Neiguan point (P6)

Related Terms

Acupoint, acupoint stimulation, acupressure, acupuncture, acupuncture point stimulation, acustimulation wristbands, EA, electroacupuncture, Neiguan point (P6), portable TENS (transcutaneous electrical nerve stimulation), shiatsu, TAES, TEAS, transcutaneous acupoint electrical stimulation, transcutaneous electrical acupoint stimulation, transcutaneous electrical acustimulation.
Not included in this discussion: Acupuncture, acupressure, shiatsu, TENS.

Background

Acustimulation is the mild electrical stimulation of acupuncture points to control symptoms such as nausea and vomiting. A low intensity electrical current is used to penetrate just slightly below the surface of the skin.
It may be delivered by acupuncture needles attached to electrodes or, more commonly, by battery-powered appliances that can be worn on the body (touching the surface of the skin).
The Neiguan point (P6) is an acupuncture point on the wrist that has been used in acupuncture (without electricity) for approximately 3,000 years to overcome gastric symptoms such as nausea and vomiting. This is the most common point used in acustimulation.

Theory

Acustimulation is a distinct modality from acupuncture. However, it borrows from Chinese acupuncture theory to locate points on the body where electrical stimulation, as an alternative to needles, may be applied to reduce certain symptoms.
Western science explains the effects of acustimulation in terms of affecting the nervous system, rather than the circulation of chi (vital energy, life force), which is the basis of Chinese acupuncture theory.
The system of chi pathways ("meridians") used in Chinese acupuncture theory has certain parallels with the nervous system. This makes it possible to use the Chinese map of acupuncture points to identify locations where electrical stimulation may influence certain responses of the nervous system.
Nausea and vomiting are believed to be caused by disturbances in the normal nerve impulses passing between the brain and stomach. Acustimulation uses a mild electrical current at the wrist to modulate these nerve impulses and restore normal signals between the brain and stomach, thus reducing nausea and vomiting.

Evidence Table

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. GRADE *
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. GRADE *


There is evidence from small but well-designed studies of seasickness and artificially-induced motion sickness (using laboratory equipment) indicating that
acustimulation can reduce symptoms of nausea and vomiting. It may slow down, but not necessarily prevent, the development of motion sickness.

 B


There is evidence from small but well-designed studies of seasickness and artificially-induced motion sickness (using laboratory equipment) indicating that
acustimulation can reduce symptoms of nausea and vomiting. It may slow down, but not necessarily prevent, the development of motion sickness.

 B


There is good evidence that acustimulation by wearing the ReliefBand? helps in reducing post-operative nausea and vomiting. The effect may be comparable to anti-nausea medication and may be enhanced when combined with medication. There is also evidence that transcutaneous electrical nerve stimulation (TENS) for five minutes on the P6 point may be effective in children receiving tonsillectomy.

 B


There is good evidence that acustimulation by wearing the ReliefBand? helps in reducing post-operative nausea and vomiting. The effect may be comparable to anti-nausea medication and may be enhanced when combined with medication. There is also evidence that transcutaneous electrical nerve stimulation (TENS) for five minutes on the P6 point may be effective in children receiving tonsillectomy.

 B


One study suggested that 15 minutes of transcutaneous electrical acupoint stimulation (TEAS) three times weekly for a month reduced fatigue and depressed mood and increased sleep quality in patients receiving hemodialysis. However, the design of the study makes interpretation of the findings difficult. More studies are needed to determine whether acustimulation should be recommended in hemodialysis patients.

C


One study suggested that 15 minutes of transcutaneous electrical acupoint stimulation (TEAS) three times weekly for a month reduced fatigue and depressed mood and increased sleep quality in patients receiving hemodialysis. However, the design of the study makes interpretation of the findings difficult. More studies are needed to determine whether acustimulation should be recommended in hemodialysis patients.

C


Acustimulation has been examined in the treatment of high blood pressure in one small study of patients diagnosed with diastolic hypertension. A set of four different acupuncture points were used, with results showing an immediate reduction of diastolic blood pressure. At this time, the evidence is insufficient to recommend acustimulation for high blood pressure.

C


Acustimulation has been examined in the treatment of high blood pressure in one small study of patients diagnosed with diastolic hypertension. A set of four different acupuncture points were used, with results showing an immediate reduction of diastolic blood pressure. At this time, the evidence is insufficient to recommend acustimulation for high blood pressure.

C


One small study suggests that acustimulation to the P6 wrist point and the ST36 point below the knee may help patients with irritable bowel syndrome to reduce symptoms and pain. However, the design was weak, and more studies are needed to determine benefits in IBS.

 C


One small study suggests that acustimulation to the P6 wrist point and the ST36 point below the knee may help patients with irritable bowel syndrome to reduce symptoms and pain. However, the design was weak, and more studies are needed to determine benefits in IBS.

 C


The evidence on the use of acustimulation wristbands for chemotherapy nausea and vomiting is mixed. Some studies suggest no benefit and that simple acupressure massage may be more effective. Other studies have found benefit that when acustimulation is combined with anti-nausea medications, the bands may reduce the amount of medication needed and they may help with more severely nauseous patients. More studies are needed to clarify the relationship between patient responses, types of cancer, and types of chemotherapy.

