基于“血不利则为水”理论探讨活血利水法在眼科疾病中的应用

Exploration of the Application of the Blood-Activating and Water-Resolving Therapy in Ophthalmic Diseases Based on the Theory of “Impaired Blood Circulation Leading to Fluid Retention”

摘要: “血不利则为水”首载于张仲景《金匮要略》，原指血脉不通可致水液停聚。眼部脉络纤细、玄府精微，血行滞涩极易导致津液输布失常，形成“血瘀水停”之局。文章系统梳理“血不利则为水”理论的中医眼科病机内涵，重点从视网膜静脉阻塞继发黄斑水肿、糖尿病视网膜病变、青光眼、中心性浆液性脉络膜视网膜病变等常见眼病出发，深入论述各疾病“血不利则为水”的具体病机演变及活血利水法的应用理论基础，并总结常用方药规律与名家经验。研究认为，活血利水法通过“活血以治本、利水以治标”，可有效改善眼部微循环、促进水肿消退，从而改善眼部疾患症状，临床常需联合益气、养阴、疏肝、健脾等法随证施治，为眼科疑难病的中西医结合诊疗提供思路。

Abstract: “Impaired Blood Circulation Leading to Fluid Retention” was first recorded in Zhang Zhongjing’s “Jin Kui Yao Lue”. Originally, it referred to the situation where blocked blood vessels could cause water accumulation. The ocular vessels are slender, and the internal organs are delicate; blood stagnation and sluggish flow are highly likely to lead to abnormal distribution of body fluids, resulting in the condition of “blood stasis and water retention”. This article systematically reviews the internal mechanism of this theory in traditional Chinese medicine ophthalmology, focusing on common eye diseases such as retinal vein occlusion followed by macular edema, diabetic retinopathy, glaucoma, and central serous chorioretinopathy. It deeply discusses the specific pathogenesis of “blood deficiency leads to water retention” in each disease and the theoretical basis for the application of the method of activating blood circulation and promoting water flow. It also summarizes the regularities of commonly used prescriptions and the experiences of famous physicians. It is believed that the method of activating blood circulation and promoting water flow can effectively improve the microcirculation of the eyes, promote the regression of edema, and thereby alleviate the symptoms of eye diseases. Clinically, it is often necessary to combine methods such as tonifying qi, nourishing yin, soothing the liver, and strengthening the spleen to treat the disease according to the syndrome, thereby providing ideas for the combined diagnosis and treatment of difficult ophthalmic diseases in both traditional Chinese and Western medicine.