Abstract
The use of acupuncture to treat stable angina pectoris is increasing popularity. Based on the prevalence of this treatment over the past 20 years, the rule of acupoint selection and prescription were summarized in this study. The China National Knowledge Infrastructure, China Academic Journal Database, Chinese Science and Technology Periodical Database, PubMed and Web of Science were used for literature search clinical studies on acupuncture in the treatment of stable angina pectoris conducted over the past 20 years were identified, 225 studies were included. Prescriptions were entered into the Traditional Chinese Medicine heritage calculation platform and association rule analysis and complex entropy clustering analysis were performed. Of the sixty-seven acupoints were regularly used and PC6, BL15 and RN17 were the most common. Commonly used meridians were the foot sun bladder meridian, Renmai and hand Shaoyin pericardium meridian; Get the basic prescription of PC6, RN17 and BL15and have two new prescriptions: BL15, ST36 and GB39; DU10, DU11 and RN17. All acupoints act on the heart through neural regulation mechanism. There are many clinical practice guidelines worldwide for writing acupuncture into the recommended therapy. Acupuncture has a clear therapeutic effect on stable angina pectoris. In the treatment of stable angina pectoris, all acupoints directly or indirectly act on the heart, dredge meridians and relieve angina symptoms.
Keywords: acupuncture, selection and prescription rules, stable angina pectoris, Traditional Chinese Medicine Inheritance calculation platform
1. Introduction
Stable angina pectoris, caused by myocardial ischemia, results in discomfort in the chest and surrounding structures and can be accompanied by cardiac dysfunction. Typically brought about by exertion, most stable angina pectoris events occur behind the sternum, potentially radiating to the anterior and ulnar sides of the left arm, to the lateral side of the right arm, to both arms, or to the neck and mandible. Usually lasting for several minutes. Stable angina pectoris often dissipates rapidly after rest or administration of sublingual nitroglycerin.[1–3] Angina pectoris is a clinical symptom of myocardial ischemia, which is caused by a temporary imbalance in myocardial oxygen supply and demand.[4,5] Stable angina is the most common type of angina in China, accounting for 49.4% of all types of angina.[6] This disease is an indication for acupuncture therapy and clinical reports on acupuncture treatment of stable angina pectoris are increasing in number and recognition. Acupuncture is an external therapy of Traditional Chinese Medicine. A large number of studies have shown that acupuncture treatment of stable angina has significant effect.[1,7,8] It is necessary to summarize the criteria for acupoint selection and prescription based on the complex compatibility of acupoints to provide theoretical direction for future clinical practice.[9,10]
Neurophysiology has proven that organ function is regulated by the corresponding spinal ganglion segment. The heart is controlled by the nerves from fourth lumbar vertebra (L4)-fourth sacral vertebra (S4).[11] Modern studies have shown that nerves lie deep to the acupoints. The related ganglion segments are stimulated by acupuncture, thus playing a role in the treatment of visceral diseases. Among the selected acupoints, all have their own ganglion segments, among which the PC6 and sixth cervical vertebra (C6)-first thoracic vertebra (T1) median nerves pass deeper,[12] with the intercarpal artery distributing the forearm medial cutaneous nerve and forearm lateral cutaneous nerve. The ulnar nerve from seventh cervical vertebra (C7)-T1 in the ulnar nerve and ulnar artery pathways,[13] BL14, distributed from fourth thoracic vertebra (T4) thoracic nerve hind limbs, accessory nerve, BL15, distributed from fifth thoracic vertebra (T5) thoracic nerve hind limbs, accessory nerve; BL17, distributed from seventh thoracic vertebra (T7) thoracic nerve, thoracic dorsal nerve; the common peroneal nerve of L4-S1 (first sacral vertebra (S1)) was distributed in ST36 and the tibial nerve from L4-S3 (third sacral vertebra (S3)) was deep; ST40, distributed common peroneal nerve from L4-S3; SP6, distributed from the second lumbar vertebra (L2)-4 morning saphenous nerve, from the L4-S3 tibial nerve.[14]
2. Materials and methods
2.1. Search strategy
The China National Knowledge Infrastructure, China Academic Journal Database, Chinese Science and Technology Periodical Database, PubMed and Web of Science were searched from January 2000 to December 2021, utilizing the terms stable angina pectoris, acupuncture and acupoint.
