REN-13 (Shang Wan) Upper Venter

What does REN-13 Shang Wan do?

Shang Wan REN-13 is the highest of the three "Wan" points on the upper abdomen, and its recorded work is to harmonise the Stomach and regulate qi, to descend rebellious qi and stop vomiting, and — unusually for a digestive point — to regulate the Heart. Sacred Lotus sources & references classify it as a Meeting Point of the Conception Vessel with the Stomach and Small Intestine Channels, and that classification is what licenses a midline point to act on the Stomach at all. The three actions are carried in our own record and they divide cleanly: two belong to the stomach's upper opening, and the third belongs to what sits above it.

• Harmonises the Stomach and regulates qi — the core action, shared with the whole Wan group. "Harmonising the Stomach" in this literature means restoring the downward direction of Stomach qi, and it is the recorded basis for REN-13's use in epigastric pain, fullness and distension.
• Descends rebellion and alleviates vomiting — the action that distinguishes REN-13 from its two companions. The classical texts map the three Wan points onto the stomach itself, and REN-13 falls over its upper opening, the cardia. A point over the inlet is the point for what comes back up: vomiting, regurgitation, hiccup, belching and the sensation of food refusing to go down. Where REN-10 Xia Wan, over the lower outlet, is the point for food that will not leave, REN-13 is the point for food that will not stay down.
• Regulates the Heart and calms the spirit — the third recorded action, and the one that explains the two indications in our record that look out of place beside the digestive ones: epilepsy and insomnia. REN-13 sits high on the abdomen, close under the sternocostal angle and therefore close to the region the tradition assigns to the Heart, and the classical corpus uses it in chest and cardiac presentations as well as gastric ones. This is not an inference — the point is named directly in the ancient prescriptions for chest obstruction and heart pain, discussed under research below.
• Resolves phlegm and opens the chest — an extension of the two actions above rather than a separate claim. Phlegm and food obstructing the upper part of the middle burner is the pattern in which REN-13's gastric and spirit indications meet, and it is the reasoning the reference literature gives for the point's use in mania and epilepsy.

Why the meeting-point classification matters here is worth stating plainly. REN-13 is where the Stomach and Small Intestine channels are held to arrive at the midline. The Stomach connection is the obvious one and accounts for the gastric actions. The Small Intestine connection is the less obvious one, and it is the tradition's own explanation for why a point on the belly reaches upward: the Small Intestine is the interior-exterior partner of the Heart, and its channel arriving here gives the classical texts their route from this point to the chest.

Source: Sacred Lotus sources & references (channel, meeting-point classification and existing action record); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 512); Chinese Acupuncture & Moxibustion (p. 239); PMID 41074530; cross-referenced against multiple online sources.

What is REN-13 Shang Wan used for?

Shang Wan REN-13 is used above all for vomiting and for pain and fullness in the upper epigastrium — the presentations of the stomach's upper opening — and secondarily for epilepsy and insomnia, which is the "Heart" half of its recorded action. The indications carried in Sacred Lotus sources & references are stomachache, abdominal distension, nausea, vomiting, epilepsy and insomnia; the standard reference literature sets them out more fully below. They describe traditional use, not proven treatment, and this point carries the safety facts set out under needling, including the recorded pregnancy caution.

• Vomiting, nausea and retching
• Regurgitation and acid reflux
• Hiccup and belching
• Difficulty swallowing and the sense of food not going down
• Epigastric pain, especially high in the epigastrium
• Abdominal distension and fullness after eating
• Poor appetite and indigestion
• Pain or fullness in the chest and beneath the heart
• Palpitations and disturbed spirit
• Insomnia
• Epilepsy and mania
• Coughing with phlegm, where the chest and stomach are both involved
• Jaundice recorded in the classical texts

Source: Sacred Lotus sources & references (existing indication record); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 512); Chinese Acupuncture & Moxibustion (p. 239).

Where is REN-13 Shang Wan, and how is it used in practice?

