LI-04 (He Gu) Union Valley

What does LI-04 He Gu do?

He Gu LI-04 is the Source (Yuan) point of the Large Intestine channel of Hand Yang Ming, and the tradition's principal point for the face, the mouth and the exterior of the body. Sacred Lotus sources & references additionally classify it as a Gao Wu Command Point — the member of that group of four that governs the face and mouth — and as one of Ma Dan-yang's Heavenly Star points. Those three classifications together explain why it is probably the most-needled point in the world.

• Regulates the defensive (wei) qi and adjusts sweating — the classical formulation is that it can both promote sweating when the exterior is blocked and restrain it when the defensive qi fails to hold the pores closed. This dual capacity is unusual and is the reason the point appears in both exterior-excess and exterior-deficiency treatments.
• Expels wind and releases the exterior — used for the earliest stage of wind-cold and wind-heat invasion, with fever, aversion to cold, headache and body ache.
• Regulates the face, eyes, nose, mouth and ears — its Command Point action. The Yang Ming channel travels through the face, so the tradition treats the whole facial region from the hand.
• Activates the channel and alleviates pain — the general analgesic action for which the point is best known, applied along the channel and, in the classical scheme, to the head and face at a distance.
• Induces labour — recorded plainly in the standard sources, and the direct reason for the pregnancy contraindication set out below.
• Restores the yang — recorded for collapse patterns, generally with moxibustion and with points such as REN-04 and REN-06.

Safety reference, stated up front rather than buried: because "induces labour" is one of its documented actions, needling He Gu LI-04 is contraindicated during pregnancy in the standard reference literature. Its combination with San Yin Jiao SP-06 is the classical labour-inducing pair.

Source: Sacred Lotus sources & references (channel, Source-point and Command-point classifications, and the recorded actions above); Deadman & Al-Khafaji, A Manual of Acupuncture, p. 103; Chinese Acupuncture & Moxibustion, p. 140; cross-referenced against multiple online sources.

What is LI-04 He Gu used for?

He Gu LI-04 is used above all for pain and disorders of the face, head and mouth, and for the onset of a common cold. The indications recorded in our sources cluster into four groups: the face and sense organs, the exterior and febrile presentations, painful and obstructive conditions of the arm, and a small number of abdominal and obstetric entries. These describe traditional use, not proven treatment.

• Headache
• Pain and stiffness of the neck
• Toothache
• Swelling of the face
• Facial paralysis and deviation of the mouth
• Trismus (clenched jaw)
• Parotitis
• Redness, swelling and pain of the eye
• Nasal obstruction and rhinorrhoea
• Epistaxis (nosebleed)
• Sore throat
• Deafness
• Febrile disease without sweating
• Excessive sweating
• Abdominal pain
• Dysentery
• Constipation
• Amenorrhoea
• Delayed labour
• Infantile convulsion
• Pain, weakness and motor impairment of the upper limb

Source: Sacred Lotus sources & references (existing indication record); Chinese Acupuncture & Moxibustion, p. 140; Deadman & Al-Khafaji, A Manual of Acupuncture, p. 103.

How is LI-04 He Gu used in practice?

He Gu lies on the back of the hand in the fleshy web between the thumb and the index finger, against the radial side of the second hand bone at about its midpoint — the bulge that rises when the thumb is pressed firmly against the base of the index finger. It is one of the easiest points on the body to find and one of the most strongly sensitive, which is part of why it dominates clinical practice.

• With LIV-03 Tai Chong — the pairing known as the Four Gates: the Source points of a hand yang channel and a foot yin channel, needled bilaterally. It is the standard combination for moving qi and blood through the whole body, for pain, and for tension and constraint.
• With LI-11 Qu Chi — the Source point below and the He-Sea point above on the same channel, the standard Yang Ming pairing for clearing heat and releasing the exterior.
• With LU-07 Lie Que — the interior–exterior pairing of the Metal channels, and the classical opening of a wind-cold invasion; both are Gao Wu Command Points, LU-07 for the head and nape and LI-04 for the face and mouth.
• With ST-44 Nei Ting, ST-06 Jia Che and ST-07 Xia Guan — the standard treatment of toothache, joining the distal Yang Ming points of the arm and leg to local points at the jaw.
• With LI-20 Ying Xiang — for nasal obstruction and loss of smell, the distal Command Point with the local point beside the nostril.
• With ST-36 Zu San Li, BL-40 Wei Zhong and LU-07 Lie Que — its category peers. The Gao Wu Command Points divide the body between them: LI-04 takes the face and mouth, LU-07 the head and nape, ST-36 the abdomen, BL-40 the lower back.
• With SP-06 San Yin Jiao — the classical labour-inducing combination, and for that reason a pairing the reference literature treats as contraindicated at any other stage of pregnancy. It is recorded for delayed labour and retained placenta only.

