Clinical Study Of Traditional Chinese Medicine On The Treatment For Uveitis Macular Edema

Uveitis is one of the common blinding eye diseases,roughly 4%to 10%of the blindness are caused by the uveitis,occupying the 5th to 7th in leading causes among the blinding eye diseases.Most conditions are caused by immune response with the characteristic of high recurrence.Especially the macular edema resulted from post-and panuveitis is the main reason for patients’ vision loss,the incidence rate could reach from 28%up to 74%.Currently,the western medicine treatments for this kind of macular edema mainly include systemic corticosteroids or immunosuppressants,which may cause many contraindications and systemic side effects.The local injection of triamcinolone acetonide(TA)could sustain three to four weeks with certain curative effect.However,the incidence of complication from the elevated intraocular pressure is high,and even results in serious adverse reactions such as endophthalmitis.In clinical research,we found that the traditional Chinese medicine have some certain advantages in the treatment for UME.According to TCM theory,the pathogenesis of recurrent and long-lasting UME is due to root deficiency and tip excess with deficiency-excess complex syndrome,In clinic,the deficiency of spleen and kidney Yang is the most common pattern,and the deficiency means ’qi’ and’Yang’deficiency of spleen and kidney,thus causing water-damp diffusion.The excess is phlegm and blood stasis binding together thus causing patheogen stucking in the eye collaterals.The treatment is based on the rule of fostering the therapeutic principle,using methods of benefiting Qi,Warming yang,disinhibiting water,activating blood and brightening eyes.Guided by these theories,Prof.ZeFeng Kang modified Zhen Wu Decoction and Fang Yi Huang Qi Decoction and set up the ’Yiqi Gushen formula’.To observe the effect of ’Yiqi Gushen formula’on UME with spleen-kidney Yang syndrome and investigate the activity mechanism,as well as develop a new TCM treatment for UME,we carried out this project.Purpose:1.Explore the TCM syndrome types and analyze the common formulas of UME.2.Observe the effect of ’Yiqi Gushen formula’ on UME with spleen-kidneyYang deficiency syndrome.Methods:1.TCM syndrome types and formulas analysis of UME.We collected in-patients and out-patients suffered from UME of Eye Hospital,and analyzed the TCM syndromes and formulas.2.Clinical study of traditional Chinese medicine on the treatment for uveitis macular edema90 cases(90 eyes),as the research object were selected with spleen-kidney Yang deficiency type UME,and were randomly divided into Chinese medicine treatment group,the combination of traditional Chinese and western medicine treatment group and triamcinolone acetonide treatment group.Each group with 30 cases(30 eyes),were treated for 3 months and kept following up after 6 months.Compare the best corrected visual acuity(BCVA)before curing and after treatment within 1,3,9 months,fundus macular retinal thickness,and observe the occurrence of complications.Results:1.TCM syndrome type and clinical analysis on UME.By retrospectively analysis on 163 UME patients(227 eyes)UME,totally 10 kinds of TCM syndrome types were obtained,which are respectively the spleen-kidney Yang deficiency type 47 cases(29%),Courage lively type 33 cases(20.5%),Liver depression and qi stagnation type 12 cases(7.1%),Liver wind heat type 25 cases(15.3%),the wind type thermal perturbation on 6 cases(3.9%),Yin deficiency type fire 19 cases(11.5%),phlegm and blood stasis mutual junction 4 cases(2.5%),wind hot wet 8 cases(4.7%),poison flaming fire type 5 cases(3.3%),qi and blood deficiency type 4 cases(2.2%).The main medicine is zhenwu decoction,Tetrandra and Astragalus Decoction、linggui zhugan decoction、Gentian purging liver soup、sanren decoction、newly-made chailian decoction、Danzhi Xiaoyao Powder、Xiao Chaihu decoction、Yiguanjian、Yinqiao powder、huanglian jiedu decoction、Zhibaidihuang decoction、bazhen decoction、guipi decoction、jia Jian Er Chen decoction、buyang huanwu decoction more than 30 formulas were modified and priscribed.There were 83 medicinal herbs used in th formulas.Among them,the kind of strengthening the spleen and replenishing ’qi’ medicinal herbs occupied 14.5%,the kind of warming Yang occupied,dispersing wind and clearing heat(8.8%),strengthening the spleen and dredgingwater(21%),cooling blood and removing stasis(6.8%),softening firm and resolving lumps(2.3%),dehumidifying dampness and transforing phlegm(7.2%),benefiting qi and nourishing blood(7.6%),smoothing the liver and resolving depression(5.5%),nourishing the heart and quite the spirit(3.2%),moisting the intestines and freeing the stool(1.8%),calming the liver and extinguishing the wind(3.9%),clearing heatness and drying dampness(3.5%),stoping cough and transforming phlegm(1.2%).2.Clinical research on ’Yiqi Gushen prescription’ curing spleen and kidney Yang deficiency type UME.90 cases(90 eyes),as the research object were selected with spleen-kidney Yang deficiency type UME,and were randomly divided into Chinese medicine treatment group,the combination of traditional Chinese and western medicine treatment group and triamcinolone acetonide treatment