Liver 4 Zhongfeng, Middle Seal

Liver 4 is a great point for pain in the lower abdomen and genitals, especially if from Liver Qi stagnation, Damp or Heat.
Liver 4
Liver 4 - Copyright Acupuncture-Points.org

Liver 4 Zhongfeng is an acupuncture point on the Liver channel. It is a great point for pain in the lower abdomen, especially if caused by Damp or Heat – or both (- these are syndromes in Chinese medicine!)

  • Jing-River point
  • Metal point

 

Note: if by mistake you strayed onto this site when looking for information about the Liver from the Western medical point of view, click Liver instead. (But before doing that, why not stay and read what Chinese medicine has been saying about the Liver, for well over 2000 years!)

Liver 4 Location

There are a number of ways of describing Liver 4’s location.

1/ At the anterior flexure of the ankle, BETWEEN the tendon tibialis anterior and the extensor hallucis longus. This is where I was originally taught to find the point, and it seemed to work just fine. That’s the position shown in the picture. However, most books nowadays suggest you find it at the following position:

2/ 0.5 to 1.5 cun anterior to the medial malleolus in the depression formed when the foot is dorsi-flexed (ie medial to the tendon tibialis anterior)

3/ 1 cun anterior to the inferior margin of the medial malleolus, medial to the tendon tibialis anterior.

4/ Half-way between Spleen 5 and Stomach 41

If you wonder where Spleen 5 is, it is in much the same place but a little distal to Liver 4 and, I think, often needled instead of Liver 4 by mistake if using location 2, above.

However, Spleen 5, in my opinion is better described as being half-way between the medial malleolus and the navicular bone, whereas Liver 4 is needled just behind the tendon tibialis anterior which is the tendon that stands out when dorsi-flexing the big toe.

By needling Liver 4 towards Stomach 41 you (ie from position 2. above), but close to the tendon, you actually needle the same place (ie under the tendon) as you would have if you had needled Liver 4 vertically to the skin from position 1.

Having said all that, the point is found when you get the results you intended. Of course, it helps to get deqi too, for confirmation! Against that, when using it the way Kiiko Matsumoto suggests, you don’t need deqi because you know you got the point when you get positive feedback from palpating the abdomen.

Needling

Vertically to the skin, although can be needled obliquely either towards the big toe or underneath the tendon from position 2 above towards Stomach 41. Depth, up to 0.5 cun.

Needle sensation

Local, distending, or towards the toes.

Moxa on Zhongfeng

Up to 3 moxa. (The Japanese say up to 7, but they use much smaller moxa cones.)

Liver 4 Zhongfeng, Middle Seal Video

Actions of Zhongfeng

  • Spreads Liver Qi and pacifies the Liver
  • Clear the channels
  • Clears Heat and Damp-Heat from the channel
  • Regulates the lower abdomen (lower jiao)

 

To understand how this point works, you need to know the areas or functions that the Liver controls.

For instance,

  • the Liver channel encircles the genitals, so this point (and also other points on the Liver channel such as Liver 3 and 5) has a strong action on the genitals, whether from excess or deficiency and urinary organs, especially when caused by excess eg Damp-Heat (for instance in sexually transmitted diseases)
  • the Liver has a major controlling effect on the Lower abdomen (lower jaio) so any kind of problems there, including pain, distension or discomfort, dysuria, urinary retention, also constipation, may benefit from Zhongfeng
  • also, the Liver and Gallbladder have a major effect on the tendons so many spasms, cramps and contractions, but also deficiency in the form of bones that often dislocate, benefit from it
  • This being a Jing-River point, it is particularly good for assisting the natural flow of Qi along the channel including deep within the body, so on this principle is useful for assisting Lung  to clear wheezing, cough and asthma when caused by Liver Qi stagnation, for instance, when one might expect emotional factors to have produced sighing, or deep breaths from frustration, on the way to getting the wheeze. 
  • When Qi flows the wrong way (see Chong mo for more about this), the extremities get cold, even numb. This point, being a Jing-River point, helps Qi flow properly again.

Comment on Liver 4

Of course, the point is also useful for ankle pain. If you know where the pain is, your acupuncturist, having got deqi, may try to direct the needle and deqi sensation towards it.

If the pain is elsewhere in the foot, try directing the needle towards the pain, even if not apparently on the Liver channel. This is because the Liver is responsible for the free flow of Qi, and pain is caused by a blockage in that free flow. So, many Liver points can be used in addition to other local points elsewhere on the body to regulate Qi.

Click here to find out about the Liver’s functions in Chinese medicine

Click to find out about the liver organ in WESTERN medicine

 

For points along the Liver channel, click below:

 

Liver-1DadunGreat Clarity
Liver-2XingjianWalk Between
Liver-3TaichongGreat Pouring
Liver-4ZhongfengMiddle Seal
Liver-5LigouWoodworm Groove
Liver-6ZhongduCentral Capital
Liver-7XiguanKnee Joint
Liver-8QuquanSpring at the Bend
Liver-9YinBaoYin Wrapping
Liver-10ZuwuliLeg Five Miles
Liver-11YinlianYin Angle
Liver-12JimaiUrgent Pulse
Liver-13ZhangmenSystem Gate
Liver-14QimenCycle Gate
Jonathan Brand colours

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