Shang Wan lies on the midline of the abdomen five cun above the navel — roughly two-thirds of the way from the umbilicus up toward the lower tip of the breastbone. Deadman & Al-Khafaji fix the same position from the other end, as three cun below the angle where the ribs meet the sternum. It is the thirteenth point of the Conception Vessel and the highest of the three points named for the wan, the cavity of the stomach.

In practice REN-13 is almost never chosen alone. It is the point added to a middle-burner prescription when the presentation is weighted toward the top of the stomach — vomiting rather than bloating, regurgitation rather than sluggish digestion, the sense of things coming back up rather than sitting still. Its second register, the spirit indications, belongs to a much older layer of use and appears in the classical record far more than in modern practice. Sacred Lotus sources & references record moxibustion as applicable at this point.

Which points is REN-13 combined with?

• With Zhong Wan REN-12 — one cun below it, and the anchor of the whole region: the Front-Mu point of the Stomach and the Hui-Meeting point of the fu organs. REN-13 is used with REN-12 far more often than without it. The data-mining analysis of the earliest ancient prescriptions for epigastric pain found Zhongwan CV-12 and Shangwan CV-13 as the first and second most frequently used points in the whole classical record for that complaint, and specifically found the two coordinated together across the etiologies of parasites, food retention, masses, qi stagnation and stomach cold (Zhongguo Zhen Jiu 2025;45(2):253–261, PMID 39943771).
• With Xia Wan REN-10 — completing the three-Wan set, at two cun above the navel. All three are held in this library, and the classical texts use them together where the whole stomach is disturbed rather than one part of it.
• With Nei Guan P-06 — the Connecting point of the Pericardium channel at the wrist and the tradition's principal distal point for nausea, vomiting and rebellious Stomach qi. This is the pairing that most directly matches REN-13's leading action.
• With Zu San Li ST-36 — the He-Sea point of the Stomach channel below the knee, and the standard distal partner for every abdominal digestive point. The same classical analysis places Zusanli third in the ancient epigastric-pain record, immediately after the two Wan points (PMID 39943771).
• With Ju Que REN-14 — one cun above REN-13 and the Front-Mu point of the Heart. Where REN-13's spirit and chest indications are the reason for choosing it, REN-14 is its natural companion, and the two together are the classical upper-midline pairing for palpitations, chest oppression and mania.
• With Feng Long ST-40 and Jian Shi P-05 — added where phlegm is held to be obstructing the chest and clouding the mind, which is the pattern behind REN-13's epilepsy indication.
• With Pi Shu BL-20 and Wei Shu BL-21 — the Back-Shu points of the Spleen and Stomach, used with the abdominal points as a front-and-back treatment. The ancient prescription analysis identified back-shu with front-mu as one of the four commonest combination structures in the classical epigastric-pain record (PMID 39943771).

What are the three Wan points, and how do they divide the work?

Sacred Lotus sources & references hold all three, and they only make sense as a set. The classical texts map them onto the stomach itself, and each point takes the indications of the part it lies over:

• Shang Wan REN-13 — the Upper Venter, five cun above the navel, over the stomach's upper opening. The point for what comes back up: vomiting, regurgitation, hiccup. This page.
• Zhong Wan REN-12 — the Central Venter, four cun above the navel, over the body of the stomach. The point for the Stomach as an organ, and by far the most heavily classified of the three: Front-Mu point of the Stomach, Hui-Meeting point of the fu organs, and a meeting point of the Conception Vessel with the Small Intestine, Sanjiao and Stomach channels.
• Xia Wan REN-10 — the Lower Venter, two cun above the navel, over the stomach's lower outlet. The point for what will not leave: food stagnation, fullness after meals, undigested food in the stool. Classified as a meeting point of the Conception Vessel with the Spleen channel.

Three adjacent points, three different sets of convergence and three correspondingly different clinical weights. Between REN-13 and REN-12 the numbering skips nothing, but between REN-12 and REN-10 sits Jian Li REN-11, the least used point of the group, weighted toward abdominal distension and oedema. Reading the three names in order — upper, central, lower — is the fastest way to learn this stretch of the Conception Vessel, and it is the reason the Wan points are taught as a unit rather than singly.

