基于中医传承辅助平台挖掘针灸治疗膝骨关节炎的取穴规律

Analysis of Acupoint Selection Rules of Acupuncture and Moxibustion Treatment of Knee Osteoarthritis Based on TCMISS

目的通过中医传承辅助平台(TCMISS V2.5),对现有且经过临床检验的针灸治疗膝骨关节炎(Knee Osteoarthritis,KOA)处方进行数据统计,从而总结针灸配伍规律,并挖掘新的组穴处方。方法计算机检索建库至2020年12月CNKI期刊数据库中关于针灸治疗KOA的临床研究文献,严格按照纳入和排除标准,筛选针灸穴位处方并录入TCMISS,运用软件进一步分析,集成数据规律。结果共纳入144首穴位处方,包含11条经脉,46个穴位;最常使用的穴位有犊鼻(12.7%)、内膝眼(12.7%)、阳陵泉(11.0%)、血海(10.3%)、梁丘(9.8%)、足三里(9.6%)、阴陵泉(8.2%)等;以足阳明胃经(42.3%)穴位出现的频率最高,其次是足太阴脾经(26.7%)、足少阳胆经(18.9%)、足太阳膀胱经(7.1%)、足厥阴肝经(1.6%);出现不同穴性14种,共计714次,其中以合穴(42.4%)出现的频次最高,其次是下合穴(30.7%)、郄穴(13.2%)、交会穴(3.9%)、背俞穴(2.5%)、八会穴(2.4%)、原穴(1.5%);位于前6的穴位组合为“内膝眼-犊鼻”“内膝眼-阳陵泉”“犊鼻-阳陵泉”“内膝眼-血海”“犊鼻-血海”“血海-梁丘”;得到“阳陵泉,足三里,大肠俞,血海”“合谷,内膝眼,风市,委阳,犊鼻”“梁丘,阳陵泉,阴陵泉,大肠俞,肾俞”3组备选新方。结论针灸治疗KOA重视腧穴的近治作用,多使用局部取穴;归经以胃经、脾经、胆经、膀胱经为主;常配伍使用合穴、下合穴、八会穴、背俞穴;重视脏腑整体,调元气以通经络。

Objective Through the TCMISS V2.5,statistics on existing and clinically tested prescriptions for acupuncture treatment of knee osteoarthritis(KOA),so as to summarize the rules and dig new acupoint prescriptions.Methods The clinical research literature on acupuncture and moxibustion treatment of KOA in the CNKI from 1992 to 2020 was searched.According to the inclusion and exclusion conditions,acupuncture point prescriptions were selected and entered into TCMIS for further analysis and mining rules.Results A total of 144 acupoint prescriptions were included,including 11 meridians and 46 acupoints.The most commonly used acupoints were Dubi(ST35)(12.7%),Neixiyan(EX-LE4)(12.7%),Yanglingquan(GB34)(11.0%),Xuehai(SP10)(10.3%),Liangqiu(ST34)(9.8%),Zusanli(ST36)(9.6%),Yinlingquan(SP9)(8.2%).The frequency of acupuncture points in the Stomach Channel of Foot-Yangming(42.3%)is highest,followed by Spleen Channel of Foot-Taiyin(26.7%),Gallbladder Channel of Foot-Shaoyang(18.9%),Urinary Bladder Channel of Foot-Taiyang(7.1%),Liver Channel of Foot-Jueyin(1.6%).There are 14 different acupoint types,a total of 714 times,of which the He acupoint(42.4%)has the highest frequency,followed by Lower Xiahe acupoint(30.7%),Xi acupoint(13.2%),Jiaohui acupoint(3.9%),Beishu acupoint(2.5%),Bahui acupoint(2.4%),Yuan acupoint(1.5%).The first 6 acupoint combinations are“Neixiyan(EX-LE4)-Dubi(ST35)”,“Neixiyan(EX-LE4)-Yanglingquan(GB34)”,“Dubi(ST35)-Yanglingquan(GB34)”,“Neixiyan(EX-LE4)-Xuehai(SP10)”,“Dubi(ST35)-Xuehai(SP10)”,“Xuehai(SP10)-Liangqiu(ST34)”;and“Yanglingquan(GB34)-Zusanli(ST36)-Dachangshu(BL25)-Xuehai(SP10)”,“Hegu(LI4)-Neixiyan(EX-LE4)-Fengshi(GB31)-Weiyang(BL39)-Dubi(ST35)”,“Liangqiu(ST34)-Yanglingquan(GB34)-Yinlingquan(SP9)-Dachangshu(BL25)-Shenshu(BL23)”3 groups of new prescriptions.Conclusion Acupuncture and moxibustion treatment of KOA pays more attention to the recent treatment of acupoints,and uses local acupoint selection;the main meridians are stomach meridian,spleen meridian,gall bladder meridian,and bladder meridian;He acupoints,Xiahe acupoints,Bahui acupoints,and Backshu are often used in combination Points.The principle of treatment pay attention to the whole viscera,adjust vitality to clear the meridians.