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Acupuncture point Liver 3 (LIV-3)

By Tom Kennedy

The acupuncture point Liver 3 (LIV-3) is one of the most commonly used points of all by acupuncturists. In this post, I’ll introduce some of its key attributes, discuss some interesting research, and share my own clinical experience (please share your own in the comments section!). You can also read the entire Liver 3 section from A Manual of Acupuncture below for in-depth information.

What makes acupuncture point Liver 3 special?

As the commentary in A Manual of Acupuncture reminds us (see below), Liver 3 is ‘arguably the most important point of the liver channel’. Xu Feng, the Ming dynasty physician, revered it’s powers so much that he added it to Ma Danyang’s famous ‘eleven heavenly star points’. It’s the Shu-Stream and Yuan-Source point of the channel, categories which suggest its usefulness in a wide variety of situations.

Research relating to Acupuncture point Liver 3

In an interesting piece of research undertaken in 2015 at Guangzhou University of Chinese Medicine in China, resting-state functional magnetic resonance (fMRI) imaging was used to investigate the effects on the brain of needling acupuncture points Liver 3 and Kidney 3. Perhaps most notably, the authors suggest that areas of the brain associated with emotion and vision were activated. Activity was decreased in another area also associated with emotion. Although the authors admit there were potential flaws in the methodology, it is intriguing that there may be a correlation between the traditional usage of Liver 3 (see below) and demonstrable effects on regions of the brain. This lends weight to a similar previous study using just Liver 3 carried out in 2014, which came to similar conclusions.

Another fMRI study carried out in 2014, this time using the 4 Gates (Liver 3 and Large Intestine 4), again showed significantly increased activity in various brain regions. Crucially, the same effects were not observed using sham acupuncture.

I’d love to see more of this kind of research done using various needle techniques to see whether the physiological response is different. This would be hard to control for in an experimental setting of course, but perhaps an acceptable standardised method could be developed to achieve this.

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Clinical experience with Acupuncture point Liver 3

Liver 3 is probably one of the first points most acupuncturists think of when their patients exhibit signs and symptoms of Qi stagnation – for example frequent sighing, muscle tension, and cold hands and feet. When this is very obviously the case, I might needle Liver 3 on its own at the earliest opportunity in the treatment – even during the consultation section – to allow it to get to work. I’ll also often include it in acupressure self-massage ‘homework’ routines for patients suffering from Qi stagnation.

Liver 3 combines famously well with Large Intestine 4 (another famous acupuncture point, on the hand). These four points – known as the ‘four gates’ – stimulate the extremities and have the effect of strongly moving stagnation if they are stimulated correctly. Calming points such as Yintang and the ear point Shenmen also combine well with the four gates.

But Liver 3 shouldn’t be thought of exclusively in terms of moving Qi. It can also be a calming, tonifying point (it is a yuan-source point after all – you can read more about this below). To use it this way, I find it’s best to use a very slow and gentle needle technique. Needling Liver 3 can easily produce strong ‘deqi’ sensations (deep aching feelings, shooting sensations etc.), which may be appropriate if moving stagnation is the treatment principle. However, if approached carefully, it is possible to needle Liver 3 more deeply to connect with Kidney 1, creating a deeper and more subtle sensation. This might be ideal when a patient exhibits signs of Qi stagnation, combined with Kidney deficiency.

Liver 3 is a point I will often call upon when there are problems is the eyes and head, especially tension headaches, red eyes, dizziness etc. More generally, I will use it to draw the body’s attention down and away from the head. Massaging this point and using it as a focal area during meditation can be very helpful for people who have a tendency to ‘live in their heads’.

Be aware that if there are repressed emotions (often the case when Qi stagnation is present), Liver 3 sometimes seems to bring these to the surface. This doesn’t always happen during a treatment, but many times patients have reported to me that they’ve been surprised by their own outbursts of anger/fearfulness etc. in the days following treatments including Liver 3. On most occasions, they feel this is a positive, cathartic response, but it’s worth warning patients about this possibility.

Acupuncture point Liver 3 location and needling video (taken from A Manual of Acupuncture digital products)

Acupuncture point Liver 3: excerpt from A Manual of Acupuncture

The following text is taken from the Yintang section of A Manual of Acupuncture, by Peter Deadman and Mazin Al-Khfaji with Kevin Baker. A Manual of Acupuncture is the primary acupuncture point resource used in colleges and universities throughout the world, and contains extensive information on all the acupuncture points and channels. The full text includes point classifications, Chinese calligraphy, detailed location and needling instructions, point actions and indications, a summary of clinical application, and point combinations.

