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 meta-
carpal bone and close to its radial border, at the highest
point of the muscle when the thumb is held close to the
hand.
midpoint
Hegu L.I.-4
Needling
i. Perpendicular insertion 0.5 to 1 cun, ii. Oblique inser-
tion 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
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, pro-
longed labour, failure of dead foetus to descend, dysen-
tery-type disorder, infantile malnutrition disorder, sim-
ple 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 Points’2. Some 800
years later it is one of the most frequently used acupunc-
ture 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 treat-
ment of this condition is to release the exterior by induc-
ing 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 patho-
genic 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 regulat-
ing 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 wind-
heat 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
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 JOURNAL OF CHINESE MEDICINE NUMBER 38 JANUARY 1992

the ears, and headaches other than frontal ones. and Lieque LU-7.
Hegu L.I.-4 is considered to have a particular ability to 2. Zusanli ST-36 for the abdomen, Weizhong BL-40 for
ease pain, especially in the areas discussed above, and is the back and lumbar region, Lieque LU-7 for the head
a commonly used point in acupuncture analgesia. Ac- and neck, Hegu L.I.-4 for the face and mouth.
cording to Chinese medicine, Shi pain arises when im-
3. Some authorities go so far as to attribute Qi tonifying
paired circulation of Qi and blood leads to stagnation.
properties to Hegu L.I.-4, especially with other tonifying
This is expressed in the saying "without movement there
points such as Zusanli ST-36 to strengthen the Wei Qi.
is pain, with movement there is no pain". The special
action of Hegu L.I.-4 intreating pain is explained by the
The above extract is taken from 'A Manual of Acupunc-
statement “Yangming channels are abundant in Qi and
ture', a comprehensive illustrated textbook on the acu-
blood”, reflecting the particular ability of points on these
puncture points to be published in 1993.
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 disor-
ders 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 ap-
peared 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 contrain-
dicated 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 BL-
2 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 rein-
force 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 Compen-
dium).
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 shoul-
der and back: Hegu L.I.-4 and Taichong LIV-3 (Ode of Xi
Hong).
Notes
1. Zusanli ST-36, Neiting ST-44, Quchi L.I.-11, Weizhong
BL-40, Chengshan BL-57, Taichong LIV-3, Kunlun BL-
60, Huantiao GB-30, Yanglingquan GB-34, Tongli HE-5

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