基于“少阳主枢”浅析小柴胡汤治疗wAMD

Analysis of the Efficacy of Xiaochaihu Decoction in Treating Wet Age-related Macu⁃lar Degeneration Base on the Theory of Shaoyang Governing Pivot

湿性年龄相关性黄斑变性(wAMD)是眼科常见病及疑难病,也是老年人致盲的主要原因,西医治疗存在局限性,中医辨证使用补法常效果不佳,而小柴胡汤治疗wAMD收获良效。本文基于“少阳主枢”浅析wAMD的病因病机,并为小柴胡汤在wAMD中应用提供依据。“少阳主枢”就脏腑功能而言,主行诸气,决渎水道,宣布相火,畅达气血;就部位而言,位于表里之间,沟通脏腑。wAMD病位在视网膜,属半表半里少阳经;少阳枢机不利为发病关键环节,三焦失司可见水肿,气血失畅可见出血;水肿与出血并见,即“寒热往来”,属小柴胡汤证。故治疗上以和法为基本原则,小柴胡汤为主方辨证施治,可获良效。

Wet age-related macular degeneration(wAMD)is a common and challenging condition in ophthalmology and is a major cause of blindness in the elderly.Western medical treatments have limitations,and Traditional Chinese Medicine(TCM)therapies using tonification methods often yield suboptimal results.However,Xiaochaihu Decoction has shown promising efficacy in treating wAMD.This paper explores the pathogenesis of wAMD based on the theory of Shaoyang governing pivot and provides a rationale for the application of Xiaochaihu Decoction in wAMD treatment.The theory of Shaoyang governing pivot addresses organ functions,emphasizing the movement of various Qi,regulation of water pathways,dissemination of ministerial fire,and facilitation of Qi and blood circulation.Anatomically,Shaoyang lies between the interior and exterior,connecting the organs.In wAMD,the disease location in the retina corresponds to the semi-exterior and semi-interior Shaoyang meridian syndrome.Impairment of the Shaoyang pivot mechanism is a key factor in disease onset,with triple burner dysfunction resulting in edema,and impaired Qi and blood flow leading to hemorrhage.The concurrent presence of edema and hemorrhage,characterized by alternating chills and fever,indicates a Xiaochaihu Decoction syndrome.Therefore,treatment should be based on the harmonizing principle,using Xiaochaihu Decoction as the primary formula,and modifying it according to the syndrome differentiation to achieve good results.