Yao Xu, Lin Xian-Ming
Department of Acu-moxibustion, Tongde Hospital of Zhejiang Province, Hangzhou 310012, China.
Department of Acu-moxibustion, the Affiliated 3rd Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou 310005.
Zhen Ci Yan Jiu. 2016 Aug 25;41(4):351-5.
To observe the routes of acupuncture needle-insertion of the "nape four acupoints"(BL 10,GB 20,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.
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 the 4 acupoints.
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 lateral to the posterior midline in parallel to BL 10; (2) Tianzhu (BL 10)Ⅱ(perpendicular insertion), about 0.6 cun lateral to the posterior midline at the skull base level; (3)Tianzhu(BL10) Ⅲ (perpendicular insertion),about 0.6 below the BL 10 and about 1.3 lateral 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 lateral 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 lateral to the posterior midline; (5) Wangu(GB 12) Ⅰ(perpendicular insertion along the bone surface), about 0.7 above the GB 12, i.e., the inferior of the junction of the mastoid posterior root and the skull base; (6)Tianyou (SJ 16)Ⅰ, about 0.7 below the SJ 16, i.e., the posterior margin of the sternocleidomastoid muscle, being the same to SJ 16 in the operation.
According to anatomical analysis, it is recommended to insert the acupuncture needles into the nape four acupoints along the Tianzhu (BL 10) Ⅰ, Ⅱ, Ⅲ, Fengchi(GB 20)Ⅰ, Wangu (GB 12) Ⅰ and Tianyou(SJ 16)Ⅰ routes mentioned above for achieving a better therapeutic effect. Cervical headache may have a close relation with the trigger-points at the occipital nape.
观察人体尸体上“项部四穴”（天柱穴（BL 10）、风池穴（GB 20）、完骨穴（GB 12）、天牖穴（SJ 16））的针刺路径，探寻颈源性头痛可能的触发点位置，为其临床应用提供解剖学依据。
本研究使用5具人体尸体（男性3具，女性2具）。首先用龙胆紫标记项部天柱穴（BL 10）、风池穴（GB 20）、完骨穴（GB 12）和天牖穴（SJ 16）这四个穴位的针刺路径。以枕外隆凸为原点，上项线的水平投影为横坐标，后正中线为纵坐标，建立二维直角坐标系，测量“项部四点”的水平投影并估算触发点位置，随后分析它们的空间关系，确定这4个穴位合理的针刺路径。
对于“项部四穴”，可采用6种针刺路径或部位：（1）天柱穴（BL 10）Ⅰ（直刺），即平行于天柱穴，在距后正中线旁开约0.5寸处；（2）天柱穴（BL 10）Ⅱ（直刺），在颅底水平距后正中线旁开约0.6寸处；（3）天柱穴（BL 10）Ⅲ（直刺），在天柱穴下方约0.6寸，距后正中线旁开约1.3寸处，或在天柱穴右下方斜刺；（4）风池穴（GB 20）Ⅰ（沿颅底向鼻尖方向斜刺），在胸锁乳突肌与斜方肌上部交界处凹陷处，平行于颅底水平，距后正中线旁开约2.25寸处，且距后正中线旁开2.25寸；（5）完骨穴（GB 12）Ⅰ（沿骨面直刺），在完骨穴上方约0.7寸处，即乳突后根与颅底交界处下方；（6）天牖穴（SJ 16）Ⅰ，在天牖穴下方约0.7寸处，即胸锁乳突肌后缘，操作时与天牖穴位置相同。
根据解剖学分析，建议沿上述天柱穴（BL 10）Ⅰ、Ⅱ、Ⅲ，风池穴（GB 20）Ⅰ，完骨穴（GB 12）Ⅰ和天牖穴（SJ 16）Ⅰ路径针刺项部四穴，以获得更好的治疗效果。颈源性头痛可能与枕部项部的触发点密切相关。
