Needling Of The Large Intestine Meridian

Steven K.H. Aung, MD

Figure 1. Dr Steven K.H. Aung shown needling his wife, Debbie Aung, on LI 4a and LI
4b. Photography by Tom Turner.

As every competent practitioner of Traditional Chinese Medicine knows, classical acupoints are
like the "gates" of Qi (vital energy) flow located on the 12 Regular Organ Meridian Energetic
Pathways and also, the Extraordinary Meridians). The LI encompasses 20 acupoints, and the
general Qi flow is from near the tips of the index fingers, to the elbows (superficial level) and into
the shoulders and neck (intermediate level and then ascending to the sides of the nostrils, with
major collaterals descending into the lungs (LU) and the LI organ (deep level) where the LI
interconnects with the Stomach (ST) meridian. While not the most glamorous star of our 12
Zang Fu system, we should all be thankful when the humble LI constantly fulfills its vital role in
continuing and helping to complete the function of the Small Intestine (SI) in transforming the
clear from the turgid, and completing the essential physiological process of eliminating toxic
waste from our body.

Like the SI, the LI transfers nutrients to the blood/lymph system, squeezing and wringing out the
remnants of nutrient energy and generating the waste material that must be excreted on a
regular daily basis for one's optimal health. The LI is considered a Fu ("hollow" - Yang) organ; its
Zang ("solid" - Yin) partner is the Lung (LU).

The first 7 LI acupoints have specific energetic functions, which manifest in all the Regular
meridians, namely, Jing Well (LI 1, where Qi rises to the surface), Ying Spring (LI 2, where Qi
gushes at the surface), Shu Stream (LI 3, where Qi flows abundantly and swiftly at the surface
among many streams), Yuan Primary (LI 4, where innate Qi accumulates), Jing River (LI 5,
where Qi flows widely, deeply, and powerfully like a river to the sea, accumulating at the He Sea
point L1 11), Luo Connecting (LI 6, where the Qi and Blood of the LI and LU meridians
converge), and Xi Cleft (LI 7, where the Qi and Blood converge and accumulate).

General indications and syndromes (Chinese traditional patterns/synergies of Qi imbalance) of

the LI system largely pertain to various bowel dysfunctions; notably, diarrhea, constipation, and
abdominal distention as well as sinus congestion and general pain. It is necessary for
physicians and other practitioners to properly evaluate these conditions (in view of the fact that
the LI and LU are interconnected [LU Qi must descend harmoniously to facilitate LI functioning])
to arrive at a viable treatment plan customized and compassionately fine-tuned for each and
every patient.

With respect to LI 4 (Hegu), it is considered one of the most effective acupoints for general pain
control, especially in the upper half of the body. It is indicated for Chinese traditional medical
syndromes associated with Wind invasion and the resulting conditions such as headache,
sinusitis, myofacial pain, toothache, and TMJ dysfunction. It is also one of the key acupoints
utilized in acupuncture anesthesia during surgery as well as postoperative pain, distension, and
discomfort. This was so in the famous case of New York Times reporter James Reston who,
while in Beijing in the early 1970s covering a news story relating to diplomatic ties between the
People's Republic of China and the United States of America, suffered an attack of appendicitis.

I believe it is important for medical acupuncturists to note the difference between the classic LI 4
(Hegu), depicted in this photo as LI 4a, and the additional point depicted as LI 4b; LI 4b is distal
to LI 4a about 1.0 cun, (the basic qualitative "body inch" assessment of the width of the
interphalangeal joint of a patient's thumb).

It is not my intention to attempt in this brief "photo essay" to revise the Chinese traditional
medical meridian system by engaging in the mere gratuitous proliferation of acupoints, of which
there are already more than enough. However, over a quarter of a century of direct "hands on"
clinical acupuncture experience has taught me that stimulating LI 4b is effective for pain control
and healing with respect to the various soft tissue conditions of the skin of the face and head,
including eczema, acne, hematoma, bruises, and lacerations, in addition to nasal congestion,
both allergic and vasomotor rhinitis, along with post-surgical conditions/trauma and other such
conditions above the upper chest.

The pivotal case example vis-�-vis my own clinical experience pertains to a 25-year-old man
who was referred to me by his family physician. He was suffering from severe intermittent
headaches apparently due to sinusitis, along with severe acne and other skin lesions. I treated
him successfully over a period of several weeks largely using LI 4a (Hegu), which seemed to
not totally relieve his symptoms. When I began to insert a needle more obliquely and deeply in
the direction of LI 5, a better overall response was obtained.

Over the years of intensive clinical practice, I began to hypothesize the locale between LI 4 and
LI 5 to be an unknown gate, which I thought of as LI 4b and which, for want of a better name,
may be termed Hegu 2 (Adjoining Valley). It is located on the back of the hand in the depression
between the 1st and 2nd metacarpal bones at the tip of the angle of the metacarpal bone. I
have found it to be useful in combination with ST 43 and BL 60 for headache and general pain
control, and in combination with SI 6, GV 7, and GV 9 for skin conditions. Acupressure,
electrical, and laser techniques are also applicable and appear to be effective.

Certainly, if the time and resources are available, then randomized controlled trials (RCTs) could
be conducted to attempt to prove or disprove this clinical observation. I remember reading
somewhere in the vast expanse of enlightening biomedical literature that a single properly
conducted RCT could cost a million dollars or more. This does not negate the fact that
stimulating either LI 4a or its seemingly silent yet resilient, resonant partner, LI 4b, may or may
not be a kind of placebo effect which makes our patients and indeed, ourselves, at least a little
happier and hopefully, more compassionate, competent, and creative in our daily lives.
Photographs, however, whether moving or still, and while often extremely interesting, are like
mere echoes, nuances, or resonances of our universal healing endeavor.

AUTHOR INFORMATION
Dr Steven Aung is a Geriatric and Family Practice physician, and a Traditional Chinese
Medicine (TCM) practitioner and teacher. At the University of Alberta, Dr Aung is an Associate
Clinical Professor in the Departments of Medicine and Family Medicine, and Adjunct Professor
of Extension. He is a World Health Organization advisor on TCM. Dr Aung was awarded a
Professional Excellency from the Academie Diplomatique de la Paix in 1986, the Alberta Order
of Excellence in 2002, and the Queen Elizabeth II Golden Jubilee Medal in 2003. His primary
interest is in the integration of TCM and Western biomedicine within the context of a more
natural, compassionate approach to health care.

Steven K.H. Aung, MD, OMD, PhD, FAAFP*

9904 � 106 St NW
Edmonton, AB T5K 1C4
Canada
Phone: 780-426-2760 � Fax: 780-426-5650
E-mail: draung@aung.com
*Correspondence and reprint requests