Acupuncture & AcupressurePoints, meridians, needles — and the best evidence in this library
Nearly twenty-one thousand patients across thirty-nine randomised trials. This is the most rigorously tested practice on this site — and what the testing found is more interesting than either side usually admits.
One half of this page you can practise tonight with your own hands, for nothing. The other half involves needles through skin and belongs to a trained, licensed practitioner — and that division is the first thing worth being clear about.
How to read this page
Part I teaches acupressure properly, because it is genuinely yours to do. Part II is the theory, the evidence — which is unusually good — and the safety.
What this actually is
If you have never encountered any of this, start here. Nothing below assumes you know anything.
The basic idea
A very old Chinese medical system holds that something — called qi, usually translated as vital energy or life force — moves through the body along defined pathways. When it moves freely you are well; when it stalls or floods somewhere, you are not. Treatment means influencing that flow at particular places on the body.
You do not have to believe any of that to use this page. The map was drawn by people making careful observations over a very long time, and — as §08 shows — pressing and needling those places has measurable effects whatever you think is flowing.
A specific, named, repeatable location on the body — roughly the size of a fingertip. Almost all of them sit in a hollow, beside a bone, or between two tendons, which is why you can find them by feel rather than by guessing.
There are somewhere around 360 classical points, plus hundreds of extras. You need about a dozen. This page teaches those.
A line along which points are grouped. Twelve main channels, each named for an organ — Lung, Large Intestine, Stomach, Spleen, Heart, and so on — plus two on the midline.
⚠ The organ names are not anatomical claims. The “Heart” channel is not about cardiology. Treat them as the names of routes, not statements about your organs.
LI4 means the fourth point on the Large Intestine channel. PC6 is the sixth on the Pericardium channel. SP6, Spleen six.
Every point also has a Chinese name — LI4 is Hegu, “joining valley.” The codes are a modern convenience for teaching and research, and they are what a practitioner will use with you.
The two practices, and how they differ
The same map, worked with your fingers. Firm sustained pressure on a point instead of a needle in it.
No training required, no equipment, no cost, and essentially nothing that can go badly wrong beyond a bruise. This is the whole of Part I, and you can start tonight.
Very fine needles inserted through the skin at those same points, by somebody licensed to do it.
There is no home version and this page will not teach you one. Needling has real risks — §09 — and they are the reason it is a regulated clinical practice nearly everywhere.
Acupressure is weaker than acupuncture and enormously more available. For nausea and everyday tension that trade is often worth taking. For chronic pain, the evidence in §08 is about needles.
Acupressure, taught in full
Same map, same points, no needles. Firm sustained pressure with a thumb or a knuckle — and it is free, portable, and impossible to get badly wrong.
Point locations are given in cun (pronounced “tsoon”), a proportional unit — measured on the body being treated, not a fixed distance. A tall person’s cun is bigger than a child’s, which is why the system travels.
Use your own hand as the ruler:
- 1 cun — the width of your thumb at the knuckle.
- 1.5 cun — index and middle finger together.
- 2 cun — index, middle and ring finger together.
- 3 cun — all four fingers together, measured at the knuckle line.
“Three finger-widths” means 2 cun, not three inches. That one confusion accounts for most badly located points.
1. Find it by feel, not by millimetre. Measure roughly, then hunt. A live point feels different from the tissue around it — tender, dense, gritty, or slightly electric. When you find that, you have found the point. If nothing feels different, move a fingertip-width in each direction before concluding it is not there.
2. Angle into it. Most points sit in a hollow, beside a bone, or between tendons. Press toward the bone or into the hollow rather than straight down into flat muscle. GB20 at the base of the skull, for instance, is pressed upward and inward.
3. Build pressure over about five seconds rather than jabbing. Firm enough to be definite; a deep dull ache is right. Sharp, bright or radiating pain means back off — you are on a nerve or pressing too hard.
4. Hold one to three minutes. Static pressure, or small circles about the size of a coin. Breathe out slowly while you press and let the pressure deepen slightly on the exhale.
5. Do both sides unless the point is on the midline. Most points are bilateral and the tradition treats them as a pair.
6. Release slowly, over a couple of seconds, then rest a moment before moving on.
How often: two or three times a day for something acute, once daily for something ongoing. Repetition beats intensity every time — and bruising means you overdid it, not that it worked.
When to expect something: nausea and tension frequently shift within a few minutes. Anything chronic wants a week or two of daily practice before you judge it. If it has done nothing in three weeks, it is not going to.
Routines — what to actually do
Points are the vocabulary; a routine is the sentence. Each of these is an ordered sequence with timings — work down the list, both sides, then stop.
Do the whole sequence rather than one point harder. The order is doing work: open, treat, settle.
What an acupuncture session is actually like
Worth knowing before you book, because the reality surprises people in both directions.
