The Four Gates

Star

四關 (Sì Guān)

Classical Prescriptions Constitutional

Classical Chinese acupuncture; the pairing is recorded in the Ming-dynasty literature and is standard in every modern textbook.

Points

  1. LI4 Hegu bilateral

    Yuan-Source of the Large Intestine; governs the upper body and the qi

  2. LV3 Taichong bilateral

    Yuan-Source of the Liver; governs the lower body and the blood

Treatment Principle

Open the gates of qi and blood, above and below, so that stagnation anywhere in the body can move.

Indications

Qi and blood stagnation of any kindirritability, frustration and emotional constraintheadache and dizzinessgeneralised paindysmenorrhoea and premenstrual tensioninsomnia from tensionmuscle spasm and crampinghypertensionfacial paralysisstress and anxiety

Method

Both points needled bilaterally, giving four needles. Even or reducing technique depending on the presentation; retain 20 to 30 minutes.

Needle order: LI4 first, then LV3 — upper before lower.

⚠ Cautions

Both points are contraindicated in pregnancy, which rules the combination out entirely for a pregnant patient. Can be strongly moving; reduce stimulation in the depleted.

About

Perhaps the single most-used two-point combination in acupuncture. LI4 is the Yuan-Source of a hand yang channel and LV3 the Yuan-Source of a foot yin channel, so the pairing spans hand and foot, yin and yang, qi and blood.

Rationale

The four needles form a frame: two above and two below, two on yang channels and two on yin. Classical commentary describes them as the four gates through which qi and blood enter and leave the body, and their being opened together as the reason the combination moves stagnation wherever it sits rather than at any one location.

Clinical Notes

The default opening of a treatment for a tense, frustrated, physically knotted patient. Effective enough on its own that it is worth resisting the urge to add to it before seeing what it does.

Sources

  • Deadman, Peter; Al-Khafaji, Mazin; Baker, Kevin. A Manual of Acupuncture. Journal of Chinese Medicine Publications.

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