WHO針灸經穴定位國際標準化之反思

中醫針灸為人類非物質文化遺產之一，臨床上針灸也不斷的證明了其有效性，世界衛生組織(WHO)於2008年訂定出一套世界通用的經絡穴位系統，這套經絡穴位系統將各穴位的體表取穴位置(2D)、所屬經絡、與相關的解剖構造都給予了明確的標準，這些成就也反應在當今許多的教科書上，提供後學在經絡與穴位學習上明確的教材，並且使中醫針灸可以更有效的在國際間進行溝通。然而，2D的位置並不足以提供完整的取穴資訊，故本文中我們透過文獻的探討來反思目前針灸標準化的得失與未來可以更加進步的方向。我們發現歷史上與取穴相關文獻不只記載了穴道的2D位置，而是如《針灸甲乙經》、《針灸大成》中也同時記載了針刺深度、下針前患者的姿態等更精細的資訊，明代的高武更是注意到了男、女及兒童穴位有所差別，因而分別鑄造了三種針灸銅人模型來做為取穴上的參考，另外，穴道亦非只能歸屬一條經絡，而可能是同時歸屬多條經的「會穴」，這些經驗都明示著針灸取穴上該更加精準的方向。總之，從文獻中可發現當今的標準化仍可朝以下四個方向加強：1.穴道歸經的重審；2.穴道深度的附加；3.取穴時患者的擺位與動作；4.男/女、長/幼之不同。

關鍵字

針灸；針灸甲乙經； WHO ；穴位標準化

並列摘要

Acupuncture is one of the intangible cultural heritage of mankind which has been proved for its clinical effectiveness. In 2008, World Health Organization (WHO) had stipulated a standardized system of meridians and acupuncture points that can be used universally. This system has provided a precise standard on the acupuncture point locations (2-dimentional), the respective meridians and the related anatomical structures. These achievements are also reflected in the many current textbooks to provide explicit teaching materials of the meridians and acupuncture points for the new learners. In addition, it has provided an effective communication internationally among the Chinese Medicine Practitioners. However, the 2D illustrations are insufficient to provide a complete information of acupuncture point locations. In this study, we explore the pros and cons of the standardization of the acupuncture point locations and the possible future improvement through literature review. We have discovered that historically, the related literatures on acupuncture points location not only recorded the 2D illustrations. The early acupuncture publications such as Zhen jiu jia yi jing [The Systematized Canon of Acupuncture and Moxibustion] and Zhen jiu da cheng [The Great Compendium of Acupuncture and Moxibustion] had also recorded detailed information eg the needling depth, the arrangement of the patient's posture before the treatment etc. In Ming Dynasty, the physician Gao Wu had also observed the difference in the acupuncture point locations among the male, female and children. Hence, he had cast three acupuncture bronze models to illustrate the acupuncture point locations as a reference. In addition, one acupuncture point may not just belong to one meridian, it can also be a ＂Meridian Hui-meeting point＂ which belongs to multiple meridians. These considerations have clearly shown how acupuncture point locations can be more accurately defined. All in all, ancient literature points to four directions along which standardization could be refined: 1. To re-examine which meridian each acupuncture point belongs to; 2. Addition of the depth of acupuncture points; 3. Consideration of the patient's posture and action while locating acupuncture points; 4. Differences between the sexes and age while locating acupuncture points.