A Manual of Acupuncture is now available in digital form – via iOS/Android apps, and a fully-featured Online Edition – offering students and practitioners access to a whole host of features, including location and needling videos (see example above), multiple self-testing modules, channel pathway videos and much more.

Acupuncture point Liver 3

LIV-3 Tàichōng 

Great Rushing 太沖

Shu-Stream, Yuan-Source and Earth point of the Liver channel
Ma Dan-yang Heavenly Star point

Location
On the dorsum of the foot, in the hollow distal to the junction of the first and second metatarsal bones.

Location note
Run a finger from Xíngjiān LIV-2 along the interspace between the first and second metatarsal bones towards the ankle, into the pronounced depression before the junction of the bases of the first and second metatarsals.

Needling
In the direction of Yǒngquǎn KID-1, 0.5 to 1.5 cun.

Actions
Spreads Liver qi
Subdues Liver yang and extinguishes wind
Nourishes Liver blood and Liver yin
Clears the head and eyes
Regulates menstruation
Regulates the lower jiao

Indications
Headache, dizziness, numbness of the head, opisthotonos, contraction of the sinews of the hands and feet, epilepsy, childhood fright wind, deviation of the mouth, tetany, hypertension.

Distention and pain of the lateral costal region, inability to catch the breath all day long, sighing, swelling of the axilla, pain of the Liver and Heart, Heart pain with a wiry pulse, distention of the Heart, breast pain, epigastric or abdominal pain, periumbilical pain, pain and fullness of the hypogastrium, shan disorder, sudden shan disorder in children, swollen testicles, retracted testicles, unilateral sagging of the testicle, pain of the genitals.

Insomnia, easily fearful.

Blurred vision, cloudy vision, redness, swelling and pain of the eyes.

Cracked lips, swelling of the lips, distention of the throat, pain of the throat, dry throat with desire to drink, internal heat with thirst, low grade fever, death-like green complexion.

Amenorrhoea, irregular menstruation, incessant uterine bleeding, uterine prolapse, ceaseless and profuse sweating after childbirth, insufficient lactation.

Enuresis, difficult urination, retention of urine, painful urinary dysfunction, the five types of painful urinary dysfunction, deficiency-taxation oedema.

Jaundice, vomiting, vomiting blood, nausea, constipation, difficult defecation, borborygmus, diarrhoea containing undigested food, diarrhoea with thin stools, bloody diarrhoea and dysenteric disorder, blood in the stools.
Emaciation, insufficiency of essence (semen) in men, seminal emission, insufficiency of qi.

Lumbar pain radiating to the lower abdomen, lumbar pain, pain of the inner and outer knee, pain of the lower leg, flaccidity and weakness of the legs, inability to walk, cold sensation in the knees and feet, cold feet, pain of the inner malleolus, swelling of the elbow, contraction of the five fingers.

Commentary
Tàichōng LIV-3 is the shu-stream and yuan-source point of the Liver channel. The Spiritual Pivot in Chapter 6 recommends the use of the shu-stream points in disorders of the zang, whilst in Chapter 1 it says “When the five zang are diseased, select [from] the twelve yuan-source [points]”. Tàichōng LIV-3 is arguably the most important point of the Liver channel, with an extensive range of actions, and may be used with equal effect for both excess and deficiency patterns of the Liver zang and its channel. So important did the Ming dynasty physician Xu Feng consider Tàichōng LIV-3 to be, that he added it to Ma Danyang’s ‘eleven heavenly star points’ when listing them in his work Complete Collection of Acupuncture and Moxibustion. Since this time, these points have become known as Ma Danyang’s ‘twelve heavenly star points’.

Master Zhu Dan-xi in the 14th century said “The Liver governs spreading and draining” and “When the qi and blood flow harmoniously, the ten thousand diseases will not arise. Once there is constraint, all diseases may arise”. The Liver’s function of spreading means that although the Liver is not considered responsible for the production of qi, it ensures that the flow of qi in the body remains free, easy, open, relaxed and unobstructed. This function may be impaired in three main ways. Firstly, and most commonly, it may develop when the spontaneous expression of any of the emotions is restricted, especially anger. Secondly, the spreading function of the Liver is an expression of its yang qi, and a saying of Chinese medicine stresses “The body of the Liver is yin whilst its function is yang”. In other words, the Liver yang is dependent on Liver yin. Stagnation of Liver qi may therefore result from failure of yin or blood to moisten, nourish and soften the Liver. Thirdly, the ability of the Liver to spread qi may be obstructed by the presence of pathogenic damp-heat. A full understanding of Liver disharmony also stresses one further point which is that Liver qi stagnation may bring about the development of any other Liver pattern, for example by transformation into Liver fire, the consequent consumption of yin and hence the uprising of Liver yang, or by transformation of either Liver fire or Liver yang into wind. For this reason it is said that clinically any pattern of disharmony of the Liver may be accompanied by qi stagnation.

