Abstract
Background:
Acupuncture is widely used in the treatment of tinnitus worldwide because of its good efficacy and safety. However, the criteria for selecting acupoint prescriptions and combinations have not been summarized. Therefore, data mining was used herein to determine the treatment principles and the most effective acupoint selection for the treatment of idiopathic tinnitus.
Methods:
The clinical research literature of acupuncture in the treatment of idiopathic tinnitus from the establishment of the database to September 1, 2023 in China National Knowledge Infrastructure, China Medical Journal Full-text Database, PubMed, Embase, Cochrane Library and Web of Science databases was retrieved and extracted. Microsoft Excel 2016 was used to establish the acupoint prescription database and the frequency statistics of acupoints, meridians and specific acupoints were carried out. IBM SPSS Statistics 25.0 software was used for cluster analysis of acupoints, and IBM SPSS Modeler18.0 software was used for association rule analysis of acupoints.
Results:
A total of 112 articles were included, involving 221 acupuncture prescriptions, including 99 acupoints, with a total frequency of 1786 times. The 5 most frequently used acupoints were Tinggong (SI19), Tinghui (GB2), Yifeng (TE17), Ermen (TE21), and Zhongzhu (TE3). The commonly used meridians were Sanjiao meridian of hand-shaoyang, Gallbladder meridian of foot-shaoyang and Small intestine meridian of hand-taiyang. The specific points are mostly Crossing point, Five-shu point and Yuan-primary point. The core acupoint combination of association rules was Ermen (TE21)–Tinggong (SI19)–Tinghui (GB2)–Yifeng (TE17), and 3 effective clustering groups were obtained by cluster analysis of high-frequency acupoints.
Conclusion:
In this study, the published literature on acupuncture treatment of idiopathic tinnitus was analyzed by data mining, and the relationship between acupoints was explored, which provided a more wise choice for clinical acupuncture treatment of idiopathic tinnitus.
Keywords: acupoint, acupuncture, association rule, cluster analysis, data mining, idiopathic tinnitus
1. Introduction
Tinnitus is one of the most common otological symptoms. It was reported that the annual global incidence of tinnitus is about 1%, most of which are middle-aged and elderly people.[1] Idiopathic tinnitus is also called neurological tinnitus with or without hearing loss.[2] It is a subjective feeling that the patient consciously has a sound in the ear or intracranial, but there is no corresponding sound source outside.[3] Tinnitus is easy to cause anxiety and depression in patients, which seriously affects their quality of life. The pathogenesis is still unclear,[4] may be related to the damage of peripheral cochlea and auditory nerve,[5] local tissue ischemia, hypoxia, lesions of auditory center and auditory conduction pathway, cochlear hair cell lesions, and enhancement of middle ear muscle tension affecting endolymphatic circulation.[6] At present, there are drug therapy, neuromodulation, hypnosis, and surgery, but the curative effect is not ideal.[7]
Acupuncture is a kind of traditional Chinese medicine. Because of its green therapy and safety, it is recognized by more and more people. Acupuncture at the acupoints near the ear can accelerate the microcirculation of the inner ear,[8] improve the permeability of the capillaries in the ear, prevent or reduce the necrosis of the inner ear spiral organ hair cells, and improve the function of the cochlea.[9] Studies have found that acupuncture treatment of idiopathic tinnitus has a certain therapeutic advantage, is an important treatment.[10–12] However, based on different treatment concepts, the selection of acupoints is complicated. In order to explore the rules of acupoint selection in the treatment of idiopathic tinnitus by acupuncture, the author uses data mining technology to sort out the clinical literature of acupuncture in the treatment of idiopathic tinnitus, and analyzes the rules of prescription acupoint selection, meridian selection, core acupoints and compatibility characteristics, and further refines acupuncture prescriptions, in order to provide reference for guiding clinical practice and scientific research.
