DU-23 (Shang Xing) Upper Star

What does DU-23 Shang Xing do?

Shang Xing DU-23 sits on the midline of the forehead one cun inside the front hairline, and it is the Governing Vessel's principal nose point. Sacred Lotus sources & references record three actions for it: it benefits the nose and eyes, it eliminates wind and benefits the head and face while dispelling swelling, and it calms the spirit. The Governing Vessel runs up the midline of the back, over the crown and down the forehead to end at the gum, so it crosses the nose directly — and DU-23 is the point on that stretch the tradition weights most heavily toward nasal disease. It is also recorded here as one of Sun Si-miao's Ghost points.

• Benefits the nose and eyes — the defining action, and the reason the point is reached for. Nasal congestion, running nose, chronic and allergic rhinitis, loss of smell, nosebleed, and painful or swollen eyes.
• Eliminates wind and benefits the head and face; dispels swelling — for the frontal headache, heaviness and facial swelling the tradition attributes to wind attacking the upper body. Wind is described in the classics as rising to the highest parts, which is why so many head-top points carry a wind action.
• Calms the spirit — recorded for agitation and disordered mental states, and the action that connects to the point's Ghost-point status. It is the least prominent of the three at this point; DU-24 Shen Ting immediately in front of it and DU-20 Bai Hui at the crown are the Governing Vessel's primary spirit points, and this record does not overstate DU-23's share of that role.

The three actions are more unified than they look. Frontal headache, blocked nose and heavy pressure behind the eyes are one presentation clinically, and DU-23 is the single midline point that addresses all of it — sitting directly above the frontal sinuses and on the vessel that continues down over the nose.

Source: Sacred Lotus sources & references (channel and Ghost-point classifications, and the recorded actions above — the broken list markup in that record corrected here); Deadman & Al-Khafaji, A Manual of Acupuncture, p. 556; Chinese Acupuncture & Moxibustion, p. 234; cross-referenced against multiple online sources.

What is DU-23 Shang Xing used for?

Shang Xing DU-23 is used above all for nasal congestion, running nose and nosebleed, and for frontal headache. The indications recorded in Sacred Lotus sources & references fall into a nasal group, a head-and-eye group and a small mental-emotional group. They describe traditional use, not proven treatment, and the point carries the frontal-bone needling considerations set out below.

• Nasal congestion and blocked nose
• Rhinorrhoea (running nose), including chronic and allergic rhinitis
• Epistaxis (nosebleed)
• Loss of the sense of smell
• Frontal headache and heaviness of the head
• Ophthalmalgia — painful eyes
• Redness, swelling and pain of the face
• Dizziness and vertigo
• Mental disorder and agitation
• Febrile disease without sweating

Nosebleed deserves a note, because it looks paradoxical on a point used for the nose. The classical record has DU-23 in both directions — it is named for stopping epistaxis, and the same texts record pricking the point to cause a small amount of bleeding as a technique for heat in the head. Both are in the source literature and both are reported here.

Source: Sacred Lotus sources & references (existing indication record, reformatted here as a list); Chinese Acupuncture & Moxibustion, p. 234; Deadman & Al-Khafaji, A Manual of Acupuncture, p. 556.

How is DU-23 Shang Xing used in practice?

Shang Xing sits on the midline of the forehead, one cun back from the front hairline — roughly a thumb's width inside it — and half a cun behind Shen Ting DU-24. The two are near neighbours on a very short stretch of the Governing Vessel, and the whole of the front-hairline group is measured from the hairline rather than from any bony landmark. Where a hairline has receded, both our sourced location records and the general practice of the reference texts measure from where the hairline would ordinarily fall, not from its present edge; that is the usual source of error in finding this point.

Classic combinations

• With LI-20 Ying Xiang — the essential nasal pairing, joining the forehead point on the midline to the point beside the nostril. Our LI-20 record names DU-23 from the other side, and LI-20 is the point almost every nasal prescription in the literature begins from. Held here.
• With Bi Tong (Shang Ying Xiang) — the extra point at the top of the nasolabial groove, the local specialist for the blocked nose. DU-23, LI-20 and Bi Tong together are the group the modern rhinitis literature uses most often. Held here. Note what Bi Tong is: an extra point on no channel, which is why our Bi Tong record does not claim channel-theory actions for it — the channel mechanics for the nose sit with LI-20 and with this point.
• With Yin Tang — the extra point between the eyebrows, added for the frontal pressure and sinus component. Yin Tang and DU-23 are frequently joined in the Chinese literature by a needle threaded from one toward the other along the midline. Held here.
• With LI-04 He Gu — the distal point for anything on the face, added to almost any nasal or facial prescription. Held here.
• With DU-24 Shen Ting and DU-20 Bai Hui — the midline group of the front and top of the head, used together for headache and for the spirit indications, and commonly threaded one into the next. Both held here.
• With GB-20 Feng Chi — the great wind point at the back of the head; the pairing treats the head from front and back at once for wind headache and for nasal disease of external origin. Held here.
• With BL-07 Tong Tian — on the Bladder channel above and lateral, a point with its own strong nasal reputation, added for chronic nasal obstruction. Held here.

