A Cross-sectional Observational Study On Phenomena And Patterns Of Acupoint Sensitization In Colorectal Cancer

Objective In this study,the cross-sectional study method was used to study patients with colorectal cancer(CRC),and changes in acupoint temperature and changes in acupoint mechanical pain threshold were used as observation indexes.By analyzing the manifestation anddistributionof acupoint sensitization phenomenonand incidence of sensitization in CRC patients under different disease states,the characteristics and patterns of acupoint sensitization phenomenon in CRC were explored,and the correlation between acupoint sensitization phenomenon and disease status was analyzed to provide an objective reference basis for the selection of acupoints for clinical treatment of CRC.Methods1.Cite Space visual analysis software was used to compare the differences in research hotspots andfrontier between domestic and international research of traditional Chinese medicine(TCM)on CRC,and to predict the research trends in this field.2.Using bibliometrics,ancient and modern literature related to CRC acupoint sensitization was analyzed and summarized to provide a methodology for subsequent study on the phenomenon and patterns of acupoint sensitization inpatientswith CRC.3.Byusingacross-sectional observationalstudy,384 patients with CRC who met the inclusion criteria were screened as subject,using acupoint temperature and mechanical pain threshold as observation indicators,and general information was collected.The incidence and degree of acupoint sensitisation under different disease states(including disease duration,cancer grading,surgery,lesion site and chemotherapy)were analysed to clarify the correlation between the phenomenon of acupoint sensitisation(including the type and distribution of sensitisation)and CRC disease,and to recommend aoptimumtreatmentforpatientswith CRC.Results1.Research hotspots and trends of TCMon CRC.(1)Research in TCM on CRC covers subjects such as oncology,pharmacology,integrative and complementary medicine,immunology,toxicology,public,environmental and occupational health,and genetics.(2)China and the United States are the major sources of output and funding in this field,while European countries have a higher intensity of research collaboration.The most influential journal in this research area is CA-CANCER J CLIN(Freq: 185,Centrality: 0.04,Year: 2002),the most influential author is Rebecca L Siegel(Freq: 86,Centrality: 0.08),and the most influential reference is Bray F et al,2018(Freq: 28).(3)The current international research hot topics in Chinese medicine for CRC are: colorectal cancer,acupuncture,inflammation,chemotherapy,and prevention.The frontiers of research in this field after 2021 and the research themes that still have much attention and room for research are:(i)Chinese research: TCM constitution,cancer-caused fatigue,drug use patterns,data mining,efficacy,TCM evidence,right hemicolectomy,network pharmacology,intestinal flora,mechanism of action;(ii)English research: mechanism of action,NF-κB,inflammation.2.Study of the ancient and modern literature on acupoint sensitization of CRC.(1)Eligible ancient literature(24 articles): 8 articles from the Warring States period to the Qin and Han dynasties(5 articles from the Yellow Emperor’s Classic of Internal Medicine,1 article from the Classic of Difficulties,and 2 articles from the Golden Chamber Synopsis),1 article from the Wei and Jin dynasties,3 articles from the Song dynasty(2 articles from the Zishengjing of Acupuncture and Moxibustion,and 1 article from the Moxibustion for Emergency),6 articles from the Ming dynasty(1 article from the Jing Yue Complete Book,2 articles from the Prescriptions for Universal Relief,1 article from the Ming History,and 1 article from the Dacheng of Acupuncture and Moxibustion),and 6 articles from the Qing dynasty(1 article each from the Lan Tai Gui Fan,the Complete Library of the Four Treasures of Knowledge,the Continuing Cases of Famous Doctors,the Shen Jiu Jing Lun,the Nei Jing Bo Yi,and the Revised Synopsis of Pediatric Massage).