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  • Title: [Rules of acupoint selection and pattern-acupoint relationship in treatment with acupuncture and moxibustion for endometriosis based on complex network analysis technology].
    Author: Zhang Q, Meng X, Huang S, Huang L, Wu L, Zhou Z.
    Journal: Zhongguo Zhen Jiu; 2024 May 12; 44(5):602-10. PubMed ID: 38764113.
    Abstract:
    OBJECTIVE: To explore the rules of acupoint selection and pattern-acupoint relationship in treatment with acupuncture and moxibustion for endometriosis (EMs) based on complex network analysis technology. METHODS: The articles for clinical trial of EMs treated with acupuncture and moxibustion were searched from CNKI, Wanfang, VIP, SinoMed, PubMed, EMbase and Cochrane Library from the inception of the databases to December 14, 2022. Using Microsoft Excel 2019 software, the database was established to collect the use frequency of acupoint, meridian tropism, location and pattern-acupoint relationship. SPSS Modeler 18.0 Apriori algorithm was adopted to conduct the association rule analysis, Cytoscape3.7.2 software was used to plot the complex co-occurrence network map; and SPSS Statistics 26.0 was adopted to perform hierarchical cluster analysis on high-frequency acupoints and a tree diagram was drawn. RESULTS: A total of 163 articles were included, and 167 core acupoint prescriptions and 74 pattern-associated acupoint prescriptions were extracted, involving 92 acupoints, with a cumulative frequency of 1 223 times. The top five acupoints with the highest use frequency were Guanyuan (CV 4), Sanyinjiao (SP 6), Zhongji (CV 3), Zigong (EX-CA 1) and Qihai (CV 6). The selected acupoints were mostly distributed in the chest, abdomen and lower limbs; and the involved meridians included the conception vessel, the spleen meridian of foot-taiyin and the stomach meridian of foot-yangming. The acupoint compatibility of high frequency referred to Guanyuan (CV 4) - Sanyinjiao (SP 6), Guanyuan (CV 4) - Zhongji (CV 3), and Guanyuan (CV 4) - Zigong (EX-CA 1). The close association was presented among Guanyuan (CV 4), Sanyinjiao (SP 6), Qihai (CV 6) and Zhongji (CV 3), which had the strongest connection with the other acupoints; among the top 25 acupoints with the highest use frequency, 5 acupoint prescriptions with high frequency were obtained by the cluster analysis. Guanyuan (CV 4), Qihai (CV 6), Sanyinjiao (SP 6), Zigong (EX-CA 1) and Zhongji (CV 3) were selected for cold and blood stagnation; Guanyuan (CV 4), Sanyinjiao (SP 6), Zhongji (CV 3), Dahe (KI 12) and Taixi (KI 3) for kidney deficiency and blood stagnation; Zhongji (CV 3), Guanyuan (CV 4), Sanyinjiao (SP 6), Xuehai (SP 10) and Diji (SP 8) for qi and blood stagnation; Qihai (CV 6), Guanyuan (CV 4), Zusanli (ST 36), Xuehai (SP 10), and Zigong (EX-CA 1) for qi deficiency and blood stagnation; Sanyinjiao (SP 6), Fenglong (ST 40), Zhongliao (BL 33), Ciliao (BL 32) and Xialiao (BL 34) for interaction of phlegm and stasis; and Daheng (SP 15), Guanyuan (CV 4), Zhongji (CV 3), Qihai (CV 6) and Zhongwan (CV 12) for retention of damp and heat. CONCLUSION: The core acupoints are Guanyuan (CV 4), Sanyinjiao (SP 6), Zhongji (CV 3), Qihai (CV 6) and Zigong (EX-CA 1) in treatment of endometriosis with acupuncture and moxibustion. Six patterns/syndromes are involved in clinical practice. In terms of the properties, functions and indications, the supplementary acupoints are selected on the basis of the core acupoints for different patterns/sydnromes of the disease. 目的：基于复杂网络分析技术探索针灸治疗子宫内膜异位症（EMs）的选穴规律与证-穴关系。方法：检索中国期刊全文数据库（CNKI）、万方数据知识服务平台（Wanfang）、维普中文科技期刊数据库（VIP）、中国生物医学文献数据库（SinoMed）、PubMed、EMbase、Cochrane Library建库至2022年12月14日收录的针灸治疗EMs的临床研究文献。采用Microsoft Excel 2019软件建立数据库，统计腧穴频次及频率、腧穴归经、腧穴分布、证-穴关系，并使用SPSS Modeler 18.0软件中的Apriori算法进行关联规则分析；采用Cytoscape3.7.2软件绘制复杂共现网络图谱；运用SPSS Statistics 26.0软件对高频腧穴实现层次聚类分析并绘制树状图。结果：共纳入163篇文献，提取核心处方167条，证型-腧穴处方74条，涉及腧穴92个，累计频次1 223次。使用频次前5的腧穴为关元、三阴交、中极、气海、子宫；腧穴归经以任脉、足太阴脾经与足阳明胃经为主，胸腹部与下肢部腧穴占比较高；关元-三阴交、关元-中极、关元-子宫为高频腧穴配伍；关元、三阴交、气海、中极相互之间联系紧密，与其他穴位的联通性最好；前25位高频腧穴可分为5个有效聚类群。寒凝血瘀证常用穴位为关元、气海、三阴交、子宫、中极；肾虚血瘀证常用穴位为关元、三阴交、中极、大赫、太溪；气滞血瘀证常用穴位为中极、关元、三阴交、血海、地机；气虚血瘀证常用穴位为气海、关元、足三里、血海、子宫；痰瘀互结证常用穴位为三阴交、丰隆、中髎、次髎、下髎；湿热瘀阻证常用穴位为大横、关元、中极、气海、中脘。结论：针灸治疗EMs核心处方为关元、三阴交、中极、气海、子宫，临床以6类证型为主，当根据不同证型在核心处方基础上配以对证穴位。.
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