To the Point: Working With Tsubo

Energy Medicine

By Kondañña (Barry) Kapke

Originally published in Massage & Bodywork magazine, August/September 2004.

To hold, press, or rub an area of the body that hurts is a natural response. We do it without thinking — for headaches, stomachaches, back pain, bumped knees, cramps — and such contact usually offers relief. Acupressure is a skillful way of relieving pain and disharmony through simple, intentional touch.

Acupuncture and acupressure work from the same model of energetic anatomy — there are channels of energy flow in the body and specific points for engaging with that energy movement. Whereas acupuncture utilizes needles or heat (moxabustion) to restore harmony to the body’s energetic currents, acupressure uses applied pressure.

Acupoints, called tsubo in Japan, are weak spots along the path of a channel. They are places where the activity of that channel may be more easily affected. Typically, they occur near joints, in the depressed junctures where muscles meet, in areas where nerves emerge from muscle, or in a knot or band of tension within a muscle. Dr. Katsusuke Serizawa, a leading authority on tsubo research, identified 365 principal tsubo in the body. Different points have different characteristics. Some points supplement or stimulate the channel, organ, or physiological function. Some have a draining or calming effect. Others appear to be homeostatic. The tsubo are “windows” reflecting internal disharmonies on the body’s surface, and they are also “doorways” by which to therapeutically influence those internal conditions.

Tsubo are particularly sensitive to bioelectrical impulses in the body and readily conduct those impulses. According to Michael Reed Gach, author and founder of the Acupressure Institute of America, stimulation of tsubo triggers the release of endorphins, neurotransmitters that relieve pain.1,2 In addition to relieving pain, acupressure helps to increase vitality and promote the smooth flow of qi (energy), thereby supporting the effective functioning of the body’s systems and preventing illness and disharmony from arising.

Tracing the Origins

From an energetic point of view, intention plays a large part in whether a tsubo may be healing or harmful. In Chinese martial arts (wushu), one of the most deadly movements is dianxue, in which a special point on the opponent’s body is struck hard by the challenger’s finger, incapacitating the body by momentarily blocking the flow of blood (xue) and energy (qi). Operating with a different intention, the fingers or thumbs of the acupressure therapist may stimulate the same acupoint to promote the flow of blood and energy and, thereby, to heal an injury.

In the 14th century, Zhang Sanfeng, a Taoist priest and martial artist, discovered 72 acupoints on the body that were vulnerable to dianxue. With the development of Shaolin martial arts came the need for treatments for the injuries caused by it. The resulting “Shaolin traumatology” evolved into a branch of Traditional Chinese Medicine that specialized in the treatment of injuries of bones, sinews, and muscles. The roots of modern acupressure therapy may be traced to traumatologists who applied the theory of dianxue to serve a healing purpose. The 72 points identified by Zhang more than 500 years ago are among those still used by acupressure therapists today.

The larger view of energy channels and points can be traced back even further. The Chinese discovered, more than 5,000 years ago, that pressing on certain tender areas on the body relieved pain where it occurred and also benefited other parts of the body remote from the pain. They learned that certain points not only alleviated pain, but also reflexively influenced the functioning of certain internal organs and helped to heal illnesses. In the Neijing Suwen, one of the early canonical texts of Traditional Chinese Medicine, the physician Qi Bo comments, “In the spring and autumn when food is plentiful and people tend to become lazy and slothful, finger pressure is used to increase digestive fire and restore vigor.” This statement points to the therapeutic use of acupressure as an accepted medical practice, predating acupuncture.

Working With Tsubo

An acupressurist works strategically like an acupuncturist, selecting specific points based on a diagnosis to affect a certain result. Acupressure may be practiced as a spot treatment — a particular recipe of points for a particular outcome — or it may be integrated within a session that works the whole body and the entire channel system. The numerous styles of bodywork that apply pressure to stimulate energy flow — such as shiatsu, Jin Shin Jyutsu, anma, tui na, traditional Thai massage, Insight Bodywork™, dzub-nyin, marma massage, etc. — may all be considered systems that employ acupressure, in its general sense, but they may or may not focus on specific points in a routine session. Precise points may be decided prior to a session and then incorporated into the full body treatment, or the points may be addressed separately after the meridians have been worked. Acupressure can thus be seen as a facet of, or an adjunct to, many forms of bodywork.

Part of the skill of the therapist is in discerning the disharmony that is to be treated and in selecting the appropriate combination of points that will work together harmoniously to treat the whole person and the specific complaint. Generally, kyo (deficiency or emptiness) conditions will often benefit from techniques and tsubo that bring the energy inward — to the center of the body and to the affected area. Therefore, local points — tsubo on or near the affected area — are important. In the case of jitsu (situations of excess and stagnation), techniques and tsubo that disperse and move qi outward to the surface of the body and extremities are helpful. Tsubo that are located far away from the problem site, known as distal points, are significant to the treatment of jitsu manifestations. A combination of local and distal points is the most widely used method for balancing of points.

When a point has been properly stimulated, a sensation called “de qi” is experienced, which verifies that the qi of the point has been contacted. This sensation may be felt as a pain or ache accompanied by a simultaneous feeling of release; a feeling that spreads out to the affected area; a distending soreness; warmness; a tingling or numbness; or an electric sensation. If no sensation is felt, then the tsubo was not located correctly, the pressure was not applied correctly, or the client is extremely deficient in qi and xue.

