Bladder Channel

Pishu BL-20

Chinese: 脾俞

Pinyin: Pí Shū

Location

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

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.

Main actions

  1. Tonifies the Spleen Qi and Yang
  2. Resolves Dampness
  3. Nourishes Blood
  4. Lifts Spleen Qi and stop bleeding

Indications

Fatigue Jaundice Diarrhoea Weak Limbs Borborygmi Heavy limbs Loose stools sticky taste Poor appetite Heavy periods Bloody stools Abdominal pain Blood in urine Uterus prolapse Stomach prolapse Feeling of fullness Abdominal distention Feeling of heaviness Feeling of bearing down Undigested food in the stools

Needling

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.

Commentary for Pishu BL-20

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.