EA at He gu generally led to a significant decrease in the ipsilateral blood flow velocity of median cerebral artery during the stimulation period and post-stimulation period, in normal healthy subjects. It also reduced heart rate, though so did sham acupuncture. (12)

Manual acupuncture at He gu also reduced blood flow in the putamen. This could enhance pain relief by optimizing the pain modulation functions, support motor recovery in conditions such as stroke or Parkinson’s disease and/or iImprove emotional well-being through regulation of reward and motivation systems (13).

Acupuncture at He gu, with Nei guan (PC6), can modulate heart rate variability and other cardiac output measures, though the effect depends on the functional state of the individual, in this study fatigue vs non fatigue states were compared (14).  

Acupuncture at Tai chong (LV3) and He gu (LI4), for just 3 minutes, can increase functional connectivity to the retrosplenial cortex in patients with Alzheimer’s disease. This is often one of the first areas to show reduced functional connectivity and related to memory impairment (15). 

Acupuncture at He gu and Qu chi (LI11) may activate segments of the spinal cord around C2 and C6 in healthy and spinal cord injury patients (16). Further research found that, ‘When LI4 was injected with Cholera toxin subunit B (CTB), CTB-labeled sensory neurons ranged from C5 to T1 dorsal root ganglia, and their transganglionic axons terminated in the C–5 to C–8 spinal dorsal horn as far as the cuneate nucleus, while labeled motor neurons were located in the C7 to T1 spinal ventral horn (17). Another study went further still showing that the vast majority of the sensory and motor neurones associated with He gu are calcitonin gene-related peptide positive. Meaning calcitonin gene-related peptide could be involved in the therapeutic effects related to He gu (18). 

Acupuncture at He gu as well as facial points and ‘stroke points’, including Nei guan (PC6), Shui gao (DU26) and San yin jiao (SP6), was used for post stroke facial paralysis. Different ‘intensities’, i.e. needling directions and retention time were applied at He gu. Treatment was daily for 14 days. Any use of He gu (which was not used in the control group) significantly increased outcomes. Its seemed like 5s of twirling with an oblique insertion opposite to the direction of the meridian gave the best results, although they did not reach statistical significance (19). 

Acupuncture at He gu and Tai chong, 6x a week for 4 weeks reverses reductions in learning-memory as well as improving cerebral chemistry by reducing hippocampal amyloid beta 42 expression and interleukin-1beta content and in up-regulating interleukin-2 level back to normal levels (20).

Acupuncture at He gu markedly increased occipital EEG power. The increase in the fast alpha1 waves was accompanied by a decrease in the theta frequencies and the ratio alpha1/theta was shifted to the benefit of alpha1. This was paralleled by a short increase of the ECG ratio between low frequency and high frequency, followed by an increase of HF-power (21). 

Curiously, the central effect of acupuncture at left and right He gu (LI4) is dissymmetry, indicating right hemisphere laterality. The right lobus insularis and cingulate gyrus may be the key regions in the acupuncture at Hegu (22).

Further fMRI research shows that acupuncture needle manipulation at He gu may modulate the activity of the limbic system and subcortical structures. The researchers hypothesised that modulation of subcortical structures may be an important mechanism by which acupuncture exerts its complex multisystem effects (23)

Acupuncture has benefit for amyotrophic lateral sclerosis, the most comomnly chosen points are He gu (LI4, 67%), Zu san li (ST36, 67%), Qu chi (LI11, 52%), San yin jiao (SP6, 48%), and Yang ling quan (GB34, 45%) (24). 

2 days of EA of LI4 can up-regulate the percentages of blood and bone marrow endothelial progenitor cells and blood CXC chemokine receptor 4+ cells as well as blood stromal cell-derived factor 1alpha protein content in CI/RI rats, which may contribute to its effect in improving cerebral ischemia (25). 

Acupuncture can benefit cerebral palsy patients. Zusanli (ST 36), Quchi (LI 11) and Hegu (LI 4) were most frequently used. Head points Baihui (GV 20) and Sishencong (Ex-HN 1) were also frequently used (26). 

The most frequently selected acupoints for Tourette’s syndrome are Tai chong (LR3), Bai hui (DU20), Feng chi (GB20), He gu (LI4), Si shen cong (EX-HN 1), San yin jiao (SP6) and Zu san li (ST36) (27).

Acupuncture at He gu and facial points can significantly improve eye blood perfusion of the acute facial paralysis, enhance metabolic activity of the affected facial tissues, and promote the recovery of facial nerve function (28)

Acupuncture can benefit post-stroke epilepsy. He gu is amongst the most commonly used points. Based on this research a good prescription is Shui gou (DU26), Nei guan (PC6), He gu (LI4), Bai hui (DU20), though it is recommended that more are added based on the patients needs for improved efficacy (29). 

