P-04 (Xi Men) Cleft Gate

What does P-04 Xi Men do?

P-04 is the Xi-Cleft point of the Pericardium channel, and its name says so outright — Cleft Gate. Xi-Cleft points are where a channel’s qi gathers deeply, and they are the classical choice for acute and severe conditions. On yin channels they carry a second, specific role: they are the points for bleeding. P-04’s recorded actions show both halves of that rule at work.

• Invigorates blood and dispels stasis — the blood-level action
• Cools blood and stops bleeding — the yin-channel Xi-Cleft function proper
• Calms the spirit — the Pericardium’s relationship to the Heart
• Moderates acute conditions — the Xi-Cleft function proper

The yin-channel bleeding rule, stated precisely. This library holds sixteen Xi-Cleft points. On the yin channels — LU-06 Kong Zui, HT-06 Yin Xi, P-04, SP-08 Di Ji, KI-05 Shui Quan, LIV-06 Zhong Du — the classical texts add the bleeding indication. On the yang channels — LI-07, ST-34, SI-06, BL-63, SJ-07, GB-36 — they do not. Our own record for SP-08 Di Ji shows the rule applying (a gynaecological bleeding point), and our record for ST-34 Liang Qiu notes explicitly that it does not apply there. P-04 is a yin-channel case, so it does.

Not to be confused with the Xi-Cleft of an extraordinary vessel. P-04 is the Xi-Cleft of the channel. Several points in this library are Xi-Cleft points of vessels instead — KI-09 Zhu Bin for the Yin Wei Mai, KI-08 Jiao Xin for the Yin Qiao, BL-59 Fu Yang for the Yang Qiao, GB-35 Yang Jiao for the Yang Wei. The distinction changes what the point reaches.

Source: Sacred Lotus sources & references (channel, category and action records; all sixteen Xi-Cleft points queried from our own data), cross-referenced against multiple online sources.

What is P-04 Xi Men used for?

P-04 is used for acute chest and heart symptoms, for bleeding, and for mental-emotional disturbance. Our own indication record is reproduced here in full.

• Cardiac pain
• Palpitations
• Chest pain
• Nosebleed (epistaxis)
• Vomiting blood (haematemesis)
• Coughing blood (haemoptysis)
• Furuncle (boils)
• Epilepsy

Read that list against the classification and it is coherent rather than miscellaneous. Three of the eight are bleeding indications — exactly what the yin-channel Xi-Cleft rule predicts. Three are acute chest and heart symptoms — what a Xi-Cleft point is for. Epilepsy and boils belong to the spirit-calming and blood-cooling actions respectively.

An important framing note. Cardiac pain, coughing blood and vomiting blood are medical emergencies. This record describes classical use; it is not a suggestion that any of them be managed with acupuncture, and a reader encountering them should seek emergency medical care. The same framing applies here as on the collapse and resuscitation points in this library.

How it is combined. With P-06 Nei Guan, the Luo-Connecting point and Confluent point of the Yin Wei Mai, which is the channel’s most-used point and the one with genuinely strong modern evidence for nausea and vomiting — that evidence belongs to P-06 and is not transferable here. With P-07 Da Ling, the Yuan-Source and sedation point. With HT-06 Yin Xi, the Heart channel’s own Xi-Cleft point, for the same acute and bleeding logic on a neighbouring channel. All are held here.

Source: Sacred Lotus sources & references (indication record; P-06, P-07 and HT-06 classifications queried from our own data), cross-referenced against multiple online sources.

Where is P-04 Xi Men located?

P-04 lies on the front of the forearm, five cun above the wrist crease, between the two tendons that stand out when the wrist is flexed against resistance. It is on the line from P-07 Da Ling at the wrist to P-03 Qu Ze at the elbow.

• 5 cun proximal to P-07 Da Ling, on the P-07 to P-03 line
• Between the tendons of palmaris longus and flexor carpi radialis — the same landmark pair used for P-06 Nei Guan
• P-06 Nei Guan sits at 2 cun above the wrist on the same line, so P-04 is three cun further up

The tendon landmark is shared, so counting matters. P-04, P-05 Jian Shi and P-06 Nei Guan all lie between the same two tendons at 5, 3 and 2 cun respectively. They are distinguished by measurement alone, and confusing them substitutes a Xi-Cleft point for a Luo-Connecting point — different classifications with different uses. Note also that in a minority of people the palmaris longus tendon is absent, which removes one half of the landmark.

Source: Sacred Lotus sources & references (location record, retained unchanged; P-05 and P-06 positions queried from our own data).

• A Manual of Acupuncture (p. 373): On the flexor aspect of the forearm, 5 cun proximal to Daling P-7, on the line connecting Daling P-7 and Quze P-3, between the tendons of palmaris longus and flexor carpi radialis.
• Chinese Acupuncture and Moxibustion (p. 200): 5 cun above the transverse crease of the wrist, on the line connecting Quze (PER-3) and Daling (PER-7), between the tendons of m. palmaris longus and m. flexor carpi radialis.

How is P-04 Xi Men needled?

The standard texts record perpendicular insertion to roughly 0.5–1.0 inch, with moxibustion applicable. What follows is a neutral record of what the reference literature documents, not instruction for a reader.

• Angle and depth as recorded: perpendicular, 0.5–1.0 inch.
• Moxibustion: recorded as applicable.
• Regional anatomy: the median nerve runs deep between the tendons of palmaris longus and flexor carpi radialis — the same two tendons that form this point’s landmark — with the median artery’s remnant accompanying it in some people. The anterior interosseous neurovascular bundle lies deeper still, on the interosseous membrane.

Hazard, stated proportionately. The forearm has no body cavity beneath it and this is not a high-hazard point. The relevant anatomy is the median nerve, and the relevant fact is that it lies in the same tendon interval used to find the point. Our record for P-06 Nei Guan, on the same line three cun distal, cites a cadaveric study placing the needle path within 2 cm of the median nerve and an ultrasound report of painless nerve perforation — those measurements were made at P-06, not at P-04, and are not presented here as describing this point. No study measuring a safe depth at P-04 could be located, and no case report naming P-04 as the site of an injury was located.

Source: Sacred Lotus sources & references (needling record, retained unchanged), cross-referenced against multiple online sources; regional anatomy from standard anatomical description.

What does the name Xi Men mean, and is there research on P-04?

“Xi Men” means Cleft Gate, and it is one of the few point names that states its own classification. Xi is the same character used for the Xi-Cleft category itself — a cleft or fissure where qi gathers deeply — and men is a gate. A reader who knows the name knows the category, which is unusual: most point names are positional or poetic.

Research: no trial isolates P-04. Where the point appears it is in multi-point protocols, most often cardiac or anxiety-related. As with every such case in this library, a study that includes a point in a protocol is not evidence about that point.

Be especially careful with this channel. P-06 Nei Guan is the one acupuncture point with a genuinely strong Western evidence base — Cochrane-level reviews for post-operative nausea and vomiting — and it sits three cun from P-04 on the same line, sharing the same tendon landmark. Evidence about P-06 is evidence about P-06. The temptation to let a neighbour’s research drift onto an adjacent point is precisely the error this library keeps intercepting, and the short distance between these two makes it easier here than almost anywhere.

Our library codes this channel P-04, P-06, P-07 and so on, not PC-. Searches using the PC- prefix will return different results, and neither prefix is more correct — but a reader comparing our records against a paper should know which convention each uses.

Source: Sacred Lotus sources & references (name, classification and channel-coding records; P-06's classification and evidence status queried from our own data).