BL 43 — Gāo Huāng Shū (膏肓俞) — Vital Region Shu
BL 43 (Gao Huang Shu) is the famous classical point for chronic depletion, recommended by Sun Si Miao for “all chronic and difficult diseases”. Located 3 cun lateral to the lower border of T4, it is the back-shu point of the “vital region” (the area between the Heart and Diaphragm where deep pathology takes root). Used for chronic asthma, chronic fatigue, recovery from prolonged illness and deep-seated Yin deficiency.
On this page
1. About BL 43 (Gao Huang Shu)
BL 43 — Gāo Huāng Shū — is on the Bladder meridian. “Gao” refers to the region above the diaphragm and “Huang” to the region below the Heart — together meaning the deep central space where chronic disease takes hold. The Tang Dynasty physician Sun Si Miao (581–682 CE) famously recommended Gao Huang Shu with moxibustion (often hundreds of cones over weeks) for “all hundred diseases that have become chronic”.
2. BL 43 location
3 cun lateral to the lower border of the spinous process of T4. Best located with the patient seated and arms crossed in front, which pulls the scapulae outward and exposes the point.
3. Actions
- Tonifies Lung Qi and Yin
- Nourishes Heart Yin and Blood
- Tonifies Kidney essence
- Treats chronic depletion and the deepest levels of deficiency
4. Indications
- Chronic asthma, chronic cough and pulmonary disease
- Tuberculosis (historical) and chronic chest disease
- Chronic fatigue syndrome and ME
- Convalescence after prolonged or serious illness
- Deep Yin deficiency with night sweats, malar flush, low-grade fever
- Loss of essence after chronic illness
- Adjunct in chronic cancer-related fatigue
5. Needling
Oblique insertion towards the spine 0.3–0.5 cun, or transverse insertion along the muscle. Deep perpendicular insertion is contraindicated — risk of pneumothorax. Moxibustion is the principal traditional method — classical texts recommend many cones over weeks for chronic depletion.
6. Clinical notes
Gao Huang Shu is one of the most important points in classical TCM for chronic disease. Sun Si Miao’s endorsement made it foundational in the treatment of consumptive disease, with cumulative moxibustion regarded as restorative at the deepest level. In modern practice it is used in the management of chronic asthma, chronic fatigue and post-viral syndromes, often combined with BL 13 (Fei Shu), BL 23 (Shen Shu) and ST 36.
7. Treatment at my clinic
I use BL 43 as part of tailored acupuncture prescriptions for chronic fatigue syndrome, chronic asthma, recovery from prolonged illness and deep depletion. I see patients in person at my clinic in Wokingham, Berkshire. Visit the prices page for consultation fees.
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