“Back shu” (Bei Shu) points are commonly used in modern acupuncture; however, some practitioners claim that needling them is forbidden, others believe that they should be needled for no longer than 10 min or just twisted, flicked and shortly after removed; some others maintain that they can be used but the insertion of needles at these points should be slanted (towards the spine), in order to avoid the organs.
The controversy originates from chapter 51 of the Ling Shu where it is said that needling these points is forbidden and it is advised to treat them only using direct moxa. The compilers of the Nei Jing do not mention any alternative techniques or time of retention.
[if you] moxa it then [you] may, [if you] pierce it then [you] may no
Below I report most of the available English translations of Ling Shu 51 and relative translators’ comments. I find it interesting how some translators add interpretative sentences to the text perhaps to justify the current use of these points: according to Van Nghi only “acupuncture without reflection” is forbidden and Wu Jing-Nuan twists the literal translation implying that moxa should be used on back shu points if needles have failed to be effective. Finally, as reported below, it should be stressed that needling them is advised in several other passages of the Nei Jing.
Van Nghi’s translation
Therapeutically, moxabustion is absolutely advised, and acupuncture, without reflection, is strictly forbidden. Disperse in the event of fullness, and tonify in the event of emptiness. During the use of fire (moxa) to tonify, do not blow on the fire to put it out, but allow it to die out by itself. During use of fire (moxa) to disperse, blow on the fire to help it go out; then on the field, replace it with another fire (moxa) which must also rapidly go out.”
Van Nghi’s comments
“Moxabustion is indicated and acupuncture is advised against.” It concerns advice given to novice physicians because deep needling the dorsal region can injure the lung and heart and cause serious accidents. This does not mean to say that acupuncture performed on the back is strictly forbidden as proportionately less of this classic (Lingshu) and the Suwen had developed in several chapters the methods of needling practiced in this region.
From Chapter 20 of the Lingshu (“The Five Perverse”), Paragraph 1, Volume I:
It is necessary to needle… the point apart from the 3rd dorsal vertebra. Needling this point is confirmed by a sensation of relief during pressure of the fingers.
From Chapter 22 of the Lingshu (“Yin Madnesses and Yang Madnesses”), Paragraph 18, Volume II:
It is necessary to needle the points… at the spot where the cough responds to pressure of the hand and the Shu points of the back (Bei Shu) at the spot where the patient feels a relief upon pressure of the fingers.
From Chapter 55 of the Suwen (“Complementary Study on the Chapters of the Depth of Needling”), Paragraph 1, Volume II:
In the chronic affliction of the 5 organs, needling must approach the organs at the level of the Shu points of the back (Bei Shu)…
The back shu points are to be treated by moxibustion, not by acupuncture needle. When energy is excessive, sedation should be applied; when energy is deficient, tonification should be applied. When moxibustion is applied for tonification, fire should not be blown out and should be left extinction by itself. When moxibustion is applied for sedation, fire should be kept up by blowing it while holding the moxa by hand, and then it should be blown out quickly.
Slanted needling (towards the vertebrae) is advised to avoid the organs
Moxibustion can be effective when needling is not effective. When the qi is full, disperse; when hollow, tonify. When using fire to tonify, do not blow on the fire. In a moment it will go out by itself. When using the fire to disperse, quickly blow on the fire to propagate the action of the Artemisia, then extinguish the fire.
Back shu points are also treated in Huang Fu Mi’s JiaYiJing (a classical text aiming at the almost impossible task of finding a synthesis of NeiJing an NanJing)
Charles Chase’s JiaYiJing
They may be moxaed but cannot be needled. If there is an exuberance of qi, they should be drained; while if there is a vacuity of qi, they should be supplemented. In supplementing with fire (i.e., moxibustion), do not blow on the fire, as it must be left to die on its own. When draining with (moxa), blow vigorously on the fire while holding (the moxa) steady until it burns out.”
On the issue of needling the associated points on the back, a modem commentary suggests that, while the associated points may be needled, caution should be exercised and that they should not be needled excessively deeply. When supplementing with moxa, the ember must be allowed to burn slowly and be extinguished of its own accord. This allows for the accumulation of correct qi at the point. When draining with moxa, the ember should be blown and also allowed to go out on its own. Blowing on the moxa causes the heat to penetrate, thus purging the illness and is therefore draining.
To have an idea of the meaning of each character used in the chapter I asked my friend and colleague Deborah Woolf if she would provide a literal translation of the chapter. She gracefully accepted the task and her translation is below.
LingShu 51 from Chinese Text Project translated by Deborah Woolf
Back shu [points]
The Yellow Emperor asked Qi Bo, saying:
I hope to hear [about] the five storage’s shu/acupoints, those which come out at the back.
Qi Bo said: in the back [there are] great shu/acupoints, [they] start at Great Shuttle,
The Lung shu is between the 3 jiao, the Heart shu is between the 5 jiao,
The diaphragm shu is between the 7 jiao, the Liver shu is between the 9 jiao,
The Spleen shu is between the 11 jiao, the Kidney shu is between the 14 jiao.
They all clasp spine, and mutually come at 3 cun distance [from the spine], if you then wish to obtain and test [for] them,
[then] press their location, [it will] respond in the centre and pain [will be] dispelled, hence it they transport.
[if you] moxa it then [you] may, [if you] pierce it then [you] may not.
[if] Qi is flourishing then drain it, [if it is] deficient then supplement it.
[If you] supplement it by means of fire, [then do] not blow its fire, [it] must extinguish itself;
[If you] drain it by means of fire,[then the] illness blows its fire, [and] spreads/transmits the moxa, [so you] must extinguish its fire.
Name of Du14.
This may be an alternative name/character for ‘vertebrae’.
Ie. you may moxa but not needle these points.
Ie. let it go out! Slow heat and it extinguishes itself is a supplementing action.
Ie. strong heat, but put it out quickly to have a draining action.