: Xinshu : Heart Shu

Bl-15 : Foot Taiyang Bladder 15

Location Guides:

Classifications:

Back Shu point of the Heart
Master Tung's Double Phoenixes
Master Tung's Behind the Heart points

Trigger point (Travell & Simons, 1998, Trigger Point Manual; Melzack, Stillwell & Fox, 1977, Trigger Points and Acupuncture Points for Pain: Correlations and Implications, Pain 3, p3-23)

Meetings:

Meeting of Bladder with Bladder Divergent, Gall Bladder Divergent, Liver Divergent, Stomach Divergent, Spleen Divergent, Small Intestine Divergent and Heart Divergent


Location:

1.5 cun lateral to the lower border of the spinous process of the fifth thoracic vertebra (T5).


Needling:

Oblique insertion towards the spine 0.5 - 1 cun, or transverse-oblique insertion 1 - 1.5 cun


Warnings:

Perpendicular needling or oblique needling away from the spine carries a substantial risk of causing a pneumothorax.


Classical Needling:

"The Taiyang usually has much Blood and little Qi" (Su Wen 素問 ch. 24) implying this channel should normally be bled.
"The foot Taiyang is to be pierced 5 fen deep and remain inserted for seven exhalations" (Ling Shu 靈樞 ch. 12).
"It is needled to a depth of three fen, (the needle) is retained for a duration of seven exhalations, and it is prohibited to moxibustion" (Huangfu Mi 皇甫謐, 3rd Century, Zhenjiu Jiayi Jing 針灸甲乙經).


TCM Actions:

Tonifies and nourishes the Heart
Regulates Heart Qi
Calms the Shen
Unbinds the chest and resolves Blood stasis
Clears Heart Fire

TCM Indications:


Neuroanatomy:

Superficial Innervation: Posterior cutaneous thoracic nerves from T5

Dermatome Segment: T5

Deeper Structures: Dorsal rami of spinal nerves from T5 if directed inward and accessory nerve (CN XI) if directed into trapezius and dorsal scapular (C5) if directed into rhombus major


Trigger Point Associations:

Muscle:
Trapezius, rhomboid major or multifidus at deep levels

Myotome Innervation:
Trapezius: Motor - accessory nerve (CN XI), Sensation - dorsal rami of C2 - C3; Rhomboid major: Dorsal scapular nerve (C4 - C5); Multifidus: Dorsal rami of spinal nerves from T5

Pain Referral Pattern:
Trapezius and rhomboid major: Across back and to chest
Multifidus: local to point and to the midline

Indications:
Back and shoulder pain ; Back pain ; Cardiac syndromes


Martial Applications & Effects of Injury:

Damage to this point can damage the Heart or cause heart failure or upset the Shen causing social and psychological dysfunction. Can also cause a winding effect (Montaigue, Dim Mak Locations, Taijiworld.com).


Major Combinations:


I Ching Hexagram:

Tong Ren Fellowship.

Trigrams: Li (Fire) below, Qian (Heaven) above.

Clarity within, strength without — the bright flame rises toward heaven, and all things are illuminated. This is fellowship: the gathering of people around a shared light.

Nuclear trigrams: Lines 2-3-4 form Xun (Wind). Lines 3-4-5 form Qian (Heaven). Beneath the fellowship, there is gentle penetration (Xun) and creative strength (Qian). The hidden message: the shared light spreads gently, like wind, and is grounded in something universal.

Judgement:

Fellowship with Men. Fellowship with men in the open country. Success. It is favourable to cross the great river. It is favourable for the gentleman to persevere.

Fellowship is good, but only when it is open and universal. The moment it becomes exclusive — "us versus them" — it loses its power. The image of the open country is the key: the widest possible space, the most inclusive gathering.

Lines:

Line Yin/Yang Image Literal Translation Commentary
1 Yang Fellowship at the gate. No trouble. Yang at the bottom. The beginning of fellowship. The gate is the threshold between private and public. No trouble because it is sincere and not yet exclusive.
2 Yin Fellowship only with one's clan. Regret. The ruler line. Yin at 2, central and correct, but it is limiting fellowship to the clan. This is the danger of Tong Ren: if it draws only its own kin, it becomes a faction. Regret because the exclusivity destroys the fellowship.
3 Yang Hiding weapons in the thicket. Ascending the high hill. For three years, no rising. The threshold. The fellowship has become conspiratorial. Weapons are hidden. The high hill is watched. But nothing happens for three years — the conspiracy is exposed to the light and cannot act.
4 Yang Mounting the wall, cannot attack. Gain. Yang at 4. The temptation to attack is strong, but the attack cannot succeed. The wall is too high. Gain because the attack is abandoned.
5 Yang Fellowship. First weeping and wailing, then laughter. The great army conquers and meets. Yang at 5, central and correct. The fellowship has been tested. There is weeping first — the pain of separation and struggle. Then laughter — the joy of reunion. The great army is the strength of Qian. It conquers the obstacles and the fellowship meets again.
6 Yang Fellowship in the outskirts. No remorse. Yang at the top. The fellowship has moved to the outskirts — still outside the city, but not as wide as the open country. No remorse because it is still sincere, even if not fully universal.