- The intake is long. A first session is usually an hour or more, and much of it is questions — sleep, digestion, temperature, energy, mood, menstrual cycle. Tongue and pulse are examined. This is diagnostic within the tradition's own framework.
- The needles are far finer than you are imagining. Roughly the width of a hair — several would fit inside a hypodermic. Most insertions are felt as a tap or nothing at all.
- Numbers vary; commonly five to twenty. Often in the limbs and ears rather than the site of the problem.
- You may feel de qi — a heavy, dull, spreading ache around the needle. Practitioners generally regard it as desirable. It should not be sharp.
- Then you lie there for twenty to thirty minutes. Many people fall asleep. This resting period is a real part of the treatment and probably a real part of the effect.
- Related methods you may meet: moxibustion (burning mugwort near the skin), cupping, gua sha, electroacupuncture, and auricular (ear) points.
Expect a course, not a session. Trials that show benefit generally use six to twelve treatments, and the dose-response data suggest more sessions and more needles track with better outcomes.
Choosing a practitioner
Are you licensed, and by whom? Acupuncture is regulated in most countries. Ask for the specific licensing body, not a certificate on the wall.
Do you use single-use sterile disposable needles? The answer must be yes, and you should be able to see the sealed packet opened.
What would make you refer me elsewhere? A practitioner with a clear referral threshold is a safer practitioner, in this field as in every other.
⚠ And one you ask yourself: is this alongside medical care, or instead of it? It should always be alongside.
A note on dry needling. Physiotherapists and others increasingly use fine needles into trigger points, framed in Western anatomical terms rather than meridians. Whether this is a distinct practice or acupuncture with different vocabulary is genuinely disputed, including in court and in regulatory filings. The needle is the same; the training requirements frequently are not — ask about hours.
The traditional theory, and its actual age
Attested The system is genuinely old. The Huangdi Neijing — the Yellow Emperor's Inner Canon — is the foundational text, compiled over centuries around the Han period. Qi circulating through channels, yin and yang, the five phases, and points at which the flow can be influenced.
But the version practised worldwide today is substantially twentieth-century. Contemporary “Traditional Chinese Medicine” as a standardised, systematised body of knowledge was consolidated in the People's Republic from the 1950s — a deliberate modernising synthesis of a far more varied and regionally inconsistent inheritance. Point numbering systems like LI4 and PC6 are modern conveniences for teaching and research.
Ancient roots, standardised recently. That is the same pattern as almost everything in this library — and here it changes nothing about whether the treatment works.
Contested Meridians have no anatomical correlate. No structure corresponding to a channel has been identified. This matters less than it sounds, because — as §06 shows — the clinical question was answered separately from the mechanistic one.
The evidence — and read this carefully
Studied The Acupuncture Trialists' Collaboration ran an individual patient data meta-analysis — not pooled summary statistics, but the raw records of every patient, reanalysed in one database. Trials were included only where allocation concealment was unambiguously adequate.
patients, across 39 randomised trials in the 2017 update — up from 17,922 across 29 trials in the original 2012 analysis.
conditions: back and neck pain, osteoarthritis, chronic headache, and shoulder pain.
Acupuncture beat sham acupuncture for back and neck pain, osteoarthritis and chronic headache — and beat non-acupuncture controls by more.
Acupuncture is better than sham. That is the finding, from high-quality trials, and it means the effect is not entirely placebo. The authors state it directly: acupuncture is more than a placebo, and the effects persist over time.
And the difference from sham is modest. The authors say that too, in the same breath — which implies that a large part of the total benefit comes from factors shared with sham: the ritual, the attention, the lying still, the expectation, the hour of somebody's careful concentration.
Both halves are true and neither is the whole story. A page that reports only the first is advertising; a page that reports only the second is dismissing.
One methodological detail that cuts in acupuncture's favour, and is rarely mentioned: effect sizes were smaller in trials whose sham used a penetrating needle than in trials using non-penetrating sham or no needle at all. Sticking a needle in somebody at a “wrong” point may not be an inert control — which means the primary estimates may understate the difference.
Where the evidence is strongest: the four chronic pain conditions above, and chemotherapy-induced and post-operative nausea, where P6 has repeated support. Where it is weak or absent: most other conditions, and the broad claims about internal organs, fertility and immunity.
What may be happening
- Endogenous opioids. Needling releases endorphins and related neuropeptides — the best-supported mechanistic account, and consistent with the analgesic pattern.
- Gate control and diffuse noxious inhibitory control. A mild controlled stimulus modulating pain signalling elsewhere. Would predict that point specificity matters less than needling itself, which is roughly what the sham data show.
- Local effects. Microtrauma, blood flow changes, adenosine release, connective tissue response around the needle.
- Autonomic shift. Thirty minutes lying still in a quiet room being attended to. Not a trivial contributor, and there is no reason to be embarrassed about it.
