Acupressure, shiatsu, tuina

March 22, 2017


Acupressure, shiatsu, tuina

Natural Standard Bottom Line Monograph, Copyright © 2013 (www.naturalstandard.com). Commercial distribution prohibited. This monograph is intended for informational purposes only, and should not be interpreted as specific medical advice. You should consult with a qualified healthcare provider before making decisions about therapies and/or health conditions.

While some complementary and alternative techniques have been studied scientifically, high-quality data regarding safety, effectiveness, and mechanism of action are limited or controversial for most therapies. Whenever possible, it is recommended that practitioners be licensed by a recognized professional organization that adheres to clearly published standards. In addition, before starting a new technique or engaging a practitioner, it is recommended that patients speak with their primary healthcare provider(s). Potential benefits, risks (including financial costs), and alternatives should be carefully considered. The below monograph is designed to provide historical background and an overview of clinically-oriented research, and neither advocates for or against the use of a particular therapy.

Related Terms

  • Acupoints stimulation, acupressure point K-D2, aromatic acupressure, Asian bodywork therapy, auricular acupressure, automated massage chair, barefoot shiatsu, Bodymind acupressureTM, finger acupressure, five element shiatsu, G-Jo acupressure, high touch acupressure, integrative eclectic shiatsu, Japanese shiatsu (Namikoshi shiatsu, Nippon shiatsu), Jin Shin acupressure, Jin Shin acutouch, Jin Shin Do®, Ki-Shiatsu®, Korean acupressure point K-D2, Korean hand acupressure, macrobiotic shiatsu, Ohashiatsu, oriental bodywork therapy, Sea-Band, Seitei shiatsu, shiatsu anma therapy, tapas acupressure techniqueTM, Tao shiatsu, traditional Chinese medicine, tuina, tuina massotherapy, vaginal acupressure, WatsuTM, Wu Shu, Zen shiatsu.

  • Not included in this review: Acupuncture, acutherapy, AMMA® therapy, Ampaku, Ampuku® therapy, anma (amma), anmo (an-mo, an mo), Ayurvedic (marma) massage therapy, Chi Nei Tsang, Chinese reflexology, Hoshino therapy®, Kerala kalari massage, Indian head massage, Jin Shin Jyutsu®, Okazaki restorative massage, point holding, SHEN® Therapy, Qi gong, Taoist pressing point massage, Tibetan massage (Ku Nye), Tibetan pulsing, traditional Thai massage (Nuad Bo Rarn).


  • The practice of applying finger pressure to specific acupoints throughout the body has been used in China since 2000 BC, prior to the use of acupuncture. Acupressure techniques are widely practiced internationally for relaxation, wellness promotion, and the treatment of various health conditions. Multiple human studies suggest the effectiveness of wrist-point (P6) acupressure for treating nausea.

  • Shiatsu means finger (Shi) pressure (Atsu) in Japanese. Shiatsu technique involves finger pressure at acupoints and along body meridians. It can incorporate palm pressure, stretching, massaging, and other manual techniques. Shiatsu practitioners 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 with more soft tissue manipulation and structural realignment. Tuina is a common form of Asian bodywork used in Chinese-American communities.


  • Several traditional Asian medical philosophies consider health to be a state of balance in the body that is maintained by the flow of life energy along specific meridians. A disease state is believed to occur when energy flow is blocked, is deficient, or is in excess. A goal of acupressure is to restore normal life energy flow using finger and palm pressure, stretching, massaging, and other bodywork techniques. It is believed that there are 12 primary channels and eight additional pathways circulating life energy throughout the body, maintaining the balance of yin and yang.

  • It is proposed that acupressure may reduce muscle pain and tension, improve blood circulation, release endorphins, and release/eliminate toxins. The mechanism of action may be similar to other techniques such as acupuncture (stimulation of acupoints with needles), moxa (burning with a stick including dried mugwort leaves), or other forms of manual stimulation. Techniques that involve soft tissue manipulation may have similar effects on the body as therapeutic massage.

Scientific Evidence


These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.



