Part 2 of 6 in the stiff and aching neck and shoulder series. Part 1 is "blocked means pain" and the four words; part 3 is the NHS account and the two packs; part 4 is a table of five situations; part 5 is what a consultation does first; part 6 is when to see a doctor.
An air-conditioning vent on the back of the neck all afternoon, and by evening it starts to tighten — a line readers often mention.
Part 1 set out that TCM theory reads the ache and stiffness as "blocked means pain": qi and blood not moving through that spot. This part answers the next question: what does the blocking in the neck and shoulders, and why the theory puts cold on one side and warmth on the other.
The short version
- The HKU School of Chinese Medicine column splits "blocked" into two sources: injured muscle contracts and tightens, and a bone out of position pulls the sinew attached to it tight.
- In the column's example, the patient's neck muscles are tense, and the cervical joints are also out of position.
- Why cold makes it worse: the WHO's TCM terminology standard defines pathogenic cold as a factor characterised by coldness, stagnation, congealing and contraction, with separate entries for "cold congeals and stagnates" and "cold causes contraction".
- The standard also carries a treatment method, "warm the meridians and dissipate cold" — for cold retention in the meridians. It is the theory's statement, not a judgement about you.
First, the things that cannot wait
Chest pain that feels tight or squeezing, or chest pain spreading to your arms, neck or jaw — call 999 now, or go to the nearest hospital emergency department. The NHS heart attack page lists both chest pains among its reasons to call 999, and states that a heart attack happens when blood flow to the heart is blocked. This is an emergency, not a consultation booking.
Persistent numbness or weakness in the arm or fingers — get urgent help. The NHS lists "pins and needles that do not go away" and "no feeling in your arm or shoulder" among the reasons to get urgent help.
The full list is in part 6.
A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.
I. Sinew, or bone: the column's two routes
The first sentence of the HKU column is the whole frame: musculoskeletal pain arises from nothing other than bone out of alignment or sinew not supple, leading to local blockage of qi and blood, and where there is blockage there is pain.
It then describes the two routes separately. The first is sinew: when muscle is injured, it contracts and tightens. The second is bone: when a bone is out of position, the sinew attached to it is pulled tight.
The column's example is 颈椎病, a cervical-spine condition: the neck muscles are tense, and the cervical joints are also out of position. Both routes in one person at once.
In other words, in the theory the "blockage" in the neck and shoulders has two sources — soft tissue held tight, and joint position — and both are read as the same thing: qi and blood not moving through that spot. That is this article's summary of the column.
The distinction is not just filing: it changes whether a consultation should press "harder". That passage is part 5.
💡 Remember: the theory's "blockage" has two sources, sinew and bone. Telling which way it leans is a consultation's work, not a conclusion to press out for yourself.
A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.
II. Why the theory brings in cold: cold congeals and contracts
The WHO's TCM terminology standard defines "pathogenic cold" (寒邪) as a pathogenic factor characterised by coldness, stagnation, congealing and contraction. Pathogenic cold is a category of cause inside the theory, not a reading on a thermometer.
Each of its two properties has its own entry:
- "Cold congeals and stagnates" (寒性凝滞) — pathogenic cold causes qi and blood to stagnate, blocks the meridians and causes pain.
- "Cold causes contraction" (寒性收引) — pathogenic cold constricts qi, blocks the skin pores and causes contractions.
The cause the CUHK School of Chinese Medicine column gives for 漏肩风 (lou jian feng, a classical TCM disease name for one kind of shoulder pain) follows the same reasoning: wind, cold and damp enter the sinews, bones and joints directly, qi and blood are obstructed by them, the channels stop flowing freely, and pain results.
Together it is one line: cold → congealing and contraction → blockage → pain. That line is this article's arrangement of the sentences above, not the standard's own.
III. Why the theory puts warmth opposite
The standard carries a treatment method named "warm the meridians and dissipate cold" (温经散寒): a method to warm yang, dissipate cold and unblock the meridians, indicated for conditions due to cold retention in the meridians.
This is a pair inside the theory: pathogenic cold causes qi and blood to stagnate and blocks the meridians; 温经散寒 warms yang, dissipates cold and unblocks them. Setting the two as a pair is this article's arrangement, not the standard's.
It is the theory's statement, not a judgement about you. The next section's keep-warm habits come from here; whether needles, herbs or hands-on work are used, and how, is for the practitioner who has seen you.
