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.

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.

Blepharitis Ciliaris

eye
By Shandong Science And Technology Press (1985)

Blepharitis ciliaris is a very common subacute or chronic inflammation of the lid margin. Its pathogenesis is general weakness, infection of bacteria or stimulation by discharge due to chronic conjunctivitis.Symptoms and Signs

It occurs in the following three types:

  1. Ulcerative blepharitis: congestion, swelling and scales at the base of lashes. Ulcers may be presented when scales removed. Lashes may be glued together and easily lost but they are not replaced. Painful sensation, photophobia and lacrimation often associated.
  2. Scaly blepharitis: congestion of lid margin. There are whitish scales in the bases of the lashes, which are easily lost but not replaced.
  3. Canthal blepharitis: the inflammatory reaction usually occurs in the canthal margin of the lid, marked local congestion, ulceration and itching sensation present.

Blepharitis usually caused by diplococci of Morax-Axenfeld.

Treatment

A Points: Ermen and Hegu are the primary points. In the case of upper lid, Yuyao, Zanzhu, Sizhukong are associated. Yingxiang is associated for blepharitis of lower lid. Tongziliao is associated for lateral canthal blepharitis and Jingming for medical canthal blepharitis.

B Procedure: Ermen, perpendicular penetration performed 0.5 ~ 1 inch in deep with scraping the needle. Hegu, penetrated toward the Laogong. For all above points, retain the needle 5 ~ 10 minutes and manipulate once every 5 ~ 10 minutes. All associated points, except Jingming, are stirred up with three-edged needle till bleeding. Those are given once every other day.

Method of puncturing Jingming seen for acute conjunctivitis.

C Case example

Patient Guo, female, 63 years old, a peasant.

Blepharitis of lower lids and right medial canthus for more than 10 years. The severity was various with times and recurred though frequent remedies given.

Patient worked tiredly in recent days and sleep was not enough, symptoms thus became severe. Redness of lid margin, photophobia, lacrimation and increase of discharge. There were many small ulcers on the base of lashes.

The diagnosis was ulcerative blepharitis, and the treatment given was puncturing Ermen and Hegu given once daily, retained the needle 30 minutes, manipulated the needle once every 10 minutes. Stirred up Yingxiang till bleeding, once every other day. Redness of lid margin and discharge fluid diminished after three punctures. Swelling of lids lost after 6 punctures, discharge much reduced but slight congestion of lid margin remained. Symptoms all lost after further 3 remedies given. Patient had attacks twice in following days and cured with same treatments as above. The therapeutic effect was well in after 3 years.

Remarks

Blepharitis is like “Jian Xuan Chi Lan” , “Lan Yan Bian” or “Hong Yan Bian”. It was described in ancient Chinese medical book: “Over fatigue may cause redness and ulceration due to fire. Alcoholism may cause those symptoms to become severe. Too much crying may cause suffering of fire and wind-heat appears”.

Author treated 7 cases of blepharitis with above prescription. The results were 3 cases symptoms lost and no recurrence in after 1 year. 2 cases markedly improved, with partial symptoms lost; 1 case slightly improved; treatment discontinued in 1 case against advice.

Retinopathy

Eye
By Shandong Science And Technology Press (1985)

Retinopathy is common fundus disease in clinic, which is difficult to treat. It includes central retinitis, centro-retino-choroiditis, retinal central vein occlusion, retinal arterial occlusion, retinal hemorrhage and retinal arteriosclerosis.

Symptoms and Signs:

Those diseases occur more in adult males. Patient may suffer from a varying degree of decreasing visual acuity and metamorphopsia.In case of retinal arterial occlusion, the patient may suddenly lose his visual acuity completely or partially. If it is not treated in time, vision may be severely impaired.

Treatment

Remedy 1

A Points: there are two groups of points used:
Group 1. Jingming, Yiming, Yangbai Guangming;
Group 2. Qiuhou, Taiyang, Fengchi, Xingjian.

B Procedure: two groups of points used alternately in courses of treatment. Manipulations for Jingming, same as in acute conjunctivitis, and those for Yiming penetrate perpendicularly 0.5 ~ 1 inch with twirling. In Yangbai needle is directed toward the Yuyao with twirling and scraping the needle. Penetrate Guangming toward the contraside with 1 ~ 1.5 inch deep and twirling the needle.

During puncturing Qiuhou, let patient look forward, the physician takes the needle as holding a writing brush and penetrates along the lower border of the orbit perpendicularly with 1 ~ 1.5 inch.

