意舍 : Yishe : Abode of Thought

Classifications:

Spirit point

Trigger point (Travell & Simons, 1998, Trigger Point Manual)

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Location:

3 cun lateral to the midline, level with the lower border of the spinous process of the eleventh thoracic vertebra (T11) and level with Pishu Bl-20.

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Needling:

Oblique insertion 0.3 - 0.5 cun

Warnings:

Deep perpendicular or deep oblique needling in a medial direction 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).
"Locate it with the" (patient) seated upright. It is needled to a depth of five fen and moxaed with three cones" (Huangfu Mi 皇甫謐, 3rd Century, Zhenjiu Jiayi Jing 針灸甲乙經).

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TCM Actions:

Clears Damp-heat
Regulates the Spleen and Stomach

TCM Indications:

• Distension and fullness of the abdomen, distension and pain of the chest and lateral costal region, slippery diarrhoea, difficult ingestion, vomiting, reddish-yellow urine, heat in the body with yellow face and eyes.
  
• Back pain, wasting and thirsting disorder, aversion to wind and cold.

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Neuroanatomy:

Superficial Innervation: Posterior cutaneous thoracic nerves from T11

Dermatome Segment: T11

Trigger Point Associations:

Muscle:
Serratus posterior inferior and iliocostalis thoracis

Myotome Innervation:
Serratus posterior inferior: Intercostal nerves from T9 - T12; Iliocostalis: Dorsal rami of T11

Pain Referral Pattern:

Serratus posterior inferior: Around point
Iliocostalis thoracis: Along intercostal space and to lower lateral quadrant of abdomen. Some spillover along back and shoulder

Indications:
Nagging ache in lower thoracic region after other points have been deactivated ; Back pain

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Martial Applications & Effects of Injury:

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

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Major Combinations:

• Heat in the five Zang:
    Yishe Bl-49 with Pohu Bl-42, Shentang Bl-44, Hunmen Bl-47 and Zhishi Bl-52
    (Anon, 400BC-260AD: Huang Di Nei Jing Ling Shu, 黃帝內經靈樞, Yellow Emperor's Inner Classic: Spiritual Pivot, Ch. 23, On Heat Diseases).
  
  
• Wasting and Thirsting disorder with great desire to drink:
    Yishe Bl-49 with Guanchong SJ-1 and Rangu Kid-2
    (Wang Zhizhong, 王執中, 1220: Zhen Jiu Zi Sheng Jing, 針灸資生經, Classic of Supporting Life with Acupuncture and Moxibustion).
  
  
• Wasting and Thirsting disorder with great desire to drink:
    Yishe Bl-49 with Chengjiang Ren-24, Guanchong SJ-1 and Rangu Kid-2
    (Sun Simiao, 孫思邈, 625: Bei Ji Qian Jin Yao Fang, 備急千金要方, Essential Prescriptions Worth A Thousand Gold).
  
  
• Kidney deficiency Wasting and Thirsting disorder, absence of sweating, difficulty in moving the lumbar spine, distention of the abdomen and pain of the lateral costal region:
    Yishe Bl-49 with Zhonglushu Bl-29
    (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:
    Yishe Bl-49 with Zhongting Ren-16 and Shufu Kid-27
    (Wang Zhizhong, 王執中, 1220: Zhen Jiu Zi Sheng Jing, 針灸資生經, Classic of Supporting Life with Acupuncture and Moxibustion).
  
  
• Yellow eyes:
    Yishe Bl-49 with Yanggang Bl-48, Naohu Du-17 and Danshu Bl-19
    (Wang Zhizhong, 王執中, 1220: Zhen Jiu Zi Sheng Jing, 針灸資生經, Classic of Supporting Life with Acupuncture and Moxibustion).
  
  
• Inability to think or focus:
    Needle Pishu Bl-20 outwards and Yishe Bl-49 perpendicularly
    (Yuen, 2005, 3 Spirits & 7 Souls, see notes below on mechanism).
  
  
• Excessive worry or pensiveness:
    Needle Yishe Bl-49 obliquely inwards and Pishu Bl-20 downwards
    (Yuen, 2005, 3 Spirits & 7 Souls, see notes below on mechanism).

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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). One possible answer to this is that the Shen is often agitated by excessive Heat making clearing Heat from the Zang a possible protocol for calming the mind.

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In five element acupuncture indicated for an earth cf, obsessive thoughts, overthinking, eating disorders.

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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, Shentang Bl-44, Hunmen Bl-47 and Zhishi Bl-52 clear Heat from the five Zang.

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Jeffrey Yuen (2005, 3 Spirits & 7 Souls) suggests for inability to express our Yi we can direct the Yuan qi to here for expression by needling Pishu Bl-20 outwards and then this point relatively perpendicularly.
For excessive worry or pensiveness we can direct it back to the Zang by needling this point obliquely towards the inner Bladder line and then needling Pishu Bl-20 downards.

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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

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