2.2. Inclusion and exclusion criteria
Studies were selected according to the following criteria: randomized trials with more than 40 patients, treatment method of acupuncture or acupuncture combined with other treatments, identified prescription for treatment and curative results. The search was not limited to studies conducted in China. Initially, 14,789 studies were identified and screened. Studies reporting individual case studies, literature reviews, animal studies and duplicate studies (those published in more than one journal) were all excluded. As a result of screening, 225 studies were included.
2.3. Specification for acupoint names
The name of acupoints refers to the name and location of acupoints and standardizes the acupoints in the journal literature.
2.4 . Data collection and analysis
2.4.1. Data management.
The retrieved literature was screened according to the inclusion and exclusion criteria. To ensure accuracy, the selected literature and corresponding acupoint prescriptions were entered into Excel by two reviewers to establish a database, as shown in Figure 1.
Figure 1.
. Flow chart of clinical literature screening for acupuncture treatment of stable angina pectoris.
2.4.2. Frequency analysis.
Microsoft Excel 2021 was used to count the frequency of acupoints, the meridian of acupoints and the usage of specific acupoints.
2.4.3. Citation network analysis.
With the help of citation network, users can see the relationship between original documents, reference documents and citing documents and the number of citations. The denser the lines, the more related the literatures; the longer the lines extend, the higher the attention to the topic and the deeper the research level in the China National Knowledge Infrastructure.
2.4.4. Association rule analysis.
Traditional Chinese Medicine inheritance calculation platform software was used for modeling and Apriori algorithm was used to quantitatively analyze the closeness of acupoints. This included using support and confidence to study the acupoint combinations with high correlation in acupoint compatibility. In this review, support refers to the frequency of occurrence of anterior and posterior acupoints in the prescription and confidence refers to the probability of occurrence of posterior acupoints in cases using of anterior acupoints.
2.4.5. Entropy clustering analysis.
In the new acupoint prescription function of the Traditional Chinese Medicine inheritance calculation platform, the correlation degree was set to eight and the punishment degree was set to two. Unsupervised entropy clustering analysis was performed using clustering and extraction combination functions.
2.5. Ethics
Because this study does not involve patient privacy, there are no ethical requirements.
3. Results
3.1. Results of the search
A total of 225 articles were included in this study. The number of documents published from 2000 to 2021 increased year by year, as shown in Figure 2. The citation network analysis shows that in the statistics of relationship strength ≥ 10, the citation frequency of chronic stable angina pectoris diagnosis and treatment guidelines is the highest, reaching 2445 times, as shown in Figure 3.
Figure 2.
. Trend chart of acupuncture treatment for stable angina pectoris from 2000 to 2021.
Figure 3.
. Analysis of literature inter-citation network.
3.2. Frequency analysis
3.2.1. Frequency statistics of acupoints.
Within the 225 included studies, 916 acupoints and were used. Nearly all consisted of 67 specific points. The 10 most commonly selected points for the treatment of stable angina pectoris were PC6, BL15, RN17, ST36, BL17, BL14, HT7, SP6, HT5 and ST40, as shown in Table 1.
Table 1.
Statistical table of the top 10 acupoints used frequency.
| Serial number | Acupoints | Frequency of occurrence | Serial number | Acupoints | Frequency of occurrence |
|---|---|---|---|---|---|
| 1 | PC6 | 182 | 6 | BL14 | 37 |
| 2 | BL15 | 122 | 7 | HT7 | 31 |
| 3 | RN17 | 95 | 8 | SP6 | 29 |
| 4 | ST36 | 50 | 9 | HT5 | 27 |
| 5 | BL17 | 37 | 10 | T40 | 27 |
3.2.2. Frequency statistics of specific acupoints.
Sixty-seven acupoints selected for the treatment of stable angina pectoris using acupuncture and moxibustion were classified and counted. The results showed that the top three acupoints in total frequency were collateral points, back-shu points and eight-vessel intersection points. PC6 is both a collateral point and eight-vessel intersection point.[15] The mean frequency was 182, as shown in Table 2.
