LI 4 — Hé Gǔ (合谷) — Joining Valley

LI 4 (Large Intestine 4; Hegu, “Joining Valley”) is the Yuan-Source point of the Large Intestine meridian and the most important analgesic point in acupuncture. Located on the back of the hand between the first and second metacarpal bones, it is the command point for the face and mouth, the primary point for headaches, toothache, sinusitis and any facial complaint, and a powerful general pain reliever. Strictly contraindicated throughout pregnancy — LI 4 has well-documented uterotonic effects and is used to induce labour.

On this page

1. Overview
2. Location
3. Actions
4. Indications
5. Needling
6. Clinical notes
7. Common point combinations
8. Treatment at my clinic
9. Frequently asked questions about LI 4

1. About LI 4 (He Gu)

LI 4 — Hé Gǔ (合谷) — is an acupuncture point on the Large Intestine meridian. Its English name, Joining Valley, refers to the wide hollow formed between the thumb and index finger when they are pressed together. It is the Yuan-Source point of the channel and, in classical and modern TCM practice alike, the single most important pain-relieving point in acupuncture. It is used regularly in acupuncture practice for headaches, facial complaints, dental pain, fevers and labour induction.

I am Dr (TCM) Attilio D’Alberto, a member of the British Acupuncture Council with over 25 years of clinical experience. I use LI 4 as part of individually tailored acupuncture prescriptions at my clinic in Wokingham, Berkshire.

2. LI 4 location

On the dorsum of the hand, between the 1st and 2nd metacarpal bones, at the midpoint of the 2nd metacarpal bone on its radial side. To find it: when the transverse crease of the thumb of one hand is placed along the web margin of the other, the point lies below the tip of the thumb. The point is usually tender to palpation, particularly in patients with headaches, sinus problems or upper-body pain.

3. Actions

1. Expels Wind and releases the Exterior
2. Stops pain — the command point for the face and mouth
3. Regulates the face, nose, mouth and eyes
4. Promotes the smooth flow of Qi throughout the body
5. Induces labour (contraindicated in pregnancy)
6. Clears Heat and reduces fever
7. Restores Yang in collapse (combined with PC 6 and ST 36)

4. Indications

1. Headache — one of the most important points for all types of headache
2. Toothache, facial pain, sinusitis and nasal congestion
3. Common cold, fever and sore throat from exterior invasion
4. Pain anywhere in the body — the primary analgesic point in acupuncture
5. Labour induction and difficult labour (contraindicated in all stages of pregnancy)
6. Constipation and bowel disorders
7. Skin conditions from Wind-Heat
8. Jaw pain and TMJ disorder

5. Needling

Perpendicular insertion 0.5–1.0 cun. Strong De Qi usually achieved quickly — LI 4 is one of the most reliably responsive points on the body. Strictly contraindicated throughout pregnancy — has documented uterotonic effects and is used to induce labour.

Important: Acupuncture should only be performed by a fully qualified practitioner. Never attempt self-needling. All needles I use are sterile, single-use and disposed of immediately after treatment in a clinical sharps container.

6. Clinical notes

LI 4 is the Yuan-Source point of the Large Intestine meridian and, together with LV 3, forms the famous “Four Gates” combination — one of the most powerful Qi-regulating combinations in acupuncture, used for stress, pain, emotional constraint and general meridian regulation. The Large Intestine channel runs up the arm, across the shoulder and to the face, ending at the nose; LI 4 is the master point for everything that channel reaches.

It is the most important acupuncture point for any condition involving pain in the head, face, mouth, sinuses or throat. The classical phrase “mian kou Hegu shou” — “for the face and mouth, gather it at Hegu” — expresses two thousand years of clinical experience in a single line. In acute fevers and common colds, LI 4 is needled to release the exterior and bring fever down. It must be avoided in pregnancy, where its strong descending and labour-inducing action poses a real risk of miscarriage in the first two trimesters.

