Nebula (Mu Yi)

Eye

There is much confusion as to what is YI (nebula) in ancient medical records of ophthalmology. Nebula refers to the cataract on the back of the eye and a clouding of the eye. Nebula discussed in this section refers to the clouding of the back of the eye (cornea). There are two types of nebula: new and old. New nebula refers to keratitis and corneal ulcer in western medicine. No matter how thick or thin the nebula is, it will influence the eyesight, if the nebula is in the pupillary zone. The principle for treating this disease is improving acuity of vision and removing nebula.

Etiology and Pathogenesis

Nebula results from the injury of the back of the eye, or an infection of noxious evils leading to an inflammation of the cornea with a scar left after being cured. It is thought in Chinese Medicine that the pathogensis of this disease is an exogenous invasion of wind heat or upward disturbance of heat in the liver and gallbladder.

Differentiation

The scar left after an inflammation is smooth on the surface with a clear boundary and different in thickness. That which is not cured may appear redness of the eyes and lacrimation. The thickness of the nebula is like congealed fat, patients may include the following symptoms headache, photophobia, constipation and dark urine, a yellow tongue coating and a slippery and rapid pulse.

Treatment

Treatment Principle: Improving acuity of vision and removing nebula

Acupoint Selection: Zanzhu (Ub 2), Taiyang (Ex 2), Sibai (St 2), Fengchi (Gb 20), Hegu (Li 4), Zusanli (St 36).

Explanation: Zanzhu (Ub 2), Taiyang (Ex 2), Sibai (St 2) and Fengchi (Gb 20) can be used to expel pathogenic wind and dredge the meridians, improve acuity of vision and remove nebula. It is said in Internal Classic (Nei Jing) that the essence of the Five Zang and Six Fu is produced by the spleen, and nourishes the eyes. Therefore, select Hegu (Li 4) and Zusanli (St 36) to regulate the spleen and stomach so as to improve acuity of vision and remove nebula.

Method: Puncture Zanzhu (Ub 2), Taiyang (Ex 2), Sibai (St 2) and Fengchi (Gb 20) lightly, retaining the needles. Give Hegu (Li 4) and Zusanli (St 36) moderate stimulation with even method and retain the needles for 20 – 30 minutes. Treat once a day or once every other day. Ten times constitutes one course of treatment.

Ancient and Contemporary Empirical Points

1 A Collection of Medical Experience on Acupuncture and Moxibustion (Zhen Jiu Yi Xue Yan Ji). The principal points for treating keratitis and corneal ulcer are Zanzhu (Ub 2), Sizhukong (Sj 23), Yangbai (Gb 14), Jingming (Ub 1), Tongziliao (Gb 1) and Sibai (St 2). The supplementary points are Hegu (Li 4) and Zusanli (St 36). Puncture the points with moderate stimulation, retain the needles for 30 minutes, once a day. Ten times constitutes one course.

2 Acupoint Diagnosis and Needling Therapy (Xue Wei Zhen Duan Yu Zhen Ci Liao Fa). Select Zanzhu (Ub 2), Taiyang (Ex 2), Fengchi (Gb 20) and Hegu (Li 4) for keratitis, corneal ulcer, nebula of cornea and spot nebula. Puncture the points once a day or every other day.

3 Acupuncture and Moxibustion Therapy in Ophthalmology (Yan Ke Zhen Jiu Liao Fa). Select Jingming (Ub 1), Zanzhu (Ub 2), Sibai (St 2), Juliao (St 3), Hegu (Li 4), Daling (P 7), Zusanli (St 36), Dazhui (Du 14), Ganshu (Ub 18), Feishu (Ub 13), Danshu (Ub 19) and Shenshu (Ub 23) for phlyctenular keratoconjunctivitis. Moxibustion may be applied to the last five points in severe cases. Select Jingming (Ub 1), Hegu (Li 4), Ganshu (Ub 18) and Yuwei for catarrhal keratitis. Give moderate stimulation every day. Select Chengqi (St 1), Taiyang (Ex 2), Zanzhu (Ub 2), Yangbai (Gb 14), Sibai (St 2), Juliao (St 3), Jiache (St 6), Dicang (St 4), Baihui (Du 20), Fengchi (Gb 20), Yifeng (Sj 17) and Hegu for neuroparalytic keratitis, give moderate stimulation on the healthy side and slight stimulation on the diseased side, and moxibustion may also be applied (but give acupuncture only on the first three points). Treat once a day or every other day. Select Zanzhu, Taiyang, Feishu, Ganshu, Shenshu, Quchi (Li 11), Hegu, Zusanli (St 36), Yifeng and Heliao (Sj 22) for herpetic keratitis, apply acupuncture to the first two points, the others may be treated by both acupuncture and moxibustion. Select Jingming (Ub 1), Zanzhu (Ub 2), Tongziliao (Gb 1), Sibai (St 2), Hegu (Li 4), Zusanli (St 36), Guangming (Gb 37), Fengchi (Gb 20), Dazhui (Du 14), Ganshu (Ub 18), Shenshu (Ub 23) and Gaohuang (Ub 43) for scar of cornea (nebula of cornea), moxibustion may be added to Dagukong (Ex) and Xiaogukong (Ex).

