合谷 : Hegu : Joining Valley

Location Guides:

Classifications:

Yuan-Source point
Gao Wu command point
Ma Dan-yang Heavenly Star point
Entry point from Lieque Lu-7
Shokanten Nine continents Pulse for Lower Jiao, Jueyin and chest
Trigger point (Travell & Simons, 1998, Trigger Point Manual; Melzack, Stillwell & Fox, 1977)
Homeostatic point 12 (Ma, Ma & Cho, 2005, Biomedical Acupuncture for Pain Management)
Nine Points for Returning Yang (Third Trinity: Reunion)

Meetings:

Meeting of Large Intestine with Large Intestine Divergent

Location:

On the dorsum of the hand, between the first and second metacarpal bones, at the modpoint of the second metacarpal bone and close to its radial border

Needling:

Perpendicular insertion 0.5 - 1 cun
Oblique insertion directed proximally 1 - 1.5 cun

Warnings:

Contraindicated in Pregnancy

Classical Needling:

"The Yangming usually has much Qi and much Blood" (Su Wen 素問 ch. 24) implying this channel can normally be needled or bled.
"The hand Yin and Yang receive their Qi via nearby paths so their Qi arrive swiftly. The depth of piercing must not exceed 2 fen and must not remain inserted for longer than one exhalation" (Ling Shu 靈樞 ch. 12).
"It is needled to a depth of three fen, (the needle) is retained for a duration of three exhalations, and it is moxaed with three cones" (Huangfu Mi 皇甫謐, 3rd Century, Zhenjiu Jiayi Jing 針灸甲乙經).

TCM Actions:

Activates Wei-Defensive Qi and adjusts sweating
Expels Wind and releases the Exterior
Regulates the face, eyes, nose, mouth and ears
Activates the channel and alleviates pain
Induces labour
Restores the Yang

TCM Indications:

• Exterior wind-cold patterns, chills and fever, injury by cold with great thirst, copious sweating, absence of sweating, febrile disease with absence of sweating, floating pulse.
  
• Headache, one-sided headache, headahce of the whole head, hypertension.
  
• Redness, swelling and pain of the eyes, dimness of vision, Superficial Visual Obstruction.
  
• Nosebleed, nasal congestion and discharge, rhinitis, sneezing.
  
• Toothache or pain of tooth decay in the lower jaw, mouth ulcers, lotus flower tongue, cracked tongue, rigid tongue, lips do not close, tightness of the lips.
  
• Throat Painful Obstruction (喉痹, Hou Bi), childhood Throat Moth, mumps, loss of voice.
  
• Swelling of the face, deviation of the face and mouth, lockjaw, deafness, tinnitus.
  
• Amenorrhoea, prolonged labour, delayed labour, retention of dead foetus.
  
• Dysenteric disorder, childhood nutritional impairment, Childhood Fright Wind, wind rash, Malarial (瘧, Nue) Disorders, mania.
  
• Painful obstruction and atrophy disorder of the four limbs, hemiplegia, pain of the sinews and bones, pain of the arm, contraction of the fingers, pain of the lumbar spine.

I Ching Hexagram:

䷪ Guai 夬 Breaking Through

Shared with Lieque Lu-7. Balanced by ䷖ (Fenglong St-40 or Taibai Sp-3).
Also shares a Rising and Falling Hexagram with Taodao Du-13, balanced by Shenque Ren-8.

Hexagram attributions are my own with an explanation given in the glossary.

Neuroanatomy:

Superficial Innervation: Superficial radial nerve (C6 - C8)

Dermatome Segment: C7

Deeper Structures: Branches of the ulnar nerve (C8, T1)

Trigger Point Associations:

Muscle:
Adductor pollicis and first interosseous

Pain Referral Pattern:
Along the radial aspect of the first finger and across dorsum of hand (first interosseous) or to the radial and palmar areas at the base of the thumb (adductor pollicis)

Indications:
Sprain of the thumb ; Tendinous strain in the hand

Martial Applications & Effects of Injury:

In seizing martial arts (Qin Na) this point is a cavity pressing point (Dian Xue, 點穴). Pressing this area can cause numbness if minor pain is caused, or if serious pain is caused the opponent may pass out (Yang, 2004, Analysis of Shaolin Chin Na, 2nd Edition).

