By Susan Johnson
Four Horses consists of three points on each thigh: 88.17, 88.18, and 88.19, Middle, Upper and Lower Four Horses, totaling six points. This point pattern is wonderfully effective, easy to locate, and very versatile. Tung’s Points practitioners highly value these points, as they treat a wide and diverse array of disorders. I love these points and use them more frequently than any other point pattern in my practice. In this paper, I present the point locations and indications, and provide a detailed explanation of how the Four Horses point pattern works when combined with certain other important points in Master Tung’s system.
One could argue that Four Horses earned its name because it may include an extra point; however, the name actually reflects the fact that these are among the most powerful points in the entire body. A carriage drawn by four horses moves very quickly, with extraordinary momentum. A one-horse carriage ride through the countryside on a lazy Sunday afternoon would not be a fitting metaphor for the strong and lasting effects of these amazing points.
The Four Horses points are located using GB31 Fengshi (Wind Market), or Tung’s 88.25 Middle Nine Miles, as a reference point. Therefore, the location of GB31 Fengshi determines the location of Four Horses. Yet there are differences of opinion about the location of GB31. Most practitioners believe GB31 is nine cun above the popliteal crease, on the gallbladder meridian. However, some books situate this point seven cun above the crease. I recommend that you choose a distance nine cun from the popliteal crease to locate GB31. Some find it where the tip of the middle finger touches the leg when the arm is extended alongside the body. Although that method may be accurate for certain patients, it is inaccurate for people with very long arms, or for those who are lying on a table with a bolster under their legs, causing a bend in the knees. In addition, this method locates the point two cun, or three fingers, proximal to where it is found when measuring up from the knee. For these reasons, I count up from the top of the patella, rather than locating GB31 from the tip of the middle finger or from the popliteal crease. I place a bolster under the patient’s legs and measure eight cun above the top of the patella, because the popliteal crease falls approximately mid-patella, or one cun distal to a point opposite the uppermost edge of the patella.
Based on your method of locating GB31, Four Horses may include an additional proximal point if you are measuring up from the patella, or an additional distal point if you are beginning from the tip of the middle finger. Dr. Young Wei-Chieh, our leading expert on Tung’s Acupuncture, when asked which locations are accurate, has said, “It doesn’t matter. They all work.” He is correct; whether you find them proximally or distally, the points all work beautifully. Fortunately, GB31 is very easy to palpate, and when you have found it, both you and the patient know, because the point is often quite sensitive and full of energy.
Considering the above explanation, the simplest and most direct way to locate Middle Four Horses is as follows: from the top of the patella, measure eight cun (or four fingers twice, plus three fingers), then follow the lateral edge of the patella up to reach 88.17, the primary point. This should be three cun to three and a half cun anterior to GB31. Be consistent with point location on both sides of the body.
Upper and Lower Four Horses, the supporting points known as 88.18 and 88.19, are located two cun proximal and two cun distal to Middle Four Horses, respectively, on a line drawn directly up from the lateral edge of the patella. One of my students invented an easy word game to remember two different point patterns: the points of Four Horses are three fingers apart, whereas the points of Three Yellows are four fingers apart. This makes the distance between the points in each of these combinations easy to remember.
A reliable approach to locating the Four Horses line is to identify where the muscle changes from a horizontal plane to a vertical plane. Whether this is three cun or three and a half cun anterior to GB31, the points are located where the muscle plane changes. At each point, you will also find a little depression, which may feel like a small hole or pool of energy. Needles inserted correctly will appear to be at a 45 degree angle to the body, because they are placed precisely where the planes of the muscles change, so they are, in fact, inserted perpendicular to the surface.
The above guidelines about the needling of Four Horses should facilitate precise point location. These points are packed with qi, as they are situated in large muscle with big blood supply and big nerve supply, making Four Horses an extremely powerful point combination.
Overview of Indications
Four Horses are primary points for asthma and pneumonia, and are also very good for acute or chronic cough. This point combination is my first choice for colds and flus. It is also an excellent choice for allergies, seasonal allergies, and immune system weakness. It is used for rhinitis and all sinus problems, including sinus infection, sinus inflammation, and mucus. Four Horses is effective for nasal polyps and nasal atrophy as well. Nasal atrophy means a loss of the ability to smell, and therefore a subsequent inability to taste; this occurs, for example, in post-surgical patients who wake up from anesthesia and cannot smell or taste.