Source: Sacred Lotus sources & references (location, meeting-point classification, and the full run of Conception Vessel abdominal point records queried directly — REN-10, REN-11, REN-12 and REN-14 among them); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 512); Chinese Acupuncture & Moxibustion (p. 239); PMID 39943771; cross-referenced against multiple online sources.

Where is REN-13 located?

• A Manual of Acupuncture (p. 512): On the midline of the abdomen, 5 cun above the umbilicus and 3 cun below the sternocostal angle.
• Chinese Acupuncture and Moxibustion (p. 239): On the anterior midline, 5 cun above the umbilicus.

How is REN-13 Shang Wan needled, and what cautions are recorded?

Two things must be stated before anything else. First: Sacred Lotus sources & references carry an explicit caution that great care is required when needling the Conception Vessel points from Qu Gu REN-02 up to Shang Wan REN-13 in pregnant women — and REN-13 is the upper bound of that range, the point at which the caution stops. Second: REN-13 lies on the upper abdominal midline, high enough to sit close under the sternocostal angle, and the abdominal wall is all that separates the needle from the viscera. That is why the depth recorded in the texts is a bounded range rather than an open one. Everything below is recorded as neutral reference data describing what the textbooks and the published anatomical studies state. 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 record perpendicular insertion of 0.5 to 1.2 inches at REN-13, with moxibustion applicable — the same bounded figure our records carry for its neighbours REN-11 Jian Li and REN-10 Xia Wan, which is what one would expect of three points on the same stretch of abdominal wall.
• Deadman & Al-Khafaji (p. 512) and Chinese Acupuncture & Moxibustion (p. 239) record a comparable bounded perpendicular range.
• Moxibustion is documented as applicable. It is worth noting a curious classical detail here: the data-mining study of ancient prescriptions for epigastric pain found that on the trunk moxibustion was the usual method at Weishu BL-21, Pishu BL-20, Geshu BL-17, Zhongwan CV-12, Juque CV-14 and Qihai CV-6 — but recorded Shangwan CV-13 as the exception, needled rather than moxaed (Zhongguo Zhen Jiu 2025;45(2):253–261, PMID 39943771). Our own record carries moxibustion as applicable, and modern practice uses it; the classical preference recorded in that analysis ran the other way.
• The standard abdominal cautions recorded across the reference literature apply to the whole group: the margin is narrower in thin patients and in children, where an organ is enlarged, and where a hollow organ is distended. Because REN-13 is the highest of the three Wan points, the structures it is closest to are the left lobe of the liver and the stomach itself rather than the intestine.

