Acupuncture
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EX-LE-4
Safety Warnings
- Dangerous point - requires extra caution
- Deep needling contraindicated - shallow insertion only
Needle Depth
0.5–1.0 cun
Needle Angle
90° (Perpendicular), 45° (Oblique)
Body Area
Knee
Location
With the knee flexed, inferior to the patella, in a depression medial to the patellar ligament. Dubi ST-35 is at the same level, in a depression lateral to the patellar ligament. Both points form the Extra point of Xiyan EX-LE-5.
Main Actions
- Expels Wind-Damp
- Reduces swelling and pain
Indications
Commentary
Dubi ST-35 and Neixiyan EX-LE-4 form the Extra point of Xiyan EX-LE-5. All of them are important local points in treating various knee disorders such as swellings and pain.
Classical Sources
Beiji Qianjin Yaofang (備急千金要方, Essential Prescriptions Worth a Thousand Gold) by Sun Simiao (652 CE): "Located below the kneecap, in the depressions on both sides, in the hollow." This Tang dynasty text is one of the earliest sources to document this point.
Waitai Miyao (外台秘要, Arcane Essentials from the Imperial Library): Records that for leg qi (beriberi), when the heart and abdominal qi are settled but the outer thighs and knees feel oppressed, moxibustion at the knee eyes with 7 cones is appropriate.
Taiping Shenghuifang (太平聖惠方, Imperial Grace Formulary): "Knee eyes, four points, below the kneecap on both sides, in the depressions. Needle 0.5 fen. Retain for three breaths, drain for five inhalations. Indicated for unceasing cold pain in the knee. Moxibustion is contraindicated."
Bianque Shenying Zhenjiu Yulong Jing (扁鹊神应针灸玉龙经, Bian Que's Miraculous Jade Dragon Classic of Acupuncture): "For leg pain: Hip bone can treat pain in both legs, the same for knee redness and swelling. Knee joints and knee eyes must all be needled. Needle 3 fen, moxibustion contraindicated."
How to Locate
It is recommended to flex the knee to better locate the point. There are two eyes of knee located on the level of the lower border of the patella, lateral and medial to the patellar ligament. The medial one is Neixiyan EX-LE-4.
Caution
This point is located directly adjacent to the knee joint capsule. Avoid needling too deeply to prevent intra-articular puncture and potential joint infection. Direct scarring moxibustion is contraindicated at this location. Some classical texts contraindicate all moxibustion at this point. When needling obliquely toward Dubi ST-35 (threading technique), exercise caution regarding depth. Maintain strict sterile technique due to proximity to the joint space.
Needle Angle
90° (Perpendicular) / 45° (Oblique)
Depth Category
Medium
Standard Depth
0.5–1.0 cun
Needling Directions
0.5–1 cun vertically or obliquely towards the lateral eye of the knee. Caution: Do not needle too deeply to avoid intra-articular puncture.
Expected Deqi Sensation
Local distension and soreness at the knee that may spread throughout the knee joint. Some patients experience a sensation of fullness within the joint capsule. Directing the needle toward the center of the knee or toward Dubi ST-35 intensifies the sensation.
Moxibustion
Recommended
Duration: 10–15 minutes
Cupping
Recommended
Bloodletting
N/A
Gua Sha
Questionable
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