Yang Tianye 1, Supervisor: Wang Yin 2
1. Department of Rehabilitation, Guangwai Hospital, Xicheng District, Beijing, 100055
2.Guang’anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053
Abstract: Professor Wang Yin believes that the spleen and stomach are the core of the body. In clinical diagnosis and treatment, he attaches great importance to regulating the spleen and stomach. Based on the foundation of “Ten Ancient Needles” of Wang Leting, combined with his own years of clinical experience, he created an acupuncture method for regulating the spleen and stomach. The acupoints are mainly from the Ren, the Spleen, and the Stomach channels. Through regulating the spleen and stomach, replenishing qi and blood, promoting qi circulation, and nourishing the five internal organs, various difficult and complicated diseases are treated. The basic acupoints are Zhongwan CV12, Liangmen ST21, Tianshu ST25, Zhongzhu KD15 with Siman KD14 and Qixue KD13 with one needle threaded through the three points, threading from Daheng SP15 through Zhongji CV3, and Zusanli ST36. The acupuncture method combines channel penetration and tonifying and purging acupuncture. This paper will introduce these ideas with applications for spleen and stomach disorders and insomnia.
Keywords: spleen and stomach regulating acupuncture; Wang Yin; famous Chinese medicine experience
Professor Wang Yin is the chief physician of the Acupuncture Department of Guang’anmen Hospital of China Academy of Chinese Medical Sciences, a master’s tutor, a director of the Chinese Acupuncture Association, and a consultant of the Beijing Acupuncture Association. Professor Wang Yin has been engaged in TCM clinical practice, teaching and scientific research for nearly 50 years and has rich clinical experience. In clinical diagnosis and treatment, he pays great attention to the regulation of spleen and stomach. Based on the “Ten Ancient Needles” of Wang Leting, combined with his own years of clinical experience, he created the “Acupuncture Method for Regulating Spleen and Stomach”. The points are primarily from the Ren, Spleen and Stomach channels. By regulating the spleen and stomach, replenishing qi and blood, promoting qi circulation, and nourishing the five internal organs, various complicated diseases can be addressed.
1. Theoretical basis of the academic thought of regulating spleen and stomach
In the Huang Di Nei Jing Su Wen Huangdi asks: “I have heard that when the five epidemics come, they are all easily transmitted, regardless of size, the symptoms are similar. If no treatment is given, how can people not be affected?” Qibo said: “Those who are not infected have upright qi in their bodies, and evil cannot interfere. They avoid the toxic qi.” The sentence “[When there is] upright qi in the body, evil cannot interfere” in the text succinctly summarizes the concept of pathogenesis in the Nei Jing, which has important guiding significance for the diagnosis, prevention, treatment, and rehabilitation of diseases. “Upright Qi” is one of the more important and basic concepts in traditional Chinese medicine, referring to the summation of the functional activities of the human body, including the viscera, channels, qi, and blood, as well as the body’s ability to resist disease and recover. Traditional Chinese medicine believes that upright qi has the functions of defense, maintaining the body’s internal balance, immune monitoring, etc., and has certain benefits for one’s own health. If the body’s qi is insufficient, or relatively weak, it is easy for evil energy to enter the body, causing the body’s yin and yang to be out of balance, and the organs and channels to become disordered, which in turn causes disease. “Evil Qi” is a general term for all pathogenic factors. “Evil Qi” in traditional Chinese medicine includes all kinds of pathogenic factors that may cause dysfunction of the human body and imbalance of the internal and external environment, including the six exogenous evils, epidemic diseases, internal injuries, seven emotions, improper diet, too much work or rest, as well as external injuries, and insect and animal bites and stings. The body “containing upright qi” is a sign of health, so we should pay attention to maintaining upright qi, preventing injuries and maintaining normal functions; after injuries and illnesses, we should emphasize supporting upright qi and unblocking the movement of qi to promote functional recovery. Acupuncture, massage, medicine, and diet are all effective measures to maintain upright qi. Maintaining upright qi, on the one hand, is to replenish the qi, blood, Yin and Yang of the internal organs, strengthen the material basis of the body, and overcome the decline of body functions; on the other hand, eliminating pathogenic factors, regulating channels, and smoothing qi and blood can also achieve the purpose of maintaining upright qi. The principle of maintaining upright qi is to regulate original qi (Yuan Qi), which is a general term for the material basis of life activities and their functions. It is the most basic and important qi in the human body and can be said to be the root of all qi. Therefore, the dominant position of upright qi and the external conditions of negative energy determine that in the clinical treatment of diseases, special emphasis should be placed on protecting the upright qi.
