Shi Qi Zhui Xia Below the Seventeenth Vertebra

What does Shi Qi Zhui Xia do?

Shi Qi Zhui Xia is an extra point on no channel, so it carries no channel-theory actions — everything recorded here is drawn from documented clinical use rather than from channel or organ mechanics. In that documented use it does two things, and they are the two the reference literature and the trial evidence both support: it relieves pain in the lower back, and it relieves period pain.

• Relieves lumbosacral pain — the defining documented use and the reason the point was recorded. It is used for low back pain, lumbar strain and stiffness of the lower back, and it is one of the standard midline points of that region.
• Relieves menstrual pain — the documented use that has attracted almost all of this point's research. It is used for painful periods and for irregular menstruation, and it is one of the very few points in the whole repertoire to have been tested as a single-point treatment in trials of several hundred patients. That evidence is set out under the notes below.
• Relieves pain referred into the buttock, thigh and leg — recorded for the pain that radiates down from the lower back, and used in that presentation alongside the channel points of the region.
• Strengthens and supports the lower back — recorded for weakness and aching of the lumbar region, the dull, long-standing, worse-with-fatigue presentation.

A correction worth stating plainly. Our own earlier record described this point as "activating the local channel". That phrase has been removed. Activating a channel is channel theory, and Shi Qi Zhui Xia is on no channel — queried directly, our own records place it among the extra points with no channel affiliation and no point classification of any kind. The mistake is easy to make here, because of an accident of geography that deserves its own explanation: the point lies exactly on the midline, on the line the Governing Vessel runs along — but it is not a Governing Vessel point. The Governing Vessel's own points in this stretch are Yao Yang Guan DU-03, below the fourth lumbar vertebra, and Yao Shu DU-02 at the sacral hiatus below; Shi Qi Zhui Xia sits between them, in a gap the Governing Vessel numbering does not fill. Those two, along with Ming Men DU-04 higher up, are the points that genuinely carry the midline channel actions here. For the Kidney and lumbar organ actions the carrier is Shen Shu BL-23, the Back-Shu point of the Kidneys, and for the local Bladder-channel action Da Chang Shu BL-25 and, distally, Wei Zhong BL-40. All are held in Sacred Lotus sources & references. What the sources document at Shi Qi Zhui Xia is clinical use, not a channel mechanism, and the distinction matters on a site people cite.

Source: Sacred Lotus sources & references (existing action and use records, corrected as described; extra-point status, absence of channel and of any point classification, and the DU-02, DU-03, DU-04, BL-23, BL-25 and BL-40 records queried directly); Deadman & Al-Khafaji, A Manual of Acupuncture, extra points (p. 573); Chinese Acupuncture & Moxibustion (p. 246); cross-referenced against multiple online sources.

What is Shi Qi Zhui Xia used for?

Shi Qi Zhui Xia is used for two things above all: pain in the lower back, and painful periods. The indications carried in Sacred Lotus sources & references are lumbar pain, thigh pain, paralysis of the lower limbs, irregular menstruation and dysmenorrhoea; the wider reference literature sets them out as follows. They describe traditional use, not proven treatment.

• Lumbar pain and low back pain
• Lumbar strain and stiffness of the lower back
• Pain in the sacral region
• Dysmenorrhoea — painful periods
• Irregular menstruation
• Pain radiating from the lower back into the buttock and thigh
• Thigh pain
• Weakness and impaired movement of the lower limbs
• Paralysis of the lower limbs
• Difficulty in bending and straightening the back
• Aching of the lower back that is worse with fatigue

Source: Sacred Lotus sources & references (existing indication record); Deadman & Al-Khafaji, A Manual of Acupuncture, extra points (p. 573); Chinese Acupuncture & Moxibustion (p. 246).

Where is Shi Qi Zhui Xia, and how is it used in practice?

Shi Qi Zhui Xia lies exactly on the midline of the lower back, in the hollow immediately below the tip of the last lumbar vertebra — the fifth, counting down from the waist — just above where the spine joins the sacrum. Sacred Lotus sources & references give it in those terms. It is a single midline point, not a bilateral pair, which distinguishes it immediately from most of the lumbar points a reader will meet alongside it. Run a finger down the bumps of the lower spine and the last one that moves independently is the fifth lumbar vertebra; the hollow just below it is the point.

