World Journal ofAcupuncture-Moxibustion (WJAM)

ELSEVIER Vol. 26, No.3, 30th Sep. 2016 ·73 •

Review

The rules of acupoint-selection of acupuncture for polycystic

ovary syndrome based on data mining
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YU Chao-chao (..t.-:A!:A!)\ KONG Li-hong (JLiL~i C81, MA Chao-yang (~-'}] fa)\
SHEN Feng (iX ~)\ YAO Guo-Jin (:Mt l!l-f")\ XIONG Yuan (~~ .$..)\ ZHOU Huan-jiao ()lJ ~*i

1. Hubei University of Chinese Medicine, Wuhan 430061, Hubei Province, China; 2. Department of
Rehabilitation, Wuhan Central Hospital Affiliated to Tongji Medical College, Huazhong University of
Science and Technology ( 1. Wj~t9=lJK~*~, Wj~t~& 430061; 2. ~&rP9=lJL.'~~.~f4)

ARTICLE INFO ABSTRACT

First author: YU Chao-chao (1990- ), male,
postgraduate
E-mail: kiterunner2@163.com
C81 Corresponding author: KONG Li-hong
(1960- ), female, professor.
Research filed: the mechanism of
acupuncture in brain disease.
E-mail: xiyu1618@sina.com
Accepted on April 18, 2016
Objective To excavateand analyze the acupoint selection rules of acupuncture
for pcas. Methods A literature search was conducted in databases of Chinese
Biomedicine Database (CBM), Chinese National Knowledge Infrastructure
Database (CNKI), Wanfang Database, Chongqing VIP Chinese Science and
Technology Periodical Database (VIP) and PubMed. All clinical trials evaluating
the effects of acupuncture in the treatment of polycystic ovary syndrome
(PCaS) were included with or without methods of randomization and/or
control. Four authors extracted information and two reviewers recorded
information on titles, journals, interventions, main acupoints in self-
established Excel sheet. Results The top ten acupoints of acupuncture therapy
used most frequently were, by turns, Sanyinjiao (.=:~3t SP 6), Guanyuan (:~
5f; CV4), Zh6ngjf (9=tfbt CV3), ZTg6ng (-=f'S EX-CA t), Qlhai (.E(.#!f CV6), ZusanlT
()E'=:.m ST 36), Shenshu ('/ftrr BL 23), Tianshu (::K~ ST 25), Guilaf (J/3* ST
29), Zh6ngwan (9=t JI* CV 12). Conclusion Our study indicates that modern
acupuncture treatment for pcas is based on selection of specific acupoints
according to traditional Chineseacupuncture theory. Points of spleen meridian,
stomach meridian and conception vessel are chosen frequently which are
most located on the abdomen and the lower limbs. Specific points used most
are the front-mu points, the he-sea points, matching points and the back-shu
points.
KEY WORDS: polycystic ovary syndrome (PCaS); acupuncture; acupoint
selection rules

INTRODUCTION pharmacological treatments, such as oral contraceptive

Polycystic ovary syndrome (pCaS), the most
common endocrine and metabolic disorder among
women of reproductive age, is characterized by
hyperandrogenism, chronic ovulatory dysfunction, and
polycystic ovary''?'. The most prominent characteristic
of pcas is hyperandrogenism, manifested
by hirsutism, obesity, acne, and biochemical
abnormalities'<", including elevated levels of
androgens, sex steroid precursors, and estrogens [3].
Most women with pcas need to take prolonged
pills and insulin sensitizers which are usually effective
but have adverse effects affecting quality of life!",
In recent years, a growing number of clinical trials
investigating the effacy of acupuncture on pcas have
been conducted and results indicated that acupuncture
proved to be effective in relieving insulin resistance and
symptoms of hyperandrogenism, inducting ovulation
'
as we 11 as improving. th e rate 0 f ctertility
'1' [6-7"9 21-22] .
Acupuncture, a form of sensory stimulation
with needles inserted into the skin and muscles, is
 620 records
identified (Pubmed: 93, CNKI: 171, CBM: 181,
Wanfang: 100 and VIP: 75)

