足三里 : 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
Nine Points for Returning Yang (Third Trinity: Reunion)

Trigger point (Travell & Simons, 1998, Trigger Point Manual; Melzack, Stillwell & Fox, 1977)
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


Classical Needling:

"The Yangming usually has much Qi and much Blood" (Su Wen 素問 ch. 24) implying this channel can normally be needled or bled.
"The foot Yangming is to be pierced 6 fen deep and remain inserted for ten exhalations" (Ling Shu 靈樞 ch. 12).
"It is needled to a depth of one cun and five fen,‘82 (the needle) is retained for a duration of seven exhalations, and it is moxaed with three cones" (Huangfu Mi 皇甫謐, 3rd Century, Zhenjiu Jiayi Jing 針灸甲乙經).

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 Shen
Activates the channel and alleviates pain
Revives the Yang and restores consciousness

TCM Indications:

I Ching Hexagram:

䷳ Gen 艮 Mountain

Shared with Taibai Sp-3. Balanced by ䷹ (Shangyang LI-1 or Jingqu Lu-8).

Hexagram attributions are my own with an explanation given in the glossary.

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

Martial Applications & Effects of Injury:

Besides obvious immediate physical leg damage and pain, this strike also causes considerable damage to the Zangfu, especially the Spleen due to its categorisation as a Horary Earth, He-Sea point and a "Sea of Nourishment point". The result is great weakness which will slowly get worse if left untreated (Montaigue, Dim Mak Locations, Taijiworld.com).

Major Combinations:


Notes:

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


Gao Wu command point for the abdomen.


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.

Ling Shu Ch. 1, On the Nine Needles and the Twelve Origins, suggests using this point to remove Yang responsible illness in the Yin realm.

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. Another interpretation that would match with common practice today, based on the idea of odd numbers being Yang/moving/clearing while even numbers are Yin/tonifying/reinforcing, is that the points on the channel to be cleared are pierced on one side only while those on the channel to be tonified are pierced bilaterally.

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. 34, On the Five Disturbances, advises regulating the Spleen through this point in all instances of deficiency or excess, of Yin and Yang.

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.


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


The Nine Points for Returning Yang are used for assisting those close to death. They may be used to resuscitate collapse from deserted Yang, or if it is their time, to assist them in their passage. They are divided into three trinities, related to separation, transition and reunion.

This point belongs to the third trinity, related to reunion, deliverance and the otherworld. They rouse, tonify and anchor the Yang Qi, open the orifices, draw energy back into the Yangming and Gallbladder and aid delivery. Symptoms include:

- Cessation of breathing, appearance as if dead, collapse or flatline.

They basically shock the person back to life rousing the Yang Qi and opening the orifices. If these points did not work it meant the person was meant to move on now. They draw energy back into the Gallbladder and Stomach, anchoring and tonifying the Kidney Yang.

This point recovers collapsed Yang and strengthens Wei, Ying, Yuan Qi and Blood. Kaatz says it provides the strength and stamina to deliver what is important, even if not easy, to finish and accomplish goals that require large reserves of energy and gives us the strength to walk the fullness of our path.

J. Yuen lectures on death/dying and the spirit of points, posted as Facebook comments, 19 Dec 2020.


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; Si Hua Fu, Four Flowers Append (77.10), 2.5 cun below that, just below Xiajuxu St-39; and Si Hua Xia, Lower Four Flowers (77.11), 2.5 cun below that.

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).


Jin's Three Needles for Weight Reduction are located at this point, Zhongwan Ren-12 and a point 1.8 cun inferior to Zhangmen Liv-13 threaded along the Dai Mai towards the umbilicus with a 4 cun needle and stimulated with tense and disperse electrical stimulation. They are indicated for obesity, especially belly fat (eLotus, 2021).

Jin's Three Needles for Cholesterol are located at this point, Neiguan Pc-6 and Sanyinjiao Sp-6. They are indicated for high cholesterol (eLotus, 2021).



Avicenna describes cupping at this point in his treatise On Cupping:

"Cupping below the knee is beneficial when the pain in the knee is caused by sharp humours, bad abscesses, and old sores in the shank and the foot." (Aspects of Treatment According to General Diseases, 22nd section in Abu-Asab, Amri & Micozzi, 2013, Avicenna's Medicine)


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:

Basic information on location, needle depth, TCM actions, indications and combinations is taken from Deadman et al (2001): A Manual of Acupuncture with additional anatomical information researched by reference to Gray's Anatomy (38th Ed., 1995) unless otherwise referenced. Images were found on acupunctureschoolonline.com and can be traced back to Claudia Focks (2008) Atlas of Acupuncture originally. I cannot claim any credit or rights over them. Other sources should be quoted in the text.

For some of the more unusual terms I have created a glossary here

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