Your patient’s back pain might not be from their back at all. (15mins Read)

What if that dull ache between the shoulder-blades isn’t just a musculoskeletal issue … but is a signal from an internal organ trying to speak through the back-shu line (背 俞 穴, bei shu xue)?

In Traditional Chinese Medicine (TCM), the set of Back-Shu points are one of the most powerful diagnostic and treatment portals. For centuries, practitioners have read the back like a map of the internal organs, tracing how tenderness, firmness, colour changes and other signs reflect the state of the zang-fu (臟腑) organs.

In this post we’ll explore why the Back-Shu points exist, how they work from both classical and modern-anatomical perspectives, and how you can use them in your study and your clinic.

What are the Back-Shu Points (背 俞 穴)

The term “Back-Shu” (背 俞) refers to the acupoints on the dorsal (back) side of the body, located on the two sides of the spine, each corresponding to a specific zang-organ (臟) or fu-organ (腑). According to classical texts, the qi of the organs “infuses” through these points.

From a modern anatomical view, studies show that many of these Back-Shu points lie in zones adjacent to spinal nerves, sympathetic trunks, or viscerocutaneous reflex areas.

In short:

• Classical TCM: Back-Shu = mirror of internal organ’s qi, a key diagnostic and treatment locus.
  
• Modern research: Back-Shu points align with neuro-segmental zones and spinal innervation of visceral organs.
  Thus your story of “internal organs speaking through the back” has both traditional and emerging biomedical support.
  
  

Why the Back-Shu Points matter

1. Diagnostic value

Because each Back-Shu point corresponds to a specific organ, tenderness, bulging, colour change, or even palpable hardness at that point may reflect dysfunction of that organ. Classical texts emphasise palpation along the dorsal line to “read” organ states. 

Example:

• If the Back-Shu point of the Lung (肺 俞, Fei shu) shows sensitivity, you may suspect respiratory or skin issues.
  
• If the Stomach Back-Shu (胃 俞, Wei shu) is tight and tender, you may suspect digestive stagnation.

This way of reading the body increases your clinical sensitivity.

2. Therapeutic value

By stimulating (with acupuncture, moxibustion, cupping, etc.) the Back-Shu point, you aim to regulate the organ qi, harmonise zang-fu, and modulate neuro-visceral reflexes. Modern work shows that needling these points can influence visceral functions (e.g., gut mobility) via nervous/segmental pathways. 

Research Article: Anatomical structures and needling method of the back-shu points BL18, BL20, and BL22 related to gastrointestinal organs: A PRISMA-compliant systematic review of acupoints and exploratory mechanism analysis 

Moreover, a recent animal study found that acupuncture at Back-Shu points improved insomnia in rats and altered their gut microbiota, suggesting a gut-brain axis effect mediated through these points.

RESEARCH article: Front. Microbiol., 19 June 2025

Effect of acupuncture at Back-Shu points on gut microbiota in insomnia model rats based on metagenomic sequencing technology

From an anatomical perspective:

• Each Back-Shu point lies near dorsal rami or sympathetic trunks corresponding to that spinal level.
  
• For example, BL18 (肝 俞, Gan shu) corresponds to T9 level, innervated by T9 spinal nerve, and is associated with liver and digestive functions.

Thus when you palpate along the dorsal line, you’re indirectly accessing neural and neuro-visceral networks.

📘Study Tips for TCM Students 🎓

 This mapping makes the system logical, not arbitrary.

Also, the Bladder Channel (足太陽膀胱經) runs down both sides of the spine, and each point along it corresponds to one of the zang-fu organs.

Here’s an easy way to picture them from top to bottom 👇

• BL13 Fei Shu (肺俞) — Lung point. Helps breathing, skin, and releases grief.
  
• BL14 Jue Yin Shu (厥陰俞) — Pericardium point. Calms the mind and supports circulation.
  
• BL15 Xin Shu (心俞) — Heart point. Balances emotions, helps with sleep and anxiety.
• UB 16 Du Shu (督俞) — Governor Vessel point.
  
• BL17 Ge Shu (膈俞) — Influential point of Blood. Moves Qi and Blood in the chest.
  
• BL18 Gan Shu (肝俞) — Liver point. Soothes stress, moves Liver Qi.
  
• BL19 Dan Shu (膽俞) — Gallbladder point. Clears Damp-Heat, helps decision-making.
  
• BL20 Pi Shu (脾俞) — Spleen point. Strengthens digestion, transforms Damp.
  
• BL21 Wei Shu (胃俞) — Stomach point. Regulates the middle Jiao and appetite.
  
• BL22 San Jiao Shu (三焦俞) — Triple Burner point. Balances water metabolism.
  
• BL23 Shen Shu (腎俞) — Kidney point. Tonifies Yin, Yang, and Essence — vital for energy.
  
• BL25 Da Chang Shu (大腸俞) — Large Intestine point. Aids bowel movement.
  
