Entry exit points | Five Element Acupressure

In 1988 I travelled to southern California to study Jin Shin Do® Bodymind Acupressure™ with Iona Teeguarden. While there I helped to type the JSD Foundation newsletter and was invited to reply to a letter from a reader enquiring about Iona’s non-standard location of Liver 14. In those early days of my studies and with internet research a thing of the future, I was unable to respond. Here then, 35 years late, is my reply.

Qimen ~ Cycle Gate/Gate of Hope ~ Liver 14

The last point of the Liver meridian is a significant one. Here the Qi completes the cycle of the 12 meridians before flowing through to Lung 1 whence it started. It is a place where Qi can become blocked, causing congestion in the chest, and reflecting stagnation in the Liver organ, or pent-up feelings of frustration and anger. Its location, however, is not straightforward, and I have encountered three different locations that derive from different traditions. What follows is something of a detective story as I try to unravel the historical origins of each location. Please forgive me, reader, for my attention to such arcane detail. It seems my Metal Element is showing through.

Standard Qimen

The standard location in Traditional Chinese Medicine (TCM) of Qimen – Cycle Gate – Liver 14 is in the chest, in the 6^th intercostal space and 4 cun lateral to the midline, on what is known as the mammillary line (in line with the nipple). This is the location that is most widely used and became the standard with the codification of acupuncture in China in the 1950s. Here is the location from Peter Deadman’s A Manual of Acupuncture.

Lower Qimen

A minority of practitioners locate Liver 14 much lower, on the border of the ribcage, also on the mammillary line. This location became standard for students of JR Worsley’s Five Element Acupuncture method which became especially widespread in England and the USA. Here is the location from Worsley’s Traditional Chinese Acupuncture Vol 1 which is known affectionately in his community as “the big red book”.

This alternative location has become widely enough known that it is acknowledged by Deadman, and by Jarmey in his Practical Guide to Acupoints, as “Lower Qimen”:

As a keen student of history and of lineage, I had always wondered about the origin of Worsley’s deviation. I found a possible answer earlier this year when I obtained a copy of the book Chinese Acupuncture by the Taiwanese acupuncturist Dr Wu Wei-Ping. Published in 1962, his work was translated into French by Jacques Lavier which was in turn translated into English by Philip Chancellor. It is known that Worsley studied with Wu Wei-Ping in Taiwan. Peter Eckman in his book, In the Footsteps of the Yellow Emperor, shows photos of Worsley with Wu in 1966. Wu’s location is clearly at “Lower Qimen”:

Where did Wu get his alternative location? One possible source is Japan which ruled Taiwan from 1895-1945 and had strong cultural influences over the island. In my searches I discovered at least one Japanese luminary who made use of the lower location. That is Dr Yoshio Manaka (1911-89).

Eckman describes Manaka as having good relationships with many of the Japanese schools of acupuncture but never became identified with any one. He also had numerous contacts among the French and German schools which were being established and he made several teaching trips to Europe. It’s possible that Worsley had direct contact with Manaka. Here is the location from Manaka’s book, Chasing the Dragon’s Tail. (Mislabelled as LV 4)

Acupuncturists of the Worsley lineage consider Lower Qimen to have greater psycho-emotional and spirit associations that are not ascribed to the standard location by TCM practitioners. Indeed, Worsley gave the name Gate of Hope to this lower point rather than the usual translation Cycle Gate. This suggests its power to support a person to face the future with clarity and enthusiasm, alleviating depression caused by stagnation of Liver Qi.

Several years ago, I received an email from Peter Borten, an acupuncturist in Portland, Oregon, in response to my original blog on this point. His comments made an impact on my view of of the two different locations. Peter said,

“As I went first to a TCM school and then a Five Element school under J.R. Worsley, I see the TCM and Five Element locations of this point as having distinctly different energetics. When I’m needling this point for its Five Element “spirit of the point” properties, or to clear an entry-exit block, I always go with the Five Element location at the bottom of the ribcage.”

I now follow this advice in clinic, using Lower Qimen as a “spirit” point and when I detect an entry-exit block between Liver 14 and Lung 1.

One other thing to note before we leave Gate of Hope, is that Worsley-trained acupuncturists often needle Liver 13 (Chapter Gate) and Liver 14 (Gate of Hope) together: a new chapter of life heralds the hope of moving forward.

Inner Qimen

Now we come to the third and most obscure of the three locations, the one that was subject of the letter to the Jin Shin Do Foundation. We might call this “Inner Qimen”. Iona Teeguarden located Liver 14 at the bottom of the ribcage but more medially to the Worsley location. (Number 5 in the JSD system.) In her 1978 book Acupressure Way of Health, she located it on the ribcage at the junction of the ninth rib cartilage to the eighth rib, in a little indentation inside the nipple line. This places it about 1 cun medial and superior to the Lower Qimen. In her later book Joy of Feeling, Teeguarden calls this point Gate of Hope, so clearly there was a Worsley connection.

I used this location for many years until I moved to the standard location in the 6^th intercostal space. However, I do return to it from time to time. I find it very helpful in releasing points in the neck. When Small Intestine 16 is not releasing, I will hold it in combination with the opposite “Inner Qimen” and find that usually opens the neck wonderfully.