Table 2.
Statistical table of specific acupoints frequency.
| Serial number | Special acupoints | Total frequency | Specific acupoints frequency |
|---|---|---|---|
| 1 | Luo points | 245 | PC6(182) HT5(27) ST40(27), SP4(4) SJ5(2) LU7(2) LI6(1) |
| 2 | Back-shu points | 236 | BL15(122) BL17(37) BL14(37) BL18(15) BL23 (12) BL20 (7) BL21(3) BL13(2) BL25(1) |
| 3 | Eight confluence points | 157 | PC6 (182) SP4(4) SI5 (2) LU7 (2) GB41(1) SI3 (1) BL62(1) |
| 4 | Five-shu point | 157 | ST36(50) HT7(31) LR3(21) KI3(11) |
| 5 | Eight hui points | 104 | RN17 (95) RN12(2) LR3(2) GB34 (2) GB39(2) LU9(1) |
| 6 | Original point | 70 | HT7(31) LR3(21) KI3(11) PC7(4) LI4(2) LU9(1) |
| 7 | Crossing point | 55 | SP6(29) RN4(15) RN12(2) LR3(2) |
| 8 | Lower confluent point | 52 | ST36(50) GB34(2) |
| 9 | Front-mu points | 41 | RN14(22) RN4(15) LR3(2) GB34(2) GB39(2) LU9(1) |
| 10 | Xi points | 33 | PC4(18) HT6(12) SP8(SP3) |
3.2.3. Frequency statistics of meridians.
The meridians associated with the 67 commonly used acupoints were identified. The top three meridians used were the urinary bladder meridian of foot-taiyang, Ren and pericardium channel of hand-jueyin,[16,17] as shown in Table 3.
Table 3.
Statistical table of acupoint selection frequency of meridians.
| Serial numbers | Name of meridians | Frequency of occurrence | Support (%) |
|---|---|---|---|
| 1 | The urinary bladder meridian of foot-taiyang | 237 | 26.07 |
| 2 | Pericardium channel of hand-jueyin | 215 | 23.65 |
| 3 | Ren channel | 155 | 17.05 |
| 4 | The stomach meridian of foot-yangming | 78 | 8.58 |
| 5 | The heart meridian of hand-shaoyin | 76 | 8.36 |
| 6 | The spleen channel of foot-taiyin | 52 | 5.72 |
| 7 | Du Mai | 28 | 3.08 |
| 8 | The liver meridian of foot-jueyin | 24 | 2.64 |
| 9 | The kidney meridian of foot-shaoyi | 14 | 1.54 |
| 10 | Triple energizer meridian | 10 | 1.10 |
| 11 | The gall bladder channel of foot-shaoyang | 7 | 0.77 |
| 12 | Large Intestine channel of hand-yangming | 6 | 0.66 |
| 13 | The lung meridian of hand-taiyin | 5 | 0.55 |
| 14 | The small intestine meridian of hand-taiyang | 1 | 0.11 |
3.3. Association rule analysis
Of 225 prescriptions, 67 acupoints were selected. Support and confidence were used as the relevant evaluation indices of acupuncture point compatibility in the treatment of stable angina pectoris.[18] Association support analysis of the first 10 acupoints was used to obtain the network of association rules, as shown in Figure 4. When the support was 20% and confidence was 80%, the association rules of 18 acupoints were obtained, as shown in Table 4.
Figure 4.
. Network diagram of main acupoints association rules in acupuncture treatment of stable angina pectoris.
Table 4.