2. Materials and methods
2.1. Literature source and search strategy
Literature on acupuncture for idiopathic tinnitus in China National Knowledge Infrastructure, China Medical Journal Full-text Database, PubMed, Embase, Cochrane Library, and Web of Science databases were searched from their inception to September 1, 2023, and their publication year was from the establishment of the database to September 1, 2023. For Chinese literature, the search formula is SU = (“针刺” or “针灸” or “电针” or “温针灸” or “腹针” or “头皮针”) AND SU = (“耳鸣” or “神经性耳鸣” or “原发性耳鸣” or “特发性耳鸣”). For English literature, the search formula is: TS = (“acupuncture” or “acupuncture and moxibustion” or “electroacupuncture” or “warm acupuncture” or “abdominal needle” or “scalp acupuncture” or “needles” or “needle” or “needling” or “warm needling”) AND TS = (“tinnitus” or “neurological tinnitus” or “primary tinnitus” or “idiopathic tinnitus”).
2.2. Inclusion criteria
The inclusion criteria were as follows:
Randomized controlled trials (RCTs) and self-control and retrospective studies were included.
According to the diagnostic criteria of traditional Chinese medicine or western medicine, patients diagnosed with ‘idiopathic tinnitus’ were clearly diagnosed, regardless of the age, gender, nationality, degree of illness, and other factors of the subjects.
Acupuncture treatment is the main treatment, including acupuncture, acupuncture and moxibustion, electroacupuncture and warm acupuncture, etc. It can be combined with other Chinese and Western medicine therapies. The clinical efficacy is definite and the literature of acupuncture prescription is clearly given, and the selected acupoints range from 14 meridian points, extrameridian points, and Ashi points.
2.3. Exclusion criteria
The exclusion criteria were as follows:
Republished literatures retained only the original literature.
Studies with ambiguous acupoint prescriptions, inability to extract clear acupoint prescriptions that matched the acupoint trigger points, and no significant efficacy in the intervention group were excluded.
Reviews, case studies, systematic reviews, academic conferences, and animal experiments.
2.4. Literature screening
Two researchers independently screened the eligible articles according to the inclusion and exclusion criteria; If the 2 researchers disagree on an article, the article will be screened by a third researcher, and the problem will eventually be solved by voting. If the literature involves dialectical acupoint selection, it is necessary to indicate the main point and the matching point, and the main point plus 1 matching point is equal to 1 acupuncture prescription.
2.5. Database establishment and quality assessment
The research literature that meets the requirements was entered into Excel 2016 software to establish a database of acupuncture prescriptions. The entry contents included the name of the literature, the first author, publication time, acupuncture prescription and acupoint meridian tropism, etc. The name of the entry acupoints was based on the World Health Organization’s Standard Acupuncture Point Location in the Western Pacific Region and the China National Standard “Naming and Positioning of Acupoints” (GB/T 12346-2006) as the standard.[13]
The revised Cochrane Risk of Bias Tool for Randomized Trials was used to assess the risk of bias of RCTs. The quality of included RCTs was assessed according to the following 5 domains: randomization process, deviations from intended interventions, missing outcome data, measurement of the outcome, and selection of the reported result.
2.6. Data mining analysis
2.6.1. Descriptive analysis.
Excel 2016 software was used to make descriptive statistics on acupoints, meridian tropism and specific acupoints in acupuncture prescriptions, and their frequency of use was calculated.
2.6.2. Network analysis.
In order to obtain the core acupoint prescription for acupuncture treatment of idiopathic tinnitus, IBM SPSS Modeler 18.0 software was used to analyze the correlation between selected acupoints and construct an acupoint interconnection network. The acupoints in the network diagram (defined as the ‘nodes’ of the network) are connected through the ‘lines’ in the network. The stronger the correlation between the acupoints, the thicker the connection line between the 2.
2.6.3. Cluster analysis.
IBM SPSS Statistics 25.0 software was used to perform cluster analysis on the high-frequency acupoints with the top 13 frequency of use, and a cluster analysis tree diagram was drawn.
2.6.4. Association rule mining analysis.
IBM SPSS Modeler 18.0 software was used to analyze the association rules of acupoints by Apriori algorithm, and the association network diagram of acupoints was drawn. Association rules are expressed in the form of {A → B}. The item set A represents the ‘antecedent’, and the item set B represents the ‘consequent’. The strength of association rules can be measured by its support, confidence and lift. The lift is used to verify that 2 itemsets are dependent on one another, which makes the rule valuable when the lift’s value is larger than 1; the confidence indicates the possibility of the existence of item set B in the case of the existence of item set A, and the calculation formula is Confidence {A → B} = P {AUB}/P {A}; The support represents the proportion of item sets A and B appearing in the total transaction set C at the same time. The calculation formula is Support {A → B} = P {AUB}/P {C} = num {AUB}/num {C}. Note: C represents the total transaction set, and num {} represents the number of occurrences of a specific item set in the transaction set.