The measured anatomy — and which point was actually measured

• What the ultrasound work measured: REN-12, one cun below REN-13. An observational ultrasound study recruited 85 healthy volunteers and obtained usable images in 83, measuring the "allowable needle insertion range" at Zhongwan CV-12. The mean allowable range was 25.3 ± 10.2 mm, generally greater in women than in men, and the liver was visible in the ultrasound image in 62.7 per cent of subjects; those in whom no liver was seen had a thicker allowable range and a higher body-mass index. The authors concluded that anthropometric factors predict the range but that individual differences are not negligible, and that anatomical structures and organ positions should be assessed rather than assumed (Chu H et al., Healthcare (Basel) 2022;10(9):1707, PMID 36141319, PMC9498562). These figures were measured at REN-12, not at REN-13, and none of them is attributed here to REN-13. They are cited because REN-13 sits on the same midline one cun higher, in the same abdominal wall — and because the liver finding is, if anything, more relevant the higher up the midline one goes.
• A paediatric CT series that did include CV-13 among its points. A retrospective study measured, directly from abdominal CT images, the safe needling depth — defined as the distance from the skin of the point to the transverse fascia — at twelve Conception Vessel points, CV-2 to CV-7 and CV-9 to CV-14, in 219 patients aged 7 to 15 at a single Taiwanese hospital. CV-13 is inside that range. The study's reported findings are that, apart from CV-2, there was no significant difference between the sexes; that safe depth at all twelve points increased significantly with age, body weight and waist girth (P < 0.001); and that the variation was very large — depths were 1.3 to 2.1 times greater in the 12-to-15-year-old group than in the 7-to-9-year-old group, and 1.7 to 3 times greater in overweight than in underweight children (Chen HN et al., Complement Ther Med 2008;16(6):331–335, PMID 19028333). We could not obtain the per-point table, so no millimetre figure is claimed for CV-13 here — what is stated is that the point was among those measured and what the study concluded across the set. A companion paper from the same group compared textbook therapeutic depth against measured safe depth at twelve abdominal points in 204 children and found the ratio ran from 0.67 to 0.88 and rose with weight, age and waist girth, meaning the recorded needling depth approaches the measured limit most closely in older and heavier children (J Altern Complement Med 2009;15(9):1033–1037, PMID 19715462). That second study's twelve points were CV-3, CV-4, CV-6, CV-10, CV-12, CV-14, KI-12, ST-24, ST-25, SP-15, LIV-13 and LIV-4 — CV-13 is not among them, and it is cited for the region rather than for this point.
• No single agreed safe depth exists for any point. Two systematic reviews of the safe-depth literature — 33 studies in the first, 47 in the second, using magnetic resonance imaging, computed tomography, ultrasound and cadaveric dissection — concluded that depths measured for the same point differ greatly between subject groups and methods, and that "safe depth" has never been standardised (J Altern Complement Med 2011;17(3):199–206, PMID 21417806; Evid Based Complement Alternat Med 2013;2013:740508, PMID 23935678). A textbook depth figure describes an average body, not a constant.

What is actually documented

Injury to the abdominal viscera. A 2026 emergency-medicine case report describes four perforations of the small intestine caused by abdominal acupuncture in a 71-year-old man who had a giant abdominal wall hernia and intestinal obstruction, confirmed at emergency laparotomy; the authors conclude that in that specific combination of circumstances the normal anatomical safeguards are lost (Int J Emerg Med 2026;19(1):120, PMID 41840473, PMC13104277). A radiology case report separately describes acute haemoperitoneum from direct liver injury caused by acupuncture (J Radiol Case Rep 2023;17(8):15–20, PMID 37654899, PMC10435255) — the relevant organ for an upper-midline point. Two systematic reviews of the Chinese case-report literature place traumatic organ injury among the serious recorded events and attribute them chiefly to improper technique (PMID 22967282; PMID 21124716, PMC2995190). Against that, a meta-analysis of prospective clinical studies estimated serious adverse events at approximately 1 per 10,000 patients and about 8 per million treatments, with about half of all recorded events being bleeding, pain or flare at the needle site (BMJ Open 2021;11:e045961, PMID 34489268).

The pregnancy caution, and where REN-13 sits in it

What our own record says. Sacred Lotus sources & references carry, on this point, the caution that great care should be taken when puncturing the Conception Vessel points from Qu Gu REN-02 to Shang Wan REN-13 in pregnant women. REN-13 is the top of that range: the caution covers the whole abdominal run of the channel below it and stops here, which is a useful thing to know precisely rather than approximately. It is a caution across a range of the channel, framed as care rather than as absolute prohibition, and the same wording is carried on the neighbouring Conception Vessel points held here and on the extra point Zi Gong Xue. It is stated as safety reference because it is among the facts a reader most needs about points in this band. It is worth recording alongside it that the modern evidence for actual harm from the traditionally forbidden points is weak: a review of the scientific literature found no objective evidence of harm across 15 clinical trials (823 women, several thousand treatments at one or more forbidden points), a cohort of 5,885 pregnant women, and animal work, with rates of preterm birth, miscarriage and stillbirth comparable to untreated controls (Carr DJ, Acupunct Med 2015;33(5):413–419, PMID 26362792), and a later systematic narrative review of randomised trials reached a similar conclusion about reported adverse outcomes (Med Acupunct 2019;31(6):346–360, PMID 31871522). The honest position is that the traditional caution is long-standing and near-universal in the texts, while the controlled evidence has not confirmed the harm it anticipates — and that most practitioners continue to observe it.

