Large Intestine 4 lies on the back of the hand in the angle between the first and second metacarpal bones. It’s approximately level with the midpoint of the second metacarpal bone and near its radial border.
The point is often sore when you press it firmly.
Find it by pressing the thumb against the forefinger. Where the bulge in the flesh is at its highest is often where to needle, in the direction underneath the second metacarpal, or vertically, or proximally.
Depth, up to 1.5 cun
If being used for facial or dental analgesia, press around the general area between the thumb and forefinger for the spot that controls the pain, and use that – but warn the patient because your needling will probably feel strong. It must also be in the right direction and depth, which you discover by probing. Read up about acupuncture point location.
An artery runs close to the point. If you can, feel for it and then avoid it.
3 – 5 cones
Easily down to wrist, forefinger and thumb. With skill, up to the head. (For more about this, see comment, below.)
Early on, in the attack by an external pathogenic factor, use Large Intestine 4 to clear out or expel invasion of Wind-Heat or Wind-Cold – for example, cold or virus. It’s not much use at clearing a well-established cold bug. However, even here it can still help clear the sinuses, ease a headache, comfort eyes and ears if blocked or muffled.
I think it is better at clearing Wind Heat than Wind Cold.
It descends qi, thereby clearing the head. But this descending function means it is used to clear pain and tension wherever occurring. Very useful for Qi stagnation type problems, when it is often combined with Liver 3 Taichong, to form the ‘four gates’ use of which eases many kinds of problem.
If there is no sweating but there should be (as can happen with invasion by Wind Cold), reinforce Hegu and reduce Fuliu Kidney 7.
If there is too much perspiration and there shouldn’t be, reduce Hegu and reinforce Fuliu.
Although you can use it for any kind or location of headache, theory suggests it will work best when clearing frontal headaches and headaches of face and forehead.
Think of using it for any kind of face or mouth condition, including epistaxis and post-stroke facial deviation.
Because, although a yang point, it strongly descends qi, it is a cooling point. So use it for hot smelly diarrhoea, or skin rashes from Blood heat (although other points may be just as good, eg Large Intestine 11 Quchi and Spleen 10 Xuehai.
Though forbidden in pregnancy, its descending action can be used to abort a dead fetus.
Hegu is a very yang point. It can increase yang in the body, and in fact Mary Austin, under whom I trained in the 1970s, having sedated most of her patients with treatments always including Governor 20, woke them up afterwards by quickly reinforcing this point!
It can both increase yang and expel or clear out external or pathogenic yang.
It’s a strong point. If you know how, and even if you don’t, it can usually get strong deqi, the cramping, heavy sensation which Chinese acupuncturists like to get. So it is a good idea to warn your patient that they might feel it strongly. Of course, in weak, tired, and often in elderly patients, it is harder to elicit.
I once saw Large Intestine 4 being used to move deqi up the Large Intestine channel to the neck to clear a very stubborn case of mumps in a tremendously strong road-digger.
He knew nothing of acupuncture or of what to expect, so the acupuncturist asked him to put his other hand over where he felt the deqi had reached. Doing so, he traced the path of the channel out with remarkable accuracy.
When it reached his swollen neck (the swelling was in size somewhere between a large grapefruit and a football – ie huge) he said it felt like a balloon collapsing and was quite surprised that the swelling was still there.
We asked him back for another treatment the next day but he never returned and the work colleagues he sent to us said he was back at work the next morning, looking his usual self and working normally.
He had arrived in our department because the hospital’s Western medicine departments had thrown everything they had at him without success over a period of many weeks.
Chinese medicine sees pain as arising from
Large intestine 4 forces Qi along the channels, so use it for any of these kinds of pain. The patient won’t much like the immediate – strong – effect in the first or third example, but may then quickly feel benefit, as he does immediately in the second example.
I think we over-use it, when milder points could achieve as much without such strong deqi: it’s a bit like using a mallet to crack a nut.
Lack of a palpable pulse at the wrist after labour: Use Large Intestine 4 with Kidney 7 and Pericardium 5.
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