推拿治疗脑卒中后肩手综合征手法及选穴规律分析

Analysis on the Rule of Manipulation and Acupoint Selection Laws of Massage for Shoulder and Hand Syndrome after Stroke

目的:通过使用数据挖掘技术总结推拿治疗脑卒中后肩手综合征(SHS)的手法与腧穴使用规律并提炼相关处方。方法:检索中国生物医学文献数据库、万方数据库、维普数据库、中国知网数据库、Pubmed数据库、WOS数据库所收录的1995年至2023年发表的关于推拿治疗脑卒中后肩手综合征的文献,采用数据挖掘技术通过对数据开展描述性与关联性分析来提炼处方。结果:数据库共纳入文献227篇,涉及手法26种、腧穴93个。手法以揉法使用频次最高,占总频次的19.66%,腧穴以曲池使用频次最高,占总频次的13.75%;常用手法(使用频次大于20)有11个,常用腧穴(使用频次大于30)有10个;常用手法类型以挤压类为主,常用腧穴归经以手阳明大肠经为主;关联规则网络显示,高频手法得到15条关联规则,高频腧穴得到15条关联规则;从聚类分析中得出,高频手法可分成4类,高频腧穴可分成4类。结论:推拿治疗脑卒中后肩手综合征手法选择应该以挤压类手法为主,摆动类手法为辅,以“行气活血、舒经活络”为治疗原则,配以高频腧穴的聚类及关联分析所揭示的选穴规律,将手法与腧穴相结合,为临床应用提供参考。

Objective: To use data mining technology to analyze the rule of manipulation and acupoint selection laws of massage for shoulder and hand syndrome (SHS) after stroke, and to summarize its application rules. Methods: Clinical research literature about massage for the treatment of shoulder and hand syndrome after stroke was retrieved from China Biology Medicine disc, Wanfang database, VIP database, CNKI database, Pubmed database, and WOS database from 1995 and 2023, and established database, using data mining techniques for descriptive and relational analysis. Results: A total of 227 literatures were included in the database, involving 26 manipulations and 93 acupoints. Press-kneading manipulation is the most frequently used technique, accounting for 19.66% of the total frequency, and Quchi (LI11) is the most frequently used acupoint, accounting for 13.75% of the total frequency;there are 16 common manipulations (used more than 10 times) and 19 commonly used acupoints (used more than 10 times);the commonly used types of manipulations are mainly squeezing manipulations, and the commonly used acupoints are directed towards the Large Intestine Meridian of hand-yangming;The association rule network shows that 15 association rules are obtained for high-frequency manipulations, and 15 association rules for high-frequency acupoints;Through clustering analysis, high-frequency manipulations were clustered into 4 categories, and high-frequency acupoints were clustered into 5 categories. Conclusion: The selection of manipulations for shoulder-hand syndrome after stroke should be dominated by squeezing manipulations, supplemented by swinging manipulations, based on the principle of “promoting qi and blood circulation, relaxing meridians and activating collaterals”, combine with the rules revealed by the clustering and correlation analysis of high- frequency acupoints, and together with the manipulations and acupoints to provide reference for clinical application.