According to a biography on the Jin Shin Do Foundation website, Iona learned Jin Shin Jytsu with Mary Burmeister who was a student of the founder of that method, Jiro Murai. Iona travelled to Japan in 1976 and studied with Dr Haruki Kato, also a student of Jiro Murai. She states that “some of the JSJ points were in different locations than I had learned from Mary.” One of Burmeister’s “safety energy locks” (SEL 14) was in the location of Lower Qimen; I infer that this was one of those points which varied and that Inner Qimen is from Kato. The following illustration is from Alice Burmeister’s book The Touch of Healing.

While researching for this blog. I stumbled upon a graphic produced by Shohaku Honma (1904-1962) which shows Liver 14 on the ribcage but clearly more medial to Lower Qimen. I have not seen this location anywhere else, but here it is being used by a famous Japanese acupuncturist with whom Worsley studied. What could be the connection between Teeguarden and Honma? Could it be Kato? As part of his studies, Kato became a licensed acupuncturist so he could have professional and legal standing. Perhaps here is a connection to Honma.

Clinical Implications

Well, dear reader, if you are still with me after this deep dive into history, congratulations! I salute your perseverance.

Let me finish by summarising the clinical implications of these three different locations of Qimen Liver 14, for it is the clinical outcomes that are of greatest importance.

Standard Qimen is the mu point of Liver and so treats acute conditions that relate to the Liver organ. It also treats local congestion in the chest and ribcage. It can have an effect on the emotion of anger which, when out of balance, is stored in the Liver.

Lower Qimen is the Worsley location. It is also a mu point and treats at the physical level. But more significantly it treats psycho-emotional disharmony in the Wood Element and at the level of spirit. It helps lift depression, enabling a person to see clearly the way forward and make plans with hope for the future. It also is useful when there is an entry-exit block between Liver and Lung.

Inner Qimen is a useful alternative for both physical and psycho-emotional issues, for suppressed anger and frustration, for releasing the diaphragm and the associated neck segment.

As in all cases, the point is not on the chart, it is where you feel the Qi.

In my street in the Adelaide Hills the deciduous trees have almost finished shedding their leaves, forming glorious, multi-coloured piles to line the footpaths. Autumn is drawing to a close. Jut time to squeeze in a Metal blog, a treatment for congestion in the distal end of the Lung channel.

A fairly common complaint in clinic is pain in the thumb that arises from overuse. This may be, for example, a massage therapist who is doing a lot of deep tissue work, a rock climber who is using a lot of hand strength, a gardener who’s been doing a lot of pruning, or a sheep farmer who has been crutching several hundred sheep. Sometimes the pain arises spontaneously and may be related to emotional issues. And then there is arthritis, an inflammation of the joints which typically affects the thumbs first.

The meridian that passes through the thumb is that of the Lung. It begins at the outside of the upper chest, passes down the arm near the biceps muscle, along the inside of the radius bone, through the pad of the thumb, and finishes at the nail bed of the thumb. The exit point of this channel is Lung 7, quite some distance from the end. (See below for point locations and illustrations.) The Qi flows from there into the entry point of its partner meridian at Large Intestine 4 in the webbing of the hand. One might expect these exit and entry points to be the first and last points of a meridian, but this is not always so. In this case, neither the exit point of Lung nor the entry point of Large Intestine is the end point. (The end points are Lung 11 and Large Intestine 1 respectively.)

The only authority I can find who offers any discussion of this is Felix Mann in his 1962 book “Acupuncture: the ancient Chinese art of healing”. He implies that, where the points are not the last or first, there is a secondary connection between the last and first points. Nonetheless, I have noted a tendency in these cases for a stagnation to occur in the sections of the meridian distal to the exit points.

Let’s look at these points on the Lung channel that are distal to the exit point, namely Lung 8, 9, 10 and 11, for these are the points I’m interested in treating when there is pain in the thumb.

The first thing I look for is a block between Lung 7 and Large Intestine 4 which are the true exit and entry points between these Metal meridians. Hold the two points together for about 3 minutes or until there is a feeling of flow and balance between the two points. Then continue to hold Lung 7 with one hand and with the other hand, hold in succession Lung 9, Lung 10 and Lung 11 , feeling for a sense of blockage in the points. (I’ve excluded Lung 8 here because it is so close to Lung 7.) Often Lung 10 will be the most tight, sore and blocked.

A further technique that can be employed is to add a gentle stretch to the thumb. This is not acupressure but works at the level of the fascia. * Gently grasp the thumb and apply a slight traction while you hold each point in succession from Lung 7 to Lung 10. Maintain these holds for up to 3 minutes each or until you feel the Qi move and the fascia begin to soften. It can feel like something opening, flowing, spreading or rushing under your fingers.

Finally, check the “secondary” exit and entry points that Mann suggested by holding Lung 11 and Large Intestine 1 together.

For those clients who continue to place strain on the thumbs, and probably for arthritis sufferers too, the effects of this technique will likely be short term but should offer relief. And for those for whom the issue is acute, there is a good chance of resolving the case.

It may also be worthwhile to investigate at the emotional level. Is the person carrying long-term grief? Is there difficulty letting go of a person, object, idea or belief that is no longer serving? If so, then working with other Lung-related points such as Lung 1, Bladder 13 and Bladder 42 can help. It’s interesting to note how the notion of holding on with the mind is reflected in the clenching of the hand, and how the thumb places the cap on the clenching.

The falling autumn energy in Nature demonstrates that letting go is a natural phase of all existence. It may be a good time to take her hint and shed some of the things that you’ve been hanging on to.

* A review of the recent research into the connection between meridians and the fascial network can be seen here in my article How Does Acupressure Work? Exploring the connection between meridians and fascia (PDF)