Association rules of main acupoints.
| Serial number | Organization rules | Support (%) | Degree of confidence (%) |
|---|---|---|---|
| 1 | PC6→BL15 | 71.20 | 89.89 |
| 2 | BL15→RN17 | 68.00 | 80.00 |
| 3 | PC6→RN17 | 68.00 | 89.41 |
| 4 | BL15→RN17、PC6 | 60.80 | 81.58 |
| 5 | RN17→BL14 | 28.80 | 80.56 |
| 6 | PC6→BL14 | 28.80 | 94.44 |
| 7 | RN17→BL17 | 25.60 | 81.25 |
| 8 | BL15→BL17 | 25.60 | 96.88 |
| 9 | PC6→BL17 | 25.60 | 84.38 |
| 10 | RN17→BL17、BL15 | 24.80 | 80.65 |
| 11 | PC6→BL17、BL15 | 24.80 | 83.87 |
| 12 | PC6→SP6 | 23.20 | 89.66 |
| 13 | BL15→BL14、RN17 | 23.20 | 82.76 |
| 14 | PC6→BL14、RN17 | 23.20 | 93.10 |
| 15 | RN17→BL17、PC6 | 21.60 | 81.48 |
| 16 | BL15→BL14、RN17、PC6 | 21.60 | 85.19 |
| 17 | PC6→BL17、BL15、PC6 | 20.80 | 80.77 |
| 18 | PC6→HT7 | 20.00 | 80.00 |
3.4. Entropy clustering analysis
In the new acupoint prescription function of the Traditional Chinese Medicine inheritance calculation platform, the correlation degree was set to eight and the punishment degree was set to two. Unsupervised entropy clustering analysis was performed using clustering and extraction combination functions. The results showed that the cluster classifications of acupuncture and moxibustion in the treatment of stable angina pectoris were PC6 - BL15 - RN17, ST36- BL17-BL14, HT7-SP6- HT5-ST40, RN14- LR3 - DU9 - PC4, RN6 - BL18- RN4 and BL23-HT6- KI3-SP10, as shown in Figure 5. Through cluster analysis, acupoints in the treatment of stable angina pectoris by acupuncture and moxibustion were divided into two categories: one category was PC6, RN17, BL15[19] and other acupoints were classified into another category, as shown in Figure 6. The group evolved 10 core combinations and three new combinations, as shown in Tables 5 and 6.
Figure 5.
. Cluster ice figure of main acupoints in acupuncture treatment of stable angina pectoris.
Figure 6.
. Cluster tree of main acupoints in acupuncture treatment of stable angina pectoris.
Table 5.
Core combinations.
| Serial number | Core combinations |
|---|---|
| 1 | PC6、BL15、RN17 |
| 2 | RN17、PC6、SP6 |
| 3 | PC6、ST36、ST40 |
| 4 | PC6、SP10、BL17 |
| 5 | BL15、BL14、PC4、HT6 |
| 6 | PC6、ST36、SP6 |
| 7 | RN17、ST36、RN14 |
| 8 | BL15、PC6、SP6 |
| 9 | BL15、RN6、ST36、SP6 |
| 10 | PC6、LR13、BL18、LR3 |
Table 6.
new prescription combinations.
| Serial number | New prescription combinations |
|---|---|
| 1 | BL15、ST36、PC7 |
| 2 | DU10、DU11、RN17 |
4. Discussion
In the recent years, acupuncture treatment of stable angina pectoris has been increasingly reported and shown to have a specific effect.[20,21] Based on the statistical analysis of existing clinical studies conducted over the past 20 years, treatment of stable angina pectoris includes 67 acupoints. This reflects both the extent of experience using acupuncture in the treatment of stable angina pectoris, as well as the lack of general consensus on treatment protocols. This study found that of the 67 acupoints, the most commonly used acupoints are PC6, BL15, RN17, ST36, BL20, BL14, HT7, SP6, HT5 and ST40.[10,19] Of the 14 meridians identified, the most frequently used were the urinary bladder meridian of foot-taiyang, pericardium channel of hand jueyin and Ren meridian.
