养老穴主治。项背痛牵引颈部，魄户穴主治。肩痛胸满凄厥，脊背急强，神堂穴主治。肩背髀痛，手臂不能举起，寒热凄索，肩井穴主治。
【《素问》】寸口脉触手中促急上击者，称为肩背痛。（出自平人气象论篇）
[Danxi] Discussion on the Blackening of the Face and Nose upon Exposure to Cold: All Yang meridians converge at the head; therefore, the face is "Yang within Yang." The nose resides in the center of the face, where the Yangming meridians originate. The blood circulating to the face and nose, which are Yang regions, consists of extremely pure and refined Qi and Blood. Wine has a nature that promotes movement and ascending, possessing intense heat and severe toxicity. In individuals who consume excessive wine, the fumes of wine steam the face and nose. The Blood becomes extremely hot due to the wine; when this hot Blood encounters cold, it is constrained by Yin pathogens, leading to turbid coagulation and stagnation without flow. Hence, the complexion first turns purple and subsequently black. It is necessary to employ methods to resolve stagnant Blood, allowing it to circulate freely, generate new Blood, and restore metabolic function, so that the disease may be cured. I once used Siwu Tang (Four Substances Decoction) processed with wine, adding Huangqin (Scutellariae Radix) stir-fried with wine, Chenpi (Citri Reticulatae Pericarpium), Sheng Gancao (Raw Glycyrrhizae Radix), Honghua (Carthami Flos) processed with wine, and Shengjiang (Zingiberis Rhizoma Recens). After decocting, Wu Lingzhi powder (Trogopteri Dung) was mixed in for oral administration. For patients with weak Qi and obese physique, Huangqi (Astragali Radix) processed with wine was added, yielding consistent results. (A few drops of good-quality wine were added as a guiding agent.)
Shoulder and back pain belongs to the pathological domain of the Lung. The Classics state: "West wind arises in autumn, the disease is in the Lung, manifesting in the shoulder and back." Thus, autumnal pathogens often affect the shoulder and back. It is also stated: "Excessive Lung Qi in autumn causes disease; externally, it leads to rebellious Qi and a lingering sensation of pain in the back."
[Yuan] The *Mai Jing* (Pulse Classic) states: "Wind-cold with sweating, shoulder and back pain, and wind-stroke with frequent urination and scanty voids indicate that Wind-Heat has invaded the Lung, causing severe Qi stagnation. One should drain Wind-Heat to unblock Qi, using Fangfeng Tang (Saposhnikoviae Decoction)."
Chaihu (Bupleuri Radix), Shengma (Cimicifugae Rhizoma), Mahuang (Ephedrae Herba) (each 1 qian); Fangfeng (Saposhnikoviae Radix), Qianghuo (Notopterygii Rhizoma et Radix), Chenpi (Citri Reticulatae Pericarpium), Renshen (Ginseng Radix), Gancao (Glycyrrhizae Radix) (each 0.5 qian); Gaoben (Ligustici Rhizoma et Radix), Qingpi (Aurantii Fructus Immaturus) (each 0.3 qian); Huangbai (Phellodendri Cortex) (0.1 qian); Baokouren (Amomi Fructus Rotundus) (0.2 qian).
Crush the above herbs into coarse pieces. Prepare one dose, decoct in water, and take warm after meals. Suitable for those with robust Qi; contraindicated for those with pale complexion, loss of luster, and shortness of breath.
Inability to turn the head due to shoulder and back pain indicates Qi stagnation in the Hand-Taiyang meridian; disperse it with Wind-dispelling herbs.
[Danxi] Treated a male patient who suddenly experienced a linear pain starting from the interscapular region, extending upward to the shoulder and crossing to the lateral chest and hypochondrium. The pain persisted day and night, unbearable. His pulse was wiry and rapid; deep palpation revealed a hollow and large quality, with the left pulse larger than the right. I surmised that the interscapular region corresponds to the Small Intestine meridian. This must have resulted from overthinking damaging the Heart; although the Heart itself was not diseased, its paired Fu organ, the Small Intestine, was affected first, hence the pain originated in the interscapular area. Further analysis led me to consider the Gallbladder, explaining why the pain stopped at the chest and hypochondrium. This represents Small Intestine Fire attacking Gallbladder Wood, where the child (Fire) attacks the mother (Wood), constituting an Excess pathogen. Inquiry confirmed the illness stemmed from unsuccessful planning. Therefore, I prescribed Renshen (Ginseng Radix) 4 fen and Mutong (Akebiae Caulis) 2 fen decocted in water, used to swallow Longdan Wan (Gentian Pills) several times, resulting in recovery.
