针刺对不同中医证型原发性开角型青光眼眼压影响的临床观察
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摘要
青光眼是一组威胁视神经视觉功能,主要与眼压升高有关的临床征群或眼病,即眼压超过了眼球内组织,尤其是视网膜视神经所能承受的限度,将带来视功能的损害。原发性开角型青光眼是指病理性高眼压引起视神经乳头损害和视野缺损,而且眼压升高时前房角开放的一类青光眼。本病发病隐蔽,早期常无自觉症状,诊断困难故不易被察觉,而视野逐渐缩小,最后视力不可逆的完全丧失,它属于中医学“青风内障”病范畴。本研究在参阅国内外相关文献,了解青光眼研究现状的基础上,通过临床观察,客观评价针刺对治疗不同中医证型原发性开角型青光眼的临床效果,研究针刺治疗原发性开角型青光眼的临床价值及意义,并探讨针刺治疗原发性开角型青光眼中医辩证论治的必要性,为原发性开角型青光眼的针刺治疗提供新的临床思路。
第一部分文献研究
本文综述了从《黄帝内经》到唐宋元明清时期祖国医学对原发性开角型青光眼的病名、病因病机、治疗方法的认识,及现代中医家在临床上对原发性开角型青光眼针灸治疗的研究成果,并总结国内外西医学者对本病的流行病学、病因病理、发病机制、诊断及治疗的研究进展,及国内外目前对原发性开角型青光眼研究的趋势及方向。
第二部分临床研究
1、目的:观察针刺球后、太阳、合谷、太冲(均取双侧)对不同中医证型原发性开角型青光眼各时段眼压的影响,探讨原发性开角型青光眼辩证取穴的必要性。
2、方法:对纳入本研究的原发性开角型青光眼患者28例47眼次进行辩证分型,进而针刺固定穴位,记录针刺前、针刺后即时、针刺后30分钟、针刺后1小时的眼压变化,通过自身前后对照,观察针刺对不同中医证型的原发性开角型青光眼患者的眼压变化的影响。
3、结果:
(一)原发性开角型青光眼患者的中医证型分布中,气郁化火证组患者最多(53.2%),痰湿泛目证及肝肾亏虚证组患者较少(分别为25.5%、21.3%)。
(二)原发性开角型青光眼各中医证型组年龄、病程比较。提示原发性开角型青光眼不同中医证型组之间的年龄比较,从低到高依次是痰湿泛目证组＜气郁化火证组＜肝肾亏虚证组,各组之间差别有统计学意义(P＜0.01或P＜0.05)。不同中医证型之间病程的比较显示,从短到长依次为痰湿泛目证组＜气郁化火证组＜肝肾亏虚证组,其中气郁化火证组与痰湿泛目证组之间差别无统计学意义(P＞0.05),而气郁化火证组与肝肾亏虚证组、痰湿泛目证组与肝肾亏虚证组之间差别有统计学意义(P＜0.05)。
(三)原发性开角型青光眼各中医证型组就诊时的初始眼压无明显差别(P＞0.05)。
(四)原发性开角型青光眼各中医证型组针刺后不同时段眼压变化的对比。提示针刺后各时段原发性开角型青光眼眼压均有不同程度的下降,其中气郁化火证组各时段下降幅度均大于其他两组,且之间差别有统计学意义(P＜0.01或P＜0.05)。痰湿泛目证组与肝肾亏虚证组之间对比针刺后眼压各时段下降幅度均无统计学意义(P＞0.05)。
第三部分结论
一、原发性开角型青光眼患者的中医证型中,气郁化火证组患者最多(53.2%),痰湿泛目证及肝肾亏虚证组患者较少(分别为25.5%、21.3%)。表明原发性开角型青光眼与肝经之间有密切的关系,本病的发生主要与肝的阴阳气血失调有关。
二、原发性开角型青光眼不同中医证型之间的年龄比较,从低到高依次是痰湿泛目证组＜气郁化火证组＜肝肾亏虚证组;不同中医证型之间病程的比较显示,从短到长依次为痰湿泛目证组＜气郁化火证组＜肝肾亏虚证组。提示原发性开角型青光眼的中医证型由实证向虚证发展的趋势。
三、原发性开角型青光眼各中医证型就诊时的初始眼压无明显差别。
四、原发性开角型青光眼针刺治疗后各时段,气郁化火证组的眼压下降幅度明显优于痰湿泛目证组及肝肾亏虚证组。痰湿泛目证组与肝肾亏虚证组各时段眼压下降幅度之间无明显差别。结果提示针刺的疗效可能跟太冲穴的经络特异性、四关穴的配伍作用有关,从而佐证我们在临床针刺中有必要进行辩证取穴,提高针刺对原发性开角型青光眼的疗效。
Glaucoma is a group of clinical syndromes or eye diseases that threaten the vision of optic nerve and mainly being relative to ocular hypertension. that is,more than intraocular pressure within the eyeball organizations,in particular the retinal optic nerve can bear the very least,will bring damage to visual function.Primary open-angle glaucoma, a type of glaucoma,is that patho-intraocular hypertension causes the damage to the optic papilla and visual field defect,and that angle of anterior chamber is open during intraocular hypertention.At the onset, this disease is hidden,often no early symptoms,and difficult to diagnose,so it is difficult to detect,but thethe field of vision will gradually narrower,and finally the vision loss completely and irreversibly. It belongs to qingfengneizhang in Traditional Chinese