Effects of Depth of Needle Insertion with Risperidone Long-Acting Injectable in Persons with Schizophrenia: A Randomized Double-Blind Study

In some cases, if the insertion depth is shallower than expected, intramuscular (IM) injection of risperidone long-acting injectable (RLAI) may not penetrate the muscle fascia. However, if needle insertion depth is deeper than anticipated, needle penetration may cause damage to nerves, arteries and veins. Few clinical studies were done to evaluate the depth of needle length insertion reaching the intended gluteal muscle. The aim of this study was to evaluate the suitable depth of injecting RLAI. Twenty-six patients with schizophrenia were treated with RLAI, and randomly divided into two groups: 50 mm needle inserted group (Group-D, deep insertion, n = 13) and 20 mm needle insertion group (Group-S, shallow insertion, n = 13). For Group-S, the needle length was marked with a spacer at exactly 20 mm. Injections were performed by the psychiatrist or nurse, alternating between the two gluteal sites by double-cross method every two weeks. Clinical psychotic symptoms and injection site reactions were recorded throughout the study period. Experienced psychologists who were blinded from the needle-length experimental variable evaluated patients’ psychotic symptoms using the Positive and Negative Syndrome Scale (PANSS) every two weeks. The plasma 9-hydroxyrisperidone (9-OH-RIS) concentrations were measured every two weeks;comparison data were determined on the 8th week and the 14th week. No significant difference was observed in 9-OH-RIS concentrations, psychotic symptoms, injection site skin reactions of subjects in both groups. However, in Group-D, injection site adverse reactions were confirmed in two subjects (15%). In Group-S, injection site reactions were confirmed in six subjects (46%). Although effective 9-OH-RIS concentrations were obtained with the insertion using both depth, it was concluded that the 50 mm insertion length was more suitable for dorsogluteal IM injections in adult patients with schizophrenia as demonstrated by the incidence of local adverse skin reactions.

Differential Insertion Depths of Filiform Needle, Concept and Application

In this paper, the background, evolution, basic meaning, clinical application and the detail operating procedures of the differential insertion depth in filiform needle acupuncture were discussed based on the classical expositions of the Yellow Emperor’s Canon of Medicine. It is believed that the differential insertion depth reflects the basic idea of expelling the evil Qi from the body in the application of traditional acupuncture. Since the site of evil invasion has different shades, the position of evil Qi and correct differentiation has become the operation key points of needle insertion. Apart from this, the Yellow Emperor’s Canon of Medicine has further associated the clinical application of filiform needle insertion depth with the seasonal change of Yin and Yang, the body built of the patients, the nature of the diseases, the heat or cold pathogenic factors of the illness, the excess and deficiency of the patient, and the reinforcing and reducing function of acupuncture. These elaborations have greatly enriched the basic content of acupuncture and laid a systematic theoretical foundation of filiform needle operation. The differential insertion depth in acupuncture has its specific meaning, the emphasis of insertion depth of filiform needle with its differentiated clinical implication exemplifies the perceptual thinking features of traditional acupuncture and typical reveals the uniqueness of Chinese civilization.

Acupuncture analgesia and the direction,angle and depth of needle insertion

Literatures on acupuncture analgesia of the recent 30 years are analyzed through the target pain syndromes, points and tools selected for needling as well as the chosen direction, angle and depth of insertion. The relationship between effect of acupuncture analgesia and needling direction, angle as well as depth is initially optimized to enhance the analgesic effect. The result shows that the 3 factors are the key influences. However, studies on the above mentioned relation are still far from enough. Aiming at enhancing the effect of acupuncture analgesia and exploring the relative mechanism, it is held that multivariate analysis should be adopted to do systematic analysis on relationship between effect and mechanism of acupuncture analgesia and direction, angle and depth of the needle insertion.

CLINICAL APPLICATION OF POINT-THROUGH-POINT ACUPUNCTURE

Point-through-point acupuncture is atechnique in which a long needle is insertedin various directions and depths and acts ontwo or more points in treating disease.It iscommonly used in clinical practice.The ap-plication of point-through-point acupunc-ture and its effects are summarized as fol-lows.

