2 English reference nipple isolation [Chinese medical terminology Committee]. Terminology of Traditional Chinese Medicine (2004)]
Contracting students [Chinese medicine terminology Committee]. Terminology of traditional Chinese medicine (20 13)]
Iris-cyclocheilitis [Chinese terminology committee]. Terminology of traditional Chinese medicine (20 13)]
3. Overview of contracted students; ; Iris cyclophilitis is the name of disease syndrome [1]. See the standard of syndrome differentiation and treatment of miscellaneous diseases. Also known as mydriasis (see Yao Xincha), pupillary atresia (out of obscurity), pupillary constriction (see Yan Ophthalmology), pupillary constriction (1) and pupillary constriction (1). It refers to an eye disease characterized by continuous pupil contraction, ineffective expansion and contraction, and often accompanied by red eye, mental confusion and eye pain [2]. What's more, yellow liquid can be seen upwelling or blood filling the pupil [1]. If the pupil loses its perfect circle, its edge is uneven, and Ren Huang is dry and disgraceful, which means that the pupil is dry [3]. The ancient literature was first recorded in The Secret Biography of Ophthalmology, Long Mu's Theory, but it was not until the Standard of Syndrome Differentiation and Treatment that it was named according to the onset characteristics of tight pupils and was comprehensively discussed [3]. Although there are differences between them, they are both Ren Huang's disease, and miosis is caused by inadequate treatment. Its etiology is complex and diverse, and it is easy to recur [3]. If it is not treated properly, it will often be complicated with other diseases, leading to blindness [3].
The pupil is tight and small, similar to western medicine's iridocyclitis [1][3].
4 Etiology and Pathogenesis of Pupillary Shrinkage can be caused by excessive liver and gallbladder fire, rheumatic fever, deficiency of liver and kidney yin and inflammation [1]. It may also be caused by trauma and some diseases such as white eyes and dark circles [1].
1. Wind-heat in the liver meridian or fire in the liver and gallbladder cause eye damage.
2. Exogenous rheumatism and stasis heat; Or the rope body is full of yang, containing heat evil, heavy feeling of rheumatism, rheumatic fever pulse combined with it, and the upper body is guilty of clearing the orifices.
3. Injury to the liver and kidney due to fatigue or yin due to long-term illness, and inflammation due to deficiency fire.
All the above factors can make evil heat burn Ren Huang, make Huang Renzhan not shrink, and make his pupils tight.
In addition, fire, white flowers, coagulated fat, mixed eye disease, crab eye disease, true eye injury and so on. Invasion of pathogenic toxin often leads to pupil contraction.
5 Symptoms of pupil contraction: "The pupil gradually shrinks like a needle, even like a needle", the expansion and contraction are out of balance, and the pain of the leader can be seen, the tears are hot and shameful, the vision is reduced, the wheel is red and the water is turbid, white spots can be attached to the lower part of the inner wall of dark circles, and the texture of Ren Huang is blurred. What's more, you can see yellow liquid rushing up, or blood filling the pupils. In the case of treatment failure, Ren Huang attached to its late Polygonatum sibiricum, resulting in pupil-body deficiency [1].
The pupil is tight and small, which is mainly manifested in the continuous narrowing of the pupil, ineffective expansion and contraction, red wheel, unclear water and eye pain [2].
The pupil is tight and small, and it loses its normal dilation and contraction function, and it continues to shrink, accompanied by eye pain and photophobia, red chakras, punctate deposits on the back wall of black eyeballs, turbid water and decreased vision [4].
There are acute and chronic pupil contraction [3]:
1. In acute cases, there are symptoms such as tears due to shame, eye drops pain and refusal to press, brow bone pain, or pain connected with forehead and temporal bone, blurred vision, or awareness of mosquitoes and flies flying in front of you.
Examining the eyes, we can see that the wheels are red, the Ren Huang is dark, the texture is blurred, the pupils are narrowed, and the dilation and contraction are disordered. Huang Renzhi's pupil is easily attached to the crystal beads behind him (Figure 1), so that the pupil is not round (Figure 2).
Figure 1 Pupil without trunk side view
Fig. 2 Front view of pupil loss
If you use collective light inspection or slit light microscope inspection, white dust or dots are attached to the inner wall of black eyes (Figure 3), and spirits and water are mixed together. In severe cases, yellow liquid can be seen rushing up.