64 articles included for data mining

Extraction of information about

titles, journals, interventions, main acupoints

Analysis of frequencies of
acupoints and meridians
 0
10
20
40
50
60

30 56
SP6

46
CV4
CV3

3938
EX-CA1

31
CV6

26
ST36

21
BL23
ST25
ST29
CV12
LR3

1212
KI3
SP10
ST40

171714 111111
BL18
SP9
BL20
BL17
BL32
LI4
ST24
KI12

10108 7 6 5 5 5
PC6
SP15
ST28

444
DU20
GB26
SP8
Linggu
Gyneco
LR2

332222
LI13
GV4
Ovary
ST26
KI11
KI7
Qimen
GB23
GV14

111111111
CV17

·76·
meridian qi. CV 4 and CV 3, the intersecting points of
Conception Vessel and three Foot yin merdians, can
reinforce kidney, regulate the function of conception
vessel and thoroughfare vessel. Zhenjiu Zisheng Jing
(Ht~~~~» Classic of Nourishing Life with
Acupuncture and Moxibustion) documented that "Cv'
4, the indispensable acupoint to treat infertility of
female suffering from reproductive diseases". CV
6 can also replenish primary qi and regulate qi and
blood in TCM theory. Stimulating ST 36 (the lower
he-sea points of stomach), ST 25 (the front-mu points
of large intestine) and CV 12 (the front-mu points of
stomach) can also promote digestion and absorption
of spleen and stomach, two substantial zang-fu organs
related to digestive function in TCM theory. The
better the spleen & stomach function, the more qi and
blood (material of menstrual blood) the human body
will get, so the menstrual period will be normal. The
kidney, the most important zang-organ related to the
reproductive function, stores the essence of life in
Chinese medicine theory. And the essence of kidney
provides the material base for Tiangui which was
documented in SitWen (<<~r.:u» Plain Questions) as
forementioned, plays a decisive role in menstruation
and fertility. So the the back-shu points of kidney, vital
in nourishing kidney, were selected to supplement the
essence of kidney. Therefore, the theory of acupoints
we discussed and explained above, based on Chinese
medicine, may be the reason why these points were so
frequently used in the treatment of pcas.
However, in the treatment of pcas by western
medical acupuncture, the needles are inserted into
the abdominal muscles and the muscles below the
knee in somatic segments[I3-22] corresponding to
the innervation of the ovaries (Tl2-L2, S2-S4i23].
Interestingly, our results showed that the mostly
used acupoints by acupuncture were SP 6, CV 4,
CV 6, ST 36, ST 25, CV 12 and BL 23, which were
also corresponding to the innervation of the ovaries
in terms of neuroanatomy'i". But, we found that
the points or locations selected by western medical
acupuncture were almost all in the abdominal area and
in the muscles below the knee with little referred to
the back-shu points after we searched a lot of relating
studies!"?", However, the frequency of BL 23, a
famous and vital back-shu point, was also high too
based on our data-mining result. Studies on relation
between the acupoints treating ovary diseases and
ovary's corresponding dorsal ganglion has proved that
the reactive point-area (BL 23--GV4 area, SP 6-ST 36
area, CV12 area, CV 4-EX-CA 1 area) of plasma
extravasation resulted from inflammation of ovary
were identical to the ovary's corresponding dorsal
WorldJournal ofAcupuncture-Moxibustion (WJAM)
Vol. 26, No.3, 30th Sep. 2016 ELSEVIER
ganglion. Acupuncture at the corresponding acupoints
of the reactive point-areas has specific regulative action
on ovarian functions [25-26]. Clinical trials[27-29] have
also showed that BL 23 has an obvious and helpful
effects on regulating hormone level and improving the
function of uterus and ovary. This existing difference
we found may provide an another sight and notion
when it comes to the acupoint selection in treatment of
pcas by acupuncture.
Our results showed that the points used
frequently in the treatment of pcas mostly belonged
to conception vessel, the stomach merdian of the foot-
yangming, spleen merdian of the foot-taiyin and the
bladder merdian of the foot-tainyang. Conception
vessel, whose travelling course of meridian originates
from uterus, is "the sea of yin merdians" and plays
an indispensable role in fertility". Sit Wen ( «~fif]»
Plain Questions), a sufficiently famous and important
work in TCM, documented that "Conception vessel
and thoroughfare vessel activate the menstruation
