The acupuncture point neiguan (Pericardium-6) is probably best known in the West as a treatment for nausea and vomiting.It has been claimed in Western literature that not only standard acupuncture needling is effective for this application, but that one can use finger pressure massage (acupressure) at that site or even have the person wear a wristband that includes a bump that will press into neiguan when positioned properly. Unfortunately, the limited research on finger pressure for nausea and vomiting was notably flawed (see: Status of acupuncture research).

A clinical evaluation of stimulating neiguan to treat cisplatin-induced nausea also revealed no effect from using a 0.5 cm steel ball compressed against the point and held in place by a band (24).However, the researchers claimed that there was a high degree of success when applying, instead, a magnetic disk at neiguan, but not a non-magnetic disk.This result, implying that a magnetic field could markedly affect the point, appears suspicious with the lack of any detailed reporting in the publication, even at the level usual for Chinese medical publications.Further, in the several years since the study, follow-up research with magnet application has yet to appear in the literature.

Needling neiguan was used to alleviate nausea, vomiting, and chest pain caused by transcatheter arterial chemoembolization (a catheter is introduced into an artery that feeds the liver to locally introduce chemotherapy drugs in the treatment of liver cancer).In a study (26), involving 187 patients, treatment would be given once the side effects were noted during the invasive medical procedure.Needles were inserted to a depth of 0.8-1.0 cun, and after the needling sensation was attained, the needles were manipulated by lifting and thrusting 10-15 times (bird-pecking maneuver), this being repeated every 2 minutes.The needles were retained until the end of the procedure, which usually took about 50 minutes.The authors reported that Western medical treatments (the drugs zofran or granisetron given intravenously) could control the nausea and vomiting, but did not affect the chest pain.However, needling neiguan could alleviate the chest pain very rapidly.Nausea and vomiting could also be alleviated by the acupuncture treatment, but usually only after longer stimulus: in the most successful cases, after about 1minute, but in many cases after 1-7minutes of the intensive needling.The treatment of nausea and vomiting by this method is acceptable in China, where the drug therapies are quite expensive and needling can be done in the hospital at the same time as the catherization, but is less practical in the West, where intensive needle stimulation for several minutes may be impractical.Still, the rapid alleviation of chest pain-which was not attained with drug therapy-but was achieved by needling neiguan bilaterally, may yield a practical application even outside of China.

It turns out that, in China, the use of neiguan needling for nausea and vomiting is not the major application either historically (see following section) or in modern practice, though neiguan is sometimes included as a secondary point in such cases.For example, acupressure treatment of nausea (as commonly suggested by Western practitioners) was clinically evaluated by applying the pressure to hegu (Large Intestine-4) rather than neiguan (9); this study involved patients who become nauseated or even vomit during oral or laryngopharyngeal examination or treatment.The choice of the acupoint to treat was explained this way: “As the hegu point is used in treating facial and pharyngeal diseases and vomiting in pregnancy, the point was studied for possible prevention of nausea.”

For the treatment of morning sickness (1), characterized by nausea and, in severe cases, vomiting, a clinical trial involved acupuncturing women according to differential diagnosis (stomach-deficiency, liver heat, or phlegm-damp), using two acupuncture points (bilaterally, a total of four needles) as the main ones.In each case, zusanli was selected as one of the points (see: Zusanli), with either taichong (Liver-3) or fenglong (Stomach-40) as the second point.It was reported that most patients were relieved of vomiting after needling the main points.If curative effects were insignificant, however, auxiliary points were resorted to. Auxiliary points in this study were an additional point or pair of points (treated bilaterally), for which neiguan was included for the phlegm-damp category (only point added) and neiguan was added along with zhongwan (Conception Vessel-12) for the stomach-deficiency category.The basis for adding neiguan was that it “has the action of regulating the triple burner, reducing rebellious qi, and stopping vomiting.”

When neiguan is the main point in a treatment, it has a different use, at least in China.?According to reports, stimulating neiguan with appropriate techniques is an effective treatment for cardiovascular diseases, particularly cases where there is irregular heart rhythm or constricted blood flow (e.g., angina or heart attack). The most frequent application of neiguan stimulation, however, is as an adjunctive point to a number of acupuncture formulas, for which it has many uses aside from treating either cardiac disorders or nausea/vomiting.