Four Horses are good for pleurisy, and wonderful for upper back pain. They also treat sciatica and lower back pain due to lung deficiency. These points are very effective for breast pain and chest pain, including chest pain due to injury, especially if the pain moves from the front to the sides. Because this very potent point combination is found between the Shao Yang and the Yang Ming channels, it treats breast and chest pain, which are related to Yang Ming, but it also treats pain that migrates to the side, which relates to Shao Yang. Due to the Shao Yang connection, the points are likewise used bilaterally, or unilaterally, for opposite side rib, costal, intercostal and flank pain.
Four Horses are my favorite points for nearly all kinds of skin disorders. Muscle treats muscle. Muscle also treats skin. These are fabulous points for the skin—for itching, pruritis, acne, shingles, psoriasis, and eczema. They treat skin fungus as well as thickening of the skin or scleroderma. Located very near the stomach channel and in large muscle with significant nerve and blood supplies, these points tonify the spleen and the qi. They adjust the spleen and stomach, and can be very effective in the treatment of fibromyalgia and multiple sclerosis, as well as skin disorders. You may also use these points for hemiplegia, facial paralysis or spasm, and postpartum invasion of external wind chill causing joint pain, also known as after-birth wind.
This point pattern can help the ears, too. For otitis media, ear inflammation, ear infection, deafness, and tinnitus, try Four Horses. The combination is effective for thyroid issues, hyperthyroid, enlarged thyroid, goiter, and protrusion of the eyeballs due to hyperthyroid.
This incredibly versatile combination may also be used for abdominal pain, lower leg strain or trauma, heart problems, and coronary heart disease.
The needling depth may range from 0.8 to 2.5 cun. The most distal point will typically contact bone; when it does, tap it very gently to avoid injury to the periosteum. It is beneficial to gently touch the bone with all three points. In order to insert the needles to the necessary depth, use 40mm needles on Four Horses; if a patient has larger thighs, a 60mm needle may be required. These points do not generally bruise.
Usually, but not always, Four Horses are needled bilaterally. For conditions such as asthma, colds and flus, allergies, and thyroid disorders, needle these points bilaterally. However, for conditions located on one side of the body, such as facial paralysis, hemiplegia, sciatica, flank pain, rib pain, and breast pain, an opposite side needling technique may be used. Upper back pain is an indication that may utilize either bilateral needling or the opposite side technique.
For optimal results, please put some qi into your needling. Insert the needle deeply, hold the handle firmly, catch the qi and strongly stimulate these points. I am not suggesting that a patient should experience pain when receiving Four Horses; they should not. But very strong and forceful energy is available here, and you have an opportunity to direct and deliver it. Don’t waste the opportunity! Patients consistently report strong movement of qi in both directions when I needle these points. Downsize your needle diameter to the patient’s comfort level, and then decisively move the qi for immediate and excellent results.
Leave the needles in for a minimum of one hour; they need this amount of time to be effective. A fifteen-minute treatment—given during a patient’s lunch break, for example—will not be successful with Four Horses. If a patient has suffered from asthma for twenty years and you intend to significantly improve the condition, give the needles a full hour.
Typically, we needle 88.17, the primary point, first. The other two are auxiliary points, located using 88.17 as a reference. When needling for acne on the face, start with the most distal point and needle toward the proximal. When using the points for skin issues, start by inserting the needle to the deepest level; after ten minutes, pull it up to medium depth, and after an additional ten minutes, pull it to the superficial level. In this way you are connecting with the qi, or calling the qi. The technique of calling the qi and then bringing it to the surface is only used in the treatment of skin disorders, such as psoriasis, shingles, acne, or rashes.
In my clinic, when I am treating a patient’s skin condition, I insert the Four Horses needles as soon as I enter the room. I then have a conversation with the patient, during which I raise the needles. Just before leaving the room, I pull them up to the superficial level. If the clinic is busy and I don’t have time to pull the needles up in stages, instead I reach the deep to medium level, stimulate strongly, then pull the energy to the surface level. However, the more gradual method may yield better results, depending on the skill of the practitioner.
Effects on the Lung and Liver
Four Horses are primary for lung diseases, and the lung relates to the sinuses and the skin. Four Horses are found in the “reaction area” of the lung and liver. Considering that the lung governs the skin, while the liver cleans the blood, these points are critically important in the treatment of all skin disorders. They also treat conjunctivitis and hyperthyroid, both of which have a relationship with the liver.
