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.

Acupuncture: ST25, RN12, RN6
There is a traditional treatment called the Four Doors treatment, in which ST25, RN12 and RN6 are needled.  The Four Doors combination is famous for treating obesity.  Another name for the Four Doors treatment is "cross acupuncture." The cross refers to the layout of the points chosen and emphasizes the connection between the organs and the channels.  The name "cross acupuncture" also implies the gravity of the conditions which it may treat.

Moxa: ST25, RN12, RN4
In a variation of the Four Doors treatment, moxa, rather than needles, is applied to RN12, ST25, and RN4.  According to the meditation books, this treatment is the last resort for elderly people not responding well to other treatments or other situations of chronic disease.  Its power is in warming the Front-mu points of the stomach, large intestine, and small intestine.  It facilitates overall qi of the body.

COMPOSITION OF THE FOUR GATES

What makes the Four Gates special?

In Korean Acupuncture there are actually 24 Four Gates.  The popular combination of LI4 and LV3 is just one of the Four Gates combinations.  There are many reasons why LI4 and LV3 are a Four Gates pair: 

1. Locations
The name of LI4 is translated as "Union Valley," due to its location as the pivot, or center, of the thumb and the fingers.  When the hand grasps an object, LI4 is the bending point.  The location of LV3 on the foot mirrors the location of LI4 on the hand.  When the foot grasps at an object, LV3 is the pivotal point.

2. Elemental Energies
The Large Intestine channel is a yang channel and metal element, conversely the Liver channel is a yin channel and wood element.  Both LI4 and LV3 are yuan-source points. 

3. The Six Energies
The Large Intestine channel is a yang-ming meridian, while the Liver channel is a jue-yin meridian. This implies polarity between the most outward and bright levels versus the deepest levels. 

4. Four Substances
LI4 has metal energy and strongly influences the qi, while LV3 has wood and strongly influences blood (as well as qi).

5. Yin-Yang
It is notable that the LI channel is the only yang channel with a jing-well point starting from the medial side of the extremity, and LI4 is at the junction of transition of the channel from yin to yang.  On the other hand, the Liver channel is the only yin meridian with a jing-well point located at the lateral side of the extremity, and LV3 is at the junction of transition from yang to yin.  So the use of these two points is superb for balancing yin and yang, which is of course the main concept of TCM. 

6. Korean Acupuncture
In Korean traditional "Opening Qi Acupuncture (Tong-gi Chim)," a Four Gates treatment is always used at least for the first treatment of any condition.

7. Yintang & DU20
Yintang and DU20: Yintang and DU20 are generally also used with the Four Gates treatment.  Four Gates treatments are good to link nature (heaven and earth) to body (human), effectively aligning us in time and space with the universe.  Four Gates treatments can be used for jet lag or better cognition before playing sports, for example. 

In addition, Yintang and DU20 can help to open the mind's powers of intuition intuition and psychic ability.

Yintang belongs to the Ajna Chakra which is considered the chakra of the mind. When something is seen in the mind's eye, or in a dream, it is being 'seen' by Ajna. Ajna Chakra also bears the names The Third Eye or Shiva's Eye and it represents the superior mental consciousness that has direct perception of otherwise imperceivable dimensions, as well as more subtle aspects of our own world.

DU20 (Baihui) belongs to Sahasrana which symbolizes detachement from illusion; an essential element in obtaining supreme higher consciousness of the truth that one is all and all is one. In oriental literature, it is known as "the supreme center of contact with God."

These two points are the most important points to open in order to communciate with nature, our immediate surroundings, and the universe. That's why with Four Gates treatments, in combination with Yintang and DU20, it is recommended to open the Eight Extra Vessels.  The Eight Extra Vessels are located dementionally between nature and the primary channels.

8. Time
Normally the Four Gates are needled first; however, at 11 pm-1 am and 11 am-1 pm, the head points (Yin Tang, DU20) are needled first because that's the only time when humans are in line with heaven and earth from head to toe.  So, the needling order according to time of day is as follows: 
a. 11 pm-1 am: DU20 - Yintang - Four Gates
b. 1 am-11 am: Four Gates - DU20 - Yintang
c. 11 am-1 pm: Yintang - DU20 - Four Gates
d. 1 pm-11 pm: Four Gates - Yintang - DU20

Q:  I have a friend that recently had back surgery for a herniated disk. During his recovery he has developed numbness and weakness in his right foot making it difficult to walk.

Is there an effective treatment for foot drop?


