Current status and outlook of research on the integration of Chinese and Western medicine in uveitis

  It can be caused by a variety of pathogens such as bacteria, viruses, fungi and parasites, as well as autoimmune, rheumatic diseases, trauma and tumors, and there are many different types of uveitis, with a high proportion of young adults suffering from the disease. The causes and mechanisms of uveitis are not fully understood, and there is a lack of ideal prevention and treatment methods, so it is of great significance to conduct clinical research on uveitis.  The most widely used classification of uveitis is the anatomical location classification developed by the International Study Group on Uveitis in 1987. The Guangdong Zhongshan Eye Center conducted a statistical analysis of the medical records of 1,214 patients who presented to the uveitis specialist from January 1996 to December 2001. The incidence of uveitis in our country. According to their study, the clinical types of uveitis, classified by anatomical location, were most frequent in anterior uveitis (44.98%), followed by total uveitis (43.66%), intermediate uveitis (6.43%), and posterior uveitis (4.94%), with Behcet’s disease and Vogt-Koyanagi-Harada syndrome accounting for a relatively high proportion of total uveitis in these patients. The most common type of total uveitis was Behcet’s disease, accounting for 41.13% and 17.85% of the 1,214 patients, which was significantly higher than the previously reported 4.7%, suggesting that the incidence of Behcet’s disease in China may be similar to that in Japan and Italy, with an increasing trend. Compared with Europe and the United States, the etiology and type of total uveitis in Europe and the United States are significantly different from those in China, with Behcet’s disease and Vogt-Koyanagi-Harada syndrome being rare and sarcoidosis being the most frequent type, whereas sarcoidosis in China is rare and manifests as anterior uveitis. This difference may be related to the preference for pets such as cats and dogs in Europe and the United States, which makes it easy for cross-infection between humans and animals. The age distribution of Behcet’s disease and anterior uveitis associated with ankylosing arthritis is particularly pronounced, with 90.37% and 84.44% of young adults having uveitis, respectively, while juvenile chronic arthritis with uveitis is more common in young adults. The average age of onset of uveitis in patients with juvenile chronic arthritis is only 10.94 years old, and the gender ratio of uveitis is slightly higher in males than in females, although there are different patterns for specific types.  The immunological mechanism of uveitis is closely related to immunity, in the sense that it is an autoimmune disease or at least a disease with an autoimmune response. Animal experiments have demonstrated that any one of the types I-IV described by Gell can be induced in the uvea. The doctrine of autoimmunity in uveitis and its related studies have become the most active topic in the field of ophthalmic immunology. α, β, and γ crystal proteins, in addition to cystic membrane components, epithelial substances, intracellular and cell membrane enzymes, etc., which enter the atrial fluid in large quantities for various reasons and cause disease; and (iii) retinal soluble antigen (i.e., S-antigen), which may be a subunit of retinal adhesive protein. It can induce experimental autoimmune uveitis similar to human intermediate uveitis; ④ immune complexes (IC) and human leukocyte antigens (HLA), IC can be measured in serum and atrial fluid of different types of patients, and many uveitis are accompanied by different specific HLA antigens, which are related to immune regulation disorders.  3 Research on combined Chinese and Western medicine treatment Broadly speaking, uveitis refers to inflammation occurring in the uvea, retina, retinal vessels, and vitreous humor, and it is a class of diseases rather than a disease. Uveitis is a very complex and diverse group of diseases in terms of anatomic location, etiology and type of inflammation, associated systemic diseases, involved tissues and consequences, and disease spectrum. This complexity and diversity determines the diversity and inconsistency of treatment options for uveitis. Currently, western medical treatment of uveitis is based on the use of anti-inflammatory agents and immunosuppressive agents. There are two main classes of anti-inflammatory agents, non-steroidal anti-inflammatory drugs and glucocorticoids. There are many types of immunosuppressants, such as cyclophosphamide, azelaic acid, cyclosporine A, etc. The mechanisms of action, indications, and toxic side effects of these drugs are very different, so there is a problem of treatment formatting and drug encirclementation in the western medical treatment of uveitis, resulting in drug waste and serious side effects. Accordingly, some knowledgeable people in the Western medical field have proposed individualized treatment protocols, which are based on the type of uveitis, the location, nature and severity of the inflammation, the patient’s age, gender, physique, underlying diseases, economic factors, and other factors to develop a suitable treatment plan for the patient, but there are still some difficulties in clinical operation, and complications and side effects such as hormone dependence cannot be avoided. The clinical application is limited.  