P-06 (Nei Guan) Inner Pass

What does P-06 Nei Guan do?

Nei Guan P-06 is the Luo-Connecting point of the Pericardium and the Confluent point of the Yin Linking Vessel, and its central recorded action is to unbind the chest and regulate qi — to release constriction in the chest and settle qi that is rising when it should descend. The two great strands of its traditional use follow directly from that: the chest and heart on one side, the stomach and nausea on the other.

• Unbinds the chest and regulates qi — the primary recorded action. The Pericardium is described as the outer wrapping of the Heart, and this is the point used for the tight, oppressed, constricted feeling in the chest that the tradition attributes to qi stagnation there.
• Regulates the Heart and calms the spirit — recorded for palpitations, cardiac pain, anxiety and insomnia. In the classical scheme the Pericardium takes the Heart's disorders on itself, and the spirit-calming action belongs to that role.
• Harmonises the Stomach and alleviates nausea and vomiting — the action for which the point is now best known worldwide. The Pericardium channel is described as descending through the diaphragm and connecting with the three burners, which is the classical explanation for a wrist point reaching the stomach.
• Clears heat — recorded for febrile disease with agitation and restlessness.
• Opens the Yin Linking Vessel — the Yin Wei Mai is described as binding together the yin channels of the body, and its disorder is characterised in the classics as heart pain. P-06 is the point that gives access to it.

Why does being a Luo-Connecting point matter here?

A Luo point is where a channel throws off a branch to its interior–exterior partner. P-06 connects the Pericardium to the Sanjiao, and the classical rule is that a Luo point treats disorders of both the channel it belongs to and the one it links to, and is chosen when the disorder is chronic or when the two channels need bringing into balance. That is the technical reason a Pericardium point is used for a Sanjiao-region complaint, and part of the reason its indications reach so far beyond the chest.

Source: Sacred Lotus sources & references (existing action record and point categories); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 376); Chinese Acupuncture & Moxibustion (p. 201); Ling Shu and Nan Jing, on the Luo-Connecting points and the eight extraordinary vessels; cross-referenced against multiple online sources.

What is P-06 Nei Guan used for?

Nei Guan P-06 is used for nausea and vomiting, for chest and heart complaints, and for agitation and insomnia. The indications carried in Sacred Lotus sources & references are listed below and cross-checked against the standard reference literature. They describe traditional use; the separate question of what has been tested in clinical trials — and for this point a great deal has — is dealt with under the research heading.

• Nausea and vomiting
• Hiccup
• Stomach ache and epigastric pain
• Cardiac pain
• Palpitations
• A stuffy, oppressed or constricted feeling in the chest
• Pain in the hypochondriac region — the flanks and lower ribs
• Insomnia
• Irritability and restlessness
• Mental and emotional disorders; the disturbed states the classics group under dian kuang
• Epilepsy
• Febrile disease with agitation
• Malarial disorders
• Contracture and pain of the elbow and arm

Source: Sacred Lotus sources & references (existing indication record); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 376); Chinese Acupuncture & Moxibustion (p. 201).

Where is P-06 Nei Guan, and how is it used in practice?

Nei Guan sits on the inner forearm, two cun — roughly three finger-widths — above the wrist crease, in the channel between the two prominent tendons that stand out when the wrist is flexed against resistance. Those tendons are palmaris longus and flexor carpi radialis; the point lies between them, directly above P-07 Da Ling at the wrist crease. It is one of the easiest points on the body for a layperson to find, which is why the commercial acupressure wristbands sold for travel sickness are designed to press exactly here. A minority of people lack the palmaris longus tendon on one or both sides, in which case the reference texts describe locating the point from the midline of the forearm instead.

Which points is P-06 combined with?

• With SP-04 Gong Sun — the classical confluent pair. Of the eight Confluent points, P-06 (Yin Linking Vessel) and SP-04 (Penetrating Vessel) are coupled, and the pair is the classical selection for disorders of the heart, chest and stomach. Both are held in this library, and both happen also to be Luo-Connecting points, which is unusual and gives the pair unusual reach.
• With ST-36 Zu San Li and REN-12 Zhong Wan — the standard combination for nausea, vomiting and epigastric discomfort, joining the wrist point to the Stomach's He-Sea point and the Front-Mu point of the stomach.
• With HT-07 Shen Men — for palpitations, anxiety and insomnia, pairing the Pericardium's Luo point with the Heart's Source point.
• With REN-17 Shan Zhong — for chest oppression, joining the distal point to the Hui-Meeting Point of Qi on the breastbone.
• With P-04 Xi Men — for acute cardiac pain, using the channel's Xi-Cleft point, the classical choice in acute and painful conditions.
• With LIV-03 Tai Chong and LI-04 He Gu — added to the Four Gates where constraint is felt in the chest as well as generally.
• With ST-25 Tian Shu — for abdominal disorders with nausea, joining the wrist point to the Front-Mu point of the Large Intestine.

