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Subject:

Re: Adverse effects following AP at LI4 Hegu

From:

Matthew Miller <[log in to unmask]>

Reply-To:

Acupuncture research in the UK and beyond.

Date:

Mon, 28 Jul 2003 04:06:25 +0100

Content-Type:

text/plain

Parts/Attachments:

Parts/Attachments

text/plain (67 lines)

Hi All,

>>
>> Like they say in realestate LOCATION, LOCATION, LOCATION
>> Stan
>
> three of the instructors in school consistently
> located the point in "their" location. Each gave a
> good reason and shrugged their shoulders saying there
> is a lot of controversy regarding the location of
> LI-4. The one consistent with all the point locations
> is none were to close to the metacarpal.  According
> to one instructor, needling to close to the
> metacarpal increases the likelihood of injury...
> Chris

In the <Su Wen> Hegu LI4 is described as being "between
the thumb and forefinger, at the point where the pulse
is felt."  ("Ben Shu" chapter)

Perhaps this is a relic from the pre-acupuncture
moxibustion days.  In needling any point, one certainly
should not be aiming for a pulse, especially in light
of Anthony Campbell's post to JISCM:

> report of 2 serious hand injuries in Germany caused
> by needling LIO4; in at least one of these cases the
> result was amputation of the hand. The mechanism was
> damage to the radial artery, which was effectively an
> end artery in these cases owing to lack of
> anastomosis with the ulnar artery. AC

Like Chris, my teachers in China had different methods
of locating LI4.  The classical Chinese sources I have
read also give several variations for LI4's location.

One alternate name for the point is "Meeting of the
Bones" (rather than "Meeting Valley").  Some sources
(eg Zhen Jiu Da Cheng) describe the point as being in
the "depression where the 1st and 2nd metacarpals
separate," which would place the point much more
proximal than is typically described in modern texts.

There is also the technique of placing the crease of
the interphalangeal joint of one thumb over the margin
of the web between the index finger and thumb of the
opposite hand.  LI4 is located "where the tip of the
thumb touches." Clearly this would not be close to
either metacarpal.

Another method found in Chinese sources: "Squeeze the
thumb and index finger together.  Hegu is found at the
highest point of the muscle between the fingers."
Again, this is not near the metacarpals.

Of course, given the very common phenomenon of
individual anatomic variations in peripheral blood
vessels and nerves, it does not seem that any location
would be completely "safe."  Shallow (subcutaneous)
needling probably would be.

For those on the list who responded with tales of LI4
injuries, it might be interesting to know *which
location* of LI4 you were needling -- and to what
depth.

Matthew

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