Data Mining of Acupuncture Prescriptions for Lateral Epicondylitis: A Literature-Based Analysis of Acupoint Patterns and Parameters

This data-mining study represents a comprehensive analysis of acupuncture prescriptions for lateral epicondylitis (tennis elbow), examining 42 clinical studies published between January 2015 and March 2025. Lateral epicondylitis is a common musculoskeletal condition that affects 1-3% of the general population, causing significant pain and functional limitation of the elbow, especially during gripping and lifting heavy objects. Although acupuncture has demonstrated efficacy as adjuvant therapy for this condition, there is considerable heterogeneity in clinical protocols, limiting standardization of treatments. The researchers conducted systematic searches of eight electronic databases, including PubMed, Embase, Web of Science, the Cochrane Library, and Chinese databases such as CNKI and Wanfang.

Randomized controlled trials and controlled clinical trials that reported acupuncture prescriptions for lateral epicondylitis were included, excluding reviews, meta-analyses, animal experiments, and case reports. The analysis was conducted using data-mining techniques, including association rule analysis, complex network analysis, and hierarchical cluster analysis. With respect to treatment parameters, the study identified consistent patterns in clinical practice. The most frequently used needle type was 0.30 mm × 40 mm (28.13% of cases), followed by 0.35 mm × 50 mm and 0.35 mm × 40 mm.

Retention time of 30 minutes was predominant (58.82% of studies), suggesting that this duration may be optimal for achieving therapeutic effects in lateral epicondylitis. Treatment frequency of seven times per week was the most common (65.71%), with a total duration of 20 days being preferred (23.53% of studies). The analysis of acupoint selection revealed that 40 points were used across 196 occurrences in the 42 studies. The five most frequently used acupoints were: Ashi point (15.82%), Quchi/LI-11 (14.80%), Shousanli/LI-10 (13.27%), Hegu/LI-4 (9.18%), and Waiguan/TE-5 (8.16%).

The Ashi point, based on the traditional theory of "taking the painful area as the acupoint," was the most central, appearing in 31 of the 42 studies. The meridian analysis showed predominance of the Hand Yangming Large Intestine Meridian, representing 47.96% of all acupoint occurrences. This predominance is theoretically justified by the anatomical location of this meridian in the elbow region and by Traditional Chinese Medicine theory that establishes that "Yangming is abundant in qi (氣) and blood" and can nourish tendons and promote joint movement. Among specific points, the Wu-Shu points were the most used (42.38%), followed by confluence points (12.58%).

The association rule analysis using the Apriori algorithm identified 59 association rules, with the LI-10–LI-11 combination showing the highest support (57.14%) and confidence (92.31%). Complex network analysis confirmed five central acupoints: Ashi, LI-4, LI-11, LI-10, and TE-5, consistent with the results of the frequency analysis. Hierarchical cluster analysis categorized the acupoints into four distinct groups: Cluster 1 (distal points for qi regulation and analgesic effects), Cluster 2 (local points of the Large Intestine meridian), Cluster 3 (Ashi point exclusively), and Cluster 4 (extra-meridian points). Regarding safety, only four studies reported adverse events, mainly minor reactions related to acupuncture such as pain, numbness, dizziness, nausea, and hematoma, all well tolerated and resolved spontaneously.

Limitations include heterogeneity in the included studies, inability to establish direct causal relationships, absence of patient subclassification based on TCM pattern differentiation, and the need for validation through well-designed clinical trials. The findings provide an evidence-based reference for clinical practice, identifying consistent patterns that may contribute to the standardization of acupuncture treatment for lateral epicondylitis.