Fig. 3 Deposits on the inner wall of black eyes
2. There are more black flowers floating in front of chronic patients, and the rest of the eye symptoms are basically similar to the former, but the condition is mild. Vitreous opacity can be seen under ophthalmoscope. This disease develops slowly and is easy to recur, which often leads to dry pupils. If the pupil edge is completely attached to the crystal bead, the pupil is locked; If a gray-white membrane barrier is formed on the surface of the crystal bead behind the pupil, the pupil can be closed (Figure 54). Both of them can prevent the water from flowing forward from the back of the pupil, make the water stagnate in it, oppress Ren Huang, swell forward, and make both eyes hard to swell, resulting in cataract caused by breeze. Due to the change of divine water, crystal beads can still become increasingly turbid, which makes people blind.
Fig. 4 Closed side view of pupil capsule
In addition, if the condition is serious or prolonged, it will also lead to the exhaustion of divine water, eye weakness and blindness [3].
6 Treatment of mydriasis 6. 1 Syndrome differentiation and treatment of this disease is more common [3]. The excess syndrome is mostly caused by exogenous wind, dampness, heat evil or stagnation of liver and gallbladder, and the onset is more urgent. Syndrome of excess and deficiency is often caused by yin deficiency of liver and kidney and excessive fire, or transformed by long-term injury of yin and elimination of pathogenic heat, and its course is often lingering [3]. Clinical syndrome differentiation should be combined with systemic symptoms [3]. Internal treatment, empirical common methods such as expelling wind and removing dampness, clearing away heat and toxic materials, cooling blood and removing blood stasis, etc. Deficiency and excess are mixed, and yin deficiency and fire are flourishing, so nourishing yin is given to reduce fire [3]. As for the late stage of the disease, although the pathogenic factors recede, the liver and kidney are deficient and the eyes are unclear, but it is appropriate to nourish the liver and kidney, benefit the orifices and improve the eyesight [3]. At the same time of oral treatment, we must pay attention to local medication, enlarge the pupil in time, and prevent the pupil from being dry [3].
6. 1. 1 liver meridian wind-heat type pupil refers to liver meridian wind-heat, pupil shrinkage, red wheel holding, gray punctate deposits on the back wall of dark circles, mental confusion, photophobia and tears, eye drops pain, forehead.
6. 1. 1. 1 Symptoms: pupil constriction, red grip, gray punctate deposits on the back wall of dark circles, mental confusion, photophobia, eye drops pain, headache and forehead pain, red tongue, thin white or yellowish fur, and floating pulse [2].
Acute onset, tight pupils, eye pain, blurred vision, red tugboat, turbid water, dull Ren Huang and unclear texture [3]. General symptoms can be seen as headache and fever, lipstick, thin white or yellow tongue coating and floating pulse [3].
6. 1. 1.2 Syndrome analysis: wind-heat attack is acute. Pathogens are trapped in the eyes along the liver meridian, so the eyes are dizzy with pain and the tugboat is red. Heat-evil torture leads to the mixing of spirit and water. Ren Huang belongs to the liver. Its dark color, unclear texture and pupil contraction are all caused by wind-heat invasion of liver meridian, blood circulation of evil sinus and Ren Huang swelling, which is vertical and relaxed, spreading but not shrinking. The general symptoms are headache and fever, lipstick, thin white or yellow fur and floating pulse, all of which are wind-heat symptoms. [3]
6. 1. 1.3 Treatment of expelling wind and clearing heat [3].
6. 1. 1.4 Prescriptions can be treated with Xinzao Chailian Decoction [Remarks] Xinzao Chailian Decoction (Ophthalmology Outline): Bupleurum, Coptis, Scutellaria baicalensis, Radix Paeoniae Rubra, Vitex negundo, Gardenia, Gentiana, Akebia, Glycyrrhiza, Schizonepeta and Saposhnikovia divaricata. Indications: pupil constriction, pupil dryness and fat coagulation. Improved therapy [3].
Solution: The original prescription mainly has the effects of expelling pathogenic wind, clearing liver and purging heat. If eye swelling and pain are serious, Radix Rehmanniae, Cortex Moutan, Radix Salviae Miltiorrhizae and Fructus Leonuri can be added to cool blood and promote blood circulation to enhance the effect of relieving swelling and pain. [3]
6. 1.2 miotic hepatobiliary leaf fever refers to liver and gallbladder burning, including eye pain, eyebrow bone pain, photophobia, tears and decreased vision; Eyelids are red and swollen, white eyes are mixed with red, punctate or suet-like deposits can be seen in the back wall of black eyes, and there is turbid spirit water, or yellow liquid flushing, Ren Huang swelling, unclear texture, pupil contraction, ineffective expansion and contraction, or fine dust turbidity in ointment, bitter taste, dry throat, constipation, red tongue and yellow fur, and the number of pulse strings are common symptoms of pupil contraction [2].