Assessment of the operation standard and safety on the individualized deep acupuncture at Tiānshū (天枢 ST 25) under CT

Objective To discuss the individualized operation standard and its safety on the deep acupuncture at Tianshu （天枢 ST 25）. Methods Acupuncture was applied to Tianshu （天枢 ST 25）） in 39 patients. The individualized standard depth of insertion at the acupoint was determined as the penetrating the peritoneum with needle by 1 to 2 mm. The regression analysis was adopted to analyze the impacts of abdominal circumference （AC, cm） on the peritoneal position via CT cross-section scanning and image survey. Results The formula of rational needling depth at Tianshu （天枢 ST 25） with individualized deep acupuncture was： depth=-0.562＋0.045. AC. Conclusion The depth of insertion at Tianshu （天枢 ST 25）, determined as penetrating the peritoneum with needle by 1 to 2 mm is safe and feasible, which may be applicable and have the guidance significance for the assessment of clinical operation and safety on the deep acupuncture at the other acupoints on the abdominal region.

Thoughts on the conclusion of no differences between acupuncture and sham acupuncture in clinical researches of migraine in foreign countries

Aiming at the conclusion that ＂there is no difference in efficacy between acupuncture and sham-acupuncture＂ in clinical research field of migraine in foreign countries in recent years, through the discussions on the definition of sham acupuncture （placebo acupuncture）, the principles required to be obey in satisfactory placebo acupuncture, the definition, location, function as well as clinical results of shallow puncture, the authors probed into whether shallow puncture could be the control method of sham acupuncture （placebo acupuncture） in clinical research of acupuncture. It was demonstrated in the results that ＂acupuncture with minimal stimulation on skin superficial layer of meridian points or non-meridian points＂, the so-called control method of ＂sham acupuncture （placebo acupuncture）＂ excited holistic regulation of human body quite probably through ＂shallow puncture on cutaneous region of meridians＂ to achieve therapeutic effects. Hence, this method is not the appropriate control method of placebo acupuncture and cannot be the control method of sham acupuncture （placebo acupuncture） in clinical research of acupuncture. Therefore, it is naturally to repudiate the conclusion that ＂there is no difference in efficacy between acupuncture and sham acupuncture＂ in the research where this method is taken as the control of placebo acupuncture.

肾俞穴穴性及用法新探

肾俞穴作为肾脏之气输注于背腰部的腧穴,其属于足太阳膀胱经范畴,在临床上广泛运用于生殖泌尿系统等疾病的治疗。该穴位于人体背部足太阳膀胱经直行支脉循行处,且为足少阴经脉之标部所在,故具有特殊的穴性。但当前对于肾俞穴穴性及运用缺乏深入研究。该文基于经脉、标本、四海等理论探究了其穴性,并通过古籍溯源及临床实践探究其疗效发挥与刺灸方法、穴位配伍、针刺深度等关系。结果表明,不同的刺灸方法、穴位配伍、针刺深度能激发肾俞穴不同的穴位疗效,因此,只有明辨肾俞穴穴性并辅予合适的刺灸方法、穴位配伍及针刺深度,才可更好地发挥肾俞穴的治疗效果。

基于立体结构与刺法的腧穴观探析

腧穴是一个三维立体的结构,临床应用时往往需要针具以一定的角度刺入腧穴一定的深度,而刺激到不同层次的组织结构,从而发挥不同的临床效应。文章通过经典文献回顾、不同深浅/角度针刺的穴效关系临床研究和不同刺法的穴效关系机制研究等方面,探讨腧穴的不同组织结构对腧穴效应的影响。并提出理解腧穴主治时,需基于腧穴的立体结构与刺法,具体表述其同一腧穴不同刺法刺激到不同的组织结构可治疗的具体病症,以期进一步加深对腧穴的认识。

《内经》结合现代文献谈颈椎病针刺深度、频次、留针时间及排布

从《素问·痹论》及《素问·举痛论》两篇分析颈椎病病因病机,并根据颈椎病病因病机、相关经脉、患病人群特点等,从《内经》内容及现代相关文献,总结出颈椎病治疗应当重视浅刺针法,重视留针治疗,还应注意不宜连续针刺次数过多,且应灵活运用针刺排布,以增强疗效。

CT下经完骨穴穿刺面神经方向研究

目的:通过CT影像多平面重建,模拟经完骨穴向瞳孔方向穿刺路径,以茎乳孔为参照对象,探讨经完骨穴穿刺面神经的可行性与安全性。方法:选择扫描范围包含颅底的CT影像24例为观测样本,多平面重建后,设计穿刺路径,统计模拟穿刺线成功穿刺至茎乳孔附近的例数并测量与茎乳孔直线距离,观察茎乳孔与周围解剖结构位置关系。结果:在24例观测样本横断面上模拟穿刺,共得到穿刺路径48条,模拟穿刺线行经均未见骨性结构,穿刺成功率100%。经过计算得到模拟穿刺线与茎乳孔外口的空间直线距离,最短1.55 mm,最长10.35 mm,平均(5.03±1.93)mm,左右两侧直线距离差异无统计学意义(P>0.05),不同性别被观测者直线距离差异无统计学意义(P>0.05)。模拟穿刺路线均未途经颈静脉孔、颈动脉管外口。结论:经完骨穴向瞳孔方向穿刺至面神经附近是安全可行的。

