In this post, I will discuss Master Tung’s points known as the Four Horses, and in particular, I want to examine some of the lesser-known functions of these points. While the Four Horses are known for treating skin and respiratory disorders, I will primarily explore some of the other functions of these points including treating costal pain and breast pain.
A summary of the indications of these points can be found below, along with a video that reviews the locations.
The Four Horses (88.17, 88.18, 88.19)
Respiratory disorders - Cough, colds, asthma, allergies, sinusitis, rhinitis, lung deficiency
Skin disorders
Costal pain, costochondritis, intercostal pain
Breast pain
Back and hip pain
The Four Horses for Costal Pain
The Four Horses are very useful for pain in the ribcage related to costochondritis, intercostal pain, and ribcage pain in general. Typically in TCM, we think of ribcage pain as being a liver-related pattern and use points like LV 3, LI 4, and GB meridian points. In TCM stomach meridian points are not typically recommended for rib-related conditions. Considering the similarity between the stomach meridian and the fascial line known as the Superficial Front Line (SFL), we can begin to understand how the Four Horses can be used for costal pain.
The Ribs, Sternum, and Costal Cartilage
The fascial line known as the Superficial Front Line (SFL) looks very similar to the stomach meridian and includes the sternalis muscle that runs adjacent to the sternum. Also closely associated with the SFL is the costal cartilage which connects the ribs to the sternum and gives the ribcage motility. Fascia that is part of the SFL also surrounds the sternochondral joints and we find a convergence of the ribs, cartilage, fascia, sternum, and abdominis rectus muscle in this region.
The ribcage, intercostals, and abdominis rectus muscles are active in respiration, and the Four Horses are known to be some of the best Master Tung acupuncture points for lung disorders and rib pain. As the Four Horses are on the SFL, we can comprehend how these points can influence the distant structures in the chest. The ability of these points to treat rib and lung conditions is perhaps best suited for disorders that involve mechanical dysfunction in the ribcage, sternum, sternocostal fascia, and SFL.
Other muscles of the respiratory system such as the diaphragm and intercostals are on different myofascial lines. The diaphragm is on the Deep Front Line (DFL), which is associated with the leg yin meridians, while the intercostals are on the Lateral Line (LL) which mirrors the GB meridian.
In TCM we recognize patterns of joint kidney and lung deficiencies, such as kidney yang, qi, or yin deficiency causing lung-related symptoms. In these patterns, we would use a point like kidney 7 (KI 7) which can influence the diaphragm and the DFL. Similarly, the respiratory system, lungs, and ribcage may also be influenced by needling GB meridian points since it passes through the ribcage. Anatomically, the intercostal muscles are on the myofascial line known as the Lateral Line, which follows the same course as the gallbladder meridian. In TCM, we recognize patterns of liver qi stagnation or liver fire overacting on the lungs. In the Master Tung system, there are a group of points (Lateral Three Passes, 77.27) on the lateral aspect of the leg that are used for lung disorders.
In summary, when treating lung disorders and conditions affecting the ribcage, it is important to determine what structures, meridians, and organs are most involved in the pathology. If the sternochondral joints or sternal fascia are involved, the best results may be achieved by needling the Four Horses. However, if the diaphragm is affected then acupuncture points on the DFL like KI 7 and SP 6 are best to use. Similarly, problems that affect the intercostal muscles are best treated with acupuncture points on the gallbladder meridian and/or lateral line.
The Four Horses - Some of the Best Acupuncture Points for Breast Pain
The use of these points for breast pain first caught my attention when a friend asked if I could do anything for the breast pain she was having during menstruation. She was very uncomfortable and did not feel like participating in some activities we had planned. I was also without my acupuncture needles since it was the weekend and we were going to go out for a show. Since I didn't have any needles, I needed to consider what points would work best for the pain using only acupressure.
Some of the best TCM acupuncture points for breast pain include LI 4, LV 3, SP 6, and ST 34. Since the stomach meridian passes through the breast we can use stomach points like ST 34 for mastitis, and breast pain in general. When I started palpating her legs I found that the region of the Four Horses had several sensitive ashi points. Using palm pressure I pressed up and down the stomach meridian on the most sensitive (right) side.
While doing the acupressure she had an emotional release and commented on several personal situations and health-related matters. We also discussed the connection between menstruation and emotions, and how important it is for people to feel heard and share sensitive experiences. I continued to apply acupressure with my palm moving up and down the stomach meridian in the area of the Four Horses for about 10 - 15 minutes. After this time, the pain had greatly improved and she was feeling better emotionally.
Initially, the right breast was the most painful, but after the acupressure, the pain had subsided and was almost completely gone. She laughed about the left side being more painful now, even though she didn't notice much pain on that side before we started. I then used the same method of using palm pressure to move up and down the stomach meridian in the area of the Four Horses. After about 10 minutes, she commented that the pain had subsided.
I mention this experience because it was one of many along the way that helped me to make embodied connections between the meridians, myofascial lines, and point functions. Through the years I have been able to greatly refine my point selections by including myofascial anatomy into my assessments, diagnosis, and treatment methods. Myofascial anatomy has also allowed me to fully integrate TCM protocols with Master Tung's points, biomechanics, structural factors, neurology, and more. If you are ready to get more clarity about how acupuncture points work via myofascial connections, check out some of my classes. The link below will take you to a special sales page where you can save 30 - 50% on single classes and course packages.
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