The Jin Gui Yao Lue states that “[when] the spleen is strong in all seasons one cannot receive evils”, which is a specific expression of the idea that “upright qi exists inside, and evil cannot enter”. In the physiological activities of the human body, the spleen and stomach are the source of qi and blood production and the foundation of vital energy. The two are in the middle of the human body and are the hub of the qi mechanism. The spleen is in the center of the five visceral organs and can irrigate the other four viscera, because the spleen earth produces lung metal, benefits kidney water, nourishes liver wood, and replenishes heart fire. Therefore, any deficiency of qi and blood in the other four visceral organs can be treated through the spleen and stomach. In the etiology and pathogenesis of diseases, Li Dongyuan’s Treatise on the Spleen and Stomach, in Discussion on the Transmission and Transformation of Spleen Qi and Deficiency says: “After reading various articles and referring to them, I found that the sufficiency of the original qi is always due to the spleen qi being intact, and then it can nourish the original qi. If the stomach qi is weak, and the diet is doubled, the spleen qi will be damaged, and the original qi will not be sufficient, and various diseases will arise.” From this, it can be seen that “if the spleen and stomach are damaged, all kinds of diseases will arise”, so protecting the normal function of the spleen and stomach is often the key to treating diseases. Professor Lu Zhizheng, the first master of traditional Chinese medicine, inherited Li Dongyuan’s concept of “internal damage to the spleen and stomach, [allows] all kinds of diseases will arise”, Ye Gui’s concept of “nourishing the stomach yin”, and Wu Cheng’s “regulating spleen yin”, and further elaborated on these ideas. Lu believes that the spleen and stomach are the foundation of the body. The body’s nutrients are transported and transformed by the spleen and stomach. Suppose the spleen and stomach function are damaged. In that case, the transport and transformation will be disrupted, the ascending and descending will be disordered, dampness will be generated internally, and the qi will be blocked, which will lead to various diseases. Therefore, regulating the spleen and stomach is the top priority in treating various diseases [1].
Professor Wang Yin believes that people nowadays live at a fast pace, study hard, work under great pressure, and think too much, which can easily damage the spleen and stomach. In addition, their material life is rich, and people eat too much fatty and sweet food, and are fond of spicy and cold foods, which leads to the spleen and stomach receiving and transporting disorders, thus, the function of the spleen and stomach in modern people is often insufficient. Therefore, in clinical practice, great emphasis is placed on the regulation of the spleen and stomach. After years of exploration and experience accumulation, a unique acupuncture formula for regulating the spleen and stomach was formed based on the ” Ten Ancient Needles” of “The King of Golden Needles” Wang Leting, which plays the role of regulating the spleen and stomach, replenishing qi and blood, promoting qi circulation, and nourishing the five internal organs.
In clinical practice, Professor Wang emphasizes the importance of regulating the spleen and stomach. Through years of exploration and accumulation of experience, he has developed a unique acupuncture prescription for regulating the spleen and stomach, building on the “ Ten Ancient Needles” of the Golden Needle King, Wang Leting. This method effectively regulates the spleen and stomach, benefits qi and blood, smooths the qi mechanism, and nourishes the five viscera.
2. Acupuncture prescription
2.1 Acupoint selection:
The main acupoints are Zhongwan CV12, Liangmen ST21, Tianshu ST25, Zhongzhu KD15 threaded with Siman KD 14 and Qixue KD13 (three acupoints with one needle), Dahengtou SP15 Zhongji CV3, and Zusanli ST 36. This acupoint prescription is derived from a variation on the “Ten Ancient Needles” of Want Leting. The ten ancient needles are as the upper, middle and lower venter points (Shangwan CV 13, Zhongwan CV12 and Xiawan CV10), Qihai CV4, Tianshu ST25 (bilateral), Zusanli ST36 (bilateral), Neiguan PC6 (bilateral), which has the effect of tonifying the middle burner and replenishing qi.
