Wrist-Ankle Acupuncture (or Wrist and Ankle Acupuncture, WAA) was invented and first published in 1975 by Professor Zhang Xinshu, an expert in the Department of Neuropsychiatry at the Changhai Hospital of the Second Military Medical University. WAA utilizes twelve thoughtfully selected points on the wrists and ankles to treat various ailments across the whole body. It is a modern style of acupuncture that features simplicity, fewer points, and painless needling with shallow, subcutaneous insertion over deep penetration. It focuses on the wrists and ankles because the three yin and three yang channels travel through these areas, and points here are convenient and practical to utilize for treatment.
WAA uses superficial stimulation of the subcutaneous layer to harmonize local meridian qi and blood to treat diseases of the channels. Due to the proximity of these points to the channels' Luo (connecting) points, they can also indirectly connect the zang fu to treat diseases of the whole body. This method works great for pain control, with excellent results demonstrated for headaches, toothache, joint and nerve pain, dysmenorrhea, post-surgical pain, and pain from traumatic injuries. It is also effective for post-stroke rehabilitation and treating various conditions such as runny/congested nose, dizziness, sore throat, asthma, itchy or chronically ulcerous skin, leucorrhea, hypertension, and many more.
The development of this technique originated in the mid-1960s from several successful one-session treatments with strong electrical stimulation that cured symptoms in patients with up to 20 years of paralysis and brain damage. Through extensive research over the next decade, Dr. Zhang further refined the method to focus on a small number of 12 bilateral wrist and ankle points. He also adopted and optimized the subcutaneous needling technique to maximize clinical efficacy while minimizing patient discomfort, as revealed in clinical studies that effective analgesic effects do not require the intense sensations associated with traditional oblique needling. The stream-lined treatment principles are easy to learn and perform and have shown remarkable clinical results.
| 1. | Simple and Easy |
WAA uses a small number of points and simple treatment guidelines and needling techniques that are easy to learn and perform. |
|---|---|---|
| 2. | Practical and Safe |
It utilizes points at the wrist and ankle that are convenient to locate and practical for treatment. These points are also safer for needling due to the lack of prominent organs, vessels, or nerves nearby. |
| 3. | Patient-Friendly Painless Needling |
It applies a subcutaneous needling technique that is painless and, thus, more agreeable to patients. |
| 4. | Fast Results with Broad Applications |
It works for a wide range of ailments and, for certain conditions, demonstrates immediate results. |
| 5. | Extendable and Compatible |
When needed, the subcutaneous needle(s) can be secured and retained to extend a treatment session with minimal interference to daily activities. WAA is also widely compatible with other treatment modalities. |
WAA defines six points around each wrist and ankle for treating conditions associated with six defined body regions. These points are located in the center of the respective regions - three on the palmer/medial side and three on the dorsal/lateral side. All wrist points are located about 2.0 cun above the transverse crease of the wrist, and ankle points are about 3.0 cun above the medial and lateral malleoli.
The following table outlines the wrist and ankle points and the corresponding body regions they treat by their echoing traditional body channels. Read further in the Treatment section for the definitions and common indications of the six body regions. Click on the point names below to learn more about the details of each wrist and ankle point, including how to accurately locate the point, how to needle the point, and their specific indications.
| Upper Body - Wrist Points | |
|---|---|
| Hand Three Yin Channels | |
| Shaoyin HT | WAA Upper 1 |
| Jueyin PC | WAA Upper 2 |
| Taiyin LU | WAA Upper 3 |
| Hand Three Yang Channels | |
| Yangming LI | WAA Upper 4 |
| Shaoyang TH | WAA Upper 5 |
| Taiyang SI | WAA Upper 6 |
| Lower Body - Ankle Points | |
| Foot Three Yin Channels | |
| Shaoyin KI | WAA Lower 1 |
| Taiyin SP | WAA Lower 2 |
| Jueyin LR | WAA Lower 3 |
| Foot Three Yang Channels | |
| Yangming ST | WAA Lower 4 |
| Shaoyang GB | WAA Lower 5 |
| Taiyang BL | WAA Lower 6 |
WAA categorizes diseases and symptoms by their location into six longitudinal body regions, as detailed below. This classification is critical for selecting the points for treatment, and incorrectly locating a symptom or indicator will lead to inaccurate point selection and impaired results.
