The Four Bars

by Bob Flaws, Dipl. Ac. & C.H., FNAAOM, FRCHM

Keywords: Chinese medicine, acupuncture, Four Bars, Four Gates, acupuncture points, acupoints

Most acupuncturists are aware of the famous point combination called the si guan or Four Bars. The Four Bars are He Gu (LI 4) and Tai Chong (Liv 3) when needled bilaterally. The Four Bars are first spoken of in the Ling Shu (Spiritual Pivot) in the chapter titled, “The Nine Needles & Twelve Sources,” where it says,

The 12 sources [or origins] exit from the Four Bars. The Four Bars rule the treatment of the five viscera.

Seventeen hundred years later, Yang Ji-zhou, in his Zhen Jiu Da Cheng (Great Compendium of Acupuncture & Moxibustion), recorded the “Ode to Elucidate the Profound,” which says:

The Four Bars – the six bowels have 12 sources which exit from the Four Bars. These are Tai Chong (Supreme Surge) and He Gu (Union Valley). Therefore, on the day Tai Ji moves his palace, he commands the evils of the eight winds, making humans hot or cold or in pain. If [one] is able to open the Four Bars on the two hands and the two feet, by piercing them, there is an end [to those evils].

In the English-speaking West, the Four Bars are commonly spoken of as the Four Gates, and a gate may either open or close. However, in Chinese, the word guan more commonly refers to something which closes or shuts out rather than to something that opens or lets in. According to the authors of The Pinyin Chinese-English Dictionary, guan means to shut or close, to turn off, to lock or shut up, to close down, or a barrier, such as a customhouse in a pass. ^[1] When Chinese wish to say, “Close the door,” they typically say, guan men, shut or bar the door, whereas, when they want to say, “Open the door,” they typically say, kai men, open the door. As the author of the “Ode to Elucidate the Profound” states, when one needles these points, one opens what has formerly been closed or shut. In particular, one is causing the source qi to flow more freely into and through the channels and vessels. This influx of source qi into and through the channels and vessels can either help overcome evil qi within those channels or help reestablish balance in the viscera and bowels connected to those channels. In particular, Tong Jing, in an article titled, “Raising the Borders of the Clinical Use of the Four Bars Points,” says that, when these two points are used together, they course wind and harmonize the network vessels, regulate and harmonize the spleen and stomach, emolliate the liver and extinguish wind, course the liver and resolve depression, and move the qi and quicken the blood. ^[2] The following four case histories exemplify Tong’s understanding and use of these extremely important acupoints.

Case 1, stomach pain

The patient was a 38 year old female who was first examined by Dr. Tong on Jun. 9, 1996. The patient said that she had had almost constant stomach duct distention and pain for more than 10 years. This was accompanied by burping, acid eructations, and torpid intake. The patient’s tongue fur was thin, and her pulse was fine (or thready) and bowstring (or string-like). A Western medical diagnosis of gastritis was established by x-ray examination, while Dr. Tong categorized this woman’s Chinese medical patterns as liver qi’s loss of coursing and discharge with horizontal counterflow assailing the stomach. Thus the stomach had lost its fortification and movement. In order to treat this condition, Dr. Tong posited that it would be necessary to supplement and drain at the same time. Therefore, he supplemented He Gu (LI 4) and Zu San Li (St 36) and drained Tai Chong (Liv 3) and Nei Guan (Per 6). He also Artemesia moxaed Zhong Wan (CV 12). After treating the patient with this protocol for one month, all her symptoms were eliminated and her eating and drinking had returned to normal. On follow-up after one year, there had been no recurrence, and x-ray examination revealed no abnormalities. 

According to Dr. Tong, because the disease had endured for a long time, vacuity had become mixed with repletion. The repletion was qi depression. This had led to wood checking spleen earth. Thus the spleen had become vacuous and weak and earth had lost its fortification and movement. In this case, draining the liver channel’s source point, Tai Chong, was meant to treat the liver qi’s counterflow. Nei Guan is one of the eight vessel meeting points. Draining it loosens the chest, rectifies the qi, and stops pain. He Gu is the large intestine channel source point. Supplementing it and Zu San Li supplements the spleen vacuity and treats the torpid in-take. Thus these two points were meant to supplement the root visceral vacuity. In addition, moxaing Zhong Wan harmonized the center, fortified and moved, thus moistening and nourishing the stomach’s network vessels. This was a method for banking the root.

Case 2, facial paralysis

The patient was a 25 year old male who was first examined by Dr. Tong on Jun. 9, 1996 [sic]. The day before coming to see Dr. Tong, the patient had not been able to move the right side of his face, and spittle drooled from the corner of his mouth. The man had difficulty closing his right eye, and the right pupil was dilated. Tears ran from his right eye and mucus ran from his right nostril. His tongue fur was thin and white, and his pulse was fine. Based on these signs and symptoms, Dr. Tong categorized this man’s Chinese medical pattern as wind cold lodged in the network vessels causing qi and blood obstruction and stagnation and loss of nourishment to the channels and network vessels. Therefore, Dr. Tong’s treatment principles were to dispel wind, course the network vessels, and move the qi and blood. To do this, Dr. Tong chose He Gu (LI 4), Di Cang (St 4), Jia Che (St 6), Si Bai (St 1), Tai Yang (M-HN-9), and Yi Feng (TB 17) on the right side and Tai Chong (Liv 3) bilaterally. Treatment was once per day, with needles retained for 30 minutes per session. Even supplementing-even draining hand technique was used. After five treatments, the patient’s symptoms improved, and, after 10 treatments, he was cured.

