Data Mining-based Approach On Efficacy And Rules Of Acupuncture And Moxibustion On Myofascial Pain Syndrome

ObjectiveMyofascial pain syndrome(MPS)is a chronic soft tissue disease with high clinical incidence.Its main symptoms are local pain,referred pain and radiating pain in corresponding areas,which is closely related to bi disease of traditional Chinese medicine(TCM).This study aims to understand the research status and trend of MPS through scientific means,explore the treatment rules of neck and shoulder bi disease-MPS and local "inducing(connecting)pain" based on ancient and modern literature,thus providing data support and reference for the clinical acupuncture and moxibustion treatment of neck shoulder and back MPS,evaluating the effectiveness and safety of modern acupuncture and moxibustion treatment,and providing evidence-based medical support for the study of acupuncture and moxibustion treatment of related diseases.Methods1.Review of research status on MPSTo better understand the research status and trend in this field,by analyzing the literature of related academic journals with the help of the literature measurement visualization analysis tool provided by the platform of China National Knowledge Infrastructure(CNKI),this paper reviewed different aspects of MPS including the occurrence,development,physiological anatomy,clinical features,characteristics of the onset population,and the treatment status of this disease at home and abroad in the past 5 years.The method is to conduct professional search on the main topics of "myofascial pain syndrome","MPS","trigger points","myofascial trigger points" and "MTrps" in CNKI database.The search condition was"SU=myofascial pain syndrome+fascial pain syndrome+trigger point+myofascial trigger points+trigger points+MTrps+TrPs ",available from the general library of academic journals until December 2022.2.Review on the treatment of MPS by TCMTo summarize the concept,etiology,pathogenesis and treatment of bi diseases,and conclude the acupoints selection rules of treating neck and shoulder bi diseases and "inducing(connecting)pain" disease based on ancient literature,a series of searches is performed.Taking two ancient acupuncture and moxibustion books A and B Classics of Acupuncture and Moxibustion and Compendium of Acupuncture and Moxibustion included in the fifth version of Chinese Medical Classics as retrieval nodes,the computer was used to retrieve the full text with "neck","shoulder" and "back" as the search terms respectively.For the articles related to prescriptions,acupoints,meridians and collaterals,as long as there were bi or pain(severe,urgent,inducing pain)appeared at the relevant sites treated by acupuncture and moxibustion,these articles were recorded.Articles unrelated to acupuncture treatment of neck,shoulder and back bi diseases and the same articles in the same works shall be deleted.The derived articles were managed,and the names of the included acupoints were standardized and the frequency statistics were made.3.Study on acupoint selection rules of shoulder and back MPS treated by acupuncture based on modern literatureUsing the search method combining the subject words of "myofascial pain syndrome","myofascial pain","acupuncture" and "acupuncture and moxibustion" and other free words,the relevant clinical randomized controlled trial literatures on the acupuncture treatment items of shoulder and back MPS were collected from six databases(CNKI,Wanfang,VIP,Embase,Pubmed).The limited time was from the establishment of database to June 31,2022 for screening records.Using the Excel software to establish the acupoint selection rule research knowledge base for acupuncture and moxibustion treating related diseases.The frequency of acupoints,meridians of acupoints and frequency of specific acupoints were counted by applying mathematical statistics and attribute partial order structure data mining technology.The relationships among "acupuncture and moxibustion treating nuchal and back MPS:acupoint-selection","meridian-tropism-selection" and "special effect acupointselection" were analyzed to form an attribute partial order structure visualization map,and thus analyzing the characteristics and rules of the points selections in acupuncture and moxibustion prescriptions.4.Systematic evaluation of the effectiveness of acupuncture in the treatment of neck and shoulder MPS in modern literatureThe computer was used to search four Chinese databases and two English databases including CBMdisc(Chinese biomedical literature database),WF DATA(Wanfang Data Resource System database),CNKI(full-text Database of Academic journals of