Points Database

: Shentang : Hall of the Spirit

Bl-44 : Foot Taiyang Bladder 44

Classifications:
Spirit point
One of the "59 piercings" for clearing Heat in Su Wen Ch. 61
Master Tung's Five Mountain Ranges
Master Tung's Nine Monkeys
Master Tung's Capital Points
Master Tung's Behind the Heart Points

Trigger point (Travell & Simons, 1998, Trigger Point Manual; Melzack, Stillwell & Fox, 1977, Trigger Points and Acupuncture Points for Pain: Correlations and Implications, Pain 3, p3-23)


Meetings:
Meeting of Bladder with Bladder Divergent

Location:
3 cun lateral to the midline, level with the lower border of the spinous process of the fifth thoracic vertebra (T5) and level with Xinshu Bl-15.

Needling:
Oblique insertion 0.3 - 0.5 cun

Warning:
Deep perpendicular or deep oblique needling in a medial direction carries a substantial risk of causing a pneumothorax.


TCM Actions:
Unbinds the chest and regulates qi
Activates the channel and alleviates pain

TCM Indications:
  • Cough, asthma, dyspnoea, fullness of the chest with rebellious qi.
  • Stiffness and pain of the back, pain of the shoudler and back that radiates to the chest, oesophageal constriction.

    Neuroanatomy:
    Superficial Innervation: Posterior cutaneous thoracic nerves from T5
    Dermatome Segment: T5
    Deeper Structures: Neuromuscular junction of accessory nerve XI with trapezius muscle and branches of C3 - C4

    Trigger Point Associations:
    Muscle: Lower trapezius and rhomboid major
    Myotome Innervation: Trapezius: Motor - accessory nerve (CN XI), Sensation - dorsal rami of C2 - C3; Rhomboid major: Dorsal scapular nerve (C4 - C5)
    Pain Referral Pattern: Lower trapezius: To the origin and insertion points of the trapezius at the acromion and the occiput, and along the muscle at the area between these two points
    \nRhomboid major: Local to point and around medial border of scapula
    Indications: Shoulder arm and neck pain ; Headache ; Intrascapular pain

    Notes:
    Like the other outer bladder points of the five zang, despite being named after their spiritual aspect they have little indication for treatment of psychological disorders in the classical literature but are mainly used for draining heat from their corresponding zang (Deadman et al, 2001).

    In five element acupuncture indicated for a fire cf, spirit issues, emotional/psychological trauma, anxiety, insomnia.

    The "59 piercings" are named in the Su Wen Ch. 61 and mentioned in Su Wen Ch. 32 and Ling Shu Ch. 23 for treating Heat diseases. This point along with Pohu Bl-42, Hunmen Bl-47, Yishe Bl-49 and Zhishi Bl-52 clear Heat from the five Zang.

    Jeffrey Yuen (2005, 3 Spirits & 7 Souls) suggests for inability to express joy we can direct the Yuan qi to here for expression by needling Xinshu Bl-15 outwards and then this point relatively perpendicularly.
    For excessive joy we can direct it back to the Zang by needling this point obliquely towards the inner Bladder line and then needling Xinshu Bl-15 downwards.

    When using the Bladder or Small Intestine Divergent meridians to expel a pathogen a band around the chest at this point, including Shendao Du-11, Xinshu Bl-15 and Shanzhong Ren-17, should be treated with Gua Sha before commencing needling (Cecil-Sterman, 2012, Advanced Acupuncture).

    In Master Tung's system this point is one of the five mountain ranges (Wu Ling). They consist of five sets of points in three lines representing the phases of the Wu Xing in a series of lines:

    The first set is along the midline, below each vertebrae from T2 to T11. From T2 to T8 relate to Fire, T9 to T11 relate to Earth.
    The second set is 3 cun from the midline. from T2 to T9. From T2 to T6 relate to Metal, T7 to T9 relate to Wood.
    The third set is 6 cun from the midline from T2 to T8. From T2 to T4 relate to Metal, T5 to T8 relate to Wood.

    They are indicated for fever, common cold, hypertension, headache, lumbar pain, numbness of the hands and feet, hemiplegia, acute stomachache, vomiting or acute enteritis by releasing heat, wind and stagnation from the organs relating to their phase and treated with a pricking method to release a drop of blood (McCann, 2014, Pricking the Vessels).

    It is also the location of Tung's Three Metals (San Jin) located at Bl-42, Bl-43 and Bl-44 for knee pain (ibid.).

    Tung's Capital (Ding Zhu) points are located 3 cun lateral to the midline from T4 to T9 and 6 cun lateral to the midline from T4 to T8 indicated for lumbar pain, especially when associated with arteriosclerosis, acute back sprain and chest pain upon breathing (ibid.)

    Tung's Behind the Heart (Hou Xin or Bei Xin) points are located under spinous processes from T4 to T9, 1.5 cun laterally to T4 to T7 and 3 cun laterally from T4 to T6. They are indicated for "wool like furuncles", clove sores, weakness and debility of the Heart zang, Stomach diseases, acute heart disease leading to numbness and paralysis, wind-cold entering the interior, severe wind-cold, stroke, externally contracted diseases that manifest with papules. They clear heat from the Heart and Lung and release the exterior so are useful in dermatological disorders (ibid.).

    This sort of technique may make greater sense than regular needles as shallow depth without retention may be safer over the spine and lungs and the larger gauge used may provide better stimulation to this relatively insensitive area.

    In Thai massage:
    Acupressure point (Salguero & Roylance, 2011, Encyclopedia of Thai Massage)


    Reference Notes: (click to display)