7. Common point combinations

1. LI 4 + LV 3 (Taichong) — the classical “Four Gates” combination, regulates Qi throughout the body. Used for stress, emotional constraint, pain anywhere, headache and general meridian harmonisation.
2. LI 4 + ST 44 (Neiting) — clears Heat from the face. Used for toothache, gingivitis, mouth ulcers and acne on the lower face.
3. LI 4 + GB 20 (Fengchi) — the standard combination for tension headache and migraine, particularly with cervical or sinus involvement.
4. LI 4 + LU 7 (Lieque) — the classical pair for common cold and influenza, releasing the exterior and relieving nasal congestion.
5. LI 4 + ST 7 (Xiaguan) — the key combination for TMJ pain, jaw clicking and trigeminal neuralgia.
6. LI 4 + SP 6 (Sanyinjiao) — the labour-induction combination, used only at term in difficult or overdue labour. Strictly avoided during pregnancy.

8. Treatment at my clinic

I use LI 4 as part of tailored acupuncture prescriptions for conditions including headaches, migraines, jaw and TMJ pain, trigeminal neuralgia, labour induction at full term, and general pain relief. Each treatment is individually designed following a full TCM assessment.

I see patients in person at my clinic in Wokingham, Berkshire. Visit the prices page for consultation fees. Return to the acupuncture points directory or the acupuncture main page.

9. Frequently asked questions about LI 4

What are the acupuncture points LI4 used for?

The acupuncture points LI4 (Hegu) are used primarily for pain relief, particularly headaches, toothache, sinusitis and facial pain. LI 4 is the most important analgesic point in acupuncture and the command point for the face and mouth. It is also used for the common cold, fever, constipation, jaw pain (TMJ), and at full term for labour induction. Acupuncture points LI4 must be strictly avoided during pregnancy.

Where do you press acupressure points LI4?

To find acupressure points LI4: place the thumb crease of one hand on the web between the thumb and index finger of the other hand. The point sits where the tip of the thumb falls, in the muscle on the back of the hand between the bones of the thumb and index finger. Press firmly with your thumb for 1–3 minutes. Acupressure points LI4 are typically tender, particularly during headaches or sinus problems. Do not use during pregnancy.

Can LI 4 help with headaches?

Yes — LI 4 is the single most important point in acupuncture for headaches of any kind: tension headaches, migraines, sinus headaches, cluster headaches and headaches from stress. It is combined with GB 20 (Fengchi) for migraine and tension headache, and with Yintang for frontal headache. Most acupuncture treatments for headache include LI 4.

Can LI 4 help with toothache?

Yes. LI 4 is the classical primary point for toothache and dental pain, particularly upper-jaw teeth. Acupuncture or firm acupressure at LI 4 provides genuine analgesia within minutes for most patients with tooth or jaw pain — it is not a substitute for a dentist, but it is a useful holding remedy while waiting for treatment. Combined with ST 44 (Neiting) for lower-jaw teeth.

Can LI 4 induce labour?

Yes — LI 4 is one of the two main labour-induction points in acupuncture, paired with SP 6 (Sanyinjiao). It is used at or after term in overdue labour, in early latent labour to encourage progression and in difficult labour with weak contractions. This action also makes it strictly contraindicated throughout the rest of pregnancy.

Is LI 4 safe during pregnancy?

No. LI 4 is strictly contraindicated throughout pregnancy. It has well-documented uterotonic effects and is regularly used to induce labour from 40 weeks onwards. Acupuncture or firm acupressure at LI 4 should be completely avoided from confirmation of pregnancy until full term, when it may be used under qualified care to encourage labour.

What does LI 4 mean in Chinese?

LI 4 is called Hé Gǔ (合谷) in Chinese, which translates as “Joining Valley”. The name refers to the wide hollow that forms in the muscle between the thumb and index finger when they are pressed together — the “valley” in which the point sits.