In the analysis of association rules,[1] the combinations with the highest support were PC6–BL15, BL15–RN17and PC6–RN17 and the acupoints involved are PC6, BL15 and RN17. PC6 is a pericardium meridian point that reduces sympathetic excitability and provides cardiac reperfusion function.[22] The BL15 is the back-shu point of the heart meridian of hand-shaoyin, which is located near the thoracic cavity. Acupuncture at PC6, BL15 and RN17 can improve coronary blood flow in patients, improve symptoms of myocardial ischemia and relieve symptoms of stable angina pectoris.[23]
Acupoint selection and prescription rules for stable angina pectoris: all acupoints act on the heart through neural regulation mechanism. As a result of the cluster analysis,[24] the acupoints were divided into two categories a core combination of PC6- RN17- BL15 and when combined with the analysis of association rules, the treatment of stable angina pectoris using the PC6 - RN17 - BL15 combination is selected over all other combinations. The efficacy of DU11 and DU10 was similar to that of BL15 and BL16. Two new formulas were derived from this group: BL15, ST36, PC7, DU10, DU11, RN17. Several points in these combinations are known to have therapeutic benefits when used in treatment. Among them, ST36 which has positive effects on bone marrow, stamina, meridians flow and pain.[25] DU11 is located at the spinous process depression of T5. DU10 is located at the sixth thoracic spine spinous process. Back-shu points are used to treat visceral disease. Acupuncture DU11, DU10 stimulate T5-6 spinal nerve posterior branch, the spinal ganglion T5-6 along the visceral branch to the heart. Studies have shown that acupuncture at these points can effectively improve coronary heart disease in patients with asymptomatic myocardial ischemia ECG and hemodynamics by reducing acute myocardial infarction or sudden cardiac death.[26] Acupuncture at PC7 significantly improves left ventricular fractional shortening (FS%), stroke volume (SV), cardiac output(CO), cardiac index (CI), ejection fraction (EF%) and other cardiac function indexes in patients with coronary heart disease, thus improving the pumping function of the heart.[27]
This paper systematically identifies the rules of association rule analysis for acupuncture and moxibustion in the treatment of stable angina pectoris. There are, however, some shortcomings: the literature collected in this paper addresses clinical studies from the past 20 years and therefore does not emphasize the more pertinent issues raised in recent years. Among the studies included in this paper, the quality of the literature is inconsistent; however, this study did classify the syndrome types of stable angina pectoris. Considering the above problems, additional quality studies are necessary.
The use of acupuncture for the treatment of stable angina pectoris is an established modality. Its efficacy, however, remains unclear.[28] While documented extensively, acupoint selection and prescription are relatively complex. As a result of this review, the compatibility of BL15, PC6 and RN17, as the primary points for acupuncture and moxibustion in the treatment of stable angina pectoris appears to be the most effective, providing theoretical and empirical support for future clinical treatment with acupuncture therapy.
Author contributions
Conceptualization: Kaiwei Yang, LiLi Zhang, Tingting Liu, Yuqiao Chao, Wenfeng Li, Ruohan Cao, Shaozong Chen.
Data curation: Kaiwei Yang.
Formal analysis: Lili Zhang.
Funding acquisition: Shaozong Chen.
Project administration: Shaozong Chen.
Resources: Kaiwei Yang.
Software: Kaiwei Yang, LiLi Zhang, Tingting Liu, Yuqiao Chao, Wenfeng Li, Ruohan Cao, Shaozong Chen.
Validation: Kaiwei Yang.
Visualization: Kaiwei Yang.
Writing—original draft: Kaiwei Yang, LiLi Zhang, Tingting Liu, Yuqiao Chao, Wenfeng Li, Ruohan Cao and Shaozong Chen.
