辨治干眼临证心得

Clinical Experiences on Treating Dry Eye by Syndrome Differentiation

干眼是眼科常见疾病之一,以眼部干涩、疼痛、畏光为主要症状,中医称之"白涩症"。干眼发病原因往往错综复杂,其标在眼,其本在脏腑、气血,"治病必求于本"。以七法辨治:(1)疏散邪毒、通畅泪窍,选用银翘散或桑白皮散加减;(2)疏肝理气、解郁通窍,选用逍遥散或丹栀逍遥散、化肝煎加减;(3)宣肺润肺、充津润目,选用清燥救肺汤加减;(4)滋肝补肾、润泽目珠,选用杞菊地黄丸或养阴润目汤加减;(5)健脾益气、上升清阳,选用补中益气汤或益气聪明汤加减;(6)清热利湿、化浊升清,选用三仁汤或甘露消毒丹加减;(7)逐瘀通络、活血舒睛,选用血府逐瘀或补阳还五汤加减。同时配合外用眼药水、针灸、心理疏导等综合调治,"疏其血气,令其调达,而致和平"。

Dry eye is one of the common ophthalmic diseases,with the sensation of dryness and pain of eyes and aversion to light as the main symptoms.It is named as "Dry Astringent Eyes"in Traditional Chinese Medicine with complicated causes.It shows symptoms in the eyes but roots in the Zang-Fu organs,Qi and blood."Treatment should be based on the root."There are7 methods to treat dry eye based on syndrome differentiation as follows.(1)Modified Yinqiao Powder or Modified Sangbaipi Powder can be used to clear the tear orifices by dispersing the pathogenic toxins;(2)Modified Xiaoyao Powder or Modified Danzhi Xiaoyao Powder or Modified Huagan Decoction can be used to dispel depression and clear orifices by regulating the liver and Qi;(3)Modified Qingzao Jiufei Decoction can be used to increase the fluid to moisturize eyes by dispersing and moisturizing lungs;Modified Qiju Dihuang Pills or Modified Yangyin Runmu Decoction can be used to moisturize eyes by nourishing the liver and kidney;(5)Modified Buzhong Yiqi Decoction or Modified Yiqi Congming Decoction can be used to strengthen the spleen and Qi and make clear Yang ascend;(6)Modified Sanren Decoction or Modified Danlu Xiaodu Pills can be used to transform the turbid into the clear by clearing the heat and discharging the dampness;(7)Modified Xuefu Zhuyu Decoction or Modified Buyang Huanwu Decoction can be used to activate the blood and comfort eyes by removing the stasis and clearing the meridians and collateral.Good therapeutic effects can be achieved by comprehensive treatments including eye drops,acupuncture and psychological instruction in accordance with the principle of "dispersing and regulating the blood and Qi to achieve harmony".