Contemporary Acupressure Therapy PDF

Journal of Traditional and Complementary Medicine xxx (2016) 1e13 Contents lists available at ScienceDirect Journal of Traditional and Complementary Medicine journal h...

Journal of Traditional and Complementary Medicine xxx (2016) 1e13 Contents lists available at ScienceDirect Journal of Traditional and Complementary Medicine journal homepage: http://www.elsevier.com/locate/jtcme Review article Contemporary acupressure therapy: Adroit cure for painless recovery of therapeutic ailments Piyush Mehta a, Vishwas Dhapte b, Shivajirao Kadam c, Vividha Dhapte d, * a Department of Quality assurance, Bharati Vidyapeeth University, Poona College of Pharmacy, Pune 38, India b Department of Chemistry, Bharati Vidyapeeth University, Yashwantrao Mohite College, Pune 38, India c Bharati Vidyapeeth University, Bharati Vidyapeeth Bhavan, Lal Bahadur Shastri Marg, Pune 38, India d Department of Pharmaceutics, Poona College of Pharmacy, Bharati Vidyapeeth University, Pune, India a r t i c l e i n f o a b s t r a c t Article history: Since time immemorial, complementary and alternative medicines (CAM) have played a significant role Received 12 January 2016 in human health care. CAM is known to have a strong reputation and reliability within every culture to Received in revised form provide basic health care treatment for patients. CAM acts as a better therapeutic option in human being 12 June 2016 for treating various diseases and improving quality of life with apt consideration to the economic aspects. Accepted 15 June 2016 Available online xxx Acupressure, one of the known CAM, originated in ancient China is based on the principal of acupoints activation across the meridians which correct the imbalance between Qi. Activation of specific points on the meridians is known to facilitate reduction of pain at the local sites. It also reduces the pain from other Keywords: CAM body parts. This review outlines various types, devices and mechanisms involved in the acupressure Acupressure treatment. Acupoints Copyright © 2016, Center for Food and Biomolecules, National Taiwan University. Production and hosting Marma and acupressure devices by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/). 1. Introduction 2. Acupressure CAM has become one of the fastest growing remedial ap- Acupressure was originated in ancient China.2 It showed su- proaches. It has already achieved very distinctive reliability and perior therapeutic potential against numerous disease conditions. eminence outside territory of traditional medicine system due to Acupressure is a type of acupuncture. Both acupressure and their various therapeutic attributes. Some forms of CAM have acupuncture are based on same fundamental principle of acu- been practiced for centuries, whereas others like electrotherapy points activation across the meridians. In acupressure, muscular are more recent in origin.1 Acupressure is one of the known tension is released by applying pressure with hand at specific CAM practices across the world. It is based on fundamental acupoints or pressure of the thumbs on specific points or the principle of activation of acupoints across the meridians. Acti- application of pressure to acupoints is used to balance the flow of vation of acupoints is facilitated by use of fingers or the simply the physiological energy.3,4 Acupressure also resembles reflex- available various hand-held acupressure devices. Due to easy ology; however in reflexology therapeutic response was obtained and safe manual (hands-on) therapy, acupressure is exercised by by work on predetermined reflux zone.5 Acupressure demand number of people across the globe. As these are often used in application of physical pressure on trigger points/acupoints/spe- people to build health and as remedy for various ailments, it's cific pressure points which are positioned along the meridians. essential to have knowledge about the current acupressure Meridians are the channels within human body which helps to techniques along with investigation of its scientific and maintain Qi and thus, steadiness of health condition. Each me- biomedical scope. ridian is connected to various organs and tissues of human body. Activation of specific point on meridian by pressure facilitates pain reduction at the local site and also reduces the pain from other parts of the body.6 It is a pressure point, hand-mediated energy healing technique which is considered as useful strategy * Corresponding author. Peer review under responsibility of The Center for Food and Biomolecules, for the management of multiple symptoms, along with beneficial National Taiwan University. physical comforts, satisfaction and economy.2,7 As a whole, http://dx.doi.org/10.1016/j.jtcme.2016.06.004 2225-4110/Copyright © 2016, Center for Food and Biomolecules, National Taiwan University. Production and hosting by Elsevier Taiwan LLC. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). Please cite this article in press as: Mehta P, et al., Contemporary acupressure therapy: Adroit cure for painless recovery of therapeutic ailments, Journal of Traditional and Complementary Medicine (2016), http://dx.doi.org/10.1016/j.jtcme.2016.06.004 2 P. Mehta et al. / Journal of Traditional and Complementary Medicine xxx (2016) 1e13 acupressure is a manually operated, needle-free, non-invasive, equilibrium with each other.17 In accordance to traditional Chinese cost-effective and non-pharmacological healing intervention to medicine (TCM), acupressure uses pressure to stimulate specific promote patients' well-being. acupoints for therapeutic purposes and stimulating these points can correct imbalance between Qi through channels and subse- 2.1. Acupoints quently treat the diseases.18 Re-equilibrium of Qi achieve thera- peutic benefits by improving the physiological functions of body Entire human body