| In 1976 Professor Lu mianmian contributed Treatment of Chinese OpthalmologyIintegrsted with Western Medcine, which is the first ophthalmography in the field. In thisbook Prof Lu first time differentiate regional symptoms and signs in optic fundi withophthalmology theory of TCM. The approach was so useful in clinic that it was composedinto Ophthalmology of TCM—one of the fifth edition teaching materials.With thedevelopment of technology and the improvement of examination device especially withfundus fluorescence angiography(FFA) and optical coherence tomography(OCT) we canclearly both defect and quantizate the minute pathological changes. As make it possibileto carry out a new study on regional differentiation of combination of TCM with Westernmedicine to serve clinic practice better.It was reported recently by World Health Organization that in the world there were 37million blind person among the total 161 million patients with visual functional impairment.In developed nations such as the United States of America the primary causes of visualdisorder and blindness are diabetic retinopathy(DR) and age related ophthalmopathy(cataract, age related macular degeneration and glaucoma). Retinal vein obstruction is thesecond ophthalmopathy resulting in blindness following diabetic retinopathy. Some maculadiseases such as central serous choroirttinopathy(CSC), central exudative chorioretinopathy(CEC) , myopic degeneration of macula (MDM) and age related macular degeneration(AMD) severely influence visual acuity of sufferer because maculae is the most privilegedincisive site in the sense of sight. Furthermore the latter three diseases, AMD and DR havealready been the obstinate and refractorinessly ailments in the ophthalmology Clinic. Withthe popularation of cataract operation, there is gradual increasing tendency in the incidenceof the following disease. So we examine the fundi of them with FFA and OCT.Retinal edema andneovascular in fundi were only one part of the entire study.ObjectiveThis study is to clear out the relation between retinal edema and neovascular in the optic fundi and Syndrome differentiation of TCM by surveying the major Pattern (symptom)characteristics of retinal edema and neovascular, differentiating macroscopic andmicroscopic regional signs and unifying more exquisite entirety differentiation bysurveying retinal edema and neovascular in the optic fundi of eyeground disease throughophthalmoscope, FFA and OCT. The end purpose is to integrate recognition of eyegrounddiseases between modern medicine and traditional Chinese medicine, differentiatemacroscopic and microscopic regional signs and unifying more exquisite entiretydifferentiation are the main approaches to protrude superiority and characteristic of TCM.MethodsIn ophthalmology department of jiangsu hospital of TCM, 104 patients suffering CSC,CEC, MDM, AMD, RVO and DR had been chosen as study subjects. All cases were foundretinal edema and/or neovascular in the optic fundi by ophthalmoscope, FFA and OCTexamination. According to TCM clinical diagnose and treat terms of State Standard of thePeople’s Republic of China(GB/T16751.2—1997), formulate case report form(CRF) andrecord every patient’s symptoms , tongue and pulse interpretation on it. During theobservation uniformity of standard and compliance of patients were ensuredthatDifferentiating and sort general symptoms, zangfu location, Pattern on the basis ofcomplaint from patients. During descriptive statistics analysis percentage and constituentratio were used in qualitation data while T-test was used in quantitation data. Ratiocomparison depended on X~2 test. Neovascular grade was analysed with Ridit.ResultsIn 104 cases, there involved 60 men, which account 56.92%, and 44 wemen, whichaccount 43.08%.1. Among 90 patients with retinal edema in optic fundi symptoms with frequency ofoccurrence above 20% were insufficient vitality and hypodynamia, dizziness, tinnitus,anypnia, morbid forgetfulness, loose stool, xerostomia and dry pharynx in order whileamong 46 patients with retinain neovascular in optic fundi symptoms with frequency ofoccurrence above 20% were hypodynamia, anypnia, morbid forgetfulness, dizziness,tinnitus, xerostomia and dry pharynx, abdominal distension, loose stool, poor orexia,alopecie, burning sensation of five areas, constipation and polyorexia.2. In the cases with retinal edema pattern constituent was: 54 cases(60%) belong tospleen-Ql deficiency ; 41 cases (45.56%) kidney-YIN deficiency ;29 cases (32.22%)heart-blood deficiency ; 7 cases (7.78%) kidney-YANG deficiency ;5 cases (5.56%) 2. In the cases with retinal edema pattern constituent was: 54 cases(60%) belong tospleen-QI deficiency ; 41 cases (45.56%) kidney-YIN deficiency ;29 cases (32.22%)heart-blood deficiency ; 7 cases (7.78%) kidney-YANG deficiency ;5 cases (5.56%)stagnation of QI and Blood; 3 cases(60%)Damp Heat and 9 cases(10%)no pattern.3. In the cases with retinal neovascular Pattern constituent was: 45 cases (70.31%)belong to spleen-QI deficiency ; 40 cases (62.50%) heart-blood deficiency ; 32 cases (50%)kidney-YIN deficiency ; 10 cases (15.63%) kidney-YANG deficiency; 3 cases (4.69%)stagnation of QI and Blood; 10 cases(15.63%)stagnation pattern of tongue and pulse and2 cases (3.13%) no pattern.4. In the cases with retinal edema, there were 73 cases (81.11%) of deficiencysyndrome and 8 case (8.89%) of excess syndrome. In the cases with retinal neovascular,there were 59 cases (92.19%) of deficiency syndrome and 3 case (4.69%) of excesssyndrome.5. In the patients with neovasular grade 3 appeared most in spleen-QI deficiency andkidney-YANG deficiency Pattern in contrast to heart-blood deficiency and kidney-YINdeficiency Pattern. The ratio of grade 3 in spleen-QI deficiency and kidney-YANGdeficiency Pattern was more than that in heart-blood deficiency and kidney-YINdeficiency Pattern.6. The pattern of Reinal neovasular revolved spleen-QI deficiency, kidney-YANGdeficiency, heart-blood deficiency, kidney-YIN deficiency and stagnation of QI and Bloodet al. One patient often showed two Patterns. The pattern of subreinal neovasular revolvedspleen-QI deficiency, heart-blood deficiency and kidney-YIN deficiency.Conclusion1. According to clinical manifestation and symptom, differentiation of retinal edemaand neovascular had some regularity. Pattern characteristic of the former was : spleen-QIdeficiency pattern is the most,the second is kidney-YIN deficiency,the third is heart-blooddeficiency. Pattern characteristic of the latter was : spleen-QI deficiency pattern is the most,the second is heart-blood deficiency, the third is kidney-YIN deficiency.2.There were resemblance of appearance between internal medicine and retinal edemabut pattern of syndrome had evident difference, blood and YIN deficiency can result inretinal edema.3 Accoding to regional signs retinal edema and neovascular show the appearance ofexcess syndrome but their origin was deficiency of QI, Blood and YIN. By essence they were Deficiency Syndrome Transforming into Excess or simultaneous Deficiency andExcess.4. The patients in QI and YANG deficiency had more and server neovasular.5. The pattern of Reinal neovasular is more complex than that of subretinalneovasular. |
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