基于复杂网络探究针灸治疗急性痛风性关节炎的临床特点

Study of the clinical distinctions of acupuncture-moxibustion treatment of acute gouty arthritis based on complex networks

目的:基于复杂网络探讨针灸治疗急性痛风性关节炎(AGA)的选穴和穴位配伍规律,以及疗法的应用特点,为AGA的针灸治疗提供参考依据。方法:检索中国知网(CNKI)、重庆维普数据库(CQVIP)、万方数据知识服务平台(Wanfang)、中国生物医学文献服务系统(SinoMed)、PubMed、科学网(WOS)和荷兰医学文摘数据库(EMBASE)从建库至2023年3月31日的针灸治疗AGA文献。根据纳入及排除标准筛选文献后建立针灸处方数据库。应用SPSS Modeler 18.1和Gephi 0.9.7软件对腧穴进行关联规则分析和复杂网络分析。结果:共筛选145篇文献,提取382条针灸处方,涉及104个腧穴,总使用频次1288次。使用频次最高的腧穴为阿是穴,经脉选用以足太阴脾经、足阳明胃经较多;疗法以毫针刺和放血较为常见。关联规则结果显示“阿是穴-足三里”、“三阴交-足三里”支持度最高,体现了远近配穴、表里配穴的原则。对主穴进行复杂网络分析,获得了以阿是穴、足三里、三阴交、阴陵泉及太冲为主的核心腧穴配伍组合。配穴选择包括辨证取穴和辨部取穴,注重对证候和关节相关症状的改善。结论:针灸治疗AGA遵循主穴与辨证或辨部位配穴相结合原则,主穴选择注重调理本虚之脏腑,配穴选择注重对证和症的改善,重视疗法效应特异性。

Objective:To discuss the point-selection and point-grouping patterns and therapeutic application features in acupuncture-moxibustion treatment of acute gouty arthritis(AGA)based on complex networks and to provide references for treating AGA with acupuncture-moxibustion therapy.Methods:Articles related to acupuncture-moxibustion treatment of AGA were searched across the China National Knowledge Infrastructure(CNKI),Chongqing VIP Database(CQVIP),Wanfang Data Knowledge Service Platform(Wanfang),Chinese Biomedical Literature Service System(SinoMed),PubMed,Web of Science(WOS),and Excerpta Medica Database(EMBASE)from their inception till March 31,2023.An acupuncture-moxibustion prescription database was established after the articles were screened according to the inclusion and exclusion criteria.The association rule and complex network analyses of points were conducted using SPSS Modeler 18.1 and Gephi 0.9.7.Results:A total of 145 articles were collected,contributing 382 pieces of acupuncture-moxibustion prescriptions involving 104 points with a total frequency of 1288.Ashi points contributed the highest frequency.The Spleen Meridian of Foot-Taiyin and the Stomach Meridian of Foot-Yangming were more commonly selected.Filiform-needle acupuncture and bloodletting therapy were more frequently used.The association rule analysis revealed that the highest degree of support belonged to“Ashi point-Zusanli(ST36)”and“Sanyinjiao(SP6)-Zusanli(ST36)”,which reflected the rules of point combination of distal and proximal areas and point combination of the coupled meridians.The complex network analysis of the major points discovered a core point prescription mainly consisting of Ahi point,Zusanli(ST36),Sanyinjiao(SP6),Yinlingquan(SP9),and Taichong(LR3).Pattern differentiation and region differentiation were used in selecting adjunct points,stressing the improvements of patterns and joint-related symptoms.Conclusion:Acupuncture-moxibustion treatment of AGA follows the principle of combining major points with adjunct points selected based on pattern or region differentiation;the selection of major points focuses on regulating the deficient Zang-Fu organs,and the selection of adjunct points emphasizes improving patterns and symptoms.The specificity of therapeutic effects is also stressed.