One of the 36 vital points of Feng Yiyuan 馮一元 listed in the Wu Bei Zhi 武備志 (Treatise on Armament Technology) by Mao Yuanyi 茅元儀 (1621) (McCarthy, 2016, Bubishi: The Classic Manual of Combat).

Striking causes Qi drainage and local pain. It can be used as a set up point to a strike to Zhongfu Lu-1 or to Zangmen Liv-14. Struck right on the point with a smaller weapon such as a one-knuckle punch, this point will cause confusion in the brain. However, it is not easy to strike as that strike must be very accurate (Montaigue, Dim Mak Locations, Taijiworld.com).

Major Combinations:

• Little sweating:
    Reinforce Hegu LI-4 and reduce Kid-7
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Copious sweating:
    Reduce Hegu LI-4 and reinforce Kid-7
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Cold Damage with sweating:
    Reduce Hegu LI-4 and Neiting St-44 and reinforce Fuliu Kid-7 and Bailiao Ex-HN-30
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Cold Damage with great heat that does not recede:
    Reduce Hegu LI-4, Quchi LI-11, Xuangzhong GB-39, Zusanli St-36, Dazhui Du-14 ad Yongquan Kid-1
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Diseases of the head, face, ears, eyes, mouth and nose:
    Hegu LI-4 with Quchi LI-11
    (Za Bing Xue Fa Ge, 雜病穴法歌, Song of Points for Miscellaneous Diseases. First recoreded in Gao Wu, 高武. 1529: Zhen Jiu Yu Jing, 針灸聚英, Glorious Anthology of Acupuncture and Moxibustion).
  
  
• Headache:
    Hegu LI-4 with Tianchi Pc-1, Tongziliao GB-1, Yuji Lu-10, Sibai St-2, Tianchong GB-9, Sanjiaoshu Bl-22 and Fengchi GB-20
    (Haungfu Mi, 皇甫謐, 282: Zhen Jiu Jia Yi Jing, 針灸甲乙經, Systematic Classic of Acupuncture and Moxibustion).
  
  
• One-sided or generalised headache:
    Hegu LI-4 with Sizhukong SJ-23 and Fengchi GB-20
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• One-sided or generalised Head Wind:
    Hegu LI-4 with Baihui Du-20, Qianding Du-21, SHenting DU-24, Shagnxing Du-23, Sizhukong SJ-23, Fengchi GB-20, Zanzhu Bl-2 and Touwei St-8
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Head Wind and dizziness:
    Hegu LI-4 with Fengling St-40, Jiexi St-41 and Fengchi GB-20
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Head Wind with splitting sensation, pain between the eyebrow and the eye:
    Hegu LI-4 with Yangbai GB-14 and Jiexi St-41
    (Wang Guorui, 王國瑞, 1329: Bian Que Shen Ying Zhen Jiu, Yu Long Jing, 扁鵲神應針灸玉龍經, Bian Que's Spiritual Guide to Acupuncture and Moxibustion, Classic of the Jade Dragon).
  
  
• Pain of the head and nape:
    Hegu LI-4 with Houding Du-19 and Baihui Du-20
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Dimness of vision:
    Hegu LI-4 with Yanglao SI-6 and Quchai Bl-4
    (Wang Zhizhong, 王執中, 1220: Zhen Jiu Zi Sheng Jing, 針灸資生經, Classic of Supporting Life with Acupuncture and Moxibustion).
  
  
• When Jingming Bl-1 is ineffective in treating diseases of the eye:
    Combine with Hegu LI-4 and Guangming GB-37
    (Xi-Hong Fu, 席弘賦, Ode of Xi-Hong. First recorded in: Xu Feng, 徐鳳, 1439: Zhen Jiu Da Quan, 針灸大全, Complete Collection of Acupuncture and Moxibustion).
  
  
• Superficial Visual Obstruction:
    Hegu LI-4 with Jingming Bl-1 and Sibai St-2
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Loss of voice:
    Hegu LI-4 with Yongquan Kid-1 and Yangjiao GB-35
    (Haungfu Mi, 皇甫謐, 282: Zhen Jiu Jia Yi Jing, 針灸甲乙經, Systematic Classic of Acupuncture and Moxibustion).
  
