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Needling Of The Large Intestine Meridian
Steven K.H. Aung, MD
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Figure 1. Dr Steven K.H. Aung shown needling his wife, Debbie Aung, on LI 4a and LI 4b. Photography by Tom Turner.
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As every competent practitioner of Traditional Chinese Medicine knows, classical acupoints are like the "gates" of Qi (vital energy) flow located on the 12 Regular Organ Meridian Energetic Pathways and also, the Extraordinary Meridians). The LI encompasses 20 acupoints, and the general Qi flow is from near the tips of the index fingers, to the elbows (superficial level) and into the shoulders and neck (intermediate level and then ascending to the sides of the nostrils, with major collaterals descending into the lungs (LU) and the LI organ (deep level) where the LI interconnects with the Stomach (ST) meridian. While not the most glamorous star of our 12 Zang Fu system, we should all be thankful when the humble LI constantly fulfills its vital role in continuing and helping to complete the function of the Small Intestine (SI) in transforming the clear from the turgid, and completing the essential physiological process of eliminating toxic waste from our body.
Like the SI, the LI transfers nutrients to the blood/lymph system, squeezing and wringing out the remnants of nutrient energy and generating the waste material that must be excreted on a regular daily basis for one's optimal health. The LI is considered a Fu ("hollow" - Yang) organ; its Zang ("solid" - Yin) partner is the Lung (LU).
The first 7 LI acupoints have specific energetic functions, which manifest in all the Regular meridians, namely, Jing Well (LI 1, where Qi rises to the surface), Ying Spring (LI 2, where Qi gushes at the surface), Shu Stream (LI 3, where Qi flows abundantly and swiftly at the surface among many streams), Yuan Primary (LI 4, where innate Qi accumulates), Jing River (LI 5, where Qi flows widely, deeply, and powerfully like a river to the sea, accumulating at the He Sea point L1 11), Luo Connecting (LI 6, where the Qi and Blood of the LI and LU meridians converge), and Xi Cleft (LI 7, where the Qi and Blood converge and accumulate).
General indications and syndromes (Chinese traditional patterns/synergies of Qi imbalance) of the LI system largely pertain to various bowel dysfunctions; notably, diarrhea, constipation, and abdominal distention as well as sinus congestion and general pain. It is necessary for physicians and other practitioners to properly evaluate these conditions (in view of the fact that the LI and LU are interconnected [LU Qi must descend harmoniously to facilitate LI functioning]) to arrive at a viable treatment plan customized and compassionately fine-tuned for each and every patient.
With respect to LI 4 (Hegu), it is considered one of the most effective acupoints for general pain control, especially in the upper half of the body. It is indicated for Chinese traditional medical syndromes associated with Wind invasion and the resulting conditions such as headache, sinusitis, myofacial pain, toothache, and TMJ dysfunction. It is also one of the key acupoints utilized in acupuncture anesthesia during surgery as well as postoperative pain, distension, and discomfort. This was so in the famous case of New York Times reporter James Reston who, while in Beijing in the early 1970s covering a news story relating to diplomatic ties between the People's Republic of China and the United States of America, suffered an attack of appendicitis.
I believe it is important for medical acupuncturists to note the difference between the classic LI 4 (Hegu), depicted in this photo as LI 4a, and the additional point depicted as LI 4b; LI 4b is distal to LI 4a about 1.0 cun, (the basic qualitative "body inch" assessment of the width of the interphalangeal joint of a patient's thumb).
It is not my intention to attempt in this brief "photo essay" to revise the Chinese traditional medical meridian system by engaging in the mere gratuitous proliferation of acupoints, of which there are already more than enough. However, over a quarter of a century of direct "hands on" clinical acupuncture experience has taught me that stimulating LI 4b is effective for pain control and healing with respect to the various soft tissue conditions of the skin of the face and head, including eczema, acne, hematoma, bruises, and lacerations, in addition to nasal congestion, both allergic and vasomotor rhinitis, along with post-surgical conditions/trauma and other such conditions above the upper chest.
The pivotal case example vis-à-vis my own clinical experience pertains to a 25-year-old man who was referred to me by his family physician. He was suffering from severe intermittent headaches apparently due to sinusitis, along with severe acne and other skin lesions. I treated him successfully over a period of several weeks largely using LI 4a (Hegu), which seemed to not totally relieve his symptoms. When I began to insert a needle more obliquely and deeply in the direction of LI 5, a better overall response was obtained.
Over the years of intensive clinical practice, I began to hypothesize the locale between LI 4 and LI 5 to be an unknown gate, which I thought of as LI 4b and which, for want of a better name, may be termed Hegu 2 (Adjoining Valley). It is located on the back of the hand in the depression between the 1st and 2nd metacarpal bones at the tip of the angle of the metacarpal bone. I have found it to be useful in combination with ST 43 and BL 60 for headache and general pain control, and in combination with SI 6, GV 7, and GV 9 for skin conditions. Acupressure, electrical, and laser techniques are also applicable and appear to be effective.
Certainly, if the time and resources are available, then randomized controlled trials (RCTs) could be conducted to attempt to prove or disprove this clinical observation. I remember reading somewhere in the vast expanse of enlightening biomedical literature that a single properly conducted RCT could cost a million dollars or more. This does not negate the fact that stimulating either LI 4a or its seemingly silent yet resilient, resonant partner, LI 4b, may or may not be a kind of placebo effect which makes our patients and indeed, ourselves, at least a little happier and hopefully, more compassionate, competent, and creative in our daily lives. Photographs, however, whether moving or still, and while often extremely interesting, are like mere echoes, nuances, or resonances of our universal healing endeavor.
AUTHOR INFORMATION
Dr Steven Aung is a Geriatric and Family Practice physician, and a Traditional Chinese Medicine (TCM) practitioner and teacher. At the University of Alberta, Dr Aung is an Associate Clinical Professor in the Departments of Medicine and Family Medicine, and Adjunct Professor of Extension. He is a World Health Organization advisor on TCM. Dr Aung was awarded a Professional Excellency from the Academie Diplomatique de la Paix in 1986, the Alberta Order of Excellence in 2002, and the Queen Elizabeth II Golden Jubilee Medal in 2003. His primary interest is in the integration of TCM and Western biomedicine within the context of a more natural, compassionate approach to health care.
Steven K.H. Aung, MD, OMD, PhD, FAAFP*
9904 – 106 St NW
Edmonton, AB T5K 1C4
Canada
Phone: 780-426-2760 • Fax: 780-426-5650
E-mail: draung@aung.com
*Correspondence and reprint requests
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