Source: Sacred Lotus sources & references (existing needling record, including the REN-02 to REN-13 pregnancy caution); Deadman & Al-Khafaji, A Manual of Acupuncture (p. 512); Chinese Acupuncture & Moxibustion (p. 239); PMID 36141319 (PMC9498562, measured at REN-12); PMID 19028333; PMID 19715462; PMID 21417806; PMID 23935678; PMID 41840473 (PMC13104277); PMID 37654899 (PMC10435255); PMID 22967282; PMID 21124716 (PMC2995190); PMID 34489268; PMID 26362792; PMID 31871522; PMID 39943771 — each verified resolvable and checked for retraction status before citation.

What does the name Shang Wan mean?

Shang Wan means "Upper Venter" — shang, upper, and wan, the cavity of the stomach. Wan is a specific anatomical word rather than a poetic one: it names the hollow of the stomach, and "venter" is the old English anatomical term used to render it. The name is therefore purely positional, and it only makes sense as one of a set of three — Shang Wan REN-13, the Upper Venter at five cun above the navel; Zhong Wan REN-12, the Central Venter at four cun; and Xia Wan REN-10, the Lower Venter at two cun. All three are held in Sacred Lotus sources & references, and read together the three names divide the stomach into an upper, a middle and a lower part. REN-13, over the upper opening, is the vomiting-and-regurgitation point of the three.

Why does the meeting-point classification matter at REN-13?

Sacred Lotus sources & references classify REN-13 as a Meeting Point of the Conception Vessel with the Stomach and Small Intestine Channels, and this is the point's only formal category — it carries no five-shu, yuan, luo, xi-cleft, back-shu or front-mu classification, and none is invented here. Meeting points are places where two or more channels are held to converge, so that a single needle reaches beyond the channel it sits on. The consequence at REN-13 is direct and two-sided. The Stomach convergence accounts for the gastric actions: a Conception Vessel point at which the Stomach channel arrives is a natural place to treat the stomach. The Small Intestine convergence is the less obvious half, and it is the tradition's own route from this point to the chest — the Small Intestine being the interior-exterior partner of the Heart. That is why "regulates the Heart" appears in our action record for what looks like a purely digestive point.

The contrast with its neighbours is instructive. Zhong Wan REN-12 is a far more heavily classified point — Front-Mu of the Stomach, Hui-Meeting point of the fu organs, and a meeting point with the Small Intestine, Sanjiao and Stomach channels — while Xia Wan REN-10 meets the Spleen channel only. Three adjacent points, three different sets of convergence, and three correspondingly different clinical weights.

Is there research on REN-13 Shang Wan?

The honest answer is that no controlled trial has tested REN-13 on its own for any indication. What does exist is unusually good of its kind: two independent data-mining analyses of the earliest recorded classical prescriptions both place Shang Wan among the highest-frequency points of the entire ancient corpus, once for digestive complaints and once for cardiac ones — which is a direct confirmation of the two halves of the action recorded here.

