Bladder Meridian
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BL-49
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 lateral to the lower border of the spinous process of the 11th thoracic vertebra (T11).
Main Actions
- Resolves Damp-Heat
- Benefits the Intellect
Indications
Commentary
Yishe BL-49 is at the same level as Pishu BL-20, which is the Back Transporting-Shu point of the Spleen. Therefore they share some similar functions.
Most importantly, Yishe BL-49 clears Damp-Heat, characterized by dark urine, general heat in the body as well as yellow face and eyes.
It also regulates the Stomach and Spleen. Typical symptoms include vomiting, difficult ingestion, abdominal distention and fullness as well as slippery diarrhoea.
Furthermore, Yishe BL-49 strengthens the Intellect (Yi) as well. It clears the Mind from obsessive thoughts, brooding, worry and pensiveness due to Spleen Deficiency. Thus it enhances memory and concentration.
Classical Sources
Zhenjiu Dacheng (Great Compendium of Acupuncture and Moxibustion): Located 3 cun lateral to the spinous process of the 11th thoracic vertebra, located with patient sitting upright. Needling depth: 0.5 fen. Moxibustion: 50-100 cones.
Indications from Classical Sources: Abdominal fullness and distension, slippery diarrhea, reddish-yellow urine, back pain, aversion to wind and cold, inability to eat or drink, vomiting, wasting-thirst syndrome (xiaoke), body heat, and yellow eyes.
Zhenjiu Jiayi Jing (Systematic Classic of Acupuncture): Moxibustion 3 cones, needling 5 fen depth.
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. Yishe BL-49 is 3 cun lateral to the lower border of T11. Pishu BL-20 is at the same level but 1.5 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
Risk of pneumothorax with perpendicular or deep needling. Always needle obliquely toward the lateral direction, away from the spine. Avoid needling too deeply or in the wrong direction. Maximum safe depth is typically 0.5 cun with oblique insertion. Extra caution in thin patients with less subcutaneous 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 aching sensation spreading across the mid-back region. Deqi may radiate toward the spine or laterally along the intercostal space. Some patients report a dull, warm sensation in the epigastric area.
Moxibustion
Recommended
Duration: 10–15 minutes
Cupping
Recommended
Bloodletting
N/A
Gua Sha
Recommended
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