环跳穴针刺深度对气滞血瘀型腰椎间盘突出症疗效的影响

目的观察环跳穴不同针刺深度对气滞血瘀型腰椎间盘突出症临床疗效的影响。方法招募150例气滞血瘀型腰椎间盘突出症患者,用随机数字表法分为深刺组(75例)和浅刺组(75例)。深刺组采用芒针深刺环跳穴治疗,浅刺组采用毫针针刺环跳穴治疗。分别在治疗前、治疗1个疗程后、治疗后和随访时,观察两组疼痛视觉模拟量表(visual analog scale,VAS)评分、日本骨科协会(Japanese Orthopaedic Association,JOA)腰椎评分、肌力评分和患侧膝踝反射评分的变化。比较两组临床疗效。结果深刺组治愈率高于浅刺组(P<0.05)。两组各时间点VAS评分、JOA腰椎评分、肌力评分和患侧膝踝反射评分比较,差异有统计学意义(P<0.05)。治疗后和随访时,深刺组VAS评分均低于浅刺组(P<0.05);治疗1个疗程后、治疗后和随访时,深刺组JOA腰椎评分和肌力评分均优于对照组(P<0.05)。结论环跳穴深刺治疗气滞血瘀型腰椎间盘突出症的临床疗效优于浅刺,可更有效地缓解疼痛,改善症状,提高肌力。

足三里穴进针角度和深度的研究

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。

谈腧穴深度与针刺深度

本文讨论了腧穴的深度与针刺深度之间的关系。认为腧穴的深度取决于经脉所在位置的深度;虽然腧穴的深浅决定针刺的深浅,但针刺深度不能等同于腧穴的深度,针刺的深度也不应以安全深度为准;腧穴的深度及针刺深度应以腧穴位于体表的点至最佳针感的深度为标志。

危险穴位针刺安全深度的研究——严振国教授的学术成果介绍

选取51具成人尸体,采用断面解剖学研究方法,对头颈部、胸腹部以及腰背部的74个危险穴位进行针刺安全深度、危险深度及易损伤脏器的研究,旨在提高针刺疗效,预防意外事故。

深刺与浅刺治疗突发性耳聋的疗效观察

目的探讨及评价不同针刺深度治疗突发性耳聋的疗效。方法将47例患者随机分为治疗组23例(深刺耳前3穴即耳门、听宫、听会配合体针疗法);对照组24例(浅刺耳前3穴配合体针疗法),观察和比较治疗后不同时期两组听力变化及伴随症状的变化。结果治疗组的有效率为87.0%,对照组的有效率为29.2%,经统计学处理,P<0.05,差异有显著性意义。结论深刺组疗效优于浅刺组。

应用MRI测量乳根穴针刺深度的研究

目的:研究乳根穴在MRI定位下的针刺安全深度,为针灸临床医生提供参考数据,提高针刺的安全性,减少针刺意外。方法:选取身体健康志愿者20人,其中男、女各10人。标记乳根穴的体表定位点行MRI扫描,在影像图像上测量乳根穴到胸膜的直刺深度。结果:男性组针刺危险深度:左侧(23.65±1.95)mm、右侧(25.31±2.83)mm;安全深度:左侧(17.73±1.47)mm、右侧(18.99±2.12)mm。女性组针刺危险深度:左侧为(25.14±2.46)mm、右侧为(26.42±2.78)mm;安全深度:左侧为(18.85±2.13)mm、右侧为(19.81±2.24)mm。针刺危险深度男女性别差异比较P>0.05,无明显差异;左右侧差异性比较P>0.05,说明无明显差异。结论:乳根穴针刺危险深度:左侧为(24.39±2.21)mm、右侧为(25.87±2.80)mm;安全深度:左侧为(18.29±1.80)mm、右侧为(19.40±2.18)mm。MRI检查为乳根穴的穴位针刺深度的研究提供了更安全、精确的研究方法。

