|
Advances In Research On The Safety Of
Acupuncture For Acupoints GV 15, GV 16, And GB 20
In The Treatment Of Cerebrovascular Disease
Jixian Zhao, MD
Bing jie Jiao, MD
ABSTRACT
Acupoints GV 15, GV 16, and GB 20 are significant in the treatment of cerebrovascular disease. Incorrect direction or the wrong depth of needling will result in damage to the tissue of the central nervous system. The recommended regression equation for clinical depth of needling GV 15, 16 when obtaining Qi, is:
GV 15 Y(cm)=2.7183 + 0.07X
GV 16 Y(cm)=2.6475 + 0.0778X
X Length of the cervical girth of the patient
Y Depth of needling when obtaining Qi
In ancient Chinese classical work in acupuncture, the safe direction of needling insertion for GB 20 is in the direction of the contralateral eyeball. Recent Chinese researchers suggest that the correct direction of needling insertion for GB 20 is in the direction of the apex of the nose. We discuss herein the depths and directions of needling for GV 15, GV 16 and GB 20.
KEY WORDS
Acupuncture, GV 15, GV 16, GB 20, Safety, Cerebrovascular Disease
INTRODUCTION
Clinical experience demonstrates that acupuncture at GV 15, GV 16, and GB 20 for cerebrovascular disease is effective. Li et al summarized the treatment with acupuncture at GV 15-16 in 125 patients with ischemic cerebrovascular disease. The total curative effect was 99%; for the patients with cerebral hemorrhage, curative effect was 83%; the control group with another acupoint was 37%.1,2
GV 15, 16, and GB 20 are located near the medullary bulb and bulbar center. The authors reviewed the research on the safety of acupuncture for these acupoints. Medical errors may occur when needling too deeply or in the wrong angling of needling insertion.
CLINICAL AND ANATOMICAL STUDIES FOR GV 15 and GV 16
Clinical Studies
Li et al summarized the interrelation between the depth of needle insertion and the cervical girth when needling GV 15, 16 and obtaining Qi in 197 patients with cerebrovascular disease. The regression equations are: 3,4
GV 15 Y(cm)=2.7183+ 0.07X
GV 16 Y(cm)=2.6475+0.0778X
X Length of the cervical girth of the patient
Y Depth of needling when obtaining Qi
The regression equation was derived based on the mean depth of needling when obtaining Qi, and the mean length of the cervical girth of the patient by means of the Least Square Method in 197 patients. Total sessions of acupuncture were 10,578. The cervical girth was measured on the level of 3 cm above the apex of spinous process of the 7th cervical vertebrae. (The accurate unit of measurement was in centimeters.) In ancient Chinese classical work, GV 15 is located on the GV Meridian 1.65 cm directly above the hairline; GV 16 is 3.33 cm above the hairline. Because the human hairline is different for each individual, it is necessary to needle GV 15 and 16 according to the anatomical mark.
Anatomical Studies
Li et al measured the cervical girth and the depth of needling insertion at GV 15, 16 when needling insertion reached the anterior margin of the atlanto-occipital ligament and yellow ligament in 52 cadavers. The cadavers were all more than 3 months postmortem and were fixed by 10% Formalin solution. The anatomical measurement showed that the rate of the depth of needling insertion to cervical girth is 0.14 in both male and female at GV 16, and 0.13 at GV 15. A positive interrelation exists between the depth of needling insertion and the cervical girth of the cadaver.
When needling GV 16, it appears to be safest when the direction of needling insertion is perpendicular or oblique insertion in the lower direction. The patient should be sitting with the head leaning forward slightly and relaxed. (Some acupuncturists suggest that whenever needling GV 15, 16, it is safest when the direction of needling insertion takes an oblique insertion in the direction of the oral cavity or mandible.)
It is necessary to avoid lifting, thrusting, twisting, and twirling the needle; the depth of insertion should be limited from 0.5 cm to 1.0 cm. To avoid injury of the medullary bulb5,6,8,9 when needling GV 15 and 16, insertion in the direction of the upper position or deep insertion should be avoided.
CLINICAL AND ANATOMICAL STUDIES OF GB 20
Clinical Studies
In the ancient classical works of Chinese acupuncture, the safest needling insertion of GB 20 was in the direction of the contralateral eyeball.13 However, in the past 10 years, Chinese research on the anatomical construction and safest acupuncture techniques reveal that the above-mentioned direction of needling insertion for GB 20 is inaccurate and may damage the medullary bulb.7,10,12
Fang measured the planes from GB 20 to: 1) the contralateral inner canthus of the eye, 2) the contralateral eyeball and, 3) the apex of the nose, by 3-dimensional computed tomography scan (CT) in 16 patients (8 females, 8 males). Results showed the most danger to be when GB 20 needle insertion was deeply in the direction of the contralateral eyeball, because it may damage the medullary bulb when needling deeply in the direction of the inner canthus of the contralateral eye. Also, it may occasionally damage the vertebral artery and medullary bulb. Less dangerous is needle insertion in the direction of the apex of the nose; however, it may damage the vertebral artery if inserted too deeply.14
Most acupuncturists in China today agree on this viewpoint, i.e., that needling insertion should be in the direction of the apex of the nose, and the depth of insertion should be limited from 0.8 to 1.2 cm.
