Gaohuang (BL43): The Point Beside the Shoulder Blade for an Aching Upper Back

Where Gaohuang Sits

This point sits on the upper back, one on each side, right against the inner edge of the shoulder blade. It is level with the fourth bump of the spine below the large bump at the base of the neck, roughly a hand's width out from the middle of the back.

The line it belongs to is the longest in the body. It begins at the inner corner of the eye, runs over the top of the head and down the back of the neck, then splits into two parallel lanes on each side of the spine. The inner lane runs close to the spine; the outer lane runs further out, along the inner edge of the shoulder blade and down past the waist and buttock. Vietnamese and Chinese texts call it the Bladder channel. This point is the forty-third stop, on the outer lane, and it is the best known point on that lane.

The old texts place it level with the lower edge of the fourth thoracic vertebra, three body inches out from the midline. A body inch here is measured on your own back: the distance from the middle of the spine to the inner edge of the shoulder blade, with the arms relaxed, counts as three. So in practice the point sits on the inner edge of the blade itself. Another useful landmark is the bony ridge that crosses the top of the shoulder blade. Its inner end lines up with the third vertebra. This point sits one bump lower, a little below the inner end of that ridge.

Underneath, three layers of muscle stack up. On top is the broad, flat trapezius, which lifts and steadies the shoulder. Below it lie the rhomboids, two strap-like muscles that pull the shoulder blade toward the spine. Deeper still are the long muscles that hold the spine upright. Under all of them are the ribs. The rhomboids are supplied by a nerve from the fifth cervical root that runs down along the inner edge of the blade. The skin over the point is served by the third and fourth thoracic roots, which wrap around the chest wall. That is why a deep ache here can sometimes be felt toward the front of the chest.

Why This Spot

On the anatomical side, this is where most people's upper back gives out first. When the head and shoulders lean forward, at a table, a steering wheel or a sink, the muscles along the inner edge of the shoulder blade are stretched and asked to hold the weight for hours. They tire, tighten into cords and grow tender. Run a ball down the edge of the blade on almost anyone over fifty and you will find a sore knot at about this level.

In this tradition the point carries an unusual reputation. It is not counted among the special transport points, yet for over a thousand years it has been described as a point for deep tiredness, for a body that has been run down by long illness, and for a weak chest and a lingering cough. Teachers describe it as reaching a place that is hard to reach. In Vietnamese practice it is commonly used for an aching upper back that comes with fatigue.

The name means the hidden region between the heart and the diaphragm; the Vietnamese name, Cao Hoang, says the same.

What the Old Texts Say About Gaohuang

The name comes from one of the oldest medical stories in Chinese writing. The Zuo Zhuan, a chronicle from the fourth century BCE, tells of Duke Jing of Jin, who fell gravely ill. The night before his physician arrived, he dreamed his illness took the shape of two children who hid below the heart and above the diaphragm, where no remedy could reach them. The physician examined him and said the same: the illness sat in that hidden place, out of reach. The phrase "the illness has entered the gao and huang" became a common saying for a condition beyond help, and the point that bears the name was later said to reach that very place.

Sun Simiao, the great physician of the seventh century, wrote about this point in his Prescriptions Worth a Thousand Gold. He gave careful instructions for finding it, because the shoulder blade hides it: the person sits, holds the arms forward and folds them so the blades move apart, and only then is the spot sought along the inner edge. He praised it for the long-depleted and the worn out. Later, in the Song dynasty, a whole small book was written on locating this one point.

The Vietnamese handbook of points and channels by Ngo Trung Trieu, published by Hong Duc, lists it for a long-standing weak chest and cough, for inflammation of the airways and the lining of the chest, and for nervous exhaustion. It adds that the point is used to raise the body's resilience and to protect against illness. For locating it, the book gives the same old advice: place one hand on the opposite shoulder, so the shoulder blade is drawn outward and the point is exposed.

Those entries come from long use, not from modern trials. What a self-presser can take from them: this is a point for an upper back that is tired as much as it is tight.

Points That Work With Gaohuang

The first partner sits on the same shoulder blade, a little lower and further out. Picture a line from the middle of the bony ridge across the top of the blade down to its bottom tip. The partner lies about a third of the way down that line, in the soft hollow in the middle of the blade. In this tradition the two are commonly worked one after the other when the whole shoulder blade aches.

The second sits on the top of the shoulder, halfway between the bump at the base of the neck and the bony point at the outer end of the shoulder. Squeeze the thick muscle there between your thumb and fingers. It is used with this one when the stiffness climbs from the upper back into the neck. If you are pregnant, skip that partner.

The third is on the front of the shin, four fingers below the dip at the outer lower edge of the kneecap and one finger out from the shin's sharp edge. The old teachers paired it with this point for people who feel run down.

How to Find and Press Gaohuang

Getting Into Position

You will need help from a wall or a tool. For the ball, stand with your back to a smooth wall, feet a short step out from it, knees soft. For a stick, sit upright on a firm chair. In both cases, cross your arms in front of you and hold the opposite shoulders, or let the arm on the working side hang forward across your body. This slides the shoulder blade outward and opens the strip where the point lies.

