| BackgroundIn1990, the national standard "Location of Points" in Chinese and English was promulgated by China. In2006, the revised version of the standard "Nomenclature and Location of Acupuncture Points" was published again. In November1st,2006, the international standard "Location of Acupuncture Points" was adopted in the expanded conference of World Health Organization Western Pacific Region. In February1st,2010,"WHO Standard Acupuncture Point Locations in the Western Pacific Region", the international standard location of acupoints, was published. The standardization of acupoint locations has made the clinical manipulation standardized, the development of acupuncture education promoted, the international academic exchanges strengthened, and guaranteed the orderly spreading of acupuncture internationally. Howerver, it has also led some acupuncturists excessively emphasize the fixed acupoint locations, while ignore the necessity of "seeking acupoints" or "feeling acupoints", resulting in problems like poor clinical efficacy, etc. The acupoint is not a simple isolated stationary point located on the "skin, flesh, sinews and bones", but an area interlinked with meridian qi, and being able to react the functional changes of meridian qi. The meridian belongs to viscera internally and is connected to segments externally, with a function of "moving blood qi, and nourishing yin yang". Therefore, the viscera, meridians and acupoints are closely linked, and the state of acupoint will vary with the qi and blood changes of viscera and meridians. That is to say, the physiological function, pathological response and the treatment effect of acupoints will constantly change with the excess and deficiency of visceral qi and blood, and the exuberance and debilitation of the visceral functional status. The above characteristic of acupoints is called dynamism."Before needling, the acupuncturist must check the excess and deficiency of meridian by palpating alongthe meridian……" Since the acienct time, acupuncturists have recognized the dynamism of acupoints, and tend to obtain the real acupoint by seeking or feeling acupoints, so that a better clinical efficacy can be achieved. At the different time and states of body, the function level and surface area of acupoints will vary with the qi and blood changes of viscera and meridians, and the surface area will be expanded in pathological state. At present, researches about dynamism of acupoints are mostly limited in theorectical study without objective test data to support. Researches about acupoint surface area are also less, and the further study is needed. ObjectiveTo study the dynamism of acupoints with the objective test data by evaluating the tenderness reaction and surface tenderness area of acupoints in different physiological and pathological states.Method60females between15and35years old were enrolled into the trial,30with primary dysmenorrhea as test group, and30healthy ones without dysmenorrhea as control group. The tenderness occurrence rate, visual analog scales (VAS) value and tenderness threshold were measured to evaluate the tenderness reaction of SP6(sanyinjiao), SP8(di ji) and SP9(yin ling quan) of the spleen meridian on both sides; the tenderness range, the distance between the most sensitive point in the surface tenderness area and the standard location point, the distance between the farthest point in the surface tenderness area and the standard location point, and the distance between the furface tenderness area of SP6(sanyinjiao) and SP8(di ji) and the adjacent meridians were measured. All measurements were done separately in menstrual period when abdominal pain occurred (menstrual period) and non-menstrual period in test group, and the menstrual period and non-menstrual period in control group.ResultsTrial1Research on the Tenderness Reaction of Acupoints on Spleen Meridian1. Comparison of tenderness occurrence rate in menstrual and non-menstrual periodThe tenderness occurrence rates of SP6(sanyinjiao) and SP9(yin ling quan) in menstrual and non-menstrual period of both groups are all very high, reaching94%-100%, and there is no significant difference between the two groups and the two periods (P>0.05). The tenderness occurrence rate of SP8(di ji) in menstrual period of test group (88.3%) is significantly higher than that in non-menstrual period of test group (63.3%) and menstrual period of control group (51.7%)(P<0.05); that in non-menstrual period of test group is significantly higher than that in non-menstrual period of control group (31.7%)(P<0.05); while there is no significant difference in the menstrual period and non-menstrual period of control group (P>0.05).2. Comparison of tenderness VAS value and tenderness threshold in menstrual and non-menstrual periodThe VAS values of SP6(sanylnjiao), SP8(di ji) and SP9(yin ling quan) in menstrual period of test group were separately significantly higher than that in non-menstrual period of test group, and in menstrual and non-menstrual periods of control group (P<0.05). The tenderness thresholds of SP6(sanyinjiao), SP8(di ji) and SP9(yin ling quan) in menstrual period of test group were separately significantly lower than that in non-menstrual period of test group, and in menstrual and non-menstrual periods of control group (P<0.05). For the VAS values and tenderness thresholds of SP6(sanyinjiao), SP8(di ji) and SP9(yin ling quan), there is no significant difference between the menstrual and non-menstrual periods of control group (P>0.05). For the VAS values and tenderness thresholds of SP6(sanyinjiao) and SP8(di ji), there is no significant difference between the non-menstrual periods of test group and control group (P>0.05). The VAS value of SP9(yin ling quan) in non-menstrual period of test group was significantly higher than that in non-menstrual period of control group (P<0.05), and the tenderness threshold of SP9(yin ling quan) in non-menstrual period of test group was significantly lower than that in non-menstrual period of control group (P<0.05).3. Comparison of tenderness reaction among the acupoints of spleen meridianIn menstrual period of test group and control group, the tenderness occurrence rates and tenderness sensitivities of SP6(sanyinjiao) and SP9(yin ling quan) are significantly higher than those of SP8(di ji)(P<0.05). In menstrual period of test group, the tenderness sensitivity of SP9(yin ling quan) is significantly higher than that of SP6(sanyinjiao)(P<0.05), while in menstrual period of control group, there is no significant