- Expectation. Real, measurable, and part of every effective treatment including the pharmaceutical kind.
You do not need qi to explain the results. You also do not need to have explained the results to be entitled to the relief.
⚠ Safety
In trained hands acupuncture has a good safety record, and serious events are rare. Rare is not never, and the serious ones are specific.
⚠ And the one that matters most: acupuncture is not a treatment for infection, cancer, or any condition with effective conventional treatment. Alongside is a reasonable position. Instead of is where people die.
What a new seeker should actually ask
- Are you licensed, and by which body?
- Single-use sterile needles, opened in front of me?
- ⚠ Is this alongside my medical care, or being offered instead of it?
- What is being treated, and is it one of the things the evidence actually supports? Chronic musculoskeletal pain and nausea are well supported. Most other claims are not.
- How many sessions, and how will we know if it is working? A practitioner who cannot say what improvement would look like cannot tell whether to stop.
- Could I get some of this from acupressure at home, free? For nausea and tension, frequently yes.
- Am I being sold herbs alongside? That is a separate practice with separate risks, including real drug interactions.
Provenance
The individual patient data meta-analysis Studied
Vickers, Cronin, Maschino, Lewith, MacPherson, Foster, Sherman, Witt & Linde for the Acupuncture Trialists' Collaboration, Archives of Internal Medicine (2012) — 29 of 31 eligible RCTs, 17,922 patients. Updated in The Journal of Pain (2018, searched to 31 December 2015) — 39 trials, 20,827 patients. Inclusion required unambiguously adequate allocation concealment; sham trials with high risk of bias from poor blinding were excluded. Acupuncture superior to sham for back and neck pain, osteoarthritis and chronic headache (all p < 0.001), and superior by a larger margin to non-acupuncture controls, with effects persisting over time. The authors describe differences between true and sham as relatively modest.
The sham-type finding Studied
MacPherson, Vertosick, Lewith, Linde, Sherman, Witt & Vickers, PLOS ONE (2014) — secondary analysis of 29 trials, 20 with sham controls (n = 5,230) and 18 non-sham (n = 14,597). Acupuncture was superior to every category of control. Trials using penetrating sham needles showed smaller effect sizes than those using non-penetrating or non-needle sham, difference −0.45 (95% CI −0.78 to −0.12; p = 0.007), reducing to −0.19 after excluding outliers. Implication stated by the authors: the primary estimates may have underestimated the effect versus sham.
Dose Studied
MacPherson, Maschino, Lewith, Foster, Witt & Vickers, PLOS ONE (2013) — more needles and more sessions associated with better outcomes versus non-acupuncture controls, with the authors noting potential confounders including differences in control group and sample size.
The tradition Attested Contemporary
Huangdi Neijing, compiled over centuries around the Han period, as the foundational text. “Traditional Chinese Medicine” as a standardised system was consolidated in the People's Republic of China from the 1950s, drawing together a far more varied regional inheritance. Alphanumeric point codes are a modern teaching and research convention.
Where the record is thin Contested
Adverse-event rates for acupuncture come largely from prospective practitioner surveys rather than mandatory reporting, so absolute incidence figures should be treated as estimates. The dry needling question — whether it is a distinct modality or acupuncture under another name — is genuinely unresolved and is being contested through regulators and courts rather than through evidence.
✦ For practitioners
- ⚠ Know your depths over the thorax. Pneumothorax is the one that ends careers and harms people, and it comes from depth over the chest, upper back and shoulders.
- Open the packet in front of them. It answers the infection question before it is asked and it models the standard.
- Say what the evidence supports and what it does not. You have the best evidence base in this library — you do not need to overclaim, and overclaiming is what costs the field its credibility.
- Give acupressure away. P6 for nausea, LI4 for tension. A client who can help themselves between sessions is better served, and it costs you nothing.
- Have a referral threshold and say it out loud.
✦ For those guiding others
- This is one to take seriously. If somebody's chronic back pain improved with acupuncture, the evidence is on their side and scepticism here is misplaced.
- Watch the scope creep. The pain and nausea evidence is good; the fertility, immunity and organ claims are not, and the same clinic frequently offers both.
- ⚠ Herbs are a separate risk. Chinese herbal formulas prescribed alongside carry genuine drug-interaction and quality-control issues, and they are not covered by the acupuncture evidence.
- Teach the two points anybody can use. P6 and LI4 cover a surprising amount of ordinary life for free.
We are not vouching for these, only pointing at them.
- Vickers et al. (2012 and 2018) — the individual patient data meta-analysis and its update. The single best evidence document in this library, and readable.
- MacPherson et al. (2014) on control type. A short, clean lesson in why the design of a placebo determines the answer.
- Your national licensing body's register. Free, and it answers §04 question one in a minute.
- Any good history of the Huangdi Neijing — and, separately, of the 1950s standardisation. The gap between them is the interesting part.