Acupressure, Shiatsu, Tuina

Learn about Acupressure for treatment of depression, anxiety, addiction and other psychiatric disorders.

Before engaging in any complementary medical technique, you should be aware that many of these techniques have not been evaluated in scientific studies. Often, only limited information is available about their safety and effectiveness. Each state and each discipline has its own rules about whether practitioners are required to be professionally licensed. If you plan to visit a practitioner, it is recommended that you choose one who is licensed by a recognized national organization and who abides by the organization's standards. It is always best to speak with your primary health care provider before starting any new therapeutic technique.

• Background
  Potential Dangers
• Theory
• Evidence
• Unproven Uses
• Summary
• Resources

Background

Acupressure, the practice of applying finger pressure to specific acupoints throughout the body, was used in China as early as 2000 B.C., pre-dating the practice of acupuncture. Acupressure is widely practiced both professionally and informally throughout Asia for relaxation, for the promotion of wellness and for the treatment of disease. These techniques are growing in popularity in North America and Europe. Numerous trials in humans suggest the effectiveness of wrist-point (known as the P6 acupoint) acupressure for treating nausea; this is the most studied use of acupressure.

Shiatsu is a Japanese form of acupressure. Its literal translation is finger (shi) pressure (atsu). Shiatsu emphasizes finger pressure not only at acupoints but also along the body's meridians. (In traditional Chinese medicine, the meridians are channels in the body believed to conduct chi, or elemental forces.) Shiatsu can also incorporate palm pressure, stretching, massage and other manual techniques. A nationwide survey in England found that shiatsu practitioners most commonly treat musculoskeletal and psychological conditions, including neck, shoulder and lower back problems; arthritis; depression; and anxiety.

Tuina (Chinese for "pushing and pulling") is similar to shiatsu, but it places more emphasis on soft-tissue manipulation and structural realignment. Tuina is reported as being the most common form of Asian bodywork practiced in Chinese-American communities.

Theory

In some traditional Asian medical philosophies, health is considered to be a state of balance in the body, maintained by the flow of life energy along specific meridians. The philosophy that disease is caused by imbalance has led to treatments directed at establishing balance through points along these meridians. Disease is believed to occur when there is blockage in the flow of energy or when energy flow is deficient or in excess.

Acupressure aims to restore normal flow of life energy by means of finger pressure, palm pressure, stretching, massage and other techniques. There are said to be 12 primary channels and eight additional pathways that circulate life energy through the body, maintaining the balance of yin and yang.

It is suggested that acupressure may reduce muscle pain and tension, improve blood circulation and release endorphins (a type of hormone). As an acupressure point is pressed, muscle tension is thought to yield to the pressure, enabling muscle fibers to elongate and relax, allowing blood to flow more freely and toxins to be released and eliminated.

Acupressure is related in some ways to acupuncture. Theoretically, stimulation of acupoints with needles, moxa (burning with a stick including dried mugwort leaves) or finger pressure may evoke similar effects on the body. Likewise, acupressure techniques that involve massage and manipulation of soft tissues may work similarly to therapeutic massage.

Evidence

Scientists have studied acupressure, shiatsu and tuina for the following health problems:

Nausea, motion sickness
There is scientific evidence from numerous studies supporting the use of wrist acupressure at the P6 acupoint (also known as Neiguan) in the prevention and treatment of nausea and vomiting. In particular, this research has reported effectiveness for postoperative nausea, intra-operative nausea (during spinal anesthesia), chemotherapy-induced nausea, and motion-related and pregnancy-related nausea (morning sickness). Effects have been noted in both children and adults. This therapy has grown in popularity because it is noninvasive, is easy to self-administer, has no observable side effects and is low cost.

Sleep
There is early evidence from one randomized controlled trial to support the use of acupressure for improving sleep quality in elderly participants. Another small study found positive results in otherwise healthy volunteers. However, these studies did not have high-quality designs, and further research is needed to clarify the role of acupressure for sleep.

Low back pain
There is promising research from a few studies suggesting that acupressure may be useful in the relief of low back pain. Additional research is needed before a firm conclusion can be made.

