Commanding the Command Points

A guide to using these points for beginners and for those who learned them only for the test. (I know they're important, but they're so confusing...)

This is part 1 of what will be at the least a 2 part narrative on these really useful points. The next part will cover Luo, Yuan and Xi cleft points and we might end up with a brief explanation of five elements approaches. TBD In this part, I’m just going to talk about Jing-Well, Ying-Spring, Shu-Stream, Jing-River, and He-Sea. If the use of these is at your fingertips in the exam room, you can be a great acupuncturist. I think often these points get memorized for the test and then become a weird mashup of I’m not quite sure what to do with it or how it works when people get to the exam room. Hopefully after reading through this, you’ll feel a lot more secure in the use of these points. They’re ancient and have been helping human and veterinary acupuncturists since there has been human and veterinary acupuncture.

Let’s start with the fact that this group of points have a lot of different names depending on which book you opened or where you were taught. I took my basic veterinary acupuncture course from IVAS 1999-2000 so Command points is in my brain. You will see this in some of the human acupuncture literature as well. Xie’s blue book of acupuncture points refers to them as the Shu-Transporting points. This is not unusual and you may see them referred to as Shu points (Deadman’s acupuncture text) or as Transporting points. For our veterinary brains, referring to them as Shu points confuses them with the back Shu Points on the dorsum. They are often referred to in the Classical Chinese Medical literature as the Antique points. This is how they are referred to in Ann Cecil-Sterman’s Advanced Acupuncture Book. If you go to a Jeffrey Yuen seminar, you will probably hear this term at least once. This initially confused me, and then I realized that these were among the first acupuncture points described and classified, which then made more sense.

To make things more confusing Jing-Well points are also often referred to as Ting points.

Worry less about what they’re called and more about what they do and how to use them. A rose by any other name…and all the other platitudes. I’m going to call them Command points because I use them to command things. You are welcome to call them anything that makes you comfortable.

These points do not need to be needled bilaterally. In fact, they may work better when needled unilaterally. Whether you choose to needle the right side or the left side is one of those “it depends” kind of situations. That is up to user discretion. In theory, Yin is right and Yang is left, but your mileage may vary if you’re using this as a balance situation for channel acupuncture.

Well, what are they then?

These are the 5 points below the elbow and the stifle that are grouped together as 5 points that Do Important Things. The most distal three points on each primary channel are all Command points. The most distal are the Jing-Well points; the Ying-Spring points are the second most distal; and the Shu-Stream points, the third most distal. The He-Sea points are at the elbow. These are commonly used points such as LI-11, SP-9, ST-36. The Jing-river points are the ones that are a little tricky to remember. most of these are near the hock or the carpus.

Here is a reprise of the above paragraph in chart form:

Wait! I hear you say. What’s up with Gall Bladder Shu-Stream point?! Well there’s always one that doesn’t want to follow the rules. Just keep that in mind as an exception that proves the rule.

Now about those Jing-River points

LU-8, LI-5, ST-41, SP-5, HT-4, SI-5, BL-60, KID-7, PC-5, TH-6, GB-38, LV-4

What can we say about these? That they’re hock-ish/carple-ish? Kind of. That some of them are familiar and others are not. How exactly are we going to remember this when we need to use them in clinic.

Well, you’re in luck, because clinic is an open book exam. If you’re in control of your exam room, as I am, you create a chart for yourself to use as a cheat sheet. You can also work off of the bubble chart. You do you. Here’s a picture of my chart if you want to see it:

Yes, I did draw it with colored pencils and it may make sense primarily to me. Remember what I said in the Learning is supposed to be difficult episode? Engaging in the material is how you learn it. So you can post a bubble chart and use it, or you can create a bubble chart that makes sense to you and use that.

If you zoom out, you’ll also see that I have the eight extraordinary meridians points posted.

This is because as veterinarians, we tend to be doing several things at once. Watching the patient, while the owner is talking to us, while heaven only knows what else could be happening in your exam room. This is a quick way to check yourself before you insert the needles. No one will judge you for this, the way no one judges you when you confirm a drug dosage. They assume it’s because you want to do the best for the patient.

So now we know that many of the command points are easy to recall, some are not. We also know that cheat sheets are allowed when you use them, which makes them easier to use. What do we do with them?

