基于数据挖掘针灸治疗卒中后痉挛瘫的中医古籍选穴规律分析

Analysis of Acupoint Selection Patterns in Ancient Chinese Medical Books for Acupuncture Treatment of Post-Stroke Spastic Paralysis Based on Data Mining

摘要: 目的：收集整理古代医籍文献中关于针灸治疗卒中后痉挛性瘫痪的选穴组方，总结古代医家治疗卒中后痉挛瘫的选穴规律。方法：对第5版《中华医典》中收录的古籍进行检索，收集针灸治疗卒中后痉挛瘫的相关内容，利用Microsoft Excel 2021软件进行归纳整理，对处方中所有的腧穴及其归经、特定穴分布进行频次统计；采用IBM SPSS Modeler 18.0软件，运用关联规则Apriori算法进行复方腧穴关联规则分析。结果：本研究最终纳入16本中医古籍，合计古今条目共51条，15组穴位处方，其中条目最多的著作为《针灸大成》。腧穴使用总频次为89次，共涉及44个腧穴，使用次数排名前三的腧穴分别为曲池、肩髃和阳陵泉。对腧穴所属经脉进行统计，以阳经使用为多，其中足少阳胆经所应用的腧穴最多，阳陵泉为足少阳胆经中使用最多的腧穴。手阳明大肠经次之，曲池为手阳明大肠经中使用最多的腧穴。采用IBM SPSS Modeler 18.0对15组穴位处方进行复杂网络图展示，根据关联分析，关系最紧密的是合谷–曲池，其次为合谷–昆仑。结论：针灸治疗卒中后痉挛性偏瘫时以阳经选穴为主，阳经中又以曲池、肩髃、阳陵泉使用次数最多。但中医古籍中有关针灸治疗卒中后痉挛性偏瘫的条文较少，且多以单穴为主，因此在临床上使用针灸治疗卒中后痉挛瘫时不应拘泥于古籍穴位，应该在古籍穴位的基础上与现代临床研究相结合，选择更适合患者病症的腧穴配伍组合以及更加规范的手法标准。

Abstract: Objective: To collect and organize information from ancient medical texts on acupuncture point selection and prescription for the treatment of spastic hemiplegia after stroke, and to summarize the patterns of point selection used by ancient physicians in treating spastic paralysis. Methods: Search the ancient texts included in the 5th edition of the “Chinese Medical Encyclopedia”, collect relevant content on acupuncture treatment for spastic hemiplegia, and use Microsoft Excel 2021 to categorize and organize the data. Perform frequency statistics on all acupoints in the prescriptions, including their meridian attribution and specific point distribution; then use IBM SPSS Modeler 18.0 software and apply the Apriori algorithm of association rules to analyze the association rules of compound acupoints. Result: This study ultimately included 16 ancient Chinese medical books, totaling 51 entries from past and present, with 15 groups of acupuncture point prescriptions. The text with the most entries was “Zhen Jiu Da Cheng”. The total frequency of acupoint usage was 89, involving 44 acupoints. The top three most frequently used acupoints were Quchi, Jianyu, and Yanglingquan. Statistical analysis of the meridians to which the acupoints belong showed that Yang meridians were used most frequently, with the Gallbladder Meridian of Foot Shaoyang having the highest number of acupoints used, Yanglingquan being the most frequently used acupoint in this meridian. The Large Intestine Meridian of Hand Yangming was next, with Quchi being the most frequently used acupoint in this meridian. IBM SPSS Modeler 18.0 was used to create a complex network map of the 15 groups of acupoint prescriptions. Association analysis showed that the closest relationship was between Hegu and Quchi, followed by Hegu and Kunlun. Conclusion: In acupuncture treatment for post-stroke spastic hemiplegia, acupoints on the Yang meridians are primarily selected, with Quchi, Jianyu, and Yanglingquan being the most frequently used. However, ancient Chinese medical books contain few references to acupuncture for post-stroke spastic hemiplegia, and they mostly focus on single acupoints. Therefore, in clinical practice, acupuncture treatment for post-stroke spastic hemiplegia should not be limited to acupoints listed in ancient texts. Instead, it should combine these traditional acupoints with modern clinical research to select acupoint combinations that are more suitable for the patient’s condition, along with more standardized techniques.