Understanding and treatment of dry eye in traditional Chinese Medicine

Abstract: dry eye is a common disease in clinical ophthalmology. If it is not treated in time, it will cause serious consequences such as corneal opacity, ulcer, vision loss, and even blindness. TCM syndrome differentiation and treatment can improve the tear secretion of patients as a whole and inhibit the evaporation of tears, which has achieved good results. This paper discusses the research progress of dry eye from the perspective of TCM.

dry eye disease refers to a kind of disease that causes eye discomfort due to tear film instability and eye surface damage caused by abnormal tear volume or quality. It is a common eye surface disease, which is called white astringency in traditional Chinese medicine. The common main symptoms are foreign body sensation, dryness, burning sensation, photophobia, blurred vision, fatigue and other symptoms. At present, it is considered that the etiology is related to video terminal syndrome, environmental pollution, wearing corneal contact lenses, female endocrine abnormalities, age and other factors. This paper reports on the understanding of dry eye in traditional Chinese medicine.

1 etiology of dry eye

traditional Chinese medicine believes that dry eye belongs to the category of white astringency and “Shenshui will wither”. Its pathogenesis is based on the syndrome differentiation of the wheel and viscera of the five wheel theory, emphasizing that the eye surface is the standard (wheel) and the viscera is the foundation. It is appropriate to distinguish the deficiency and excess of the wheel and viscera, and give consideration to the treatment principles and specimens.

  1。 Deficiency of kidney qi and deficiency of kidney essence

and

the kidney governs the storage of essence. “Su Wen? Ancient naive theory” says: “the kidney governs water and is stored by the essence of the five zang organs.” The kidney contains both innate and acquired essence. The kidney governs the water. “Su Wen? Inverse regulation theory” says: “the kidney is dirty, and it governs the body fluid.” The kidney plays an important role in the metabolism and distribution of water and fluid in the body. “Lingshu? Five different kinds of body fluid” points out: “the body fluid of the five zang organs seeps into the eyes.” If the kidney qi and kidney energy are abundant, and the body fluid is actively metabolized under the regulation of the kidney and continuously transported to the eyes, which provides material guarantee for the moisturizing water outside the eyes and the fluid filling and nourishing the eyes, the eyes are moist and smart; If the kidney qi is deficient and the kidney essence is insufficient, the kidney is lost, and the body fluid can not moisten the eyes. Over time, the eyes lose the body fluid and become dry eyes.

  1。

the liver opens its orifices in the eyes, and the eyes are outside the liver. “On the waiting of various diseases? The waiting of eye diseases” day: “the eyes are outside the liver.” The liver governs the storage of blood. On examining the Yao letter? The eye is the most precious theory, “the real blood is the blood that rises in the liver and transports in the eye. Light and clear blood is the blood that nourishes the eyes and meridians.” The liver governs tears, moistens the eyes, and “Su Wen? Xuanming five Qi chapter” day: “the five zang organs melt… The liver is tears.” “Silver Sea essence” points out: “tears are the liquid of the liver.” Therefore, whether the eyes are moist is related to the metaplasia of tears, and the generation and excretion of tears are related to whether the liver function is normal and whether the real blood stored in the liver is abundant. If the liver Qi is harmonious and the liver blood is abundant, the liver is lax. The real blood stored in the liver can be transported to the eyes, metaplasia tears, moisten the eyes and their meridians, and the tears run orderly without overflow. If the liver is maladjusted and the real blood stored in the liver is deficient, the tears are liquefied, the source of life is insufficient, and the tears are scarce, the eyes are lost in moistening, and the eyes become dry over time.

2 clinical manifestations of dry eye symptoms of

dry eye are: (1) dry eyes and easy to get tired. (2) Foreign matter, sand and gravel. (3) Burning and tingling. (4) Often itchy eyes. (5) Contact lenses often don’t work. (6) I often feel blurred eyes and foreign body sensation. (7) Temporary blurred vision. (8) Often tight eyelids, heavy and uncomfortable. (9) Sensitive to external stimuli (light, wind, smoke) and photophobia. (10) The secretion is thick.

and

mainly include dry eyes, foreign body sensation, photophobia, blurred vision or vision fluctuation. Severe keratoconjunctival dryness is often manifested as keratoconjunctival dryness, ulcer, scar, corneal pannus, etc. lasting lesions can reduce corneal transparency and vision, affect work, study and life, and even lead to blindness.