  
• Swollen painful throat:
    Hegu LI-4 with Shaoshang Lu-11 and Tiantu Ren-22
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Nasal polyps and nasal congestion and discharge:
    Hegu LI-4 with Taichong Liv-3
    (Anon, nd, Shi Si Jing Yao Xue Zhu Zhi Ge, 十四經要穴主治歌, Song of the Points of the Fourteen Primary Channels).
  
  
• Red eyes and nosebleed:
    Hegu LI-4 with Toulinqi GB-15 and Taichong Liv-3
    (Anon, nd, Shi Si Jing Yao Xue Zhu Zhi Ge, 十四經要穴主治歌, Song of the Points of the Fourteen Primary Channels).
  
  
• Bleeding from the nose:
    Hegu LI-4 with Tianfu Lu-3
    (Gao Wu, 高武, 1529: Bai Zheng Fu, 百症賦, Ode of a Hundred Symptoms).
  
  
• Rhinitis with clear nasal discharge:
    Hegu LI-4 with Fengmen Bl-12, Shenting Du-24, Zanzhu Bl-2, Yingxiang LI-20, Zhiyin Bl-67 and Futonggu Kid-20
    (Sun Simiao, 孫思邈, 625: Bei Ji Qian Jin Yao Fang, 備急千金要方, Essential Prescriptions Worth A Thousand Gold).
  
  
• Deafness:
    Hegu LI-4 with Zulinqi GB-41 and Jinmen Bl-63
    (Anon, nd, Shi Si Jing Yao Xue Zhu Zhi Ge, 十四經要穴主治歌, Song of the Points of the Fourteen Primary Channels).
  
  
• Purulent ear sores with discharge:
    Hegu LI-4 with Yifeng SJ-17 and Ermen SJ-21
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Swelling, pain and redness of the ear:
    Hegu LI-4 with Tinghui GB-2 and Jiache St-6
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Itching and swelling of the face:
    Hegu LI-4 with Yingxiang LI-20
    (Xi-Hong Fu, 席弘賦, Ode of Xi-Hong. First recorded in: Xu Feng, 徐鳳, 1439: Zhen Jiu Da Quan, 針灸大全, Complete Collection of Acupuncture and Moxibustion).
  
  
• Swelling of the face and abdomen:
    Hegu LI-4 with Zhongfu Lu-1 and Jianshi Pc-5
    (Sun Simiao, 孫思邈, 625: Bei Ji Qian Jin Yao Fang, 備急千金要方, Essential Prescriptions Worth A Thousand Gold).
  
  
• Deviation of the mouth and eye:
    Hegu LI-4 with Jiache St-6, Dicang St-4, Renzhong Du-26. Chengjaing Ren-24 and Tinghui GB-2
    (Zhang Jiebin, 張景岳, 1624: Lei Jing Tu Yi, 類經圖翼, Illustrated Supplement to the Classic of Categories).
  
  
• Sudden mania:
    Hegu LI-4 with Jianshi Pc-5 and Houxi SI-3
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Manic raving with fear and fright:
    Hegu LI-4 with Yuji Lu-10, Zhizheng SI-7, Shaohai He-3, Quchi LI-11 and Wangu SI-4
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Lockjaw following Windstroke:
    Reduce Hegu LI-4, Jiache St-6, Renzhong Du-26, Baihui Du-20 and Chengjiang Ren-24
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Loss of consciousness from Windstroke:
    Hegu LI-4 with Renzhong Du-26 and Zhongchong Pc-9. If this is ineffective, needle Yamen Du-15 and Dadun Liv-1
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Difficult delivery:
    Reinforce Hegu LI-4 and reduce Sanyinjiao Sp-6 and Taichong Liv-3
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Abscence of lactation:
    Hegu LI-4 with Shaoze SI-1 and Shanzhong Ren-17
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Prolapse of the rectum:
    Hegu LI-4 with Dachangshu Bl-25, Baihui Du-20, Changqiang Du-1, Jianjing GB-21 and Qichong St-30
    (Liao Runhong, 廖润鸿, 1874: Zhen Jiu Ji Cheng, 針灸集成, Compilation of Acupuncture and Moxibustion).
  
