Peng-Fei JIANGa, Ya-Sha ZHOUa, Yi-Chen LIa, Qing-Hua PENGa,b*, Xiang-Dong CHENb
a.Hunan University of Traditional Chinese Medicine, Changsha, China
b.First Affiliated Hospital of Hunan University of Traditional Chinese Medicine, Changsha, China
Qing-Hua PENG, male, Professor II, research areas: TCM treatment and prevention of ocular fundus diseases, glaucoma, and ocular surface diseases and the normalization of ophthalmic symptoms.
In traditional Chinese medicine, ophthalmic syndrome differentiation is an ophthalmology-specific method for identifying syndromes based on the “Five Orbiculi” theory. It was devised by Professor Qing-Hua PENG through an unprecedented combination of syndrome element differentiation and ophthalmic clinical practices, based on the Clinical Terminology of Chinese Medical Diagnosis and Treatment—Syndromes of the National Standards of the People's Republic of China. This approach integrates an ophthalmic syndrome differentiation system with digital Chinese medicine, and proposes the extraction of syndrome elements of ophthalmic diseases from research on digital Chinese medicine. These elements are then quantified and organized to form a model of digital diagnosis and treatment specific to ophthalmology, which should help to achieve synergistic development of the ophthalmic syndrome differentiation system and digital Chinese medicine.
TCM diagnosis and treatment of diseases are advantageous as they mainly revolve around the fundamentals of syndrome differentiation and treatment—the clinical application and practice of TCM principles, methods, recipes, and medicines1. The existing differentiation methods, such as ba gang (eight principle patterns) differentiation, zang-fu organ differentiation, wei-qi-ying-blood pattern differentiation, six-channel pattern differentiation, san-jiao pattern differentiation, qi-blood-body fluid pattern differentiation, differentiation based on etiology, differentiation of the nature of the disease, pathogenesis differentiation, and meridian differentiation, are mainly applicable to internal medicine, gynecology, and pediatrics, especially the syndrome differentiation of internal medical diseases. None of these standard approaches is specific to ophthalmic diseases2. The ophthalmic syndrome differentiation system is a more systematic and comprehensive approach adapted to ophthalmology, developed by supplementing and amending the Clinical Terminology of Chinese Medical Diagnosis and Treatment—Syndromes of the National Standards of the People's Republic of China (referred to as “Terminology” hereinafter). Through research on digital Chinese medicine, syndrome elements can be extracted from the ophthalmic syndrome differentiation system and quantified and reorganized to refine the diagnosis, treatment, and scientific research in the field of ophthalmology.
2.Necessity of the Ophthalmic Syndrome Differentiation System
Ophthalmic syndrome differentiation and diagnoses usually rely on the terminology of integrative internal medicine. They are unable to reflect the specificity of ophthalmic syndromes, the symptoms of which develop mainly in the eyes. This gives rise to difficulty in diagnosing ophthalmic syndromes, or to inaccurate use of syndrome terminology that fails to represent the characteristics of ophthalmology. For example, invasion of the eyes by wind-heat leads to symptoms such as aversion to wind, fever, pain and redness in the eyes, excessive rheum, over-sensitivity to light, tearing, and floating pulse; this syndrome is generically called attack on the exterior by wind-heat. However, the same term generally refers to invasion of the defensive exterior by wind-heat, which normally causes symptoms such as fever, slight aversion to wind and cold, headache, mild thirst, thin yellow coating on the tongue, and floating pulse, whereas the main symptoms of the syndrome in question are related to the eyes—redness and swelling of the eyelids, redness of the eyes, excessive rheum, over-sensitivity to light, and tearing. In short, attack on the exterior by wind-heat does not represent the characteristics of the syndrome. Instead, invasion (attack) of the eyes by wind-heat (fire) is gives a more specific and precise syndrome differentiation2.
