---
title: "Wrist-ankle acupuncture"
url: "https://acuiq.com/wiki/techniques/wrist-ankle-acupuncture"
updated: 2026-10-12
last_verified: 2026-10-12
license: CC-BY-4.0
license_url: "https://creativecommons.org/licenses/by/4.0/"
section: "techniques"
basis: "Modern research"
audience: "Anyone"
published: "2026-10-12"
reading_minutes: 8
sources: 10
---

# Wrist-ankle acupuncture

_Shallow needles laid flat under the skin at 12 sites above the wrist and ankle: the zone scheme, how the needle goes in, and what reviews of pain, surgery and stroke trials report._

Wrist-ankle acupuncture places every needle at one of a small set of sites just above the wrist or the ankle and slides it flat under the skin, whatever part of the body the complaint is in. A [2017 trial protocol](https://doi.org/10.1186/s12906-017-1923-9) by Chen and colleagues credits Professor Zhang Xinshu and his colleagues at Changhai Hospital, part of the Second Military Medical University in Shanghai, with developing it in the 1970s. In a 2021 review of its use for cancer pain, Dong and colleagues write that it is based on electrical stimulation therapy, combined with modern neurology and traditional acupuncture theory.

## Six zones and twelve sites

Chen and colleagues set out the scheme: each side of the body, and each limb, is divided lengthwise into six zones, and each zone has one needling site at the wrist or the ankle. A complaint above the diaphragm is treated at the wrist on the same side, and one below it at the ankle. A [2025 shingles trial](https://doi.org/10.1371/journal.pone.0318386) by Pu and colleagues adds that this diaphragm is not the anatomical muscle but a line drawn level with the spinous process of the 7th thoracic vertebra. So each side of the body carries 12 sites, six at the wrist (Upper 1 to Upper 6) and six at the ankle (Lower 1 to Lower 6), each numbered after its zone. Chen’s protocol, written for period pain in the lower abdomen, needles Lower 1 on both ankles and places it close to the inner edge of the Achilles tendon.

A [2026 review of the technique for shoulder-hand syndrome after stroke](https://doi.org/10.1016/j.ijnsa.2026.100580), by Zhao and colleagues, found all four of its trials needling Upper 4, 5 and 6 on the paralysed side, and places those sites along the courses of the large intestine, sanjiao and small intestine channels of the arm. A [2017 paper by Wang and Zhou](https://pubmed.ncbi.nlm.nih.gov/29231612/) (Chinese, with an English abstract) argues that the six zones match the twelve cutaneous regions of classical channel theory, that the sites lie near the courses of the twelve channels and their connecting points, and so that the method is a development of traditional acupuncture rather than a separate system.

## How the needle goes in

Chen’s protocol uses a 0.25 mm by 25 mm needle. The skin is pulled slightly taut, the tip goes in quickly at 30 degrees, and the needle is then laid flat and advanced slowly until the whole shaft sits in the tissue under the skin, where its handle is taped down for 30 minutes. The person feels only a slight prick as the tip passes the skin. Pu’s trial inserted the same way, leaving 2 mm of shaft showing, and instructed that the needle should meet no resistance and that the person should feel no soreness, numbness, swelling or pain; if they did, the needle was taken out and reinserted at a corrected angle. Zhao’s review describes deeper insertion into muscle, or any of those sensations, as improper technique.

## How it differs from body acupuncture

The 2014 review by [Zhu and colleagues](https://doi.org/10.1155/2014/261709) at the University of Hong Kong, who searched Chinese databases under its Chinese name _wanhuaizhen_, sets out three differences from routine acupuncture: no _deqi_ is sought (the aching, heavy or spreading sensation that body acupuncture usually aims for, described in [Needling and deqi](/wiki/techniques/needling-and-deqi)); the sites lie at the wrists and ankles, away from major organs and vessels; and the site is chosen from where the symptoms are, without the pattern diagnosis of traditional practice.

Because no needling sensation is wanted, Chen’s protocol could use as its sham a needle cut down to 2 to 3 mm and blunted, taped flat on the skin, so that the person feels the same slight prick and nothing else. Zhao’s review notes that nurses in China may perform the technique on their own, likening it to a subcutaneous injection, although acupuncture is otherwise outside nurses’ scope of practice there.

