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Table of Contents
GUIDELINES
Year : 2022  |  Volume : 8  |  Issue : 3  |  Page : 453-461

International clinical practice guideline of Chinese medicine retinal vein occlusion


Eye Hospital of China Academy of Chinese Medical Sciences, Beijing, China

Date of Submission09-Feb-2022
Date of Acceptance29-Apr-2022
Date of Web Publication14-Jul-2022

Correspondence Address:
Dr. Li-Ke Xie
Eye Hospital of China Academy of Chinese Medical Sciences, Beijing
China
Dr. Xiao-Feng Hao
Eye Hospital of China Academy of Chinese Medical Sciences, Beijing
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2311-8571.350881

Rights and Permissions

How to cite this article:
Xie LK, Hao XF. International clinical practice guideline of Chinese medicine retinal vein occlusion. World J Tradit Chin Med 2022;8:453-61

How to cite this URL:
Xie LK, Hao XF. International clinical practice guideline of Chinese medicine retinal vein occlusion. World J Tradit Chin Med [serial online] 2022 [cited 2023 Feb 3];8:453-61. Available from: https://www.wjtcm.net/text.asp?2022/8/3/453/350881



World Federation of Chinese Medicine Societies

International Standard of WFCMS Issued & implemented on December 14 2021


  Foreword Top


Please note that some of the contents of this document may involve patents, and the issuing agency of this document is not responsible for identifying patents.

The main drafting committees of this guideline: Eye Hospital of China Academy of Chinese Medical Sciences, Hunan University of Traditional Chinese Medicine, Wangjing Hospital of China Academy of Chinese Medical Sciences, Eye Hospital of Shandong University of Traditional Chinese Medicine, Xijing Hospital of Air Force Military Medical University.

The drafting committees of this guideline: First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Xiyuan Hospital of China Academy of Chinese Medical Sciences, Eye School of Chengdu University of Traditional Chinese Medicine/Teaching Ineye Hospital of Chengdu University of Traditional Chinese Medicine, Third Hospital of Peking University, First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine, The Third Affiliated Hospital of Beijing University of Traditional Chinese Medicine, First Affiliated Hospital of Henan University of Traditional Chinese Medicine, Eye Hospital of Heilongjiang Jiaoshi, China-Japan Friendship Hospital, Affiliated Hospital of Changchun University of Traditional Chinese Medicine, Taizhou Fourth People's Hospital of Jiangsu Province, Hubei University of Traditional Chinese Medicine, Chengdu University of Traditional Chinese Medicine, Xi'an Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine, China Academy of Chinese Medical Sciences, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Hubei Provincial Hospital of Traditional Chinese Medicine, Gansu Provincial Hospital of Traditional Chinese Medicine, Henan University of Traditional Chinese Medicine, Guangdong Provincial Hospital of Traditional Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Affiliated Hospital of Yunnan University, Beijing Tongren Hospital Affiliated to Capital Medical University, Ankang Hospital of Traditional Chinese Medicine, Eye Hospital of Hebei Province, The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, the Affiliated Hospital of Shaanxi University of Traditional Chinese Medicine, Shanghai Purui Eye Hospital, The Second Affiliated Hospital of Nanjing University of Traditional Chinese Medicine, Dongzhimen Hospital Affiliated to Beijing University of Traditional Chinese Medicine, Zaozhuang Hospital of Traditional Chinese Medicine of Shandong Province, Affiliated Hospital of Jiangnan University of Wuxi, Dongfang Hospital Affiliated to Beijing University of Traditional Chinese Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Hebei Province, Guang'anmen Hospital of China Academy of Chinese Medical Sciences, First People's Hospital of Shanghai, Eye Optometry Hospital Affiliated to Wenzhou Medical University, Zhuhai Kangning Group, Beijing Hospital of Traditional Chinese Medicine Affiliated to Capital medical university, Beijing Hepingli Hospital, First Affiliated Hospital of Shandong First Medical University, Eye Hospital of Shenzhen Ximalin Shunchao, Qian'an Yanshan Hospital, Second Affiliated Hospital of Liaoning University of Traditional Chinese Medicine, Hong Kong Baptist University School of Chinese Medicine, Taiwan China Medical University, Wellspring clinic, Vancouver BC, Canada (Canada), National Institutes of Health Ophthalmology (USA), Texas A&M University (USA), American Learning and Vision Association (USA), St. Olav Eye Clinic (Norway), Singapore Chinese Hospital (Singapore).

