Sudden Blindness (Bao Mang)

man blind
Clinical Acupuncture & Moxibustion
Tianjin Science & Technology Translation & Publishing Corporation (1996)

Sudden blindness refers to a condition of sudden loss of vision of one eye or two eyes with normal appearance of the eyes, it is one of the “emergency cases” in the department of ophthalmology. It is seen in thrombosis of central vein of retina, thrombosis of central artery, retinal periphlebitis, hypertensive arteriosclerotic eyeground bleeding, diabetic eyeground bleeding, acute optic neuritis, retinal detachment, hysterical blindness and cortical psychic blindness in western medicine.

It is mostly caused by deficiency of qi and blood of qi and blood, or qi stagnation and blood stasis, or liver stagnation transforming into fire, which runs up to disturb the eyes. Therefore, the treatment principle for this disease includes invigorating qi and blood, resolving blood stasis by improving blood circulation, soothing the liver qi and clearing away pathogenic heat.

Etiology and Pathogenesis

  1. The impairment of seven emotions causes liver qi stagnation, which transforms into fire, then the fire runs up to the eyes, and leads to sudden loss of vision.
  2. Preference for alcohol and spicy food leads to accumulation of the stomach heat, which goes upward along with the liver qi. Qi stagnation and blood stasis block the eye system, or bleeding due to injury results in blood stasis in the meridians causing sudden blindness.
  3. Deficiency of qi and blood resulting from various chronic diseases leads to the unnourishment of the eyes, sudden blindness may occur.

 

Differentiation

Normal appearance of the eyes without any feeling of visual obstruction, or occasional distension of the eyes, headache or flying of mosquitoes and flies in front of the eyes at the beginning period, fluttering of the clouds and fog, visual redness, presence of a black figure with a covering like a piece of curtain, all of these may lead to sudden disease of the eyesight of one eye or two eyes, and then inability to distinguish between brightness and darkness and finally sudden loss of vision occur.

1 Liver Qi Stagnation Transforming into Fire (Gan Yu Hua Huo)

Vertigo, distending pain of the eyes, irritability, easy to fly into a rage, bitter taste in the mouth, a red tongue and a wiry and rapid pulse are symptoms and signs which may occur before the onset in case of liver stagnation transforming into fire.

2 Qi Stagnation and Blood Stasis (Qi Zhi Xue Yu)

Distending pain of the eyes, visual redness, splitting headache, a dark purple tongue and a deep, choppy, wiry and slow pulse are due to qi stagnation and blood stasis. It may also be caused by trauma.

3 Deficiency of Qi and Blood (Qi Xue Liang Xu)

Pale complexion, softness and weakness of the voice, weakness of the four limbs, anorexia, a pale tongue and a weak pulse are the symptoms due to deficiency of qi and blood.

Treatment

1 Liver Qi Stagnation Transforming into Fire

Treatment Principle: Soothing the liver qi and clearing away heat

Acupoint Selection: Zanzhu (Ub 2), Taiyang (Ex 2), Fengchi (Gb 20), Zusanli (St 36), Yanglingquan (Gb 34).

Explanation: Yanglingquan (Gb 34) can be used to soothe the liver qi and clear away heat, and Zusanli (St 36) promote flow of the stomach qi, ascend clearness and descend turbidness, and Zanzhu (Ub 2), Taiyang (Ex 2) and Fengchi (Gb 20) dredge the meridians and collaterals of the eyes’ region. These points are applied together to purge the pathogenic fire of the liver and resolve the blood stasis.

Method: Puncture Yanglingquan (Gb 34) and Zusanli (St 36) perpendicularly 1.0 inch with even method, puncture Zanzhu (Ub 2), Taiyang (Ex 2) and Fengchi (Gb 20) lightly. The needle sensation of Fengchi (Gb 20) point should radiate to the eyes.

2 Qi Stagnation and Blood Stasis

Treatment Principle: Promoting qi and blood circulation and improving eyesight

Acupoint Selection: Select Qiuhou (Ex) and Jingming (Ub 1) as main points. Select Fengchi (Gb 20), Ququan (Liv 8) and Hegu (Li 4) as supplementary points.

Explanation: Qiuhou (Ex 7) and Jingming (Ub 1) are effective points for treating sudden blindness. Fengchi (Gb 20) is used to remove pathogenic wind and improving eyesight. Ququan is used to soothe the liver and regulate qi. Hegu (Li 4) is used to promote qi circulation.

Method: Push the eyeball upward gently, then puncture Qiuhou (Ex 7) perpendicularly 0.5 inch along the orbital margin slowly without movements of lifting, thrusting, twisting and rotating the needle. Puncture Jingming (Ub 1) perpendicularly 0.3 inch. Puncture Fengchi (Gb 20) obliquely 0.5 inch toward the tip of the nose. Puncture Ququan and Hegu (Li 4) perpendicularly 0.5 inch with the reducing method. Do not retain the needle at Qiuhou (Ex 7), and retain the needles at the other points for 20 minutes.

3 Deficiency of Qi and Blood

Treatment Principal: Invigorating the spleen and stomach and improving eyesight.

Acupoint Selection: Select Qiuhou (Ex 7) and Jingming (Ub 1) as main points. Select Pishu (Ub 20), Zusanli (St 36), Qihai (Ren 6) and Baihui (Du 20) as supplementary points.