When Liver qi stagnates it gives rise to sensations of pressure, distention and pain, predominantly in those areas traversed by the Liver channel and its interiorly-exteriorly coupled Gall Bladder channel. Qi stagnation tends to move around and fluctuate, mainly according to emotional changes, and is relieved by emotional expressiveness and physical activity, both of which free the flow of qi. The name of Tàichōng LIV-3 ‘Great Rushing’ refers to this point’s function as the great passageway for the flow of qi in the channel. It is a primary point for promoting the free-flow of Liver qi, and can resolve Liver qi stagnation giving rise to distention and pain in any part of the body, whether the head, eyes, throat, chest, Heart, breasts, epigastrium, abdomen, lateral costal region, uterus or genitals.

According to the Spiritual Pivot “The Liver stores blood, the blood is the residence of the ethereal soul (hun); when Liver qi is deficient there is fear”. Although much used in modern clinical practice for emotional and psychological manifestations of qi stagnation such as depression, frustration, pent-up feelings, irritability, premenstrual tension, mood swings, weepiness etc., it is striking that with the exception of fearfulness, psycho-emotional indications are almost entirely absent from major classical sources.

Tàichōng LIV-3 is an essential point for subduing Liver yang and pacifying Liver wind. The Liver is the zang of wood and wind and is entrusted with the ministerial fire. Its qi is vigorous, forceful and active, and according to sayings of Chinese medicine “The Liver governs uprising” and “The Liver dominates physical movement”. It is common, therefore, for the hot, aggressive, ascending, and moving nature of the Liver to exceed normal limits and manifest as upsurging of Liver yang, or progress to the stirring up of Liver wind. Alternatively wind may stir due to deficient blood and consequent emptiness of the blood vessels. Typical manifestations of wind for which Tàichōng LIV-3 is indicated include headache, dizziness, numbness of the head, childhood fright wind, tetany, epilepsy, opisthotonos and deviation of the mouth.

Tàichōng LIV-3 is equally important for all deficiency patterns of the Liver. It promotes the generation of both Liver blood and Liver yin and hence nourishes those areas of the body dominated by the Liver, namely the eyes, sinews and uterus. Liver yin deficiency is the root of hyperactivity of Liver yang, whilst Liver blood or yin deficiency frequently lie at the root of Liver wind. Tàichōng LIV-3, therefore, is able both to subdue excess and nourish deficiency, and thus treat both the root and manifestation of these patterns.

The Spiritual Pivot says “Liver qi opens into the eyes, when the Liver is in harmony the eyes are able to distinguish the five colours” whilst the Essential Questions states “When the Liver receives blood it gives rise to vision”. Tàichōng LIV-3 is indicated for failure of the Liver blood or yin to nourish the eyes resulting in blurred or failing vision, as well as for excess disharmonies where Liver fire, Liver yang, or Liver channel wind-heat result in red, swollen, and painful eyes, or where Liver wind leads to unusual movement of the eyes or eyelids.

The Liver channel connects with the brain at Bǎihuì DU-20, the topmost point of the body, and is the only yin channel to ascend directly to the upper part of the head. Tàichōng LIV-3, therefore, is used to treat many disorders of the head, especially headache and dizziness, due to both excess and deficiency patterns of the Liver. It is specifically indicated for vertex headaches, although it is worth noting that neither headache nor dizziness are found as indications for this point in any major classic.

The Liver is closely related to the menstrual cycle. The Liver stores the blood and its channel enters the lower abdomen and connects with the Conception vessel at Qūgǔ REN-2, Zhōngjí REN-3 and Guānyuán REN-4, whilst it is the free movement of Liver qi prior to menstruation which ensures the smooth flow of blood. So important is the Liver to menstruation that Ye Tian-shi stated “the Liver is the pre-heaven qi of women”. Liver qi stagnation, Liver fire or deficiency of Liver blood may therefore give rise to such disorders as amenorrhoea, irregular menstruation and incessant uterine bleeding. Tàichōng LIV-3 is an important point in the treatment of any of these disorders.

