Original Article  原始文章

Received 13 January 2023  收到日期：2023 年 1 月 13 日
Revised 2 March 2023
修订于 2023 年 3 月 2 日
Accepted 11 April 2023
接受于 2023 年 4 月 11 日
Available online 15 May 2023
2023 年 5 月 15 日在线可用

Dry needling（DN）  干针疗法（DN）
De－meridian  去经线
Classical acupuncture  经典针灸
Modern acupuncture  现代针灸
Inheritance  继承
Innovation  创新
Acu－reflex points（ARPs）

© 2024 World Journal of Acupuncture－Moxibustion House．Publishing services by Elsevier B．V．on behalf of KeAi Communications Co．Ltd．
© 2024 世界针灸杂志－艾灸之家．出版服务由 Elsevier B．V．代表 KeAi Communications Co．Ltd．提供
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这是一篇在 CC BY－NC－ND 许可证下的开放获取文章（http：／／creativecommons．org／licenses／by－nc－nd／4．0／）

Dry needling（DN），aimed mostly at trigger points and originally used to treat myofascial pains［1－3］，is in essence，a form of mod－ ern acupuncture［4－6］．During the past two decades，DN＇s rapid rise of popularity and usage in the west has garnered much atten－ tion and triggered deep self－reflections from within the acupunc－ ture profession．On one hand，most licensed acupuncturists are op－ posed to non－acupuncturist DN practitioners＇attempt at bypassing state or provincial regulations by claiming that DN is not acupunc－ ture $[7,8]$$[7,8]$[7,8][7,8] ．On the other hand，certain significant implications of DN for the proper inheritance and necessary innovation of classical acupuncture are beginning to unfold．
干针疗法（DN），主要针对触发点，最初用于治疗肌筋膜疼痛［1－3］，本质上是一种现代针灸形式［4－6］。在过去的二十年中，DN 在西方的快速普及和使用引起了广泛关注，并促使针灸行业进行深刻的自我反思。一方面，大多数持证针灸师反对非针灸师的 DN 从业者试图通过声称 DN 不是针灸来规避州或省的法规 $[7,8]$$[7,8]$[7,8][7,8] 。另一方面，DN 对经典针灸的正确传承和必要创新的某些重要影响开始显现

This paper briefly reviews the historical background and the current state of DN in the west including the＂anti－DN indepen－ dence＂movement like that of＂oppose practice acupuncture with－ out license＂［8］motto shouted out by the U．S．acupuncture profes－
本文简要回顾了西方 DN 的历史背景和现状，包括“反对 DN 独立”运动，如美国针灸专业人士高喊的“反对无证行针”［8］口号

sion，and reiterates that DN is merely a＂de－meridian style of mod－ ern acupuncture［5］．Moreover，it presents and examines certain advantages or drawbacks of DN with in－depth discussions around the inspirations for future acupuncture trials or research，especially on how to make sense of the necessity in inheriting and innovating classical acupuncture．
sion，并重申 DN 仅仅是现代针灸的一种“去经络”风格［5］。此外，它还通过深入讨论未来针灸试验或研究的灵感，呈现和审视 DN 的某些优点或缺点，特别是如何理解继承和创新经典针灸的必要性

Whenever revisiting the history of DN ，it is obvious that one first need to go way back in time to the discovery of＇trigger point＇ in the early 19th century，then the recognition of myofascial pain ［9－11］a bit later．The term myofascial trigger point（MTrP）was coined by Dr．Janet Travell（1901－1997）and Seymour Rinzler in the 1950s［11］，reflecting their finding that hardened knots do ex－ ist and often refer pain to both muscles and overlying fascia［12］． The two－volume book Myofascial Pain and Dysfunction：The Trig－ ger Point Manual，which Dr．Travell co－authored with David Simons
每当回顾 DN 的历史时，很明显首先需要追溯到 19 世纪初“触发点”的发现，然后是对肌筋膜疼痛的认识［9－11］。肌筋膜触发点（MTrP）这一术语是由 Janet Travell 博士（1901－1997）和 Seymour Rinzler 在 1950 年代创造的［11］，反映了他们发现硬化的结节确实存在，并且常常将疼痛传递给肌肉和覆盖的筋膜［12］。Travell 博士与 David Simons 共同撰写的两卷本书《肌筋膜疼痛与功能障碍：触发点手册》
［1，2］represents decades of keen observation and research on my－ ofascial pain and MTrPs．As for the word DN，it is coined by Paulett JD in 1947 ［13，14］．
［1，2］代表了我对肌筋膜疼痛和触发点的几十年深入观察和研究。至于 DN 这个词，它是由 Paulett JD 在 1947 年创造的［13，14］

For a long time，DN was originally called intramuscular man－ ual stimulation，or intramuscular needling［1］．In the past two decades，when it was gradually incorporated into the scope of non－ acupuncturist DN practitioners such physical therapists（PTs）and doctors of chiropractic（DCs），it was later renamed to trigger point DN or MTrP DN．In actuality，the stimulation method and needles currently used by non－acupuncturist DN practitioners are identical to acupuncture except that targets of DN are called trigger points instead of acupuncture points／acupoints［2］．
长期以来，DN 最初被称为肌肉内手动刺激或肌肉内针刺［1］。在过去的二十年中，当它逐渐被纳入非针灸师 DN 从业者（如物理治疗师（PTs）和脊医（DCs））的范围时，后来被重新命名为触发点 DN 或 MTrP DN。实际上，非针灸师 DN 从业者目前使用的刺激方法和针与针灸相同，只是 DN 的目标被称为触发点，而不是针灸点/腧穴［2］

Nowadays，many non－acupuncturists like PTs or DCs in the west have learnt DN and attempted to add it to their existing scopes of practice［15］．For this，there are mainly three reasons．
如今，许多西方的非针灸师，如物理治疗师或脊医，已经学习了干针疗法，并试图将其添加到他们现有的执业范围中［15］。对此，主要有三个原因

First，PTs and DCs＇usual clientele，specialties and scope of prac－ tice mostly overlap with that of the licensed acupuncturist or acupuncture，which has become popular in the west over the re－ cent decades．Of course，there is also the factor of clinical efficacy for acupuncture，sometimes they consider are far more superior than their traditional modalities（e．g．subluxation，manual therapy）， which may be a factor in causing their own professions to regress somewhat．This is also exactly why more and more of these non－ acupuncturists are studying to become licensed acupuncturists as well so they can try to integrate acupuncture into their practice． In reality，it was known long before the rise of DN that many DCs already used acupressure or electrical stimulation devices to treat patients in their clinics．
首先，物理治疗师和脊椎按摩师的常规客户群、专业领域和实践范围大多与持证针灸师或针灸的重叠，这在最近几十年在西方变得越来越流行。当然，针灸的临床疗效也是一个因素，有时他们认为针灸远远优于他们的传统疗法（例如，半脱位、手动治疗），这可能导致他们自己的职业在某种程度上有所退步。这也是为什么越来越多的这些非针灸师正在学习成为持证针灸师，以便他们可以尝试将针灸融入他们的实践中。实际上，在干针疗法兴起之前，许多脊椎按摩师已经在他们的诊所中使用指压或电刺激设备来治疗患者，这一点早已为人所知

Second，DN is merely a＂de－meridian＂style of acupuncture［5］． It completely discards the underlying meridian theory and other traditional Chinese medicine（TCM）theories and only considers MTrPs as primary stimulation targets along with the local twitch－ ing response（LTR）as the sole indicators for a successful treatment． Moreover，it aims to eliminate the hard knots in the muscle or re－ lieve any referred trigger pain so that its main indication is my－ ofascial pain syndrome．This may be the reason why DN is gener－ ally easier to be accepted by western non－acupuncturists who are typically better－trained in anatomy and physiology．On the other hand，modern medicine is considered conventional in the west， so people in the west are generally familiar with the use of in－ jectable needles，making it easier to accept DN in comparison to wet needling．
其次，DN 仅仅是一种“去经络”风格的针灸［5］。它完全抛弃了基础的经络理论和其他传统中医学（TCM）理论，仅将肌肉触发点（MTrPs）视为主要刺激目标，并将局部抽动反应（LTR）作为成功治疗的唯一指标。此外，它旨在消除肌肉中的硬结或缓解任何放射性触发疼痛，因此其主要适应症是肌筋膜疼痛综合症。这可能是 DN 通常更容易被西方非针灸师接受的原因，因为他们通常在解剖学和生理学方面受过更好的训练。另一方面，现代医学在西方被视为常规，因此西方人通常熟悉使用可注射针头，这使得与湿针相比，更容易接受 DN

Third，DN education and training activities are extremely com－ petitive and prevalent in the North America and the rest of the west，where non－acupuncturist healthcare practitioners typically need only 50 h or a full plate of weekend to learn the essentials of DN［7］to meet their minimum clinical practice needs．In states that have passed DN legislation，these non－acupuncturist practi－ tioners can practice DN without the need to apply for an acupunc－ ture license and thus not governed by strict needling regulations required for acupuncturists．This further caters to and promotes the market demand of DN for PTs and DCs．
第三，DN 教育和培训活动在北美及其他西方国家极具竞争性和普遍性，非针灸医疗从业者通常只需 50 小时或一个完整的周末来学习 DN 的基本知识，以满足他们最低的临床实践需求。在已经通过 DN 立法的州，这些非针灸从业者可以在不申请针灸执照的情况下进行 DN 实践，因此不受针灸师所需的严格针刺规定的约束。这进一步满足并促进了物理治疗师和脊医对 DN 的市场需求

In the United States，physical therapy is considered part of mainstream medicine and there seems to be a large clientele base for the DN practice．There are more and more PTs learning DN while the number of states that have officially added DN therapy into the PTs＇scope of practice is ever growing．Up to now，the state number allowed DN has expanded to 38 of the 50 ，whereas there are only five states that strictly prohibit PTs to practice DN［16］．
在美国，物理治疗被视为主流医学的一部分，似乎有大量的客户群体支持 DN 实践。越来越多的物理治疗师学习 DN，而正式将 DN 治疗纳入物理治疗师执业范围的州数量也在不断增加。到目前为止，允许 DN 的州数量已扩展到 50 个州中的 38 个，而只有五个州严格禁止物理治疗师实践 DN