Region 1 spans along the sides of the body's anterior midline. In the limbs, Region 1 echoes the Shaoyin Heart channel in the upper body and the Shaoyin Kidney channel in the lower body.
Covered Areas: the head region, including the forehead, eye, nose, mouth, front teeth, tongue, and throat; the neck and chest region, including the trachea, esophagus, and heart; and the abdominal region, including the upper abdomen, umbilicus, lower abdomen, uterus, urinary bladder, and perineum.
Common Conditions: sinus headache, frontal headache, eye abnormalities, nasal obstruction, allergies, trigeminal neuralgia, frontal toothache, a thick tongue coating, pharyngitis, tracheitis, stomachache, dysmenorrhea, excess vaginal discharge, and nocturnal enuresis.
Region 2 covers the two sides of the frontal body, lateral to Region 1. In the limbs, Region 2 echos the Jueyin Pericardium channel in the upper body and the Jueyin Liver channel in the lower body.
Included Areas: the anterior-temporal area, cheek, back teeth, mandibular area, sub-maxillary area, thyroid gland, areas along the mid-clavicular line such as the supraclavicular fossa, the breast, lungs, costal and hypochondriac area, and the lateral abdominal area.
Common Conditions: anterior-temporal headache, aching back teeth, breast distension and pain, chest pain, asthma, hepatic pain, and lateral abdomen pain.
Region 3 covers a narrow vertical area on the lateral borders of the body's front, along the anterior or the auricle and the axilla. In the limbs, Region 3 echos the Taiyin Lung channel in the upper body and the Taiyin Spleen channel in the lower body.
Included Areas:
Common Conditions: pain in the superficial temporal artery and chest pain along the anterior border of the axilla.
Region 4 includes the borders along the junction of the front and back of the body. In the limbs, Region 4 echos the Yangming Large Intestine channel in the upper body and the Yangming Stomach channel in the lower body.
Included Areas: the vertex Baihui (GV 20), the ear lobe, the trapezius border of the shoulder, the vertical area between the axilla, and the anterior superior iliac spine.
Common Conditions: parietal headache, earache, tinnitus, temporomandibular arthralgia, and chest pain along the mid-axillary line.
Region 5 consists of the two sides of the dorsal body, directly opposite Region 2. In the limbs, Region 5 echos the Shaoyang Triple Heater channel in the upper body and the Shaoyang Gallbladder channel in the lower body.
Included Areas: the posterior-temporal region, the lateral side of the back of the neck, and the area along the mid-scapular line passing down to the lumbus.
Common Conditions: posterior-temporal headache, scapula discomfort, and abnormalities of the transverse processes of the lumbar vertebrae.
Region 6 spans the area along the sides of the body's posterior midline, directly opposite Region 1. In the limbs, Region 6 echoes the Taiyang Small Intestine channel in the upper body and the Taiyang Urinary Bladder channel in the lower body.
Included Areas: the occipital portion of the skull, the vertebral column, and the anus.
Common Conditions: occipital headache, pain in the posterior portion of the neck, lower back pain, rectum prolapse, and hemorrhoids.
| 1. | Select the point in the matching region | Use the WAA point in a region to treat the indicated symptoms and conditions. For example, use Upper 1/Lower 1 to treat symptoms and conditions indicated in Region 1. |
|---|---|---|
| 2. | Upper for upper body, Lower for lower body | Use the wrist points for upper body symptoms above the diaphragm and the ankle points for lower body symptoms below the diaphragm. |
| 3. | Left side for the left, right side for the right | Use a point to treat a condition on the same side of the body. Use the same point bilaterally if the symptom is bilateral or on the midline. |
| 4. | Bilateral Upper 1 for systemic conditions | Use bilateral Upper 1 if the symptom is not location-specific or affects the entire body (for example, night sweats, insomnia, some psychoses) |
WAA recommends targeting the treatment with precise (fewer and more accurate) point selection to achieve the best therapeutic results. This principle sets it aside from most other acupuncture styles that primarily treat diseases with a combination of points.