and reproductive function of female in puberty,
while deficient decline of conception vessel and
thoroughfare Vessel in menopause phase results in
the fertility dysfunction" in Shanggu Tianzhen Lun
( «-L l!:1:7(.i~» ), which points out the close relation
between conception vessel and thoroughfare vessel
and menstruation, fertility. There is an exterior-
interior relationship between the spleen merdian of
the foot-taiyin and the stomach merdian of the foot-
yangming.Qi and blood originate from zang-organ
spleen and fu-organ stomach, provide material bases
for menstruation in TCM theory. Jing Yue QUlin ShU
(<<:j:-ffi~45» Complete Works of [Zhang] Jing-yue),
a famous TCM monograph elaborated that the energy
of conception vessel and thoroughfare vessel were
highly associated with the digestion and absorption of
spleen and stomach, so the basis of menstruation lay
great on conception vessel, thoroughfare vessel, qi of
spleen and stomach. The locations of back-shu points
of five zang-organs were on the travelling course of
the bladder merdian of the foot-tainyang, which were
first recorded Lingshu ( o{.m» Miraculous pivot)
comprehensively discussing the theories of merdians
and collaterals, points, techniques of acupuncture
and moxibustion. Studies[30-3Il indicated that the
pathogenesis of pcas was much related with kidney,
spleen and liver zang-organs. Sit Wen (<< ~ r.:u»
Plain Questions) documented as "Treating yang for
yin disease to achieve a balance of yin & yang (1m m
¥€tim)". The attribute of zang-organs is yin based on
TCM theory, so the back-shu points on the back whose
attribute is the opposite yang are chosen to treat yin
disease. And in view of acupoint location, the most
 World Journal ofAcupuncture-Moxibustion (WJAM)
ELSEVIER Vol. 26, No.3, 30th Sep.2016
frequently used points in treatment of PCOS were in
abdomen which accounted for up to 50.9%, followed
by acupoints in lower extremities and dorsum,
which accounted for 31.9% and 12.8%, respectively.
Acupoints selected in abdomen showed proximal
point selection method, while the points chosen in
lower extremities and dorsum manifested distal point
selection rule. This pattern that distal and proximal
point combination method was applied in acupuncture
prescription in the treatment of PCOS were in
accordance with the rules that "the local lesion could
be treated by acupoints in merdians passing through"
and "local lesion could be treated by local acupoints".
CONCLUSION
Taking a wide view of the included clinical
trials in the treatment of PCOS with acupuncture
therapy, we found that the rules of acupoint-selection
lay significantly on the meridian theory and zang-fu
organs theory in TCM, which reflects the features of
syndrome differentiation and treatment of PCOS in
TCM. Even though our results based on data mining
may be useful to acquire new understanding of
acupuncture therapies.
There were still some limitations. First,
those trials were lack of evidence-based medicine
methodologies. So the quality of the included studies
was not evaluated in this paper which may affect
the scientific quality and objectivity of the results as
a result of the inconsistent quality of the literature.
Second, there were many shortcomings of the patterns
of acupoint selection, such as a strong subjectivity in
the process of acupoint-selection, lack of persuadable,
convincing methods which can be promoted
widely and lack of evidence of evidence-based
researches. What's more, the mechanism of acupionts
compatibility effect has not yet been systematically
studied and discussed. So, more attention should be
paid to the standardization and data-driven approach
for getting a more objective results in the further study
on the acupoint selection of acupuncture for PCOS.
AUTHORS' CONTRIBUTION
YU Chao-chao contributed to the conception of
this study, carried out the data analysis and drafted the
paper and should be considered the first author. MA
Chao-yang, SHEN Feng, YAO Guo-jin, XIONG Yuan
and ZHOU Huan-jiao collected and extracted the data.
KONG Li-hong participated in the design of the study
and helped to revise the paper. All authors gave their
final approval for publication of the paper.
·77·
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