Establishment Of TCM Fundus Ocular Diagnosis Method Based On Syndrome Principle And Clinical Validation Study On Type 2 Diabetic Retinopath

Objective: With the development of social economy,the incidence rate of fundus diseases is increasing year by year.Traditional Chinese medicine has its unique advantages in the prevention and treatment of fundus diseases,but due to the objective conditions and limitations of technical means,traditional Chinese medicine cannot visually grasp the condition of fundus lesions,thus limiting the advantages of Chinese medicine.Therefore,in this study,we conducted theoretical research on four aspects of TCM diagnosis: TCM visual diagnosis,TCM eye diagnosis,evidence-based diagnosis and TCM diagnosis of type 2 diabetic retinopathy(T2DR),analyzed the shortcomings of current TCM visual diagnosis,proposed the necessity and feasibility of establishing TCM fundus visual diagnosis coordinates based on the principle of evidence-based diagnosis,and conducted a clinical validation study using T2 DR.The clinical validation study was carried out with T2 DR as the object,which provided a new method for future TCM diagnosis of fundus disease.Methods : In this study,under the guidance of the holistic concept of TCM,the coordinates of TCM fundus visualization were established by applying the principle of Cartesian two-dimensional coordinate system,taking the center of the optic disc as the origin and the transverse diameter of the optic disc as the subdivision measurement unit,and dividing the fundus images into several corresponding regions.On this basis,based on the modern fundus visualization method,the clinical validation study of the TCM fundus visualization coordinates was carried out based on eight fundus lesion characteristics,namely,fundus hemorrhage,hard exudate,microangioma,neovascularization,cotton wool spot,macular edema,fibrous membrane and retinal detachment,and 190 patients with T2 DR,to realize the standardization and measurability of TCM fundus visualization and extend the deficiency of traditional TCM visualization.Results:1.Establishment of TCM fundus visualization coordinates: Based on the principle of evidence-based identification,the TCM fundus visualization coordinates were established with the center of the optic disc as the origin and the transverse diameter of the optic disc as the zonal measurement unit.2.Clinical validation study was conducted on T2 DR patients to analyze the relationship between fundus coordinates zoning and fundus lesion characteristics and evidence elements,and the following results were obtained.(1)Distribution of evidence elements in T2DR:(1)main pathological elements: liver,kidney,spleen,heart,mind,meridians,lung,tendons and bones,and gallbladder;(2)main pathological elements: deficiency elements are yin deficiency,yang deficiency,blood deficiency,qi deficiency,essence deficiency,and qi insecurity,and actual elements are heat,phlegm,dampness,blood stasis,yang hyperactivity,and cold.(2)Relationship between T2 DR fundus lesion condition and fundus coordinate subdivision:(1)hard exudate was scattered in 44 areas,mainly concentrated in: D3-1,B1-1,A1-1,D1-1,C1-1,C3-1,C2-1,D1-2,D2-1 areas;(2)microangioma was scattered in 39 areas,mainly concentrated in: C3-1,C2-1,D2-1,D3-2,C4-1,D2-2,D1-1,D4-1,D3-1,C1-1;(3)fundus hemorrhage was scattered in 43 regions,mainly in: D2-2,C2-1,D2-1,D3-2,C3-2,C4-1,D1-2,D3-3,D4-2,D5-2;(4)neovascularization was scattered in 34 areas,mainly in: D1-1,C1-1,D2-2,D2-1,C2-1,C2-2,D3-1,D3-2,C3-1,D1-2 areas;(5)cotton wool spots were scattered in 31 areas,mainly in: C1-1,D1-1,C1-2,D2-1,C1-3,D2-2,D4-1,C2-2,C2-3,C3-2 areas;(6)macular edema scattered in 9 areas,mainly concentrated in:D3-1,D4-1,C3-1,D3-2,D2-1,C4-1,D4-2,D5-1,D5-2 areas;(7)fibrous membrane scattered in 32 areas,mainly concentrated in:D1-2,D2-3,D3-1,D4-1,C2-2,C5-1,D4-2,D5-1,D5-2,C1-2 areas;(8)retinal detachment was scattered in14 areas,mainly concentrated in:C4-1,C5-1,C5-2,D3-5,D4-1,D4-2,C3-2,C4-2,D3-4 areas.(3)Relationship between T2 DR fundus conditions and evidence elements:(1)the main evidence elements of fundus hemorrhage are:liver,kidney,spleen,yang deficiency,heat,and blood deficiency;(2)the main evidence elements of hard exudate are: liver,spleen,and qi deficiency;(3)the main evidence elements of microangioma are: liver,yin deficiency,yang deficiency,and qi deficiency;(4)the main evidence elements of cotton wool spots are: yang deficiency;(5)the main evidence elements of macular edema are: kidney;(6)The main evidence factor of fibrous membrane is: heat;(7)the main evidence factor of retinal detachment is: yin deficiency.(4)Relationship between T2 DR evidence and fundus coordinates:(1)liver is mostly found in A1-1 and D3-1;(2)kidney is mostly found in C3-2,D4-1 and D5-1;(3)spleen is mostly found in A1-1 and C4-2;(4)yin deficiency is mostly found in C2-1,C3-1 and D2-1;(5)heat is mostly found in A1-1,C5-1 and D1-1;(6)yang deficiency is mostly found in A1-1,C5-1 and D1-1;(7)blood deficiency is mostly found in C3-2,C4-2,D2-1 and D5-1 zones;(8)qi deficiency is mostly found in C3-1,D1-1 and D4-2 zones.Conclusion:1.It is necessary to establish the TCM fundus visualization coordinates,which can help to realize the standardization and objectivity of TCM fundus visualization and has greater feasibility.2.The TCM fundus coordinate partition correlates with the characteristics of fundus lesions and TCM evidence,and the TCM fundus visualization coordinates provide the basis for it.3.The fundus lesions of different evidence of T2 DR have their characteristics and correlation with fundus coordinate partition,whi ch can provide reference for TCM diagnosis.