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Chapter 51 of 81
黄帝内经·灵枢
Overall Paraphrase
The Yellow Emperor asked Qi Bo: I would like to hear about the Shu points (specific acupoints that serve as reactive sites on the body surface for the qi of the internal organs) where the qi of the five viscera is infused along the back. Qi Bo replied: The great Dashu point (i.e., Dazhu acupoint, located lateral to the spinous process of the first thoracic vertebra) of the chest is at the tip of the zhugu (spinous process of the first thoracic vertebra); the Feishu point (lung Shu) is lateral to the third vertebra; the Xinshu point (heart Shu) is lateral to the fifth vertebra; the Geshu point (diaphragm Shu) is lateral to the seventh vertebra; the Ganshu point (liver Shu) is lateral to the ninth vertebra; the Pishu point (spleen Shu) is lateral to the eleventh vertebra; and the Shenshu point (kidney Shu) is lateral to the fourteenth vertebra. These points all flank the spine, roughly three cun lateral to the spinal column on both sides. To locate and verify them, one can press the corresponding area with the hand; if there is a sensation within the body and the original pain is alleviated after pressing, then that is the location of the Shu point. These Back Shu points can be regulated with moxibustion 🔥, but are not suitable for needling. When pathogenic qi is excessive and replete, the reducing method should be used; when upright qi is deficient, the reinforcing method should be used. For reinforcement with moxa fire, do not blow on the fire—allow the moxa fire to extinguish naturally; for reduction with moxa fire, blow vigorously to fan the fire, and allow the fire to transmit through the moxa cone, continuing until the fire is extinguished.
Note: The phrases "back running," "the Shu of the five viscera," "lung fen," "heart brain," "diaphragm fen," "liver weng," "spleen fen," "kidney胞" in the original text are all errors from the process of hand-copying transmission. They have been corrected according to the standard version of Lingshu · Back Shu Points to "背腧" (Back Shu points), "五脏之腧" (Shu points of the five viscera), "肺腧" (lung Shu), "心腧" (heart Shu), "膈腧" (diaphragm Shu), "肝腧" (liver Shu), "脾腧" (spleen Shu), and "肾腧" (kidney Shu). The character "焦" is equivalent to "椎" (vertebra), referring to the segment between spinal spinous processes. Therefore, "between the three jiao" refers not to the Triple Burner organ, but to the position between the third vertebra.
The Theory of Back Shu Points
The qi of the five viscera each has a fixed infusion site on the back, located in the region traversed by the Foot Taiyang Bladder Meridian. These Back Shu points correspond internally and externally with their respective viscera, forming a "viscera—back—channel" connection network. This represents an important manifestation of the holistic view of viscera and channels in the Inner Canon era.
The Diagnostic Principle of "Pain Relief Upon Pressing Response"
The original text presents a simple method for locating and verifying acupoints: by pressing specific areas on the back, if there is a sensation within the body and the original pain or discomfort is alleviated, that location can be identified as the corresponding Back Shu point. This reflects the early observation of body-surface—visceral reflexes by the ancients and represents a prototype of the "pain as acupoint" (Ashi point) approach.
The Treatment Principle of "Moxibustion is Permissible, Needling is Not"
Because the Back Shu points are adjacent to the viscera, the ancients believed that the muscular layers at these sites are shallow with vital organs beneath, and therefore advocated moxibustion while cautioning against needling. This reflects the preliminary understanding in the Lingshu of needling risks at different body sites, and also indicates that Back Shu points were primarily used for warming and regulating in early times.
Reinforcing and Reducing Techniques of Moxibustion
"Do not blow on the fire; allow it to extinguish naturally" constitutes the reinforcing method, while "blow vigorously on the fire and transmit it through the moxa" constitutes the reducing method. The distinction lies in combustion speed and stimulation intensity: slow, gentle heat tends to be warming and reinforcing, while rapid, intense heat tends to be dispersing and reducing—reflecting the traditional principle of "slow and gentle for reinforcement, quick and forceful for reduction."
Modern Research on Back Shu Points
Back Shu points are primarily distributed along both sides of the spinal column and are closely related to the segmental distribution of spinal nerve posterior rami and the sympathetic nerve chain. Modern medicine recognizes that stimulating specific areas of the back can regulate the function of corresponding internal organs through body-surface—visceral reflexes, which echoes the ancient concept of "visceral qi communicating with the back." However, discrepancies exist between the locations described in ancient texts (three cun lateral) and modern standard positioning (1.5 cun lateral to the posterior midline), possibly related to differences in point-location standards across eras, proportional body measurement conversions, or transcription errors—these differences should be viewed rationally.
Value and Limitations of the Palpation Diagnostic Method
"Pain relief upon pressing" as a method for locating acupoints and judging related visceral responses is similar to modern clinical tenderness point examination or the application of Ashi points, and has some observational basis. However, relying solely on palpation responses to diagnose internal organ diseases lacks sufficient specificity and standardization and cannot replace modern medical examination.
Scientific Interpretation of Moxibustion Reinforcing and Reducing Techniques
In moxibustion reinforcing and reducing, "not blowing the fire" versus "vigorously blowing the fire" primarily affects combustion temperature and the rate of thermal penetration. Modern thermal science can explain this as: slow combustion produces gentle heat with deeper, slower penetration; rapid blowing produces brief, high temperature with stronger stimulation. These different rates of temperature change may produce different physiological effects, but the traditional meaning of "reinforcement and reduction" is mostly experiential summary that still requires more evidence-based research.
Historical Limitations
The statement "moxibustion is permissible, needling is not" in this text is based on the anatomical understanding and needling instruments of that era. Modern acupuncture clinical practice has established safer and more standardized depth and angle requirements for needling Back Shu points. Therefore, the needling and moxibustion methods described in this text reflect only the understanding of the Inner Canon era and should not be directly applied to modern practice.
Back Warmth and Stretching 🌿
Traditional Chinese medicine holds that "the back is yang" and that the qi of the five viscera is infused into the back. In daily life, paying attention to keeping the back warm, and performing moderate movements such as chest expansion, waist rotation, and shoulder-back stretching can help maintain smooth flow of qi and blood in the back and reduce discomfort from prolonged sitting and fatigue.
Palpation Awareness, Not Self-Diagnosis
In a non-disease state, one can gently press the back muscles to notice any abnormal tension or tender points as a reference for daily relaxation. However, excessive force should be avoided, and one should never self-diagnose illness or self-treat based on palpation sensations.
Moxibustion Requires Professional Guidance
The moxibustion reinforcing and reducing techniques described in this text belong to ancient external treatment principles and are provided only for understanding traditional approaches. Actual moxibustion involves multiple factors including point selection, fire intensity, duration, and constitutional type, and must be performed under the guidance of qualified professionals—never self-administered without proper training.
Following Visceral Rhythms
Back Shu points correspond to the five viscera. In daily life, one should follow the rhythms of the four seasons and the circadian cycle, avoid excessive fatigue and emotional dysregulation that may harm the viscera, and indirectly affect the smooth flow of qi in the back channels.
Related Concepts
Back Shu points, Foot Taiyang Bladder Meridian, viscera–channel interconnection, Shu point palpation diagnostic method, moxibustion reinforcement and reduction, Dazhu point, proportional body measurement (cun), body-surface—visceral reflex.
Further Reading
This content is based on classic traditional Chinese medicine texts and is provided solely for traditional cultural learning and study. It does not constitute any form of medical diagnosis, medication, or treatment advice. If you experience any discomfort, please seek medical attention promptly.