About the Research Databases

The Wellness Evidence team of doctor consultants selected four of the most respected evidence-based medicine databases that are also particularly useful for wellness-focused research: Natural Standard, The Cochrane Library, PubMed and the TRIP Database.

Please read “Important Things to Know,” including info on each database.

We’ve made researching a particular therapy simple by pre-searching the evidence at each database. (See evidence below.) However, please note that evidence-based medicine relies on a research hierarchy, because not all evidence is created equalLearn more about how the medical experts classify this research.

We’d like to hear from you. If there is a Wellness Evidence discipline you would like to see on these pages, please email us.

Natural Standard

An international research collaboration that systematically reviews (and limits its focus to) scientific evidence on complementary and alternative medicine (CAM). Founded in 2000, Natural Standard assigns a grade to each CAM therapy, reflecting the level of available scientific data for or against the use of each therapy for a specific medical condition.

Natural Standard is subscription-based, and each of the database’s monographs aggregates data from other resources like AMED, CANCERLIT, CINAHL, CISCOM, the Cochrane Library, EMBASE, HerbMed, International Pharmaceutical Abstracts, Medline and NAPRALERT – and 20 additional journals. Data analysis is performed by healthcare professionals conducting clinical work and/or research at academic centers, using standardized instruments pertaining to each monograph section

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 the 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.

Evidence Table
The grades A-F ascribed to the specific health conditions below have a very specific meaning. i.e., a “C” can still mean evidence of benefit from a small randomized trial, etc. Read about what each grade actually means. 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. Effects have been noted in children as well as adults.
A
Anxiety
Acupressure may significantly reduce general and pre-operative anxiety. However, these studies have been small and poorly designed, warranting better-quality research.
B
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.
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
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
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.
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. 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 healthcare 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
Stroke
Promising early data suggests acupressure may aid in the recovery of post-stroke paralysis.
C
Cervical spondylosis
Results from a meta-analysis do not support use of tuina for cervical spondylosis.
D
Weight loss/obesity
Preliminary evidence suggests that acupressure may not be effective for weight loss but may aid in weight maintenance following weight loss.
D
Theory

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

Tradition

The below uses are based on tradition, scientific theories, or limited research. 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 provider. There may be other proposed uses that are not listed below.

Abuse (sexual, physical, psychological), angina, attention deficit hyperactivity disorder, anorexia nervosa, apoplectic hemiplegia, arthritis, beauty treatment, Bell’s palsy, bloating (after surgery), cancer therapy for children, cancer treatment side-effects (other than nausea), carpal tunnel syndrome, cerebral birth injuries (infants), childbirth facilitation/induction, colds/flu, congestion, constipation, chronic fatigue syndrome, dementia, edema, emotional repression/trauma, eyestrain, fatigue, fibromyalgia, gag reflex abnormalities (for prevention during dental procedures), gastrointestinal disorders, gum disease, head injury, HIV/AIDS, hormonal pain, hyperactivity, immune deficiencies, itchiness, joint inflammation, jetlag, kidney infection (related pain), menopausal pain, multiple sclerosis, muscle tension/ache, neuralgia (postherpetic), optic atrophy, organ transplantation, phobias, poor circulation, post-traumatic stress disorder, prolapse of lumbar intervertebral disc, psoriasis, recurrent urinary tract infections, renal disease, restless leg syndrome, Rett syndrome, sickle cell anemia (pain), sinus problems, sports injuries, stress, sunburn pain, tendonitis, toothache, ulcer pain, weight gain (premature infants).

Safety

Many complementary techniques are practiced by healthcare professionals with formal training, in accordance with the standards of national organizations. However, this is not universally the case, and adverse effects are possible. Due to limited research, in some cases only limited safety information is available.

Attribution

This patient information is based on a professional level monograph edited and peer-reviewed by contributors to the Natural Standard Research Collaboration (www.naturalstandard.com): Wendy Chao, PhD (Natural Standard Research Collaboration); William Collinge, PhD, MPH (Collinge & Associates); Dawn Costa, BA, BS (Natural Standard Research Collaboration); Jill M. Grimes Serrano, PhD (Natural Standard Research Collaboration); Shaina Tanguay-Colucci, BS (Natural Standard Research Collaboration); Catherine Ulbricht, PharmD (Massachusetts General Hospital); Wendy Weissner, BA (Natural Standard Research Collaboration); Regina C. Windsor, MPH (Natural Standard Research Collaboration).

Bibliography

Natural Standard developed the above evidence-based information based on a thorough systematic review of the available scientific articles. Selected references are listed below.

  1. 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.
  2. 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.
  3. Chen HM,Chen CH. Effects of acupressure at the Sanyinjiao point on primary dysmenorrhoea. J Adv Nurs 2004;48(4):380-387.
  4. 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.
  5. 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.
  6. 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.
  7. 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.
  8. 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.
  9. Puangsricharern A, Mahasukhon S. Effectiveness of auricular acupressure in the treatment of nausea and vomiting in early pregnancy. J Med Assoc Thai. 2008; 91(11):1633-8.
  10. 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.
  11. Sheehan P. Hyperemesis gravidarum–assessment and management. Aust Fam Physician 2007 Sep;36(9):698-701.
  12. 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.
  13. 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.
  14. 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.
  15. Wang SM, Escalera S, et al. Extra-1 acupressure for children undergoing anesthesia. Anesth Analg. 2008; 107(3):811-6.

Cochrane

British epidemiologist Archie Cochrane is regarded as the originator of the Evidence-Based Medicine concept (in the 1950s). And the Cochrane Library is a collection of very high-quality medical databases, which have, at their core, the Cochrane Reviews, systematic reviews and meta-analyses which summarize and interpret the results of well-conducted, randomized controlled trials… the ‘gold standard’ in Evidence-Based Medicine.

The Cochrane Library is a subscription-based database but offers free access to abstracts.

PubMED

A service of the U.S. National Library of Medicine, PubMed was released in 1996 as a free digital archive of references and abstracts on life sciences and biomedical topics. PubMed comprises 20-million-plus citations for biomedical literature from MEDLINE, life science journals and online books from around the world. Some 11.5 million articles are listed with their abstract and 3.1 million articles are available in full-text for free.

TRIP

The TRIP Database, launched in 1997, is a search engine designed to allow clinicians to quickly find answers to their medical questions using the best available evidence. Trip’s founders realized medical professionals were being forced to perform time-consuming searches at multiple websites to get at the most relevant information. So, they designed TRIP as a meta-search engine, allowing users to both simultaneously search thousands of databases, medical publications and resources, as well as easily filter the results: limiting searches to the most stringent, highest-quality medical evidence or expanding them to include results like patient information, news articles, etc.