Medicine (TCM).This research based on referring to domestic and international literature and mastering the current research situation,objectively assessed the clinical value and significance in the acupuncture's influence on intraocular tension of POAG with different TCM syndromes, explored the need of dialectical treatment of primary open-angle glaucoma, and provided a new idea to primary open-angle glaucoma acupuncture treatment.
Part one Literature Research
This paper summarized the name,pathogenesis,treatmentof POAG in TCM from "Huang Di Nei Jing" to the Tang,Song,Yuan,Ming and Qing periods, and modern traditional Chinese physician's achievements results of research on acupuncture treatment of POAG in clinic.It alao summarized the domestic and foreign scholars's progress on the epidemiology,etiology, pathology,pathogenesis,diagnosis and treatment,and the research trend and directionat of POAG,at home and abroad now.
Part two Clinical Research
1.Objective:To observe the influence b on intraocular tension of POAG with different TCM syndromes after acupuncture,with the Qiuhou,Taiyang, Hegu,Taichong(both from bilateral),and explore the need to choose points in the treatment of POAG with different TCM syndromes.
2.Method:28 POAG patients with 47 eyes were included in this study,we first gave a dialectical type to each patient,then acupunctured with the fixed points,and recorded intraocular pressure before acupuncture treatment, the time just after acupuncture treatment,30 minutes and 1 hour after the treatment.Through its own control before and after,the observation of intraocular pressure change of POAG with different TCM Syndromes.
3.Result
(1)Among the primary open-angle glaucoma patients,the ratio of syndrome of stagnated QI transforming into fire was highest(53.2%),the ratio of syndrome of phlegmatic hygrosis drifting eye and asthenia on both liver and kidney was lower(25.5%,21.3%).
(2)To compared the age and course of POAG with different TCM syndromes: From younger to older,the age followed by the group of syndrome of phlegmatic hygrosis drifting eye0.05),while the differences between the group of syndrome of stagnated QI transforming into fire and the group of syndrome of phlegmatic hygrosis drifting eye,and the group of syndrome of stagnated QI transforming into fire and the group of syndrome of asthenia on both liver and kidney were significant (P＜0.O5).
(3)The patients of POAG with different TCM syndromes had no significant difference in the initial intraocular pressure(P＞0.05).