Proposer of this guideline: Li-Ke Xie

The main drafters of this guideline: Li-Ke Xie, Xiao-Feng Hao, Qing-Hua Peng, Li-Na Liang, Jing Liu, Hong-Sheng Bi, Yan-Nian Hui.

The drafters and reviewer of this guideline (Sort alphabetically by last name):

China: Guo-Jun Chao, Xiang-Dong Chen, Li-Qun Chu, Jun-Guo Duan, Xue-Feng Feng, Jun Feng, Ying Gao, Yun Gao,

Xiao-Bo Hao, Ping He, Qin Huo, Hong Jiao, Chuan-Hong Jie, Xiu-Xin Jiao, Ming Jin, Qi Jin, Yuan Ju, Wei Kang, Chuan-Ke Li, Da-Jing Li, Du-Jun Li, Qiang Li, Jian-Chao Li, Xiang Li, Feng-Ming Liang, Shao-Yan Liu, Xin-Quan Liu, Zhao-Lan Liu,

Xue-Jing Lu, Ji-Hong Luo, Jin-Hua Luo, Xiang-Xia Luo, Hai-Jiang Lu, Li-Na Ma, Long Pang, Hua Peng, Hong Qin, Bo Qin, Li-Xin Qiu, Lan-Ke Shen, Hui-Jun Shi, Jian-Tao Song, He Sun, Jin-Gan Tong, Fu-Bin Wang, Wei Wang, Yang-Zhong Wang, Ying Wang, Zhe Wang,

Ji-Hong Wang, Dong Wei, Qi-Ping Wei, Dan-Wei Wu, Lie Wu, Xin-Wei Wu, Sheng-Jin Xia, Han-Xing Xie, Xue-Jun Xie, Guang Yang, Lai-Qing Yang, Ying-Xin Yang, Yong-Sheng Yang, Jing Yao, Xiao-Lei Yao, Qiong Yi, Lian-Rong Yin, Jing-Sheng Yu, Cang-Xia Zhang, Guo-Liang Zhang, Hong Zhang, Hong-Xing Zhang, Ming-Lian Zhang, Shou-Kang Zhang, Yin-Jian Zhang, Hui Zhao, Jian-Hao Zhao, Shu-Yang Zhong, Jian Zhou, Shang-Kun Zhou, Jin Zhu, Tao Zuo.

Hong Kong, China: Xin Liu

Taiwan, China: Ying-Shan Chen

Canada: Wei-Dong Yu

The United States: Wen-Xin Ma, Wang-Kun Xie, Yue Zhou

Norway: Erik Vinje Olbjørn, Ole Jørgen Frydenlund

Singapore: Qiu-Xia Lin

Australian: Chi-Jing Liu

Japan: Xiao-Fei Liu

Ukraine: Vitalii Samsonov

The drafting process of this document follows the “World Federation of Chinese Medicine International Organization Standards Management Measures” and “Standard formulation and release work specifications” (SCM 0001-2009) issued by the World Federation of Chinese Medicine Societies.

This document is issued by the World Federation of Chinese Medicine Societies, and the copyright belongs to the World Federation of Chinese Medicine Societies.


  Introduction Top


The main content of this document standardizes the diagnosis and treatment of Traditional Chinese Medicine (TCM) for retinal vein occlusion (RVO). It aims to provide the TCM therapeutic strategies and methods of RVO for international TCM practitioners. The document is concise and practical with strong operability, guideline, university and reference, which meets medical regulations and legal requirements. It could be regarded as valuable reference for clinical practice, diagnosis and treatment regulations and quality evaluation.