## What reviews and trials report

| Source | What it covered | What it found |
| --- | --- | --- |
| [Zhu and colleagues, _Evidence-Based Complementary and Alternative Medicine_, 2014](https://doi.org/10.1155/2014/261709) | Pain of any cause: 33 trials, 3,598 people, searched to December 2012; 7 trials, 723 people, scored well enough to pool, compared with drugs in 4, sham in 2 and body acupuncture in 1 | More people with at least 30% less pain (risk difference 0.15, 95% CI 0.06 to 0.24) and lower pain scores in the 3 trials that could be pooled (standardised mean difference −1.20, −1.62 to −0.78) |
| [Dong and colleagues, _BMC Complementary Medicine and Therapies_, 2021](https://doi.org/10.1186/s12906-020-03193-y) | Cancer pain: 13 trials, 1,005 people, searched to July 2020, against painkillers | More people with pain relief (risk ratio 1.31, 1.15 to 1.49); for the technique alone against painkillers, no clear difference, and a sensitivity analysis found that result unstable |
| [Xu, Liu and Rong, _Pain Medicine_, 2022](https://doi.org/10.1093/pm/pnac065) | Pain after orthopaedic surgery: 11 trials and 1 cohort study, 845 people, the technique added to multimodal pain relief | Lower pain scores (standardised mean difference −1.34, −1.76 to −0.91), less patient-controlled intravenous analgesia used, and fewer adverse events (risk ratio 0.38, 0.30 to 0.49); heterogeneity between trials was high |
| [Chen and colleagues, _Journal of Orthopaedic Surgery and Research_, 2023](https://doi.org/10.1186/s13018-023-03569-z) | Acute pain after orthopaedic surgery: 10 trials, 725 people, searched to July 2021; half combined the technique with other treatment | Lower pain scores (mean difference −0.29, −0.37 to −0.21) and less painkiller used |
| [Han and colleagues, _Journal of Integrative Medicine_, 2023](https://doi.org/10.1016/j.joim.2023.02.001) | 132 people after thyroid surgery: sham for 30 minutes, or the real technique for 30, 45 or 60 minutes | Pain straight after 30 minutes lower than sham (adjusted mean difference −0.43, −0.58 to −0.28), and lower again with 45 or 60 minutes; the effect lasted 6 to 12 hours and the four groups converged after 24; no difference in extra painkillers |
| [Yu and colleagues, _Journal of Investigative Surgery_, 2026](https://doi.org/10.1080/08941939.2026.2652778) | 132 women at high risk of nausea and vomiting after surgery, patients and assessors blinded, against sham; four sites, 30 minutes | Nausea or vomiting within 24 hours in 42.4% against 71.2% (risk ratio 0.60, 0.42 to 0.82); anti-sickness drug use not clearly different |
| [Pu and colleagues, _PLoS One_, 2025](https://doi.org/10.1371/journal.pone.0318386) | 106 people with acute shingles, open-label, the technique added daily for 7 days to antiviral and pain drugs | Free of pain at day 7 in 87% against 65%; lower pain scores on days 2 to 6; no difference from day 7 to day 28 |
| [Zhao and colleagues, _International Journal of Nursing Studies Advances_, 2026](https://doi.org/10.1016/j.ijnsa.2026.100580) | Shoulder-hand syndrome after stroke: 4 trials, 256 people, all in China, against usual care | Less shoulder pain (mean difference −1.41, −2.24 to −0.58) and better arm function and daily living, all at low certainty |

Most of these trials measured pain after surgery or during an acute illness, for hours or days. [Postoperative pain](/wiki/evidence/postoperative-pain) covers the wider acupuncture evidence for that use, and AcuiQ’s page on [shingles](/symptoms/herpes-zoster) lists the protocols individual studies prescribed, each with its citation.

