療效觀察

 

中醫藥治療病毒性角膜炎臨床觀察

 

中國•杭州市湖濱醫院中醫眼科  羅哲人


Zheren Luo:     Abstract:    Based on TCM theory, viral keratitis is caused by the accumulation of heat and toxic materials in liver and gallbladder, stagnation of liver Qi, wind-heat evils of the liver channel, or long-term ambushed exogenous wind-evil heat-toxicity in the liver and gallbladder. The basal pathogenesis of viral keratitis is the disordered transportation of Qi and blood as well as their further stagnation in the liver channels. The clinical symptoms and signs are usually including turbid cloudy corneas with irregular nebular, eyeball distention, pain, red eye membrane, wiry-rapid pulse, and yellow-sticky coating.  The general treatments are: 1) Oral doses of traditional Chinese medicine. The proven recipe Tui-Yi-San (Eliminate Nebula Powder) has the effect of dispelling the exogenous wind and clearing away heat, which consists of bupleurum root, schizonepeta, ledebouriella root, notopterygium root, pubescent angelica root, peppermint, chuanxiong rhizome, radix isatidis, periostracum cicada, shite atractylodes rhizome, scutellaria root, platycodon root, skin of immature bitter orange, rhizome smilacis glabrae, and earthworm etc. For cases with a red tongue, fresh rehmamia root and fresh rhizome should be added and for cases that include constipation, there is an addition of fresh rhubarb. 2) The external application of traditional Chinese medicine: The proven recipe Xiong-Huang-Gao is effective to clear heat and toxic materials, removing nebula. This formula consists of Fel Ursi, Radix Scutellariae, Corlex Phellodendri, Radix Gentianae, Rhizoma Coplidis, etc., and is prepared as eye-drops for external application in  combination with acupuncturing at the points Zanzhu, Sizhukong, Jingming, Taiyang, Hegu, Fengchi, Chengqi. In this report, 121 cases were treated using the above methods. The effectiveness rate was 45% for chronic cases; curative rate was 80.4% for acute cases.

 

    病毒性角膜炎是眼科中的疑難病症之一。由於其病症頑固,發展過程緩慢,治療週期長,且一般預後較差,加之在多數情況下尚存在著治療後遺症──“角膜斑翳。因此,如不及時採取積極有效的治療措施,不僅會使患者的視力受到嚴重損害,嚴重者可導致失明。本院自19941995年收治了不同程度的病毒性角膜炎患者共121例, 其中男38例,女83例,年齡最大為62歲,最小為14歲,病程最長者為9年,最短為一週。經檢查確診後, 分別採用抗病毒消翳、清熱敗毒之中藥內服,純中藥製劑眼藥外敷等綜合治療方法治療,新發生病例療程最短為42天,陳舊性病例最長為15個月,治療結果統計表明:採用本方案對陳舊性病例的有效率可達45%,新發生病例治癒率可達80.4%, 分別經1~3個月的隨訪,療效鞏固。

治療方法

    一、內治法:驗方退翳散加減。黑睛屬風輪內應於肝,風熱上犯熏灼黑睛致黑睛渾濁生翳。治宜祛風清熱方:柴胡6g,荊芥9g,防風9g,羌活4g,獨活4g,薄荷6g,川芎6g,板藍根6g,蟬衣9g,白朮9g,黃芩9g,桔梗9g,枳殼6g,土茯苓9g,地龍9g 若舌質紅可加鮮生地15g,鮮石斛15g,便秘加生軍9g

    二、外治法:驗方熊黃膏,功能清熱,解毒,退翳。方用熊膽5g,西黃1g,黃芩15g,黃柏15g,龍膽草15g,川連15g,野荸薺10g,月石2g,蘆甘石2g,珠粉3g,和上藥,梅冰2g(後加),煎汁濾淨濃縮加蜂蜜適度收薄膏,滴眼,每日三次。

    三、刺穴法:取穴攢竹空、絲竹空、睛明、太陽、合谷、風池、承泣,以瀉法刺之。

典型病例

    ××,女,70歲,住本市登雲新村。1991613日初診。主訴:患眼疾五個多月,經多處醫院檢查診斷病毒性角膜炎,久治未癒,來本院中眼科就診。檢查:右眼角膜混濁,可見白色絮狀斑翳彌漫,結膜充血水腫、瞳孔對光反映遲鈍,可見虹膜輕度粘連、視力光感、眼球壓痛較著,脈弦數,苔薄黃而膩。

    臨床分析:患者初起外感風寒,日久不癒,風邪熱毒內攻,致肝經風熱上壅、熏灼黑睛,故混濁不清,抱輪紅赤,因熱毒鬱結上攻目系致眼球腫痛,又因頭為諸陽之會,眼為清竅之所,風熱上擾,故頭痛眼脹,納差,便秘,心煩,皆因熱盛化火鬱結不散所致。

    治療經過:

    1、外治:(1)驗方熊黃膏滴眼每日三次。(2)右眼虹膜部分粘連而成瞳孔乾缺(不規則),用1%阿托品眼藥水滴眼,每天一次,防止瞳孔閉鎖等嚴重後遺症。

    2、內治:(1)首用銀翹散加減以祛風清熱。(2)外感控制後即服驗方退翳散加減。加生軍以清熱瀉火,使鬱結之火毒得以緩解,經一個月內外兼治,達消翳退障之功效。

    3、刺穴法:取穴太陽、風池、合谷、曲池、睛明,用瀉法輔助內治以達祛風散熱。

    患者於40天後復查,角膜透明度正常、結膜充血消除,視力恢復0.6(患者原有老年性白內障,發病前視力為0.6)。

   

    中醫認為頭為諸陽之會,清陽之府,又為髓海所在,凡五臟精華之血皆上注於目而涵目。故凡六淫之邪上犯巔頂,邪氣稽留,導致氣血逆亂,瘀阻經絡致目發病。其症黑睛渾濁(角膜)兼有條狀不規則之斑翳增生,視力下降,眼球脹痛伴有少量赤膜起於黑睛邊際。或因患者身體素質偏弱,生活起居失常,寒暖不調,或遇外邪侵襲年邁體虛,過度勞累。初起皆伴外感之症,日久風邪熱毒內侵、鬱結化火上攻於目而致黑睛斑翳叢生,視力下降,體徵:精神倦怠,納差,脈弦,苔微黃而膩。

    病毒性眼角膜炎的治療,從臨床觀察分析,凡由外感風邪引起而致邪入於內鬱結化火,宜祛風清熱為先導。因肝氣鬱結,肝陽上亢者當以平肝清熱主之。在治療該症時必須同時重視外用藥的應用。驗方熊黃膏以熊膽、西黃為君,從多例病案中觀察熊膽和西黃對角膜疾病特別是病毒性眼疾有較好的抑制作用,佐以黃連、黃柏、黃芩、龍膽草而達清熱、敗毒之功;月石、蘆甘石、野荸薺退翳消障,珠粉生肌,採用內外兼治法當能有較滿意的療效。



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