The published guideline has played a guiding role in the treatment of RVO with Chinese medicine. However, the previous guidelines were limited to conditions, and the formulation process was mostly based on expert consensus as the recommended standard, and the international recognition was low. With the rapid development and application of evidence-based medicine in the field of TCM, research results with higher levels of evidence continue to emerge. This document is based on previous guidelines and is used in high-quality research on the treatment of RVO with higher-level evidence. Screen out the treatment methods that are clinically effective, safe, and easy to promote, so as to improve the clinical efficacy of TCM treatment.

This document is a declarative document based on existing research evidence and scientific evaluation methods. In clinical practice, physicians can refer to this document and carry out individualized treatment based on the specific conditions of the patient.


  International Clinical Practice Guideline of Chinese Medicine Retinal Vein Occlusion Top


1 Scope

This document stipulates the terms and definitions, diagnosis, differentiation, and treatment for RVO.

As a diagnosis and treatment basis for RVO, this document applies to TCM ophthalmologists, combined Chinese and Western medicine ophthalmologists at various levels. This document can also be a reference for Western medicine ophthalmologists or doctors of other TCM departments.

2 Normative references

The following documents are indispensable for the application of this document. For dated reference documents, only the dated version applies to this document; for undated reference documents, the latest version (including all modified versions) applies to this document.

GB/T16751.1 Clinic terminology of traditional Chinese medical diagnosis and treatment-Diseases

GB/T16751.2 Clinic terminology of traditional Chinese medical diagnosis and treatment-Syndrome

GB/T16751.3 Clinic terminology of traditional Chinese medical diagnosis and treatment-Therapeutic methods

ZY/T001.1 Diagnosis and treatment efficacy standard of Chinese medical syndrome

SCM2 Chinese-English International Standard for Basic Terminology of Traditional Chinese Medicine

“WHO International Standards for Traditional Medical Terminology in the Western Pacific Region”

3 Terms and definitions

The following terms ad definitions apply for this document.

3.1 Retinal vein occlusion

Acute blood flow obstruction occurs in the central vein or branch vein of the retina due to various reasons, leading to the expansion and tortuousness of veins, the stasis of blood flow, retinal hemorrhage and edema.

Note: Retinal vein occlusion is classified as “Sudden Blindness,” “Collateral Stasis to Sudden Blindness,” “Blurring Vision,” etc., of TCM.

3.2 Sudden blindness

It is eye disease of internal visual obstruction that the appearance of the eye is normal, and the visual acuity of one or both eyes suddenly drops sharply, and even the eye is blind.

3.3 Collateral stasis to sudden blindness

It is eye disease in which the veins and collaterals of the fundus are blocked, the blood does not flow through the meridians, and overflows outside the collaterals, causing sudden loss of vision.

Note: Collateral stasis to sudden blindness belongs to the category of “Sudden Blindness,” which is equivalent to retinal vein occlusion in Western medicine.

3.4 Blurring Vision

It is eye disease that the appearance of the eye is normal, and the visual acuity in the one and both eyes became dim, which gradually became worse, eventually causing blindness.

Note: Blurring vision is equivalent to retinal vein occlusion or age-related macular degeneration in Western medicine.

4 Diagnosis

4.1 Diagnostic indicator

This disease is more common in middle-aged and elderly people, with monocular disease and occasional binocular disease. Most of them are accompanied by hypertension, arteriosclerosis, cardiovascular and cerebrovascular diseases, diabetes and other systemic diseases. The diagnosis of RVO includes the following:

  1. Vision loss
  2. Dilatation and distortion of retinal vein
  3. Retinal surface hemorrhage and edema in the affected vein area
  4. FFA: The time of retinal circulation prolongs, leakage of capillary, retinal nonperfusion area can be seen.


4.2 Types and stages

4.2.1 CRVO

Central retinal vein occlusion (CRVO) staging by Gass, it is rarely seen in the aura clinical stage, and most of the patients are moderate or severe. The moderate and severe (divided into non-ischemic and ischemic according to retinal ischemia) are just different stages in the development process, and they are unable to be regarded as two different types of diseases, the classification of mild, moderate, and severe is because that it is not yet possible to distinguish ischemic type and nonischemic type in the early stage of disease, many moderate patients develop into severe CRVO after a period of time, and with severe complication.