Postoperative pain
There is preliminary evidence suggesting possible benefits of acupressure in postoperative pain relief. This research reports that acupressure may be as effective as intravenous pain relievers, although further evidence is needed from a randomized controlled trial before a recommendation can be made.

Headache
There is preliminary research suggesting possible benefits of self-administered acupressure in the treatment of tension or migraine headache. Future well-designed studies are needed to confirm these findings.

Exercise performance
Preliminary research reports that ear acupressure may reduce muscle fatigue and lactic acid production, thereby possibly improving athletic performance. Additional research is necessary before a firm conclusion can be drawn.

Bedwetting (in children)
One small, low-quality study reports reduced bedwetting in children whose parents administered "micromassage" at several acupoints. Another small study compared acupressure with oxybutinin and found acupressure to be an effective alternative nondrug therapy. Further study is needed before a recommendation can be made.

Weight loss, obesity
There is initial evidence that acupressure is not an effective weight loss therapy.

Menstrual pain
Based on initial research, acupressure may reduce menstrual pain severity, pain medication use, and anxiety associated with menstruation. Further research is needed before a clear recommendation can be made.

Dyspnea (shortness of breath)
A small study of patients undergoing pulmonary rehabilitation reported acupressure to be beneficial for decreasing dyspnea. Larger, well-designed studies are needed before clear conclusions can be drawn.

Facial spasm
There is preliminary positive evidence from one small study in this area. Further research is needed before a clear recommendation can be made.

Palliative care
Preliminary research in patients with advanced progressive diseases reports that acupressure may improve energy levels, relaxation, confidence, symptom control, thought clarity and mobility. Further research is necessary to confirm these findings before a recommendation can be made.

Anxiety
Preliminary clinical trials suggest that acupressure may significantly reduce anxiety. However, these studies have been small and poorly designed, warranting better-quality research.

High blood pressure
Small studies in men and women report that acupressure may reduce blood pressure. Study results on the effect of acupressure on heart rate have yielded missed results. Large, well-designed studies are needed before conclusions can be drawn.

Gastrointestinal motility
A small study suggests acupressure may improve gastrointestinal motility. Additional research is necessary before a firm conclusion can be drawn.

Depression
Several studies suggest that fatigue and depressive mood may improve with acupressure therapy. Further research is necessary to confirm these findings.

Labor pain
One study reports that LI4 and BL67 acupressure may reduce labor pain specifically during the first stage of labor. Further study is needed before a recommendation can be made.

Asthma (quality of life)
Preliminary research suggests that patients with chronic asthma who receive acupressure may experience improved quality of life. Further well-designed studies are needed before firm conclusions can be drawn.

Sleep apnea
A small study reports that acupressure may provide early prevention and treatment for sleep apnea. Larger, well-designed studies are needed before conclusions can be drawn. Patients with known or suspected sleep apnea should consult with a licensed health care professional.

Drug addiction
Preliminary evidence suggests that acupressure may be a helpful adjunct therapy to assist with the prevention of relapse, withdrawal, or dependence. Further research is necessary to confirm these findings before a firm conclusion can be reached.

Unproven Uses

Acupressure, shiatsu and tuina have been suggested for many other uses, based on tradition or on scientific theories. However, these uses have not been thoroughly studied in humans, and there is limited scientific evidence about safety or effectiveness. Some of these suggested uses are for conditions that are potentially life-threatening. Consult with a health care provider before using acupressure, shiatsu or tuina for any use.

Angina (chest pain)
Anorexia nervosa
Arthritis
Attention-deficit hyperactivity disorder
Bell's palsy
Bloating (after surgery)
Cancer treatment side effects
Carpal tunnel syndrome
Cerebral birth injuries
Chest congestion
Childbirth facilitation or induction
Chronic fatigue syndrome
Colds and flu
Constipation
Eating disorders
Edema
Epileptic seizure (in children)
Eye strain
Fibromyalgia
Gag reflex prevention (for dental procedures)
Gastrointestinal disorders/obstruction
Gum disease
Head injury
HIV/AIDS
Immune deficiency
Intestinal obstruction after laparotomy
Itchiness
Jet lag
Joint inflammation
Kidney infection (related pain)
pains
Migraine
Multiple sclerosis
Muscle tension, muscle ache
Nasal congestion
Neck or shoulder pain
Optic atrophy
Organ transplantation
Paralysis after stroke
Parkinson's disease
Phobias
Poor circulation
Post-traumatic stress disorder
Psoriasis
Recurrent urinary tract infection
Restless leg syndrome
Sexual dysfunction
Sinus disorders
Smoking cessation
Sports injuries
Sunburn
Tendonitis
Tension headaches
Toothache
Ulcer pain

Potential Dangers

Acupressure is generally reported as safe when performed by an experienced practitioner. No serious complications have been published, despite millions of treatments every year. Self-administered acupressure is believed to be safe with proper training.