The Liver channel passes through the genitals and lower abdomen, and is closely related to the genito-urinary organs. Normal excretion of urine depends mainly on the Kidneys and Bladder but is also assisted by the Liver’s spreading function. Tàichōng LIV-3 is indicated for retention of urine, painful urinary dysfunction or difficult urination characterised by qi stagnation, as well as for shan disorder, pain of the genitals and swelling or retraction of the testicles. Due to its general affinity for this area, however, Tàichōng LIV-3 is also indicated for deficiency urinary patterns such as enuresis, incontinence and deficiency-taxation oedema. In fact there are other indications of the ability of Tàichōng LIV-3 to tonify deficiency in this region, for example insufficiency of essence (semen) in men and seminal emission.

In the intestinal region, failure of the qi to flow freely may lead to binding of the stools, and Tàichōng LIV-3 may be used for constipation or difficult defecation due to qi stagnation or stagnant heat. When Liver qi stagnation co-exists with Spleen deficiency, the commonly-seen clinical pattern of abdominal pain and diarrhoea with thin stools, alternating with difficult defecation or constipation, may be encountered. Tàichōng LIV-3 is an important point for the treatment of this pattern, and may be combined for example with Zhāngmén LIV-13, the front-mu point of the Spleen. In the middle jiao, Tàichōng LIV-3 is indicated for vomiting due to Liver-Stomach disharmony and jaundice due to Liver and Gall Bladder damp-heat.

Bilateral Tàichōng LIV-3 and Hégǔ L.I.-4 are known as ‘the four gates’. This combination first appeared in the Ode to Elucidate Mysteries which said “for cold and heat with painful obstruction, open the four gates”. The text goes on to imply that the yuan-source points of the six yang channels emerge at the four gates. Since a fundamental principle for treating painful obstruction is to select points from yang channels, this helps to explain why these two points are considered so effective in treating painful obstruction. Subsequently, the use of these points has been extended to treat a variety of disorders involving pain and spasm. This is an elegant combination. Hégǔ L.I.-4 on the upper extremity lies in the wide valley between the first and second metacarpals, whilst Tàichōng LIV-3 on the lower extremity lies in the wide valley between the first and second metatarsals. Hégǔ L.I.-4, the yuan-source point, belongs to yangming channel which is ‘abundant in qi and blood’ whilst Tàichōng LIV-3, the shu-stream and yuan-source point of the Liver channel, has the function of spreading the qi. Together they are able to vigorously activate the qi and blood and ensure their free and smooth passage throughout the body. Finally Tàichōng LIV-3 is indicated for a variety of channel disorders such as lumbar pain, pain or weakness of the knee and leg, coldness of the knees and feet and contraction of the five fingers.

Summary of clinical application
Principal point for promoting the free-flow of Liver qi in the head, eyes, throat, chest, Heart, breasts, epigastrium, abdomen, lateral costal region, uterus or genitals.

Subdues Liver yang and pacifies Liver wind: headache, dizziness, epilepsy, opisthotonos, deviation of the mouth.

Treats eye disorders: blurred or failing vision, red, swollen, and painful eyes, unusual movement of the eyes or eyelids.

Regulates menstruation: amenorrhoea, irregular menstruation, incessant uterine bleeding.

Regulates the genito-urinary system: retention of urine, painful urinary dysfunction, difficult urination, enuresis, incontinence, shan disorder, pain of the genitals, swelling or retraction of the testicles.

Treats constipation and difficult defecation as well as diarrhoea due to Liver-Spleen disharmony.

With Hegu L.I.-4 (the ‘four gates’) to relieve pain and spasm.

Combinations
Red eyes and bleeding from Yíngxiāng L.I.-20 (i.e. nosebleed): Tàichōng LIV-3, Tóulínqì GB-15 and Hégǔ L.I.-4 (Song of Points).

Nasal congestion, nasal polyp and nasal congestion and discharge: Tàichōng LIV-3 and Hégǔ L.I.-4 (Song of Points).

Swelling of the lips: Tàichōng LIV-3 and Yīngchuān ST-16 (Supplementing Life).
Cracked and bleeding tongue: Tàichōng LIV-3, Nèiguān P-6 and Yīnjiāo REN-7 (Miscellaneous Diseases).

Erosion, heat and dryness of the mouth: Tàichōng LIV-3, Láogōng P-8, Shàozé SI-1 and Sānjiān L.I.-3 (Thousand Ducat Formulas).

For most types of acute throat pain: first needle Bǎihuì DU-20 then Tàichōng LIV-3, Zhàohǎi KID-6 and Sānyīnjiāo SP-6 (Ode of Xi-hong).

Dry throat with desire to drink: Tàichōng LIV-3 and Xíngjiān LIV-2 (Thousand Ducat Formulas).

Pain of the Liver and Heart: Tàichōng LIV-3 and Xíngjiān LIV-2 (Thousand Ducat Formulas).

