Most acupuncturists are aware of the famous point combination called the si guan or Four Bars. The Four Bars are he gu (LI 4) and tai chong (Liv 3) needled bilaterally.
The Four Bars are first spoken of in the Ling Shu (Spiritual Pivot) in the chapter titled "The Nine Needles & Twelve Sources," where it says:
The 12 sources [or origins] exit from the Four Bars. The Four Bars rule the treatment of the five viscera.
Seventeen hundred years later, Yang Ji-zhou, in his Zhen Jiu Da Cheng (Great Compendium of Acupuncture & Moxibustion), recorded the "Ode Communicating the Profound," which says:
The Four Bars - The six bowels have 12 sources which exit from the Four Bars. These are tai chong [supreme surge] and he gu [union valley]. Therefore, on the day tai ji [supreme ultimate] moves his/its palace, he/it commands the evils of the eight winds, making humans hot or cold or in pain. If [one] is able to open the Four Bars on the two hands and the two feet, by piercing them, there is an end [to those evils].
In the English-speaking West, the Four Bars are commonly referred to as the "Four Gates," and a gate may either open or close. However, in Chinese, the word guan more commonly refers to something that closes or shuts out rather than something that opens or lets in. According to the authors of The Pinyin Chinese-English Dictionary, guan means to shut or close; to turn off; to lock or shut up; to close down; or a barrier, such as a customhouse in a pass.1 When the Chinese wish to say, "Close the door," they typically say, guan men, "Shut or bar the door," whereas, when they want to say, "Open the door," they typically say, kai men.
As the author of the "Ode Communicating the Profound" states, when one needles these points, one opens what has formerly been closed or shut. In particular, one is causing the source qi to flow more freely into and through the channels and vessels. This influx of source qi into and through the channels and vessels can either help overcome evil qi within those channels or help re-establish balance in the viscera and bowels connected to those channels. In particular, Tong Jing, in an article titled, "Raising the Borders of the Clinical Use of the Four Bars Points," says that when these two points are used together, they course wind and harmonize the network vessels; regulate and harmonize the spleen and stomach; emolliate the liver and extinguish wind; course the liver and resolve depression; and move the qi and quicken the blood.2
The following four case histories exemplify Tong's understanding and use of these extremely important acupoints.
Case One: Stomach Pain
The patient was a 38-year-old female who was first examined by Dr. Tong on June 9, 1996. The patient said she had had almost constant stomach duct distention and pain for more than 10 years. This was accompanied by burping, acid eructations and torpid intake. The patient's tongue fur was thin, and her pulse was fine (or thready) and bowstring (or string-like). A Western medical diagnosis of gastritis was established by X-ray examination, while Dr. Tong categorized this woman's Chinese medical patterns as liver qi's loss of coursing and discharge with horizontal counterflow assailing the stomach. Thus, the stomach had lost its fortification and movement.
To treat this condition, Dr. Tong posited that it would be necessary to supplement and drain at the same time. Therefore, he supplemented he gu and zu san li (St 36) and drained tai chong and nei guan (Per 6). He also artemesia moxaed zhong wan (CV 12). After treating the patient with this protocol for one month, all her symptoms were eliminated, and her eating and drinking had returned to normal. On follow-up after one year, there had been no recurrence, and X-ray examination revealed no abnormalities.
According to Dr. Tong, because the disease had endured for a long time, vacuity had become mixed with repletion. The repletion was qi depression. This led to wood checking spleen earth. Thus, the spleen had become vacuous and weak, and earth had lost its fortification and movement. In this case, draining the liver channel's source point, tai chong, was meant to treat the liver qi's counterflow. Nei guan is one of the eight vessel meeting points. Draining it loosens the chest; rectifies the qi; and stops pain. He gu is the large intestine channel source point. Supplementing it and zu san li supplements the spleen vacuity and treats the torpid intake. Thus, these two points were meant to supplement the root visceral vacuity. In addition, using moxa on zhong wan harmonized the center, fortified and moved earth, thus moistening and nourishing the stomach's network vessels. This was a method for banking the root.
Case Two: Facial Paralysis
The patient, a 25-year-old male, was also first examined by Dr. Tong on June 9, 1996. The day before coming to see Dr. Tong, the patient was unable to move the right side of his face, and spittle ran from the corner of his mouth. The man had difficulty closing his right eye, and the right pupil was dilated. Tears ran from his right eye and mucus ran from his right nostril. His tongue fur was thin and white, and his pulse was fine. Based on these signs and symptoms, Dr. Tong categorized this man's Chinese medical pattern as wind cold lodged in the network vessels, causing qi and blood obstruction and stagnation, and loss of nourishment to the channels and network vessels. Therefore, Dr. Tong's treatment principles were to dispel wind; course the network vessels; and move the qi and blood.
