Pishu BL-20 location
BL-20

Pishu BL-20

Spleen Shu · 脾俞 · Pí Shū
Bladder Meridian

Safety Warnings

  • Dangerous point - requires extra caution
  • Deep needling contraindicated - shallow insertion only

Needle Depth

0.5–0.8 cun

Needle Angle

45° (Oblique)

Body Area

Back — Upper (Thoracic)

Location

1.5 cun lateral to the lower border of the spinous process of the 11th thoracic vertebra (T11).

Previous on channel

Danshu BL-19

Next on channel

Weishu BL-21

Main Actions

  • Tonifies the Spleen Qi and Yang
  • Resolves Dampness
  • Nourishes Blood
  • Lifts Spleen Qi and stop bleeding

Commentary

Pishu BL-20 is one of the most important Back Transporting-Shu points with various functions. 

First of all, it strongly tonifies the Spleen Qi and Yang. The typical symptoms of Spleen Qi Deficiency are tiredness, loose stools, no appetite and abdominal distension. When combined with Weishu BL-21, it tonifies the Stomach Qi as well. Both Organs are the Root of the Post-Heaven Qi, Blood and Food Essences. They are often used together for patient who suffers from long-term physical and mental exhaustion or simply low in energy. 

Furthermore, stronger Spleen function prevents Qi Sinking or Collapsing, while stronger Spleen Qi is able to hold Blood in the vessels and stop bleeding. Combined with Shenshu BL-23, BL-23 treats some symptoms such as heavy menstruation, Blood in stools or urine, Uterus or Stomach prolapse or feeling of bearing-down in the lower abdomen. 

Pishu BL-21 nourishes Blood as well, because the the Spleen contributes to the Blood creation. For this purpose, it is often combined together with Shenshu BL-23 and applies direct moxibustion. 

The Spleen also rules the transformation and transportation of Body Fluids. Thus impaired Spleen function may lead to Dampness and Phlegm. BL-20 is able to resolve this disharmony. 

Classical Sources

Ling Shu (灵枢·背腧): The point first appears in this classical text, establishing it as the Back-Shu point of the Spleen where the Qi of the spleen infuses into the back.

Bei Ji Qian Jin Yao Fang (备急千金要方): "For consumptive disease with white turbid urine, moxa Pishu 100 cones. Pishu and Weiguan [treat] jaundice."

Zhen Jiu Da Cheng (针灸大成): Indicates the point for jaundice, frequent yawning, and loss of appetite.

Yi Zong Jin Jian (医宗金鉴): Lists the point for chronic infantile convulsions due to Spleen deficiency.

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 11th thoracic vertebra (T11) is eleven 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. T11 is four thoracic vertebra below. Or locate the articulation of the most inferior rib (T12) and palpate in a superior direction to T11. Pishu BL-20 is 1.5 cun lateral to the lower border of T11. Yishe BL-49 is at the same level but 3 cun lateral to T11. 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 point lies over the thoracic cavity at the level of T11. Perpendicular needling or needling angled away from the spine carries a substantial risk of causing pneumothorax. Always needle obliquely toward the spine at a 45° angle to a depth of 0.5-0.8 cun. Avoid deep insertion. In thin patients, extra caution is required as the pleura may be closer to the surface.

Needle Angle

45° (Oblique)

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 at the point, with sensation often spreading to the waist region. The deqi sensation may radiate along the intercostal space. Patients typically feel a deep, dull ache characteristic of Back-Shu points.

Moxibustion

Particularly Recommended

Duration: 10–15 minutes

Cupping

Recommended

Bloodletting

N/A

Gua Sha

Recommended

Organ & Tissue Associations

Back-Shu Point for:

Spleen

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