Image:

Heaven and fire: Tong Ren. Thus the gentleman distinguishes the classes of things and analyzes their natures..

Heaven is above, fire is below. The fire rises toward heaven, and all things are illuminated. The gentleman distinguishes the classes of things (, lei zu) and analyzes their natures (, bian wu). Fellowship does not mean blurring all distinctions. It means understanding differences clearly and then bringing them together in a higher unity. The open country is not a melting pot; it is a gathering of distinct people who share a common light.

Acupuncture Point Connections:

Shared with Xiaochangshu Bl-27.
Inverted into (Tongli He-5 or Wangu SI-4).
Balanced by (Jingmen GB-25 or Zhongji Ren-3).

Hexagram attributions are my own with an explanation given in the glossary.



Notes:

As the back shu point of the Heart this point is the main back point for dealing with all disorders of the heart, including spiritual and psychological issues. It is often combined with Jueyinshu Bl-14 for physical heart symptoms.



Ling Shu Ch. 51, On the Back Transport Points, advises that the back Shu points of the Yin organs should be pressed. If this elicits a response, either pain or the relief of a existing pain, then these points should be supplemented or drained with moxa and not pierced. To supplement with moxa the cone is to be left to burn down naturally, to drain it is to be blown on to make it burn more fiercely.

Ling Shu Ch. 52, On the Wei Qi, considers this to be the tip of the hand Shaoyin meridian with the root being at Shenmen He-7.




One of the Aggressive Energy Drain points in five element acupuncture, along with Feishu Bl-13, Jueyinshu Bl-14, Ganshu Bl-18, Pishu Bl-20 and Shenshu Bl-23, indicated where psychological or emotional issues are blocking treatment. They are needled from left to right, top to bottom, with the exception of Xinshu Bl-15 that is needled last, along with controls outside the Bladder channel at the same levels. If aggressive energy is present the points should become redder than the test points and are left until the redness disappears. If not then needles can be removed and treatment continued.



When using the Bladder or Small Intestine Divergent meridians to expel a pathogen a band around the chest at this point, including Shendao Du-11, Shentang Bl-44 and Shanzhong Ren-17, should be treated with Gua Sha before commencing needling (Cecil-Sterman, 2012, Advanced Acupuncture).



In Master Tung's system a line of points corresponding to the inner back Shu points from T2 to T8, known as the double phoenix points (Shuang Feng), can be pricked to release a drop of blood in cases of pain or numbness in the extremities or arteriosclerosis.
They all relate to the Fire element and the Heart and so have the function of quickening the Blood in the Heart and the extremities (McCann, 2014, Pricking the Vessels).

Tung's Behind the Heart (Hou Xin or Bei Xin) points are located under spinous processes from T4 to T9, 1.5 cun laterally to T4 to T7 and 3 cun laterally from T4 to T6. They are indicated for "wool like furuncles", clove sores, weakness and debility of the Heart zang, Stomach diseases, acute heart disease leading to numbness and paralysis, wind-cold entering the interior, severe wind-cold, stroke, externally contracted diseases that manifest with papules. They clear heat from the Heart and Lung and release the exterior so are useful in dermatological disorders (ibid.).



In ayurvedic medicine:
Vrihati marma point
Size: 1/2 angula (cun)
Structure: Blood vessels
Effect of Injury: Premature death (kalantarpranahar marma)
(Harish Johari, 1996, Ayurvedic Massage, Sanatan Society; Anupama Bhattacharya, n.d. Marma Shastra)



In Tibetan medicine:
Moxa point (AMNH, Tibetan Medical Paintings)



Reference Notes:

Basic information on location, needle depth, TCM actions, indications and combinations is taken from Deadman et al (2001): A Manual of Acupuncture with additional anatomical information researched by reference to Gray's Anatomy (38th Ed., 1995) unless otherwise referenced. Images were found on acupunctureschoolonline.com and can be traced back to Claudia Focks (2008) Atlas of Acupuncture originally. I cannot claim any credit or rights over them. Other sources should be quoted in the text.

For some of the more unusual terms I have created a glossary here