下关前穴的发现、新技术应用及机理分析

Discovery of Xiaguan Anterior Acupoint, Application of New Technique as Well as Its Mechanism

本文报告了对原发性头痛具有特异治疗作用的新穴位(下关前穴)的发现经过、基于中医经络理论、神经解剖、神经生理理论的“下关前穴针刺(技法)技术”的临床应用及相关机理分析。该穴位于下关穴水平近鼻侧向前方约1寸的位置,根据中医经络学说及十四经脉体表循行部位分析,该穴位于足阳明胃经、足少阳胆经和手阳明大肠经循行的交汇处,故拟定新穴位名称为下关前穴,相当于交会穴。其浅层布有上颌神经的眶下神经分支,面神经的颧支、颊支,面横动、静脉的分支或属支,深层有三叉神经的下颌神经分支分布。现代医学关于偏头痛发生机制涉及到三叉神经血管系统的激活,三叉神经支配成为头痛发作的最终共同上游途径。降钙素基因相关肽(CGRP)阳性的感觉纤维、酪氨酸羟化酶阳性的交感神经和乙酰胆碱转运体阳性的副交感神经纤维在头面部穴位附近形成神经网络。下关前穴附近有丰富的三叉神经分支和自主神经(交感和副交感)纤维分布。这是针刺该穴位发挥头痛治疗作用的解剖和生理学基础。针刺该穴位产生快速而强大的镇痛作用,更大可能是通过调节穴位附近的三叉神经痛觉传递、自主神经(交感和副交感纤维)及其相关的血管舒缩功能活动水平而实现的。在针刺下关前穴技法上突破常规针刺规范,即采用3寸毫针近80度角度斜刺或直刺该穴位或向下关穴方向针刺约2寸。本文所述的新发现和新技术,治疗以偏头痛为代表的头面部疾病,具有“便利、安全、绿色、高效”等优势特点,为简化针灸防治包括偏头痛在内的头面部疾病取穴方案提供了有力技术支撑。This article reported the discovery of new acupoint (Xiaguan anterior acupoint) with specific therapeutic effect on primary headache, the clinical application and related mechanism analysis of “Xiaguan anterior acupoint acupuncture technique” based on the theory of channels and collaterals, nerve anatomy and nerve physiology. This point is located at the site about an inch in front of the nose at the level of the Xiaguan point. According to the theory of channels and collaterals in traditional Chinese medicine and the analysis of the circulation of the body surface of the fourteen meridians, this acupoint is located at the intersection of the Stomach Meridian of Foot-Yangming, St, the Gallbaldder Meridian of Foot-Shaoyang, GB and the circulation of the large intestine of the hand-Shaoyang. Therefore, the name of this new acupoint is suggested to be named Xiaguan anterior acupoint, which is equivalent to the intersection acupoint. In the superficial layer of this new acupoint, there are suborbital branches of maxillary nerve, zygomatic branch and buccal branch of facial nerve, and branches or branches of transverse facial artery and vein. In the deep layer of this new acupoint, there are trigeminal nerve branches of mandibular nerve. In modern medicine, the mechanism of migraine involves the activation of the trigeminal nerve vascular system. Trigeminal nerve becomes the ultimate common upstream pathway of headache onset. CGRP-positive sensory fibers, Tyrosine 3-monooxygenase-positive sympathetic nervous system fibers, and acetylcholine transporter-positive parasympathetic nervous system fibers form neural networks near acupoints on the head and face. There are abundant trigeminal nerve branches and autonomic (sympathetic and parasympathetic) fibers near the anterior Xiaguan acupoint. This is the anatomical and physiological basis for acupuncture to exert its therapeutic effect on headache. Acupuncture at this point produces a rapid and powerful analgesic effect, which is more likely to be achieved by regulating the activity levels of trigeminal neuralgia, autonomic (sympathetic and parasympathetic) nerves and their related vasomotor functions near acupoints. The technique of acupuncture at Xiaguan Qianxue was improved by oblique or direct needling at an angle of about 80 degrees or about 2 inches in the direction of Xiaguan with a filiform needle or an elongated needle. The new discovery and new technique described in this paper is characterized by convenience, safety, green, high efficiency in the treatment of head and face diseases represented by migraine, which provides strong technical support for simplifying acupuncture point selection scheme for prevention and treatment of head and face diseases including migraine.