ST-35 (Du Bi) Calf's Nose

What does ST-35 Du Bi do?

Du Bi ST-35 is the Stomach channel's point at the knee — the lateral "eye" of the knee, in the hollow beside the kneecap tendon — and its recorded work is to dispel wind-damp and reduce swelling, and to activate the channel and relieve pain. Sacred Lotus sources & references record both actions directly. Unlike the extra point that shares its hollow, ST-35 is a channel point, and that is the whole difference between them: the Stomach channel of Foot Yang Ming runs down the front of the thigh, crosses the knee at exactly this spot and continues down the shin, so ST-35 carries channel reasoning that a non-channel point in the same dimple cannot.

• Dispels wind-damp and reduces swelling — the first recorded action. "Wind-damp" is the tradition's name for the painful, swollen, stiff, weather-sensitive joint — the presentation classically called bi, painful obstruction. The knee is the joint the phrase was coined for, and ST-35 is the point at the front of it. The swelling half of the action is anatomically apt: the two hollows either side of the kneecap tendon are precisely the places that fill and flatten when the knee swells, so a point sited in one of them is sited in the swelling itself.
• Activates the channel and alleviates pain — the second recorded action and the busier one in practice. This is the local action of a channel point at a joint the channel crosses. It covers pain at the front of the knee, stiffness, difficulty bending and straightening, and pain referred up the thigh or down the shin along the channel's own line.
• Benefits the sinews and eases movement of the joint — an extension of the second action rather than a separate one. The reference literature records ST-35 where the knee is guarded and restricted as well as where it is painful at rest, and where the leg is weak and heavy on standing.

Why does ST-35 carry no point category — and why does being a channel point still matter?

Queried directly, ST-35 holds no five-shu, yuan, luo, xi-cleft, back-shu, front-mu or confluent classification and no element. The Stomach channel's classified points sit elsewhere: Liang Qiu ST-34 just above the knee is the channel's Xi-Cleft point, Zu San Li ST-36 just below it is a Gao Wu Command Point, a Ma Dan-yang Heavenly Star Point and a Point of the Sea of Water and Grain, and the five-shu points run down to the foot — all held here and all queried. ST-35 has none of them and sits between two of the most classified points on the body.

It nonetheless matters a great deal that ST-35 is a channel point, because the extra point occupying the same hollow is not. Our Xi Yan record — the pair of "knee eyes" — had channel-theory language removed from it during review precisely because a non-channel point cannot dispel wind-damp or activate a channel; that record names ST-35, along with GB-34 Yang Ling Quan (the Hui-Meeting Point of the Sinews), SP-09 Yin Ling Quan and ST-34 Liang Qiu, as the points that genuinely carry the reasoning. This is the record that carries it. A reader who wants the channel argument for treating a knee at the front of the joint is in the right place here; a reader who wants the pair of hollows as a purely local treatment wants the Xi Yan record.

Source: Sacred Lotus sources & references (existing action record, reformatted here as a list; channel confirmed as the Stomach Channel of Foot Yang Ming and the absence of point categories and element queried directly; the Xi Yan, He Ding, ST-34, ST-36, SP-09, SP-10 and GB-34 records queried directly); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 157); Chinese Acupuncture & Moxibustion (p. 154); cross-referenced against multiple online sources.

What is ST-35 Du Bi used for?

Du Bi ST-35 is used for the knee, and overwhelmingly for one condition: knee osteoarthritis, in which it is the single most frequently selected acupoint in the published electroacupuncture literature. The indications carried in Sacred Lotus sources & references are pain, numbness and motor impairment of the knee, and beriberi; the standard reference literature sets them out more fully below. These describe traditional use, not proven treatment. This is a low-hazard limb point, for the reasons set out under needling.