As a Source point, LI-04 is the point at which the Yuan qi of the Large Intestine is said to surface and be accessible, which is the technical basis for using it in both excess and deficiency of its channel — the same logic that governs LU-09, SP-03 and LIV-03 on their own channels.

Source: Sacred Lotus sources & references (location and point categories); Deadman & Al-Khafaji, A Manual of Acupuncture, p. 103; Chinese Acupuncture & Moxibustion, p. 140; cross-referenced against multiple online sources.

Where is LI-04 located?

• A Manual of Acupuncture (p. 103): On the dorsum of the hand, between the first and second metacarpal bones, at the midpoint of the second metacarpal bone and close to its radial border. <br /><br /> Ask the patient to squeeze the thumb against the base of the index finger, and locate Hegu L.I.-4 at the highest point of the bulge of the muscle and approximately level with the end of the crease.
• Chinese Acupuncture and Moxibustion (p. 140): On the dorsum of the hand, between the first and second metacarpal bones, approximately in the middle of the second metacarpal bone on the radial side. <br /><br /> Or, place in coincident position the transverse crease of the interphalangeal joint of the thumb with the margin of the web between the thumb and the index finger of the other hand. The point is where the tip of the thumb touches.

How is LI-04 He Gu needled, and when is it contraindicated?

Reference fact, stated plainly and first: the standard acupuncture literature records that needling He Gu LI-04 is CONTRAINDICATED IN PREGNANCY. The reason is not precautionary vagueness — "induces labour" is one of the point's own documented traditional actions, and LI-04 together with San Yin Jiao SP-06 is the classical labour-inducing combination. The two points are the pair the tradition names when a pregnancy is to be brought on, which is exactly why they are the pair it forbids while a pregnancy is to be maintained. Everything below records what the textbooks document; it is not instruction, and this page does not teach technique.

The angle and depth the texts record

• Chinese Acupuncture & Moxibustion records perpendicular insertion of 0.5–0.8 cun, with moxibustion noted as applicable, and states the pregnancy contraindication explicitly.
• Deadman & Al-Khafaji record a comparable perpendicular range and additionally describe oblique insertion directed toward the base of the index finger or proximally along the channel for facial and channel disorders.
• Sensation: the references note that LI-04 characteristically produces a strong propagated sensation, and that it is among the most sensitive points routinely used — a reason it is frequently selected in trials that need a reliable deqi response.

Anatomy documented at the point

LI-04 lies in the first dorsal interosseous muscle. An anatomical dissection study of forty hands reported that LI-04 sits closer than LI-02, LI-03 or LI-05 to the point at which a vascular branch of the superficial branch of the radial nerve reaches the radial artery — a mean of about 4 mm, against 33–64 mm for the neighbouring points (PMID 31341499). The finding has been publicly commented on and contested in the same journal (PMID 34970328), so it is reported here as an anatomical observation under discussion rather than a settled result. In practical terms the region contains superficial veins, the superficial radial nerve and branches of the radial artery, so bleeding and a strong radiating sensation are the ordinarily documented occurrences.

General safety context

LI-04 carries no cavity or organ hazard and is one of the safer points on the body in that respect; its safety literature is dominated by the pregnancy contraindication rather than by trauma. In proportion, a meta-analysis of prospective clinical studies estimated serious acupuncture-related adverse events at roughly 1 per 10,000 patients, with most recorded events being bleeding, pain or flare at the needle site (PMID 34489268). Acupuncture is performed by qualified practitioners; this record documents the literature.

Source: Chinese Acupuncture & Moxibustion, p. 140 (including the recorded pregnancy contraindication); Deadman & Al-Khafaji, A Manual of Acupuncture, p. 103; Sacred Lotus sources & references (existing needling record, which also carries the pregnancy contraindication); PubMed PMID 31341499, 34970328, 34489268, each checked as active and not retracted.

What does the name He Gu mean?

He Gu means "Union Valley" — he for joining or coming together, gu for a valley. The name is purely descriptive of the terrain of the hand: the thumb and index finger converge like two ridges, and the web between them forms the valley in which the point lies. The same region is called the "tiger's mouth" in Chinese anatomical usage. Both landmarks in our recorded location — the midpoint of the second hand bone on its thumb side, and the crest of muscle that rises when the thumb is squeezed against the index finger — describe the same spot from two directions.

Why does the Source (Yuan) point classification matter at LI-04?

Source points are where the Yuan (original) qi of an organ is said to gather and become reachable at the surface. Classically they are used both to drain an excess and to supplement a deficiency of their own channel and organ, and they were among the earliest points used diagnostically by palpation. LI-04's Source status is why the tradition treats it as the general regulator of the whole Large Intestine channel rather than as a point with one narrow job — and, joined to its Command Point status for the face and mouth, why a point on the hand ends up governing the teeth, nose, eyes and jaw.