4 Complete Collection of Acupuncture and Moxibustion (Zhen Jiu Ji Cheng). Select Shangxing (Du 23), Baihui (Du 20), Zanzhu (Ub 2), Sizhukong (Sj 23), Jingming (Ub 1), Tongziliao (Gb 1), Taiyang and Hegu (Li 4) for red and swelling nebula of the eyes. Prick Neiyingxiang (Ex) to cause bleeding.

5 New Acupuncture and Moxibustion Science (Xin Zhen Jiu Xue). Select Yangbai (Gb 14), Zanzhu (Ub 2), Jingming (Ub 1), Sizhukong (Sj 23), Tongziliao (Gb 1), Touwei (St 8), Toulinqi (Gb 15), Fengchi (Gb 20), Baihui (Du 20), Ganshu (Ub 18), Houxi (Si 3) and Yifeng (Sj 17) for neuroparalytic keratitis.
6 Great Compendium of Acupuncture and   Moxibustion (Zhen Jiu Da Cheng). Select Zanzhu (Ub 2), Houxi (Si 3) and Yemen (Sj 2) for red nebula (blood vessel nebula).

7 Complete Works of Jingyue (Jingyue Quan Shu). Put seven moxa-cones on Yifeng (Sj 17) point for white and red nebula.

8 A Valuable Manual of Ophthalmology (Shen Shi Yao Han). Nebula occurred at the early stage can be cured, first puncture Jingming (Ub 1) and Hegu (Li 4) continuously 3 times, then puncture Taiyang and Guangming  (Gb 37) with the same way.

9 A Prescription Work on Acupuncture and Moxibustion (Zhen Jiu Chu Fang Ji). Select Jingming (Ub 1), Zanzhu (Ub 2), Xuanli (Gb 6), Tonggu (Si 18), Yindu (K 19), Neiguan (P 6), Shangqu (K 17), Gaohuangshu (Ub 43) and Zhongzhu (K 15) for keratitis.

Other Therapies

1 Moxibustion

Point Selection: Yangxi (Li 5)

Method: Use garlic-indirected moxibustion. Select a slice of garlic about 1.5cm in diameter and 0.1cm in thickness (or a slice of fresh ginger) with holes pricked on it. Put a moxa-cone the size 08 like a piece of soya bean on it and light it. Give moxibustion to Yangxi on the right side for the disease occurring on the left, and vice versa. Give moxibustion to Yangxi on both sides for disease occurring in both eyes. Put 6 – 7 moxa-cones each time, once or twice a day for 3 – 5 days. Do not apply eye drops or take medicine.

2 Catgut Implantation at Acupoint

Point Selection: Select Jingming (Ub 1), Qiuhou (Ex 7), Jianyang (Ex) and Chengqi (St 1) as main points, and Ganshu (Ub 18), Shenshu (Ub 23), Guangming (Gb 37) and Wanli (Ex) as supplementary points.

Method: Select one main point and 1 or 2 supplementary points each time, once every four days or every two weeks. Five times constitutes one course of treatment. Begin another course of treatment after one month of rest.

3 Chinese Medicine

For keratitis, take Longdan Xiegan Wan (Bolus of Radix Gentianae for Purging Liver Fire).

For nebula of the cornea, take Boyun Tuiyi Wan (Bolus for Removing Nebula).

Notes

Keratitis should be treated at the early stage with antibiotic so as to avoid scars left on the diseased eye. Acupuncture treatment has a good effect on relieving spasm and pain. Treating nebula in combination with acupuncture and moxibustion can improve the therapeutic effect, shorten the course of treatment and lessen the sequela.

Ancient Medical Record

A Collection for Preserving life and the Mechanism of Diseases from Plain Questions (Su Wen Bing Ji Qi Yi Bao Ming Ji). Nebula is due to wind heat in the body, or spots in the eye. An overabundance of liver qi may scatter to affect the surface of the body, then nebula occurs. It is advisable to remove the nebula after the pathogenic factors are dispersed.

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