• Knee pain — the defining indication, and particularly pain at the front of the joint
• Knee osteoarthritis — by far the commonest modern application
• Swelling of the knee joint
• Stiffness of the knee, with restricted bending and straightening
• Numbness around the knee and the front of the leg
• Motor impairment and weakness of the knee
• Painful obstruction (bi) of the knee — the wind-damp presentation
• Knee injury and post-traumatic knee pain
• Pain of the lower leg along the front of the shin
• Heaviness and weakness of the leg on standing and walking
• Beriberi — the classical indication, discussed below

What "beriberi" means in this list, and why it is kept. Our own indication record carries beriberi at this point, and it is worth explaining rather than quietly dropping. In the classical Chinese literature jiao qi — literally "leg qi" — names a syndrome of weakness, numbness, swelling and pain of the legs, and it was the standard heading under which disorders of the lower limb were gathered for many centuries. The English word "beriberi", which now denotes thiamine deficiency specifically, was adopted as its translation and has been carried in acupuncture texts ever since. The old indication is about weak, numb, swollen legs; it is not a claim about vitamin deficiency. Reading it as the latter would be a translation error rather than a piece of traditional knowledge, and the accurate thing is to record the term and explain what it meant.

What is not on the list. The reference literature does not record ST-35 for internal organ disorders, for systemic complaints or for anything above the thigh. This is a local point of one joint, and keeping its list short is the accurate thing to do. Where a knee problem is part of a wider pattern, the points that carry that reasoning are elsewhere on the channels — SP-09 Yin Ling Quan for damp, GB-34 Yang Ling Quan for the sinews, and BL-23 Shen Shu and KI-03 Tai Xi for the deeper deficiency to which weak knees are traditionally attributed. All are held here.

Source: Sacred Lotus sources & references (existing indication record, reformatted here as a list from a bare comma-run; the SP-09, GB-34, BL-23 and KI-03 records queried directly); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 157); Chinese Acupuncture & Moxibustion (p. 154); PMID 36045455 (PMC9429477); cross-referenced against multiple online sources.

Where is ST-35 Du Bi, and is it the same as Xi Yan?

Du Bi lies in the soft hollow on the outer side of the kneecap tendon, immediately below the kneecap, and it only exists when the knee is bent. In our own words: bend the knee and the patellar ligament — the strong cord running from the bottom of the kneecap down to the shin bone — stands out, with a soft dimple on either side of it. ST-35 is the outer dimple. Straighten the leg and both dimples disappear. Sacred Lotus sources & references hold two location records for it and they agree: both specify the knee flexed, immediately below the patella, lateral to the patellar ligament. There is no discrepancy between them to flag.

And yes — the outer dimple has two names, which is the most mis-stated relationship in this part of the repertoire. The pair of hollows together is the extra point Xi Yan, "Eyes of the Knee", held separately in this library; queried directly, our Xi Yan record locates the pair "immediately below the patella and both medial and lateral to the patellar ligament", while our ST-35 record locates this point in the lateral hollow alone. So the lateral hollow is described twice under two names, and the medial hollow is carried only inside the Xi Yan entry — this library holds no separate record under the name Nei Xi Yan ("Medial Xi Yan"), which is how many sources distinguish the inner one. That was confirmed by direct query rather than recall. The practical consequence is worth stating: a reader who reaches this page wanting the channel reasoning is in the right place, and a reader who wants the pair as a local unit wants the Xi Yan page.

A coding collision in the published literature is flagged here rather than smoothed over, exactly as our Xi Yan record flags it from its side. The same location is printed in indexed trials as EX-LE 4, as EX-LE 5 and as ST 35, sometimes within the same body of work on the same condition; our own Xi Yan needling record additionally carries the older code MN-LE-16. Papers can be found listing "Xiyan (EX-LE5), Dubi (ST35)" as two separate points in one prescription and "Neixiyan (EX-LE4), Dubi (ST35)" as two separate points in another — both usages are in print, and they do not mean the same thing. Neither our ST-35 location nor our Xi Yan location has been altered; the overlap is documented because the points genuinely overlap, and the note is added because a reader comparing point lists across papers will otherwise be badly misled.

Which points is ST-35 combined with?

