Clinical Study Of Acupuncture And Drug Combination Therapy For NAION Based On Xuanfu Theory

Objective: This study aims to explore the pathogenesis and treatment of non-arteritic anterior ischemic optic neuropathy(NAION)from the perspective of the Xuanfu theory.By observing the clinical efficacy of pressing needle combined with traditional Chinese medicine Buyang Huanwu Decoction in the treatment of NAION,the therapeutic effect of acupuncture and medicine combination on NAION is explored,providing new ideas for the clinical application of the Xuanfu theory in the diagnosis and treatment of NAION.Methods: The first part is theoretical research,which was to search for relevant literature on Xuanfu theory through CNKI,summarize the characteristics and applications of Xuanfu theory,analyze and explore the internal connection between Xuanfu theory and NAION,provide a basis for the application of Xuanfu theory,and provide guidance for the pathogenesis and clinical treatment of NAION.The second part is clinical study,used a randomized controlled trial to collect 60 patients with Qi deficiency and blood stasis type NAION who met the inclusion criteria from the ophthalmology outpatient department and ward of the Affiliated Hospital of Shandong University of Traditional Chinese Medicine from November 2020 to December 2022.They were randomly divided into a control group of 30 cases and a treatment group of 30 cases.On the basis of administering citicoline sodium capsules and compound Xueshuantong capsules to both groups,the treatment group was treated with pressing needle combined with traditional Chinese medicine Buyang Huanwu Decoction.Four weeks is one course of treatment,with two consecutive courses of treatment.The patients’ visual acuity(Log MAR BCVA),visual field(VFI,MD),retinal nerve fiber layer thickness(RNFLT),vessel density(VD),disease efficacy and TCM syndrome score were observed before treatment,after 4 weeks of treatment and after 8 weeks of treatment.Statistical analysis was conducted using SPSS26.0 software to objectively evaluate the clinical efficacy of the obtained results.Results:(1)Theoretical discussion: The Xuanfu theory is one of the fundamental theoretical systems in traditional Chinese medicine ophthalmology,and has important clinical application value.Since the structural and functional characteristics of the optic disc and the pathogenetic symptoms of NAION are related to the physiopathological characteristics of the xuanfu and the clinical manifestations of the eyes when the xuanfu is depressed and closed,respectively,the xuanfu theory is applied to NAION.Based on the theory of Xuanfu,the pathogenesis of NAION is characterized by a mixture of deficiency and reality.The ultimate foothold of the disease lies in the stagnation of Xuanfu caused by insufficient vitality,blood stasis in the eyes’ veins,loss of nourishment in the eye system,and increasingly abnormal expression of divine light.Therefore,this study chose NAION of Qi deficiency and blood stasis type as the research object.The main prescription of traditional Chinese medicine is Buyang Huanwu Decoction,with the basic principle of opening the Xuanfu and the basic treatment methods of "tonifying qi" and "removing blood stasis".The fundamental goal is to restore the normal opening and closing function of the Xuanfu.The external treatment uses pressing needle acupuncture to regulate Xuanfu,combined with the internal treatment of dispersing,searching,tonifying deficiency,and promoting blood circulation to achieve the function of opening Xuanfu.(2)General information: In this study,60 NAION patients(72 eyes)completed the study,with 30 cases(33 eyes)in the control group and 30 cases(39 eyes)in the treatment group.The majority of the research subjects are middle-aged and elderly patients,with 90% being over 45 years old,with an average age of 59.35 ± 10.24 years old.There were 27 cases(45%)with hypertension,15 cases(25%)with diabetes,9 cases(15%)with coronary heart disease,7 cases(11.7%)with hyperlipidemia,and 6 cases(10%)with cerebral infarction.(3)Baseline data comparison: There was no statistically significant difference(P>0.05)in the comparison of objective indicators such as eye type,gender,age,Log MAR BCVA,VFI,MD,RNFLT,VD,and TCM syndrome score between the two groups of NAION patients before treatment,indicating comparability of the study.(4)Comparison of objective indicators between groups: After 4 weeks of treatment,there was a statistically significant difference in VD between the two groups of NAION patients(P<0.05),while there was no statistically significant difference in other indicators(Log MAR BCVA,VFI,MD,RNFLT,and TCM syndrome score)(P>0.05).After 8 weeks of treatment,there was a statistically significant difference in VD and TCM syndrome score(P<0.05),The differences in other indicators(Log MAR BCVA,VFI,MD,and RNFLT)were not statistically significant(P>0.05).(5)Comparison of objective indicators within the group: There was no statistical difference in VFI between the control group and the control group(P>0.05),while there were statistical differences in RNFLT,VD,and TCM syndrome score(P<0.05);There was no statistically significant difference in MD between before and after 4 weeks of treatment(P>0.05),while there was a statistically significant difference in Log MAR BCVA between before and after4 weeks of treatment(P<0.05);There were statistical differences in Log MAR BCVA and MD between before and after 8 weeks of treatment(P<0.05);There was no statistically significant difference in Log MAR BCVA and MD between 4 weeks of treatment and 8 weeks of treatment(P>0.05).There were statistical differences(P<0.05)in the Log MAR BCVA,VFI,MD,RNFLT,VD,and TCM syndrome score compared in pairs within the treatment group.(6)Comparison of total effective rate: After 4 weeks of treatment,the total effective rate of the control group was 78.7%,while the total effective rate of the treatment group was 84.6%,with no statistically significant difference(P>0.05).After 8 weeks of treatment,the total effective rate in the control group was 78.8%,while the total effective rate in the treatment group was 92.3%,with a statistically significant difference(P<0.05).Conclusion: Based on the Xuanfu theory,the pathogenesis of NAION is insufficient vitality,Xuanfu stagnation,blood stasis in the eyes’ veins,loss of nourishment in the eye system,and increasingly abnormal expression of divine light.Opening the Xuanfu is the basic principle for treating NAION.The combination of pressing needle and Buyang Huanwu Decoction can treat NAION by combining internal and external treatment to open the Xuanfu,regulate local and systemic qi and blood,and achieve significant therapeutic effects in improving patient RPC vessel density and overall and eye discomfort symptoms.It is worth in-depth exploration and has clinical research value.