An Observational Study Using Ultrasound to Assess Allowable Needle Insertion Range of Acupoint CV12.

BACKGROUND: Abdominal organ injuries are a rarely reported complication when deep acupuncture needling is applied to the abdomen. In order to ascertain the allowable needle insertion range (ANIR) of the abdomen region, we selected acupoint CV12, which is commonly used for treating gastric disease, and ANIR was measured with an ultrasound device. METHOD: Eighty-five healthy volunteers were recruited, of which 83 cases of ultrasound images were obtained. To investigate the prediction factor of ANIR, we also measured several anthropometric factors. RESULTS: The average ANIR was 25.3 ± 10.2; generally, the ANIRs of females were thicker than those of males; and the liver was observed in 62.7% subjects' ultrasound images. The non-observed group showed thicker ANIR and higher BMI than the liver-observed group. CONCLUSION: There are reliable variables that make it possible to predict the ANIR. It is advised to refer to anthropometric factors in needling acupoint CV12 to avoid complications with the acupuncture treatment. However, individual differences are not negligible when applying deep needling. Thus, if the risk is not judged before or during the procedure, practitioners could consider the patient's ANIR on CV12 when applying acupuncture by examining the individual anatomical structures using ultrasound and considering internal organ positions to prevent adverse events due to acupuncture.

Using magnetic resonance imaging to measure the depth of acupotomy points in the lumbar spine: A retrospective study.

BACKGROUND: The acupotomy is an acupuncture device recently used to stimulate lumbar vertebrae such as transverse processes (TPs) and facet joints (FJs). However, there are many organs, nerves, and blood vessels, which can lead to side effects if the needle misses the treatment target. Therefore, information regarding appropriate insertion depths, which is currently lacking, could facilitate its safe use. We retrospectively investigated the depth from the skin to the TP and FJ of the lumbar vertebrae, using magnetic resonance imaging (MRI). METHODS: This retrospective chart review was conducted at a single medical centre in Korea. From 55,129 patient records, 158 subjects were selected. Perpendicular depth from the skin to the left and right TPs and FJs was measured using T1-weighted sagittal plane MRI. Depth differences between the left and right sides were evaluated using the paired t-test and analysis of covariance (body mass index [BMI] as a covariate). The influence of BMI on depth at each location was evaluated by simple linear regression analysis. RESULTS: The mean age was 43.2 years and mean BMI was 23.6 kg/m2. The depth from skin to the TPs or FJs was unaffected by age, sex, or side. Mean depths (cm) were as follows: (TPs) L1 = 4.5, L2 = 4.9, L3 = 5.3, L4 = 5.7, L5 = 5.9; (FJs) L12 = 3.8, L23 = 4.0, L34 = 4.4, L45 = 4.6, L5S1 = 4.6. Depth was highly correlated with BMI at each location. CONCLUSION: The depth of TPs and FJs adjusted for BMI can safely and effectively be used for treatment via various invasive interventions, including acupotomy treatment, in the lumbar region.

Magnetic resonance imaging study of safe needling depth and angulation for acupuncture at BL40.

OBJECTIVES: The objectives of this study were to identify the mean safe needling depth and angle at BL40 between subjects, taking into account variables including sex and body mass index (BMI). METHODS: One hundred and twenty-four participants who had undergone magnetic resonance imaging (MRI) examination of the knee region for clinical indications were included in this study. BL40 needling sites were localized by World Health Organization (WHO) standards and were measured by MRI. As much as 70% of the value of AN (from the needle insertion point to the popliteal artery) was considered to represent the safe depth, and angle alpha between the BL40 straight line and the AN line was regarded as the safe angle. RESULTS: Overall, mean safe depth regardless of BMI and sex was 18.51 ± 3.56 mm (95% confidence interval (CI), 17.88%-19.14%). Mean safe depth was 17.24 ± 3.14 mm in the low and normal BMI group, 18.76 ± 2.90 mm in the overweight group, and 22.01 ± 3.71 mm in the obese group. Thirteen patients (10.5%) had internal deviation of angle alpha (95% CI, 5.6%-15.3%), while 111 patients (89.5%) had external deviation (95% CI, 84.7%-94.4%). The mean internal and external deviations of angle alpha were 8.78° ± 2.92° (95% CI, 7.01°-10.55°) and 9.75° ± 3.46° (95% CI, 9.10°-10.41°), respectively. CONCLUSION: We would suggest that, when using a straight needle insertion at BL40, it is safe to advance a 25-mm needle approximately 12.5 mm, and 17.5 mm should be safe for patients with BMI greater than 28 kg/m2. Practitioners should decrease the depth of penetration when treating patients of low body weight or height.

[Different needling depth for benign prostatic hyperplasia: a randomized controlled trial].