2.2 Meaning of the prescription:
Zhongwan CV12 and Liangmen ST21: Zhongwan CV12 is in the Ren channel, which is the meeting point of the three yang channels and six bowels hollow organs（bowels）, the gathering point of the stomach, where the bowels gather, and can open the bowels and harmonize the stomach. Liangmen ST21 belongs to the stomach channel, which is thought of as a Portal. Insert the needle from Liangmen ST21 and pierce towards Zhongwan CV12, to open the stomach gate and open the Ren channel.
Zhongzhu KD15 with Siman KD14 and Qixue KD13 (one needle and three points): Professor Wang Yin believes that although the Ren channel is the “sea of the yin channels”, it starts below Zhongji CV3 and does not belong to any viscera. It is connected to the viscera’s channels through intersection points. It is the channel for the visceral qi and blood to gather and flow. It is good at opening but not good at replenishing. The kidney’s primordial qi is the innate essence, which is difficult to replenish. It can only be continuously nourished and protected by the essence of water and grain. Therefore, these points are needled by threading downward, embracing the ren channel on both sides, to lead the essence of qi and blood into the dantian. The purpose is to lead the fire back to its origin. When used together with the stomach’s mu point Zhongwan CV12, it can play a role in the harmony of the innate and the acquired.
Daheng SP15 penetrates to Zhongji CV3: Daheng is a spleen channel point, located 4 inches lateral to the umbilicus, also known as Shenqi “Kidney Qi”. The Daheng points on both sides and the Zhongji point form a triangle on the lower abdomen. The area inside the triangle includes spleen, stomach, kidney channels, and overlaps with points on the chong, ren, and dai vessels. There are both yin meridians and yang meridians, including the three of the eight extraordinary vessels. The spleen and stomach are the foundation of the acquired constitution, and the kidney is the foundation of the innate constitution. The Daheng SP15 acupoint is needled towards Zhongji CV3, which can also play a role in the harmony of the acquired constitution.
Tianshu ST25: Direct puncture to open the stomach and intestines and mobilize the qi of the triple burner.
Zusanli ST36: It is the lower He-sea point of the stomach, where the qi of the stomach channel converges into the sea. This point is used to strengthen the spleen and stomach and regulate the qi of the viscera.
2.3 Special acupuncture methods for abdominal threading
● Penetrating acupoints: Zhongzhu KD15 + Siman KD14 + Qixue KD13 wiht one needle
● Daheng through Zhongji
Threading technique: Before acupuncture, the patient is instructed to empty the bladder, lie flat, and expose the abdomen. The doctor massages the patient’s abdomen clockwise with his hands, with the force gradually increasing from light to heavy. The needle can be used only when the acupoints are opened and there is no resistance under the fingers. Needle insertion: The needling hand holds the handle of a 5-inch (125mm) needle, and the pressing hand holds the lower end of the needle body, which is against the Zhongzhu KD15 acupoint or Daheng SP15 acupoint at a shallow angle, with the needle tip facing the Qixue KD13 or Zhongji CV 3 point. Both hands cooperate to apply force at the same time, combining piercing and twisting, gently twisting and slowly advancing, and the needle is inserted to a depth of 4 inches (100mm). Needle sensation: After the needle is inserted to a certain depth, a sinking, tight, and coarse or rough sensation will appear under the needle. To strengthen the qi sensation, the needle should be moved continuously. When moving the needle, the needle handle is held between the thumb, middle, and index finger of the needling hand. While gently shaking the needle handle, the needle body is withdrawn and thrust lightly in and out while it is twisted back and forth quickly with low amplitude (160-200 times/minute). The index finger of the other hand gently presses the needle body downward, like a bird pecking. To expand the sensation, the lifting and thrusting movement can be slightly larger. The movements of both hands should be coordinated, frequently and finely, gently and softly, so as not to cause discomfort to the patient. While moving the needle, the patient may feel a slight achy and bloated feeling in the lower abdomen, or possibly a more comfortable feeling of heat. The needle sensation of some patients can even be transmitted to the lower limbs and groin. Needle removal: After the acupuncture point is penetrated, the needle can be left in place for 20-30 minutes. When removing the needle, the piercing hand and the pressing hand must cooperate to slowly withdraw the needle, and press the needle hole with a sterilized cotton ball for a while. After the needle is removed, gently massage the patient’s abdomen again, and let the patient rest for a few minutes before leaving.
