Part 1 of 6 in the stiff and aching neck and shoulder series. 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 5 is what a consultation does first; part 6 is when to see a doctor.
"My neck and shoulders are basically permanent now. A rub loosens it, and it's back the next day." Neck and shoulders are a subject readers raise often, and an easy one to write off as minor and keep putting off.
The answer first: TCM theory reads it as "blocked means pain" (不通则痛). Musculoskeletal pain arises when bone is out of alignment or sinew is not supple, so qi and blood are blocked locally — and where there is blockage, there is pain. That is how a practitioner at the University of Hong Kong's School of Chinese Medicine puts it.
The short version
- Stiff is reduced range; aching is a broad heaviness with no exact spot; painful has a clearer location. Numb is different, and needs a doctor first.
- TCM theory's answer is "blocked means pain": the HKU column writes that bone out of alignment or sinew not supple blocks qi and blood locally.
- "Blocked" is not a figure of speech. The WHO's TCM terminology standard defines the meridians as the pathways qi and blood flow through, and qi impediment as the movement of qi inhibited.
- The CUHK column's direction on 漏肩风 is to keep warm and keep the shoulder out of the cold; the NHS direction is to keep the neck moving, unless a doctor tells you not to.
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. First: stiff, aching, painful and numb are different words
Four words get used interchangeably, but a consultation keeps them well apart:
- Stiff — commonly described as reduced range; the head will not turn past a certain point.
- Aching — commonly described as a sustained heavy or full feeling over a broader area, with no exact spot.
- Painful — commonly described as a clearer location, or a movement that sets it off.
- Numb — an entirely different matter, and a signal that needs a doctor's assessment first. See part 6.
How TCM theory explains the first three is in the next section. "Numb" is not explained by the theory; it goes to part 6 first.
💡 Remember: swapping "uncomfortable" for stiff, aching, painful or numb makes the consultation run more smoothly.
II. How TCM sees it: "blocked means pain", and wind-cold
① "Blocked means pain." Bone out of alignment or sinew not supple leads to local blockage of qi and blood, and where there is blockage there is pain — the HKU practitioner's summary on musculoskeletal pain; the same column's other line is "when the bone is right, the sinew is supple" (骨正则筋柔).
In plain terms, the theory holds that the ache and stiffness are qi and blood not flowing smoothly through that spot.
② Wind-cold. 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 — the cause a registered CUHK practitioner gives for 漏肩风 (lou jian feng, a classical TCM name for one kind of shoulder pain); so, he writes, daily life should emphasise keeping warm and keeping the shoulder out of the cold.
③ The direction for the neck and shoulders, in one line: keep warm, avoid the cold, and do not stay still for long. The first two are the CUHK column's directions on 漏肩风 above. The third is the NHS neck-pain page's: keep your neck moving, unless a doctor tells you not to, and do not hold it in one position for a long time.
Heat is on the NHS neck-pain page's list of things you can do yourself too: a hot water bottle wrapped in a tea towel on the neck for 20 minutes, 2 to 3 times a day. What each pack is doing is part 3. Do not apply heat first in any part 6 situation.
In Malaysian life those lines become a handful of concrete habits — that passage is part 2, alongside "why cold".
What a TCM practitioner typically considers: acupuncture, tuina, herbal medicine, and the directions above. Which of them, whether at all and when, is the practitioner's judgement after seeing you; this article predicts no outcome.
⚠️ 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.
III. "Blocked" is not a figure of speech: four words from the standard
The last section said qi and blood are not moving. So what is qi and blood, where does it move, and what state is "blocked"? All four words are defined in the World Health Organization's 2022 international standard terminologies on TCM.
The pathways it flows through are the meridians (经络). The standard: pathways for qi and blood to flow throughout the body, forming a network linking the tissues and internal organs into one whole.
The side that drives the blood is qi. The standard's entry "qi is the commander of the blood" (气为血之帅) refers to qi's functions in transforming, circulating and governing blood. Qi and blood is the theory's own category, not the blood in the vessels.
The two states of not moving are qi impediment and blood stasis. The standard defines "qi impediment" (气滞) as a pathological state in which the movement of qi is inhibited, and "blood stasis" (血瘀) as a pathological state of slow, coagulated or stagnant circulation of blood.
Put the HKU column's "local blockage of qi and blood" back into those definitions, and it is these two states occurring in the neck and shoulders — that sentence is this article's reading, not the standard's.
So what does the blocking in the neck and shoulders? The column gives two routes: sinew, and bone. That passage, and why cold makes it worse, is part 2.
💡 Remember: the theory's "blocked" means the flow of qi and blood through the meridians held up in one place; the standard's names for the two states are qi impediment and blood stasis — definitions inside the theory, not judgements about you.
The words in this part
- Blocked means pain (不通则痛) — the HKU column: where qi and blood are blocked locally, there is pain. The sentence TCM reaches for most often; you will hear it in a consultation.
- When the bone is right, the sinew is supple (骨正则筋柔) — the same column: with the bone back in position, the sinew attached to it is no longer pulled tight.
- 漏肩风 (lou jian feng) — a classical TCM disease name for one kind of shoulder pain; the CUHK column's cause for it is wind, cold and damp entering the sinews, bones and joints.
- The meridians (经络) — the WHO standard: pathways for qi and blood to flow throughout the body, linking the tissues and internal organs into one whole.
- Qi impediment (气滞) · blood stasis (血瘀) — two pathological states in the WHO standard: movement of qi inhibited; circulation of blood slow, coagulated or stagnant.
The other five parts
- 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 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 ache that loosens with a rub and comes back the next day, 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
