Introduction
In a small clinic in Beijing, an acupuncturist inserts four needles — two in the hands, two in the feet — and within minutes, a patient with chronic migraine feels the tension dissolve. This is not a scene from ancient China, though the technique is over two thousand years old. It's happening today, in modern hospitals across the country, and it's backed by a growing body of scientific research.
The technique is called Kai Siguan (开四关) — "Opening the Four Gates." It uses just two pairs of acupoints: Hegu (LI4) on the hands and Taichong (LR3) on the feet. Four needles, profound effects.
What makes this combination so special? Why do these specific points treat conditions as diverse as migraine, insomnia, chronic pain, Alzheimer's disease, and post-stroke depression? And for international patients considering medical tourism to China, what does treatment actually involve?
Let's explore the Four Gates — from the classical texts of the Yellow Emperor to the fMRI machines of Beijing's top research hospitals.
The Ancient Roots: What Are the Four Gates?
The Four Gates technique originates from one of TCM's most foundational texts, the Ling Shu (Spiritual Pivot), part of the Huangdi Neijing (Yellow Emperor's Inner Classic), written over 2,000 years ago.
Chapter 1 of the Ling Shu — "Nine Needles and Twelve Source Points" — states: "The twelve Source points originate from the Four Gates, and the Four Gates treat the five Zang organs."
This passage is dense with meaning. In TCM theory, Source points (Yuan points) are where the body's original Qi surfaces and gathers. Each of the twelve main meridians has a Source point, and these are the primary access points for regulating the internal organs.
The "Four Gates" refers to the four major joints of the body — the two elbows and two knees. All Source points are located below these joints, on the extremities. But over centuries of clinical practice, Chinese physicians refined this concept to focus on a specific combination: LI4 (Hegu) and LR3 (Taichong).
Here's the genius of this pairing:
| Point | Meridian | Nature | Location |
|---|---|---|---|
| Hegu (LI4) | Large Intestine (Yangming) | Yang, descending/closing | Between thumb and index finger |
| Taichong (LR3) | Liver (Jueyin) | Yin, descending/closing | On the foot, between 1st and 2nd metatarsal |
Both points belong to meridians classified as "closing" (He) in the classical Six Meridian system — the Liver Meridian is the closing Yin channel, and the Large Intestine Meridian is the closing Yang channel. By pairing them, the acupuncturist harmonizes the most fundamental polarities of the body: upper and lower, left and right, Yin and Yang, interior and exterior.
As the renowned TCM scholar Tang Zonghai (唐宗海) noted in the late Qing dynasty, the liver and large intestine have a special internal connection — a theory called Zang-Fu Bietong (脏腑别通), or "organ interconnection." This framework explains why stimulating a hand point can influence the liver, and a foot point can regulate the intestines.
What Modern Science Tells Us
Over the past decade, Chinese researchers have put the Four Gates technique through rigorous scientific testing. The results are remarkable.
Alzheimer's Disease Research
A 2021 study published in Neural Plasticity by researchers at Capital Medical University's Xuanwu Hospital in Beijing examined the effects of Hegu and Taichong stimulation on patients with Alzheimer's disease. Using resting-state functional MRI, they found that acupuncture at these two points significantly enhanced functional connectivity in several large-scale brain networks, including the default mode network, salience network, and visual network.
In a follow-up 2025 study in Frontiers in Neuroscience, the same research team demonstrated that the Four Gates technique specifically modulates connectivity between the retrosplenial cortex — one of the earliest brain regions affected in Alzheimer's — and other memory-related networks. This provides a neurological mechanism for how these two points might slow cognitive decline.
Migraine Management
A 2025 systematic review and meta-analysis published in Complementary Therapies in Clinical Practice analyzed 19 randomized controlled trials (1,312 participants) on Siguan points-based acupuncture for migraine. The conclusion: acupuncture at LI4 and LR3 significantly reduces migraine intensity and frequency, with a favorable safety profile compared to conventional medication. Trial sequential analysis confirmed the robustness of these findings.
The review highlighted that the Four Gates technique appears to regulate neurovascular function, providing both acute relief and preventive benefits.
Post-Stroke Depression
A 2026 study published in Brain Research investigated electroacupuncture at Siguan acupoints for post-stroke depression. Using a rat model, researchers found that electroacupuncture at bilateral LI4 and LR3 alleviated depression-like behaviors by inhibiting ER stress-induced apoptosis in the prefrontal cortex. This opens new possibilities for non-pharmacological treatment of post-stroke emotional disorders.
Pain Management
Beyond these specific conditions, the Four Gates is most commonly used in Chinese hospitals for chronic pain management. A 2024 study from the Shanghai University of TCM found that combined LI4-LR3 stimulation activates descending pain inhibitory pathways more effectively than either point alone, confirming the synergistic nature of the pairing.
What to Expect During Four Gates Acupuncture Treatment
If you're considering acupuncture treatment in China, here's what a typical session looks like:
Initial Consultation (30-60 minutes): A TCM doctor takes your pulse, examines your tongue, and discusses your medical history. This diagnostic process determines your specific pattern of imbalance.
Needle Insertion: Four ultra-thin sterile needles are inserted — one at each Hegu and Taichong point. The sensation is minimal; most patients feel a slight tingling or warmth.
Retention: The needles remain in place for 20-30 minutes. Many patients report a deep sense of relaxation and may fall asleep.
Removal: The needles are removed gently. Some points may be followed by cupping or moxibustion for enhanced effect.
Treatment Course: Chronic conditions typically require 10-15 sessions, often scheduled daily or every other day. Acute conditions may show improvement after 3-5 sessions.
Cost Comparison: Acupuncture in China vs. the West
This is where medical tourism to China becomes genuinely compelling. Even for a treatment as widely available as acupuncture, the cost difference is dramatic.
| Expense | China (USD) | USA (USD) | UK (GBP) |
|---|---|---|---|
| Single acupuncture session | $15 - $40 | $75 - $150 | £40 - £80 |
| Initial TCM consultation | $30 - $80 | $150 - $300 | £80 - £150 |
| Herbal prescription (2 weeks) | $10 - $40 | $50 - $150 | £30 - £80 |
| Comprehensive 2-week program | $500 - $2,000 | $2,500 - $6,000+ | Not typically offered |
| 4-week intensive program | $1,000 - $3,500 | N/A | N/A |
At JCI-accredited hospitals with English-speaking international departments — such as Guang'anmen Hospital in Beijing or Yueyang Hospital in Shanghai — prices are at the higher end of this range but still represent 60-80% savings versus equivalent care in Western countries.
Top TCM Hospitals for International Patients
Beijing
- Guang'anmen Hospital (China Academy of Chinese Medical Sciences): The gold standard for TCM. Treated over 10,000 international patients in 2025. Specializes in neurology, pain management, and internal medicine. International department with English-speaking staff.
- Dongzhimen Hospital (Beijing University of Chinese Medicine): Excellent acupuncture department with many English-speaking physicians. Strong research program in neurological applications of acupuncture, including the migraine meta-analysis mentioned above.
Shanghai
- Longhua Hospital: JCI-accredited, one of China's oldest TCM hospitals. Known for comprehensive wellness programs and neurological rehabilitation.
- Yueyang Hospital: JCI-accredited with a dedicated International Medical Center. Offers integrated TCM-Western medicine approaches and full English-language coordination for international patients.