3 treats

3. TCM treatment of

and

some scholars have divided the disease into eight syndrome types: Qingfei Yiyin Decoction (Fangfeng, jingmustard ear, Scutellaria baicalensis, uncaria, Anemarrhena Anemarrhena, mulberry bark, Ophiopogon japonicus, Scrophularia, Guiwei, safflower, reed root, June snow and licorice); Zifei Yiyin Decoction (Radix ginseng, Ophiopogon japonicus, pollen, Angelica sinensis, Herba Cassiae, Dendrobium, Platycodon grandiflorum, Schisandra chinensis, Fangfeng, white peony and Polygonatum) is used to treat the deficiency of lung yin; Dehumidification Yiyin Decoction (Yuzhu, Fangfeng, tangerine peel, faxia, Scutellaria baicalensis, Perrin, Atractylodes rhizome, Poria cocos, clematis, Forsythia suspensa, talcum and licorice) is used for the treatment of Yin injury with damp heat: Sanren decoction is used for the treatment of spleen and stomach damp heat; Jiawei Yigong powder is used for the treatment of spleen and lung qi weakness; Jiawei Shizhen decoction is used for water does not contain wood; The treatment of liver depression and blood deficiency is based on Xiaoyao Powder; For kidney yang deficiency, use Fugui Dihuang Decoction. Studies have proved that Sangbaipi decoction, Yangyin Qingfei Decoction, Sanren Decoction and Qiju Dihuang pill are mainly used to treat the nostalgia for evil heat, deficiency of lung yin, damp heat of spleen and stomach, loss of liver and kidney and deficiency of Yin blood. Wang Gao takes the treatment principle of “moistening dryness and protecting body fluid in the treatment of internal dryness, replenishing qi and distributing body fluid in the treatment of yin deficiency, and inducing fire to return to the original in the treatment of deficiency of lung yin”. For deficiency of lung yin, Yangyin Qingfei Decoction, Liuwei Dihuang decoction for deficiency of liver and kidney yin, Jinkui Shenqi decoction for deficiency of fire, and Guipi Decoction for deficiency of Spleen Qi.

  3。 2 acupuncture treatment of

and

he Huiqin divided the acupuncture group into two types according to the condition: hot and hot Yin injury and phlegm and blood stasis. Sibai, Yingxiang, Quchi, Hegu, Sanyinjiao and Sibai, Xuehai, yinlingquan, Zusanli, Sanyinjiao and Zhaohai were used for acupuncture respectively. Hou Shuhong massages zanzhu point, Shangming point, tongziiliac point, Chengqi, Sibai, temple, etc., in combination with traditional Chinese medicine and artificial tears to treat visual fatigue and dry eyes.

4 discussion the occurrence of

dry eye disease is mainly due to too little tear secretion, which is congenital and primary, and caused by some diseases. Congenital and primary are rare; Dry eye caused by some diseases is more common. Such as trachoma, diphtheria conjunctivitis, ocular pemphigus, chemical burns, trauma or surgery, which destroys the lacrimal duct or causes lacrimal gland atrophy, resulting in too little lacrimal secretion; Because the trigeminal nerve, facial nerve and other nervous systems are paralyzed or damaged by diseases, it will also directly lead to the reduction of tear secretion; In addition, some systemic diseases, such as autoimmune diseases, endocrine diseases and vitamin A deficiencyAnd other symptoms can also reduce the secretion of tears.

and

at present, western medicine only focuses on symptomatic and local treatment, and mostly uses artificial tear substitutes, permanent or temporary closure of lacrimal duct system, wearing wet room glasses and other methods to preserve tears to improve clinical symptoms, which can not fundamentally achieve curative effect. Therefore, it is an urgent problem to find a safe, reliable and satisfactory new treatment method for dry eye disease. Traditional Chinese medicine has its own advantages in local treatment and syndrome differentiation. Looking at the methods and theoretical basis of TCM syndrome differentiation and treatment, this disease should be the syndrome of yin deficiency and Jin deficiency and eye and canthus stasis in TCM. The disease mainly occurs in the meridians of liver and kidney, yin deficiency is the origin of the disease, Jin deficiency is the source of the disease, and blood stasis is the local pathological change. This disease is based on deficiency, which belongs to the syndrome of deficiency and excess.

and

should be mainly used for nourishing Yin, generating fluid, clearing liver and brightening eyes, promoting blood circulation and dredging collaterals, so that the whole and local treatment can complement each other. TCM syndrome differentiation and treatment can improve the tear secretion of patients as a whole and inhibit the evaporation of tears. Stabilizing tear film, protecting ocular surface tissue and treating dry eye are effective not only because they regulate immunity, but also probably regulate hormone secretion and coordination of nervous system. Its mechanism and long-term effect need to be further observed.