It should be noticed that if insertion of the needle must be slow after the needle has passed subcutaneous tissue, then lifting and scraping the needle slowly. In puncture of Taiyang, the needle is at a 450 angle and toward the Xiaguan with depth of 1 ~ 1.2 inch and then thrusting, lifting and scraping the needle. The method used for Fengchi is the same as in acute conjunctivitis.

Xiangjian is penetrated perpendicularly 0.3 ~ 0.6 inch and twirling method is used.

Retaining of needles in above points are 15 ~ 30 minutes. Once manipulation is given for every 5 ~ 10 minutes. Remedy is given once every day. Seven treatments are therapeutic course and are given with interval of 2 ~ 3 days between the course.

The treatment described above is indicative for central retinitis.

C Case Examples:

Case 1. Wang, male 34 years old, Jun 13, 1975 O.P.D. patient.

Vision much impaired suddenly for 3 days, headache and vertigo associated. Ophthalmologic examination performed in other hospital the results are: Swelling of macular region of fundus ++, severe cloudiness, no reflex seen in the disc. Visual acuity O.S. 0.3, O.D. 1.5. Diagnosis was central retinitis. Patient was treated with both modern and Chinese traditional medicines but no improvement obtained. Acupuncture therapy thus acquired.
In author’s O.P.D. patient was treated with remedy 1 with retaining of needle 30 minutes. Puncture is given once daily. Patient’s visual acuity markedly improved after 3 times of acupuncture, O.S. increased to 0.6, vertigo and headache much diminished also.

Group 2 points were used in the second therapeutic course with acupuncture once daily. On Jun 29, patient’s vision increased to 1.2, swelling of macula region all lost. Central macula reflex presented but the color discrimination still not quite definite.

Therapeutic effect still presents in after half year.

Case 2. Oct. 10, 1977, O.P.D. patient Liu, male, 37 years age, a worker.

Metamorphosis, micropsie and diminution in acuteness of vision occurred rapidly since recent 8 months. Diagnosis given in other hospitals is central retinitis. Patient was hospitalized for more than 6 months there, various treatments received, but the visual acuity still diminished progressively and had decreased to 0.04 O.U.

Visual acuity just before acupuncture was 0.1. Acupuncture was given as above, two groups of points were adapted alternately for each therapeutic course.

The interval between treatment courses was 3 days. Vision acuity increased to 0.5 after 3 punctures and increased to 0.7 after one course of treatment. Flashing lights sensation diminished, central dark spot in the fundus reduced.

Vision acuity increased to 0.8, metamorphosia lost after second treatment. Vision acuity remained 0.8 in third course of therapy, and the treatment discontinued since then.

Acuteness of vision remained 0.8 in after one year.

Remedy 2

A Points: Jingming, Hegu

B Procedure: At first, puncture left Jingming slowly with depth about 1 inch. Scraping the needle, patient may feel numbness sensation in fundus of eye and lateral canthus during acupuncture. Lacrimation may also present.

The next step is to puncture right Jingming with same method as in left side.

Puncture Hegu and twirl the needle.

Retaining of needles for above point are 15 ~ 30 minutes in duration.

Puncture given once daily with manipulation once every 15 ~ 30 minutes.

This method of treatment is prevalent on central retinal arterial occlusion.

C Case example:

Sept. 20, 1970, O.P.D. patient Yin, female, 28 years of age, a staff.

Vision O.S. lost suddenly 3 days ago. Ophthatmological examination performed in a hospital: Vision acuity O.D. 0.8, light sensation O.S. Dilation of right pupil with dullness to direct light reflex. Macula appears cherry red. Retinal artery became narrow as a thread. Optic disc whitish with indefinite border.

Diagnosis: Central retinal arterial occlusion

Patient was treated as above with retaining needle 30 minutes. Manipulated the needle once every 10 minutes. Remedy was given once every day. Patient’s vision was improved to 0.5 after treatment, and 3 remedies were given totally. Then the patient’s vision acuity increased to 1.0 after the treatments.

Remedy 3

A Points: Fengchi, Luxi, Jiaosun, Dazhui, Ganshu, Shenshu, Jingming, Taiyang, Yangbai, Yuyao, Zanzhu, Gaohuang

B Procedure: for making brain to be clear and eyes to be good in vision and relieving the blood stasis, Fengchi, Luxi, Jiaosun, Dazhui, Ganshu and Shenshu are adapted with manipulation for inducing heat sensation.

In the point of Jingming, insertion of needle should be gentle.

