by Yao Shuying
　　(Institute of Acupuncture and Moxibustion, China Academy of TCM, Beijing 100700, China)
　　The so-called “four-pass"?points are referred to bilateral Hegu (LI 4) plus bilateral Taichong (LR 3). Hegu (LI 4) is the source-point of the Large Intestine Meridian of Hand Yangming and is one of the important points for inducing analgesia and tranquilization, while Taichong (LR 3) is the source-point of the Liver Meridian of Foot-Jueyin and is of relieving the depressed liver and promoting the circulation of qi. These two acupoints used in combination can function in regulating the functional activities of qi, ascending and descending of qi and coordinating yin and yang. During long-term clinical practice, the author of the present paper has been using the four-pass points to treat liver-qi stagnation resulting in various kinds of disease and obtained satisfactory results. It is introduced as follows.
　　Case Examples
　　1. Hysteromyoma
　　Mrs Wu, aged 42 years, an office worker, had suffered from irregular endometrorrhagia for more than 2 years at the treatment time. It was diagnosed as hysteromyoma by the Department of Gynecology of the Third Affiliated Hospital of Beijing Medical University. Ultrasonic examination showed the tumor being 7.2×4.6 cm in size. She once tried treatment with Western and Chinese medicines but the therapeutic effect was poor. She then asked for acupuncture treatment instead. Examination showed the lump similar to the size of a fist, being touchable at the upper site of the pubic symphysis, harder in texture and a concurrent light pressure pain. She sometimes experienced dysphoria and also had got an irritable temperament, emaciated physique, poor sleep, light red tongue with thin yellowish coating and taunt slippery pulse. The Four pass points (stimulated with reducing manipulation), Zigong (EX-CA 1) and Qugu (CV 2) ( stimulated with uniform reinforcing and reducing manipulation) were needled, once every other day. The needles were retained for 20 min. After 8 sessions of treatment, she felt the tumor reduced slightly in size. After 20 sessions of treatment, ultrasonic examination conducted in the Third Affiliated Hospital of Beijing Medical University showed the tumor being about 3.1×1.2 cm in size; and after 36 sessions of treatment, ultrasonic examination indicated the tumor was 0.6×0.4 cm in size. Her menstruation then got normal, she did not have any abnormal feeling when having urination or defecation, and slept better obviously. Note: Hysteromyoma belongs to the category of “Zheng jia (abdominal mass)"?in traditional Chinese medicine, and is a tangible disease caused by blood stasis. According to this patient's tongue coating, pulse condition, etc., it was differentiated as the type of stagnation of the liver qi. Zigong (EX-CA 1) and Qugu (CV 2) in the local area were used to resolve the mass and the four-pass points served to regulate the depressed liver qi and promote f low of qi of the whole body which functioned together in accelerating blood circulation and qi flow in meridians, favouring dispersion of the mass.
　　2. Insomnia
　　Ms Liu, aged 21 years, a shop assistant, visited me on June 8, 1998, complaining of having got melancholy mind, insomnia or even being unable to fall asleep all night, and migraine on the left side due to disappointment in her love affair one month ago. Examination showed agony and heavy hearted complexion, bitter taste in the mouth, dry mouth, poor appetite, distention and fullness in the chest and hypochondrium, frequent sigh; red tongue with thin yellowish coating and taut thready pulse. It was differentiated as liver qi stagnation type insomnia. The four-pass points (stimulated with reducing manipulation), Touwei (ST 8) and Shuaigu (GB 8) (stimulated with uniform reinforcing and reducing manipulation) were taken. After 3 sessions of treatment, her headache was relieved significantly and she could fall asleep during night intermittently. After 10 sessions of treatment, all of her symptoms disappeared.
