Part 5 of 6 in the stiff and aching neck and shoulder series. Part 1 is "blocked means pain" and the four words; part 2 is sinew, bone and cold; part 3 is the NHS account and the two packs; part 4 is a table of five situations; part 6 is when to see a doctor.

A neck and shoulder that loosens with a rub and is back the next day — massage shop, or consultation? The difference is not the force. It is what happens before a hand touches you.

The short version

• A consultation's usual order is four steps: ask, look at range of movement, screen out what needs a doctor first, and only then decide the direction.
• A massage shop offers relaxation; TCM tuina is manual therapy after a practitioner's assessment — there is a consultation before it, a judgement, and situations where it is not done.
• The Qing-dynasty《医宗金鉴》sums tuina up as "placing the injured bone and sinew with both hands so that they return to their former state"; on that basis the HKU column explains that everything from very gentle pressing, rubbing and kneading to large joint movements counts as tuina.
• An online consultation can do steps one, three and four; for step two, the practitioner asks you to describe the range, and a hands-on check needs an in-person visit.

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. A consultation's usual order: four steps

• ① Ask first: location and extent (back of the neck, top of the shoulder, between the shoulder blades, or into the arm); how it changes across the day (worst on waking, or built up by the afternoon); the relationship to posture (which movement worsens it, whether changing position eases it); whether anything comes with it (headache, dizziness, numbness in the hand, disturbed sleep); stress and routine (whether tense periods worsen it, whether weekends differ from workdays).
• ② Look at range of movement first: turning the head, raising the arm, reaching behind — at which angle it hurts or catches. This step separates "cannot turn it" from "can turn it but it hurts".
• ③ Screen out part 6 first: with numbness, weakness, pain after an injury, fever or loss of bladder or bowel control, the practitioner sends you to a doctor before doing anything hands-on.
• ④ Only then decide the direction: acupuncture, tuina, herbal medicine, or starting with the everyday directions. The HKU column says it plainly: do not assume treating pain must mean using force. Light or firm follows the distinction in part 4 — sinew held tight, or bone out of position.

Which of these, whether at all, and when, is the practitioner's judgement after seeing you; this article predicts no outcome.

II. How that differs from a relaxation massage

It is not a question of which is better, but of which one you need right now. A massage shop offers relaxation; TCM tuina (推拿) is manual therapy after a practitioner's assessment — there is a consultation before it, a judgement, and situations where it is not done.

The Qing-dynasty《医宗金鉴》sums tuina up as "placing the injured bone and sinew with both hands so that they return to their former state", and on that basis the HKU column explains that everything from very gentle pressing, rubbing and kneading to large joint movements counts as tuina.

So "is tuina just pressing harder?" is answered by the definition: light and firm both count as tuina, and the difference is in those three steps before it. The detail is in tui na or massage?.

Don't rush to have someone "press harder". Hands-on work near the neck should follow assessment, especially when there is numbness or weakness.

III. Which steps an online consultation can do

What an online consultation can do is ①, ③ and ④ — ask, triage, explain the direction. For ②, the practitioner asks you to describe the range; a hands-on check needs an in-person visit. In-person consultations are coming soon.

On the overall order of a pain consultation: how TCM approaches pain. If you are unsure where your situation should go: when an online consultation is not the right choice.

Frequently asked

Can I go for a massage? It is not a question of which is better, but of which one you need right now. A massage shop offers relaxation; TCM tuina is manual therapy after a practitioner's assessment. The difference is in part 4: a consultation first distinguishes whether this "blockage" leans to sinew or to bone, then decides light or firm; a relaxation massage does not need that step. The HKU column's words: do not assume treating pain must mean using force.

The NHS shoulder-pain page adds: do not completely stop using your shoulder, and do not make up your own strenuous exercises. For the situations in part 6, neither is the first step — see a doctor.

Can acupuncture be used for the neck and shoulders? It can be discussed. Acupuncture, tuina and herbal medicine are the directions a practitioner typically considers (part 1); whether and how any is used is the judgement of the practitioner who has seen you, and this article predicts no outcome.

Acupuncture is an in-person procedure, and HansMed Modern TCM's in-person consultations are coming soon; an online consultation can ask, triage and explain the direction first. For the kind where the arm will not lift: is shoulder pain always frozen shoulder?

Is numbness in my hand a neck problem? Possibly, possibly not — telling that apart is the doctor's job. One direction the American Academy of Orthopaedic Surgeons' patient page describes: a nerve in the neck compressed or irritated where it branches away from the spinal cord, with pain that may radiate into the shoulder and arm and may come with muscle weakness and numbness.

