When should four gates ( LI 4 and LV 3) be used together or more importantly when they sould not be used for a patient. From your previous answer you wrote to me that 4 gates can spread energy
outward instead of keeping it in the body? Can you expend on that.
Thank you for your clear and vry helpful answers.
Comment by Chad J. Dupuis, L.Ac.
The four gates is a powerful combination which, in my opinion, is probably over used by many practitioners. When you are treating patients you have to do things in stages. A patient that is both stagnant and weak needs, in most cases, to have the stagnation moved first and then tonified - otherwise you run the "risk" of adding more energy to the stagnant areas. This could, possibly, make the patient worse.
So in the case you mentioned before, you want to tonify first as that is the primary pattern - and it is hard to tonify when you are drawing the energy outwards which the four gates accomplishes very well. To explain the function look at the actions of both LV 3 and LI 4 individually - LI 4 basically draws energy out of the upper body/face and LV 3 descends and circulates energy. Compare that with a point such as CV 6, which would add energy directly into the person.
For a basic list of conditions where the four gates are helpful, see the four gates extraordinary vessel treatment within the Japanese section.