In practice it is used in two quite separate settings. In the back clinic it is a local point for lumbar pain, chosen because the complaint is in the lower back and treated alongside the channel points either side of it. In gynaecological practice it is used for period pain, and there it is used in a distinctive way: it is one of the small number of points with a published record of being used entirely on its own, and it is treated at a particular moment in the cycle rather than continuously. Moxibustion, warm needling, cupping and acupressure over the lumbar midline are all recorded here, and the acupressure use has been trialled in its own right.

Which points is Shi Qi Zhui Xia combined with?

• With San Yin Jiao SP-06, Di Ji SP-08 and Ci Liao BL-32 — the standard multi-point prescription for period pain, and the comparison arm in most of the trials of this point. SP-06 is the meeting point of the three leg yin channels, SP-08 the Cleft point of the Spleen channel, and BL-32 the second sacral foramen point; all three are held here. Two published trials set exactly this group against Shi Qi Zhui Xia alone, and the results are set out under the notes below.
• With Yao Yang Guan DU-03 and Ming Men DU-04 — the Governing Vessel points on the same midline, above it. DU-03 sits one vertebral level higher, below the fourth lumbar vertebra, and DU-04 higher still at the second. These are the channel points of the midline that Shi Qi Zhui Xia sits between.
• With Shen Shu BL-23, Da Chang Shu BL-25 and Yao Yan — the points of the lumbar region either side. Read the lower back outward from the spine and the picture is orderly: the midline (DU-03, DU-04 and this point), then the inner Bladder line at one and a half cun (BL-23, BL-25), the outer Bladder line at three cun (BL-52 Zhi Shi), and the extra point Yao Yan furthest out at about three and a half. All are held here, and our Yao Yan record sets out the same map from its own position.
• With Wei Zhong BL-40 — the distal point for the lower back at the back of the knee, and the classical partner of any local lumbar point. It is one of the Command points, the tradition's short list of distal points for the major regions of the body, and its region is the back.
• With the sacral foramen points — Ci Liao BL-32 and its neighbours, for the pain that runs from the low back into the buttock and thigh.
• With moxibustion — warming methods over the lumbar midline are widely recorded for the chronic, cold, worse-with-tiredness presentation of low back ache, and for period pain of the cold type.
• With acupressure rather than needling — this point has been trialled specifically as an acupressure point in labour, and the finger-pressure use is a documented one rather than an improvisation. See the research under the notes.

Source: Sacred Lotus sources & references (existing use record and location; extra-point status and the DU-02, DU-03, DU-04, BL-23, BL-25, BL-32, BL-40, BL-52, SP-06, SP-08 and Yao Yan records queried directly); Deadman & Al-Khafaji, A Manual of Acupuncture, extra points (p. 573); Chinese Acupuncture & Moxibustion (p. 246); cross-referenced against multiple online sources.

Where is Shi Qi Zhui Xia located?

• A Manual of Acupuncture (p. 573): On the midline of the lower back, in the depression below the spinous process of the fifth lumbar vertebra (L5).

How is Shi Qi Zhui Xia needled, and what does the literature record about depth?

Reference record only — this sets out what the standard texts document, not instruction for a reader. Sacred Lotus sources & references record perpendicular insertion of 0.5 to 1 cun at Shi Qi Zhui Xia, with moxibustion widely recorded over the lumbar region. This is a low-hazard point by the standards of this library: there is no body cavity above it, no lung, and no abdominal organ behind it. What lies behind it is the spine itself, and the useful thing to understand is precisely what that means — because it is not the same concern that applies at the lumbar points either side of it.

The angle and depth the texts record

• Sacred Lotus sources & references record perpendicular insertion of 0.5 to 1 cun. That is shallower than the 1 to 1.5 cun our records give for Yao Yan out at about three and a half cun lateral, and shallower than the 1 to 1.2 inch recorded at Shen Shu BL-23 — which is the right way round, because the midline offers less soft tissue and a bony floor closer to the surface than the muscle mass either side of it.
• Deadman & Al-Khafaji (p. 573) and Chinese Acupuncture & Moxibustion (p. 246) record a comparable perpendicular range at this point.
• Moxibustion, warm needling and cupping are all recorded here and are common, particularly for the cold, chronic presentations of both low back ache and period pain. None carries a depth consideration at all.
• Acupressure is a documented technique at this point in its own right and has been formally trialled here (see the research under the notes). Finger pressure raises no depth question whatever, which is part of why it is used in settings — such as labour — where needling would be impractical.