3. Clinical application examples
3.1 Diarrhea Patient, male, 89 years old, consultation date: June 5, 2024. Chief complaint: occult blood in stool for nearly 2 years, intermittent purulent blood, watery stool for half a month. Current medical history: The patient was found to have positive occult blood in stool during a physical examination nearly 2 years ago. Later, a pelvic CT scan at the Third Hospital of Beijing University showed a malignant tumor of the rectum. Because the patient and his family requested conservative treatment, no surgery, radiotherapy, chemotherapy or other related treatments were given. Half a month ago, the patient had intermittent watery stools, which occasionally had a small amount of mucus and purulent blood and was admitted to the undergraduate department for follow-up treatment. The patient is now sleepy, sleeping 12-15 hours/day, with a pale face, physical fatigue, shortness of breath, laziness, low appetite, normal food intake, normal urination, intermittent watery stools sometimes with mucus or purulent blood, 6-8 bowel movements/day, 20-50ml/time. The tongue is pale with thin fur, and the pulse is deep and weak. History: hyperlipidemia for 5 years, regular use of atorvastatin, denial of other chronic diseases such as hypertension, coronary heart disease, diabetes, etc. Personal history: denial of a history of smoking and drinking, has 2 sons, and the spouse is healthy. Diagnosis: diarrhea (Qi and blood deficiency syndrome). Treatment principle: replenish Qi and nourish the blood. Acupoints: Adding Yinbai SP1 to the main points Zhongwan CV12, Liangmen ST21, Tianshu ST25, Zhongzhu KD15 and Siman KD14 with Qixue KD13 (three acupoints with one needle), Daheng SP15, Zhongji CV3, and Zusanli ST36, and treat twice a week. Follow-up: After 2 and a half weeks of treatment, the patient’s watery stool became firmer as loose stool, 5-6 times/day, 20-50ml/time, occasionally having a small amount of mucus in the stool, but no visible blood. His poor appetite slightly improved. Although he was still quite tired, the total time he was sleeping was shortened to 10-12 hours/day. Note: According to Jing Yue Quan Shu•by Zhang Jingyue, it says: “The root of diarrhea is all due to the spleen and stomach”. Long-term diarrhea is mainly caused by spleen deficiency. The spleen and stomach are the source of qi and blood production. The patient has long-term occult blood loss, and diarrhea, and the qi is consumed along with the blood, resulting in qi and blood deficiency. Therefore, the author’s acupoint prescription is used to start from the spleen and stomach in the middle jiao, protect the spleen and stomach, replenish the upright qi, and achieve the purpose of replenishing qi and nourishing blood. In addition, Yinbai SP1 is the well point of the spleen channel, which strengthens the spleen and stomach, replenishes qi and regulates blood, warming yang and reviving from fainting. It is effective for all kinds of abnormal bleeding. The book Zhenjiu Zisheng Jing written by Wang Zhizhong in Song Dynasty said: “If a woman’s menstruation is overflow and does not stop, acupuncture will heal it immediately.” Professor Wang Yin also cited the example of moxibustion on Yinbai to treat women with continuous uterine bleeding. Therefore, acupuncture of Yinbai was added to treat blood in the stool, and the effect was significant.
