证治诸说 森立夫云∶愚谓肩背痛者，属二经。手太阳小肠经，上肩 ，绕肩解。足太阳膀胱经，循
肩，侠脊背。二经之气相通。若逆而不顺，或外感寒邪，或劳伤，以致二经
之虚，皆足使痛。其酸痛为虚，重痛为寒，刺痛为气逆也。（《万安》）
肩背痛，未辨何证，俱宜和气饮，每服加乌药半钱。当肩背一片冷痛，背膂疼痛，古方用神保丸愈者，
此有积气故也。其人素有痰饮，流注肩背作痛，宜星香散（用南星、木香），或导痰汤下五套丸（见
《和剂》），更于呕吐门停饮证选药。有肾气（即奔豚气之谓）不循故道，气逆挟背而上，
致肩背作痛，宜和气饮，每服加炒 香半钱，炒川椒十粒。
有素虚人，及病后心膈间痛，或牵引乳胁，或走注肩背，此
乃元气上逆，当引使归元，不可复下疏刷之剂，愈刷愈痛，发汗太过人患此者众，惟宜温补。拘于气无补
法之说误矣。经曰汗者心之液，又曰阳受气于胸中，汗过多则心液耗，阳气不足，故致疼也；（《要诀》）
背痛，肥人多痰，年高必用人捶而痛快者属虚，除湿化痰，兼补脾肾。醉饱后多痛欲捶，是脾不运而湿热作
楚也，须节饮。瘦人多是血少阴虚，亦不禁酒及浓味而然，养血清火，四物、酒芩、连、牡丹皮。背痛须
加羌活、防风引经，肥人少佐附子。（《六要》）
脊者，督脉之经与膀胱之经皆取道于脊也。故项脊常热而痛者，阴虚也，六味丸加麋茸。常寒而痛者，
阳虚也，八味丸加鹿茸。（《医通》）（宜参《颈项痛》。）
太阳经风湿肩背痛，兼气郁滞痛者，则常常作痛。气虚郁痛者，则时止时痛。血虚郁痛者，则夜甚时止。
血瘀郁痛者，则夜痛不止。风气郁盛者，痛则项背强。湿气郁甚者，痛则肩背重。
痰风凝郁者，痛则呕眩。（《金鉴》）
治方 肩背痛不可回顾者，此手太阳气郁而不行，以风药散之。脊痛项强，腰似折，项似拔，此
足太阳经不通行，以羌活胜湿汤主之。
羌活 独活（以上各一钱） 本 防风 甘草（炙） 川芎（以上各五分） 蔓荆子（三分）
上 咀，都作一服，水二盏，煎至一盏，去渣大温服，空心食前。（《内外伤辨》）
提肩散，治风湿乘肺，肩背强直作痛。
羌活（密节者） 防风（去芦） 本 川芎 白芍药（炒各七分）
川连（酒炒） 黄芩（酒拌炒各五分） 甘草（四分）
上水二钟，姜三片，煎服。（《辨疑》）
加减当归饮子（《圣惠方》），治肩忽疼。（按∶今《圣惠》无考，《准绳》引《玄珠》。）
当归 大黄（两半） 芍药（一两） 防风 黄芩 人参（各一两） 黄连（五钱） 甘
草（一两三钱） 生地黄（两半） 滑石（六两） 柴胡（一两半）
上 咀，每服五钱，水二盏，煎至一盏，去滓食后通口服。（《袖珍》）
有因湿热，肩背沉重而疼者，当归拈痛汤。（《统旨》）
真武汤，治肩项酸疼，两肩欲脱，背 痛不欲伸，短气 虚弱。（《万安》）（按∶此佚出典，当考。）
灸法 背疼乃作劳所致，技艺之人与士女刻苦者，多有此患（士之书学，女之针指，皆刻苦而成背
疼矣），色劳者亦患之，晋之景公是也，惟膏肓为要穴。予尝于膏肓之侧，去脊骨四寸半，隐隐微疼，按之则
疼甚，漫以小艾灸三壮，即不疼，它日复连肩上疼，却灸肩疼处愈，方知千金方之阿是穴犹信云。予尝肩背
痛，已灸膏肓，肩痛犹未已，遂灸肩井三壮而愈，以此知虽灸膏肓，而他处不可不灸云。两肩头冷疼，
尤不可忽。予屡见将中风人臂骨脱臼，不与肩相连接，多有治不愈者。要之，才觉肩上冷疼，必先灸肩 等
穴，毋使至于此极可也。予中年每遇寒月，肩上多冷，常以手掌心抚摩之，夜卧则多以被拥之，仅能不冷，
后灸肩 ，方免此患。盖肩 系两手之安否，环跳系两足之安否，不可不灸也。（《资生》）
【证治诸说】
森立夫说：我认为肩背痛，归属于两条经脉。手太阳小肠经，上行至肩部，环绕肩胛部。足太阳膀胱经，循行于肩部，夹脊背而行。这两条经脉的气机是相通的。如果气机逆乱而不顺畅，或者外感寒邪，或者劳力损伤，导致这两条经脉虚弱，都足以引起疼痛。酸痛属于虚证，重痛属于寒证，刺痛属于气机逆乱。（出自《万安》）
肩背痛，在未辨别具体证型之前，都适宜服用和气饮，每次服药时加入乌药半钱。如果是肩背部一片冷痛，背脊疼痛，古方用神保丸治愈的，这是因为有积滞之气所致。这类人平素有痰饮，流注于肩背而作痛，适宜使用星香散（由南星、木香组成），或者用导痰汤送服五套丸（见《和剂局方》），更可以在呕吐门中针对停饮证候选择药物。如果有肾气（即奔豚气的说法）不循常道，气逆挟带背部而上冲，导致肩背作痛，适宜服用和气饮，每次服药时加入炒沉香半钱，炒川椒十粒。
