基于颈源性头痛病因“项四穴”进针点解剖位置微调  

Anatomical Study on Acupuncture Needle-insertion Routes of the “Nape Four Acupoints” in Human Corpse

作　　者：姚旭[1] 林咸明[2] 

机构地区：[1]浙江省立同德医院针灸科,杭州310012 [2]浙江中医药大学附属第三医院针灸科,杭州310005

出　　处：《针刺研究》2016年第4期351-355,共5页Acupuncture Research

基　　金：浙江省中医药科技计划(No.2011ZA 043)

摘　　要：目的:探寻颈部诱发头痛的疼痛激惹点定位,微调"项四穴"针刺进针点方案。方法:解剖尸体枕项部标本5具10侧,确定"项四穴"(天柱、风池、完骨、天牖)针刺路径。穴位针刺路径染色,枕项部层次解剖;以枕骨粗隆为原点,以上项线水平投影为横坐标,以后正中线水平投影为纵坐标,建立二维直角坐标系,测量"项四穴"和疼痛解剖激惹点的水平投影坐标,分析二者空间位置关系,微调"项四穴"进针点定位。结果:"项四穴"进针点可微调至6个针刺刺激点:(1)天柱Ⅰ刺激点,即平天柱穴旁开后正中线约0.5寸处,直刺。(2)天柱Ⅱ刺激点,即颅底水平旁开后正中线约0.6寸处,直刺。(3)天柱Ⅲ刺激点,即天柱穴下移0.6寸,后正中线旁开1.3寸处,直刺;或者天柱穴体表定位不变,向正下方斜刺。(4)风池Ⅰ刺激点,即斜方肌与胸锁乳突肌结合部凹陷上方平颅底水平,约后正中线旁开2.25寸,沿颅底向鼻尖下方斜刺。(5)完骨Ⅰ刺激点,完骨穴向上移0.7寸,即乳突后根部与颅底结合处下缘,沿骨面直刺;(6)天牗Ⅰ刺激点,即天牖穴下0.7寸,胸锁乳突肌后缘处,操作与针刺路径同天牖穴。结论:颈源性头痛与枕项部疼痛激惹点密切相关,可将"项四穴"分别微调至天柱Ⅰ、Ⅱ、Ⅲ,完骨Ⅰ,风池Ⅰ,天牗Ⅰ刺激点进行针刺治疗,可能通过针至病所,以增强疗效。Objective To observe the routes of acupuncture needle-insertion of the ＂nape four acupoints＂（BL 10,GB20,GB 12,SJ 16）in the human cadavers and to explore the possible trigger-point location of cervical headache,so as to provide anatomic evidence for their clinical application.Methods Five human cadavers（male 3,female 2）were used in the present study.The needle inserting routes of the four acupoints Tianzhu（BL 10）,Fengchi（GB 20）,Wangu（GB 12）and Tianyou（SJ 16）at the nape were labeled with gentian violet first.The occipital tuberosity was taken as the original point,the horizontal projection of superior nuchal line as the abscissa,and the posterior median line as the ordinate,then,a two-dimension rectangular coordinate system was established to measure the horizontal projection of the＂nape four points＂and to estimate the trigger-point location,followed by making an analysis on their spatial relationship,and determining the reasonable routes of needle-insertion of the4 acupoints.Results For the＂nape four points＂,six needling-inserting routes or spots could be taken：（1）Tianzhu（BL 10）Ⅰ（perpendicular insertion）,i.e.,about 0.5 cunlateral to the posterior midline in parallel to BL 10;（2）Tianzhu（BL 10）Ⅱ（perpendicular insertion）,about 0.6cun lateral to the posterior midline at the skull base level;（3）Tianzhu（BL10）Ⅲ（perpendicular insertion）,about 0.6 cun below the BL 10 and about 1.3 cunlateral to the posterior midline,or the right inferior of BL 10 for oblique insertion;（4）Fengchi（GB 20）Ⅰ（oblique insertion along the skull base toward the lower part of the nose-tip）,about 2.25 cunlateral to the posterior midline at the depression site of the junction of the sternocleidomastoid and trapezius muscles on the upper portion in parallel to the skull base level and 2.25 cunlateral to the posterior midline;（5）Wangu（GB 12）Ⅰ（perpendicular insertion along the bone surface）,about 0.7 cun above the GB 12,i.e.,the inferior of the jun

关 键 词：进针点 针刺疗法 项四穴 解剖定位分析 

分 类 号：R224.2[医药卫生—中医基础理论]