3.2 Insomnia
The patient is a 49-year-old female nurse. Date of consultation: October 15, 2024. Main complaint: Difficulty falling asleep for half a year. Current medical history: The patient had irregular sleep due to fatigue half a year ago, and then had difficulty falling asleep, and occasional panicked feelings, but did not take it seriously. Later, the symptoms gradually worsened, and the local hospital treated her with 2mg qn of estazolam (benzodiazepine type sedative medication). Current symptoms: fatigue, difficulty falling asleep, need to take estazolam every night to fall asleep, easy to wake up, difficulty falling asleep again after waking, typically only getting 3-4 hours of sleep per night, dizziness in the morning, no headache, nausea or other symptoms. When she’s tired, she is prone to palpitations. She has a poor appetite, unformed stool, with one bowel movement per day, normal urination, a pale tongue with thin white fur, and a weak pulse. History: 3 years of arrhythmia, no regular medication, deny other chronic diseases such as hypertension, coronary heart disease, and diabetes. Personal history: denies the history of smoking and drinking, has 1 son and 1 daughter, healthy spouse, and is in menopause. Diagnosis: Insomnia (Qi and blood deficiency syndrome). Treatment principle: Strengthen the spleen and replenish Qi, nourish blood, and calm the mind. Acupoints: Add scalp acupuncture to the stomach area, Baihui GV20, and Anmian (extra point under mastoid process) along with the root treatment of Zhongwan CV12, Liangmen ST21, Tianshu ST25, Zhongzhu KD15 + Siman KD14 + Qixue KD13 (one needle and three acupoints), Dahengtou SP15 Zhongji CV3, and Zusanli ST36 points, and treat 3 times a week. Follow-up: After 3 weeks of treatment, the patient’s difficulty falling asleep significantly improved. When she did not have to get up at night to work, she no longer needed to take estazolam. She had dreamless sleep 5-6 hours per night, and her fatigue and loss of appetite improved.