OBJECTIVE: To observe the therapeutic effect of different needling depth for benign prostatic hyperplasia. METHODS: A total of 70 patients with benign prostatic hyperplasia were randomized into an elongated needle group (35 cases, 1 case dropped off) and a filiform needle group (35 cases, 2 cases dropped off). Basic treatment combined with acupuncture were adopted in both groups, acupuncture was applied at Guanyuan (CV 4), Zhongji (CV 3), Shuidao (ST 28), Sanyinjiao (SP 6), Taixi (KI 3), Zhigou (TE 6). In the elongated needle group, acupuncture was performed at Guanyuan (CV 4), Zhongji (CV 3), Shuidao (ST 28) by elongated needle, the needling depth was 60-73 mm. In the filiform needle group, acupuncture was performed at Guanyuan (CV 4), Zhongji (CV 3), Shuidao (ST 28) by filiform needle, the needling depth was 25-30 mm. The treatment was given once a day (except Sunday), 2 weeks as one course, 1 course was required in both groups. Before and after treatment, the international prostate symptom score(IPSS), quality of life (QOL) score and prostate volume were observed in the two groups, and the therapeutic effect was evaluated. RESULTS: Compared before treatment, the IPSS and QOL scores after 1, 2-week treatment were reduced (P<0.01), and the IPSS and QOL scores after 2-week treatment were lower than those after 1-week treatment in the two groups (P<0.01); the IPSS and QOL scores after 2-week treatment in the elongated needle group were lower than the filiform needle group (P<0.05, P<0.01). After 2-week treatment, the prostate volume was reduced in the two groups (P<0.01, P<0.05). The total effective rate was 91.2% (31/34) in the elongated needle group, which was superior to 72.7% (24/33) in the filiform needle group (P<0.05). CONCLUSION: Both elongated needle and filiform needle can improve the symptom and quality of life in patients with benign prostatic hyperplasia, and elongated needle has the better therapeutic effect.

[Anatomic study on safe insertion of acupuncture needle in Qiuhou (EX-HN7) acupoint].

OBJECTIVE: To explore the anatomical structure of acupuncture point Qiuhou (EX-HN7) area for safe insertion of acupuncture needle. METHODS: A total of 28 orbital specimens of adult corpses (14 men and 14 women) were randomly selected to be observed by anatomical sectioning and layering methods. The acupoint EX-HN7, located at the junction between the 1/4 of the outer boundary and 3/4 of the inner boundary of the infraorbital margin according to the "Standardization of Acupoint Position" implemented by the People's Republic of China, and marked first with a color pen, followed by cutting the head into horizontal sections along the cross line by using a cadaver cutter and measuring the distance between the skin and blood vessels and main nerves with a digimatic caliper. When the anatomic hierarchy was performed, the blood vessels and nerves in the orbit, the morphological characteristics of the structure around the needle body were particularly focused. RESULTS: When an acupuncture needle was vertically inserted into EX-HN7 region, the tissues through which the needle passes are skin, subcutaneous tissue, orbicularis muscle, orbital adipose body, inferior oblique muscle and inferior orbital wall, respectively. When an acupuncture needle was inserted obliquely upward and along the inferior orbital wall to a depth of (26.5±1.7)mm, the needle tip met the posterior ciliary artery; when to a depth of (41.4±1.3)mm, it reached the superior ophthalmic vein. When inserted to a depth of (40.4±1.5)mm, the needle tip may damage the ophthalmic artery and optic nerve. When the acupuncture needle was inserted inferiorly and closely along the orbital inferior wall to a depth of (13.2±1.4)mm, the infraorbital artery in the suborbital sulcus would be hurt. CONCLUSION: It is recommended that when insert vertically into a depth of 12.0 mm in EX-HN7, the acupuncture needle tip should be slightly inclined inward and posterior-upward, and the depth should not exceed 26.0 mm.

Anatomic study on safe insertion of acupuncture needle in Qiuhou (EX-HN7) acupoint / 针刺研究

OBJECTIVE: To explore the anatomical structure of acupuncture point Qiuhou (EX-HN7) area for safe insertion of acupuncture needle. METHODS: A total of 28 orbital specimens of adult corpses (14 men and 14 women) were randomly selected to be observed by anatomical sectioning and layering methods. The acupoint EX-HN7, located at the junction between the 1/4 of the outer boundary and 3/4 of the inner boundary of the infraorbital margin according to the "Standardization of Acupoint Position" implemented by the People's Republic of China, and marked first with a color pen, followed by cutting the head into horizontal sections along the cross line by using a cadaver cutter and measuring the distance between the skin and blood vessels and main nerves with a digimatic caliper. When the anatomic hierarchy was performed, the blood vessels and nerves in the orbit, the morphological characteristics of the structure around the needle body were particularly focused. RESULTS: When an acupuncture needle was vertically inserted into EX-HN7 region, the tissues through which the needle passes are skin, subcutaneous tissue, orbicularis muscle, orbital adipose body, inferior oblique muscle and inferior orbital wall, respectively. When an acupuncture needle was inserted obliquely upward and along the inferior orbital wall to a depth of (26.5±1.7)mm, the needle tip met the posterior ciliary artery; when to a depth of (41.4±1.3)mm, it reached the superior ophthalmic vein. When inserted to a depth of (40.4±1.5)mm, the needle tip may damage the ophthalmic artery and optic nerve. When the acupuncture needle was inserted inferiorly and closely along the orbital inferior wall to a depth of (13.2±1.4)mm, the infraorbital artery in the suborbital sulcus would be hurt. CONCLUSION: It is recommended that when insert vertically into a depth of 12.0 mm in EX-HN7, the acupuncture needle tip should be slightly inclined inward and posterior-upward, and the depth should not exceed 26.0 mm.

