从“瘀”论治视网膜动脉阻塞

Treatment of retinal artery occlusion from"blood stasis"

血瘀理论为中医病因病机学说的重要组成部分,本文以治“瘀”为切入点,探讨视网膜动脉阻塞(RAO)的治疗思路。RAO属中医“络阻暴盲”范畴,“瘀血”为RAO的主要病因,并据此建立活血化瘀通络的治疗法则。本研究将RAO辨证分为实证及虚证,认为早期多从肝脾论治,用药以行气活血通窍为主;中晚期多从脾肾论治,用药以益气活血通络为主。此外,针对视网膜水肿者应辅以利水渗湿之法,陈旧性RAO者适当予破血逐瘀之品。中医将治“瘀”作为治疗法则对RAO进行辨证论治,结合整体观及“治未病”理念,辨证选用方剂、成药、针刺推拿等治疗方法,可以在治疗RAO的同时降低继发性疾病的发病风险。中医在RAO诊治中具有独特优势,重视中医治疗对RAO患者的视功能恢复及预防继发性疾病具有重要意义。

The theory of blood stasis is an important part of the theory of etiology and pathogenesis of Traditional Chinese Medicine(TCM).This paper discussed the treatment of retinal artery occlusion(RAO)from the perspective of treating blood stasis.RAO belongs to the category of"sudden blindness due to collateral obstruction"in TCM,and"blood stasis"is the main cause of RAO.In this study,the syndrome differentiation of RAO was divided into excess syndrome and deficiency syndrome.It was believed that in the early stage,the treatment was mainly based on the liver and spleen,and the medication was mainly to promote Qi and blood circulation and clear the orifices.In the middle and late stage,the treatment was mainly based on the spleen and kidney,and the medication is mainly used to replenish Qi,and activate blood activation and unblock collaterals.In addition,for retinal edema,the method of diuresis and dampness permeation should be supplemented,and for old RAO,the medication of breaking blood and removing blood stasis should be appropriately given.TCM treats RAO according to syndrome differentiation by taking the treatmnet of blood stasis as the treatment principle.Combining the holistic view and the concept of preventive treatment of disease,TCM selects prescriptions,proprietary medicine,acupuncture,massage and other treatment methods according to syndrome differentiation,which can reduce the risk of secondary diseases while treating RAO.TCM has unique advantages in the diagnosis and treatment of RAO,and it is of great significance to pay attention to TCM treatment for the recovery of visual function of RAO patients and the prevention of secondary diseases.