What are the Four Command Points?

The Gao Wu Command Points are a set of four distal points, each assigned a region of the body, and all four are held in this library: LI-04 He Gu for the face and mouth, LU-07 Lie Que for the head and nape, ST-36 Zu San Li for the abdomen, and BL-40 Wei Zhong for the lower back. The scheme is a mnemonic for distal treatment: a problem in one of those regions is approached from a point far away on a limb. LI-04 is additionally one of Ma Dan-yang's eleven Heavenly Star points, a separate classical selection of the points held to be most broadly useful.

Is there research on LI-04 He Gu?

LI-04 is one of the most-studied points in acupuncture, but the research base is large and uneven, and most of it studies protocols in which LI-04 is one point among many. The honest picture is that point-specific human evidence for LI-04 is thinner than its fame suggests.

• Labour and cervical ripening — the point's own traditional claim. A randomised controlled trial in Vienna needled LI-04 and SP-06 bilaterally every second day from the estimated date of delivery in 45 women; the acupuncture group had a shorter cervix on days 6 and 8 and delivered on average 5.0 days after the estimated date against 7.9 days in controls, though the induction rate did not differ significantly (PMID 11802511). The trial is small. Pooled across the field, the Cochrane review of acupuncture or acupressure for induction of labour included 22 trials and 3456 women and found no clear benefit in reducing caesarean section, with some benefit in cervical maturation and evidence quality ranging from low to high (PMID 29036756). So the tradition's specific claim about this point has been tested, and the result is suggestive at best rather than established.
• Labour pain. A systematic review and meta-analysis of acupressure at SP-06 and LI-04 reported less pain immediately after intervention at LI-04 (standardised mean difference −0.94, 95% CI −1.36 to −0.53) and a shorter active phase and second stage, but drew on small trials of limited quality and compared against a touch control (PMID 29344038). The broader Cochrane review of acupuncture or acupressure for labour pain — 28 trials, 3960 women — concluded that no included study was at low risk of bias across all domains, and that certainty was low to very low for most comparisons (PMID 32032444).
• Dental pain. A triple-blind randomised trial in 40 patients with symptomatic irreversible pulpitis needled LI-04 for 15 minutes before an inferior alveolar nerve block and reported success rates of 60% against 20% with a sham procedure (PMID 26092771). This is a genuinely point-specific trial in the point's classical territory of the mouth, but it is very small and, at 40 patients, cannot settle the question.
• Uterine mechanism, animal. An experiment in late-pregnancy rats studied electroacupuncture at LI-04 and SP-06 explicitly as "a traditional acupuncture formula that induces labor" and reported increased amplitude, frequency and duration of uterine contraction waves, best with a 2/50 Hz dense–disperse wave (PMID 21227039). Animal mechanism work rather than clinical evidence — but it is direct evidence that the classical pairing does something measurable to the uterus, which is the material point behind the pregnancy contraindication.
• Toothache, protocol level. A randomised comparison of 85 patients with toothache used LI-04, LI-02, ST-44, ST-06 and ST-07 in its comparator arm and reported that a five-shu-based selection outperformed it (PMID 23227682). LI-04 appears in the protocol but is not the variable tested.

Much of the remaining LI-04 literature is brain-imaging work in which the point is used as a convenient strong stimulus — for instance functional imaging of LI-04 with LIV-03 in Alzheimer's disease (PMID 33747074, PMID 24906968). These studies establish that needling this point changes measurable brain activity; they do not establish clinical benefit, and the site does not present them as though they did.

How does He Gu differ from the points near it?

LI-04 sits between two five-shu points of the same channel that are held here and easily confused with it. LI-03 San Jian, the Shu-Stream and Wood point, lies just distal on the same side of the same bone and is weighted toward the channel and the fingers rather than the face. LI-02 Er Jian, the Ying-Spring and Water point, is the smaller heat-clearing point of the pair and is chosen for toothache and sore throat where heat dominates. On the leg, LIV-03 Tai Chong is LI-04's mirror image — also a Source point, also a Heavenly Star point — and the two are combined as the Four Gates far more often than either is used alone. The extra point group Ba Xie, held here, occupies the webs between all the fingers including the one LI-04 sits above, but is a local point for the hand rather than a distal point for the face.

Source: Sacred Lotus sources & references (name, categories and cross-referenced point records); Deadman & Al-Khafaji, A Manual of Acupuncture, p. 103; Chinese Acupuncture & Moxibustion, p. 140; PubMed PMID 11802511, 29036756, 29344038, 32032444, 26092771, 21227039, 23227682, 33747074, 24906968, each checked as active and not retracted; cross-referenced against multiple online sources.