Follow the directions below to select WAA points for treatment more precisely:
| 1. | Consider the locations/regions of both the manifested symptoms and pressure points (sensitive surface spots with dull/sharp pain or stiffness caused by disorders). Common pressure points to check include BL 10 and GB 21. |
|---|---|
| 2. | Treat the primary (most severe) symptom first if a patient has multiple symptoms. |
| 3. | Pain is considered a primary symptom and should be treated before addressing any chronic disease. |
| 4. | If a condition is located on the midline but extends to one side, treat it on the affected side (in Region 1 or Region 6) to target the therapeutic effects. |
| 5. | If a disease is found on both the anterior and posterior parts of the body, include points on both sides of the wrist/ankle (for example, Upper 2 and Upper 5) for treatment. |
| 6. | To treat motor impairment of the limbs, such as paralysis and tremors, use Upper 5 for upper limb impairments but Lower 4 for lower limb impairments. |
| 1. | Select the point in the matching region | Use the WAA point in a region to treat the indicated symptoms and conditions. For example, use Upper 1/Lower 1 to treat symptoms and conditions indicated in Region 1. |
|---|---|---|
| 2. | Upper for upper body, Lower for lower body | Use the wrist points for upper body symptoms above the diaphragm and the ankle points for lower body symptoms below the diaphragm. |
| 3. | Left side for the left, right side for the right | Use a point to treat a condition on the same side of the body. Use the same point bilaterally if the symptom is bilateral or on the midline. |
| 4. | Bilateral Upper 1 for systemic conditions | Use bilateral Upper 1 if the symptom is not location-specific or affects the entire body (for example, night sweats, insomnia, some psychoses) |
WAA recommends targeting the treatment with precise (fewer and more accurate) point selection to achieve the best therapeutic results. This principle sets it aside from most other acupuncture styles that primarily treat diseases with a combination of points.
Follow the directions below to select WAA points for treatment more precisely:
| 1. | Consider the locations/regions of both the manifested symptoms and pressure points (sensitive surface spots with dull/sharp pain or stiffness caused by disorders). Common pressure points to check include BL 10 and GB 21. |
|---|---|
| 2. | Treat the primary (most severe) symptom first if a patient has multiple symptoms. |
| 3. | Pain is considered a primary symptom and should be treated before addressing any chronic disease. |
| 4. | If a condition is located on the midline but extends to one side, treat it on the affected side (in Region 1 or Region 6) to target the therapeutic effects. |
| 5. | If a disease is found on both the anterior and posterior parts of the body, include points on both sides of the wrist/ankle (for example, Upper 2 and Upper 5) for treatment. |
| 6. | To treat motor impairment of the limbs, such as paralysis and tremors, use Upper 5 for upper limb impairments but Lower 4 for lower limb impairments. |
Different sources suggest using filiform needles ranging from gauge 30-32 to 34-38 that are 1.5 to 2 cun long. Use shorter 1 cun needles for children.
Put a patient in a sitting position to needle the wrist points and a supine or prone position to needle the ankle points. Ensure the patient is comfortable and relaxed, especially for the muscles around the treatment wrist/ankle.
For a WAA treatment, needles are inserted along the limbs toward the location of the symptoms, pointing in one of two directions: away from the wrist/ankle if the disorder is proximal, like elbow or knee pains, or towards the wrist/ankle if the condition is distal to the joint, like finger or heel pains. When inserting a needle towards the wrist/ankle, move the insertion point proximally slightly so there's sufficient room to push the needle forward without hurting the joint.
