Bladder Meridian
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BL-18
Safety Warnings
- Dangerous point - requires extra caution
- Deep needling contraindicated - shallow insertion only
Needle Depth
0.5–0.8 cun
Needle Angle
45° (Oblique), 10-15° (Transverse)
Body Area
Back — Upper (Thoracic)
Location
1.5 cun lateral to the lower border of the spinous process of the 9th thoracic vertebra (T9).
Main Actions
- Resolves Damp-Heat
- Invigorates Liver Qi and Blood
- Nourishes Liver Blood
- Extinguishes Interior Wind
- Benefits the eyes and sinews
Indications
Tetany
Nausea
Lockjaw
Jaundice
Red eyes
Eye pain
Neck pain
Dizziness
Sinew pain
Stiff neck
Tearfulness
Eye itching
Lumbar pain
Muscle pain
Bloody nose
Opisthotonos
Swollen eyes
Shoulder pain
Cholecystitis
Abdominal pain
Blurred vision
Abdominal mass
Coughing blood
Epigastric pain
Spine stiffness
Hypogastric pain
Floaters in eyes
Vomiting of blood
Hypochondriac pain
Sour regurgitation
Eye upper orbit pain
Diminished night vision
HypochondriaI distension
Commentary
As the Back Transporting-Shu point of the Liver, Ganshu BL-18 is indicated for most Liver related patterns.
Excess/Full patterns include Liver Qi Stagnation, Damp-Heat in the Liver and Gall Bladder, Liver Fire and Liver Blood Stagnation.
It is widely used to invigorate Liver Qi, in order to ease distension and pain of the hypochondrium, epigastrium, abdomen and hypogastrium. Other symptoms include sour regurgitation, nausea and etc.
By resolving Damp-Heat, Ganshu BL-18 treats jaundice and cholecystitis. By invigorate Liver Blood, it treats abdominal masses.
This point also extinguish Interior Wind so as to ease stiff neck and spine, lockjaw, opisthotonos, or tetany.
Since the Liver opens to the eyes and controls sinews, the point benefits the eyes and sinews in case of blurred vision, excessive lacrimation, upper orbit pain or redness, pain and itching of the eyes as well as pain in lumbar, neck, shoulder and etc.
On the other hand, Ganshu BL-18 can also be used for Empty patterns such as Liver Blood Deficiency. Together with Geshu BL-17, it is able to treat symptoms such as dizziness and blurred vision. In this case, Tonifying Needling method or direct moxibustion should be applied.
Classical Sources
Ling Shu (Spiritual Pivot), Chapter on Back-Shu Points: The earliest classical reference to Ganshu appears in the Ling Shu, which establishes it as the Back-Shu point of the Liver, located at the level of the ninth thoracic vertebra.
Zhen Jiu Jia Yi Jing (Systematic Classic of Acupuncture and Moxibustion): Describes the location as "at the ninth vertebra, 1.5 cun lateral on each side" and lists indications including jaundice, hypochondriac pain, and eye disorders.
Zhen Jiu Da Cheng (Great Compendium of Acupuncture and Moxibustion): Further elaborates on the therapeutic actions of this point for treating Liver disorders, mental conditions, and eye diseases, establishing many of the clinical applications still used today.
How to Locate
First locate the spinous process of the 7th cervical vertebra (C7), which is still palpable when the neck is being flexed and extended, while the 6th cervical vertebra (C6) starts to slide anteriorly and gradually disappears. The spinous process of the 9th thoracic vertebra (T9) is nine spinous process below C7. Or first locate the spinous process of T7, which is level with the inferior angle of the scapula, when the patient is seated with their arms hanging down. T9 is two thoracic vertebra below. Ganshu BL-18 is 1.5 cun lateral to the lower border of T9. Hunmen BL-47 is at the same level but 3 cun lateral to T9. Points located between Fufen BL-41 and Zhibian BL-54 are in the lateral branch of the Bladder Channel, while these between Fengmen BL-12 and Baihuanshu BL-30 are in the medial branch.
Caution
This is a dangerous point due to its location over the thoracic cavity. Perpendicular or deep needling carries substantial risk of pneumothorax (collapsed lung). Always needle obliquely toward the spine at 0.5-0.8 cun depth, or transversely 1-1.5 cun. The underlying structures include the pleura, lungs, liver, and spleen—all of which can be damaged by improper technique. Never needle perpendicular to skin surface or away from the spine. Patients should be monitored for signs of pneumothorax (sudden chest pain, difficulty breathing) after treatment.
Needle Angle
45° (Oblique) / 10-15° (Transverse)
Depth Category
Shallow
Standard Depth
0.5–0.8 cun
Needling Directions
0.5–1 cun obliquely towards the spine. Or 1 to 1.5 cun transversely towards the spine. This method applied more often as it allows the patients to lie in a supine position easily during needling retention. Caution: Pneumothorax.
Expected Deqi Sensation
Local distension and soreness that may radiate along the intercostal space or spread across the back. Some patients experience a sensation of warmth or heaviness in the liver region. The deqi may also radiate toward the spine or laterally along the ribs.
Moxibustion
Recommended
Duration: 10–15 minutes
Cupping
Recommended
Bloodletting
Questionable
Gua Sha
Recommended
Organ & Tissue Associations
Back-Shu Point for:
Liver
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