Explanation: Puncturing Qiuhou (Ex 7) and Jingming (Ub 1) are also effective on treating sudden blindness due to deficiency of qi and blood. Pishu (Ub 20) and Zusanli (St 36) are effective points for invigorating the spleen and stomach. Qihai (Ren 6) is used to reinforce qi, and Baihui (Du 20) to lift Yang qi.

Method: Qiuhou (EX 7) and Jingming (Ub 1) should be punctured as above mentioned. Puncture Pishu (Ub 20), Zusanli (St 36) and Qihai (Ren 6) perpendicularly 1.0 inch with the reinforcing method. Puncture Baihui (Du 20)  subcutaneously 0.5 inch. Do not retain the needle at Qiuhou(Ex 7), and retain the needles at the other points for 20 minutes.

Ancient and Contemporary Empirical Points

1 Confucians’ Duties to Their Parents (Ru Men Shi Qin). Sudden loss of vision is due to pathogenic fire and overabundance of qi and blood of Taiyang (Ex 2) and Yangming meridians. Puncture Bizhong (Ex) and Zanzhu (Ub 2) and the other five points on the head, prick them to cause bleeding, then the eyesight will regain.

2 Great Compendium of Acupuncture and Moxibustion (Zhen Jiu Da Cheng). If eye disorder occurs, first puncture Tongziliao (Gb 1), Hegu (Li 4), Toulinqi (Gb 15) and Jingming (Ub 1), then give repeated needling at Guangming (Gb 37), Tianfu (Lu 3) and Fengchi (Gb 20).

3 Ophthalmology in Chinese Medicine (Zhong Yi Yan Ke Xue). Trombosis of central artery of retina and acute orbital optic neuritis can be treated by acupuncture. Select Jingming (Ub 1), Qiuhou (Ex 7), Tongziliao (Gb 1), Chengqi (St 1), Zanzhu (Ub 2), Taibai (Sp 3), Fengchi (Gb 20), Neiguan (Pc 6), Hegu (Li 4), Taichong (Liv 3), Mingmen (Du 4) and Shenshu (Ub 23). Puncture 2 – 4 points each time with strong stimulation.

4 Acupuncture and Moxibustion Therapy in Ophthalmology (Yan Ke Zhen Jiu Liao Fa). For the optic disc neuritis, select Qiuhou (Ex), Jingming (Ub 1), Fengchi (Gb 20), Hegu (Li 4), Quchi (Li 11), Zusanli (St 36), Ganshu (Ub 18) and Guanyuan (Ren 4) as the principal points. In case of acute orbital optic neuritis, puncture Guangming (Gb 37), Shangxing (Du 23) and Erjian (Li 2). Then puncture Zanzhu (Ub 2), Taiyang (Ex 2) and Neiyingxiang (Ex) to cause bleeding. If it is a chronic case, puncture Jingming (Ub 1), Chengqi (St 1), Tongziliao (Gb 1) and Zusanli (St 36) with moderate stimulation. Apply moxibustion to Danshu (Ub 19), Shenshu (Ub 23), Ganshu (Ub 8), Xinshu (Ub 15), Yanglao (Si 6) and Shangyang (Li 1) points, once a day or once every other day. Qiuhou (Ex 7) and Jingming (Ub 1) are selected as the principal points, they can be applied in both acute and chronic cases on the affected side. Fengchi (Gb 20), Hegu (Li 4), Zusanli (St 36) and Guangming of both sides are selected as supplementary points. Select one principal point and two supplementary points each time. Needing stimulation is given in turn at these points.

Other Therapy

Chinese Medicine

For the kidney Yin deficiency, take Mingmu Dihuang Wan (Radix Rehmanniae Pills for Improving Eyesight).

For the hyperactivity of fire due to Yin deficiency, take Zhi Bo Dihuang Wan (Bolus of Rhizoma Anemarrhenae Cortex Phellodendri and Rhizoma Rehamnniae).

For the hyperactivity of liver Yang, use Tongqiao Huoxue Tang (Decoction for Promoting Blood Circulation) or Dadingfeng Zhu (Bolus for Serious Endogenous Wind Syndrome).

For the disorder due to phlegm turbidity, use Daotan Tang (Decoction for Eliminationg Phlegm).

For the Qi and blood deficiency, use Shiquan Dabu Wan (Powerful Tonic Bolus of Ten Drugs) and Shengmai San (Powder for Restoring Pulse Beat).

Notes

1 Eye ground examination is required to help find out the causative factors.

2 This disease is marked by sudden onset, so, try to get a prompt treatment. Do not delay the illness, or it may influence the therapeutic effect and be difficult to cure.

3 Sudden blindness treated with acupuncture can have satisfactory therapeutic effect, if it is given prompt and proper treatment.

Ancient Medical Records

1 Standards of Diagnosis and Treatment (Zheng Zhi Zhun Sheng). Sudden blindness generally refers to normal appearance of the eyes without other diseases and without the injury of pupil, but with sudden loss of vision.

2 A Valuable Manual of Ophthalmology (Shen Shi Yao Han). This disease is marked by sudden onset. Prompt treatment can regain the eyesight. Otherwise, the delayed treatment will be useless.

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