is a cluster of pressure points.8 Acupoint is systems or Zang-fu in the process.19 Zang-fu is a combined term for the point closest to the surface of the skin and activation of acu- human internal organs; five zang organs are the heart, liver, spleen, point is the prime step in acupressure.9 Stimulation of specified lungs and kidneys, along with the six fu organs involve gallbladder, acupoints is known to elicit functional responses that can be used stomach, small intestine, large intestine, urinary bladder and san- to treat diseases.10 Acupoints are any specific points for needle jiao (the triple energizer).20 It is simply a non-pharmacological insertion in acupressure; mostly these are area of high electrical intervention on the body to treat a wide range of conditions by conductance on the body surface.4 Each acupoint possess a applied pressure to specific acupoints.21 It is the massage of acu- different sensation based on the body part which suffers from the points performed with the fingertips, knuckles, thumbs, elbows or pain or a specific problem. Simply, application of pressure at suitable devices to achieve effective treatment that would last from different points cause different effects.11,12 Acupuncture points per several minutes to hours post a single treat-ment.2,22,23 Acupres- se have different physical effects according to location.13 Location of sure is a multi-modal therapy whose working mechanism can be each acupoint on specified meridian is determined in terms of body elucidated by miscellaneous theories.24 inch (BI) or Cun. One BI/Cun equals one thumb width at the base of According to Gate Control Theory by Melzack and Wall, the finger nail.14 BI/Cun are known as acupressure units of mea- acupressure at specific point passes pleasurable impulses to the surement (AUM). brain at a rate four times faster than painful stimuli. Continuous Local Points (LP) and Distal Points (DP) are the two important impulses shut the neural ‘GATES’ and slower messages of pain are acupoints, employed by acupressurists to treat the patients in blocked from reaching the brain and helps to improve or routine clinical practice. Acupuncture and acupressure show strengthen the pain perception threshold of body.25 Based on the different physiological effects on these points. Application of location of stimulation, pressure-generation activates the small acupressure on only LP exhibits the therapeutic response on myelin nerves in the muscles and pass stimulations to the higher autonomic nervous system. Tender points (TP) are the third type of nerve centres including spinal cord, midbrain, hypothalamus and acupoints present on nociceptors and polymodal receptors. Acti- pituitary axis.26 Magnetoencephalography (MEG) studies demon- vation of such TP sensitized polymodal receptors result in better strated conditioning of primary somatosensory response during effects on pain relief.15 In acupressure, acupoints can be activated the acupressure. In addition to sub-cortical effects on endogenous by elbows, fingers, feet, knuckles, palms, thumb or specific tools. In pain regulation acupressure also exhibits potential for affecting ancient China, acupoints were activated with the help of stones, primary somatosensory processing and possibly altering mal- known as Bian Stones.5 Currently, numerous acupressure or elastic adaptive neuroplasticity.27 Auricular acupressure (AA), a micro- bands with a protruding plastic button are available.16 acupuncture is a non-invasive technique similar to reflexology in which endocrine functions are improved effectively. It is known to 2.2. Mechanism of action exert its effects via stimulating the central nervous system through the cranial/spinal nerves on the auricle of the ear.28,29 Qi permeates everything and it is vital energy of life. It is the Biochemical mechanism (Fig. 1) of acupressure involves the quality attribute that determines the state of one's health. Yin and stimulation of acupoints that leads to complex neuro-hormonal Yang are customary medicinal traits conflicting as well as in responses.30 It involves the counteraction among hypothalamic- Fig. 1. Biochemical mechanism of acupressure. Please cite this article in press as: Mehta P, et al., Contemporary acupressure therapy: Adroit cure for painless recovery of therapeutic ailments, Journal of Traditional and Complementary Medicine (2016), http://dx.doi.org/10.1016/j.jtcme.2016.06.004  P. Mehta et al. / Journal of Traditional and Complementary Medicine xxx (2016) 1e13 3 pituitary-adrenocortical axis that leads to overproduction of microcirculatory efficacy and underlying mechanisms of acupres- cortisol and cause a relaxation response.31 Also, it modulates the sure therapy. In comparison to LDM, NIRS is more sensitive in physiological response by increasing endorphin and serotonin detecting the tissue in-flow changes as it can penetrate much transmittance to the brain and specific organs through nerves and deeper in the sample.40e42 meridians.32e34 After exercise, restorative meridian acupressure Applying a continuous pressure for approximately 1 min at helps to change the concentration of stress hormones and lactic specific hyperalgesic points helps to reduce both local as well as acid.35 Specifically in case of the respiratory function, acupressure propagating pain.13,43 Acupressure results in acute reduction in plays a moderating role. Activation of acupoint activates myelinated pain sensitivity and pressure pain sensitivity (PPS).44 In most of the neural fibres that stimulate the hypothalamus and pituitary gland, surgical process, acupressure aids in preventing surgical haemor- leading to the release of b-endorphins from the hypothalamus into rhage and accelerating the healing process.45 In summary, the spinal fluid and pituitary into the blood stream, respectively. acupressure helps to decrease tissue