(4)To compare intraocular pressure's change on different time after the acupuncture treatment on POAG with different TCM syndromes:All the patients's intraocular pressure was decline in different degree,the group of syndrome of stagnated QI transforming into fire was larger than the other two groups,and there were significant differences between them(P＜0.01 or P＜0.05).The differences between the group of syndrome of phlegmatic hygrosis drifting eye and the group of syndrome of asthenia on both liver and kidney were not significant on different time(P＞0.05). Part three Conclusion
First,Among the primary open-angle glaucoma patients,the ratio of syndrome of stagnated QI transforming into fire was highest(53.2%),the ratio of syndrome of phlegmatic hygrosis drifting eye and asthenia on both liver and kidney was lower(25.5%,21.3%).It showed that the relation between POAG and liver meridian was close,the imbalance of yinyang,Qi,and blood of liver induced POAG.
Second,to compared the age and course of POAG with different TCM syndromes:From younger to older,the age followed by the group of syndrome of phlegmatic hygrosis drifting eye＜the group of syndrome of stagnated QI transforming into fire＜the group of syndrome of asthenia on both liver and kidney.From shorter to longer,the course followed by the group of syndrome of phlegmatic hygrosis drifting eye＜the group of syndrome of stagnated QI transforming into fire＜the group of syndrome of asthenia on both liver and kidney.It shaowed TCM syndromes of POAG had the tendency which from sthenia syndrome to asthenia syndrome.
Third,the patients of POAG with different TCM syndromes had no significant difference in the initial intraocular pressure.
Fourth,To compare intraocular pressure's change on different time after the acupuncture treatment on POAG with different TCM syndromes: The group of syndrome of stagnated QI transforming into fire was larger than the other two groups,The differences between the group of syndrome of phlegmatic hygrosis drifting eye and the group of syndrome of asthenia on both liver and kidney were not significant on different time.It showed that the acupuncture influence was relative to Taichong's specificity in meridian and Siguan's compatibility effect,and this supported the need to choose point dialecticaly in acupuncture treatment of POAG.
第一部分文献研究
本文综述了从《黄帝内经》到唐宋元明清时期祖国医学对原发性开角型青光眼的病名、病因病机、治疗方法的认识,及现代中医家在临床上对原发性开角型青光眼针灸治疗的研究成果,并总结国内外西医学者对本病的流行病学、病因病理、发病机制、诊断及治疗的研究进展,及国内外目前对原发性开角型青光眼研究的趋势及方向。
第二部分临床研究
1、目的:观察针刺球后、太阳、合谷、太冲(均取双侧)对不同中医证型原发性开角型青光眼各时段眼压的影响,探讨原发性开角型青光眼辩证取穴的必要性。
2、方法:对纳入本研究的原发性开角型青光眼患者28例47眼次进行辩证分型,进而针刺固定穴位,记录针刺前、针刺后即时、针刺后30分钟、针刺后1小时的眼压变化,通过自身前后对照,观察针刺对不同中医证型的原发性开角型青光眼患者的眼压变化的影响。
3、结果:
(一)原发性开角型青光眼患者的中医证型分布中,气郁化火证组患者最多(53.2%),痰湿泛目证及肝肾亏虚证组患者较少(分别为25.5%、21.3%)。
(二)原发性开角型青光眼各中医证型组年龄、病程比较。提示原发性开角型青光眼不同中医证型组之间的年龄比较,从低到高依次是痰湿泛目证组＜气郁化火证组＜肝肾亏虚证组,各组之间差别有统计学意义(P＜0.01或P＜0.05)。不同中医证型之间病程的比较显示,从短到长依次为痰湿泛目证组＜气郁化火证组＜肝肾亏虚证组,其中气郁化火证组与痰湿泛目证组之间差别无统计学意义(P＞0.05),而气郁化火证组与肝肾亏虚证组、痰湿泛目证组与肝肾亏虚证组之间差别有统计学意义(P＜0.05)。
(三)原发性开角型青光眼各中医证型组就诊时的初始眼压无明显差别(P＞0.05)。