group,each group with 30 cases(30 eyes).The comparison on BCVA among the three groups:after one month treatment,for the P<0.05,triamcinolone acetonide group is superior to the traditional Chinese medicine group,the combination of Chinese and western medicine treatment group show the best curare effect;After treatment for 3 months,the Chinese medicine group is the best one;While,after following up for 6 months,for P<0.05,the combination of traditional Chinese and western medicine treatment group expressed the best behavior,with statistical significance on comparison of the other two groups,the same to the comparison between Chinese medicine group and triamcinolone acetonide group.The comparison of macular thickness among the three groups after treatment:after one month treatment,for thickness of macular central sunken comparison between the three groups,P<0.05,the triamcinolone acetonide group is superior to the traditional Chinese medicine group,the combination of Chinese and western medicine treatment group show the best curare effect;After 3 months treatment,P<0.05,the Chinese medicine group is the best;While,after following up for 6 months,for P<0.05,the combination of traditional Chinese and western medicine treatment group expressed the best behavior,with statistical significance on comparison of the other two groups,the same to the comparison between Chinese medicine group and triamcinolone acetonide group.The comparison on 6 mm macular volume among the three groups after treatment:after one month treatment,for thickness of macular central sunken comparison between the three groups,P<0.05,the triamcinolone acetonide group is superior to the traditional Chinese medicine group,the combination of Chinese and western medicine treatment group show the best curare effect;After 3 months treatment,P<0.05,the Chinese medicine group is the best;While,after following up for 6 months,for P<0.05,the combination of traditional Chinese and western medicine treatment group expressed the best behavior,with statistical significance on comparison of the other two groups,the same to the comparison between Chinese medicine group and triamcinolone acetonide group.The comparison on recurrence rate of macular edema among these three groups:during the follow-up in 6 months,recurrence rate group treated with Ta(30%),was obviously higher than that of traditional Chinese medicine group(13.4%)and the combined treatment group(6.7%),the last one with the lowest recurrence rate.That combination treatment group has good resistance on relapsing of UME.After three months treatment,for comparisons of the efficiency on improved systemic symptoms,the Chinese traditional medicine group with 93.3%,combined treatment group being 96.7%,Ta treatment group full of invalidity.In one word,the combination group and Chinese medicine group were superior to Ta treatment group.After followed up in 6 months later,the Chinese traditional medicine group’s efficiency on improved systemic symptoms reached 93.3%;combined treatment group was 90%;Ta treatment group was still invalid.In conclusion,the combination therapy group and Chinese medicine group were superior to Ta treatment group.The comparison on complications during the followed-up period:In this clinical experiment,the triamcinolone acetonide groups had 6 patients with high intraocular pressure(IOP),with the highest IOP reaching 35 MMHG;subconjunctival hemorrhage was 1 case.For the combined traditional Chinese and western medicine group,2 patients were detected with high intraocular pressure,the highest IOP with 32 MMHG.While,there is no complications found in Chinese traditional medicine group,without glaucoma,cataract,and so on and so forth.For the recurrence in 6 months,there were 6 cases found in Chinese traditional medicine group.While,the triamcinolone acetonide groups had 18 cases.And the combining Chinese and western medicine group only existed 5 cases,the comparison among the three groups,P<0.05,with statistical significance.For the inter-groups,the comparison with combination of Chinese and western medicine group and Chinese medicine group,P>0.05,means that there is no clinical difference between the two groups.While,the comparison between each of these two groups with triamcinolone acetonide group were full of statistically significance,with P<0.05.Conclusion:1.The spleen and kidney Yang deficiency type UME is the most common case.2.The adoption of UME prescription should mainly apply TMC with the function of supplementary’qi’ and kidney,warming yang,diuresis-promoting,strengthening the spleen and eliminating wetness.3.’Yiqi Gushen prescription’ can improve the visual function of spleen and kidney Yang deficiency type UME,and promote the absorption of fundus macular edema.4.Employed ’Yiqi Gushen prescription" curing on UME,could improve the patients’ systemic symptom and reduce recurrence of UME.Adopting ’Yiqi Gushen prescription’ with triamcinolone acetonide ball by injection treatment on UME patients could bring fewer complications as well as higher safety.5.’Yiqi Gushen prescription’ with triamcinolone acetonide ball by injection,the combining traditional Chinese and western medicine,reaches the best treatment effect on UME.