4.2.1.1 Mild to moderate CRVO

Clinical from mild to moderate, the following conditions may occur:

  1. Extensive intraretinal hemorrhage in the four quadrants of the retina, involving macular fovea, with tortuous and dilated veins, which are dense around the optic disc
  2. Visual acuity is usually higher than 0.1;
  3. Optic disc edema and macular edema
  4. Cotton wool spots are easy to occur in patients with hypertension
  5. Accompanied by transient venous sheath
  6. Time of retinal circulation is significantly prolonged on FFA.


4.2.1.2 Severe CRVO

When the following conditions occur, the probability of becoming severe is high.

  1. Visual acuity drops sharply below 0.1
  2. Pupillary light reflex is slow and may occur relative afferent pupillary defect RAPD (+)
  3. Hemorrhage sharply increased, forming extensive fusion Hemorrhage, and obscuring the edge of the optic disc
  4. Obvious optic disc edema
  5. Multifocal white cotton wool spots
  6. The retinal venous pressure was significantly increased, and the retinal circulation time was significantly increased, and acupressure eyeballs, there is no pulsating of retinal veins.


4.2.2 BRVO

Branch retinal vein occlusion (BRVO) is divided into nonischemic type and ischemic type:

  1. Nonischemia type: Retinal hemorrhage and edema are mild, vision is mildly and moderately drops, and visual field is less damaged. FFA showed no or small areas with nonperfusion
  2. Ischemia type: Retinal radiation-like hemorrhage, severe edema of the optic disc and retina, cotton wool spots, visual acuity decreased significantly, visual field damage was obvious, FFA shows a large area with nonperfusion area.


4.3 Clinical examination

The patients of RVO can do the following physical and chemical examinations:

4.3.1 Color fundus photography

The condition and extent of fundus lesions are assessed.

4.3.2 Fundus fluorescein angiography

The extent of vascular obstruction and the degree of ischemia are assessed; it can also locate the leakage of microangioma and the nonperfusion area of capillary, distinguish the collateral vessels, and serve as a reference for the treatment of laser photocoagulation.

4.3.3 Visual field or microperimetry

It can be seen that the visual field defect corresponding to the damaged area of the retina can show the darkspots of the nerve fiber bundles, and the density of the dark spots depends on the degree of ischemia, which can assist in judging the types of ischemic and non-ischemic. The microperimetry can assess function of macular.

4.4.4 Optical coherence tomography/Optical coherence tomography angiography

Optical coherence tomography (OCT) can find the location and degree of macular edema. Follow-up OCT can judge the progress of the disease and evaluate the effect of treatment. OCT angiography can visually see the degree of damage of the macular arch ring structure and the density of super capillaries and deep capillaries, without the need of FFA.

4.3.5 Flicker electrophysiology (Flicker-electroretinogram)

If the b-wave amplitude drops by 40%, and combined with relative afferent pupillary defect, it can be considered ischemic type of RVO.

4.3.6 Carotid color Doppler or/and Transcranial Doppler

Ultrasound can find the location and degree of atherosclerotic plaque and stenosis of common carotid artery, internal and external carotid artery. Transcranial Doppler can show intracranial segment of the internal carotid artery, especially the stenosis and blood flow of the siphon segment, the ophthalmic artery opens in the siphon segment of the internal carotid artery, the decline of blood flow at this site will directly affect the blood supply of the ophthalmic artery system.

4.3.7 Gonioscopy

Observe whether there is iris neovascularization hidden in the corner of the chamber, which has guiding significance for ischemic RVO.

4.3.8 Laboratory tests

Including blood routine examination, biochemical routine examination (including blood lipids, blood sugar, creatinine, electrolytes, homocysteine, etc.), glycated hemoglobin, anti-phospholipid antibodies, etc.

4.4 Differntial diagnosis

4.4.1 Diabetic retinopathy

Diabetes is a common causative factor of RVO, and the two should be distinguished. Diabetic retinopathy has a clear medical history of diabetes and onset with both eyes. Microhemangioma, small dots, or round deep hemorrhage can be seen in the fundus at early stage, and as the development of the disease, there may be abnormalities of retinal small vessel, hard exudation or cotton-like plaque, no perfusion area, neovascularization, vitreous hemorrhage, and proliferative lesions.