However，ever since exposing the attempts by certain DN pro－ ponents insisting DN is purely different from acupuncture，such notions have been ridiculed by an overwhelming majority of Amer－ ican TCM practitioners or acupuncturists．There is an ongoing debate in regard whether DN can be practiced legally without acupuncture license，especially among acupuncturists and PTs，as largely reflected in various types of DN legislation across the coun－
然而，自从揭露某些干针（DN）支持者坚持干针与针灸完全不同的尝试以来，这种观点已被绝大多数美国中医 practitioners 或针灸师嘲笑。关于干针是否可以在没有针灸执照的情况下合法实践，尤其是在针灸师和物理治疗师（PT）之间，仍然存在持续的争论，这在全国各地的各种干针立法中得到了很大反映
try．Also，a battle of public opinion opposing＂illegal practice of acupuncture＂and subsequent opposition of＂the attempt of DN independence from acupuncture＂（referred to as＂anti－DN indepen－ dence＂movement）were launched since 2015 using different social media platforms．Several major TCM societies and associations in this country responded swiftly by immediately establishing a non－ profit organization，American Alliance for Professional Acupuncture Safety（AAPAS），through advocacy，legal proceedings，research pub－ lication gathering，etc．From these perspectives，it has clearly un－ covered and criticized the fraudulence attempts that proponents of DN sought to make DN independent from acupuncture so that non－acupuncturist DN practitioners could legally practice DN，by－ passing the regulations of acupuncture［7］．
尝试。此外，自 2015 年以来，公众舆论对“非法针灸行为”的反对以及对“DN 独立于针灸的尝试”（称为“反 DN 独立运动”）的后续反对在不同的社交媒体平台上展开。该国几大中医协会和组织迅速作出反应，立即成立了一个非营利组织——美国专业针灸安全联盟（AAPAS），通过倡导、法律程序、研究出版物收集等方式。从这些角度来看，显然揭露并批评了 DN 支持者试图使 DN 独立于针灸的欺诈行为，以便非针灸师的 DN 从业者能够合法地实践 DN，绕过针灸的相关规定［7］

Although DN does not use meridian theory as its underly－ ing guiding principle and only emphasizes stimulation on MTrPs as targets，DN essentially utilizes the same filiform needles or needling methods as the classical acupuncture［4］．In this re－ gard，DN does share similar traits with certain forms of modern acupuncture such as auricular or scalp acupuncture as well as Zhong－hua FU＇s subcutaneous needling（which some goes as far as calling it the new DN），that are invented under modern theories beyond the meridian theory．They are all considered as types of modern yet TCM－inspired acupuncture．Due to the same reason，it is totally incorrect to say that DN is not acupuncture simply be－ cause it does not use TCM meridian theory as the basis．Accord－ ingly，all practitioners of DN in the United States should conform to various state acupuncture laws and regulations．That means they must first obtain qualified acupuncture training，pass state or na－ tional board exams and obtain an acupuncture license．Otherwise， they are considered＂illegally practicing acupuncture without li－ cense＂．
虽然 DN 并不将经络理论作为其基本指导原则，仅强调对肌肉触发点的刺激，但 DN 本质上使用与经典针灸相同的细针或针刺方法。在这方面，DN 确实与某些现代针灸形式（如耳针或头皮针灸）以及中华傅的皮下针刺（有些人甚至称其为新 DN）具有相似特征，这些都是在超越经络理论的现代理论下发明的。它们都被视为现代但受中医启发的针灸类型。出于同样的原因，单纯因为 DN 不使用中医经络理论作为基础而说 DN 不是针灸是完全错误的。因此，美国所有的 DN 从业者应遵守各州的针灸法律和法规。这意味着他们必须首先获得合格的针灸培训，通过州或国家的执业考试并获得针灸执照。否则，他们将被视为“无执照非法行医”

However，in certain states，some compromises were reached so PTs could practice DN in a limited scope while increasing train－ ing hours of DN courses．On the other hand，some acupuncturists， who insist on mainstream acupuncture into conventional medicine， are learning various modern styles of acupuncture including MTrP acupuncture to treat myofascial pain syndrome．In response to this fluid situation，some PTs who practice DN also go through formal TCM education to obtain an acupuncture license，and begin to en－ gage in dual training：training of MTrP acupuncture for acupunc－ turists and training of DN for PTs，whereas the continuing educa－ tion is often around topics of＂trigger point needling or acupunc－ ture＂instead of trigger point DN［3］．As one can see from the web－ site of the Cleveland Clinic，not only do they have acupuncturists on staff，but also many non－acupuncturist DN practitioners include PTs and DCs besides medical acupuncturists or MDs［17］．
然而，在某些州，达成了一些妥协，以便物理治疗师可以在有限的范围内进行干针治疗，同时增加干针课程的培训小时数。另一方面，一些坚持将主流针灸纳入常规医学的针灸师，正在学习包括肌筋膜触发点针灸在内的各种现代针灸风格，以治疗肌筋膜疼痛综合症。针对这种流动的情况，一些进行干针治疗的物理治疗师也接受正式的中医教育，以获得针灸执照，并开始进行双重培训：为针灸师培训肌筋膜触发点针灸，为物理治疗师培训干针治疗，而继续教育通常围绕“触发点针刺或针灸”的主题，而不是触发点干针治疗。如克利夫兰诊所的网站所示，他们不仅有针灸师在职，还有许多非针灸师的干针治疗从业者，包括物理治疗师和脊医，除了医学针灸师或医学博士

As the above mentioned，DN proponents in the west，nowa－ days frequently claim that DN is not acupuncture（de－acupuncture） as it does not use the meridian theory as a guide principle（de－ meridian），and its non－acupuncturist practitioners do not need to receive the necessary training required by acupuncturists．In 2016， the authors published a pioneer paper［5］to refute this miscon－ ception，and clarified that＂De－Meridian＂is not＂De－Acupuncture＂． DN is acupuncture，and at best，a form of modern acupuncture， namely，MTrP acupuncture．
如上所述，西方的 DN 支持者如今常常声称 DN 不是针灸（去针灸），因为它不使用经络理论作为指导原则（去经络），而且其非针灸从业者不需要接受针灸师所需的必要培训。2016 年，作者发表了一篇开创性论文［5］以驳斥这一误解，并澄清“去经络”并不是“去针灸”。DN 是针灸，充其量是一种现代针灸形式，即 MTrP 针灸

So what exactly is the＂de－meridian＂notion of acupuncture？It has at least three kinds of manifestations［5－18］．First，it ignores the meridian theory while emphasizes locations and effects of acu－ points or stimulation targets．Secondly，since no special structures beyond the known anatomical tissues can be found to prove the existence of the meridians，the meridians are merely functional connections or information pathways，and acupoints are the out－ puts or windows reflecting internal physiological or pathological
那么，针灸的“经络”概念究竟是什么？它至少有三种表现形式。首先，它忽视了经络理论，而强调腧穴或刺激目标的位置和效果。其次，由于无法找到超出已知解剖组织的特殊结构来证明经络的存在，经络仅仅是功能连接或信息通道，而腧穴是反映内部生理或病理的输出或窗口

Fig．1．Dry Needling：A form of modern acupuncture
图 1．干针疗法：一种现代针灸形式
Notes：This figure illustrated by Bonnie Xia JIN－used with permission from AAPAS www．OPAWL．us）［8］．
注：此图由 Bonnie Xia JIN 绘制，已获 AAPAS 许可（www．OPAWL．us）［8］．
information onto the body surface，or the terminals of inputting acupuncture treatment information on the body surface to gener－ ate effects．Thus，the stimulation targets of acupuncture need not be confined to the positions of acupoints recorded in classical TCM publications［19，20］．Instead，one should pay attention to the pres－ ence of actual reflex zones or points for stimulation in the clinic， regardless of whether they are acupoints or located at or around the meridians．Third，it completely denies the existence or func－ tion of the meridians，and advocates that needling should aban－ don the meridians theory［21］，while believing that acupuncture including DN remains effective as long as the stimulation target is determined based on anatomical and physiological knowledge．
将信息输入到身体表面，或在身体表面输入针灸治疗信息的终端以产生效果。因此，针灸的刺激目标不必局限于经典中医文献中记录的腧穴位置［19，20］。相反，应该关注临床中实际存在的反射区或刺激点，无论它们是腧穴还是位于经络附近。第三，它完全否定了经络的存在或功能，并主张针刺应放弃经络理论［21］，同时认为只要刺激目标基于解剖和生理知识确定，针灸（包括 DN）仍然有效

Actually，according to these manifestations of the＂de－ meridian＂，there has been a similar trend in the moderniza－ tion movement of classical acupuncture in China over the past few decades．However，that has never been considered as＂de－ acupuncture＂［18］．The current prevailing of DN in the west seems to be similar to the third manifestation mentioned above，but DN proponents not only promote＂de－meridian＂but also＂de－ acupuncture＂，which is totally illegitimate and is the reason why it subjected to the widespread opposition of the global acupunc－ ture profession．
实际上，根据这些“去经络”的表现，过去几十年中国古典针灸的现代化运动中出现了类似的趋势。然而，这从未被视为“去针灸”［18］。目前西方对 DN 的普遍接受似乎与上述第三种表现相似，但 DN 的支持者不仅推广“去经络”，还推广“去针灸”，这完全是非法的，也是其遭到全球针灸界广泛反对的原因

In 2019，AAPAS launched a nationwide acupuncture safety education campaign called＂Oppose Practice Acupuncture with－ out License（OPAWL）contest＂where the main theme was ＂DN＝Acupuncture＂，which attracted many entries of acupunctur－ ists who stand in unison in proclaiming that DN is acupuncture， or at best，a modern form of acupuncture using different nomen－ clature，and firmly oppose any filiform needling practice by practi－ tioners without acupuncture license．One of the co－authors of this paper created Fig． 1 and submitted to the contest and was sur－ prised to learn that she won a silver medal．Fig． 1 depicts a ro－ tating acupuncture needle piercing an acupuncture point through multiple tissue layers of the body surface，which are symbolized by six three－dimensional Taiji diagrams．
在 2019 年，AAPAS 发起了一项全国性的针灸安全教育活动，名为“反对无执照针灸（OPAWL）竞赛”，其主要主题是“DN=针灸”，吸引了许多针灸师的参赛作品，他们一致宣称 DN 是针灸，或者说，至少是一种使用不同名称的现代针灸形式，并坚决反对任何无针灸执照的从业者进行的细针刺实践。本文的一位共同作者创作了图 1 并提交到竞赛中，惊讶地得知她获得了银奖。图 1 描绘了一根旋转的针灸针穿透身体表面多个组织层的针灸点，这些层通过六个三维太极图表示