CNKI),VIP(VIP full-text Database),PubMed(Biomedical Information database)and Embase(database)according to the set retrieval strategy.All the literature related to "treating neck and shoulder MPS with acupuncture and moxibustion" since the establishment of databases to June 31,2022 were searched.According to the established inclusion and exclusion criteria,initial screening and re-screening were conducted to include valid literature.Excel table is used to extract relevant data information from qualified and included effective literature.According to the bias risk assessment manual recommended by the Cochrane Collaboration Network and RevMan5.3 software,literature quality evaluation was performed,and then metaanalysis was performed to evaluate the improvement of VAS visual analog score,realistic pain intensity(PPI),pain rating index(PRI)and clinical efficacy of acupuncture in patients with this disease.Results1.Research status of myofascial pain syndrome(MPS)According to the search conditions,a total of 7187 results were found,including 6380 Chinese and foreign academic journals,among them 1485 Chinese journals and 4894 foreign journals.In terms of published papers,the overall trend is gradually increasing.In the past 20 years,the number of published papers has increased greatly,forming a small peak in 2010 and 2016,and the peak is in 2020.However,the number of published papers has decreased in 2021 and 2022.No matter the distribution of main topics or secondary topics,it shows that scholars in this field pay great attention to "trigger points",which is a research hotspot in this field.Subject co-occurrence showed that myofascial stimulation points were closely associated with the superior trapezius muscle and appeared more frequently in one literature together with dry needle therapy.The proportion of core journals and SCI journals in Chinese and foreign languages is quite high,indicating that the quality of the literature published is good.The literature belongs to a wide range of disciplines,TCM and surgery two major fields ranked front.Among the published papers,literature supported by the national Nature Foundation ranked top.2.Acupoint selection rules of ancient literature in treating neck,shoulder and back bi disease and "inducing(connecting)pain" disease with acupuncture and moxibustion(1)The use of single acupoint accounts for a large proportionThere were 274 articles related to acupuncture and moxibustion treatment,with single acupoint accounting for 82.48%.Opposite points accounted for 9.49%and multiple points accounted for 8.03%.It indicates that the ancients used more prescriptions of single point in the treatment of neck,shoulder and back bi diseases.(2)Rules of acupointsAfter collecting statistics on the acupoints after integration,the acupoints used ≥5 times were DU 16 12 times(3.29%),SI3 11 times(3.01%),RN24 10 times(2.79%),LI15 9 times(2.47%),GB20 9 times(2.47%),BL40 9 times(2.47%),BL60 9 times(2.19%),LI4 8 times(2.19%)and GB21 8 times(2.19%),SJ3 8 times(2.19%),LI11 7 times(1.92%),BL13 6 times(1.64%),BL58 5 times(1.37%),LI10 5 times(1.37%),GB15 5 times(1.37%),and SJ10 5 times(1.37%).(3)Distribution rules of acupointsAccording to the analysis of the distribution of the prescription acupoints on the human body,the number of acupoints and the frequency of use were the highest on the upper extremity,with 42 acupoints and a frequency of 31.35%.This was followed by 80 times of shoulder,back and waist,81 times of head and neck,61 times of lower limbs,and 27 times of chest and abdomen.(4)Rules of meridians and collateralsThe majority of acupoints belonged to the Yang meridian,accounting for 78%,with a total frequency of 270 times(82.20%).The meridians with high frequency were 88 times of foot Taiyang meridian(24.11%),48 times of foot Shaoyang meridian(13.15%),45 times of hand Yangming meridian(12.33%)and 43 times of hand Taiyang meridian(11.78%),hand Shaoyang meridian 37 times(10.14%),du meridian 30 times(8.22%).(5)Rules of specific acupointsThe frequency of specific acupoints was 259 times;the number of non-specific acupoints was 111 times.Among the acupoints with specific acupoints,the number of acupoints with intersecting acupoints was 24,with the highest frequency of 75 times(20.55%).The number of Five Shu acupoints was 31,and the frequency of use was 107 times(29.32%).Among the Fvie Shou acupoints,the frequency of use was arranged from high to low,namely,31 times of Shu acupoints(8.49%)and 26 times of he-sea acupoints(7.12%).