The concept of “forbidden points” originates from the historical practice of Traditional Chinese Medicine (TCM) and refers to specific acupuncture locations requiring extreme caution or complete avoidance under certain circumstances. These points are not inherently harmful, but their powerful physiological effects or close proximity to vital anatomical structures elevate their risk profile when improperly stimulated. While acupuncture is widely recognized as a safe therapy, these historically designated points emphasize the importance of precision and patient screening in clinical practice.
Identifying the Five Forbidden Points
The five most commonly cited acupuncture points traditionally designated as “forbidden” are categorized by their strong, downward-moving actions on the body’s energy, or Qi, making them generally contraindicated in pregnancy. These points are often used to stimulate or regulate circulation, which is why their power is considered too strong for a developing fetus. Large Intestine 4 (LI-4), known as Hegu, is located on the fleshy web between the thumb and index finger. Spleen 6 (SP-6), or Sanyinjiao, is situated on the inner lower leg, approximately four finger-widths above the inner ankle bone.
Gallbladder 21 (GB-21), or Jianjing, is found on the top of the shoulder, midway between the neck and the shoulder joint. Urinary Bladder 60 (BL-60), or Kunlun, is located behind the outer ankle, in the depression between the Achilles tendon and the ankle bone. The fifth point is often listed as Urinary Bladder 67 (BL-67), or Zhiyin, found at the outer corner of the small toenail. This point is historically used to correct breech presentation.
Anatomical and Physiological Risks
The primary physiological concern for points like LI-4, SP-6, BL-60, and BL-67 is their powerful ability to move Qi and Blood, which can lead to uterine stimulation. Strong manipulation or deep needling of these points during pregnancy, particularly in the first two trimesters, is thought to potentially trigger premature labor or miscarriage. This risk is based on the points’ established use in late-term labor induction protocols, where their stimulating effect is intentionally utilized.
Other forbidden points pose a direct anatomical risk due to their location near vital organs or major neurovascular bundles. Gallbladder 21 (GB-21) on the shoulder is a prime example, as it lies close to the apex of the lung. Improper angle or excessive depth when needling GB-21 carries a documented risk of puncturing the lung membrane, a serious complication known as pneumothorax, or collapsed lung. The lung tissue can be as little as 10 to 20 millimeters beneath the skin surface in this area, demanding specialized oblique needling techniques.
Points on the back overlying the kidneys, such as specific points on the Bladder meridian (e.g., BL-23), require shallow, angled insertion to avoid internal injury. Similarly, points near the carotid artery in the neck (like Stomach 9, ST-9) or points on the chest near the heart must be approached with extreme caution to prevent vascular injury or syncope. The historical warning associated with these points highlights the need for practitioners to possess a detailed understanding of human anatomy to practice safely.
Modern Standards and Safe Practice
In contemporary, regulated acupuncture practice, the term “forbidden” has largely been replaced by “contraindicated” or “use with extreme caution,” reflecting a shift from absolute prohibition to risk assessment. Licensed acupuncturists receive extensive training that includes in-depth study of human anatomy, focusing on the safe needling depths and angles for every point on the body. This training is designed to mitigate the anatomical risks associated with points near the lungs, major vessels, and nerves.
For the points related to pregnancy, patient screening is the primary defense against improper use. A thorough intake process includes mandatory questioning about a patient’s pregnancy status, allowing the practitioner to avoid or modify treatment protocols that include points like LI-4 and SP-6. If a pregnant patient requires treatment, the points are simply excluded from the session until the final weeks of gestation, when they may be used intentionally as part of a labor preparation protocol.
The modern standard emphasizes that the safety of acupuncture is directly linked to the training and licensure of the practitioner. While the historical warnings remain a valuable part of the tradition, they reinforce the high level of precision and diligence required. Understanding the modern context provides reassurance that a properly trained professional can safely navigate these complex points.