Where does P-06 sit among its peers?

P-06 is one of the eight Confluent points of the extraordinary vessels, all held in this library alongside it: SP-04 Gong Sun for the Penetrating Vessel, LU-07 Lie Que for the Conception Vessel, KI-06 Zhao Hai for the Yin Motility Vessel, SI-03 Hou Xi for the Governing Vessel, BL-62 Shen Mai for the Yang Motility Vessel, and their partners. Within that group P-06 is the busiest in modern practice. It is also one of the fifteen Luo-Connecting points, of which LU-07, LIV-05 Li Gou and BL-58 Fei Yang are also held here. What separates P-06 from all of them is not classical status but something external: it is the only acupuncture point in the world with a repeatedly updated Cochrane review devoted to it by name.

Source: Sacred Lotus sources & references (location, categories and cross-referenced point records); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 376); Chinese Acupuncture & Moxibustion (p. 201); cross-referenced against multiple online sources.

Where is P-06 located?

• A Manual of Acupuncture (p. 376): On the flexor aspect of the forearm, 2 cun proximal to Daling P-7, between the tendons of palmaris longus and flexor carpi radialis.
• Chinese Acupuncture and Moxibustion (p. 201): 2 cun above the transverse crease of the wrist, between the tendons of m. palmaris longus and m. flexor radialis.

How is P-06 Nei Guan needled, and what is the risk?

Sacred Lotus sources & references record perpendicular insertion of 0.5 to 0.8 inch at P-06, with moxibustion applicable. The structure that governs that depth is the median nerve, which lies directly beneath the point. This is recorded as neutral reference data describing what the textbooks and published anatomical studies document. It is not instruction, and this page does not teach technique. Needling is carried out only by a qualified, licensed practitioner.

The angle and depth the texts record

• Sacred Lotus sources & references — perpendicular, 0.5 to 0.8 inch; moxibustion applicable.
• Deadman & Al-Khafaji (p. 376) and Chinese Acupuncture & Moxibustion (p. 201) record perpendicular insertion in a comparable range, and both note that oblique insertion proximally or distally along the channel is also documented.
• The reference literature records that a strong electric sensation travelling into the hand indicates contact with the median nerve, and describes this as a signal to withdraw rather than a treatment goal.

What the anatomical evidence actually shows

The needling path at this point has been dissected and imaged directly, and the findings are specific.

• Cadaveric study of the needle path at PC6. Needles were inserted at P-06 in eight wrists from four bodies to a depth of 2 cm and the forearms dissected. The needles passed between the tendons of palmaris longus and flexor carpi radialis, then penetrated flexor digitorum superficialis, flexor digitorum profundus and pronator quadratus — and in each case lay adjacent to the median nerve. The authors' conclusion was that needles should not be inserted deeply at this point, and that anatomical variation in the median nerve and in the persistent median artery matters clinically (Joo Oh H et al., Acupunct Med 2012;30(1):44–6, PMID 22203641). Two centimetres is roughly 0.8 inch — the upper end of the depth our own record documents.
• Ultrasound demonstration that nerve contact can be silent. In a self-experiment, investigators used ultrasound to watch an acupuncture needle completely perforate the median nerve at P-06. Only a slight sensation was reported, and no pain. Their conclusion was that the median nerve may in individual cases be perforated without pain or neurological consequence (Kessler J, Streitberger K, Acupunct Med 2008;26(4):231–3, PMID 19098694). This is the important nuance: the absence of an electric shock is not proof that the nerve has been avoided.
• Documented nerve injury. A case report describes isolated median sensory neuropathy following needling at a point on the wrist, with absent sensory nerve action potential in the index finger and severe hypothermia of that finger on thermography (Lee CH et al., Arch Phys Med Rehabil 2008;89(12):2379–81, PMID 19061751). Such reports are rare, but they establish that focal peripheral nerve injury at this location is possible rather than theoretical.

What the trial literature reports about harm

Because P-06 has been studied more than any other point, its safety record is unusually well documented. The 2025 Cochrane network meta-analysis of 77 trials in 9,847 participants found that none of the included studies reported serious or long-term complications. Thirty-nine studies involving 5,334 participants reported minor, self-limiting side effects — skin irritation, redness and swelling, chiefly from acupressure bands — and the review graded even that evidence as very uncertain because of inconsistent reporting (PMID 40938065). The earlier 2015 review reached the same conclusion, describing side effects as minor, transient and self-limiting in the 14 trials that reported them (PMID 26522652).