• With the medial knee eye — that is, with Xi Yan. The two hollows are used as a pair as a matter of routine, needled separately or connected as an electroacupuncture pair across the front of the joint, and in some documented techniques threaded from one to the other behind the patellar ligament. This is the single commonest thing done at this point.
• With He Ding — the extra point "Crane's Summit" in the depression at the middle of the top edge of the kneecap, held here. He Ding above and ST-35 below bracket the joint, and our He Ding record names this relationship from its own side.
• With Liang Qiu ST-34 and Xue Hai SP-10 above, Yin Ling Quan SP-09 and Yang Ling Quan GB-34 below. All four are held here and all were queried. ST-34 is the Xi-Cleft point of this very channel and therefore the classical choice for an acute, painful, swollen knee; GB-34 is the Hui-Meeting Point of the Sinews and the point for tendons and ligaments; SP-09 is the principal point for resolving dampness; SP-10 is the "Sea of Blood". That group plus the two knee eyes is, near enough, the standard local knee prescription in modern practice.
• With Zu San Li ST-36 — the next point down on the same channel, three cun below the knee, and one of the most used points in acupuncture. ST-35 and ST-36 are constant partners simply because they are neighbours on the channel that crosses the knee, and ST-36 adds the systemic, strengthening dimension that a purely local point does not have.
• With Xi Yang Guan GB-33 — on the outer side of the knee above the joint line, held here, and the lateral-side counterpart to the front-of-knee points.
• With Wei Zhong BL-40 — behind the knee, held here as a Gao Wu Command Point and a Ma Dan-yang Heavenly Star Point. Where ST-35 covers the front of the joint, BL-40 covers the back of it, and the pair is the usual front-and-back combination.
• With San Yin Jiao SP-06 and Ashi points. SP-06, the Meeting Point of the Spleen, Liver and Kidney channels, is held here and appears alongside ST-35 in most published knee protocols; "Ashi" points are simply the tender spots found on the individual, which the knee literature includes almost universally.

What do the published protocols actually use?

ST-35 is not merely common in the knee literature — in the largest systematic look at what those trials actually did, it is the most used point of all. A data-mining analysis of clinical studies of electroacupuncture for knee osteoarthritis published between 2012 and 2021, drawn from PubMed, the Cochrane Library, Embase and Web of Science, included 46 articles and extracted every stimulation parameter and every acupoint used. Eighteen acupoints appeared, and the most used were Dubi ST-35, followed by Liangqiu ST-34, Neixiyan EX-LE 4, Xuehai SP-10, Yanglingquan GB-34 and Yinlingquan SP-09; the commonest parameters were a 0.30 mm × 40 mm needle, continuous wave, 2 Hz, 30 minutes per treatment, once daily, and the most strongly associated acupoint pair was ST-34 with SP-10 (Cai FH et al., Eur J Med Res 2022;27:162, PMID 36045455, PMC9429477). A separate validation study comparing sixteen randomised trials against what practitioners actually do found the core set to be ST-34, ST-35, ST-36, SP-06, SP-09, SP-10, GB-34, Xiyan and Ashi points, with only minor differences between research protocols and practice (Acupunct Med 2012;30(3):187–194, PMID 22759902). Every point named in both lists is held in this library, and each was queried. The caveat belongs firmly attached: these are findings about what gets prescribed. They establish that ST-35 is the central point of this literature; they do not establish that it works.

Source: Sacred Lotus sources & references (both location records; the Xi Yan, He Ding, ST-34, ST-36, SP-06, SP-09, SP-10, GB-33, GB-34 and BL-40 records queried directly); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 157) and extra points (p. 583); Chinese Acupuncture & Moxibustion (pp. 154, 252); PMID 36045455 (PMC9429477); PMID 22759902 — each verified resolvable and checked for retraction status before citation; cross-referenced against multiple online sources.

Where is ST-35 located?

• A Manual of Acupuncture (p. 157): On the knee, in the hollow formed when the knee is flexed, immediately below the patella and lateral to the patellar ligament.
• Chinese Acupuncture and Moxibustion (p. 154): When the knee is flexed, the point is at the lower border of the patella, in the depression lateral to the patellar ligament.

How is ST-35 Du Bi needled, and is it a dangerous point?

