The Four Horses (88.17, 88.18, 88.19)
Location: Draw a line from the ASIS to the superior lateral border of the patella, this is the stomach meridian. The points are located on the ST meridian 5, 7, and 9 cun above the lateral superior border of the patella.
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When locating these points first palpate the region by using the palm of your hand. This will let you know the degree of sensitivity in the region. To locate the most effective points for each patient, use your thumb or fingers to find the precise points where there is the most pain with palpation.
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The Four Horses for Respiratory disorders
The Four Horses are widely known for treating respiratory and skin disorders. This can be traditionally described through 5 - Element theory, where the earth element and stomach meridian can be used to supplement the metal element and lung.
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In myofascial anatomy we can observe a kinetic link between points on the quadriceps and fascia of the chest. The image shows the Superfical Front Line (SFL) and it includes the tibialis anterior, quadriceps, rectus abdominis, and sternalis muscles. Fascia that connects to the sternum is also a part of this line, as are the secondary respiratory muscles of the sternocleidomastoid (SCM).
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In TCM the acupuncture points ST 36 and ST 40 are used for various lung patterns and disorders, and those points are also a part of the superfical front line.
Stomach Meridian Points for the Lungs
In TCM style acupuncture it is common to use ST 36 for boosting the wei qi and lung qi. Similarly, stomach 40 is used for phlegm in the lungs. While there are various zang-fu patterns that would warrant the use of ST 36 and ST 40, TCM style acupuncture does not typically use points on the ST meridian in the area of the thigh.
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In Master Tung style acupuncture two point groups on the stomach meridian are used for treating the lungs. The Four Horses are likely the most commonly suggested points, but the Four Flowers are also widely recoginzed for treating lung diseases as well. The Four Flowers are similar to ST 36, ST 37, and ST 40.
Contrasting the Four Horses with ST 36, ST 37, and the Four Flowers
In the Master Tung system the Four Flowers include 77.08, 77.09, and 77.11. The first point 77.08 is located near stomach 36 but is located on the edge of the tibia and in the space between the edge of the bone and the tibialis anterior muscle. The second point is also on the edge of the tibia and 7.5 cun distal to ST 35. The point 77.11 is 12.5 cun distal to ST 35 and also on the edge of the tibia. These points are often needled as a dao ma or three point combination.
In some regards the Four Flowers are similar to the Four Horses because they are a three point unit on the stomach meridian. Both point groups also treat respiratory conditions. However, the Four Flowers are also indicated for heart disorders, shoulder problems (think ST 38), and more.
A question then becomes, when should one use the Four Horses over the Four Flowers? The simplest way to answer this is to examine the clients overall pattern, and specifically their top three health concerns. For a client that has both a respiratory condition and cardiovascular disease, I would be more likely to needle the Four Flowers since they are indicated for both. However, for a client with asthma, rib-side pain, and psoriasis I would needle the Four Horses. When choosing between two similar point groups like this, it is crucial to ask the client about their top three health complaints, and use this as a factor in making your final point decisions.
The Four Horses For Skin Conditions
Skin disorders can be difficult to treat but these points can frequently provide effective results. The ability of these points to treat skin conditions may also have something to do with the myofascia. As we know the fascia surround the muscles, and are also located in the region between the skin and muscles. Fascia and other connective tissues provide structural support to the body in a variety of ways, and fascia are also densely filled with nerves.
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The needle technique to use when using the Four Horses for skin conditions is to needle to the deep level and twirl the needles for at least 3 - 5 seconds. After that retain the needles at the deep level for 5 - 10 minutes and depending on the clients overall sensitivity and responsiveness to acupuncture. After that bring the needles to the middle level, twirl them for 3 -5 seconds, and leave for another 5 - 10 minutes. Repeat this process a final time at a shallow skin level. Doing this applies stimulus at all three levels of heaven, people, and earth.
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I prefer twirling technique, as research by Helene Langvine has shown that twirling the needles causes them to stretch the fascia and elicit changes in connective tissue protein physiology. Twirling at the deep, middle, and superfical skin levels possibly causes systemic changes in the fascia and specifically in the region between the skin and muscles. This may provide a partial account for why these points can treat skin disorders. The size of the quadriceps and the volume of connective tissues in this area may also play a role in affecting the skin througut the body.
The Four Horses, Skin, and Diet
While the Four Horses are beneficial for many skin conditions, the role of diet cannot be neglected in a holistic health program. Many times I have used the Four Horses successfully but the client would only get temporary results. The results could last a few days, weeks, or even months; however, if dietary factors are contributing to the problem that must be addressed as well.
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When clients present with both skin disorders and digestive problems there is almost always a link between the two. This occurs especially when there are inflammatory bowel conditions, or any other kind of chronic inflammation in the gastro-intestinal system.
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Identifying the reactive foods is key to the success of these kinds of patients. I always suggest and encourage the clients to keep a dietary journal. While they may be able to identify problematic foods fairly quickly, it often takes months to identify and isolate all the foods involved in pathology. When beneficial results are noticed with both the digestive and skin disorders it is a great relief to patients.
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For abdominal pain due to allergic food reactions I highly recommend adding 66.05 to the total treatment protocol.