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and

he Huiqin divided the acupuncture group into two types according to the condition: hot and hot Yin injury and phlegm and blood stasis. Sibai, Yingxiang, Quchi, Hegu, Sanyinjiao and Sibai, Xuehai, yinlingquan, Zusanli, Sanyinjiao and Zhaohai were used for acupuncture respectively. Hou Shuhong massages zanzhu point, Shangming point, tongziiliac point, Chengqi, Sibai, temple, etc., in combination with traditional Chinese medicine and artificial tears to treat visual fatigue and dry eyes.

4 discussion the occurrence of

dry eye disease is mainly due to too little tear secretion, which is congenital and primary, and caused by some diseases. Congenital and primary are rare; Dry eye caused by some diseases is more common. Such as trachoma, diphtheria conjunctivitis, ocular pemphigus, chemical burns, trauma or surgery, which destroys the lacrimal duct or causes lacrimal gland atrophy, resulting in too little lacrimal secretion; Because the trigeminal nerve, facial nerve and other nervous systems are paralyzed or damaged by diseases, it will also directly lead to the reduction of tear secretion; In addition, some systemic diseases, such as autoimmune diseases, endocrine diseases and vitamin A deficiency, can also reduce the secretion of tears.

and

at present, western medicine only focuses on symptomatic and local treatment, and mostly uses artificial tear substitutes, permanent or temporary closure of lacrimal duct system, wearing wet room glasses and other methods to preserve tears to improve clinical symptoms, which can not fundamentally achieve curative effect. Therefore, it is an urgent problem to find a safe, reliable and satisfactory new treatment method for dry eye disease. Traditional Chinese medicine has its own advantages in local treatment and syndrome differentiation. Looking at the methods and theoretical basis of TCM syndrome differentiation and treatment, this disease should be the syndrome of yin deficiency and Jin deficiency and eye and canthus stasis in TCM. The disease mainly occurs in the meridians of liver and kidney, yin deficiency is the origin of the disease, Jin deficiency is the source of the disease, and blood stasis is the local pathological change. This disease is based on deficiency, which belongs to the syndrome of deficiency and excess.

and

should be mainly used for nourishing Yin, generating fluid, clearing liver and brightening eyes, promoting blood circulation and dredging collaterals, so that the whole and local treatment can complement each other. TCM syndrome differentiation and treatment can improve the tear secretion of patients as a whole and inhibit the evaporation of tears. Stabilizing tear film, protecting ocular surface tissue and treating dry eye are effective not only because they regulate immunity, but also probably regulate hormone secretion and coordination of nervous system. Its mechanism and long-term effect need to be further observed.