The reaction area is not included in most modern publications on Tung’s Acupuncture. It seems as if Master Tung may have taken his full understanding of the reaction areas to his grave. To date, I have not met a practitioner who can fully explain what “reaction area” means. One of my students is mapping the reaction areas of the body in an attempt to understand how Master Tung might have developed the concept. However, at times when we don’t understand how a point is working, we can study the reaction area for crucial information, as in Four Horses’ uniquely keen effect on the skin, or their use in the treatment of hyperthyroid conditions, both explained by the fact that the points are located in the lung and liver reaction area.
The Four Horses combination is used for breathing and asthma, common colds and flus, and all lung deficiencies, as well as any kind of pain from lung deficiency. A lung deficient type of sciatica is usually related to the UB channel, Hand Tai Yin/Foot Tai Yang. It is not necessary to use Four Horses for sciatica, since so many of Tung’s Points can effectively treat this disorder. However, if you are treating a patient who has both sciatica and asthma, the sciatica will improve with the application of Four Horses for asthma. Similarly, if you are treating sciatica in a patient who also has psoriasis, Four Horses is an excellent choice for this combination of disorders.
Common Colds and Flus
Four Horses are very good for the sinuses, eyes, ears, nose and throat. For rhinitis, sinusitis, and allergies, we choose Four Horses and add A04 Sanchasan and LI20 Yingxiang (Welcome Fragrance). Find Sanchasan at the location of SJ2 Yemen, but needle it with the patient’s hand in a fist or with the ring and little fingers bent, while they relax the rest of the hand. Sanchasan is found just anterior to the dorsal ligament that connects the dorsal distal heads of the fourth and fifth metacarpals. Flexing the wrist all the way backwards naturally creates the optimum finger position for needling this point. Do not bring the needle more distal for a more palmar insertion. Direct the needle between the knuckles, where a small tunnel is located; when you find this tunnel, the needle will slide in easily. Insert a 30mm needle all the way into the space, with strong stimulation. With some patients you may use a 40mm needle, but in this case, you may contact a blood vessel. This point is needled toward HT8 Shaofu, which partly explains its effectiveness in the treatment of itching.
LI20 is needled toward Yintang, using a technique in which the needle’s handle is held up to create a curve in the shaft that lifts the tip of the needle up and over the nasal bone, for a horizontal insertion. If the needle is not curved in this way, it will strike bone. Move the point of insertion away from the nasal ala, using the laugh lines, which are worn and desensitized, following them toward Yintang. A 30mm needle may be fully inserted. As the needle advances, the tip will be visible under the skin, arriving just below the bridge of the nose. Many blood vessels surround the nasal ala; therefore, perpendicular needling close to the nostril is very painful. Compared with perpendicular insertion, this technique is virtually painless, as the needle travels up and over the bone. With this technique, LI20 clears the entire sinus cavity within ten minutes; patients are surprised when they can suddenly breathe easily through both nostrils. Therefore, for allergies, colds and flus, the combination of Four Horses with Sanchasan and LI20 is a perfect pattern.
If a patient has a headache with a cold or flu, instead of Sanchasan, use 22.04 Da Bai, which is very useful in treating headaches. Alternately, for an even better treatment, needle Da Bai on one side and Sanchasan on the other side.
When treating a cold or flu, always start by cupping the patient’s neck and upper back in order to pull out the invading external wind. Make sure the room is very warm; turn on the heater before the patient disrobes. If the patient has already caught a chill, don’t create an additional source of cold in their environment. Another remedy for people who are sick with a cold is jook, which is soupy rice cooked with slices of fresh ginger and green onion with its roots intact. Although many people who are sick don’t want to eat, they can usually cook and eat a pot of jook to expel the cold wind through nutrition.
Allergies and Asthma
Four Horses is a wonderful combination for allergies. One of my patients came to me for treatment of allergies and asthma. She had been taking birth control pills for more than fifteen years. After a few months, I convinced her to stop taking birth control, and it took us longer than usual, six months, to start her monthly bleeding again. Now she is bleeding regularly. However, asthma was her primary reason for coming to the clinic. She is 27 years old and had childhood asthma and very bad allergies, including allergic reactions to her dog, who sleeps in her bedroom. Exposure to cats and rabbits, and alcohol consumption, caused her to congest and wheeze immediately. She liked to jog, but was no longer able to run. She often went to her sister’s house to help with her children, and she always had an asthma attack as soon as she walked into the house.
