ST-37 (Shang Ju Xu) Upper Great Hollow

What does ST-37 Shang Ju Xu do?

Shang Ju Xu ST-37 is the Lower He-Sea point of the Large Intestine — the point at which, in classical physiology, the qi of the large intestine enters the deep — and it is the tradition's principal distal point for disorders of the intestines. It sits on the Stomach channel of Foot Yang Ming, three cun below ST-36 Zu San Li on the outer side of the shin. The apparent oddity, that the Large Intestine's most important lower point lies on the Stomach channel rather than on its own, is the single fact that explains everything else about it, and it is set out under the Lower He-Sea heading below.

• Regulates the intestines and transforms stagnation — the defining recorded action in our own data. It is the point chosen when the intestines are held to be obstructed, congested or moving badly, in either direction: constipation and abdominal distension at one extreme, urgent diarrhoea at the other.
• Clears damp-heat and alleviates diarrhoea and dysenteric disorder — the classical territory of foul, urgent, painful stool with tenesmus, which the tradition attributes to damp-heat lodged in the intestines.
• Regulates the Spleen and Stomach — recorded in our own data, and the reason ST-37 appears alongside ST-36 in digestive prescriptions rather than only in intestinal ones.
• Activates the channel and alleviates pain — the local and regional action along the Stomach channel of the leg: pain, weakness, numbness and atrophy of the lower limb, and paralysis following windstroke.
• Dispels wind-damp from the leg — the extension of that local action to the heavy, aching, obstructed lower limb.

What is a Lower He-Sea point, and why is the Large Intestine's on the Stomach channel?

The Ling Shu sets out a separate scheme from the ordinary five-shu points: six Lower He-Sea points, all on the leg, one for each of the six fu (hollow) organs. The reasoning is that the fu organs of the abdomen are reached most effectively from below the knee, and that the three fu organs whose channels run in the arm — Large Intestine, Small Intestine and San Jiao — therefore need a point on a leg channel to serve them. The set, as recorded in the reference literature and reproduced identically in the ST-36 record on this site, is:

• Stomach — ST-36 Zu San Li
• Large Intestine — ST-37 Shang Ju Xu. This page.
• Small Intestine — ST-39 Xia Ju Xu
• Gall Bladder — GB-34 Yang Ling Quan
• Bladder — BL-40 Wei Zhong
• San Jiao — BL-39 Wei Yang

All six are held in Sacred Lotus sources & references. It should be said openly that this point's own category record carries a different classification — Point of the Sea of Blood, one of the Four Seas of the Ling Shu, which it shares here with ST-39 Xia Ju Xu and BL-11 Da Zhu — and does not itself spell out the Lower He-Sea status. Within our holdings only BL-39 Wei Yang carries the words in its category field. The Lower He-Sea status of ST-37 is nonetheless standard in the reference literature and is stated as such in the ST-36 record already published on this site; it is recorded here on that basis rather than on our own category field, and readers are entitled to know the difference.

Source: Sacred Lotus sources & references (channel; existing action and indication records; the Sea of Blood classification and the six Lower He-Sea points each confirmed by query against our own holdings); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 162); Chinese Acupuncture & Moxibustion (pp. 154–155); Ling Shu (Spiritual Pivot), on the Lower He-Sea points and the Four Seas; cross-referenced against multiple online sources.

What is ST-37 Shang Ju Xu used for?

Shang Ju Xu ST-37 is used above all for disorders of the intestines — diarrhoea, dysenteric disorder, constipation, abdominal pain, distension and rumbling — and secondarily for weakness and pain of the lower leg. The indications carried in Sacred Lotus sources & references are abdominal pain and distension, borborygmus, diarrhoea, dysentery, constipation, enteritis, paralysis due to stroke, and beriberi; the standard reference literature sets them out more fully below. These describe traditional use, not proven treatment.