difference between the tenderness sensitivities of SP6(sanyinjiao) and SP9(yin ling quan)(P>0.05). In non-menstrual period of test group, the tenderness sensitivity of SP9(yin ling quan) is significantly higher than that of SP6(sanyinjiao) and SP8(di ji)(P<0.05). In non-menstrual period of control group, the tenderness occurrence rates of SP6(sanyinjiao) and SP9(yin ling quan) are significantly higher than that of SP8(di ji)(P<0.05), while there is no significant difference among the tenderness sensitivities of the three acupoints (P>0.05).Trial2Research on the Surface Tenderness Range of Acupoints on Spleen Meridian1. The distribution range of the most sensitive points in surface tenderness areaThe distribution ranges of the most sensitive points in surface tenderness area to the standard acupoint locations of SP6(sanyinjiao), SP8(di ji) and SP9(yin ling quan):in menstrual period of test group, are separately0.597-0.796cm,0.565-0.903cm,1.069-1.528cm; in non-menstrual period of test group, are separately0.574-0.8443cm,0.515-0.974cm,0.713-1.07cm; in menstrual period of control group, are separately0.586-0.778cm,0.656-1.031cm,0.707-1.089cm; in non-menstrual period of control group, are separately0.598-0.806cm,0.571-1.156cm,0.552-0.86cm. For the distribution ranges of the most sensitive points in surface tenderness area of SP6(sanyinjiao) and SP8(di ji), there is no significant difference between the two groups and the two periods (P>0.05). For the distribution range of the most sensitive points in surface tenderness area of SP9(yin ling quan), there is no significant difference between the menstrual periods of test group and control group, menstrual and non-menstrual periods of control group, non-menstrual periods of test group and control group (P>0.05), while that in menstrual period of test group is significant larger than that in non-menstrual period (P<0.05).2. The distribution range of the farthest points in surface tenderness areaThe distribution ranges of the farthest points in surface tenderness area to the standard acupoint locations of SP6(sanyinjiao), SP8(di ji) and SP9(yin ling quan):in menstrual period of test group, are separately1.5112-1.7788cm,1.553-1.918cm,2.166-2.628cm; in non-menstrual period of test group, are separately1.6302-1.8964cm,1.462-2.012cm,1.869-2.201cm; in menstrual period of control group, are separately1.2979-1.4970cm,1.399-1.733cm,1.752-2.152cm; in non-menstrual period of control group, are separately1.3444-1.5591cm,1.24-1.77cm,1.445-1.793cm. For the distribution ranges of the farthest points in surface tenderness area of SP6(sanyinjiao), SP8(di ji) and SP9(yin ling quan), there is no significant difference between the menstrual and non-menstrual periods of test group, menstrual and non-menstrual periods of control group (P>0.05). The distribution ranges of the farthest points in surface tenderness area of SP6(sanyinjiao) and SP8(di ji) in menstrual period of test group are larger than that in menstrual period of control group, while there is no significant difference (P>0.05). The distribution range of the farthest points in surface tenderness area of SP9(yin ling quan) in menstrual period of test group is significantly larger than that in menstrual period of control group (P<0.05). The distribution ranges of the farthest points in surface tenderness area of SP6(sanyinjiao) and SP9(yin ling quan) in non-menstrual period of test group are significant larger than that in non-menstrual period of control group (P<0.05). For the distribution range of the farthest points in surface tenderness area of SP8(di ji), there is no significant difference between the non-menstrual period of test group and the non-menstrual period of control group (P>0.05).3. Location relationship between the surface tenderness area and the adjacent meridiansFor the intersecting rates of the surface tenderness area and spleen-liver meridian boundary of SP6(sanyinjiao), there is no significant difference between the two groups and the two periods (P>0.05). For the intersecting rates of the surface tenderness area and spleen-kidney meridian boundary, there is no significant difference between the menstrual and non-menstrual periods of test group, the menstrual and non-menstrual periods of control group (P>0.05), while that in menstrual period of test group is significant higher than that in menstrual period of control group (P<0.05), and that in non-menstrual period of test group is significantly higher than that in non-menstrual period of control group (P<0.05). For the intersecting rates of the surface tenderness area and spleen-liver meridian boundary of SP8 (di ji), there is no significant difference between the menstrual and non-menstrual periods of test group, the menstrual and non-menstrual periods of control group (P>0.05), while that in menstrual period of test group is significantly higher than that in menstrual period of control group (P<0.05), and that in non-menstrual period of test group is significantly higher than that in non-menstrual period of control group (P<0.05).Conclusion1. When the lower abdominal pain occurs in the primary dysmenorrhea patients, there is an obvious positive reflection of tenderness at SP6(sanyinjiao), SP8(di ji) and SP9(yin ling quan).2. The tenderness VAS value and tenderness threshold of SP6(sanyinjiao), SP8(di ji) and SP9(yin ling quan) keep varying with the changes of physiological and pathological states of the female menstruation. There are dynamism characteristics for the tenderness sensitivity of SP6(sanyinjiao), SP8(di ji) and SP9(yin ling quan).3. The distribution ranges of the most sensitive points and the farthest points in the surface tenderness area of SP6(sanyinjiao), SP8(di ji) and SP9(yin ling quan), and the location relationship between the surface tenderness area and the adjacent meridians of SP6(sanyinjiao) and SP8(di ji) keep varying with the changes of physiological and pathological states of the female menstruation. There are the dynamism characteristics for the tenderness distribution ranges of SP6(sanyinjiao), SP8(di ji) and SP9(yin ling quan).4. There are tenderness sensitivity phenomena for young nulliparous women both in physiological and phathological states, and SP6(sanyinjiao) and SP9(yin ling quan) appear a higher occurrence than SP8(di ji).5. The tenderness sensitivities of SP6(sanymjiao) and SP9(yin ling quan) are higher than that of SP8(di ji) in menstrual period for females with or without primary dysmenorrhea. |
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