BL-46 (Ge Guan) Diaphragm Pass

What does BL-46 Ge Guan do?

BL-46 regulates the diaphragm, benefits the middle jiao and descends rebellion, and it activates the channel and alleviates pain. Its name says the same thing: Diaphragm Pass.

• Regulates the diaphragm, benefits the middle jiao and descends rebellion — “rebellion” being the classical term for qi moving the wrong way, upward instead of down
• Activates the channel and alleviates pain

Name and position agree exactly, which is not always the case. BL-46 sits on the outer Bladder line level with BL-17 Ge Shu — Diaphragm Shu — on the inner line, and both names carry the same character ge, diaphragm. The outer-line points are conventionally paired with the inner-line point at their own level, and here the naming makes the pairing explicit. Our BL-48 Yang Gang record shows the same relationship with BL-19 Dan Shu, the Gallbladder’s.

Why hiccup and belching belong to a point on the back. The diaphragm is what hiccups; belching, vomiting and difficulty swallowing are all upward movement where downward is wanted. A point named for the diaphragm at the level where the diaphragm attaches, recorded as descending rebellious qi, is coherent from name through position to action — and its indication list follows.

Source: Sacred Lotus sources & references (channel, action, location and translation records; the BL-17 and BL-48 records and the outer-line pairings queried against our own data), cross-referenced against multiple online sources.

What is BL-46 Ge Guan used for?

BL-46 is used for difficulty swallowing, hiccup, vomiting, belching, and back pain and stiffness. Our own indication record is reproduced here in full.

• Dysphagia (difficulty swallowing)
• Hiccup
• Vomiting
• Belching
• Pain and stiffness of the back

Four of the five are upward movement, and that is the point’s whole logic. Swallowing that will not go down, hiccups, vomiting, belching — every one is the classical picture of rebellious qi, and every one is anatomically about the diaphragm and the oesophagus passing through it. This is one of the more internally consistent records in the library: name, level, action and indications all say the same thing.

An honest note, and the first entry is the one that matters. DIFFICULTY SWALLOWING REQUIRES PROMPT MEDICAL ASSESSMENT. New, progressive or painful difficulty swallowing — particularly with weight loss, or food sticking — is a symptom with serious causes that are treatable when found early, and it should never be managed by a classical indication instead of being investigated. Persistent vomiting requires assessment, and vomiting blood or material like coffee grounds is an emergency. Hiccups lasting more than a day or two warrant assessment. This record documents classical use; nothing here should delay any of that.

How it is combined. With BL-17 Ge Shu at the same level on the inner line — the inner-and-outer pairing, and BL-17 is the Hui-Meeting point of the blood. With REN-12 Zhong Wan, the Hui-Meeting point of the fu organs, and REN-17 Shan Zhong for the qi — the front-and-back pairings. With P-06 Nei Guan and ST-36 Zu San Li distally for the upward-movement indications. All held here.

Source: Sacred Lotus sources & references (indication and action records; the BL-17, REN-12, REN-17, P-06 and ST-36 records queried from our own data), cross-referenced against multiple online sources.

Where is BL-46 Ge Guan located?

BL-46 is on the back, three cun out from the midline, level with the lower edge of the seventh thoracic spinous process — the same level as BL-17 Ge Shu.

• 3 cun lateral to the midline, level with T7 — the outer Bladder line
• Level with BL-17 Ge Shu on the inner line at 1.5 cun, and with DU-09 Zhi Yang on the midline
• BL-45 Yi Xi lies one level above at T6; BL-47 Hun Men two levels below at T9

Counted, not felt. The outer Bladder line has no palpable landmark of its own, so every point on it is located by counting vertebrae and measuring laterally. Miscounting a level moves the point into a different organ’s territory while the lateral distance stays correct — the commonest error on the back, and the reason this library states the reference level on every one of these records.

A useful check at this particular level. T7 is where the inferior angle of the scapula sits when the arms are at the side — a visible, palpable bony landmark. It is not exact in every body, but it is one of the few independent references available on the upper back, and it is worth having where a counting chain would otherwise stand alone.

On the name. “Ge Guan” means Diaphragm Pass. Ge is the diaphragm, shared with BL-17 Ge Shu at the same level; guan is a gate or pass, the same character as in DU-03 Yao Yang Guan and P-06 Nei Guan. Positional and functional at once.