How to Find It

Find the large bump at the base of your neck, the one that sticks out most when you bow your head. Count down four more bumps with the fingertips of your other hand, as far as you can reach; most people can feel two or three, and the rest is estimation. Now picture the inner edge of the shoulder blade on the same level, roughly a hand's width out from the spine. If a helper is with you, they can find the edge easily with the arms crossed.

Place the tennis ball or the rounded tip of the tool there. Move slowly in small steps up and down along the inner edge of the blade. Much of it will feel like ordinary tight muscle. One spot will sting: a small, sharp, pinpoint tenderness, often in a rope-like cord. That spot is the point. Remember that the ribs lie beneath, so you are feeling for a sore spot in muscle, not trying to dig between bones.

How to Press It

With a ball, lean gently back so the ball presses on the stinging spot, then bend and straighten your knees a little so the ball rolls in small circles, about the size of a fingernail, without leaving the spot. With a stick, hook the rounded tip over the opposite shoulder, hold the lower handle with your other hand, and pull gently so the tip presses inward. Rub in small circles, roughly one each second. Aim the pressure straight in, toward the front of the chest, not sideways under the blade.

How Much Pressure

Sharp under the ball or tool is right. That small sting tells you that you are on the point. The test is what happens when you ease off: the sting should fade within moments. If the pain stays after you step away from the wall, if it spreads around to the front of the chest, or if the area turns swollen, hot or red, stop and leave it for several days. If you are holding your breath, or your shoulders have crept up toward your ears, you are pressing too hard. Ease off until you can breathe slowly through the sting.

How Long

Work each side for one to three minutes. In the first sessions keep to about one minute, because this spot is often very tender at the start. As the days go on, add a little time, up to three minutes. Do both sides, even when only one complains. Once or twice a day is plenty. Pressing longer does not add benefit; it mostly adds soreness.

When to Do It

Late afternoon suits the ache that builds after hours of sitting, reading or housework. Before bed is a good time too, as part of winding down. Do not press in the middle of the night. If an aching back wakes you, pressing then tends to wake you further. Keep the pressing for the day and the evening.

What This Won't Do

It will not change the reason your upper back aches. Most often the reason is posture: a head that drifts forward, rounded shoulders, a chair that is too low or a screen that is too far. A point beside your shoulder blade will not out-argue any of that. Pressing works best alongside the plain things: getting up every half hour, squeezing the shoulder blades gently together, a cushion behind the lower back, and a little daily movement.

It will not replace a diagnosis either. Pain between the shoulder blades can come from the organs of the chest and upper belly, not only from muscle. New pain there that comes with breathlessness, sweating, pressure in the chest or pain spreading into the jaw or arm needs emergency help, not pressing. So does sudden severe pain that tears through to the back. Pain that comes with a fever, a cough that will not settle, or weight loss you cannot explain belongs with a doctor. If you have been told you have thinning bones and the pain started suddenly after a minor strain, have it checked before you press anything.

Safety First

Do not press over skin that is broken, burned, infected, badly bruised or rashy. Leave the area alone after a recent rib injury, a fall onto the back, or surgery on the chest, spine or shoulder. If you have osteoporosis or fragile bones, ask your doctor before leaning on a ball, because the ribs lie right under this spot. If you take blood thinners, bruise easily, or have a bleeding disorder, use lighter pressure, keep sessions short, and talk to your doctor first.

Stop at once if the pain stays after you ease off, spreads around the chest, or if the area becomes swollen, hot or red. Nothing here requires you to push through pain. 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 Gaohuang (BL43) pressure point? Gaohuang (BL43) sits on the upper back, one on each side, right against the inner edge of the shoulder blade. It is level with the fourth bump of the spine below the large bump at the base of the neck, roughly a hand's width out from the spine. In English it is called the Vital Region; in Vietnamese, Cao Hoang.

How can I press Gaohuang on my own back? Honestly, your hand will rarely reach it without straining the shoulder. Two ways work well. Put a tennis ball between your back and a wall, against the inner edge of the shoulder blade, and lean into it. Or hold a long-handled pressing tool, the hooked or S-shaped kind, and hook its rounded tip over the opposite shoulder onto the spot.

Why do I have to hug myself to find it? When your arms hang, the shoulder blade lies over the point and hides it. Crossing your arms and holding your shoulders slides the blades outward, away from the spine, and the strip of muscle along their inner edge comes into reach. The old texts give the same instruction.

How long should I press Gaohuang? One to three minutes on each side. Start with about a minute, because this spot is often tender, then add a little time over the days, up to three. Once or twice a day is plenty. Work both sides even if only one aches.

Can I use a ball against the wall if I have fragile bones? Ask your doctor first. The ribs lie right under this point, and leaning your full weight onto a ball puts pressure on them. If you get the go-ahead, use a soft ball, stand close to the wall, and lean in gently rather than pushing hard.

Is this the knot I get between my shoulder blades after sitting at a table? Very often, yes. The muscles that hold the shoulder blades back stretch and tire when you lean forward for long hours, reading, sewing or at a screen. The tender knot people rub between their blades frequently sits right on this point.

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: BL43 · Gaohuang · Vital Region · Cao Hoang.)