有素体虚弱的人，以及病后心膈之间疼痛，或者牵引至乳房胁肋，或者游走窜痛至肩背，这乃是元气上逆，应当引导其回归本源，不可再用下法疏泄刷荡的药物，越疏泄疼痛越剧烈。发汗太过的人患此病者众，只适宜温补。拘泥于“气无补法”的说法是错误的。经文说：“汗是心的津液”，又说“阳气受气于胸中”，出汗过多则心之津液耗损，阳气不足，所以导致疼痛；（出自《要诀》）
背痛，肥胖人多痰湿，年高之人必定喜欢被人捶打而感到痛快，这属于虚证，治疗应除湿化痰，兼补脾肾。醉饱之后多痛欲捶打，这是脾运化失职而湿热作祟，必须节制饮酒。瘦人多因血少阴虚，也是不禁酒及浓味食物所致，治疗宜养血清火，用四物汤加酒芩、黄连、牡丹皮。背痛须加羌活、防风作为引经药，肥胖者少佐附子。（出自《六要》）
脊柱，是督脉与膀胱经共同经过的地方。所以项脊经常发热而痛的，属于阴虚，用六味丸加麋茸。经常发冷而痛的，属于阳虚，用八味丸加鹿茸。（出自《医通》）（宜参考《颈项痛》章节。）
太阳经风湿引起的肩背痛，兼有气郁滞痛的，则常常疼痛。气虚郁滞引起的疼痛，则时好时痛。血虚郁滞引起的疼痛，则夜间加重，白天停止。血瘀郁滞引起的疼痛，则夜间疼痛不止。风气郁盛引起的疼痛，则项背强直。湿气郁滞严重的，则肩背沉重。痰风凝滞郁结引起的疼痛，则伴有呕吐眩晕。（出自《金鉴》）
【治方】
肩背痛不能回顾的，这是手太阳经气郁滞而不运行，用风药发散它。脊痛项强，腰像折断一样，项像被拔起一样，这是足太阳经不通畅，用羌活胜湿汤主治。
羌活、独活（以上各一钱）、藁本、防风、甘草（炙）、川芎（以上各五分）、蔓荆子（三分）。
以上切碎，全部作为一服，用水二盏，煎至一盏，去渣，大温服，空腹食前服用。（出自《内外伤辨惑论》）
提肩散，治疗风湿乘袭肺脏，肩背强直作痛。
羌活（密节者）、防风（去芦）、藁本、川芎、白芍药（炒，各七分）、黄连（酒炒）、黄芩（酒拌炒，各五分）、甘草（四分）。
以上用水二钟，生姜三片，煎服。（出自《辨疑》）
加减当归饮子（《圣惠方》），治疗肩膀突然疼痛。（按：今本《圣惠方》已无法考证，《准绳》引用自《玄珠》。）
当归、大黄（两半）、芍药（一两）、防风、黄芩、人参（各一两）、黄连（五钱）、甘草（一两三钱）、生地黄（两半）、滑石（六两）、柴胡（一两半）。
以上切碎，每服五钱，用水二盏，煎至一盏，去滓，食后通口服。（出自《袖珍方》）
有因湿热导致的，肩背沉重而疼痛的，用当归拈痛汤。（出自《统旨》）
真武汤，治疗肩项酸疼，两肩感觉快要脱臼，背部疼痛不想伸展，短气虚弱。（出自《万安》）（按：此处出处缺失，应当考证。）
【灸法】
背疼乃是由于劳作所致，从事技艺工作与刻苦读书的女子，多有此患（士人的书法学习，女子的针线女红，都是刻苦而成背疼），面色黧黑劳累的人也会患此病，晋景公就是如此，只有膏肓穴是关键穴位。我曾经在膏肓穴旁边，距离脊骨四寸半处，隐隐微痛，按压则疼痛加剧，随意用小艾炷灸了三壮，疼痛立即消失。后来再次连及肩上疼痛，却灸了肩痛处而痊愈，这才知道《千金方》中的阿是穴确实可信。我曾经肩背痛，已经灸了膏肓穴，但肩痛仍未停止，于是又灸了肩井穴三壮而痊愈，由此知道即使灸了膏肓穴，其他部位也不可不一并施灸。两肩头冷痛，尤其不可忽视。我多次见到将中风的人臂骨脱臼，不与肩关节连接，多有治疗不愈的。总之，才觉得肩上冷痛，必须先灸肩髃等穴，不要让它发展到这种地步即可。我中年以后每逢寒冷月份，肩上多冷，常用手掌心抚摸它，夜间睡觉则多用被子拥裹它，仅仅能避免寒冷，后来灸了肩髃穴，才免除了这个祸患。因为肩髃穴关系到双手的安全与否，环跳穴关系到双足的安全与否，不可不灸。（出自《资生经》）
[Theories on Syndrome Differentiation and Treatment]
