Medicine D U N G S E C O N D E D I T I O N AC U P U N CTU R E A C an anatomical approach U P Practiced for more than 2,000 years, acupuncture was once restricted U to the realm of alternative medicine. It was thought to be based on mythical elements and not easily understood by those in the scientific N community. Acupuncture: An Anatomical Approach, Second Edition dispels these notions and brings this once backroom therapy into the C S E C O N D E D I T I O N forefront—explaining it in terms that can be easily comprehended by all medical professionals. T ACU P U NCTU RE U Presenting a scientific, anatomical approach to acupuncture, this volume discusses the basics of the nervous system, acupuncture points through- R out the body, and measurement and quantification of pain. It reviews applications of acupuncture in clinical practice, from cases easy to treat E to those more challenging, and concludes with theories on the future of a n a n a t o m i c a l acupuncture. S E a p p r o a c h C The treatment of pain, in general, is controversial, as many therapies O have unintended consequences and side effects. Acupuncture provides N D a therapy that is quick, easy to perform and requires no medications. H O U C H I D U N G This volume enables physicians, osteopaths, pain specialists, chiroprac- E D tors, and other health professionals to perform this effective treatment I T for their patients who experience both chronic and acute pain. I O N Houchi Dung, Ph.D., University of Texas Health Science Center, San Antonio, USA. K18907 S E C O N D E D I T I O N ACU P U NCTU RE a n a n a t o m i c a l a p p r o a c h S E C O N D E D I T I O N ACU P U NCTU RE a n a n a t o m i c a l a p p r o a c h H O U C H I D U N G Boca Raton London New York CRC Press is an imprint of the Taylor & Francis Group, an informa business CRC Press Taylor & Francis Group 6000 Broken Sound Parkway NW, Suite 300 Boca Raton, FL 33487-2742 © 2014 by Taylor & Francis Group, LLC CRC Press is an imprint of Taylor & Francis Group, an Informa business No claim to original U.S. Government works Version Date: 20130925 International Standard Book Number-13: 978-1-4665-8193-7 (eBook - PDF) This book contains information obtained from authentic and highly regarded sources. While all reasonable efforts have been made to publish reliable data and information, neither the author[s] nor the publisher can accept any legal responsibility or liability for any errors or omissions that may be made. 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Contents Preface to Second English Edition ...................................................................................................xv Preface to First English Edition ......................................................................................................xxi Preface to Anatomical Acupuncture ............................................................................................xxiii Author ............................................................................................................................................xxv Chapter 1 Introduction ..................................................................................................................1 References ..................................................................................................................10 Chapter 2 Anatomy in Acupuncture ...........................................................................................11 2.1 General Consideration .....................................................................................11 2.2 Identity of Acupoints .......................................................................................11 2.3 All in the Sensory Nerves ...............................................................................12 2.3.1 Organization of the Nervous System .................................................12 2.3.2 The Peripheral Nervous System .........................................................13 2.3.3 The Neuron .........................................................................................13 2.3.4 Histology of Nerves ............................................................................14 2.3.5 Divisions of the Nerves ......................................................................16 2.4 Efferent Fibers .................................................................................................16 2.4.1 Efferent Fibers to Skeletal Muscles ....................................................16 2.4.2 Autonomic Nervous System ...............................................................16 2.5 Afferent Fibers .................................................................................................16 2.5.1 For Special Senses ..............................................................................17 2.5.2 For General Senses .............................................................................17 2.6 Muscular Nerve Branches ...............................................................................18 2.7 Cutaneous Nerve Branches .............................................................................19 2.8 Anatomical Features Contributing to the Formation of Acupoints .................19 2.8.1 Size .....................................................................................................19 2.8.2 Depth ..................................................................................................19 2.8.3 Penetration of the Deep Fascia ...........................................................19 2.8.4 Passage through Bone Foramina ........................................................20 2.8.5 Motor Point .........................................................................................20 2.8.6 Concomitant Blood Vessels ................................................................20 2.8.7 Nerve Fiber Compositions ..................................................................21 2.8.8 Points of Bifurcation ..........................................................................21 2.8.9 Sensitive Points on Tendons and Ligaments ......................................21 2.8.10 Suture Lines on the Skull ...................................................................22 2.9 Discussion and Conclusion ..............................................................................22 References ..................................................................................................................23 Chapter 3 Acupoints of the Cranial Nerves ................................................................................25 3.1 Cranial Nerves without Acupoints ..................................................................25 3.1.1 Afferent Fibers Only ..........................................................................25 3.1.1.1 Olfactory Nerve ..................................................................25 3.1.1.2 Optic Nerve .........................................................................25 vii viii Contents 3.1.1.3 Statoacoustic Nerve ............................................................25 3.1.2 Efferent Fibers Only ...........................................................................26 3.1.2.1 Oculomotor Nerve ..............................................................26 3.1.2.2 Trochlear Nerve ..................................................................26 3.1.2.3 Abducens Nerve ..................................................................26 3.1.2.4 Hypoglossal Nerve ..............................................................26 3.2 Cranial Nerves with Acupoints .......................................................................26 3.3 Trigeminal Nerve .............................................................................................26 3.3.1 Acupoints of Cutaneous Branches .....................................................28 3.3.1.1 Supraorbital .........................................................................28 3.3.1.2 Supratrochlear and Infratrochlear ......................................28 3.3.1.3 Lacrimal..............................................................................29 3.3.1.4 Infraorbital ..........................................................................29 3.3.1.5 Zygomaticotemporal and