基于数据挖掘技术探讨针灸治疗脑卒中后痉挛性偏瘫的选穴特点

Based on Data Mining Technology to Explore the Characteristics of Acupuncture and Moxibustion in the Treatment of Spastic Hemiplegia after Stroke

目的运用数据挖掘技术探讨针灸治疗脑卒中后痉挛性偏瘫的选穴特点。方法检索中国期刊全文数据库(CNKI)、万方数据库、维普中文科技期刊数据库(VIP)、中国生物医学文献数据库(CBM)、PubMed上从建库至2020年5月5日的文献,按照纳入和排除标准收集治疗脑卒中后痉挛性偏瘫的针灸处方,利用SPSS 24.0、IBM SPSS Modeler 18软件,对其进行描述性分析、聚类分析和关联规则分析。结果共纳入文献436篇。治疗方法频次最高的是针刺,其次是针刺+康复锻炼。频次应用较高的腧穴:主穴是合谷、三阴交、肩髃等,配穴是丰隆、太溪、太冲等。用穴频次较高的经脉:主穴是手阳明大肠经、足阳明胃经、足太阴脾经经穴等,配穴是足阳明胃经、足少阳胆经、手阳明大肠经经穴等。用穴频次较高的部位:主、配穴均是下肢、上肢、头颈部等。支持度最高的关联群:主穴是合谷-曲池,配穴是太冲-丰隆、太溪-丰隆;置信度最高的关联群:主穴是三阴交-阴陵泉,配穴是地仓-颊车。聚类分析:主穴分为2类,尺泽、极泉、内关、三阴交、阴陵泉、照海、大陵、血海为第一类,合谷、曲池、外关、肩髃、手三里、阳陵泉、足三里为第二类;配穴分为3类,丰隆、太冲、太溪、气海、内庭、血海、风池、足三里为第一类,地仓、颊车、廉泉为第二类,合谷、丘墟、肩髃、曲池为第三类。结论针灸治疗脑卒中后痉挛性偏瘫,以阳经选穴为主,尤其是手、足阳明经,阳经或者阴经取穴大多单独使用,取穴部位多是四肢。主穴多选用特定穴,应用最多的是合穴,其次为交会穴、八脉交会穴、络穴,且多位于拮抗肌(群)肌腹或肌腱之间。配穴多是辨证取穴、随症取穴及按部位取穴,而辨证取穴多从风、痰、虚致病因素考虑。

Objective To use data mining technology to explore the characteristics of acupuncture and moxibustion in the treatment of spastic hemiplegia after stroke.Methods Papers on acupuncture treatment of spastic hemiplegia after stroke were retrieved from CNKI,Wanfang,VIP,CBM,PubMed during the time of establishment of each database and May 5,2020.Acupuncture prescriptions for the treatment of spastic hemiplegia after stroke were collected according to the inclusion and exclusion criteria.SPSS 24.0 and IBM SPSS Modeler 18 software were used for descriptive analysis,cluster analysis and association rule analysis.Results A total of 436 articles were included.The most frequent treatment method is acupuncture,followed by acupuncture+rehabilitation exercise.Frequently used acupoints,the main acupoints are Hegu,Sanyinjiao,Jianyu,etc.,and the matching acupoints are Fenglong,Taixi,and Taichong.The meridians with a higher frequency of use of acupoints,the main points are the Large Intestine Meridian of Hand Yangming,Stomach Meridian of Foot Yangming,Spleen Meridian of Foot Taiyin,etc.The matching points are Stomach Meridian of Foot Yangming,Gallbladder Meridian of Foot Shaoyang,Large Intestine Meridian of Hand Yangming.The main and matching points are the lower limbs,upper limbs,head and neck,etc.,where the acupoints are frequently used.The association group with the highest support,the main point is Hegu-Quchi,the matching point is Taichong-Fenglong,Taixi-Fenglong;the highest confidence association group,the main point is Sanyinjiao-Yinlingquan,and the matching point is Dicang-jiache.According to cluster analysis,the main points are divided into two categories,Chize,Jiquan,Neiguan,Sanyinjiao,Yinlingquan,Zhaohai,Daling,and Xuehai are the first category,Hegu,Quchi,Waiguan,Jianyu,Shousanli,Yanglingquan,and Zusanli are the second category;the matching points are divided into 3 categories,Fenglong,Taichong,Taixi,Qihai,Neiting,Xuehai,Fengchi,and Zusanli are the first category,and Dicang,Jiache,Lianquan are the second category,and Hegu,Qiuxu,Jianpi,and Quchi are the third category.Conclusion In acupuncture treatment of spastic hemiplegia after stroke,acupoints from yang meridians are mainly selected,especially the meridians of Hand and Foot Yangming.Acupoints of yang meridians or yin meridians are mostly used alone,and most of them are selected from the limbs.The main acupoints are mostly selected specific acupoints,He-Sea acupoints are most frequently used,followed by confluent acupoints,eight confluence points,and luo-connecting points.They are mostly located between the muscle bellies and tendons of the antagonistic muscles(groups).Most matching acupoints are selected according to syndrome,symptom and location differentiation,while syndrome differentiation is mostly considered from the pathogenic factors of wind,phlegm and deficiency.