Liver 13: Zhangmen Gate of the System

Liver 13 is the thirteenth point along the main Liver acupuncture channel and is:

• Alarm point – Mu point – of the Spleen
• Meeting point of the 5 Zang organs
• Assembly point of the Liver and Gallbladder channels

Location of Liver 13

Zhangmen lies at the tip of the 11th rib, or just inferior and anterior to it.

Needling Liver 13

1/ Perpendicular to the skin. Recommended depth of needle is no more or less than that required to reach the point. In thin people this may be only a quarter of an inch, whereas in fat people it could be two inches or even more. With that in mind, beware of needling too deeply.

The way I reach it is to palpate the point which, if it needs treatment, is usually sensitive if not actually sore, and assess how deeply I have to press the skin inwards to reach it.

Then I insert the needle with the skin pressed inwards on either side of the point, so that the actual depth from the surface of the skin to the point is less.

Once I have deqi, I slowly release the flesh with the other hand and as it springs back to normal I allow it to ride up the sides of the shaft of the needle which I’m keeping stationery so as to remain in contact with the point.

This means that in fat people you must start with a longer needle, otherwise the flesh as it rises will eventually drag the needle’s point away from the point.

2/ Parallel to the rib either medially or laterally, but in this case you must insert the needle from either further forward (if needling laterally) or further back (if needling medially). This increases the difficulty of finding the point, I find.

Sensation

Local to the area, but frequently extends across the abdomen, or upwards or downwards, depending on the disharmony being treated.

Moxibustion on Zhangmen

Moxa: 5 – 10 cones

ACTIONS of Liver 13

• Regulates interaction between Liver and Spleen
• Releases Qi stagnation, including that caused by the Liver
• Harmonises the middle and lower jiao
• Strengthens the Spleen

Regulates interaction between Liver and Spleen

• That the Spleen Alarm point is on the Liver channel shows how closely together these two zang interact. Moreover, it suggests that most Spleen problems are related to the Liver, or at least that they are in so far as problems exist in the trunk.
• Abdominal distension
• Circulation of Qi and Blood
• Resolves Damp where indicated by TCM for eg ascites
• Sore ribs, tender even to lie on
• Cardiac area pain

Releases Qi stagnation, including that caused by the Liver

• Indigestion
• Vomiting
• Enlargement of Spleen and Liver
• Chest pain
• Lumps and distension in the chest from stagnant qi
• Suppressed anger or tendency to get angry too easily
• Pain in the abdomen from stagnant qi
• Oesophageal spasm or constrictoin

Harmonises the middle and lower jiao where for example in:

• Enteritis
• Hepatitis
• Diarrhoea from cold in middle jiao
• Hypochondriacal pain
• Pain on the flanks
• Pain in the right upper abdomen area and under the right ribs for liver and gallbladder disease. Also in the left upper abdomen area and under the left ribs for stomach and spleen-pancreas conditions.  Use the Liver 13 point on the side of the pain.
• Its name translates as the ‘Chapter Gate’, or ‘Gate of the System’, or ‘Gate of Order’, which therefore suggests how important to our health is this ability to harmonise the middle and lower jiao.

Note: ‘Jiao’ means ‘burning space’ and in Chinese medicine your trunk has three: above the diaphragm, below the diaphragm but above the umbilicus, and below the umbilicus. You could say this means the chest, the upper and the lower abdomen, but the word ‘jiao’ – ‘burning space’ describes not just the place but the activity: it tells you more about the function.