Acupuncture Points Notebook

Location Guides:

: Zhongfeng : Middle Seal

Liv-4 : Foot Jueyin Liver 4

Jing-River and Metal Point

On the ankle, anterior to the prominence of the medial malleolus, in the significant depression just medial to the tendon of tibialis anterior when the ankle is extended (dorsiflexed, by pulling the toes upwards)

Perpendicular insertion 0.3 - 0.5 cun, or oblique insertion medially towards Shangqiu Sp-5, or laterally towards Jiexi St-41.

TCM Actions:
Spreads liver qi and regulates the lower jiao
Clears liver channel stagnant heat

TCM Indications:
  • Pain and retraction of the genitals, hypogastric pain, shan disorder, cold shan disorder, seminal emission, seminal emission due to deficiency-taxation, seminal emission with dreams, difficult urination, the five types of painful urinary dysfunction, retention of urine.
  • Pain and swelling of the lower abdomen, abdominal discomfort after eating, periumbilical pain, difficult defecation, no pleasure in eating.
  • Green complexion, sighing, jaundice, yellow body with low grade fever, low grade fever, malaria, goitre, dry throat.
  • Lumbar pain, contracted sinews, numbness of the body, diminished qi, heaviness of the body, pain of the medial aspect of the knee, cold inversion of the feet, pain and swelling of the medial malleolus.

    Superficial Innervation: Saphenous nerve (L3 - L4)
    Dermatome Segment: L4

    In the Five Element tradition Metal controls Wood which makes this point capable of "cutting" through Stagnation of Qi and Blood in the Liver, especially in the lower Jiao.


    Ling Shu Ch. 2 says that needling this point contrary to the flow of the channel will cause blockage while needling in accordance with the direction of the channel enable unimpeded flow. It is the only point in this chapter in which a specific action is given.

    Ling Shu Ch. 6 suggests piercing the Jing points of the Yin channels if a disease is in the Yin of the Yang realm (e.g. the sinews and bones). This would mean using this point to treat disorders of the hip, knee and ankle.

    Ch. 7 then suggests using paired needles either side of the tendon to remove a tendon blockage illness, and straight needling to the bone for bone blockage illness. This could be interpreted as using these technique on this point, on either side of the tibialis anterior in incidences of injury to this tendon or straight in cases of ankle injury, or using them as local techniques while Ch. 6 is a distal point suggestion.

    Ling Shu Ch. 44, On the Qi Moving in Accordance with the Norms, indicates that the Jing-River points should be pierced in late summer or when the disease affects the voice. The seasonal aspect should not be interpreted literally as it describes the voice and musical notes as "controlled by late summer". It also describes the morning, afternoon, evening and night cycle of the day to be like the four seasons of the year although late summer is not included in this comparison but presumably has some correlate (maybe late afternoon).

    Ling Shu Ch. 52, On the Wei Qi, considers this to be the root of the foot Jueyin meridian with the tip being at Ganshu Bl-18.

    Reference Notes: (click to display)