Study On The Academic Thoughts And Clinical Experiences Of Zhuang Zengyuan Applying The Theory Of Xuanfu In Eye Diseases Treatment

BackgroudThe academic thinking and clinical experience of the prominent TCM doctors is the fortune of TCM. It is the tiptop of TCM academic development. Studying the academic thinking and clinical experience of the prominent TCM doctors is very important to preservation and innovation of TCM.The theory of Xuanfu is an important part of TCM theory, which provide a new idea for the prevention and treatment of many intractable diseases. Its clinical value and application prospect had been shown. The systematic study on the academic thinking and clinical experience of prominent TCM doctors applying the theory of Xuanfu in eye diseases is not been found so far. Zhuang Zengyuan has been learned, researched and applied the theory of Xuanfu in clinical practice for many years. He summarized many methods of recanalizing Xuanfu. It has significant therapeutic effect on ophthalmic intractable diseases with the methods. Therefore, summarizing the academic thinking of Zhuang Zengyuan applying the theory of Xuanfu in eye diseases is highly important for enriching ophthalmic theory of TCM.Objective1. To summarize the academic thinking and the clinical experience of Zhuang Zengyuan applying the theory of Xuanfu in eye diseases and its theoretical origin, in order to provide a new idea for the prevention and treatment of intractable diseases in ophthalmology.2. To evaluate the efficacy of Chailing decoction therapy in patients with serous pigment epithelium detachment secondary to age-related macular degeneration.Methods1. Literature Research1.1 Literature research method was performed to summarize the academic origin of Pro. Zhuang Zengyuan.1.2 Literature research method was performed to summarize the theoretical origin of theory of Xuanfu according to time sequence of its formation and development.2. Theoretical Research2.1 Original medical records and learning notes were classified and sorted. Experience summary and individual cases analysis method were adopted to summarize systematically the clinical experience of Zhuang Zengyuan applying Xuanfu theory in eye diseases.2.2 A systematic investigation of the clinical experience of Zhuang Zengyuan applying Xuanfu theory in eye diseases was performed. His academic thinking was extracted according to it, which included Xuanfu theory playing a very important role in ophthalmology and treating age-related macular degeneration based on Xuanfu theory.3. Clinical ResearchIn a prospective case series, the included patients were diagnosed AMD patients with serous PED. They received Chailing decoction orally twice daily for a period of 6 months. Baseline and follow-up visits included best-corrected visual acuity, complete ophthalmic examination, and optical coherence tomography(OCT). Fundus fluorescein angiography(FFA) and indocyanine green angiography(ICGA) was performed at baseline. The change in visual acuity and maximum PED height from baseline to month 6 was determined.Results1. Theoretical Origin1.1 Increasingly perfecting of Zhuang Zengyuan’s academic thinking and continuous enrichment of his clinical experience is based on reading the TCM classics, selecting the prominent teachers and practising more.1.2 The theoretical origin of the Xuanfu theory. Canon of Medicine lay a theoretical foundation for Xuanfu theory. Liu Wansu inherited and developed Xuanfu theory in Jin-Yuan dynasties. He considered that Xuanfu exsited in all things on earth and it was the portal of the ascending, descending, exiting and entering of Qi. He suggested that Xuanfu occlusion was the basic pathogenesis of many diseases, and therefore the recanalizing of Xuanfu was very important in disease treatment, meanwhile, he applied firstly Xuanfu theory to the field of ophthalmology. Xuanfu theory was improved and its application was enlarged in eye diseases in Ming-Qing dynasties.2. Academic Thinking2.1 Xuanfu theory plays a very important role in ophthalmology. Xuanfu exsits in every part of the eye, which is the portal of the ascending, descending, exiting and entering of original essence, Qi, blood, body fluid and spirit. The reason that the eye maintain normal function is that the essencial Qi of Zang Fu can continuously reach its area through the unobstructed Xuanfu. Dredging Xuanfu plays an important role in the treatment of many eye diseases because Xuanfu occlusion is the basic pathogenesis of them. The practical therapy of dredging Xuanfu is different because of the different causes of Xuanfu occlusion, therefore, we must comply with the basic pathogenesis of Xuanfu occlusion in clinical practice. Dr. Zhuang attaches great importance to the relationship between depression and