Comment: This patient worked hard, had an irregular life, and was worried a lot. Over time, this damaged the heart and spleen. The heart governs the blood vessels, and the spleen is the source of qi and blood production. If both the heart and spleen are deficient, the qi and blood production will be insufficient. Therefore, Professor Wang Yin’s acupuncture point selection scheme was used to start with the spleen and stomach in the middle jiao, protect the spleen and stomach, replenish the positive qi, and achieve the purpose of replenishing qi and nourishing blood. The head is the place where all yang and channels gather. Scalp acupuncture in the stomach area can regulate the spleen and stomach. Baihui GV20 boosts the yang and benefits the qi and Anmian (extra point) can be used together to calm and stabilize the mind.
4. Summary
The spleen and stomach acupuncture method is one of the point prescriptions most used by Professor Wang Yin in clinical practice. It is often used to treat digestive diseases such as chronic gastritis, gastric ulcer, duodenal ulcer, reflux esophagitis, functional dyspepsia, hiccups, diarrhea, etc. It is also used for sleep disorders, dizziness, obesity, irregular menstruation, tinnitus, skin diseases, etc., with significant clinical efficacy. Professor Wang Yin uses the method of “regulating the middle jiao” to smooth the qi, harmonize qi and blood, and regulate the various organs. It focuses on the patient as a whole, and uses the cultivation of positive energy to adjust the balance of yin and yang, qi and blood, and internal organs, thereby mobilizing the body’s functions to resist pathogenic factors and drive them out. This is also the specific manifestation of the connotation of “positive energy is inside, and evil cannot be interfered with.”
淺析王寅教授調理脾胃針法——“正氣存內、邪不可幹”
作者：楊田野1 指導: 王 寅2
1. 北京市西城區廣外醫院複健科，北京 100055
2. 中國中醫科學院廣安門醫院，北京 100053
摘要：王寅教授認為脾胃是機體的核心，在臨床診療中非常注重對脾胃的調理，在金針王樂亭的「老十針」的基礎上，結合自己多年臨床經驗，總結出調理脾胃針法，取穴主要來自任脈、足太陰脾經及足陽明胃經，透過調脾胃、益氣血、暢氣機、養五臟，治療各種疑難雜症。基本穴為中脘、梁門、天樞、中注+四滿+氣穴（一針三穴）、大橫透中極、足三裡等，針刺方法將循經透刺和平補平瀉針刺法相結合。透過脾胃病和失眠臨床實例，詳細介紹調理脾胃針法的臨床應用。
關鍵字：調理脾胃針法；王寅；名中醫經驗
王寅教授是中國中醫科學院廣安門醫院針灸科主任醫師，碩士生研究生導師，第四、五、六批北京市級老中醫藥專家學術經驗繼承工作指導老師，中國針灸學會理事，北京市針灸學會貼敷療法分會顧問。從事中醫臨床、教學與科學研究近50年，臨床經驗豐富。王寅教授在臨床診療中非常注重對脾胃的調理，在金針王樂亭的“老十針”的基礎上，結合自己多年臨床經驗，總結出“調理脾胃針法”，取穴主要來自任脈、足太陰脾經及足陽明胃經，透過調脾胃、益氣血、暢氣機、養五臟，治療各種疑難雜症。
