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It feels like Wang Qingren’s soul has transmigrated into the new century
Original Link
https://mp.weixin.qq.com/s/0To6IVNA2vN2v__-I4zVuQ
Main Text
Human Anatomy Observation Notes
Preface
Recently, following seniors, I revisited anatomy. The cadaver teacher was under 30 years old and was dissected within 48 hours after thawing, with freshness far superior to formalin-fixed specimens and plastinated specimens. The observational conclusions extremely conform to the real human body conditions, solving many of my clinical doubts. The following are the records of these findings.
The narrative language is straightforward to ensure the most authentic record, but inferred conclusions might have inaccuracies. The author will separate records and inferences for readers’ reference.
Important Questions
1. Can the needle knife sever or injure nerves?
Regarding the needle knife, there have always been concerns in the industry: whether the needle knife can injure or even sever nerves? Some say that because the nerve surface is smooth, the needle knife will slide along the nerve surface; others say it can indeed cause damage. This issue cannot be generalized without considering needle specifications, technique, and specific location. The author chose a 0.4mm×0.40mm small needle knife, selected nerves about 0.4mm thick, teased out and stretched the nerve, then cut perpendicular to the nerve direction with the small needle knife. The result showed that indeed, touching the nerve causes a cut on the nerve surface, but placing the nerve at the midpoint of the blade with greater force, the blade cannot cut along the nerve surface. It is possible to transversely cut an opening in the nerve; multiple stabs can sever the nerve. However, the force required must be very large because nerves are very tough. The inference is that in a living human body, if the technique is appropriate and the small needle knife is parallel to nerve fibers, the probability of nerve injury is low; however, cutting perpendicular repeatedly increases the chance of nerve damage, and the wider the blade and the thinner the nerve, the greater the danger.
2. Can acupuncture needles penetrate the intestinal wall, bladder, or liver?
There is a treatment for stubborn constipation that involves inserting a three-inch needle at Tianshu to cause abdominal warmth or intestinal peristalsis. When the author first learned this method, there was concern about whether it would penetrate the intestinal wall. The instructor said it would not; when the needle tip touched the intestinal wall, the intestine would automatically split. The author once tested with pig large intestine and found it can pierce through. This time, using a 0.3mm acupuncture needle on a human body, it was found that if the insertion is slow, the intestinal wall will first dent without being pierced; only when the needle tip pushes further down will the wall be pierced. However, fast insertion is more likely to cause perforation. Thus, the industry idea that the intestine automatically splits when the needle tip touches the intestinal wall is considered wishful thinking by the author. Also, perforating the intestinal wall leaves a visible small hole; it remains unclear whether such penetration by acupuncture needles poses danger and whether the needle holes allow abdominal contents to leak.
Penetrating the bladder is more difficult. The bladder surface is much denser than the intestinal wall, with obvious resistance to penetration requiring a certain finger force. Clinically, when encountering the bladder wall, needle tip resistance is apparent, contrasting with fat, fascia, and muscle above the bladder. Even if the patient does not urinate, experienced acupuncturists can distinguish the needle tip feeling and avoid or stop on the bladder surface fairly easily.
Sticking the acupuncture needle into the liver feels like stabbing jelly, but after withdrawing the needle, no needle hole is visible on the liver surface. Although the Huangdi Neijing records “stabbing the liver, death in five days, with disturbance of speech,” it remains unclear what specific harm a 0.30mm acupuncture needle penetrating the liver surface would cause.
3. Is there really a risk of puncturing the eyeball when needling the pterygopalatine ganglion?
Needling the pterygopalatine ganglion (Xingwu point) is an effective technique for treating rhinitis. After pioneer Li Xingwu promoted this method, it gradually spread nationwide, centered on Tongren Hospital. With many learners, some clinicians raised doubts that when the needle is sufficiently deep, the tip might pass through the inferior orbital fissure and puncture the eyeball, exiting the orbit; others believe this is impossible. Those unfamiliar often first hear the efficacy of this technique but then hesitate after hearing, “If done improperly, the needle might come out of the eyeball.”
In this anatomy, it was found that inserting an acupuncture needle at the pterygopalatine ganglion point with the tip directed toward the eyeball can indeed penetrate the inferior orbital fissure and cause direct injury or even puncture the eyeball. This is the source of claims of risk. However, the author once studied this technique under Chen Luquan, a direct disciple of Li Zheng’s at Tongren. It must be noted that Tongren has a strict standard for insertion angle and method. Following Li’s method, it is absolutely impossible for the needle to exit from the inferior orbital fissure. The author found that many clinicians needle this ganglion by following online videos or experience without fully understanding Tongren’s original method; thus some half-informed persons slander the method. Without hands-on dissection or observation on cadavers, relying only on models and atlases makes it hard to judge which claims are reliable. In summary, two facts about this technique: 1. It is somewhat difficult but effective when the needle is in place. 2. Tongren has a system of needling; it is best to fully learn the system if possible.
