.
Deng Aimin, Chinese Medical Aid Team in Morocco Shanghai Pudong Hospital
Keywords: channels and network vessels, acupuncture point, Dubi [ST-35]
The two points known as “Du Bi” or Xi Yan, are located medially and laterally at the lower border of the patella, and are important points used clinically to treat various knee joint issues. They course the channels and unblock the network vessels, resolve spasms, and alleviate pain. They have a noticeable effect on acute and chronic pathological changes to the knee joint when there are symptoms such as swelling, pain, numbness, and loss of function. Most historical literature on acupuncture considers the medial Du Bi to be an extraordinary point, while lateral Du Bi is classified as belonging to the yangming stomach channel. Modern acupuncture texts, including the Acupuncture Point Wall Chart that was reviewed and published by People’s Publishing House, are all in agreement with this view. However, in light of the theoretical principles regarding the channels and properties of points in Chinese medicine, and considering the indications, functions, and effects of this point in clinical practice, this position is open to discussion.
In TCM theory it is believed that “the hundred bones of the human body, the joints of its four limbs, the five viscera and six bowels, above and below, and the interior and exterior all are connected to each other by the channels and network vessels, and all are covered with points” . Among these, the points belonging to the twelve channels as well as the Ren Mai and Du Mai are called “channel points”, while the others are categorized as “extraordinary points” . However, the discovery and categorization of points on the channels and network vessels, the generalization and verification of their functions and indications, and the summarization and enhancement of theoretical knowledge is not set in stone, and this knowledge has undergone a long process of development and refinement. Taking the point Gao Huang Shu [BL-43] as an example, it was originally classified as a non-channel ex- traordinary point used for moxibustion. Because of its remarkable therapeutic effects, it was described in detail by Tang-dynasty doctors in Qian Jin Fang [Thousand Gold Pieces Prescriptions] and Qian Jin Yi Fang[Thousand Gold Pieces Supplemental Prescriptions]. Late Song-dynasty works such as Tongren Shuxue Zhenjiu Tujing [Illustrated Manual of Acupuncture Points of the Bronze Figure] listed it as part of the foot taiyang [greater yang] bladder channel, thus making it a channel point. Meanwhile, some extraordinary points, such as Taiyang and Fengshi [GB-31] have overshadowed the original channel points located nearby in terms of clinical application due to their convenient locations and remarkable effects. This shows that the attributions of channel points and extraordinary points are not only not set in stone, but are also not determined by their degree of therapeutic effect.
Discussions of the therapeutic functions of channels, network vessels, and points in the Huang Di Nei Jing point out that “that which a channel or network vessel passes through is that which is covered by the indications [for that channel or vessel]” . This is to say that, aside from treating local pathological changes, channel points more importantly can treat the areas their channel reaches and related pathological changes in the corresponding organ. For instance, He Gu [LI-4] may be needled for toothache, Hou Xi [KD- 3] may be used for stiff neck, Kong Zui [LU-6] can subdue cough and wheezing, and Shao Shang [LU-11] disperses throat illnesses. All of these reflect the special function of channel points to treat areas reached by their channels and pathological changes in associated organs. This is the theoreti- cal basis for choosing points on the lower body to treat the upper body, choosing points on the right to treat the left, and on the left to treat the right in the clinical practice of acupuncture. It is also an important principle for formulating local and distal point selections.
Returning to extraordinary points, although they are effective in treating local pathological changes, they do not have the function of treating distal ones. Although there are a few extraordinary points, such as Yao Tong Xue on the back of the hand or Xue Ya Dian [Blood Pressure Point] located 0.5 cun lateral to the transverse process of the sixth cervical vertebra, that have the theoretical effects of treating lumbar pain and lowering blood pressure, respectively, their effects are not notable in clinical practice and have not received much attention from doctors. In short, channel points have comprehensive therapeutic effects, while extraordinary points’ effects are limited to the local area. This is the key to differentiating channel points from extraordinary points.
From this it can be seen that lateral Dubi obviously does not fit the standards for a channel point. Xue Hai [SP- 10], located on the medial side of the knee joint, harmonizes the construction and clears heat. It can treat func-tional uterine bleeding, urticaria, and flooding and spotting. Wei Zhong [BL- 40] located behind the knee joint drains heat and fortifies the lumbar area, and has a clear effect in treating summer-heat stroke and lumbar sprain. Moreover, both Zu San Li [ST-36], known for its association with the stomach and abdomen, and Shang Ju Xu [ST-37] are located near lateral Du Bi on the foot yangming stomach channel. These points regulate the stomach and fortify the spleen, adjust qi and tonify blood, clear heat and transform dampness, harmonize the middle and unblock stagnation. These comprehen- sive actions make these two points important for treating illnesses of the stomach and intestinal tract. In contrast, aside from lateral Du Bi’s local action of treating pathological knee joint changes, there are no records in the literature that report on its functions in treating other distal pathological changes. Therefore, both lateral and medial Du Bi should be classified as extraordinary points and not channel points.