adhesion, promote relaxation Thus, the analgesic and sedative effect of b-endorphins facilitates and regional blood circulation, increase parasympathetic nerves the normal respiratory function of patient.36 activity and intramuscular temperature along with reduction in As per the Meridian theory, on stimulation of acupoints, the area neuromuscular excitability.46 along the meridian will be affected whereas stimulating proximate acupoints would affect the functioning of local tissues.37 Acupres- 2.3. Acupressure and devices sure mediates nitric oxide (NO) signal, known to improve local microcirculation via cyclic guanosine monophosphate (cGMP).38 It A wide range of portable acupressure devices (elastic or inelastic helps in enhancing the physical performance by suppressing bands, mats with protruding plastic points) are available in market. fatigue-inducing molecules in the blood.39 The specific relationship These devices are designed by considering the patient comfort and between acupressure and microcirculation can be enumerated by ease of application. By considering the patient need numerous various spectroscopic methods. Near-infrared spectroscopy (NIRS) device generating electrical impulse and vibrational energy based assists in determining the regional oxygen saturation whereas devices are available to serve the purpose. A list of patented devices Laser Doppler measurement (LDM) is used to examine the is given in Table 1. Most of the available devices exert the constant Table 1 Types of patented acupressure devices. Patented Devices Description References Acupressure foot board Foot board consist of multiple pressure rods extending upwardly and positioned at reflex points within 48 outlines of average foot sizes. Pressure rods are made up of plastic, wood, jade, ocher, or metallic magnetic material. These rods are activated electrically also (Fig. 2A). Acupressure device for fingers Inner surface of device is casted with plurality of projections for creating pressure at the end of the finger. It 49 helps to enhances blood circulation by creating negative (anions) ions (Fig. 2B). Acupressure and reflexology clamp Clamp helps to deliver incrementally variable and reproducible quantities of pressure to specific body 50 positions and maximizing the effective relief with interchangeable pressure delivery tips (Fig. 2C). Acupressure device for treating insomnia Device applies pressure to correct the ionic imbalance of the treatment zone to produce calming/soothing 51 effect (Fig. 2D). Automatically modulating acupressure device Device helps to automatically modulate the pressure over the wrist (P6 acupoint) for treatment of nausea and 47 vomiting (Fig. 2E). Adjustable foot acupressure and pain relief Massage grains of pain-relief board provide novel massage and pain relief through stimulating the acupressure 52 platform points on the soles of feet. Excellent analgesic effect can achieved through it (Fig. 2F). Electrical pulse acupressure system Device is placed over an outer ear of a human being. It employs both the physical pressure and an electrical 53 pulse at acupuncture joint (Fig. 2G). Finger acupressure apparatus It consists of a pair of upper and lower pressing plates configured with adjustable distance. It helps to provide 54 pressure against fingers or the palm muscle for physical therapy purposes (Fig. 2H). Hand-held acupressure device It consists of a semi-rigid ball attached to a rigid tube by means of an elastic cord. It helps the ball to freely-roll 55 in all directions over a limited distance for the purpose of effectively applying pressure onto the various acupressure points to treat targeted muscle spasms (Fig. 2I). Massage footwear It is footwear with projections on inner sole for massaging the underside of the foot (Fig. 2J). 56 Opto-mechatronic acupressure pen An opto-mechatronic acupressure pen capable of provide non-intrusive stimulation for therapeutic 57 treatments without piecing the skin (Fig. 3K). Quantitative acupressure device Non-invasive device provide precise and repeatable therapeutic pressure to the skin and underlying tissue. 58 Digital controller connected to device monitor helps to the measured applied pressure (Fig. 3L). Spinal acupressure device It is a central fabric panel belt fixed with opposed elastic panels Projections from the belt are positioned to 59 apply pressure to the L1-L4 acupressure points associated with lower spine (Fig. 3M). Acupressure instrument for applying rolling Device supply rolling pressure on various acupoints of the human body (Fig. 3N). 60 pressure to the human body Acupressure device for ear Device exerts pressure on acupoints of external ear for the treatment of various disorders (Fig. 3O). 61 Detachable acupressure device It is a wristband with projections for applying acupressure against joint region (Fig. 3P). 62 Acupressure ring Rings provide acupressure due to projection extending inwardly from the inner surface of the ring. Ring 63 consists of visual indicator to assess the function (Fig. 3Q). Acupressure apparatus for treatment of soft It is a multi-purpose method and device comprising a plurality of pins. Device helps to provide relaxation and 64 tissue injuries reenergizing of an injured or tyred body. It also treats the soft tissue injuries (Fig. 3R). Acupressure clip It is a clip which provides the pressure at LI-4 acupoint to relieve the headache pain (Fig. 3S). 65 Acupressure apparatus with foot control Applied pressure to the LI4 acupressure points on both hands (Fig. 4A). 66 Point pressure therapy device Device made up of spherical mounted ball to provide drag across the skin of a patient, rather than roll (Fig. 4H). 