目的 运用数据挖掘技术和统计学分析,探索临床针灸等中医药疗法通过穴位治疗癌痛的取穴规律.方法 2017年3—5月,检索中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普中文期刊数据库(VIP)、万方数据知识服务平台、PubMed、Cochrane Library、EMBase等关于针刺、艾灸或其他疗法作用于人体穴位治疗癌痛的临床随机对照试验,并辅以手工检索.提取纳入文献的取穴处方,对经络、穴位、治疗方式统一规范整理,对使用高频穴位进行关联分析和聚类分析.结果 本研究共纳入文献87篇,穴位处方291首.文献共涉及113组治疗方法,针刺+药物(非西药)〔18.6%(21/113)〕、单纯针刺〔16.8%(19/113)〕是癌痛最常用的治疗方法.共选用14条经脉,其中足阳明胃经取穴频次多达93次,其次为足太阳膀胱经(69次).最常使用的穴位有足三里、内关、合谷、三阴交、阿是穴、太冲、中脘、丘墟、支沟、血海、梁丘,该11个穴位关联分析显示,相关性较好的穴位有合谷与足三里、内关与三阴交、内关与合谷,挖掘出高频穴位关联规则14条,聚类分析可聚类为6类.结论 中医治疗癌痛以局部取穴为基础,结合辨证配穴,部分配穴既能提升癌痛患者免疫力又具有良好的疏通经络、行气止痛作用.%Objective To explore the rules of acupoint selection used in acupuncture and moxibustion or other TCM therapies for the treatment of cancer pain by using data mining and statistical analyses. Methods From March to May 2017, we searched CBM,CNKI,VIP and Wanfang Data Knowledge Service Platform,PubMed,Cochrane Library and EMBase and reviewed some printed journals for randomized controlled trials in which cancer pain was treated by acupoint acupuncture,moxa-moxibustion,or other therapies involving human acupoints. We extracted acupoint prescriptions from the included articles, and sorted out the used collaterals,acupoints and treatment methods in a unified and standardized way. The association analysis and cluster analysis of high frequency acupoints were carried out. Results A total of 87 articles were included,involving 291 acupoint prescriptions,and 133 therapies. Acupuncture plus drugs(non western medicine)〔18.6% (21/113)〕and simple acupuncture 〔16.8% (19/113)〕 were the most commonly used treatment methods for cancer pain. Of the 14 channels selected,the top one from which acupoints were most frequently selected were Stomach Channel of Foot Yangming(93 times),followed by Bladder Channel of Foot Taiyang(69 times). The most frequently used acupoints were Zusanli, Neiguan,Hegu,Sanyinjiao,Ashi,Taichong,Zhongwan,Qiuxu,Zhigou,Xuehai,and Liangqiu. Association analysis of these 11 acupoints found that,a strong relationship existed between Hegu and Zusanli,Neiguan and Sanyinjiao,Neiguan and Hegu;14 association rules of high-frequency acupuncture points were identified. And the high-frequency acupoints were clustered into 6 categories. Conclusion For treating cancer pain by TCM,selecting local acupoints is the base,and matching acupoints can be selected based on syndrome differentiation when needed. Puncturing and moxibustion of some matching acupoints can not only improve the immunity of cancer patients,but also well dredge the channels and collaterals,promote the circulation of qi and relieve pain.
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