Stated plainly: ST-35 is a low-hazard point. There is no body cavity, no lung, no great vessel and no internal organ anywhere near it. What bounds the depth here is the knee joint itself, which lies directly beneath — the recorded depths are enough for a needle to reach the joint capsule, and every genuine consideration at this point follows from that one fact rather than from anything the rest of the body is exposed to. Everything below is recorded as neutral reference data describing what the textbooks and the published literature state. It is not instruction, this page does not teach technique, and needling is carried out only by a qualified, licensed practitioner. The framing here is deliberately kept identical to our Xi Yan record, which describes the same two hollows from the extra point's side.

The angle and depth the texts record

• Sacred Lotus sources & references record perpendicular insertion of 0.7 to 1.0 inch, with moxibustion applicable. Our Xi Yan record, describing the same pair of hollows, carries the wider figure of 1 to 2 cun together with three documented approaches — perpendicular toward Wei Zhong BL-40 behind the knee, oblique medially and upward behind the kneecap, and through-needling from one hollow to the other.
• Deadman & Al-Khafaji (p. 157) and Chinese Acupuncture & Moxibustion (p. 154) record comparable perpendicular and oblique insertion into the hollow with the knee flexed. The flexed knee is not a matter of comfort: with the leg straight the hollow does not exist and there is no point to locate.
• Where this figure sits among its neighbours. Queried directly, our He Ding record carries a shallower figure at the top edge of the kneecap, while ST-35 and Xi Yan below the kneecap carry deeper ones — there is more soft tissue between skin and joint below the patella than above it. Depth figures in this literature track the structure underneath.
• Moxibustion and electroacupuncture are both recorded here and both are common. The data-mining analysis of electroacupuncture at this point found the typical parameters to be continuous wave at 2 Hz for 30 minutes (PMID 36045455), and moxibustion trials have used ST-35 by name in their point regimens (Zhen Ci Yan Jiu 2024;49(2):171–176, PMID 38413038).

What actually lies beneath

• The knee joint and its capsule lie immediately deep to the point. At the recorded depths a needle is in or at the edge of the joint. That is the single fact that governs everything else here.
• The infrapatellar fat pad fills the space behind the two hollows. It is a well-recognised source of knee pain in its own right and is sensitive to being disturbed, which is why local soreness after treatment at this point is common and expected rather than a sign that anything has gone wrong.
• The patellar ligament is medial to the point — it is the cord the point is defined relative to. The lateral retinaculum and the fibrous capsule surround the hollow.
• The inferior lateral genicular artery runs in the neighbourhood, one of the vessels forming the anastomosis around the knee. It is small; bruising at the knee is among the commoner minor events after needling anywhere on the limb.
• No cavity, no organ, no nerve trunk of consequence. The common peroneal nerve winds around the neck of the fibula well lateral and below this point, and the popliteal vessels and tibial nerve are behind the knee, not in front of it.

What the published safety literature says

• Joint infection is the theoretical serious event at any point overlying a synovial joint, and strict clean-needle technique is the standard practice that addresses it. A 2024 review of acupuncture safety lists infections among the small number of genuinely serious adverse events and attributes them to contaminated needles and inadequate skin disinfection rather than to needling as such (Am J Chin Med 2024;52(6):1555–1587, PMID 39460372). A knee that becomes hot, swollen and increasingly painful after any needling requires immediate medical assessment.
• Existing joint disease and joint replacement change what lies beneath the skin. The reference literature treats a prosthetic joint as a reason for particular caution at local points, on infection grounds.
• The trial evidence on tolerance is reassuring and is worth quoting rather than paraphrasing. The largest randomised trial of acupuncture for chronic knee pain — 282 patients aged over 50, four arms comparing needle acupuncture, laser acupuncture, sham laser and no acupuncture — reported no serious treatment-related adverse events (Hinman RS et al., JAMA 2014;312(13):1313–1322, PMID 25268438).
• Risk in proportion. A meta-analysis of prospective clinical studies estimated serious adverse events in acupuncture at approximately 1 per 10,000 patients and about 8 per million treatments, with roughly half of all recorded events being bleeding, pain or flare at the needle site (Bäumler P et al., BMJ Open 2021;11:e045961, PMID 34489268). Systematic reviews of the Chinese case literature place the serious events over the chest, the abdomen, the neck and the orbit (He W et al., PMID 22967282; Zhang J et al., Bull World Health Organ 2010;88(12):915–921C, PMID 21124716, PMC2995190). The knee is in none of those groups.
• No imaging or cadaveric study measuring a safe needling depth at ST-35 could be located, and none is needed in the way it is over the ribs or the neck: the depth is bounded by a joint that can be felt, not by a membrane that cannot. No published case report of injury at ST-35 could be sourced either, and none is asserted. Where a point is low-hazard, the useful thing is to say so plainly rather than import a warning from a different region, and that is what is done here.

