JOURNAL OF CHINESE MEDICINE NUMBER 38 JANUARY 1992

HEGU L.I.- 4
by Mazin Al-Khafaji, Peter Deadman and Tim Martin
Location
On the dorsum of the hand, between the first and second metacarpal bones, at the midpoint of the second metacarpal bone and close to its radial border, at the highest point of the muscle when the thumb is held close to the hand. pain of tooth decay in the lower jaw, mouth ulcers, heavy tongue, cracked tongue, rigid tongue, lips do not close, tightness of the lips, swollen face, throat Bi, loss of voice, deafness, tinnitus, deviation of the the face and mouth, exterior wind-cold syndrome, fever without sweating, much sweating, lockjaw, tetanus, amenorrhoea, prolonged labour, failure of dead foetus to descend, dysentery-type disorder, infantile malnutrition disorder, simple tonsillitis in children, childhood convulsions, mumps, wind rash, scabies, malaria, mania, pain of the lumbar spine, Bi and Wei of the four limbs, hemiplegia, pain of the tendons and bones, pain of the arm, spasm of the fingers.

Commentary
According to Ma Dan Yang, the great physician of the Jin dynasty, Hegu L.I.-4 is one of the twelve fundamental acupuncture points1. The Gatherings From Outstanding Acupuncturists by the Ming dynasty author Gao Wu includes it among the Four Dominant Points2. Some 800 years later it is one of the most frequently used acupuncture points by acupuncturists throughout the world. Hegu L.I.-4 is a primary point to expel wind-cold or wind-heat and to release the exterior. Thus The Great Compendium recommends this point for injury by cold with a floating pulse, chills and fever, headache, rigid spine, no sweating. This is the classic presentation of wind-cold binding the exterior portion of the body. A basic principle within Chinese medicine for the treatment of this condition is to release the exterior by inducing sweating, thereby expelling the pathogen along with the sweat and facilitating the circulation of Wei Qi. In fact, Hegu L.I.-4 may also be used for attack of pathogenic wind-heat or wind, both of which conditions may involve sweating that does not expel the pathogenic factor. The wide-ranging action of Hegu L.I.-4 in regulating sweating is reflected in the advice given in The Great Compendium to reinforce Hegu L.I.-4 and drain Fuliu KID-7 if there is no sweating, and to reinforce Hegu L.I.4 in cases with much sweating. The explanation of this apparently contradictory function is that Hegu L.I.-4 is able to regulate Wei Qi and hence adjust the pores3. Even more commonly, Hegu L.I.-4, the Yuan-Source point of the Large Intestine channel is combined with Lieque LU-7, the Luo-Connecting point of its coupled channel, in cases of attack by exterior wind-cold or windheat to release the exterior and promote the descending and disseminating function of the Lung. Hegu L.I.-4 is the single most important point to treat disorders of the face and the upper orifices. According to the Canon of the Jade Dragon, Hegu L.I.-4 treats all diseases of the head, face, ears, eyes, nose, cheeks, mouth and teeth. This point is essential in the treatment of these areas, whether the condition is acute or chronic, hot or cold, Xu or Shi, but in practice is less used to treat

midpoint

Hegu L.I.-4

Needling
i. Perpendicular insertion 0.5 to 1 cun, ii. Oblique insertion directed proximally 1 to 1.5 cun, iii. towards or to join with Houxi SI-3 for spasm and pain of the hand and fingers. Caution: contraindicated in pregnancy.

Actions
Regulates the Wei Qi, expels wind and releases the exterior Regulates the face, eyes, nose, mouth and ears Stops pain Induces labour Activates the channel and invigorates the collaterals

Indications
Headache, one-sided headache, headache of the whole head, swelling redness and pain of the eyes, lack of visual clarity, superficial visual obstruction, nosebleed, nasal congestion and discharge, sneezing, toothache or

1 17

JOURNAL OF CHINESE MEDICINE NUMBER 38 JANUARY 1992

the ears, and headaches other than frontal ones. Hegu L.I.-4 is considered to have a particular ability to ease pain, especially in the areas discussed above, and is a commonly used point in acupuncture analgesia. According to Chinese medicine, Shi pain arises when impaired circulation of Qi and blood leads to stagnation. This is expressed in the saying "without movement there is pain, with movement there is no pain". The special action of Hegu L.I.-4 intreating pain is explained by the statement Yangming channels are abundant in Qi and blood, reflecting the particular ability of points on these channels to promote circulation of Qi and blood, and thus dispel obstruction and stop pain. Points of the arm and leg Yangming channel are further used both to bring nourishment to the limbs in cases of Wei syndrome and hemiplegia, and to promote circulation in painful disorders such as Bi syndrome. Thus Hegu L.I.-4 is commonly linked with Jianyu L.I.-15 and Quchi L.I.-11 in the chain and lock point association method for pain, paralysis or atrophy of the upper limb. Bilateral Hegu L.I.-4 and bilateral Taichong LIV-3 are known as the Four Gates. This combination first appeared in the Ode of the Standard of Mystery which said "for hot and cold Bi pain, open the Four Gates. Since then, the use of this combination has been extended to treat a variety of disorders involving pain and spasm. Hegu L.I.-4 has a strong action on promoting labour. The Ode of the Standard of Mystery tells how the Song dynasty Crown Prince, in a dispute with the doctor Xu Wenbai over whether a pregnant woman was carrying a girl or twins, ordered her belly to be cut open to find out. Xu Wenbai begged to use his needles instead, and on draining Zusanli ST-36 and reinforcing Hegu L.I.-4 two babies emerged. For this reason, Hegu L.I.-4 is contraindicated in pregnancy. Combinations Aphasia: Hegu L.I.-4, Yongquan KID-1 and Yangjiao GB-35 (A Systematic Classic). Head wind and dizziness: Hegu L.I.-4, Fenglong ST-40, Jiexi ST-41 and Fengchi GB-20 (The Great Compendium). Headache due to injury by cold: Hegu L.I.-4, Zanzhu BL2 and Taiyang (Extra) (The Great Compendium). No sweating: first reinforce Hegu L.I.-4, then drain Fuliu KID-7. Much sweating: first drain Hegu L.I.-4 then reinforce Fuliu KID-7 (The Great Compendium). Difficult labour: first reinforce Hegu L.I.-4, then drain Sanyinjiao SP-6 and Taichong LIV-3 (The Great Compendium). Throat Bi: Hegu L.I.-4, Yongquan KID-1, Tiantu REN-22 and Fenglong ST-40 (The Great Compendium). In hot and cold Bi pain, open the Four Gates [Hegu L.I.4 and Taichong LIV-3 bilaterally] (Ode of the Standard of Mystery). Unendurable pain of the arm that radiates to the shoulder and back: Hegu L.I.-4 and Taichong LIV-3 (Ode of Xi Hong).

and Lieque LU-7. 2. Zusanli ST-36 for the abdomen, Weizhong BL-40 for the back and lumbar region, Lieque LU-7 for the head and neck, Hegu L.I.-4 for the face and mouth. 3. Some authorities go so far as to attribute Qi tonifying properties to Hegu L.I.-4, especially with other tonifying points such as Zusanli ST-36 to strengthen the Wei Qi. The above extract is taken from 'A Manual of Acupuncture', a comprehensive illustrated textbook on the acupuncture points to be published in 1993.

Notes
1. Zusanli ST-36, Neiting ST-44, Quchi L.I.-11, Weizhong BL-40, Chengshan BL-57, Taichong LIV-3, Kunlun BL60, Huantiao GB-30, Yanglingquan GB-34, Tongli HE-5
18 2