## Adverse events

The reviews report minor harms only, where trials reported harms at all. Zhu’s review found adverse events reported in 4 of its 7 pooled trials, mostly small bleeds under the skin at the needle site, at a rate no different from sham. Dong’s review lists bleeding under the skin and dizziness, and Chen’s lists bleeding under the skin and fainting during needling, in a small share of people; in both, the comparison groups had more adverse events, chiefly nausea, vomiting, dizziness, drowsiness and urinary retention, which Chen and colleagues attribute to the painkillers. Pu’s shingles trial recorded no fainting, broken needles or bruising, and Yu’s trial no adverse events. In Zhao’s review two trials reported none and two did not report.

## What the reviews could not settle

Nearly every trial behind these reviews was run in China and published in Chinese, and the reviewers rated most of them at high or unclear risk of bias. Zhu found most trials scored 2 or less on a 5-point quality scale; Dong found no trial reporting concealed allocation; Chen found 3 of 10 that did, and one that blinded the people assessing outcomes. Most compared the technique, alone or added to other care, with painkillers or usual care, which Chen and colleagues note makes blinding difficult and the effect easy to overestimate.

Few used a sham, and Zhu and colleagues question whether a non-penetrating sham is an inert control for a technique whose real needle is itself shallow; [Sham acupuncture](/wiki/research/sham-acupuncture) sets out that problem. How long the needle should stay in is also open: Han’s trial found 45 and 60 minutes outperformed the 30 minutes most trials use. A protocol entry on AcuiQ names the modality the study used; [Reading a protocol](/wiki/method/reading-a-protocol) explains each field.

### Sources

1. Chen Y, Tian S, Tian J, Shu S, Wrist-ankle acupuncture (WAA) for primary dysmenorrhea (PD) of young females: study protocol for a randomized controlled trial, BMC Complementary and Alternative Medicine 2017 — https://doi.org/10.1186/s12906-017-1923-9
2. Dong B, Lin L, Chen Q, et al, Wrist-ankle acupuncture has a positive effect on cancer pain: a meta-analysis, BMC Complementary Medicine and Therapies 2021 — https://doi.org/10.1186/s12906-020-03193-y
3. Pu J, Li D, Luo X, et al, Wrist-ankle acupuncture alleviates pain in the acute phase of herpes zoster: a randomized controlled trial, PLoS One 2025 — https://doi.org/10.1371/journal.pone.0318386
4. Zhao J, Chau JPC, Wang W, et al, The effectiveness of wrist-ankle acupuncture on post-stroke shoulder-hand syndrome: a systematic review and meta-analysis, International Journal of Nursing Studies Advances 2026 — https://doi.org/10.1016/j.ijnsa.2026.100580
5. Wang Q, Zhou Q, Theoretical origin and clinical application of wrist-ankle acupuncture therapy, Zhongguo Zhen Jiu 2017 (Chinese, English abstract) — https://pubmed.ncbi.nlm.nih.gov/29231612/
6. Zhu LB, Chan WC, Lo KC, Yum TP, Li L, Wrist-ankle acupuncture for the treatment of pain symptoms: a systematic review and meta-analysis, Evidence-Based Complementary and Alternative Medicine 2014 — https://doi.org/10.1155/2014/261709
7. Xu N, Liu LL, Rong W, Wrist-ankle acupuncture as additional therapy for postoperative multimodal analgesia in orthopedic surgery: systematic review and meta-analysis, Pain Medicine 2022 — https://doi.org/10.1093/pm/pnac065
8. Chen M, Xu Y, Fu X, et al, Wrist-ankle acupuncture for the treatment of acute orthopedic pain after surgery: a meta-analysis, Journal of Orthopaedic Surgery and Research 2023 — https://doi.org/10.1186/s13018-023-03569-z
9. Han XR, Yue W, Chen HC, et al, Treatment duration of wrist-ankle acupuncture for relieving post-thyroidectomy pain: a randomized controlled trial, Journal of Integrative Medicine 2023 — https://doi.org/10.1016/j.joim.2023.02.001
10. Yu L, Wang X, Mei L, et al, Wrist-ankle acupuncture on postoperative nausea and vomiting prophylaxis in high-risk female patients: a pragmatic, randomized, single-blind, sham-controlled trial, Journal of Investigative Surgery 2026 — https://doi.org/10.1080/08941939.2026.2652778