(2)In ancient literature,the sensitization sites were mainly the abdomen and the umbilical region;the sensitization acupoints were the Great Intestine Yu,the Gate of Life,the Divine Que,the Gate of the Heart and the Heavenly Hub;the sensitization acupoints and sites were mainly attributed to the meridians of the Foot Yang Ming Stomach Meridian,the Foot Sun Urinary Bladder Meridian and the Ren Vessel;the types of sensitization involved were pain sensitization,form sensitization,sensory sensitization and heat sensitization,with the two forms of sensitization,pain sensitization(6 times)and form sensitization(16 times),occurring most frequently.(3)Twelve modern texts were included,involving a total of 28 acupoints,of which the most frequent were ST36(8 times),ST25(6 times),and Shang ST37(5times);18 acupoints belonged to specific acupoints,with the most frequent being the Lower-He point(16 times);the sensitized acupoints were mainly attributed to the Foot Yang Ming Stomach meridian(21 times),the Ren meridian(14 times),and the Foot Sun Bladder meridian(13 times).(4)A total of four articles were related to pain sensitization,with the test indicators being pressure pain threshold(three articles)and mechanical pain threshold(one article);eight articles were related to heat sensitization,with the test indicators being the individualized amount of saturated desensitizing moxibustion(seven articles)and infrared thermogram(one article).3.Cross-sectional observational study of the phenomena and patterns of acupoint sensitizationin CRC.(1)Temperature analysis of acupoint in CRC patients.(1)The thermal sensitization rates of acupoints in CRC patients ranged from39.00% to 81.15%(average thermal sensitizationrates 58.69%).(2)The top three acupoints with higher thermal sensitization rates in CRC patients were LI14(81.15%),CV4(77.45%)and SP9(71.99%).(3)The pattern of thermal sensitization of CRC acupoints was related to the gender of the patient and the presence or absence of chemotherapy.Gender was an influential factor in temperature sensitization at ST25,CV12,SP15 and SP14,with higher sensitization rates in women than in men.The presence or absence of chemotherapy was an influential factor in the thermal sensitization of SP9,with a higher rate of sensitization with chemotherapy than without.(2)Mechanical pain threshold analysis of acupoint sensitization in CRC patients.(1)The pain threshold sensitization rates of acupoints in CRC patients ranged from 33.80% to 58.10%(average pain threshold sensitization rates 58.69%).(2)The top three acupoints with higher pain threshold sensitization rates were,in descending order,BL25(58.10%),SP9(52.40%),and CV12(51.50%).(3)The pattern of pain sensitization at CRC acupoints was related to the patient’s gender,whether or not they underwent surgery,the duration of the disease,and whether or not they were treated with chemotherapy.Gender was an influential factor in the sensitization of mechanical pain at BL25,with a higher rate of sensitization in women than in men.Before and after surgery were influencing factors for mechanical pain sensitization at ST36,with a lower rate of sensitization after surgery than before.The duration of illness was an influential factor in the sensitization of mechanical pain in CV6,SP9,ST36,ST39,BL25,LI11,TE6 and LI14.Patients with a duration of disease greater than or equal to 2 months and less than 10 months or greater than a grade of 10 months had lower sensitization rates compared to those with a duration of disease less than 2 months.The presence or absence of chemotherapy was an influential factor in the sensitization of mechanical pain in the middle and abdominal nodes,with a higher rate of sensitization without chemotherapy than with chemotherapy.(3)Pressure pain threshold of acupoint sensitization in CRC patients.Themeasured indicator ofsensitive pointsnear BL25,LI11,ST37,ST25,ST36 is strongly correlated with themechanical pain thresholdofnearest acupoints(P <0.05).The pain-sensitive points of the CRC patients were concentrated within 1.85 cmto4.6cm around the acupoints,and 42.55 % of the pain-sensitive points were distributed near the BL25 and LI11.(4)Distribution characteristics of acupoint sensitization in CRC patients.(1)The differences in temperature sensitization rates between different meridians in CRC patients were statistically significant(P<0.001).Among them,the temperature sensitization rate of spleen meridian(81.09%)was greater than that of the other meridians.The difference in mechanical pain sensitization rates between different meridians in CRC patients was not statistically significant.