I. Principles of treatment of uveitis
There are three basic principles in the treatment of uveitis, namely, the principles of individualization, simplicity and “long-term treatment”.
1, the principle of individualization
The principle of individualization is a concrete manifestation of discriminatory and aesthetic thinking in treatment, which emphasizes the need to develop a treatment plan suitable for each patient based on the type of uveitis, severity of inflammation, patient’s age, gender, physique, underlying disease, tolerance to drugs, patient’s expectations for treatment, and patient’s economic status.
2.Simplification principle
The principle of simplicity is the specific embodiment of the four types of thinking: systematic thinking, discriminative thinking, holistic thinking and aesthetic thinking in the treatment. The so-called simplicity principle, that is, through discriminatory thinking, systemic thinking and holistic thinking to remove the falsehoods and save the truth, remove the coarse and save the fine, from a variety of phenomena to find the root cause, essence and main contradiction of the occurrence of uveitis, with a highly targeted one or a few drugs to treat uveitis, in order to cure uveitis from the source, from the root, this treatment principle is a good reflection of the least drugs, the easiest way, the most economical This principle of treatment embodies the aesthetic concept of curing the disease with the least amount of drugs, the easiest way, the most economical cost, and the least amount of pain for the patient and without realizing it.
1. “Long-term treatment” principle
The “long-term cure” is the specific application of systemic and aesthetic thinking in the clinical treatment of uveitis. The term “long-term treatment” refers to systematic thinking, grasping the type, course and progression of uveitis and the individual characteristics of the patient, and giving systematic and standardized treatment in order to fundamentally eliminate the causes and mechanisms of chronicity and recurrence of uveitis and achieve a complete cure of uveitis.
Treatment strategies in uveitis
In addition to the guiding ideology and treatment principles, there should also be treatment strategies in the treatment of the disease, and the authors have summarized the following strategies for the treatment of uveitis in their clinical work.
1. “Quick and dirty” strategy
The purpose of treatment for this type of uveitis is to quickly “eliminate” the inflammation and avoid or reduce the occurrence of complications, so it is appropriate to adopt a “quick fix” strategy. “In patients with acute anterior uveitis, for example, the author uses frequent doses of 0.1% dexamethasone drops for The treatment can often achieve significant therapeutic effects in the short term, such as giving low-frequency, mild glucocorticoid eye drops to such patients, making it difficult for the inflammation to subside quickly and prone to complications such as post-iris adhesions.
2. “Protracted war” strategy
Some types of uveitis exhibit chronic and persistent inflammation, for this type of inflammation can not take a quick-fix strategy, but should take a “protracted war” strategy, that is, the use of small doses (just enough to control the inflammation dose), a small number (i.e., with one or a few drugs) of drugs so that the inflammation is slowly “This strategy appropriately reproduces the “aesthetic thinking” proposed by the author.
3. Emergency treatment strategy
In patients with uveitis, the sudden rise in IOP due to complete post-iris adhesions, inflammation is no longer the main conflict, but the sharp rise in IOP is the most prominent conflict, which will cause serious damage to visual function in the short term if not controlled in a timely and effective manner. This is the so-called emergency treatment strategy. In severe acute retinitis or optic neuritis, which can cause serious damage to the retina or optic nerve in a short period of time, it is also advisable to use the strategy of treating the symptoms as a matter of urgency, that is, to give high doses of glucocorticoids (the high doses emphasized here are reasonable high doses, not the larger the better high doses) to quickly “extinguish” the inflammation and reduce the damage caused by inflammation In order to win the time to save the visual function, and then take a long view and give the standardized individualized medication, so as to fundamentally cure the uveitis.
4. Combined medication strategy
In some types of uveitis, treatment with one immunosuppressant may require a large dose to control inflammation, but the patient cannot tolerate such a large dose of drugs, so a combination of two or more drugs is needed; in some types of uveitis, when treatment with one immunosuppressant is not sufficient to control inflammation, it is also appropriate to combine two or more immunosuppressants; in addition, the patient needs to use a drug ( In addition, patients who need to be treated with one drug (e.g., glucocorticosteroids) but have an underlying disease (e.g., diabetes mellitus) may be treated with a combination of drugs to reduce the impact on the pre-existing disease. Generally speaking, the dose of combined drugs is smaller than the dose used alone, so the side effects of drugs can be reduced and easily tolerated by patients.
5. “Support the righteous and dispel the evil” strategy
The long-term use of immunosuppressants for the treatment of uveitis often causes some side effects, such as leukopenia, liver and kidney function damage, to borrow the terminology of Chinese medicine, that is, in the process of “eliminating evil” hurt the “righteousness”, the righteousness is not supported to fight the disease, at this time should be given “At this time, Chinese herbal medicine should be given to regulate the yin and yang qi and blood to reduce or avoid the side effects caused by immunosuppressive drugs, so that the positive qi can be restored and the treatment can be tolerated and continued, otherwise the patient may be forced to discontinue the treatment due to the side effects of the drug, and stopping the drug means that the patient’s uveitis loses effective treatment. It can be seen that the combination of Chinese herbal medicine in the treatment of patients with immunosuppressive drugs can be a good adjunct to the treatment according to TCM evidence-based treatment. In addition, Chinese herbal medicine has a beneficial effect on the recovery of uveitis and also has a good therapeutic effect on some systemic manifestations of patients such as irritability, irritability, insomnia, fatigue, constipation, and loss of appetite.