A:  Treatment
Acupuncture
Left side: SI3, UB62
Right side: +HT8, +SP2, -LV1, -SP1 (SP tonification with 4 needles)

Formula: Bu Zhong Yi Qi Tang modification
Huang Qi  12g
Ren Shen  8g
Bai Zhu  8g
Gan Cao  8g
Dang Gui  4g
Chen Pi  4g
Sheng Mai  2.4g
Chai Hu  2.4g
Huai Niu Xi  8g
Du Zhong  8g
Mu Gua  8g

Clinical Indication of LU7 (Lie que)

1. Name
The name of LU7 is "Broken Sequence," which implies that this acupuncture point is not located exactly on the channel, but slightly off.  Because it is off the channel, it is an exit point to the next channel.  Some Five-Element schools, however, do locate LU7 on the line between LU9 and LU5. 

2. Luo-Connecting Point
This is the the luo-connecting point of the Lung.  In general, Xi-cleft points are used for acute conditions, and luo-connecting points are used for chronic conditions.  Needling the luo-connecting points has the effect of also needling the paired channel.  To make the treatment stronger, pair the luo-connecting point with the yuan-source point of the paired channel, for example LU7 and LI4.  This is called the host-guest treatment.  The combination of LU7 and LI4 is clinically effective for wind-cold, wind-water (yang edema), and nasal congestion.

3. Command Point
LU7 is one of the four command points.  This point can be used for any problems of the neck and head regardless of the etiology or symptoms.  Command points have the strongest and most general influence on a specific area.  The concept of the command points originated in the Ming dynasty in Gao Wu's Glorious Anthology of Acupuncture and Moxibustion.  The other command points are LI4 for the face, ST36 for the abdomen, and UB40 for the back.  Some classical texts after the Ming dynasty added the command points of PC6 for the chest and DU26 for resuscitation.

4. Confluent Point
LU7 and KD6 are an Eight Extra Vessel pair which influence and nourish yin in the Lung system, including lung, throat, chest, and diaphragm.  One of the keys of Eight Extra Vessel treatments is to use the pair of points together simultaneously.  The power of the Eight Extra Vessels is released when the points are combined together, like opening the floodgates to release water from the reservoir.  When used together, the pair of points opens the Extra Vessel and has a unique effect which is different from using either of the points individually.  LU7, individually, is the luo-connecting point of the Lung and the Command point of the neck and head, used primarily for exterior wind-cold conditions.  KD6, on its own, is the Confluent point of the Yin Qiao meridian and indicated primarily gynecological and urinary disorders.  When used as a pair, the effect is nourishing yin in the Lung system.

5. Irregular Pulse
Some practitioners use LU7, LU8, and LU9 simultaneously to treat irregular pulse or heart failure due to yang deficiency.  In this case, needle LU7, LU8, and LU9 toward the Heart channel, below the radial artery.  Energetic direction is more important than depth of insertion.  With needles inserted, feel the pulse on the opposite side to check it has returned to normal.  If it has not, needle LU7, LU8 and LU9 on both sides.  RN6 and RN12 can be added to this treatment.

Usages of 8 Extra Vessels

1. Combinations
LU7 (Ren) + KD6 (Yinqiao)
SI3 (Du) + UB62 (Yangqiao)
PC6 (Yinwei) + SP4 (Chong)
SJ5 (Yangwei) + GB41 (Dai)

2. Reserviors
The concept of the Eight Extra Vessels comes from the experience of ancient civilizations and the vital need for water.  Cities thrived near rivers, but all was lost in times of flooding.  Wise men developed ways to divert the flood waters away from the cities through canals and into reservoirs.  This not only prevented flooding, but also created a water source to be used in times of need.  This is the intelligent design of all living beings.  Qi and blood routinely flow through the main channels.  When there is an excess of qi and blood, it is diverted into the Extra Vessels, which serve as a reservoir.  That is why the Chong and Du channels are called the "Sea of Blood" and the "Sea of Yang."  When there is a deficiency of qi or blood, the reserve sources stored in the Extra Vessels can be used.   

3. Warfare
Consider warfare.  If an army is strong and the enemy is weak, there is no need to call for additional troops.  However, if the army has been weakened and the enemy is stronger, the general will call in the reserves for assistance.  Think of the army as the Righteous Qi, the enemy as the Pathogenic Qi, and the Eight Extra Vessels as the reserves.  An appropriate circumstance for choosing Eight Extra Vessel treatment is in the case of disease in which the Righteous Qi (army) is weak and Pathogenic Qi (enemy) is strong, as is often the case of chronic disease (long term warfare).