,  1。 Deficiency of kidney qi, deficiency of kidney essence, kidney dominates the storage of essence. “Su Wen? Ancient naive theory” says: “the kidney dominates the water and is stored by the essence of the five zang organs.” The kidney contains both innate and acquired essence. The kidney governs the water. “Su Wen? Inverse regulation theory” says: “the kidney is dirty, and it governs the body fluid.” The kidney plays an important role in the metabolism and distribution of water and fluid in the body. “Lingshu? Five different kinds of body fluid” points out: “the body fluid of the five zang organs seeps into the eyes.” If the kidney qi and kidney energy are abundant, and the body fluid is actively metabolized under the regulation of the kidney and continuously transported to the eyes, which provides material guarantee for the moisturizing water outside the eyes and the fluid filling and nourishing the eyes, the eyes are moist and smart; If the kidney qi is deficient and the kidney essence is insufficient, the kidney will be lost and the body fluid will not moisten the eyes. Over time, the eyes will lose the body fluid and become dry eyes.,   1。 2. The liver is out of harmony, the liver blood is insufficient, the liver opens its orifices in the eyes, and the eyes are outside the liver. “On the syndrome of various diseases? The syndrome of eye diseases” day: “the eyes are outside the liver.” The liver governs the storage of blood. On examining the Yao letter? The eye is the most precious theory, “the real blood is the blood that rises in the liver and transports in the eye. Light and clear blood is the blood that nourishes the eyes and meridians.” The liver governs tears, moistens the eyes, and “Su Wen? Xuanming five Qi chapter” day: “the five zang organs melt… The liver is tears.” “Silver Sea essence” points out: “tears are the liquid of the liver.” Therefore, whether the eyes are moist is related to the metaplasia of tears, and the generation and excretion of tears are related to whether the liver function is normal and whether the real blood stored in the liver is abundant. If the liver Qi is harmonious and the liver blood is abundant, the liver is lax. The real blood stored in the liver can be transported to the eyes, metaplasia tears, moisten the eyes and their meridians, and the tears run orderly without overflow. If the liver is maladjusted and the real blood stored in the liver is deficient, the tears are liquefied, the source of life is insufficient, and the tears are scarce, the eyes are lost to moistening, and the eyes become dry over time., 2. The clinical manifestations and symptoms of dry eye are: (1) dry eyes and easy to get tired. (2) Foreign matter, sand and gravel. (3) Burning and tingling. (4) Often itchy eyes. (5) Contact lenses often don’t work. (6) I often feel blurred eyes and foreign body sensation. (7) Temporary blurred vision. (8) Often tight eyelids, heavy and uncomfortable. (9) Sensitive to external stimuli (light, wind, smoke) and photophobia. (10) The secretion is sticky., It is mainly caused by dry eyes, foreign body sensation, photophobia, blurred vision or vision fluctuation. Severe keratoconjunctival dryness is often manifested as keratoconjunctival dryness, ulcer, scar, corneal pannus, etc. lasting lesions can reduce corneal transparency and vision, affect work, study and life, and even lead to blindness., 3 treatment, 3. In TCM treatment, some scholars divided the disease into eight syndrome types: Qingfei Yiyin Decoction (Fangfeng, Schizonepeta tenuifolia, Scutellaria baicalensis, uncaria, Anemarrhena Anemarrhena, mulberry, Ophiopogon japonicus, Scrophularia Scrophularia, Guiwei, safflower, reed root, June snow and licorice); Zifei Yiyin Decoction (Radix ginseng, Ophiopogon japonicus, pollen, Angelica sinensis, Herba Cassiae, Dendrobium, Platycodon grandiflorum, Schisandra chinensis, Fangfeng, white peony and Polygonatum) is used to treat the deficiency of lung yin; Dehumidification Yiyin Decoction (Yuzhu, Fangfeng, tangerine peel, faxia, Scutellaria baicalensis, Perrin, Atractylodes rhizome, Poria cocos, clematis, Forsythia suspensa, talcum and licorice) is used for the treatment of Yin injury with damp heat: Sanren decoction is used for the treatment of spleen and stomach damp heat; Jiawei Yigong powder is used for the treatment of spleen and lung qi weakness; Jiawei Shizhen decoction is used for water does not contain wood; The treatment of liver depression and blood deficiency is based on Xiaoyao Powder; For kidney yang deficiency, use Fugui Dihuang Decoction. Studies have proved that Sangbaipi decoction, Yangyin Qingfei Decoction, Sanren Decoction and Qiju Dihuang pill are mainly used to treat the nostalgia for evil heat, deficiency of lung yin, damp heat of spleen and stomach, loss of liver and kidney and deficiency of Yin blood. According to Wang Gao’s treatment principle, the symptoms of internal dryness should be treated by moistening dryness and protecting the body fluid, the symptoms of yin deficiency should be treated by supplementing qi and distributing the body fluid, and the deficiency of fire should be treated by inducing fire to return to the original “. The deficiency of lung Yin should be treated by Yangyin Qingfei Decoction, the deficiency of liver and kidney Yin by Liuwei Dihuang Decoction, the deficiency of fire by Jingui Shenqi decoction, and the deficiency of spleen qi by Guipi Decoction.,   3。 2 acupuncture treatment, according to his condition, he Huiqin divided the acupuncture group into two types: Hot Yin injury and phlegm and blood stasis, taking Sibai, Yingxiang, Quchi, Hegu, Sanyinjiao, Sibai, Xuehai and Yinling respectively