Syndrome differentiation is the most important basis of TCM diagnostics. There are significant differences between the syndrome names used in integrative internal medicine and those used in clinical ophthalmic practices; these differences have posed obstacles to ophthalmic diagnoses. To improve the clinical prevention and treatment of ophthalmic diseases, it is necessary to formulate fundamental rules for ophthalmology-specific syndrome differentiation, and construct an accurate basic model for related clinical differentiation based on the theory of TCM syndrome differentiation and treatment. Therefore, the Terminology made radical, systematic, and standardizing improvements to the naming of ophthalmic syndromes, devising a unique naming system that is distinctive from that of other disciplines. As the system locates diseases based on the “Five Orbiculi” theory, the disease locations can represent the distinctions made in ophthalmology. Unlike the usual naming method, it is not limited to the mere indication of the zang-fu organ or meridian associated with the disease; the resulting locations are more precise and specific. For example, syndromes such as invasion of the eyes by wind-heat, external injury of the ocular vessel, phlegm and dampness in the flesh wheel (eyelids), and qi deficiency in the flesh wheel (eyelids) indicate that the diseases occur in the eyes or eyelids. Their names reflect the differences in the cause and nature of disease, such as wind-heat, external injury, phlegm and dampness, and qi deficiency. Moreover, the associated symptoms are specific to particular parts of the eyes, as in red and sore eyes, dryness of the eyes, blurred vision, reduced sight, swollen and sore eyeballs, abnormal vision, shrunken field of vision, turbid reddening of white of the eye, corneal nebula, hypopyon, dilated pupils, turbid fundus, papilledema or optic disc whitening, blood stasis in the fundus, etc.
Although the Terminology proposed a set of syndromes specific to ophthalmic differentiation, the 53 ophthalmic syndromes identified are insufficient to meet the practical needs of the clinic. Thus, the ophthalmic syndrome differentiation system is still under construction.
3.Introduction to the Ophthalmic Syndrome Differentiation System
The ophthalmic syndrome differentiation system is a unique ophthalmology-specific method that combines traditional “Five Orbiculi” differentiation with syndromes pertaining to the invasion of the eyes by excessive evil qi. It was devised by Professor Qing-Hua PENG, who was the first to go beyond the differentiation system of integrative internal medicine to integrate syndrome element differentiation and ophthalmic clinical practices based on the Terminology. There are 6 syndrome categories and 53 ophthalmic syndromes in the system. Syndromes related to invasion of the eyes by excessive evil qi include: invasion (attack) of the eyes by wind-heat (fire), invasion (entry) of wind-cold pathogens (into) the eyes, invasion of the eyes by wind-dampness, external injury of the ocular vessel, and pattern/syndrome of worm accumulation transforming into malnutrition. Syndromes related to the qi wheel (the white of the eye) include: wind-heat in the qi wheel, damp-heat in the qi wheel, blood stasis in the qi wheel, heat-toxicity in the qi wheel, yin deficiency in the qi wheel, and deficiency of yin blood. Syndromes related to the blood wheel (the inner and outer canthi) include: excessive heat in the blood wheel, deficient heat in the blood wheel, yin deficiency in the blood wheel, and qi and blood deficiency in the blood wheel. Syndromes related to the flesh wheel (eyelids) include: stasis-heat in the flesh wheel, wind-heat in the flesh wheel, heat-toxicity in the flesh wheel, damp-heat in the flesh wheel, phlegm-damp in the flesh wheel, wind-phlegm blocking the collaterals in the flesh wheel, qi deficiency in the flesh wheel, and blood deficiency in the flesh wheel. Syndromes related to the wind wheel (the iris) include: wind-heat in the wind wheel, wind-cold in the wind wheel, damp-heat in the wind wheel, excessive heat in the wind wheel, heat-toxicity in the wind wheel, phlegm-heat accumulated in the wind wheel, blood heat with blood stagnation in the wind wheel, yin deficiency and fluid impairment in the wind wheel, and yin deficiency with lingering pathogens in the wind wheel. Syndromes related to the water wheel (the pupils) include: wind-heat in the water wheel, wind-fire in the water wheel, excessive fire (heat) in the water wheel, heat stagnation in the water wheel, damp-heat in the water wheel, phlegm-heat in the water wheel, yin deficiency in the water wheel, heat deficiency in the water wheel, qi deficiency in the water wheel, qi failing to control blood in the water wheel, qi and blood deficiency in the water wheel, qi deficiency and blood stagnation in the water wheel, qi and blood stagnation in the water wheel, intermingled phlegm and blood stasis in the water wheel, heat injuring the collaterals in the water wheel, blood vessel obstruction in the water wheel, yang deficiency and collateral obstruction in the water wheel, qi deficiency and collateral obstruction in the water wheel, and essence deficiency and collateral obstruction in the water wheel3,4,5,6,7,8. By inheritance and innovation, the ophthalmic syndrome differentiation system brings about scientific advances in the syndrome differentiation and treatment of ophthalmic diseases. This leads to a more accurate manifestation of the general rules of ophthalmic syndrome differentiation as well as greater efficacy in clinical syndrome differentiation and treatment.