3. Results
3.1. Eligible studies
The research process is shown in Figure 1. A total of 908 articles were retrieved in this study, including 535 in China National Knowledge Infrastructure, 193 in PubMed, 94 in Web of Science, 77 in Embase, 9 in China Medical Journal Full-text Database. No relevant literature was found in Cochrane Library. After reading the full text and screening in strict accordance with the inclusion and exclusion criteria, 112 articles were finally included. In all included studies, including 93 RCTs, 18 self-control studies and 1 retrospective studies, the overall quality of bias of the RCTs was assessed as low risk (50.5%), some concerns (34.4%), and high risk (15.1%). The results are shown in Figures 2 and 3.
Figure 1.
Literature screening flow chart.
Figure 2.
Risk of bias assessment.
Figure 3.
Risk of bias assessment.
3.2. Frequency of acupoint analysis
A total of 221 acupoint prescriptions were extracted from 112 articles, including 99 acupoints, with a total frequency of 1786 times. The top 5 acupoints with the highest frequency were Tinggong (SI19), Tinghui (GB2), Yifeng (TE17), Ermen (TE21), and Zhongzhu (TE3). A total of 13 acupoints with a frequency of greater than or equal to 36 times were used as high-frequency acupoints. The results are detailed in Table 1.
Table 1.
Frequency of acupoints used in the treatment of idiopathic tinnitu.
| NO. | Acupoint | Frequency | Percentage |
|---|---|---|---|
| 1 | SI19 | 193 | 10.81% |
| 2 | GB2 | 189 | 10.58% |
| 3 | TE17 | 187 | 10.47% |
| 4 | TE21 | 131 | 7.33% |
| 5 | TE3 | 111 | 6.22% |
| 6 | GB20 | 83 | 4.65% |
| 7 | GV20 | 57 | 3.19% |
| 8 | TE5 | 55 | 3.08% |
| 9 | KI3 | 54 | 3.02% |
| 10 | LR3 | 53 | 2.97% |
| 11 | ST36 | 52 | 2.91% |
| 12 | GB43 | 50 | 2.80% |
| 13 | GB12 | 36 | 2.02% |
Note: Frequency represents the number of occurrences of acupoints in acupuncture prescriptions; Percentage = frequency of an acupoints/ total frequency*100%.
3.3. Frequency of meridian analysis
According to the statistics of the meridians of 99 acupoints, the total frequency of meridians was 1786 times. The use frequency of Sanjiao meridian of hand-shaoyang was the highest, followed by Gallbladder meridian of foot-shaoyang and Small intestine meridian of hand-taiyang. The results are detailed in Table 2.
Table 2.
The frequency of meridians used in the treatment of idiopathic tinnitus.
