(230) ST36 (Foot Three Miles)

[HB KIM]

CLINICAL USES & CONTRAINDICATIONS OF ST36 (ZU SAN LI)

1. NAME
(1) Leg Three Miles: Zu San Li, the name of ST36, can be translated as "leg three distances," or "leg three rectifications," because of both its location (3 cun below ST35) and its ability to treat multiple organs and symptoms.  Zu San Li is the command point of the abdomen and the He-sea point of the Stomach.

(2) A heavenly name: Points with the number three in their name tend to be very strong and popular points.  Three is considered a heavenly number since it represents the unity of heaven, human, and earth on the macro level; on the micro level the upper, middle, and lower burners.  "Three"  in the name of the point indicates great power and special abilities; so naturally, combinations of points with "three" in the name are popular. 


2. "SAN LI" COMBINATIONS
There are two theories about how to combine the "San Li" points to treat abdominal problems:

(1) ST36 + LI10: Both are "San Li" points which can connect the elements of heaven, human, and earth.  These points are both yang-ming, full of qi and blood, so they have a strong effect on the body.  ST36 and LI10 are also both located at the second major joint from the trunk (knee, elbow), so they're effect of balancing the qi is particularly strong.  Hand San Li (LI10) is said to treat problems below the umbilicus, while Foot San Li (ST36) can treat problems above the umbilicus.  Together they could harmonize the entire abdomen, but they are actually more effective for the immune system than abdominal complaints.

(2) ST36 + SP6: To me, this combination makes more sense and is more effective to treat abdominal problems.  SP6, San Yin Jiao, is the point at which the three foot yin channels intersect.  Additionally, the three foot yin channels also cross at RN3 and RN4, so SP6 has stronger ties to the abdomen than LI10.  Another benefit of combining ST36 and SP6 is balance in the combination of one yin channel and one yang channel, and complementary locations of one point around the knee joint (which balances the qi) with one point around the ankle joint (which moves the qi).


3. ST36 + SP3 COMBINATION
A great combination to strongly tonify the middle jiao is ST36 plus SP3.  They are both horary points (earth point on an earth channel), so they strongly tonify the earth aspects of the body. To enhance middle jiao tonification even more, add the Back-shu points of the Spleen and Stomach, UB20 and UB21.


4. ST36 + RN12 COMBINATION
This combination is very popular for two reasons.  First, ST36 is the He-sea point of the Stomach and RN12 is the Stomachʼs Front-mu, so they are a good combination for digestive problems.  The application of these two points is a little broader, however.  ST36 is the Command point of the abdomen, while RN12 is the Influential point of the Fu organs.  So this combination can treat problems of the entire abdomen and gastrointestinal system, not only just the Stomach.  When PC6 is added to this combination, the target shifts to just the epigastric area.


5. STOMACH ACID
ST36 actually increases stomach acid.  This may be beneficial or detrimental depending on the patient's condition.  It's good if there is poor digestion and lack of movement in the gastrointestinal tract. Avoid ST36, or exercise caution, in case of ulcers or gastric hyperacidity.  To help decrease the acid, use SP8, the Xi-cleft point of the Spleen. Although famous for treating dysmenorrhea, it also can decrease stomach acid.  Herbs to counteract gastric acidity include Mu Li, Hai Piao Xiao and Wa Leng Zi.


6. DESCENDING ACTION
(1) Descending Fire: The application of moxa to ST36 has a strong action of descending fire.  It actually contracts cerebral vessels and diverts the excess blood to the intestines.  For this reason, it is a very effective treatment to reduce the hot flashes associated with menopause. 

(2) Children's growth: Many practitioners avoid using ST36 on infants and children.  It is believed that the very strongly descending action of ST36 can prevent upward growth.  DU12, "Body Pillar," is a favored point to use for children.  When constructing a building, the pillars are first set as a framework for support.  "Body Pillar," DU12 reinforces a strong and upright physique in a growing child.


7. MOXA ST36
(1) Strengthen Righteous Qi: The name Zu San Li may be translated as "foot three distances" or "foot three rectifications."  It is known that applying moxa to ST36 will make a travel-worn hiker well enough and strong enough to walk three more miles.  Before modern transport this was hugely important, obviously.  Try it next time you go hiking; you will definitely feel more strength and stamina in your legs!  The traditional, more aggressive style of moxibustion treatment causes scarring.  In old times there was a saying, "Don't travel with a person who doesn't have moxa scars on ST36."  Such a person was not believed to have the stamina to complete the journey, which undoubtedly would have been on foot.  Yesterday and today, ST36 is one of the most basic and popular treatments around the world. 

(2) Disease prevention: In modern acupuncture, ST36 may be broadly applied to treat almost any condition, including the prevention of disease.  When combined with UB12, the effect is to prevent exterior wind in the same manner as Yu Ping Feng San.  ST36 in combination with GB39 or LI11 can prevent stroke.  For stroke prevention, I recommend alternating treatments of ST36 + GB39 and ST36 + LI11.

(3) Moxa Method: The rhythm and movement of life is balanced overall, but the balance is dynamic.  When we dance or walk, we shift from left leg to right leg, back and forth.  To direct the same amount of energy and strength to both legs at the same time would cause stiff and cumbersome movement.  That is why, when applying moxa to ST36, the best method is to apply a little more moxa to one side for each treatment, and alternate between the left side and right side receiving more.  This not only makes the legs stronger, but also can help the elderly to sleep well. 


8. OPENING TREATMENT
If someone is afraid of needles, especially a first-time patient, use gentle needling on the St36 and/or the Four Gates to help relieve the fear.  When people are fearful, the body is not communicating well with itself overall.  For example, a nervous patient may have cold hands, but a warm abdomen.  ST36 or the Four Gates are effective points to improve circulation and communication between the three jiaos, the five organs, and the limbs.  The idea is to gently tonify qi and blood, and improve circulation.  Less weakness results in less fear, relaxing the mind.  Don't be tempted to try to fix everything for a nervous patient on the first visit.  If the treatment experience is too harsh for them, they won't come back regardless of whether the impact was positive or negative.  It increases the fear.  Using the Four Gates and/or ST36 is a simple, yet very effective treatment.  It relieves the fear of the patient as well as balancing the body and aligning it with nature.  The patient will have immediate benefit, as well as be in a better condition to receive future treatments.   


9. NASAL BLOCKAGE
Nasal blockage can be relieved by ST36 because of its strong descending action, and because the channel pathway flows over the maxillary sinus next to the nose.  To achieve relief of nasal congestion, use ST36 on the same side.  Needle ST36 on the left for left-sided nasal blockage and ST36 on the right for right-sided nasal blockage.


10. CE SAN LI (TUNG STYLE ACUPUNCTURE)
This is a master point in Tung Style Acupuncture.  The location is at the same level as ST36, but the point lies on the GB channel.  It is often used in combination with Ce Xia San Li (located 2 cun below Ce San Li).  These points are good for treating facial paralysis, toothache, and temporal headaches.  The technique is to needle them both at the same time, on the side opposite of the pain.