Analysis of the Frequency of Clinical Acupoint Use Based on ‘Traditional Chinese Medical Acupuncture-moxibustion Information Databank’

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1 Department of Mechanics and Engineering Science, Fudan University, Shanghai 200433, China

2 Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China

3 Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China

4 Shanghai Research Center of Acupuncture and Meridian, Shanghai 201203, China

SPECIAL TOPIC FOR 973 PROGRAM

Analysis of the Frequency of Clinical Acupoint Use Based on ‘Traditional Chinese Medical Acupuncture-moxibustion Information Databank’

Yang Ling1, Huang Qin-feng2, Wu Huan-gan2, Liu Xiao-xu3, Ding Guang-hong1,4, Ma Xiao-peng2, Feng Xiao-ming2, Dou Chuan-zi2

1 Department of Mechanics and Engineering Science, Fudan University, Shanghai 200433, China

2 Shanghai Research Institute of Acupuncture and Meridian, Shanghai 200030, China

3 Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China

4 Shanghai Research Center of Acupuncture and Meridian, Shanghai 201203, China

Author: Yang Ling, M.D.

E-mail: jackitcm@126.com

The frequencies of use of 361 human acupoints in 74 academic journals of traditional Chinese medicine published between 1949 and 2010 are arranged in order using ‘Traditional Chinese Medical Acupuncturemoxibustion Information Databank’. The frequencies of use are divided into five grades: most frequent use, more frequent use, frequent use, less frequent use and infrequent use. The most frequently used acupoints and infrequently used acupoints are summarized and analyzed to help point selection for clinical acupuncture and selection of acupuncture research projects in the future.

Acupoint; Bibliometrics; Evaluation Studies; Databases, Bibliographic; Traditional Chinese Medicine; Acupuncture-moxibustion Therapy

Acupuncture-moxibustion, an important component of traditional Chinese medicine plays a great role in clinical treatment. An acupoint is a special position where qi of human viscera and meridians is infused and spread to the body surface. It is not only a special place where qi and blood converge, transfer and pass in and out but also a stimulation site for promoting flow of qi and blood and regulating visceral functions. Point selection is directly linked to acupuncture-moxibustion effect. This article deals with the frequencies of use of 361 human acupoints selected, using‘Traditional Chinese Medical Acupuncture-moxibustion Information Databank’, from acupuncture-moxibustion information in 74 academic journals of traditional Chinese medicine published between 1949 and 2010. The purpose is to objectively show the selection and use of the 361 acupoints in clinical acupuncture-moxibustion and provide evidence for further analysis and clinical application.

1 Data Sources

The data come from ‘Traditional Chinese Medical Acupuncturemoxibustion Information Databank’ (original ‘China Modern Acupuncturemoxibustion Information Databank’) developed by the Shanghai Research Institute of Acupuncture and Meridian. The databank collects and reviews 73 158 pieces of literature on acupuncture-moxibustion in 74 scientific journals of acupuncture-moxibustion, traditional Chinese medicine and combined traditional Chinese and Western medicine published from the foundation of People’s Republic of China to 2010 and makes a comprehensive analysis by a bibliometric method. ‘Traditional ChineseMedical Acupuncture-moxibustion Information Databank’ highly processes the input type, input criteria, included literature, indexing and included references and tries deep data mining using a mathematic model[1]. This article refers to the statistical chapter for acupoint-disease analysis and acupoint systems. It is done by inputting an acupoint name or code, e.g. Zusanli or ST 36 and Tianchi or PC 1.

2 Results and Analysis

2.1 A summary of the frequency of acupoint use

The frequencies of use of 361 human acupoints in clinical acupuncture-moxibustion are summarized on the basis of ‘Traditional Chinese Medical Acupuncture-moxibustion Information Databank’. The acupoints are graded according to the frequencies of their use. Acupoints used at a frequency of more than 1 000 times are classified as most frequently used points; acupoints used at a frequency of 500-999 times, as more frequently used points; acupoints used at a frequency of 100-499 times, as frequently used points; acupoints used at a frequency of 10-99 times, as less frequently used points; acupoints used at a frequency of less than 10 times, as infrequently used points. The details are seen in Table 1.