Acupuncture, primarily, at Hegu (LI 4), Taichong (LR 3), Zusanli (ST 36), Qihai (CV 6) and Quchi (LI 11) can reduce peripheral neuropathy caused by chemotherapy, specifically Paclitaxel or Oxaliplatin, and is more effective than Cobamamide (30).

He gu is among the most commonly chosen 20 acupuncture points for radiation induced xerostomia (dry mouth) (31). 

Three days of daily electroacupuncture at He gu can significantly reduce the pain associated with toothache (32). 

Electroacupuncture at He gu can down-regulate the mRNA expressions of P2X2 and P2X3 receptors, which is plausibly the action mechanism of its analgesia effects in rats with dental pain (33). 

In a review of treatment protocols for ‘nasal conditions’ researchers found that He gu was one of the most commonly used and useful points, especially when combined with Shang xing (DU23) and Ying xiang (LI20) (34). 

Further to this, acupuncture at Ying xiang (LI20), He gu (LI4), and Yin tang (Ex-HN 3) was shown to alleviate the symptoms of persistent allergic rhinitis rapidly and safely, especially nasal obstruction, and improved the patients’ life quality. The effects were similar, if slightly less, than budesonide nasal spray (35). 

Both EA of Fu tu (LI18) and He gu (LI4) – Nei guan (PC6) can significantly suppress formalin-injection induced pain reactions in the thyroid region, which may be closely associated with its effects in upregulating expression levels of cervico-spinal GABA(B) R1 mRNA, GABA(B) R2 mRNA and GABA(A) R mRNA, and reduce regional inflammatory reactions in the thyroid region (36).

He gu is also in the top ten points used for lazy eye (amblyopia). The points are, in order of most used, Jing ming (BL1), Tai yang (EX-HN 5), Zan zhu (BL2), Feng chi (GB20), Bai hui (DU20), He gu (LI4), Guang ming (GB37), Si bai (ST2), Cheng qi (ST1) and Si zhu kong (SJ23) (37).

He gu could be a good option for gastritis, reducing pain, though should be accompanied by additional points or treatments depending on the condition (38). 

He gu is amongst the most commonly used points for post operative nausea and vomiting. In order of the top then, they are Nei guan (PC6), Zu san li (ST36), He gu (LI4), Zhong wan (REN12), Shang ju xu (ST37), San yin jiao (SP6), Tai chong (LR3), Yang ling quan (GB34), Qu chi (LI11) and Xia ju xu (ST39) (39). 

When used perioperatively with Nei guan and Zu san li it can significantly reduce the incidence of post operative nausea and vomiting in dogs (40)

Acupuncture at Quchi (LI 11), Waiguan (TE 5), Hegu (LI 4), Tianshu (ST 25), Zusanli (ST 36), Sanyinjiao (SP 6) and Taichong (LR 3) as well as medication can help diabetic patients with neuropathic pain. Improving motor and sensory nerve conduction rates and reducing pain to a greater effect than if medication were to be used on its own. This beneficial effect may be due to acupuncture’s regulation of lipid metabolites (41). 

He gu can be added to a core protocol, of Nei guan (PC6), Zu san li (ST36) and Tian tu (REN22), for elders with hiccups, with additional respiratory issues, to good effect (42). 

He gu is in the top 6 most used points for hyperthyroidism with and without exophthalamus. The points are San yin jiao (SP6), Nei guan (PC6), Zu san li (ST36), Shui tu (ST10), He gu (LI4), Tai chong (LR3) and Feng chi (GB20), Shang tian zhu (Extra), He gu (LI4), San yin jiao (SP6), Cuan zhu (BL2), Yang bai (GB14), respectively (43).

Electroacupuncture at bilateral He gu (LI4) plus intravenous dripping of oxytocin can intensify the uterine contraction, shorten the birth process to avoid probable systemic exhaustion due to excessive consumption, and with no side effects on life signs of the birthing mother and newborns. All indices observed remained in the normal range; including heart rate, respiratory frequency, blood pressure, fetal heart rate and birth process (44).

Transcutaneous electrical nerve stimulation at He gu and San yin jiao can benefit the first stage of pregnancy by reducing pain, shortening the time till dilation, and reducing the need for oxytocin (45).

Electroacupuncture at He gu and San yin jiao (SP6) for 25 minutes benefits medical abortions, reducing pain levels and shortening foetal sac discharge duration (46). Another study showed He gu and San yin jiao can reduce post medical abortion symptoms and reduce abdominal pain (47). 

In an interesting study pointing to the bidirectional ability of acupuncture, i.e. its ability to upregulate and down regulate functions depending on the bodies context, He gu was shown

to reduce uterus motility in pregnant and non-pregnant rats probably by regulating cyclooxygenase-2, which in turn regulates prostaglandin release and inflammatory processes and could thus regulate complicated preterm labor (48). 