For this patient, I am using Four Horses, Sanchasan, and LI20, as well as 1010.19 and 1010.20 Water Gold, Water Through on the chin, excellent points for asthma. Because we are also balancing her hormones, I use 11.06 Return to the Nest and 11.24 Gynecological Points. When she is premenstrual and tearful or angry, I always add 11.17 Mu (Wood Anger) points. In my mind, she is also anorexic, although she would argue with that diagnosis. Low self-image, which is another element of her situation, can be very difficult to work with. She recently told me that she is dealing with alcohol addiction, too. Fortunately, her asthma and allergies are virtually gone, and she is running again. She can be in the house with the bunny, dog, and cats, without a reaction. For a very long time, she carried her herbs everywhere she went; she took them before entering her sister’s house in order to prevent asthma attacks. Now she is able to decrease her use of herbs, since she is no longer wheezing. She has not used an inhaler in more than six months. However, when she drinks alcohol, she gets a slight wheeze; this is currently our biggest obstacle. Otherwise, she is doing very well. The combination of Water Gold, Water Through with Four Horses is incredibly powerful.
This same patient often experienced a breakout of tiny bumps, more like eczema than acne, always in the same area on her chin, just before her menstrual period. She recently caught a common cold, for which I prescribed a Lung and Sinus formula. She later said, “The minute I started taking those lung herbs, the skin outbreak completely went away.” This side effect of the formula can be attributed to the close connection between the lung and skin.
Another of my patients has suffered from a lifetime of severe asthma. A retired school teacher, she is now 65 years old. She had breast cancer in her mid-thirties, and underwent a double mastectomy approximately ten years before I met her. She had silicone breast implants inserted and reconstructive surgery performed along with the mastectomy. She came to me for treatment when she experienced avalanche bleeding with menopause. We quickly stopped the bleeding, using 11.06 Return to the Nest, 11.24 Gynecological Points, and alternating 88.04, 88.05, 88.06 Three Sisters and Three Plum Blossom. After a short time, using Four Horses, we also had her asthma completely under control, so that she was able to exercise daily and discontinue using inhalers.
Sadly, one day five years ago, one of her breast implants burst. The surgeon cleaned it up surgically, “as best he could.” Since that day, she has had asthma that does not respond to any treatment. We work on her kidneys and lungs; we use Four Horses and Water Gold, Water Through; we bleed LU5 Chize or LU10 (Tung’s 22.11 Tu Shui); and we cup DT01 and DT02, the Toxin Points. Currently, she manages her asthma by taking Claritin-D every day, since no other approach seems to work as well. We had successfully completed her asthma treatment, and she was breathing easily without inhalers for more than fifteen years, when that incident occurred. Apparently, silicone cannot be entirely cleaned out of the body. It was most unfortunate.
For the vast majority of patients, Four Horses and Water Gold, Water Through are remarkable points for asthma. If a patient is having a severe asthma attack and is going to the emergency room to be put on a respirator, I either bleed or cup Dingchuan, on either side of GV14 Dazhui, to slow the wheezing and gain time for further treatment. I then needle the points reviewed above. I may add 33.13, 33.14, 33.15 Man, Earth and Heaven Scholars on the forearms, if necessary. Such a treatment includes far more needles than I would normally use for an average asthma case. In this type of emergency situation, I might also bleed either LU5, or any available veins found along the Four Flower line, 77.08 to 77.14.
Four Horses with Water Gold, Water Through requires a lot of needles, but is a very powerful combination of points. Four Horses works on the lung and liver, while Water Gold, Water Through works on the lung and kidney. This combination’s reference to gold, or metal, relates to the lung, while water clearly relates to the kidney. Water Gold, Water Through will strengthen the kidneys to hold the lung qi. Lung qi is meant to descend and to be grasped by kidney energy. If kidney energy is weak, the lung qi floats, resulting in coughing and wheezing. These points are very good for acute or chronic cough and asthma.
For virtually any kind of skin disorder, consider using Four Horses. If the disorder is severe, you may also want to bleed any veins on the upper third of the back of the ear. The Shao Yang and Tai Yang channels both extend to the back of the ear; Shao Yang is related to internal wind, while Tai Yang relates to external wind. Both internal and external wind may be connected with skin diseases. You may also bleed the ear apex, which is the tip of the ear when the ear is folded forward. Bleeding treatments like these can be given once a week.
