从“阳不统血”理论探讨DR增殖期患者玻璃体切割术后再出血的辨治

To explore curative effect of vitreous rebleeding after vitrectomy in patients with proliferative diabetic retinopathy by theory of yang failing to control blood

糖尿病视网膜病变(DR)增殖期玻璃体切割手术后如果反复出现玻璃体腔内积血,无论中医还是西医,治疗棘手,预后差。掌握该时期的根本病机,既是该病防治的难点,也是突破口。古之消渴与今之糖尿病存在诸多不同之处,前者以主观的症状为主要诊断依据,而后者以客观的实验室血糖指标为主要诊断依据。随着诸多学者对糖尿病的发病机制认识的突破,DR增殖期的发病机制——“阴损及阳”也逐渐得到广泛认可,尤其是总结出阳虚可能是DR从非增殖期转化为增殖期的关键病机,亦可能是DR增殖期病变发生的始动因素。因此,本文从“阳不统血”理论出发,以理论阐述和病案发挥的形式,探讨“阳不统血”理论在增殖期DR玻璃体切割术后玻璃体腔内再积血治疗中的指导作用。

It is difficult to treat repeatedly vitreous hemorrhage after vitrectomy in proliferative diabetic retinopathy case,and its prognosis is poor,for both Traditional Chinese Medicine and Western Medicine.How to understand the basic pathogenesis of this period is both the difficult point and the breakthrough point of the disease prevention and treatment.There are many differences between wasting-thirst(Xiaoke)and diabetes,the former is based on subjective symptoms,while the latter is based on objective laboratory blood glucose indexes.At present,with the breakthrough of many scholars'understandings of the pathogenesis of diabetes,detriment to yin affecting yang in the proliferative stage of diabetic retinopathy is gradually widely recognized.In particular,it is concluded that yang deficiency may be the key pathogenesis of the transformation from non-proliferative phase to proliferative phase,and may also be the initiating factor of the occurrence of proliferative phase.Therefore,this paper starts from the theory of yang failing to control blood theory,and discusses the guiding role of yang failing to control blood theory in the treatment of vitreous hemorrhage after vitrectomy in proliferative diabetic retinopathy cases in the form of theoretical explanation and medical records.