😤 Four Gates: The History and Uses of LV-3 + LI-4
Four Gates: LV-3 (Taichong) + LI-4 (Hegu).
Whether it's for menstruation issues or just general stress, this is one of the most commonly-used point combinations for moving Liver qi.
But where did it come from and what was it originally used for?
Let's take a look at the history of Four Gates...
Sì Guān - The Four Gates
Much to my surprise, four gates (四关 sì guān) actually goes back to the classics.
It was first mentioned in the Ode to Elucidate Mysteries (标幽赋 Biāo Yōu Fù) dating back to the mid-13th century:
...for chills, fever, and painful obstruction, opening the Four Gates puts an end to them.
(Note: This is not the first time the term "four gates" shows up in the classics. For example, Chapter 1 of the Ling Shu mentions the four gates, but here it's referring to the limbs or the elbows/knees. But the Ode to Elucidate Mysteries was the first time the term was used to refer to acupuncture points.)
An Elegant Combination
The two points are mirror images:
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LI-4 (Hegu) is located on the hand, in the wide valley between the first and second metacarpals
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LV-3 (Taichong) is located on the foot, in the wide valley between the first and second metatarsals
And both of them are Yuan-Source points.
As the Neijing states, the Yangming channel is abundant in both qi and blood. Therefore, LI-4 excels at promoting the circulation of qi and blood and stopping pain.
(In fact, LI-4 is so moving that it's contraindicated during pregnancy. 🚫🤰)
The Liver governs dredging and draining, therefore LV-3 is widely used to spread Liver qi.
And this creates an elegant combination: one point is yin, and one point is yang. One point ascending and one point is descending. One point is the gate of qi and the other is the gate of blood.
Wang Ju-Yi summarizes it like this:
The four gates are the gates of qi on the yang ming channel and the gates of blood on the jue yin channel. This pair moves both qi and blood and, although both are source points on their respective channels, they are not used for tonification. Instead the benefit of using source points in this case is derived from their ability to move qi and blood throughout the body due to the association of source points with the triple burner.
What Is It Used For?
Nowadays, we tend to use four gates for things like stress or general Liver constraint.
But notice that these were absent in the original indications; the Ode to Elucidate Mysteries used the pair for heat/cold and bi syndrome (painful obstruction, arthritis).
So what can these points actually do?
Here's a summary from Applied Channel Theory by Wang Ju-Yi:
1. Scatters external wind
By moving qi and blood, this pair can direct wind out of the body. This is especially useful for external excess with some fever but little sweating. For this application, consider adding DU-14 (Dazhui).
2. Extinguishes internal wind
Besides external wind, this pair can also extinguish internal wind. Not only does the pair move qi and blood, but LV-3 also has a reliable action of subduing Liver yang and extinguishing wind.
This makes it useful for twitching, spasm, and other wind signs. If the wind is due to blood deficiency which allows the wind to blow, add in SP-6 (Sanyinjiao).
3. Tracks wind in the hundred joints
This refers to pain moving from one area of the body to another, or chronic arthritis that comes and goes.
This mirrors the original indication for this pair, which was bi syndrome. Painful obstruction that moves from joint to joint would be an example of wind-predominant bi.
4. Regulates the channels and collaterals (for 'channel confusion')
This is an interesting use for four gates by Wang Ju-Yi: these points can "reset" the qi tranformation in the channel in cases of 'channel confusion' or 'channel exhaustion'.
This can be used in situations where the patient is not responding normally to treatment, or when repeated unsuccessful treatments have left the channels confused or exhausted.
(Wang Ju-Yi likens this to a violin that is out of tune.)
Needling the four gates is like hitting the reset button.
According to Miriam Lee
In Insights of a Senior Acupuncturist, Miriam Lee lists another use for these points:
Four Gates are “used for complicated cases in which yīn and yáng symptoms are mixed, such as mental disturbance and drug addiction.”
Other Point Pairs
Obviously the pair LV-3 + LI-4 is a famous combination, but is it too famous?
When it comes to moving LV/GB qi, are there other points that might work better depending on the situation?
What about Jueyin and Shaoyang point pairs like:
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LV-5 + PC-6
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LV-2 + PC-7
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GB-34 + SJ-6
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GB-41 + SJ-5
Each of these pairs has a slightly different emphasis depending on the channel dynamic you're working with.
That's what Patrick and I cover in our upcoming continuing education course on Four Gates.
More on that soon.
What about you?
Do you use the pair four gates, or do you think it's overrated?
What situations do you use four gates for in the clinic?
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