Nerve injury was reported in the hand of one man after shiatsu massage. Herpes zoster (shingles) developed in one woman in the area where she received vigorous shiatsu massage, although the episode was not clearly caused by the shiatsu massage. Vigorous acupressure may cause bruising in sensitive individuals. Carotid dissection and retinal and cerebral artery embolism have been associated with acupressure treatments, although the patients may have been predisposed to these adverse effects. Speak with your doctor or another qualified health care provider before receiving treatment.

Summary

Forms of acupressure, including shiatsu and tuina, have been suggested for many conditions. The most studied and promising area is the treatment of nausea with wrist (acupoint P6) acupressure. Acupressure can be a cost-effective treatment and is generally well tolerated when the appropriate amount of force is used. Speak with your health care provider if you are considering acupressure.

The information in this monograph was prepared by the professional staff at Natural Standard, based on thorough systematic review of scientific evidence. The material was reviewed by the Faculty of the Harvard Medical School with final editing approved by Natural Standard.

Resources

1. Natural Standard: An organization that produces scientifically based reviews of complementary and alternative medicine (CAM) topics
2. National Center for Complementary and Alternative Medicine (NCCAM): A division of the U.S. Department of Health & Human Services dedicated to research

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Selected Scientific Studies: Acupressure, Shiatsu, Tuina

Natural Standard reviewed more than 430 articles to prepare the professional monograph from which this version was created.

Some of the more recent studies are listed below:

1. Agarwal A, Bose N, Gaur A, et al. Acupressure and ondansetron for postoperative nausea and vomiting after laparoscopic cholecystectomy. Can J Anaesth 2002;Jun-Jul, 49(6):554-560.
2. Allison DB, Kreibich K, Heshka S, et al. A randomised placebo-controlled clinical trial of an acupressure device for weight loss. Int J Obes Relat Metab Disord 1995;19(9):653-658.
3. Ballegaard S, Norrelund S, Smith DF. Cost-benefit of combined use of acupuncture, Shiatsu and lifestyle adjustment for treatment of patients with severe angina pectoris. Acupunct Electrother Res 1996;Jul-Dec, 21(3-4):187-197.
4. Bertalanffy P, Hoerauf K, Fleischhackl R. Korean hand acupressure for motion sickness in prehospital trauma care: a prospective, randomized, double-blind trial in a geriatric population. Anesth Analg 2004;98(1):220-223.
5. Bertolucci LE, DiDario B. Efficacy of a portable acustimulation device in controlling seasickness. Aviat Space Environ Med 1995;Dec, 66(12):1155-1158.Comment in: Aviat Space Environ Med 1996;May, 67(5):498.

