{
  "schemaVersion": "1.0",
  "workId": "BRC-2026-W105",
  "published": "2026-08-15",
  "question": {
    "ko": "배열(등의 열감)과 배수혈 사이에 원문상, 공간상, 생리상 또는 임상적으로 입증된 관련성이 있는가?",
    "en": "Is there a textually, spatially, physiologically, or clinically demonstrated relation between heat felt on the back and Back-Shu points?"
  },
  "scope": {
    "kind": "purposive evidence map",
    "efficacyReview": false,
    "patientData": false,
    "classicalQueries": ["背熱", "背俞", "五藏俞", "肺俞"],
    "modernQueries": ["back-shu", "acupoint skin temperature", "thermography", "pain sensitivity", "Back-Shu anatomy"]
  },
  "classicalCorpus": {
    "system": "HanScope local artifact locator",
    "snapshotBuiltAt": "2026-08-14",
    "documents": 1121,
    "sections": 61958,
    "verificationPolicy": "Generated synthesis is not evidence. Claims require a local artifact locator and a checked public witness where available."
  },
  "classicalEvidence": [
    {
      "id": "CL-001",
      "source": "허준, 『동의보감』 외형편 권2 「배」, 「배열」",
      "localDocumentId": "km-dongui-oehyeong.md",
      "localLocator": "lines 6374-6378",
      "artifactSha256": "4c85bd2fa572fc66449835c5870dea8e1272240b8d0bedeb634fdbc8a4c3585d",
      "publicWitness": "https://app.mediclassics.kr/books/%EB%8F%99%EC%9D%98%EB%B3%B4%EA%B0%90/pages/1483",
      "passage": "背熱屬肺肺居上焦故熱應於背[入門]",
      "supports": "A historical lung-upper-burner explanation for heat on the back.",
      "doesNotSupport": "Feishu/BL13, Back-Shu palpation, needling, skin-temperature specificity, a modern pulmonary diagnosis, or treatment efficacy."
    },
    {
      "id": "CL-002",
      "source": "『황제내경 영추』 「배수」",
      "localDocumentId": "km-theqi-oldbook-book183.md",
      "localLocator": "line 989 (downstream witness)",
      "artifactSha256": "128a9a4687e21795f308063b8047580c8131fb361e8b107e99a6f75b02e9819b",
      "publicWitness": "https://ctext.org/huangdi-neijing/bei-yu",
      "passage": "背中大腧，在杼骨之端，肺腧在三焦之間，心腧在五焦之間，膈腧在七焦之間，肝腧在九焦之間，脾腧在十一焦之間，腎腧在十四焦之間。",
      "supports": "Back-Shu as a vertebrally distributed series identified by location and palpatory response.",
      "doesNotSupport": "Spontaneous heat on the back, skin temperature, or temperature specificity at Back-Shu sites."
    },
    {
      "id": "CL-003",
      "source": "『황제내경 소문』 「수열혈론」",
      "localDocumentId": "km-theqi-oldbook-book250.md",
      "localLocator": "line 2018 (downstream witness)",
      "artifactSha256": "fd2c4a0f9cee627a2ca702cc07cbe769ac2a0aba3a239e02950e5256377a4c11",
      "publicWitness": "https://ctext.org/huangdi-neijing/shui-re-xue-lun/zh",
      "passage": "五藏俞傍五此十者，以寫五藏之熱也。",
      "supports": "A historical relation between heat-illness needling and points beside the visceral Shu points.",
      "doesNotSupport": "Spontaneous localized back heat, heat at Back-Shu points themselves, diagnostic accuracy, or treatment effect for back heat."
    }
  ],
  "modernEvidence": [
    {
      "id": "MD-001",
      "citation": "Yang E, et al. Skin Temperature of Acupoints in Health and Disease: A Systematic Review. 2022.",
      "pmid": "35475679",
      "doi": "10.1089/jicm.2021.0437",
      "design": "systematic review",
      "sample": "1771 records screened; 10 studies included",
      "finding": "Selected studies reported point-temperature differences across seven clinical conditions or state changes.",
      "limits": "Substantial heterogeneity and thermal-method quality problems prevented pathology-specific conclusions."
