Wrist-Ankle Acupuncture (腕踝针) Guide
A modern microsystem using 12 painless subcutaneous needling points around the wrists and ankles to treat conditions throughout the body via a 6-zone longitudinal body map.
Developed in 1966 by neurologist Dr. Zhāng Xīnshù (张心曙) at the Second Military Medical University in Shanghai, Wrist-Ankle Acupuncture (腕踝针 · Wàn Huái Zhēn) is one of the most accessible and best-tolerated modern acupuncture systems. Its painless, no-de-qi insertion makes it especially valuable for needle-sensitive patients, paediatrics, and emergency / post-operative analgesia.
How the 6-Zone System Works
Each side of the body is divided vertically into 6 longitudinal zones, numbered from the anterior midline (Zone 1) around to the posterior midline (Zone 6). The diaphragm divides the body horizontally:
- Above the diaphragm → use the matching wrist point (Upper 1–6) on the same side as the symptom.
- Below the diaphragm → use the matching ankle point (Lower 1–6) on the same side as the symptom.
- Midline symptoms → needle bilaterally.
- Whole-side pain (e.g. post-stroke hemiplegia) → needle the wrist and ankle on the affected side.
Anatomical Placement — Wrist & Ankle Cross-Sections
Limb side
Switch between right and left limb cross-sections (left is the mirror image).
Right Wrist — transverse cross-section
At the level ~2 cun proximal to the wrist crease, viewed from above (looking toward the right hand). Six points spaced around the circumference.
Right Ankle — transverse cross-section
At the level ~3 cun proximal to the malleoli, viewed from above (looking toward the right foot). Six points spaced around the circumference.
Right Wrist — Upper points (RU1–RU6)
Right Ankle — Lower points (RL1–RL6)
Symbol key
- Gold dot — skin-entry point on the limb circumference.
- Dashed line — subcutaneous needle path (10–15°, 1.0–1.4 cun) toward the labelled chip.
- 3Jade chip — numbered point label (1–6) for the corresponding zone.
- RBone landmarks — R radius, U ulna (wrist); T tibia, F fibula (ankle).
Gold dots mark the skin-entry point. Dashed lines indicate the subcutaneous needle path (10–15° angle, 1.0–1.4 cun) threaded distally toward the symptom. Toggle between right and left limbs above — the left limb is the exact mirror image of the right. Always palpate for the radial artery (Upper 3) and saphenous vein (Lower 1–2) before insertion.
The 12 Needling Points (12)
Upper 1 (上1)
腕上1 · Wrist
Location:
Anterior wrist, ulnar border, between the ulna and flexor carpi ulnaris tendon, ~2 cun proximal to the wrist crease.
Body zone:
Zone 1 — anterior midline of head, neck, chest & abdomen (forehead, eyes, nose, tongue, throat, sternum, epigastrium, lower abdomen, perineum).
Indications:
Most commonly used wrist point. Treats midline anterior pathology of the upper body and emotional / shen disturbances.
WristUpper 2 (上2)
腕上2 · Wrist
Location:
Anterior wrist, between palmaris longus and flexor carpi radialis tendons (over PC-6 area), ~2 cun proximal to wrist crease.
Body zone:
Zone 2 — anterior chest, lateral to midline (precordium, breast, lateral throat, anterior shoulder).
Indications:
Mirrors PC-6 territory. Strong indication for cardio-respiratory and emotional symptoms in the anterior chest band.
WristUpper 3 (上3)
腕上3 · Wrist
Location:
Anterior wrist, radial side of the radial artery, ~2 cun proximal to wrist crease.
Body zone:
Zone 3 — narrow strip along the antero-lateral chest wall (along the radial artery line projected up the body).
Indications:
Less commonly needled because of proximity to the radial artery. Always palpate and avoid the artery.
WristUpper 4 (上4)
腕上4 · Wrist
Location:
Lateral (radial) wrist, on the radial border of the radius, ~2 cun proximal to wrist crease (between LU and LI channels).
Body zone:
Zone 4 — lateral side of the head, face, neck, shoulder & lateral chest (temple, ear, jaw, lateral neck, shoulder joint).
Indications:
Workhorse point for unilateral head, face, ear and shoulder complaints. Use ipsilateral side to the symptom.
WristUpper 5 (上5)
腕上5 · Wrist
Location:
Posterior (dorsal) wrist, midpoint between radius and ulna (over SJ-5 area), ~2 cun proximal to wrist crease.
Body zone:
Zone 5 — posterolateral upper body (posterior shoulder, lateral upper arm, scapular region, posterior neck).
Indications:
Excellent local-distal point for posterolateral upper limb and shoulder-girdle pain syndromes.
WristUpper 6 (上6)
腕上6 · Wrist
Location:
Posterior wrist, ulnar border on the radial side of the ulna (over SI-7 area), ~2 cun proximal to wrist crease.
Body zone:
Zone 6 — posterior midline of the upper body (occiput, posterior cervical spine, upper thoracic spine, interscapular).
Indications:
First-choice point for posterior midline neck and upper back pain. Pairs well with Lower 6 for full spinal coverage.
WristLower 1 (下1)
踝下1 · Ankle
Location:
Medial ankle, between the medial border of the Achilles tendon and the posterior border of the tibia, ~3 cun above the medial malleolus.
Body zone:
Zone 1 — anterior lower midline (lower abdomen, genitals, perineum, anus, anteromedial thigh).
Indications:
Sister point to Upper 1 for the lower body. Strong gynaecological and urogenital indications.