Source: Sacred Lotus sources & references (existing needling record; the Xi Yan and He Ding needling records queried directly for comparison); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 157); Chinese Acupuncture & Moxibustion (p. 154); PMID 36045455 (PMC9429477); PMID 38413038; PMID 39460372; PMID 25268438; PMID 34489268; PMID 22967282; PMID 21124716 (PMC2995190) — each verified resolvable and checked for retraction status before citation.

What does the name Du Bi mean?

Du Bi means "Calf's Nose" — du, a calf, and bi, a nose. Sacred Lotus sources & references translate it exactly that way. The image is one of the most literal in the whole repertoire, and it is easiest to see if the two hollows are taken together rather than one at a time: bend the knee and look at it from in front, and the pair of soft dimples either side of the kneecap tendon sit like a pair of nostrils, with the tendon between them like the bridge of a muzzle — the whole arrangement resembling the nose of a calf. Straighten the leg and the picture disappears. The related name is worth knowing alongside it: the pair of hollows regarded as eyes rather than nostrils gives the extra point Xi Yan, "Eyes of the Knee", held separately here. Two images, one anatomy, two names in current use — which is exactly why the coding of this location is such a mess in the literature, as set out under how the point is used.

How is ST-35 different from the points around it?

Xi Yan is the comparison that matters most, and it is set out in full under uses: the extra point covers both hollows, ST-35 the lateral one only, and the medial hollow is carried inside the Xi Yan entry rather than under a separate heading. The difference in what they may be said to do is real and not merely bureaucratic — ST-35 is a channel point and carries channel actions; Xi Yan is an extra point and carries documented local use. He Ding sits at the middle of the top edge of the kneecap and brackets the joint with ST-35 from above. Liang Qiu ST-34, two cun above the kneecap on the same channel, is the Xi-Cleft point and the acute-knee point proper. Zu San Li ST-36 is the next point below on the same channel and is one of the most classified points in acupuncture, carrying three designations where ST-35 carries none. Xue Hai SP-10 above the inner knee and Yin Ling Quan SP-09 below it are the Spleen channel's contribution; Yang Ling Quan GB-34 below the outer knee is the Hui-Meeting Point of the Sinews; Xi Yang Guan GB-33 is above it on the outer side; and Wei Zhong BL-40 is directly behind the knee. All of these are held in this library and all were queried. Among them ST-35 is the channel point in the outer knee eye, and it is the one the modern literature has used most.

Is there research on ST-35 Du Bi?

Yes — more than for almost any other local point on the body, and the honest answer requires separating two very different things. There is genuinely point-specific evidence that ST-35 is the most-used point in the knee osteoarthritis literature. There is no evidence that isolates what ST-35 itself contributes. Those are not the same claim, and the difference is the whole of an honest reading.