deficiency, and advocates the compatible effects of tonics and dredging drugs.2.2 Differentiating and treating of age-related macular degeneration(AMD) based on Xuanfu Theory. AMD is divided into four types of TCM syndromes based on Xuanfu theory. The first one is deficiency of original essence and Qi. It is common in the early stage of AMD. The deficiency of kidney essence may lead to the insufficiency of Qi and blood in the aged, and furthermore the latter can cause Xuanfu occlusion because of lacking of nutrition. The principle of treatment is nourishing kidney and benefiting essence. The second one is imbalance of Qi and body fluid Whose therapeutic principle is dredging Xuanfu because Xuanfu occlusion leads to accumulation and retention of excessive fluid. The third one is collaterals being injured and bleeding Whose therapeutic principle will be cooling blood and clearing stasis. The last one is stagnation of phlegm and stasis. The therapeutic principle is activiating blood and dissolving stasis.3. Clinical Experience3.1 External oculopathy could be treated by dispelling wind and dredging Xuanfu. External oculopathy is caused by Xuanfu occlusion, which is induced by exogenous pathogenic factors and heat evil stagnating in the eye. Wind is frequently the guide of them. Therefore, dispelling wind will play an important role in the treatment of external oculopathy. ① The vernal conjunctivitis is mostly caused by Xuanfu occlusion of Qilun due to wind and lung heat, whose therapeutic principle could include not only dispelling wind and clearing away lung heat but also dredging Xuanfu. (2)Herpes simplex keratitis is mostly caused by wind-heat blocking Xuanfu of cornea. The principle of treatment will be focused on expelling wind, reducing heat and dredging Xuanfu. ③ Blepharitis is mostly induced by Xuanfu obstruction of Roulun, which is caused by wind, damp and heat stagnating in the lid margin. Eliminating dampness is a major treatment measure because heat is attached on dampness.3.2 Internal oculopathy may be caused by Xuanfu obstruction due to the deficiency of original essence and Qi, or due to the main pathogenic factors such as heat, stasis, phlegm and dampness. So dredging Xuanfu will play an important role in the treatment of the internal oculopathy. ②　Leber hereditary optic neuropathy is caused by Xuanfu occlusion due to the congenital deficiency of kidney essence. Its treatment will be focuse on nourishing kidney, benefiting essence and dredging Xuanfu. Xuanfu occlusion is also the basic pathogenesis of optic atrophy although its etiology is complicated. dredging Xuanfu is the principle of treatment of optic atrophy. ② The pathogenesis of primary retinitis pigmentosa is based on deficiency of essence and blood which may lead to Xuanfu occlusion. ③ The pathogenesis of pathologic myopia is based on congenital deficiency of kidney essence which nourishes liver, thus causing Xuanfu occlusion due to the deficiency of liver blood. The key treatment is to nourish blood, benefy essence and dredge Xuanfu.3.3 Prof. Zhuang is good at applying wind-drug. He thinks that wind-drug has mild and lively properties and can reach each part of the body. It could dredge striae of skin outside as well as Xuanfu inside.4. Effect of Chailing decoction for serous retinal pigment epithelium detachment associated with age-related macular degeneration.Twenty-nine patients were included and completed the trial with Chailing decoction treatment. During the 6 months of the trial. The visual acuity improved or remained stable in 24 eyes (89.7%), and 12 eyes (41.4%) showed a significant increase (≥2 lines). In 20 eyes (69.0%), Mean maximum PED height was reduced at last visit, including complete flattening in 8 eyes (27.6%). There was no significant difference in retinal thickness between pre and post treatment. Pigment epithelium detachment response to treatment did not correlate with visual acuity at baseline. No patient sustained the retinal pigment epithelium rip and the subretinal hemorrhage, as well as other side effects during the study period.ConclusionsZhuang Zengyuan applying the theory of Xuanfu in eye diseases has notable curative effect, especially in intractable diseases in ophthalmology. His academic thinking and the clinical experience applying Xuanfu theory provide a new idea for the prevention and treatment of intractable diseases in ophthalmology. Chailing decoction can improve and stabilize the visual acuity of patients with serous retinal pigment epithelium detachment associated with age-related macular degeneration, meanwhile, it reduce the fluid within the PED. It is highly safe to use Chailing decoction in patients with serous retinal pigment epithelium detachment associated with age-related macular degeneration.