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UPPER AND MIDDLE BACK PAIN, STIFFNESS AND TENSION

TAI YANG ZHONG FENG

Clinical Manifestations	Neck pain and stiffness Aversion to Wind Mild, or severe chills Mild fever which may be persistent Uneasiness from fever Spontaneous perspiration Headache Nausea Nasal irritation Nasal obstruction Tendency to snore Itchy throat T: Normal C: Thin and white P: Superficial and slow or Moderate and maybe weak
Treatment Principle	Create sweat to relieve the Exterior and expel Wind Harmonize Ying and Wei to protect digestion and nourish Wei Qi
Herb Formulas	Gui Zhi Jia Ge Gen Tang
Points	Bitong, DU-16, GB-20, GB-21, KI-7, LI-4, LI-20, LU-7, SJ-5, UB-12, UB-13, Yintang

TAI YANG SHANG HAN

Clinical Manifestations	Upper back pain and stiffness which may radiate to the back of the neck Sharp, sudden pain at the upper or middle back, alleviated by warmth and aggravated by Cold Limited back movement Neck and shoulder pain and stiffness discomfort in the scapular region Severe chills Mild or no fever Headache Purplish or slight blue facial complexion Generalized discomfort Stiff neck and shoulders Body aches Joint ache Nausea Vomiting Hiccups Anhidrosis Gasping Stabbing joint pain Itchy throat Cough Asthma Aversion to Wind and Cold Maybe low back pain Maybe frozen shoulder Maybe dyspnea Maybe epistaxis (severe) T: Normal C: Thin and white P: Floating and tight or Wiry, thready and tight
Treatment Principle	Relieve the Exterior Expel Cold Disperse the Lungs Stop asthma
Herb Formulas	Hua Gai San Ge Gen Tang modified Wu Tou Tang modified Gui Zhi Jia Ge Gen Tang Chinese Patent Medicine: San She Dan Zhui Feng Wan
Points	For upper back pain: 1. DU-16, GB-20, GB-21, LI-4, LU-7, SI-3, SJ-5, Taiyang, UB-12, UB-13, UB-62 2. DU-14, SJ-5, UB-12, UB-13 For a headache: + GB-20, Taiyang For a fever: + LI-11 For a sore throat: + LU-7 For a cough: + LU-1 For nasal congestion: + LI-20 3. Ahshi, GB-20, LI-4, LU-7, UB-12, UB-58, UB-60 With stiff muscles: + HuatuojiajiC-5 through T-11 With severe aversion to Cold in the upper back: + moxa With the pain worse at night: + UB-17 With a headache: + Taiyang, Yintang For middle back pain: GB-20, LI-4, LU-7, SI-3, UB-13, UB-14, UB-58 With a stiff neck: + GB-21 With nasal obstruction: + LI-20 With Stomach pain: + ST-34 With diarrhea: + ST-25

TAI YANG - YANG MING

Clinical Manifestations	Chills and fever Anhidrosis Stiff and rigid neck, shoulders and upper back Intolerance of Wind Dislike of Cold Inflammation Vomiting Muscle spasms Mucosal swelling Nasal congestion Sensitivity to dust Headache Wind-Cold Bi (few joints affected, intense but short lived, changes over days or weeks) Inflammation T: Normal C: Thin and white P: Floating and tight
Treatment Principle	Releases Wind-Cold in the Exterior and muscle layer Generates Fluids Relieves muscle-ache of the neck
Herb Formulas	Ge Gen Jia Ban Xia Tang
Points

WIND-HEAT INVADES THE LUNGS

Clinical Manifestations	Sudden upper or middle back pain with a burning or prickling sensation or Sharp, constant upper or middle back pain or Constant upper back pain The pain is aggravated by warmth and alleviated by cold Cough with thick, sticky, yellow sputum Sore, red, swollen throat Thirst with a desire to drink cold liquids Runny or blocked nose with thick, yellow discharge Fever with perspiration Slight chills (aversion to Cold) Aversion to Wind Headache Maybe dyspnea with flared nostrils Maybe chest pain Dark, scanty urine T: Red tip C: Thin and yellow P: Superficial and rapid
Treatment Principle	Expel Wind Clear Heat Ventilate the Lungs
Herb Formulas	Yin Qiao San Chinese Patent Medicines: Yin Qiao Pian Huang Lian Shang Qing Wan
Points	For upper back pain: 1. DU-14, DU-16, GB-20, LI-4 + LU-7 or LI-4 + SJ-5, LU-5, LU-10, LU-11, UB-12, UB-13 2. Ahshi, DU-14, GB-20, LI-4, SI-11, SJ-5, UB-58, UB-60 With a fever: + LI-11 With a cough: +LU-5, UB-13 With chest pain: + LU-6 With a burning sensation in the upper back: + UB-66 For middle back pain: DU-14, LI-4, SJ-5, UB-17, UB-18, UB-58 With chills and fever: + LI-11 With a headache: + GB-20 With a cough: + LU-7 With expectoration of profuse yellow Phlegm: + LU-5 With constipation: + ST-25

