基于“亢害承制”阐释视网膜微环境缺氧对青光眼视网膜神经节细胞凋亡的影响  

Influence of retinal microenvironment hypoxia on retinal ganglion cells apoptosis of glaucoma based on theory of‘harmful hyperactivity and responding inhibition'

作　　者：陈爽 张丽霞[1,2] CHEN Shuang;ZHANG Lixia(Eye Hospital,China Academy of Chinese Medical Sciences,Beijing 100040,China;China Academy of Chinese Medical Sciences,Beijing 100700,China)

机构地区：[1]中国中医科学院眼科医院,北京100040 [2]中国中医科学院,北京100700

出　　处：《中华中医药杂志》2024年第3期1144-1149,共6页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金面上项目(No.82074500)。

摘　　要：青光眼是全球首位不可逆性致盲性眼病,视网膜神经节细胞(RGCs)凋亡是造成视野缺损的关键,而视网膜微环境缺氧被认为是青光眼RGCs凋亡的早期和突出事件。“亢害承制”理论是中医学阐明生理制化、病理失衡及指导调燮用药的重要法则,体现了事物承制自稳的内在调控机制。天人相应,机体需依赖承制规律维持脏腑调和的稳态。“承制不及,亢而为害”贯穿青光眼RGCs凋亡全过程。脾气亏虚,承制不及,失于维持视网膜氧化还原系统动态平衡,则气血失和,浊瘀内生,亢而为害,壅塞目络,表现为细胞内氧自由基蓄积,视网膜组织缺氧,RGCs凋亡。故结合青光眼气虚为本、浊瘀为标的特点,以“承而制之,平其所亢”为治则,遣选方药以壮水制火、升阳健脾、宣闭通络,可有效恢复脏腑承制功能以祛邪外出,改善组织缺氧,抑制RGCs凋亡,提高视功能。Glaucoma is the first irreversible blinding eye disease in the world.The apoptosis of retinal ganglion cells(RGCs)is the key to resulting in visual field defect,and hypoxia of retinal microenvironment is considered as the early and prominent event of apoptosis of glaucoma RGCs.The theory of harmful hyperactivity and responding inhibition'is an important principle for traditional Chinese medicine to understand the physiological system and pathological imbalance and guide the regulation of drugs,revealing the internal regulation mechanism of objects control and self stabilization.Corresponding to the nature,the body also needs to rely on the laws of regulation to maintain a steady state of visceral harmony.The whole process of the occurrence and development of apoptosis in glaucoma RGCs runs through the process of insufficient control,excessive damage'.The deficiency of spleen qi and lack of control caused the failure to maintain the dynamic equilibrium of the retinal redox system,resulting in the disharmony of viscera's qi and blood,phlegm turbidness and blood stasis endogenous,hyperactivity becoming harmful,and the middle eye veins were being obstructed.It is manifested as accumulation of oxygen free radicals in cells,aggravating retinal hypoxia and RGCs apoptosis.In combination with the characteristics of glaucoma with qi deficiency as the foundation and turbidity and stasis as the target,we should takeinheriting and controlling it,restraining its hyperactivity'as the treatment principle and select prescription to trengthen water for regulating fire,promote yang for strengthening spleen,and promote the circulation of collaterals.As a result,the regulating function of visceral function can be effectively restored to remove evil,and then tissue hypoxia be improved,the apoptosis of RGCs be inhibited,and visual function be enhanced.

关 键 词：亢害承制 青光眼 缺氧 视网膜神经节细胞 病机 治则 

分 类 号：R276.7[医药卫生—中医五官科学]