(6)Acupoint selection rule of local bi disease with "inducing(connecting)pain"Acupuncture and moxibustion have the treatment of single point and group point for local bi "inducing(connecting)pain".For single acupoint treatment,there were 10 kinds of"inducing(connecting)pain",involving a total of 24 acupoints,and the total frequency of use was 29 times.①The treatment of "neck" used Quepen,Fengchi and Tianchuang.②The treatment of“neck(including Quepen at the front of neck" used Fengchi,Touqiaoyin and Shangyang.③Treating chest and flank with Burong,Juliao,Benshen,Jinggu.④Treating back with Burong,Xiongxiang,Pishu and Yixi.Among them,Burong,Benshen,Jinggu and Jianshi were recorded for treating pain at "heart(chest and flank)" and "neck and shoulder".⑤Treating shoulder with Jianzhen and Tianjing.⑥Treating shoulder bi pain with Naoshu and Naohui.⑦Treating upper extremity(including fingers,elbow and arms)with Naoshu,Juliao,Houxi and Shaohai.⑧Treating waist pain with Shaohai and Pangguangshu.⑨Treating pain at heat,neck and chin with Touqiaoyin.⑩Treating pain and umbilical pain with Guanyuan.There are 5 different groups of acupoints for the treatment of 5 different types of "inducing(connecting)pain",for "head and neck tenderness,inducing shoulder and back pain",the group acupoints Houxi,Chengzhi,Baihui,Jianjing and Zhongzhu are used.Hegu and Taichong group points were used for finger arm lead shoulder ridge pain.Shoulder and back pain with the group of two points,Shangyang,Weizhong,Kunlun;Yang Chi and Neiguan are used to treat the pain caused by the wind invading the shoulder and back "induce(connect)" elbow.Arm pain "induce(connect)" shoulder and back,with Linqi,Jianjing,Quchi,Zhongzhu group points for treatment.3.Results of acupoint selection in the treatment of shoulder and back MPS based on modern literatureLiteratures on acupuncture treatment of shoulder and back MPS were sorted out,and a total of 55 literatures were in line with the standard of inclusion and exclusion criteria.including 56 acupoints and 298 acupoints.(1)Selection of acupoints14 acupoints have frequency ≥5,and the top 5 commonly used acupoints are:Ashi acupoint ASH 50 times,Jianjing GB21 29 times,Fengchi GB20 28 times,Dazhui DU 14 18 times,Jia Chi point EX-B2 16 times.Among them,Ashi point and Jianjing point are the basic points,and Ashi point is the core point.{Ashi Point,Jianjing,Fengchi,Geshu,Dazhui} is the core branch,{Ashi Point,Jianjing,Fengchi},{Ashi Point,Jianjing,Dazhui},{Ashi Point,Jianjing,Jiaji},{Ashi point,Fengchi,Dazhui},{Ashi point,Geshu} are commonly used acupoint pairs.(2)Meridian tropism of acupointsFor the meridians with a frequency≥ 25 times,there are gallbladder meridian with 62 times,bladder meridian 57 times,no meridian tropism 50 times,small intestine meridian 36 times,governor vessel 27 times.The commonly used meridians are gallbladder meridian,small intestine meridian and bladder meridian.The core meridian is the gallbladder meridian,and the bladder meridian is the most used acupoint.{Gallbladder meridian,small intestine meridian,sanjiao},{gallbladder meridian,small intestine meridian,large intestine meridian},{gallbladder meridian,small intestine meridian,bladder meridian} are commonly used meridian pairs.(3)Selection of specific acupointsThe top five specific acupoints in the frequency statistics are jiaohui acupoint with 86 times,bahui acupoint 25 times,bamai confluence acupoint 22 times,wushu acupoint 18 times,and beishu acupoint 15 times.4.Systematic evaluation of the effectiveness of acupuncture in the treatment of neck and shoulder MPS in modern literatureA total of 45 Chinese and English studies on the treatment of shoulder and back MPS by acupuncture were included,all of which were RCT-controlled trials,including 3368 patients.(1)In terms of literature quality,in general,one included study(2.22%)used the correct random assignment method,assignment concealment method and blinding method,reported complete results without selective reporting and other bias,and was assessed as low risk of bias.Four studies(8.89%)were assessed as having a high risk of bias due to the use of incorrect random sequence generation methods and imperfect distribution hiding.Most of the rest of the research literature could not evaluate the risk of bias due to unclear methodological reports.