You only have to create the macro in one spot—either in ISBoxer, or in game, but not both. What my next question was going to be was... did you already bind Alt+4 in game? If so, then that was your problem, since you can't bind multiple things (macros, action bar buttons, etc.) to the same key.
EDIT: I see that the answer to my second question was "yes," and I missed that in your original post.
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