Its role among its peers

The Governing Vessel points of the front and top of the head held in this library run DU-20 Bai Hui at the crown, DU-21 Qian Ding and DU-22 Xin Hui between crown and hairline, DU-23 Shang Xing one cun inside the hairline, DU-24 Shen Ting half a cun inside it, DU-25 Su Liao at the tip of the nose and DU-26 Shui Gou below it. Within that run the division of labour is fairly clean: DU-20 and DU-24 are the spirit points, DU-26 is the revival point for collapse, and DU-23 is the nose point. It is the one a practitioner reaches for when the complaint is specifically nasal and a midline point is wanted.

Among the nose points the library holds — LI-20 Ying Xiang, Bi Tong, DU-25 Su Liao, BL-07 Tong Tian and this point — DU-23 is the only one on the forehead, and therefore the only one that reaches the frontal-sinus territory rather than the nostril and the groove beside it.

Source: Sacred Lotus sources & references (location, and the LI-20, Bi Tong, Yin Tang, LI-04, DU-20 to DU-26, GB-20 and BL-07 records queried directly); Deadman & Al-Khafaji, A Manual of Acupuncture, p. 556; Chinese Acupuncture & Moxibustion, p. 234; cross-referenced against multiple online sources.

Where is DU-23 located?

• A Manual of Acupuncture (p. 556): At the top of the head on the midline, 1 cun posterior to the anterior hairline and 0.5 cun posterior to Shenting DU-24.
• Chinese Acupuncture and Moxibustion (p. 234): 1 cun directly above the midpoint of the anterior hairline.

How is DU-23 Shang Xing needled in the textbooks?

Reference record only — this documents what the standard texts state, not instruction for a reader. The single governing fact at DU-23 is that the frontal bone lies immediately beneath the skin, so the texts record transverse, subcutaneous insertion only; perpendicular insertion is not a documented option at this point. Sacred Lotus sources & references record subcutaneous puncture of 0.3–0.5 cun, or pricking to cause bleeding, with moxibustion applicable. Chinese Acupuncture & Moxibustion (p. 234) and Deadman & Al-Khafaji (p. 556) record the same transverse insertion along the scalp, directed either backward toward DU-24 and DU-20 or forward toward the hairline according to the complaint.

• Angle documented: transverse (subcutaneous), lying along the scalp. There is no meaningful soft tissue between skin and skull here — scalp, the thin frontal belly of the occipitofrontalis muscle, periosteum, bone — so a needle is laid flat under the skin rather than driven in.
• Depth documented: approximately 0.3–0.5 cun along the surface. The figure describes how far the needle travels beneath the skin, not how deep it goes.
• Threading: the point is commonly joined to a neighbour by a single needle threaded between them — toward DU-24 in front, toward DU-20 behind, or toward Yin Tang below. This is a documented technique in the Chinese literature on head points rather than an unusual practice.
• Bleeding technique: pricking the point to release a drop or two of blood is recorded in both our own and the reference sources, for heat in the head.
• Moxibustion: documented as applicable. A data-mining study of ancient acupuncture prescriptions for headache found that where head points were treated, moxibustion was the technique generally associated with Xin Hui GV 22, Shang Xing GV 23 and Bai Hui GV 20, while needling was associated with Feng Fu GV 16, He Gu LI 4 and Zu San Li ST 36 (Li S, Wang J, Zhongguo Zhen Jiu 2024;44(2):224–230, PMID 38373772). That is a documentary finding about the classical record, and it matches the transverse-only constraint: at a point where a needle can only lie flat, heat was the classical alternative.

The infant prohibition — a real, age-dependent hazard

Sacred Lotus sources & references record that this point is prohibited in infants with metopism, that is, where the metopic suture of the frontal bone is still open. This is worth stating plainly because it is a genuine anatomical hazard that depends on the age of the person rather than on the technique. The frontal bone forms as two halves joined on the midline by the metopic (frontal) suture; that suture normally begins closing in the first year or two of life and is usually fused by around eight years, though in a minority of adults it persists. DU-23 lies on the midline directly over its line. In an infant in whom it has not closed there is no continuous bone at the point, and the anterior fontanelle — the soft spot — lies just behind, at the level of DU-22 Xin Hui, whose name, "Fontanel Meeting", records exactly that. The prohibition is therefore about who is in front of the practitioner, not about how the needle is held.

