Formulas · Text · Donguibogam 東醫寶鑑

Neck and Nape

Gyeonghang

한글 경항 · Pinyin Jing Xiang

The stiff neck, the soft neck, and why the nape must be kept covered

頸項

A short chapter with a narrow focus. After measuring the neck and naming the points that ring it, Heo Jun gives almost the whole of his space to one complaint — the nape that has gone rigid and will not turn — and divides it three ways: damp settling in the greater yang, phlegm-heat lodging there, and Kidney Qi surging up the spine and backing up. The two case histories from the Bonsa fang are the chapter's centre of gravity, one explaining why a stiff neck should flare every afternoon and the other why a neck that failed every wind medicine resolved on a single dose of pepper and aconite. A brief pediatric section on the soft neck and a closing argument for keeping the nape wrapped complete it.

Measures of the Neck and Nape 頸項寸數

結喉以下至缺盆中, 長四寸, 項髮以下至背骨, 長二寸半. 《靈樞》

From the knotted throat (結喉, the laryngeal prominence) down to the middle of the empty basin is 4 chon; from the hairline of the nape down to the back bone is 2.5 chon.

Clinical note As with the arm measures in the Hand chapter, these are proportional body-inch figures that scale to the patient. The two landmarks chosen — laryngeal prominence in front, posterior hairline behind — are still the ones a practitioner uses to orient on the neck.

Yeongchu 靈樞

The Regions of the Neck and Nape 頸項部位

前曰頸, 後曰項.

The front is called the neck (頸); the back is called the nape (項).

Clinical note The distinction is not decorative — it runs through the whole chapter. 項强 (stiff nape) is a posterior, greater yang complaint; 頸腫 (swollen neck) in the acupuncture section is anterior and treated on the yang brightness. English collapses both into "neck," so the translation preserves neck and nape throughout.

Yeongchu 靈樞

缺盆之中, 任脉也. 名曰天突. 一次任脉側之動脉, 足陽明也. 名曰人迎. 二次手陽明之脉, 名曰扶突. 三次手太陽之脉, 名曰天窓. 四次足少陽之脉, 名曰天容. 五次手少陽之脉, 名曰天牖. 六次足太陽之脉, 名曰天柱. 七次項中央督脉, 名曰風府. 《靈樞》

In the middle of the empty basin runs the controlling vessel; the point there is called Cheonchul (天突, CV22). First lateral to it, the pulsating vessel beside the controlling vessel is the foot yang brightness; its point is called Inyeong (人迎, ST9). Second, the hand yang brightness vessel; its point is called Butol (扶突, LI18). Third, the hand greater yang vessel; its point is called Cheonchang (天窓, SI16). Fourth, the foot lesser yang vessel; its point is called Cheonyong (天容, SI17). Fifth, the hand lesser yang vessel; its point is called Cheonyu (天牖, TE16). Sixth, the foot greater yang vessel; its point is called Cheonju (天柱, BL10). Seventh, at the centre of the nape, the governing vessel; its point is called Pungbu (風府, GV16).

Clinical note A sweep from the front midline around to the back midline, naming one point per channel in order — an elegant piece of topographic teaching that turns the neck into a numbered sequence. One inconsistency is inherited from the Lingshu: Cheonyong is assigned here to the foot lesser yang, but in the standard channel system it belongs to the hand greater yang (SI17). The discrepancy is old and well known, and is left as the text has it. Note that Cheonju (the celestial pillar) and Pungbu (the wind mansion) both reappear later in the chapter — the first in the pediatric section, the second in a section of its own.

Yeongchu 靈樞

Stiff Nape 項强

諸痙項强, 皆屬於濕. 《內經》

All tetany with stiff nape belongs to damp.

Clinical note One of the nineteen pathomechanisms of the Suwen, and the premise the section builds on. It is also, notably, the premise the section goes on to qualify — two of the four formulas that follow treat causes other than damp.

Naegyeong 內經

項强, 卒口噤, 背反張爲痓. 《仲景》

Stiff nape, sudden clenching of the jaw, and the back arched backward constitute tetany (痓).

Clinical note The graph 痓 is used throughout this section where 痙 (tetany) is meant — a substitution so common in Ming and Qing printings that it became conventional, and it is left standing here rather than emended. What is described is unambiguous: trismus with opisthotonos. **Modern correspondence: tetanus, meningitis, or any cause of meningismus with opisthotonic posturing.** This is the one presentation in the chapter that is a medical emergency, and it sits two lines away from ordinary stiff neck — which is precisely why the distinction matters.

Sanghallon 傷寒論

頸項, 乃足太陽膀胱之經, 足少陰腎經, 與膀胱經爲表裏. 故太陽感風濕, 爲頸項强痛, 身腰反張爲痓. 《本事》

The neck and nape belong to the foot greater yang bladder channel; the foot lesser yin kidney channel stands as interior to the bladder channel's exterior. Therefore when the greater yang is affected by wind-damp, there is stiffness and pain of the neck and nape; and when the body and lumbus arch backward, it is tetany.