[Effects of needling depth on clinical efficacy of lumbar disc herniation: a systematic review].

OBJECTIVE: To evaluate the effects of needling depth on clinical efficacy of lumbar disc herniation (LDH). METHODS: Ten electronic databases, including China National Knowledge Infrastructure (CNKI), VIP Database, Chinese Biomedical Literature Database (CBM), Wanfang Database, MEDLINE, CENTRAL, CINAHL PLUS, AMED, Embase, PsycINFO, and 6 registry platforms of clinical trials were searched. All randomized controlled trials (RCTs) that compared the effect of needling depth on clinical efficacy of LDH were collected; in addition, the reference lists of the studies included were hand searched. Data were extracted independently by two reviewers. RevMan 5.3 was applied to carry out statistical analysis. RESULTS: Totally 8 716 articles were retrieved, and 10 RCTs were included after screening, involving 1 116 patients. The results showed the effects of deep acupuncture onrelievingpain, reducing the Oswestry disability index (ODI), improving total effective rate and Japanese Orthopaedic Association (JOA) were superior to those of shallow acupuncture in patients with LDH. CONCLUSION: It is preliminarily indicated that deep acupuncture is helpful to improve the therapeutic effect of LDH; however, due to the low research quality and small sample size, the evidence is insufficient, and more high-quality researches are needed to further confirm the results.

Effects of needling depth on clinical efficacy of lumbar disc herniation: a systematic review / 中国针灸

<p><b>OBJECTIVE</b>To evaluate the effects of needling depth on clinical efficacy of lumbar disc herniation (LDH).</p><p><b>METHODS</b>Ten electronic databases, including China National Knowledge Infrastructure (CNKI), VIP Database, Chinese Biomedical Literature Database (CBM), Wanfang Database, MEDLINE, CENTRAL, CINAHL PLUS, AMED, Embase, PsycINFO, and 6 registry platforms of clinical trials were searched. All randomized controlled trials (RCTs) that compared the effect of needling depth on clinical efficacy of LDH were collected; in addition, the reference lists of the studies included were hand searched. Data were extracted independently by two reviewers. RevMan 5.3 was applied to carry out statistical analysis.</p><p><b>RESULTS</b>Totally 8 716 articles were retrieved, and 10 RCTs were included after screening, involving 1 116 patients. The results showed the effects of deep acupuncture onrelievingpain, reducing the Oswestry disability index (ODI), improving total effective rate and Japanese Orthopaedic Association (JOA) were superior to those of shallow acupuncture in patients with LDH.</p><p><b>CONCLUSION</b>It is preliminarily indicated that deep acupuncture is helpful to improve the therapeutic effect of LDH; however, due to the low research quality and small sample size, the evidence is insufficient, and more high-quality researches are needed to further confirm the results.</p>

Clinical Study on Puncturing Taiyang (EX) by Different Depths in Preventing Migraine in Remission / 上海针灸杂志

Objective To observe the change of Visual Analogue Scale (VAS) and satisfaction with treatment in preventing remissive migraine by puncturing Taiyang (EX-HN 5) at different depths. Methods Forty eligible migraine patients were randomized into a treatment group and a control group, 20 in each group. The treatment group was intervened by deep needling at Taiyang (EX-HN 5) as the predominant treatment, while the control group was by superficial needling at Taiyang (EX-HN 5) as the predominant treatment. The VAS score and satisfaction degree with treatment were evaluated before and after treatment. Results The VAS score was significantly changed after intervention in the treatment group (P0.05). Conclusions Compared to superficial needling at Taiyang (EX-HN 5), deep needling at Taiyang (EX-HN 5) can significantly reduce the headache degree..

An Anatomical Study of the Chengqi (ST1) / 浙江中医药大学学报

[Objective]To explore the anatomical structures,depth and direction of needling at Chengqi (ST1).[Methods] Forty-eight adult orbital specimens were observed by dissection.[Results] When a needle was vertically inserted into Chengqi (ST1),the needle tip would pass through the skin,subcutaneous tissue,orbicularis muscle,orbital adipose body,inferior obliges and inferior rectus.[Conclusion] The acupuncture of the Chengqi (ST1) should select straight sting needling back-upwards.The depth should not exceed 25.0mm.