(2)The results of meta-analysis using the random effect model showed that acupuncture and moxibustion therapy had a significant effect and statistical results on the visual analogue scale VAS,actual pain intensity PPI,pain level score PRI index,clinical total effective rate P<0.05,suggesting that acupuncture and moxibustion therapy can better improve the VAS,PPI,PRI and clinical effectiveness of the patients than the control group.With large heterogeneity,the subgroup analysis showed that subcutaneous embedding,acupotomy,electroacupuncture,floating needling,warm needling moxibustion,and acupoint catgut embedding can all improve VAS,PPI,and PRI of patients,and acupuncture alone can improve VAS,PPI,and PRI of patients significantly,and the acupuncture and moxibustion can improve the VAS and P PI of patients.Blade acupuncture,pricking and cupping can relieve the VAS pain score of the patients.Although there was a large heterogeneity among the studies,the sensitivity analysis confirmed that the results of the meta-analysis were stable.(3)In terms of adverse reactions,10 studies reported adverse reactions among 45 included articles,including 6 studies(3 acupuncture,1 electroacupuncture,1 acupuncture combined with mixed moxibustion,and 1 study of acupuncture combined with pricking and cupping)reported no obvious adverse reactions;2 studies related to subcutaneous imbedding reported 2 cases of skin ecchymosis,and 2 cases of local pain aggravated after treatment;1 study of acupuncture reported 1 case of vasovagal syncope;1 case of acupuncture allergy was reported in 1 study of acupuncture combined with exercise.The remaining 35 studies did not report the relevant aspects of adverse reactions.Conclusions1.The research status and trend of MPS are related to its main characteristic "pain trigger point",which belongs to the research hotspot in this field.The "trigger point" is closely associated with the superior trapezius muscle and dry needle therapy.2.Acupoint selection rules of ancient and modern acupuncture treatment of neck,shoulder and back bi diseases-MPS:(1)In the selection of meridians,ancient and modern attention is paid to the application of Yang meridian,especially the bladder and gallbladder meridian;(2)For acupoints selection,In ancient times,Fengfu and Houxi were used more frequently in the treatment of neck,shoulder and back bi diseases,and they were belonging to the fourteen meridians.A single point or a group of points were selected and the proximal point and the distal point were combined when applying.Modern treatment of neck shoulder and back MPS is influenced by the idea of "pain point inactivation".Ashi point is the most used,often used alone or in combination with other points.(3)In terms of the selection of specific points,intersection points are commonly used in ancient and modern times to treat neck,shoulder and back bi diseases-MPS.3.It was recorded in ancient acupuncture and moxibustion books that local bi diseases can appear the manifestation of "inducing(connecting)pain",and it is applied to single point or group of points for treatment,which can provide reference for the treatment of modern disease MPS with distal involvement pain,radiating pain and other manifestations.4.The theory of meridian sinews and the theory of myofascial chain communicate with each other.Even if belonging to different medical systems,but both emphasize a holistic approach,similar in terms of route,distribution,function,pathology,clinical treatment ideas,and treatment methods.Dry needle therapy is closely related to traditional acupuncture therapy in terms of needle equipment,treatment site,acupuncture method,indications,etc.,and cannot be completely independent of the system of traditional acupuncture therapy.5.In terms of systematic review of modern literature:Meta-analysis showed that acupuncture and moxibustion had advantages in the treatment of shoulder and back MPS,and the improvement of pain intensity,current pain intensity,pain grading and the total effective rate were superior to the control group.Different acupuncture and moxibustion treatments have their own advantages and disadvantages in the improvement of different indexes.Acupuncture,press needle,electric acupuncture,floating acupuncture,warm acupuncture and acupoint catgut embedding comparison treatment groups may have better efficacy in the effective rate of patients.Acupuncture alone can improve the current pain intensity and pain grading significantly,and acupuncture combined can improve the pain intensity and current pain intensity of patients.Acupuncture and cupping can relieve pain intensity.However,there are still major defects in the report quality of the original research literature and the clinical implementation methodology.It is necessary to conduct highquality evidence-based medicine implementation and standardized research reports with strict,large sample and multi-center RCTS in the future,so as to provide a better reference for the clinical practice of acupuncture and moxibustion therapy and a good basis for further promotion of acupuncture and moxibustion therapy.