Fig． 1 vividly illustrates that the filiform needle is the most commonly used stimulating tool in both classical and modern
图 1 生动地说明了丝状针是古典和现代中最常用的刺激工具
styles of acupuncture．The top Taiji piece（black fish in blue and white fish in pink）being stuck by the filiform needle repre－ sents classical acupuncture under the guidance of meridian the－ ory（aimed at balancing the yin and yang states of the body）． However，with the advancement of science and technology，the modern acupuncture theory has more details about the stimu－ lating layers or targets within acupoints．These were termed as needling the skin，needling the muscle／tendon，needling the blood vessel，and needling the bone corresponding to the depth of re－ lated anatomical structures（the skin，the subcutaneous tissue，the muscle／tendon，the blood vessel，the periosteum and the nerve） in modern acupuncture（see the 2nd to 6th Taiji pieces in which the black fish is no longer the same as that in the first Taiji piece）．The corresponding modern styles of acupuncture are the cutaneous／subcutaneous acupuncture，the DN／muscle acupuncture， the blood－letting acupuncture，the periosteal acupuncture，and the neural acupuncture．This picture clearly and concisely shows that DN is merely a style of modern acupuncture（the muscle acupunc－ ture）．
针灸的风格。顶部的太极图（黑鱼在蓝色，白鱼在粉色）被细针刺入，代表了在经络理论指导下的经典针灸（旨在平衡身体的阴阳状态）。然而，随着科学技术的发展，现代针灸理论对腧穴内的刺激层或目标有了更多细节。这些被称为皮肤针刺、肌肉/腱针刺、血管针刺和骨针刺，分别对应于相关解剖结构的深度（皮肤、皮下组织、肌肉/腱、血管、骨膜和神经）在现代针灸中（见第二到第六个太极图，其中黑鱼不再与第一个太极图相同）。相应的现代针灸风格包括皮肤/皮下针灸、DN/肌肉针灸、放血针灸、骨膜针灸和神经针灸。这幅图清晰简洁地表明，DN 仅仅是现代针灸的一种风格（肌肉针灸）

As we classified earlier［5］，the stimulating targets of DN－MTrPs are actually Ashi points in the classical acupuncture．Both MTrPs and Ashi points can be detected at the body surface through touch－ ing or feeling by hands，but MTrPs are only distributed in the mus－ cular level，while Ashi points can either be on the skin，subcuta－ neous tissue or in the muscles，sometimes even in the bone mem－ brane［21］．When finger pressing or needling MTrPs or Ashi points， certain needling sensations，such as LTR or deqi（a needle－pulling sensation seen or felt by the acupuncturist like＂fish swallowing bait＂）could be evoked，and propagated to the diseased region or along with the traveling course of meridian on the body surface． This is why the authors have insisted that MTrPs are just specific subsets of Ashi points，or more precisely，a type of somatic acu－ reflex points（ARPs），which may explain why DN targeting MTrPs for myofascial pains could often attain good results．
正如我们之前分类的那样［5］，DN－MTrPs 的刺激目标实际上是经典针灸中的 Ashi 点。MTrPs 和 Ashi 点都可以通过手触摸或感觉在身体表面被检测到，但 MTrPs 仅分布在肌肉层，而 Ashi 点可以位于皮肤、皮下组织或肌肉中，有时甚至在骨膜中［21］。当按压或针刺 MTrPs 或 Ashi 点时，某些针刺感觉，如 LTR 或得气（针灸师看到或感觉到的针拉动感觉，像“鱼吞饵”）可能会被引发，并传播到病变区域或沿着身体表面的经络行程。这就是为什么作者坚持认为 MTrPs 只是 Ashi 点的特定子集，或者更准确地说，是一种躯体针反射点（ARPs），这可能解释了为什么针对 MTrPs 的 DN 治疗肌筋膜疼痛通常能够取得良好效果

Thus，one should not shy away from the fact that various＂de－ meridian＂styles of acupuncture，including DN，are based on mod－ ern anatomy and physiology and do play a positive role in advo－
因此，人们不应回避这样一个事实，即各种“去经络”风格的针灸，包括 DN，都是基于现代解剖学和生理学，并在倡导中发挥了积极作用

Fig．2．The relation of acu－reflex points，myofascial trigger points and classical acupoints
图 2．腧反射点、肌筋膜触发点与经典腧穴的关系
Notes：A：The relation between the three types of ARPs（central，visceral and somatic）and MTrPs；B：The relation between MTrPs and APs of 14 regular meridians and extraordinary meridians；C：The relation of all the ARPs（yellow），MTrPs（blue）and classical APs（gray）；MTrP：myofascial trigger point；ARP：acu－reflex points；AP：acupuncture point．（For interpretation of the references to colour in this figure legend，the reader is referred to the web version of this article．）
注释：A：三种类型的 ARP（中央、内脏和体表）与 MTrP 之间的关系；B：MTrP 与 14 条常规经络和奇经的 AP 之间的关系；C：所有 ARP（黄色）、MTrP（蓝色）和经典 AP（灰色）之间的关系；MTrP：肌筋膜触发点；ARP：针灸反射点；AP：针灸点。（有关本图例中颜色引用的解释，请参阅本文的网络版本。）
cating for the benefits of acupuncture while helping to clarifying its mechanisms．
为针灸的好处辩护，同时帮助阐明其机制

To gain insight into the necessity of inheritance and innovation of classical acupuncture from the rise of DN，we can first analyze the drawbacks or limitations of DN．Because DN refuses to inherit the meridian theory，it will miss the experience of thousands of years of classical acupuncture，limit its indications，and neglect a holistic notion in the clinic．The following are five drawbacks or limitations in its clinical application．
为了深入了解从 DN 的兴起中经典针灸的继承和创新的必要性，我们可以首先分析 DN 的缺点或局限性。由于 DN 拒绝继承经络理论，它将错过数千年经典针灸的经验，限制其适应症，并忽视临床中的整体观念。以下是其临床应用中的五个缺点或局限性
（1）The stimulation of DN only targets at the muscle level and neglects other layers of the body surface．In the treatment of my－ ofascial pain，DN only selects MTrPs as the sole stimulation tar－ gets．However，local positive reflex points of myofascial pain can also be found in the skin，subcutaneous tissue and even the perios－ teum．Moreover，MTrPs are not the only manifestation of the reflex points for muscle disorders，other manifestations such as regional skin temperature changes also frequently occur．These positive re－ actions are very important to capture needling targets．Therefore， in the treatment of muscle disorders，the stimulation targets of DN should not be solely limited to the taut bands or hardened knots within the muscle layer．（2）The optimal stimulation targets for treating myofascial pain should not only be limited to the lo－ cal affected area，but also those in the distal areas of the body． The reflex points of myofascial pain can frequently be found lo－ cally，including MTrPs，but also in the tissue structures of the dis－ tal or contralateral parts of the body．In other words，for myofas－ cial pain，although performing DN on the MTrPs of the affected part can achieve good effects，it is not necessarily the most op－ timal needling way．There are at least four other needling op－ tions available：the resistance needling，the wrist－ankle needling， the nerve trunk（point）needling，and the juci／miuci（contralateral needling）．Stimulating only local MTrPs is clear indication for DN to lack holistic view in the target selection process．（3）Oftentimes joint inflammations coexist with myofascial pain．When they do occur，it is necessary to find and stimulate ARPs of other tissues （such as joint cavity or ligament）beside the muscle．For exam－ ple，various ARPs may appear near the acupoints located at joints， such as Xiyan（EX－LE5），Jianyu（LI15），Shaohai（HT3），Baliao（bilateral Shangliao［BL31］，Ciliao［BL32］，Zhongliao［BL33］and Xialiao［BL34］）． The trigger point theory focuses only on MTrPs at the myofas－ cial sites，not on ARPs within affected joints．This greatly limits the efficacy of DN in the treatment of various complex somatic pains．For example，for knee osteoarthritis coexisting with myofas－
（1）DN 的刺激仅针对肌肉层，忽视了身体表面的其他层次。在肌筋膜疼痛的治疗中，DN 仅选择 MTrPs 作为唯一的刺激目标。然而，肌筋膜疼痛的局部阳性反射点也可以在皮肤、皮下组织甚至骨膜中找到。此外，MTrPs 并不是肌肉疾病反射点的唯一表现，其他表现如区域皮肤温度变化也经常发生。这些阳性反应对于捕捉针刺目标非常重要。因此，在治疗肌肉疾病时，DN 的刺激目标不应仅限于肌肉层内的紧张带或硬结。（2）治疗肌筋膜疼痛的最佳刺激目标不仅应限于局部受影响区域，还应包括身体远端区域的目标。肌筋膜疼痛的反射点通常可以在局部找到，包括 MTrPs，但也可以在身体远端或对侧部位的组织结构中找到。换句话说，对于肌筋膜疼痛，尽管在受影响部位的 MTrPs 上进行 DN 可以取得良好的效果cts，针刺并不一定是最优的针刺方式。至少还有四种其他的针刺选择：阻力针刺、腕踝针刺、神经干（点）针刺，以及 juci/miuci（对侧针刺）。仅刺激局部肌肉触发点（MTrPs）明显表明 DN 在目标选择过程中缺乏整体视角。（3）关节炎症常常与肌筋膜疼痛共存。当它们发生时，有必要找到并刺激其他组织（如关节腔或韧带）的活跃反应点（ARPs），而不仅仅是肌肉。例如，各种 ARPs 可能出现在位于关节的腧穴附近，如膝眼（EX-LE5）、肩髎（LI15）、少海（HT3）、八髎（双侧上髎［BL31］、次髎［BL32］、中髎［BL33］和下髎［BL34］）。触发点理论仅关注肌筋膜部位的 MTrPs，而不关注受影响关节内的 ARPs。这极大限制了 DN 在治疗各种复杂躯体疼痛中的疗效。例如，对于伴有肌筋膜疼痛的膝关节骨关节炎
cial pain in the leg，direct insertion of the needle into the artic－ ular cavity through EX－LE5 is critical to attain great results，yet it is not a MTrP．（4）There is a vague understanding of the underly－ ing mechanisms of MTrPs，and the improper distinction between latent and active MTrPs．For example，MTrPs can also come from non－muscle disorders（certain visceral disorders that have visceral－ somatic reflexes，such as acute appendicitis）．It is also difficult to distinguish between so－called latent and active，and perhaps a bet－ ter and more proper distinction is to rename them as physiological and pathological because MTrPs can occur not only under diseased state／pathological conditions，but also under physiological condi－ tions［19］．（5）The mechanism for generating LTR during DN stim－ ulation is poorly understood．According to the MTrP theory，LTR is induced when the end－plate potential is released by DN，this is both inaccurate and incorrect．The commonly observed LTR during needling can be caused by three different mechanisms：the stretch reflex induced by stimulating the muscle spindle，the flexor reflex induced by pain stimulation，and the muscle contraction（an effect caused by directly stimulating the motor nerve trunk or the motor points）［19］．
腿部的局部疼痛，通过 EX-LE5 直接将针插入关节腔对于获得良好效果至关重要，但这并不是一个肌肉触发点（MTrP）。对 MTrP 的潜在机制的理解模糊不清，且对潜在和活跃 MTrP 的区分不当。例如，MTrP 也可以源于非肌肉疾病（某些具有内脏-躯体反射的内脏疾病，如急性阑尾炎）。区分所谓的潜在和活跃也很困难，或许更好和更恰当的区分是将它们重新命名为生理性和病理性，因为 MTrP 不仅可以在疾病状态/病理条件下发生，也可以在生理条件下发生。关于在 DN 刺激期间产生 LTR 的机制理解不够。根据 MTrP 理论，当 DN 释放终板电位时会诱发 LTR，这既不准确也不正确。在针刺过程中常见的 LTR 可以由三种不同的机制引起：通过刺激肌肉梭引起的拉伸反射，通过疼痛刺激引起的屈肌反射，以及肌肉收缩（直接刺激引起的效果）刺激运动神经干或运动点）［19］．

