后溪穴实体解剖结构研究

Anatomical study of the physical structures of the Houxi (SI3) acupoint

摘要

目的 探索后溪穴的实体解剖结构。方法 ①检索读秀学术搜索、《中华医典》古籍数据库，查阅包含后溪穴定位的古籍，整理归纳古籍中对后溪穴的定位描述。②选取20名志愿者，根据古代文献中后溪穴的定位进行体表按压，确定出现穴感位置并标记，标定为穴位的体表投影点，并使用B超观测指端按压的组织结构。③选取10名志愿者，根据古籍整理归纳的穴位定位，在手指按压标记区域及其周边不同深度、方向针刺，当出现明显穴感时，使用B超观测针尖所触碰的穴感结构。④在10侧新鲜人体上肢标本上，解剖观测后溪穴穴感结构。⑤根据解剖结果，在志愿者身上用B超找到后溪穴穴感结构，用拇指指端按压该结构与其周围组织，对比感知差异。⑥根据解剖观察到的穴位结构，在志愿者身上用B超找到后溪穴穴感结构，用毫针分别针刺该结构及其周围组织，对比感知差异。结果 ①古籍中描述后溪穴在“手小指外侧本节后陷中”。②体表按压出现“穴感”时，B超下观测按压位置在第5掌骨颈尺掌侧。③针刺出现“穴感”时，B超下观测针尖触碰的穴感结构为第5掌骨颈尺掌侧。④通过系统层次解剖与断层解剖后发现，针尖触碰到的穴感结构为第5掌骨颈尺掌侧处的骨门。⑤在B超下对第5掌骨颈尺掌侧及周围组织按压，发现当只有按压到第5掌骨颈处时，可产生明显有别于其他部位的穴感。⑥在B超引导下对第5掌骨颈尺掌侧骨门及周围组织针刺，发现当只有针尖触碰到第5掌骨颈尺掌侧骨门时，可产生明显有别于其他部位的穴感。结论 后溪穴实体解剖结构位于第5掌骨胫尺掌侧骨门处。

Abstract

Objective To investigate the gross anatomical (physical) structures underlying the Houxi (SI3) acupoint. Methods 1) We searched the Duxiu Academic Database and the Zhonghua Yidian Classical Literature Database for ancient texts describing the location of Houxi, and summarized the historical location descriptions. (2) Twenty volunteers were enrolled; based on the locations reported in classical texts, thumb-tip pressure was applied on the skin to identify sites eliciting an acupoint sensation, which were marked as the surface projection points of the acupoint. B-mode ultrasound was used to observe which tissue structures were compressed by the fingertip. (3) Ten volunteers were selected for needling: according to the literature-based location, filiform needles were inserted at different depths and directions in and around the marked area; when a clear acupoint sensation occurred, B-mode ultrasound was used to observe which structure the needle tip contacted. (4) Ten fresh human upper-limb specimens were dissected for observation of the anatomical structures corresponding to the Houxi acupoint. (5) Based on the dissection result, volunteers were examined by ultrasound to locate the anatomical structure; thumb-tip pressure was applied to that structure and to surrounding tissues to compare perceived sensations and test whether a distinct acupoint sensation occurred only when the dissected structure was pressed. (6) Under ultrasound guidance, filiform needles were used to puncture the dissected structure and adjacent tissues in volunteers to compare sensations, testing whether a distinct acupoint sensation occurred only when the needle tip contacted the anatomically identified structure. Results 1) Classical texts describe Houxi as located “on the posterior depression of the basal joint of the little finger on its lateral side.” (2) When acupoint sensation was evoked by surface pressure, ultrasound showed the pressed site corresponded to the ulnopalmar aspect of the neck of the 5th metacarpal. (3) When needling evoked acupoint sensation, ultrasound showed the needle tip contacted the structure at the ulnopalmar aspect of the neck of the 5th metacarpal. (4) Systematic layered dissection and sectional anatomy revealed that the structure contacted by the needle tip is the osseous foramen located at the ulnopalmar aspect of the neck of the 5th metacarpal. (5) Under ultrasound, pressure on the ulnopalmar aspect of the 5th metacarpal neck produced a distinct acupoint sensation that was different from sensations elicited at surrounding sites, and this distinct sensation occurred only when pressure reached the osseous region at the 5th metacarpal neck. (6) Ultrasound-guided needle puncture of the osseous foramen at the ulnopalmar aspect of the 5th metacarpal neck elicited a distinct acupoint sensation only when the needle tip contacted that osseous structure, compared with puncture of surrounding tissues. Conclusion The physical (gross anatomical) correlate of the Houxi acupoint is located at the osseous foramen on the ulnopalmar aspect of the neck of the fifth metacarpal.

关键词

腧穴 / 后溪穴 / 解剖 / 实体解剖 / 骨门

Key words

acupoint / Houxi (SI3) / anatomy / gross anatomy / osseous foramen

参考文献

[1] 宿杨帅, 景向红. 穴位——针灸国际研究的焦点与分歧[J]. 针刺研究, 2025, 50(5): 519-525.

[2] 王增涛. 古典穴位实体解剖结构探索[J]. 现代中医临床, 2024, 31(1): 16-21.

[3] 王增涛. 对传统穴位实施实体解剖结构研究的背景及进程[J]. 山东医药, 2023, 63(9): 1-2.

[4] 沈雪勇, 刘存志. 经络腧穴学[M]. 5版. 北京: 中国中医药出版社, 2021: 87.

[5] 王春霖, 束钊昱, 张帅, 等 . 列缺穴实体解剖结构研究[J]. 北京中医药大学学报, 2025, 48(7): 992-999.