6. 1.2. 1 Symptoms: eye pain, eyebrow bone pain, photophobia, tears, and decreased vision; Eyelids are red and swollen, white eyes are mixed with red, punctate or suet-like deposits can be seen in the back wall of black eyes, liquid is turbid, or yellow liquid is flushed, Ren Huang is swollen, texture is unclear, pupils are narrowed, dilation and contraction are ineffective, or the paste is fine and dusty, with bitter taste and dry throat, constipation, red tongue and yellow fur, and rapid pulse [2].
The pupil is very small, and the bead hurts and refuses to press it. It hurts even the eyebrows and temples. The wheel is very red and the water is turbid. After the eyes are black, blood deposition or yellow liquid can be seen [3]. Systemic symptoms include bitter mouth and dry throat, irritability, red tongue with yellow coating and rapid pulse [3].
6. 1.2.2 The object of syndrome analysis is the liver orifices, and the eyebrows and temples belong to the liver and gallbladder. The liver and gallbladder are attacked by fire, and the heat is full of blood, so the beads are painful and unwilling to press, the eyebrows are painful, and the circle is very red. Divine water becomes turbid after burning, or is washed away by yellow liquid. If fire enters the blood collaterals and forces blood to overflow, blood stasis can be seen after dark eyes. Systemic diseases such as bitter taste, irritability, red tongue with yellow fur and rapid pulse are also caused by hyperactivity of liver and gallbladder. [3]
6. 1.2.3 method of clearing liver and benefiting gallbladder [3]. Purging excess fire in liver and gallbladder [1].
6. 1.2.4 Prescription can be treated with Longdan Xiegan Decoction [Remarks] Longdan Xiegan Decoction (Li Dongyuan Prescription): Radix Gentianae, Bupleuri Radix, Alismatis Rhizoma, Plantaginis Semen, Akebia Akebia, Radix Rehmanniae, angelica tail, Gardenia, Scutellariae Radix and Glycyrrhizae Radix. Indications: Cell swelling, such as peach, polycythemia, coagulated fat, red bean with wind wheel, pupil contraction, pupil loss and sudden blindness. Modification processing [1][3].
Fang Jie: The original prescription focuses on breaking the liver and gallbladder. If the eyes are red, swollen and painful, or there is blood stasis after dark circles, Cortex Moutan, Radix Paeoniae Rubra and Pollen Typhae can be added to cool blood, promote blood circulation or stop bleeding. If you see thirst and constipation, add gypsum, Rhizoma Anemarrhenae and Radix et Rhizoma Rhei to clear the fire of Yangming, or refer to Chapter 4, Yellow Liquid. [3]
If yellow liquid is flushed up or blood is full of pupils, it is advisable to clear away heat and toxic materials, cool blood and stop bleeding, and add and subtract Rhinoceros Horn Dihuang Decoction or Qingying Decoction [1].
6.65438+ wheel hugs red, with speckled or suet-like deposits on the back wall of black eyes, turbid water, Ren Huang swelling, unclear texture, tight or out-of-round pupils, often accompanied by common symptoms such as heavy head, chest tightness, sore limbs, red tongue, yellow and greasy fur, and rapid pulse [2].
6. 1.3. 1 Symptoms are either acute or slow, with dripping pain in the eyes, even dull pain in the brow bone and temporal bone, blurred vision, or conscious eyes with black flowers flying, blushing and tears, red embrace, little or suet-like deposits on the back wall of dark circles, watery turbidity, Ren Huang swelling, blurred texture, and tight or short pupils.