(四)原发性开角型青光眼各中医证型组针刺后不同时段眼压变化的对比。提示针刺后各时段原发性开角型青光眼眼压均有不同程度的下降,其中气郁化火证组各时段下降幅度均大于其他两组,且之间差别有统计学意义(P＜0.01或P＜0.05)。痰湿泛目证组与肝肾亏虚证组之间对比针刺后眼压各时段下降幅度均无统计学意义(P＞0.05)。
第三部分结论
一、原发性开角型青光眼患者的中医证型中,气郁化火证组患者最多(53.2%),痰湿泛目证及肝肾亏虚证组患者较少(分别为25.5%、21.3%)。表明原发性开角型青光眼与肝经之间有密切的关系,本病的发生主要与肝的阴阳气血失调有关。
二、原发性开角型青光眼不同中医证型之间的年龄比较,从低到高依次是痰湿泛目证组＜气郁化火证组＜肝肾亏虚证组;不同中医证型之间病程的比较显示,从短到长依次为痰湿泛目证组＜气郁化火证组＜肝肾亏虚证组。提示原发性开角型青光眼的中医证型由实证向虚证发展的趋势。
三、原发性开角型青光眼各中医证型就诊时的初始眼压无明显差别。
四、原发性开角型青光眼针刺治疗后各时段,气郁化火证组的眼压下降幅度明显优于痰湿泛目证组及肝肾亏虚证组。痰湿泛目证组与肝肾亏虚证组各时段眼压下降幅度之间无明显差别。结果提示针刺的疗效可能跟太冲穴的经络特异性、四关穴的配伍作用有关,从而佐证我们在临床针刺中有必要进行辩证取穴,提高针刺对原发性开角型青光眼的疗效。
Glaucoma is a group of clinical syndromes or eye diseases that threaten the vision of optic nerve and mainly being relative to ocular hypertension. that is,more than intraocular pressure within the eyeball organizations,in particular the retinal optic nerve can bear the very least,will bring damage to visual function.Primary open-angle glaucoma, a type of glaucoma,is that patho-intraocular hypertension causes the damage to the optic papilla and visual field defect,and that angle of anterior chamber is open during intraocular hypertention.At the onset, this disease is hidden,often no early symptoms,and difficult to diagnose,so it is difficult to detect,but thethe field of vision will gradually narrower,and finally the vision loss completely and irreversibly. It belongs to qingfengneizhang in Traditional Chinese Medicine (TCM).This research based on referring to domestic and international literature and mastering the current research situation,objectively assessed the clinical value and significance in the acupuncture's influence on intraocular tension of POAG with different TCM syndromes, explored the need of dialectical treatment of primary open-angle glaucoma, and provided a new idea to primary open-angle glaucoma acupuncture treatment.
Part one Literature Research
This paper summarized the name,pathogenesis,treatmentof POAG in TCM from "Huang Di Nei Jing" to the Tang,Song,Yuan,Ming and Qing periods, and modern traditional Chinese physician's achievements results of research on acupuncture treatment of POAG in clinic.It alao summarized the domestic and foreign scholars's progress on the epidemiology,etiology, pathology,pathogenesis,diagnosis and treatment,and the research trend and directionat of POAG,at home and abroad now.
Part two Clinical Research
1.Objective:To observe the influence b on intraocular tension of POAG with different TCM syndromes after acupuncture,with the Qiuhou,Taiyang, Hegu,Taichong(both from bilateral),and explore the need to choose points in the treatment of POAG with different TCM syndromes.
2.Method:28 POAG patients with 47 eyes were included in this study,we first gave a dialectical type to each patient,then acupunctured with the fixed points,and recorded intraocular pressure before acupuncture treatment, the time just after acupuncture treatment,30 minutes and 1 hour after the treatment.Through its own control before and after,the observation of intraocular pressure change of POAG with different TCM Syndromes.