Numerous scientific studies support the use of wrist acupressure at the P6 acupoint (also known as Neiguan) in the prevention and treatment of nausea after surgery, intra-operative nausea (during spinal anesthesia), nausea from chemotherapy, as well as pregnancy related nausea/vomiting and morning sickness. Effects have been noted in children as well as adults.



Acupressure may significantly reduce general and pre-operative anxiety. However, these studies have been small and poorly designed, warranting better-quality research.



Acupressure using aromatic essential oils (lavender) may reduce pain intensity, stiffness, and stress in patients with neck pain for up to one month.Auricular acupressure may reduce pain and anxiety among hip fracture patients. Acupressure may also aid in the improvement of hemiplegic shoulder pain and motor power among stroke patients.


Agitated behavior (in dementia)

Acupressure may decrease verbal and physical agitation among dementia patients. Further study is needed before recommendations can be made.



Acupressure at stimulation and relaxation points may have different effects on alertness in a classroom setting. Further research is necessary to confirm these findings.


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.


Bed-wetting (children)

Early research seems promising. Further research is necessary before a recommendation can be made.


Chronic obstructive pulmonary disease (COPD)

A combination of acupressure and massage may reduce dyspnea (labored breathing) and anxiety in patients with chronic obstructive pulmonary disease who use prolonged mechanical ventilatory support. Further study of acupressure alone is needed before a recommendation can be made.



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


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.


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.


Epilepsy (children)

Preliminary evidence suggests that acupressure may help epileptic seizures among children. Further research is needed to confirm these results.


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.


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.


Gastrointestinal motility

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



Self-administered acupressure is reported to help tension or migraine headaches in early studies. More research is needed before a recommendation can be made.


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 mixed results. Large, well-designed studies are needed before conclusions can be drawn.


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.


Low back pain

One study showed that acupressure was effective in reducing low back pain in terms of disability, pain scores, and functional status. The benefit was sustained for six months. More study is needed to make a firm recommendation.


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.


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.


Parkinson's disease

Acupressure may benefit several measures of severity of Parkinson's disease. Further study is needed before recommendations may be made.


Post-operative pain

Several studies report that acupressure provides pain relief to patients after surgeries. Research suggests that acupressure may be as effective as intravenous pain medications. However, further evidence is needed from well-designed trials before a firm conclusion can be drawn.


Sexual dysfunction

Results from preliminary study suggest a benefit of vaginal acupressure/pelvic massage in the reduction of aspects of sexual dysfunction. Additional studies are needed.


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 healthcare professional.


Sleep quality

Preliminary research supports the use of acupressure for improving sleep quality in elderly patients and possibly in healthy adults of all ages. Better-designed trials are needed to support these results.


Smoking cessation

Early study indicates that auricular acupressure may help with quitting smoking. Further research is needed to confirm these results.



Promising early data suggests acupressure may aid in the recovery of post-stroke paralysis.


Cervical spondylosis

Results from a meta-analysis do not support use of tuina for cervical spondylosis.


Weight loss/obesity

Preliminary evidence suggests that acupressure may not be effective for weight loss but may aid in weight maintenance following weight loss.


*Key to grades:A: Strong scientific evidence for this use; B: Good scientific evidence for this use; C: Unclear scientific evidence for this use; D: Fair scientific evidence against this use (it may not work); F: Strong scientific evidence against this use (it likely does not work).


The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious and should be evaluated by a qualified health care professional.

  • Abuse (sexual, physical, psychological), angina, attention deficit hyperactivity disorder, anorexia nervosa, apoplectic hemiplegia, arthritis, beauty treatment, Bell's palsy, bloating (after surgery), cancer therapy for children, cancer treatment side-effects (other than nausea), carpal tunnel syndrome, cerebral birth injuries (infants), childbirth facilitation/induction, colds/flu, congestion, constipation, chronic fatigue syndrome, dementia, edema, emotional repression/trauma, eyestrain, fatigue, fibromyalgia, gag reflex abnormalities (for prevention during dental procedures), gastrointestinal disorders, gum disease, head injury, HIV/AIDS, hormonal pain, hyperactivity, immune deficiencies, itchiness, joint inflammation, jetlag, kidney infection (related pain), menopausal pain, multiple sclerosis, muscle tension/ache, neuralgia (postherpetic), optic atrophy, organ transplantation, phobias, poor circulation, post-traumatic stress disorder, prolapse of lumbar intervertebral disc, psoriasis, recurrent urinary tract infections, renal disease, restless leg syndrome, Rett syndrome, sickle cell anemia (pain), sinus problems, sports injuries, stress, sunburn pain, tendonitis, toothache, ulcer pain, weight gain (premature infants).


Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

  • With proper training, self-administered acupressure and that performed by an experienced therapist appear to be generally safe. There is a lack of serious long-term complications reported in the scientific literature. Hand nerve injury, herpes zoster ("shingles"), carotid dissection, and retinal and cerebral artery embolism cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.

Author Information

  • This information is based on a systematic review of scientific literature edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).


Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. For comprehensive information about alternative and complementary therapies on the professional level, go to www.naturalstandard.com. Selected references are listed below.

  1. Agarwal A, Ranjan R, Dhiraaj S, et al. Acupressure for prevention of pre-operative anxiety: a prospective, randomised, placebo controlled study. Anaesthesia 2005 Oct;60(10):978-8. View Abstract

  2. Barker R, Kober A, Hoerauf K, et al. Out-of-hospital auricular acupressure in elder patients with hip fracture: a randomized double-blinded trial. Acad Emerg Med 2006 Jan;13(1):19-23. View Abstract

  3. Chen HM,Chen CH. Effects of acupressure at the Sanyinjiao point on primary dysmenorrhoea. J Adv Nurs 2004;48(4):380-387. View Abstract

  4. 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. View Abstract

  5. Harris RE, Jeter J, Chan P, et al. Using acupressure to modify alertness in the classroom: a single-blinded, randomized, cross-over trial. J Altern Complement Med 2005 Aug;11(4):673-9. View Abstract

  6. Ho CM, Tsai HJ, Chan KH, et al. P6 acupressure does not prevent emesis during spinal anesthesia for cesarean delivery. Anesth Analg 2006 Mar;102(3):900-3. View Abstract

  7. Hsieh LL, Kuo CH, Lee LH, et al. Treatment of low back pain by acupressure and physical therapy: randomised controlled trial. BMJ 2006 Mar 25;332(7543):696-700. View Abstract

  8. Maa SH, Sun MF, Hsu KH, et al. Effect of acupuncture or acupressure on quality of life of patients with chronic obstructive asthma: a pilot study. J Altern Complement Med 2003;9(5):659-670. View Abstract

  9. Puangsricharern A, Mahasukhon S. Effectiveness of auricular acupressure in the treatment of nausea and vomiting in early pregnancy. J Med Assoc Thai. 2008; 91(11):1633-8. View Abstract

  10. Roscoe JA, Jean-Pierre P, Morrow GR, et al. Exploratory analysis of the usefulness of acupressure bands when severe chemotherapy-related nausea is expected. J Soc Integr Oncol 2006 Winter;4(1):16-20. View Abstract

  11. Sheehan P. Hyperemesis gravidarum--assessment and management. Aust Fam Physician 2007 Sep;36(9):698-701. View Abstract

  12. Smith CA, Collins CT, Cyna AM, et al. Complementary and alternative therapies for pain management in labour. Cochrane Database Syst Rev 2006 Oct 18;(4):CD003521. View Abstract

  13. Stein DJ, Birnbach DJ, Danzer BI, et al. Acupressure versus intravenous metoclopramide to prevent nausea and vomiting during spinal anesthesia for cesarean section. Anesth Analg 1997;84(2):342-345. View Abstract

  14. Tsay SL, Wang JC, Lin KC, et al. Effects of acupressure therapy for patients having prolonged mechanical ventilation support. J Adv Nurs 2005 Oct;52(2):142-50. View Abstract

  15. Wang SM, Escalera S, et al. Extra-1 acupressure for children undergoing anesthesia. Anesth Analg. 2008; 107(3):811-6. View Abstract

Copyright © 2013 Natural Standard (www.naturalstandard.com)

The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. Information is based on review of scientific research data, historical practice patterns, and clinical experience. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.


March 22, 2017