• What is genuinely point-specific: prescribing frequency. The data-mining analysis of 46 electroacupuncture studies for knee osteoarthritis found Dubi ST-35 the most used of the eighteen acupoints that appeared (PMID 36045455, PMC9429477), and the practice-validation study of sixteen randomised trials placed it in the nine-point core set alongside ST-34, ST-36, SP-06, SP-09, SP-10, GB-34, Xiyan and Ashi points (PMID 22759902). A separate methodological paper reading knee osteoarthritis through the classical Dongyuan needling scheme lists Dubi ST-35 among the "earth points and acupoints on the earth meridians" chosen for the condition, alongside SP-09, SP-10, ST-34, ST-36 and GB-34 (Zhongguo Zhen Jiu 2023;43(2):209–212, PMID 36808517). All of this is evidence about what practitioners and trialists choose. It establishes ST-35 as the central point of the knee repertoire and nothing more.
• Trials in which ST-35 appears — and what they compared. A randomised moxibustion trial in 80 patients with knee osteoarthritis compared a six-point regimen (Xiyan EX-LE 5, Dubi ST-35, Zusanli ST-36, Dazhu BL-11, Xuanzhong GB-39, Yongquan KI-01) against a three-point local regimen (EX-LE 5, ST-35, ST-36), 30 minutes three times weekly for four weeks; both groups improved on WOMAC and visual analogue pain scores and on serum interleukin-1α, interleukin-17A, tumour necrosis factor α, bone gla protein and osteoprotegerin, with the six-point regimen better on several measures though the difference in total effective rate (89.5 versus 83.8 per cent) was not significant (Zhen Ci Yan Jiu 2024;49(2):171–176, PMID 38413038). A three-arm trial in 84 patients compared acupuncture, electroacupuncture and moxibustion using Neixiyan, Dubi ST-35, Heding, Liangqiu ST-34, Xuehai SP-10, Zusanli ST-36 and Ashi points, and reported moxibustion best on pain and stiffness (Zhen Ci Yan Jiu 2020;45(7):569–573, PMID 32705832). A multicentre randomised trial in 216 patients compared traditional moxibustion against its separated light and heat components at EX-LE 4, ST-35 and ST-36 (Zhongguo Zhen Jiu 2020;40(6):623–628, PMID 32538014). In every one of these, ST-35 is a fixed component of both arms. None tests the point; they test the technique or the surrounding regimen.
• What the highest-quality evidence says about the whole treatment. The Cochrane systematic review of acupuncture for peripheral joint osteoarthritis pooled sixteen trials in 3,498 people. Against sham it found statistically significant but clinically irrelevant short-term improvements in pain and function that fell below the review's own predefined thresholds, and that shrank to non-significance when analysis was restricted to the sham designs judged most likely to blind participants successfully; against a waiting list it found large, clinically relevant improvements (Manheimer E et al., Cochrane Database Syst Rev 2010;(1):CD001977, PMID 20091527). The large four-arm randomised trial in 282 people with chronic knee pain found neither needle nor laser acupuncture better than sham laser at twelve weeks on pain or function, and concluded that the findings did not support acupuncture for these patients (JAMA 2014;312(13):1313–1322, PMID 25268438). Against that, the individual-patient-data meta-analyses of acupuncture for chronic pain, covering some 20,000 and then nearly 21,000 patients across trials including osteoarthritis, found effects superior to both sham and no-acupuncture controls, with a substantial but not complete persistence of benefit at one year (Vickers AJ et al., Arch Intern Med 2012;172(19):1444–1453, PMID 22965186; J Pain 2018;19(5):455–474, PMID 29198932). Both the negative and the positive results are reported here, and the reason they can coexist — how much of the effect survives a credible sham — is the central unresolved question of the field. None of these studies isolates ST-35.
• What is not here. There is no trial in which ST-35 is the variable — no study adding or removing this one point from an otherwise identical protocol, and no sham-controlled comparison of ST-35 against a nearby non-point. For the most-used point in the most-studied acupuncture indication, that gap is remarkable and it is stated flatly rather than obscured by the volume of surrounding literature.
• A search caution, because point-code searches are how this literature is found. A database search on this point's romanised name returns a substantial number of papers that have nothing to do with it — the string appears within Chinese personal names in unrelated fields. Every study cited on this page was read rather than counted, and each names Dubi or ST 35 as an acupoint.

Source: Sacred Lotus sources & references (name, translation, channel and the absence of point categories queried directly; the Xi Yan, He Ding, ST-34, ST-36, SP-06, SP-09, SP-10, GB-33, GB-34, GB-39, BL-11, BL-40, BL-23, KI-01 and KI-03 records queried directly); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 157); Chinese Acupuncture & Moxibustion (p. 154); PMID 36045455 (PMC9429477); PMID 22759902; PMID 36808517; PMID 38413038; PMID 32705832; PMID 32538014; PMID 20091527; PMID 25268438; PMID 22965186; PMID 29198932 — each verified resolvable and checked for retraction status before citation; cross-referenced against multiple online sources.