4.4.2 Retinal periphlebitis (Eales disease)

Most patients of Eales Disease are young people, and often onset with both eyes, the hemorrhage, vascular white sheath or vascular white line are mostly located in the peripheral part of retina, which may be combined with inflammatory vitreous opacity, edema of optic disc and macular. Fundus cannot be examined directly when vitreous opacity is affected, and thus the surrounding retina of the contralateral eye should be examined, which will present the signs of vascular inflammation or hemorrhage. FFA showed diffuse capillary leakage, as well as nonperfusion areas and neovascularization, etc.

5 Syndrome differentiation

5.1 Blood heat hurting collateral

The appearance of the eye is normal, the visual acuity suddenly drops, the flaming hemorrhage can be seen on the fundus, distributed along the veins, the color of hemorrhage is bright red, and often with cotton-like plaques exudation; Accompanied by fullness and discomfort in the chest and rib-side, vexation and agitation with anger, the color of complexion and ears are red, dizziness, bitter taste in the mouth and dry in the throat; red tongue, yellow coating, rapid and wiry pulse.

5.2 Qi stagnation and blood stasis

Blurred visual acuity, dark red hemorrhage at the fundus, the boundary of optic disc is blurred, and edema are often covered by hemorrhage. Artery thinning, accompanied by a lot of hardening, and dilatation and distortion of vein, edema of macular and retina, and star-like exudation or cystoid macular edema; accompanied by eyes distention and headache, fullness and discomfort in the chest and rib-side, or emotional disorders, eating less and belching; red tongue with stasis macules, thin and white tongue, wiry pulse or rough pulse.

5.3 Phlegm and blood stasis blocking the collaterals

The appearance of the eye is normal, the visual acuity suddenly drops, the flaming hemorrhage can be seen on the fundus, distributed along the veins, the color of hemorrhage is dusky red, dilated and tortuous veins, retinal edema, starburst-like exudation or cotton-like plaque exudation, cystoid macular edema, or accompanied by neovascularization or fibroblast proliferation; Accompanied by epigastric oppression and eating less, thirst without a desire to drink, dusky tongue with stasis macules, greasy coating, wiry, and rough pulse.

5.4 Qi and blood deficiency

Visual loss for a long term, the color of the retina is turbid, the hemorrhage is partly absorbed, the color of hemorrhage is dusky-black, the occluded vessels appearing white line shape; Accompanied by fatigue and speaking less, dyspnea and lacking of strength, dizziness and tinnitus; light and dusky tongue with stasis macules, and teeth-marked tongue, deep and thread pulse.

5.5 Liver-kidney Yin deficiency

Visual loss, and repeated hemorrhage in the fundus, but the amount of hemorrhage is less, or with a few neovascularization; Accompanied by the lip and area of sacrum are red, bitter taste in the mouth and dry in the throat, dizziness and tinnitus, rheumatic pain of waist and knees, seminal emission and lacking of strength, vexing heat in the five centers (chest, palms, and soles); crimson tongue with less coating, wiry, and thread pulse.

6 Treatment

6.1 Therapeutic principles

The key to the pathogenesis of this disease is blood stasis, which is closely related to qi stagnation, qi deficiency, phlegm-fluid retention, urination, and dampness. If there is static blood, Qi is unable to move, and unable to upper move water and fluids, accumulation blood transforming into phlegm and water, lingering and binding, stagnation is difficult to eliminate. Therefore, the treatment should take into account blood, stasis, qi, fire, phlegm, dampness, and water, the main therapeutic principle and method is to invigorate blood and dissolve stasis, combined with systemic syndromes and signs, supplemented by the treatment of rectifying qi to resolve constraint, calming the liver and subduing yang, dispelling phlegm and draining dampness, enriching yin and reducing fire, unblocking the collaterals and dispelling accumulation, to promote absorption of retinal hemorrhage and regression of retinal edema, preventing the occurrence and development of complications. At the same time of symptomatic differentiation treatment, we should actively find the cause and treat the primary disease. Ischemic type of RVO should be treated with integration of Chinese and Western medicine.