The onset is urgent or slow, the pupils are tight or short and round, the eyes are red and swollen and painful, the eyebrows and temples are dull and painful, the vision is blurred, or the black flowers are self-evident, the water is turbid, and the Ren Huang texture is unclear. It is often accompanied by symptoms such as heavy head, chest tightness, sore limbs, yellow and greasy tongue coating, and rapid pulse. [3]
6. 1.3.2 Syndrome analysis: rheumatism and summer heat beat each other, blocking in the middle, clearing yang but not rising, and dampness and turbidity spreading upward, thus causing red eyes and pain, dizziness, stuffy eyebrows and temples, blurred vision and dark flowers. Steam the magic water on the damp heat, and it will stick; Fumigating Ren Huang, Ren Huang swelling, unclear texture, spreading and not shrinking; Huang Rentong is attached to the crystal bead, but it is not round. As for the whole body, the chest is full, the limbs are sore, the tongue is red and the coating is yellow and greasy, and the pulse string or pulse number are all caused by rheumatic fever. Although both suffer from rheumatic fever, those who suffer from wind-heat tend to have more acute onset and more severe eye symptoms; People with insufficient heat and excessive rheumatism generally have a slow onset, and the symptoms of red-eye pain are light and heavy, which is easy to recur. Ren Huang is dull, and most students are absent and round. [3]
6. 1.3.3 Treatment of expelling wind, removing dampness and clearing heat [3].
6. 1.3.4 Yiyang Jiulian Powder [Remarks] Yiyang Jiulian Powder (revealed by the original machine): Radix Rehmanniae, Radix Angelicae Pubescentis, Cortex Phellodendri, Radix Saposhnikoviae, Rhizoma Anemarrhenae, Fructus Viticis, Radix Peucedani, Notopterygii Rhizoma, Radix Angelicae Dahuricae, Radix Glycyrrhizae, Scutellariae Radix, Natrii Sulfas, Fructus Gardeniae, Rhizoma Coptidis and Radix Stephaniae Tetrandrae. Indications: tight pupils and dry pupils. Modification processing [1][3].
Solution: The original prescription mainly uses Radix Angelicae Pubescentis, Notopterygii Rhizoma, Radix Stephaniae Tetrandrae, Radix Angelicae Dahuricae, Radix Saposhnikoviae and Fructus Viticis. Coptidis Rhizoma, Scutellariae Radix, Fructus Schisandrae Chinensis, Cortex Phellodendri, and Natrii Sulfas for clearing away heat and purging fire; Radix Rehmanniae and Rhizoma Anemarrhenae nourish yin and suppress yang; Glycyrrhiza uralensis Fisch is blended with traditional Chinese medicine, which has the functions of expelling wind and removing dampness, clearing away heat and suppressing yang. This prescription is used for patients with severe wind and heat, redness and pain. Appropriately reduce pungent and warm herbs such as Radix Angelicae Pubescentis, Notopterygii Rhizoma and Radix Angelicae Dahuricae, and add Herba Leonuri and Radix Paeoniae Rubra to clear liver, cool blood, promote blood circulation and relieve pain. If it is used for patients with severe rheumatism, mild heat pathogen and dull fur, it is advisable to reduce the cold and diarrhea gunpowder such as Anemarrhena asphodeloides, Cortex Phellodendri and Natrii Sulfas, and add Cortex Magnolia Officinalis, Fructus Amomi Rotundus, Poria and Coicis Semen to remove dampness. [3]
6. 1.4 The contraction pupil of yin deficiency and fire excess refers to yin deficiency and fire excess, which is characterized by slow illness or persistent illness, sometimes aggression, dry eyes, blurred vision, reddish eyes, continuous deposition on the back wall of black eyes, and slight mixing of spirit and water. Red tongue with little coating and thready pulse are common symptoms of mydriasis [2].
The course of disease is long, and the pupil is narrowed, which is mostly caused by yin deficiency of liver and kidney and excessive fire [1].
6. 1.4. 1 Symptoms: onset is slow or persistent, sometimes prone to occur, dry eyes, blurred vision, round red, persistent deposition on the back wall of dark circles, mixed spirit and water, dry eyes, insomnia, upset and fever, dry mouth and throat; Red tongue with little fur and thin pulse [2].
Mild or late illness, dry and uncomfortable eyes, blurred vision, mild and severe red pain, recurrent attacks, dry and round pupils [3]. Common dizziness, insomnia, vexation and fever, dry mouth and throat, red tongue with little coating, rapid pulse and so on [3].
