Points Database

Location Guides:

: Hegu : Joining Valley

LI-4 : Hand Yangming Large Intestine 4

Classifications:
Yuan-Source point
Gao Wu Command point
Ma Dan-yang Heavenly Star point
Entry point from Lieque Lu-7

Trigger point (Travell & Simons, 1998, Trigger Point Manual; Melzack, Stillwell & Fox, 1977, Trigger Points and Acupuncture Points for Pain: Correlations and Implications, Pain 3, p3-23)
Homeostatic point 12 (Ma, Ma & Cho, 2005, Biomedical Acupuncture for Pain Management)

Location:
On the dorsum of the hand, between the first and second metacarpal bones, at the modpoint of the second metacarpal bone and close to its radial border

Needling:
Perpendicular insertion 0.5 - 1 cun Oblique insertion directed proximally 1 - 1.5 cun

Warning:
Contraindicated in Pregnancy


TCM Actions:
Activates defensive qi and adjusts sweating
Expels wind and releases the exterior
Regulates the face, eyes, nose, mouth and ears
Activates the channel and alleviates pain
Induces labour
Restores the yang

TCM Indications:
  • Exterior wind-cold patterns, chills and fever, injury by cold with great thirst, copious sweating, absence of sweating, febrile disease with absence of sweating, floating pulse.
  • Headache, one-sided headache, headahce of the whole head, hypertension.
  • Redness, swelling and pain of the eyes, dimness of vision, superficial visual obstruction.
  • Nosebleed, nasal congestion and discharge, rhinitis, sneezing.
  • Toothache or pain of tooth decay in the lower jaw, mouth ulcers, lotus flower tongue, cracked tongue, rigid tongue, lips do not close, tightness of the lips.
  • Throat painful obstruction, childhood throat moth, mumps, loss of voice.
  • Swelling of the face, deviation of the face and mouth, lockjaw, deafness, tinnitus.
  • Amenorrhoea, prolonged labour, delayed labour, retention of dead foetus.
  • Dysenteric disorder, childhood nutritional impairment, childhood fright wind, wind rash, malaria, mania.
  • Painful obstruction and atrophy disorder of the four limbs, hemiplegia, pain of the sinews and bones, pain of the arm, contraction of the fingers, pain of the lumbar spine.

    Neuroanatomy:
    Superficial Innervation: Superficial radial nerve (C6 - C8)
    Dermatome Segment: C7
    Deeper Structures: Branches of the ulnar nerve (C8, T1)

    Trigger Point Associations:
    Muscle: Adductor pollicis and first interosseous
    Myotome Innervation: Deep branch of the ulnar nerve (C8–T1)
    Pain Referral Pattern: Along the radial aspect of the first finger and across dorsum of hand (first interosseous) or to the radial and palmar areas at the base of the thumb (adductor pollicis)
    Indications: Sprain of the thumb ; Tendinous strain in the hand

    Notes:
    Main distal point for headaches, toothache and all conditions of the head, face and sense organs. Also major point for boosting the immune system and pain control. This point has been well researched and shown to boost tolerance to painful stimuli for some time after needling.
    Often combined with Taichong Liv-3 to form the 4 gates, a common combination for moving stagnation causing pain and spasm anywhere in the body.

    In Tung acupuncture the Ling Gu, Spirit Bone, point (22.05) is located slightly proximal to this point between the first and second metacarpals. It is often combined with the Da Bai, Big White, point (22.04, at Sanjian LI-3) in almost any disease due to their ability to move Qi and Blood and their location on the arm Yangming which controls Qi and Blood in the entire body (Chu, 2015).

    Tung's Fu Ke, Gynaecology, points are also located near here on the dorsal-ulnar aspect of the proximal segment of the thumb, 1/3 and 2/3 of the distance from the base of the thumb. It is indicated for all kinds of gynaecological disorders, especially when combined with Sanyinjiao Sp-6 (Chu, 2015).

    Medieval phlebotomy point (John de Foxton, 1408: Liber Cosmographiae, maa.cam.ac.uk; Hans von Gersdorff, 1517: Feldtbüch der Wundartzney, www.nlm.nih.gov)

    Galen used this point to relieve a long standing pain in the area where the liver reaches the diaphragm (Brain, 1986, Galen on Bloodletting, P.98). He pierced it and then let the bleeding stop of its own accord.

    In ayurvedic medicine:
    Kurcha marma point
    Size: 4 angula (cun)
    Structure: Tendon
    Effect of Injury: Disability (vaikalyakar marma)
    (Harish Johari, 1996, Ayurvedic Massage, Sanatan Society; Anupama Bhattacharya, Marma Shastra)

    Lad and Durve (2008) in Marma Points of Ayurveda call this point Angushtha Mula and associate it with Prana Vayu, Apana Vayu, Vyana Vayu, Udana Vayu, Ranjaka Pitta and Tarpaka Kapha.

    They give the following functions:
    - Stimulates flow of prana, vyana and apana vayus
    - Enhances circulation and relieves congestion
    - Relieves pain and headaches
    - Benefits liver and spleen functions
    - Benefits hands
    - Calms the mind and releases suppressed emotions

    Siddha practitioners call this point Puta Nati, literally "malignant spirit pulse", which is examined as a part of pulse diagnosis to ascertain possession by the spirit (pey piti-ttal) of a diseased person or malevolent god (Sieler, 2015, Lethal Spots, Vital Secrets, p.146).

    In Tibetan medicine:
    Moxa point (AMNH, Tibetan Medical Paintings)

    In Thai massage:
    Acupressure point indicated for facial pain/numbness/paralysis,gastrointestinal ailments, headache, hypertension, indigestion, stomach ache, stress and toothache (Salguero & Roylance, 2011, Encyclopedia of Thai Massage)


    Reference Notes: (click to display)