It can be seen in Table 1 that there are 53 acupoints most frequently used at a frequency of more than 1 000 times in clinical acupuncturemoxibustion. Zusanli (ST 36) is the only point used at a frequency of more than 10 000 times. Therefore, Zusanli (ST 36) is worthy of a great point for recuperation and health care. Experimental studies have showed that moxibustion on Zusanli (ST 36) can warm and reinforce the stomach and spleen, improve symptoms of spleen deficiency and energy metabolism in rats[2], increase bodily immunity and prevent aging[3]. Clinical studies have also showed that moxibustion on Zusanli (ST 36) can improve bodily microcirculation, speed lactic acid metabolism, produce an anti-fatigue effect, decrease human resting blood pressure, increase cardiovascular reserve capacity, promote post-sport recovery of blood pressure and exert a good regulating effect on the heart and blood vessels. Needling Zusanli (ST 36) can markedly promote the recovery of gastrointestinal functions and decrease complications after abdominal surgery and facilitate the recovery of neural functions[4-7]. The top 10 most frequently used points are Zusanli (ST 36), Hegu (LI 4), Sanyinjiao (SP 6), Taichong (LR 3), Fengchi (GB 20), Quchi (LI 11), Shenshu (BL 23), Yanglingquan (GB 34), Neiguan (PC 6) and Baihui (GV 20) in order. They all are specific points (specific points refer to the points of fourteen meridians that have special names and functions). Acupuncture-moxibustion theory considers that a specific point is a place where meridian qi converges to a greater extent. Specific points not only account for about 57.3% of the total acupoints[8]but also occupy an important position in the clinical application of acupuncture-moxibustion.

Analysis of data on top 10 most frequently used points has showed that top 3 systemic and major diseases that these points are indicated are all concentrated in the nervous, cardiovascular and motor systems. The corresponding disease spectrum includes facial paralysis, stroke sequelae, hiccup, insomnia and dysmenorrhea[9]. That confirms a close relationship between the most frequently used points and a spectrum of effectively treated diseases and also validates the therapeutic effects of specific points from one side (Table 2).

2.2 Analysis of meridians to which acupoints pertain

Meridians to which acupoints most frequently used at a frequency of more than 1000 times in clinical acupuncture-moxibustion pertain are, in order of the frequencies of acupoint use, the Bladder Meridian of Foot Taiyang ＞the Conception Vessel ＞the Stomach Meridian of Foot Yangming ＞the Governor Vessel＝the Large Intestine Meridian of Hand Yangming＝the Gallbladder Meridian of Foot Shaoyang＞the Spleen Meridian of Foot Taiyin ＞the Triple Energizer Meridian of Hand Shaoyang＝the Small Intestine Meridian of Hand Taiyang＞the Pericardium Meridian of Hand Jueyin＝the Heart Meridian of Hand Shaoyin＝the Liver Meridian of Foot Jueyin＝the Kidney Meridian of Foot Shaoyin (Table 3). There are no points of the Lung Meridian of Hand Taiyin among the most frequently used points.

Meridians to which the infrequently used points pertain are in order of the Kidney Meridian of Foot Shaoyin＞the Spleen Meridian of Foot Taiyin＞the Gallbladder Meridian of Foot Shaoyang＝the Bladder Meridian of Foot Taiyang＞the Triple Energizer Meridian of Hand Shaoyang＞the Pericardium Meridian of Hand Jueyin＝the Conception Vessel＝the Stomach Meridian of Foot Yangming (Table 4).

A further analysis has showed that the most frequently used points are mainly located on the Taiyang and Yangming Meridians. Points infrequently used at a frequency of less than 10 times are mainly located on the Kidney Meridian of Foot Shaoyin and the Spleen Meridian of Foot Taiyin. Both account for more than half of the infrequently used points. None of them are located on the Governor Vessel, the Large Intestine Meridian of Hand Yangming, the Small Intestine Meridian of Hand Taiyang, the Liver Meridian of Foot Jueyin, the Heart Meridian of Hand Shaoyin and the Lung Meridian of Hand Taiyin.

