近30年针刺治疗孤独症谱系障碍规律探讨

General Rules of Acupuncture Treatment of Autism Spectrum Disorder in Past 30 Years

目的 总结近30年中医针刺治疗孤独症谱系障碍(autism spectrum disorders, ASD)一般规律,为临床提供参考。方法 以“针刺”“孤独症”“针灸”“自闭症”“孤独症谱系障碍”“Autism spectrum disorders”“acupuncture”为中英文联合检索词,检索中国知识资源总库(CNKI)、中文科技期刊数据库(VIP)、中国生物医学文献服务系统(SinoMed)、Pubmed、MEDLINE、Clinical Trial等国内外主要数据库,依据标准纳入文献提取数据予以分析。结果 检索文献227篇,经遴选纳入文献82篇。纳入文献中共涉及研究病例1 974例,男1 523例,女451例,男∶女为3.38∶1,平均诊断年龄(3.85±1.79)岁。穴位应用频率占总报道文献≥20%的穴位有25处,其中使用频率最高的前10处穴位为四神聪、本神、神庭、脑空、脑户、神门、印堂、阳白、水沟、率谷;频次居前6位的经脉依次为督脉、经外奇穴、足少阳胆经、手少阴心经、足厥阴肝经、手厥阴心包经;在辨证取穴中,主穴中所有证型共用穴位有四神聪、神庭、本神、脑空、脑户、印堂、神门7处;配穴使用情况较复杂,频次较高配穴有合谷、太冲、少府、行间、丰隆、大陵、太溪常用穴位。结论 针刺治疗ASD取穴以四神聪、本神、神庭等头部穴位为主,经络归属以督脉、经外奇穴及足少阳胆经所属穴位为主。文献提示针刺治疗ASD疗效可靠,而普及率较低,且存在南北区域分布极不均衡,需引起关注。

Objective To summarize the general rules of acupuncture treatment of Autism Spectrum Disorder(ASD)in the past 30 years to provide reference for current clinical trails.Methods “Acupuncture”,“Autism”,“Autism Spectrum Disorder” and “acupuncture” were used as search terms to search in the main databases as CNKI,VIP,SinoMed, Pubmed, Medline and Clinical Trial at home and abroad.According to the corresponding standards, the whole paper were read, the data was extracted and analyzed.Results A total of 227 literatures were retrieved and 82 were included.A total of 1974 cases including 1523 males and 451 females were included.The male-to-female ratio was 3.38∶1,and the mean age at diagnosis was about 3.85±1.79 years old.There were 25 acupoints whose application frequency accounted more than 20% of the total reported literature, among which the top 10 acupoints with the highest use frequency were Sishencong(EX-HN1),Benshen(BG13),Shenting(DU24),Naokong(GB19),Naohu(DU17),Shenmen(HT7),Yintang(EX-HN3),Yangbai(GB14),Shuigou(DU26)and Shuigu(GB8).The top 6 meridians in frequency were Du meridian, foot Shaoyang gallbladder meridian, hand Shaoyin heart meridian, foot Jueyin liver meridian and hand Jueyin pericardium meridian.In the acupoint selection of syndrome differentiation, the common acupoints of all syndrome types included Sishencong(EX-HN1),Shenting(DU24),Benshen(BG13),Naokong(GB19),Naohu(DU17),Yintang(EX-HN3)and Shenmen(HT7).The use of acupoint matching was more complex.The commonly used acupoints were Hegu(LI4),Taichong(LR3),Shaofu(HT8),Xingjian(LR2),Fenglong(ST40),Daling(PC7)and Taixi(KI3).Conclusion Existing literature suggests that acupoints in the treatment of ASD are mainly the head acupoints such as Sishencong(EX-HN1),Benshen(BG13)and Shenting(DU24),and the meridian attribution is mainly the acupoints of Du meridian, extra meridian acupoints and foot Shaoyang gallbladder meridian.The literature suggests that acupuncture has a reliable curative effect in the treatment of ASD,but the penetration rate is low, and there is an extremely uneven distribution between the north and the south China, which requires attention.