Safety in proportion

Set beside that one constraint, DU-23 is a low-hazard point. There is no body cavity, no organ and no major vessel beneath it; the scalp is vascular so a small bruise or a drop of bleeding at withdrawal is the ordinarily documented occurrence, and the point is not recorded as contraindicated in pregnancy. A meta-analysis of prospective clinical studies estimated serious adverse events across all acupuncture at approximately 1 per 10,000 patients, with roughly half of all recorded events being bleeding, pain or flare at the needle site (BMJ Open 2021;11:e045961, PMID 34489268). A study specifically designed to test the safety of penetrating needling at head points — including threading from Shen Ting GV 24 to Shang Xing GV 23, and from Shang Xing GV 23 to Yin Tang — in sixty patients with acute-stage cerebral haemorrhage found blood, urine and stool parameters, blood pressure, respiration, heart rate and liver and kidney function all remained within normal range in the acupuncture group, with a lower rate of ECG abnormality than the medication-only group (Yuan P et al., Zhongguo Zhen Jiu 2012;32(7):577–581, PMID 22997780). That is a small single-centre study, but its outcome measure was safety and its technique was threading at this exact point.

Standard clean-needle practice applies. Acupuncture is performed by qualified, licensed practitioners; this record documents the literature and is not a technique guide.

Source: Sacred Lotus sources & references (existing needling record, including the infant metopism prohibition); Chinese Acupuncture & Moxibustion, p. 234; Deadman & Al-Khafaji, A Manual of Acupuncture, p. 556; PubMed PMID 38373772, 22997780, 34489268 — each verified resolvable and checked for retraction status before citation.

What does the name Shang Xing mean?

Shang Xing means "Upper Star" — shang, upper or above, and xing, a star. The classical reading is astronomical and quite deliberate. The head was understood as the heavens of the body, and the points along its midline were named for celestial features: the crown is Bai Hui, "Hundred Convergences", where all the yang channels meet, and the forehead below it carries a star. Commentators place the star specifically over the nose and eyes — the organs by which a person perceives the world — so the name says that this point shines down on them, which is exactly the action recorded for it. An older name for the point, Ming Tang ("Bright Hall"), makes the same association with light and with the forehead.

The naming of this small stretch of the head is unusually dense. Within a couple of inches of one another sit DU-22 Xin Hui ("Fontanel Meeting"), DU-23 Shang Xing ("Upper Star"), DU-24 Shen Ting ("Spirit Court") and, laterally, GB-13 Ben Shen ("Root Spirit") — a fontanelle, a star, a courtyard and the root of the spirit. The concentration of celestial and spirit naming is itself evidence of how the region was regarded.

Why is Shang Xing a Ghost point?

Sun Si-miao, the seventh-century physician and author of the Qian Jin Yao Fang, listed thirteen "Ghost points" — gui xue — needled in sequence for madness, seizures and the frightening mental states classical medicine described as possession. In that list each point is renamed with the character gui, ghost; DU-23 appears as Gui Tang, "Ghost Hall". That membership is why "mental disorder" sits in this point's indication list alongside a set of otherwise thoroughly nasal complaints, and why "calms the spirit" is among its recorded actions.

Sacred Lotus sources & references record twelve points as Sun Si-miao Ghost points: LU-11 Shao Shang, SP-01 Yin Bai, P-07 Da Ling, P-08 Lao Gong, BL-62 Shen Mai, DU-16 Feng Fu, DU-23 Shang Xing, DU-26 Shui Gou, REN-01 Hui Yin, REN-24 Cheng Jiang, LI-11 Qu Chi and ST-06 Jia Che. Note that DU-24 Shen Ting — the "Spirit Court" half a cun in front of this point, and the more obviously spirit-named of the two — is not a Ghost point, while DU-23 is. That is a useful discriminator between two points a student otherwise finds hard to separate.

Is there research on DU-23 Shang Xing?

There is no clinical trial that isolates DU-23, and no research testing the point on its own for the nose. What exists is of two kinds: documentary studies of the classical record, which are genuinely about this point, and clinical trials of nasal and head protocols in which DU-23 is one named point among several. That distinction is stated here rather than blurred.