Move the insertion point closer or further away from the wrist/ankle in the following conditions. Avoid moving laterally or medially to retain the correspondence between the region and the point.
The number of treatments required depends on the condition's nature. In acute cases, treatment is recommended once a day; in chronic cases, treatment should be done once every other day. A complete course of treatment typically comprises ten sessions, and there is no need for a break between two consecutive courses of treatment.
The patient should be able to walk or use the hands after needles are fully inserted and secured in place. If the patient experiences needle sensation or pain after insertion, the needles are not in the correct layer and need adjustment.
Check with the patient after insertion to ensure the needling is effective*. Certain symptoms, such as pain, can be resolved entirely in one treatment. You will need to adjust the needles if any of the following occurs:
After adjusting the needles and obtaining the best results, secure the needles to keep them in place.
*When treating certain disorders that require needle retention for symptomatic relief, needle adjustment might not be necessary since the effectiveness of needling cannot be immediately evaluated.
Needles are typically retained for 20-30 minutes, requiring no further stimulation during treatment. In case of more severe or chronic conditions, needles may be retained for an extended period, with some sources suggesting up to 24 hours or even two days. However, it's important to note that prolonged needle retention can increase the risk of scarring and infection. Therefore, practitioners must exercise discretion while prolonging needle retention and take necessary precautions to prevent infection.
To remove a needle, gently press a sterile cotton ball on the insertion point and withdraw the needle completely. Request that the patient remain in position until any bleeding stops.
The following are potential conditions to watch out for when performing a WAA treatment:
If you accidentally puncture the capillaries during needling, blood can accumulate between the skin and muscle layers, causing subcutaneous hematoma. In patients with thicker limbs, the densely populated veins in the wrists and ankles are less visible, making them more prone to damage during treatment than in patients with slender limbs.
Using fine needles for treatment can reduce the risk of subcutaneous hematoma. If bleeding occurs, the patient may report experiencing sharp pain, and you will notice swelling under the skin around the tip of the needle. In this case, it is important to withdraw the needle immediately, squeeze the blood out, and apply pressure to stop the bleeding. Remember to reassure the patient that the subcutaneous bleeding will subside without leaving any lasting injury.
Fainting is a rare side effect that may occur during treatment, particularly when treating the wrist (versus the ankle). If a patient shows signs of fainting, such as dizziness, nausea, tinnitus, blurred vision, paleness, sweating, cold sensations, or slowed heart rate during treatment, remove the needle immediately. Lay the patient flat with loosened clothing and check their blood pressure. You can also needle Upper 1 bilaterally to help the patient recover faster, but the current treatment session should stop. Reconvene the next day only when the patient is ready.
If you accidentally puncture the capillaries during needling, blood can accumulate between the skin and muscle layers, causing subcutaneous hematoma. In patients with thicker limbs, the densely populated veins in the wrists and ankles are less visible, making them more prone to damage during treatment than in patients with slender limbs.
Using fine needles for treatment can reduce the risk of subcutaneous hematoma. If bleeding occurs, the patient may report experiencing sharp pain, and you will notice swelling under the skin around the tip of the needle. In this case, it is important to withdraw the needle immediately, squeeze the blood out, and apply pressure to stop the bleeding. Remember to reassure the patient that the subcutaneous bleeding will subside without leaving any lasting injury.
Fainting is a rare side effect that may occur during treatment, particularly when treating the wrist (versus the ankle). If a patient shows signs of fainting, such as dizziness, nausea, tinnitus, blurred vision, paleness, sweating, cold sensations, or slowed heart rate during treatment, remove the needle immediately. Lay the patient flat with loosened clothing and check their blood pressure. You can also needle Upper 1 bilaterally to help the patient recover faster, but the current treatment session should stop. Reconvene the next day only when the patient is ready.