Pain of the Heart with a green complexion like death, inability to catch the breath all day long, pain of the Liver and Heart: Tàichōng LIV-3 and Xíngjiān LIV-2 (Systematic Classic).

Breast pain: Tàichōng LIV-3 and Fùliū KID-7 (Systematic Classic).
Swelling and sabre lumps of the axilla: Tàichōng LIV-3, Xiáxī GB-43 and Yángfǔ GB-38 (Thousand Ducat Formulas).

Abdominal distention leading to back pain: Tàichōng LIV-3 and Tàibái SP-3 (Great Compendium).

Pain of the genitals: Tàichōng LIV-3, Shènshū BL-23, Zhìshì BL-52 and Jīnggǔ BL-64 (Supplementing Life).

The seven kinds of shan disorder: Tàichōng LIV-3 and Dàdūn LIV-1 (Song of Points).

Profuse and ceaseless uterine bleeding: Tàichōng LIV-3, Jiāoxìn KID-8, Yīngǔ KID-10 and Sānyīnjiāo SP-6 (Supplementing Life).

Profuse and ceaseless uterine bleeding: Tàichōng LIV-3 and Sānyīnjiāo SP-6 (Great Compendium).

Uterine prolapse: Tàichōng LIV-3, Shàofǔ HE-8, Zhàohǎi KID-6 and Qūquán LIV-8 (Great Compendium).

Difficult delivery: reduce Tàichōng LIV-3 and Sānyīnjiāo SP-6, reinforce Hégǔ L.I.-4 (Great Compendium).

Red and white leucorrhoea: Qūgǔ REN-2 [7 cones of moxa], Tàichōng LIV-3, Guānyuán REN-4, Fùliū KID-7, Sānyīnjiāo SP-6 and Tiānshū ST-25 [one hundred cones of moxa] (Compilation).

Difficulty in defecation: Tàichōng LIV-3, Zhōngliáo BL-33, Shímén REN-5, Chéngshān BL-57, Zhōngwǎn REN-12, Tàixī KID-3, Dàzhōng KID-4 and Chéngjīn BL-56 (Supplementing Life).

Diarrhoea with thin stools, dysenteric disorder with blood in the stools: Tàichōng LIV-3 and Qūquán LIV-8 (Thousand Ducat Formulas).

Diarrhoea with thin stools: Tàichōng LIV-3, Shénquè REN-8 and Sānyīnjiāo SP-6 (Great Compendium).

The five types of haemorrhoids: Tàichōng LIV-3, Wěizhōng BL-40, Chéngshān BL-57, Fēiyáng BL-58, Yángfǔ GB-38, Fùliū KID-7, Xiáxī GB-43, Qìhǎi REN-6, Huìyīn REN-1 and Chángqiáng DU-1 (Great Compendium).

Blood in the stool: Tàichōng LIV-3, Chéngshān BL-57, Fùliū KID-7 and Tàibái SP-3 (reat Compendium).

Deficiency-taxation oedema: moxa Tàichōng LIV-3 one hundred times, also moxa Shènshū BL-23 (Thousand Ducat Formulas).

Enuresis: Tàichōng LIV-3, Jīmén SP-11, Tōnglǐ HE-5, Dàdūn LIV-1, Pángguāngshū BL-28, Wěizhōng BL-40 and Shénmén HE-7 (Supplementing Life).

Wasting and thirsting disorder: Tàichōng LIV-3, Xíngjiān LIV-2, Chéngjiāng REN-24, Jīnjīn (M-HN-20), Yùyè (M-HN-20), Rénzhōng DU-26, Liánquán REN-23, Qūchí L.I.-11, Láogōng P-8, Shāngqiū SP-5, Rángǔ KID-2 and Yǐnbài SP-1 (Great Compendium).

“For cold and heat with painful obstruction, open the “Four Gates” [Tàichōng LIV-3 and Hégǔ L.I.-4] (Ode to Elucidate Mysteries).

Unendurable pain of the arm that radiates to the shoulder and spine: Tàichōng LIV-3 and Hégǔ L.I.-4 (Ode of Xi-hong).

Flaccidity of the legs: Tàichōng LIV-3, Yánglíngquán GB-34, Chōngyáng ST-42 and Qiūxū GB-40 (Great Compendium).

Weakness of the legs: moxa Tàichōng LIV-3, Lìduì ST-45 and Fēngshì GB-31 (Outline of Medicine).

Inability to walk: Tàichōng LIV-3, Zúsānlǐ ST-36 and Zhōngfēng LIV-4 (Ode of the Jade Dragon).