基于现代文献分析针刺治疗原发性痛经辨证选穴的规律

目的基于现代文献分析针刺治疗原发性痛经辨证选穴的用穴规律。方法系统检索中国知网、万方数据知识服务平台、维普数据库自建库至2018年10月20日的针刺治疗原发性痛经辨证选穴的相关文献,将文献导入Note express软件进行查重,根据纳入、排除标准进行选择,建立Excel工作表对将最终纳入文献的年份、文题、文章类型、辨证分型、各证型针刺选穴等信息进行提取,同时对文献中证型名称、腧穴名称进行规范化管理,并运用SPSS 20.0统计软件进行频次、频率分析。结果(1)共检索到1656篇文献,纳入46篇,共涉及64个穴位,11种证型。(2)11种证型分为实证、虚证2类,其中实证用穴59个、虚证用穴46个。实证选穴使用频次位居前5位的是三阴交、关元、次髎、地机、太冲;虚证选穴使用频次位居前5位的是足三里、三阴交、关元、次髎、肾俞。对所有实证、虚证选穴的所属经脉分别进行统计,实证前5条经脉依次是足太阴脾经、任脉、足太阳膀胱经、足厥阴肝经、足阳明胃经;虚证前5条经脉依次是足太阳膀胱经、任脉、足太阴脾经、足阳明胃经、足少阴肾经。(3)11种证型根据出现频次高低依次为气滞血瘀证、寒湿阻滞证、气血两虚证、肝肾亏虚证、寒凝血瘀证、肝郁气滞证、湿热瘀阻证、肝郁湿热证、肾气亏虚证、寒凝证、胞宫虚寒证;以上证型使用频次位居前5位的依次是三阴交、关元、次髎、地机、太冲。同时各证型具体选穴又有所不同,其中前5个证型其使用频次位居前5位的穴位分别如下,气滞血瘀证:太冲、三阴交、关元、次髎、地机;寒湿阻滞证:三阴交、关元、地机、次髎、中极;气血两虚证:足三里、三阴交、关元、气海、次髎;肝肾亏虚证:肾俞、三阴交、关元、肝俞、足三里;寒凝血瘀证:关元、三阴交、次髎、中极、肾俞。结论针刺治疗原发性痛经总体选穴以阴经穴位为主,多选用足太阴脾经、任脉腧穴。辨证分型以气滞血瘀证最为多见,各证型间、实证和虚证间具体选穴有所不同,均体现了辨证选穴。

Analysis on the law of syndrome differentiation and point selection in acupuncture treating primary dysmenorrhea based on modern literature

Objective To analyze the law of syndrome differentiation and point selection in acupuncture treating primary dysmenorrhea based on modern literature.Methods The relevant documents on syndrome differentiation and point selection in acupuncture treating primary dysmenorrhea were systematically retrieved,from China Zhiwang(CNKI),Wanfang data knowledge service platform,Weipu database from self-built database to October 20,2018.The documents were imported into the Note express software to do duplicate checking,and they were selected according to the inclusion and exclusion criteria.Then the Excel worksheet was established to extract the information including the year,title,article type,syndrome types,point selection of each syndrome.While the names of syndrome types and points in the documents were standardized.And SPSS 20.0 statistical software was finally used to analyze the frequency and rate.Results(1)A total of 1656 articles were retrieved,46 articles were selected,including 64 points and 11 syndrome types.(2)11 syndromes were divided into 2 categories,including excess syndrome and deficiency syndrome,and 59 points were used in excess syndrome and 46 points were used in deficiency syndrome points.The top five points selected by excess syndrome was Sanyinjiao(SP6),Guanyuan(CV4),Ciliao,Diji(SP8)and Taichong(LR3),the top five points selected by deficiency syndrome was Zusanli(ST36),Sanyinjiao(SP6),Guanyuan(CV4),Ciliao,Shenshu(BL23).The points selection of excess syndrome and deficiency syndrome respectively belonging to which meridian was counted.The first five meridians of excess syndrome were spleen meridian of foot-taiyin,ren meridian,bladder meridian of foot-taiyang,liver meridian of foot-jueyin,stomach meridian of foot-yangming;and the first five meridians of deficiency syndrome were bladder meridian of foot-taiyang,ren meridian,spleen meridian of foot-taiyin,stomach meridian of foot-yangming and kidney meridian of foot-shaoyin.(3)According to the occurrence frequency of 11 syndromes were successively syndrome of qi stagnation and blood stasis,syndrome of cold-dampness blocking collaterals,syndrome of deficiency of both qi and blood,syndrome of deficiency of liver and kidney,syndrome of cold congelation and blood stasis,syndrome of liver depression and qi stagnation,syndrome of blockade dampness-heat and static blood,syndrome of liver depression and dampness-heat,syndrome of deficiency kidney qi,syndrome of congealing cold,syndrome of deficient cold in uterus.The using frequency of points ranking the top 5 in above syndromes successively were Sanyinjiao(SP6),Guanyuan(CV4),Ciliao,Diji(SP8)and Taichong(LR3)successively.Meanwhile,specific points selection of each syndrome are different,among which points of the first 5 syndromes with their using frequency ranking the top 5 are as follows:syndrome of qi stagnation and blood stasis,Taichong(LR3),Sanyinjiao(SP6),Guanyuan(CV4),Ciliao,Diji(SP8);syndrome of cold-dampness blocking collaterals,Sanyin jiao(SP6),Guanyuan(CV4),,Diji(SP8),Ciliao,Zhongji(RN3);syndrome of deficiency of both qi and blood:Zusanli(ST36),Sanyinjiao(SP6),Guanyuan(CV4),Qihai(CV6),Ciliao;syndrome of deficiency of liver and kidney:Shenshu(BL23),Sanyinjiao(SP6),Guanyuan(CV4),Ganshu(BL18),Zusanli(ST36);syndrome of cold congelation and blood stasis,Sanyinjiao(SP6),Ciliao,Zhongji(RN3),Shenshu(BL23).Conclusion In the treatment of primary dysmenorrhea,points are mainly selected from the yin meridian,and most of them are selected from the spleen meridian of foot-taiyin and ren meridian.The most common syndrome types is syndrome of qi stagnation and blood stasis,and the specific points selection is different among different syndrome types,excess syndrome and deficiency syndrome,which all reflect the point selection based on syndrome differentiation.