Acupressure

Acupressure is firm, sustained pressure applied with the fingers, thumbs or a band to specific points on the body. It comes from the same tradition as acupuncture and uses the same map of points, with pressure in place of needles — which is the usual reason people choose it, and a perfectly good one.

Of the therapies in this section it has the most in its favour, and the honest summary is narrower than the claims usually made for it: there is reasonable evidence that it helps with nausea, weaker evidence that it helps with some kinds of pain, and no good reason to think it treats disease.

The explanation and the findings are separate questions

Acupressure is traditionally explained in terms of chi flowing along channels called meridians, with illness arising from blockage and pressure freeing the flow. That is a traditional explanatory framework several thousand years old. Meridians have not been demonstrated as anatomical structures, and chi is not something that has been measured.

None of which settles whether the practice does anything, because a treatment can work for reasons other than the ones given for it. Pressing firmly on a particular point of the wrist either reduces nausea or it does not, and that can be tested without resolving anything about energy. So the sensible approach is to set the framework aside and look at what the trials found.

Nausea, which is the strongest case

One point does most of the work: PC6, on the inner forearm just above the wrist. It is the point the commercially sold anti-sickness wristbands press on.

A Cochrane review of PC6 stimulation for nausea and vomiting after an operation found that, compared with a sham, it reduced nausea, reduced vomiting, and reduced the need for rescue anti-sickness drugs. Compared with anti-sickness drugs themselves, there was no clear difference. The certainty of that evidence was rated low, with the usual caveats about variable trial quality, though the reviewers judged the main findings firm enough. Side effects were minor and temporary — some skin irritation, redness or soreness under a band.

For pregnancy sickness and nausea during chemotherapy, a broader review of acupressure found the results most consistently positive, although the trials were weak. These are two situations where a safe, cheap, drug-free option with even modest benefit is genuinely worth having, since the medicines available in pregnancy are limited and nobody having chemotherapy needs another tablet.

And one finding that cuts the other way, worth stating because it concerns what the bands are mostly bought for: in the trials reviewed, acupressure did not help motion sickness. The wristbands sold for travel are safe and cheap and have little behind them for that particular use. A broader review also described the post-surgical results as equivocal where the Cochrane review found benefit, which is a fair indication of how much the answer depends on which trials are counted.

Pain, fatigue and sleep

Pain is the next best supported, and the pain trials were on average the better-conducted ones. Nine of ten reported benefit, mostly for period pain, labour pain and pain after injury. One trial of surgical pain found no reduction in pain or in painkiller use.

Fatigue and insomnia trials all reported benefit and were of low quality, and one sleep study found no difference from a sham version. For sleep specifically, the treatments with real evidence behind them are set out under insomnia, and acupressure is not among them.

Breathlessness in lung conditions has a handful of positive but poor-quality trials.

How good is the evidence, plainly

Across forty-three randomised trials of acupressure, most reported benefit and the reviewers concluded the trials were not rigorous enough to establish that it works. Only about one in twenty reached the top quality rating. Many were not properly blinded, several did not report who dropped out, and the trials varied so widely in which points were used, how hard, and for how long that the results could not be pooled.

There is also a structural problem that is nobody's fault: acupressure is very hard to test blind. The person receiving it knows they are being pressed, and the practitioner knows where. Sham acupressure — pressing somewhere else — is the usual solution and it is an imperfect one, since pressing anywhere is pleasant and relaxing.

So the fair conclusion is that acupressure is a reasonable thing to try for a symptom, that the nausea case is the one with real support behind it, and that anyone promising more than that is going beyond the evidence.

The toxins are not real

Writing on acupressure, and on massage generally, routinely claims that pressure releases toxins from the tissue, which then travel to be processed and excreted, and that water should be drunk afterwards to flush them out.

There is no toxin. Nothing identifiable is released by pressing on a muscle, nothing accumulates in a knot that needs clearing, and nothing requires flushing. Drinking water is harmless, which is why the advice survives — it costs nothing and feels like doing something.

The claim matters a little more than it looks, because it is the mechanism by which a pleasant and harmless treatment gets described as detoxifying, and from there as treating conditions it does not treat.

What pressure on a tense muscle genuinely does is reduce the discomfort of the tension, increase local blood flow briefly, and feel good. That is a real effect and enough to justify it.

Doing it, and finding PC6

The practical appeal of acupressure is that it needs no practitioner, no equipment and no money.

PC6 sits on the inner forearm, about three finger-widths up from the wrist crease on the palm side, in the dip between the two tendons running down the middle. Pressing firmly with a thumb for a minute or two, on both wrists, repeated as needed, is the whole technique. A wristband does the same thing continuously and is easier when both hands are busy or when the nausea is persistent.

Pressure should be firm and steady rather than sharp, and should not be painful. A session with a practitioner typically lasts a quarter of an hour or more and can be done sitting, lying or standing; some discomfort in a tense area is normal and real pain is not.

Safety, and where not to press

Acupressure is among the safest things in this section. Still:

• Not over broken skin, a wound, a burn, an infection, a rash or a recent fracture.
• Not over varicose veins, or any area that is hot, swollen and painful — which could be a clot or an infection and needs assessing rather than pressing.
• Light pressure only for anyone taking an anticoagulant or who bruises easily.
• Not on an undiagnosed lump, or an unexplained pain that has not been looked at. Getting a diagnosis comes first.
• In pregnancy, some points are traditionally avoided, so general point-work from a book or a video is not the thing to improvise. A PC6 wristband for sickness is fine, and anything more is worth doing with a practitioner who knows the person is pregnant, and with the midwife told.
• For anyone having cancer treatment, gentle is the word and there are areas to avoid; the same considerations as for massage techniques apply, and the hospital team is the right place to ask.

What it does not replace

Older writing on this subject ended by suggesting acupressure before reaching for over-the-counter medicine. As a general instruction that is the wrong way round, and in one situation it is actively unsafe.

Severe sickness in pregnancy is a medical problem, not a wristband problem. Anyone unable to keep fluids down, losing weight, or vomiting many times a day needs seeing, and there is effective treatment for it. The same applies to persistent vomiting from any cause.

Beyond that: acupressure is an addition to treatment rather than an alternative to it, and the Cochrane finding that most favours it is a finding about PC6 combined with anti-sickness drugs.

When to see a GP

• Nausea or vomiting that is persistent, or that comes with weight loss, difficulty swallowing, or blood in the vomit.
• Pregnancy sickness that is preventing eating and drinking.
• Any new, severe or unexplained pain — particularly abdominal pain, chest pain, or a headache that is the worst ever.
• Pain that has been treated with pressure and massage for weeks without improving.
• A lump, or an area that is hot, red, swollen and tender.
• Fatigue that is persistent and unexplained, which has a long list of treatable causes worth excluding.