What actually lies beneath — and why this point differs from its neighbours

• On the midline, the structure behind is the interspinous ligament and, behind that, the vertebral canal. The needle passes through skin, the thick fibrous layer of the thoracolumbar fascia and the supraspinous ligament, into the interspinous ligament between the fifth lumbar spinous process and the sacrum. Behind that lie the ligamentum flavum and then the vertebral canal. This is a very different anatomy from the lumbar points to either side, and it deserves to be stated rather than glossed.
• An important anatomical fact about this level. In the adult the spinal cord itself ends at about the first or second lumbar vertebra; below that the canal contains the cauda equina — the loose bundle of nerve roots — suspended in cerebrospinal fluid, which is precisely why lumbar punctures and spinal anaesthetics are performed at these lower lumbar interspaces rather than higher. Shi Qi Zhui Xia sits at the fifth lumbar level, well below the end of the cord. That is a reassuring fact rather than an alarming one, and it is recorded here because a reader who meets "the vertebral canal lies behind this point" deserves to know what is actually in it at this height.
• The concern at the lateral lumbar points does not apply here. Our Yao Yan record sets out the documented concern for that point — deep needling passing beyond the paraspinal muscles into the retroperitoneal space — and cites the MRI evidence for it: a study of 61 healthy subjects measured the dangerous depth and the effective safe depth of perpendicular and oblique needling at the acupoints of the kidney region, naming BL-21, BL-22, BL-23, BL-50, BL-51 and BL-52, and found that safe depth varies substantially with body size, being markedly shallower in underweight subjects (Zhongguo Zhen Jiu 2022;42(9):1006–1010, PMID 36075596). Every point that study measured is one and a half or three cun lateral to the midline. None of them is Shi Qi Zhui Xia, and the retroperitoneal concern belongs to the paravertebral position rather than to the midline one. It is recorded here to be explicit about what does not transfer, because importing a lateral point's hazard onto a midline point would be exactly the kind of borrowed warning this library sets out to avoid.
• Honest limit. We could not locate any imaging study measuring a safe needling depth at Shi Qi Zhui Xia, and no published case report of injury at it. None is asserted. What is recorded is the bounded depth the reference texts give, the anatomy of the lumbar midline, and the general principle — established across the whole safe-depth literature — that depth in this region tracks body size rather than being a constant.
• The general principle about depth. Two systematic reviews of the safe-depth literature — 33 studies in one, 47 in the other, by MRI, CT, ultrasound and cadaveric dissection — both concluded that measured depths for the same point differ greatly between subject groups and measuring methods, and that "safe depth" has never been standardised (J Altern Complement Med 2011;17(3):199–206, PMID 21417806; Evid Based Complement Alternat Med 2013;2013:740508, PMID 23935678). A textbook depth figure describes an average body, not a constant.

Risk in proportion

A meta-analysis of prospective clinical studies estimated serious adverse events in acupuncture at approximately 1 per 10,000 patients and around 8 per million treatments, with about half of all recorded events being bleeding, pain or flare at the needle site (Bäumler P et al., BMJ Open 2021;11:e045961, PMID 34489268). Systematic reviews of the Chinese case literature find the serious events concentrated at points over the chest, the abdomen, the neck and the orbit, attributed chiefly to improper technique (He W et al., PMID 22967282; Zhang J et al., Bull World Health Organ 2010;88(12):915–921C, PMID 21124716, PMC2995190). The lumbar midline is not in that group, and the accurate summary is that Shi Qi Zhui Xia is one of the straightforward points of the repertoire.

Source: Sacred Lotus sources & references (existing needling record; the BL-23 and Yao Yan needling records queried directly for comparison); Deadman & Al-Khafaji, A Manual of Acupuncture, extra points (p. 573); Chinese Acupuncture & Moxibustion (p. 246); PMID 36075596 (measured BL-21, BL-22, BL-23, BL-50, BL-51 and BL-52 — not this point); PMID 21417806; PMID 23935678; PMID 34489268; PMID 22967282; PMID 21124716 (PMC2995190) — each verified resolvable and checked for retraction status before citation.

What does the name Shi Qi Zhui Xia mean?

Shi Qi Zhui Xia means "Below the Seventeenth Vertebra" — shi qi, seventeen, zhui, vertebra, xia, below. Sacred Lotus sources & references translate it exactly that way, and the name is nothing more than a set of instructions for finding the point. It is also, once decoded, the clearest possible confirmation of where the point is.