The channel attributes of points are a summary of long-term medical experience and, more importantly, are an important basis guiding clinical point selection. This essay represents one perspective on this issue and is intended to start a discussion in the hopes that experts will contribute their suggestions.
外犢鼻穴的屬性探討
中國駐摩洛哥醫療隊 鄧愛民上海浦東醫院
關鍵詞：經絡 穴位 犢鼻穴
位於髕骨下緣內外兩側的犢鼻穴，又稱膝眼穴，是臨床上治療各種膝關節病症的重要穴位。其功能疏經通絡， 解痙鎮痛，對膝關節急慢性病變，腫 痛，麻木，功能障礙等，均有顯著的療效。歷代針灸文獻中，大多把內犢鼻穴稱為奇穴，而將外犢鼻穴歸於足 陽明胃經。近代各類針灸專著及人民衛生出版社審核發行的《針灸穴位掛圖》等，均贊同此觀點。但是，對照祖國醫學中有關穴位歸經屬性的理論原則，結合臨床實踐中穴位主治的功能療效，這一說法值得商榷。
中醫理論認為“人體百骸，四肢關節，五臟六腑，上下內外，皆以經絡相聯繫，均為穴位所覆蓋”。其中，屬於十二經脈以及任、督兩脈的穴位稱為經穴，其餘統歸於奇穴。可是，經絡穴位的發現分類，功能主治的歸納驗證， 理論認識的總結提高，並非一成不變， 而是經歷了漫長的發展完善過程。以膏肓穴為例，其原是屬於施行灸法的經外奇穴，唐代醫家因其療效顯著載入《千金方》和《千金翼方》中，詳加介紹。後宋代《銅人腧穴針灸圖經》等書就把它列入足太陽膀胱經，從此成為經穴。 而有些奇穴，如太陽，風市等，因其定位方便，療效顯著，在臨床應用的範圍卻超過了原來附近的經穴。這表明，經穴奇穴的屬性定位，既非一成不變又不取決於治療效果的高低。如此看來，區別經穴和奇穴，究竟以什麼為標准，又有什麼實際的臨床意義呢？
祖國醫學的經典著作《黃帝內經》，在論述經絡，穴位的治療作用時精辟的指出“經脈所過，主治所及”就是說，經穴除了能治療局部的病變外，更重要的，是能治療本經絡循行部位以及相聯繫臟腑的有關病變。例如，針合谷穴治齒痛，取後溪穴療落枕，選孔最穴平咳喘，刺少商穴消咽疾，無不體現出經穴治療所屬經絡循行部位，相關臟腑病變 的特異性作用。這就是針灸臨床上病下取，下病上取，左病右取，右病左取所依照的理論根據。也是制定局部取穴和遠道取穴的重要原則。反觀奇穴，儘管具有治療局部病變的療效，卻並不具備治療遠處病變的功能。即使有一些奇穴，如掌背的腰痛穴、第六頸椎橫突旁 開0.5寸的血壓點，有治療腰痛，降低血壓的理論功能，但臨床實踐的效果並不 明顯，也不受醫家重視。總而言之，經穴的治療作用是綜合性的，奇穴則是局限性的，這是區別划分經穴和奇穴的關鍵所在。
由此看來，外犢鼻穴顯然不符合經穴的標准。膝關節內側的血海穴和營清熱，能治療功能性子宮出血，蕁麻疹，崩漏。膝關節后側的委中穴泄熱健腰，對中暑，腰扭傷有明顯的療效。外犢鼻穴附近，同屬足陽明胃經，素有“肚腹 三里留”之稱的足三里穴和上巨虛穴，更具備理胃健脾，調氣補血，清熱化溼，和中通滯等綜合性功效，是治療胃腸道疾病的重要穴位。而外犢鼻穴除治療膝關節病變的局部功效外，尚無文獻記載報道有治療其他遠處病變的功能，所以外犢鼻穴和內犢鼻穴一起應該歸於奇穴而不是經穴。
有關穴位的歸經屬性，即是長期醫學實踐的經驗總結，更是指導臨床選穴的重要根據。本文作為一家之言，意在拋磚引玉，誠盼專家指正。
