基于病证结合从气血水辨治急性黄斑区神经视网膜病变

Treatment of Acute Macular Neuroretinopathy Based on Combination of Disease and Syndrome from the Theory of Qi,Blood and Water

气、血、水是构成和维持目功能活动的基本物质,三者生理上同源互化、病理上交互为患,是辨治眼底病不可或缺的证候要素。基于病证结合的气血水理论,急性黄斑区神经视网膜病变主要病机为气、血、水输布和代谢障碍、目络阻塞,病位在黄斑目系络脉,与肝、脾、肾三脏密切相关,可采用中药联合针刺进行治疗。药物治疗以益气活血、利水通络法为治法,以补阳还五汤为基本方,根据气滞、血瘀、水停及肝、脾、肾脏腑功能障碍加减用药;针刺选穴以局部穴位为主、远端穴位为辅,以达益气化瘀、通络明目之功。

Qi,blood and water are the basic substances that make up and maintain visual function activities.The physiological homology and pathological interaction among the three are essential elements for the diagnosis and treatment of retinal diseases.Based on the combination of disease and syndrome from the theory of qi,blood,and water,the main pathogenesis of acute macular neuroretinopathy(AMN)is the distribution and metabolic disorders of qi,blood,and water,as well as obstruction of the eye meridians.The disease is located in the meridians of the macular system,closely related to the liver,spleen,and kidney.TCM combined with acupuncture can be used for treatment.The medication treatment is based on the methods of tonifying qi,promoting blood circulation,promoting diuresis,and unblocking collaterals,with Buyang Huanwu Decoction as the basic formula.The medication is modified according to the principles of qi stagnation,blood stasis,water stagnation,and dysfunction of the liver,spleen,and kidney organs;acupuncture selection mainly focuses on local acupoints,supplemented by distal acupoints,in order to achieve the functions of tonifying qi,removing blood stasis,unblocking collaterals,and improving eyesight.