Case Report / Kasuistik

Complement Med Res Received: August 26, 2019

Accepted: February 5, 2020
DOI: 10.1159/000506360 Published online: March 30, 2020

A Case Report of Acupuncture at

Neiguan Point (P6) for Paroxysmal
Supraventricular Tachycardia
Peizhong Liu a Chuangpeng Li a Yiting Lu c Qing Liu a, b
a Department
of Cardiology, Guangdong Provincial Hospital of Chinese Medicine, Guangdong Provincial Hospital
of Chinese Medicine-Zhuhai Hospital, Guangzhou and Zhuhai, China; b The Second Clinical School of Medicine,
Guangzhou University of Chinese Medicine, Guangzhou, China; c The Fifth Clinical School of Medicine, Guangzhou
University of Chinese Medicine, Guangzhou, China

Keywords Akupunktur des Neiguan-Akupunkturpunkts (P6) bei

Paroxysmal supraventricular tachycardia · Acupuncture · paroxysmaler supraventrikulärer Tachykardie
Neiguan point (P6) · Case report

Abstract
Paroxysmal supraventricular tachycardia (PSVT) is a com-
mon medical emergency, and this case report describes an
acupuncture treatment of traditional Chinese medicine ter-
minating PSVT. In this case report, a 67-year-old female pa-
tient diagnosed with PSVT had a recurrence in the ward; ac-
companying symptoms were heart palpitations and short-
ness of breath. Modified Valsalva maneuver, the first-line
treatment, failed to convert paroxysmal supraventricular
tachycardia. However, acupuncture at Neiguan point (P6) for
about 1 min on her right hand successfully treated the pa-
tient. This case indicates that the application of acupuncture
in the clinic may serve as an alternative and complementary
treatment for PSVT. © 2020 S. Karger AG, Basel
Schlüsselwörter
Paroxysmale supraventrikuläre Tachykardie ·
Akupunktur · Akupunkturpunkt Neiguan (P6) ·
Fallbericht
Zusammenfassung
Die paroxysmale supraventrikuläre Tachykardie (PSVT) ist
ein häufiger medizinischer Notfall, und der vorliegende
Fallbericht beschreibt die Beendigung einer PSVT durch
Akupunktur, die Teil der traditionellen chinesischen Me­
dizin ist. Im vorliegenden Fall kam es bei einer 67-jährigen
Patientin mit diagnostizierter PSVT während des statio­
nären Aufenthalts zu einem Rezidiv, begleitet von Palpita-
tionen und Kurzatmigkeit. Die First-Line-Therapie in Form
des modifizierten Valsalva-Manövers führte nicht zu einer
Konversion der PSVT. Dagegen konnte die Patientin durch
Akupunktur am Akupunkturpunkt Neiguan (P6) an der
rechten Hand für etwa 1 Minute erfolgreich behandelt
werden. Dieser Fall zeigt, dass der Einsatz von Akupunktur
in der Klinik eine alternative und komplementäre thera-
peutische Option bei PSVT sein kann. © 2020 S. Karger AG, Basel
193.51.85.197 - 4/14/2020 9:07:00 AM

karger@karger.com © 2020 S. Karger AG, Basel Qing Liu

www.karger.com/cmr The Second Clinical School of Medicine
Guangzhou University of Chinese Medicine
Université de Paris
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111 Dade Road, Yuexiu District, Guangzhou, Guangdong 510405 (China)