    },
    {
      "id": "MD-002",
      "citation": "Yuan X, et al. Lumbosacral and Back-Shu thermography in lumbar disc herniation low-back pain. 2024.",
      "pmid": "38621730",
      "design": "case-control thermography",
      "sample": "50 patients and 45 healthy controls",
      "finding": "Greater lumbosacral and bilateral asymmetry; affected-side BL23 and BL25 were warmer than the unaffected side.",
      "limits": "Participants were not recruited for back heat; felt heat was not measured; non-point specificity is not established by the public abstract."
    },
    {
      "id": "MD-003",
      "citation": "Moon H, et al. Biomechanical Properties and Pain Sensitivity at Back-Shu Points. 2024.",
      "pmid": "39199515",
      "doi": "10.3390/brainsci14080823",
      "design": "exploratory cross-sectional study",
      "sample": "48 healthy adults",
      "finding": "BL23 differed from other measured sites in tone, stiffness, and pressure sensitivity.",
      "limits": "No temperature and no clinical group; regional anatomy can create apparent point differences and confound visceral interpretation."
    },
    {
      "id": "MD-004",
      "citation": "Cabioglu MT, Arslan G. Neurophysiologic basis of Back-Shu and Huatuo-Jiaji points. 2008.",
      "pmid": "18543382",
      "doi": "10.1142/S0192415X08005916",
      "design": "narrative physiological review",
      "finding": "Proposes somato-visceral and autonomic pathways.",
      "limits": "Mechanistic plausibility is not evidence that a Back-Shu process causes spontaneous back heat."
    },
    {
      "id": "MD-005",
      "citation": "Cho Y, et al. Anatomy and needling of BL18, BL20, and BL22: systematic review. 2022.",
      "pmid": "36316824",
      "doi": "10.1097/MD.0000000000029878",
      "design": "systematic review",
      "sample": "115 studies, mostly insertion depth and angle",
      "finding": "Maps relevant anatomy and proposed spinal, sympathetic, and diaphragmatic pathways.",
      "limits": "Few mechanism/effect studies and generally limited quality; no back-heat construct."
    },
    {
      "id": "MD-006",
      "citation": "Lee IS, et al. Front-mu and Back-shu Acupoint Selection Patterns. 2024.",
      "pmid": "39712517",
      "doi": "10.1089/acu.2024.0048",
      "design": "data mining and network analysis",
      "sample": "421 clinical studies",
      "finding": "Describes selection and combination patterns.",
      "limits": "Usage pattern is not diagnostic accuracy or treatment efficacy for back heat."
    },
    {
      "id": "MD-007",
      "citation": "Nishie M, et al. Bilateral pneumothorax after acupuncture treatment. 2021.",
      "pmid": "33649032",
      "doi": "10.1136/bcr-2020-241510",
      "design": "case report",
      "finding": "Documents bilateral pneumothorax after acupuncture; pleura was approximately 22 mm deep in the reported anatomy.",
      "limits": "Safety boundary only; does not estimate incidence or assess efficacy."
    }
  ],
  "claimBoundary": {
    "supported": [
      "A researchable historical connection exists between heat concepts and the vicinity of visceral Shu points.",
      "Temperature and tissue properties can be measured at Back-Shu sites.",
      "Segmental and autonomic mechanisms are physiologically plausible hypotheses.",
      "A blinded spatial and temporal concordance study is feasible."
    ],
    "notEstablished": [
      "Back-Shu points cause spontaneous heat on the back.",
      "A warm Back-Shu point diagnoses dysfunction of its named viscus.",
      "BL13 is specifically related to back heat because the Donguibogam attributes back heat to the lung.",
      "Needling Back-Shu points treats back heat.",
      "Existing temperature findings are specific to point centres rather than adjacent anatomy."
    ]
  },
  "nextStudy": {
    "sequence": [
      "Record participant wording and body map before revealing an acupoint grid.",
      "Acquire standardized thermography during an episode and repeat on a symptom-free day.",
      "Overlay Back-Shu coordinates by an analyst blinded to participant and symptom data.",
      "Compare point centres with surrounding annuli, non-point sites at the same level, and mirrored contralateral regions.",
      "Test spatial concordance and within-person temporal reproducibility before any organ-diagnostic or treatment claim."
    ],
    "primaryOutcomes": ["spatial concordance beyond chance", "within-person temporal reproducibility"],
    "treatmentTrialBeforeConcordance": false
  }
}