| Meridian | Frequency | Percentage | Amount | Acupoints (frequency) |
|---|---|---|---|---|
| Sanjiao meridian of hand-shaoyang | 518 | 29.00% | 13 | TE17(187), TE21(131), TE3(111), TE5(55), TE6(15), TE18(6), TE7(3), TE20(3), TE22(2), TE2(2), TE19(1), TE9(1), TE4(1) |
| Gallbladder meridian of foot-shaoyang | 470 | 26.32% | 17 | GB2(189), GB20(83), GB43(50), GB12(36), GB41(25), GB8(24), GB40(23), GB34(17), GB9(6), GB11(5), GB39(3), GB42(2), GB31(2), GB7(2), GB13(1), GB3(1), GB38(1) |
| Small intestine meridian of hand-taiyang | 209 | 11.70% | 5 | SI19(193), SI5(7), SI3(6), SI6(2), SI2(1) |
| Stomach meridian of foot-yangming | 94 | 5.26% | 6 | ST36(52), ST40(25), ST44(8), ST25(5), ST7(3), ST37(1) |
| DU meridian | 84 | 4.70% | 8 | GV20(57), GV16(11), GV24(5), GV14(3), GV4(3), GV29(3), GV26(1), GV15(1) |
| Kidney meridian of foot-shaoyin | 74 | 4.14% | 5 | KI3(54), KI6(11), KI1(4), KI17(3), KI19(2) |
| Ren meridian | 72 | 4.03% | 9 | CV6(28), CV4(24), CV12(10), CV10(5), CV24(1), CV23(1), CV17(1), CV13(1), CV8(1) |
| Liver meridian of foot-jueyin | 66 | 3.70% | 5 | LR3(53), LR2(10), LR1(1), LR14(1), LR6(1) |
| Bladder meridian of foot-taiyang | 64 | 3.58% | 10 | BL23(32), BL20(13), BL17(7), BL18(4), BL21(2), BL52(2), BL57(1), BL19(1), BL13(1), BL15(1) |
| Spleen meridian of foot-taiyin | 50 | 2.80% | 4 | SP6(33), SP10(12), SP9(4), SP15(1) |
| Large intestine meridian of hand-yangming | 39 | 2.18% | 3 | LI4(34), LI11(3), LI6(2) |
| Pericardium meridian of hand-jueyin | 18 | 1.01% | 2 | PC6(14), PC8(4) |
| Other acupoints(ashi point and Extra points) | 17 | 0.84% | 8 | EX-HN1(5), EX-HN14(4), JLSXX-QX(2), ashi point(2), EN-HN15(1), EX-HN6(1), EX-B2(1), EX-HN5(1) |
| Heart meridian of hand-shaoyin | 9 | 0.50% | 2 | HT7(7), HT8(2) |
| Lung meridian of hand-taiyin | 2 | 0.11% | 2 | LU7(1), LU11(1) |
Note: Frequency represents the number of occurrences of meridians in acupuncture prescriptions; Percentage = frequency of a meridians/ total frequency*100%; Amount represents the number of acupoints belonging to the same meridian.
3.4. Specific acupoint analysis
In this study, the total frequency of specific acupoints was 1934 times, including 78 acupoints; the total frequency of nonspecific acupoints was 210 times, including 21 acupoints. The most commonly used specific points were Crossing point, followed by Five-shu points and Yuan-primary point. The results are detailed in Table 3 and Figure 4. Crossing point refers to the acupoints where 2 or more meridians intersect. Five-shu point is the general name of Jing, Ying, Shu, Jing and He points, a total of 60 acupoints. Yuan-primary point is the place where the original qi of the viscera passes through and remains.
Table 3.
Frequency of special acupoints used in the treatment of idiopathic tinnitu.
| Special acupoints | Frequency | Percentage | Amount | Acupoints (frequency) |
|---|---|---|---|---|
| Crossing point | 906 | 46.85% | 32 | SI19(193), GB2(189), TE17(187), GB20(83), GV20(57), GB12(36), SP6(33), CV4(24), GB8(24), KI6(11), GV16(11), CV12(10), GB9(6), CV10(5), GV24(5), GB11(5), KI17(3), GV14(3), ST7(3), TE20(3), KI19(2), GB7(2), TE22(2), CV24(1), CV13(1), SP15(1), LR14(1), GV26(1), GV15(1), GB13(1), GB3(1), CV23(1) |
| Five-shu point | 438 | 22.65% | 23 | TE3(111), KI3(54), LR3(53), ST36(52), GB43(50), GB41(25), GB34(17), TE6(15), LR2(10), ST44(8), HT7(7), SI5(7), SI3(6), PC8(4), KI1(4), SP9(4), LI11(3), HT8(2), TE2(2), LR1(1), LU11(1), GB38(1), SI2(1) |
| Yuan-primary point | 172 | 8.90% | 6 | KI3(54), LR3(53), LI4(34), GB40(23), HT7(7), TE4(1) |
| Eight confluent point | 112 | 5.80% | 6 | TE5(55), GB41(25), PC6(14), KI6(11), SI3(6), LU7(1) |
| Luo-connecting point | 97 | 5.02% | 5 | TE5(55), ST40(25), PC6(14), LI6(2), LU7(1) |
| Lower sea point | 70 | 3.62% | 3 | ST36(52), GB34(17), ST37(1) |
| Back-shu point | 54 | 2.80% | 7 | BL23(32), BL20(13), BL18(4), BL21(2), BL13(1), BL15(1), BL19(1) |
| Front-mu point | 41 | 2.12% | 5 | CV4(24), CV12(10), ST25(5), CV17(1), LR14(1) |
| Eight influential point | 38 | 1.96% | 5 | GB34(17), CV12(10), BL17(7), GB39(3), CV17(1) |
| Xi point | 6 | 0.31% | 3 | TE7(3), SI6(2), LR6(1) |
Note: Frequency represents the number of occurrences of special acupoints in acupuncture prescriptions; Percentage = frequency of a special acupoint/ total frequency*100%; Amount represents the number of acupoints belonging to the same special acupoint.