AnkleLower 2 (下2)
踝下2 · Ankle
Location:
Medial ankle, on the posterior border of the tibia, ~3 cun above the medial malleolus (around SP-6 area).
Body zone:
Zone 2 — anteromedial lower body (medial thigh, medial knee, medial leg).
Indications:
Overlaps anatomically with SP-6 but is needled subcutaneously, not as a classical point.
AnkleLower 3 (下3)
踝下3 · Ankle
Location:
Anteromedial ankle, on the medial border of the tibial crest, ~3 cun above the medial malleolus.
Body zone:
Zone 3 — narrow strip on the antero-medial leg.
Indications:
Less frequently used; reserved for narrow zone-3 musculoskeletal pain.
AnkleLower 4 (下4)
踝下4 · Ankle
Location:
Anterior ankle, midpoint between tibialis anterior tendon and the lateral tibial border, ~3 cun above the lateral malleolus.
Body zone:
Zone 4 — anterolateral lower body (anterior thigh, knee, anterior shin, dorsum of foot).
Indications:
Major point for anterior knee pain and post-stroke foot drop. Often paired with Upper 4 for ipsilateral hemibody disorders.
AnkleLower 5 (下5)
踝下5 · Ankle
Location:
Lateral ankle, on the posterior border of the fibula (over GB-39 area), ~3 cun above the lateral malleolus.
Body zone:
Zone 5 — posterolateral lower body (lateral thigh, lateral knee, lateral leg, lateral ankle).
Indications:
Workhorse point for lateral lower-limb pain and GB-channel sciatica.
AnkleLower 6 (下6)
踝下6 · Ankle
Location:
Posterior ankle, on the lateral border of the Achilles tendon, ~3 cun above the lateral malleolus.
Body zone:
Zone 6 — posterior midline & paraspinal lower body (lumbar spine, sacrum, posterior thigh, calf, heel).
Indications:
First-choice point for lumbar and BL-channel sciatica. Pairs with Upper 6 for full posterior axis treatment.
AnkleTreatment Method — Step by Step
Step 1 — Locate the Symptom Zone
Mentally map the symptom onto one of the 6 longitudinal body zones (1 = anterior midline → 6 = posterior midline). Use the same side as the symptom; for midline symptoms, needle bilaterally.
Step 2 — Choose Wrist or Ankle
Above the diaphragm → wrist point (Upper 1–6). Below the diaphragm → ankle point (Lower 1–6). For symptoms crossing the diaphragm (e.g. whole-side pain after stroke), needle BOTH wrist and ankle on the affected side.
Step 3 — Insertion
Use a fine 0.25 × 40 mm filiform needle. Insert at a 10–15° angle, bevel up, then thread the needle subcutaneously toward the symptom for 1.0–1.4 cun. Insertion should be painless. The patient must NOT feel de qi — if they do, withdraw 1–2 mm and re-direct more superficially.
Step 4 — Retention & Stimulation
Retain needles for 30 minutes for acute conditions, up to 24 hours for chronic pain (secured with surgical tape). No manipulation is performed during retention — the technique relies on subcutaneous afferent stimulation, not de qi.
Step 5 — Course of Treatment
Acute pain: 1–3 sessions, often within minutes. Chronic conditions: 10 sessions per course, 1–2 sessions per week, with a 3–7 day rest between courses. Re-evaluate after each course and adjust zone selection if symptoms migrate.
Safety & Cautions
- Avoid the radial artery at Upper 3 — palpate before insertion.
- Do NOT seek de qi. Painful insertion or strong sensation indicates wrong angle/depth — withdraw and reinsert subcutaneously.
- Avoid the saphenous vein on the medial ankle (around Lower 1–2).
- Do not use Lower 1 in pregnancy (analogous to forbidden lower-abdominal points).
- Maintain strict aseptic technique — single-use sterile needles only.
- Stop treatment and reassess if no improvement after 3 sessions for acute pain or 1 course for chronic pain.
Historical Context & Clinical Legacy
Origin: Dr. Zhang Xinshu (张心曙)
Wrist-Ankle Acupuncture (腕踝针 · Wàn Huái Zhēn) was developed in 1966 by neurologist Dr. Zhang Xinshu at the Second Military Medical University in Shanghai. It grew out of his research into peripheral nerve stimulation for chronic pain and emotional disorders, synthesising classical zone theory with modern neuroanatomy.
Six-Zone Body Map
The body is divided into 6 longitudinal zones on each side of the midline (1 = anterior midline through to 6 = posterior midline). Symptoms above the diaphragm are treated at the corresponding wrist point (Upper 1–6); symptoms below the diaphragm at the ankle point (Lower 1–6). Same-side selection is the rule — needle the side where the symptom is located.
Subcutaneous Needling Technique
Needles are inserted almost horizontally (10–15° angle), threaded subcutaneously toward the symptom for 1.0–1.4 cun. The patient should feel NO de qi — no soreness, distension, or electrical sensation. If de qi occurs, withdraw and re-angle. Needles are retained for 30 minutes (up to 24 hours for chronic pain, with appropriate fixation).
Modern Clinical Use
Wrist-Ankle Acupuncture is now widely used in Chinese hospital pain clinics, emergency departments, and post-operative analgesia. Over 1,000 published clinical studies support its use for musculoskeletal pain, post-operative pain, migraine, dysmenorrhoea, anxiety, and insomnia. It is included in the Chinese national TCM curriculum.
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