病证结合辨治病理性近视黄斑病变的诊疗思路

Diagnosis and treatment of maculopathy caused by pathological myopia based on the combination of disease identification and syndrome differentitation

随着教育压力、近距离工作和电子视频终端设备使用的增加,我国儿童、青少年近视患病率持续增长,随之而来的病理性近视发生率也不断上升。与单纯性近视不同,病理性近视眼轴不断增长,终身进展,主要表现为后巩膜葡萄肿以及多种眼底改变,尤其是黄斑区病变严重损伤视功能,已成为我国重要的致盲性眼病,造成了严重的社会和经济负担。中医药在防治病理性近视眼底并发症方面具有独特优势,基于最新的近视性黄斑病变ATN分类系统,在中医整体观念指导下,对亢泽峰教授病证结合辨治病理性近视黄斑病变的诊疗思路进行了总结,认为该病主要从肝、脾、肾论治,其病程较长,病机呈现一定的规律发展,早期肝肾亏虚,气血生化乏源,目络空虚失荣,久病脾虚湿浊内生,成痰或瘀,痰湿“邪阻”于目络,血不养脉,络道亢进,久生“败络”,络损血溢,出现视力损伤,契合近视性黄斑病变的现代医学认识,能够更好地指导临床。

With the pressure of education,close work and the increase in the use of electronic video terminal equipment,the prevalence of myopia in children and adolescents in China has a continuous growth,and the incidence of pathological myopia has also increased.Unlike simple myopia,the axial length of pathological myopia has been growing continuously with a life-long progress.It is mainly manifested by posterior scleral staphyloma and a variety of fundus changes,especially macular disorders that seriously damage the visual function,and has become ann important blinding eye disease in China,causing a serious social and economic burden.Traditional Chinese Medicine(TCM)has unique advantages in the prevention and treatment of fundus complications of pathological myopia.Based on the latest ATN classification system of myopic maculopathy,under the guidance of the holistic concept of TCM,this paper summarized Professor KANG Zefeng's diagnosis and treatment ideas of combining disease identification and syndrome differentiation in the treatment of pathological myopic macular diseases.It is believed that the disease is mainly treated from liver,spleen and kidney,with a long course of disease and a regular development pattern of its pathogenesis.The early state is charactierized by liver and kidney deficiency,lack of source of generating Qi and blood,loss of supply in eyes and collaterals,while endogenous spleen deficiency and dampness occur with prolonged disease,causing phlegm or blood stasis.When phlegm-dampness obstructs the ocular meridians evilly,blood can not be nourished by the veins,collaterals become hyperactive,causing injured collaterals and overflowing of blood,which can lead to visual impairment.This understanding is consistent with modern medical understanding on maculopathy caused by myopia,and can better guide clinic practice.