• Diarrhoea, including watery and urgent diarrhoea
• Dysenteric disorder with urgency and tenesmus
• Constipation
• Abdominal pain and distension
• Borborygmus (rumbling of the intestines)
• Intestinal inflammation and intestinal abscess (the classical chang yong, which includes appendicitis)
• Pain around and below the navel
• Poor appetite and indigestion
• Weakness, numbness or atrophy of the lower limb
• Paralysis and hemiplegia following windstroke
• Pain and swelling along the front of the shin
• Beriberi (recorded in the classical sources)
• Wind-damp obstruction of the leg

Source: Sacred Lotus sources & references (existing indication record); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 162); Chinese Acupuncture & Moxibustion (pp. 154–155).

Where is ST-37 Shang Ju Xu, and how is it used in practice?

Shang Ju Xu lies on the front of the lower leg, three cun below ST-36 Zu San Li — that is, six cun below the knee — one finger-breadth out from the sharp front edge of the shin bone. The practical method is to find ST-36 first, which is the more familiar landmark, and then measure a hand's breadth straight down the same line. Our two location records agree: one measures six cun down from ST-35 Du Bi at the knee, the other three cun down from ST-36. Both place the point the same finger-width lateral to the tibial crest, and no discrepancy arises between them.

Which points is ST-37 combined with — and what is the Large Intestine triad?

The most useful thing on this page for a practitioner is the three-point set for the Large Intestine, and all three points are held in this library with those exact classifications. The tradition assigns each fu organ a point on the front of the body where its qi collects, a point on the back beside the spine where it is transported, and — for the arm fu organs — a Lower He-Sea point on the leg. For the Large Intestine those are:

• ST-25 Tian Shu — the Front-Mu point of the Large Intestine, two cun to the side of the navel, directly over the organ.
• BL-25 Da Chang Shu — the Back-Shu point of the Large Intestine, beside the fourth lumbar vertebra.
• ST-37 Shang Ju Xu — the Lower He-Sea point of the Large Intestine, on the leg. This page.

Front-Mu with Back-Shu is a classical pairing in its own right, sandwiching the organ between front and back; adding the Lower He-Sea point gives a distal point that can be needled and manipulated without disturbing a painful abdomen. Together they are a genuinely useful triad rather than a mnemonic, and they are the reason the three points appear together so often in both classical prescriptions and modern trial protocols.

What other combinations is ST-37 used in?

• With ST-36 Zu San Li — three cun above it on the same channel, and the Lower He-Sea point of the Stomach. The pair covers stomach and intestine together, and is the commonest two-point digestive selection on the leg.
• With ST-39 Xia Ju Xu — three cun below it, the Lower He-Sea point of the Small Intestine. ST-36, ST-37 and ST-39 sit at even three-cun intervals down the same line and correspond, top to bottom, to Stomach, Large Intestine and Small Intestine — a sequence discussed further under research, because it does not follow the order of digestion.
• With ST-25 Tian Shu and REN-06 Qi Hai — the standard abdominal combination for chronic diarrhoea and for abdominal pain and distension.
• With LI-11 Qu Chi — the He-Sea point of the Large Intestine's own channel at the elbow, paired with its Lower He-Sea point on the leg. This upper-and-lower pairing of the same organ's two He-Sea points is a recognised selection method and appears repeatedly in the experimental literature.
• With the extra point Lan Wei Xue — the "Appendix Point", which lies on the same stretch of shin between ST-36 and ST-37 and is held in this library. It is the point traditionally palpated for tenderness in suspected intestinal abscess, and ST-37 is its immediate neighbour and usual companion.
• With SP-09 Yin Ling Quan — added where damp is prominent: watery diarrhoea, heaviness, oedema of the leg.

Where does ST-37 sit among its category peers?

Among the six Lower He-Sea points, ST-37 is the one with the narrowest and clearest brief. BL-40 and GB-34 are famous for the back and the sinews respectively and are used far more often for musculoskeletal complaints than for their organs; ST-36 has become a general tonic point used for almost anything; BL-39 is comparatively little used. ST-37, by contrast, is used for very nearly one thing — the intestines — and its literature, classical and modern, reflects that. Our own record additionally classifies it as a Point of the Sea of Blood, one of the Four Seas of the Ling Shu, a classification it shares here with ST-39 Xia Ju Xu and with BL-11 Da Zhu, whose own category record carries the same Sea of Blood classification.