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. So the answer to numbness is not in TCM theory; it is with the doctor — see a doctor first, and talk TCM once there is a judgement.

The words in this part

• Tuina (推拿) — TCM manual therapy. On the《医宗金鉴》definition as the HKU column relays it, everything from very gentle pressing, rubbing and kneading to large joint movements counts.
• Manual therapy (手法治疗) — hands-on work done only after a practitioner's assessment, with a consultation and a judgement before it, and situations where it is not done.
• Range of movement (动作范围) — what step two looks at: turning the head, raising the arm, reaching behind, and at which angle it hurts or catches.
• Treating sinew and bone together (筋骨并重) — the central idea of TCM orthopaedics in the HKU column's words: light and firm combined, sinew and bone read together.

The other five parts

• Part 1: "Blocked means pain", and the four words
• Part 2: Sinew or bone, and why cold makes it worse
• Part 3: The NHS account: movement, heat and cold
• Part 4: Five common neck-and-shoulder situations
• Part 6: When to see a doctor first

👉 If you are not sure "whether this neck and shoulder should go to a massage shop or to a consultation", 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

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
• 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/
• AAOS OrthoInfo, Cervical Radiculopathy (Pinched Nerve) — https://www.orthoinfo.org/en/diseases--conditions/cervical-radiculopathy-pinched-nerve/

本文是「肩颈僵硬酸痛」系列的第 5 篇，共 6 篇。第 1 篇讲「不通则痛」和僵、酸、痛、麻的分别，第 2 篇讲是筋还是骨、寒为什么会加重，第 3 篇讲 NHS 的说法与两种敷法，第 4 篇是五种常见情况的表，第 6 篇讲什么时候要先看医生。

「捏一捏就松、隔天又回来」的肩颈，该去按摩店，还是该看诊？差别不在力道，在于手碰到您之前发生的事。

一分钟看完

• 看诊的一般顺序是四步：先问清楚、先看动作范围、先筛掉要先看医生的情况，然后才决定方向。
• 按摩店提供的是放松；中医推拿是医师评估之后的手法治疗，前面有问诊、有判断，也有不适合做的情况。
• 清代《医宗金鉴》把推拿总结为「以两手安置所伤之筋骨，使仍复于旧也」；港大中医药学院的专栏据此说明，无论是很轻柔的按、摩、揉，还是大幅度活动关节，都属于推拿。
• 线上问诊能做第一、三、四步；第二步的动作范围，医师会请您描述，用手检查要亲诊。

先说不能等的几件事

胸口发紧或疼痛，或胸痛蔓延到手臂、颈部或下巴——请立刻拨打 999，或前往最近的医院急诊部。NHS 的心脏病发作页面把这两种胸痛都列为要立刻拨打 999 的情况，并写明心脏病发作是流向心脏的血流被阻断。这是急症，不要先安排问诊。

手臂或手指持续麻木、无力——请马上求医。NHS 把「持续的麻或刺痛」与「手臂或肩膀失去感觉」列为要马上求医的情况。

完整的清单在第 6 篇。

小提醒：本段仅为一般知识说明。相关情况请以西医的诊断与治疗为主，并在需要时及时就医。

一、看诊的一般顺序：四步

• ① 先问清楚：位置与范围（后颈、肩上方、肩胛之间，还是延伸到手臂）；一天里的变化（早上最明显，还是下午累积出来的）；和姿势的关系（哪个动作会加重、换姿势会不会缓解）；有没有伴随的情况（头痛、头晕、手麻、睡眠受影响）；压力与作息（紧绷的时期会不会加重、周末与上班日有没有差别）。
• ② 先看动作范围：转头、抬手、往后摸，到哪一个角度会痛或卡住。这一步分辨的是「转不过去」和「转得过去但会痛」。
• ③ 先筛掉第 6 篇的情况：只要有麻木、无力、外伤后、发烧、大小便失控这些情况，医师会请您先看医生，而不是先动手。
• ④ 然后才决定方向：针灸、推拿、中药，或先从生活方向开始。港大中医药学院的专栏写得直接：别以为治疗痛症一定要大力。手法的轻重，跟着第 4 篇说的那个分辨走——筋绷紧，还是骨的位置不正。

