郭承伟教授治疗病毒性角膜炎经验举隅

Professor GUO Chengwei’s experience in the treatment of viral keratitis

病毒性角膜炎是临床常见的感染性角膜病,以单纯疱疹病毒性角膜炎最为常见。临床表现为畏光流泪,沙涩疼痛,黑睛生翳,可伴有乏力、自汗、恶风、畏寒、易感冒、体质弱等,多次发作可形成角膜新生血管及斑翳,甚至导致失明。本病发病率和复发率高,具有致盲性,至今仍无统一治疗手段。中医药以独特优势和显著疗效,已成为病毒性角膜炎的优先治疗手段。郭承伟教授长期从事中医眼科临床工作,具有深厚的中医理论功底和丰富的临床经验,针对眼自身的生理病理特点,形成了完善的病毒性角膜炎诊疗思路。在重视“翳自热生”的角膜炎中医发病机制的基础上,又特别强调目为清窍,清阳灌目是视瞻和抵御外邪的关键。认为黑睛生翳早期,以外感风热为主,治疗强调发散祛邪,祛风为先,风散则火热无所依附,翳退目自明。同时,用药重视辛温发散、寒热并用,既能增强发散祛邪之功,又可避免凉遏之弊;重视将整体辨证与局部辨证相结合,遵守扶正祛邪,标本兼治的原则。郭承伟教授针对不同个体,坚持辨病与辨证相结合的思想,能够切中病症关键,效如桴鼓,体现了郭承伟教授知常达变,“临证察机,使药要和”的辨治理念,对临床诊疗具有良好的指导意义。

Viral keratitis is a common clinical infectious keratitis,and herpes simplex virus keratitis is the most common.Clinical manifestations include photophobia tears,astringency pain,black eye opacity,which can be accompanied by fatigue,spontaneous sweating,wind aversion,fear of cold,easy to get cold,weak physique,etc.,multiple attacks can form corneal neovasculosis and spot,and even lead to blindness.This disease has high incidence,high recurrence rate and blinding,so far there is no unified treatment.Traditional Chinese medicine,with its unique advantages and remarkable curative effect,has become a priority treatment for viral keratitis.Professor GUO Chengwei has been engaged in the clinical work of traditional Chinese medicine ophthalmology for a long time,and he has profound theoretical foundation of traditional Chinese medicine and rich clinical experience.According to the physiological and pathological characteristics of the eye itself,he has formed a perfect diagnosis and treatment idea of viral keratitis.On the basis of paying attention to the pathogenesis of keratitis caused by“self-generated heat”in traditional Chinese medicine,it is especially emphasized that the eye is a clear orifice,and abundant clear yang qi is the key to seeing and resisting external evil.Professor GUO believes that in the early stage of black eye opacity,exogenous wind and heat are predominant,the treatment emphasizes the divergence and dispelling evil,the heat will dissaper if exogenous wind is removed,and the opacity will recede from the eyes.At the same time,the medication pays attention to the divergence of hypothermia and the combination of cold and heat,which can not only enhance the power of diverging and dispelling evil,but also avoid the disadvantages of cooling repression.Importance is attached to the combination of the whole syndrome differentiation and the local syndrome differentiation,and abides by the principle of promoting health and dispelling evil,treating both symptoms and root causes.For different individuals,Professor GUO Chengwei adheres to the idea of combining disease differentiation and syndrome differentiation,often targets the key disease,and achieves immediate effect,reflecting that Professor GUO Chengwei knows the regularity and change,the differentiation and management idea of“clinical inspection,making medicine to be in harmony”has good guiding significance for clinical diagnosis and treatment.