WIND-DAMPNESS

Clinical Manifestations	Fixed upper back pain Heavy, painful head Middle back pain with a sensation of heaviness Generalized sensation of heaviness Heaviness in the limbs Generalized pain or muscle ache Difficulty bending or rotating trunk Mild fever Slight aversion to Wind and Cold Aversion to Cold and Damp Dizziness Anorexia A feeling of fullness in the Stomach Anhidrosis Stiffness of the neck Sciatica Chest oppression Chills No perspiration Lassitude Scanty urination Diarrhea T: Pink C:White or Greasy and white P: Superficial or Superficial and slow or Superficial and soft or Superficial and tight or Deep and rolling or Rolling
Treatment Principle	Dispel Wind Eliminate Dampness Relieve the Exterior Alleviate pain
Herb Formulas	Qiang Huo Sheng Shi Tang modified Chinese Patent Medicine: Tian Ma Qu Feng Bu Pian
Points	Upper back pain: Ahshi, GB-20, SI-3, SJ-5, SP-9, UB-58, UB-60 For scapular pain: + SI-9, SJ-14 For a headache with a heavy sensation in the head: + ST-8 For vomiting: + PC-6 Middle back pain: LU-7, SJ-5, SP-6, SP-9, UB-17, UB-18, UB-40, UB-58 For middle back stiffness: + Huatuojiaji from T-7-T-12 For a headache and heaviness in the head: + GB-20, SI-3 For joint pain: + SI-3 For diarrhea: + ST-25, ST-36 For a poor appetite: + REN-12, SP-3

HEART BLOOD STAGNATION

Clinical Manifestations	Upper back pain Palpitations Stabbing pain in the anterior region over the Heart Suffocating sensation in the chest Maybe drawing pain down the internal aspect of arm (especially the left arm) Pain (in chest and/or arm) tends to be severe and intermittent Severe cases: Cold limbs Cyanosis of lips and nails T: Dark red with purple spots or Purple body C: Little P: Minute (scarcely perceptible) and thready or Knotted
Treatment Principle	Clear Yang Invigorate the Blood Transform Stagnation
Herb Formulas	Gua Lou Xie Bai Bai Jiu Tang
Points	HT-5, HT-6, HT-7, PC-3, PC-4, PC-5, PC-6, PC-7, REN-14, REN-17, UB-15, UB-17

OBSTRUCTION OF THE HEART VESSELS

Clinical Manifestations	Oppression and pain in the chest, often on the left side Pain radiates to the shoulder and upper back Pain is worse at night T: Dark purple with echymoses C: White P: Thready and uneven or Knotted With Phlegm Obstruction in the Heart: A feeling of oppression in the chest TC: Greasy P: Slippery With Cold Obstruction in the Heart: Sudden attacks of severe pain in the chest Pain refers to the upper back Pain is alleviated by warmth P: Deep and slow With Liver Qi Stagnation: Distending pain radiating to the upper back A feeling of oppression in the chest Aggravation of the pain by stress and emotional upset T: Reddish C: Thin and white P: Wiry
Treatment Principle	Promote the circulation of Qi and Blood Tonify Qi or Yang Resolve Phlegm
Herb Formulas	Gua Lou Xie Bai Ban Xia Tang modified Chinese Patent Medicines: Guan Xin Su He Wan Fu Fang Dan Shen Pian
Points	HT-5, SP-6, UB-15, UB-17 With numbness in the upper back: + plum blossom the area With a headache: + Taiyang, Yintang With severe chest pain: + HT-6, PC-4 With palpitations: + HT-3