  
• Dysenteric disorder:
    Hegu LI-4 with Zusanli St-36. If severe add Zhonglushu Bl-29
    (Anon, nd, Shi Si Jing Yao Xue Zhu Zhi Ge, 十四經要穴主治歌, Song of the Points of the Fourteen Primary Channels).
  
  
• "For Cold and Heat with Painful Obstruction" open the Four Gates":
    Hegu LI-4 with Taichong Liv-3
    (Biao You Fu, 標幽賦, Ode to Elucidate Mysteries. First recoreded in Shi Guitang, 施桂堂. 1241: Zhen Jiu Zhi Nan, 針灸指南, Guide to Acupuncture and Moxibustion).
  
  
• Unendurable pain of the arm that radiates to the shoulder and spine:
    Hegu LI-4 with Taichong Liv-3
    (Xi-Hong Fu, 席弘賦, Ode of Xi-Hong. First recorded in: Xu Feng, 徐鳳, 1439: Zhen Jiu Da Quan, 針灸大全, Complete Collection of Acupuncture and Moxibustion).
  
  
• Contraction of the arm with tightness of the sinews of both hands resulting in inability to open the hands:
    Hegu LI-4 with Quchi LI-11, Chize Lu-5, Yangchi SJ-4 and Zhongzhu SJ-5
    (Yang Jizhou, 杨继洲, 1601: Zhen Jiu Da Cheng, 針灸大成, Great Compendium of Acupuncture and Moxibustion).
  
  
• Acute dysmenorrhoea:
    Hegu LI-4 with Diji Sp-8 (Deadman, Al-Khafaji & Baker, 2001, A Manual of Acupuncture).
  
  
• Loss of smell:
    Yingxiang LI-20 with Yintang Ex-HN-3, Jingming Bl-1, Meichong Bl-3, Shangxing Du-23, Erheliao SJ-22, Hegu LI-4 and Ear Shenmen
    (Empirical combination from western anosmia specialist in Germany).

Notes:

Main distal point for headaches, toothache and all conditions of the head, face and sense organs. Also major point for boosting the immune system and pain control. This point has been well researched and shown to boost tolerance to painful stimuli for some time after needling.

Often combined with Taichong Liv-3 to form the 4 gates, a common combination for moving stagnation causing pain and spasm anywhere in the body.

It is noteworthy than the transverse Luo points which connect to these points, Lieque Lu-7 and Guangming GB-37, are the only two Luo whose longitudinal directions travel distal across the hands and feet.

Hukou 虎口 Tiger's Mouth is a common term used in martial arts for this point.

The Su Wen Ch. 20, Discourse on the Three Sections and Nine Indicators, describes "The earth [indicator] of the central section: the hand yang brilliance [locations].. The earth [indicator] serves to examine the qi in the chest". Wang Bing's commentary says this means "This is to say: the vessels of the large intestine. Their movement can be felt at the 'union valley' section at the junction of the bones between the thumb and the index finger" indicating this point (Huang Di Nei Jing Su Wen, trans. Unschuld & Tessenow, 2011).

Gao Wu command point for the face and mouth.

The contraindication for pregnancy seems to be from its use in protocols for difficult labour to stimulate contractions and not an absolute contraindication if used appropriately in conjunction with other points (Betts & Budd, 2011). A review of trials where "forbidden points" were used in pregnancy found no objective evidence of harm (Carr, 2015).

The Nine Points for Returning Yang are used for assisting those close to death. They may be used to resuscitate collapse from deserted Yang, or if it is their time, to assist them in their passage. They are divided into three trinities, related to separation, transition and reunion.

This point belongs to the third trinity, related to reunion, deliverance and the otherworld. They rouse, tonify and anchor the Yang Qi, open the orifices, draw energy back into the Yangming and Gallbladder and aid delivery. Symptoms include:

- Cessation of breathing, appearance as if dead, collapse or flatline.

They basically shock the person back to life rousing the Yang Qi and opening the orifices. If these points did not work it meant the person was meant to move on now. They draw energy back into the Gallbladder and Stomach, anchoring and tonifying the Kidney Yang.