6.2 Prescription

6.2.1 Blood heat hurting collateral

The therapeutic methods: Clearing heat and cooling the blood, stanching bleeding and invigorating blood.

Prescription: Ningxue Decoction (<Traditional Chinses Medicine Ophthalmology>). Xianhecao (Herba Agrimoniae), Hanliancao (Herba Ecliptae), Shengdihuang (Radix Rehmanniae), Zhizitan (Fructus Gardeniae Praeparatus), Baishao (Radix Paeoniae Alba), Baiji (Rhizoma Bletillae), Bailian (Radix Ampelopsis), Cebaiye (Cacumen Platycladi), Ejiao (Colla Corii Asini), Baimaogen (Rhizoma Imperatae) (Level of Evidence IV, low priority).

Addition and subtraction: If there is red tongue and rapid pulse in the early stage of bleeding, adding Jingjietan (Herba Schizonepetae Carbonisatum), Daji (Herba Cirsii Japonici), Xiaoji (Herba Cirsii); If there are a lot of bleeding in the fundus, and the color of blood is purle-dusky, adding Shengpuhuang (Pollen Typhae), Qiancao (Radix et Rhizoma Rubiae), Yujin (Radix Curcumae); If the edema of retina is obvious, adding Yimucao (Herba Leonuri), Yiyiren (Coix Seed), Cheqianzi (Semen Plantaginis).

6.2.2 Qi Stagnation and blood stasis

The therapeutic methods: Rectifying Qi and resolving constraint, dissolving stasis and stanching bleeding.

Prescription: Xuefu Zhuyu Decoction (<Correction of Errors in Medical Works>). Danggui (Radix Angelicae Sinensis), Shengdihuang (Radix Rehmanniae), Taoren (Semen Persicae), Honghua (Flos Carthami), Zhiqiao (Fructus Aurantii), Chishao (Radix Paeoniae Rubra), Chaihu (Radix Bupleuri), Gancao (Radix et Rhizoma Glycyrrhizae), Jiegeng (Radix Platycodonis), Chuanxiong (Rhizoma Chuanxiong), Niuxi (Radix Achyranthis Bidentatae) (Level of evidence Ib, high priority),

Addition and subtraction: If there are a lot of bleeding, and the color of blood is purple-dusky, adding Shengpuhuang (Pollen Typhae), Qiancao (Radix et Rhizoma Rubiae), Sanqi (Radix et Rhizoma Notoginseng) to dissolve stasis and stanch bleeding; If there are congestion and edema in the optic disc, and retinal edema is obvious, adding Zelan (Herba Lycopi), Yimucao (Herba Leonuri), Cheqianzi (Semen Plantaginis) to invigorate blood and drain water; If patients are insomnia and profuse dreaming, adding Zhenzhumu (Concha Margaritiferae Usta), Yejiaoteng (Caulis Polygoni Multiflori) to calm the mind.

6.2.3 Phlegm and blood stasis blocking the collaterals

The therapeutic methods: Clearing away heat and phlegm, dissolving stasis and dredging collaterals.

Prescription: Taohong Siwu Decoction and Wendan Decoction. (<Yizong Jinjian>, <Sanyin Ji Yi Bingzheng Fang Lun>) Taoren (Semen Persicae), Honghua (Flos Carthami), Shengdihuang (Radix Rehmanniae), Danggui (Radix Angelicae Sinensis), Chuanxiong (Rhizoma Chuanxiong), Baishao (Radix Paeoniae Alba), Fuling (Poria), Fabanxia (Rhizoma Pinelliae Praeparatum), Zhiqiao (Fructus Aurantii), Zhuru (Bamboo Shavings), Chenpi (Pericarpium Citri Reticulatae), Shengjian (gingerg), Dazao (Jujubae Fructus), Gancao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle). (Level of evidence I b, high priority).