For Taiyang, Yangbai, Yuyao, and Zanzhu, ordinary methods are adapted.

In order to regulate the function of liver and tranquilization, invigorate the kidney to strengthen the body, Gaohuang, Ganshu, Shenshu are adapted for inducing heat sensation but not retaining the needle.

For other symptoms, associated points may be selected (Zheng Yulin: J. Chinese Traditional Med. 1957. 6).

Remedy used for 41 cases by author, the results were 12 cases radically cured; 6 cases markedly improved; 19 cases slightly improved; 4 cases no effect.

Remarks:

Retinopathy belongs to “Nei Zhang” in Chinese traditional medicine, which is very similar to eye diseases such as “Shi Zhan Hun Miao”, “Bao Mang” or “Shi Huo” etc. The pathogenesis is very complicated. Over fatigue, depression of liver-energy, dryness of fire and wind, deficiency of kidney function, congenital deficiency, acquired malnutrition etc. may cause this disease.

It was considered that “Nei Zhang” usually belongs to Xu in nature, the treatment of this disease according to the deficiency of blood and asthenia of kidney and liver is not very reasonable. Points in acupuncture therapy should be selected symptomatically.

The points in local area for treating retinopathy are Jingming, Qiuhou, Yangbai, Taiyang.

Point Qiuhou locates near the ciliary ganglion and ciliary nerve, which supplies the eyes. Puncture of Qiuhou is very effective in treating retinopathy directly.

“Exploration to Formations of Internal Organs” described: “Channels all belong to the eyes”. So, eye diseases are the reaction of pathological change of internal organs. Therefore, in treating eye diseases not only select the local points near the eye, such as Yiming and Fengchi, but also the points away from the eyes, such as Hegu, Guangming, Xingjian. Thus balance of various portions of whole body may be resulted and the cure of fundus diseases may also be successful.

Duration of treating retinopathy is usually long. The manipulation of needle is still under discussion. Author suggested that method of manipulation in acupuncture may be various in different patients. Physician Yang Ji Zhou said: “ The methods of treating disease are various with persons but do not depend upon the number of treatments given. Variations of treating methods depend upon the kind of disease but not the remedy used.”

It has been proved that acupuncture is very effective to fundus diseases, improvement of visual acuity usually obtained by first treatment and get better progressively after each remedy. There was a case, patient Xu suffered from retinochoroiditis with loss of vision for 8 years, improvement was gotten after first acupuncture and even better after 7 times of treatment.

Pathological Changes of Optic Nerve

Eyeball
By Shandong Science And Technology Press (1985)

The common pathological changes of optic nerve are atrophy of optic nerve and optic neuritis, which includes papillitis, and retrobular optic neuritis.Those above diseases may be infected from the foci such as tonsillitis, parasinusitis, caries teeth, virus, or tuberculosis. They may also be spread from retinitis, choroiditis etc.

Atrophy of optic nerve may be either primary or secondary in nature. The primary optic atrophy caused usually by surgical trauma, bony fracture, intracraninal compression, or intoxication due to methyl alcohol, quinine or lead. The secondary optic atrophy is commonly seen in case of papilitis, papilar edema or in the late stage of glaucoma.

Symptoms and Signs:

1 Retrobulbar optic neuritis: impairment of vision, pain of eyeball (may be excited with movements of the eyeball), central scotoma, and contraction of visual field.

2 Papillitis: usually unilateral in nature, vision markedly reduced at the beginning of disease, contraction of visual field, and central scotoma and frequently associated.

3 Optic atrophy: the primary symptoms are diminution of visual acuity, even blind, contraction of visual field and color blindness.

Treatment:

Remedy 1

A Points:  Three groups of points may be adapted.
Group 1: Jingming, Qimai, Yangbai, Yiming, Ganshu, and Gukong.
Group 2: Qiuhou, Taiyang, Fengchi, Shenshu, and Guangming.
Group 3: Chengqi, Geshu, Sizhukong, and Xingjian

B Procedure: Jingming, Yangbai, Yiming, Qiuhou, Taiyang, Fengchi, Guangming, Xingjian same as for acute conjunctivitis and pathological changes of retina.

Qi Mai is penetrated along the skin surface 0.3 ~ 0.6 inch and scrap the needle.

Ganshu and Geshu are penetrated with needle in 300 angle and obliquely downward 0.8 ~ 1.2 inch. Twirl the needle at the same time.

In puncturing Shenshu, needle is inserted in 300 angle with the manipulation of twirling.

