ST43 (Xiangu / Sunken Valley) Acupuncture Point Guide
Practitioner Guide from The Acupuncture Supply Co.
ST43 Xiangu is a shu-stream; wood point of the Stomach channel. This Project Lotus reference brings together surface landmarks, traditional theory and practical safety considerations for qualified practitioners.
Quick reference
| Point | ST43 — Xiangu (Sunken Valley) |
|---|---|
| Channel | Stomach — Foot Yangming |
| Classification | Shu-Stream; Wood |
| Region | Dorsum of foot |
| Laterality | Bilateral |
| Location | Between the second and third metatarsals on the top of the foot, in the hollow just proximal to the second metatarsophalangeal joint. |
Location of ST43 Xiangu
Between the second and third metatarsals on the top of the foot, in the hollow just proximal to the second metatarsophalangeal joint.
Landmark sequence
- Support the foot with its dorsum visible.
- Identify the second toe and trace the second metatarsal proximally.
- Find the adjacent third metatarsal.
- Palpate the intermetatarsal hollow immediately proximal to the second metatarsophalangeal joint.
Where a B-cun measurement is given, use the patient’s proportional body measurement. It is not a fixed centimetre distance or a universal number of the practitioner’s finger breadths. Confirm the relevant landmarks by palpation before deciding on a technique.
Distinguishing nearby points
ST43 is between metatarsals, proximal to the joint. ST44 is nearer the web between the second and third toes.
Traditional functions
Within traditional East Asian medicine, this point is commonly described in terms of the following functions:
- Activates the channel
- Regulates the Spleen and Stomach in traditional theory
- Dispels Dampness and oedema
Traditional applications
Traditionally considered for dorsal foot pain or swelling and for digestive or fluid-metabolism patterns involving the Stomach channel. Oedema requires assessment of its underlying cause.
These descriptions express traditional theory. They are not claims that this individual point has been proven to prevent or cure a medical condition. A symptom or channel label alone is insufficient to select a treatment.
Planning a point combination
Consider the treatment principle, local versus distal selection and the patient’s complete presentation. Related Project Lotus guides for comparison include ST36, SP9. These are educational comparison points, not a fixed prescription. Confirm the rationale, laterality and technique within accredited training.
Anatomy and essential safety
Consider extensor tendons, interosseous tissues, superficial vessels and sensory branches. Inspect for infection, oedema, ulcers and reduced protective sensation.
- Inspect the skin and assess local tissue, circulation and sensation. Do not needle through infected, ulcerated, inflamed or otherwise unsuitable tissue.
- Review relevant surgery, injuries, implants, bleeding risk, medication, pregnancy and previous adverse reactions.
- Use sterile single-use needles, appropriate infection control and safe sharps disposal. Obtain informed consent and document the treatment.
- Choose angle, depth and stimulation from anatomical assessment and accredited training. This guide gives no universal insertion depth. Stop and reassess unexpected sharp pain, neurological symptoms or a concerning response.
When medical assessment takes priority
A hot red foot with fever, rapidly increasing swelling, or a diabetic foot wound requires prompt medical assessment.
Moxibustion
Moxa is not an automatic addition. Consider the traditional pattern, local anatomy and the practitioner’s training. Where heat is appropriate, assess sensation, skin condition, ventilation and the patient’s ability to report discomfort; supervise continuously and prevent burns.
Research note
Evidence concerning an acupuncture treatment or a multi-point protocol cannot be assigned automatically to this point alone. This guide does not claim an independently established clinical effect for ST43. Traditional functions and clinical evidence should be discussed separately.
Frequently asked questions
Is this point bilateral?
Yes. The surface landmarks apply on both sides. Treatment laterality depends on assessment and the chosen clinical strategy.
Can the image replace palpation?
No. The image shows the landmark relationship schematically. Body proportions, tendon visibility and tissue depth vary, so trained examination remains essential.
Is this a self-needling guide?
No. It is an educational reference for qualified practitioners and does not replace professional training or medical assessment.
Continue exploring Project Lotus
Browse our Acupuncture Point Guides and professional acupuncture needles.
Professional note: Educational material for qualified acupuncture practitioners. Individual assessment, consent, safe technique and appropriate referral remain the practitioner’s responsibility.
References: WHO Standard Acupuncture Point Locations, updated reprint 2009 (entry ST43); CEIMEC point atlas (cross-check; WHO takes precedence where descriptions differ); Joel Penner, American Dragon: traditional point reference; NCCIH: acupuncture evidence and safety. Checked 5 October 2026.
