Bladder Meridian
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BL-54
Safety Warnings
- Dangerous point - requires extra caution
Needle Depth
1.5-3.0 cun
Needle Angle
90° (Perpendicular), 45° (Oblique)
Body Area
Back — Sacral, Hip / Gluteal
Location
At the level of the 4th posterior sacral foramen, 3 cun lateral to the posterior midline.
Main Actions
- Benefits the back and eases pain
- Regulates urination and treats haemorrhoids
Indications
Commentary
Zhibian BL-54 is not used for its energetic function, but it is a very important local point to remove obstructions from the Channel, so that it treats lower back pain, especially if it spreads to the legs and buttocks as well. In this case, it should always be checked for tenderness. A long needle (at least 5 cm) should be used if it is tender.
Ideally, the needling sensation should reradiate all the way down to the foot, then the single use of BL-54 is enough. Otherwise, other points can be needled to strengthen the effect. Furthermore, if the pain is caused by Cold or Dampness invading the Channel, moxibustion can be used together with needling.
BL-54 also treats urinations issues and haemorrhoids.
Classical Sources
Zhenjiu Jiayi Jing (Systematic Classic of Acupuncture and Moxibustion): "Lumbar pain with sacral cold, difficulty in bending forward and backward, genital pain with heaviness below, inability to urinate—Zhibian governs these."
This classical text, compiled by Huangfu Mi around 259 CE, first documented this point and established its primary indications for lower back pain, urinary difficulty, and genital disorders. The point name reflects its position as the lowest point in the orderly sequence of back Shu points along the Bladder channel.
How to Locate
First identify the Tuffier's line which connects the highest points of the iliac crest. The spinous process of the 4th lumber vertebra (L4) mostly falls on this line. Then palpate in an inferior direction, passing L5, and reach the most superior 1st sacral foramen. Palpate further to the 4th sacral foramen. Zhibian BL-54 is at the level of the 4th sacral foramen and 3 cun lateral to the posterior midline. 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 in a region with significant neurovascular structures. The sciatic nerve, inferior gluteal nerve and vessels, posterior femoral cutaneous nerve, and internal pudendal vessels pass through this area. Deep needling should be performed with caution and proper anatomical knowledge. When using long needle techniques (such as threading toward ST-28 Shuidao), specialized training is required. The point penetrates through the gluteus maximus muscle and may reach the piriformis muscle at depth. Research suggests needling may stimulate uterine contractions, so use with reduced stimulation during pregnancy.
Needle Angle
90° (Perpendicular) / 45° (Oblique)
Depth Category
Deep
Standard Depth
1.5-3.0 cun
Needling Directions
Vertically 1.5–2 cun or 2–3 cun in the direction of the anus or the genital region, depending on the indication.
Expected Deqi Sensation
Local distension and soreness in the buttock region. With proper technique, the deqi sensation should radiate down along the posterior thigh toward the foot (treating lower limb conditions), toward the anus (for hemorrhoids), or toward the genitalia and lower abdomen (for urogenital conditions). Patients may feel warmth, fullness, or relaxation in the pelvic cavity.
Moxibustion
Recommended
Duration: 10-20 minutes
Cupping
Recommended
Bloodletting
N/A
Gua Sha
Recommended
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