中心性浆液性脉络膜视网膜病变祛湿四法  

On Treatment of Central Serous Chorioretinopathy with Four Methods of Draining Dampness

作　　者：郝婷婷 陈大威 毛泉报 李真 HAO Ting-ting;CHEN Da-wei;MAO Quan-bao;LI Zhen(Dezhou United Hospital,Dezhou,Shandong,China,253000)

机构地区：[1]德州联合医院,山东德州253000

出　　处：《河南中医》2020年第10期1494-1496,共3页Henan Traditional Chinese Medicine

摘　　要：中心性浆液性脉络膜视网膜病变的病机为肝、脾、肾脏腑功能失调,湿热、瘀血、浊毒内蕴而发病,亦正亦邪、亦虚亦实,多为本虚标实之证,而湿邪为本病主要致病因素。故临证时多从湿邪入手,若湿浊之邪上犯目窍,以利湿泻浊兼健脾为基本大法,方选参苓白术散、苓桂术甘汤等;痰、瘀相互为病,导致眼底黄斑区反复水肿、渗出、出血,以利湿活血为治疗大法,方选五苓散合桃红四物汤、温胆汤合通窍活血汤;眼底黄斑区水肿及黄色或白色渗出者,以清热利湿为法,方选三仁汤、连朴饮、厚朴夏苓汤等;肝郁脾虚型中心性浆液性脉络膜视网膜病变,治以疏肝解郁、运脾化湿,方选柴胡疏肝散、五苓散、龙胆泻肝汤、茵陈蒿汤等。但临床证候复杂多变,若表现为相兼性证候,亦可合方治之,可收到显著疗效。The pathogenesis of central serous chorioretinopathy is dysfunction of liver,spleen and kidney,dampness heat,blood stasis and turbid toxin,which are both positive and evil,deficiency and excess.Most of patients have intermingled syndrome of deficiency and excess,mostly deficiency as primary and excess as secondary,and dampness pathogen is the main pathogenic factor.Therefore,dampness should be first considered in clinical practice.If dampness pathogen and turbidity invades the eye orifices,the basic method is to drain dampness and purge turbidity combined with invigorating spleen.Ginseng and Poria and White Atractylodes Powder,Poria and Cinnamon Twig and Atractylodes Macrocephala and Licorice Decoction can be adopted.If phlegm and blood stasis are diseases of each other,resulting in repeated edema,exudation and bleeding in the macular area of the fundus,the treatment is to drain dampness and promote blood circulation.Five Substances Powder with Poria combined with Peach Kernel and Carthamus Four Substances Decoction,Gallbladder-Warming Decoction combined with Decoction for Unblocking Orifices and Promoting Blood Circulation can be adopted.For those with macular edema and yellow or white exudation,the treatment is to clear away heat and remove dampness.Three Kernels Decoction,Coptis and Officinal Magnolia Bark Beverage,Officinal Magnolia Bark and Rhizoma Pinelliae and Poria Decoction can be adopted.For the central serous chorioretinopathy of liver depression and spleen deficiency type,the treatment is to sooth the liver and relieve depression,activate the spleen and drain dampness.Bupleurum Liver-Soothing Powder,Five Substances Powder with Poria,Gentian Liver-Draining Decoction,Virgate Wormwood Decoction can be adopted.However,the clinical syndromes are complex and changeable.If the clinical manifestations are facultative,they can also be treated by combination of formulas,which can receive significant curative effect.

关 键 词：中心性浆液性脉络膜视网膜病变 利湿泻浊 利湿活血 利湿清热 利湿疏肝 

分 类 号：R276.774.13[医药卫生—中医五官科学]