Supplementary Material
Abbreviations:
- C6 =
- sixth cervical vertebra
- C7 =
- seven cervical vertebra
- L2 =
- second lumbar vertebra
- L4 =
- forth lumbar vertebra
- S1 =
- first sacral vertebra
- S3 =
- third sacral vertebra
- S4 =
- fourth sacral vertebra
- T1 =
- first thoracic vertebra
- T4 =
- fourth thoracic vertebra
- T5 =
- fifth thoracic vertebra
- T7 =
- seventh thoracic vertebra
Supplemental Digital Content is available for this article.
No human participants were involved in this study, so there is no ethics involved.
This study was supported in part by the National Key Research and Development Program of China (No. 2019YFC171205).
Supplemental Digital Contents is available for this article, http://links.lww.com/MD/H833.
The datasets generated during and/or analyzed during the current study are publicly available.
The authors have no conflicts of interest to disclose.
How to cite this article: Yang K, Zhang L, Li B, Liu T, Chao Y, Li W, Cao R, Chen S. Analysis of acupoint selection and prescription rules of acupuncture for treatment of stable angina pectoris based on a Traditional Chinese Medicine inheritance calculation platform: A systematic review. Medicine 2022;101:49(e31466).
Contributor Information
Kaiwei Yang, Email: 2396817272@qq.com.
Lili Zhang, Email: 18253141131@163.com.
Bai Li, Email: 2629385180@qq.com.
Tingting Liu, Email: 2211858632@qq.com.
Yuqiao Chao, Email: 2435895277@qq.com.
Wenfeng Li, Email: 2629385180@qq.com.
Ruohan Cao, Email: 2637025109@qq.com.
References
- [1].Zhao L, Song Q, Wu H, et al. Acupuncture as adjuvant therapy for treating stable angina pectoris with moderate coronary artery lesions and the mechanism of heart-brain interactions: a randomized controlled trial protocol. Evid Based Complement Alternat Med. 2021;2021:6634404. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [2].Salazar CA, Basilio Flores JE, Veramendi Espinoza LE, et al. Ranolazine for stable angina pectoris. Cochrane Database Syst Rev. 2017;2:67–79. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [3].Rousan TA, Mathew ST, Thadani U. Drug therapy for stable angina pectoris. Drugs. 2017;77:265–84. [DOI] [PubMed] [Google Scholar]
- [4].Ford TJ, Berry C. Angina: contemporary diagnosis and management. Heart. 2020;106:387–98. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [5].Picard F, Sayah N, Spagnoli V, et al. Vasospastic angina: a literature review of current evidence. Arch Cardiovasc Dis. 2019;112:44–55. [DOI] [PubMed] [Google Scholar]
- [6].Balfour PC, Jr, Gonzalez JA, Kramer CM. Non-invasive assessment of low- and intermediate-risk patients with chest pain. Trends Cardiovasc Med. 2017;27:182–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [7].Lan L, Yin T, Tian Z, et al. Acupuncture modulates the spontaneous activity and functional connectivity of calcarine in patients with chronic stable angina pectoris. Front Mol Neurosci. 2022;15:842674. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [8].DeVon HA, Uwizeye G, Cai HY, et al. Feasibility and preliminary efficacy of acupuncture for angina in an underserved diverse population. Acupunct Med. 2022;40:152–9. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [9].Liu Y, Meng HY, Khurwolah MR, et al. Acupuncture therapy for the treatment of stable angina pectoris: an updated meta-analysis of randomized controlled trials. Complement Ther Clin Pract. 2019;34:247–53. [DOI] [PubMed] [Google Scholar]
- [10].Zhao L, Li DH, Zheng H, et al. Acupuncture as adjunctive therapy for chronic stable angina:a randomized clinical trial. JAMA Intern Med. 2019;179:1388–97. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [11].Ifrim Chen F, Antochi AD, Barbilian AG. Acupuncture and the retrospect of its modern research. Rom J Morphol Embryol. 2019;60:411–8. [PubMed] [Google Scholar]