Zygomaticofacial .......................29 3.3.1.6 Mental .................................................................................29 3.3.1.7 Auriculotemporal ................................................................29 3.3.1.8 Paranasal .............................................................................30 3.3.2 Acupoints of Connective Tissue .........................................................30 3.3.2.1 Bregma ................................................................................32 3.3.2.2 Pterion .................................................................................32 3.3.2.3 Nasion .................................................................................32 3.3.2.4 Coronal Suture ....................................................................32 3.3.2.5 Temporomandibular ............................................................32 3.3.3 Acupoints of Muscular Branches .......................................................33 3.3.3.1 Masseter ..............................................................................33 3.3.3.2 Temporalis ..........................................................................34 3.3.3.3 Anterior Auricular and Superior Auricular ........................34 3.4 Facial Nerve .....................................................................................................34 3.5 Glossopharyngeal Nerve .................................................................................35 3.6 Vagus Nerve ....................................................................................................35 3.7 Spinal Accessory Nerve ..................................................................................36 References ..................................................................................................................37 Chapter 4 Acupoints in the Neck Region ....................................................................................39 4.1 Boundaries of the Neck ...................................................................................39 4.2 Formation of the Cervical Plexus ....................................................................39 4.3 Acupoints of the Cutaneous Branches .............................................................40 4.3.1 Greater Auricular ...............................................................................40 4.3.2 Lesser Occipital ..................................................................................40 4.3.3 Transverse Cervical ............................................................................41 4.3.4 Supraclavicular ...................................................................................42 4.4 Acupoints of Muscular Branches ....................................................................42 References ..................................................................................................................42 Chapter 5 Acupoints in the Upper Limb .....................................................................................43 5.1 Topography of the Upper Limb .......................................................................43 5.2 Organization of the Brachial Plexus ................................................................43 5.3 Acupoints on the Pectoral Region ...................................................................44 5.4 Acupoints over the Scapular Region ...............................................................45 5.4.1 Dorsal Scapular ..................................................................................45 Contents ix 5.4.2 Supraspinatus or Suprascapular II......................................................46 5.4.3 Infraspinatus or Suprascapular I ........................................................46 5.5 Arm and Forearm ............................................................................................47 5.5.1 The Muscular Branches ......................................................................47 5.5.1.1 Musculocutaneous or Biceps Brachii .................................47 5.5.1.2 Median ................................................................................47 5.5.1.3 Axillary...............................................................................47 5.5.1.4 Teres Minor .........................................................................48 5.5.1.5 Deltoid.................................................................................49 5.5.1.6 Radial ..................................................................................49 5.5.1.7 Deep Radial ........................................................................50 5.5.1.8 Posterior Interosseus ...........................................................50 5.5.2 Cutaneous Branches ...........................................................................50 5.5.2.1 Posterior Brachial Cutaneous .............................................50 5.5.2.2 Lateral Brachial Cutaneous ................................................50 5.5.2.3 Medial Brachial Cutaneous ................................................51 5.5.2.4 Lateral Antebrachial Cutaneous .........................................51 5.5.2.5 Medial Antebrachial Cutaneous .........................................51 5.5.2.6 Posterior Antebrachial Cutaneous ......................................51 5.5.3 Acupoints over Tendons and Ligaments.............................................51 5.5.3.1 Tendon of the Biceps Brachii ..............................................52 5.5.3.2 Lateral Epicondyle of the Elbow ........................................52 5.5.3.3 Flexor Retinaculum over the Wrist .....................................52 5.6 Wrist and Hand ................................................................................................52 5.6.1 Muscular Branches .............................................................................53 5.6.1.1 Recurrent of Median ...........................................................53 5.6.1.2 Ulnar ...................................................................................54 5.6.2 Cutaneous Branches ...........................................................................54 5.6.2.1 Superficial Radial ...............................................................54 5.6.2.2 Interphalangeal Points ........................................................54 References ..................................................................................................................54 Chapter 6 Acupoints in the Body Trunk .....................................................................................55 6.1 Defining a Typical Spinal Nerve .....................................................................55 6.1.1 Two Roots with One Ganglion ...........................................................55 6.1.2 Two Primary Rami .............................................................................55 6.1.3 Muscular Branches without Anatomical Names ................................55 6.1.4 Three Cutaneous Nerves with Six Terminal Branches ......................55 6.2 Composition of Fibers in the Typical Spinal Nerves .......................................57 6.2.1 Efferent Fibers to Skeletal Muscles ....................................................57 6.2.2 Autonomic Nervous System ...............................................................57 6.2.2.1 Sympathetic Nerves ............................................................57 6.2.2.2 Parasympathetic Nerves .....................................................58 6.2.3 Afferent Fibers for General Senses ....................................................58 6.3 Distributions of Acupoints...............................................................................59 6.3.1 Back of the Body Trunk .....................................................................59 6.3.2 Front of the Body ...............................................................................59 6.3.3 Lateral Side ........................................................................................59 6.4 Acupoints on Back of the Neck .......................................................................60 6.4.1 Greater Occipital ................................................................................60