67 Acupressure gloves It provides self-applying acupressure. Interior of glove fitted with nodules positioned over acupoints to 68 provide therapy to hands, wrists and fingers. User can apply direct pressure from exterior of the glove. Roller type hyperthermo radiative mat It helps to enhance effects of the hot compress and acupressure to the user. 69 Please cite this article in press as: Mehta P, et al., Contemporary acupressure therapy: Adroit cure for painless recovery of therapeutic ailments, Journal of Traditional and Complementary Medicine (2016), http://dx.doi.org/10.1016/j.jtcme.2016.06.004 4 P. Mehta et al. / Journal of Traditional and Complementary Medicine xxx (2016) 1e13 level of pressure at specific pressure point. Due to the limitation of philosophy technique. Body-Mind acupressure provides platform nerve accommodation, the action potential is stimulated for shorter for the pain-management with unique mental health consoling.82 time which diminishes quickly. This leads to short term benefits which may not be sufficient enough to cause the desirable effects 2.4.3. Auricular acupressure (AA) but may lead to adverse side effects. This challenge of short term In 1950, Dr. Paul Nogier, a French neurosurgeon hypothesized benefits is overcome by applying automatically modulating the somatotopic correspondence of specific parts of the body to acupressure devices.47 Various patented devices are given in specific parts of the ear.83 AA is non-invasive therapy performed on Figs. 2e4. outer ear to treat numerous ailments.84,85 The present-day AA therapy practiced worldwide is based on Dr. Nogier's principles. 2.4. Types of acupressure World Health Organization (WHO) considers AA therapy as a form of micro-acupuncture that can affect the whole body.86 AA practice Acupressure techniques have been classified in various types is based on the theory that specific points on the auricles corre- depending upon its origin, method and combination with other spond to major organs of the body and thus, therapeutic effects on techniques.76 the corresponding target organ can be achieved by manipulating the auricular acupoints.87 2.4.1. Shiatsu (Japanese acupressure) 2.4.4. Tapas acupressure technique (TAT) Initially shiatsu was originated in China and popular as ‘Anma’ TAT is well-known as ‘Power therapy’.88 In TAT, mind and body therapy and then it was brought to Japan.77 In Japan, acupressure is interventions are achieved via tapping or holding specific acupoints well known as ‘shiatsu’. In shiatsu, pressure is applied using thumb, with specific mental imagery for treatment of wide range of med- elbow or knee perpendicularly to the skin at acupoints along with ical and psychological maladies.89 passive stretching and joints-rotation.4 Disease diagnosis is per- formed through body touch by gentle application of pressure across 3. Ayurveda and acupressure the complete body physiology.78 Finger pressure (tsubos),77 finger massage,79 palms and heels are employed to apply pressure and Marma chikitsa is the oldest technique of Indian surgery and stimulate specific points along the meridians of the body to cure recognized from the Vedic era. Acupoints are known as ‘Marma’ in the pain.80 Across the globe and specifically in European countries, Ayurveda. There are 107 vital points on human body which are shiatsu is practiced in various styles, philosophical approaches and known as Marma points. These points are spread over the flesh, theoretical bases. Zen Shiatsu, Macrobiotic Shiatsu, Healing Shiatsu, veins, arteries, tendons, bones and body joints.90 Based on the ef- Tao Shiatsu, Seiki, Namikoshi Shiatsu and Hara Shiatsu are the fect of trauma, Marmas are categorized into 5 groups as shown in known shiatsu techniques prevalent in Britain.81 Watsu is a shiatsu Table 2. Marma points work depending on the nature, types, con- which involves use of warm water and routinely employed for pain stituents and effect of trauma as well as are centred on various reduction, improvement in blood circulation. Watsu is also helpful physical properties (Fig. 5).91 for patients suffering from orthopaedic problems.77 4. Acupressure applications 2.4.2. Jin Shin Do's (Body-mind acupressure) Jin Shin Do's is amalgamation of western psychology with Jap- CAM therapies provide a platform which plays a paramount role anese acupressure, Chinese acupuncture theory and Taoist in human health and welfare.20 Acupressure alleviates wide range of Fig. 2. Patented devices (AeJ). Acupressure device name: A. Acupressure foot board, B. Acupressure device for fingers, C. Acupressure and reflexology clamp, D. Acupressure device for treating insomnia, E. Automatically modulating acupressure device, F. Adjustable foot acupressure and pain relief platform, G. Electrical plus acupressure system, H. Finger acupressure apparatus, I. Hand-held acupressure device, and J. Massage footwear. Please cite this article in press as: Mehta P, et al., Contemporary acupressure therapy: Adroit cure for painless recovery of therapeutic ailments, Journal of Traditional and Complementary Medicine (2016), http://dx.doi.org/10.1016/j.jtcme.2016.06.004  P. Mehta et al. / Journal of Traditional and Complementary Medicine xxx (2016) 1e13 5 Fig. 3. Patented devices (KeS). Acupressure device name: K. Opto-mechatronic acupressure pen, L. Quantitative acupressure device, M. Spinal acupressure device, N. Acupressure instrument for applying rolling pressure to the human body, O. Acupressure device for ear, P. Detachable acupressure device, Q. Acupressure ring, R. Acupressure apparatus for treatment of soft tissue injuries, and S. Acupressure clip. disease conditions ranging from immune ailments to emotional point acupressure helps to improve the symptoms of dysmenor- disorders. It is a complementary treatment which effectively relieves rhoea in both spasmodic and congestive types.104 It also offers diverse pains while managing multiple symptoms in a variety of effective relief from primary dysmenorrhoea.105e107 Continuous patient population.92,93 