Anatomical Studies
Zhou measured the distance in cadavers between the skin on GB 20 and the corresponding point of GB 20 on the posterior membrane of atlanto-occipitalis. The maximum value was 48.5 mm; minimum value was 41.6 mm.7,10
Yang measured the depth of acupuncture safety at GB 20 in 52 cadavers (17 females, 35 males); males, mean value was 41.21±3.82 mm; females, mean value was 43.88±4.61mm. Li et al measured the distance in 8 male cadavers; maximum value was 49 mm; minimum value was 41 mm; mean value was 44 mm. It appears to be safest that needling insertion at GB 20 be limited to not more than 35-40 mm.
CONCLUSION
The anatomical constructions of acupoints GV 15, 16, and GB 20 are located near the great occipital foremen, lower segment of the medullary bulb, cerebellum, and cervical segment of the spinal cord. If needling insertion is too deep or in a wrong direction, acupuncture of these 3 points may damage the anatomical construction and vertebral artery or posterior artery of the spinal cord. Subarachnoid hemorrhage may develop.
When needling GV 15 and GB 16, the direction of needling insertion should be perpendicular to or in the direction of the oral cavity or mandible. The depth of needling insertion for GV 16 should be limited to 3.3 cm; for GV 15, it should be limited to 3.3 cm. When needling GB 20, it is necessary that the direction of needling insertion should be in the direction of the apex of the nose; the depth of needling insertion should be limited to 3.96 cm. It should be emphasized that needling insertion ought to be limited to obtain Qi according to the accurate angle and the depth of needling insertion.
REFERENCES
- Li D, Zhao J, Niu L, et al. Clinical observation on acupuncture treatment in 125 cases with cerebral hemiplegia. J Shanxi Traditional Chinese Medicine. 1988;3:37.
- Li D, Li W, Zhao Y, et al. Clinical report of acupuncture for cerebral hemorrhage. J Traditional Chinese Medicine. 1988;5:30.
- Li D, Li Y. Research on the effect of needling acupoint DU 16, DU 15 (Editor's Note: GV 16, GV 15). J Shanghai Acupuncture and Moxibustion. 1991;4:29.
- Li R, Li D, Yr G, et al. Morphological study on acupoint DU 16, DU 15 (GV 16, GV 15). Chinese J Anatomy. 1987;1:50.
- Sn C. China Acupuncture and Moxibustion. Beijing, People's Republic of China: Beijing People's Medicine Publishing House; 2000.
- Cheng B. New Dictionary of Acupuncture and Moxibustion Beijing. Beijing, People's Republic of China: Huaxia Publishing House; 1995.
- Zhou J. Acupuncture Damage and Safe Acupuncture for Dangerous Acupoints. Chengdu, Sichuan, People's Republic of China: Chengdu Sichuan Science and Technology Publishing House; 1995.
- Sun G. Acupuncture and Moxibustion. Beijing, People's Republic of China: Beijing People's Medicine Publishing House; 1998.
- Guo C, Zhang L, Ma H. Study and Use of Acupuncture and Moxibustion. Beijing, People's Republic of China: Beijing Xue Yuan Publishing House; 1998.
- Zhou J. Research on safe acupuncture for GB 20 J.Yunnan. Traditional Chinese Medicine. 1989;1:28.
- Zhanlin Y, Zanhou S, Niu X, et al. Research on the depth for DU 16 , DU 15 (GV 16, GV 15), GB 20. J Shanxi Traditional Chinese Medicine. 1985;1:45.
- Li W, Du Z, Fang, Z et al. Research on the anatomical construction and safe acupuncture for GB 20. J Chinese Acupuncure and Moxibustion. 997;8:505.
- Institute of TCM. Brief Acupuncture and Moxibustion. Beijing, People's Republic of China: Beijing People's Medicine Publishing House; 1976.
- Jinliang F, Ying HW, Min Z, et al. Primary study for safe acupuncture of GB 20 by computed tomography scan. J Chinese Acupuncture and Moxibustion. 2000;5:287.
AUTHORS' INFORMATION
Dr Jixian Zhao is Professor of Surgery and Chief of Division of Urology at Shenyang Red Cross Hospital in Shenyang, People's Republic of China. Dr Zhao is a member of the China Association of Acupuncture and Moxibustion, and practices Medical Acupuncture full-time with general patients.
Jixian Zhao, MD*
389 Zhongshan Rd
Shenyang 110013
P R China
Phone: 086-024-22942012, #3317 • Fax: 086-024-22903566
E-mail: jixzhao@hotmail.com
Dr Bing jie Jiao is Associate Professor in the Department of Traditional Chinese Medicine at Shenyang Obstetric and Gynecology Hospital. Dr Jiao is a member of the China Association of Acupuncture and Moxibustion, and is a member of the TCM Association.
Bing jie Jiao, MD
90 Youth St
Shenyang 110014
P R China
*Correspondence and reprint requests
|