Table 1. A summary of the frequencies of use of 361 human acupoints in clinical acupuncture-moxibustion

Table 1 (continued). A summary of the frequencies of use of 361 human acupoints in clinical acupuncture-moxibustion

2.3 Analysis of the regions where acupoints are distributed

Where acupoints are distributed is divided into 13 regions. An analysis of the regions where acupoints are distributed has showed that acupoints most frequently used at a frequency of more than 1 000 times are located in order of on the head and neck＞yang part of the leg＞the upper back＞the lower abdomen＞the lower back＝y(tǒng)ang part of the arm＞yin part of the leg＞the dorsum of hand＝the chest and epigastrium＝y(tǒng)in part of the foot＞the dorsum of foot＝the palm＝y(tǒng)in part of the arm (Table 5).

The infrequently used points are mainly distributed on the chest and epigastrium, which account for 73.9%. Secondly, two of them are distributed on the head and neck and one of them, on each of the upper back, yang part of the leg, yang part of the arm and the dorsum of foot. None of them are distributed on the lower back, yin part of the leg, the lower abdomen, the dorsum of hand, the palm, yin part of the arm and yin part of the foot (Table 6).

2.4 Analysis of the frequencies of specific point

Among 53 acupoints most frequently used at a frequency of more than 1 000 times in clinical practice of acupuncture-moxibustion, there are 43 specific points, accounting for 81.1% (Table 7).

Among 23 infrequently used points, there are six specific points. Of them, there are five crossing points, which in order are Fubai (GB 10), the crossing point of the Foot Taiyang and the Foot Shaoyang Meridians; Tianchi (PC 1), the crossing point of the Hand Jueyin and the Foot Shaoyang Meridians; Youmen (KI 21), the crossing point of the Thoroughfare Vessel and the Foot Shaoyin Meridian; Futonggu (KI 20), the crossingpoint of the Thoroughfare Vessel and the Foot Shaoyin Meridian; Erheliao (TE 22), the crossing point of the Hand Shaoyang, the Foot Shaoyang and the Hand Taiyang Meridians; and Zutonggu (BL 66), the Xing-Spring point of the Foot Taiyang Meridian.

3 Discussion

This article arranges in order and summarizes the frequencies of clinical use of 361 acupoints in 74 academic journals of traditional Chinese medicine published after the foundation of People’s Republic of China on the basis of ‘Traditional Chinese Medical Acupuncture-moxibustion Information Databank’.

3.1 Characteristics of the most frequently used points

3.1.1 Broad range of indications

Most of these points have body-regulating and health-protecting or special effects in addition to treating local diseases. For example, Zusanli (ST 36) is not only the He-Sea point and Lower He-Sea point of the Stomach Meridian, which has a good regulating effect on the stomach, but also a health-protecting point for improving human immunity and reinforcing vital qi and a basic point used for all chronic diseases[10]. Hegu (LI 4) can treat craniofacial diseases as well as arm and digital joint diseases and moreover regulate the functional activity of qi in the body[11].

3.1.2 Frequent selection of yang meridian points

The most frequently used points are mainly located on Taiyang and Yangming Meridians, especially the Bladder and the Stomach Meridians. Some of them are located on the Conception and Governor Vessels, few of them on the Pericardium, Liver, Heart and Kidney Meridians and even none of them on the Lung Meridian.

3.1.3 Main distribution on the head and neck

The head is an important place where meridian qi converges and is closely related to human visceral organs and their functions. The head is the gathering area of the yang, and the brain is the sea of marrow and the house of primordial spirit. The head governs the functional activities of viscera and meridians and is an important place that regulates qi and blood all over the body. Acupoints on the head and neck are most extensively applied because they are well exposed and the use of them is not restricted by seasonal cold and heat, and clothes.

Table 2. Main diseases suitable for the most frequently used points that rank in the top 10

Table 3. Analysis of meridians to which the most frequently used points pertain

Table 4. Analysis of meridians to which the infrequently used points pertain

3.1.4 Specific points as the main part

Specific points, which contain the crossing points, Five Shu points, Back-Shu points, Yuan-Primary points, Eight Influential points and Front-Mu points, account for 81.1% of the most frequently used points and 73.3% of those points located on the head and neck on which those points are mainly distributed. Specific points account for 75.0% of the most frequently used points located on the Bladder Meridian on which those points are mainly distributed. Moreover, Back-Shu points account for more than half of the specific points, suggesting that Back-Shu points are very extensively applied clinically. Specific points account for 87.5% of the most frequently used points located on the Conception Vessel on which those points are second distributed. Of them, Front-Mu points account for 50.0%. Back-Shu points and Front-Mu points are most frequently applied, suggesting that combination of Back-Shu and Front-Mu points is clinically often used.