1.調理脾胃學術思想的理論基礎
《黃帝內經素問•刺法論》載「黃帝曰：余聞五疫之至，皆相染易，無問大小，病狀相似，不施救療，如何可得不相移易者？歧伯曰：不相染者，正氣存內，邪不可幹，避其毒氣，天牝從來，複得其往，氣出於腦，即不邪幹。
文中「正氣存內，邪不可幹」精闢的概括了《內經》的發病觀，對臨床疾病的診斷、防治及康復等均有重要的指導意義。 「正氣」是中醫比較重要、基本的概念之一，指人體的機能活動，包括臟腑、經絡、氣血等功能，以及人體抗病、複健能力。中醫認為正氣具有防禦功能、維持機體內在平衡、免疫監督等功能，對於自身健康有一定好處。若人體正氣不足，或正氣相對虛弱時，容易導致邪氣入體，導致機體陰陽失調，臟腑經絡功能紊亂，進而引發疾病。「邪氣」則為一切致病因素的總稱。中醫學的「邪氣」包括了一切可能導致人體功能失調、內外環境失衡的各種致病因素等。包括外感六淫、疫病、內傷七情、飲食、勞逸以及外傷、蟲獸傷等。「正氣存內」是健康的標誌，因此我們平時應注重保養正氣，預防傷病的發生，保持正常的功能；傷病後，應強調扶助正氣，疏通氣機的運行，以促進功能的恢復。針灸、按摩、藥物、食療等，都是保養正氣的有效措施。而保養正氣，一方面是補益臟腑的氣血陰陽，增強物質基礎，克服機體功能的衰退；另一方面，祛除致病因素，通調經絡，流暢氣血，同樣能起到保養正氣之目的。保養正氣的原則即調補元氣，「元氣」是生命活動的物質基礎及其功用的總稱，是人體最基本、最重要的氣，可謂諸氣之本。因此正氣的主導地位和邪氣的外在條件決定了在臨床治療疾病中，尤其要著重固護正氣。
《金匱要略》載“四季脾旺不受邪”，是對“正氣存內，邪不可幹”內涵的具體發揮。在人體生理活動中，脾胃為氣血生化之源，元氣之本。二者居於人體中焦，為氣機升降之樞紐。五臟中脾居中央，能灌溉四髒，因脾土能生肺金、益腎水、養肝木、補心火，蓋凡四髒氣血不足，均可從脾胃論治。在疾病的病因病機中，金元四大家之一的李東垣在《脾胃論卷上脾氣虛實傳變論》載「曆觀諸篇而參考之,則元氣之充足，皆由脾氣之氣無所傷，而後能滋養元氣。若胃氣之本弱，飲食自倍,則脾氣之氣既傷，而元氣亦不能充，而諸病之所由生也。 ”由此可見“脾胃內傷，百病乃生”，因此固護脾胃功能正常往往是治療疾病的關鍵。首屆國醫大師路志正教授繼承了李東垣「內傷脾胃，百病由生」和葉桂「養胃陰」、吳澄「理脾陰」等學說，對其學術思想進行了進一步闡述。路老認為：脾胃為後天之本，全身營養之精微全靠脾胃的運化轉輸，若脾胃功能受損，則運化失司，升降失調，濕濁內生，氣機不暢而變生諸病。因此調理脾胃是治療各種疾病的重中之重［1］。
王寅教授認為現在人們生活節奏快、學習緊張、工作壓力大，思慮過度易傷及脾胃；加之物質生活豐富，過食肥甘厚味，嗜食辛辣生冷，致脾胃受納、運化失司，故現代人的脾胃功能常常不足。因此在臨床中非常注重對脾胃的調理，經過多年的探索和經驗積累，在“金針大王”王樂亭的“老十針”的基礎上形成其獨特的調理脾胃針灸穴方，起到調脾胃、益氣血、暢氣機、養五臟的作用。
2. 針刺處方
2.1 取穴：
以中脘、梁門、天樞、中注+四滿+氣穴（一針三穴）、大橫透中極、足三裡等為主穴。此穴方由「老十針」加減而來，老十針取穴：上、中、下三脘，氣海，天樞（雙），足三裡（雙），內關（雙），具有補中益氣之效。
2.2 配穴方義：
中脘、梁門：中脘位於任脈，為三陽六腑之會，胃之募穴，是腑氣彙聚所在，可通腑和胃。梁門屬胃經，有門戶之意，由梁門入針，刺向中脘，取開胃門、通任脈之意。
中注+四滿+氣穴（一針三穴）：王寅教授認為任脈雖為“陰脈之海”，然其起於中極之下，不絡屬臟腑，透過交會穴與臟腑經脈相通，是臟腑氣血彙聚流通的通道，善通而不善補，腎中元氣為先天之精氣，難以補充，只能由水谷精微不斷滋養固護，因此沿兩側腎經向下透刺，引氣血精華入丹田，目的引火歸元，與胃之募穴中脘合用，可起到先後天同調的作用。
大橫透中極：大橫為脾經腧穴，位於臍旁4寸，別名「腎氣」。雙側大橫穴與中極穴在下腹部可形成等腰三角形。在此三角形中，囊括了足太陰脾經、足陽明胃經、沖脈、足少陰腎經、任脈及帶脈的穴位。既有陰經，又有陽經，也包括奇經八脈中的三脈。脾胃為後天之本，腎為先天之本，大橫穴透中極穴，也可起到先後天同調的作用。
天樞：直刺通胃腸，調動三焦氣機。
足三裡：為胃下合穴，是胃經經氣最後匯合入海之處，取此穴以健脾和胃、通調腑氣。
2.3 特殊刺法（腹部透刺）：
透刺穴位：中注+四滿+氣穴（一針三穴）、大橫透中極
透刺手法：針刺前囑患者先排空膀胱，平臥，暴露腹部。醫者以手順時針按揉患者腹部，力量由輕漸重，當感到腧穴打開，指下無阻力時方可動針。進針：刺手執5寸（125mm）芒針針柄，押手執針身下端，抵在中注穴/大橫穴上，針尖朝向氣穴/中極穴，兩手同時配合用力，刺撚結合，輕撚緩進，進針深度4寸（100mm）左右。行針：進針到一定深度後，針下出現沉、緊、澀感，為加強得氣感，應繼續行針。行針時刺手以拇指、中指、食指夾持針柄，在輕柔抖動針柄時，小幅度上下提插針身，同時前後小幅度快速撚轉（160-200次/分）。押手食指輕輕向下循按針身，如雀啄之狀。為擴大感應，提插範圍可略大。雙手動作要配合默契，頻而細，輕而柔，以免引起病人不適。在運針的同時，患者可感覺少腹部有微酸脹感，甚至出現較為舒服的熱感，部分患者的針感甚至可傳導至下肢、腹股溝處。出針：透穴後可留針20-30分鐘，出針時，亦需刺手及押手配合，沿刺入之方向緩緩退出，用消毒幹棉球按壓針孔片刻。出針後再次輕揉患者腹部，讓患者休息幾分鐘後再離開。
