Rules of acupuncture point selection in the treatment of rheumatoid arthritis through data mining

Lan Zhou ,Wei Zhou ,Ming-Yu Li ,Li Liu ,Mi Liu

1.College of Acupuncture and Massage,Hunan University of Traditional Chinese Medicine,Changsha 430100,China

2.The First Affiliated Hospital of Hunan University of Traditional Chinese,Changsha 430100,China

3.Liuyang Chinese Medicine Hospital,Liuyang 430181,China

Keywords:Data mining Electric acupuncture Rheumatoid arthritis

ABSTRACT Objective:To explore the rules of acupuncture point selection in thetreatment of rheumatoid arthritis by applying data mining and modern Statistical software.Methods:We retrieved literature from China hownet(CNKI),VIP database(VIP),Wanfang,PubMed,MEDLINE,Embase database from the founding of the database to February 1,2020.The main information of meridians and acupoints were entered into Excel,SPSS22.0 was used to extract data and do clustering analysis.Results:Quchi,Zusanli,Hegu,Yanglingquan,Xiyan were often chosen for electropuncture treatment of rheumatoid arthritis.Most of the acupoints are located in the large intestine channel of hand yangming bladder meridian or bladder channel of foot Taiyang,Shaoyang gallbladder channel of foot,stomachmeridian of foot Yangming,the energizer meridian and concentrated in the upper and lower extremities.The frequency of use of five Shu points,crossing point,source point,lowerconfluent and eight meeting points acupoints is higher.Cluster analysis can divide the included acupoints into 5 clusters.Conclusion:Quchi,Zusanli,Hegu,Yanglingquan,Xiyan are often chosen for electropuncture treatment of rheumatoid arthritis.Most of the selected acupoints aremostly distributed in the acupoints which are located in the large intestine channel of hand yangming bladder meridian or bladder channel of foot Taiyang,Shaoyang gallbladder channel of foot,Stomach meridian of foot Yangming,and the energizer meridian.

1.Introduction

Rheumatoid arthritis (RA) is an autoimmune disease of chronic progressive synovitis,with a high disability rate,which often leads to patients losing their ability to work[1,2].According to epidemiological data,80 The age of patients is 35～50 years old,and the female patients are about three times that of men.The prevalence rate in China is 0.32～0.36[3].At present,most of the therapeutic drugs for rheumatoid arthritis have great side effects[4].Clinically,there is an urgent need for a treatment method with clear therapeutic effect andless side effects.Acupuncture and moxibustion treatment has obvious curative effectin relieving joint pain,eliminating joint swelling,improving activity and improving qualityof life,and has little adverse reactions[5].Relevant studies have shown that electroacupuncture can reduce joint inflammatory reaction,promote the proliferation of joint synovium and vascularendothelial cells,improve joint pain and swelling,improve patients' quality of life,and achieve the effect of treating RA[6-9].Data mining is a method commonly usedin clinic to summarize experience in medication,which can objectively analyze the law ofclinical syndrome differentiation,prescription and medication[10].This paper uses data mining to analyze the meridian law of acupoint selection in electroacupuncture treatment of RA.

2.Data and methods

1.1 Data sources

Selected from CNKI and VIP(VIP),Wanfang,PubMed,EMBASE and MEDLINE databases contain clinical literature on electroacupuncture treatment of rheumatoid arthritis fromthe establishment of the database to February 1,2020.

2.2 Research methods

2.2.1 Search methods

Chinese search:(1) "Electroacupuncture" or "acupuncture";(2)"Rheumatoid arthritis" or "arthralgia syndrome" or "RA";(3)The first plus the second key word.English Search:(1) "Electric acupuncture" OR "acupuncture";(2) "Rheumatoid Arthritis" OR"RA" OR "polio myelitis";(3) The first plus the second keyword.According to the characteristics ofeach database,the search words are adjusted appropriately in order to achieve better search results.

2.2.2 Inclusion criteria

(1) The original literature is clinical research,which can include RCT and clinical efficacy observation;(2) There are clear diagnostic criteria forthe diagnosis of rheumatoid arthritis.The diagnosis and classification of traditional Chinese medicine refer to the clinical diagnosis and treatment of rheumatoid arthritis intraditional Chinese medicine(11);Western medicine refers to RA proposed by American College rheumatology(ACR) and European League Against Rheumatism(EULAR) Classification criteria(12),with a score of 6 or more,RA can be diagnosed;It has obvious clinical effect in the literature;(3) The main treatment measure in the literature is electroacupuncture,which can assist other treatment methods according to the complexity of the disease,and there is a control group of other treatment methods;(4) Theacupoints selected for treatment are body acupoints;(5) The original documents shall be primary documents;(6) There is no limit to the languages included in the literature.

