THERAPIES & TRADITIONS · GUIDE
Large Intestine 4 (Hegu, LI4): Traditional Description, Research and Pregnancy Caution
The traditional description of Large Intestine 4 (Hegu, LI4), what small studies of the point have found, and why it is traditionally cautioned in pregnancy.
Content last updated . This page has not been medically reviewed.
Back to AcupunctureName and place in the tradition
Large Intestine 4, written LI4 and also called Hegu, is a point on the Large Intestine channel in the acupuncture tradition. [1][2] It is among the best-known points in research papers, so many studies mention it. This is a traditional framework. For how points are named see Acupuncture Points Explained.Traditional location
A cadaver study of 25 forearms and hands from 16 embalmed bodies described LI4 on the back of the hand, on the skin radial to (on the thumb side of) the midpoint of the second metacarpal bone. [1] The study also found that errors can arise from differences between cun measuring systems. This is a description of where the tradition places it, not an instruction.What research found
| Study type | What was found | Label |
|---|---|---|
| fMRI, 36 people with Bell's palsy | Electrical stimulation at LI4 or ST6 activated brain regions more than a sham point; authors say this supports point specificity [3] | Preclinical to promising but limited: small, imaging only |
| fMRI, 14 people with Alzheimer disease and 14 controls | Brain network connectivity changed after stimulation at two points (LI4 and Liv3), and the study did not separate the effect of LI4 from the other point [4] | Insufficient evidence |
| Labor trial, 45 women | See pregnancy section | Insufficient evidence |
No source we read tests LI4 alone for a health condition in a large trial. Proper evidence not found for point-specific clinical benefit; we searched PubMed for LI4 and Hegu with pain and labor terms. Because many trials combine several points, results cannot be assigned to LI4. For condition-based evidence see Acupuncture for Nausea and Other Uses and Acupressure.
Frequently asked questions
Where is LI4?
Described traditionally on the back of the hand by the second metacarpal. [1]
Is LI4 safe in pregnancy?
Traditionally cautioned. Research on harm is limited, and a few papers find no plausible mechanism. [6] Discuss with your doctor or midwife first.
Does LI4 start labor?
One small trial using LI4 with SP6 found a shorter time to delivery. [2] A Cochrane review found no clear reduction in cesarean sections. [8]
What is Hegu?
Its Chinese name; LI4 is the channel code. [2]
Is pressing LI4 at home safe?
Acupressure is covered at Acupressure. If pregnant, ask your clinician first.
More details: evidence, limits and cautions
The details behind this page: cautions, limits of the evidence and where sources disagree. Open any note to read it.
Pregnancy caution
What research shows:
- A 2011 discussion paper notes the literature ranges from avoiding these points at any time in pregnancy to saying they are not contraindicated in normal pregnancy. [5]
- Another 2011 paper examined proposed risks (changes in oxygen to the embryo, progesterone, uterine contractions) and found no plausible physiological mechanism. [6]
- A third says it is difficult to confirm a harmful effect and the few publications seem to show the concern is not correct, calling for animal research and a systematic review. [7]
- In a small trial of 45 women at term, LI4 and SP6 were pierced on both sides every second day; cervical length and time from due date to delivery were shorter than controls (5.0 vs 7.9 days, P=0.03), while the share needing labor induction (20% vs 35%, P=0.3) did not differ significantly; this was a small comparison with a control group, and the abstract does not describe blinding. [2]
- A Cochrane review of 22 trials (3,456 women) found no clear benefit of acupuncture or acupressure in reducing cesarean sections, some benefit for cervical readiness, and a need for better trials. [8]
- For pain in labor, acupressure results were mostly very low certainty. [9]
- A 2014 systematic review of 105 studies of needling in pregnancy found a total adverse event rate of 1.9%, all mild or moderate where acupuncture was a possible cause, though detailed adverse events were reported in only 25 of 105 studies. [10]
Plain summary: the caution is traditional, the evidence on harm is limited and unsettled, and the trials on labor are small. It is safest to tell any practitioner you are pregnant and to avoid trying to bring on labor yourself. Also see Acupuncture Points Commonly Cautioned in Pregnancy, Acupressure in Labor and Pregnancy and Therapies in Pregnancy. Pregnancy complications need medical care; contact your midwife or doctor, or 911 in the US for emergencies.