Pishu (BL20): The Back Point Just Above the Waist, for Bloating and a Tired, Aching Back

Where Pishu Sits

This point sits on the back, about two finger-widths out from the centre of the spine, a little above the waist. It is near the level where the lowest ribs curve in to meet the spine. It lies on the thick ridge of muscle beside the spine, at a place many people describe as the ache across the back just above the belt.

It belongs to the line that Vietnamese and Chinese texts call the Bladder channel. That line begins at the inner corner of the eye, runs over the top of the head, and comes down the back in two tracks on each side of the spine. The inner track, about two finger-widths from the centre, carries a row of points, one for each organ in this tradition. This one, the twentieth stop on the line, belongs to the spleen.

The old texts place it below the eleventh vertebra, one and a half units out from the spine. They count from the vertebra just under the big knob at the base of the neck, so the eleventh is the eleventh bump of the upper back, the second-last bump before the lower back begins. The modern standard from the World Health Organization says the same: level with the lower border of the eleventh thoracic spinous process, one and a half units out from the midline. One and a half units is about the width of your index and middle fingers laid side by side.

Under the skin lies the tough sheet of connective tissue that wraps the lower back, and over it the wide, flat muscle that sweeps up toward the armpit (the latissimus dorsi). Beneath them runs the long muscle that keeps the spine upright (the erector spinae). The skin is served by small back branches of the eleventh and twelfth thoracic nerves. Deeper, the lowest ribs fan out, and beneath them, well protected, lie the upper parts of the kidneys and, on the left, the spleen.

Why This Spot

On the anatomical side, this is the meeting place of two parts of the back. Above it the ribs hold the spine fairly stiff; below it the lower back bends freely. Every time you bend forward to tie a shoe or lift a bag, the strain passes through here. The muscles tire and tighten, and a dull ache sits just above the waist. The nerves from this level also run around to the front of the belly. That is one reason a tired, aching back and an uncomfortable stomach can turn up together at this height.

In this tradition, every organ has a transport point on the back, and this is the one for the spleen. In Vietnamese and Chinese medicine, the spleen is described as the organ that takes in food and turns it into energy and flesh, more like the whole of digestion than the organ on a scan. When it is tired, people feel a heavy, bloated stomach after meals, loose bowels, a poor appetite, heavy legs, and a weariness that sleep does not fix. This tiredness is said to grow common with age. That is why this point is one of the first a teacher reaches for when an older person says their stomach feels heavy and their energy is low.

The name says what it does. Pi is the spleen; shu means to transport. Its Vietnamese name, Tỳ Du, carries the same meaning.

What the Old Texts Say About Pishu

The Spiritual Pivot, the Lingshu, from the Han dynasty, has a short chapter on the back transport points. It places the spleen point at the eleventh vertebra, below the liver point at the ninth and above the kidney point at the fourteenth. The chapter also gives a test that has lasted two thousand years: press the place, and if something inside answers or the ache eases, that is the point. That is what you are doing when you hunt for the spot that stings.

The Systematic Classic of Acupuncture and Moxibustion, the Jiayi Jing, compiled by Huangfu Mi in the third century, fixes it below the eleventh vertebra, one and a half units out on each side. That location is still the one in use.

The Vietnamese handbook of points and channels by Ngô Trung Triều, published by Hồng Đức, follows the same count. Draw a line across the tip of the eleventh bump of the upper back, it says, and meet it with a vertical line one and a half units out from the centre. It lists the point for stomach pain and ulcers, long-standing loose bowels, weakness of the belly muscles, itching skin, and several conditions of the liver and blood. Many of those need a doctor. What the list shows is how firmly this tradition ties the back at this level to digestion. In the wider tradition, it is one of the points most often warmed and pressed for a weak, bloated stomach and low energy. That reputation rests on long use rather than proof.

Points That Work With Pishu

The first partner sits lower on the back, at about waist level, the same two finger-widths out from the spine. It is the back point for the kidney in this tradition. The two are worked together when the stomach is weak and the lower back is tired, the pairing teachers use for the weariness of later life. A tennis ball moved down reaches it in the same sitting.

The second is on the front of the lower leg, about four finger-widths below the bottom of the kneecap and one finger-width out from the shin bone. It is easy to reach in a chair and is the best known point in this tradition for digestion and energy. Pair it with this one for bloating and tiredness.

The third is on the front of the belly, on the centre line, halfway between the bottom of the breastbone and the navel. It sits right over the stomach. Pressing the front and the back at the same level is a classic pairing in this tradition for a heavy, bloated stomach.

How to Find and Press Pishu

Getting Into Position

Be honest with yourself about reach. Many people can press this level with their thumbs when their hands are on their hips, but the thumbs tire quickly, and stiff shoulders make it harder. That is normal. Stand with your back to a wall, feet about a foot out from it, knees soft, and use a tennis ball between your back and the wall. A stick with a rounded end, reached around the waist, is another way.

How to Find It

Put your hands on your hips with your thumbs pointing back, resting on the top edge of the hip bones. The line between your thumbs crosses the spine at the fourth bump of the lower back. Count five bumps up from there: three bumps take you to the top of the lower back, one more to the last bump of the upper back, and one more to the eleventh. Another check: follow your lowest ribs round the side to the back; they meet the spine near here. The point lies on each side of the gap below that bump, two finger-widths out.

