Points Database

Location Guides:

: Zusanli : Leg Three Miles

St-36 : Foot Yangming Stomach 36

Classifications:
He-Sea and Earth point

Gao Wu Command point
Ma Dan-yang Heavenly Star point
Point of the Sea of Water and Grain
Horary point of the Stomach channel
One of the "59 piercings" for clearing Heat in Su Wen Ch. 61

Trigger point (Travell & Simons, 1998, Trigger Point Manual; Melzack, Stillwell & Fox, 1977, Trigger Points and Acupuncture Points for Pain: Correlations and Implications, Pain 3, p3-23)
Homeostatic point 24 (Ma, Ma & Cho, 2005, Biomedical Acupuncture for Pain Management)

Location:
Below the knee, 3 cun inferior to Dubi St-35, one fingerbreadth lateral to the anterior crest of the tibia.

Needling:
Perpendicular insertion 1 - 1.5 cun

TCM Actions:
Activates the channel and alleviates pain
Fortifies the spleen and resolves dampness
Supports the correct qi and fosters the original qi
Tonifies qi and nourishes blood and yin
Clears fire and calms the spirit
Activates the channel and alleviates pain
Revives the yang and restores consciousness

TCM Indications:
  • Epigastric pain, nausea, vomiting, bitter vomiting, vomiting pus and blood, hiccup, belching, distension and pain of the abdomen, fullness and distension of the Heart and abdomen, heat in the middle jiao with propensity to hunger, hunger without desire to eat, poor appetite, difficult ingestion.
  • Borborygmus, flatulence, diarrhoea and dysenteric disorder, undigested food in the stool, cold in the middle jiao with borborygmus, cold in the intestines, chronic diarrhoea, sudden turmoil disorder, leg qi, oedema, heaviness of the four limbs, lower abdominal pain and swelling with inability to urinate, jaundice.
  • The five taxations and the seven injuries, insufficiency of original qi, insufficiency of yin qi, insufficiency of zang qi, insufficiency of Stomach qi, deficient dyspnoea, shortness of breath and cough, dyspnoea with inability to stand for long.
  • Dizziness, post-partum blood dizziness, dimness of vision, tinnitus, palpitations, hypertension.
  • Mania-depression, manic singing, raving, abusive talk, anger and fright, tendency to sadness, outrageous laughter, agitation with heat in the body.
  • Throat painful obstruction with inability to speak, chills and fever, febrile disease with absence of sweating, febrile disease with heavy head and pain of the forehead, headache, cold nose, pain of the brain, pain of the lateral costal region, blood stasis in the interior, blood stasis in the chest, sudden Heart pain, fullness of the chest and lateral costal region, qi rushing up to the chest.
  • Lockjaw, clonic spasm, loss of consciousness.
  • Breast abscess, swelling of the breast, pain of the knee and shin, pain of the thigh and shin, windstroke, hemiplegia, muscle pain, chronic painful obstruction, lumbar pain with inability to turn, shan disorder.

    Neuroanatomy:
    Superficial Innervation: Lateral femoral cutaneous nerve of the calf (L4 - S1)
    Dermatome Segment: L5
    Deeper Structures: Common fibular (peroneal) nerve (L4 - S3)

    Trigger Point Associations:
    Muscle: Tibialis anterior
    Myotome Innervation: Deep fibular (peroneal) nerve (L4 - S3)
    Pain Referral Pattern: Inferior to the point, across the front of the leg to the anterior of the ankle and the big toe
    Indications: Strain of dorsiflexors of foot ; Ankle sprain

    Notes:
    One of the most commonly used points in acupuncture for a wide range of conditions.

    This point is also on the 5th trajectory of the Chong mai relating to digestive functions (Yuen, 2005, The Extraoridinary Vessels)

    The "59 piercings" are named in the Su Wen Ch. 61 and mentioned in Su Wen Ch. 32 and Ling Shu Ch. 23 for treating Heat diseases. This point along with Qichong St-30, Shangjuxu St-37 and Xiajuxu St-39 clear Heat from the stomach.

    Ling Shu Ch. 6 suggests piercing the He points of the Yang channels if a disease is in the Yang of the Yang realm (e.g. the skin). This would mean using this point, presumably needled at a very superficial level, to treat skin level disorders relating to this channel.

    Combining this with the needling techniques described in Chapter 7 we could suggest using either superficial needling here to influence pathogens in the skin, or leopard spot needling (three needles aimed at letting blood from each side) for pathogens in the Blood.