Figure 4.
Frequency of special acupoints used in the treatment of idiopathic tinnitu.
3.5. Cluster analysis
Cluster analysis was performed on the acupoints with the first 13 frequencies (Table 1). According to the results of the pedigree chart, the acupoints can be divided into 3 effective clustering groups. Cluster group 1: Tinghui (GB2)–Yifeng (TE17)–Tinggong (SI19)–Ermen (TE21); Cluster group 2: Zhongzhu (TE3)–Xiaxi (GB43); Cluster group 3: Baihui (GV20)–Wangu (GB12)–Waiguan (TE5)–Taichong (LR3)–Taixi (KI3)–Zusanli (ST36)–Fengchi (GB20). The results are detailed in Figure 5.
Figure 5.
Tree chart of the cluster analysis of acupuncture for idiopathic tinnitu.
3.6. Association rule mining analysis
IBM SPSS Modeler18.0 software was used to analyze the association rules of 99 acupoints in 221 prescriptions. The maximum number of links that could be displayed was set to 80. The results showed that there were 6 strong links (link number > 120) and 11 medium links (link number 50-120). The association rule network diagram visually shows that ‘Ermen (TE21), Tinggong (SI19), Tinghui (GB2), and Yifeng (TE17)’ is the core acupoint for the treatment of idiopathic tinnitus, as shown in Figures 6 and 7. The support is set to be greater than or equal to 50%, the confidence is greater than or equal to 80 %, and the maximum number of preceding items is 2, and 21 association rules are obtained. The top 3 combinations with the highest confidence were {Ermen (TE21) → Tinghui (GB2)}, {Ermen (TE21) and Tinggong (SI19) → Tinghui (GB2)} and {Ermen (TE21) and Yifeng (TE17) → Tinghui (GB2)}, with the confidence of 97.71%, 97.60%, and 97.52%, respectively. The results are detailed in Table 4.
Figure 6.
Acupoints association network of acupuncture for idiopathic tinnitus treatment.
Figure 7.
The core acupoint of for the treatment of idiopathic tinnitus.
Table 4.
Association rules of acupoints for idiopathic tinnitu treatment.
| Post-item | Ex-item | Confidence | Support | Lift | Post-item | Ex-item | Confidence | Support | Lift |
|---|---|---|---|---|---|---|---|---|---|
| GB2 | TE21 | 97.71% | 59.28% | 1.14 | TE17 | GB2 and SI19 | 90.91% | 74.66% | 1.07 |
| GB2 | TE21 and SI19 | 97.60% | 56.56% | 1.14 | GB2 | TE17 and SI19 | 90.91% | 74.66% | 1.06 |
| GB2 | TE21 and TE17 | 97.52% | 54.75% | 1.14 | TE17 | GB2 | 90.48% | 85.52% | 1.07 |
| TE17 | TE3 | 97.30% | 50.23% | 1.15 | GB2 | TE3 | 89.19% | 50.23% | 1.04 |
| SI19 | TE21 | 95.42% | 59.28% | 1.09 | SI19 | TE17 | 88.24% | 84.62% | 1.01 |
| SI19 | TE21 and GB2 | 95.31% | 57.92% | 1.09 | SI19 | GB2 and TE17 | 87.72% | 77.38% | 1.00 |
| SI19 | TE21 and TE17 | 95.04% | 54.75% | 1.09 | SI19 | GB2 | 87.30% | 85.52% | 1.00 |
| TE17 | TE21 | 92.37% | 59.28% | 1.09 | SI19 | TE3 | 86.49% | 50.23% | 0.99 |
| TE17 | TE21 and GB2 | 92.19% | 57.92% | 1.09 | GB2 | SI19 | 85.49% | 87.33% | 1.00 |
| TE17 | TE21 and SI19 | 92.00% | 56.56% | 1.09 | TE17 | SI19 | 85.49% | 87.33% | 1.01 |
| GB2 | TE17 | 91.44% | 84.62% | 1.07 |
4. Discussion