Historical Background

Neiguan is one of the 365 classical acupuncture points, located on the forearm portion of the short pericardium meridian that has a total of only nine standard points (see Figures 1 and 2). The term nei (inner) probably refers to the fact that it is on the inner side of the forearm; it appears to secondarily refer to the fact that the meridian travels between two tendons in the forearm, as is mentioned in the Lingshu (2) and the Compendium of Acupuncture (also known as the Systematic Classic of Acupuncture and Moxibustion (3)).Guan (pass) refers to the fact that the point is a luo vessel connecting point; that is, it is where there is a connection via the luo vessels (originally identified as the veins, easily seen in the area of neiguan) to waiguan (outer pass) on the triple burner meridian.In this case, wai (outer) refers to the fact that the meridian is running on the outer part of the forearm; guan has the same implication, with connection from the triple burner meridian to the pericardium meridian.According to the analysis presented in Grasping the Wind (4) both points have just the one name.

The pericardium (as an organ), pericardium meridian, and pericardium points barely get mentioned in the Neijing (5) and there is only a short passage in the Ling Shu that describes the pathway of the meridian and its influences:

When this channel is shaken [disturbed], it results in the palm of the hand being hot, the forearm and elbow being warped and stiff, and swelling in the armpit.In extreme cases, it results in fullness in the chest and ribs, palpitations of the heart, the face becoming red, yellow eyes, and incessant laughter.This channel controls the blood channels and pulses and may give rise to diseases such as anxiety in the heart, pains in the heart, and heat in the middle of the palm.

There is little mention of neiguan in the Compendium of Acupuncture (1691 A.D.).?In The Golden Needle (6) these comments are presented:

Jianli [CV-11] and neiguan sweep out suffocation within the chest.

A full sensation in the chest due to abdominal pain-needle neiguan.

A stomachache-then go for gongsun (SP-4), neiguan is the proper response and it must surely heal.

Clamber through neiguan to zhaohai (KI-6) to cure a severe tummy-pain [this probably means treating both points; zhaohai is reportedly used for retention of urine, which would cause abdominal pain].

Illness within the breast, neiguan will support.

It can be seen that the dominant historical uses are for fullness or illness in the chest and abdominal pain. The historic basis of needling neiguan for cardiac disorders (such as heart attack) resulting in chest fullness and epigastric pain is explained by Tang Zhaoliang (10), who has outlined the traditional descriptions of cardiac diseases:

In traditional Chinese medical literature, many physicians of various Dynasties recorded symptoms such as xin bi (heart pain) and zhen xin tong (genuine heart pain), both of which are very similar to those of coronary heart disease.In Su Wen, the chapter on the vitality of the vital organs has this account: Cardiac patients usually complained of chest pain, substernal fullness, epigastric pains, back and interscapular aching, and pain in both arms.Ling Shu, the chapter on collapse describes: patients suffering genuine cardiac pain show cyanosis in the extremities, severe chest pains, and usually die in the evening if the attack starts in the morning, or die the next morning if the attack starts in the evening.Compendium of Acupuncture describes that acupuncturing neiguan causes the regaining of consciousness and the relief of cardiac pain.If the cardiac pain is acute, the reducing maneuver is indicated; if it is chronic, the reinforcing maneuver is indicated.

Modern Applications

The references to neiguan in the historical literature are not many, suggesting that the widespread use of it that occurs today is due to relatively recent interpretations of how the point can function in larger point formulas.The modern applications of neiguan, as the main point in a treatment, are described in Chinese Acupuncture and Moxibustion (7):

Cardiac pain, palpitation, stuffy chest, pain in the hypochondriac region, stomachache, nausea, vomiting, hiccup, mental disorders, epilepsy, malaria, contracture and pain of the elbow and arm.

In another book by the same name (8), the following list is presented for neiguan indications:

Cardiac pain, palpitations, stuffiness in the chest, gastric pain, vomiting, epilepsy, febrile diseases, motor impairment of the upper limbs, hemiplegia, insomnia, vertigo, unilateral headache (migraine).

The principal use of neiguan in modern China, when used as a single point or primary point in a small group of points in modern China, is cardiac disorders, with pain in the stomach area as a second application, and other uses being relatively minor, as will be seen.For purposes of clinical and experimental research, zusanli, a widely used and extensively researched acupoint that is not deemed specific for cardiovascular disorders, is sometimes utilized as a control.Hegu (Large Intestine-4) is also sometimes utilized as a control treatment, but because of its proximity to neiguan, and the possibility of overlapping actions, it may not be as suitable for that purpose.

[1] [2] [3]