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Acupuncture Today – September, 2002, Vol. 03, Issue 09

The Ancient Use of ST36 (Zusanli) with Different Needle Techniques and Point Combinations

By Skya Abbate, DOM

As practitioners of Oriental medicine, we know that acupuncture points are a nexus of physiological activities that govern certain body parts. These points may have certain elemental energies, such as "water" points that regulate water, or they may have domain over the zang fu organs or essential substances.

These functions are not automatically activated simply by sticking needles into a point. It could involve active twirling of the needle (a typical Chinese technique), or simply the subtle but equally effective positioning of a needle in relation to the flow of qi in the meridian (a common Japanese method).

In this article, I will illustrate these concepts by explaining the use of a particular point, ST36 (zusanli), and how it can achieve varied clinical effects in two ways: first, by the specific needle technique employed; second, by its combination with other points. I've chosen zusanli specifically because of its multiple clinical energetics and its importance in the clinician's repertoire of treatment points.

In the Chinese selection of points, ST36 is perhaps the most renowned. From a classical standpoint, we know it as the he-sea point of the stomach meridian. He-sea points are those in which the qi of the channel is deeply converged. Because of this, they have a direct effect upon the organ, in this case the stomach. Likewise, on a yang meridian, he-sea points correspond to earth points elementally. As such, this means these points can regulate earth energy be adding to or taking away that energy, for instance, dampness. The way to achieve this, however, is by way of needle technique. A tonification technique can strengthen the earth element; a dispersion technique can disperse excess earth energy. Therefore, we can appreciate the critical relationship of needle technique to point selection. Point selection, of course, is contingent upon the treatment in plan, which in turn is constructed in coordination with the diagnosis.

Returning specifically to ST36, as an earth point on an earth meridian, confers its additional status as an horary point. Horary points have the same elemental energy as the meridian on which they are located. Possessing this unique quality is analogous to a "double dose," so to speak, of that elemental energy. In the case of ST36, this makes it a very "earthy" point, but again, it is through needle technique that we decide what to do with that earth energy.

In terms of indications (clinical conditions that are a direct function of the classical energetics discussed above), ST36 is known for its use in treating the following conditions: gastric pain; vomiting; abdominal distention; indigestion; borborygamus; diarrhea; constipation; dysentery; mastitis; dizziness; mental disorders; hemiplegia; beriberi; aching of the knee joint; abscessed breast; edema of the limbs; difficult urination; incontinence; paralysis; seizures; asthma (lung or kidney type); duodenal ulcers; depression; and abdominal and gastric illness.

Now let us turn our attention to the use of ST36 with other acupuncture points, to see how they work synergistically, and to see which needle technique needs to be chosen to accomplish those results. Source materials for this discussion were obtained in a lecture I attended in 1988 at the International Training Center of the Academy of Traditional Chinese Medicine in Beijing, China, entitled "Very Famous Old Prescriptions for ST36." In lieu of a lengthy discussion, and for clinician convenience, this information is summarized in the table that follows. The practitioner may select any tonification (reinforcement) or dispersion (reduction) technique that he/she prefers. Standard point locations and depths of insertion should be used and, if required, can be consulted.

