Liver 4 Zhongfeng, Middle Seal

Liver 4 Zhongfeng is an acupuncture point on the Liver channel. It is a great point for pain in the lower abdomen, especially if caused by Damp or Heat – or both (- these are syndromes in Chinese medicine!)

• Jing-River point
• Metal point

Note: if by mistake you strayed onto this site when looking for information about the Liver from the Western medical point of view, click Liver instead. (But before doing that, why not stay and read what Chinese medicine has been saying about the Liver, for well over 2000 years!)

Liver 4 Location

There are a number of ways of describing Liver 4’s location.

1/ At the anterior flexure of the ankle, BETWEEN the tendon tibialis anterior and the extensor hallucis longus. This is where I was originally taught to find the point, and it seemed to work just fine. That’s the position shown in the picture. However, most books nowadays suggest you find it at the following position:

2/ 0.5 to 1.5 cun anterior to the medial malleolus in the depression formed when the foot is dorsi-flexed (ie medial to the tendon tibialis anterior)

3/ 1 cun anterior to the inferior margin of the medial malleolus, medial to the tendon tibialis anterior.

4/ Half-way between Spleen 5 and Stomach 41

If you wonder where Spleen 5 is, it is in much the same place but a little distal to Liver 4 and, I think, often needled instead of Liver 4 by mistake if using location 2, above.

However, Spleen 5, in my opinion is better described as being half-way between the medial malleolus and the navicular bone, whereas Liver 4 is needled just behind the tendon tibialis anterior which is the tendon that stands out when dorsi-flexing the big toe.

By needling Liver 4 towards Stomach 41 you (ie from position 2. above), but close to the tendon, you actually needle the same place (ie under the tendon) as you would have if you had needled Liver 4 vertically to the skin from position 1.

Having said all that, the point is found when you get the results you intended. Of course, it helps to get deqi too, for confirmation! Against that, when using it the way Kiiko Matsumoto suggests, you don’t need deqi because you know you got the point when you get positive feedback from palpating the abdomen.

Needling

Vertically to the skin, although can be needled obliquely either towards the big toe or underneath the tendon from position 2 above towards Stomach 41. Depth, up to 0.5 cun.

Needle sensation

Local, distending, or towards the toes.

Moxa on Zhongfeng

Up to 3 moxa. (The Japanese say up to 7, but they use much smaller moxa cones.)