2.2.3 Exclusion criteria

(1) Literatures include animal experimental research,review systematic evaluation,theoretical discussion,incomplete data,physician experience,case report,case report,unable to obtain the full text,incomplete description of intervention measures and so on;(2) The diagnostic criteria or efficacy evaluation criteria in the literature are not clear;(3) The intervention measures were electroacupuncture as adjuvant therapy;(4) The main acupoints or non body acupuncture such as ear acupuncture and scalp acupuncture were not clearly given in the literature;(5) Only onerepeatedly published literature was selected.

2.2.4 Data extraction

First,two researchers shall conduct a preliminary screening of all the included documents and summarize the documents that meet the inclusion criteria.If two researchers disagree,the third researcher shall make a decision.In order to minimize human error,the third researcher shall carefully read the documents to ensure the accuracyand integrity of the included documents,so as to ensure that the included data are more reliable.

2.2.5 Data standardization and database establishment

(1) Data sorting and standardization:before data extraction,the entered acupoint names and meridians shall be standardized according to the textbook of meridians andacupoints in the 13th five year plan for higher education in the national traditional Chinese medicine industry.The entered contents include acupoint name,meridians,location of acupoints and specific acupoints,In order to ensure the accuracy of the data,the data included in the literature of the Institute shall be independently extracted and entered by two researchers,andthen the data shall be checked.Any objection can besolved through discussion.If it cannot be solved,consult the third researcher.(2) Database establishment:2283 literatures related to the research content were retrieved according to the search words.After strict screening,the literatures that meet the inclusion criteria were included and the literatures that meet the exclusion criteria were excluded.The resulting 44 literatures and 675 acupoints were summarized andentered into excel,The contents of the database include acupoints,meridians,parts and meridians in the prescription.

3.Results

3.1 Descriptive analysis results

3.1.1 Analysis of selection frequency of meridians

44 literatures that meet the inclusion criteria are included.The included literatures are counted by Excel for acupointfrequency,and the use frequency and percentage of each acupoint are summarized.The results show that the top 5 acupoints used in the prescription of electroacupuncture for the treatment of rheumatoid arthritis are Quchi,Zusanli,Yanglingquan,Hegu,Jianyu;The frequency of use was 39,34,28,24 and 21 times respectively;The percentages are 5.78%,5.04%,4.15%,3.56%,3.11%.See Table 1.

3.1.2 Frequency analysis of meridians

Classify the acupoints counted in Excel table into meridians.The results show that the acupoints for electroacupuncture treatment of rheumatoid arthritis are distributedon 14 meridians.In addition,some acupoints are extrameridian Qi acupoints and Ashiacupoints,among which the top 5 meridians are hand Yangming large intestine meridian Foot Shaoyang gallbladder meridian,foot Taiyang bladder meridian,Foot Yangmingstomach meridian and hand Shaoyang Sanjiao meridian;Its use frequency is 114,104,86,86 and 75 respectively;The percentages were 16.89%,15.41%,12.74%,12.74%,11.11%.See Table 2.

3.1.3 Application analysis of specific acupoints

The acupoints counted in Excel are classified into specific acupoints.The results show that the acupoints for the treatment of rheumatoid arthritis are involved in 10 categories of specific acupoints,with a total frequency of 739 (some acupoints can bemultiple specific acupoints at the same time),and some acupoints do not belong to specific acupoints.Among them,the top 5 specific acupoints are five acupoints,intersection acupoints,original acupoints Xiahe point and Bahui point;The use frequencies are 267,115,77,63 and 51 respectively;Their percentages were38.84%,16.78%,10.83%,8.39%,7.17%.See Table 3.

Table 1Acupoint application frequency(frequency>12 times)

Table 2Human meridians application frequenc

Table 3Application frequency of specific acupoints

3.1.4 Location frequency analysis

Classify the acupoints counted in Excel,and divide the human body into head,neck The results showed that the acupoints for the treatment of rheumatoid arthritis were distributed in all parts of the human body except the neck,and most of the acupoints were located in the lower limbs,upper limbs,waist,back,head,chest and abdomen;The use frequencies are 286,224,68,36 and 13 respectively;The percentages were 45.93%,34.52%,10.37%,4.15%,2.22%.See Table 4.

3.2 Cluster analysis results

The acupoints used more than 12 times in Table 1 are applied with SPSS 22.0 for cluster analysis.If the classification is the most detailed,it is divided into 6 categories:Category 1:Zusanli;Category 2:Quchi;Category 3:Hegu;Category 4:Yanglingquan;Category 5:Waiguan,Jianyu,Jianyu,Shenshu and YangChi,BaXie,XuanZhong;Category 6:Taichong,Pishu,Yangxi,Dazhui,Qiuxu,shousanli,Guanyuan,Fengchi,Sanyinjiao,JieXi and Kunlun.See Figure 1.