Sen Rifu stated: I believe that shoulder and back pain belongs to two meridians. The Hand-Taiyang Small Intestine Meridian ascends to the shoulder and circles the scapular region. The Foot-Taiyang Bladder Meridian follows the shoulder and runs alongside the spine and back. The Qi of these two meridians is interconnected. If the Qi flows in a rebellious and unsmooth manner, or if exposed to external Cold pathogenic factors, or due to overexertion and injury leading to deficiency in these two meridians, all can cause pain. Soreness and pain indicate Deficiency; heavy pain indicates Cold; stabbing pain indicates rebellious Qi. (From *Wan An*)
For shoulder and back pain, before differentiating the specific syndrome, it is generally suitable to administer Heqi Yin (Harmonizing Qi Decoction), adding half a qian of Mayao (Linderae Radix) per dose. If there is a patch of cold pain across the shoulder and back, with pain in the spinal muscles, ancient formulas used Shenbao Wan (Divine Preservation Pill) for cure; this is due to accumulated stagnant Qi. Such individuals typically have Phlegm-Fluid retention flowing into the shoulder and back causing pain. It is suitable to use Xingxiang San (Arisaema and Costus Powder, composed of Nanxing/Arisematis Rhizoma and Muxiang/Vladimiriae Radix), or to administer Wutao Wan (Five-Ring Pill) via Daotan Tang (Phlegm-Draining Decoction) (see *Heji Jufang*). One may also select medications from the Vomiting section targeting Fluid Retention syndromes. If Kidney Qi (referring to Ben Tun Qi/Panic Qi) does not follow its normal pathway, and rebellious Qi rushes upward along the back causing shoulder and back pain, it is suitable to take Heqi Yin, adding half a qian of Chao Chenxiang (Stir-fried Aquilaria Wood) and ten stir-fried Sichuan Peppercorns (Chuanjiao/Sichuan Zanthoxyli Pericarpium) per dose.