For Sizhukong, needle is inserted upward and along the border of orbit with depth of 0.3 ~ 0.5 inch.

Moxibustion performed on Gukong with putting the cone on a piece of ginger (0.1 ~ 0.17 inch in thick). Three to five cones for one therapy will be enough.

To the point Chengqi, penetrate perpendicularly and slowly with depth of 0.5 ~ 1.5 inch and acrape the needle. For preventing intraorbital bleeding due to trauma of blood vessel, twirling and twisting are contra indicated and if it appears, compress the eyeball with cotton sponge 3 ~ 5 minutes.

It is a rule, puncture Shu points in dorsal aspect of the trunk first, and the retaining of needle is usually short. Other points are penetrated afterward with retaining of the needle 30 ~ 60 minutes and manipulate the needle once every 10 ~ 20 minutes.

Treatment is given once daily. Every 5 treatments are a course of therapy. The interval between courses is 1 ~ 2 days.

Following Chinese medicinal herb and pills should be given at the same time:

  • A Herb broth:
  • Rhizoma Rehmanniae Praeparatae
  • Fructus Lycii
  • Radix Polygoni Multiflori
  • Fructus Ligustri Lucidi
  • Radix Salriae Miltiorrhizae
  • Radix Angelicae Sinesis
  • Radix Bupleuri
  • Semen Cassiae
  • Concha Haliotidis
  • Rhizoma Atractylodis Macrocephalae
  • Herba Dendrobii
  • Radix Ledebouriellae

In treating the pathological change of optic nerve with herb, to nourish Yin and to supplement kidney is the primary principal. Other drugs may be used for dispersing the depressed liver-energy and depressive syndrome, eliminating the phlegm and clearing away the wind-heat.

Given by decoction in water for oral dose Q.D.

B Pills: Sheep liver pills (according to prescription given in “Golden Mirror for Original Medicine”

C Case example:

April 27, 1965, O.P.D. patient Zhu, female, 60 years old, a farmer. Diminution of vision occurred for 2 years suggesting hyperopia. Symptom increased in recent 5 months, only light perception still present.

Patient was examined in a hospital and represented that external occurs normal, margin of papillae became blurring and pale, central fovea diminished, narrowing of retinal artery. The diagnosis was optic atrophy.

Physical examination in author’s O.P.D. revealed pale fur, pulse sinking and weak in its proximal portion.

Thirst, pain of back and insomnia are complained.

Patient was treated in author’s O.P.D. with acupuncture and Chinese traditional medicine. Among which, Chinese traditional medicines are used for nourishing Yin and kidney, relaxing the liver and improving the blood circulation.

Sheep liver pills were also given.

Above groups of points adapted alternately for each course of therapy. Patient was treated for 3 months as above.

Seventy herb broth taken totally, after treatments described above, patient’s visual acuity recovered to 0.3 O.S.; 0.2 O.D. Since then, patient can take care of herself and attend to homework.

Remedy 2

(A) Points: There are seven groups of points to be selected.
Group 1: Fengfu, Fengchi, and Taiyang
Group 2: Shangxing, Muchuang, and Yingxiang
Group 3: Binao, Hegu, and Guangming
Group 4: Zhaohai, Hegu, and Zanzhu
Group 5: Yuyao, Sibai, and Shenmai
Group 6: Jingming, Tongziliao, and Head-Linqi
Group 7: Mingmen and Ganshu

(B) Procedure: One group of points adapted alternately by 1 day.

Each therapeutic course consisted of 7 days. Twirl and scrape the needle in case of Ganshu and Mingmen quickly.

In other points besides Ganshu and Mingmen, manipulate the needle once every 5 ~ 10 minutes and retain the needle 15 ~ 30 minutes.

Fengchi is penetrated perpendicularly with slow insertion and 0.3 ~ 0.5 inch deep, scraping the needle gently. In order to avoid injury of medulla, deep penetration is contraindicated.

In point of Muchuang, push the needle forward horizontally 0.3 ~ 0.5 inch and manipulate the needle by twirling and scraping.

Needle penetrating Binao is directed upward 450 angle and 0.8 ~ 1 inch and that puncturing Zhaohai is directed perpendicularly with 0.3 ~ 0.5 inch in deep. The needles penetrating above two points are manipulated with twirling.

Zanzhu is penetrated toward Yuyao and Shenmai is punctured perpendicularly 0.3 ~ 0.5 inch.

Head-Linqi is penetrated forward horizontally with 0.3 ~ 0.5 inch deep.