Table 4Application frequency of specific body parts

Figure 1 Cluster analysis results

4.Discussion

Rheumatoid arthritis belongs to the scope of "arthralgia","arthralgia syndrome","lijiefeng" and "hegenfeng" in traditional Chinese medicine,and its pathogenesis is mostly based on deficiency and excess.In recent years,the efficacy of acupuncture and moxibustion in the treatment of rheumatoid arthritis has been recognized by the medical community and valued by more and more clinicians[13].Acupuncture and moxibustion can protect vascular endothelial cells and synovial tissue by improving the inflammatory response of affected limbs and inhibiting the production of inflammatory transmitters,so as to fundamentally achieve the effect of treating rheumatoid arthritis[14].Electroacupuncture stimulation of Hegu Point and Taichong Point plays an important role in the treatment of many diseases,good therapeutic effects have been achieved inimmune regulation and analgesia[15,16].

The results of this study show that Quchi,Zusanli,Yanglingquan,Hegu,Jianlu,Waiguan,Shenshu and Jianlu are used more frequently.Among them,the acupoints are mainly divided into three categories.The first category is Zusanli and Shenshu.Shenshu is a acupoint where kidney qi is injected into the back and waist,which has the function of tonifying kidney qi and regulating the viscera of the whole body.It canadjust the deficiency of Qi and liver and kidney;Zusanli is the combined point of the stomach meridian and the combined point under the stomach.The spleen and stomach are the biochemical source of Qi and blood.The combination of Zusanli and Shenshu can treat both congenital and postnatal RA patients together.It can not only warm yang,invigorate and tonify the internal causes of positive deficiency,but also play the role of near treatment[17].At the same time,the intervention of Zusanli and Shenshu can significantly reduce the levels of serum TNF-a and IL-6[18],and improvethe morning stiffness time,pain index,joint swelling index,joint tenderness index,average grip strength of both hands,ESR CRP,RF,anti CCP,etc[19].Category 2:Yanglingquan,which is located in the gallbladder meridian.The gallbladder governs the bone.The bone produces marrow,so it can treat rheumatoid arthritis closely related to boneand marrow[20].Category 3:Hegu,jianliao,Waiguan and jianyu are all distributed at acupoints Near the joint,which can be used for near treatment and pain relief.In theselection of acupoints,RA specimens are taken into account and work together.

Most of the acupoints involved in this study are located in the large intestine meridian of hand Yangming,gallbladder meridian of foot Shaoyang,bladder meridian of foot Taiyang and stomach meridian of Foot Yangming.The large intestine meridian ofhand Yangming and stomach meridian of Foot Yangming are of the same name.Theyare the main diet,metabolize Qi and blood and nourish the whole body;Beishu pointis located in the bladder meridian,which can regulate the five internal organs and help healthy qi;"The gall tastes bitter and goes through the bone,so the gall dominats the bone".The main lesion of rheumatoid arthritis is in the joint,so the foot Shaoyang gall meridian is selected.Most of the selected acupoints for electroacupuncture inthe treatment of rheumatoid arthritis are in the upper and lower limbs.Rheumatoid arthritis is characterized by multiple joints,symmetry and invasive arthritis of the small joints of hands and feet,so more acupoints in the upper and lower limbs are taken.

Among the acupoints selected by electroacupuncture for the treatment of rheumatoid arthritis,some acupoints belong to specific acupoints,of which five acupoints,intersection acupoints,Yuan acupoints,Xiahe acupoints and Bahui acupoints are used most frequently.The five acupoints can regulate the movement of viscera and meridians and treat viscera and meridians diseases;The original acupoint is the place where theoriginal Qi passes through and stays.It can treat the diseases of their respective viscera and viscera;Xiahe point is an effective point for treating six Fu organs diseases;The five acupoints,the original acupoints and the Xiahe acupoints are mostly locatedbelow the elbows and knees of the limbs,which can play a role in near treatment and alleviate the symptoms of the corresponding joints.Bahui point is the eight acupoints gathered by the essence and Qi of viscera,viscera,Qi,blood,tendons,veins,bones and marrow.It can treat qi stagnation and blood stasis,viscera imbalance and osteoarthritis of rheumatoid arthritis.The results of cluster analysis show that it can be divided into six cluster groups,which can be divided into two categories:Zusanli,Shenshu and Pishu;Zusanli,Shenshu,Pishu and Guanyuan support healthy qi,enhance resistance,and prevent rheumatoid arthritis from internal causes due to lack of healthy qi;Category 2:Quchi,Yanglingquan,Hegu,Jianliao,Waiguan,Jianyu,Xuanzhong,Baxie,Yangchi,Taichong,Dazhui,Yangxi and ShousanLi,Qiuxu,Sanyinjiao,Fengchi,Kunlun and JieXi.These acupoints play a role of near treatment.They are located next to bones and joints and can alleviate joint symptoms.For the symptoms themselves,the two kinds of acupoints play a role of giving consideration to both specimens.

The clinical application and theoretical research of electroacupuncture in the treatment of rheumatoid arthritis have become more and more in-depth.Continuous practice has proved that electroacupuncture is safe and effective in the treatment of rheumatoid arthritis,but there are still deficiencies:(1) Most literatures only select points for symptomatic treatment of RA without dialectical treatment;(2) Clinical trials also need to be supported by multi center and large sample studies.