In short，the authors believe that needling MTrPs in muscles can be used to treat not only local myofascial pain but also other distal somatic or visceral diseases through nerve reflexes．Even for the local treatment of myofascial pain，it is possible to select and stimulate various positive ARPs across different layers of the body（skin，muscle，tendon，periosteum，joint，nerve trunk，etc．） as targets，not just MTrPs，under the guidance of a holistic view that is＂body surface－body surface correlation＂or＂body surface－ visceral correlation＂．The authors have long suggested that patho－ logical ARPs，a set of spots or acupoints on or near the meridians that can induce specific local and systemic reflex responses，on the body surface can be divided into at least three categories：somatic， visceral，and central．MTrPs primarily belong to local somatic ARPs， while others are considered distal somatic ARPs（Fig．2）．For the treatment of somatic pain，there are often other and somewhat better options（including using distal somatic ARPs in addition to local somatic ARPs like MTrPs）．The author＇s clinical experience has shown that many patients who first used MTrPs DN treatment but did not receive expected outcome，often received better results af－ ter distal or other somatic ARPs are found and stimulated．
简而言之，作者认为在肌肉中针刺肌肉触发点（MTrPs）不仅可以用于治疗局部肌筋膜疼痛，还可以通过神经反射治疗其他远端躯体或内脏疾病。即使是局部肌筋膜疼痛的治疗，也可以在“体表－体表相关”或“体表－内脏相关”的整体观指导下，选择和刺激身体不同层次（皮肤、肌肉、肌腱、骨膜、关节、神经干等）中的各种积极的病理反应点（ARPs）作为目标，而不仅仅是 MTrPs。作者长期以来建议，体表上的病理 ARPs 是一组位于经络上或附近的点或腧穴，可以引发特定的局部和系统性反射反应，可以分为至少三类：躯体、内脏和中枢。MTrPs 主要属于局部躯体 ARPs，而其他则被视为远端躯体 ARPs（图 2）。对于躯体疼痛的治疗，通常还有其他一些更好的选择（包括使用远端躯体 ARPs，除了局部躯体 ARPs 如 MTrPs）。作者的临床经验表明，许多最初使用 MTrPs 干针治疗但未获得预期效果的患者通常在发现并刺激远端或其他体性 ARP 后，获得更好的结果

The rapid rise and popularity of DN in the west has provided two important inspirations for the development of acupuncture to－ day．First，for the rapid integration of acupuncture into mainstream
DN 在西方的快速崛起和流行为今天针灸的发展提供了两个重要的启示。首先，针灸迅速融入主流的
medicine，the principles of acupuncture therapy must be able to be comprehended in a modern context，and the whole process of acupuncture therapy，including the selection of the stimulation tar－ get，the control of the stimulation amount，and the correct assess－ ment of the efficacy，must be able to scientifically guided．Secondly， the heritage of classical acupuncture techniques that have already had a thousand years of clinical experience should be inherited and not simply discarded．The latter point is evident from the anal－ ysis of the drawbacks or limitations of DN in the previous sec－ tion．Especially important，although it has been recognized that the meridians are not special anatomical tubes，their core recognition of the＂body surface－body surface correlation＂or＂body surface－ visceral correlation＂between the various parts of the body is ra－ tional and still of great value in guiding clinical acupuncture．
医学上，针灸疗法的原则必须能够在现代背景下被理解，整个针灸疗法的过程，包括刺激目标的选择、刺激量的控制以及疗效的正确评估，都必须能够得到科学指导。其次，已经有千年临床经验的经典针灸技术的遗产应当被继承，而不是简单地被抛弃。后一点从前一部分对 DN 缺点或局限性的分析中显而易见。尤其重要的是，尽管已经认识到经络并不是特殊的解剖管道，但它们对“体表-体表相关”或“体表-脏器相关”的核心认识在身体各个部分之间是合理的，并且在指导临床针灸方面仍然具有重要价值

In recent years，there are more clinical studies involving DN than ever before，some of which are extreme high－quality stud－ ies for the acupuncture profession＇s reference．Here，let＇s take a randomized clinical trial of DN for neck pain by Martín－Sacristán et al．［22］（refers to Martín－Sacristán＇s trial）as an example to see the importance of inheritance and innovation in the develop－ ment of acupuncture，though the sample size of the trial is rela－ tive small．Martín－Sacristán＇s trial was published in the Scientific Reports，2022，compared the efficacy of deep dry needling（DDN） on active MTrPs versus latent－MTrPs versus non－MTrP locations， for pain reduction and cervical disability，in patients with chronic neck pain．The study had a sample of 65 patients who were di－ vided into non－MTrP－DDN，active－MTrP－DDN and latent－MTrP－DDN groups，respectively via a randomized and double－blind design． Only one session of DN was administered for each group．Changes in the visual analog scale，patient pain reproduction，LTR frequency， pressure pain threshold and neck disability index were assessed before，during and after the intervention and at 1 －month post－ intervention．
近年来，涉及干针（DN）的临床研究比以往任何时候都要多，其中一些是极高质量的研究，供针灸专业参考。在这里，我们以 Martín－Sacristán 等人进行的针对颈痛的干针随机临床试验为例［22］（指 Martín－Sacristán 的试验），来看看在针灸发展中继承与创新的重要性，尽管该试验的样本量相对较小。Martín－Sacristán 的试验发表于《科学报告》，2022 年，比较了深层干针（DDN）对活跃肌筋膜触发点（MTrPs）、潜在 MTrPs 和非 MTrP 部位在减轻疼痛和颈部残疾方面的疗效，研究对象为慢性颈痛患者。该研究的样本为 65 名患者，分别通过随机双盲设计分为非 MTrP－DDN 组、活跃 MTrP－DDN 组和潜在 MTrP－DDN 组。每组仅进行了一次干针治疗。在干预前、干预期间、干预后及干预后 1 个月时评估视觉模拟量表、患者疼痛再现、LTR 频率、压痛阈值和颈部残疾指数的变化

The first step in the application of acupuncture is to select stim－ ulation targets：acupoints．Classical acupuncture views acupoints as fixed sites situated along the traveling courses of regular merid－ ians on the body surface．Any spots that are considered offsite from these classical recognized locations are considered non－acu－ points，not to mention the fact many of them are nowhere near the traveling courses of meridians，even those that are on the courses but slightly deviate from the fixed locations are not consid－ ered the original acupoints．Otherwise，Compendium of Acupuncture and Moxibustion by Ji－zhou YANG of the Ming Dynasty would not have forewarned that＂rather missing acupoints than the meridi－ ans＂，and thousands of novel and extraordinary points would not have been discovered since that time．In the case of the Zusanli （ST36），for example，there are now some novel points in its vicin－ ity，such as Erliban（ 0.5 cun superior to ST36），Wanli（ 0.5 cun infe－ rior to ST36），and appendix point（1－2 cun inferior to ST36）［19］．
应用针灸的第一步是选择刺激目标：腧穴。经典针灸将腧穴视为位于身体表面经络行走路径上的固定点。任何被认为偏离这些经典认可位置的点都被视为非腧穴，更不用说许多点根本不在经络的行走路径上，即使那些在路径上但稍微偏离固定位置的点也不被认为是原始腧穴。否则，明代杨继洲的《针灸大成》就不会预警“宁可错过腧穴，不可错过经络”，自那时以来也不会发现成千上万的新奇和非凡的点。例如，在足三里（ST36）的情况下，现在在其附近有一些新奇的点，如二里半（位于 ST36 上方 0.5 寸）、万里（位于 ST36 下方 0.5 寸）和附加点（位于 ST36 下方 1-2 寸）［19］。

Although the perception that acupoints have fixed locations has been repeatedly questioned or challenged by certain modern acupuncturists，such as Prof．Jia WEI＇s distinction between＂dy－ namic and static points＂［23］and the authors own concept of ARPs and acu－reflex zones（ARZs）［19］．To date，most clinical trials of acupuncture distinguish acupoints and non－acupoints by whether they are in fixed locations of the meridians．Moreover，those trial designs rarely consider what layers of tissue structures that may be stimulated within the acupoint，and most trials only indicated the inserting depth of needle，which usually cannot specify what tissue punctured，especially in terms of their different needling effects． Even though some current studies begin to assess how different depths of needling may produce different effects（e．g．deep versus shallow needling）．For example，when setting up a sham acupunc－
尽管某些现代针灸师（如贾伟教授）对腧穴具有固定位置的看法提出了质疑或挑战，例如他对“动态和静态点”的区分，以及作者自己对 ARP 和腧反射区（ARZ）的概念。迄今为止，大多数针灸临床试验通过腧穴是否位于经络的固定位置来区分腧穴和非腧穴。此外，这些试验设计很少考虑在腧穴内可能被刺激的组织结构层次，大多数试验仅指明针刺的深度，通常无法具体说明刺入了哪些组织，尤其是在不同的针刺效果方面。尽管一些当前研究开始评估不同针刺深度可能产生的不同效果（例如，深针与浅针）。例如，在设置假针灸时……
ture control group，performing shallow needling on certain non－ acupoints（those that are not on any meridians）are often consid－ ered sham acupuncture［24］，however，further refining stimulation targets at different depths to account for the difference or impact of needling effects remains to be explored．
真实对照组，在某些非腧穴（不在任何经络上的腧穴）上进行浅层针刺的常被认为是假针灸［24］，然而，进一步细化不同深度的刺激目标以考虑针刺效果的差异或影响仍有待探索

