针刺层次与针感的关系

Relationship between needling layers and needling sensations in acupuncture

根据《内经》"三才""五体"的人体结构层次观点,结合现代解剖学的组织结构理论,以及笔者30多年的针灸临床实践,将人体针刺的结构层次分为4层,各层产生不同的针感。第一层为皮肤层,针尖入皮肤时,主要表现为"痛"感;第二层为皮下浅筋膜层,针尖在这一层则出现强烈的"胀"感,并可沿一定方向传导;第三层是深筋膜和肌肉层,如针尖刺到深筋膜是"重"感,针尖刺入肌肉时,则为"酸"楚感;第四层为骨膜和骨层,针尖一旦触及,则出现剧"痛"。此外,每一层都有血管和神经分布,针尖刺到血管时则"痛",刺到神经时则"麻",并沿神经走行方向传导。反之,我们通过病人的针感,也可得知针尖所在的层次和部位。掌握针刺层次与针感的关系,对进一步研究针法、针刺的疗效和病人的感觉及调控病人的针感有重要意义。

Based on the sancai（literally three talents referring to ＂earth＂, ＂human＂ and ＂heaven＂） and wuti（literally five organs referring to skin, muscle, vessel, tendon and bone, which correspond to five internal organs： lungs, spleen,heart, liver and kidney respectively） in Neijing（Internal Classic）, as well as the tissue structure theory of modern anatomy,and in combination with the clinical practice of acupuncture by the author in the past over 30 years, it is proposed that four layers are divided in needling depth of acupuncture. The different needling sensations are induced at different layers.The first layer is the skin. When the needle is inserted into the skin, the main sensation is ＂pain＂. The second layer is the subcutaneous layer（superficial fascia）. The needle tip at this layer generates a strong ＂swelling＂ sensation, which radiates along a certain direction. The third layer is the deep fascia and muscle layer. If the needle tip touches the deep fascia,there is a ＂heavy＂ feeling. If the needle tip goes into the muscle, an ＂acid＂ sensation will occur. The fourth layer is the periosteum and bone layer, which produces a strong sensation of ＂pain＂ when touched by the needle tip. In addition, each layer has blood vessels and nerve distribution. When the needle tip touches the blood vessels, a sense of ＂pain＂ happens.If the needle tip touches the nerve, there will be a sensation of numbness, which spreads along the direction of nerve conduction. On the contrary, through the patient＇s needling sensations, we can roughly know which layer and direction the needle tip goes. Better understanding of the relationship between the needling layers and needling sensations contributes to the further study of needling techniques, therapeutic effects of acupuncture and patient＇s sensations. It is significant for the regulations of needling sensations in patients.