| Objective: To observe the clinical effect and mechanism of Huang Ban Fu Ming decoction combined with acupuncture on the treatment of age-related macular degeneration,so as to further explore the TCM syndrome differentiation regularity of age-related macular degeneration,and supply clinical reference for treatment of the disease by combined use of acupuncture and medicine.Age-related macular degeneration(AMD)is the structure changes of macular area by aging,which often happens in people over 50 years.Changing according to age is its characteristic.It is a blinding eye disease characterized by metamorphopsia and central visual impairment,and has serious influence on patient's quality of life.There is no specific treatment for the disease in modern medicine.TCM named this disease as " blurred vision " and think this disease is caused by dysfunction of liver,spleen and kidney.The kidney domains boom and bust,and essence is stored in it,which can brighten eyes;Liver stores blood,and has relation with eyes,the blood can also nourish the eyes;Spleen domains transformation and transportation,and spleen deficiency could lead the produce of sputum which influence the vision.Thus,liver and kidney deficiency and spleen deficiency is the main pathogenesis of the disease.Professor Bai Shimiao treated this disease from liver,spleen,and kidney with treatment with nourishing liver and kidney,strengthening spleen and eliminating dampness,activating blood circulation and eliminating stasis.He created Huang Ban Fu Ming decoction as the basic prescription,and treat the disease according to syndrome differentiation and eyeground disease,he also combined with acupuncture treatment at the same time.The clinical effect is remarkable.Methods: 60 patients were enrolled according the diagnostic criteria for age-related macular degeneration,inclusion criteria and exclusion criteria.These patients were enrolled in He Bei province hospital of ophthalmology during March 2014 to January 2016.Then the patients were randomly divided into treatment group and control group,each group includes 30 cases.The two group have no significant difference in age,sex and course(P > 0.05).The treatment group was treated with Huang Ban Fu Ming decoction combined with acupuncture treatment;Control group were treated with vitamin C and vitamin E,combined with Qi Ye Yang Di Huang Shuang Gan eye drops.The course were 4 weeks.Then observe the clinical efficacy of two groups,subjective symptom(metamorphopsia,eyes shadow),optical coherence tomography imaging(OCT)changes.Treatment group: Treatment with Huang Ban Fu Ming decoction orally(gou qi zi?nv zhen zi?dan shen?dang gui?jue ming zi,everyone give 15 g.tu si zi?mu dan pi?fu ling?bai zhu?ju hua?mu zei?shi chang pu,everyone give 10 g,gives huang qi 10 g,gives san qi fen 3g,gives gan cao 6g).According to the clinical symptoms and fundus to add and subtract.300 ml,2 times each day.Acupuncture prescription: local point: tai yang?cuan zhu?cheng qi?feng chi ? yi ming.Distal points are selected according to clinical syndrome differentiation,and are took on both sides.Operation method: eye acupuncture points need to slowly advance the needle,there is sensation of soreness and distensionneedle.Do not twist the needle.To prevent bleeding after a needle to press gently with the disinfection swab pinhole 1-3 minutes.Distal acupoints should be combined with syndrome differentiation,using different methods: treating deficiency syndrome with tonifying methods,treating excess syndrome with purgative methods,mild reinforcing and attenuating.Retaining needle for 30 minutes each time,1 time/day.Control group: Treated with vitamin C(orally,0.2 g,three times/day),vitamin E(orally,0.1 g,1 time/day),both in half an hour after a meal.Qi Ye Yang Di Huang Shuang Gan eye drops,1 drop every time(4 times/day).The course is 4 weeks.Then observe the clinical curative effect before and after treatment.Results:1 Comparison of clinical effect of the two groups before and after the treatment(Table 6):According to the clinical effect evaluation standard,there were 30 cases in the treatment group,among which 8 cases excellence,effective 19 cases utility,3 cases nutility.The obvious effective rate was 26.7%,and the total effective rate was 90.0%.Among the 30 cases of the control group,1 case excellence,18 cases utility,11 cases nutility.The obvious effective rate was 3.3%,and the total effective rate was 63.3%.After processing of statistical analysis,there was significant difference between the two groups(P < 0.05),indicating combined use of acupuncture and medicine was superior to western medicine.2 Comparison of self-conscious symptom of two groups before and after the treatment(metamorphopsia,eyes shadow)(Table 4,Table 5):Metamorphopsia was alleviated in both groups,and the treatment group was better than the control group(P < 0.05).Eyes shadow was alleviated in the two groups and the treatment group was much better than the control group(P < 0.01).3 Comparison of OCT examination of the two groups before and after treatment(Table 7):According to the results of OCT examination,the drusen and edema and so on in the macular area were improved in the two groups,and the treatment group was better than the control group(P < 0.05).Conclusion:1 Huang Ban Fu Ming decoction combined with acupuncture was superior to the control group when came to clinical effect,subjective symptom,and OCT examination of age-related macular degeneration.2 Combing use of acupuncture and medicine was reliable,and could improve the systemic symptom.Besides,it could reduce the recurrence rate and also had the advantages such as anti-aging.3 Safety analysis:Both groups had no drug related adverse reactions during the treatment.4 Treatment of age-related macular degeneration with combined use of acupuncture and medicine embodied the features of traditional Chinese Medicine.The therapy was effective,cheap,convenient,and was worth prompting in the clinic. |
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