 C


The evidence on the use of acustimulation wristbands for chemotherapy nausea and vomiting is mixed. Some studies suggest no benefit and that simple acupressure massage may be more effective. Other studies have found benefit that when acustimulation is combined with anti-nausea medications, the bands may reduce the amount of medication needed and they may help with more severely nauseous patients. More studies are needed to clarify the relationship between patient responses, types of cancer, and types of chemotherapy.

 C


Transcutaneous acupoint electrical stimulation has been tested in one small study of patients receiving electroshock therapy for mental illness, to determine whether it might reduce nausea and vomiting after this procedure. The design of the study makes interpretation difficult, and more studies are needed to determine the benefits in this use.

 C


Transcutaneous acupoint electrical stimulation has been tested in one small study of patients receiving electroshock therapy for mental illness, to determine whether it might reduce nausea and vomiting after this procedure. The design of the study makes interpretation difficult, and more studies are needed to determine the benefits in this use.

 C


There is a lack of solid evidence on the effects of acustimulation for nausea associated with pregnancy. Although experts express a general opinion that it is likely beneficial, well-designed studies are needed to document the benefits.

C


There is a lack of solid evidence on the effects of acustimulation for nausea associated with pregnancy. Although experts express a general opinion that it is likely beneficial, well-designed studies are needed to document the benefits.

C


A study of patients recovering from abdominal surgery found that both high- and low-intensity levels of acustimulation reduced their need for pain medication. However, the higher intensity stimulation was more effective. More studies are needed to determine recommendations for the use of acustimulation in pain management.

 C


A study of patients recovering from abdominal surgery found that both high- and low-intensity levels of acustimulation reduced their need for pain medication. However, the higher intensity stimulation was more effective. More studies are needed to determine recommendations for the use of acustimulation in pain management.

 C


One study has suggested that the use of the ReliefBand? to stimulate the P6 wrist point does not reduce nausea and retching during the gastroscopy procedure. Theoretically, future studies could contradict this finding, yet the nausea and retching is caused by the invasiveness of the procedure itself, rather than by internal factors in the patient, making it unlikely.

 D


One study has suggested that the use of the ReliefBand? to stimulate the P6 wrist point does not reduce nausea and retching during the gastroscopy procedure. Theoretically, future studies could contradict this finding, yet the nausea and retching is caused by the invasiveness of the procedure itself, rather than by internal factors in the patient, making it unlikely.

 D
* 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 for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)
* 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 for this use (it may not work)
F: Strong scientific evidence against this use (it likley does not work)

Tradition / Theory

The below uses are based on tradition, scientific theories, or limited research. 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 healthcare provider. There may be other proposed uses that are not listed below.

Safety

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.

Attribution

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).

Bibliography

Bertolucci LE, DiDario B. Efficacy of a portable acustimulation device in controlling seasickness. Aviat Space Environ Med 1995;66(12):1155-1158.
Kabalak AA, Akcay M, Akcay F, et al. Transcutaneous electrical acupoint stimulation versus ondansetron in the prevention of postoperative vomiting following pediatric tonsillectomy. J Altern Complement Med 2005;11(3):407-413.
Kramer BA, Kadar AG, Clark K. Transcutaneous acupoint electrical stimulation in preventing and treating nausea and vomiting in patients receiving electroconvulsive therapy. J ECT 2003;19(4):194-196.
Lee A, Done ML. Stimulation of the wrist acupuncture point P6 for preventing postoperative nausea and vomiting. Cochrane Database Syst Rev 2004;(3):CD003281.
Roscoe JA, Matteson SE, Morrow GR, et al. Acustimulation wrist bands are not effective for the control of chemotherapy-induced nausea in women with breast cancer. J Pain Symptom Manage 2005;29(4):376-384.
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;26(2):731-742.
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.
Shiao SY, Dibble SL. Metaanalyses of acustimulation effects on nausea and vomiting across different patient populations: a brief overview of existing evidence. Explore (NY) 2006 May;2(3):200-1.
Slotnick RN. Safe, successful nausea suppression in early pregnancy with P-6 acustimulation. J Reprod Med 2001;46(9):811-814.
Tarcin O, Gurbuz AK, Pocan S, et al. Acustimulation of the neiguan point during gastroscopy: Its effects on nausea and retching. The Turkish Journal of Gastroenterology 2004;15(4):258-262.
Treish I, Shord S, Valgus J, et al. Randomized double-blind study of the Reliefband as an adjunct to standard antiemetics in patients receiving moderately-high to highly emetogenic chemotherapy. Support Care Cancer 2003;11(8):516-521.
White PF, Hamza MA, Recart A, et al. Optimal timing of acustimulation for antiemetic prophylaxis as an adjunct to ondansetron in patients undergoing plastic surgery. Anesth Analg 2005;100(2):367-372.
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;97(5):1075-1081.
Williams T, Mueller K, Cornwall MW. Effect of acupuncture-point stimulation on diastolic blood pressure in hypertensive subjects: a preliminary study. Phys Ther 1991;71(7):523-529.
Zarate E, Mingus M, White PF, et al. The use of transcutaneous acupoint electrical stimulation for preventing nausea and vomiting after laparoscopic surgery. Anesth Analg 2001;92(3):629-635.