Point Combination Needle Method Energetics Clinical Conditions
ST36 (Sanyinjiao) and Reinforce To elevate the yang qi For rheumatic disease, bi-syndromes, numbness of the legs
SP6 Reinforce To strengthen the yin and blood; for deficiency and cold of the spleen or deficiency of qi
Overall, the main prescription to tonify the qi and blood
ST36 and Reduce He-Sea point to eliminate turbidity in the stomach Diarrhea, vomiting, nausea, acid regurgitation, bi-syndrome, knee pain, beriberi of the foot
GB34 (Yanglingquan) Reduce He-sea point to clear heat in the liver and gallbladder
Overall aim: to harmonize wood and earth. For diseases of wood and earth, such as retention of phlegm in the middle jiao
ST36 and Reinforce both points or use even technique As he-sea points, they strengthen the middle jiao, dispel damp, and promote transformation and transportation Reduces edema caused by the heart and dysfunction of the kidney, dysuria, edema of the lower extremities, for digestion with abdominal distention, chronic diarrhea
SP9 (Yinlingquan)
ST36 and Reduce Promotes circulation of meridians and collaterals Poliomyelitis, wei-syndrome
GB39 (Xuanzhong) Reduce (apply moxa to GB39 to prevent wind-stroke) Reduces/clears heat/fire in the gallbladder. A must for any marrow problem. Tonifies the marrow Early signs of wind-stroke such as numbness or hemiplegia
For kidney problems caused by gallbladder fire Hypertension
ST36 and Reinforce Strengthens earth, harmonizes stomach For chronic hepatitis and jaundice
LR3 (Taichong) Reduce Pacifies the liver
ST36 and Moxa recommended over needle Affects the fetus Difficult labor, promotes menstrual flow
BL67 (Zhiyin)
ST36 and Reinforce For perversion of qi, any qi going the wrong way, brings qi down Coma due to anger, sunstroke, toxic coma, respiratory failure, dehydration, makes blood pressure normal
ST36 and KI1 (Yongquan) Reduce
ST36 and Reinforce Both points of the foot and hand yang ming Acute or chronic rhinitis, nasal obstruction due to invasion of wind-cold (deficiency case)
LI20 (Yingxiang) Reduce
ST36 and Tonify Benefits and stregthens the stomach Deficiency couch caused by fatique, deficiency asthma
LU7 (Lieque) Reduce Resolves phlegm
ST36 and Reduce Clears heat in the diaphragm and chest Stifling sensation in the chest, dry retching, irritability, belching, irascibility, vomiting, acid regurgitation, lassitude
PC8 (Laogong) Reduce Clears heat in heart and lung, descends upward attack of heat
ST36 and Reduce Clears heat in the diaphragm and chest Stifling sensation in the chest, dry retching, irritability, belching, irascibility, vomiting, acid regurgitation, lassitude
PCS (Laogong) Reduce Clears heat in heart and lung, descends upward attack of heat
ST36 and Reduce Reduces fire in the yang ming, clears heat in the stomach meridian Toothache caused by upward attack of stomach fire, headache due to upward attack of heat in the yang ming, sore throat, frontal headache, redface
Li2 (Erjian) Reduce
ST36 and Reduce ST36 for fu organs Famous prescription for constipation due to depression of qi in 3 jiaos and dysfunction of spleen and stomach. Can use for constipation in pregnancy
TE6 (Zhigou) Reinforce TE6 for regulating qi of 3 jiaos of the fu organs
ST36 and Reinforce Regulates the qi of the foot and hand yang ming Stomach and intestinal problems. Good formula for health
LI10 (Shousanh) Reinforce For disorders of the qi of the stomach and intestines Weakness in spleen and stomach, abdominal distention, fullness and pain, loose stools, irregular bowel movement, constipation, anorexia
Deficiency of qi and blood in general and in the elderly Dizziness, vertigo, blurry vision, weakness of lower limbs, fatigue, hemiplagia, wei- and bi-syndromes, trembling of extremities due to qi and blood deficiency seen in older patients
Point Combination Needle Method Energetics Clinical Conditions
ST36 and Reduce Very famous ancient prescripton to regulate the upper and middle jiao Removes food retention
CV21 (Xuangi) Reduce Sends qi downward; when spleen and stomach lose the ability to transform and transport Severe asthma, improper food intake, abdominal distention, nausea, anorexia, fullness, belching, loose stools, hard masses
Overall, the main prescription to tonify the qi and blood
ST36 and Reinforce He-sea point to eliminate turbidity in the stomach Strengthens the spleen and stomach
CV11 (Jianli) Reinforce Harmonizes the stomach, ascends the clear, resolves damp Eases the chest, chronic diarrhea due to dysfunction of the stomach and intestines
Main prescrption for stomach disorders and epigastric pain Abdominal pain, spontaeous sweat, lassitude
ST36 and Reinforce Main prescription for stomach ulcer Stomach ulcer, epigastric pain
CV12 (Zhong wan) Reinforce
ST36 and Reinforce Regulates and harmonizes the qi of the stomach and intestines Wide indications. Chronic diarrhea - reinforce; acute diarrhea - reduce; bacterial dysentery - reduce. Very effective in treating bacterial dysentery; constipation due to disorders of transportation in the intestines
ST25 (Tiantu) Reinforce (retain needle two hours for dysentery) Disorders of transportation in the intestines
ST36 and Reinforce Main prescription to tonify qi; especially good for qi deficiency Wide indications; after severe disease
CV6 (Qihai) Reinforce (if qi is dranged, reduce)
ST36 and Reinforce Eliminates the pathogens Tuberculosis of the lung deficiency due to fatique
BL43 (Gaohuang) Reinforce Strengthens the antipathogenic qi for keeping fit and healthy
ST36 and Reinforce or even Harmonizes the blood, checks bleeding Vomiting blood due to coldness in spleen (failure to control the blood)
BL17 (Geshu) Reinforce (or even needle). Position tip of needle toward spine. Produces blood For upper respiratory and digestive tract
ST36 and Reinforce Promotes qi Dizziness, blurry vision due to deficiency of liver blood
BL18 (Ganshu) Reinforce* (Needle BL 18 first) Replenishes blood Lassitude due to dysfunction of stomach and liver, dysfunction of spleen and stomach
ST36 and Reinforce Decline of mingmen fire Impotence, prospermia
GV4 (Mingmen) Reinforce (moxa can be used)
ST36 and Reinforce or even Harmonizes the stomach, invigorates yang qi Stops vomiting spontaneous sweat caused by yang xu
PC6 (Neiguan) Movement
ST36 and Reinforce Tonic points Premature ejaculation
CV4 (Guanyuan) Reinforce Abdominal crossing of 3 leg yen; better than SP6; includes function of SP6; tonifies source qi Impotence due to qi xu
ST36 and Reduce Anti-inflammatory; lowers white blood cells when there is inflammation White blood cell pathology
DU14 (Dazhid) Reduce (can raise white blood cells with use of moxa)
ST36 and Reinforce Regulates the qi of stomach and intestines Acute and chronic diarrhea due to qi dysfunction
LI4 (Hegu) Reinforce (reduce if due to an accumulation of damp and heat) Failure of qi to ascend or descend Vomiting, nausea related to the intestines

Click here for previous articles by Skya Abbate, DOM.

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