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Combination of Chinese and Western medicine treatment of diabetic retinopathy_852

By Jesus Nichols,2014-10-30 13:39
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Combination of Chinese and Western medicine treatment of diabetic retinopathy_852

    Combination of Chinese and Western medicine treatment of diabetic retinopathy

     Abstract Objective To observe the combined Chinese and Western medicine treatment of diabetic retinopathy clinical efficacy. Methods of diagnosis of 26 patients with diabetic

    retinopathy were treated with combined Chinese and Western medicine treatment (Western Taohongsiwu Decoction), self-

    control fundus pathological changes before and after treatment and vision to improve the situation. Results The total

    effective rate 76.92%, retinal hemorrhage edema lesions significantly improved visual acuity was improved statistically significant (P <0.05). Conclusion Chinese and Western medicine treatment of diabetic retinopathy with good effect, to maximize the promotion of functional recovery in

    patients with vision.

     Key words Chinese and Western medicine with diabetic retinopathy Taohongsiwutang blood circulation of

     Diabetic retinopathy (Diabetic retinopathy, DR) in patients with diabetes complicated by retinal microvascular

    disease and neurological diseases general, the incidence rate of 44% [1], has a high rate of blindness, pathological changes of retinal hemorrhage, exudation, edema, emergence of the new blood vessels, and finally broke down due to

    neovascularization, vitreous hemorrhage, machine-oriented,

    causing traction retinal detachment and blindness. Western medicine laser coagulation, improve circulation, bleeding, anticoagulant fibrinolytic and other symptomatic treatment, although to achieve a certain effect, but still can not stop the disease's development. Improve vision, reduce the rate of blindness in the medical profession need to be resolved an important issue in recent years, we apply the combination of

Chinese and Western medicine treatment of this disease,

    results were satisfactory, are reported below.

     A clinical data

     1.1 General Information

     26 cases of DR patients from 16 cases in our hospital outpatient ophthalmology and endocrine patients suffering from 10 cases, 34 eyes; 15 males and 11 females; aged 49 to 78 years of age; diabetes duration of 5 to 23 years; logarithmic visual acuity (3.2 ? 0.4); combined coronary heart disease, diabetes, kidney disease, a total of 10 cases of diabetic foot; fasting plasma glucose (FPG) (14.8 ? 4.8) mmol / L,

    glycosylated hemoglobin (HBA1C) 8.5% ~ 2.4 /%.

     1.2 Diagnostic Criteria

     Confirmed 26 cases of DR patients were in line with 1999 WHO diagnostic criteria for type 2 diabetes mellitus (T2DM) patients with decreased visual acuity, ophthalmoscopy, or fundus fluorescein angiography examination showed that: ?

    retinal hemorrhage, or plaques scattered spotting, ? "soft

    "or" hard "seepage spots, ? macular edema, ? new blood

    vessels, microvascular tumor formation or vitreous hemorrhage.

    ? retinal arteriosclerosis or atresia, venous stenosis.

     Two treatment

     2.1 Western medicine due to the treatment

     (1) control of blood glucose: the original exercise the same dietary treatment, oral hypoglycemic agents (glibenclamide, sugar, fitness level, glimepiride, rosiglitazone, etc.) and / or insulin (Novolin 30R) subcutaneous injection to control FPG goal <7.0 mmol / L, postprandial 2 h blood glucose (2 hPG) <10.0 mmol / L. (2) support therapy: Vitamin C, rutin, Clofibrate iodine, etc.,

    (3) anticoagulant thrombolytic therapy: Fundus examination essential to stop bleeding, bleeding did not expand the scope of those, 5 000 units of urokinase dissolved in 1 ml normal saline, the OK retrobulbar injection, 2 d 1 second, 10 d for a

    course of treatment, rest 5 d, proceed to the next course of treatment, used in conjunction 4 treatment, treatment should

    be examined fundus bleeding, there is fresh hemorrhage stop anticoagulation therapy.

     TCM treatment of 2.2 square selection Taohongsiwutang

    addition and subtraction, medicinal peach kernel 15 g, safflower 15 g, Radix Paeoniae Rubra 20 g, habitat 30 g, Chinese angelica 20 g, Chuanxiong 12 g, Radix Astragali 30 g, red ginseng 6 g, chrysanthemum 15 g, Chinese wolfberry 15 g,

    fresh retinal hemorrhage were added Puhuang, five WULINGZHI (Shixiaosan); retinal hemorrhage eventually becoming absorbed by Canadian 37 and try to use Salvia 60 g; Qi stagnation were added Bupleurum, Citrus aurantium , Cyperus rotundus; liver yang dizziness were added Gastrodia elata, hook D; 1 / d, conventional frying method, 30 d for a course of treatment, rest 3 d to the next one course of treatment, a total of 3 to 6 courses.

     3.1 Efficacy rates are based on visual acuity of vision improvement and development of retinal changes.

     3.1.1 markedly increased by 4 lines or restore vision prior to the onset level, increased by 10-degree field of

    vision, retinal hemorrhage, exudation absorption or most of the absorption, edema disappeared, markedly improved retinal

    blood supply, neovascular occlusion. Reposted elsewhere in the paper for free download http://

     3.1.2 Effective visual acuity was improved 2 to 3 lines by 5 ~ 10 degree field of vision, retinal hemorrhage, exudation part of the absorption, edema, to narrow the scope.

