从络病理论浅析息肉样脉络膜血管病变

Analysis of polypoid choroidal vasculopathy from theory of collateral disease

目为宗脉之所聚,目与经络,尤其是与络脉之间存在内在联系,构建了其视瞻的基础。通过对络脉生理病理的阐述,结合络脉与目的相关性,探讨络脉病变与息肉样脉络膜血管病变(PCV)之间的关系。PCV病机总属络阻血瘀,有因虚因实之别,包括目络虚损、目络阻滞、络损血溢3个方面原因。在治疗方面,应注重3点:(1)以剔络化瘀为法,目络虚损者,宜养血剔络化瘀;目络阻滞者,宜活血剔络化瘀;络损血溢者,宜止血剔络化瘀;(2)注重整体与局部辨证相结合;(3)攻补兼施,在疾病发展的各个阶段酌情使用健脾益气等扶正药,使祛瘀而不伤正,扶正而不留瘀。在用药上,应重视虫类药物与活血化瘀药的联合应用,强调虫类搜剔络脉,如蜈蚣、全蝎、地龙等,如此方能获得良效。

The veins converge to the eyes.There is a particularly prominent internal connection between the eye and the collaterals,especially the meridian,which forms the basis of vision.This article aimed to explore the application of the theory of collateral disease on polypoidal choroidal vasculopathy.The author further explored the role of collateral disease in the process of polypoidal choroidal vasculopathy by elaborating on the physiology and pathology of collaterals and combining the correlation between collaterals and the eye.The main pathogenesis of PCV is collaterals and blood stasis.Collaterals and blood stasis include three aspects of eye collateral deficiency,eye collateral block,and blood loss due to collateral damage.When referring treatment,three methods should be paid attention to:(1)dredging collaterals and removing blood stasis should be used as the main principle,for eye collateral deficiency cases,method of nourishing the blood,dredging collaterals and resolving stasis should be used;for eye collateral block cases,method of activating blood,dredging collaterals and resolving stasis should be used;for blood loss due to collateral damage cases,method of stopping bleeding,dredging collaterals and blood stasis should be used;(2)combination of overall and local syndrome differentiation;(3)treat with both elimination and reinforcement.Specifically,spleen-fortifying and qi-tonifying herbs should be used in various stage of the disease to dissipate the stasis without harming the healthy qi,to reinforce the healthy qi without causing stasis.For drug selection,it is suggested worm drugs should be used as well as blood-activating and stasis-resolving herbs.If worms such as scolopendra subspinipes,dried body of scorpion and earthworm were used adequately to dredge collaterals,favorable effects would be achieved.