This study found that the top 5 acupoints in the frequency of acupuncture treatment of idiopathic tinnitus were Tinggong (SI19), Tinghui (GB2), Yifeng (TE17), Ermen (TE21) and Zhongzhu (TE3). Tinggong (SI19), Tinghui (GB2), Yifeng (TE17), and Ermen (TE21) are acupoints near the ear, which can dredge the qi and blood of the ear meridians and improve the symptoms of tinnitus.[10] From the perspective of anatomical structure, Ermen (TE21), Tinggong (SI19), and Tinghui (GB2) are in front of the tragus, and there are preauricular branches of the superficial temporal artery and vein, the great auricular nerve, the auricular temporal nerve and the facial nerve. Near Yifeng (TE17), there are posterior auricular artery, vein and superficial external jugular vein, with great auricular nerve, and deep facial nerve trunk penetrating from stylomastoid process. These 4 acupoints are directly related to the nerves and blood vessels of the ear, which can improve the microcirculation of the inner ear and brainstem, promote the material exchange between the blood and the labyrinth, and repair and regenerate the inner ear cells and auditory nerves that have not been completely necrotic.[9,14] Studies have confirmed that acupuncture at these acupoints can increase the activation of some areas of the human brain, relieve anxiety, and depression in patients,[15] improve sleep quality, reduce the frequency of tinnitus, and reduce tinnitus loudness.[16] Zhongzhu (TE3) is a acupoint far away from the disease location in the ear meridian, located on the back of the hand, can dredge the qi of shaoyang meridian. It is combined with Tinggong (SI19), Tinghui (GB2), Yifeng (TE17), and Ermen (TE21) to treat tinnitus, which is in line with the theory of acupuncture combined with near and far acupoints. Moreover, the meridians of these 5 acupoints all pass through the ears, which is the so-called ‘meridians pass, indications reach’. Through thermal imaging technology, some researchers have found that acupuncture at Zhongzhu (TE3) can change the local temperature of the ear, thereby improving the symptoms of tinnitus. The mechanism may be related to the improvement of cochlear blood flow dysfunction.[17]
The most frequently used meridians are Sanjiao meridian of hand-shaoyang, followed by Gallbladder meridian of foot-shaoyang and small intestine meridian of hand-taiyang. The 3 meridians all pass through the ear, such as Sanjiao meridian enters the ear from behind the ear, leaves the front of the ear and reaches the outer canthus of the eye; gallbladder meridian enters the ear from behind the ear, leaves the front of the ear, and reaches the rear of the outer canthus; small intestine meridian runs upward to the cheek, to the outer canthus of the eye, and into the ear. In clinical practice, the acupoints on these 3 meridians are often used to treat tinnitus,[18,19] which is the embodiment of the thought of ‘treating the disease and seeking the root’ in the theory of traditional Chinese medicine.