Manipulate the needle with scraping and twirling for Head-Linqi, Shenmai and Zanzhu.

There were 21 cases of retrabulbar optic neuritis treated with the method mentioned above in Congqing hospital of TCM, among them, 7 cases were cured.

Remarks:

Pathological changes of optic nerve belong to the class of “Qing Bao” and “Shi Zhan Hun Miao” in Chinese traditional medicine. In the ancient medical book “Comprehensive collection on Medicine” considered: “Patients lose their visual acuity without any abnormality in the appearance of the eye.”

The cause of this disease usually suggests as the deficit of liver and loses of seven modes of emotions. Kidney is the water storage and is also the congenital essential substance. If the kidney loses its function congenitally, the wood could not be nourished.

The eye is the orifice to live. Once wood is malnourished, the liver blood becomes deficient and can not flow upward to the eye. Ancient Chinese medical book “The Canon of Internal medicine” described: “Visual acuity only presents when blood is gotten and blindness occurs when blood is lost”.

Therefore, in treating eye disease, strengthening Yin and restoring kidney are the essential principle. Because kidney is essential to liver, the liver may be nourished after kidney restored and visual acuity recovered spontaneously after liver wood has been nourished.

However, the disease is not so simple. The deficiency of kidney may be in some time associated with wind-heat, wetness-phlegm, and depression of liver-energy. Therefore, selection of point in acupuncture and prescription in medication would be nimble with adaptability.

Experiences about acupuncture therapy for eye diseases have been reported. There are three aspects in selecting points:

1 Select the points in local region or near the eye, e.g. Jingming, Qiuhou, Chengqi, Sizhukong, Yangbai, Taiyang etc.

2 Points along the channels, e.g. Shenmai, Guangming, Fengchi, Qimai etc.

3 Points various with symptoms, e.g. Zhaohai, Shenshu, Ganshu, and Geshu.

Thus, the eye disease is treated both locally and generally. If the primary cause and secondary cause are treated at the same time, good effect will be obtained therefore.

The pathological changes of the eye are a kind of degenerative disease, it is necessary to treat for long time. Groups of points may be adapted alternately, for elevating its sensitivity and the therapeutic effect.

Cataract II

eye
By Shandong Science And Technology Press (1985)

Cataract is a condition of any opacity of lens and is a common eye diseases.There is neither nerve nor blood vessel in the lens. The nutrition of lens depends upon aqueous humor, which nourishes the lens through its capsule, thus the metabolism of lens is retained. Any condition disturbing the lens metabolism (e.g. inflammation, trauma etc) may cause opacity of lens.

Cataract may be present in any year of age but more in senile.

Symptoms and Signs:

According to the time of attack, cataract may be divided into two types – congenital and acquired. Acquired cataract mostly occurs in senile age. Cataract may also be caused by trauma. Adolescent cataract and cataract due to other disease may be also present.

The opacity of lens may look like flower of date or as oil floating on the water. The margin of opacity is usually clear. The range of disturbance in vision is various with location opacity.

Treatment:

A Points:
Group 1: Jingming, Yangbai, Fengchi, and Hegu
Group 2: Qiuhou, Taiyang, Yiming, and Binao

B Procedure:

Adapt two group points alternately for each seven days, which are recorded as a therapeutic course. The internal between courses is 2 ~ 3 days. Remedy is given once daily. The manipulation of needles is same as in pathological changes of optic nerve, retinopathy and acute conjunctivitis. All manipulation should be quick.

C Case Examples:

Case 1.

Oct 3, 1964, O.P.D. patient Ke, male 37 years old, a cadre.

There was a piece of white opacity on the right upper on the right lens, sized as a date flower with clear margin. Vision much disturbed when looked to the right. Patient received treatments in past half year in a hospital but did not cure and he was advised to treat with acupuncture therapy in author’s O.P.D. Jingming, Yangbai, Fengchi, Hegu were penetrated once daily with quick manipulation. Lens opacity disappeared after 5 treatments given. No recurrence in 10 years.

Case 2.

Nov 7, 1965, O.P.D. patient Li, male, 11 years old, a student.

There was a small area of lens opacity in the medical lower portion of left lens, looking as a new moon, the color was whitish with clear margin. Patient’s visual acuity was much disturbed.

Treatments were given as above. Two groups of points adapted alternately, one group for each course with the internal of 3 days. Remedy was given once daily. Lens opacity much diminished after 5 courses of treatment.

