Si Feng Four Seams, Four Cracks

What does Si Feng do?

Si Feng is an extra point — it belongs to no channel and carries no point category, so it has no channel-theory actions; everything below comes from documented clinical use. In that documented use it is the paediatric point: the classical point for the malnourished, poorly-growing, poorly-eating child, used on the finger creases and almost never on adults.

• The classical point for childhood malnutrition — gan ji, the traditional syndrome of a wasted, distended, listless child with poor appetite and stalled growth. This is the defining documented use and the reason the point was recorded.
• Used for childhood anorexia and refusal of food — the modern form of the same territory, and the indication with by far the most research attached to it.
• Used for food stagnation and indigestion in children — abdominal distension, undigested food in the stool, foul breath and disturbed sleep from an overloaded stomach.
• Used for whooping cough — recorded in the traditional indications carried by our own sources and by the wider reference literature. This one rests on tradition alone; no modern research addresses it.
• Extended in modern Chinese practice to other paediatric conditions — childhood diarrhoea, constipation and, in recent trial work, as an adjunct in childhood pneumonia. These are recent extensions, not classical uses, and should be read as such.

A correction worth stating plainly. Si Feng is often described as "strengthening the Spleen and Stomach". That is an organ-theory phrase, and Si Feng is on no channel — it has no five-shu, yuan, luo, xi-cleft, back-shu or front-mu classification. Our own earlier record opened with exactly that phrase and it has been removed. The points that genuinely carry the Spleen and Stomach's own regulating work are ST-36 Zu San Li, the sea point of the Stomach channel; REN-12 Zhong Wan, the front-mu point of the Stomach; and BL-20 Pi Shu and BL-21 Wei Shu, the back-shu points of the Spleen and Stomach — all held in Sacred Lotus sources & references. What the sources actually document for Si Feng is the clinical result in children: appetite restored, weight gained, accumulation cleared.

Source: Sacred Lotus sources & references (existing action and indication record, corrected as described); Deadman & Al-Khafaji, A Manual of Acupuncture, extra points (p. 577); Chinese Acupuncture & Moxibustion (p. 249); PubMed PMID 37748564, 16491747; cross-referenced against multiple online sources.

What is Si Feng used for?

Si Feng is used for the digestive complaints of childhood — malnutrition, poor appetite and food stagnation — and for whooping cough. The indications carried in Sacred Lotus sources & references are malnutrition and indigestion syndrome in children and whooping cough; the wider reference literature sets them out as follows.

• Childhood malnutrition (gan ji) — the leading and defining indication
• Childhood anorexia and refusal of food
• Poor appetite with failure to gain weight
• Food stagnation and indigestion in children
• Abdominal distension in children
• Undigested food in the stool
• Whooping cough (traditional indication)
• Childhood diarrhoea (modern extension)
• Childhood constipation (modern extension)
• Cough and phlegm in childhood chest infection, as an adjunct (modern extension)

A note on who this point is for. Si Feng is a paediatric point, and the reference literature treats it as one almost without exception: the trials are in children aged roughly one to seven, the traditional indication is a childhood syndrome, and the point rarely appears in adult prescriptions at all. Isolated reports of adult use exist — hiccup, skin conditions, finger spasticity after stroke — but they are scattered case series rather than a body of practice, and they should not be read as though Si Feng were a general point that happens to be used in children.

Source: Sacred Lotus sources & references (existing indication record); Deadman & Al-Khafaji, A Manual of Acupuncture, extra points (p. 577); Chinese Acupuncture & Moxibustion (p. 249); PubMed PMID 37748564, 16491747, 23819238, 33068349; cross-referenced against multiple online sources.

How is Si Feng used in practice?

Si Feng is not one spot but four: the midpoints of the creases across the middle joints of the index, middle, ring and little fingers, on the palm side of the hand. One name, four positions per hand, eight in all when both hands are treated — which is how the reference literature and the clinical trials describe it. Like Er Bai (two positions), Shi Xuan (ten fingertips) and Ba Xie (eight positions between the knuckles), all held in Sacred Lotus sources & references, this is an extra point whose name denotes a set.

How often is Si Feng treated?

Weekly, and briefly — which is unlike almost every other point on the site. The trials that define its evidence base treated once a week for four weeks in total, and the reference literature describes the same rhythm. There is no daily course and no retained needle. That schedule follows directly from the technique: the point is pricked rather than needled and retained, so a treatment lasts seconds rather than the twenty to thirty minutes a conventional session runs, and the interval between treatments is long enough for the fingers to settle. For a small child who will not lie still, that is the whole practical point of it.

Which points is Si Feng combined with?