It is important the practitioner remain mindful of her own energetic connection with a tsubo. Author Carola Beresford-Cooke points out it is the natural action of qi to pulsate as it alternates between Yin and Yang.3 The practitioner will consequently tend to lose the sense of connection with a point after several seconds. When this disconnection occurs, the therapist can release the point and then enter it again, reconnecting with the qi. She suggests this cycle is repeated for a minimum of one minute, up to a maximum of five minutes, and that two to three minutes is usually sufficient to obtain the intended effect.

While tsubo are mostly to be found along the 14 channels, Ah Shi (“That’s it!”) points are a special category that may manifest anywhere on the body. These tsubo du jour are better known in the West as trigger points. These tender points are abnormally sore or painful to palpation. While the classical tsubo are the reflexive points where theoretically Qi and Blood can best be adjusted, since Ah Shi points are the actual sites of blockage and stagnation, it is important to disperse them in the course of treatment.

Types of Points

Of the 17 categories of acupoints, below are some that may prove useful in selecting a treatment plan.

The Shu (Yu, in Japanese) points and Mu (Bo, in Japanese) points have an immediate, powerful effect on their related organs. They are frequently tender, spontaneously or on palpation, and are useful in diagnosis of organ disharmonies. Together, they constitute an especially powerful treatment.

The Shu points, also known as Associated or Back Transporting points, are located along the spine directly above the pertaining organ to which they transport qi. In directly tonifying the organs, they are beneficial in both acute and chronic conditions, particularly when there is depletion of the vital substances. Shu points also treat the orifices pertaining to their associated organ.

Lung UB-13
Heart UB-15
Pericardium UB-14
Large Intestine UB-25
Small Intestine UB-27
Triple Heater UB-22
Stomach UB-21
Bladder UB-28
Gall Bladder UB-19
Spleen Lv-13
Kidney UB-23
Liver UB-18

The Mu points are also known as Alarm or Front Collecting points. They are located on the chest and abdomen, directly above their pertaining organs. The qi of each of the internal organs converges and accumulates there. Mu points have a direct and immediate effect on the internal organs and are often used in acute conditions to treat the yang (fu) organs. They may be used to supplement and tonify both yin (zang) and yang (fu) organs.

Lung Lu-1
Heart Ht-14
Pericardium Ren-17
Large Intestine St-25
Small Intestine Ren-4
Triple Heater Ren-5
Stomach Ren-12
Bladder Ren-3
Gall Bladder GB-24
Spleen Lv-13
Kidney GB-25
Liver Lv-14

The Source (Yuan) points for each of the 12 channels are found at the wrists and ankles and are considered to be in direct communication with that channel’s associated organ. They may be used for either supplementing or draining and are very important in the treatment of any chronic condition, particularly when there is depletion of the vital substances. They are of most significance on the yin channels.

Lu-9, LI-4, St-42, Sp-3, Ht-7, SI-4, UB-64, Kd-3, Pc-7, TW-4, GB-40, Lv-3.

The Connecting (Luo) points are used when there is an imbalance between paired yin/yang channels, since they are the departure points for a given channel’s connecting vessel. They are often used to transfer an excess pathogen from one organ to another (usually from the yin channel to its yang pair). Connecting points are also useful in the treatment of channel disorders and emotional problems.

Lu-7, LI-6, St-40, Sp-4, Ht-5, SI-7, UB-58, Kd-4, Pc-6, TH-5, GB-37, Lv-5.

The Accumulation (Xi) points, or Cleft Points, are where the qi of the channels accumulates. They are used to treat acute, excess conditions either of the organ itself or of the channel, particularly where there is pain. On the yin channels, they also treat disorders of the Blood (including heat and stasis of Blood). They are useful for particularly stubborn conditions and may be combined with Meeting points for good effect.

Lu-6, LI-7, St-34, Sp-8, Ht-6, SI-6, UN-63, Kd-5, Pc-4, TW-7, GB-36, Lv-6.

The Eight Meeting (Hui) points are where the energy of the organs, certain tissues, and vital substances gathers and accumulates. These points may be added to any treatment for conditions affecting these tissues or functions.

Qi CV-17
Yin Organs Lv-13
Yang Organs CV-12
Blood UB-17
Blood Vessels Lu-9
Sinews GB-34
Bones UB-11
Marrow GB-39

The Six Command points have a special influence on, and are used to treat problems of, a particular body region.

Abdomen St-36
Thorax/Chest Pc-6
Face/Mouth LI-4
Back UB-40

Head & back of neck Lu-7
Consciousness GV-26

The Five Transporting Points are found on the extremities, distal to the elbows and knees on each channel. The energetic character is compared to that of the flow of water, beginning at a well and proceeding along the spring, stream, and river to the sea. They are sometimes referred to as “Antique Points,” being some of the most ancient of points used in treatment. Each of the five points has a five-phase correspondence, and they are employed in the treatment of imbalances between the Elements.

The use of tsubo a la carte as therapeutic recipes to treat certain ailments, weaknesses, and imbalances, or as a featured ingredient within a larger session plan, may add a significant dimension of therapeutic incisiveness — getting directly to the point. Thinking of tsubo as windows and doorways, they are portals of communication. Gentle, non-forceful acupressure is a safe way to listen to, explore, and assist the energies of the body in the pursuit of harmony.