I studied these for the test but now I don’t remember and can’t use them well

This is not uncommon. There are a ton of things in a new language that we study for the certification test. Applying this information later becomes more difficult, because we have to retrieve the information. Let’s go over it again so that you can use it in a minute on your next patient.

This is a poem Dr. Liane Sperlich and I wrote to remember what the Command points were for when we took the IVAS certification test

Buckle up kids. There will be more bad poetry to come.

As most things for the test, this is a place to start, but there is actually more to do. Still, this poem is good to remind you of some critical uses for these points. Let’s go a little further in depth though.

These points move from most superficial, the Jing-Well points/Ting points to the points where the Qi takes a deep dive into the body, the He-Sea points. They are some of the oldest points described in acupuncture texts, dating back to the period of the Ling Shu written during the Han dynasty around 100 CE. You can read about it Here if you’re interested in going down into the weeds. It is important to know that these points have proven useful for possibly over two millennia, so maybe they are a good thing to have at your fingertips.

These points are also given five element attributes, if you’re using five element theory to treat your patients. This is noted on the bubble chart. Counting from most distal to proximal, every Yang meridian starts with Metal, every Yin meridian starts with Wood. So, if you need the Fire point on the Yang Fire meridian of Small Intestine, you can count on your fingers: Metal, Water, Wood, Fire, FIRE 🔥 So, Jing-River.

Damn. I don’t know my Jing-river points (grabs bubble chart) oh yeah! SI-5. Now, I can bring some real Yang fire power into this point combination. Boom 💥.

(Aside: for what it’s worth there’s also a human app for this if you’re interested. This app gives you easy access to a ton of point information and also herb information for a reasonable price TCM clinic aid. I’m not familiar with a veterinary equivalent, but this one is on my phone and on my iPad and no, I’m not getting paid to mention it. )

Going back to the command points.

We can use these points as a type of short hand to the body in our point prescriptions for what we want to do. Let’s break down the poem and what we know so far.

Jing-Well points where the Qi emerges. When I was a beginner acupuncturist, this was not informative. What I find important to know about this point is that it is at the end of your meridian, which means, you can use it to open the door and let bad juju (aka pathogenic factors) out. This is why it works for mental health issues. You can release the badness that is stuck in your meridian here. This also makes it a potentially useful pain point, but not as good as its brother pain point. Still, important to remember. Energy flips here between the Yin and the Yang meridians. As both humans and animals devote a large part of their sensory map in their brains on their cortical homonculus to finger tips/paw tips, this makes these very useful points. Even though I don’t like my Jing well points needled (but will tolerate without biting) many animals are fine with this if you use small needles. Don’t hesitate to treat these if you need to.

Ying-Spring points where the Qi trickles. These are the second most distal points on the meridian. Ying translates to spring or pool of water, so more water than the well, not as much water as the stream that comes next. These are Fire points on the Yin Channels and Water points on the Yang channels. As they’re close to the end of the meridians, they’re dynamic (cough homunculus, cough) so we use them judiciously. They are useful to eliminate pathogenic factors, but especially when there is a heat component involved. Spring points are good for when there is a hot sensation in the body. How do we know our patient is having a hot sensation? Think about the old dogs that suddenly pant at night for 10 minutes then stop. This is probably a deficient Yin heat sensation. Think about the young dog that chooses to lay in the coldest place in the house in the middle of winter. Is that what this dog has always done? Is this new behavior? This could be an Excess Heat situation. Ying-Spring points are a good choice here.

There is an emergency use for these points to restore consciousness and rescue collapse with extreme heat. You can prick and bleed all 12 Jing-Well points for this. Think about this for a heat stroke patient that is carried into a clinic. Grab a 23 gauge needle- you know it’s right next to the treatment table. Insert and pull out into each of these 12 Jing-well points. Do the points unilaterally. I’d probably alternate Yin and Yang legs when I did it. Let whatever bleeds bleed. You can probably achieve this in about a minute while your techs are getting the fluids and the ice bath ready. Have this knowledge in your bag of tricks.

Shu-Stream points where the Qi begins to pour. This is where the inside meets the outside, where the channel starts to move more internal. These are indicated for heaviness in the body per the classics and are good to clear Wind and Dampness in the channels. Wind and Dampness are the cause of a lot of joint pain, especially in the older patients, so it is particularly good to remember “Shu-Stream points for achy joints. In general, we tend to use the Yang Shu-Stream points for pain treatment. Again, there is an exception that proves the rule and this is LV-3.

