Literature Review And Analysis Of Acupuncture And Moxibustion In The Treatment Of Age-related Macular Degeneration

Objective:The article is aimed to collecte and analyze the ancient literature on Age-related Macular Degeneration(AMD),in the aspects of disease name,etiology and pathogenesis,principles and methods of treatment,and then summarize the development of AMD and the experience of medical doctors in the past dynasties.At the same time,the author use the evidence-based medicine and statistical methods to analyze the modern literature on the treatment of AMD by acupuncture and moxibustion,systematically evaluate its effectiveness and safety,and explore the regulations of acupoint selection,so as to provide certain basis and guidance for clinical application and research.Methods:1.Using the fifth edition of the Encyclopedia of Traditional Chineses Medicine to retrieve the Age-related Macular Degeneration with its traditional Chinese name "Shizhan Hunmiao"and its name of related symptoms or alias "Yunwu Yijing","Shizhi Ruqu","Shiwu Yixing","Xueguan Tongshen","Shizhan","Baomang","Shihuo","Muwangjian","Mumangmang","Mubuming" and so on,with catalogue search and full text search respectively,and correcte the relevant provisions with ancient books.Collect documents that meet the requirements,and summarize the development history of AMD and the experience of doctors in the past dynasties by taking the disease name,etiology,pathogenesis and treatment principle as the outline,and taking time as the axis.2.Search for the electronic databases including CNKI,Wanfang Database,VIP,CBM,PubMed,Embase,Cochrane Library and Web of Science from the establishment of the database to December 31,2020,to collect domestic and foreign randomized controlled trials on acupuncture and moxibustion in the treatment of AMD.According to the inclusion and exclusion criteria,two researchers independently screen the literatures,extract the data and check the results strictly.Cochrane bias risk assessment tool was used for quality assessment,and RevMan5.3 software was used for Meta-analysis.Randomized controlled trials,clinical observations and empirical cases of acupuncture and moxibustion in AMD were selected to extract their acupoint prescriptions,analyze the rules of acupoint selection from the aspects of high frequency acupoints,common meridians,distribution of acupoints and common combination,by using the acupoint analysis module in the "data analysis" of the traditional Chinese medicine inheritance calculation platform(V3.0)system.Results:1.AMD in ancient belongs to "Muhun","Muwu Suojian","Mumangmang","Mubuming","Shiwu Bujian","Shihuo","Wangjian" and so on.The first record about this description can be traced back to "Neijing",and generations of physicians have discussed."Zhengzhi Zhunsheng·Qiqiaomen·Mu" by Kentang Wang of Ming Dynasty has put forward the name of "Shizhan Hunmiao" for the first time,It has been used to this day.Wet AMD patients,with macular massive bleeding into the vitreous and vision sudden drop,can be attributed to the traditional Chinese medicine "blood perfusion pupil","sudden blindness"category.The understanding of this disease was mainly attributed to "lack of water","excess fire","great deficiency of qi" or "blood stasis".The main treatment method is Traditional Chinese medicine,which is recorded in the "Zhengzhi Zhunsheng" in detail.Traditional Chinese medicine is divided into internal medicine and external medicine,mainly from the aspects of tonifying liver and kidney,tonifying qi and nourishing blood,promoting blood circulation and removing blood stasis,nourishing Yin and clearing heat.Acupuncture and moxibustion is recorded in detail in "Acupuncture and Moxibustion Zishengjing".Acupoints around the eyes are commonly used,and then dialectically compatible according to systemic symptoms.The commonly used meridians are the three Yang meridians of hands and feet.Moxibustion can be used for deficiency syndrome,while heat syndrome can prick collateral and let blood.The methods of Daoyin to cure the invisibility is recorded in "Zhubing Yuanhoulun·Mubing Zhuhou",It's of great