    Ling Shu Ch. 9, On Ends and Beginnings, advises that in the case of Heat associated with receding Yin Qi the Yang conduit should be pierced once and the Yin conduits twice. Based on other recommendation to use the He-Sea of the Yang conduits (Ch. 19) and the Yuan-Source with the Ying-Spring points (Chs. 6, 19 and 24) to clear Heat from the Zangfu, that would suggest this point, Taibai Sp-3 and Dadu Sp-2 as a protocol to clear Heat in the Stomach/Spleen. Next it advises that in Cold associated with receding Yang Qi the Yang should be pierced twice and the Yin once but no such obvious protocol is evident for this situation.

    Ling Shu Ch. 19, on the Four Seasonal Qi, advises using the He-Sea points in autumn when diseases are in the Fu organs. Later it suggests using this point for several further illnesses:
    - to remove Damp and Cold type joint pain
    - when there is disease of the Stomach that is not relieved by digestion or defecation, drain excess and supplement deficiency
    - in leprosy, along with the swelling which is squeezed until the swelling reduces
    - for disease in the Large Intestine with borborygmus and rushing against the chest, use this hole, Shangjuxu St-37 and either the diaphragm (Unschuld, 2016) or Qihai Ren-6 (Wu & Wu, 2010)
    - vomiting of bile, with bitter flavour, breathing heavily and fear: drain from this point and if the Stomach Qi is counterflowing add the Shaoyang Luo vessels as well as harmonising excess and deficiency.
    - when the lower abdomen is swollen, there is difficulty urinating and the swelling is reaching the the stomach. Prior to this it is treated with the big Luo of the Taiyang (Feiyang Bl-58) and the Luo of the Jueyin (Ligou Liv-5) if they are knotted with blood

    Ling Shu Ch. 20, On the Five Evils, advises piercing Xingjian Liv-2 while supplementing this point to warm the middle, removing malign blood from the vessels and from the green veins in the ears to remove pathogens in the Liver causing flank pain, cold centre, cramping joints and swollen legs. Wu & Wu, 2010, say the vessels should be "of the same channel" while Unschuld, 2016, only specifies "Blood is removed from the vessels" leaving both unclear as to whether it should be the Liver or Stomach Luo. Stomach makes more sense as the Stomach point is mentioned immediately before and its Luo covers the hypochondriac region where the "malign blood" is residing while the Liver Luo only goes to the genitals.

    Ling Shu Ch. 34, On the Five Disturbances, advises this point and Taibai Sp-3 to remove disturbing Qi in the Stomach and Intestines causing cholera symptoms (vomiting, cramps and watery diarrhoea).

    The same chapter also advises regulating the Spleen through this point in all instances of deficiency or excess, of Yin and Yang.

    Ling Shu Ch. 59, On Abnormal Wei Qi, advises this point and Qichong St-30 to drain accumulations in the abdomen. If there are accumulations in the chest and abdomen then these three points are coupled with Renying St-9, Tiantu Ren-22 and Lianquan Ren-23 (referred to as Houzhong) used for draining accumulations above and Zhangmen Liv-13 in the middle. In severe cases a "chicken claw" technique, using three needles positioned like the character 个 Ge, are to be used. If the pulse is large and wiry and the the abdomen is tense it must not be pierced.

    Ling Shu Ch. 73, Each According to His Ability, suggests using this point when a Cold counterflow reaches beyond the knees. It would suggest it is moving from the extremities towards the centre to become a more internal Cold.

    In Tung acupuncture this point is called Si Hua Shang (77.08), Upper Four Flowers, and is located on the border of the tibia instead of one fingerbreadth lateral. It is indicated for problems of the Stomach channel including respiratory, cardiac and digestive illness as well as pain (Chu, 2015). Presumably it would pair well with Si Hua Zhong, Center Four Flowers (77.09), located 4.5 cun inferior, midway between Shangjuxu St-37 and Xiajuxu St-39, next to the bone.

    Another Tung point, Ce San Li, Side of the 3 Miles (77.22), is located midway between thjis point and Yanglingquan GB-34, 0.5 - 1.5 cun lateral to this point. It is often combined with a second point, 2 cun inferior called Ce Xia San Li, Beside and Below 3 Miles (77.23) and together they are indicated for all problems of Yangming and Shaoyang channels (Chu, 2015).

    In Mayan medicine:
    Used to treat swellings of the legs and feet (Garcia, Sierra, Balam, 1999: Wind in the Blood)

    Medieval phlebotomy point (John de Foxton, 1408: Liber Cosmographiae, maa.cam.ac.uk)

    In Thai massage:
    Acupressure point along the Sahatsarangsi (left) and Tawaree (right) sen lines.
    Indicated for gastrointestinal ailments, indigestion, insomnia, menstruation disorders, PMS, reproductive ailments and stomach ache.
    (Salguero & Roylance, 2011, Encyclopedia of Thai Massage)


    Reference Notes: (click to display)