Clinical note This passage supplies the anatomical logic for everything that follows, including the otherwise surprising Kidney formula. Because bladder and kidney are paired as exterior and interior, a nape complaint can arise from either side — wind-damp striking the exterior channel, or Kidney Qi failing from within. Chobu-san treats the second, and the case attached to it makes the point explicitly.

Bonsa 本事

項强, 宜木瓜煎ㆍ椒附散ㆍ回首散ㆍ羌活勝濕湯.

For stiff nape, use Mogwa-jeon 木瓜煎, Chobu-san 椒附散, Hoesu-san 回首散, or Ganghwalseungseup-tang 羌活勝濕湯.

Clinical note Four formulas, four different causes, and the chapter does not sort them for the reader — the sorting has to be done from the case histories and the formula texts. In practice: Ganghwalseungseup-tang for the wind-damp exterior pattern the Suwen line predicts; Hoesu-san for the acute wry neck from sleeping; Mogwa-jeon for tense sinews with a Liver-Blood picture; Chobu-san for the chronic case where wind medicines have already failed.

Donguibogam · Gyeonghang

一人項强, 不能回顧, 動則微痛, 脉弦數實. 作痰熱客太陽經, 治用二陳湯方見痰飮, 加酒芩ㆍ羌活ㆍ紅花, 二服愈. 《丹心》

A man had a stiff nape and could not turn to look behind him; movement brought slight pain, and the pulse was stringlike, rapid and replete. It was treated as phlegm-heat lodging as a guest in the greater yang channel, using Ijin-tang 二陳湯 formula in the Phlegm-Rheum chapter with the addition of wine-processed scutellaria, notopterygium and safflower. Two doses cured it.

Clinical note A fifth cause, given as a case rather than as a formula entry: phlegm-heat. The discriminating findings are the replete rapid stringlike pulse and the mildness of the pain relative to the restriction — the neck is locked more than it hurts. Note the modification: wine-processed scutellaria to carry cooling upward, notopterygium to reach the greater yang, safflower to move the Blood, over an Ijin-tang base. The same wine-processing device appears in the Hand chapter's Banhageumchul-tang for the same reason.

Dansim 丹心

傷寒項强, 結胸項强, 痓病亦項强, 幷見本門.

Stiff nape in cold damage, stiff nape in chest bind, and the stiff nape of tetany disease are all discussed under their own chapters.

Clinical note A closing disclaimer that narrows the chapter's scope: three important causes of stiff nape are treated elsewhere, so what remains here is the ordinary musculoskeletal complaint. Worth noting when using this chapter clinically — it is not a complete differential for neck rigidity, and it says so.

Donguibogam · Gyeonghang

Soft Nape 項軟

項軟者, 天柱骨倒也. 宜用健骨散ㆍ生筋散方幷見小兒. 小兒久患疳疾, 體虛不食, 及諸病後, 天柱骨倒, 醫者不識, 謂之五軟. 《綱目》

Soft nape is the falling of the celestial pillar bone (天柱骨, the cervical spine). Use Geongol-san 健骨散 or Saenggeun-san 生筋散 both formulas in the Children's chapter. When a child has long suffered gan disorder, with a weak body and refusal of food, or after various illnesses, the celestial pillar bone falls; physicians who do not recognize it call it one of the five flaccidities (五軟).

Clinical note A pediatric section, and a clinically serious one. The named antecedents — chronic gan disorder, wasting with refusal of food, the aftermath of illness — describe a malnourished or convalescent child who has lost the strength to hold the head up. The complaint about physicians who file it vaguely under the five flaccidities is a call for specific diagnosis. **Modern correspondence: head lag from severe malnutrition, chronic illness, or neuromuscular weakness in infants.** In current practice this is a presentation for urgent pediatric assessment, not for herbal management alone.

Gangmok 綱目

小兒, 因風頸起軟, 頭不得正, 或去前或去後, 宜用天柱元ㆍ五加皮散, 風熱項軟, 合用涼肝元方見小兒. 《得效》

When in a child the neck goes soft on account of wind, so that the head cannot be held straight but falls forward or backward, use Cheonju-won 天柱元 or Ogapi-san 五加皮散. For soft nape from wind-heat, combine with Yanggan-won 涼肝元 formula in the Children's chapter.

Clinical note The description of the head falling forward or backward rather than to one side distinguishes this from torticollis and matches the picture of axial weakness. Cheonju-won is taken internally and Ogapi-san applied externally, so the two can run together — the gentler external option matters in a child too weak to eat.

Deukhyo 得效

The Wind Mansion Should Be Protected 風府宜護

風府穴名也. 在腦後.

Pungbu (風府, Wind Mansion, GV16) is the name of a point. It lies behind the brain.