Both, acupuncture and acupressure are use of SP6 point acupressure is effective in relieving pain and effective, safe, simple and economical therapies but acupressure is menstrual distress level resulting from dysmenorrhoea.108 SP6 and more people-compliant due to its non-invasive and needle free na- SP8 points acupressure helps to reduce pain severity of dysme- ture.94,95 Acupressure is more compatible to pharmacotherapy due to norrhoea up to 2 h after application.109 Single point LI4 (Hegu),110 ease of self-administration. It plays a vital role in pain restoration, LV3 (Taichong)111,112 acupoint acupressure also helps to effectively promotion of psychological well-being as well as patients' quality of reduce menstrual pain during primary dysmenorrhoea. Collateral life.96 People who are not yet comfortable with needles or when there meridian acupressure therapy (CMAT) is effective in relieving the is need of stimulating more delicate acupoints, acupressure therapy associated symptoms of dysmenorrhoea and has to produce a long- is preferred. Acupressure assists the practitioner to identify the lasting effect on dysmenorrhoea.113 AA is also useful to reduce the specific acupoints prior to acupuncture with needle. The best part pain, anxiety, stress related to peri and early postmenopausal fe- about acupressure is that it provides safe, gentle and emotional touch male patients.114e116 It helps to relieve the pain of primary dys- for promoting the wellbeing in human population. menorrhoea.117 With interactive internet instruction, AA helps to reduce the distress in menopause and improve self-care behav- 4.1. Acupressure for women health iours.118 LI4, SP6 and LI4 acupressure is known to decrease the pain and duration of labour without any adverse effects.119,120 KI21 Acupressure has proved as a holistic medical toolbox for reju- (Youmen) point acupressure more effectively reduces nausea and venating women health. In female population, acupressure benefits vomiting occurring in pregnancy.121 Pericardium 6 (P6) or Neiguan by resolving various menstrual and pregnancy related problems. point acupressure relieves morning sickness in pregnant Acupressure at sanyinjiao point (SP6) work as self-manageable women.122 It reduces the frequency of nausea in early pregnancy; in approach to improve women's general health.97 Pelvic massage fact it is equivocal with pyridoxine (vitamin B6) without any evi- i.e. acupressure though the vagina helps to control hormonal dence of teratogenicity.123 Guoshu acupoint pressure therapy is problems, orgasmic malfunctioning in woman.98,99 It facilitate effective on acute mastitis during lactation.124 BL32 (Ciliao) acu- various problems like lower back ache,100 overactive bladder,101 point acupressure provide maternal supportive care by reducing urodynamic stress102 and active phase of labour pain.103 SP6 delivery pains.125 Korean hand acupressure (K-K9) is effective Please cite this article in press as: Mehta P, et al., Contemporary acupressure therapy: Adroit cure for painless recovery of therapeutic ailments, Journal of Traditional and Complementary Medicine (2016), http://dx.doi.org/10.1016/j.jtcme.2016.06.004 6 P. Mehta et al. / Journal of Traditional and Complementary Medicine xxx (2016) 1e13 Fig. 4. Patented devices (AeH). Acupressure device name: A. Acupressure apparatus with foot control, B. Acupressure head clamp70, C. Acupressure element for cupping device71, D. Handheld acupressure applicator72, E. Hinged handheld acupressure device73, F. Non invasive pain relief apparatus74, G. Acupressure device75, and H. Point pressure therapy device. Table 2 nausea in many patients.130 It effectively reduces the morning Various Marmas and their points. sickness, motion sickness and gastric tachyarrhythmia symptoms Marmas Marma points along with termination of paroxysmal supraventricular Sadya pranahara (fatal) marma 19 tachycardia.122,131e133 It moderates vomiting in patients undergoing Kalantara pranahara (delayed fatal) marma 33 appendectomy and has proved to be as effective akin to ondense- Vishalyaghna (fatal after removal of foreign body) marma 03 tron (4 mg, i.v.) in preventing postoperative nausea after laparo- Vaikalyakara (disabling) marma 44 scopic cholecystectomy.134e136 It helps to treat patients with acute Rujakara (painful) marma 08 vertigo.137 P6 acupressure device is effective in improving neuro- vegetative symptoms and it can be routinely applied to acute ver- tigo and during labyrinth stimulation.138 Sea-Band is the elasticized method for reducing postoperative nausea and vomiting in women band available commercially to apply pressure to P6 point as it after minor gynaecological laparoscopic surgery.126 shows antiemetic action and can be used effectively for treatment of nausea and vomiting in pregnancy.12,139 Wristbands are used to 4.2. Acupressure for men healthcare reduce the chemotherapy-induced symptoms in gynaecological cancer patients and decrease to antiemetic use after chemotherapy Similar to women population, acupressure is also helpful in by producing acupressure at point P6.140 P6 point acupressure male by work out various sexual problems. The Ren Mai (Concep- reduce the postoperative signs within 24 h after strabismus (sur- tion/Directing Vessel e CV/DV) opens on the midline between anus gery to corrects eye muscle function) surgery.141 Pericardium me- and scrotum in men. Between anus and posterior labial commis- ridian point acupressure helps to treat migraine-associated sure in women. Acupressure on these points help to improve men's nausea.142 P6 acupressure helps to nullify the opioids-induced sexual health. They helps to resolve problems like infertility and nausea and accelerate the recovery of patients who are using impotence. Ren-6 Qihai is a cardinal point when treating impo- patient-controlled analgesia after surgery.143 