[6] 康姊玉, 王强, 王增涛, 等 . 鱼际穴实体解剖结构[J]. 现代中医临床, 2024, 31(1): 22-27.

[7] 李猛智, 亓恒涛, 齐耀东, 等 . 合谷穴实体解剖结构[J]. 山东医药, 2023, 63(9): 3-7.

[8] 赵延茹, 董丽琨, 亓恒涛, 等 . 三间穴实体解剖结构[J]. 山东医药, 2023, 63(9): 8-11.

[9] 王琨, 赵如元, 康姊玉, 等 . 二间穴实体解剖结构[J]. 现代中医临床, 2024, 31(1): 28-31.

[10] 南京中医学院. 黄帝内经[M]. 上海: 上海科学技术出版社, 2018: 142.

[11] 高武. 针灸节要[M]. 张建斌, 刘海蓉, 校注. 北京: 中国中医药出版社, 2018: 110.

[12] 黄龙祥. 黄帝明堂经辑校[M]. 北京: 中国医药科技出版社, 1987: 89.

[13] 皇甫谧. 针灸甲乙经[M]. 黄龙祥, 整理. 北京: 人民卫生出版社, 2006: 45.

[14] 王惟一. 铜人腧穴针灸图经[M]. 影印本. 北京: 中国书店, 1987: 18.

[15] 郑金生. 圣济总录[M]. 北京: 人民卫生出版社, 2013: 577.

[16] 王执中. 针灸资生经[M]. 北京: 人民卫生出版社, 2023: 91.

[17] 滑寿. 十四经发挥(大字版)[M]. 北京: 中国医药科技出版社, 2018: 23.

[18] 陈会. 神应经[M]. 北京: 中医古籍出版社, 1990: 13.

[19] 黄龙祥. 针灸集书点评[M]. 北京: 中国医药科技出版社, 2021: 58.

[20] 高武. 针灸聚英[M]. 闫志安, 校注. 北京: 中国中医药出版社, 1997: 48.

[21] 徐春甫. 古今医统大全集要[M]. 沈阳: 辽宁科学技术出版社, 2007: 64.

[22] 祁坤. 外科大成[M]. 新1版. 上海: 上海科学技术出版社, 1958.

[23] 孙思邈. 备急千金要方[M]. 影印本. 北京: 人民卫生出版社, 1955: 340.

[24] 阎明广. 子午流注针经[M]. 李鼎, 李磊, 校订. 上海: 上海中医学院出版社, 1986: 45.

[25] 孙思邈. 千金翼方[M]. 影印本. 北京: 人民卫生出版社, 1955: 223.

[26] 吴棹仙. 子午流注经说难[M]. 北京: 中国中医药出版社, 2019: 66.

[27] 李鼎. 西方子明堂灸经校注[M]. 上海: 上海中医学院出版社, 1990: 75.

[28] 朱橚. 普济方·针灸门[M]. 北京: 北京科学技术出版社, 2018: 24.

[29] 汪机. 针灸问对[M]. 新1版. 上海: 上海科学技术出版社, 1959: 65.

[30] 石学敏. 中西汇参铜人图说[M]. 长沙: 湖南科技出版社, 2021: 118.

[31] 廖润鸿. 勉学堂针灸集成[M]. 赵小明, 校注. 北京: 中国中医药出版社, 1998: 29.

[32] 管周桂. 针灸学纲要[M]. 新1版. 北京: 人民卫生出版社, 1955: 69.

[33] 王傈. 考正穴法[M]. 北京: 中医古籍出版社, 1987: 129.

[34] 李守先. 针灸易学[M]. 董晋宝, 点校. 北京: 人民卫生出版社, 1990: 39.

[35] 杨继洲. 针灸大成[M]. 北京: 人民卫生出版社, 2024: 76.

[36] 王国瑞. 扁鹊神应针灸玉龙经[M]. 韩辉, 校注. 北京: 中国医药科技出版社, 2025: 84.

[37] 琼瑶真人. 针灸神书[M]. 陆寿康, 校注. 北京: 中医古籍出版社, 2014: 130.

[38] 吴崑. 针方六集[M]. 黄龙祥, 点评. 北京: 中国医药科技出版社, 2021: 39.

[39] 黄龙祥. 循经考穴编点评[M]. 北京: 北京科学技术出版社, 2021: 41.

[40] 张介宾. 类经图翼[M]. 北京: 人民卫生出版社, 1965: 213.

[41] 傅仁宇. 审视瑶函[M]. 郭君双, 赵艳, 整理. 北京: 人民卫生出版社, 2006: 168.

[42] 吴谦. 医宗金鉴[M]. 北京: 中国医药科技出版社, 2024: 134.

[43] 李学川. 针灸逢源[M]. 上海: 上海科学技术出版社, 1987: 121.

[44] 张三锡. 经络考[M]. 丁侃, 校注. 北京: 中国医药科技出版社, 2012: 18.

[45] 方慎庵. 金针秘传[M]. 北京: 人民卫生出版社, 2008: 114.

[46] 黄龙祥. 针灸大全点评[M]. 北京: 人民卫生出版社, 2021: 65.

[47] 陈寿田. 经脉图考[M]. 北京: 人民卫生出版社, 1976: 103.

[48] 李永明, 陈波. 一篇被反复错引的重要针灸文献及60年代初的穴位解剖研究[J]. 中华中医药学刊, 2024, 42(4): 12-14.

基金资助

安徽省中医药传承创新科研项目计划(皖中医药秘〔2024〕6号)