Considering Martín－Sacristán＇s trial again，one can see that it has a very clear and refined classification of stimulation targets： active MTrPs，latent MTrPs，or non－MTrP sites．Active MTrPs are those that cause spontaneous pain or specific pain during move－ ment，stretching or compression．Latent MTrPs are usually asymp－ tomatic，but they produce pain or discomfort when they are com－ pressed．In this trial，selected non－MTrP sites were asymptomatic of any type and were at least 2 cm away from other latent MTrPs selected in the upper trapezius muscle．
考虑到马丁－萨克里斯坦的试验，可以看出它对刺激目标有非常清晰和精细的分类：主动肌筋膜触发点（MTrPs）、潜在肌筋膜触发点或非 MTrP 部位。主动 MTrPs 是指在运动、拉伸或压迫时引起自发性疼痛或特定疼痛的点。潜在 MTrPs 通常是无症状的，但在被压迫时会产生疼痛或不适。在这个试验中，选择的非 MTrP 部位在任何类型上都是无症状的，并且距离上斜方肌中选择的其他潜在 MTrPs 至少有 2 厘米

As classical acupuncture is often difficult to know which part or layer of anatomic tissues were needled，their stimulation tar－ gets are generally more complex than those of DN，which mostly target the MTrPs in the muscles．For example，when needling acu－ points at muscular areas，the tissues of the body surface that can be stimulated by the needle tip or body has at least six levels from outside in：skin $>$$>$>> subcutaneous tissue $>$$>$>> muscle or tendon（in－ cluding deep fascia）＞nerve trunk or its branches＞blood vessels $>$$>$>> periosteum．Because the morphological basis of needling sensa－ tion is the receptors and nerves innervating acupoints，the anatom－ ical levels of and receptors within acupoints should be familiar．The efficacy of acupuncture and its repeatability would not be ensured unless the selection and determination of the stimulation target， mode，amount，and corresponding effects could be considered from different tissue levels within acupoints．
由于经典针灸常常难以确定针刺的解剖组织的哪个部分或层次，因此它们的刺激目标通常比 DN 更复杂，后者主要针对肌肉中的触发点（MTrPs）。例如，当在肌肉区域针刺腧穴时，针尖或针体可以刺激的体表组织至少有六个层次，从外到内依次为：皮肤 $>$$>$>> 皮下组织 $>$$>$>> 肌肉或肌腱（包括深筋膜）＞神经干或其分支＞血管 $>$$>$>> 骨膜。由于针刺感觉的形态学基础是支配腧穴的受体和神经，因此应熟悉腧穴的解剖层次和受体。除非能够从腧穴内不同组织层次考虑刺激目标、模式、数量和相应效果的选择和确定，否则针灸的疗效及其重复性将无法得到保证

A large number of forms or techniques of modern acupunc－ ture（including DN）have demonstrated that the selection of tender points or sensitive points（which the authors call ARPs）is a key to improve the efficacy of acupuncture，and most ARPs appear in the locations of regular meridians while some may appear at extraor－ dinary points，so they generally overlap．The same is true for the relationship between acupoints and MTrPs，which are local somatic ARPs，their distribution partially overlaps．Melzack et al．found a remarkably high degree（ $71\mathrm{\%}$$71\mathrm{\%}$71%71 \% ）of overlapping between MTrPs and acupoints［25］，while Dorsher P．found $92\mathrm{\%}$$92\mathrm{\%}$92%92 \% of the 255 MTrPs over－ lap with acupoints［26］．
现代针灸（包括 DN）的大量形式或技术已经证明，选择压痛点或敏感点（作者称之为 ARPs）是提高针灸疗效的关键，大多数 ARPs 出现在常规经络的位置，而一些可能出现在奇经八脉的点上，因此它们通常是重叠的。针灸点与肌肉触发点（MTrPs）之间的关系也是如此，MTrPs 是局部的体性 ARPs，它们的分布部分重叠。Melzack 等人发现 MTrPs 与针灸点之间有着显著的高度重叠（ $71\mathrm{\%}$$71\mathrm{\%}$71%71 \% ），而 Dorsher P.发现 255 个 MTrPs 中有 $92\mathrm{\%}$$92\mathrm{\%}$92%92 \% 与针灸点重叠［26］

In other words，at least $70\mathrm{\%}$$70\mathrm{\%}$70%70 \% to $90\mathrm{\%}$$90\mathrm{\%}$90%90 \% of acupoints may show pos－ itive manifestations of MTrPs．The criteria to determine so－called active MTrPs in Martín－Sacristán＇s trial must have any two of these positive manifestations：a palpable hardened nodule（taut band），a hypersensitive site on pressure，referred pain and the re－ production of any of the symptoms experienced by the patient with perceived pain．On the other hand，ARPs encompass all MTrPs of DN and Ashi points in classical acupuncture．In a review article ［27］，Hong CZ correlated the tender points with Ashi points and also correlated LTR to deqi based on the work of Melzack et al．In－ deed，Fig． 2 vividly illustrates the relationships among ARPs，MTrPs and acupoints（APs）．
换句话说，至少 $70\mathrm{\%}$$70\mathrm{\%}$70%70 \% 到 $90\mathrm{\%}$$90\mathrm{\%}$90%90 \% 个腧穴可能会显示 MTrPs 的积极表现。在 Martín-Sacristán 的试验中，确定所谓的活跃 MTrPs 的标准必须具备以下两种积极表现：可触及的硬结（紧绷带）、在施压时的超敏感点、放射性疼痛以及患者感知疼痛时经历的任何症状的再现。另一方面，ARPs 包括经典针灸中的所有 DN 和 Ashi 点的 MTrPs。在一篇综述文章中［27］，Hong CZ 将压痛点与 Ashi 点相关联，并根据 Melzack 等人的研究将 LTR 与得气相关联。实际上，图 2 生动地展示了 ARPs、MTrPs 和腧穴（APs）之间的关系

Martín－Sacristán＇s trial compared the effects for pain relief and cervical mobility in the patients of chronic cervical disorders re－ ceiving one－time DDN across several groups of MTrPs：active－ MTrPs，latent－MTrPs and non－MTrPs on the trapezius muscle．The results showed that the stimulation of active MTrPs with positive manifestations had the more optimal effect．It was found that al－ though the pain intensity，neck disability index and pressure pain threshold were equally improved for all three groups instanta－ neously post－treatment．However，at 1 －week and 1－month post－ treatment，the active－MTrP group showed greater improvement in pain reduction compared to latent－MTrP group or non－MTrP group．
Martín－Sacristán 的试验比较了在慢性颈部疾病患者中，接受一次性 DDN 治疗对疼痛缓解和颈部活动度的影响，涉及多个 MTrP 组：活跃 MTrP、潜伏 MTrP 和非 MTrP 在斜方肌上的效果。结果显示，刺激具有积极表现的活跃 MTrP 效果更为理想。研究发现，尽管所有三个组在治疗后瞬间疼痛强度、颈部残疾指数和压痛阈值均有相同改善，但在治疗后 1 周和 1 个月时，活跃 MTrP 组在疼痛减轻方面的改善程度明显优于潜伏 MTrP 组或非 MTrP 组

This result of the trail once again provides solid evidence for the first formula of acu－reflex point acupuncture（rather miss the meridians and acupoints than miss the reflex phenomena）pro－ posed in the authors＇ 2007 book Contemporary Medical Acupunc－ ture：A Systems Approach［20］．In other words，as long as an ARP is found and stimulated，no matter if it is lodged at or near the clas－ sical meridians，it will take effect，and may even be better than stimulating a non－ARP acupoint in the long run［19］．
这次试验的结果再次为作者在 2007 年出版的《当代医学针灸：系统方法》一书中提出的第一条针灸反射点公式（宁可错过经络和腧穴，也不要错过反射现象）提供了有力的证据。换句话说，只要找到并刺激一个 ARP，无论它位于经典经络的哪个位置，都会产生效果，长期来看，甚至可能比刺激一个非 ARP 腧穴更有效

In short，DN，which primarily takes MTrPs（a form of somatic ARPs or acupoints）as the targets of stimulation，hints that acu－ points are essentially the terminals at the body surface that are reflexively connected to the internals of the body．In other words， the basic property of acupoints seems connecting the internals and the externals of the body by reflexes from the perspective of sys－ tems medicine［28］．
简而言之，DN 主要以 MTrPs（一种体态 ARP 或腧穴）作为刺激目标，暗示腧穴本质上是与身体内部反射性连接的身体表面的末端。换句话说，从系统医学的角度来看，腧穴的基本属性似乎是通过反射连接身体的内部和外部［28］

Paging through most of the current clinical studies of acupunc－ ture，one can observe an interesting fact that except for elec－ troacupuncture，which has a strict control protocol of various stim－ ulation parameters，studies involving manual acupuncture often lack quantitative norms．At most，there are only a few general pro－ visions on stimulation duration，needle－retention duration，treat－ ment frequency，and a general classification of the manipulation strengths（light，mild or strong）．The classical reinforcing and re－ ducing needle manipulation technique，can only add another layer of mystery to the stimulus amount of acupuncture unless the true definition of reinforcing and reducing is revealed．There is also a lack of detailed description of the stimulation response under the needle，which is one of the most important indicators of the stim－ ulus amount．At most，many studies only simply refer to needling sensation as deqi or present a few texts on the nature of needling sensations felt by the subjects．Moreover，the assessment of thera－ peutic efficacy is mostly completed by acupuncturists themselves．
翻阅大多数当前的针灸临床研究，可以观察到一个有趣的事实：除了电针有严格控制各种刺激参数的协议外，涉及手动针灸的研究往往缺乏定量标准。最多只有一些关于刺激持续时间、针留置时间、治疗频率和操作强度（轻、中或强）的总体规定。经典的补泻针法技术，除非揭示补和泻的真正定义，否则只能为针灸的刺激量增添另一层神秘感。针下的刺激反应缺乏详细描述，而这正是刺激量最重要的指标之一。最多，许多研究仅简单地将针刺感觉称为得气，或呈现一些关于受试者感受到的针刺感觉性质的文本。此外，治疗效果的评估大多由针灸师自己完成