• BL27 Xiao Chang Shu (小腸俞) — Small Intestine point. Helps separate clear from turbid.
  
• BL28 Pang Guang Shu (膀胱俞) — Bladder point. Regulates urination and water flow.

Now, practice palpation on yourself or a partner. Feel along the spine, 1.5 cun lateral, and observe any tension, tenderness or asymmetry. Make note of what you find.

Connect classical theory with modern anatomy. For example, when you read that Gan shu treats “hypochondriac fullness and liver qi stagnation”, map that to the T9-T10 spinal segment and its neural connections. This dual-coding (TCM + anatomy) deepens your memory and understanding.

Clinical Application for Practitioners 🩺

• Start your session with back inspection/palpation. Before needling limbs, take your hands along the dorsal line of the patient. Look for: skin colour change, bulging, hollows, muscle tightness, asymmetry. This informs your point-selection.
  
• Choose Back-Shu points for organ regulation. If you’re treating a digestive complaint, include BL18 (Gan shu), BL20 (Pi shu), BL21 (Wei shu) etc. Use them as key anchor points to regulate the organ system first, before local symptomatic points.
  
• Combine techniques appropriately. For example:
  
  
  • Use cupping or moving cupping along the Back-Shu line to release chronic tension and enhance circulation.
    
  • Use moxibustion at Back-Shu points where organ yang is deficient.
    
  • Use acupuncture/ electro-acupuncture at Back-Shu + front-Mu combination for stronger regulatory effect.
    
  • Use palpation feedback: If back-shu is highly tender and relaxes after treatment, that can be a real-time marker of improved organ Qi flow.
    

• Explain to the patient. “We’re working on the internal organ via the back because the organ manifests itself here — so the back is your body’s signal panel.” Such an explanation improves compliance and trust.
  
• Monitor responses. Post-treatment you may observe: reduced back tenderness, improved visceral symptoms (e.g., better digestion, better breathing), improved autonomic signs (heart-rate variability, sleep quality). Some studies support Back-Shu intervention modulating autonomic and visceral reflexes. 

Tip: Use our point cards from Acupuncture Deck or digital cards. It shows each Back-Shu point with clear visuals, channels, and memory anchors, Chinese characters of the name to make everything finally click. Hide location on one side, reveal organ and indication on the other.

Bridging East & West: The Neural & Visceral Link

Modern research is catching up with ancient insight: for example, one study found that stimulation of Back-Shu point BL23 (腎 俞, Shen shu) and the kidney showed overlapping sensory and sympathetic innervation in rats — suggesting a neural link between the acupoint and that organ’s neural pathways.

Correlated Sensory and Sympathetic Innervation Between the Acupoint BL23 and Kidney in the Rat

Another systematic review of anatomical structures of BL18, BL20, BL22 (肝 俞 / 脾 俞 / 三焦 俞) mapped the needle-depth, neighbouring muscles, and spinal segments — offering guidance for safe and effective clinical needling. 

Research Article: Anatomical structures and needling method of the back-shu points BL18, BL20, and BL22 related to gastrointestinal organs: A PRISMA-compliant systematic review of acupoints and exploratory mechanism analysis 

The implication? When you treat Back-Shu points you’re not just doing “meridian therapy” in isolation — you’re engaging viscerocutaneous reflex zones, spinal segment neurology, and organ neural feedback loops. Using both TCM theory and modern anatomy gives your practice greater precision and credibility.

Practical “Session Walk-through”

1. The patient presents with chronic indigestion, bloating, and poor appetite.
   
2. Palpate dorsal line at BL21 (胃俞, Wei shu), BL20 (脾俞, Pi shu) — you find marked tenderness on right side.
   
3. Explain: “This area corresponds to your stomach & spleen channel; we will work there to help the organ function.”
   
4. Apply moving cupping along the dorsal line (BL20↔BL21) for 5-10 minutes. Watch the colour of cupping marks.
   
5. Then needle: BL20, BL21 bilaterally (per standard depth), plus front-Mu point on the abdomen.
   
6. Post-treatment check-in: ask about looseness of back tension, appetite changes, quality of digestion.
   
7. Schedule follow-up: monitor back palpation changes over sessions as part of objective outcome.
   

The Back-Shu points (背 俞 穴) are one of TCM’s most profound channels for reading and treating the internal organs via the back. They offer a beautiful bridge between traditional zang-fu theory, palpation diagnostics, and modern anatomical/neuroscientific understanding of visceral innervation and reflexes. 

For TCM students, mastering them means unlocking a deeper layer of your craft; for practitioners, it means more powerful diagnostic and therapeutic options.

Ready to master the Back-Shu system and hundreds of other key acupoints faster and smarter? Use the Boncho Friends Acupuncture Deck — designed for TCM students and practitioners to visualise each point, channel, organ-connection and clinical nuance. Begin today and make your point-knowledge finally click.

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