针刺深浅与系统生物学

目的:从系统生物学角度探讨针刺深浅对机体的影响。方法:概述针刺深浅的概念、意义,并简述系统生物学的概念、内涵,分析针刺深浅与系统生物学的关系及针刺深浅对机体的作用。结果:在系统生物学的基础上,从多个系统,如神经调节系统、皮肤免疫系统、筋膜系统等来论述针刺深浅对机体的作用及其主要的作用机制。结论:在系统生物学的角度探讨针刺深浅的不同影响,不仅对探讨经典针灸深浅理论具有重要意义,也是对研究系统生物学提供了新思路,对于现代针灸学和生命科学的发展都具有深刻的意义。

华佗夹脊穴(腰段)针刺深度及穴位注射后迁移轨迹的CT影像定位探析

目的观察直刺及八位注射华佗夹脊穴（腰段）的安全深度和穴位注射后药物扩散迁移轨迹的CT影像定位。方法采用cT对夹脊穴的进针深度、角度、相关组织层面及臭氧穴位注射后在局部组织扩散移动轨迹进行扫描观察。结果当针与人体久状面早0°～15°角进针并出现明显的抵触感时，观察到针尖可到达华佗夹脊穴（腰段）椎板，此为最佳进针深度，并在此注入25μg／mL臭氧10mL，CT平扫臭氧夹脊穴位注射后在局部组织扩散移动轨迹，观察司见臭氧同侧椎旁L下可扩散2～5椎体平面，并可通过椎间孔扩散至脊神经根周围、椎管内直至对侧椎间孔神经根周围。结论华佗夹脊穴（腰段）直刺穴位注射后药物扩散范围极其宽广，可以扩散至人体许多重要组织脏器，但具有一定治疗风险，其扩散移动轨迹可能是夹脊穴钊‘感传导的经络物质基础。

应用MRI测量针刺缺盆穴安全深度研究

目的：应用磁共振成像（MRI）技术分别测量男性组与女性组针刺缺盆穴的危险深度及安全深度,为临床针灸医师提供数据参考,减少针刺意外发生,提高针刺安全性。方法：选取身体健康BMI指数在18～24之间的在读研究生志愿者40名,其中男性和女性志愿者各20人。使用鱼肝油胶囊标记缺盆穴在体表的位置,并进行MRI扫描,在所获得图像上测量直刺缺盆穴至脏层胸膜深度,以此深度乘以75%为安全深度,对获得的数据应用SPSS17.0进行统计学处理。结果：男性组左侧缺盆穴危险深度为（40.54±5.43）mm,安全深度为（30.41±4.07）mm;右侧缺盆穴危险深度为（41.13±4.98）mm,安全深度为（30.85±3.74）mm。女性组左侧缺盆穴危险深度为（35.18±4.54）mm,安全深度为（26.39±3.41）mm;右侧缺盆穴危险深度为（34.89±4.29）mm,安全深度为（26.17±3.22）mm。左右侧危险深度及安全深度差异性比较P〉0.05。针刺危险深度及安全深度性别差异性比较P〈0.05。表明男性组与女性组各自的左右两侧缺盆穴危险深度、安全深度均无明显差异;男性组与女性组相比危险深度及安全深度存在差异。结论：MRI技术为活体针刺穴位安全深度研究提供了安全、可靠、精确的数据,为临床针刺危险穴位应用提供参考。

应用MRI测量大包穴针刺深度的研究

目的:研究大包穴在MRI定位下的针刺安全深度,为针灸临床医生提供安全进针的参考数据,减少针刺意外。方法:选择身体健康志愿者男女各10人。MRI扫描通过大包穴体表标记点层面,在MRI图像上测量大包穴到壁层胸膜直刺深度。结果:男组危险深度左侧(20.47±2.61)mm、右侧(21.05±2.82)mm,安全深度:左侧(15.36±1.96)mm、右侧(15.79±2.11)mm;女组危险深度:左侧(18.33±3.27)mm、右侧(18.92±4.64)mm,安全深度:左侧(13.75±2.46)mm、右侧(14.19±3.48)mm。针刺危险深度性别差异比较P﹥0.05,说明无明显差异;双侧差异性比较P﹥0.05,说明无明显差异。结论:大包穴针刺危险深度:左侧(19.40±2.98)mm、右侧(19.98±3.89)mm;安全深度:左侧(14.55±2.31)mm、右侧(14.98±2.93)mm。MRI检查为穴位针刺深度的研究提供了更安全、精确的研究方法。