肝俞 : Ganshu : Liver Shu

Location Guides:

Classifications:

Back Shu point of the Liver

Location:

1.5 cun lateral to the lower border of the spinous process of the ninth thoracic vertebra (T9).

Needling:

Oblique insertion towards the spine 0.5 - 1 cun, or transverse-oblique insertion 1 - 1.5 cun

Warnings:

Perpendicular needling or oblique needling away from the spine carries a substantial risk of causing a pneumothorax.

Classical Needling:

"The Taiyang usually has much Blood and little Qi" (Su Wen 素問 ch. 24) implying this channel should normally be bled.
"The foot Taiyang is to be pierced 5 fen deep and remain inserted for seven exhalations" (Ling Shu 靈樞 ch. 12).
"It is needled to a depth of three fen, (the needle) is retained for a duration of six exhalations, and it is moxaed with three cones" (Huangfu Mi 皇甫謐, 3rd Century, Zhenjiu Jiayi Jing 針灸甲乙經).

TCM Actions:

Spreads Liver Qi
Regulates and nourishes Liver Blood
Pacifies Wind
Cools Fire and clears Damp-Heat
Benefits the eyes and sinews

TCM Indications:

• Distension and pain of the lateral costal region, epigastric pain, abdominal (Ji Ju) masses, focal distension, hypogastric fullness and pain, lower abdominal pain, abdominal cramps, Shan (疝) Disorder.
  
• Fullness of the chest, cough with chest pain, cough with fullness of the lateral costal region and inability to catch the breath, shortness of breath, shortness of breath, jaundice, dry mouth.
  
• Much anger, Mania-Withdrawal (癲狂, Dian Kuang), epilepsy.
  
• Coughing blood, spitting blood, vomiting blood, nosebleed.
  
• Blurred vision, redness of the eyes, night blindness, excessive lacrimation, redness pain and itching of the inner canthus, Superficial Visual Obstruction, upward staring eyes, dizziness, Visual Dizziness, pain of the nose, pain of the supraorbital region.
  
• Rigidity of the neck and spine, pain of the spine, lumbar pain, pain of the neck and shoulders, lockjaw, opisthotonos, cramps, pain of the sinews, tetany.

I Ching Hexagram:

䷘ Wu Wang 無妄 Without Folly

Hexagram attributions are my own with an explanation given in the glossary.

Neuroanatomy:

Superficial Innervation: Posterior cutaneous thoracic nerves from T9

Dermatome Segment: T9

Deeper Structures: Dorsal rami of spinal nerves from T9

Martial Applications & Effects of Injury:

See Montaigue, Dim Mak Locations, Taijiworld.com for explanation of effects.

Major Combinations:

• Fullness of the hypogastrium:
    Ganshu Bl-18 with Baohuang Bl-53
    (Sun Simiao, 孫思邈, 625: Bei Ji Qian Jin Yao Fang, 備急千金要方, Essential Prescriptions Worth A Thousand Gold).
  
  
• Acute pain of both lateral costal regions:
    Ganshu Bl-18 with Pishu Bl-20 and Zhishi Bl-52
    (Sun Simiao, 孫思邈, 625: Bei Ji Qian Jin Yao Fang, 備急千金要方, Essential Prescriptions Worth A Thousand Gold).
  
  
• Coughing and spitting blood:
    Ganshu Bl-18 with Quepen St-12, Xinshu Bl-15, Juque Ren-14 and Jiuwei Ren-15
    (Wang Zhizhong, 王執中, 1220: Zhen Jiu Zi Sheng Jing, 針灸資生經, Classic of Supporting Life with Acupuncture and Moxibustion).
  
  
• Vomiting blood and spontaneous external bleeding:
    Ganshu Bl-18 with Yinbai Sp-1, Pishu Bl-20 and Shangwan Ren-13
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Liver Blood deficiency with cloudy vision:
    Reinforce Ganshu Bl-18 and reduce Zusanli St-36
    (Yu Long Ge, 玉龍賦, Song of the Jade Dragon. First recorded in Wang Guorui, 王國瑞, 1329: Bian Que Shen Ying Zhen Jiu, Yu Long Jing, 扁鵲神應針灸玉龍經, Bian Que's Spiritual Guide to Acupuncture and Moxibustion, Classic of the Jade Dragon).
  
  
• Superficial Visual Obstruction:
    Ganshu Bl-18 with Toulinqu GB-15
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Somnolence:
    Ganshu Bl-18 with Taixi Kid-3, Zhaohai Kid-6, Baihui Du-20, Tinajing SJ-10, Erjian LI-2, Sanjian LI-3and Lidui St-45
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Cold abdominal Shan Disorder:
    Ganshu Bl-18 with Yinshi St-33 and Taixi Kid-3
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).

Notes:

As back-shu point of the liver this is the main point on back for regulating all aspects of Liver function, smoothing qi, cooling heat and pacifying wind emanating from liver dysfunction.

Ling Shu Ch. 51, On the Back Transport Points, advises that the back Shu points of the Yin organs should be pressed. If this elicits a response, either pain or the relief of a existing pain, then these points should be supplemented or drained with moxa and not pierced. To supplement with moxa the cone is to be left to burn down naturally, to drain it is to be blown on to make it burn more fiercely.

Ling Shu Ch. 52, On the Wei Qi, considers this to be the tip of the foot Jueyin meridian with the tip being at Zhongfeng Liv-4.

In the Shang Han Lun, line 171, Zhang Zhong-Jing recommends using this point along with Dazhui Du-14 and Feishu Bl-13 for the dragover of Taiyang and Shaoyang disease. This is because Feishu Bl-13 can eliminate pathogens from the Taiyang while Ganshu Bl-18 can eliminate pathogens from the Shaoyang (Liu, 2016, Shang Han Lun, p. 500). This explanation uses the different ways of pairing the channels: one using the connection between both Tai stages while the other uses the internal-external relationship of the Liver-Gallbladder. Dazhui Du-14 meanwhile simply releases the exterior from all Yang channels.

One of the Aggressive Energy Drain points in five element acupuncture, along with Feishu Bl-13, Jueyinshu Bl-14, Xinshu Bl-15, Pishu Bl-20 and Shenshu Bl-23, indicated where psychological or emotional issues are blocking treatment. They are needled from left to right, top to bottom, with the exception of Xinshu Bl-15 that is needled last, along with controls outside the Bladder channel at the same levels. If aggressive energy is present the points should become redder than the test points and are left until the redness disappears. If not then needles can be removed and treatment continued.

In Tibetan medicine:
Moxa point (AMNH, Tibetan Medical Paintings)

Reference Notes:

Basic information on location, needle depth, TCM actions, indications and combinations is taken from Deadman et al (2001): A Manual of Acupuncture with additional anatomical information researched by reference to Gray's Anatomy (38th Ed., 1995) unless otherwise referenced. Images were found on acupunctureschoolonline.com and can be traced back to Claudia Focks (2008) Atlas of Acupuncture originally. I cannot claim any credit or rights over them. Other sources should be quoted in the text.

For some of the more unusual terms I have created a glossary here