1. Bledsoe BE, Myers J. Future trends in prehospital pain management. J Emerg Med Serv JEMS 2003;Jun, 28(6):68-71.
2. Chen HM, Chen CH. Effects of acupressure at the Sanyinjiao point on primary dysmenorrhoea. J Adv Nurs 2004;48(4):380-387.
3. Chen LL, Hsu SF, Wang MH. Use of acupressure to improve gastrointestinal motility in women after trans-abdominal hysterectomy. Am J Chin Med 2003;31(5):781-790.
4. Chen ML, Lin LC, Wu SC, et al. The effectiveness of acupressure in improving the quality of sleep of institutionalized residents. J Gerontol A Biol Sci Med Sci 1999;54(8):M389-M394.
5. Cheesman S, Christian R, Cresswell J. Exploring the value of shiatsu in palliative care day services. Int J Palliat Nurs 2001;May, 7(5):234-239.
6. Cho YC, Tsay SL. The effect of acupressure with massage on fatigue and depression in patients with end-stage renal disease. J Nurs Res 2004;12(1):51-59.
7. Chung UL, Hung LC, Kuo SC. Effects of LI4 and BL67 acupressure on labor pain and uterine contractions in the first stage of labor. J Nurs Res 2003;11(4):251-260.
8. Dent HE, Dewhurst NG, Mills SY, Willoughby M. Continuous PC6 wristband acupressure for relief of nausea and vomiting associated with acute myocardial infarction: a partially randomised, placebo-controlled trial. Complement Ther Med 2003;Jun, 11(2):72-77.
9. Duggal KN, Douglas MJ, Peteru EA, et al. Acupressure for intrathecal narcotic-induced nausea and vomiting after caesarean section. Int J Obstet Anesth 1998;7(4):231-236.
10. Elliott MA, Taylor LP. "Shiatsu sympathectomy": ICA dissection associated with a shiatsu massager. Neurology 2002;Apr 23, 58(8):1302-1304.
11. Fassoulaki A, Paraskeva A, Patris K, et al. Pressure applied on the extra 1 acupuncture point reduces bispectral index values and stress in volunteers. Anesth Analg 2003;Mar, 96(3):885-890. Table of Contents. Comment in: Anesth Analg 2003;Oct, 97(4):1196-1197. Author reply, 1197. Anesth Analg 2003;Sep, 97(3):925. Author reply, 925-926.
12. Felhendler D, Lisander B. Effects of non-invasive stimulation of acupoints on the cardiovascular system. Complement Ther Med 1999;Dec, 7(4):231-234.
13. Harmon D, Ryan M, Kelly A, et al. Acupressure and prevention of nausea and vomiting during and after spinal anaesthesia for caesarean section. Br J Anaesth 2000;84(4):463-467.
14. Hsieh LL, Kuo CH, Yen MF, et al. A randomized controlled clinical trial for low back pain treated by acupressure and physical therapy. Prev Med 2004;39(1):168-176.
15. Huang ST, Chen GY, Lo HM. Increase in the vagal modulation by acupuncture at neiguan point in the healthy subjects. Am J Chin Med 2005;33(1):157-167.
16. Inagaki J, Yoneda J, Ito M, Nogaki H. Psychophysiological effect of massage and shiatsu while in the prone position with face down. Nurs Health Sci 2002;Aug, 4(3 Suppl):5-6.
17. Kober A, Scheck T, Schubert B, et al. Auricular acupressure as a treatment for anxiety in prehospital transport settings. Anesthesiology 2003;Jun, 98(6):1328-1332.
18. Kober A, Scheck T, Greher M, et al. Prehospital analgesia with acupressure in victims of minor trauma: a prospective, randomized, double-blinded trial. Anesth Analg 2002;Sep, 95(3):723-727. Table of Contents.
19. Lei X. Ear point tapping and pressing therapy for giving up smoking in 45 cases. J Tradit Chin Med 1996;Mar, 16(1):33-34.
20. Li Y, Liang FR, Yu SG, et al. Efficacy of acupuncture and moxibustion in treating Bell's palsy: a multicenter randomized controlled trial in China. Chin Med J (Engl) 2004;117(10):1502-1506.
21. Li Y, Peng C. Treatment of 86 cases of facial spasm by acupuncture and pressure on otopoints. J Tradit Chin Med 2000;Mar, 20(1):33-35.
22. Lu DP, Lu GP, Reed JF 3rd. Acupuncture/acupressure to treat gagging dental patients: a clinical study of anti-gagging effects. Gen Dent 2000;Jul-Aug, 48(4):446-452.
23. Maa SH, Sun MF, Hsu KH. Effect of acupuncture or acupressure on quality of life of patients with chronic obstructive asthma: a pilot study. J Altern Med 2003;9(5):659-670.