Through association and cluster analysis, the rules of acupoint selection for acupuncture in the treatment of idiopathic tinnitus were deeply explored. Three effective clustering groups were obtained by cluster analysis, which revealed the compatibility law of acupuncture in the treatment of idiopathic tinnitus. Cluster group 1 is Tinghui (GB2)–Yifeng (TE17)–Tinggong (SI19)–Ermen (TE21), and they are all acupuncture points near the ear, which is a manifestation of the theory of local acupuncture treatment. Cluster group 2 is Zhongzhu (TE3)–Xiaxi (GB43), which are acupoints on the meridians passing through the ears and located in the limbs. This is a reflection of the theory of distal acupuncture treatment. Cluster group 3 is Baihui (GV20)–Wangu (GB12)–Waiguan (TE5)–Taichong (LR3)–Taixi (KI3)–Zusanli (ST36)–Fengchi (GB20), which is the acupoint selection of tinnitus syndrome differentiation. The analysis of association rules showed that the correlation between acupoints of ‘Ermen (TE21), Tinggong (SI19), Tinghui (GB2) and Yifeng (TE17)’ was the highest, which was consistent with cluster group 1. Combined with the frequency analysis of acupoints and meridians, ‘Ermen (TE21), Tinggong (SI19), Tinghui (GB2), Yifeng (TE17), Zhongzhu (TE3), and Xiaxi(GB43)’ can be used as the main acupoints for acupuncture treatment of idiopathic tinnitus, so as to dredge the qi and blood of ear meridians and improve the symptoms of tinnitus.[20] In addition, in cluster 3, Taixi (KI3) and Zusanli (ST36) supplement the spleen and kidney, nourished qi and blood, and stopped tinnitus; LR3 clear liver fire; Waiguan (TE5) and Fengchi (GB20) evacuate the wind evil; Wangu (GB12) and Baihui (GV20) tranquilize mind. The above acupoints can be selected according to syndrome differentiation in clinical application, combined with the main acupoints, clearing liver fire, dispelling wind evil, nourishing ear orifices, and tranquilizing consciousness.
5. Conclusion
In summary, acupuncture treatment of idiopathic tinnitus focuses on dredging the qi and blood of the meridians passing through the ears in the selection of acupoints, with Ermen (TE21), Tinggong (SI19), Tinghui (GB2), Yifeng (TE17), Zhongzhu (TE3), and Xiaxi (GB43) as the main acupoints. Other acupoints focused on strengthening spleen and kidney {Taixi (KI3) and Zusanli (ST36)}, clearing liver fire (LR3), evacuating external evils {Waiguan (TE5) and Fengchi (GB20)} and tranquilizing mind {Wangu (GB12) and Baihui (GV20)}. In the compatibility of acupoints, the combination of far and near acupoints is used, and the acupoints are mostly concentrated in Sanjiao meridian of hand-shaoyang, Gallbladder meridian of foot-shaoyang and Small intestine meridian of hand-taiyang; specific points are mostly selected Crossing point, Five-shu points and Yuan-primary point. In this study, data mining technology was used to analyze the commonly used acupoints, meridian tropism of acupoints, acupoint clustering, association rules and other aspects. The treatment principles and the most effective acupoint selection of acupuncture in the treatment of idiopathic tinnitus were summarized, which provided valuable information for clinical treatment.
6. Limitations
The present study has several limitations that need to be considered. First, the quality of the included literature is relatively low, because acupuncture treatment is difficult to achieve complete double-blindness, which may lead to potential results bias. Secondly, the evaluation criteria for tinnitus efficacy lack objective criteria and are basically subjective, such as tinnitus handicap inventory and visual analogue scale. In the future, more objective indicators of acupuncture treatment of idiopathic tinnitus are needed to improve the quality of evidence. Finally, the potential prescriptions extracted by data mining are the results of data integration and need to be verified by further clinical trials.
Acknowledgments
The author would like to thank Professor Yushan Fan for his help in this study.
Author contributions
Data curation: Rui Lin, Yaru Mo, Zhan Li.
Methodology: Yiping Zhao.
Visualization: Sen Luo.
Writing – original draft: Liangliang Huang.
Writing – review & editing: Yushan Fan.
Abbreviation:
- RCTs
- randomized controlled trials
This study is supported by National Natural Science Foundation of China (No: 82260983); Innovation Project of Guangxi Graduate Education (No: YCSW2022351).
The authors have no conflicts of interest to disclose.
Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Given that data mining does not involve private information of individuals, ethical approval is not required.
All data generated or analyzed during this study are included in this published article [and its supplementary information files].
How to cite this article: Huang L, Fan Y, Lin R, Zhao Y, Mo Y, Luo S, Li Z. Investigating acupoint selection and combinations of acupuncture for primary idiopathic tinnitus using data mining. Medicine 2024;103:12(e37107).
Contributor Information
Liangliang Huang, Email: huangliangliang911@163.com.
Rui Lin, Email: 781390168@qq.com.
Yiping Zhao, Email: 1091873905@qq.com.
Yaru Mo, Email: 1813727322@qq.com.
Sen Luo, Email: 448289087@qq.com.
Zhan Li, Email: 812533774@qq.com.
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