4. What happens if the acupuncture needle tip touches the eyeball?
There have been media reports about injuries to the eyeball from needling Jingming. Generally, acupuncture directed toward the nasal side or vertically does not injure the eyeball. There has been an industry belief that the eyeball would avoid the needle. In fact, when the needle touches the eyeball, obvious resistance is felt. The eyeball surface is not as soft as the liver but rather firm. Upon pressure, the eyeball initially indents; with more force, the eyeball is pushed away; only with very great force will the eyeball be pierced. In a living human, the eyeball is more full and easier to pierce, but the sensation on the needle differs clearly from other tissues, making them distinguishable.
5. How should needling be done through Qiuxu to Zhaohai?
Many experience posts say the ankle should be positioned at a specific angle, e.g., foot in a varus (inverted) position, similar to a sprained ankle.
This time it was observed that with the foot in inversion, the lateral distance between the calcaneus and talus increases noticeably; when the foot is everted, the medial distance between these bones does not change significantly. That is, foot inversion/eversion mainly affects the medial tibiotalar joint gap, i.e., Qiuxu point, having no effect on Zhaohai. Also, Qiuxu is naturally wider than Zhaohai. From this perspective, needling from Qiuxu toward Zhaohai is much easier than the reverse. The author found that foot inversion does not actually make penetration easier, only the insertion is somewhat easier. The key is the angle coordination between foot inversion/eversion and the acupuncture needle relative to the tibia. Each new foot position changes the optimal angle for needle penetration. For example, in some positions, the angle between the needle tip and tibia during Qiuxu-to-Zhaohai needling is 90 degrees; with foot inversion, it becomes an acute angle. No good quantification method exists yet. After stripping skin and muscle, the joint gap between the navicular and talus can also be penetrated. However, this approach was not tried on an intact foot. It is almost impossible to penetrate at the Shenmai point at the tip of the ankle. The so-called Zhaohai-to-Shenmai penetration is likely similar in direction to Qiuxu-to-Zhaohai penetration.
Qiuxu-to-Zhaohai’s structural essence is piercing through the fibrous, narrow tarsal sinus between the fibula and tibia.
6. How deep must one insert the needle at Fengfu to reach the medulla oblongata?
About two to two and a half cun insertion approaches the medulla, feeling like stabbing tofu. Deep insertion here can cause the needle tip to press upward or downward against the occipital bone, which is relatively safe.
7. Why is acupuncture at Huiyang effective for erectile dysfunction and scrotal eczema?
Huiyang is close to the perineal nerve. Similarly, men who sit long can experience penile numbness, indirectly confirming this area’s role in male and female genital diseases.
Others
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Some people’s C6 spinous process is longer and bigger than C7, so identifying Dazhui by prominence is unreliable.
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The supraorbital nerve, infraorbital nerve, and mental nerve lie on the same line.
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Normal lymph nodes are like millet grains; pathological lymph nodes can be as large as broad beans.
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After facial paralysis, pay attention to whether the relationship between the facial nerve root and cervical vertebrae is normal.
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The styloid process is very soft, like cartilage.
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The vertebral artery lies between the mastoid and transverse processes, closely attached to the transverse process.
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The serratus anterior muscle is very, very thin.
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The pubic symphysis is extremely tight; whether so-called rehabilitative pubic separation truly separates remains to be verified.
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The thigh has even more fat than the buttocks.
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Fat is columnar in shape.
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Some bursae are two-layer negative pressure fascia.
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The meniscus feels like a gel pad.
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A transverse finger lateral to the thoracic vertebra insertion can reach more than one cun deep, directly to the bone surface, with a comfortable distending sensation.
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One finger lateral to the lumbar vertebra reaches the lateral recess; lumbar insertion must be wider than thoracic, about one and a half fingers lateral to the interspinous gap, with a similar distending needle sensation.
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Veins appear darker than arteries; visually, veins look more like blood vessels because arteries have thinner walls, and some arteries look like nerves; thus ancient Western and Eastern people believed that arteries carry gases, aligning with intuitive sensation.
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Needling the thyroid does not leave a needle hole; clinically, needling the parotid and mammary glands generally does not cause safety issues; it may be possible to needle into the thyroid gland.
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Patients mentioned in the text are cautioned not to attempt these treatments on their own.