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 Introduction
Paroxysmal supraventricular tachycardia (PSVT) is a
common clinical ectopic tachyarrhythmia. Reentry is the
most common pathogenesis of PSVT. Generally, it is di-
vided into atrioventricular reentrant tachycardia, atrio-
ventricular nodal reentrant tachycardia, sinus nodal re-
entrant tachycardia, intra-atrial reentrant tachycardia,
and automatic atrial tachycardia, of which the first two
account for more than 90% [1]. Typical symptoms are
heart palpitations, shortness of breath, chest pain, and so
on. Treatments include activating the vagus (Valsalva
maneuver, pressing eye sockets, inducing vomit, etc.),
drug therapy (adenosine triphosphoric acid, verapamil,
propafenone, etc.), and radiofrequency ablation [2].
Modified Valsalva maneuver is widely used as the first-
line treatment, and studies have shown that the modified
Valsalva maneuver cannot only improve the conversion
efficiency, but can also reduce the adverse reactions
caused by drugs and cardioversion [3, 4]. In this case, af-
ter the failure of the modified Valsalva maneuver, acu-
puncture at P6 terminated PSVT, which can provide ref-
erence for such patients.
Case Report
A 67-year-old female was admitted to the hospital on June 5,
2019, for repeated palpitations for 7 years, aggravating for 2 days.
Symptoms were paroxysmal palpitations, accompanied by sweat-
ing in severe episodes, lasting for about 30 min to several hours;
the tongue was dark red with greasy fur, and the pulse was fine and
string-like; the patient had a history of hypertension. Physical ex-
amination showed a temperature of 36.3 ° C, pulse of 67 beats/min,
heart rate of 20 beats/min, blood pressure of 176/89 mm Hg, and
no other positive sign. Auxiliary examination showed thyroid-
stimulating hormone of 5.3 mIU/L, free T4 of 11.73 pmol/L, and
hemoglobin A1c of 6.2%. Cervical vascular ultrasound revealed
bilateral carotid intima-media thickening with multiple plaques
and bilateral vertebral artery tortuosity. Ultrasonic cardiogram re-
vealed an ejection fraction of 68%, enlargement of the left and right
atrium (mild), ascending aorta dilatation, left ventricular diastolic
dysfunction, tricuspid regurgitation (moderate-severe), mitral re-
Fig. 1. The ECG showed PSVT attack be-
fore acupuncture.
2 Complement Med Res
DOI: 10.1159/000506360
gurgitation (mild), and pulmonary hypertension (mild). Electro-
cardiogram (ECG) revealed PSVT and ST-T changes.
Western medicine diagnoses were (1) PSVT; (2) nonrheumatic
tricuspid valve disease (moderate-severe regurgitation); (3) coro-
nary atherosclerosis; (4) hypertension grade 3 (very high risk
group); and (5) carotid arteriosclerosis (with plaque). The Chinese
medical diagnosis was palpitations.
Therapeutic Intervention
Symptomatic treatment of integrated Chinese and Western
medicine was used. The patient had an attack of PSVT again, with
heart palpitations and shortness of breath, on the morning of June
11, 2019 (Fig. 1). The modified Valsalva maneuver was performed
immediately. The patient was asked to hold the breath for 15 s in
the semi-recumbent position; immediately afterwards, the staff
placed the patient in a supine position and raised her legs to 45° for
15 s [5], but the maneuver failed. Subsequently, acupuncture at P6
on her right hand for about 1 min quickly terminated the attack of
PSVT (Fig. 2). ECG showed sinus rhythm, incomplete right bundle
branch block, and T wave changes. Radiofrequency ablation was
performed on June 12, 2019, confirming the diagnosis of a slow-
fast atrioventricular nodal reentry tachycardia by inductive stimu-
lus. Aspirin was given for antiplatelet aggregation after the opera-
tion. Postoperative ECG showed sinus rhythm and incomplete
right bundle branch block. After treatment, the patient’s condition
improved and she was discharged.
Follow-Up and Outcome
Subsequent drug therapy was followed up, and no adverse
events occurred according to regular telephone follow-up. The pa-
tient rechecked ECG on her return visit on August 13, 2019, and
there was no recurrence of PSVT (Fig. 3, 4).
Discussion
This report shows an effective application of the acu-
puncture treatment of traditional Chinese medicine
(TCM) for PSVT, which terminated the emergency time-
ly. Yet, we just performed acupuncture once; prolonged
systemic acupuncture treatment and follow-up might be
considered to observe the prognosis. The point P6 is first
listed in the Chinese medicine classic Miraculous Pivot
Meridian. It is the luo-connecting point of the hand-jue-
yin pericardium meridian, also 1 of the 8 confluent acu-
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Université de Paris
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points connecting the 8 extra channels. The Classic of
Acupuncture and Moxibustion states that Neiguan can be
used when the patient feels palpitations, panics easily, and
feels sad. Valuable Prescriptions for Emergency suggests
that Neiguan could treat chest tightness and pain from
excess patterns, vexation and dementia due to deficiency
patterns. According to TCM, P6 can regulate the flow of
qi, calm the heart, and tranquilize the mind. Although
these are TCM perspectives which are not proven, acu-
puncture has been widely used all over the world and has
achieved good clinical effects. This report further con-
firms its efficacy. PSVT belongs to palpitation in Chinese
medicine, which is an indication of P6.
By data mining, Yan et al. [6] found that the most com-
monly used acupuncture point for the treatment of ar-
rhythmia is P6. A large number of clinical studies have
shown the effectiveness of P6 for the treatment of PSVT.
Xu et al. [7] have been using P6, Shenmen point (H7), and
Danzhong point (CV17) as the main points to convert
PSVT in 34 cases since 1995, which was effective in 31
Fig. 2. The acupuncture of Neiguan (P6) achieved cardioversion from PSVT to sinus rhythm.
Acupuncture at Neiguan Point (P6) for
PSVT
cases and ineffective in 3 cases, with a 91.2% total effective
rate. Li and Guo [8] acupunctured at P6 treating PSVT in
24 cases, which was effective in 20 cases and ineffective in
4 cases, with an 83.33% total effective rate. Jin [9] acu-
punctured at P6 to treat 32 cases of supraventricular
tachycardia, which was effective in 22 cases and ineffec-
tive in 10 cases, with a 68.75% total effective rate. Dan [10]
acupunctured at P6 combined with H7 to treat supraven-
tricular tachycardia in 42 cases, which was effective in 31
cases and ineffective in 11 cases, with a 73.81% total effec-
tive rate; the treatment was effective in atrioventricular
nodal reentrant tachycardia, intra-atrial reentrant tachy-
cardia, and atrioventricular reentrant tachycardia.
Acupuncture at P6 to convert the sinus rhythm may be
related to the following mechanisms. Xia [11] suggested
that acupuncture can improve heart function, increase
coronary blood flow, activate the body fluid factors of the
pituitary-adrenal system, and may also resist arrhythmia
to some extent. Experiments showed that acupuncture at
P6 could change the ratio of cyclic adenosine monophos-
Color version available online
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Complement Med Res 3
DOI: 10.1159/000506360
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Fig. 3. The ECG showed sinus rhythm
without PSVT attack after acupuncture
and radiofrequency ablation.

