Zusanli ST-36 location
ST-36

Zusanli ST-36

Leg Three Miles · 足三里 · Zú Sān Lǐ
Stomach Meridian
Earth-Tu Sea-He Point Ma Dan Yang Heavenly Star

Needle Depth

1.0–2.0 cun

Needle Angle

90° (Perpendicular), 45° (Oblique)

Body Area

Lower Leg — Anterior

Location

3 cun below Dubi ST-35, one finger breadth lateral to the anterior crest of the tibia, on the tibialis anterior muscle.

Main Actions

  • Tonifies Qi and Blood
  • Tonifies the Stomach and Spleen
  • Tonifies Nutritive Qi and regulates Defensive Qi
  • Brightens the eyes
  • Restores Yang and consciousness
  • Expels Wind, Cold or Dampness
  • Calms the Mind
  • Removes Obstructions from the Channel

Commentary

Zusanli ST-36 is an extremely important point with various functions. 

First of all, it strongly tonifies the Qi and Blood by tonifying the Stomach and the Spleen, which are the root of Post-Heaven Qi. The Stomach receives and ripens the food, while the Spleen rules the transformation and transportation of food Essences (nutrition), Qi, and Body Fluids and their distribution to other Zang Organs. Therefore, this point is always used for Stomach or Spleen Qi Deficiency, after chronic diseases or with general fatigue or weakness. 

By tonifying the Stomach and the spleen, Zusanli ST-36 benefits the Original Qi (Yuan Qi), which is the Pre-Heaven Qi. The well-functioning Stomach and Spleen supplies sufficient Post-Heaven Qi to replace the loss of Pre-Heaven Qi which is originated from the Kidneys. 

Zusanli ST-36 also tonifies Nutritive Qi and regulates Defensive Qi when Exterior Wind-Cold attacks the body. This is considered the Great Yang Stage according to the Six Stage Theory. When Nutritive Qi is week and at the same time, Wind-Cold invades, it impairs the Defensive Qi circulation. Then the pores are open and the patient sweats slightly. The stronger Nutritive Qi is able to stop this sweating and the well-circled Defensive Qi can expel the pathogenic factors from the pores. 

Apart from being used for treatment, this point can also be applied to prevent Exterior Pathogenic Factors by enhancing the body's immune system, which is the Defensive Qi in TCM term. In this case, it is usually used together with Qihai REN-6. Direct moxibustion every 5-7 days for about 10 minutes each time is recommended. Also, this method is more recommended for patients over 30 years old with Qi Deficiency. 

When used with direct moxibustion and with Qihai REN-6 and Baihui DU-20, Zusanli ST-36 is able to lift Yang. Thus it treats symptoms such as Organ prolapses. 

When the Defensive Qi is weak in the space between the skin and muscles, Body Fluids overflows from the Channel and causes Oedema under the skin. ST-36 resolves Oedema by strengthening the Defensive Qi. 

Furthermore, this point can be used for all types of Stomach Deficiency patterns, characterized by epigastric pain or no appetite. It also regulates the Intestines, treating abdominal distension and pain as well as constipation of a Deficient nature. It moves Qi in these two Organs. 

It brightens the eyes and can be used for blurred vision and declining eyesight in old age. 

As discussed above, Zusanli ST-36 is mostly indicated for Deficiency patterns and applied with Tonifying or Even Needling Method. Despite of that, it is also able to remove Dampness or Cold from the Channel in Painful Obstruction Syndrome of the knee or wrist by using Reducing Needle Method. 

Finally, it calms the Mind by opening the Mind's orifices. Typical symptoms are manic depression, manic singing, raving as well as inappropriate laughter. 

Classical Sources

Ling Shu (Divine Pivot): "When pathogenic factors are in the Spleen and Stomach, there is pain in the muscles. When Yang Qi is excessive and Yin Qi insufficient, there is heat in the center with hunger. When Yang Qi is insufficient and Yin Qi excessive, there is cold in the center with intestinal rumbling and abdominal pain. When both Yin and Yang are excessive or both deficient, there is both cold and heat. All should be regulated at Zusanli."

Ling Shu: "For stubborn painful obstruction that does not go away and prolonged cold, take Sanli to drain the bone." Also: "For vomiting with bitter taste, sighing, and fear of being caught, the pathogenic factor is in the Gallbladder, rebellion is in the Stomach... take Sanli to descend the rebellious Stomach Qi."

Ma Dan Yang's Heavenly Star Points Song: "Zusanli is located three cun below Xiyan (Extra) and between two tendons. It can get to the heart of abdominal distension and is good for the treatment of cold sensation in the stomach, intestinal noises and diarrhea, swollen leg, soreness in the knees."

Four Command Points Song (四總穴歌): "For the belly and abdomen, retain Zusanli" (肚腹三里留).

How to Locate

Locate Dubi ST-35 in the depression below the patella and lateral to the patellar ligament. Then locate Zusanli ST-36 by measuring 3 cun downwards. It is also one middle finger-width lateral to the anterior crest of the tibia.

Caution

Use with care during pregnancy, especially from the 9th month onward—traditionally considered capable of stimulating uterine contractions. Avoid deep needling in very thin patients to prevent discomfort. When using strong stimulation or moxibustion, monitor patients who are very weak or have significant deficiency, as this point has powerful tonifying effects that can be overwhelming. Ensure proper needle technique to avoid hitting the periosteum of the tibia, which can cause sharp pain.

Needle Angle

90° (Perpendicular) / 45° (Oblique)

Depth Category

Deep

Standard Depth

1.0–2.0 cun

Needling Directions

Vertically 1–1.5 cun.

Expected Deqi Sensation

Deqi is typically strong with sensations of soreness, distension, heaviness, and numbness spreading down the leg toward the foot and upward toward the knee. Some patients experience warmth or an electric-like sensation radiating along the Stomach channel. The tibialis anterior muscle may visibly twitch upon needle stimulation.

Moxibustion

Particularly Recommended

Duration: 10–20 minutes; 3–7 cones for direct moxa

Cupping

Recommended

Bloodletting

N/A

Gua Sha

Recommended

Five Element & Transporting Classification

Five Phase

Earth-Tu

Transporting Type

Sea-He Point

Mother-Child Role

Mother (Tonifying)

Special Point Classifications

Ma Dan Yang Heavenly Star

Organ & Tissue Associations

Lower He-Sea Point for:

Stomach

Four Seas Classification

Sea Type:

Sea of Food (Water & Grain)

Position:

Lower Point

Command Point

Commands region:

Chest & Abdomen

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