After 10 sessions of acupuncture at He gu, the symptom scores, pain index, and visual analog scale decreased significantly in patients with dysmenorrhea. The volume of blood flow in Hegu (LI 4) declined slightly. No significant evidence supported that needling caused capillary contraction, but the capillary vasomotor amplitude at Hegu (LI 4) increased remarkably. The researchers thus hypothesised that local capillary circulation may have a role to play in pain reduction (49) 

He gu, vs San yin jiao and Xue hai (SP10), is the more effective point for reducing pain in dysmenorrhagic rats, reducing writhing and uterine contractions (50). 

Acupuncture at He gu, Zu san li, or San yin jiao can significantly benefit rats with gastric carcinectomy’s immune function. Any combination of the above acupuncture points leads to considerable increases in serum IgG, IgM, IgA, C3, C4, CD4+, CD8+ and CD4+/CD8+, whilst reducing CD8+ level. The effects of ST36 + LI4 + SP6 were slightly better than those of the other 6 EA combination of the above acupuncture points. (51).

Acupuncture, predominantly at Zhi gou (SJ6), Qu chi (LI11), He gu (LI4), can increase the therapeutic effect of granulocyte colony-stimulating factor, delay the decrease of white blood cells after discontinuing granulocyte colony-stimulating factor, promote the neutrophilic granulocyte differentiating forward to mature and it is better for improving leukopenia induced by chemotherapy (52). 

Acupuncture at Baihui (DU20), Tan zhong (REN17), Qi hai (REN6), Guan yuan (REN4), Zu san li (ST36), He gu (LI4), Tai chong (LR3) and San yin jiao (SP 6) can benefit chronic fatigue syndrome patients improving physical and mental fatigue and total scores. However, warming needling at Bai hui (DU20), Qi hai (REN6), Guanyuan (REN4) and Zu san li (ST36) led to better outcomes on physical and total scores as well as patient satisfaction (53).

Acupuncture at Bai hui (DU20), Shen ting (DU24), Yin tang (EX-HN 3), Shui gou (DU26), Hegu (LI 4), Taichong (LR 3), Shenmen (HT 7) and Neiguan (PC 6) is safe and effective for post stroke anxiety, to a similar level as Alprazolam (54).

Daily electroacupuncture at He gu and Tai chong, for 21 days, is as effective as fluoxetine in preventing digestive issues in depressed rats. Specifically significantly decreasing inducible nitric oxide synthase activity and nitric oxide content significantly and increasing glutathione peroxidase activity (55). 

Acupuncture at He gu (LI4) and Tai chong (LR3), Baihui (DU20) and Yintang (EX-HN3) is similar to, if not slightly better than, Prozac and without side effects (56). 

For patients with post elbow surgery motor impairment where He gu was combined with local points and Shou san li (LI10), San Jian (LI3), Yang ling quan (GB34), Yin ling quan (SP9) recovery was faster when acupuncture was combined with rehabilitation therapy, rather than rehabilitation on its own (57). 

Acupuncture could reduce pain intensity and sensitivity of facial muscles, improve mouth opening, and reduce dysfunction in orofacial pain, specifically in patients with temporomandibular disorder. He gu, Jia Che (ST6), Xia guan (ST7),  Feng chi (GB20), Ting gong (SI19) and Zu san li (ST36) are the most commonly used points (58)

Needling He gu, vs needling a non acupoint nearby cause a dramatic increase in blood flow and changes in the sympathetic nervous activity, showing significant decreases in the relative energy contribution at 0.02–0.06 Hz and significant increases at the relative energy contribution at 0.4–1.6 Hz. The researchers suggest changes in microcirculation and nervous activity could be part of the mechanisms of acupuncture vs non acupuncture points (59).  

Acupuncture at He gu can stimulate the sympathetic nervous system and parasympathetic nervous system leading to a significant decrease in the heart rate frequency (60). 

Acupuncture at Pericardium points Xi men (PC4) and Nei guan (PC6) are able to upregulate the anti-apoptosis phosphoinositide 3-kinase/Akt signaling pathway pathway and prevent post heart attack (myocardial reperfusion) injury. He gu did not display this effect (61). 

Electroacupuncture at Nei guan can effectively relieve the damage of cardiac muscle tissue post heart attack; the possible mechanism is to increase adenosine triphosphate and reduce adenosine diphosphate, adenosine monophosphate of cardiomyocytes, so energy charge level is elevated and myocardial cell apoptosis is inhibited, leading to protective effect on cardiac muscle tissue and cells. He gu did benefit ADP and AMP levels and somewhat reduced apoptosis, but not to the same extent as Nei guan (62). 

Pricking and bleeding cupping at Da zhui (DU14) is an effective treatment for moderate acne vulgaris. Acupuncture at He gu and Qu chi can be applied to this treatment to alleviate the pain associated, however, it does not add additional therapeutic benefit (63). 

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