6. 1.4.2 Syndrome analysis shows that the disease is mild or late, with mild or severe eye diseases and recurrent attacks. , belongs to the lack of good and evil, good and evil struggle, there are advances and retreats. Factors: body yin deficiency or chronic liver and kidney yin deficiency, * * * can not be absorbed in the ear, resulting in dry eyes, blurred vision and pupil contraction. The fire burns on my body, so my eyes are red and dizzy. Fire disturbs the mind and leads to insomnia. Water due to yin deficiency can't control fire, so five people are upset and hot, dry mouth and throat, red tongue with little fur, and meticulous pulse. [3]
6. 1.4.3 therapy nourishes liver and kidney [3]. Nourish liver and kidney, clear deficiency fire [1].
6. 1.4.4 Prescription can be treated with Qijudihuang Pill [Remarks] Qijudihuang Pill (medical grade): Liuweidihuang Pill plus Lycium barbarum and Chrysanthemum. Indications: white astringency, persistent nebula, pupil contraction, dry pupil, green wind cataract, round nebula cataract, green wind cataract, blurred vision, myopia, hyperopia and fetal cataract. Improved therapy [3].
Solution: The original prescription is based on Liuwei Dihuang Pill, which nourishes the yin of liver and kidney, strengthens water and reduces fire; Lycium barbarum and chrysanthemum enhance the functions of nourishing yin, enriching blood and benefiting essence. If it is used for patients with excessive fire due to yin deficiency and severe pain in the eyes, Anemarrhena asphodeloides and Cortex Phellodendri should be added with cold and hot sauce to nourish yin and reduce fire. [3]
It can be treated with Qingshen Yiyang Pill [1].
6. 1.5 Precautions: While using internal medicine to treat pupil contraction, the pupil should be dilated in time to avoid pupil dryness [1].
Trauma or some serious diseases with white eyes and dark circles should be treated according to the symptoms shown above [1].
6.2 External Treatment 6.2. 1 Local use of mydriatic agent can rapidly and fully dilate the pupil at the initial stage of onset, which can not only prevent pupil contraction and a series of serious complications caused by it, but also help to relieve eye pain. The commonly used drugs are 1% atropine solution or ointment, and the eye drops are 1 ~ 3 times a day/kloc-0 times (after each atropine eye drop, the inner canthus should be compressed for 3 ~ 5 min), or depending on the condition. [3]
6.2.2 Scutellaria baicalensis Georgi Eye Drops (Clinical Ophthalmology) can be selected as eye drops for clearing away heat and toxic materials: Scutellaria baicalensis Georgi 100 g Method: Scutellaria baicalensis Georgi was washed with distilled water, decocted with appropriate amount of distilled water 1h, filtered out, and the residue was decocted with distilled water for 30 min, filtered out, and the two solutions were combined and concentrated to 1500g. Then add 95% ethanol (about twice the amount of the liquid medicine), stand for 5-6h, indirectly heat and evaporate the ethanol until there is no alcohol smell, filter out the liquid medicine, add 5% activated carbon to boil, add distilled water to 1000ml, filter, boil and sterilize. Its pH value is 6.5. Indications: tight pupil, lack of dryness, graying and fat coagulation. Or 10 ~ 50% Senecio Senecio Eye Drops [Remarks] Senecio Senecio Eye Drops (revised version of hospital preparation): 50g Senecio Senecio, appropriate amount of distilled water, * * * made 100 ml. The preparation method comprises cleaning Centella asiatica, draining, cutting into pieces, adding 5-6 times of ethanol, soaking for 2-8 days, filtering, adding 4-5 times of ethanol to the residue, soaking for 2 days, combining the two soaking solutions, recovering ethanol, adding 50 ml of distilled water to the concentrated solution, stirring, adding 2 g of paraffin, heating in water bath until it is completely melted, cooling, and placing in the refrigerator for 65438+/-0 hours. Suction filtration to remove carbon, filtration and clarification, adjusted to 100ml with distilled water. Indications: sudden fever, malnutrition, white astringency, erythema drooping, bloodshot eyes, tight pupils and dry pupils. [3]。
6.2.3 Local hot compress usually uses hot water or decoction of internal medicine residue as wet hot compress to reduce redness and pain [3].
6.3 Acupuncture Treatment 6.3. 1 Body Points: Smart, Promoting the Lord, Tongzi, Sizhukong, Ganshu, Zusanli and Hegu [3].
Acupuncture: take 2 points locally and 1 ~ 2 points at the distal end each time. [3]
6.3.2 Ear acupuncture can take points such as the tip of the ear, Shenmen and Eye [3].
6.4 Other therapies can be injected with eye drops or subconjunctival hormones or antibiotics when necessary [3].
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