Clinical application characteristics of acupuncture and moxibustion in treatment of cervicogenic headache based on complex network analysis

To investigate the clinical application characteristics and rules of acupuncture-moxibustion therapy in treatment of cervicogenic headache (CEH) based on complex network analysis techniques.

A comprehensive and systematic literature search was conducted across the China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform (Wanfang), VIP Chinese Science and Technology Periodical Database (VIP), SinoMed Chinese Biomedical Literature Database, PubMed, EMbase, and Cochrane Library, from their inception to May 31, 2024, to retrieve relevant articles on acupuncture-moxibustion treatments for CEH. A database was constructed using Microsoft Excel 2019 to statistically analyze and create comprehensive pivot tables for the frequency of acupoint utilization, meridian attribution, syndrome differentiation, and therapeutic protocols. Furthermore, the Apriori algorithm within SPSS Modeler 18.0 was employed to perform an association rule analysis on the primary acupoint prescriptions. Cytoscape 3.7.2 software was utilized to visualize the complex network co-occurrence patterns.

A total of 311 eligible articles were included, yielding 452 acupuncture prescriptions that encompassed 146 acupoints with a cumulative utilization frequency of 2349. The top five most frequently employed acupoints were Fengchi (GB20), Tianzhu (BL10), Jingjiaji (EX-B2), Ashi points, and Baihui (GV20). The predominant meridians targeted were the gallbladder meridian, bladder meridian, governor vessel, triple energizer meridian, and stomach meridian. Specific points, such as confluent points and five-shu points, were frequently utilized. Acupoints selected are mainly distributed on the head, neck, upper extremities, and lower extremities. The even veinforcing-reducing needling technique was dominant in acupuncture manipulation. The most commonly adopted single technique is filiform needling or electroacupuncture. Regarding the comprehensive therapy, filiform needling and tuina was combined. The highest co-occurrence frequency was observed between BL10 and GB20, and the close interconnection was presented among GB20, GV20, BL10, EX-B2 and Ashi (Extra); and these points demonstrated the strongest connectivity to other acupoints. Five syndromes/patterns of traditional Chinese medicine were involved. Shaoyang syndrome was treated with Shuaigu (GB8), Waiguan (TE5), and Taiyang (EX-HN5), liver-yang hyperactivity syndrome was with Taichong (LR3), Xingjian (LR2), and Taixi (KI3); wind-cold syndrome was with Dazhui (GV14), Fengmen (BL12), and Hegu (LI4); Taiyang syndrome was with BL10, Fengfu (GV16), and Houding (EX-HN9); and Jueyin syndrome was with GV20, LR3, and Sishencong (EX-HN1).

The core acupoint combination of acupuncture and moxibustion for CEH comprises GB20, GV20, BL10, EX-B2 and Ashi points. In clinical practice, the nearby points are principal, combined with the distal points, as well as those selected by the upper-lower combination; and the meridian differentiation is emphasized. On the basis of core acupoints, the supplementary acupoitns are selected accordingly to optimize therapeutic outcomes.