In Martín－Sacristán＇s trial，there are some good designs in these aspects．Not only does the study have a clear and refined classifi－ cation protocol for all the stimulation targets，but also has an ob－ jective description of the stimulation response to MTrPs，which is LTR．Precise needling of the MTrPs induced a brief contraction fol－ lowed by relaxation of the muscle fibers，which is exactly what LTR is，an equivalence of deqi from classical acupuncture．The LTR num－ ber induced was evaluated as a clear quantitative indicator by the DN practitioner who provided up to 12 treatments（ins and outs） $(\mathrm{n}/12)$$(\mathrm{n}/12)$(n//12)(\mathrm{n} / 12) at a frequency of 1 Hz in the MTrP or the non－MTrP．
在马丁－萨克里斯坦的审判中，这些方面有一些好的设计。该研究不仅对所有刺激目标有明确而精细的分类协议，还有对 MTrPs 刺激反应的客观描述，即 LTR。对 MTrPs 的精确针刺引发了短暂的收缩，随后是肌纤维的放松，这正是 LTR 的定义，相当于传统针灸中的得气。诱发的 LTR 数量被提供多达 12 次治疗（进出）的 DN 从业者评估为一个明确的定量指标，频率为 1 Hz，在 MTrP 或非 MTrP 中

This study also quantified the pressure pain test on MTrPs．Pres－ sure pain is defined as the minimum pressure that induces pain or discomfort with a $1{\mathrm{cm}}^2$$1{\mathrm{cm}}^2$1cm^(2)1 \mathrm{~cm}^{2} rubber disk．Pressure is applied at a rate of $1\mathrm{kg}/\mathrm{s}$$1\mathrm{kg}/\mathrm{s}$1kg//s1 \mathrm{~kg} / \mathrm{s} ．Three consecutive tests were practiced on the active，la－ tent and non MTrP of the upper trapezius muscle at 30 s intervals before and immediately after the intervention．
本研究还量化了对 MTrPs 的压痛测试。压痛被定义为使用 $1{\mathrm{cm}}^2$$1{\mathrm{cm}}^2$1cm^(2)1 \mathrm{~cm}^{2} 橡胶圆盘施加的最小压力，该压力会引起疼痛或不适。压力以 $1\mathrm{kg}/\mathrm{s}$$1\mathrm{kg}/\mathrm{s}$1kg//s1 \mathrm{~kg} / \mathrm{s} 的速率施加。在干预前和干预后立即，对上斜方肌的活动性、潜在性和非 MTrP 进行了三次连续测试，间隔 30 秒

The random，double－blind design of this trial was so strict that not only did patients not know which of the three intervention groups they were randomly categorized，even the DN practitioner did not know（actually，it is nearly impossible completely blind all parties for any needling procedure），that is，the evaluator thera－ pist marked on the skin of each participant the place where the DN practitioner not knowing which group each of the participants belonged to．The assessment of efficacy was also completed in－ dependently by a third party other than the evaluator therapist， to avoid personal bias in the therapist＇s assessment of his or her own methodology．Such a scientific research design，regardless of its outcome，makes its entire operation easily repeatable by peers and critics．
该试验的随机双盲设计非常严格，不仅患者不知道自己被随机分配到三个干预组中的哪一组，甚至 DN 治疗师也不知道（实际上，完全让所有参与者盲目进行任何针刺程序几乎是不可能的），也就是说，评估治疗师在每位参与者的皮肤上标记了 DN 治疗师不知道每位参与者属于哪个组的地方。疗效评估也由评估治疗师以外的第三方独立完成，以避免治疗师对自己方法的评估产生个人偏见。这样的科学研究设计，无论其结果如何，都使其整个操作易于被同行和批评者重复

Presently，most current clinical trials of acupuncture are often difficult to be replicated by peers or critics due to a lack of con－ crete descriptions on stimulation targets in the selected acupoints， along with an unclear indicator for the stimulus amount．Certainly， certain modern styles of acupuncture have begun to focus on in－ dicators of needling dose and reactions under the needle，such as the Xingnao Kaiqiao（resuscitating the brain and opening the ori－ fices）needling method requiring the muscle or limb to jerk when the nerve trunk innervating the muscle or limb is needled［29］， as well as having an electric shock sensation in the nasal cav－ ity when Xinwu point（sphenopalatine ganglion）is stimulated［30］． However，in clinical studies of acupuncture，there are many designs in need of further improvement．For example，when needling ST36， the needling sensations that propagate to the foot or the abdomen （ $q$$q$qq i arriving at the affected site）should be an indicator of an ap－ propriate amount of stimulation；same can be said for the occur－ rence of the flush（erythema）around the needling site has been used as an index during cutaneous acupuncture，and so on［19］． In the assessment of efficacy，it is important to get rid of possible misjudgments that may be caused by researchers＇own preferences or ways of doing things．Letting a third party do the assessment independently is the best．
目前，大多数当前的针灸临床试验由于缺乏对选定腧穴刺激目标的具体描述，以及对刺激量的不明确指标，往往难以被同行或评论者复制。当然，某些现代针灸风格已经开始关注针刺剂量和针下反应的指标，例如，Xingnao Kaiqiao（复苏大脑和开窍）针刺方法要求在针刺支配肌肉或肢体的神经干时，肌肉或肢体要有抽动［29］，以及在刺激 Xinwu 点（蝶腭神经节）时，鼻腔内有电击感［30］。然而，在针灸的临床研究中，许多设计仍需进一步改进。例如，在针刺 ST36 时，传播到脚或腹部的针刺感觉（ $q$$q$qq 到达受影响部位）应作为适当刺激量的指标；同样，针刺部位周围出现潮红（红斑）在皮肤针灸中被用作指标，等等［19］。在疗效评估中cy，重要的是消除可能由研究者自身偏好或做事方式引起的误判。让第三方独立进行评估是最好的

The effectiveness of DN also suggests that the importance of meridian theory in guiding acupuncture should be properly val－ ued．There is no dispute that the meridian theory is a time－tested guide with great significance for clinical acupuncture because the essence of the meridian is＂body surface－body surface correlation＂ and＂body surface－viscera correlation＂．It has accumulated a wealth of experience in this regard，and inheriting the meridian theory is conducive to improving the efficacy of acupuncture．However， DN is similar to other novel needling therapies created in mod－ ern times，such as scalp acupuncture，wrist／ankle acupuncture，and nerve trunk acupuncture，where most of them are also effective without the guidance of the meridian theory．This suggests that the meridian theory is not the only and absolute theory to guide clinical acupuncture．
DN 的有效性也表明，经络理论在指导针灸中的重要性应得到适当重视。毫无争议的是，经络理论是经过时间考验的指南，对临床针灸具有重要意义，因为经络的本质是“体表-体表相关”和“体表-脏腑相关”。在这方面积累了丰富的经验，继承经络理论有助于提高针灸的疗效。然而，DN 与现代创造的其他新型针刺疗法相似，如头皮针灸、腕/踝针灸和神经干针灸，其中大多数在没有经络理论指导的情况下也有效。这表明，经络理论并不是指导临床针灸的唯一和绝对理论

Since no specific structures beyond the tissues recognized by anatomy have been found to exist at acupoints，and all needling ef－ fects can be cut off once the afferent of acupuncture is blocked，it is now generally accepted that the basis of acupuncture therapy is the reflex arc［19］．The response to acupuncture stimulation is the reflective effect caused by stimulating the locally existing recep－ tors and the corresponding nerve（afferent or efferent）branches． The so－called meridians are nothing more than a plain expression of the pathways of information exchange between different body parts or between the internal organs and the body surface under ancient circumstances［19］．
由于在腧穴处未发现解剖学所识别的组织以外的特定结构，并且一旦阻断针灸的传入神经，所有的针刺效果都可以被切断，因此现在普遍接受针灸疗法的基础是反射弧［19］。对针灸刺激的反应是通过刺激局部存在的感受器和相应的神经（传入或传出）分支所引起的反射效应。所谓的经络不过是古代情况下不同身体部位或内脏与身体表面之间信息交流路径的简单表达［19］

Various forms of modern acupuncture，through the anatomical and physiological studies on the receptors of stimulation targets at the body surface，the afferent，the centers，and the effector，can of－ ten yield an efficacy that is comparable or even better than that of classical acupuncture，and may even have a better reproducibil－ ity of efficacy because it knows what it is．This is the basis for the rise and development of various＂de－meridian＂modern styles of acupuncture，including DN．
现代针灸的各种形式，通过对身体表面刺激目标的受体进行解剖和生理研究，涉及传入神经、中心和效应器，往往能够产生与经典针灸相当甚至更好的疗效，并且可能具有更好的疗效可重复性，因为它知道自己是什么。这是各种“去经络”现代针灸风格，包括 DN 兴起和发展的基础

Inheriting the theory and experience of classical acupuncture that have been undergone over several centuries is of great sig－ nificance to improve the efficacy of acupuncture．Its role includes
继承经过数百年发展的经典针灸理论和经验，对于提高针灸的疗效具有重要意义。它的作用包括
at least two aspects：first，broadening the idea of acupoint selec－ tion；second，choose more stimulation means or methods，which can either be used alone or in combination．As DN does not con－ sider itself a style of acupuncture and is completely cut off and de－ tached from the millennium－old classical acupuncture，it not only lacks holistic treatment thinking，but also its stimulation target is limited to the affected muscles，as well as having only a very nar－ row scope of indications：the myofascial pain．
至少有两个方面：第一，拓宽腧穴选择的思路；第二，选择更多的刺激手段或方法，这些手段或方法可以单独使用，也可以组合使用。由于 DN 并不认为自己是一种针灸风格，并且与千年古典针灸完全割裂和脱离，它不仅缺乏整体治疗思维，而且其刺激目标仅限于受影响的肌肉，并且适应症范围非常狭窄：肌筋膜疼痛