When Er-Yang (Yang Ming and Tai Yang) and Yi-Yin (Jue Yin) are involved in disease onset, the main manifestations are fright and terror, back pain, and frequent belching. (See full text in the section on Disease Transmission.)
According to the Theory of Five Movements and Six Qi: Shoulder and back pain all belong to diseases where Fire attacks the Lung. The Classics state: "When Year Fire is excessive, the people suffer from heat in the shoulder and back." It also states: "When Shaoyin governs the year, excessive Heat causes disease manifesting as pain in the shoulder, back, and clavicular fossa." Furthermore: "When Year Metal is deficient, internal disease involves the chest, hypochondrium, shoulder, and back, while external disease affects the skin and hair; treatment employs cold agents."
Acupuncture offers two approaches for shoulder and back pain:
First, treat the Lung. The Classics state: "For Lung disease presenting with wheezing, cough, rebellious Qi, shoulder and back pain, and sweating, select points on the meridians, specifically bleeding points located outside the Foot-Taiyin, outside the Foot-Taiyang, and inside the Jueyin." It also states: "Regarding the Hand-Taiyin Lung meridian, if Qi is excessive, there is shoulder and back pain with wind-cold sweating; if Qi is deficient, there is shoulder and back pain, aversion to cold, and shortness of breath. Treat according to excess, deficiency, heat, cold, or sinking conditions."
Second, treat the Kidney. The Classics state: "When pathogens reside in the Kidney, disease manifests as pain in the shoulder, back, neck, and nape, with occasional dizziness. Select Yongquan (KI1) and Kunlun (BL60). If blood stasis is present, bleed them completely."
[From *Yu Shu*]: Shoulder and back pain radiating to the scapula: Select Jianxia (interscapular gap) (located below the vertebral bone, directly opposite the tip of the axillary fold and arm, depth 2.5 cun, reduce method, six inhalations). Wushu (GB29) (depth 2.5 cun, reduce method, eight inhalations).
[Worldly Physicians]: Shoulder, back, and scapular pain: Select Kunlun (BL60), Xuanzhong (GB39), Jianjing (GB21).
[From *Dong Yuan*]: Pain in the shoulder, back, neck, nape, anterior axilla, radiating to the chest: Select Yongquan (KI1) (depth 1 fen, until blood appears, excellent effect). Qianye (Anterior Axilla point) (depth 1 cun).
Another method: Select Qishe (ST11) (depth 5 fen), Tiantu (CV22) (moxibustion), Quchi (LI11) (depth 1.5 cun), Tianjing (SJ10) (depth 5 fen).
[From *Jia Yi Jing*]: Bi-pain in the shoulder and back with inability to move, blood stasis in the shoulder preventing motion, is primarily treated by Jugu (SI1). Inability to dress oneself due to shoulder and back pain, pain on the lateral aspect of the forearm and wrist with inability to lift, is primarily treated by Yanggu (SI03). Sensation of the shoulder and back wanting to break, pain like pulling out hairs, inability to move hands up and down, is primarily treated by Yanglao (SI05). Neck and back pain radiating to the neck is primarily treated by Pohu (BL42). Shoulder pain with chest fullness, cold extremities, and stiffness of the spine and back is primarily treated by Shentang (BL44). Pain in the shoulder, back, and thigh, with inability to raise the arm, accompanied by chills and fever, is primarily treated by Jianjing (GB21).
[From *Tong Xuan Zhi Yao*]: Shoulder and back pain is primarily treated by Shousanli (LI10).
[From *Su Wen*]: When the Cun Kou pulse feels hurried and strikes upward upon palpation, it is termed shoulder and back pain. (From the chapter "Imaging of Healthy Persons").