Remarks:

Cataract is a modern medical term, which is much like “Yun Wu Yi Jing” in its initial stage and “Yin Nei Zhang” or “Yuan Yi Nei Zhang” in the mature stage, in Chinese traditional medicine. “A Precious Bood of Opathalmology” described: “The diseased (cataract) area is white in color, various in size and thickness. Patient feels there is some moving substance in his visual field.” The pathogenesis has also been described in same book, which is much similar to the description in modern medicine.

Since there is no blood vessel, nerve and active cells in the lens, some medical books consider that there is no metabolic activity in the lens and its pathological change is passive in nature and this treatment is therefore very difficult, only extraction may be performed.

In contrast with above, there has been much more understanding about cataracts and much experience has been obtained in treating this disease in the field of Chinese traditional medicine.

A report of acupuncture treatment for cataract presented by Zhong Shan Medical College has represented that the therapeutic efficiency in 43 cases (80 eyes) was 73.7% (59 eyes). The results of Guangxi Worker’s Hospital in 24 cases (32 eyes) were: 8 eyes cured, markedly improved 11 eyes, mildly improved 9 eyes and no effect in 4 eyes.

Reports described above indicated that acupuncture therapy to treating cataract is very appreciable.

Chinese traditional physicians thought that aqueous humor is the vital liquid in the eye, which is resulted from the accumulation of Qi which is the functional activity of organs and metabolism is also included there.

In fact, vitreous body is a part of the body and has its own metabolism but much lower than the others.

Acupuncture therapy may excite the function of the various part of the eye, disperses the channels around the eye and promote the local metabolism. Treatments given above are beneficial to the absorption of cloudy substances in case of cataract.

Trachoma

Eyes
By Shandong Science And Technology Press (1985)

It is a chronic infectious disease caused by the virus. It is a very important infection on account of its disastrous complications and squaclae, which are responsible for many cases of partial or total blindness.

Symptoms and Signs

In mild cases, there is slight foreign body sensation in the eyes and the discharge is usually small in amount. Those of severe cases are feeling of stimulation sensation and much discharge associated with photophobia, lacrimation, inversion of lids and eyelashes. Corneal ulcer may also complicate.

Treatment

A Points: penetrate Sizhukong toward Yuyao, or Zanzhu toward Yuyao; puncture Sibai toward Jingming. Fengchi and Hegu penetration also required.

B Procedure: pinch up the skin around the point with the thumb and index finger of left hand, then insert the needle rapidly toward the other point. Twirl or scrape the needle.

Twirling the needles for the points of Fengchi and Hegu only.

Acupuncture is given once daily till cure.

For all points mentioned above needles should be retained in short duration.

C Case example:

Patient Song, a female, 65 years of age, a housewife.

Patient suffered from trachoma for 10 years. The symptoms were various with time and became more severe in recent days. Photophobia, lacrimation and itching of eyes were associated.

Examinations revealed trachoma II O.S. III O.D., inversion of eye lashes, much discharge was present. Patient’s symptoms were diminished after acupuncture given twice and almost after 5 remedies.

Remark

Trachoma belongs to the class of “Jiao Chuang” or “Su Chuang” in Chinese traditional medicine, which also reported its pathogenesis, symptology and treatment.

Ancient medical book “Essentials of Ophthalmology” considered: “Congestion of lids for years causes growth of Feng Su on the lips … heating of the stomach and the spleen causes growth of Feng Su, then gradually becomes a size of rice even a shape of red bay berry. Those granular substances rub the pupil of eyes.” The treatments for it are puncturing the granules with needle … iron it if possible, better result will be presented. Much symptoms and signs had been in old medical books as follows in this disease, there are granules (as chestnut) on the lids which are caused by evil in the lungs, heat in the large intestine and wind in the liver.

From the review above, it is known that the pathogenesis is related to the following factors: evil heat in Yangming, evil accumulated in lungs, liver-heat stirring inside, gall-bladder fire moving upward and obstructing the channels, blood stasis etc. The principles of treatment therefore are clearing the heat, detoxification, promoting the blood circulation and eliminating phlegm.

Puncture of Zanzhu, Sizhukong, Sibai and Jingming may expel the local channels and eliminate phlegm.

Puncture of Fengchi may clear the wind-heat of the head region. Hegu is a primary point of large intestine channel. Lungs and large intestine are superficial and internal to each other. Puncture of Hegu can purge Yangming evil heat and detoxicate the evil in the lungs. Therefore, prescription given above is useful to treating trachoma.