Although the name of uveitis is not recorded in Chinese medicine, its clinical manifestations are similar to those recorded in Chinese medicine literature, such as tight pupils, dry pupils, and cloudy eyes, and Chinese medicine has been practiced for thousands of years in treating this disease. The clinical efficacy is significantly better than that of Western medicine alone, so it has great value for development. In recent years, the research on uveitis in Chinese medicine has been organized and found that, although there are many different schools of thought and doctrines, most of them have classified the disease into the following categories: liver and gallbladder heat, damp heat, liver and kidney yin deficiency, qi stagnation and blood stasis, and some of them also treat the disease with damp heat and wind, lung and spleen deficiency, and spleen and kidney yang deficiency. The clinical treatment of uveitis is also based on clearing the liver, promoting the development of the liver, and the development of the blood. The clinical treatment is also based on clearing the liver and gallbladder, clearing dampness and heat, promoting blood circulation, nourishing the liver and kidneys, and strengthening the spleen and kidneys, and the prescription drugs used are all within this range and are selected according to each person’s clinical experience. Specifically, the type with heat in the liver and gallbladder is usually treated with Gentian Diarrhea Liver Soup with addition and subtraction, using gallbladder herb, cypress, scutellaria, Qing Pi, Chai Hu, Chuan Niu Knee, Moutong, etc. or other heat-clearing and detoxifying and blood cooling products, such as gypsum, honeysuckle, wild chrysanthemum, zihua Di Ding, purple-backed asparagus, red peony, danpi, dandelion, and water hyacinth. For damp-heat type, we can add gardenia, tempeh, mulberry leaf, red peony, white peony, thorny mustard, windbreak, summer cress, green peel, brambles, etc. For deficiency of lung and spleen and kidney yang, we can add mulberry peel, lappa bark, brambles, brambles, etc. burdock, bramble, astragalus, schisandra, yam, boneset, poria, gorgonians, lotus seeds, etc., and as many as a hundred kinds of drugs are used clinically.  Some physicians have also explored the classification of treatment according to objective Western medical indicators to quantify and standardize TCM treatment, for example, Wu Lianxi [ 14 used herbal medicines with immune-promoting or immune-suppressing effects to treat patients in three categories according to the results of immune function measurement. The type with normal humoral immunity and low cellular immunity: use herbs with immune-promoting effects, such as those that support the body, nourish Yin and benefit Qi, and clear heat and detoxify the body. Basic formula: Astragalus, Radix Codonopsis, Atractylodes, Poria, Yinhua, Forsythia, Dandelion, Di Ding, Poria, Plantago; normal cellular immunity, elevated humoral immunity, or both: use herbs with immunosuppressive effects, such as activating blood circulation, removing blood stasis, bitter cold and detoxifying agents. Basic formula: Radix Angelicae Sinensis, Salviae Miltiorrhiza, Radix Paeoniae Alba, Radix et Rhizoma Safflower, Radix Scutellariae Sinensis, Radix Scutellariae Sinensis, Radix et Rhizoma Forsythiae, Radix et Rhizoma Chuan Lian, Radix Glycyrrhiza Uralensis, Radix et Rhizoma Fu Ling, Radix et Rhizoma Psyllium; Imbalanced type of low cellular immunity and elevated humoral immunity: use herbs with two-way regulation. Basic formula: Radix et Rhizoma Ginseng, Radix Astragali, Radix Glycyrrhiza Uralensis, Poria, Radix Angelicae Sinensis, Radix Paeoniae Alba, Radix et Rhizoma Chai Hu, Radix et Rhizoma Safflower, Radix et Rhizoma Forsythiae Sinensis, Radix et Rhizoma Poriae Alba, Radix et Rhizoma Plantago. The average treatment time was 37.6 days, with 36 cases cured (90%), 3 cases effective and 1 case ineffective. Clinical reference.  According to the statistics of western countries, about 10% of blindness is caused by uveitis, which is the third to seventh among blindness-causing ophthalmic diseases. It is closely related to many systemic autoimmune diseases, which are difficult for patients to detect, complicated for doctors to treat, and difficult for Western medicine to treat. Chinese ophthalmology has a long history and an early start of scientific research, as early as in the 1960s, the Ministry of Health took cataract acupuncture as the first scientific research achievement of Chinese medicine in China, and over the past decades, the majority of Chinese medicine, Chinese and Western medicine and Western ophthalmology workers have attached great importance to the scientific research of Chinese ophthalmology, which is considered to be the only way to modernize Chinese ophthalmology. At present, Chinese ophthalmology research is widely involved in keratoconus, cataract, glaucoma and other fundus diseases, how to strengthen scientific research in the clinical diagnosis and treatment of difficult diseases such as uveitis, in order to explore the treatment mechanism of various methods, to explore a complete and effective combined Chinese and Western medicine treatment system, so as to facilitate the promotion and application, in order to better guide clinical practice, it is urgent to be carried out by knowledgeable people in Chinese and Western medicine.