We can re－examine Martín－Sacristán＇s trial as an example．Ac－ cording to the DN experience in the treatment of myofascial pain syndrome，the selected stimulation target in this trial is only on the trapezius muscle．Of course，this is based on the suggestion that MTrPs could be responsible for the development of pain in patients with mechanical neck pain．Moreover，some studies have observed that the prevalence of MTrPs in patients with myofas－ cial pain was $93.75\mathrm{\%}$$93.75\mathrm{\%}$93.75%93.75 \% for the upper trapezius muscle，the most prevalent muscle to observe MTrPs［31］．The trial found that the active MTRP group had an increase in pain first immediately af－ ter the DN treatment，and it was only at 1 －week post－treatment that this same group had the greatest pain reduction．In the clinic of acupuncture，such a post－needling reaction is a common phe－ nomenon of microtrauma caused by local needling in the affected part．Bleeding was reported to be the most common minor adverse effect presented in $16\mathrm{\%}$$16\mathrm{\%}$16%16 \% of DN procedures［32］．
我们可以重新审视 Martín-Sacristán 的试验作为一个例子。根据 DN 在治疗肌筋膜疼痛综合症方面的经验，这个试验中选择的刺激目标仅在斜方肌上。当然，这基于这样的建议：MTrPs 可能是导致机械性颈部疼痛患者疼痛发展的原因。此外，一些研究观察到，肌筋膜疼痛患者中 MTrPs 的发生率为 $93.75\mathrm{\%}$$93.75\mathrm{\%}$93.75%93.75 \% ，上斜方肌是观察到 MTrPs 的最常见肌肉［31］。试验发现，活跃的 MTRP 组在 DN 治疗后立即感到疼痛增加，而只有在治疗后 1 周时，这个组的疼痛减轻幅度最大。在针灸诊所，这种针后反应是由于在受影响部位进行局部针刺所造成的微创伤的常见现象。报告称，出血是 $16\mathrm{\%}$$16\mathrm{\%}$16%16 \% 的 DN 程序中最常见的轻微不良反应［32］

According to the accumulated experience of clinical acupunc－ ture in the treatment of neck pain for the past few centuries，there are many distal acupoints（including acupoints on non－muscles） that can be selected，such as Xuanzhong（GB39）in the lateral area of the leg and Waiguan（TE5）on the lateral side of the forearm ［19］．Such distal acupoints for neck pain are not only to avoid the instantaneous increase of post－needling pain in the affected area， but also to achieve significant long－term curative effects．In 2011， in order to expand the idea of selecting acupoints in treating neck pain，some researchers checked the relevant contents of acupunc－ ture treatises of neck pain in 12 ancient textbooks［33］．By sorting the acupoints according to the 14 meridians，they found that the most common acupoints for neck pain in ancient times were at the foot taiyang bladder meridian，having a total of 14 acupoints． Other common meridians include the foot shaoyang gallbladder meridian（13 acupoints），the hand taiyang small intestine meridian （10 points），governor vessel（ 9 acupoints）and the hand shaoyang san jiao meridian（6 acupoints）．There are two acupoints in con－ ventional vessel，and only one acupoint in each of the remaining seven meridians．It is concluded that the acupoints for neck pain are mainly located in the taiyang，shaoyang meridians and governor vessel，but are related to all the 14 meridians．
根据过去几个世纪临床针灸治疗颈痛的积累经验，有许多远端腧穴（包括非肌肉上的腧穴）可以选择，例如位于腿部外侧的悬钟（GB39）和位于前臂外侧的外关（TE5）［19］。这些用于颈痛的远端腧穴不仅可以避免在患处针刺后瞬间疼痛的增加，还可以实现显著的长期疗效。2011 年，为了扩展治疗颈痛时选择腧穴的思路，一些研究者查阅了 12 本古代教材中关于颈痛的针灸论著的相关内容［33］。通过根据 14 条经络对腧穴进行整理，他们发现古代颈痛最常用的腧穴位于足太阳膀胱经，共有 14 个腧穴。其他常见的经络包括足少阳胆经（13 个腧穴）、手太阳小肠经（10 个腧穴）、督脉（9 个腧穴）和手少阳三焦经（6 个腧穴）。常规脉中有两个腧穴，只有一个腧穴在其余七条经络中得出结论，颈部疼痛的腧穴主要位于太阳、少阳经和督脉，但与所有 14 条经络相关

Most of these acupoints are located far from the neck region， so usually are not targets of DN stimulation，but classical acupunc－ ture may select them following the principle of＂selecting acu－ points along the meridians＂（Wherever the meridians pass，indica－ tions are present）．In fact，in modern acupuncture clinics，even if certain practitioners are not quite familiar with the meridian the－ ory，the experience of using these distal acupoints to treat neck pain is still helpful in treating neck pain．
这些腧穴大多位于颈部区域远处，因此通常不是 DN 刺激的目标，但经典针灸可能会根据“沿经络选择腧穴”的原则选择它们（经络经过的地方，常有指征）。事实上，在现代针灸诊所，即使某些从业者对经络理论不太熟悉，使用这些远端腧穴治疗颈痛的经验仍然对治疗颈痛有帮助

In addition to those hidden beneath the meridian theory，there are also valuable experiences can be gained by studying contralat－ eral needling theories or five－body needling methods，which are excellent treatment modalities stand－alone and are great ideas for treating myofascial pain syndrome，the main indication of DN． Nowadays，in the west，non－acupuncturist DN practitioners often claim DN is a new technique and not acupuncture，in essence，try－ ing to disassociate the needling with the rich acupuncture experi－ ence．
除了那些隐藏在经络理论之下的经验外，通过研究对侧针刺理论或五体针刺方法，还可以获得宝贵的经验，这些都是独立的优秀治疗方式，并且是治疗肌筋膜疼痛综合症（DN 的主要适应症）的好主意。如今，在西方，非针灸师的 DN 从业者常常声称 DN 是一种新技术，而不是针灸，实际上，他们试图将针刺与丰富的针灸经验脱钩

In addition，DN therapy defines its indications merely as my－ ofascial pain，which also reflects its shallow understanding of the needling effect at MTrPs of the muscles．In classical acupuncture，
此外，DN 疗法仅将其适应症定义为肌筋膜疼痛，这也反映了其对肌肉 MTrPs 针刺效果的浅显理解。在经典针灸中，
the acupoints that can result in deqi（i．e．，LTR in DN）are mostly located in the muscle．Stimulating them not only can treat lo－ cal or distal somatic pain，but also can treat related visceral and central diseases．Therefore，as long as non－acupuncturist DN prac－ titioners re－recognize that DN is a part of acupuncture，and the MTrPs are just acupoints in muscles，as well as learn more from the millennium－old classical acupuncture，its curative effect will be further improved，and its indications will be greatly broadened．
能够导致得气（即，DN 中的 LTR）的腧穴大多位于肌肉中。刺激这些腧穴不仅可以治疗局部或远端的躯体疼痛，还可以治疗相关的内脏和中枢疾病。因此，只要非针灸师的 DN 从业者重新认识到 DN 是针灸的一部分，而肌肉触发点（MTrPs）只是肌肉中的腧穴，并且从千年古老的经典针灸中学习更多，其疗效将进一步提高，适应症也将大大拓宽

All in all，the rise and popularity of DN in the west during the past two decades is a significant manifestation for the global acupuncture fever．Although DN proponents tried to make it in－ dependent from acupuncture so that non－acupuncturist DN practi－ tioners could get around regulations of acupuncture laws，DN，after all，remains a form of modern acupuncture，with a＂de－meridian＂ characteristic．Not only was it inspired by acupuncture，but the op－ erations of DN and the explanation of its mechanism mostly fol－ lowed the methods and research results of acupuncture．
总的来说，过去二十年来 DN 在西方的兴起和普及是全球针灸热的重要表现。尽管 DN 的支持者试图使其独立于针灸，以便非针灸师的 DN 从业者能够规避针灸法律的规定，但 DN 毕竟仍然是一种现代针灸形式，具有“去经络”的特征。它不仅受到针灸的启发，而且 DN 的操作和其机制的解释大多遵循针灸的方法和研究结果

However，ever since its inception，DN has stood tall at the gate of modern physiological anatomy for its recognition of stimula－ tion targets and stimulation methods，which makes its scientific research and clinical advocacy seem credible．This can be seen as an important inspiration for the development of acupuncture or its global fever，that is，the scientific interpretation of the princi－ ples of acupuncture must be imperative．The authors believe the development of acupuncture is totally inseparable from its theo－ retical and technical innovations．On the other hand，DN do have a series of drawbacks or limitations that suggest that in order to innovate novel concepts in acupuncture，one shall first prop－ erly inherit and learn from the valuable experience accumulated in the millennium－old development of classical acupuncture，in－ cluding the rational core of meridian theory．In other words，the motto of a revitalizing modern or contemporary acupuncture de－ velopment should be to appreciate and inherit the lost teachings of the ancient sages or books，but always be open minded to learn new skills of today and forge ahead a new path to a better，health－ ier tomorrow．
然而，自其 inception 以来，DN 在现代生理解剖学的门口屹立不倒，因为它对刺激目标和刺激方法的认可，使其科学研究和临床倡导显得可信。这可以被视为针灸发展或其全球热潮的重要启示，即对针灸原则的科学解释必须是必要的。作者认为，针灸的发展与其理论和技术创新是完全不可分割的。另一方面，DN 确实存在一系列缺点或局限性，这表明为了在针灸中创新新概念，首先应当适当地继承和学习千年古典针灸发展中积累的宝贵经验，包括经络理论的理性核心。换句话说，振兴现代或当代针灸发展的座右铭应该是欣赏和继承古代圣贤或经典的失传教义，但始终保持开放的心态，学习当今的新技能，开辟通往更好、更健康明天的新道路

No need to declare in this paper．
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You can contact the corresponding author for the data．
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本文中无需声明

Guanyuan JIN：conceptualization，original draft writing；Louis Lei JIN：final writing and revising；Belinda Jie HE：reviewing and editing；Bonnie Xia JIN：reserching references and final editing．
金冠源：概念化，原始草稿撰写；金路易：最终撰写和修订；何洁贝琳达：审阅和编辑；金博妮：研究参考文献和最终编辑

