国医大师唐由之从“血中伏火”论治脉络膜新生血管性疾病

TCM master TANG You-zhi treating choroidal neovascular diseases from the perspective of ‘fire hidden in blood’

脉络膜新生血管性疾病是指眼底出现新生血管并引发眼底出血、渗出等一系列病理改变的一类眼病。国医大师唐由之观察此类疾病多为患者年老体虚,阴虚不能制阳,气虚不能摄血,将其病机归纳为“血中伏火”,伏火辟积于眼底脉络之中,烦劳迫血,伤及脉络所致。瘀血内停,郁热内生,血热互结,故提出凉血化瘀的治法,并创立“凉血化瘀方”,以达凉血止血、活血化瘀之效。在该治法的指导下分期论治,急性出血期以止血为主治其标,出血稳定期止血化瘀并重,在机化瘢痕期又应补肝脾肾之虚以固护根本。

Choroidal neovascular disease refers to a type of eye disease in which new blood vessels appear in the fundus and cause a series of pathological changes such as fundus hemorrhage and exudation. TCM master TANG You-zhi observed that most of these diseases are elderly patients with physical insufficiency, deficiency of yin cannot control yang, and deficiency of qi cannot absorb blood, due to irritability and forcing blood, injury to the veins. Blood stasis stops, stagnation heat is endogenous,and blood heat is intertwined, so the treatment method of ‘cooling blood and removing blood stasis’ is proposed, and ‘cooling blood and removing blood stasis prescription’ is established to achieve the effect of cooling blood to stop bleeding, promoting blood circulation and removing blood stasis. Under the guidance of this treatment method, the treatment should be divided into stages. In the acute bleeding stage, hemostasis is the main symptom. In the stable bleeding stage, both hemostasis and blood stasis removal are emphasized. In the scarring stage, tonifying deficiency of liver, spleen and kidney is the foundation.