July 23, 2019
“Please lie face down,” Dr. W instructed before exiting the room. The big wooden door swung shut, and I scrambled up to the treatment table feeling a twinge of excitement, as I scurried to shed my sweater. My first face down treatment, I thought, the white table paper crinkling beneath me in anticipation. I’d sought out Dr. W primarily for his orthopedic expertise, but as I filled out the intake form that evening, a nagging pain in my lower abdomen compelled me to include a brief saga of some persistent digestive issues I’d experienced since childhood. To my surprise, not once during the back and forth of our consult was I questioned about my intestinal woes. As I lay there waiting for him to return, I silently wondered if he’d missed the big check mark scribbled next to the box designated Gas and Bloating.
My thoughts were interrupted by a faint knocking at the door, and in came Dr. W. He worked with authority, palpating and inserting needle after needle, each stick followed by a sweeping wave of relief. On the verge of falling asleep, my eyes abruptly shot open, as a strong yet painless sensation passed through my back. Wide-eyed, I came to stare at the brown shag carpet underfoot wondering what the heck had just happened. Almost immediately, I felt a churning in my lower abdomen. My belly made some savage noises as a tension previously unknown subsided. Then, pure relaxation.
“What was that?” I asked in a muffled voice smothered by the little donut-shaped head cradle. “Back shu points!” Dr. W declared, intuiting which points I was referring to. He went on to explain in detail. Something about sympathetic spinal nerves and internal organs… In my relaxed state, I’d begun to check out. As his voice trailed off I made a mental note; I needed to know just what he’d tapped into.
As it turns out, Dr. W didn’t gloss over my intestinal issues. He’d quite quickly realized the pathology affecting my intestines had reached, as we put it in Chinese medicine, organ level. There are a lot of ways to treat pathologies that have weaseled their way into the viscera and strategies often involve points near the physical organ or along its meridian pathway. But instead of choosing points on my abdomen or along the intestinal channels, Dr. W selected ones parallel to my spine called the back-shu (shu) points. After the successful treatment, I found my Western brain reflexively leaping for an explanation. How did an acupuncture treatment and putting a needle somewhere in my back enhance the motility of my gut?
Back Shu Points
The biomedical community has a thing or two to say about these back shu points. A literature review compiled by Dr. Marco Antonio Helio da Silva offers a comprehensive interpretation of shu points through the lens of neuroanatomy. Shu points are located a few inches lateral to the spinal processes and stimulation of these points triggers the branch of the corresponding spinal nerve.1 Spinal nerves serve as the peripheral nervous system messengers responsible for communicating a mixed bag of motor, sensory and autonomic signals between the body and the spinal cord.1 It’s the autonomic nervous system that’s responsible for exerting control over the internal organs so with this connection in mind, I concluded Dr. W must’ve hit one of the nerves that service the intestines.
This isn’t the case. Interestingly enough, when looking at shu points and their corresponding levels of visceral innervation, only some have the potential to stimulate nerves that correspond to their stated organ. For example, while the shu point of the lung overlays nerve fibers servicing the lung, the shu point of the stomach overlays nerve fibers connected to the adrenal glands and the bladder.1 I was surprised to learn the small and large intestine shu points don’t actually overlay nerves servicing the gut.1 So if he didn’t directly stimulate my intestines, how did Dr. W’s treatment work?
It’s these very discrepancies that shed light on the importance of understanding diagnosis and treatment from the lens of Chinese medicine to comprehend the efficacy of shu points. In Chinese medicine, the body is viewed as a continuous whole. Health is bodily systems working together in concert with the mind and spirit.2 Pathology is a result of disruption of this connectivity. This connectivity is so intricate that when one system is compromised it’s easy for others to become imbalanced: what seems to be an audible attack on one system is the consequence of a silent erosion occurring elsewhere. It’s the job of an acupuncturist to categorize all of a patient’s signs and symptoms into a unique pattern of disharmony that encompasses the root cause of an imbalance as well as its branches.
Acupuncture treatment follows a similar logic. The most effective course of action is determined by looking at the whole pattern rather than focusing on individual symptoms. Balance is restored by determining what is going to support the body’s innate ability to rid or replenish. Based on this logic, it’s possible Dr. W chose to needle the spleen shu. The spleen organ system is the foundation of nutrient assimilation in Chinese medicine and an imbalance of this system is often at the heart of many digestion issues. Or maybe he chose the liver shu, as the liver organ system is responsible for processing stress, a factor known to wreak havoc on the gut if unchecked. Whatever approach he took, Dr. W supported my GI system by treating a systemic imbalance.
While there is sometimes overlap between Chinese medicine and biomedicine, there are fundamental differences. It can be valuable to find ways to explain therapeutic benefits from a Western perspective because patients are often curious (as I was) to understand them in familiar terms. A skilled practitioner can give a brief explanation from a Western perspective if the patient desires one, just as Dr. W did in our session. However, without discussing treatment mechanisms from an Eastern perspective, the benefits can never be entirely understood. The efficacy of my treatment couldn’t be explained by isolating a single nerve. There was a systemic shift. In Chinese Medicine, all is connected, nothing is excluded and therein lies the real magic.
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1. Helio da Silva MA. A Neurosegmental Perspective of the Classical Back Shu Points. Medical Acupuncture. 2010;22(4):257-264. https://www.researchgate.net/publication/259571136_A_Neurosegmental_Perspective_of_the_Classical_Back_Shu_Points. Accessed January 25, 2019.
2. Kaptchuk TJ, Kaptchuk TJ. The Web That Has No Weaver: Understanding Chinese Medicine. New York: McGraw-Hill; 2008.
Article by AIMC Student Erin Stewart