Recently, I received a 56-year-old female patient in the outpatient clinic: "Doctor, I used to have good eyesight, but my sight suddenly changed a few days ago." Now I see that the straight line on the wall is curved. Some things were originally big, but I look smaller. And I can't see clearly. What's going on here? "Said the patient, gesturing with his hand.

According to the description, I estimate that the patient may have macular problems. After further inquiry, I learned that the patient had a history of hypertension. A few days ago, I was overworked and stressed, and my blood pressure increased significantly. The author specially gave her a fundus examination, and sure enough, she found fundus hemorrhage and macular eminence. It was diagnosed as macular edema secondary to retinal vein occlusion.

What is macular edema?

Macula is located in the center of fundus, similar to the position of target bull's-eye 10 ring. Because it is yellow when dissected, it is called macula. Macula accounts for less than 5% of the retina, but it is the center of the most acute vision. The vision we usually measure is the visual function of the macular center. Macula has a very special function, which can distinguish the color, fine shape and brightness of the object, detect the distance of the object and follow the movement of the object.

Visual distortion is mostly related to macular degeneration. Macular degeneration, macular hole, epimacular membrane, mesoosmosis and macular hemorrhage caused by various reasons can also cause visual distortion. Macular edema is one of the main causes of visual distortion. Macular edema is a common ocular fundus disease in middle-aged and elderly people, which seriously threatens visual function, but it is not an independent eye disease. Its main symptoms are visual distortion and decreased central vision.

Macular edema can be divided into cystic macular edema and diffuse macular edema. Often secondary to retinal vein occlusion, diabetic retinopathy, retinal vasculitis, uveitis and cataract after intraocular surgery. Many diseases cause the increase of retinal capillary permeability, the damage of blood-retinal barrier, and the accumulation of fluid between the outer plexiform layer and the inner layer of retina, resulting in macular retinal edema.

With the aging of population in China, the incidence of eye diseases in middle-aged and elderly people has increased, and the number of patients with macular edema has also increased. Long-term non-healing of macular edema can cause photoreceptor cell apoptosis and irreversible vision loss, resulting in decreased vision and distorted vision, which has brought great trouble to patients' life and work.

Fundus fluorescein angiography is the gold standard for the diagnosis of macular edema. Modern medicine mostly thinks that vascular endothelial growth factor and inflammation are the two main pathogenic pathways of macular edema. At present, the main means of treating macular edema in modern medicine are VEGF therapy, hormone, laser photocoagulation, surgery and non-steroidal anti-inflammatory drugs.

Understand ancient and modern Chinese medicine

Ancient doctors couldn't see the patient's fundus because they didn't have ophthalmoscope, so there was no record of macular edema in ancient literature. According to its clinical symptoms, it should be divided into "seeing straight as curved" and "seeing big as small".

The name "regarding straightness as a curve" first appeared in "Seven Tactics for Treating Syndrome". The book says: "Think of straight things as curves, bowstring rulers and the like, all like hooks." Belong to the category of illusion. There is no new description of direct aiming in later literature. The "Diagnostic Efficacy Standard of TCM Diseases" points out: "Oblique viewing refers to things that look straight, such as eye askew, which is an eye disease caused by the imbalance of clothing, body fluid and blood overflowing collaterals."

The reasons for looking straight are described in detail in ancient books. "Misunderstanding of Kao Yao's Letters" says: "If the length is white and black, the confusion is upside down, and the light is dark, the essence will decline and change." It is believed that essence and qi can not be scattered on the eyes, which will lead to delusion. Sun Simiao put forward "nine unknowns caused by deficiency and cold of spleen and stomach" in "Prescription for Preparing for a Urgent Thousand Daughters", and summarized the mechanism of eye diseases caused by spleen deficiency. "Golden Mirror of Ophthalmology" says: "If the vision is big as small and red as white, the onset of this disease is also caused by the long-term stagnation of heat evil in liver and kidney."

Modern Chinese medicine scholars believe that macular edema is closely related to liver, spleen and kidney. Etiology includes primary cause, secondary cause and inducing factors. As inducing factors, exogenous wind-heat (wind-toxin) and improper diet can cause or aggravate spleen deficiency, which leads to abnormal transport, improper ascending and descending, and imbalance of qi and blood in collaterals, and then leads to hyperactivity of yin fire, phlegm turbidity, blood stasis, macular edema, exudation and bleeding, and direct vision symptoms.

Traditional Chinese medicine has the advantages of definite curative effect, non-invasive, non-invasive, high cure rate, low recurrence rate and relatively low cost in the prevention and treatment of macular edema.

Daily health adjustment

Physical factors, internal and external environment, emotions and other comprehensive factors play an important role in the pathogenesis of macular edema. Therefore, it is very important to do a good job in health care, which can prevent diseases before they happen.

Control risk factors

Hypertension, diabetes and hyperlipidemia are high risk factors for macular edema. Patients with macular edema should pay attention to reasonable diet, limit smoking and drinking, and control their weight in daily life to prevent hypertension, hyperlipidemia and diabetes. Patients who have been diagnosed as "three highs" should actively treat the primary disease, control blood sugar, blood pressure and blood lipid within a safe and reasonable range, and have regular eye examinations. Once the early changes are found, intervention measures should be taken as soon as possible to prevent the delay from getting worse. You can also conduct self-test at ordinary times. If you find abnormal conditions such as decreased vision, deformity or reduction, and shadow occlusion in front of your eyes, you should go to the hospital in time.

Diet regulation

Develop good eating habits and maintain a balanced nutrition. Control the total amount of meals and optimize the structure. Eat vegetables, fruits, fish, nuts, and choose foods that warm the stomach, soothe the liver and tonify the kidney according to your physical condition. Wax gourd, towel gourd, bitter gourd and amaranth have the functions of clearing away heat and toxic materials, diuresis and detumescence, promoting blood circulation and dredging collaterals, and can be eaten with staple food. Lotus plumule and yam can nourish the heart, kidney and lung, and they can also be eaten in decocted soup or porridge, such as Coix seed, Gordon Euryale seed and red bean.

Harmony of seven emotions

Put your mind in your heart, calm your nerves and avoid violent and bad emotional stimulation. Arrange work and life in a planned way, reduce work pressure and tension, so as to avoid anxiety and get angry, causing or aggravating illness. Adjusting mentality, moderate exercise, and peaceful mentality treatment are helpful to mobilize healthy qi and promote rehabilitation.