- [12].Rong P, Zhu B, Li Y, et al. Mechanism of acupuncture regulating visceral sensation and mobility. Front Med. 2011;5:151–6. [DOI] [PubMed] [Google Scholar]
- [13].Yang M, Du T, Sun M, et al. Acupuncture for stable angina pectoris: a systematic review protocol. BMJ Open. 2018;8:e019798. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [14].Yang M, Sun M, Du T, et al. The efficacy of acupuncture for stable angina pectoris: A systematic review and meta-analysis. Eur J Prev Cardiol. 2019;15:5112–20. [DOI] [PubMed] [Google Scholar]
- [15].Zhang Z, Chen M, Zhang L, et al. Meta-analysis of acupuncture therapy for the treatment of stable angina pectoris. Int J Clin Exp Med. 2015;8:5112–20. [PMC free article] [PubMed] [Google Scholar]
- [16].Zhao L, Chen J, Li Y, et al. The long-term effect of acupuncture for migraine prophylaxis:a randomized clinical trial. JAMA Intern Med. 2017;177:508–15. [DOI] [PubMed] [Google Scholar]
- [17].Witt Claudia M, et al. The effect of patient characteristics on acupuncture treatment outcomes: an individual patient data meta-analysis of 20,827 chronic pain patients in randomized controlled trials. Clin J Pain. 2019;35:428–34. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [18].He Z, Yang Y, Wen Q, et al. Acupuncture for chronic stable angina pectoris based on the theory of Meridian-VisAcera Association: study protocol for a multicenter randomized controlled trial. Trials. 2020;21:915. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [19].Xue Y, Zhang X, Yang Q, et al. Acupuncture and related therapies for stable angina pectoris:A protocol for network meta-analysis. Medicine (Baltim). 2020;99:e23756. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [20].Farmakis D, Andrikopoulos G, Giamouzis G, et al. Practical recommendations for the diagnosis and medical management of stable angina: an expert panel consensus. J Cardiovasc Pharmacol. 2019;74:308–14. [DOI] [PubMed] [Google Scholar]
- [21].Nair T, Jadhav UM, Kumar KPS, et al. Consensus statement on holistic management of angina. J Assoc Physicians India. 2021;69:11–2. [PubMed] [Google Scholar]
- [22].Zhang K, Li Y, Tang Q. Acupuncture for stable angina pectoris: a few noteworthy additions. Eur J Prev Cardiol. 2020;27:2063–4. [DOI] [PubMed] [Google Scholar]
- [23].Szulc A. Classification of patients with myelodysplasia according to the level of neurosegmental lesion as a basis of motor function assessment. Ortop Traumatol Rehabil. 2011;13:113–23. [PubMed] [Google Scholar]
- [24].Yu J, Jiang Y, Tu M, et al. Investigating prescriptions and mechanisms of acupuncture for chronic stable angina pectoris: an Association Rule Mining and Network Analysis Study. Evid Based Complement Alternat Med. 2020;2020:1931839. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [25].Shen M, Huang J, Qiu T. Quality of the evidence supporting the role of acupuncture for stable angina pectoris:an umbrella review of systematic reviews. Front Cardiovasc Med. 2021;8:732144. [DOI] [PMC free article] [PubMed] [Google Scholar]
- [26].Wang R, Guo L, Cui HF, et al. Effects of pretreatment of tiaoxin anshen acupunture on apoptosis in myocardial cells of ischemic reperfusion arrhythmia rabbits. J Acupunct Moxi-bust. 2020;36:75–79. [Google Scholar]
- [27].Pan J, Liu JS, Liu Z. Function on stable angina pectoris patients on electroacupuncture heart sutra and pericardial sutra point. Mod Tradit Chin Med Mat Med-World Sci Technol. 2018;20:1564–70. [Google Scholar]
- [28].DeVon HA, Schlaeger JM, Briller JE. Acupuncture as an adjunctive therapy for stable angina. Acupunct Med. 2020;38:281–3. [DOI] [PMC free article] [PubMed] [Google Scholar]
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