Source: Sacred Lotus sources & references (location, categories and cross-referenced point records — ST-25's Front-Mu status, BL-25's Back-Shu status, the six Lower He-Sea points, the Sea of Blood set and the extra point Lan Wei Xue were each confirmed by query, not recalled); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 162); Chinese Acupuncture & Moxibustion (pp. 154–155); Ling Shu, on the Lower He-Sea points; cross-referenced against multiple online sources.

Where is ST-37 located?

• A Manual of Acupuncture (p. 162): On the lower leg, 3 cun inferior to Zusanli ST-36, one finger-breadth lateral to the anterior crest of the tibia.
• Chinese Acupuncture and Moxibustion (p. 154-155): 6 cun below Dubi (ST-35), and one finger breadth (middle finger) from the anterior border of the tibia.

How is ST-37 Shang Ju Xu needled?

Reference fact: Sacred Lotus sources & references record perpendicular insertion of 0.5 to 1.2 inches at Shang Ju Xu, with moxibustion applicable. Deadman & Al-Khafaji (p. 162) record perpendicular insertion in a comparable range of roughly 1 to 1.5 cun. These figures are set down as neutral reference data describing what the standard texts state. They are not instruction, and this page does not teach technique. Needling is carried out only by a qualified, licensed practitioner.

What lies beneath the point

• This is a low-hazard point, and it is worth saying so plainly rather than attaching a generic warning. ST-37 sits on the muscular front-outer aspect of the shin with the tibia and fibula flanking it and the interosseous membrane between them. There is no body cavity, no organ, no lung and no great vessel within reach. The standard references attach no special prohibition to it, and it carries none of the anatomical exposure of points over the thorax, the upper back or the root of the neck.
• The structures actually present are tibialis anterior and extensor digitorum longus, with the anterior tibial vessels and the deep peroneal nerve running in the plane between them. Contact with the deep peroneal nerve produces a sharp, electric sensation radiating toward the foot rather than injury, and the reference literature treats this as a normal consideration of technique. The recorded depths sit comfortably within the muscle bulk.
• The depth is set by the anatomy, not by risk. That is the honest reason the texts record more than an inch here where they record a fraction of that at points over bone or on the digits: there is simply more tissue. Stating it that way round is more useful to a reader than a caution would be.
• Moxibustion is recorded as applicable, and ST-37 is one of the points routinely moxaed in the treatment of chronic diarrhoea and cold patterns of the intestines. Several of the clinical studies cited below used moxibustion rather than needles.
• The compartments of the lower leg are worth a factual mention for completeness: the front of the shin is an enclosed muscular compartment, and this is the anatomical reason clean technique and normal post-needling observation apply here as at any deep limb point. No such event is attributed to this point in the standard reference literature.

The general safety picture

For context rather than alarm: a meta-analysis of prospective clinical studies estimated serious adverse events from acupuncture at approximately 1 per 10,000 patients and around 8 per million treatments, with about half of all recorded events being bleeding, pain or flare at the needle site, and concluded that acupuncture is among the safer treatments in medicine (Bäumler P et al., BMJ Open 2021;11:e045961, PMID 34489268). The serious events in that literature cluster at a small number of anatomically exposed points, and ST-37 is not among them. Our sources record no pregnancy contraindication for ST-37.

Source: Sacred Lotus sources & references (existing needling record); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 162); Chinese Acupuncture & Moxibustion (pp. 154–155); PMID 34489268 — checked as active with no retraction, erratum or expression of concern.

What does the name Shang Ju Xu mean?