For psoriasis, poison oak, hives, rashes and itching, Four Horses are extremely effective. Classic acupuncture points for itching include SP6 Sanyinjiao, SP10 Xuehai, and LI11 Quchi; these are good choices as well. You may rotate these points, needling Four Horses one week, then SP6, SP10, and LI11 the following week. For allergic or toxin-related types of itching, you may seven star hammer and cup the Toxin Points DT01 and DT02, found along the lateral edge of the scapula. Although patients do not typically complain of pain in this area—unless they have been painting a ceiling, trimming trees, or otherwise using the muscles on the outside of the scapula—it is a region of the body that holds pollution. Wastes are stored in this area when the liver is unable to clean them from the bloodstream. For example, in people who lay carpet, work in print shops, repair cars, or take pharmaceuticals with side effects, the toxin area must be cleaned regularly. In all of the patients in my practice, I keep this area cleaned out.
For severe itching, a practitioner may seven star hammer and cup the toxin area. Although this is a very painful treatment, for people with severe poison oak, it will provide enormous relief from insatiable itching. The seven star hammer treatment is not needed for chemical exposures from chemotherapy, radiation, HIV cocktails, or medications; in these cases, simply cup the toxin points. For itching from shingles, you may seven star hammer and cup the toxin points, but only if no shingles appear in the toxin area; if shingles occur there, the virus can be spread by this treatment.
To quickly eliminate the severe burning from searing nerve pain that often comes in the aftermath of shingles—a pain that can last up to a year—we can offer a very effective, very powerful, but extremely painful treatment. For these reasons, the treatment must be thoroughly discussed with the patient, and the patient must willingly consent. Excruciating nerve pain occurs after shingles because the toxic virus is still lodged in the surface; we need to open it and allow the poison to come out. Once the scabs have fallen from the lesions and only the fresh pink skin beneath is visible, we may seven star hammer the pink skin and cup over the area, in as many areas as possible. Because shingles often appear within the hairline or over bony areas, cups may not be easily applied. Hammer firmly, and you will not need to repeat the technique in that area. One swipe with a sterile pad will convince the patient of the immediate effectiveness of this painful approach. In most cases the nerve pain will be gone. Only occasionally have I needed to repeat the procedure. Timing is important; before the fresh pink skin has disappeared, we know where to locate the problem. Otherwise we must make a guess based on the patient’s report, which means we inevitably seven star hammer healthy skin in our attempt to cover the diseased areas. Be sure not to hammer when blisters are still present, or over a scab. This powerful treatment is also excellent in the treatment of stubborn herpes outbreaks, and guarantees that a herpes outbreak will never again occur in that same location. Patients will tell you that the short-term pain of the treatment far outweighs the reoccurring burning and itching of herpes. Of course, it is assumed that one would never consider hammering the most private areas.
LI11 Quchi is a primary point for wind, and SP10 Xuehai, the Sea of Blood point, is a primary point for blood; therefore, these points are classically combined for itching and rashes. For wind disorders, it is necessary to treat the blood. Itching and skin rashes result from the fighting of qi and blood, and of wind and fire, inflaming the skin. It is critical to expel the wind and move the blood. We can alternate LI11 and SP10 with Four Horses. Additionally, you might use SP10 with the extra point, One Hundred Insects Nest, located one cun proximal to SP10. SP6 Sanyinjiao may also be used, as it strengthens the spleen and eliminates dampness. Because itching, sores and pain all belong to the heart, H8 Shaofu, the ying-spring fire point on the heart meridian, is another good choice for itching. Egg yolk is also beneficial for itching, whereas patients with skin issues should avoid egg whites, which increase wind.
For acne, Four Horses can be used along with LI20, which helps to guide the power of Four Horses to the face. Such a guiding point is very useful, as it directs the body’s energy to the area needing treatment. For adolescent acne, adult acne, or deeper, more painful types of boils, Four Horses will excel. For all of these skin issues, the blood needs thorough cleaning, so the practitioner should cup the toxin area weekly, until the skin stops coloring, indicating that there are no more poisons in the area. Deep acne is more difficult to treat. If a patient suffers from a severe case of acne, bleed GV14, UB13 Feishu, and UB15 Xinshu (lung and heart shu) to clear heat, and/or bleed the back of the ear.
Four Horses are remarkable points for psoriasis. When I see an eczema or psoriasis patient for the first time, particularly if the case is extreme, I tell them directly and clearly that if they are not 100% compliant with the dietary requirements for these conditions, they should not waste my time or their own by coming for treatment. With psoriasis, a patient must wear cotton clothing and not polyester, and avoid lying or sitting on carpets, which contain chemical toxins. They must avoid all caffeine, alcohol, spicy foods, wheat, dairy products, and sugar, which feed inflammation. The diet is difficult to follow, but success rates are consistently high for patients who are willing to comply.
