穴位贴敷治疗原发性痛经的选穴与用药规律分析

Analysis of point selection and medication rule of primary dysmenorrhea treated by point application

目的:探索穴位贴敷治疗原发性痛经(PD)的选穴与用药规律,以用于提升临床疗效及为新药开发提供理论指导。方法:纳入PubMed、Medline、Embase、中国知网、维普、万方6个数据库中1978年-2017年间穴位贴敷治疗PD的全部文献,利用聚类算法及Apriori算法进行数据挖掘,提取并分析用药及选穴的频次、组合以及核心药物/穴位的关联情况。结果:纳入80篇文献,涵盖98味中药和23个穴位,涉及药物和穴位总频次分别为578、193次。治疗核心药物为肉桂、当归、延胡索、细辛、川芎、香附等,药性以温热性质为主;多见活血化瘀药、温里药、补虚药、理气药、止血药同用。治疗核心穴位为关元、神阙、中极、气海等,多集中在任脉。对高频用药及选穴进行聚类分析,高频用药聚成5类,高频选穴聚成4类。通过关联规则分析,高频药物得出23条关联规则,其中2味药组合16条,3味药组合7条;高频选穴得出10条关联规则,其中2个穴位组合4条,3个穴位组合5条,4个穴位组合1条。结论:中药穴位贴敷治疗PD,其治则为活血行气以治其标,温里补虚以固其本;选穴应以通调冲任胞宫为要;需对寒湿、气滞、血瘀、气血虚弱等因素辨证论治。高频用药及选穴的聚类及关联规则分析结果可为保证疗效、替代性的用药或选穴提供借鉴性参考。

Objective:To explore the point selection and medication rule of primary dysmenorrhea(PD)with point application for the purpose of improving clinical efficacy and providing theoretical guidance for the development of new drugs.Methods:All the literatures of PD treated by point application between 1978 and 2017 in six databases(PubMed,Medline,Embase,CNKI,VIP and Wanfang)were included.Data mining was performed using clustering algorithm and Apriori algorithm.The frequency and combination of medication and point selection,and the association of core drugs/points were extracted and analyzed.Results:A total of 80 articles were included,covering 98 herbs and 23 points.The total frequency of herbs and points involved were 578 and 193,respectively.The core herbs for the treatment were Cinnamon,Angelica,Rhizoma Corydalis,chuanxiong,Cyperus rotundus,etc.The herbal nature were mainly warm.Blood-activating and stasis-eliminating drugs,warming the internal drugs,tonic drugs,qi regulating drugs,and hemostatic drugs were used together.The core points for treatment were Guanyuan,Shenfu,Zhongji,Qihai and they were concentrated in Ren Meridian.High-frequency herbs and points for cluster analysis,high frequency medication into 5 categories,high-frequency points into 4 categories.Through association rule analysis,23 association rules including 16 association rules of 2 herbs and 7 association rules of 3 herbs were obtained in high-frequency drugs;10 association rules including 4 association rules of 2 points,5 association rules of 3 points and 1 association rule of 4 points.Conclusion:Point application with Chinese medicine treatment of PD,the rule is promoting blood and qi circulation for temporary solution,warming inside and reinforcing deficiency for timeproof solution.Points selection should be considered the uterus and Ren Meridian.Treatment need to be focus on cold-dampness,qi stagnation,blood stasis and deficiency of qi and blood.The results of clustering and association rules analysis of high-frequency medication and points can provide reference for guaranteeing clinical effect and alternative medications or selecting points.