Count the vertebrae the way the classical texts do — from the first thoracic vertebra downward, leaving the neck out. There are twelve thoracic vertebrae and five lumbar. Twelve plus five is seventeen. The seventeenth vertebra on that count is therefore the fifth lumbar vertebra, and "below the seventeenth vertebra" is the hollow just beneath its tip — which is exactly where our own location record places the point. The name and the location check against one another, which is a useful thing on a point whose name confuses almost everyone who meets it for the first time.

The point is designated EX-B 8 in the modern extra-point numbering; older texts write M-BW-25. Both appear in the research literature, and readers will meet the name transliterated as Shiqizhui, Shiqizhuixia or simply "the seventeenth vertebra point". They are all this point.

Is Shi Qi Zhui Xia a channel point?

No. It belongs to no channel — and that is not a technicality here, because the point sits precisely on the line a channel runs along. Queried directly, our own records place Shi Qi Zhui Xia among the extra points, with no channel affiliation and no five-shu, Yuan-Source, Luo-Connecting, Xi-Cleft, Back-Shu, Front-Mu or Confluent classification. The Governing Vessel runs up the midline of the back and passes directly over this spot, but its own points in this stretch are Yao Shu DU-02 at the sacral hiatus and Yao Yang Guan DU-03 one level above, below the fourth lumbar vertebra. Shi Qi Zhui Xia falls in the gap between them.

Two consequences follow, and both matter to a reader:

• It has no channel-theory actions, and any source that gives it some — "activates the channel", "tonifies the Kidneys", "warms the Governing Vessel" — has borrowed them from the points around it. Our own earlier record carried one such phrase and it has been removed; the correction is set out in full under this point's actions.
• Its standing is entirely empirical, and unusually strong for that. Extra points earn their place by being useful rather than by being classified, and this one has more randomised trial evidence behind it than most classified points do — including trials in which it was the only point treated. That is set out below.

Is there research on Shi Qi Zhui Xia?

Yes, and it is unusually good for an extra point: this is one of a handful of points anywhere in acupuncture to have been tested as a single-point treatment in randomised trials, in one case with six hundred patients. Almost all of it concerns period pain.