To do this, Dr. Tong chose he gu; di cang (St 4); jia che (St 6); si bai (St 1); tai yang (M-HN-9); and yi feng (TB 17) on the right side, and tai chong bilaterally. Treatment was once per day, with needles retained for 30 minutes per session. The even supplementing/even draining hand technique was used. After five treatments, the patient's symptoms improved. After 10 treatments, he was cured.
According to Dr. Tong, this was a case of wind evils attacking and lodging in the region of the face, causing the channels and vessels to lose their nourishment and the qi and blood to become obstructed and stagnant. Hence the muscles on the affected side of the face had become paralyzed and unable to function. Needling he gu and the other yang ming points on the right side regulated and rectified the qi and blood in the right side of the face, while needling tai chong bilaterally coursed and disinhibited the jue yin channel qi. This strengthened and increased the dispelling of wind, and had the functions of moving the qi and quickening the blood.
Case Three: Headache
The patient was a 35-year old female who was first examined by Dr. Tong on Oct. 16, 1997. The woman had a left-sided headache which had come and gone over five years. Each time she had a headache, it would last for three days, during which time there was crampy pain in the left side of her head, accompanied by dizziness; tinnitus; and poor sleep at night. The tip and sides of this patient's tongue were red, and her pulse was bowstring and fine. Therefore, Dr. Tong assumed that the patient's yin aspect was insufficient, and that this insufficiency had allowed vacuous yang to harass above. Hence, her clear orifices had lost their calm.
Dr. Tong's treatment principles were to subdue yang and extinguish wind, for which he chose tai chong; he gu; tai yang; and feng chi (GB 20). Dr. Tong used moving and draining techniques at each of these points and retained the needles for 30 minutes per session. After one treatment, the woman's pain was markedly decreased. After three times, the pain had stopped. Then Dr. Tong needled he gu, tai chong and tai xi (Ki 3) to secure the treatment effects.
According to Dr. Tong, this was a case of yin vacuity failing to moisten and enrich liver wood. Vacuous yang had transformed wind, which had followed the shao yang gallbladder channel to harass the head above. This caused the one-sided, crampy temporal headache. Dr. Tong chose tai chong, the liver channel's source point, to level the liver and extinguish wind. He gu has a relatively strong effect for settling pain; hence it was chosen to dispel wind and stop pain. Gallbladder channel feng chi was chosen to harmonize and resolve the shao yang, course wind and stop pain. Tai yang was a local point in the area of pain. It is an extraordinary point that harmonizes the network vessels and dispels wind locally. After these points achieved their remedial effect, Dr. Tong secured the treatment effects by needling the Four Bars plus tai xi to enrich water so that it would sprinkle or wet wood. Thus remedially, Dr. Tong treated root and tip (or branch) simultaneously, followed preventively by treating the root.
Case Four: Hiccups
The patient was a 62-year-old male first examined by Dr. Tong on September 9, 1998. The patient had a history of stomach disease. Due to a family argument, the man had become especially depressed. Liver wood had counterflowed and attacked the stomach. The stomach had thus lost its harmony and downbearing, resulting in repeated attacks of hiccups. In addition, there was chest- and rib-side distention and fullness; loss of appetite; thin tongue fur; and a fine pulse. To treat this condition, Dr. Tong needled he gu and tai chong with draining technique. Within moments, the hiccups stopped. Dr. Tong retained the needles to secure the treatment effect. One treatment was all that was needed, and there was no recurrence.
According to Dr. Tong, this disease arose due to liver qi depression and binding. Draining the foot jue yin liver channel source point tai chong soothed the liver and resolved depression, thus controlling the horizontal counterflow of liver wood from assailing and checking stomach earth. Further, draining the large intestine channel source point he gu harmonized the stomach and downbore its counterflow. Thus, the combination of these points needled together regulated and harmonized the liver and stomach; rectified the qi; freed the flow; and caused downbore.
Wu Jing-rong. The Pinyin Chinese-English Dictionary. Hong Kong: The Commerical Press, 2000, p. 248.
Tong Jing. Raising the borders of the clinical use of the four bar points. Jiang Su Zhong Yi (Jiangsu Chinese Medicine) 1999, no. 12, p. 40.
Click here for previous articles by Bob Flaws, LAc, FNAAOM (USA), FRCHM (UK).