脾俞 : Pishu : Spleen Shu

Location Guides:

Classifications:

Back Shu point of the Spleen

Trigger point (Travell & Simons, 1998, Trigger Point Manual; Melzack, Stillwell & Fox, 1977)

Meetings:

Meeting of Bladder with Stomach Divergent and Spleen Divergent

Location:

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

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 seven 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:

Tonifies Spleen Qi and Yang
Resolves Dampness
Raises Spleen Qi and holds the Blood
Regulates and harmonises the Qi of the Middle Jiao

TCM Indications:

• Distension and pain of the abdomen, focal distension, abdominal (积聚, Ji Ju) masses, lack of appetite, remains thin despite much eating, Spleen qi cold, undigested food in the stools, diarrhoea, Dysenteric Disorder (痢疾, Li Ji), chronic Childhood Fright Wind, childhood nutritional impairment, drum distension, Deficiency Taxation, jaundice, yellow body with abdominal fullness and vomiting, pain of the lateral costal region.
  
• Blood in the stools, blood in the urine, vomiting blood, menorrhagia, chronic haemorrhage, uterine prolapse.
  
• Malarial (瘧, Nue) Disorders, diseases with chills and fever, lumbar pain, pain of the shoulder and back, yawning, cough, skin pain, turbid white urine, clonic spasm.

I Ching Hexagram:

䷠ Dun 遯 Withdraw

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

Neuroanatomy:

Superficial Innervation: Posterior cutaneous thoracic nerves from T11

Dermatome Segment: T11

Deeper Structures: Dorsal rami of spinal nerves from T11

Trigger Point Associations:

Muscle:
Longissimus thoracis

Pain Referral Pattern:
Inferior to base of buttock

Indications:
Low back pain ; Myalgia of long extensors of back

Martial Applications & Effects of Injury:

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

Major Combinations:

• Spleen deficiency with undigested food in the stool:
    Pishu Bl-20 with Pangguangshu Bl-28
    (Gao Wu, 高武, 1529: Bai Zheng Fu, 百症賦, Ode of a Hundred Symptoms).
  
  
• Much eating but remains thin:
    Pishu Bl-20 with Weishu Bl-21
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Abdominal pain with no pleasure in eating:
    Pishu Bl-20 with Weishu Bl-21
    (Formulas for the Living;Wang Zhizhong, 王執中, 1220: Zhen Jiu Zi Sheng Jing, 針灸資生經, Classic of Supporting Life with Acupuncture and Moxibustion).
  
  
• Sadness below the Heart:
    Pishu Bl-20 with Tonggong SI-19
    (Gao Wu, 高武, 1529: Bai Zheng Fu, 百症賦, Ode of a Hundred Symptoms).
  
  
• Vomiting blood and spontaneous external bleeding:
    Pishu Bl-20 with Yinbai Sp-1, Ganshu Bl-18 and Shangwan Ren-13
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Loss of use of the four limbs:
    Pishu Bl-20 with Jiquan He-1 and Riyue GB-24
    (Wang Zhizhong, 王執中, 1220: Zhen Jiu Zi Sheng Jing, 針灸資生經, Classic of Supporting Life with Acupuncture and Moxibustion).
  
  
• Acute pain of both lateral costal regions:
    Pishu Bl-20 with Ganshu Bl-18 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).

Notes:

As the back-shu of the Spleen this is the main back point for digestive and abdominal issues, bleeding disorders and resolving damp.

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 and the root of the tongue to be the tip of the foot Taiyin meridian with the root being at Sanyinjiao Sp-6. Later it suggests this point along with Huangshu Kid-16 and Tianshu St-25 to release evil Qi in the abdomen. It advises to press the point for a time until there is a reaction and then pierce with the fine needle and apply a draining technique. Conditions treated are headache, dizziness and falling to the ground, abdominal pain, fullness, distension and accumulation. If it is painful and the pain moves it can be cured easily; if is is a painless fixed accumulation it is difficult.

One of the Aggressive Energy Drain points in five element acupuncture, along with Feishu Bl-13, Jueyinshu Bl-14, Xinshu Bl-15, Ganshu Bl-18 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.

The alchemical text Zhouyi Cantong Qi (周易參同契 attributed to Wei Boyang, 2nd century CE) represents the lunar cycle in sequence of 6 groups of 5 days governed by the waxing and waning trigrams. These correspond to a rotating cycle of the Early Heaven sequence, with Kan in the west and Li in the east governing the whole Yin and Yang parts of the cycle respectively.

These attributions can be mapped onto the body with the inner trigram representing the Early Heaven trigram that rules the period of 5 days and the outer trigram being its Late Heaven pair, corresponding to the Channel that governs that period. This results in a sequence that has relevance to the menstrual cycle which also corresponds to the moon.

䷭ Xun within Kun : Days 1-5 : Danzhong Ren 17
Front Mu of Pericardium, Hui of Qi and Sea of Qi point. Gathers Qi to make Blood.

䷠ Gen within Qian : Days 6-10 : Pishu Bl-20
Back Shu of the Spleen. Raises and holds the Blood by strengthening the Spleen, completing the endometrial lining and holding it in place.

䷇ Kun within Kan: Days 11-15 : Taixi Kid-3
Yuan-Source of Kidney, Kidneys govern fertility and this point in particular tonifies Kidney Yang as well as Yin, initiating the return of Yang from within Yin, representing ovulation and the start of the Yang part of the cycle.

䷚ Zhen within Gen: Days 16-20 : Yinbai Sp-1
Return of Yang. This point has many indications for stopping bleeding, especially uterine bleeding which would indicate a disorder of Yang failing to uphold the Blood. It is also a Ghost Point so has an influence on the Shen.

䷼ Dui within Xun: Days 21-25 : Jianshi Pc-5
Strong regulator of the Shen and menstruation for the pre-menstrual phase.

䷍ Qian within Li: Days 26-30 : Tongli He-5
Luo of the Heart, a strong invigorating Blood point to govern the days of the period.

One notable pattern that emerges is that the points which govern the 5 day periods corresponding to the ordinal directions only involve the Spleen and Pericardium, which are the channels that were chosen to open the Chong Mai and Yin Wei Mai. The cardinal directions of north and south are governed by the Heart and Kidneys that make up the Shaoyin Axis.

Another pattern is that the Yin part of the cycle draws upon the Ren, Du and Kidneys that connect to the Jing, while the Yang half of the cycle comprises of points that affect the Shen. This connects them to the principle of the Curious Organs, where Jing and Shen combine, and includes the uterus.

The two directions that are not part of the waxing and waning trigrams are Kan and Li. These govern the 15 day Yin and Yang halves of the cycle as a whole and correspond to:

䷮ Kan within Dui: Days 1-15 : Chize Lu-5
Water point of Taiyin, which is a term for the moon, thus representing the moon's influence on the tides and its corresponding influence on Yin aspects of the body.

䷶ Li within Zhen: Days 16-30 : Xingjian Liv-2
Fire point of Jueyin, reverting Yin, representing the return of Yang. Clinically this point clears Liver Fire, spread Liver Qi and stops bleeding due to Heat and so is appropriate for any number of issues stemming from overactive Yang in this half of the cycle.

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