基于数据挖掘技术探讨针灸古籍中针刺治疗颈肩臂痛的选穴规律

A data mining-based analysis of acupoint selection rules of acupuncture therapy for treatment of neck,shoulder and arm pain in ancient acupuncture and moxibustion books

目的:探讨针灸古籍中针刺治疗颈肩臂痛的选穴规律。方法:采用数据挖掘技术,在《中华医典》光盘和中国中医药数据库收录的针灸古籍中检索1911年之前的有关针刺治疗颈肩臂痛的文献。提取文献中的针刺处方,统计腧穴的分布和归经情况。采用Microsoft Excel 2020软件建立数据库,采用SPSS Clementine12.0软件对筛选出的高频腧穴和经络进行关联规则分析。结果:共收集92部针灸古籍,包含188首治疗颈肩臂痛针刺处方,涉及115个腧穴。针刺处方中的腧穴数目为1~14个,其中以1个腧穴的出现频次最高(146次)。在115个腧穴中,出现频次较高的为承浆(23次)、风府(17次)、后溪(17次)。对115个腧穴进行关联规则分析,得到22条关联规则,其中前3位依次为少商→委中、承浆+少商→委中、肩井+中渚→百会。利用规则涵盖关系和规则相似关系对22条关联规则进行规则简约,得到6条关联规则,其中前3位依次为承浆+少商→委中、承浆+肩井+中渚→百会、风府+哑门→风池。188首针刺处方共涉及16条经络,针刺处方中的经络数目为1~6条,其中以1条经络的出现频次最高(146次)。在16条经络中,出现频次较高的为足太阳膀胱经(44次)、手太阳小肠经(41次)、足少阳胆经(39次)。对16条经络进行关联规则分析,得到22条关联规则,其中前3位依次为任脉+手太阳小肠经+足太阳膀胱经→手太阴肺经、手太阴肺经+足太阳膀胱经→任脉、手阳明大肠经+足少阳胆经→任脉。利用规则涵盖关系和规则相似关系对22条关联规则进行规则简约,得到7条关联规则,其中前3位依次为任脉+手太阳小肠经+足太阳膀胱经→手太阴肺经、督脉+手阳明大肠经+足少阳胆经→任脉、手少阳三焦经+足少阳胆经→督脉。结论:针灸古籍中针刺治疗颈肩臂痛的选穴规律为,根据病因取穴,以局部取穴为主,重视交会穴,强调经络辨证和阴阳平衡,注重上下配穴和应用特定穴。

Objective:To excavate the acupoint selection rules of acupuncture therapy for treatment of neck,shoulder and arm pain(NSAP)in ancient acupuncture and moxibustion books.Methods:All ancient documents about acupuncture therapy for treatment of NSAP published before 1911 were retrieved from the ancient acupuncture and moxibustion books included in the Chinese Medical Code(CD-ROM)and Traditional Chinese medicine database(TCMDB)based on data mining techniques.The obtained documents were screened according to the predefined inclusion and exclusion criteria,and the acupuncture prescriptions aimed at treating NSAP were extracted from the included documents,followed by statistics on the distribution and meridian tropisms of acupoints in the extracted prescriptions.The normalized and standardized acupoints and meridian tropisms in the extracted prescriptions were input into the Microsoft Excel 2020 software for building a database,based on which the acupoints and meridian tropisms in the extracted prescriptions were statistically analyzed.The high-frequency acupoints and meridian tropisms were subjected to association rule analysis by using SPSS Clementine12.0 software.Results:Ninety-two ancient acupuncture and moxibustion books were searched out.After screening,188 acupuncture prescriptions aimed at treating NSAP were included in the final analysis,involving 115 acupoints.The number of acupoints in the acupuncture prescriptions ranged from 1 to 14,among which 1 acupoint appeared most frequently(146 times).Among the 115 acupoints,the top 3 high-frequency ones were Point CV24(Chengjiang),Point GV16(Fengfu)and Point SI3(Houxi)with the occurrence frequency of 23,17 and 17 respectively.The association rule analysis on the 115 acupoints generated 22 association rules,and the top 3 ones included Point LU11(Shaoshang)→Point BL40(Weizhong),Point CV24(Chengjiang)+Point LU11(Shaoshang)→Point BL40(Weizhong)and Point GB21(Jianjing)+Point TE3(Zhongzhu)→Point GV20(Baihui).The 22 association rules were simplified into 6 ones by using rule coverage relationship and rule similarity relationship,with the top 3 ones being Point CV24(Chengjiang)+Point LU11(Shaoshang)→Point BL40(Weizhong),Point CV24(Chengjiang)+Point GB21(Jianjing)+Point TE3(Zhongzhu)→Point GV20(Baihui)and Point GV16(Fengfu)+Point GV15(Yamen)→Point GB20(Fengchi).Sixteen meridians and collaterals(TCM)were involved in the 188 acupuncture prescriptions,and the number of meridian and collateral(TCM)in acupuncture prescriptions ranged from 1 to 6,among which 1 meridian and collateral(TCM)appeared most frequently(146 times).Among the 16 meridians and collaterals(TCM),the top 3 ones with high occurrence frequency were bladder meridian of Foot-Taiyang(BL),small intestine meridian of Hand-Taiyang(SI)and gallbladder meridian of Foot-Shaoyang(GB)with the occurrence frequency of 44,41 and 39 respectively.The association rule analysis on the 16 meridians and collaterals(TCM)generated 22 association rules,and the top 3 ones included conception vessel(CV)+small intestine meridian of Hand-Taiyang(SI)+bladder meridian of Foot-Taiyang(BL)→lung meridian of Hand-Taiyin(LU),lung meridian of Hand-Taiyin(LU)+bladder meridian of Foot-Taiyang(BL)→conception vessel(CV)and large intestine meridian of Hand-Yangming(LI)+gallbladder meridian of Foot-Shaoyang(GB)→conception vessel(CV).The 22 association rules were simplified into 7 ones by using rule coverage relationship and rule similarity relationship,with the top 3 ones being conception vessel(CV)+small intestine meridian of Hand-Taiyang(SI)+bladder meridian of Foot-Taiyang(BL)→lung meridian of Hand-Taiyin(LU),governor vessel(GV)+large intestine meridian of Hand-Yangming(LI)+gallbladder meridian of Foot-Shaoyang(GB)→conception vessel(CV)and triple energizer meridian of Hand-Shaoyang(TE)+gallbladder meridian of Foot-Shaoyang(GB)→governor vessel(GV).Conclusion:The acupoints for acupuncture treatment of NSAP in ancient acupuncture books are selected based on the etiopathogenisis,with a focus on local acupoints,an emphasis on confluent acupoints,a stress on meridians and collaterals(TCM)differentiation and yin-yang balance.Additionally,the coordination of superior-inferior acupoints and the application of specific acupoints are highlighted.