对156例葡萄膜炎黄斑水肿患者中医证型及方药回顾性分析

Study on TCM Syndrome Types and Prescriptions of 156 Patients with Uveitis and Macular Edema Retrospective Analysis

目的通过对葡萄膜炎黄斑水肿(UME)的常见中医证型及方药进行了归纳总结,为中医治疗本病提供参考。方法回顾性收集2012年1月—2022年12月在中国中医科学院眼科医院采用中医药治疗的门诊及住院UME患者的病历资料,建立数据库。根据病历中记录及中医常见证型分类标准进行辨证分型,对方剂中每味中药的功效进行归类,将各类中药所占百分比进行统计学描述。结果(1)共得出中医证型9种,排名前5位依次为脾肾阳虚型、肝胆火炽型、肝经风热型、阴虚火旺型、肝郁气滞型。(2)涉及到的中药共有83味,总频次1,335次,前5位的中药有黄芪、茯苓、甘草、薏苡仁、泽泻。高频药物主要功效构成,排名前5类依次为健脾利水类、益气健脾类、温补肾阳类、疏风清热类、益气养血类。(3)根据使用频次,排名前5的经典方剂依次为五苓散、苓桂术甘汤、真武汤、龙胆泻肝汤、知柏地黄丸。结论UME中医证型与其所处不同时期和诱发类型有关,临床以脾肾阳虚、肝胆火炽等证型常见,而痰瘀互结、气血不足、肝郁气滞常作为兼证出现。用药上以温阳健脾利水、清热泻火、祛湿滋阴等药物为主,此外也应兼顾气血不足、痰瘀、气滞等兼症的辨证治疗。

OBJECTIVE To summarize the common Traditional Chinese Medicine(TCM)syndromes and prescriptions of uveitis macular edema through retrospective study,to provide reference for TCM treatment of this disease.METHODS Medical records of outpatients and inpatients with UME who received TCM treatment in Eye Hospital of China Academy of Chinese Medical Sciences from January 2012 to December 2022 were retrospectively collected,and a database was established.According to the records in the medical records and the classification standard of TCM common witness type,syndrome differentiation was conducted,the efficacy of each Chinese medicine in the prescription was classified,and the percentage of various Chinese medicine was statistically described.RESULTS(1)There were nine Chinese medicine syndrome types,and the top five were spleen-kidney Yang deficiency type,liver-gallbladder fire-blazing type,liver-wind-heat type,Yin deficiency fire-flourishing type and liver-Qi stagnation type.(2)There were 83 Chinese Medicines involved,with a total frequency of 1,335.The top five Chinese Medicines included Astragalus membranaceus,Poria coix,Licorice,Glycyrrhiza alismatis,Atractylodes albatractyloides.The main functions of high-frequency medicines are composed of five categories,ranked as follows:tonifying spleen and promoting diuresis,benefiting Qi and invigorating spleen,warming and supplementing kidney Yang,dispersing wind and clearing heat,and benefiting Qi and nourishing blood.(3)According to the frequency of use,the top five were Wuling Powder,Linggui Zhugan Decoction,Zhenwu Decoction,Longdan Xiegan Decoction,Zhibai Dihuang Pill.CONCLUSIONS The TCM patterns in UME are related to different periods and inducing factors.Common patterns include Spleen-Kidney Yang deficiency,Liver-Gallbladder Excessive Fire,while combined patterns such as Phlegm-Stasis,Qi-Blood insufficiency,and Liver-Stagnation may also appear clinically.The treatment mainly focuses on using warming and tonifying Yang,benefiting Spleen,promoting diuresis,clearing heat,resolving dampness,and nourishing Yin.Additionally,treatment should also consider addressing the combined patterns of Qi-Blood insufficiency,Phlegm-Stasis,and Qi stagnation.