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Shiatsu

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Natural Standard Monograph, Copyright © 2008 (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 professional before making decisions about therapies and/or health conditions.

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 hand acupressure, Korean acupressure point K-D2, macrobiotic shiatsu, Ohashiatsu, oriental bodywork therapy, Sea-Band, Seitei shiatsu, shiatsu anma therapy, tapas acupressure techniqueTM, Tao shiatsu, traditional Chinese medicine, Tuina (Tui Na), 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)..

Background

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 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.

Theory

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 healthcare professional

Several traditional Asian medical philosophies consider health to be a state of balance in the body, which 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 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.

Evidence

Uses based on 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 professional.	Grade*
Nausea 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. However, results from studies are conflicting. Effects have been noted in children as well as adults. Better quality research is needed in order to make a strong recommendation.	B
Agitated behavior (in dementia) Acupressure may decrease verbal and physical agitation among dementia patients. Further study is needed before recommendations can be made.	C
Alertness Acupressure at stimulation and relaxation points may have different effects on alertness in a classroom setting. Further research is necessary to confirm these findings.	C
Anxiety Preliminary clinical trials suggest that acupressure may significantly reduce general and pre-operative anxiety. However, these studies have been small and poorly designed, warranting better-quality research.	C
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.	C
Bed-wetting (children) Early research seems promising. Further research is necessary before a recommendation can be made.	C
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.	C
Depression Several studies suggest that fatigue and depressive mood may improve with acupressure therapy. Further research is necessary to confirm these findings.	C
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.	C
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.	C
Epilepsy (children) Preliminary evidence suggests that acupressure may help epileptic seizures among children. Further research is needed to confirm these results.	C
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.	C
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.	C
Gastrointestinal motility A small study suggests acupressure may improve gastrointestinal motility. Additional research is necessary before a firm conclusion can be drawn.	C
Headache Self-administered acupressure is reported to help tension or migraine headaches in early studies. More research is needed before a recommendation can be made.	C
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.	C
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.	C
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.	C
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.	C
Pain 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. Further study is needed in order to make firm recommendations.	C
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, before a recommendation can be made.	C
Parkinson's disease Acupressure may benefit several measures of severity of Parkinson's disease. Further study is needed before recommendations may be made.	C
Post-operative pain Several studies report that acupressure provides pain relief to patients after surgeries. This 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.	C
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.	C
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 health care professional.	C
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.	C
Smoking cessation Early study indicates that auricular acupressure may help with quitting smoking. Further research is needed to confirm these results.	C
Weight loss/obesity Preliminary evidence suggests that acupressure may not be effective for weight loss.	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 against this use (it may not work);
F: Strong scientific evidence against this use (it likely does not work).
For full grading rationale, click here.

Uses based on tradition or theory

Abuse (physical, psychological, sexual), angina (chest pain), anorexia nervosa, apoplectic hemiplegia, arthritis, asthma, attention deficit hyperactivity disorder (ADHD), Bell's palsy, bloating (after surgery), cancer treatment (for children), cancer treatment side-effects (other than nausea), carpal tunnel syndrome, chest congestion, childbirth facilitation/induction, chronic fatigue syndrome, colds/flu, cosmetic uses, dementia, edema, eye strain, fibromyalgia, gag reflex abnormalities (for dental procedures), gastrointestinal disorders, gum disease, head injury, HIV/AIDS, immune deficiency, itchiness, jetlag, joint inflammation, kidney infection (related pain), menopausal pain, multiple sclerosis, muscle tension/ache, nasal congestion, optic atrophy, organ transplantation, pain (shoulder), paralysis after stroke, phobias, poor blood circulation, post-traumatic stress disorder (PTSD), prolapse (lumbar intervertebral disc), psoriasis, restless leg syndrome, Rett's syndrome, sinus disorders, sports injuries, sunburn pain, tendonitis, toothache, ulcer pain, urinary tract infection.

Safety

The U.S. Food and Drug Administration does not strictly regulate herbs and supplements. There is no guarantee of strength, purity or safety of products, and effects may vary. You should always read product labels. If you have a medical condition, or are taking other drugs, herbs, or supplements, you should speak with a qualified healthcare professional before starting a new therapy. Consult a healthcare professional immediately if you experience side effects.

With proper training, self-administered acupressure and that performed by an experienced therapist appear to be generally safe. No serious long-term complications have been reported in the scientific literature. Hand nerve injury and herpes zoster ("shingles") cases have been reported after shiatsu massage. Forceful acupressure may cause bruising.

Updates

Last updated: February 2008.

This information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com).

Selected References

Natural Standard developed the above evidence-based information based on a 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.

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.
Allison DB, Kreibich K, Heshka S, et al. A randomised placebo-controlled clinical trial of an acupressure device for weight loss. Int.J Obes.Relat Metab Disord. 1995;19(9):653-658.
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.
Chen HM,Chen CH. Effects of acupressure at the Sanyinjiao point on primary dysmenorrhoea. J Adv.Nurs. 2004;48(4):380-387.
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.
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.
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.
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.
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.
Sheehan P. Hyperemesis gravidarum--assessment and management. Aust Fam Physician. 2007 Sep;36(9):698-701.
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. Update of: Cochrane Database Syst Rev. 2003;(2):CD003521
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.
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.
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.
Wang XH, Yuan YD, et al. [Clinical observation on effect of auricular acupoint pressing in treating sleep apnea syndrome]. Zhongguo Zhong.Xi.Yi.Jie.He.Za Zhi. 2003;23(10):747-749.

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