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The Three Gates of Qimen

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 6th 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 6th 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.

Breathe Easy

Bladder 17 Geshu Diaphragm Shu

Focus on the breath is a cornerstone of meditation practices, martial arts, Tai Qi and Qigong. This points to the importance of good breathing  practices in maintaining body-mind health. Indeed, air is a vital component in the production of Qi in the body.

An impediment to taking a full breath can arise when there is constriction in the diaphragm. This is the large muscle that separates the chest cavity from the abdomen, and which is the primary muscle of respiration.

Body-centred therapists recognise the role that diaphragmatic constriction plays in patterns of emotional holding. The pioneer of somatic therapy, Wilhelm Reich, regarded the diaphragm as one of the eight segments of potential body-armouring.

In my clinic I often work with the diaphragm. Some people have difficulty taking a full breath, or their breathing ‘catches’, or they hold their breath for a short time between breaths, and the breathing is not smooth. Many of these constrictions in the breathing process are associated with emotional holding. Therefore, when working at the emotional level, it is important to free constrictions in the diaphragm.

One of the most important acupoints for this work is Bladder 17 Geshu Diaphragm Shu. This point is the hui-meeting point of Blood and is said to treat any conditions of the blood; this is the main function of this point given in acupuncture manuals. My focus here is on its function implied by the name, Diaphragm Shu. The word shu means to transport, suggesting that the point transports Qi to the diaphragm, relaxing while at the same time invigorating the muscle.

I find that there is a strong correlation between tightness, congestion or stagnation at this point, and tightness at the Liver and Gall Bladder shu points which lie below (inferior to) it. The emotions associated with these Wood organs are anger and frustration which are often held in and stored in the body. Constricting the breath, usually unconsciously, is one way of controlling these and other emotions, and the diaphragm plays its part in this control.

When working on someone else, I have them lying face up (supine) on a table. I reach underneath the back with cupped fingers, to hold Bladder 17 with the tip of my curled middle finger, left side first, then right. This allows my other hand to hold other points which will help to release this main focal point. I have three favourite points that I use, all for different reasons.

(1) The first of these is not an acupoint but lies on the Conception Vessel (Ren) between CV 14 and 15. Call it 14.5 if you like. It is the tip of the xiphoid process, a piece of cartilage that extends from the lower part of the sternum and to which the diaphragm and other muscles attach. Holding the tip of the xiphoid together with Bladder 17 is a great way to release the diaphragm and allow breathing to become freer and easier.

(2) If this doesn’t work as well as I would like, I go to the next point combination, holding Bladder 17 with Bladder 40 behind the knee. Bladder 40 is a point famous for releasing any of the back-shu points, drawing congested Qi down the inner Bladder line in the back and down the backs of the legs.

(3) The final combination in the toolbox is Bladder 17 with Stomach 40. This method draws on the principles of microsystems, where a body part represents a larger area of the body. In this case the lower leg represents the length of the spine in the torso. BL 17 is half-way along this length, mirrored by ST 40 which is halfway along the lower leg. This might sound strange, but it does work, and sometimes this point will be the one that releases BL 17 the best.

When to use this protocol

Use when someone tells you that they are having difficulty getting a full breath or when you observe that there is a catch in the breathing or a holding of the breath. If there is back pain around the bottom of the shoulder blade, this work can relax the back musculature. Use also if emotions are arising and the person struggles to express or release them. Also consider if there is suppression of anger. Frequent sighing may indicate diaphragmatic constriction. There can also be an indication on the pulse. This “diaphragm pulse” is diagnosed when it feels as if the skin in protruding between your fingers at the junction of the distal and middle pulse positions.

There are of course other ways of working with the breathing. These include Lung points (especially LU 1) and the muscles of the neck, particularly the scalene and sternocleidomastoid muscles which are involved in lifting the ribcage during inhalation. If tight, these should be addressed in conjunction with diaphragm work. In fact, in cases of deep emotional holding, releasing the upper segments of armouring should precede this work.

Working on yourself

It is very difficult to hold these points directly on yourself. Instead, lie back on a pair of tennis balls tied together in a sock. Place the balls on either side of the spine at the level of the bottom (inferior angle) of the shoulder blade. If this is too much pressure, lie on a softer surface, or use a rolled-up towel across this area. This allows you to hold the tip of the xiphoid process in combination. While you won’t be able to reach the other points in the legs, you can use your mind to hold them with intention.

This work forms part of the workshop “Working with Emotions in Five Element Acupressure” which is part of the Five Element Acupressure training program.
Details here.

BL 17 is located two fingers width (1.5 cun) lateral to the junction of the 7th and 8th thoracic vertebrae, approximately level with the inferior angle of the scapula
Tip of the xiphoid process, the cartilage that attaches to the bottom of the sternum
BL 40 in the centre of the knee crease
ST 40 is half way between the base of the patella (kneecap) and the prominence of the outer ankle bone, and 2 fingers width (1.5 cun) lateral to the crest of the tibia bone