guiding significance to the later generations.2.A total of 11 literatures including 752 AMD patients(838 eyes)were included in this Meta-analysis.The results showed that:(1)10 literatures reported the total clinical response rate,with RR and 95%CI of 1.31[1.21,1.42],P<0.00001;(2)Five literatures reported visual efficacy,with SMD and 95%CI of 0.65[0.35,0.95],P<0.0001;(3)There were 5 reports of macular fovea retinal thickness,MD and 95%CI were-32.24[-44.46,-20.02],P<0.00001;(4)Self-conscious symptom score was reported in 2 literatures,with MD and 95%CI of-0.66[-0.90,-0.42],P<0.00001;(5)Two literatures reported the efficacy of TCM syndromes,with RR and 95%CI of 1.65[1.28,2.13],P=0.0001;(6)Adverse reactions were reported in 2 literatures,and there was no significant difference in the incidence of adverse reactions between the treatment group and the control group(P>0.05).(7)One study reported the recurrence rate after two years,in which the recurrence rate was 2.8%in the treatment group and 23.3%in the control group,P=0.009.3.A total of 40 acupuncture prescriptions were included in this acupoint analysis,57 acupoints were used,with a total frequency of 366.The most frequently used acupoints were in the order of Taiyang(31 times),Cuanzhu(27 times),Fengchi(24 times),Chengqi(21 times),Jingming(17 times),Taichong(14 times),Qiuhou(14 times),Guangming(14 times),Shenshu(14 times),Sanyinjiao(13 times),Zusanli(13 times),etc.The most frequently used meridians of acupoints were the extra-meridian points and the experience points(84 times),the Bladder Meridian of Foot-Taiyang(82 times),the Stomach Meridian of Foot-Yangming(54 times)and the Gallbladder Meridian of Foot-Shaoyang(53 times).The most frequently used parts of acupoints were head and neck(207 times),lower extremity(88 times)and waist and back(41 times).The core acupoint combination with the support degree of 16(40%)includes Taiyang,Cuanzhu,Fengchi,Chengqi.There are 18 commonly used acupoint combinations,and the top 5 are Taiyang and Cuanzhu,Taiyang and Fengchi,Taiyang and Chengqi,Cuanzhu and Fengchi,Fengchi and Chengqi.There were 7 groups with acupoint correlation degree above 0.9,which were"Cuanzhu,Fengchi?Taiyang","Cuanzhu,Fengchi,Chengqi?Taiyang","Zusanli? Taiyang","Cuanzhu,Chengqi?Taiyang","Fengchi?Taiyang","Yuning?Cuanzhu","Sanyinjiao? Taiyang".Four new acupoint prescriptions were derived by cluster analysis.Conclusions:1.Age-related macular degeneration(AMD)was classified as a symptom of unclear vision in ancient times,and is now called"Shizhan Hunmiao" in Chinese medicine.The root cause of the disease lies in old age and deficiencies of the liver,spleen and kidney,and excesses of the pathological products such as heat evil,phlegm turbidity and blood stasis.The treatment is mainly focused on the liver and kidney,and treats both the symptoms and the root causes.2.According to the existing results in modern literature,acupuncture and moxibustion treatment of AMD has a significant effect on improving visual acuity,reducing the thickness of macular fovea retinal,and improving patients' conscious symptoms and systemic symptoms.The treatment of AMD by acupuncture and moxibustion alone or combined with traditional Chinese medicine is better than western medicines such as vitamin E and vitamin C.Acupuncture and moxibustion combined with the control group can enhance the efficacy of drugs in the control group and reduce the recurrence rates.3.In the rules of acupoint selection,ancient and modern literature records are basically the same,with local acupoint selection as the main,and distal acupoint selection as the auxiliary according to the dialectical.The commonly used acupoints are Taiyang,Cuanzhu,Fengchi,Chengqi,Jingming,Taichong,Qiuhou,Guangming,Shenshu,Sanyinjiao and Zusanli,etc.The distribution of acupoints was mainly on the head and neck,followed by the lower limbs and the waist and back.In the selection of meridians,the three Yang meridians of hands and feet closely related to the eye system are often used,especially the Bladder Meridian of Foot-Taiyang.Modern literature also makes good use of the extra-meridian points.