　　Note: Insomnia may be divided into deficiency and excess types in clinic. This insomnia patient belongs to stagnation of liver qi and fire syndrome induced by the depressed liver. The four-pass points were used to soothe the liver and regulate the circulation of qi for treating the fundamental cause of the disease, Touwei (ST 8) and Shuaigu (GB 8) employed to promote circulation of qi and blood for treating the secondary causes of the disease. Thus, the therapeutic effect was significant. 3. Chloasma
　　Mrs Jiang, aged 34 years, a shop assistant, had got brown chloasma in the bilateral zygomatic regions for 2 years. The chloasma darkened in color before onset of her menstrual cycle and then lightened after menstruation. She once tried treatment with multiple therapies but without any significant improvement. On June 10, 1997, she came to visit me asking for acupuncture treatment. She complained of having got a frequent delayed menstruation, accompanied with premenstrual abdominal pain and having an irritable temperament in daily life. Examination showed butterfly shaped dark brown spots in the bilateral zygomatic regions, light red tongue with white coating and taunt thready pulse. Enclosing-needling around the local patch was adopted, once every other day, with the needles retained for 30 min. After 10 sessions of treatment, the color of the patch had no apparent change. In view of patient's irritable temperament, frequent hypochondriac pain, tongue picture and pulse condition, it was diagnosed as liver qi stagnation type chloasma. The Fourpass points were needled in combination for relieving the depressed liver and regulating circulation of qi. After 6 more sessions of treatment, the color of chloasma turned lighter slightly and after another 15 sessions of treatment, the patch's color became lighter clearly and after 30 more sessions of treatment, the patch color abated and the skin of the face turned normal. Note: In the light of the theory of traditional Chinese medicine, chloasma can be divided into qi blood deficiency type and liver qi stagnation type. This patient belongs to the later type. The first 10 sessions of treatment were aimed a t treatment of the local skin and had no significant therapeutic effect. When the four-pass points were used together for enhancing the effect of acupuncture in soothing the liver and promoting circulation of qi (which corresponds to the principle of searching for the primary cause of disease in treatment), the therapeutic effect was thus satisfactory.
　　4. Mental Depression
　　Mrs Su, aged 32 years, a French student, visited our clinic department for the first time on June 26, 1998, complaining of having got fullness in the chest, pain in the left hypochondriac region, soreness in the nape and back, insomnia, poor appetite, mental gloom and frequent sigh. Examination showed light red tongue with white coating, and taut pulse. Based on the theory of traditional Chinese medicine, it was diagnosed as stagnation of liver qi. The four-pass points were needled and stimulated with stronger manipulation. After 3 sessions of treatment, all the symptoms disappeared. Note: Mental depression is often seen in women and results from stagnation of the liver-qi. The four-pass points can function in soothing the liver and regulating circulation of qi, thus the therapeutic effect is good.
　　Comments
　　 It is recorded in the classic book, Great Compendium of Acupuncture and Moxibustion that the four-pass points are referred to bilateral Taichong (LR 3) and Hegu (LI 4), which mimic the passes of circulation of qi and blood. When the pass is open, qi and blood flow freely. Hence, they are often used to treat qi-stagnation or blood stasis induced diseases. Both Hegu(LI 4) and Taichong (LR 3) communicate with the Stomach Meridian by way of Chongmai. Hegu(LI 4) is the source-point of the Hand Yangming Meridian which is full of qi and blood, when stimulated with reducing method, it can function in promoting circulation of qi to get rid of stagnation and making the qi of the Large intestine Meridian flow fluently. Taichong (LR 3) is the source point of the Foot Jueyin Meridian which h as abundant blood and less qi; when stimulated with reducing manipulation, it is capable of regulating liver qi, calming the liver to stop the pathogenic wind. Hegu(LI 4) is in charge of qi. The clear qi is light in nature and goes up in normal conditions; Taichong (LR 3) is in charge of blood. Blood is heavy in nature and descends normally. These two acupoints used together can coordinate the ascending and descending functions of qi and blood, accelerate their normal circulation and regulate functional activity of the twelve meridians. Hegu(LI 4) is a representative source-point of the yang meridians and Taichong (LR 3) is a representative source-point of the yin meridians. When used together, they can help each other in coordinating yin and yang, regulating flow of qi and soothing the liver. All the four cases listed above are liver qi stagnation type diseases. The successful treatment of the four cases provides evidence for the action of Four pass points in relieving the depressed liver and regulating flow of qi. Therefore, their clinical application should be popularized and studied further