• The largest trial: 600 patients, single point against multi-point. Six hundred women with primary dysmenorrhoea were randomly allocated to five groups of one or two hundred: acupuncture at Shiqizhui (EX-B8) alone, either before menstruation or as soon as pain began; a multi-point prescription, likewise before or at pain onset; or no treatment. Treatment ran for three menstrual cycles with three follow-up periods. All the acupuncture groups did better than the untreated control. Pain relief came within five minutes in both of the groups treated at pain onset. Treating before the period was better than treating at pain onset for the multi-point prescription; and — the finding that matters most here — the single point was better than the multi-point prescription when treatment was given at the moment pain began. The authors concluded that Shiqizhui should be chosen as a convenient point (Ma YX et al., J Ethnopharmacol 2013;148(2):498–504, PMID 23684618). The design has real limitations — it is unblinded, and one of its comparators is no treatment at all — but a 600-patient randomised trial naming one extra point is a rarity worth reporting accurately.
• A smaller single-point comparison reached the same conclusion. Thirty-eight women with dysmenorrhoea were randomised to acupuncture at Shiqizhui alone or at Shiqizhui together with San Yin Jiao SP-06, Di Ji SP-08 and Ci Liao BL-32, treated for three days from the onset of pain in each of three cycles. Cure rates were 68.4 per cent against 78.9 per cent and effective rates 31.6 per cent against 21.1 per cent, with no statistically significant difference between them on any measure — pain scale, symptom frequency or severity. The authors concluded that the single point can be as effective as the multi-point prescription (Li YM et al., Zhongguo Zhen Jiu 2011;31(3):199–202, PMID 21644298). Thirty-eight patients is a small sample, and a null result in a small sample is weak evidence of equivalence rather than proof of it.
• A third trial found the opposite emphasis, and both should be reported. Sixty-three women with moderate dysmenorrhoea were randomised to the single point or to the same four-point group, with pain measured repeatedly during and after treatment. Both produced rapid analgesia that built over thirty minutes of needle retention; but at ten minutes the multi-point group's immediate analgesia was significantly better than the single point's, and that advantage persisted for two hours after the needles came out. The authors also concluded that retention should be no shorter than thirty minutes (Chen SZ et al., Zhongguo Zhen Jiu 2011;31(4):305–308, PMID 21528594). Read the three studies together and the honest summary is: the single point works, the multi-point prescription may work somewhat better or somewhat faster, and the case for using this point alone is convenience rather than superiority.
• Timing has been tested too. Eighty women with primary dysmenorrhoea were randomised to needling at Shiqizhui before menstruation, at the onset of pain, or not at all. Both acupuncture groups did significantly better than the untreated group across three cycles and follow-up, and there was no significant difference between the two timings (Bu YQ, Zhongguo Zhen Jiu 2011;31(2):110–112, PMID 21442807).
• Acupressure at the point in labour — the only sham-controlled trial. Ninety first-time mothers in the active phase of the first stage of labour were randomised to acupressure at EX-B8, sham acupressure, or routine care, with twenty minutes of pressure applied during contractions at three stages of cervical dilatation. Pain scores were significantly lower in the EX-B8 group than in both the sham and the control groups at all three stages, with the greatest relief at 8–10 cm dilatation, and maternal and neonatal outcomes did not differ between the groups (Azadeh H et al., Pain Res Manag 2025;2025:7873155, PMID 40040748, PMC11876523). Stated for completeness: this article carries a published correction (Pain Res Manag 2025;2025:9832031, PMID 41496771). A correction is not a retraction — the paper stands — but a reader following the citation should know that the corrected version is the one to read. This is the strongest design in the set, though the intervention is finger pressure rather than needling.
• Low back use is documented but not isolated. The point appears in trials of lumbar disc herniation and lumbar pain as one point among several — for example in a study of qi-conducting needling at Governing Vessel points combined with electroacupuncture (Zhongguo Zhen Jiu 2017;37(5), PMID 29231605) and in a comparison of acupuncture therapies for lumbar disc herniation (Zhongguo Zhen Jiu 2013;33(7), PMID 24032192). Nothing in those studies is attributable to this point alone. It is worth noticing that this point's better evidence is gynaecological rather than musculoskeletal — the reverse of what its name and position would lead a reader to expect.
• What is not here. There is no imaging study measuring safe depth at this point, no anatomical study naming it, and no sham-controlled needling trial of it — the sham-controlled evidence is for acupressure. The needling trials are almost all from one small group of institutions and are unblinded.

How does Shi Qi Zhui Xia compare with the points around it?

Yao Yang Guan DU-03 lies one vertebral level above on the same midline, below the fourth lumbar vertebra, and is the Governing Vessel's own point in this stretch — the point to choose where the reasoning is channel reasoning rather than local. Yao Shu DU-02 lies below at the sacral hiatus. Ming Men DU-04, "Life Gate", is higher still at the second lumbar level and is the midline point most associated with warming and supporting the lower back. Shen Shu BL-23, one and a half cun out at the second lumbar level, is the Back-Shu point of the Kidneys and the point that genuinely carries the Kidney-supporting action often misattributed to the extra points of this region — our Yao Yan record makes the same correction from its own side. Da Chang Shu BL-25 is the Back-Shu point of the Large Intestine at the fourth lumbar level and the busiest local point for low back pain on the Bladder channel. Yao Yan, the extra point at about three and a half cun lateral, is the most lateral of the routinely used lumbar points and is a bilateral pair where this one is a single midline point. Ci Liao BL-32 over the second sacral foramen is the principal sacral point for menstrual complaints and the one Shi Qi Zhui Xia is most often trialled against. And Wei Zhong BL-40 behind the knee is the classical distal point for the whole of the lower back. All are held in Sacred Lotus sources & references.

Source: Sacred Lotus sources & references (name, translation, extra-point status, absence of channel and of any point classification, location, and the DU-02, DU-03, DU-04, BL-23, BL-25, BL-32, BL-40, BL-52, SP-06, SP-08 and Yao Yan records queried directly); Deadman & Al-Khafaji, A Manual of Acupuncture, extra points (p. 573); Chinese Acupuncture & Moxibustion (p. 246); PMID 23684618; PMID 21644298; PMID 21528594; PMID 21442807; PMID 40040748 (PMC11876523, with published correction PMID 41496771); PMID 29231605; PMID 24032192 — each verified resolvable and checked for retraction status before citation; cross-referenced against multiple online sources.