According to Dr. Tong, this was a case of wind evils attacking and lodging in the region of the face, thus causing the channels and vessels to lose their nourishment and the qi and blood to become obstructed and stagnant. Hence the muscles on the affected side of the face had become paralyzed and unable to function. Needling He Gu and the other yang ming points on the right side regulated and rectified the qi and blood in the right side of the face, while needling Tai Chong bilaterally coursed and disinhibited the jue yin channel qi. This strengthened and increased the dispelling of wind as well as had the functions of moving the qi and quickening the blood.

Case 3, headache

The patient was a 35 year old female who was first examined by Dr. Tong on Oct. 16, 1997. The woman had a left-sided headache which had come and gone over five years. Each time she had a headache, it would last for three days, during which time there was crampy pain in left side of her head which was accompanied by dizziness, tinnitus, and poor sleep at night. The tip and sides of this patient’s tongue were red, and her pulse was bowstring and fine. Therefore, Dr. Tong assumed that the patient’s yin aspect was insufficient and that this had allowed vacuous yang harass above. Hence her clear orifices had lost their calm. Dr. Tong’s treatment principles were to subdue yang and extinguish wind, for which he chose Tai Chong (Liv 3), He Gu (LI 4), Tai Yang (M-HN-9), and Feng Chi (GB 20). Dr. Tong used moving and draining technique at each of these points and retained the needles for 30 minutes per session. After one treatment, the woman’s pain was markedly decreased. After three times, the pain had stopped. Then Dr. Tong needles He Gu (LI 4), Tai Chong (Liv 3), and Tai Xi (Ki 3) in order to secure the treatment effects.

According to Dr. Tong, this was a case of yin vacuity failing to moisten and enrich liver wood. Vacuous yang had transformed wind which had followed the shao yang gallbladder channel to harass the head above. This had caused the one-sided, temporal headache which was crampy in nature. Dr. Tong chose Tai Chong, the liver channel’s source point, to level the liver and extinguish wind. He Gu has a relatively strong effect for settling pain. Hence it was chosen in order to dispel wind and stop pain. Gallbladder channel Feng Chi was chosen to harmonize and resolve the shao yang, course wind and stop pain. Tai Yang was a local point in the area of pain. It is an extraordinary point which harmonizes the network vessels and dispels wind locally. After these points achieved their remedial effect, Dr. Tong secured the treatment effects by needling the Four Bars plus Tai Xi in order to enrich water so that it would sprinkle or wet wood. Thus remedially, Dr. Tong treated root and tip (or branch) simultaneously, followed preventively by treating the root.

Case 4, hiccup

The patient was a 62 year old male who was first examined by Dr. Tong on Sept. 9, 1998. The man had a history of stomach disease. Due to family stress, he had become emotionally depressed. Thus liver wood had counterflowed horizontally to assail the stomach and the stomach had lost its harmony and downbearing. This had resulted in frequent occurrences of hiccups accompanied by chest and rib-side distention and fullness and no taste for eating. The patient's tongue fur was thin and his pulse was fine. Therefore, Dr. Tong needled He Gu and Tai Chong with draining technique. This immediately stopped the hiccups, and Dr. Tong retained the needles for 15 minutes in order to secure the treatment effects. One treatment was all that was needed, and there was no further recurrence.

According to Dr. Tong, this disease had arisen due to liver qi depression and binding. Therefore, he first drained the foot jue yin liver channel source point Tai Chong in order to soothe the liver and resolve depression, thus repressing and controlling the horizontal counterflow of liver wood from attacking stomach earth. When liver wood counterflows horizontally to assail the stomach, this results in the stomach qi upbearing and not downbearing. Thus he also chose the large intestine source point to harmonize the stomach and downbear counterflow. When both these points are used together, they regulate and harmonize the liver and stomach, rectify the qi and free the flow of downbearing.

Conclusion:

In my experience as a teacher, beginner acupuncturists, as a group, often search for arcane and esoteric points and point combinations. However, the famous points and point combinations of acupuncture are famous precisely because these are the points and combinations which are the most reliable, the most dependable in terms of outcomes. All beginning acupuncturists learn about Tai Chong and He Gu, and the overwhelming majority know that these two points, as a pair, constitute the Four Bars or Gates. While these two points may seem prosaic and pedestrian, it is my experience that we should never underestimate their power and efficacy. Zhu Dan-xi, one of the Four Great Masters of the Jin-Yuan dynasties said that, "The hundreds of diseases arise from depression," and that, without depression, there is no cause for disease. These two points regulate and rectify the qi mechanism of the entire body. Therefore, their clinical application is broad and wide-ranging. There are few patients with chronic, enduring diseases who cannot be benefitted by needling these two points.

Copyright © Blue Poppy Press, 2001. All rights reserved.

For more information on acupuncture points combinations and formulas, see Bob Flaws's Sticking to the Point, Vol. 1 & 2 as well as Blue Poppy Institute's Distance Learning program Sticking to the Point.

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