Bladder Meridian
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BL-46
Safety Warnings
- Dangerous point - requires extra caution
- Deep needling contraindicated - shallow insertion only
Needle Depth
0.3–0.5 cun
Needle Angle
45° (Oblique)
Body Area
Back — Upper (Thoracic)
Location
3 cun (about 4 finger-breadths) lateral to the lower border of the spinous process of the 7th thoracic vertebra (T7).
Main Actions
- Regulates Qi in diaphragm and descends Rebellious Stomach Qi
- Removes obstructions from the Channel and eases pain
Indications
Sighing
Belching
Vomiting
Drooling
Back pain
Dark urine
Body aches
Joint stiff
Chest fullness
Spine stiffness
Aversion to cold
Vomiting of blood
Lumbar spine pain
Diaphragm fullness
Difficult ingestion
Irregular defecation
Commentary
Guguan BL-46 is at the same level as Geshu BL-17, which is the Gathering-Hui point of the Blood. Therefore, it has many actions similar to BL-17.
Most importantly, it regulates Qi in diaphragm between the Upper and Middle Burner. To be more specifically, it removes Qi Stagnation in the Upper Burner, characterized by chest and diaphragm fullness and oppression. It also descends Rebellious Stomach Qi in the Middle Burner with typical symptoms such as vomiting, difficult ingestion and belching.
On the other hand, it is used as a local point to remove obstructions from the Channel, so as to ease pain and stiffness in the spine, back and joint area.
Classical Sources
Zhenjiu Jiayijing (The Systematic Classic of Acupuncture and Moxibustion): First recorded this point as 膈关 (Geguan), establishing its location at the seventh thoracic vertebra level, 3 cun lateral to the midline.
Name meaning: "Ge" (膈) refers to the diaphragm—the dome-shaped muscle separating the chest from the abdomen. "Guan" (关) means gate or pass. Together, the name indicates this point serves as a gateway for the Yang Qi of the diaphragm, regulating the passage of Qi between the upper and middle body regions.
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 7th thoracic vertebra (T7) is seven spinous process below C7. Or directly 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. Geguan BL-46 is 3 cun lateral to the lower border of T7. Geshu BL-17 is at the same level but 1.5 cun lateral to T7. 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
Risk of pneumothorax with deep or perpendicular needling. Always needle obliquely toward the lateral direction, keeping the depth shallow (0.3–0.5 cun). This point lies over the ribcage at the T7 level where the pleural cavity is relatively close to the surface. Patients should be positioned prone with arms relaxed. Avoid deep insertion or incorrect needle angles that could puncture the lung tissue.
Needle Angle
45° (Oblique)
Depth Category
Shallow
Standard Depth
0.3–0.5 cun
Needling Directions
Obliquely 0.3–0.8 cun. Caution: Pneumothorax.
Expected Deqi Sensation
Local distension and soreness radiating along the intercostal space. Some patients may feel the sensation extending toward the diaphragm region or laterally along the ribs.
Moxibustion
Recommended
Duration: 5–15 minutes
Cupping
Recommended
Bloodletting
N/A
Gua Sha
Recommended
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