In individuals with constitutive weakness, or after illness, pain in the heart and diaphragm region, which may radiate to the breasts and hypochondrium, or wander to the shoulder and back, is caused by rebellious Yuan Qi (Primal Qi). It should be guided back to its origin. One must not use purgative or draining agents again, as excessive draining will worsen the pain. Many who suffer from excessive sweating develop this condition; they are only suitable for warming and tonifying treatments. Adhering to the theory that "Qi cannot be tonified" is erroneous. The Classics state: "Sweat is the fluid of the Heart," and also: "Yang receives Qi from the chest." Excessive sweating depletes the Heart's fluids and causes Yang Qi deficiency, thereby leading to pain; (From *Yao Jue*)
Back pain: Obese individuals often have Phlegm; elderly individuals who find relief from percussion likely have Deficiency. Treatment should dispel Dampness and resolve Phlegm, while simultaneously tonifying the Spleen and Kidney. Pain after overeating or drinking, relieved by percussion, indicates Spleen failure to transform and transport, with Damp-Heat causing discomfort; alcohol intake must be moderated. Thin individuals often suffer from Blood deficiency and Yin deficiency, also resulting from indulgence in alcohol and rich foods. Treatment should nourish Blood and clear Fire, using Siwu Tang (Four Substances Decoction) combined with Jiuhuangqin (Scutellariae Radix fried with wine), Lian (Coptidis Rhizoma), and Mudanpi (Moutan Cortex). For back pain, add Qianghuo (Notopterygii Rhizoma et Radix) and Fangfeng (Saposhnikoviae Radix) as guiding herbs; for obese patients, add a small amount of Fuzi (Aconiti Lateralis Radix Praeparata). (From *Liu Yao*)
The spine is the pathway shared by the Du Mai (Governing Vessel) and the Bladder Meridian. Therefore, chronic heat and pain in the neck and spine indicate Yin Deficiency, treated with Liuwei Wan (Six-Ingredient Pill with Rehmanniae) plus Milu Rong (Cervi Cornu Pantotrichum). Chronic cold and pain indicate Yang Deficiency, treated with Bawei Wan (Eight-Ingredient Pill with Rehmanniae) plus Lurong (Cervi Cornu Degloriatum). (From *YiTong*) (Refer to *Neck and Head Pain*.)
Shoulder and back pain due to Wind-Dampness in the Taiyang Meridian, complicated by Qi stagnation, results in constant pain. Pain due to Qi deficiency and stagnation comes and goes. Pain due to Blood deficiency and stagnation worsens at night and stops during the day. Pain due to Blood stasis and stagnation persists throughout the night. Severe Wind stagnation causes stiffness and rigidity of the neck and back. Severe Dampness stagnation causes heaviness in the shoulder and back. Phlegm-Wind coagulation and stagnation causes pain accompanied by vomiting and vertigo. (From *Jin Jian*)
[Treatment Formulas]
For shoulder and back pain with inability to turn the head, this is due to Qi stagnation and obstruction in the Hand-Taiyang Meridian; disperse it with Wind-dispelling herbs. Spinal pain and neck stiffness, with the waist feeling like it is breaking and the neck feeling like it is being pulled, is due to obstruction in the Foot-Taiyang Meridian; treat primarily with Qianghuo Shengshi Tang (Notopterygium Decoction to Overcome Dampness).
Qianghuo (Notopterygii Rhizoma et Radix), Duhuo (Angelicae Pubescentis Radix) (1 qian each); Gaoben (Ligustici Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix), Zhigancao (Prepared Glycyrrhizae Radix et Rhizoma), Chuanxiong (Ligusticum Chuanxiong Rhizoma) (5 fen each); Manjingzi (Vittariae Spora) (3 fen).