Shang Ju Xu means "Upper Great Hollow" — shang, upper; ju, great or large; xu, a hollow, void or empty space. The name is topographical and only makes sense as half of a pair. Three cun further down the same line is ST-39 Xia Ju Xu, "Lower Great Hollow". Both sit in the long depression between the two bones of the lower leg — the gap between tibia and fibula, filled with muscle but palpable as a hollow — and the pair are named upper and lower for their position in it. Older texts also record the two under the alternative names Ju Xu Shang Lian and Ju Xu Xia Lian, "upper edge" and "lower edge" of the great hollow, which is the more explicit form of the same idea.

The Stomach channel's leg points are named unusually consistently, and the run is worth reading together: ST-36 Zu San Li ("Leg Three Li"), ST-37 Shang Ju Xu, ST-38 Tiao Kou ("Ribbon Opening"), ST-39 Xia Ju Xu. All four are held in this library, and all four lie on one straight line down the shin at three-cun intervals from the knee.

Why does the Lower He-Sea classification matter at ST-37?

Because it is the reason a point on the shin is a point for the bowel. The ordinary five-shu He-Sea point of the Large Intestine is LI-11 Qu Chi at the elbow — and LI-11 is used chiefly for heat, skin and the arm, not for the intestines. The Ling Shu's separate Lower He-Sea scheme exists precisely to give the three arm fu organs a point on the leg through which the organ itself can be reached. So the Large Intestine has two He-Sea points: one on its own channel at the elbow, and one on the Stomach channel at the shin, and it is the second that the tradition uses when the complaint is in the gut. Understanding that is the difference between memorising ST-37 and knowing when to choose it.

Is there research on ST-37 Shang Ju Xu?

ST-37 has a real point-specific research literature, unusually concentrated on one question: whether stimulating this point measurably affects the intestines. Most of it is preclinical — rodent models of colitis, constipation, visceral pain and inflammation — with a small number of clinical trials in which ST-37 is one point of a prescription rather than the tested variable. No adequately powered trial isolates the point, and that should be said before anything else.

• Why the three points are in that order — a classical question examined directly. A review noted that ST-36, ST-37 and ST-39 run down the Stomach channel corresponding to Stomach, Large Intestine and Small Intestine, which does not match the order of digestion in modern physiology (stomach, small intestine, large intestine) but does match the organs' anatomical positions from higher to lower in the abdomen. Reviewing a large body of ancient and modern literature, the authors found the recorded functions of the three points to correspond to stomach, large intestine and small intestine respectively, and concluded that the sequence reflects anatomical position rather than physiological sequence (Cheng K et al., Zhongguo Zhen Jiu 2015;35(11):1167–70, PMID 26939339). This is textual and analytical work rather than a trial, and it is the single most useful published item about this point.
• Constipation, and the enteric nervous system. A mouse constipation model induced by daily ice-cold saline was treated with electroacupuncture at ST-37 alone. The treated group showed improved carbon propulsion rates and shorter defecation times than the untreated model group, and expression of PGP9.5 and neuronal nitric oxide synthase in the myenteric plexus of jejunum, ileum and proximal colon returned toward normal levels (Liang C et al., BMC Complement Altern Med 2016;16(1):392, PMID 27756367, DOI 10.1186/s12906-016-1377-5). A single-point animal study directed at exactly the point's traditional territory — which is what makes it worth citing.
• Colitis, inflammatory markers. Electroacupuncture at ST-37 in a rat model of ulcerative colitis was reported to alter interleukin-1β and interleukin-4 levels (Yan J et al., J Tradit Chin Med 2009;29(1):60–3, PMID 19514191).
• Visceral pain. Acupuncture at ST-37 was studied in rats with chronic visceral hypersensitivity modelling irritable bowel syndrome, with effects reported through an NGF/PI3K/TRPV1 pathway (Chen CY et al., Zhen Ci Yan Jiu 2023;48(10):1017–24, PMID 37879952). Mechanism work in animals, not clinical evidence.
• Ulcerative colitis in patients — a sham-controlled trial. Sixty-three patients with ulcerative colitis were randomised, single-blind, to herb-partitioned moxibustion at REN-06 Qi Hai with bilateral ST-25 Tian Shu and ST-37 Shang Ju Xu, or to sham moxibustion. The moxibustion group showed greater reduction in endoscopic and mood scores and better quality-of-life scores, with lower measured levels of several inflammatory cytokines and of components of the TLR4 signalling pathway (Qi Q et al., J Tradit Chin Med 2021;41(3):479–85, PMID 34114407). Small and single-centre, and a three-point protocol — nothing can be attributed to ST-37 individually — but it is a real sham-controlled clinical study in the point's own territory.
• The Large Intestine triad, tested. A study of 120 patients with severe acute pancreatitis randomised them to standard treatment with ulinastatin alone or with the addition of electroacupuncture at BL-25 Da Chang Shu and ST-37 Shang Ju Xu, reporting shorter times to recovery of bowel sounds and defecation, earlier remission of abdominal pain, shorter hospital stay and lower inflammatory markers in the acupuncture arm (Zhao L et al., Zhongguo Zhen Jiu 2018;38(2):132–6, PMID 29473354). Note what the protocol is: the Back-Shu point of the Large Intestine plus its Lower He-Sea point — two-thirds of the classical triad described under practice above, chosen on classical reasoning and tested in a modern trial. Unblinded and single-centre.