For general context, a meta-analysis of prospective clinical studies estimated serious adverse events from acupuncture overall at approximately 1 per 10,000 patients and around 8 per million treatments (PMID 34489268). P-06 sits well below even that average: there is no body cavity, organ or great vessel beneath it, and the hazard is confined to a nerve and, in some people, an anatomically variant artery.

Source: Sacred Lotus sources & references (existing needling record); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 376); Chinese Acupuncture & Moxibustion (p. 201); PubMed PMID 22203641, 19098694, 19061751, 40938065, 26522652, 34489268 — each checked as active and not retracted.

What does the name Nei Guan mean?

Nei Guan means "Inner Pass" or "Inner Gate" — nei, inner or internal, and guan, a pass, barrier or frontier gate of the kind that controlled movement through a mountain range. The name works on two levels. Literally, the point sits on the inner aspect of the forearm at the gateway to the wrist and hand. Functionally, guan is the term the classics use for a point that opens or closes access to the interior — and P-06 is the point through which the Yin Linking Vessel, which binds the yin of the body together, is reached. Its partner point on the outer forearm, directly opposite it, is SJ-05 Wai Guan, the "Outer Pass" — the two names are a deliberate pair, and the two points are sometimes needled through toward one another.

Why does the Yin Linking Vessel matter?

The Yin Wei Mai is one of the eight extraordinary vessels — reservoirs described as running deeper and slower than the twelve regular channels. The classics characterise its disorder in a single phrase: heart pain. That is a remarkably narrow and specific attribution for a body-wide vessel, and it aligns exactly with the chest and cardiac half of P-06's indications. The Confluent points are the eight points that give access to these vessels, and they are used in coupled pairs; P-06 is coupled with SP-04 Gong Sun, the Confluent point of the Penetrating Vessel, and the pair covers the heart, chest and stomach. Both points are held in this library.

Is there research on P-06 Nei Guan?

Yes — and this is the exception that proves the rule. P-06 is the one acupuncture point supported by repeatedly updated Cochrane systematic reviews, and the indication is post-operative nausea and vomiting. The evidence is real, it is specific to this point, and it deserves to be reported precisely rather than either inflated or dismissed. It should equally be said that the certainty grading of most of it is low, and that the strongest single finding is that stimulating P-06 performs about as well as antiemetic drugs — not better.

Post-operative nausea and vomiting — the core evidence

• Cochrane 2025 network meta-analysis. The current version of the review — first published 2004 and updated in 2009, 2015 and 2025 — included 77 randomised trials conducted between 1986 and 2022, involving 9,847 participants, searched to June 2025 with no language restriction, and compared six broad classes of P-06 stimulation with sham and with antiemetic drugs. Against sham: invasive P-06 stimulation (needling) reduced post-operative nausea, risk ratio 0.49 (95% CI 0.38 to 0.64), low confidence, and vomiting, RR 0.47 (0.34 to 0.64), low confidence. Non-invasive stimulation (acupressure bands and similar) reduced nausea, RR 0.67 (0.58 to 0.76), and vomiting, RR 0.58 (0.49 to 0.70), both low confidence. Antiemetic drugs alone gave RR 0.73 for nausea at very low confidence. Invasive P-06 combined with antiemetics gave the largest reduction in nausea, RR 0.21 (0.10 to 0.45), at moderate confidence but from indirect evidence only, and non-invasive P-06 with antiemetics probably reduced the need for rescue antiemetics, RR 0.44 (0.28 to 0.70), moderate confidence. Certainty was assessed with the CINeMA and GRADE frameworks; the main source of high risk of bias was selective reporting (Lee A, Zhang JZ, Xie J et al., Cochrane Database Syst Rev 2025;9(9):CD003281, PMID 40938065, PMC12427171).
• Cochrane 2015 pairwise review — the head-to-head finding. The previous version pooled 59 trials in 7,667 participants. Against sham, P-06 stimulation reduced nausea (RR 0.68, 95% CI 0.60 to 0.77; 40 trials, 4,742 participants), vomiting (RR 0.60, 0.51 to 0.71; 45 trials, 5,147 participants) and the need for rescue antiemetics (RR 0.64, 0.55 to 0.73) — all rated low-quality evidence. Compared against six different antiemetic drugs, including ondansetron, droperidol and dexamethasone, there was no difference in nausea (RR 0.91, 0.75 to 1.10), vomiting (RR 0.93, 0.74 to 1.17) or rescue medication — rated moderate-quality. Trial sequential analysis found that the boundary for benefit against sham had been crossed and that further sham-controlled trials were unnecessary, and that further P-06-versus-drug trials would be futile (Lee A, Chan SKC, Fan LTY, Cochrane Database Syst Rev 2015;11:CD003281, PMID 26522652, PMC4679372). The 2009 version is PMID 19370583.
• Children. A systematic review and meta-analysis of 16 randomised trials in 1,773 children undergoing general anaesthesia found P-06 stimulation reduced vomiting in the first four hours (RR 0.47, 95% CI 0.26 to 0.84, low quality) and within 24 hours (RR 0.74, 0.60 to 0.91, low quality), reduced nausea over 24 hours (RR 0.73, 0.60 to 0.88, moderate quality) and reduced use of rescue antiemetics in the first four hours (RR 0.64, 0.45 to 0.89, moderate quality). Effects were larger when stimulation was applied before anaesthesia (Zhang Y et al., Paediatr Anaesth 2020;30(5):552–63, PMID 32198961).

