Fundus lesions can be traced and treated with TCM diagnostic approach

Fundopathy includes lesions of the retina, choroid, optic nerve, and the vitreous humor, and is classified as an "internal obstruction" in Chinese medicine. Since fundus lesions could not be detected before the application of fundoscopy, they were not identified in detail as ocular cosmetic lesions such as redness and swelling of the eye cells or keratoconus .......

Now a variety of fundus examination methods are widely used, fundus lesions can be clearly detected by imaging, in the face of these clinical data, to use Chinese medicine theory to review and analyze the etiology of these lesions, and then determine the treatment prescription, is a very important combination of Chinese and Western medicine ophthalmology.

The occurrence and progression of disease is mainly determined by the struggle between good and evil. Positive and evil in fundus disease refers to:

Positive qi: the body's ability to defend against, resist, and recover from disease and evil, and the barrier and repair function of ocular tissues.

Evil qi : the pathological products of ocular diseases, such as qi stagnation, phlegm dampness, cold condensation, blood stasis, depression and fire, etc. .......

The disease site of fundus disease is very rich in blood vessels, nerves, and collaterals, forming a network circulation, which transports and conveys qi, blood, and fluids to the eye tissues, and discharges metabolic products.

Fundus collaterals are always "through", and if there is stagnation, evil and toxicity, then the disease will develop. Although the fundus disease is "deep", its lesions can be observed by fundoscopy, and the shape and color are just like the skin appearance of sores and rashes, which can be analyzed for disease mechanism, and the results of the other four diagnostic results can be used to make diagnosis of the symptoms and can be used as the criteria for determining the efficacy of the treatment intuitively. This visualization is of great significance to the combination of disease and evidence. (Recommended reading: Visual acuity of 1.0 does not mean that there is no problem with the eyes!

The eye and the whole body is the relationship between the local and the whole. In Chinese medicine theory, "what is inside is outside". Fundus diseases can involve the heart, lungs, spleen, liver, kidney system, the etiology is complex, ophthalmology clinic should be implemented dual diagnosis, that is, Western medicine disease diagnosis, Chinese medicine symptoms diagnosis.

(Image source: shutterstock)

"Disease" is based on pathological changes, is with a certain development of the evolution of the law, "evidence" is the disease of a certain stage of the body's comprehensive performance. Therefore, the factors that cause fundopathy should be analyzed from both the overall and local aspects. Such as hypertension and cardiovascular lesions, microvascular complications of diabetes, immune system diseases caused by ophthalmopathy, kidney disease caused by ophthalmopathy, will inevitably be accompanied by systemic abnormalities, the overall factors play a dominant role in the analysis of the deficiency of cold and heat, the influence of the organs of the body on the onset of ophthalmopathy.

Common fundus diseases, such as retinopathy and macular degeneration. Pathological damage on fundus imaging, such as the production of hemorrhage, edema, exudation, microvascular tumors and neovascularization and other changes, including retinal edema and neovascularization is more common, and more harmful to vision.

The macula is a part of the retina, located in the center of the retina, and is the sharpest part of the vision, full of visual photoreceptor cells, and is mainly responsible for the function of central vision and color discrimination.

Patients with macular retinopathy will experience macular edema and exudation or hemorrhage, atrophy and degeneration of the tissues, which will blur central vision, distort the image, make it larger or smaller, and even affect the ability to distinguish colors, which can lead to blindness in severe cases. From the perspective of Chinese medicine, macula is closely related to spleen, heart, liver and kidney, while retina is closely related to heart, liver and kidney.

Possible symptoms of macular degeneration include blurred vision, dark shadows, discoloration, and distortion. This is mainly due to the degeneration of the retinal pigment cell layer and the accumulation of metabolic waste. (Recommended reading: Excessive eye use leads to macular degeneration, 4 tricks to save yourself)

Clinically, macular degeneration is divided into dry macular degeneration and wet macular degeneration, in which dry macular degeneration accounted for about 90% of all patients, mainly for the degeneration of the retinal pigment cell layer and atrophy, there is currently no clear treatment, but only maintenance of the eyes; wet (exudative age-related macular degeneration) may be the macular blood supply is insufficient to produce new blood vessels, with hemorrhage, hydrocele, and other complications. neovascularization, complicated by hemorrhage, edema ...... and so on. If not treated in time, the most serious may lead to blindness.

In general, people with high myopia (>500 degrees), smoking, old age, and three highs (hypertension, hyperlipidemia, hyperglycemia, and so on) are at high risk for vision disorders.

Localized fundus manifestations from eye effects can be divided into 4 categories:

(Image source: shutterstock)

Blood circulation disorders: If the color of the retina becomes pale, it may indicate ischemia of the macula, and Chinese medicine treatments need to increase the blood circulation of the fundus so that the blood is delivered to the retina. Produce neovascularization: When ischemia is prolonged, tissues will secrete vascular growth factor *** blood vessel neovascularization. So from TCM treatment in addition to ischemia, you have to consider if there is fire-heat. Retinal hemorrhage: Cooling the blood and stopping the bleeding is the first priority, to avoid the bleeding continues to affect vision. Commonly used Chinese herbs such as raw dihuang, raw pu huang, mudanpi, etc.. Phospholipid metabolite accumulation: In Chinese medicine, this is a type of "obstruction in the abdomen" and "water-dampness and phlegm". The use of strengthening the spleen and resolving dampness along with proper tonification of the liver, kidney and blood can assist in the regrowth of injured tissues and accelerate repair.

Through modern fundoscopy and other examination techniques, we can accurately understand the changes in the fundus that were difficult to detect in ancient ophthalmology, including the characteristics of fundus hemorrhage, vascular status, whether there is edema or oozing, and neovascularization, etc. This information provides a reliable basis for us to carry out the Chinese medicine of qi, blood, fluid, essence, and veins in the eye, and improves the accuracy of ophthalmology's clinical diagnosis, staging and treatment.

Phthalmic hemorrhage is bright red: it is early in the disease, the treatment should be cool blood to stop bleeding. Bleeding in the fundus of the eye is dark red: then it is the stage of blood stasis, it is advisable to activate blood circulation and eliminate blood stasis. Blood vessels in the fundus of the eye are atrophied or there is no blood perfusion: this is the late stage of the disease, and it is advisable to benefit the qi and nourish the blood, and dissolve phlegm and pass the collaterals. More oozing from the fundus: macular edema, this is a blood disease caused by water, "stasis of blood, water, edema, is a blood disease and water," the treatment should be blood and water treatment, the appropriate blood and water to eliminate stasis, as well as diuresis to eliminate swelling. Neovascularization of the fundus of the eye: This complication has a direct effect on the vision, and it is a variation of the disease of long standing, which should be treated on the basis of removing blood stasis and clearing up the channels and increasing the number of medicines that benefit the qi and nourish the blood.

TCM adopts the "whole body and fundus identification method" to analyze the lesion characteristics of the patient's fundus and the overall condition for diagnosis and treatment. From the perspective of Chinese medicine, the premise of fundus circulation repair is that the body's own qi, blood, essence and qi are sufficient to be sent to the eyes from the internal organs through the channels of the veins, blood vessels, meridians ...... and other channels, so as to make its nutrients sufficient, local circulation recovery to get rid of metabolites, blood stasis, deposits, to improve the repair ability of the fundus.

(This article was written by Wan-Ling Lin, an attending physician at the Department of Traditional Medicine, Taipei Medical University Hospital)

<This column reflects the opinions of experts and does not represent the position of the agency>