One study on this point has been retracted, and is excluded

A clinical study of moxa-salt hot ironing applied at ST-25 Tian Shu and ST-37 Shang Ju Xu to prevent irinotecan-induced delayed-onset diarrhoea in 120 patients with advanced colorectal cancer, published in 2022, was formally RETRACTED by the journal in January 2024 (original: Emerg Med Int 2022;2022:6587884, PMID 35912389; retraction notice: Emerg Med Int 2024;2024:9814198, PMID 38298940). It is named here rather than silently omitted, because it is indexed, freely available, reports a favourable result, and is exactly the kind of citation that gets copied forward by anyone who checks a title but not its status. It is not evidence and it is not counted among the studies above. A related systematic review of protective interventions for irinotecan-induced diarrhoea exists in the literature (PMID 38567795); whether it drew on the retracted trial has not been established here, so no conclusion from it is reported.

The honest summary: ST-37 has more point-specific experimental work behind it than most points, and it points consistently in one direction — that stimulating this point does measurable things to intestinal motility and intestinal inflammation in animals. The clinical evidence is small, mostly unblinded, always multi-point, and one item in it has been retracted. Nothing here establishes clinical benefit; what it establishes is that the point's traditional brief has been taken seriously enough to test.

How does Shang Ju Xu compare with the points around it?

ST-36 Zu San Li sits three cun above on the same line and is the Lower He-Sea point of the Stomach — the more famous point by far, and the general tonic of the leg; ST-37 is the narrower, more specifically intestinal choice. ST-38 Tiao Kou lies between ST-37 and ST-39 and is used chiefly for the shoulder, which makes it the odd one out of the group. ST-39 Xia Ju Xu, three cun below, is its named twin and the Lower He-Sea point of the Small Intestine; the two share the "Great Hollow" name and the Sea of Blood classification, and are distinguished only by which intestine they serve. The extra point Lan Wei Xue, the Appendix Point, lies on the same stretch of shin and is held here. And the two points that complete ST-37's own set are nowhere near it: ST-25 Tian Shu beside the navel and BL-25 Da Chang Shu beside the fourth lumbar vertebra — the front, back and distal points of one organ, which is the most useful grouping on this page.

Source: Sacred Lotus sources & references (name, categories and cross-referenced point records); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 162); Chinese Acupuncture & Moxibustion (pp. 154–155); Ling Shu, on the Lower He-Sea points and the Four Seas; PubMed PMID 26939339, 27756367, 19514191, 37879952, 34114407, 29473354 — each verified resolvable and checked for retraction, erratum and expression of concern, all clean; PMID 35912389 identified as RETRACTED (notice PMID 38298940) and excluded from the evidence above; cross-referenced against multiple online sources.