My most recent psoriasis patient worked very hard to improve his condition, and within three months of treatment, his head-to-toe psoriasis was 90% under control—a fine example of the remarkable effectiveness of Four Horses. This patient had a severe case of psoriasis on his hands and fingers; all of his fingernails were pitted and deformed. He worked as a real estate agent and often shook clients’ hands during the workday; his hands needed to look clear and presentable. After three months of acupuncture and herbal treatment, his hands were completely free of lesions. For this patient, I needled not only Four Horses, but also 11.17 Mu (Wood) points, bilaterally, which are specifically used for treatment of skin diseases on the hands. Bilateral Wood points can also be applied for people with dripping wet, sweating palms. For all other disorders, 11.17 is needled only on the left side, opposite the liver.
Unfortunately, the above-mentioned patient loved caffeine and alcohol. He was an alcoholic who had been sober for a number of years, but had started drinking a little bit again in the weeks before he came to see me. He also liked to eat spicy Thai food. He limited his diet for three months, which contributed to the 90% improvement of his psoriasis. However, he began missing appointments and making excuses because he did not have the emotional strength and discipline to maintain treatment. He bought a tanning bed instead of continuing acupuncture and herbs, since sunlight is very good for psoriasis. It is common for patients to become overly confident when they experience remarkable results from treatment.
Fifteen years ago, I treated another patient who also suffered from severe psoriasis. He was from the Philippines, and his skin should have been brown, but it was crusty white and pink, inflamed, and painful, with almost no healthy skin. The psoriasis had entered his joints; the fingers and knees were especially painful. We achieved excellent results in his case, as well. Psoriasis requires a good herbal formula as well as acupuncture. I gave this patient the analgesic Scheffler Root, also known as Qi Ye Lian, an extraordinary single-herb that increases circulation and brings down inflammation, and is especially helpful in cases of arthritis and joint pain. This herb does not work quickly, as pharmaceuticals do; instead, it may take up to six weeks of regular dosing before significant effects can be seen. It was very effective for the patient with psoriasis in his joints. He also took a special psoriasis formula, enjoyed regular full-body sunbaths, and was extremely disciplined with his dietary restrictions. Misery is a very good motivator. His skin slowly transformed from inflamed pink to smooth white, then from white to its natural brown hue. After a treatment duration of nearly nine months, the patient was very pleased with his results. To my knowledge, his condition never returned.
Some patients have very large psoriatric lesions, broader than the width of two hands. In some cases, it is helpful to seven star hammer the perimeter of the lesion, but only on the healthy skin around the lesion’s edges. This stimulates the healing process in the area, and results in the slow shrinking of the lesion; each week, you will notice a significant decrease in its size. However, a seven star hammer treatment is very painful, and therefore should be optional.
As psoriasis is thought to be an autoimmune disease, the patient’s abstinence from toxins and allergens is of the utmost importance. No words are spared in my initial visit with such patients. They must agree to full compliance with dietary and lifestyle restrictions before I will proceed with their treatment.
Ears and Eyes
Four Horses is used for ear infection and otitis media, due to its strong Shao Yang connection, as the Foot Shao Yang channel wraps around the ears. I typically use either Four Horses bilaterally, or 77.22 and 77.23 Beside Three Miles on the opposite side, with 22.06 Zhongbai on the affected side. Bleeding any veins in the vicinity of the external malleolus will give a nice boost to the treatment effects. An appropriate herbal formula is also recommended for these ailments.
Tinnitus can be difficult to treat, no matter what the modality. Western medicine offers little or no recourse for people suffering from ringing in the ears, and patients who seek acupuncture have often been suffering for many years with little help. Traditional Chinese Medicine ordinarily instructs us to treat this problem as a kidney deficiency, but this approach sometimes has no effect. Dr. Young has discovered that in tinnitus cases, the tonification of spleen qi often has a far superior impact. Thanks to his findings, Four Horses with 22.05 Ling Gu, which tonifies qi, is now my favorite combination for tinnitus. Sanchasan with Ling Gu and GB31 Nine Miles is also effective. SI19 Tinggong can be added as a guiding point to direct the qi toward the ear. A spleen tonifying formula, like Yi Qi Chong Ming Tang, which consists of Bu Zhong Yi Qi Tang plus Ge Gen, can be helpful, too.