Place the ball there and lean back into it slowly. Shift in small steps, a little up, down, in and out. Much of the area will feel like ordinary pressure on muscle. One spot will sting: a small, sharp, pinpoint tenderness deep under the ball. That spot is the point. Hunt for the spot that stings, because that is the one. Two balls tied in a sock let you work both sides at once, with the spine resting in the gap between them.

How to Press It

Once you are on the stinging spot, stay on it. Bend and straighten your knees a little, so the ball rubs in small circles about the size of a coin, roughly one each second, without rolling away. With a stick, hold the handle steady, place the rounded tip on the spot and make the same small circles. With your thumb tips, hands on your waist, press in and slightly toward the spine. Do not press on the bony bumps themselves.

How Much Pressure

A sharp sting under the ball is right. Stay on it. When you step away, it should fade within moments. If the pain stays after you lift off, spreads, or the area turns swollen, hot or red, stop and leave it for several days. Stop at once for any pain that shoots around the side or down a leg, or any numbness. If you are holding your breath, you are pressing too hard to keep going. Step your feet a little closer to the wall, so less of your weight goes into the ball, until you can breathe slowly through the sting while staying on the spot.

How Long

One to three minutes on each side. Keep the first sessions to about a minute, because this part of the back can feel bruised the next day. Add a little time over the following days, up to three minutes. Work both sides, even when only one complains. Once or twice a day is plenty. Longer sessions bring more soreness, not more benefit.

When to Do It

Mid-morning and mid-afternoon suit it well, an hour or more after a meal. If your stomach feels heavy in the evening, a few minutes before bed is a pleasant way to wind down. Avoid pressing on a very full stomach. Do not press in the middle of the night. If discomfort wakes you in the small hours, getting up to lean on a wall will only wake you further. Keep the pressing for the day and the evening.

What This Won't Do

It will not change how your stomach or bowels are built, and it will do nothing for your spleen as an organ. Pressing can ease a tight, aching back and leave you feeling settled for a while, which is real and worth having. What changes digestion over months is plainer: smaller meals eaten slowly, warm cooked food, enough water, a walk after eating, regular sleep, and checking your medicines with your doctor, because many of them upset the stomach. This point works best as one small part of that.

It is no substitute for a diagnosis. See a doctor promptly for bloating that is new and lasts most days for three weeks, blood in the stool or black stools, trouble swallowing, vomiting that keeps coming back, a change in bowel habit that lasts, or weight loss you cannot explain. Get help the same day for severe belly pain, belly pain with fever, or pain in the side of the back with fever or burning when you pass water. See a doctor too for back pain after a fall, especially with thin bones.

Safety First

Do not press over skin that is broken, burned, infected, badly bruised or rashy. Leave the area alone after a recent back injury or fall, with a known fracture, after recent back or belly surgery, or with unexplained swelling or a lump. If you take blood thinners, bruise easily, have thin bones or have broken a rib before, use a softer ball, lean in less, keep sessions short, and ask your doctor first.

Stop at once if pain stays after you lift off, spreads, or brings tingling or numbness. Nothing here requires you to push through pain that lingers. For the full list of cautions and the situations where pressing on yourself is not appropriate, read the full safety guide before you begin.

Questions People Ask

Where is the Pishu (BL20) pressure point? Pishu (BL20) lies on the back, about two finger-widths out from the centre of the spine, level with the eleventh bump of the upper back. That is a little above the waist, near where the lowest ribs meet the spine. Count five bumps up from the line across the tops of your hip bones. In Vietnamese it is called Tỳ Du.

How do I press a point on my back I cannot reach? Many people cannot press this level well with their hands, and that is normal. Stand with your back to a wall and lean on a tennis ball placed over the spot. Two tennis balls tied in a sock sit on both sides of the spine at once. A stick with a rounded end, reached around the waist, also works.

Can Pishu (BL20) help bloating? In this tradition Pishu (BL20) is one of the main back points for a heavy, bloated stomach, loose bowels and poor appetite. Many people find it settling to press an hour or so after a meal. New bloating that lasts most days for three weeks, blood in the stool or weight loss you cannot explain needs a doctor.

Why is it called a spleen point? In this tradition the spleen is the organ that turns food into energy, more like the whole of digestion than the organ on a scan. Pishu (BL20) is its back point. Pressing here does not test or change how your spleen works.

How long should I press Pishu? One to three minutes on each side. Keep the first sessions to about a minute, then add a little as the days go on, up to three. Once or twice a day is enough. Work both sides, even if only one side aches.

Should I press it right after eating? Wait an hour or so after a meal. Leaning into the back on a full stomach can feel uncomfortable. Mid-morning, mid-afternoon or early evening suit it well.

Other Points in This Library

Each of these sits within reach of the same hand. They are often worked in the same sitting.

This page shares general information about a traditional practice. It is not medical advice and does not replace what your doctor has given you. If you are pregnant, managing a health condition, or unsure whether this applies to you, check with your doctor first.

The whole inner edge of the foot, laid out on one page with photographs, is in The Foot Map — the free book. For every point in this library, see the full pressure point index.

(Point shown: BL20 · Pishu · Spleen Transport Point · Tỳ Du.)