HEART YANG DEFICIENCY

Clinical Manifestations	Upper back pain Palpitations Shortness of breath Excessive perspiration (daytime) Above symptoms worse after exertion or when tired Cold limbs Fatigue Weakness Maybe chills Cyanosis Suffocating sensation in chest Depression Facial pallor T: Pale and swollen C: White P: Thready and weak or Knotted or Intermittent
Treatment Principle	Warm and Clear Heart Yang
Herb Formulas	Gua Lou Xie Bai Bai Jiu Tang
Points	Moxa or moxa needle DU-25, HT-5, HT-7, HT-8, PC-3, PC-4, PC-5, PC-6, PC-7, REN-14, REN-17, SP-6, ST-36, UB-15

HEART YANG NOT VIGOROUS: WATER QI INSULTS THE HEART WITH KIDNEY YANG DEFICIENCY

Clinical Manifestations	Upper back pain Palpitations Dysuria Shortness of breath Dyspnea Dizziness Muscular twitching Whole body edema Cold body Icy limbs Cold abdomen with watery stools Edema of limbs Cough Pale complexion Lips and nails cyanosed Soreness and aching of the shoulders and back Abdominal pain Diarrhea T: Pale or Purple (Lavender) C: White and greasy P: Deep or Deep and minute
Treatment Principle	Support Yang Expel Cold Promote diuresis
Herb Formulas	Zhen Wu Tang
Points	Moxa needle DU-4, KI-3, KI-7, PC-5, PC-6, REN-4, REN-6, REN-9, REN-17, SP-6, SP-9, UB-15, UB-23

SMALL INTESTINE OVERWHELMING THE GALLBLADDER (FIRE OVERWHELMING WOOD)

Clinical Manifestations	Upper back pain and soreness associated with emotional stress Shen disturbance Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: Thin and white P: Wiry
Treatment Principle	Drain the Small Intestine Nourish the Liver and Gallbladder
Herb Formulas	Xiao Yao San modified
Points	Ahshi points, DU-14, GB-20, LIV-3, PC-6, SI-3, SI-11, UB-62

LIVER QI STAGNATION INVADES THE SPLEEN

Clinical Manifestations	Middle back pain Abdominal distention and pain Gas Borborygmus Diarrhea Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Women: Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: White and greasy P: Slippery and wiry
Treatment Principle	Soothe the Liver Invigorate the Spleen
Herb Formulas	Xiao Yao San Hei Xiao Yao San Chai Hu Shu Gan Tang Tong Xie Yao Fang
Points	LIV-3, LIV-13, SP-6, ST-25, ST-36, ST-37

LIVER QI STAGNATION INVADES THE STOMACH

Clinical Manifestations	Middle back pain Epigastric pain (worse when emotionally upset) Belching with acid regurgitation Nausea Vomiting Anorexia Epigastric distention Distention and pain in the sides or flanks Suffocating sensation in the chest Tendency to sigh Melancholy Depression Irritability Inappropriate anger Irregular menses Dysmenorrhea Breast distention and pain before and during menses T: Pink C: Thin and white P: Wiry
Treatment Principle	Soothe the Liver Harmonize the Stomach
Herb Formulas	Xiao Yao San Hei Xiao Yao San
Points	LIV-3, LIV-14, PC-6, REN-12

LIVER BLOOD DEFICIENCY WITH LIVER QI STAGANTION

Clinical Manifestations	Middle back pain Hypochondriac pain Headache Vertigo Bitter taste in the mouth Dizziness Frequent sighing Epigastric pain and distention Flatulence Dry mouth and throat Fatigue Anorexia Alternating chills and fever Irregular menstruation Breast distention Lassitude Insomnia Shoulder and back pain Rib pain Anxiety Tightness or fullness in the chest Cold extremities Pain in the arms and legs Heaviness of the head Night sweats Bloating and pain at the umbilicus and abdomen Diarrhea alternating with constipation Five sole heat Palpitations Malar flush Depression Irritability Increased desire to sleep T: Pink C: Thin white or yellow P: Wiry and Deficient or Wiry, tight and Deficient
Treatment Principle	Pacify the Liver Spread Liver Qi Strengthen the Spleen Nourish the Blood Harmonize the Liver and Spleen
Herb Formulas	Xiao Yao San
Points

YANG DEFICIENCY

Clinical Manifestations	A sore back which feels Cold Limp aching and coldness of the lower back and knees Aversion to Cold A bright white facial complexion A Cold body and limbs Loose stools Frequent, long, clear urination T: Pale C: White P: Deep and slow
Treatment Principle	Warm Yang Alleviate pain
Herb Formulas	Ba Wei Di Huang Wan modified
Points	Moxa or moxa needle DU-4, UB-26 For diarrhea with undigested food: + moxa REN-8, moxa or moxa needle ST-25 For dizziness and tinnitus: + DU-20 For impotence: + REN-3, REN-4