DIABETIC KETOACIDOSIS

DEFINITION
Diabetic ketoacidosis (DKA) is a life-threatening complication in patients with untreated diabetes mellitus (chronic high blood sugar or hyperglycemia). Near complete deficiency of insulin and elevated levels of certain stress hormones combine to cause DKA. DKA is more common among Type I diabetics, but may also occur in Type II diabetics generally when physiologically stressed, such as during an infection. Patients with new, undiagnosed Type I diabetes frequently present to hospitals with DKA. DKA can also occur in a known diabetic who fails to take prescribed insulin. DKA was a major cause of death in Type I diabetics before insulin injections were available; untreated DKA has a high mortality rate.

SIGNS AND SYMPTOMS
-Sluggish, extreme tiredness.
-Fruity (Ketone) smell to breath/compare to nail polish remover, similar to peardrops.
-Extreme thirst, despite large fluid intake.
-Constant urination
-Extreme weight-loss.
-Oral Thrush may be present, or/ yeast infections that fail to go away
-Muscle wasting.
-Agitation / Irritation / Aggression / Confusion


PATTERNS AND FORMULAS

1. HEAT ENTERS PC
thirst, drinking lots of water, unclear mental status, delirious speech, ketone smell in breathing, red tongue, dry coating, thready rapid pulse

Shi Gao  30-45g
Zhi Mu  18g
Zhi Gan Cao  6g
Geng Mi  18g


2.  YIN DEFICIENCY LEADING WIND
thirst with drinking lots of water, copious urination, dry skin, increased wrinkles

Zhi Gan Cao  18g
Sheng Di Huang  18g
Bai Shao  18g
Mai Men Dong  15g
E Jiao  9g
Huo Ma Ren  9g
Mu Li  15g
Bie Jia  24g
Gui Ban  30g


3. EXTREME YIN DEFICIENCY
thirst, drinking lots of water, extreme fatigue, difficult breathing, unclear mental status, red tongue, dry coating, faint pulse

Ren Shen  9-15g
Mai Men Dong  9-12g
Wu Wei Zi  3-6g


4. EMPIRICAL FORMULA: Benefit Qi/Yin, Clear Heat
Huang Qi  20g
Sheng Di  15g
Shan Yao  15g
Xuan Shen  17.5g
Huang Qin  7.5g
Huang Lian  7.5g
Chuan Xiong  7.5g
Huang Bai  7.5g
Chi Shao  7.5g
Cang Zhu  10g
Zhi Zi  10g
Fu Ling  10g
Dang Gui  10g
Mu Li  25g

DIABETES EMPIRICAL FORMULAS BY LOCATION, ETC.

1. Upper and Lower Jiao Xiao Ke
Ge Gen  8g
Tian Hua Fen  8g
Shi Hu  8g
Xuan Shen  8g
Sheng Di  8g
Tian Men Dong  8g
Mai Men Dong
Lian Xu  8g
Ren Shen  8g
Wu Wei Zi  8g
Sang Piao Xiao  8g
Tu Si Zi  8g
Bu Gu Zhi  8g
Shan Zhu Yu  8g
Xi Yang Shen  8g
He Shou Wu  8g
Shan Yao  8g
Nu Zhen Zi  8g

2. Middle Jiao Xiao Ke
Lian Zi  8g
Qian Shi  8g
Dang Shen  8g
Shu Di  8g
Hong Shen  8g (red ginseng)
Sang Shen  8g
Rou Cong Rong  8g
Shan Zhu Yu  8g
Fu Ling  8g
Mu Dan Pi  8g
Shan Yao  8g
Bai Zhu  8g
E Jiao  8g
Zhi Mu  8g
Huang Jing  8g
Xi Yang Shen  8g
Bai Shao  8g
Huang Bai  8g
Huang Qi  8g

3. Deficient Cold pattern
Rou Gui  6g
Fu Zi  6g
Lu Rong 3g
Sang Piao Xiao  10g
Shan Zhu Yu  12g
Dang Shen  12g
Ba Ji Tian  10g
Bu Gu Zhi  10g
Fu Pen Zi  10g
Jin Ling Zi  10g
Cang Zhu  15g
Shan Yao  30g
Qian Shi  30g
Zhi Gan Cao  10g