The Yin Shu-Stream points are useful for tonifying the Zang (Yin) organs. LU-9 is a great demonstration of this. This is a commonly used point to tonify Lung. HT-7 and KID-3 support their own organs in deficiency states. These are also a commonly used points. Did you know that PC-7 might be a better point choice than PC-6 to calm the spirit? Yes it is. Use PC-6 for nausea though, it has more effect than PC-7 for that. SP-3, a less commonly used point in veterinary acupuncture is potentially better at supporting Spleen Yang and Qi than SP-9. It’s located on the medial aspect of the hind foot just proximal to metatarsal phalangeal joint. Its bony location looks intimidating to needle, but simply thread your needle in the direction of the channel flow and you’re good to go.

Jing-River points are where the Qi of the channel flows (like a river- oh yeah!). These are the Metal points on the Yin channels and Fire points on the Yang channels. These are a good choice if the client has noticed a change in your patient’s voice. All of these are prime points for respiratory disease as the poem states. They’re also good for diseases of the sinews and bones. Everyone knows that BL-60 is the aspirin point and that KID-7 is a helpful point for old dogs with joint pains. Some of the other Jing-River points can be helpful as well including ST-41 for leg pain and atrophy disorders, SP-5 for spastic contraction of the sinews, LV-4 can be helpful for lumbar pain and pairs nicely with it’s friends LV-3 and GB-38 for wandering wind pain in the joints.

He-Sea points where the Qi of the channel becomes very deep. This is the location where the channels are said to plunge inward. If you remember only two lines of our poem above, please remember Shu-Stream points for achy joints and He-Sea eases GI diseases. These are mostly commonly used points, that show up frequently in point prescriptions. You know you use these all of the time, and now perhaps, you can use them with a little more focus. The link between GI diseases and He-Sea points also make them useful for skin diseases (cough LI-11 cough we see you).

In order to confuse you (not really, but sometimes I think it’s true) there are lower He-Sea points for the three Yang channels on the forelimb. ST-37 is the lower He-Sea point for the Large Intestine, ST-39 is the lower He-Sea point for Small Intestine and BL-39 is the lower He-Sea point for the Triple Heater. There are. Classical Chinese Medical Reasons for this but it’s really too deep in the weeds for this chronicle. What is useful about knowing this is that ST-36 and ST-37 are close together, so that you can hit both Yang-Ming channels, ST and LI with one needle threaded from ST-36 to ST-37. In human medicine, it’s thought that the upper He-Sea points of the Yang channels of the arm are more for problems within the specific channel and less for problems with the Fu organs. This may or may not be true in quadrupeds where more weight is carried on their fore vs their hind legs.

Remember that both Small Intestine and Triple Heater are Fire channels. Even though it’s easy for our western brain to think Small Intestine=Digestion, this isn’t quite how it works in Chinese Medicine. It’s not that Small Intestine doesn’t have a role in digestion, but rather that its role is more nuanced. I tend to save these meridians for engendering and controlling Fire, with Small Intestine. If I use Triple Heater Lower He-Sea, it is to control Fire and Water together. So I don’t tend to grab these He-Sea points as a first line on GI diseases. I do use their channel He-Sea points all the time for elbow pain as local points or for stifle pain as balance points. I grab their lower He-Sea points for things like bladder problems (again, TH for Fire/Water) and the SI lower He-Sea point maybe when there is cold in the digestive processing and/or clear problems with separating the Pure from the Impure during digestion. Another time you might use ST-39 as lower He-Sea for the Small Intestine would be a nasty hemorrhagic diarrhea. Again with the Fire theme.

As promised, it is now time for more bad Command Point poetry. Here you go. More elaborate and possibly not helpful. Your job is to rewrite it so it makes sense to you

Remember, the more you engage with these points and these concepts, the easier they will be to work with; that’s how learning works. So get out your colored pencils, markers or your crayons. Make a bubble chart that makes sense to you. Draw notes. put it in your acupuncture folder or on the exam room wall. Who’s going to stop you? You are the doctor. You are the doctor that does acupuncture and you aren’t afraid to use the Command points to command things.