QI STAGNATION

Clinical Manifestations	Stiffness and tightness of the neck and upper back Constipation Abdominal discomfort, distention or pain which is relieved by a bowel movement Irritability Depression Moodiness Fullness and tightness in the chest and hypochondrium Poor appetite Frequent belching Frequent sighing Premenstrual syndrome Irregular menstruation Breast tenderness T: Normal or Dark C: White P:Wiry
Treatment Principle	Regulate and move Liver and Large Intestine Qi Eliminate Stagnation Descend Qi
Herb Formulas	Li Mo Tang
Points

QI AND BLOOD STAGNATION

Clinical Manifestations	Aching or sore back Long duration of stabbing pain in the upper or middle back A history of surgery or trauma to the upper or middle back Maybe prickling pain in the back Pain worse at night Pain is worse with emotional upset Pain better with activity Pain that is fixed, stabbing and/or severe or Pains that move around Distention Depression Irritability Pan is worse with pressure Dark or purplish complexion Fixed, palpable masses Bleeding with clots Purple lips Purple nails Dry skin Blue, dark or purplish discoloration of skin in small or large areas, Varicose and spider veins Cold hands and feet Tendency to hemorrhage dark blood or clots T: Dark or Purplish C: White P: Deep and thready or Thready and choppy or Wiry and choppy
Treatment Principle	Tonify Qi Nourish and invigorate the Blood Unblock the channels
Herb Formulas	Juan Bi Tang #1 modified Shen Tong Zhu Yu Tang modified For chronic, recurrent, severe back pain: Xiao Huo Luo Dan For predominant severe Blood Stasis: Xue Fu Zhu Yu Tang modified Chinese Patent Medicines for upper back pain: Yun Nan Bai Yao Xiao Huo Luo Dan Chinese Patent Medicines for middle back pain: Yue Bi Chong Ji Yun Nan Bai Yao
Points	Upper back pain: SI-6, SI-12, UB-10, UB-17, UB-42, UB-63 With numbness in the upper back: + needle SJ-5, plum blossom the area With intolerance of Cold in the upper back: + DU-14, ST-36 With chest pain: + PC-6 With upper back pain associated with emotional upset: + GB-20, LIV-3 With pain which is worse at night: + SI-3, SP-6 Middle back pain: 1. ST-36, UB-15, UB-17, UB-20 With pricking pain in the back: + LI-4, REN-17 2. SI-3, SP-6, UB-18, UB-20, UB-22, UB-58 With severe middle back pain: + Ahshi With an intolerance of Cold: + DU-14, ST-36 With abdominal pain: + LI-4, PC-6 With constipation: + ST-25

QI DEFICIENCY

Clinical Manifestations	Intermittent upper back pain , which is worse with fatigue Pale complexion Poor appetite Loose stools Shortness of breath Aversion to Cold A tendency to catch cold Spontaneous sweating A soft voice T: Pale C: White P: Thready and weak
Treatment Principle	Tonify Qi Circulate the collaterals
Herb Formulas	Yu Ping Feng San modified Chinese Patent Medicine: Bu Zhong Yi Qi Wan
Points	ST-36, UB-11, UB-15, moxa or moxa needle UB-13, UB-20 With numbness in the upper back: + plum blossom the local area With an intolerance of Cold in the upper back: + DU-12, DU-14 With a stabbing pain in the upper back: + UB-17 With a feeling of heaviness in the upper back: + SJ-6 With generalized fatigue: + KI-3, SP-6 With diarrhea: + SP-9

DAMP-HEAT

Clinical Manifestations	Middle back pain with a burning sensation and a feeling of heaviness aggravated a hot, humid environment Lassitude Thirst with no desire to drink A low-grade fever Yellow urine A slight aversion to Cold Sticky sweat Maybe jaundice T: Red C: Yellow and greasy P: Soft and rapid
Treatment Principle	Clear Heat Dry Dampness Harmonize the collaterals
Herb Formulas	San Ren Tang
Points	SJ-3, SP-9, ST-36, UB-17, UB-18, UB-20, UB-58 With diarrhea: + ST-25 With a headache: + ST-8 With vomiting: + PC-6, REN-12 With a heavy sensation in the limbs: + SP-3, ST-40