Coarsely crush the above ingredients, combine as one dose. Add two cups of water, decoct to one cup, remove dregs, and take warm on an empty stomach before meals. (From *Neiwai Shangbian Huo Lun*)
Tijian San (Lifting Shoulder Powder), treats Wind-Dampness invading the Lung, causing stiffness and pain in the shoulder and back.
Qianghuo (Notopterygii Rhizoma et Radix, dense-jointed variety), Fangfeng (Saposhnikoviae Radix, removed rhizome), Gaoben (Ligustici Rhizoma et Radix), Chuanxiong (Ligusticum Chuanxiong Rhizoma), Shaoyao (Paeoniae Radix Alba, stir-fried) (7 fen each); Huanglian (Coptidis Rhizoma, wine-fried), Huangqin (Scutellariae Radix, mixed with wine and stir-fried) (5 fen each); Gancao (Glycyrrhizae Radix et Rhizoma) (4 fen).
Add two zhong of water and three slices of ginger, decoct and take. (From *Bian Yi*)
Jiajian Danggui Yin Zi (Modified Angelica Drink, from *Shenghui Fang*), treats sudden shoulder pain. (Note: *Shenghui Fang* is currently unavailable for verification; cited in *Zhunsheng* from *Xuanzhu*.)
Danggui (Angelicae Sinensis Radix), Dahuang (Rhei Radix et Rhizoma, 1.5 liang); Shaoyao (Paeoniae Radix, 1 liang); Fangfeng (Saposhnikoviae Radix), Huangqin (Scutellariae Radix), Ren Shen (Ginseng Radix) (1 liang each); Huanglian (Coptidis Rhizoma, 5 qian); Gancao (Glycyrrhizae Radix et Rhizoma, 1.3 liang); Shengdihuang (Rehmanniae Radix, 1.5 liang); Huashi (Talcum, 6 liang); Chaihu (Bupleuri Radix, 1.5 liang).
Coarsely crush the above. Take 5 qian per dose. Add two cups of water, decoct to one cup, remove dregs, and take orally after meals. (From *Xiuzhen Fang*)
For shoulder and back heaviness and pain due to Damp-Heat, use Danggui Niantong Tang (Angelica Decoction to Relieve Pain). (From *Zongzhi*)
Zhenwu Tang (True Warrior Decoction), treats soreness and pain in the shoulders and neck, sensation of shoulders dislocating, back pain preventing extension, shortness of breath, and weakness. (From *Wan An*) (Note: Source citation missing, requires verification.)
[Moxibustion Methods]
Back pain is caused by labor. Those engaged in skilled crafts and women who study diligently often suffer from this (scholars practicing calligraphy and women practicing needlework both develop back pain through diligence). Those suffering from complexion-darkening fatigue also get this disease, such as Duke Jing of Jin. The Gao Huang point (BL43) is the crucial acupoint. I once felt a faint pain 4.5 cun lateral to the spine beside the Gao Huang point, which intensified upon pressure. I casually applied three moxa cones, and the pain ceased immediately. Later, when pain recurred in the shoulder, I moxa-ed the painful area and was cured. This confirmed the validity of the Ashi points (trigger points) in the *Qianjin Fang*. I once suffered from shoulder and back pain; after moxa-ing Gao Huang, the shoulder pain persisted. I then moxa-ed Jian Jing (GB21) three times, and it was cured. Thus, even if Gao Huang is moxa-ed, other areas must not be neglected. Cold pain in both shoulder heads should not be ignored. I have frequently seen patients about to suffer stroke with dislocated arm bones disconnected from the shoulder joint, many of whom were not cured. In summary, as soon as one feels cold pain in the shoulder, one must first moxa points such as Jian Yu (LI15), to prevent it from reaching such an extreme. In middle age, whenever it was cold, my shoulders felt very cold. I usually rubbed them with my palms and covered them with blankets at night, barely keeping warm. After moxa-ing Jian Yu (LI15), I avoided this affliction. Since Jian Yu relates to the safety of the hands, and Huantiao (GB30) relates to the safety of the feet, both must be moxa-ed. (From *Zisheng Jing*)