| Objective:1 Using bibliometrics and data mining techniques to analyze the common syndromes of chronic urticaria(CU)and their commonly used interventions,acupoints,amount of treatment and detection indexes in ancient medical books and modern medical literatures,and to develop optimization program;2.Using randomized controlled trial method,a clinical research was carried out about three kinds of common acupuncture combined therapy(autologous blood therapy(ABT),pricking and cupping(PAC)and auricular acupressure(AA))for blood deficiency and dryness type CU,to evaluate the effectiveness of combined therapy and explore better acupuncture combined therapy.Method:1.To generate clinical optimization program of chronic urticaria by bibliometric and mining techniques(1)Ancient medical books:based on the "Encyclopaedia Chinese Medical"(fifth edition)included 1156 ancient medical books to collect the different methods of acupuncture and moxibustion for urticaria,and to analyze commonly used interventions,acupuncture points,prescription characteristics according to frequency.(2)Modern medical literatures:the literatures on the treatment of CU by various acupuncture and moxibustion methods in database of CNKI,Wangfang,CQVIP,CBM,SCI-EXPANDED,PubMed,Embase and so on were included(before 2015.11).CiteSpace was used to analyze document type and keyword by frequency and centrality to acquire the common syndromes,interventions and detection indexes.Database about needling,ABT,PAC and AA for blood deficiency and dryness type CU was established with Excel,SPSS22.0 and Clementine 12.0 software was used to analyze acupoints,duration and course by frequnecy,association rules and clustering,to mining commonly used acupoints prescription and the amount of treatment.2.Clinical randomized controlled trials of three commonly used acupuncture combined therapies for blood deficiency and dryness type CU99 included subjects were randomly assigned to group A(needling + ABT),group B(needling + PAC)and group C(needling + AA).Prescription referenced data mining and "Acupuncture Treatment"(Wang Qicai edited),course were 3 times a week,a total of 4 weeks.The follow-up period was 8 weeks after the end of treatment.Urticaria Activity Score(UAS),Dermatology Life Quality Index(DLQI),urticaria symptom grading scale(USGS)were applied as evaluation index in before treatment,4th,8th,12th week.Comprehensive effect was analyzed by UAS before and after treatment and the mechanism was analyzed by serum total IgE.Recurrence rate was analyzed by UAS at 12th week.Adverse events were recorded and analyzed.Result:1.Optimization program(1)Ancient medical books:28 books and 132 references were included.?Commonly used intervention:followed by needling and moxibustion(41),moxibustion(31)and needling(22).? Comnonly used acupoint:followed by Quchi(43),Hegu(18),Jianyu(17).? Acupoints selective features:Prescription was usually as single points(117),the main meridian was hand Yangming large intestine meridian(84),specific point was Wushu acupoints(105),the main acupoints were on the part of the upper limb(120)(2)Modern medical literatures:225 articles were included and 26 articles about needling,ABT,PAC and AA for blood deficiency CU were included.To mining common syndrome,intervention,detection index,acupoints and amount of treatment by frequnecy,centrality,association rules and clustering.? Common syndrome:blood deficiency and dryness type.? Common intervention:followed by ABT(114,centrality 0.54),PAC(14),needling(12),AA(8).? Common detection index:serum total IgE(15,centrality 0.2).? Common acupoint:needling main acupoints were Quchi,Xuehai,Zusanli,Hegu and Sanyinjiao;adjunct acupoints were Feishu,Fengchi,Spleenshu,Waiguang,Geshu.? Common amount of treatment:needle retention was 30 minutes(15),ABT injection was 1 ml per point(2),AA pressed 4 times a day(4).Course was 3 times a week,totally 12 times(5).(3)Optimization program:needling main acupoints were Quchi,Xuehai,Zusanli,Hegu and Sanyinjiao;adjunct acupoints were Feishu,Fengchi,Spleenshu,Waiguang,Geshu,needle retention was 30 minutes,ABT injection was 1 ml per point,AA pressed 4 times a day,course was 3 times a week,totally 12 times,detection index was serum total IgE.2.Clinical randomized controlled trial(1)99 subjects were included.8 cases were lost and 91 cases were completed in final.(2)Baseline:There were 39 men and 52 females;age was among 22 to 46 years old;courses were among 6 to 36 months.There was no significant difference among gender,age,course,clinical classification,UAS,DLQI,USGS,IgE among groups before treatment(P>0.05),suggesting that the baseline was balance.(3)UAS:Compared 4th week with before,the difference was statistically significant(P<0.05),suggesting that three groups both can improve urticaria activity degree in 4th week.UAS were evaluatedin 4th,8th,12th week,the trend of UAS was the same along the time.Score was lowest in 4th week,and follow-up gradually increased steadily,A group was better than C group.(4)DLQI:Compared 4th week with before,the difference was statistically significant(P<0.05),suggesting that three groups both can improve quality of life.DLQI were evaluatedin 4th,8th,12th week,the trend of DLQI was the same along the time.Score was the lowest in 4th week,and follow-up increased gradually,with 12th week being more pronounced than 8th week,the effect of three groups were equivalent.(5)USGS:Compared 4th week with before,the difference was statistically significant(P<0.05),suggesting that three groups both can improve the symptoms of urticaria grading degree.USGS were evaluatedin 4th,8th week,12th week,the trend of USGS was the same along the time.Score was lowest in 4th week,and follow-up increased gradually,with 12th week being more pronounced than 8th week,A group was better than C group.(6)Efficacy and distribution:Compared UAS among three groups in 4th week,efficacy of A group was 90.63%,B group was 86.67%and C gropu was 82.76%,the difference were statistically significant(P<0.05),by two comparison,A and C group,A and B group were different,B and C group were no difference,suggesting A group comprehensive effect is better than B and C group,B and C group were of same efficacy.Efficacy of A group was mainly distributed in recovery and markedly effective,while B and C group was mainly distributed in effetive.(7)Serum total IgE content changes:4 weeks after treatment three group can both reduce the total serum IgE levels(P<0.05),There was no significant difference between the groups(P>0.05).(8)Recurrence:recurrence rate were A group 9.39%,B group 13.33%,C group 17.24%,there were no statistically difference among them(P>0.05),suggesting that recurrence were the same in three group in follow-up.(9)Safety analysis:Acupuncture treatment does not cause adverse reactions,the ABT,PAC and AA treatment can cause mild bruises,ecchymosis,epidermal damage and pain,but can subside without special treatment.Conclusion1.Analysis of ancient medical books and modern medical literature by bibliometric and data mining technology,it refers that modern application of different acupuncture and moxibustion treatment for CU is heritage and development of the ancient,more emphasis on syndrome differentiation and rich acupoints treatment technology.Commonly used combined interventions were needling + ABT,needling + PAC and needling + AA,common syndromes was blood deficiency and dryness,optimization program of needling was Quchi and Xuehai from hand Yangming large intestine and foot Taiyin spleen meridian to nourish and expel wind,the mechanism often based on serum total IgE content changes.2.Three combined therapies applied optimization program both can improve urticaria and itching,the quality of life,degree of urticaria and total IgE.Recurrence rate were both less than 20%.According to safety analysis,inventions were at the second level,suggesting that all interventions were relatively secure.3.Needling + ABT therapy applied optimization program was effective,with low recurrent rate and safe for blood deficiency and dryness stype CU.A group was more effective than C group in improving UAS and grade level,A group effective rate was up to 90%,which was better than B and C Group.It refers that needling +ABT is the better acupuncture combined therapy,which is worthy of clinical promotion and application. |
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