Chemotherapy-induced nausea and vomiting — weaker, and with a caveat

• The Cochrane review here was withdrawn. Ezzo et al. pooled 11 trials in 1,247 patients and reported that acupoint stimulation by all methods combined reduced acute vomiting (RR 0.82, 95% CI 0.69 to 0.99), with needling alone RR 0.74 and electroacupuncture RR 0.76, while acupressure reduced acute nausea severity modestly and non-invasive electrostimulation showed no benefit; delayed symptoms were not improved (Cochrane Database Syst Rev 2006;(2):CD002285, PMID 16625560). That review was formally withdrawn by Cochrane in 2014 (PMID 25412832) and has not been replaced. It is cited here because it is the historical basis of the claim, and its withdrawal is stated because readers deserve to know the strongest source for this indication is no longer current.
• What has been published since. A 2023 meta-analysis of 10 randomised trials in 975 patients found P-06 acupressure reduced acute nausea (standardised mean difference −0.39), delayed nausea (−0.51) and acute vomiting (−0.42), with delayed vomiting not reaching significance. Only two of the ten trials were rated high quality (Xiao C et al., Support Care Cancer 2023;31(9):510, PMID 37548707). Its own authors called for larger, better-designed trials.

Motion sickness — the weakest of the three claims

The wristbands sold for travel sickness are targeted at this point, and the evidence for that use is poor. A controlled laboratory study assigned 77 participants to an acupressure band, an electrical acustimulation band (each with trained or untrained users) or placebo, then exposed them to optokinetic drum rotation with symptom scoring and gastric myoelectric recording. Symptoms and gastric dysrhythmia rose in every group. Neither band nor placebo prevented motion sickness, whether or not the device was used correctly — and none of the untrained participants managed to position the acupressure band properly at all (Miller KE, Muth ER, Aviat Space Environ Med 2004;75(3):227–34, PMID 15018290). There is no Cochrane review of P-06 for motion sickness, and it would be wrong to let the strength of the post-operative evidence carry over to this indication.

The honest summary: strong and repeatedly replicated for post-operative nausea and vomiting, though mostly at low GRADE certainty and with no advantage over antiemetic drugs; modest and lower-quality for chemotherapy-induced nausea, with its flagship review withdrawn; and effectively unsupported for motion sickness despite being the commercial basis of the wristband market.

How does P-06 differ from the points near it?

P-06 sits on a short stretch of forearm crowded with points held in this library. P-07 Da Ling, at the wrist crease directly below it, is the Yuan-Source and Shu-Stream point and is weighted toward heat, agitation and the more disturbed mental states — it is also one of Sun Si-miao's Ghost Points. P-05 Jian Shi, one cun proximal, is the Jing-River and Metal point, classically directed at phlegm misting the heart and at malarial disorders. P-04 Xi Men, further up the forearm, is the Xi-Cleft point and is the acute-pain and bleeding point of the channel. P-03 Qu Ze at the elbow is the He-Sea and Water point. P-08 Lao Gong in the palm is the Ying-Spring and Fire point, the strongest heat-clearing point of the channel. Directly opposite P-06 on the outer forearm lies SJ-05 Wai Guan, its "Outer Pass" counterpart on the partner channel. And HT-07 Shen Men, one channel over on the ulnar side of the wrist, shares P-06's spirit-calming indications but belongs to the Heart itself rather than to its wrapping.

Source: Sacred Lotus sources & references (name, categories and cross-referenced point records); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 376); Chinese Acupuncture & Moxibustion (p. 201); Nan Jing (Classic of Difficulties), on the extraordinary vessels and the Confluent points; PubMed PMID 40938065, 26522652, 19370583, 32198961, 16625560, 25412832, 37548707, 15018290, each checked as active and not retracted (PMID 25412832 is recorded and cited explicitly as a withdrawn Cochrane review); cross-referenced against multiple online sources.