💡 Remember: pathogenic cold stagnates qi and blood and blocks the meridians; warm the meridians and dissipate cold is the standard's method set against it. Both are words inside the theory, and neither is a diagnosis of you.
IV. In Malaysian life, that is a handful of habits
Malaysia has no winter, but "cold on the shoulder" has its own local form here — most often the air-conditioning.
- Do not let the vent blow on the back of your neck. If the desk cannot move, at least turn the vent away.
- Keep a light scarf or jacket in the air-conditioned room. Over the back of the chair is enough.
- Let the warm water run over the neck and shoulders a little longer in the evening shower.
- Riding a motorbike: a long held position in traffic, plus the helmet's weight and whether it fits your head, is standard ground in the consultation. A heavy or ill-fitting helmet is worth checking.
- Looking down at a phone: the NHS neck-pain page's direction is not to keep your neck in the same position for a long time. Roughly how long a day, and at what times, is part 3.
These are habits, not exercise instruction. Screen height, desk, chair and how often to get up at the office are another article's subject: screen height and how often to stand up; for the air-conditioning side of desk work, see what air-conditioning on the neck and shoulders does.
⚠️ A safety note: the above is the direction the TCM framework gives, not a diagnosis of you. TCM and Western medicine complement each other; it is not a choice between them, and when there is numbness, weakness or anything nerve-related, medical assessment first is the sounder order — see part 6.
The words in this part
- Pathogenic cold (寒邪) — the WHO standard's definition: a pathogenic factor characterised by coldness, stagnation, congealing and contraction. A category of cause inside the theory.
- Cold congeals and stagnates (寒性凝滞) · cold causes contraction (寒性收引) — two separate entries: pathogenic cold stagnates qi and blood, blocks the meridians and causes pain; pathogenic cold constricts qi, blocks the skin pores and causes contractions.
- Warm the meridians and dissipate cold (温经散寒) — a treatment method in the standard: warm yang, dissipate cold, unblock the meridians, for cold retention there.
- 颈椎病 — the HKU column's own example: neck muscles tense, cervical joints also out of position.
- Bone out of alignment (骨不正) · sinew not supple (筋不柔) — the HKU column's two sources of musculoskeletal pain: this article's two routes.
A note: this section is general information only. For conditions like these, follow your doctor's diagnosis and treatment, and seek medical attention when you need it.
The other five parts
- Part 1: "Blocked means pain", and the four words
- Part 3: The NHS account: movement, heat and cold
- Part 4: Five common neck-and-shoulder situations
- Part 5: A massage shop, or a consultation
- Part 6: When to see a doctor first
👉 If you are not sure "how TCM sees this neck and shoulder that tightens whenever the air-conditioning is on, and where it should go next", you are welcome to bring it to an online consultation with HansMed, where a practitioner registered under the T&CM Act 2016 can assess it; if anything in the section above or in part 6 applies, see a doctor first. In-person consultations are coming soon.
Sit with a licensed TCM practitioner from wherever you are.
HansMed Modern TCM
For general wellness education only — not medical advice. Consult a registered TCM practitioner for personal guidance.
Sources
- University of Hong Kong, LKS Faculty of Medicine, School of Chinese Medicine, "TCM tuina technique and the treatment of pain", Chan Ka-wing, am730 column, 14 July 2025 — https://www.med.hku.hk/zh-hk/media/knowledge-exchange/newspaper-columns/2025/jul/am730_20250714
- Chinese University of Hong Kong, School of Chinese Medicine, "A brief talk on 漏肩风", Ngan Kit (registered TCM practitioner), Sky Post column, 16 November 2017 — https://www.scm.cuhk.edu.hk/zh-tw/news-and-literature/articles/articles-skypost-list/295-2017-11-16/
- NHS, Neck pain, page last reviewed 27 April 2023 — https://www.nhs.uk/symptoms/neck-pain-and-stiff-neck/
- NHS, Shoulder pain, page last reviewed 22 May 2023 — https://www.nhs.uk/symptoms/shoulder-pain/
- NHS, Heart attack, page last reviewed 31 March 2026 — https://www.nhs.uk/conditions/heart-attack/
- World Health Organization, WHO international standard terminologies on traditional Chinese medicine, Geneva 2022 — https://www.who.int/publications/i/item/9789240042322