4.The Ophthalmic Syndrome Differentiation System and Digital Chinese Medicine
As a theoretical and practical branch of the life sciences, Chinese medicine focuses on the knowledge and understanding of the change patterns in bodily activities. It depends on the collection, storage, and use of information regarding humans’ vital signs and syndromes. Research on digital Chinese medicine, on the other hand, involves the collection, processing, expression, and use of digitalized TCM information using computer technologies.
The research team led by Zhu Wen-feng linked syndrome element differentiation with digital Chinese medicine, quantifying, concretizing, and visualizing the former with the aid of a computer diagnostic system9. Supported by “big data” techniques, the ophthalmic syndrome differentiation system can obtain ophthalmic syndrome elements, quantifying and organizing them to interweave ophthalmology and digital Chinese medicine tightly together, and establishing an ophthalmology-specific digital diagnostic pattern. Without doubt, to fully digitalize Chinese ophthalmology is no easy task. It requires a digital research platform that supports prolonged in-depth cooperation among multi-disciplinary researchers, oriented toward the normalization and standardization of ophthalmic syndrome differentiation10. Incorporating new theories, technologies, and methodologies proposed by the latest research into clinical ophthalmic practices, this platform refines the database of ophthalmic syndromes. This close integration of the theory and clinical practice of the ophthalmic syndrome differentiation system provides a clinical basis for syndrome element differentiation, while improving clinical services.
This digital research platform consists mainly of three research centers: the Research Center for Ophthalmic Digitalization Technologies, the Research Center for Digitalized Application of Chinese Medicine Diagnosis, and the Research Center for Clinical Ophthalmic Digitalization. Each has a different mission. (1) The Research Center for Ophthalmic Digitalization Technologies specializes in conducting research on information collection regarding clinical syndromes and their constituent elements, diagnostic process control, and other aspects concerning different stages of ophthalmic disease diagnosis, to support research on the structure of the ophthalmic syndrome differentiation system, clinical data mining, and other topics. (2) The Research Center for Digitalized Application of Chinese Medicine Diagnosis is mainly responsible for research on the ontology of TCM diagnostics, as well as research on TCM diagnostics and ophthalmic syndrome differentiation, including the definition of related concepts, terminology, the relationships among terms, and the reconstruction of the modern TCM diagnostics system in the context of modern science. Based on the research results, it conducts systematic studies of digital products related to TCM diagnostics and ophthalmology, such as real-time digital monitoring of ophthalmic symptoms and signs, and equipment for intelligent collection of information about clinical ophthalmic syndromes and their elements. (3) The Research Center for Clinical Ophthalmic Digitalization is committed to applying advanced digital Chinese medicine technologies and the standards and regulations of ophthalmic diagnosis to clinical research on illnesses such as glaucoma and other diseases of the cornea, iris, lens, and retina. Its studies encompass data elements related to clinical ophthalmic diagnosis, the relations among ophthalmic diseases, and normalization of ophthalmic disease names and syndrome names. Based on the research results, databases of ophthalmic syndrome elements, ophthalmic syndromes, ophthalmic disease names, and the ophthalmic syndrome differentiation system are constructed, reinforcing the foundation for future research on ophthalmic syndrome differentiation and, eventually, improvement in clinical services.
Research on digital Chinese medicine is a systemic project of substantial size and complexity. Stratifying it into clinical branches can reduce its difficulty and shorten the time required, in turn speeding up academic research on the modernization of TCM. It is hoped that synergistic development of the ophthalmic syndrome differentiation system and digital Chinese medicine can provide new perspective into the digital development of other clinical TCM branches.
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