Addition and subtraction: If there are a lot of bleeding, and the color of blood is purple-dusky, adding Shengpuhuang (Pollen Typhae), Qiancao (Radix et Rhizoma Rubiae) to dissolve stasis and stanch bleeding; If there are congestion and edema in the optic disc, and the retinal edema is obvious, adding Zelan (Herba Lycop) i, Yimucao (Herba Leonuri), Cheqianzi (Semen Plantaginis) to invigorate blood and drain water; If patients are insomnia and profuse dreaming, adding Zhenzhumu (Concha Margaritiferae Usta), Yejiaoteng (Caulis Polygoni Multiflori) to calm the mind.

6.2.4 Qi and blood deficiency

The therapeutic methods: Supplementing Qi and invigorating blood, dissolving stasis and unlocking the collaterals.

Prescription: Bazhen Decoction (<Danxi's Mastory of Medicine>), Renshen (Radix et Rhizoma Ginseng), Baizhu (Rhizoma Atractylodis Macrocephalae), Fuling (Poria), Danggui (Radix Angelicae Sinensis), Chuanxiong (Rhizoma Chuanxiong), Baishao (Radix Paeoniae Alba), Shudihuang (Radix Rehmanniae Praeparata), Gancao (Radix et Rhizoma Glycyrrhizae Praeparata cum Melle) (Level of evidence IIb, low priority).

Addition and subtraction: If patients are flusteredness and palpitations, insomnia and profuse dreaming, adding Suanzaoren (Semen Ziziphi Spinosae), Shouwuteng (Caulis Polygoni Multiflori), Baiziren (Semen Platycladi) to nourish the heart and calm the mind; If the color of retina is slight, adding Gouqizi (Fructus Lycii), Tusizi (Semen Cuscutae), Nuzhenzi (Fructus Ligustri Lucidi) to enrich and nourish the liver and kidney; If patients are emotional constraint as long-term disease, adding Chaihu (Radix Bupleuri), Baishao (Radix Paeoniae Alba), Qingpi (Pericarpium Citri Reticulatae Viride), Yujin (Radix Curcumae) to emolliate the liver and resolve constraint.

6.2.5 Liver-kidney Yin deficiency

The therapeutic methods: Enriching and nourishing liver and kidney, dissolving stasis and improving vision.

Prescription: Modified Qiju Dihuang Decoction (<Precious Mirror for the Advancement of Medicine>), Gouqi (Fructus Lycii), Juhua (Flos Chrysanthemi), Shudihuang (Radix Rehmanniae Praeparata), Shanzhuyu (Fructus Corni), Mudanpi (Cortex Moutan), Shanyao (Rhizoma Dioscoreae), Fuling (Poria), Zexie (Rhizoma Alismatis) (Level of evidence IV, low priority).

Addition and subtraction: If there are tidal fever and dryness in the mouth of patients obviously, adding Shengdihuang (Radix Rehmanniae), Maidong (Radix Ophiopogonis), Zhimu (Rhizoma Anemarrhenae), Huangbai (Cortex Phellodendri Chinensis) to enriching yin and reducing fire; If there are heavy head and light feet, adding Heshouwu (Radix Polygoni Multiflori), Gouteng (Ramulus Uncariae Cum Uncis), Shijueming (Concha Haliotidis) to enrich and nourish the liver and kidney, calm the liver and subdue yang; If the deficiency heat is obvious, adding Digupi (Cortex Lycii), Baiwei (Radix et Rhizoma Cynanchi Atrati) to clear heat and cool the blood.

6.3 Acupuncture and moxibustion therapy

Prescriptions: Jingming (BL1), Tongziliao (GB1), Fengchi (GB20), Taichong (LR3), Guangming (GB37).

Addition and subtraction: a syndrome of blood heat hurting collateral, adding Hegu (LI4) and Quchi (LI4); a syndrome of Qi stagnation and blood stasis, adding Hegu (LI4) and Geshu (BL17); a syndrome of phlegm and blood stasis blocking the collaterals, adding Fenglong (ST40) and Geshu (BL17); a syndrome of Qi and blood deficiency, adding Sanyinjiao (SP6) and Zusanli (ST36); a syndrome of liver-kidney Yin deficiency, adding liver Shu (BL18), Shenshu (BL23).