For cases of tinnitus that are clearly caused by kidney deficiency, use 22.06 and 22.07 Zhongbai and Xiabai, SI3-22.08 Wrist Prosperous, and Ling Gu, as well as GB31- 88.25 Nine Miles, GB41 Linqi and GB42. The tonifying of Three Emperors (77.18 Shenguan, with 77.19 and 77.21) and 88.12 Minghuang is also recommended. The bleeding of LU5 Chize may be helpful.
In cases of deafness or sudden hearing loss, any of the above treatments may be attempted, with an emphasis on 77.18 Shenguan (Kidney Gate). Bleed GV16 Fengfu and needle 88.32 Shiyin (Lost Voice), and add the three points in front of the ear. This condition can be very difficult to treat successfully, especially if its duration has been longer than one year.
Four Horses can also be used for conjunctivitis or eye problems such as red or irritated sclera. The sclera belongs to the lungs. This connection was illustrated for me very clearly in Cleveland, Ohio, where I taught a bleeding class. One student’s eyes were bright red and irritated, as if he had not slept for many days and nights. He volunteered to serve as the patient for my demonstration of bleeding LU5 Chize. The entire class watched as LU5 bled and his sclera cleared, changing from red to white, within ten minutes—a flawless example of the direct link between the lung and the sclera. Such extraordinary results often occur with bleeding techniques. The relationship between Four Horses and the lung and liver also explains its effectiveness in treating the eyes. For this reason, the point combination can be utilized to treat conjunctivitis.
Four Horses is not used for swollen eyelids; that disorder belongs to the spleen, since the spleen governs the eyelids. Swollen eyelids may be treated with A04 Sanchasan and 66.05 Menjin (Golden Gate), also a useful combination for people who cannot keep their eyelids open due to weakness and deficiency.
Hyperthyroidism and Goiter
According to TCM, simple goiter is phlegm accumulation in the neck, caused by qi and blood stagnation. If irritability and frustration are also present, the condition may easily transform into spleen qi (phlegm) obstruction with liver qi stagnation causing liver fire to rise, and resulting in heart yin deficiency, or a hyperthyroid condition. Commonly, there is a significant emotional component involved. Because Four Horses is located between the Shao Yang and Yang Ming channels, it is capable of addressing both wind and phlegm in a powerful way. Due to the relationships between San Jiao and gallbladder, gallbladder and liver, and spleen and stomach, as well as the location of the thyroid gland, Four Horses becomes one of the best point patterns in the treatment of hyperthyroid disease. A strong herbal formula is also required.
In two cases of gestational hyperthyroid, I chose Tung’s Points 77.25 Zuwujin and 77.24 Zuqianjin (Leg Five Gold and Leg Thousand Gold), instead of Four Horses. These points may have acted more slowly, but they worked beautifully. This diagnosis also requires a carefully designed herbal prescription, in order to avoid sedation of the fetus.
Fibromyalgia, Multiple Sclerosis, Breast Pain, Chest Pain,
Facial Spasms and Heel Pain
Because muscle treats muscle, and Four Horses is located in large muscle, this combination is very good for fibromyalgia and multiple sclerosis. Add Sanchasan for patients with these disorders. In cases of multiple sclerosis, scalp acupuncture should be used as well. In patients suffering from fibromyalgia, the nerves are ten times more reactive than when nerve sensation is normal, causing extreme nerve, muscle, and joint pain. With fibromyalgia patients, I like to apply very gentle cupping in a small area, such as a single joint or muscle group; it is painful but effective. Apply one cup, using three pumps only, and leave the cup on the body for only three minutes. Add 1010.08 Zhenjing, just above Yintang and 11.17 Mu (Wood) points to calm the spirit, since people with fibromyalgia are often very tense, and usually suffer from irritability and depression as well. Prepare the patient thoroughly, explaining the additional pain of cupping, so that they will not be surprised about the discomfort or the cupping marks.
For breast pain and breast cancer, we can use Four Horses along with Four Flower Upper and Middle. Another Tung’s Point pattern found between the Shao Yang and Yang Ming channels, 66.06 and 66.07, Mudou, Muliu (Wood Keep and Wood Scoop), is also a beneficial combination. Rather than using gallbladder points, Master Tung’s system employs many potent points between the Shao Yang and Yang Ming channels, with combined and powerful effects on both channels; such points are especially useful for diseases with wind or phlegm as causative factors.
For chest, abdomen and rib pain, breast pain and hemiplegia, needle Four Horses on the opposite side. Many additional combinations can be applied. For rib pain that moves from the front to the side, and for chest pain around the ribs, particularly flank pain, we can also use SJ6 Zhigou and GB34 Yanglingquan. For chest pain in the front, I select PC6 Neiguan and SP4 Gongsun; however, I needle PC6 first to open the chest, followed by SP4. Bilateral needling is not necessary; choose one side for each point. SP4 and PC6 are also useful for abdominal pain, but for this complaint we needle SP4 first in order to direct the body’s energy to the abdomen.