tence, infertility, prolapse of the bladder or uterus. They are one of Acupressure is well known for controlling the symptoms for the most vital tonification points on the human body. Bladder (BL) patients undergoing chemotherapy. Finger acupressure helps to 31 to 34 points are also helps to treat genital disorders in men i.e. decrease nausea in breast cancer women undergoing chemo- impotence and prostatitis.127 therapy.144 AA shows positive effect in controlling nausea in chil- dren undergoing cancer chemotherapy.145 Acupressure helps to 4.3. Acupressure for containment of side effects decrease Persistent Cancer-Related Fatigue (PCRF) in breast cancer patients.146 Self-administered relaxation acupressure is a another P6 point acupressure is well known for controlling nausea, option to control PCRF.147 Acupressure with or without essential vomiting related to various disease conditions. It helps to improve oils also helps to overcome PCRF in patients undergoing chemo- chemotherapy-induced nausea, vomiting and anxiety.128,129 P6 therapy for lung cancer.148 Acupressure at ST36 (Zusanli) acupoint acupressure and acustimulation wrist bands effectively relieves improve a patient's comfort in colorectal cancer.149 AA with laser Please cite this article in press as: Mehta P, et al., Contemporary acupressure therapy: Adroit cure for painless recovery of therapeutic ailments, Journal of Traditional and Complementary Medicine (2016), http://dx.doi.org/10.1016/j.jtcme.2016.06.004  P. Mehta et al. / Journal of Traditional and Complementary Medicine xxx (2016) 1e13 7 Fig. 5. Classification of Marmas points based on anatomy, site and properties. acupuncture plays a significant role in preventing the spasm of jaw nervous system, liver, kidney and lung) benefits by improving muscle and facial paralysis following cancer therapy.150 Acupres- mental health benefits.166 This protocol is well-known as Acu Detox sure with magnetic sticker improved the digestive functions and technique. Acupressure helps to recover patients form psycho- quality of sleep in gastro enteric tumour patients.151 geriatric problems and general psychological distress.167 It is a non-pharmacological intervention which helps to enhance mem- 4.4. Acupressure for obese population ory functions and as adjunct treatment for traumatic brain injury.168 It also overcome sleep disturbances in patients affected by Acupressure was found to be effective in maintaining body cognitive disorders i.e. insomnia and other sleep disorders and weight. Acupressure alone or in combination with other therapies patients suffering from Alzheimer's disease.169 It also improves the was used to control the body mass index (BMI). Acupressure and quality of sleep in elderly people.170 cognitive behaviour therapy helps to improve the lifestyles in obese In critical conditions like coma, acupressure helps to resolve the people.152 AA alone is used to treat overweight along with con- respiratory malfunctions. It is known to elevate the weaning trolling abdominal obesity, changes of waist circumference and indices of tidal volumes and rapid shallow breathing index in coma waist-to-hip ratio in young adults.153,154 AA is normally combined patients perusing mechanical ventilation.36 Acupressure is effective with various treatments like Sinapsis alba seeds,155 Japanese mag- as alternative non-drug therapy in various critical conditions like netic pearls or vaccaria seeds156 and transcutaneous electrical end-stage renal disease COPD for pulmonary rehabilitation via acupoint stimulation (TEAS)157 to control BMI in obese people. reduction in dyspnoea and stroke.171e173 As compared to the con- Auricular point acupressure (APA) is also effective method to con- tact pressure stimulation (PS), acupressure can exert better thera- trol BMI, blood pressure, total cholesterol, triglyceride and leptin or peutic effects due to improved microcirculatory blood-flow adiponectin.158 TAT helps to prevent weight regain following suc- perfusion.41 In haemodialysis patients, acupressure rectifies the cessful weight loss.159 pruritus condition.174 In paediatric population, it resolves paediatric nocturnal enuresis.175 In school children, it effectively reduces the physical stress.176 Acupressure decreases the pressure pain in 4.5. Miscellaneous applications of acupressure ischaemic heart disease.44 Additionally, acupressure helps to treat various disease complications like angina pectoris,177 knee osteo- Nursing professionals may promote and enrich patients' com- arthritis,95,178 distal radial trauma,179 thirst intensity180 and chronic fort in clinical set up through acupressure.160 Besides, acupressure headache.181 Acupressure is recognized to desensitize patients is also used to treat emergency conditions like coma, pain, cough as against potential allergens.77 Different types and pharmacological well as asthma.161 Acupressure is alternative non-drug therapy in applications of acupressure are given in Table 3. spinal anaesthesia,162 lumbar spine surgery163 and also aids in controlling postoperative nausea and vomiting in patients under- going spinal anaesthesia.164,165 In addition to physical discomfort, 5. Limitations acupressure helps to improve mental health of patients. AA and acupressure using the National Acupuncture Detoxification Asso- As a self-healing technique, acupressure is performed indi- ciation protocol (stimulation of 5 points in each ear, sympathetic vidually by most of the patients. Proper diagnosis and selection Please cite this article in press as: Mehta P, et al., Contemporary acupressure therapy: Adroit cure for painless recovery of therapeutic ailments, Journal of Traditional and Complementary Medicine (2016), http://dx.doi.org/10.1016/j.jtcme.2016.06.004 8 P. Mehta et al. / Journal of Traditional and Complementary Medicine xxx (2016) 1e13 Table 3 Types and pharmacological applications of acupressure. Type of therapy Applications References Acupressure UB32 (Ciliao) point acupressure effectively reduce the pain severity. 