Table 5. Analysis of the regions where the most frequently used points are distributed

Table 6. Analysis of the regions where the infrequently used points are distributed

3.2 Characteristics of the infrequently used points

There are 23 infrequently used points. They have the following characteristics

3.2.1 More distribution on the yin meridians than on the yang meridians

The yin meridians account for more than 60% of the meridians to which the infrequently used points pertain. According to the theory of traditional Chinese medicine, the back pertains to yang and the abdomen to yin; yang transforms into qi and yin takes shape. Regulating qi is the main effect of acupuncturemoxibustion and therefore, the infrequently used points are mainly the points of the yin meridians.

3.2.2 Main distribution on the Kidney Meridian and secondary distribution on the Spleen Meridian

The points of the Kidney Meridian are the greatest in number in the infrequently used points and account for 34.8% of those points and 57.1% of those points located on the yin meridians. The number of the points of the Spleen Meridian ranks second. From the meridian route, the Kidney Meridian travels from the foot to the chest, starting from Yongquan (KI 1) and ending at Shufu (KI 27). The visceral organs towhich the Kidney Meridian is related contain the kidney, bladder, liver, lung, heart, pericardium (thoracic center), laryngopharynx and tongue. The Kidney Meridian is the meridian that travels through the largest number of important visceral organs. Just because of this, points of the Kidney Meridian are less frequently selected to protect important visceral organs. Points of the Spleen Meridian are also less frequently selected because the spleen meridian has characteristics similar to those of the Kidney Meridian and especially it travels in the chest and epigastrium.

3.2.3 More distribution on the chest and epigastrium

The points on the chest and epigastrium are greatest in number in all the infrequently used points. The infrequently used points on the kidney and spleen meridians are also evenly distributed on the chest and epigastrium (Figure 1). From acupoint anatomy, acupoints on the chest and epigastrium are adjacent to important visceral organs or their shadows are projected onto those organs because of their positions[12]. For example, the shadows of Shidou (SP 17), left Shenfeng (KI 23), Bulang (KI 22) and Tianxi (SP 18) are projected onto the heart; the shadows of Yuzhong (KI 26), Shencang (KI 25), Lingxu (KI 24) and Xiongxiang (SP 19), onto the lung; the shadow of Youmen (KI 21), onto the stomach. Because thoracoepigastric muscles are thin, inappropriate acupuncture easily injures the heart and lung and results in accidents, e.g. pneumothorax, hemopneumothorax, cardiac puncture wound and hemorrhage due to large artery puncture wound, and even death in serious cases[13]. There was a report on patient death from intractable shock secondary to right ventricle injury due to inappropriate acupuncture[14]. In female patients, the exposure of acupoints on the chest and epigastrium is not convenient for performing acupuncture and may also restrict its application.

To ensure the therapeutic effects of acupuncturemoxibustion and reduce acupuncture accidents in the clinical application, acupoints that have a definite therapeutic effect and are widely used should be selected first and acupoints locate on limbs, as much as possible. When acupoints on the chest, abdomen and upper back that are adjacent to important visceral organs and large arteries are acupunctured, the anatomical layers of them must be mastered, their positions determined correctly and the manipulation performed strictly according to the standardization. During the manipulation, a doctor should pay full attention, attend to the hand feeling of the needle tip touching different tissue structures, observe the patient’s expression and do management immediately when he finds danger signals.

Table 7. Analysis of specific points among the most frequently used points

Figure 1. Infrequently used points on the chest and epigastrium

Conflict of Interest

The authors declare that there is no conflict of interest.

Acknowledgments

This work was supported by National Basic Research Program of China (973 Program, No. 2009CB522900); Leading Academic Discipline Project of Acupuncture and Tuina.

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Translator:Wang Si-you

R245.8

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Date:January 25, 2014