• With ST-36 Zu San Li — the principal digestive point of the body and the natural partner where the treatment is aimed at appetite and strength rather than at accumulation alone.
• With REN-12 Zhong Wan — the front-mu point of the Stomach, on the upper abdomen, added where distension and fullness dominate.
• With BL-20 Pi Shu and BL-21 Wei Shu — the back-shu points of the Spleen and Stomach; a modern trial paired point-embedding at back-shu and front-mu points with pricking at Si Feng, which is the clearest published example of this combination.
• With paediatric tuina — in Chinese paediatric practice Si Feng is more often combined with massage of the hand and abdomen than with other needled points, because the child's tolerance, not the theory, sets the limit. One trial paired it directly with chiropractic-style manipulation for childhood anorexia.
• With Shi Xuan — the other finger extra point, on the ten fingertips, held in Sacred Lotus sources & references; the two are frequently confused and are used quite differently, Shi Xuan for collapse and high fever, Si Feng for the chronic paediatric picture.

Source: Sacred Lotus sources & references (location and existing use record; ST-36, REN-12, BL-20, BL-21, Er Bai, Shi Xuan and Ba Xie records); Deadman & Al-Khafaji, A Manual of Acupuncture, extra points (p. 577); Chinese Acupuncture & Moxibustion (p. 249); PubMed PMID 16491747, 23620937, 24946636, 16570444; cross-referenced against multiple online sources.

Where is Si Feng located?

• A Manual of Acupuncture (p. 577): On the palmar surface of the hand, at the midpoints of the transverse creases of the proximal interphalangeal joints of the index, middle, ring and little fingers.

How is Si Feng needled in the textbooks?

Reference record only — this describes what the standard texts document, not instruction for a reader. The defining fact about Si Feng is that the standard texts do not record it as a retained needle at all. What they document is a quick prick with a fine lancet or three-edged needle, to a shallow depth of roughly 0.1 to 0.2 cun, after which the point is gently squeezed. The needle is withdrawn immediately; nothing is left in place.

• Technique documented: pricking, not insertion and retention. This is the point's distinguishing feature and the single most important thing to know about it.
• Depth documented: approximately 0.1 to 0.2 cun — superficial, into the crease itself.
• Retention documented: none. The needle is withdrawn at once.
• Expression documented: the texts record that the point is squeezed after pricking, and that a small quantity of clear yellow-white viscous fluid, or a drop of blood, may be expressed. The reference literature records that the treatment is considered to have been given whether or not fluid appears.
• Number of positions: four per hand, treated in turn; the trials record bilateral treatment.
• Frequency documented: once weekly, commonly for four treatments — the schedule used in the multicentre trial and in the trials the systematic review pooled.
• Moxibustion: not recorded as a method at this point.

Safety reference. Si Feng lies on the palmar creases of the fingers, over the middle finger joints, with no body cavity anywhere near it, so it carries none of the hazard that governs points over the thorax or the upper back. Three things nonetheless bound it in the reference record. First, it is a bleeding-type technique on a child: the literature is explicit that this is a practitioner-administered procedure using a sterile single-use lancet or three-edged needle with clean-needle technique and gentle pressure afterwards, and it is not described anywhere as something to be done at home. Second, the fingers are richly supplied with digital nerves and vessels immediately beneath thin skin, which is why the recorded depth is a fraction of a cun and why the palmar crease — not the pad or the side of the finger — is the recorded landmark. Third, the reference literature records the ordinary contraindications for any bleeding technique: disorders of clotting, anticoagulant use, and local infection or broken skin at the site. The systematic review of the point reported no serious adverse events across the trials it pooled. Acupuncture is performed by qualified, licensed practitioners; this record documents the literature and is not a technique guide.

Source: Sacred Lotus sources & references (existing needling and technique record); Deadman & Al-Khafaji, A Manual of Acupuncture, extra points (p. 577); Chinese Acupuncture & Moxibustion (p. 249); PubMed PMID 37748564, 16491747, 23620937.

What does the name Si Feng mean?

Si Feng means "Four Seams" or "Four Cracks" — si for four, feng for a seam, crack or fissure. It is a purely descriptive name: the four are the four fingers other than the thumb, and the "seams" are the transverse creases across the middle joint of each, which is exactly where the point lies. Nothing in the name refers to a function, a channel or an image — it simply tells you where to look. The site carries the modern code EX-UE 10 in the standardised extra-point numbering used throughout the research literature, and appears in older schemes as M-UE-9.

Is Si Feng a channel point?

No. Si Feng is an extra point — recorded outside the fourteen channels for an observed clinical effect rather than derived from channel theory. Extra points carry no five-shu, yuan, luo, xi-cleft, back-shu or front-mu classification, which is why our record shows no channel and no categories, and why the actions above are framed as documented uses. It is worth noting that the four positions do lie close to the palmar course of the Pericardium, Heart, Lung and Large Intestine lines on the fingers, but the point is measured from the creases, not from any of those channels, and no source treats it as belonging to them.

Why is Si Feng pricked rather than needled?

Because the technique is the point. More than any other extra point, Si Feng is defined by how it is treated rather than by where it is: a quick shallow prick with expression of a little fluid, no needle retained, repeated weekly. Two things follow. Practically, it suits the patient — a two-year-old will tolerate four brief pricks in a few seconds where they will not tolerate a retained needle for half an hour, and the whole treatment is over before the child has decided how to feel about it. Historically, the expressed fluid was itself read as diagnostic: the classical texts describe a clear yellow-white viscous fluid appearing in children with digestive accumulation and treat its presence, quantity and colour as information about the child's condition, with the fluid becoming clearer and scantier as the child improves over successive treatments. That is an observational tradition rather than a verified sign, and modern research has not tested it, but it explains why the technique was never simplified into ordinary needling.