24. Ming JL, Kuo BI, Lin JG, Lin LC. The efficacy of acupressure to prevent nausea and vomiting in post-operative patients. J Adv Nurs 2002;Aug, 39(4):343-351.
25. Nguyen HP, Le DL, Tran QM, et al. CHROMASSI: a therapy advice system based on chrono-massage and acupression using the method of ZiWuLiuZhu. Medinfo 1995;8(Pt 2):998.
26. Norheim AJ, Pedersen EJ, Fonnebo V, Berge L. Acupressure against morning sickness [Article in Norwegian]. Tidsskr Nor Laegeforen 2001;Sep 30, 121(23):2712-2715.
27. Pouresmail Z, Ibrahimzadeh R. Effects of acupressure and ibuprofen on the severity of primary dysmenorrhea. J Tradit Chin Med 2002;Sep, 22(3):205-210.
28. Roscoe JA, Morrow GR, Hickok JT, et al. The efficacy of acupressure and acustimulation wrist bands for the relief of chemotherapy-induced nausea and vomiting: a University of Rochester Cancer Center Community Clinical Oncology Program multicenter study. J Pain Symptom Manage 2003;Aug, 26(2):731-742.
29. Saito H. Preventing and resolving post-laparotomy intestinal obstruction: an effective shiatsu method. Am J Chin Med 2000;28(1):141-145.
30. Schlager A, Boehler M, Puhringer F. Korean hand acupressure reduces postoperative vomiting in children after strabismus surgery. Br J Anaesth 2000;85(2):267-270.
31. Stern RM, Jokerst MD, Muth ER, Hollis C. Acupressure relieves the symptoms of motion sickness and reduces abnormal gastric activity. Altern Ther Health Med 2001;Jul-Aug, 7(4):91-94.
32. Stone RG, Wharton RB. Simultaneous multiple-modality therapy for tension headaches and neck pain. Biomed Instrum Technol 1997;May-Jun, 31(3):259-262.
33. Takeuchi H, Jawad MS, Eccles R. The effects of nasal massage of the "yingxiang" acupuncture point on nasal airway resistance and sensation of nasal airflow in patients with nasal congestion associated with acute upper respiratory tract infection. Am J Rhinol 1999;13(2):77-79.
34. Taylor D, Miaskowski C, Kohn J. A randomized clinical trial of the effectiveness of an acupressure device (relief brief) for managing symptoms of dysmenorrhea. J Altern Complement Med 2002;Jun, 8(3):357-370.
35. Tsay SL, Cho Y, Chen ML. Acupressure and transcutaneous electrical acupoint stimulation in improving fatigue, sleep quality and depression in hemodialysis patients. Am J Chin Med 2004;32(3):407-416.
36. Tsuboi K, Tsuboi K. Retinal and cerebral artery embolism after "shiatsu" on the neck. Stroke 2001;Oct, 32(10):2441. Comment in: Stroke 2001;Mar, 32(3):809-810. Stroke 2001;May, 32(5):1054-1060.
37. Wan Q. Auricular-plaster therapy plus acupuncture at zusanli for postoperative recovery of intestinal function. J Tradit Chin Med 2000;Jun, 20(2):134-135.
38. Wang XH, Yuan YD, Wang BF. [Clinical observation on effect of auricular acupoint pressing in treating sleep apnea syndrome]. Zhongguo Zhong Xi Jie He Za Zhi 2003;23(10):747-749.
39. Werntoft E, Dykes AK. Effect of acupressure on nausea and vomiting during pregnancy: a randomized, placebo-controlled, pilot study. J Reprod Med 2001;46(9):835-839.
40. White PF, Issioui T, Hu J, et al. Comparative efficacy of acustimulation (ReliefBand) versus ondansetron (Zofran) in combination with droperidol for preventing nausea and vomiting. Anesthesiology 2002;Nov, 97(5):1075-1081.
41. Wu JM, Wei DY, Luo YF, et al. [Clinic research on heroin de-addiction effects of acupuncture and its potentiality of preventing relapse]. Zhong Xi Yi Jie He Xue Bao 2003;1(4):268-272.
42. Yip YB, Tse SH. The effectiveness of relaxation acupoint stimulation and acupressure with aromatic lavender essential oil for non-specific low back pain in Hong Kong: a randomized controlled trial. Complement Ther Med 2004;12(1):28-37.
43. Yuksek MS, Erdem AF, Atalay C, et al. Acupressure versus oxybutinin in the treatment of enuresis. J Int Med Res 2003;31(6):552-556.

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