182 SP6 (Sanyinjiao) and LI4 (Hegu) point acupressure leads to simultaneous release of lower and upper limb 183 energy and results in the alleviation of pain. LI11 (Quchi) point acupressure helps to improve the pruritus and lichenification associated with atopic 184 dermatitis. HT7 (Shenmen) point acupressure reduce higher preoperative anxiety in patients undergoing abdominal 185 surgery. Jiaji point acupressure quickly relives symptoms of irritable bowel syndrome. 186 Acupressure followed by naturopathy Helps to control blood sugar level in diabetes. 187 Acupressure or acupuncture stimulation Complementary use in treating insomnia. 188 equipment Acupressure using an acupuncture pen Reduce the fatigue in haemodialysis patients. 189 Acupressure, acupuncture and functional training. Improve the physical capability and intelligence of infantile palsy children. 190 Perineal self-acupressure It helps to improve the constipation, bowel function and provide the standard constipation treatment 191 options alone. Acupressure and acupuncture It helps to improve cancer-related fatigue. 192 Valerian acupressure HT7 (Shenmen), P6 (Neiguan), and KI11 (Yongquan) acupoints helps to improve the sleeping time and 193 quality of ICU patients. Massage-acupressure Improve the conditions in children undergoing haematopoietic cell transplant (HCT). 194 Promote relaxation, sleep and relieve stress among parents and enhance the sense of connection between 195 parent and child undergoing HCT. Acupressure, reflexology, or auricular acupressure Shows significant effect in routine treatment of insomnia. 196 Sweet potato, footbath and acupressure massage Manage constipation and defecation in acute coronary syndrome patients 197 (SFA) Acupressure combined with interactive Helps to improve visual health and related knowledge in school children 198 multimedia Acupressure, acupuncture and massage. Helps to improve conditions of patients in anorexia nervosa and sense of wellbeing also. 199 Acupressure or acupuncture. Act as adjunct therapy for the treatment of anorexia nervosa. 200 Acupressure and yoga Control blood pressure in patients with atrial fibrillation. 201 Acupressure and acupuncture Helps to reduce pain and also increasing satisfaction with pain management. 202 Acupressure hypnotherapy, and transcendental Reduced blood sugar of type 2 diabetic patients. 203 meditation (TM) Hand acupressure Helps to reduces postoperative vomiting after strabismus surgery. 204 Magnetic acupressure large intestine (LI4) Reduce the severe pain associated with this bone marrow aspiration and biopsy invasive procedure. 205 acupoint Active acupressure Helps to reduce the heart rate very fast and no effect on blood pressure was found. 206 Acupressure (acustimulation) and acupuncture In children undergoing adenoidectomy or tonsillectomy it helps to control postoperative vomiting. 207 Korean hand acupressure (K-K9) Effective method for reducing postoperative vomiting in children after strabismus repair. 208 Korean hand acupressure point (K-D2) with Effectively anaesthetist's armamentarium in the prevention of postoperative nausea and vomiting. 209 capsaicin ointment Acupressure wristband It is an alternative for morning sickness in early pregnancy. 210 Alternating bi-lateral stimulation (ABLS), with Effective in prevented vomiting and Bi-Digital O-Ring Test (BDORT) safeguard the patients from 211 ketamine, acupuncture/acupressure unpredictable untoward side effects but also promoting calmness. Pressure right acupressure device with antiemetic Effectively manage postoperative nausea and vomiting from 0 to 72 h in patient undergoing surgery. 212 drugs Acupressure and acustimulation Effectively manage symptoms related to Simulation Adaptation Syndrome (SAS). 213 Digital acupressure Helps to increase capillary arteriolar flow in cerebral pia mater of the dog. 214 Acupressure wristbands Reduce the level of nausea and vomiting experienced during chemotherapy treatment. 215 Auricular acupressure Auricular point acupressure (APA) Helps to control cancer related pain due its analgesic effect. 216 Helps to improve pain intensity and physical function in patients with chronic low back pain (CLBP). 217,218 Auricular acupressure (AA) Reduces the opioids analgesia requirement and improves the knee motion in patients with total knee 219 replacement (TKR). Improve patients' conditions in painful shoulder syndrome. 220 Reduce anxiety levels associated with in vitro fertilization (IVF) and improve the outcomes of IVF partly 29 through increasing the levels of neuropeptide Y in the follicular fluids. Improve postmenopausal insomnia by strengthening cardiac parasympathetic activity. 221 In haemodialysis patients it helps improve sleep quality for severe insomnia. 87 In patients with glaucoma it serve as complementary treatment to ameliorate intraocular pressure and 222 visual acuity. Helps in smoking termination and the management of nicotine withdrawal symptoms. 223 Improve vascular hypertension conditions by showing biphasic regulatory effects on sinus arrhythmia. 224 Improve the absorption of naringenin and hesperetin in the extracts form C. aurantium L. in the human 225 body. Alleviating postoperative pain, decreasing narcotic consumption and promoting early rehabilitation in 226 perioperative period of knee joint replacement. More effective than herbal medicine, as effective as body acupuncture or antihistamine for short-term 227 effect and more effective than anti-histamine for long-term effect in allergic rhinitis. Alleviating postoperative pain, decreasing opioids consumption and promoting early rehabilitation in 228 perioperative period of total knee arthroplasty (TKA). It helps in smoking cessation in college students by decreasing CO, cotinine and nicotine dependence. 