Bladder Channel

Ciliao BL-32

Chinese: 次髎

Pinyin: Cì Liáo

Location

In the 2nd posterior sacral foramen, about midway between the posterior superior iliac spine (PSIS) and the midline.

How to locate

First identify the Tuffier's line which connects the highest points of the iliac crest. The spinous process of the 4th lumber vertebra (L4) mostly falls on this line. 

Then palpate in an inferior direction, passing L5, and reach the most superior 1st sacral foramen. Palpate further to reach the 2nd foramen, where Ciliao BL-32 is located. 

Here is to identify the 4 sacral foramens and the corresponding points at the same time. First locate the 4th sacral foramen on the level of the superior end of the rima ani (sometimes a bit more superiorly or inferiorly).

Place the little finger on the 4th foramen, then the ring, middle and index fingers on a slightly V-shaped line in a superior direction, palpating for the depressions of the sacral foramens.

With the fingers in this position, the index finger will be resting on Shangliao BL-31 of the 1st foramen, the middle finger on Ciliao BL-32 of the 2nd foramen, the ring finger on Zhongliao BL-33 of the 3rd foramen and the little finger on Xialiao BL-44 of the 4th foramen. 

Main actions

  1. Regulates the Lower Burner and facilitates urination and defecation
  2. Resolves Dampness and regulates menstruation
  3. Benefits the lower back and legs

Indications

Enuresis Diarrhea Sciatica Dark Urine Borborygmi Leukorrhea Labor pain Infertility Sacral pain Constipation Anus prolapse Painful period Genitalia pain Lower back pain Uterus prolapse Painful urination Urinary retention Urinary difficulty Lower back numbness Defecation difficulty Irregular menstruation

Needling

Vertically 0.7–1 cun. Or 1.5-2 cun through the foramen. 

Caution:Reducing Needling techniques are contraindicated during pregnancy, except for promoting labor. 

Commentary for Ciliao BL-32

'Liao' means crevice, thus BL-31, BL-32, BL-33 and BL-34 are called 'Siliao'(Four crevices) or 'Baliao'(Eight crevice since there are four crevices on each side). They are called so, due to their location in the four sacral foramina. 

Shangliao BL-31 (Upper crevice) is at the highest sacral foramina. Ciliao BL-32 (Second crevice) is at the second. Zhongliao BL-33 (Middle crevice) the third, while Xialiao BL-34 (Lower crevice) is the last one. 

All these four points share similar actions, but Ciliao BL-32 is the most important one with the widest indication.

First of all, it regulates the Lower Burner and treats urination and defecation Difficulties. Kidney Deficiency is an important underlying pattern for this disorder, which is frequently seen in elderly and weak patients. Typical urinary manifestations include painful and difficult urination, dark and retention of urine as well as enuresis. While intestines related symptoms covers difficult defecation, constipation, borborygmi and diarrhoea. 

Furthermore, by removing Dampness from the Lower Burner, it is effective in treating gynecological disorders such as dysmenorrhoea, infertility, irregular menstruation, labor pain and leucorrhoea. BL-32 is especially useful for infertility and painful periods. It can also reduce back pain during labor. 

BL-32 is indicated for genital disorders as well, but Xialiao BL-34 has the strongest effect. Typical manifestations are swelling and painful vagina, incessant green vaginal discharge, pain of the testicles and etc. 

All these four points benefit the lumbar region, lower back and legs. They remove the Painful Obstructions from the Channel by invigorating the Qi and Blood. Ciliao BL-32 and Zhongliao BL-33 have the most effect on this action. 

Finally, BL-32 also promotes the Qi ascending so as to treat anus or Uterus prolapse.