     3.1.3 Invalid no increase or decrease visual acuity, retinal lesions have not been improved or increased.

     3.2 The treatment results in 26 cases after treatment were cured, 11 cases (42.31%), effective in 9 cases (34.62%),

    ineffective in 6 cases (23.08%), the total effective rate 76.92%, visual acuity from the pre-treatment (3.2 ? 0.4)

    (right the number of vision) to (4.6 ? 0.6) (P <0.05).

     4 Discussion

     DR development is a complex process, mainly a variety of

    high blood sugar metabolism disorders, so that increased capillary permeability, basement membrane thickening, stenosis, retinal microcirculation, ischemia and hypoxia, stimulating new capillaries formation. According to reports Liang, DR bleeding after absorption, there the formation of capillary proliferation and fundus organic matter, such as hypoxia-induced pathological changes often [2], so to improve the ocular blood circulation, increase blood oxygen is the key to treatment of the disease. Urokinase plasminogen activator, promoting fibrinolysis, bleeding as soon as possible so that absorption of the establishment of collateral circulation, we have adopted a small dose of the eye directly after injection, so that the drug directly to patients by, avoiding the

    systemic bleeding tendency medication easily lead to side effects.

     Congestion is a traditional Chinese medicine believe that the main pathological basis of diabetic retinopathy due to diabetes, injuries falling into gas, Qi unable to push the

    blood line of slow, silt blocking context; or vital energy and blood circulation due to loss of unification, overflow in the veins, the blood away from the pass through is the congestion; Diabetes late Yin Sun and yang, yin and yang, Qi, Yin, Yang

    and may also lead to blood stasis, congestion resistance network, new blood is not health, blood stasis blood deficiency head no one to support the head without hair seen. Therefore, promoting blood circulation Huayu consistently throughout the treatment, doctors believe that retinal blood circulation in acute bleeding phase banned drugs, can cause a wide range of bleeding due to aggravated disease, but the traditional Chinese medicine theory that "the blood is from the congestion by" the blood in the body can not be Add in a

    good anti-blocking new blood to the blood biochemistry of the machine, where the blood in order to permit the total deposition order to be cured. Therefore sages have "sight of blood off to stop bleeding, the first deposition when cured."

    "Congestion do not, then bleeding, new blood is not students" of the theory. In addition, there are mostly in patients with DR "blood hyperviscosity syndrome" performance, so if a large number of hemostatic, but also increased the blood thick,

    sticky, poly, coagulation state, it is possible on the basis of bleeding has resulted in new capillary blockage. Taohongsiwutang for blood circulation nourishing the name of

    party, peach kernel, safflower, herbaceous peony, Chinese angelica, Chuanxiong blood circulation Huayu; astragalus, red ginseng, habitat spleen Qi Blood; chrysanthemum, Chinese wolfberry Yanggan eyesight, various drug combination complementary advantages, played a total of spleen Qi, promoting blood circulation Huayu, Yanggan eyesight

    achievements. Modern pharmacological studies have shown that: promoting blood circulation Huayu drugs can increase the number of capillaries open, microcirculation blood flow speed, so that collateral circulation, lower blood viscosity, coagulation, promote fibrinolysis, decrease platelet adhesion and aggregation. Chuanxiong extract Ligustrazine can improve microcirculation, microvascular diameter, flow rate, flow, flow pattern also showed significant improvement; ginseng in the ginseng saponins with lower blood viscosity, prevent

    micro-thrombosis, reducing retinal tissue ischemia and hypoxia, with neurotrophic and selective neuroprotective effect [3]. According to our clinical observation, DR fundus bleeding early vision loss, progressive increase, fundus

    examination bright red bleeding lesions can be seen when a large number of vitreous hemorrhage; the mid-visible dusky

    purple hemorrhage or see a small amount of bleeding, fresh lesions coexist with the old lesions; late bleeding most of the absorption, only a small amount of congestion is not the plot of a long, dark color, or cord-like machine-oriented

    structures; to the hospital in the DR patients were more than the late, while a large number of early bleeding is rare, it can be of clinical TCM DR no need to consider ways to stop

    bleeding, while directly promoting blood circulation Huayu, a variety of promoting blood circulation Huayu drugs on blood coagulation mechanism has a two-way regulatory role, to the

    role of promoting blood circulation of blood is not moving,

    even if a large number of fresh retinal hemorrhage, as long as consistent with the principles of TCM syndrome differentiation can be applied.

     In short, combining Chinese and Western medicine treatment of DR, focus on whole and partial, dialectical combination therapy with disease differentiation principle, can significantly improve the patient's vision to improve the retinal microcirculation, increase blood supply oxygen to

    reduce retinal vascular proliferation and machine-oriented, so

    that patients to maximize recovery of visual function.

     References

     [1] Lay Hong, Wang Qi. Diabetic retinopathy combined treatment of Chinese and Western medicine [J]. Chinese Journal of Medicine, 1998,18 (8): 509.

     [2] Liang today, Liaoju Sheng, Ko Yuk-ying. Fundus

    angiography findings [J]. Chinese Journal of Ophthalmology,

    1983,19 (3): 129.

     [3] Deng Hui, Jin, Fan, shower, et al. Red diabetic retinal ganglion cells participate in the neuroprotective effect [J]. Chinese medicine Ophthalmology, 2004,14 (2) .63. Reposted elsewhere in the paper for free download http : / /

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