针灸治疗中风后肩手综合征选穴规律分析

Analysis on the Rule of Point Selection of Acupuncture and Moxibustion for Shoulder and Hand Syndrome After Stroke

目的:分析针灸治疗中风后肩手综合征的腧穴使用特点并总结其运用规律。方法:检索Medline、Pubmed、Embase、中国知网、维普、万方共6个数据库2008年1月—2019年6月发表的关于针灸治疗中风后肩手综合征的文献,在符合筛选标准的文献中提取腧穴名称等关键信息,使用聚类算法及Apriori算法进行数据挖掘。结果:共纳入文献244篇,涉及143个穴位,腧穴总频次2 257次。选用腧穴遍布十四正经及所有特定穴,但集中趋势明显。使用频次前五位的腧穴为肩髃、曲池、合谷、肩髎、外关,占总频次的36.02%。选穴集中在大肠经、三焦经、小肠经及上肢部,重视阳经腧穴、经外奇穴及五腧穴、交会穴、原穴、八脉交会穴等经气汇合、联络、散布的特定穴的使用。对高频选穴进行聚类分析聚成5类,关联规则分析得出15条关联规则。结论:针灸治疗中风后肩手综合征的选穴应以理顺气血、通络除痹为治则,结合痰、虚、瘀等因素辨证论治。通过对高频腧穴的聚类及关联分析所揭示的选穴规律,可为保证疗效、合理选穴等临床应用提供理论依据及参考。

Objective: To analyze the characteristics of the use of shu points in the treatment of acupuncture and moxibustion for shoulder and hand syndrome after stroke and summarize the rules of their application. Methods:Literatures related to the treatment of post-stroke shoulder and hand syndrome by acupuncture and moxibustion published from January2008 to June 2019,were retrieved from Medline,Pubmed,Embase,CNKI,VIP and Wanfang databases. Key information such as point name related to "shu" was extracted from literatures meeting the criteria,and data mining was carried out by using clustering algorithm and Apriori algorithm. Results:A total of 244 literatures were included,involving 143 points and2 257 times of shu points. The selected shu points were all over the fourteen main meridians and all specific points,but they had an obvious central tendency. The top five shu points in terms of frequency of use were jianyu(LI15),quchi(LI11),hegu(LI4),jianliao(SJ14) and waiguan(SJ5),accounting for 36.02% of the total frequency. The selected points were mainly on the large intestine meridian, the triple energizer meridian, the small intestine meridian and the upper limb, and attached importance to the use of specific points where meridian qi meets together,connects with each other and disperses,such as yang meridian shu points,extra point and five shu points,confluence points,yuan-source point and confluence points of the eight extraordinary collaterals. Clustering analysis of high-frequency point selection was carried out and grouped into five types;15 association rules were obtained through association rule analysis. Conclusion:The treatment of acupuncture and moxibustion to treat shoulder and hand syndrome after stroke, should take regulating and normalizing qi and blood,unblocking the collaterals and eliminating impediment as its principle,and combine factors such as phlegm,deficiency and stasis to carry out syndrome differentiation and treatment. The rules of point selection revealed by clustering and association analysis of high-frequency points can provide theoretical basis and reference for clinical application such as ensuring curative effect and rational point selection.