“补阳还五”补气行血治暴盲
A Case of Central Retinal Artery Obstruction Treated by Buyang Huanwu Decoction
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首都医科大学附属北京中医医院眼科,北京 100010
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杨潮,武燕,杨迎新.“补阳还五”补气行血治暴盲[DB/OL].(2023-12-26)[2023-12-26].https://cccl-tcm.cacm.org.cn/thesisDetails?columnId=46790568&Fpath=home&index=0&lang=zh
YANG Chao,WU Yan,YANG Yingxin.A Case of Central Retinal Artery Obstruction Treated by Buyang Huanwu Decoction[J].,
杨潮,武燕,杨迎新.“补阳还五”补气行血治暴盲[DB/OL].(2023-12-26)[2023-12-26].https://cccl-tcm.cacm.org.cn/thesisDetails?columnId=46790568&Fpath=home&index=0&lang=zh DOI:
YANG Chao,WU Yan,YANG Yingxin.A Case of Central Retinal Artery Obstruction Treated by Buyang Huanwu Decoction[J]., DOI:.
病史摘要,2,张某,58岁,中年男性,以“左眼突发视物不清8天”就诊,患者1周前无明显诱因出现左眼突发左眼视物不清,无遮挡感,无眼球转动痛,于外院明确诊断并治疗后,视力无提高来就诊。专科检查:远视力:右0.6,左0.04,眼压:右17 mmHg,左16 mmHg;双眼前节无特殊,眼底:右眼眼底未见明显异常。左眼视盘边界清,色稍淡,C/D≈0.4,动脉细,反光增强,交叉征(+),视盘鼻下方可见1小片出血,近血管走形处网膜可见棉绒斑,黄斑区轻度灰白水肿。入院症见:左眼视物模糊伴异物感,无眼球转动痛,偶有气短,无胸闷心悸,无咳嗽咳痰,无腹胀腹痛,纳差,眠差,小便调,大便3~4次/日,质稀。舌质暗淡,苔白。脉弦涩,无力。中医诊断 暴盲,气虚血瘀证。西医诊断 视网膜中央动脉阻塞(左眼)、2型糖尿病、高血压2级。干预措施 首诊:治疗上采取活血化瘀兼补气通络之法,气虚血瘀、气血不能上呈致目络淤阻,予补阳还五汤加减。二诊:左眼视力提高至0.3,患者自觉胸闷较前好转,偶有尿频,痰多,舌质暗淡,苔白。脉弦,无力。治疗上体现补气,重用黄芪,中药在前方基础上加柴胡、升麻使精气进一步上乘。三诊:诉左眼模糊较前明显好转,左眼视力达0.6。患者诉近日自觉痰多、尿频、睡眠不佳等症状明显改善,舌质暗淡,苔白。脉弦,略涩,较前稍有力。治疗上采用活血化瘀兼补气通络之法,加用黄连清心火以利小便,合用苍术薏苡仁清下焦湿热。疗效转归 目前随访6个月左眼视力稳定在0.6。
Summary of case history, A 58-year-old middle-aged male, complained of "sudden vision impairment for 8 days", had sudden blurred vision in his left eye without obvious causes a week ago , without occlusion sensation during vision, and pain during eye movement. He came to our department after treatment in other hospitals with vision did not improve significantly. Ophthalmology specialist examination: far vision: right 0.6, left 0.05, iOP: right 12.5mmHg, left 10.7mmHg; Bilateral anterior segment was not special, fundus microscopy: right eye fundus no obvious abnormality. The boundary of the optic disc in the left eye was clear, the color was slightly light, C/D≈0.4, the artery was thin, the reflection was enhanced, and the cross sign (+) was observed. The examination of the optic disc showed a small flake of bleeding below the nose, lint spots in the omentum near the vascular alignment, and mild gray edema in the macular area. Physical examination on admission showed: blurred vision in the left eye with foreign body sensation, no pain of eye rotation, no chest tightness and palpitations, no cough and sputum, no abdominal distension and pain, normal diet and sleep, urine regulation, stool 3-4 times/day, thin quality. The tongue is dull, and the fur is white. Pulse string and weak.,TCM diagnosis, sudden blindness(deficiency of qi and blood stasis),Western medicine Diagnosis, central retinal artery occlusion (left eye),Therapeutic methods, First visit: left eye vision 0.05,he method of promoting blood circulation and removing blood stasis, supplementing Qi and clearing collaterals, Qi deficiency and blood stasis, Qi and blood can not cause blockage of eyes and collaterals, and the addition or subtraction of Bu Yang Huan Wu Decoction is given. The second visit: left eye vision improved to 0.3. The patient felt occasional frequent urination, phlegm, dull tongue, white fur. Pulse string and weak. The treatment reflects the replenishing of Qi, the reuse of yellow astragalus, Chinese medicine on the basis of the front plus Bupleuri and Shengma to make the essence further superior. The third visit: the blurred left eye was significantly better than before, and the left and right vision reached 0.6. After mydriasis, the left eye fundus showed that the retinal edema was disappeared. The patient complained that the symptoms of phlegm, frequent urination, poor sleep and other symptoms were significantly improved, and the tongue was dim and the fur was white. Pulse string and weak. In the treatment, the method of activating blood stasis and supplementing Qi and clearing collaterals was adopted, and the original prescription was used in traditional Chinese medicine.,Clinical outcomes, After 2 weeks of treatment, the visual acuity of the patient's left eye stabilized at 0.6. After mydriasis examination of the right eye fundus showed no obvious retinal edema.
视网膜中央动脉阻塞气虚血瘀证暴盲补阳还五汤
central retinal artery occlusionsyndrome of qi deficiency and blood stasissudden blindnessbuyanghuanwu decoction
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