• Documentary: the ancient headache literature. A data-mining study collated the earliest recorded acupuncture-moxibustion prescriptions for headache from pre-Qin to Qing sources and applied association-rule analysis to the relationships between disease location, cause, symptoms and point selection. Among its findings on technique, moxibustion was the method generally associated with Xin Hui GV 22, Shang Xing GV 23 and Bai Hui GV 20, while needling was associated with Feng Fu GV 16, He Gu LI 4 and Zu San Li ST 36 (Li S, Wang J, Zhongguo Zhen Jiu 2024;44(2):224–230, PMID 38373772). This is a study of what the classical literature says, not of whether it works.
• Documentary: the ancient vertigo literature. A comparable study of acupuncture literature for vertigo from the pre-Qin period to the Qing dynasty ranked points by frequency of use and support degree, and found the most-selected points to be, in order, Feng Chi GB 20, Shang Xing GV 23, Yang Gu SI 5, Jie Xi ST 41, Zu Lin Qi GB 41 and Shen Ting GV 24. The authors noted that Yang Gu, Jie Xi and Fei Yang BL 58 are much less used in modern practice than the historical record would suggest (Zhan Q, Chen HD, Zhongguo Zhen Jiu 2014;34(4):359–362, PMID 24946637). DU-23 as the second most-selected point for vertigo across two millennia of the written record is a striking finding — and note that it sits alongside a rather thin modern presence for the same indication.
• Clinical: allergic rhinitis protocols naming the point. A controlled trial in 60 patients with moderate and severe allergic rhinitis used a protocol whose main points were Ying Xiang LI 20, Shang Xing GV 23, Feng Chi GB 20, Qu Chi LI 11, Xue Hai SP 10, Fei Shu BL 13, Ge Shu BL 17 and Pi Shu BL 20, against budesonide nasal spray with cetirizine for eight weeks. Symptom, sign and total scores fell in both arms with no significant difference between them, and total effective rates were 93.4% for acupuncture and 80.0% for medication at eight weeks — again not significantly different (Chen Y et al., Zhongguo Zhen Jiu 2015;35(4):339–343, PMID 26054141). A separate randomised trial added a "supporting yang and consolidating the root" acupuncture-moxibustion regimen — Shang Xing GV 23, Yin Tang, and bilateral Ying Xiang LI 20, Shang Ying Xiang EX-HN 8, Si Bai ST 2, He Gu LI 4 and Chi Ze LU 5, with warm needling at Da Zhui GV 14 — to fluticasone nasal spray in 60 patients with perennial allergic rhinitis, and reported lower nasal, non-nasal, ocular and quality-of-life scores than spray alone out to 30 weeks of follow-up, with reduced serum total IgE and IL-4 (Wu FH et al., Zhen Ci Yan Jiu 2023;48(6):600–605, PMID 37385792). Both trials are small, single-centre and unblinded, and neither can show what DU-23 contributed — every point in each protocol moved together.
• Clinical: the safety study at this point. The penetrating-needling safety trial described under needling above threaded needles from GV 24 to GV 23, and from GV 23 to Yin Tang, in patients with acute cerebral haemorrhage, and reported no deterioration in physiological or laboratory measures (PMID 22997780). Its outcome was safety rather than efficacy, which is why it is cited there rather than here as evidence of effect.

What is missing should be said plainly: for a point with two millennia of documented use for the nose, there is no trial in which DU-23 is the tested variable, and no imaging, anatomical or mechanistic study of the point specifically. Its standing rests on the classical record — which, as the two data-mining studies above show, is unusually well documented for this point — and not on modern evidence.

How does Shang Xing differ from the points near it?

DU-24 Shen Ting lies half a cun in front of it on the same midline and shares much of the same territory, but the weighting is the reverse: Shen Ting is the spirit point of the pair and DU-23 the nose point, and DU-23 is a Ghost point while DU-24 is not. Our DU-24 record makes the same distinction from the other side. DU-22 Xin Hui, "Fontanel Meeting", lies two cun behind DU-23 and carries the same infant caution in a more explicit form — its name is the caution. DU-20 Bai Hui at the crown is the great yang-raising and spirit point of the vessel, a different order of use. Yin Tang, the extra point between the eyebrows, lies below on the same midline and is the calming point of the forehead; it is on no channel, and it is the point most often threaded to or from DU-23. LI-20 Ying Xiang beside the nostril is the nose point of the Large Intestine channel and DU-23's constant partner rather than its alternative, and Bi Tong above it in the same groove is the local nasal specialist — an extra point, not a channel point. BL-07 Tong Tian sits further back and lateral on the Bladder channel with its own nasal reputation. GB-13 Ben Shen lies out to the side at roughly the hairline and belongs to the spirit group rather than the nasal one. All of these are held in Sacred Lotus sources & references.

Source: Sacred Lotus sources & references (name, categories, Ghost-point set, and the DU-20, DU-22, DU-24, DU-25, DU-26, Yin Tang, LI-20, Bi Tong, BL-07 and GB-13 records queried directly); Deadman & Al-Khafaji, A Manual of Acupuncture, p. 556; Chinese Acupuncture & Moxibustion, p. 234; Sun Si-miao, Qian Jin Yao Fang, on the Ghost points; PubMed PMID 38373772, 24946637, 26054141, 37385792, 22997780 — each verified resolvable and checked for retraction status before citation; cross-referenced against multiple online sources.