Zu San Li (ST-36), or “Leg Three Miles,” is one of the most revered acupuncture points in Chinese medicine. It is a He-Sea point, where the energy (qi) of the Stomach meridian flows deeply into the body, and an Earth point, associated with grounding, nourishment, and harmony. These attributes make ST-36 a cornerstone in acupuncture, with applications ranging from digestive health to emotional balance. This blog explores its clinical uses, historical significance, and modern research, with a focus on its role in oncology care.

How to Locate ST-36

ST-36 is located just below the knee, about three thumb-widths (3 cun) down from the lower border of the kneecap (patella), and one finger-width to the side of the shinbone (anterior crest of the tibia). This point is on the outer side of the lower knee and lies within the tibialis anterior muscle, making it accessible for both needling and moxibustion.

In acupuncture, “cun” is a unit of measurement based on the individual’s body proportions. Three cun is roughly equivalent to the width of four fingers held together (index, middle, ring, and pinky fingers). This proportional system ensures precision in locating acupuncture points across different body sizes.

Actions and Therapeutic Benefits

ST-36 is an incredibly versatile acupuncture point with wide-ranging effects. Key therapeutic benefits include:

• Improving Digestion: Alleviates symptoms like nausea, bloating, and chronic diarrhea by regulating the digestive system.
• Boosting Energy and Strength: Addresses fatigue, anemia, and low energy, helping to rebuild strength after illness or treatments like surgery.
• Reducing Inflammation and Pain: Relieves swelling, fever, knee pain, and postoperative discomfort, promoting faster recovery.
• Supporting the Immune System: Strengthens the body’s defenses, preventing infections and aiding recovery.
• Restoring Energy in Emergencies: Revives energy and alertness in cases of extreme exhaustion or fainting.
• Mental Health Benefits: Reduces depression, anxiety, and emotional instability by regulating the autonomic nervous system.

ST-36 in Oncology Care

ST-36 plays a crucial role in supporting cancer patients, especially those undergoing chemotherapy, radiation, or recovering from surgery. Its benefits include:

• Alleviating Chemotherapy-Induced Nausea and Vomiting: When combined with PC-6 (Pericardium 6), ST-36 reduces the frequency and severity of nausea and vomiting associated with chemotherapy, improving patients’ quality of life.
• Reducing Cancer-Related Fatigue: Clinical trials show that stimulating ST-36 can alleviate severe fatigue in cancer patients, helping them regain energy and maintain their daily activities.
• Supporting the Immune System: By enhancing white blood cell counts and stimulating natural killer (NK) cell activity, ST-36 helps patients strengthen their immune defenses, reducing vulnerability to infections during treatment.
• Improving Appetite and Reducing Cachexia: Cancer treatments often lead to reduced appetite and significant weight loss. ST-36 has been shown to promote appetite and counteract cachexia, allowing patients to maintain better nutritional status.
• Post-Surgical Recovery: For cancer patients undergoing surgery, ST-36 accelerates healing, reduces inflammation, and alleviates postoperative pain, minimizing reliance on pain medications.

These effects make ST-36 an invaluable tool in integrative oncology, complementing conventional treatments and improving overall patient outcomes.

Historical and Symbolic Significance

In ancient Chinese medicine, ST-36 was said to “carry you three more miles” when you were too tired to continue, symbolizing endurance and resilience. As a He-Sea point, it connects deeply with the body’s energy system, while its role as an Earth point ties it to grounding and nourishment. These qualities make ST-36 a reservoir of vitality, balancing the physical and emotional aspects of health.

Modern Research on ST-36

Contemporary studies highlight the wide-ranging applications of ST-36 in both traditional and modern medicine. Key findings include:

• Functional Dyspepsia Relief: Improves digestive motility and alleviates bloating, nausea, and stomach discomfort.
• Stroke Rehabilitation: Aids motor recovery and reduces spasticity, improving coordination and strength.
• Blood Sugar Regulation: Helps manage blood glucose levels in type 2 diabetes by enhancing insulin sensitivity.
• Hypertension Management: Lowers systolic and diastolic blood pressure, providing a natural complement to conventional treatments.
• Pain Relief: Reduces reliance on opioids post-surgery by managing inflammation and improving circulation.
• Immune System Modulation: Enhances natural killer (NK) cell activity, supporting immune response and recovery from infections.
• Athletic Performance and Recovery: Boosts stamina and supports muscle recovery by improving circulation and energy metabolism.

Spiritual and Emotional Essence

ST-36 embodies the principles of stability and nourishment. Rooted in Taoist philosophy, this point balances effort and stillness, helping individuals navigate challenges with strength. Its connection to the Earth element further emphasizes grounding and renewal, offering both physical and emotional support.

Practical Applications

ST-36 can be stimulated using two primary techniques:

1. Acupuncture: A thin needle is inserted perpendicularly to a depth of 1–1.5 cun to activate its therapeutic effects.
2. Moxibustion: This involves burning moxa, a dried herb (Artemisia vulgaris), near the point to generate heat. Moxibustion is particularly effective for conditions like low energy, chronic fatigue, or weakened immunity, as it improves circulation, promotes qi flow, and supports the body’s natural healing processes.

Conclusion

Zu San Li (ST-36) is a cornerstone in acupuncture, renowned for its ability to harmonize the body, boost vitality, and promote overall health. Whether easing digestive issues, aiding cancer recovery, or enhancing mental well-being, ST-36 continues to demonstrate the enduring wisdom of traditional Chinese medicine. With growing scientific validation, this powerful point proves to be an essential tool in both traditional and integrative healthcare practices.

References

• Deadman, P., Al-Khafaji, M. & Baker, K., 2007. A Manual of Acupuncture. Journal of Chinese Medicine Publications, England.
• Jang, A., Brown, C., Lamoury, G., Morgia, M., Boyle, F., Marr, I., Clarke, S., Back, M. & Oh, B., 2020. The Effects of Acupuncture on Cancer-Related Fatigue: Updated Systematic Review and Meta-Analysis. Integrative Cancer Therapies, 19, 1534735420949679. DOI: 10.1177/1534735420949679.
• Kaatz, D., 2011. Characters of Wisdom: Taoist Tales of the Acupuncture Points. Journal of Chinese Medicine Publications, England.
• Liao, X., Tian, Y., Zhang, Y., Bian, Z., Wang, P., Li, P., Fang, J. & Shao, X., 2024. Acupuncture for functional dyspepsia: Bayesian meta-analysis. Complementary Therapies in Medicine, 82, 103051.
• Nielsen, A., Dusek, J.A., Taylor-Swanson, L. & Tick, H., 2022. Acupuncture Therapy as an Evidence-Based Nonpharmacologic Strategy for Comprehensive Acute Pain Care: The Academic Consortium Pain Task Force White Paper Update. Pain Medicine, 23(9), 1582–1612. DOI: 10.1093/pm/pnac056.
• O’Brien, K., Ried, K., Binjemain, T. & Sali, A., 2022. Integrative Approaches to the Treatment of Cancer. Cancers (Basel), 14(23), 5933. DOI: 10.3390/cancers14235933.
• Zhang, J., Liu, Y., Li, Z., Hu, Q., Huang, X., Lv, H., Xu, J. & Yu, H., 2023. Functional magnetic resonance imaging studies of acupuncture at ST36: A coordinate-based meta-analysis. Frontiers in Neuroscience. Available at: Frontiers in Neuroscience.