3. 臨床應用舉隅
3.1 泄瀉
患者，男，89歲，就診時間：2024年6月5日。主訴：發現便潛血近2年，間斷膿血、水樣便半月。現病史：患者近2年前體檢發現便潛血陽性，後在北醫三院行盆腔CT檢查提示“直腸惡性腫瘤”，因患者及家屬要求保守治療，未予手術、放化療等相關治療。半月前患者出現間斷水樣便，偶見少量黏液膿血便，為求後續治療入住本科。現患者嗜睡，12-15小時/天，臉色蒼白，身體倦怠，少氣懶言，納差，食欲低下，納食量尚可，小便可，間斷水樣便，偶見粘液膿血便，大便6-8次/天，20-50ml/次。舌頭淡苔薄，脈沉細弱。過去史：高血脂症5年，規律服用阿托伐他汀，否認高血壓、冠狀動脈心臟病、糖尿病等其他慢性病。個人史：否認煙酒史，育有2子，配偶體健。診斷：泄瀉（氣血兩虛證）。治則：補氣養血。取穴：在中脘、梁門、天樞、中注+四滿+氣穴（一針三穴）、大橫透中極、足三裡取穴基礎上加隱白，1周治療2次。追蹤：治療2周半後，患者水樣便轉為稀溏便，5-6次/天，20-50ml/次，偶見少量黏液便，無肉眼可見膿血便，納差略改善，雖仍有嗜睡，但時間縮短，10-12小時/天。
按語：明•張景岳撰《景嶽全書•泄瀉》所謂：“泄瀉之本，無不由於脾胃”，久泄以脾虛為主，脾胃為氣血生化之源，患者長期隱性失血，加之泄瀉，氣隨血耗致氣血兩虛。故運用老師的取穴方案，從中焦脾胃入手，護脾胃、補正氣，達到益氣養血的目的。另隱白為足太陰脾經井穴，有健脾和胃、益氣統血、溫陽回厥之功，對於各種不正常之出血皆有療效。宋王執中撰《針灸資生經》雲：「婦人月事過時不止，刺立愈」。王寅教授也曾舉例灸隱白治婦人子宮出血不止。故加針刺隱白治便血，療效顯著。
3.2 失眠
患者，女，49歲，護工。就診時間：2024年10月15日。主訴：入睡困難半年。現病史：患者半年前勞累導致睡眠不規律，隨後出現入睡困難，偶有心慌，未予重視，後症狀逐漸加重，就診當地醫院予艾司唑侖2mg qn治療。現症見：神疲乏力，入睡困難，每晚需服艾司唑侖才能入睡，眠輕易醒，醒後難再入睡，3-4小時/晚，晨起頭暈明顯，無頭痛噁心等其他症狀。勞累後易有心慌，納呆，大便不成形，日行１次，小便可，舌淡苔薄白，脈沉細弱。過去史：心律不整病史3年，未規律服藥，否認高血壓、冠狀動脈心臟病、糖尿病等其他慢性病。個人史：否認煙酒史，育有1子1女，配偶體健，已停經。診斷：不寐（氣血兩虛證）。治則：健脾益氣、養血安神。取穴：在中脘、梁門、天樞、中注+四滿+氣穴（一針三穴）、大橫透中極、足三裡取穴基礎上加頭皮針胃區、百會、安眠，1周治療3次。追蹤：治療3周後，患者入睡困難明顯改善，晚間不起夜工作時可不再服用艾司唑侖，5-6小時/晚，基本無夢，神疲乏力及納呆較前好轉。
按語：此患者工作勞累，生活無規律，且思慮較多，長此以往，耗傷心脾，心主血脈，脾為氣血生化之源，心脾兩虛則氣血生化不足。故運用王寅教授的取穴方案，從中焦脾胃入手，護脾胃、補正氣，達到益氣養血的目的。頭為諸陽會、臟腑經絡之氣聚集之處，頭皮針胃區可理脾胃，百會升陽益氣與安眠穴共用以安神定志。
4. 小結
調理脾胃針法是王寅教授臨床應用最多的穴方之一，常用於治療慢性胃炎、胃潰瘍、十二指腸潰瘍、逆流性食道炎、功能性消化不良、呃逆、腹瀉等消化道疾病，也用於睡眠障礙、眩暈、肥胖、月經不規則、耳鳴、皮膚病等，臨床療效顯著。王寅教授透過「調理中焦」的方式來調暢氣機、調和氣血、調理諸髒，正是著眼於病人整體，用培補正氣來調整陰陽、氣血、臟腑的平衡，從而調動全身機能抵禦病邪，驅邪外出。而這也正是「正氣存內，邪不可幹」內涵的具體發揮。
參考文獻
References
[1]馮玲.路志正脾胃學術思想探微—新時代內傷脾胃的致病因素[J]. 中華中醫藥雜誌, 2010, 25(5): 694-696.
[1] Feng Ling. A study on Lu Zhizheng’s academic thoughts on spleen and stomach – pathogenic factors of internal injury to spleen and stomach in the new era[J]. Chinese Journal of Traditional Chinese Medicine, 2010, 25(5): 694-696.
作者簡介：
楊田野，北京市西城區廣外醫院複健科， 主治醫生。
About the author:
Yang Tianye, attending physician in Rehabilitation Department, Guangwai Hospital, Xicheng District, Beijing