The author has no competing interests to declare．
作者没有需要声明的竞争利益

［1］Travell JG，Simons DG．Myofascial pain and dysfunction：the trigger point man－ ual，1．Baltimore：Williams \＆Wilkins； 1983.
［1］Travell JG，Simons DG．肌筋膜疼痛与功能障碍：触发点手册，1．巴尔的摩：Williams \＆Wilkins；1983.
［2］Travell JG，Simons DG．Myofascial pain and dysfunction：the trigger point man－ ual，2．2nd Ed．Baltimore：Lippincott Williams \＆Wilkins；1999．set．
［2］Travell JG，Simons DG．肌筋膜疼痛与功能障碍：触发点手册，2．第 2 版．巴尔的摩：Lippincott Williams \＆Wilkins；1999．套装．
［3］Unverzagt C，Berglund K，Thomas JJ．Dry needling for myofascial trigger point pain：a clinical commentary．Int J Sports Phys Ther 2015；10（3）：402－18．
［3］Unverzagt C，Berglund K，Thomas JJ．干针疗法治疗肌筋膜触发点疼痛：临床评论．国际体育物理治疗杂志 2015；10（3）：402－18．
［4］Fan AY，Xu J，He HJ，Jin GY，Li YM．Demystifying the war of dry needling，re－ fusing the claim that dry needling is not acupuncture．J Inform TCM 2015.
［4］Fan AY，Xu J，He HJ，Jin GY，Li YM．揭开干针疗法的神秘面纱，驳斥干针疗法不是针灸的说法。J Inform TCM 2015.
［5］Jin GY，Jin LL，BX Jin．Dry Needling：a de－meridian style of acupuncture．Wrld J Acup Moxi 2016；26（2）：1－5．
［5］Jin GY，Jin LL，BX Jin．干针疗法：一种去经络风格的针灸。世界针灸与艾灸杂志 2016；26（2）：1－5．
［6］Fan AY，Xu J，Li YM．Evidence and expert opinions：dry needling versus acupuncture．Chin J Integr Med 2017；23：3－9．
［6］Fan AY，Xu J，Li YM．证据与专家意见：干针疗法与针灸的比较．中国综合医学 2017；23：3－9．
［7］Fan AY，Zheng L，Yang G．Evidence that dry needling is the intent to by－ pass regulation to practice acupuncture in the United States．J Alt Compl Med 2016；22（8）：591－3．
［7］Fan AY，Zheng L，Yang G．证据表明干针疗法是为了规避在美国实践针灸的监管。J Alt Compl Med 2016；22（8）：591－3．
［8］American Alliance for Professional Acupuncture Safety（AAPAS）＇s call for art－ work entry for the Oppose Practice Acupuncture Without License（OPAWL） contest due 8／31／2019 AAPAS Judge／Competition Committee．（2019－01－ 27）［2020－1－30］．www．aapas．org．
［8］美国专业针灸安全联盟（AAPAS）对反对无证针灸（OPAWL）比赛的艺术作品征集的通知，截止日期为 2019 年 8 月 31 日 AAPAS 评委/竞赛委员会。（2019－01－27）［2020－1－30］．www．aapas．org．
［9］Wallace DJ，Clauw DJ．Fibromyalgia and other central pain syndromes．Lippin－ cott Williams \＆Wilkins； 2005.
［9］Wallace DJ，Clauw DJ．纤维肌痛症及其他中枢疼痛综合症．Lippincott Williams & Wilkins；2005.
［10］Legge D．A history of dry needling．J Musculoskelet．Pain 2014；22（3）：301－7．
［10］Legge D. 干针疗法的历史。J Musculoskelet. Pain 2014；22（3）：301－7．
［11］Shah JP，Thaker N，Heimur J，Aredo JV，Sikdar S，Gerber L．Myofascial trigger points then and now：a historical and scientific perspective．PMR 2015；7（7）：746－61．
［11］Shah JP，Thaker N，Heimur J，Aredo JV，Sikdar S，Gerber L．肌筋膜触发点的过去与现在：历史与科学的视角．PMR 2015；7（7）：746－61．
［12］Travell JG，Rinzler SH．The myofascial genesis of pain．Postgrad Med 1952；11：425－34．
［12］Travell JG，Rinzler SH．肌筋膜疼痛的起源．Postgrad Med 1952；11：425－34．
［13］Paulett JD．Low back pain．Lancet 1947；2（6469）：272－6．
［13］Paulett JD．下背痛．柳叶刀 1947；2（6469）：272－6．
［14］Wang SY，Zhu B．Origin of＂dry needling＂．Chin Acupunct Moxibust 2021；41（3）：242．
［14］王 SY，朱 B．“干针疗法”的起源．中国针灸与艾灸 2021；41（3）：242．
［15］Dry needling．［2022－6－1］．https：／／my．clevelandclinic．org／health／treatments／ 16542－dry－needling．
［15］干针疗法．［2022－6－1］．https：／／my．clevelandclinic．org／health／treatments／ 16542－dry－needling．
［16］State Laws and Regulations Governing Dry Needling Performed by PTs． ［2022－6－1］．https：／／www．apta．org／patient－care／interventions／dry－needling／ laws－by－state．
［16］州法律和规定关于物理治疗师进行干针疗法的规定。［2022－6－1］。https：／／www．apta．org／patient－care／interventions／dry－needling／ laws－by－state．
［17］Where the acupuncture needle meets the fascia．［2022－7－4］．https：／／www． triggerpointneedlingseminars．com．
［17］针灸针与筋膜相遇的地方．［2022－7－4］．https：／／www． triggerpointneedlingseminars．com．
［18］Jin GY．Retrieving the essence of meridians，developing contemporary medical acupuncture－pondering the De－Meridian phenomena of acupuncture．Guiding J Trad Chin Med．2016；22（20）：1－4．
［18］金 GY．提取经络的本质，发展现代医学针灸－思考针灸的德经现象．指导传统中医．2016；22（20）：1－4．
［19］Jin GY，Jin LL，Xiang JJ．Clinical reflexology of acupuncture－acu－reflex point acupuncture．3rd ed．Beijing：Tsinghua University Press； 2022.
［19］金桂云，金丽丽，向金杰．针灸的临床反射疗法－针－反射点针灸．第 3 版．北京：清华大学出版社；2022。
［20］Jin GY，Jin LL，Xiang JJ．Contemporary medical acupuncture：a systems ap－ proach．New York：Springer－Verlag and Higher Education Press； 2007.
［20］金 GY，金 LL，向 JJ．当代医学针灸：系统方法．纽约：施普林格－维尔格和高等教育出版社；2007。
［21］Kalichman L，Vulfsons S．Dry needling in the management of musculoskeletal pain．J Am Board Fam Med 2010；23（5）：640－6．
［21］Kalichman L，Vulfsons S．干针疗法在肌肉骨骼疼痛管理中的应用．美国家庭医学委员会杂志 2010；23（5）：640－6．
［22］Martín－Sacristán L，Calvo－Lobo C，Pecos－Martín D，Fernández－Carnero J， Alonso－Pérez JL．Dry needling in active or latent trigger point in pa－ tients with neck pain：a randomized clinical trial．Sci Rep 2022；12（1）： 3188.
［22］Martín－Sacristán L，Calvo－Lobo C，Pecos－Martín D，Fernández－Carnero J， Alonso－Pérez JL．在颈痛患者中对活跃或潜在触发点进行干针治疗：一项随机临床试验．Sci Rep 2022；12（1）： 3188.
［23］Jin GY．The advancement of acupuncture target from ashi point to acu－reflex point and zone．World J Trad Chin Med 2021；2（1）：9－14．
［23］金 GY．针灸靶点的进展从阿是点到腧反射点和区域．世界传统中医杂志 2021；2（1）：9－14．
［24］Liu Z，Yan S，Wu J，He L，Li N，Dong G，et al．Acupuncture for chronic severe functional constipation：a randomized trial．Ann Int Med 2016；165（11）：761－9．
［24］刘 Z，严 S，吴 J，何 L，李 N，董 G，等．针灸治疗慢性重度功能性便秘：一项随机试验．内科学年鉴 2016；165（11）：761－9．
［25］Melzack R，Stillwell D，Fox E．Trigger Points and acupuncture points for pain： correlations and implications．Pain 1977；3：3－23．
［25］Melzack R，Stillwell D，Fox E．触发点和针灸点对疼痛的影响：相关性和意义．疼痛 1977；3：3－23．
［26］Dorsher PT．Trigger points and acupuncture points：anatomic and clinical cor－ relations．Med Acupunct 2006；17（3）：20－3．
［26］Dorsher PT．触发点和针灸点：解剖和临床相关性．医学针灸 2006；17（3）：20－3．
［27］Hong CZ．Myofascial trigger points：pathophysiology and correlation with acupuncture points．Acupuct Med 2000；18（1）：41－7．
［27］Hong CZ．肌筋膜触发点：病理生理学及其与针灸点的相关性．针灸医学 2000；18（1）：41－7．
［28］Jin GT，Lin F，Bao YH，Jin GY．Principles of systems medicine．Beijing：World Book Press； 2019.
［28］金 GT，林 F，包 YH，金 GY．系统医学原理．北京：世界图书出版社；2019.
［29］Song Z，Huang Q，Guo Y，Song X，Zhang X，Xiao H．Xingnao kaiqiao acupunc－ ture method combined with temporal three－needle in the treatment of acute ischemic stroke：a randomized controlled trial．Comput Intell Neurosci 2022：8145374．
［29］宋 Z，黄 Q，郭 Y，宋 X，张 X，肖 H．醒脑开窍针法结合颞部三针治疗急性缺血性中风：一项随机对照试验．计算智能神经科学 2022：8145374．
［30］Xiong PY，Yuan T，Xu L，Jia B．Effect of acupuncture of sphenopalatine ganglion for the treatment of allergic rhinitis：A protocol for a systematic review and meta－analysis．Med 2020；99（47）：e23286．
［30］Xiong PY，Yuan T，Xu L，Jia B．蝶腭神经节针灸治疗过敏性鼻炎的效果：系统评价和荟萃分析的方案．Med 2020；99（47）：e23286．
［31］Cerezo－Téllez E，Torres－Lacomba M，Mayoral－Del Moral O，Sánchez B，Dommer－ holt J，Gutiérrez－Ortega C．Prevalence of myofascial pain syndrome in chronic non－specific neck pain：A population－based cross sectional descriptive study． Pain Med 2016；17（12）：2369－77．
［31］Cerezo－Téllez E，Torres－Lacomba M，Mayoral－Del Moral O，Sánchez B，Dommer－holt J，Gutiérrez－Ortega C．慢性非特异性颈痛中肌筋膜疼痛综合症的流行率：一项基于人群的横断面描述性研究． Pain Med 2016；17（12）：2369－77．
［32］Boyce D，Wempe H，Campbell C，Fuehne S，Zylstra E，Smith G，et al．Ad－ verse events associated with therapeutic dry needling．Int J Sports Phys Ther 2020；15（1）：103－13．
［32］Boyce D，Wempe H，Campbell C，Fuehne S，Zylstra E，Smith G，等．与治疗性干针相关的不良事件．国际运动物理治疗杂志 2020；15（1）：103－13．
［33］Di Z，Fu WB．Ancient literature research on the rule of acupoint selection in acupuncture treatment of neck pain．In：Proceedings of the 12th academic seminar of Guangdong Acupuncture Society；2011．p．348－50．
［33］Di Z，Fu WB．关于针灸治疗颈痛的腧穴选择规则的古代文献研究．在：广东针灸学会第十二届学术研讨会论文集；2011．p．348－50．