Command points and the four gates

The four command points are four points named in a four-line verse, the si zong xue ge (四總穴歌, song of the four general points), which gives each one a region of the body: ST36 (Zusanli) for the abdomen, BL40 (Weizhong) for the back, LU07 (Lieque) for the head and nape, and LI04 (Hegu) for the face and mouth. The four gates, si guan (四關), is an older phrase from the first chapter of the Lingshu that later texts, and the modern studies below, read as one pair: LI04 on both hands with LV03 (Taichong) on both feet. Both groupings come from the same Ming book, Xu Feng’s Zhenjiu daquan, and this page sets out what the texts say and where they disagree.

The verse

The earliest text found for this page that contains the verse is the Zhenjiu daquan (針灸大全, Great Compendium of Acupuncture and Moxibustion) of Xu Feng, which the Wikisource edition dates to 1439. It prints the four lines under their own heading, with no author, between Ma Danyang’s song of the twelve heavenly star points and a song of eleven points titled after the Qianjin. The four lines are the whole verse.

The song of eleven points that follows it in the Zhenjiu daquan covers the same regions with more points, pairing Sanli with Neiting for the abdomen, Quchi with Hegu for the head and face, and Weizhong with Kunlun for the back. All four command points also belong to the twelve of the heavenly star verse, whose history Heavenly star points traces.

Gao Wu’s Zhenjiu juying, dated by the WHO International Standard Terminologies on Traditional Medicine to 1529, gives the same four lines under the same title. Yang Jizhou’s Zhenjiu dacheng, which the WHO terminology dates to 1601, prints them again in its fourth volume, after Ma Danyang’s twelve points and before a different verse, the Zhouhou ge (肘後歌). None of the three books names an author for the verse, and none gives it a fifth or sixth line.

The four gates in the Lingshu

Chapter 1 of the Lingshu, the half of the Huangdi Neijing that deals with needling, says the five zang organs have six fu organs, the six fu have twelve source points, and the twelve source points emerge at the four gates; the four gates govern the five zang, and when one of the five zang is ill the twelve source points are the ones to take.

The chapter then names the twelve: the source point of each of the five zang, counted on both sides of the body, and one point each for the gao and the huang, Jiuwei and Boyang. Taichong, the liver’s source point, is one of the twelve; Hegu is not, since the chapter lists no source points of the fu channels. It does not say where the four gates are. The source points of all twelve channels are listed by code in Source, connecting and cleft points.

Later commentators on the Lingshu read the gates as joints of the limbs. Zhang Jiebin’s Leijing, which the WHO terminology dates to 1624, says the four gates are the two elbows and the two knees, the great gates of the body’s joints, and that this is why every well, spring, stream, source, river and sea point lies at or below the elbow on the arm and the knee on the leg; those positions are set out in Five transport points. Zhang Zhicong’s Lingshu jizhu, which the Wikisource edition dates to 1672, reads them more widely, as the elbows, armpits and hips and a fourth pair of joints whose character is missing from that transcription.

From the four limbs to two points

The phrase reached the acupuncture verses through the Biao you fu (標幽賦, Ode to Elucidate Mysteries), printed in the Zhenjing zhinan of Dou Hanqing, whom the WHO terminology names as Dou Jie and dates to 1295. The ode says that cold, heat, pain and numbness are ended by opening the four gates, and does not say which points those are.

The commentators on the ode answer in two ways. The annotated ode in the Yuan-dynasty Bian Que shen ying zhenjiu yulong jing (Jade Dragon Classic) says the four gates are the two hands and the two feet, and places them among the sixty-six points, the transport and source points of the limbs. The annotation in the Zhenjiu daquan of 1439 repeats the Lingshu’s sentence on the twelve source points and ends: the four gates are Taichong and Hegu. Yang Jizhou’s commentary on the ode in the second volume of the Zhenjiu dacheng keeps both readings in consecutive sentences, naming Taichong and Hegu and then saying that to open the four gates is to needle the two hands and the two feet.

A 2026 textual study by Chai and colleagues in Zhongguo Zhen Jiu traces the pairing to Xu Feng. According to its abstract, Xu Feng’s annotation of the Biao you fu in the Zhenjiu daquan is the first text to tie the four gates to LI04 and LV03; physicians before him did not commonly use the two as a pair; and even after his gloss, practitioners mostly chose each point for its own indications rather than for opening the four gates. The authors conclude that research on the pair should keep formulating a theory apart from validating it.

What modern studies have tested

Studies of the four gates in English-language journals test the LI04 and LV03 pair, needled on both sides, rather than the commentators’ joints. A group at Daejeon University in Korea ran two crossover trials in healthy men, measuring how fast swallowed radio-opaque markers moved through the gut after real or sham needling. The 2007 trial by Yim and colleagues, in 20 men, found the markers distributed almost identically after real and sham needling. The 2013 trial by Shin and colleagues, in 21 men whose gut had been sped up with the drug mosapride, found motility generally lower after real needling, with a statistically significant difference at one of its time points, 24 hours after the first treatment.

A 2025 systematic review by Zhang and colleagues in Complementary Therapies in Clinical Practice pooled 19 randomised trials with 1,312 participants that compared acupuncture built on the four gates for migraine with drugs or with sham acupuncture. It reported lower headache intensity and fewer attacks in the acupuncture groups, no difference in adverse events, and rated the certainty of the evidence moderate to low under GRADE.

Imaging studies ask what the brain does during the needling. A 2014 resting-state fMRI study by Liang and colleagues needled the pair for three minutes in 14 people with Alzheimer’s disease and 14 controls, and reported changes in connectivity within the default mode network afterwards. A 2026 study by Xie and colleagues used near-infrared spectroscopy in 53 healthy right-handed adults to compare needling on the dominant side, the other side, both sides and sham, and found different patterns of cortical activity for each; the authors state that the findings do not establish that any configuration works better clinically.

Cautions in the sources

Two of the four command points carry a pregnancy caution. A 2015 review by Carr in Acupuncture in Medicine lists LI04 and LU07 among the points most often cited as forbidden throughout pregnancy, at least before 37 weeks, while noting that there is no consensus on the full list. How AcuiQ’s catalogue records those cautions is covered in Pregnancy and the forbidden points.

What these sources cannot tell you

The verse and the ode state rules and report no patients, and the Ming books that print them do not say where the verse came from. The texts cited are Wikisource transcriptions of particular printings, and the Zhenjiu daquan transcription is marked as one quarter proofread. The Korean trials measured gut transit in healthy men rather than treating a condition, and the imaging studies measured brain activity rather than symptoms. Chai and colleagues’ study and the migraine review are read here from their abstracts. A protocol on AcuiQ that uses LI04 with LV03 records that a study needled both points, not that its authors chose them as the four gates.