• Second only to Zhong Wan in the classical record for epigastric pain. Researchers at the China Academy of Chinese Medical Sciences assembled a database of the earliest ancient acupuncture and moxibustion prescriptions for epigastric pain, normalised the disease terms, etiologies, symptoms and point names, and analysed them by frequency and by the Apriori association rule. The high-frequency base points, in order, were Zhongwan CV-12, Shangwan CV-13, Zusanli ST-36, Neiguan P-06, Gongsun SP-04, Pishu BL-20 and Weishu BL-21. Across the etiologies of parasites, food retention, masses, qi stagnation and stomach cold, CV-12 and CV-13 were coordinated together. The commonest combination structures were back-shu paired with back-shu, back-shu with front-mu, front-mu with yuan-source, and back-shu with the lower he-sea points (Zhongguo Zhen Jiu 2025;45(2):253–261, PMID 39943771). This measures what the classical authors chose, not whether it worked — but it establishes that REN-13's digestive standing is not a modern gloss.
• And named in the ancient record for chest obstruction and heart pain. The same group ran the equivalent analysis on the earliest ancient prescriptions for chest obstruction and heart pain, and the high-frequency base points there were Da Ling P-07, Nei Guan P-06, Tai Xi KI-03, Tai Chong LIV-03, Shang Wan CV-13, Yong Quan KI-01 and Xin Shu BL-15 (Zhongguo Zhen Jiu 2025;45(10):1505–1511, PMID 41074530). This is the single most useful research finding on this page, because it independently corroborates the "regulates the Heart" action our own record carries — an action that would otherwise look like an oddity attached to a stomach point. Our HT-03 Shao Hai record cites the same analysis from its own side, and lists Shang Wan among the base points there too.
• Modern use, always inside a protocol. Where REN-13 appears in the modern literature it is one point of several. A randomised trial of herb-spreading moxibustion for chemotherapy-induced nausea and vomiting in gastric cancer applied the treatment over an area covering from Shangwan CV-13 down to Shenque REN-08, in 76 patients, reporting lower nausea and vomiting grades and higher performance-status scores than control (Zhongguo Zhen Jiu 2025;45(12):1723–1729, PMID 41397720) — a region, not a point. A randomised study of a combination of He-Sea and Front-Mu points for enteral-nutrition feeding intolerance in critically ill patients likewise uses the point within a set (Zhen Ci Yan Jiu 2024;49(1):64–70, PMID 38239140). In every case the result belongs to the protocol, and the site does not present them otherwise.
• A curiosity worth recording. REN-13 is one of four points a convolutional-neural-network system was trained to derive automatically from a photograph: having located Shenque REN-08 and the body outline, the system deduces Shangwan CV-13, Qugu REN-02 and bilateral Daheng SP-15 by affine transformation onto a point template (Zhongguo Zhen Jiu 2025;45(3):391–396, PMID 40097227). It says nothing about the point clinically; it is noted because it is the kind of study a reader searching for "Shangwan research" will meet, and it should be understood for what it is.

What is missing should be said plainly: there is no sham-controlled randomised trial of REN-13 alone for vomiting, epigastric pain, insomnia or any other of its uses. Its standing rests on the classical record — where, as the two analyses above show, it stands unusually high — and on the reference literature, not on modern trial evidence.

How does REN-13 compare with the points around it?

Zhong Wan REN-12, one cun below, is the dominant point of the region and the one REN-13 is nearly always used with; where REN-12 treats the Stomach as an organ, REN-13 treats its upper opening. Jian Li REN-11 and Xia Wan REN-10 continue down the midline, REN-10 completing the Wan set at the stomach's outlet. Ju Que REN-14, one cun above REN-13 and just below the xiphoid process, is the Front-Mu point of the Heart and is REN-13's partner wherever the chest and spirit indications are the reason for the treatment; the two are the pair most easily confused on this stretch, and the distinction is that REN-14 belongs to the Heart and REN-13 to the stomach's inlet. Jiu Wei REN-15, above REN-14, is the Connecting point of the Conception Vessel. Laterally, Cheng Man ST-20 lies two cun out from REN-13 on each side as its Stomach channel partner, in the same relationship that ST-21 Liang Men holds to REN-12 and ST-23 Tai Yi to REN-10. All are held in Sacred Lotus sources & references. Every point on this stretch of the midline shares the abdominal depth considerations and the recorded pregnancy caution set out under needling, and REN-13 is where that caution reaches its upper limit.

Source: Deadman & Al-Khafaji, A Manual of Acupuncture (p. 512); Chinese Acupuncture & Moxibustion (p. 239); Sacred Lotus sources & references (name, meeting-point classification, and the full run of Conception Vessel and Stomach channel abdominal point records queried directly, alongside the HT-03 record); PMID 39943771; PMID 41074530; PMID 41397720; PMID 38239140; PMID 40097227 — each verified resolvable and checked for retraction status before citation; cross-referenced against multiple online sources.