3.Result
(1)Among the primary open-angle glaucoma patients,the ratio of syndrome of stagnated QI transforming into fire was highest(53.2%),the ratio of syndrome of phlegmatic hygrosis drifting eye and asthenia on both liver and kidney was lower(25.5%,21.3%).
(2)To compared the age and course of POAG with different TCM syndromes: From younger to older,the age followed by the group of syndrome of phlegmatic hygrosis drifting eye
(3)The patients of POAG with different TCM syndromes had no significant difference in the initial intraocular pressure(P＞0.05).
(4)To compare intraocular pressure's change on different time after the acupuncture treatment on POAG with different TCM syndromes:All the patients's intraocular pressure was decline in different degree,the group of syndrome of stagnated QI transforming into fire was larger than the other two groups,and there were significant differences between them(P＜0.01 or P＜0.05).The differences between the group of syndrome of phlegmatic hygrosis drifting eye and the group of syndrome of asthenia on both liver and kidney were not significant on different time(P＞0.05). Part three Conclusion
First,Among the primary open-angle glaucoma patients,the ratio of syndrome of stagnated QI transforming into fire was highest(53.2%),the ratio of syndrome of phlegmatic hygrosis drifting eye and asthenia on both liver and kidney was lower(25.5%,21.3%).It showed that the relation between POAG and liver meridian was close,the imbalance of yinyang,Qi,and blood of liver induced POAG.
Second,to compared the age and course of POAG with different TCM syndromes:From younger to older,the age followed by the group of syndrome of phlegmatic hygrosis drifting eye＜the group of syndrome of stagnated QI transforming into fire＜the group of syndrome of asthenia on both liver and kidney.From shorter to longer,the course followed by the group of syndrome of phlegmatic hygrosis drifting eye＜the group of syndrome of stagnated QI transforming into fire＜the group of syndrome of asthenia on both liver and kidney.It shaowed TCM syndromes of POAG had the tendency which from sthenia syndrome to asthenia syndrome.
Third,the patients of POAG with different TCM syndromes had no significant difference in the initial intraocular pressure.
Fourth,To compare intraocular pressure's change on different time after the acupuncture treatment on POAG with different TCM syndromes: The group of syndrome of stagnated QI transforming into fire was larger than the other two groups,The differences between the group of syndrome of phlegmatic hygrosis drifting eye and the group of syndrome of asthenia on both liver and kidney were not significant on different time.It showed that the acupuncture influence was relative to Taichong's specificity in meridian and Siguan's compatibility effect,and this supported the need to choose point dialecticaly in acupuncture treatment of POAG.
引文
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[51]Leske MC,Connel AM,Wu AM,et al.Risk factors for open-angle the Barbados Eve Study[J].Arch Ophthalmol,1995,113(7):918-924.
[52]Gottfredsdottir MS,Sverrisson T,Musch PC,et al.Chronic open-angle glaucoma and associated ophthalmic findings in monozygotic twins and their spouses in iceland[J].J Glaucoma,1999,8(2):134-139.
[53]Wolfs RCW,Claver CCW,Ramrattan RS,et al.Genetic risk of primary open-angle glaucoma[J].Arch Ophthalmol,1998,116(8):1640-1645.
[54]Sheffield VC,Stone EM,Alward WL,et al.Genetic linkage of familial open-angle glaucoma to chromosome 1q21-31[J].Nat Genet,1993,4(1):47-50.
[55]Stone EM,Fingert JH,Aiward MLM,et al.Identifcation of a gene that causes primary open angle glaucoma[J].Science,1997,275(5300):668-670.
[56]李春武,徐聊红,满晓波.原发性开角型青光眼致病基因研究的新进展.美中眼科杂志.2001:1(3):85-87.
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[64]Meyer J H,et al.Br J Ophthalmol,1996,80:864.
[65]Flammer J.Ocular Blood Flow,Basel,Karger,1996,12.
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