用哪一种、要不要用、什么时候用，是医师看过您之后的判断，本文不预测结果。

二、和放松按摩的差别

两者不是「谁比较好」的问题，而是您现在需要的是哪一种。按摩店提供的是放松；中医推拿是医师评估之后的手法治疗，前面有问诊、有判断，也有不适合做的情况。

清代《医宗金鉴》对推拿的总结是「以两手安置所伤之筋骨，使仍复于旧也」，港大的专栏据此说明，无论是很轻柔的按、摩、揉，还是大幅度活动关节，都属于推拿。

所以「推拿是不是就是按得重一点」这个问题，答案在定义里：轻与重都算推拿，分别在前面那三步。细节在推拿和按摩有什么不同。

别急着找人「大力一点」。 肩颈附近的手法需要评估后再进行，尤其在有麻或无力的时候。

三、线上问诊能做哪几步

线上问诊能做的是①③④——问清楚、分流、说明方向。②的动作范围，医师会请您描述；用手检查要亲诊。线下亲诊服务即将推出。

疼痛问诊的整体顺序，见中医怎么看疼痛。不确定自己的情况该往哪里去，可参考哪些情况不适合线上问诊。

常见问题

可以去按摩吗？ 两者不是「谁比较好」的问题，而是您现在需要的是哪一种。按摩店提供的是放松；中医推拿是医师评估之后的手法治疗。差别在第 4 篇：看诊先分辨这一处的「不通」偏筋还是偏骨，再定轻重；放松按摩不需要这一步。港大中医药学院的专栏写的是：别以为治疗痛症一定要大力。

NHS 的肩痛页面另有一句：不要完全不用肩膀，也不要自创吃力的运动。第 6 篇列出的情况，两者都不是第一步——先看医生。

针灸可以看肩颈吗？ 可以谈。针灸、推拿、中药是医师一般会考虑的方向（第 1 篇）；用不用、怎么用，由看过您的医师判断，本文不预测结果。

针灸是亲诊的操作，汉方现代中医的线下亲诊服务即将推出；线上问诊可以先问清楚、分流、说明方向。肩膀抬不起来的那一种，另见肩膀痛就是五十肩吗。

手麻是颈椎问题吗？ 可能是，也可能不是，分辨归医生。美国骨科医师学会的病人资讯页描述的其中一个方向是：颈部的神经在离开脊髓的位置受压或受刺激，痛可牵涉到肩与手臂，并可能伴随无力与麻木。

NHS 把「持续的麻或刺痛」「手臂或肩膀失去感觉」列为要马上求医的情况。所以手麻的答案不在中医理论里，在医生那里——先看医生，有了判断再谈中医。

这篇出现的几个词

• 推拿——中医的手法治疗。按《医宗金鉴》经港大专栏转述的定义，从很轻柔的按、摩、揉到大幅度活动关节都算。
• 手法治疗——医师评估之后才进行的手法，前面有问诊与判断，也有不适合做的情况。
• 动作范围——看诊第二步要看的东西：转头、抬手、往后摸，到哪一个角度会痛或卡住。
• 筋骨并重——港大专栏说的中医骨伤科中心思想：轻重配合，筋与骨一起看。

这个系列的另外五篇

• 第 1 篇：「不通则痛」，以及僵、酸、痛、麻的分别
• 第 2 篇：是筋还是骨，以及寒为什么会加重
• 第 3 篇：NHS 怎么说：为什么要动，热敷还是冷敷
• 第 4 篇：一张表看懂五种常见的肩颈情况
• 第 6 篇：什么时候要先看医生

👉 如果您不确定「我这个肩颈该去按摩店，还是该看诊」，欢迎透过汉方中医的线上问诊，由依 2016 年 T&CM 法令注册的医师为您评估；若有本文开头或第 6 篇列出的情况，请先就医。线下亲诊服务即将推出。

无论身在何处，与持证中医师对坐。

汉方现代中医

资料来源

• 香港大学李嘉诚医学院中医药学院，〈中医推拿手法与痛症治疗〉，陈嘉荣中医师，am730 专栏 2025 年 7 月 14 日 — https://www.med.hku.hk/zh-hk/media/knowledge-exchange/newspaper-columns/2025/jul/am730_20250714
• NHS，Shoulder pain，页面最后审阅 2023 年 5 月 22 日 — https://www.nhs.uk/symptoms/shoulder-pain/
• NHS，Heart attack，页面最后审阅 2026 年 3 月 31 日 — https://www.nhs.uk/conditions/heart-attack/
• 美国骨科医师学会 OrthoInfo，Cervical Radiculopathy (Pinched Nerve) — https://www.orthoinfo.org/en/diseases--conditions/cervical-radiculopathy-pinched-nerve/