Is there research on Si Feng?

Si Feng is unusual among the extra points in having a genuine, point-specific evidence base — including a systematic review devoted to this point alone. That is rare. The quality of the underlying trials is another matter, and the reviewers themselves are blunt about it.

• A systematic review and meta-analysis of this point. Twenty-four randomised trials in 2,202 children with paediatric anorexia were pooled. Compared with medication, pricking at Si Feng was associated with higher total efficacy (OR 6.44, 95% CI 4.78–8.66), a lower food-intake-reduction score, shorter time to normal food intake, lower leptin and higher blood zinc. The authors grade the certainty of evidence as very low for most outcomes, note high or unclear risk of bias in allocation concealment, blinding and selective reporting throughout, and conclude that high-quality trials are still needed (Complement Ther Med 2023;78:102988, PMID 37748564). An odds ratio of that size across trials of that quality should be read as a signal that the trials were weak, not as a measure of effect.
• A multicentre randomised trial in childhood malnutrition. 222 malnourished infants across four centres were randomised to acupuncture at bilateral Si Feng once weekly for four treatments, or to a herbal oral liquid twice daily for four weeks; 212 completed. The acupuncture group did better on appetite, body weight and abdominal subcutaneous fat thickness, with no difference in height and no significant change in serum IGF-I (Zhongguo Zhen Jiu 2006;26(1):3–7, PMID 16491747). This is the strongest single trial of the point — genuinely multicentre, genuinely about Si Feng alone — but its comparator is another treatment rather than a sham, so it shows relative rather than absolute effect.
• Mechanism work on appetite signalling. Eighty children aged three to six with anorexia were randomised to weekly pricking at Si Feng or to a syrup for four weeks, against a healthy control group. Ghrelin and neuropeptide Y rose and leptin fell in the acupuncture group, with all three moving further than in the medication group (Zhongguo Zhen Jiu 2013;33(2):117–120, PMID 23620937). An earlier trial by a different group reported the same direction of change in serum leptin (Zhongguo Zhen Jiu 2007;27(11):801–803, PMID 18085139). These are small, unblinded and from a single research tradition, but they at least propose a testable mechanism rather than restating the effect.
• Modern extensions beyond the classical indication. Recent trial work has taken Si Feng outside digestion: a randomised trial used it as an adjunct in childhood pneumonia of phlegm-heat type (Zhongguo Zhen Jiu 2020;40(10):1076–1080, PMID 33068349), and a 2026 published protocol tests bloodletting at Si Feng alongside standard azithromycin in paediatric mycoplasma pneumonia, measuring interferon-γ and interleukin-4 (J Vis Exp 2026;(228), PMID 41801801, DOI 10.3791/69583). A further trial addressed childhood diarrhoea (Zhongguo Zhen Jiu 2013;33(4):328, PMID 23819238). These are extensions of the point's territory, not confirmations of its classical use, and the pneumonia work is at protocol and early-trial stage.
• Preclinical work. An experimental study in rats reported changes in serum zinc and gastric emptying after stimulation at the rat equivalent of Si Feng in a model of digestive weakness (Zhongguo Zhen Jiu 2007;27(8):595–597, PMID 17853759). Animal work of this kind does not transfer directly to a malnourished child.

What the evidence does not cover. Whooping cough — one of the two indications our own record carries — has no modern research at this point at all; it rests entirely on the traditional literature. Nor has any trial compared pricking at Si Feng against a credible sham, which is the study the systematic review effectively calls for. The honest summary is that Si Feng has more point-specific evidence than almost any other extra point, and that the evidence is nonetheless of low certainty and comes overwhelmingly from one country and one research tradition.

How does Si Feng compare with the other finger points?

Shi Xuan, "Ten Diffusions", sits at the very tips of all ten fingers and is the emergency point of the group — used for collapse, loss of consciousness and high fever, also by pricking, and entirely unlike Si Feng in purpose despite the similar technique. Ba Xie, "Eight Pathogens", lies between the knuckles on the back of the hand and is used for swelling, pain and stiffness of the fingers. Er Bai on the forearm is the other extra point whose name covers a set of positions rather than one. All are held in Sacred Lotus sources & references. Among them, Si Feng is the only one that is specifically and almost exclusively a children's point.

Source: Sacred Lotus sources & references (existing record; ST-36, REN-12, BL-20, BL-21, Shi Xuan, Ba Xie and Er Bai records); Deadman & Al-Khafaji, A Manual of Acupuncture, extra points (p. 577); Chinese Acupuncture & Moxibustion (p. 249); PubMed PMID 37748564, 16491747, 23620937, 18085139, 33068349, 41801801, 23819238, 17853759 — each verified resolvable and checked for retraction status before citation; cross-referenced against multiple online sources.