229 Non-invasive alternative option for smoking cessation. 230 Improve quality of life of Perennial allergic rhinitis (PAR) patients. 231 Ear acupressure Improved visual health for children. 232 Please cite this article in press as: Mehta P, et al., Contemporary acupressure therapy: Adroit cure for painless recovery of therapeutic ailments, Journal of Traditional and Complementary Medicine (2016), http://dx.doi.org/10.1016/j.jtcme.2016.06.004  P. Mehta et al. / Journal of Traditional and Complementary Medicine xxx (2016) 1e13 9 Table 3 (continued ) Type of therapy Applications References AA with a low-calorie diet Reduced plasma levels of leptin. 233 Ear acupressure and massage therapy Showed better results than the control group in relation to pain, anxiety and depression. 234 Breathing-based integrative meditation and ear Helps in outpatient treatment of cocaine addiction 235 acupressure (IMEA) AA with TEAS It helps to decreased postoperative pain, the use of equianalgesic morphine and morphine-related side 236 effects. Integrative acupoint stimulation (IAS) with It is help in lumbar spine surgery and can be regarded as a component of multimodal analgesia. patient-controlled analgesia (PCA) AA with magnetic pellets In elderly residential it helps to manage constipation. 237 of appropriate acupoint is the most important task in acupres- Chronic schizophrenic patients undergoing AA are known to suffer sure. It is essential to take reliable counselling from professional from obesity problems.254 therapist in serious disease condition. It is always better to Selection and activation of specific acupoint and pressure to consult professional acupuncturist in critical conditions involving activate particular acupoint is of prime importance. Intensity of lung, kidney, heart and other contagious diseases. With speci- pressure has to be modulated in a specified way; high intensity alised techniques and modalities, related education in this field pressure may damage any body part while low intensity pressure through accredited programs to professionals is essential.79 may prove inefficient to heal the pain. As significantly low intensity Acupressure should be avoided after meals, alcohol consump- pressure remains inexperienced in patients, it is of less use in the tion or after taking narcotics. One should not perform acupres- patients. Simultaneous activation of two or more acupoints (LP/DP/ sure on skin if that is inflamed, injured, scarred or that has a TP) should be assessed for its effect on the human body. Selection, rash.14 activation and pressure application at acupoints in special patient Even if acupressure is non-invasive and easily accessible tech- groups like paediatrics, pregnant and menstruating women is still nique, we have to take special precautions before applying it to an issue of debate. pregnant women. Acupoints viz. SP6, SP4, LI4, S36, and points on the abdomen should be completely avoided in case of pregnant 6. Conclusion women.14 It was also found that ice massage provided more persistent pain relief in active phase of labour as compared to From last few decades, CAM has fascinated the global health acupressure.238 AA was not effective in reducing the postpartum practitioners as well as patients due to several reasons including perineal pain in women during the first 48 h after delivery.239 ease of application, effectiveness, economic aspects and many Acupressure wristband was not enough effective in relieving the more. CAM therapies are the real culture specific remedies prac- labour phase and post-delivery problems.240 Saberi et al reported tised throughout the world. Acupressure is a non-invasive and non- ginger to be more effective than acupressure in relieving mild to pharmacological intervention with multidimensional roles and moderate nausea and vomiting in pregnant women up to gesta- benefits. Current investigations substantiate the traditional claims tional phase.241 and validate use of acupressure for painless treatment of numerous Although acupressure modulates blood circulation of the body diseases. Present review appraised the different patented devices surface but still it is essential to known the microcirculation at and practices with applications in the therapy of various acute and deeper peripheral tissue level.40,41,242 In case of serious cardiac chronic ailments. With modern devices, one can tune intensity of problems, individuals should avoid the use of acupressure as slight the pressure also. In addition to pain-relief, acupressure devices drop in blood pressure lead to undesirable effects.14 When hemi- offer generous advantage of absence of drugs, and consequently, no plegic shoulder pain occurs due to cardiac stroke, aromatherapy after adverse effects. To support acupressure (CAM) in the near with acupressure is more effective in comparison to acupressure future and expand CAM therapies, we have to shed more light upon alone.243 Various acupressure mechanisms and devices are therapeutic functionalities of acupressure and to encourage its commonly used for containment of the prevailing side effects yet practice across the hospitals. there use is limited. P6 point acupressure is less relevant in reducing the post-operative signs in women undergoing breast Conflict of interests surgery, children with strabismus surgery as well as appendec- tomy.134,244,245 Acupressure fails to prevent chemotherapy-induced The author has no conflicts of interest to declare. nausea and vomiting.246,247 Acupressure devices like Sea-Band applied to activate P6 point acupressure together with prophylac- tic ondensetron is not enough to reduce post-operative nausea and References vomiting.248 Wristbands exhibited variable results in controlling 1. 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