Source: Sacred Lotus sources & references (location and translation records, retained unchanged; the BL-17, BL-45, BL-47, DU-03, DU-09 and P-06 records queried from our own data).

• A Manual of Acupuncture (p. 306): 3 cun lateral to the midline, level with the lower border of the spinous process of the seventh thoracic vertebra (T7) and level with Geshu BL-17.
• Chinese Acupuncture and Moxibustion (p. 186): 3 cun lateral to Zhiyang (DU-9), at the level of the lower border of the spinous process of the seventh thoracic vertebra, approximately at the level of the inferior angle of the scapula.

How is BL-46 Ge Guan needled, and what is the pneumothorax risk?

Stated plainly: BL-46 lies over the thorax with lung beneath it, pneumothorax is the documented hazard in this band — and of the 23 points measured in the one study that covers this region, BL-46 HAS THE THINNEST MARGIN OF ALL. What follows is a neutral record of what the reference literature and the published measurements document. It is not instruction, and this page does not teach technique.

• Angle and depth as recorded: oblique, 0.3–0.5 inch. The obliquity is the safety feature, not a stylistic detail — angling toward the spine keeps the needle in muscle with bone behind it; angling outward points it at the pleura.
• Moxibustion: recorded as applicable. It carries no pneumothorax hazard, which is part of why the upper back is so often treated without needles.
• Regional anatomy: latissimus dorsi and the erector spinae group overlie the point; the seventh rib and intercostal space lie deep, with the pleura beyond, and the diaphragm’s attachment in the region below.

The measurement, attributed precisely. A study measuring safe needling depth at 23 back and shoulder points on paediatric chest CT gives BL-46 as 18.16 mm in boys and 16.96 mm in girls on average. For off-midline points such as this one the measurement is skin to the pleura; the Governing Vessel points in the same study are measured skin to the epidural layer, a different definition entirely. The paper also records that the difference between the sexes is not statistically significant at this point. These are paediatric figures and are not adult values (Wang J et al., PMID 26922245, PMC4769822).

Comparing all 23 figures, BL-46 is the thinnest margin in the table — in both sexes. The 23 points range from about 38.75 mm at SI-15 down to BL-46’s 18.16 mm in boys, and from 34.74 mm down to BL-46’s 16.96 mm in girls. Its neighbour BL-45 is next thinnest. Where the outer line runs across the lower ribs the tissue is thinnest and the pleura closest — which is exactly where these two sit, and it is the single most useful thing this page can tell a reader.

What is not claimed. These are measurements in children, and no adult figure for BL-46 could be located. Our GB-21 record carries an adult ultrasound measurement, and our BL-11 record an adult cadaveric mapping — both attributed to those points, and neither transferred here.

Source: Sacred Lotus sources & references (needling record, retained unchanged); PMID 26922245 / PMC4769822 (paediatric chest CT; BL-46 among the 23 measured points, skin-to-pleura, sex difference not significant; all 23 figures compared and BL-46 confirmed the lowest in both sexes); regional anatomy from standard anatomical description.

Is there research on BL-46, and what should a reader know?

No trial isolates BL-46. Where the point appears it is one component of a digestive or back protocol, and a study that includes a point in a protocol is not evidence about that point.

The research that names BL-46 is anatomical, and it is the most valuable thing on this page. The paediatric CT study measures this point by name and, compared across all 23 points it covers, gives it the thinnest margin above the pleura of any of them — in both boys and girls. That says nothing about whether needling BL-46 helps anyone, and a great deal about why its recorded angle is oblique and its recorded depth is three to five tenths of an inch.

What this page can state with confidence. BL-46 sits at T7 on the outer Bladder line, level with BL-17 Ge Shu — and both names carry the diaphragm character, making the inner-and-outer pairing explicit. Four of its five recorded indications are upward movement: swallowing, hiccup, vomiting, belching. And it carries the smallest measured safe depth in the one study covering this region.

A note on searching for it. “BL 46”, “UB 46” and “Geguan” searches return protocol trials and unrelated material matched on transliteration. Our library codes this channel BL- while some sources use UB-. Any claim attached to this point should be checked against what a study actually used — and in this region, against which definition of depth a study measured, since the midline and off-midline points in the same paper are measured to different layers.

Source: Sacred Lotus sources & references (action, indication and location records; the BL-17 pairing queried against our own data); PMID 26922245 for the measured depths and the 23-point comparison.