Pericardium Meridian
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PC-4
Xi-Cleft Point
Needle Depth
0.5-1.0 cun
Needle Angle
90° (Perpendicular)
Body Area
Forearm
Location
5 cun above the transverse crease of the wrist, on the line connecting Quze P-3 and Daling P-7, between the tendons of palmaris longus and flexor carpi radialis muscles.
Main Actions
- Invigorates Blood and removes Stagnation
- Cools Blood and stops bleeding
- Calms the Mind
- Opens the Channel and eases pain
Indications
Commentary
Ximen P-4 is mostly used in acute conditions and is very effective in opening the chest and remove Heart Blood Stagnation so as to stop pain. As the Accumulation-Xi point, it is particularly useful in removing the Obstruction in Pericardium Channel. Therefore, it can ease chest and Heart pain.
It is also useful in calming the Heart and regulating its rhythm. Thus it is often used to treat arrhythmia and palpitations. It calm the Mind as well. The typical symptoms are agitation, anxiety, insomnia, mental restlessness, depression and fright.
Classical Sources
《针灸甲乙经》Zhenjiu Jiayi Jing (Systematic Classic of Acupuncture): "Heart pain, nosebleed, retching, vomiting blood, fright and fear of people, insufficiency of spirit-qi - Ximen masters these."
《备急千金要方》Beiji Qianjin Yaofang (Essential Prescriptions Worth a Thousand Gold): "Vomiting blood - Daling and Ximen master this."
《类经图翼》Lei Jing Tu Yi (Illustrated Supplement to the Classified Classic): "Main treatments: vomiting blood, nosebleed, heart pain, retching with fright and fear, insufficiency of spirit-qi, chronic hemorrhoids."
《针灸大成》Zhenjiu Dacheng (Great Compendium of Acupuncture): "Main treatments: vomiting blood, nosebleed, heart pain."
How to Locate
First locate Daling P-7 in the center of the anterior wrist joint space and Quze P-3 in the cubital crease. Use the spread finger technique by placing the little fingers in both points and identify the middle point, from where measure 1 cun in a distal direction. On this level, locate Ximen P-4 between the tendons of palmaris longus and flexor carpi radialis muscles. If only one tendon is visible, this will be the tendon of the flexor carpi radialis muscle. P-4 is located on its ulnar aspect.
Caution
The median nerve lies deep to this point. Avoid excessive depth or aggressive manipulation to prevent nerve injury. The anterior interosseous artery and vein are located in the deep layers. Use perpendicular insertion with moderate depth (0.5-1.0 cun) and gentle manipulation. In patients with bleeding disorders or on anticoagulant therapy, exercise caution due to the proximity of blood vessels.
Needle Angle
90° (Perpendicular)
Depth Category
Medium
Standard Depth
0.5-1.0 cun
Needling Directions
0.5–1 cun vertically or 1–1.5 cun obliquely in a proximal direction.
Expected Deqi Sensation
Local distension and soreness at the point, with possible sensation radiating distally toward the fingertips or proximally toward the elbow. Patients may experience a numb or aching sensation along the course of the Pericardium channel. For cardiac conditions, the needle sensation may propagate toward the chest area.
Moxibustion
Recommended
Duration: 5-10 minutes
Cupping
Questionable
Bloodletting
Recommended
Gua Sha
Questionable
Special Point Classifications
Xi-Cleft Point
Related Resources
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