Operations: Puncturing Jingming (BL1) according to normative manipulation of acupoints around the eye area to prevent damage to the eyeball or intraocular bleeding; attention should be paid to the direction, angle and depth of puncturing Fengchi (GB20) to avoid piercing the foramen magnum and damaging the medulla oblongata; other acupoints are routine operate (Level of evidence IV, low priority).

Traditional Chinese Patent Medicine

The selection of traditional Chinese patent medicines must conform to the type of disease and should not be used blindly.

  1. Compound Xueshuantong Capsules: oral, 3 capsules at a time (0.5 g each), three times per day, it is suitable for blood stasis, Qi and Yin deficiency (Level of evidence Ia, high priority)
  2. Danhong Huayu Koufuye: oral, 1–2 sticks at a time (10 ml each), three times per day, it is suitable for Qi stagnation and blood stasis (Level of evidence Ib, high priority)
  3. Yunnan Baiyao Capsules: oral, 0.25-0.5 g each time, four times pro day, it is suitable for blood stasis (Level of evidence Ib, low priority)
  4. Huoxue Mingmu Tablets: oral, 1.5 g each time, three times per day, it is suitable for Yin deficiency and liver hyperactive, blood heat hurting collateral (Level of evidence IV, low priority)
  5. Xueshuantong injections: 200–400 mg are added to 500 ml 0.9% sodium chloride effluent or 500 ml 5% glucose, intravenous infusion, once per day, it is suitable for blood stasis (Level of evidence Ib, high priority)
  6. Salvianolate for injection: 20–40 ml are added to 500 ml 0.9% sodium chloride effluent or 500 ml 5% glucose, intravenous infusion, once a day, it is suitable for blood stasis (Level of evidence IV, low priority).


Financial support and sponsorship

State Administration of Traditional Chinese Medicine International Cooperation in Traditional Chinese Medicine (0610-2040NF020931); National Natural Science Foundation of China (81603666); The key research and development project of the Beijing Municipal Science and Technology Commission's Capital Clinical Characteristic Application Research (Z181100001718183); Beijing Natural Science Foundation (7192235); Beijing Traditional Chinese Medicine Science and Technology Development Fund Project (JJ2018-95); Major project of Chinese Academy of Chinese Medical Sciences (CI2021A05107); China Academy of Chinese Medical Sciences Central-level non-profit research institutes, the basic scientific research business “predominant diseases-hospital preparations-new drugs” research and development project (ZZ15-XY-PT-09).

Conflicts of interest

The “International Clinical Practice Guidelines for Traditional Chinese Medicine: Retinal Vein Occlusion” has been reviewed by the ethics committee and found no clear business, professional or other interests related to the subject of this document, as well as all conflicts of interest that may be affected by the results of this document.


  Appendices Top


Appendix A: (Informative)


  Evidence Evaluation and Recommendation Principle Top


A.1 Principles of evidence evaluation and grading standards

The evidence classification principle of this document is based on the composition of Evidence Body of Traditional Medicine and Recommendation for Its Evidence Grading by Prof Jianping Liu. In addition, if a randomized controlled trial is defined as high risk, its grade recommendation is reduced by one level.

The process of screening and evaluation of the literature is carried out independently by two evaluations. If the views of the two parties are inconsistent, they would resolve through negotiation or adjudication by a third party. See the [Table A1] below for detail:



A.2 Recommendation principle

Because the fact that most of studies on the treatment of retinal vein occlusion in Traditional Chinese Medicine are not comprehensive, the design of studies often less standardized, the selection of formula is diverse, and the efficacy standard is not uniform, which attributed to the outcome bias. Therefore, all the evidences of this document are required to obtain expert consensus before being included into the recommendation.

The recommendation grading criteria on the current guideline are generally recommended for evidence based on the recommended strength level criteria developed by the Grading of Recommendations Assessment, Development and Evaluation team, which is divided into high and low levels. When the evidence clearly shows the advantages or disadvantages of the intervention, it can be classified as a high priority by groups of this guideline, while the pros and cons are uncertain in a study or when the quality of the evidence shows the pros and cons are equivalent, it can be considered as a low priority.[12]



 
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Introduction
International Cl...
4.2.1.1 Mild to ...
4.2.1.2 Sever...
Appendices
Evidence Evaluat...
Foreword
References

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