Color version available online

Fig. 4. The timeline.

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4 Complement Med Res Liu/Li/Lu/Liu

DOI: 10.1159/000506360
Université de Paris
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phate/cyclic guanosine monophosphate (cAMP/cGMP), PSVT, acupuncture is a simple, convenient, safe, and reli-
increase the content of cGMP, and regulate the autonom- able method with high conversion rate, which is worth
ic nervous system to affect the rhythm of the heart [12]. promoting.
The content of inhibitory G (Gi) protein of the medulla
oblongata can affect the content of cAMP by adenylate
cyclase, and tachyarrhythmia may be related to the disor- Acknowledgements
der of G protein gene expression. Zheng et al. [13] con-
cluded that G protein might be involved in the regulation This research was supported by the National Natural Science
Foundation of China (No. 81603460 to Q.L.) and Postdoctoral Sci-
of cardiovascular function in the medulla oblongata, and
ence Foundation of China (No. 2015 M581533 to Q.L.).
their experiment on arrhythmic rats showed that acu-
puncture at P6 could increase Gi2 and Gi3 messenger RNA
(mRNA) to regulate the heart rate. Wang et al. [14] found
Statement of Ethics
that acupuncture at P6 could reduce the levels of norepi-
nephrine and adrenaline in rat plasma, possibly inhibit- The patient consented to the anonymous publication of her
ing the activity of the sympathetic-adrenal medulla sys- data, which is gratefully acknowledged by the authors.
tem and reducing the release of catecholamine to adjust
the heart rate. Yu et al. [15] found that the bi-directional
regulation of acupuncture at P6 in rats with tachyarrhyth- Disclosure Statement
mia and bradyarrhythmia might be related to the de-
crease of the cellular oncogene fos (c-fos)-positive cells in The authors declare no conflicts of interest.
the nucleus tractus solitarii, and the path is “acupoint
stimulation – afferent signal – integration of nucleus trac-
tus solitarii – regulation of central nervous system – de- Author Contributions
scending projection system – regulation of the heart rate.”
The study was designed by Q.L. The acupuncture operation
In summary, acupuncture at P6 can be effective in car- was made by P.L. The manuscript writing was performed by Y.L.
dioversion, and its clinical efficacy and safety are support- and Q.L. The manuscript was finalized by Q.L. All authors have
ed by the literature. Therefore, in the face of the onset of read and revised the manuscript critically.

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Acupuncture at Neiguan Point (P6) for Complement Med Res 5

PSVT DOI: 10.1159/000506360
Université de Paris
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