4. Both Blood glucose level and Urine glucose level are high
Xuan Shen  8g
Cang Zhu  8g
Mai Men Dong  8g
Du Zhong  8g
Fu Ling  8g
Huang Qi  8g
Gou Qi Zi  8g
Wu Wei Zi  8g
Ge Gen  8g
Gui Ban  8g
Lu Jiao  8g
Shu Di  8g
Shan Yao  8g
Shan Zhu Yu  8g
Mu Dan Pi  8g
Ren Shen  8g
Yu Zhu  8g

DIABETES FORMULAS
by Shi Jin Mo, Formula master (1881-1969)

1. Qi and Yin deficiency
Huang Qi  30g
Ji Nei Jin  10g
Gu Ya  10g
Mai Ya  10g
Tian Hua Fen  12g
Xuan Shen  10g
Cang Zhu  6g
Shi Gao  18g
Xi Yang Shen  10g
Pei Lan  10g
Lu Dou Yi  12g (mungbean skin)
Shi Hu  12g
Sheng Bai Guo  12p

2. Qi/Yin deficiency + LV/KD deficiency
Huang Qi  30g
Dang Shen  10g
Mai Men Dong  10g
Shan Yao  18g
Wu Wei Zi  10g
Xuan Shen  12g
Wu Mei  4.5g
Lu Dou Yi  12g
Tian Hua Fen  12g
Shan Zhu Yu  12g
Sang Piao Xiao  10g
Yuan Zhi  10g
He Shou Wu  15g
Fu Ling  10g
Sheng Di  12g

3. Qi/Yin deficiency + HT/KD deficiency
Huang Qi  30g
Fu Shen  10g
Bai Ji Li  12g
Shan Yao  24g
Mai Men Dong  10g
Bai Wei  6g
Gou Qi Zi  15g
Wu Wei Zi  10g
Xuan Shen  15g
Cang Zhu  6g
Tian Hua Fen  6g
Gua Lou Ren  6g

4. Qi/Yin deficiency + Blood Heat
Mu Dan Pi  10g
Sheng Di Huang  12g
Shi Hu  10g
Dan Shen  10g
Shi Gao  18g
Tian Hua Fen  12g
Bai Ji Li  10g
Huang Qi  30g
Gua Lou Ren  12g
Sha Yuan Ji Li  10g
Shan Yao  60g
Wu Wei Zi  10g
Lu Dou Yi  12g

5. Qi/Yin deficiency + Turbid urination
Xi Yang Shen  15g
Huang Qi  30g
Lu Dou Yi  12g
Sheng Di  10g
Shu Di  10g
Shan Yao  60g
Wu Wei Zi  10g
Shi Hu  10g
Tian Men Dong  10g
Tian Hua Fen  18g
Mai Men Dong  10g

6. Qi/Yin deficiency + Dry Heat
Sheng Di  10g
Huang Qin  10g
Mai Men Dong  10g
Shi Hu  10g
Huang Lian  5g
Xuan Shen  12g
Tian Hua Fen  12g
Huang Qi  30g
Wu Wei Zi  5g
Lu Dou Yi  12g
Shan Yao  60g
Dang Sheng  10g

7. Dry Heat damage Yin
Bai Ji Li  10g
Sheng Di  10g
Shu Di  10g
Huang Qi  30g
Sha Yuan Ji Li  10g
Shi Hu  15g
Shan Yao  30g
Mai Men Dong  10g
Dang Shen  10g
Tian Hua Fen  15g
Xuan Shen  12g
Wu Wei Zi  10g
Lu Dou Yi  12g

8. HT/KD imbalance + insomnia
Long Gu  12g
Mu Li  10g
Bai He  12g
Fu Shen  10g
Sheng Di  10g
Huang Qi  30g
Mai Men Dong  10g
Sheng Di Huang  10g
Shan Yao  18g
Suan Zao Ren  12g
Wu Wei Zi  6g
Cang Zhu  10g
Zhi Zi  10g
Yuan Zhi  10g
Bai Ji Li  12g

9. Yin deficiency leading to LV Yang rising
Zi He Che  12g
Wu Wei Zi  6g
Dang Shen  12g
Rou Cong Rong  12g
He Shou Wu  12g
Sheng Di  12g
Huo Ma Ren  12g
Huang Qi  6g
Mai Men Dong  6g
Chan Sha  12g
Bai Ji Li  12g
Tian Men Dong  6g
Yu Li Ren  6g
Gu Jing Cao  6g
Chuan Niu Xi  6g
Ci Shi  6g
Shen Qu  6g
Zhi Ke  6g
Ju Hua  12g
Shi Hu  12g
Bai Wei  6g
Bai Shao  12g
Cang Zhu  6g