(2)The difference in the sensitivity rate and cumulative sensitivity rate of sensitive points in different regionswas not statistically significant.The difference of temperature sensitization rate in different parts was statistically significant(P<0.05),and the temperature sensitization rate of lower limbs(53.1%)was the highest.The mechanical pain sensitization rates in different parts were statistically different(P<0.001),and the mechanical pain sensitization rate in the lower back(30.2%)was the highest.(3)The sensitivity rates of the sensitive points in the homotopicor adjacent nerve segment and heterotopicnerve segment were statistically different(P<0.05),and the sensitivity rate of the sensitive points in the homotopicor adjacent nerve segment(19.53%)was higher.The cumulative sensitivity rate of sensitive points in the homotopicor adjacent nerve segmentand heterotopicnerve segment was statistically different(P<0.001),and the cumulative sensitivity rate of the homotopicor adjacent nerve segment was higher(25.26%).The difference in temperature sensitization rate between homotopicor adjacent nerve segmentand heterotopicnerve segment was statistically significant(P<0.05),and the temperature sensitization rate(54.4%)of the heterotopicnerve segment was higher.The difference in mechanicalpain sensitization rate between homotopicor adjacent nerve segmentand heterotopicnerve segment was statistically significant(P<0.05),and the mechanicalpain sensitization rate(36.5%)of the heterotopicnerve segment was higher.Conclusion1.Research themes such as acupuncture,chemotherapy and efficacy are current international research hotspots in the field of TCM on CRC.2.In the ancient literature,acupoint sensitization of CRC is mainly focused on its corresponding circulating meridians,such as the foot Yangming Stomach meridian,foot Sun Bladder meridian and Ren meridian,and sensitization also occurs at specific points such as dorsal points of the corresponding organs and recruitment points.The main forms of sensitization are pain and form sensitization.The main sensitized acupoints in the modern literature for CRC are the Lower-He point of the Foot Yang Ming Stomach meridian and the He point of the Foot San Li.The meridians to which the sensitized acupoints belong are mainly the Foot Yang Ming Stomach meridian,followed by the Ren meridian and the Foot Sun Bladder meridian.The main sensitization testing index is the pressure pain threshold and the individualized amount of saturation desensitization moxibustion.3.the rate of thermal sensitization of acupoints in CRC patients was slightly higher than that of pain sensitization,and thermal sensitization may be the dominant form of sensitization in CRC.The rate of thermal sensitization and pain sensitization were both high in SP9 and CV12 in CRC patients,which may be the dominant sensitized acupoints in CRC.The acupoint sensitization phenomenon in CRC has obvious characteristics of meridian distribution,and the thermal sensitization rate of the Spleen meridian is significantly higher than other meridians,which may be the dominant meridian for temperature sensitization in CRC patients.4.Acupoint sensitization in CRC may be site-related.Through the factor analysis of temperature andmechanical pain,the acupoints can be automatically divided into three types: abdomen,distal part of extremities,and lower back.The temperature and pain threshold sensitization rates of the acupoints of distal part of extremities and lower backare higher than that of the local acupoints of abdomen.It was suggested that CRCcan be treated according to the principle of distal acupoint selectionandanterior-posterior points combination.5.For CRC patients with disease duration <2 months,priority should be given to CV6,SP9,ST36,ST39,BL26,LI11,TE6 and LI14;for pre-operative CRC patients,priority should be given to ST36;for pre-chemotherapy CRC patients,priority should be given to CV12 and SP14;for post-chemotherapy CRC patients,priority should be given to SP9.There is some variation in the selection of acupoints for different indexes in different states of the disease.6.Acupoints sensitization of CRCmay be related to factors such as gender,disease duration,whether surgery is performed,and whether chemotherapy is administered.