Donguibogam · Gyeonghang

內經曰, 巨陽者, 諸陽之屬也. 其脉連於風府, 故爲諸陽主氣也. 然則固傷寒之所自起也. 北人皆以毛裹之, 南人怯弱者, 亦以帛護其項, 俗謂三角, 是也. 凡怯弱者, 須護其項後可也. 《資生》

The Inner Classic says: the great yang is that to which all the yang belong. Its vessel connects with the Wind Mansion, and so it governs the Qi of all the yang. That being so, this is indeed the place from which cold damage arises. Northerners all wrap it in fur, and southerners of frail constitution likewise protect the nape with silk — what is commonly called the three-corner (三角) is this. In general, anyone of frail constitution ought to protect the back of the nape.

Clinical note The Donguibogam's argument for the scarf. Because the greater yang governs the exterior and its vessel meets the governing vessel at the Wind Mansion, the nape is the entry point for cold, and covering it is treated as primary prevention rather than as comfort. The ethnographic detail — fur in the north, a silk three-corner wrap in the south — shows the practice was already customary and the physician was endorsing rather than inventing it. It remains usable patient advice, and it is the only section of this chapter that is purely preventive.

Jasaeng 資生

Simple Medicinals 單方

凡四種.

Four kinds in all.

Donguibogam · Gyeonghang

黑豆. 治頭項强, 不得顧視. 豆蒸熟, 納袋中枕之. 《本草》

Black soybean (黑豆): treats stiffness of the head and nape with inability to turn and look. Steam the beans until done, put them in a bag, and use it as a pillow.

Boncho 本草

桃葉. 治風項强不得回顧. 生桃葉蒸熱入袋, 着項上熨之. 《本草》

Peach leaf (桃葉): treats wind stiffness of the nape with inability to turn and look behind. Steam fresh peach leaves until hot, put them in a bag, and iron the nape with it.

Boncho 本草

活鼠. 項强, 身中急者, 取活鼠破腹, 去五藏, 就熱傅之卽差. 《本草》

Live rat (活鼠): for stiff nape with tension through the body, take a live rat, open the belly, remove the five viscera, and apply it while still warm — it resolves.

Clinical note Recorded as documented; not usable. What the three preceding and following entries have in common is worth noticing, though — all four are warm applications held against the nape, and the bean pillow and the leaf compress are simply moist heat, which remains the standard first measure for a stiff neck.

Boncho 本草

萆麻葉. 治風濕項强, 常傅之爲妙. 《俗方》

Castor leaf (萆麻葉): treats wind-damp stiffness of the nape; applying it regularly is excellent.

Clinical note The one entry marked 俗方 — a folk formula rather than a citation from the literature, and the only Korean vernacular source in this chapter. Castor leaf poultices for stiff joints persisted in Korean domestic practice well into the modern period.

Sokbang 俗方

Acupuncture and Moxibustion Methods 鍼灸法

項强, 取承漿ㆍ風府. 《綱目》

For stiff nape, select Seungjang (承漿, CV24) and Pungbu (風府, GV16).

Clinical note Front midline and back midline, controlling vessel and governing vessel — a two-point prescription that brackets the neck on its axis rather than treating the tight muscle. Seungjang on the chin for a posterior complaint is a front-to-back pairing of the kind used when the restriction is axial.

Gangmok 綱目

頸項痛强, 取通天ㆍ百會ㆍ風池ㆍ完骨ㆍ瘂門ㆍ大杼. 《甲乙》

For painful stiffness of the neck and nape, select Tongcheon (通天, BL7), Baekhoe (百會, GV20), Pungji (風池, GB20), Wangol (完骨, GB12), Amun (瘂門, GV15) and Daejeo (大杼, BL11).

Clinical note The fullest prescription in the chapter, and the only citation from the Zhenjiu Jiayi Jing. It runs from the vertex down the occiput to the upper back, covering greater yang, lesser yang and the governing vessel — the three channels named in the topographic sweep at 6.2. Amun sits directly below Pungbu on the midline and requires care: it is a deep midline point over the spinal canal, and perpendicular deep needling is contraindicated.

Gabeul 甲乙

頸項痛, 取後谿. 《綱目》

For pain of the neck and nape, select Hugye (後谿, SI3).

Clinical note A single distal point, and the most-used line in this chapter. Hugye is the confluent point of the governing vessel and sits on the hand greater yang, so it reaches both the midline and the lateral nape from the hand. For an acute wry neck it is often needled alone with the patient actively rotating the head.

Gangmok 綱目

頸腫, 取足陽明ㆍ手陽明兩經. 《綱目》

For a swollen neck, select the two channels of the foot yang brightness and the hand yang brightness.

Clinical note The chapter's closing line returns to the distinction it opened with: swelling is anterior, so it is treated on the yang brightness, whereas everything between has been posterior and treated on the greater yang. No specific points are named — the instruction is to select along the channels, which for the anterior neck would ordinarily mean Inyeong and Butol from the survey at 6.2 together with distal points such as Hapgok.

Gangmok 綱目