One of my colleagues, Dr. Hoang Ta, recently described his use of Four Horses for facial spasms. A 75-year-old female patient told the physician that she experienced frequent spasms in the right side of her face. Because she reported that they seemed much worse when the weather was changing, damp, windy or cold, he cleverly decided to try Four Horses. Approximately ten minutes after the insertion of the needles, the spasms completely stopped. He gave her a second treatment the next day, to reinforce the first. Although this doctor applied needles to both sides, I suggest needling the opposite side first with strong stimulation, and adding the points on the other side after twenty minutes, to boost the immune system. Cupping the jaw would also be appropriate in such a case, as long as the patient is very careful to protect the post-cupping area from wind or cold, with a wrap or scarf. Moxa would also help to increase circulation in the affected area. I appreciate the physician’s logic, as he was “thinking outside the box,” a strategy applied by practitioners who truly know the points and the body.
Four Horses can be used for heel pain, and you may add the hand heel points, PC7 Daling and a point 1” distal to PC7. It is important to determine the cause of the patient’s heel pain. If it is plantar fasciitis, arch supports are an excellent remedy; without arch supports, the pain will never heal completely. Supportive shoes and calf muscle stretches are also necessary. If heel pain occurs with bone spurs, usually it is a result of soft tissue inflammation, rather than the spur itself. The body lays down calcium in the form of bone spurs to shore up an area of weakness, but in an inefficient way; the spurs cause tissue inflammation, which are the true source of the discomfort. The patient will need an herbal formula for soft tissue inflammation.
In closing, I hope that each of you reading or listening to this paper have gleaned a few helpful ideas about the many uses of the powerful Master Tung’s Points combination known as Four Horses. With proper point location and technique, and a little practice, they will become invaluable tools in your clinical repertoire. I find myself using these points many times each day, especially during the change of seasons when it is very easy for people to catch cold. But it would be a shame to stop there. The versatility of Four Horses put them in the top five of my favorites of Master Tung’s extraordinary points. I guarantee that the more familiar you become with these points, the more amazing they will become for you, and for those whom you treat.
In the clinic of my teacher, Dr. Miriam Lee, OMD, her students called these points “Tung’s Magic Points,” and the name stuck. There are many who think that the word “magic” cheapens or trivializes the points. Of course, the points are not really magic, any more than the I-Ching is magic. However, some of us see magic and nearly transcendental inspiration in the mathematical perfection of the I-Ching. Likewise, we find exquisite beauty in Tung’s Acupuncture Points. Other systems offer profound and inspired points as well, but none are more extraordinary than these. Ask those who use them, or better yet, those who receive them. The methods and reasons for the points’ effectiveness will continue to expand, the longer you study and practice them. I am deeply indebted to Dr. Young Wei-Chieh for bringing Tung’s Acupuncture to the United States, and for teaching me these points, beginning in 1987; without him, I would not be standing here.
It is such a great honor to be invited here today to celebrate the 35th anniversary of the passing of one of the greatest acupuncturists who ever walked the earth, Master Tung Ching-Chang. Knowing that his feet touched this very soil, here in Qingdou where we walk today, is a thrill that I never expected to experience. I can only pray to be worthy of this privilege, and will continue to dedicate my life to the service of humanity and to the spreading of my limited understanding of his profound body of work. Few people in the history of mankind have made as significant a contribution as Master Tung, to ease the pain and suffering that is the human condition. It is with the greatest gratitude and respect that we celebrate him on this day.
Susan Johnson, L.Ac. was licensed by the State of California, USA, in 1985. She was first exposed to Tung’s Acupuncture in 1982, in the clinic of Dr. Lee Chuan-Djin, OMD (Dr. Miriam Lee) in Palo Alto, California. Susan was a primary student of Dr. Lee for more than twelve years, and they traveled to Hefei, China together in 1987, to study bleeding techniques with Dr. Wang Xiu-Zhen. Also in 1987, Susan was introduced to Dr. Young Wei-Chieh, which began a more in-depth inquiry into these extraordinary points. Since that time, she has taken classes with Dr. Young whenever possible, maintains a clinical practice in Santa Cruz, California, and teaches courses in Master Tung’s Magic Points throughout the United States.