足三里穴进针角度和深度的研究

Study on angle and depth of needle insertion in acupuncture at Zusanli (ST 36)

目的:为针刺足三里穴提供适宜的进针角度和深度,避免对神经血管的损伤并发挥其最大功效。方法:用80只成人下肢标本,按国颁标准进针,解剖观测进针时所涉及的层次结构及毗邻重要血管神经。结果:直刺进针时,针体由皮肤到骨间膜的深度为(2·22±0·31)cm,到胫骨后肌后缘的深度为(4·42±0·53)cm;在骨间膜浅层可刺中胫前动脉和腓深神经的扇形分支。针体穿过胫骨后肌后可触及含有胫神经和胫后血管粗大的血管神经束。结论:针刺足三里穴的适宜深度为2·22cm,最大深度为4·42cm。穴位注射时直刺或略偏胫骨方向,接近与胫骨内侧面平行进针,同时进针深度一般不超过5cm较为安全。犊鼻下3寸,胫骨前肌、趾长伸肌之间的体表定位点,也是值得临床尝试的有效刺激点。

Objective To provide an appropriate angle and depth of needle insertion in acupuncture at Zusanli （ST 36） and avoid injuring the nerve and blood vessel and exert the most effect. Methods Eighty adult lower-limb samples were used to dissect and observe the relative layered structures and adjoining important nerves and blood vessels in needling Zusanli （ST 36） according to the national standard. Results The needling depth from the skin to the interosseous membrane and from the skin to posterior border of tibialis posterior is （2. 224±0.31） cm and （4. 42±0. 53） cm, respectively. There are flabellate branches of anterior tibial arteries and deep peroneal nerves around the needle in the superficial layer of interosseous membrane. The vessel and nerve bundles containing tibial nerve and posterior tibial vessels can be touched when the needle body past through tibialis posterior. Conclusion It is recommended that ideal average depth of acupuncture is 2. 22 cm and the maximum depth is 4.42 em for oblique needling Zusanli （ST 36）. When it is injected, the needle should be perpendicularly inserted or deviated slightly to the direction of tibia and paralleled to medial surface of tibia. And the safe needling depth is generally less than 5 era. The point of the body surface between tibialis anterior and extensor digitorum longus at 3 cun below Dubi （ST 35） is also an effectively stimulating point.