This point rescues collapsed Yang, regulates the Interior and Exterior, stops pain, calms Shen and anchors rebellious Qi. Kaatz says it clears what is no longer wanted with great vitality, balances the cycle of taking in and letting go, allows us to flow with openness to receive things beyond which we can imagine and clears the system, revitalising our Qi with fresh clear energy, bringing our thoughts back the understanding of our hearts.

J. Yuen lectures on death/dying and the spirit of points, posted as Facebook comments, 19 Dec 2020.

In Tung acupuncture the Ling Gu, Spirit Bone, point (22.05) is located slightly proximal to this point between the first and second metacarpals. It is often combined with the Da Bai, Big White, point (22.04, at Sanjian LI-3) in almost any disease due to their ability to move Qi and Blood and their location on the arm Yangming which controls Qi and Blood in the entire body (Chu, 2015).

Tung's Fu Ke, Gynaecology, points are also located near here on the dorsal-ulnar aspect of the proximal segment of the thumb, 1/3 and 2/3 of the distance from the base of the thumb. It is indicated for all kinds of gynaecological disorders, especially when combined with Sanyinjiao Sp-6 (Chu, 2015).

A Shokanten pulse is used to assist in diagnosis where the radial pulse is unclear, or in the comparative analysis of meridians in the upper and lower portions of the body. They are particularly used in psycho-emotional disorders. This point relates to the Lower Jiao, Jueyin and chest.

Medieval phlebotomy point (John de Foxton, 1408: Liber Cosmographiae, maa.cam.ac.uk; Hans von Gersdorff, 1517: Feldtbüch der Wundartzney, www.nlm.nih.gov)

Galen used this point to relieve a long standing pain in the area where the liver reaches the diaphragm (Brain, 1986, Galen on Bloodletting, P.98). He pierced it and then let the bleeding stop of its own accord.

Avicenna describes venesection at this point in his treatise On Venesection:

"The artery to venesect in the right hand is the one on the back of the hand between the thumb and index finger [radial artery]. It is strangely beneficial in the chronic pains of the liver and diaphragm. It is told that Galen had a vision in his dream that a person told him to venesect the artery to cure his liver problem, which he did, and recovered. Alternatively another artery closer to the middle of the hand may be venesected for the same benefit." (Aspects of Treatment According to General Diseases, 21st section in Abu-Asab, Amri & Micozzi, 2013, Avicenna's Medicine).

In ayurvedic medicine:
Kurcha marma point
Size: 4 angula (cun)
Structure: Tendon
Effect of Injury: Disability (vaikalyakar marma)
(Harish Johari, 1996, Ayurvedic Massage, Sanatan Society; Anupama Bhattacharya, n.d. Marma Shastra)

Lad and Durve (2008) in Marma Points of Ayurveda call this point Angushtha Mula and associate it with the doshas: Prana Vayu, Apana Vayu, Vyana Vayu, Udana Vayu, Ranjaka Pitta and Tarpaka Kapha.

They give the following functions:
- Stimulates flow of prana, vyana and apana vayus
- Enhances circulation and relieves congestion
- Relieves pain and headaches
- Benefits liver and spleen functions
- Benefits hands
- Calms the mind and releases suppressed emotions

Siddha practitioners call this point Puta Nati, literally "malignant spirit pulse", which is examined as a part of pulse diagnosis to ascertain possession by the spirit (pey piti-ttal) of a diseased person or malevolent god (Sieler, 2015, Lethal Spots, Vital Secrets, p.146).

In Tibetan medicine:
Moxa point (AMNH, Tibetan Medical Paintings)

In Thai massage:
Acupressure point indicated for facial pain/numbness/paralysis,gastrointestinal ailments, headache, hypertension, indigestion, stomach ache, stress and toothache (Salguero & Roylance, 2011, Encyclopedia of Thai Massage)

Reference Notes:

Basic information on location, needle depth, TCM actions, indications and combinations is taken from Deadman et al (2001): A Manual of Acupuncture with additional anatomical information researched by reference to Gray's Anatomy (38th Ed., 1995) unless otherwise referenced. Images were found on acupunctureschoolonline.com and can be traced back to Claudia Focks (2008) Atlas of Acupuncture originally. I cannot claim any credit or rights over them. Other sources should be quoted in the text.

For some of the more unusual terms I have created a glossary here