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.

Pigmentary Degeneration of Retina

retina
The article is extracted  from English-Chinese Concise, Traditional Chinese Medicine, Publishing House of Shanghai College of T.C.M. (1993)

Identification and Treatment

1)  Decline of the Fire from the Life Gate

Main Manifestations: Night blindness but with normal vision in the day time, slight contraction of visual field, lustreless eyes, pale complexion, aversion to cold and cold limbs. Pale tongue with white coating, deep and thready pulse.

Therapeutic Method: Warm and recuperate the life gate.

Decoction: Prepared rehmannia root 30g, dogwood fruit 12g, (Chinese yam 12g, Chinese angelica root 12g, wolfberry fruit 12g, eucommia bark 12g, antler glue 12g, cinnamon bark 6g, prepared aconite root 6g, and dodder seed 18g.

Patent Medicine: Kidney Yang-Tonifying Pill (You Gui Wan). Take 9g each time, twice a day.

2) Deficiency of Both Liver and Kidney

Main Manifestations: Night blindness, contraction of visual field, diminution of central vision, dryness and discomfort of the eyes, dizziness and tinnitus, insomnia and dreamfulness. Red tongue with scanty coating, thready and rapid pulse.

Therapeutic Method: Nourish the liver and kidney.

Decoction: Dried rehmannia root 18g, prepared rehmannia root 18g, red sage root 18g, dogwood fruit 12g, wolfberry fruit 12g, chrysanthemum flower 12g, Chinese yam 9g, Oriental Water plantain rhizome 9g, poria with hostwood 9g, moutan bark 9g, bupleurum root 9g, Chinese angelica root 9g, and schisandra fruit 9g.

Patent Medicine: Kidney Yin-Tonifying Pill (Zuo Gui Wan). Take 9g each time, twice a day.

Acupuncture and Moxibustion

Main Points: Jingming (Ub 1) and Qiuhou (Ex 7).

Complementary Pints: Taiyang (Ex 2), Hegu (Li 4), Zusanli (St 36) and Sanyinjiao (Sp 6).

Method: Select 1 main point and 1 or 2 complementary points for each treatment. Puncture the points with moderate stimulation and retain the needles for 20 minutes. Give one treatment a day, 10 treatments as a course.

Medicated Diet

  1. Boil fresh tender sweet potato leaf 100g and sheep liver 90g together (do not cook them too long). Take it once a day, 5 – 7 days successively.
  2. Make decoction with 15g of bat’s feces. Remove the dregs from it and cook the smashed pig liver 90 – 120g in the boiling decoction. Drink the decoction and eat the liver. Take a dose a day and 2 or 3 doses successively.
  3. Make decoction with 500g of spinach, 1 piece of sheep liver and 15g of pipewort. Eat the liver and drink the decoction. Take a dose a day, 3 or 4 doses successively.
  4. Decoct 1 piece of chicken liver, 15g mulberry leaf and 15g of silkworm excrement together in water. Take the decoction a dose a day and several doses successively.
  5. Cook 1 piece of fish liver (rid of the gallbladder), 2 eggs and 15g of fermented soya bean together in water for eating.
  6. Have 1 set of grass carp intestines washed clean and cut into short sections. Add 2 eggs and mix them thoroughly with a right amount of water, and then stew them until done for eating.
  7. Decoct 60g of sheep liver, 10g of pipewort and 10g of white chrysanthemum flower in water for eating.
  8. Make cakes or snacks for eating with walnut kernel, chestnut, Chinese yam, dried longan pulp and wolfberry fruit in a right amount respectively.
  9. Decoct 100g of celosia seed in water. Take out the extract every 20 minutes, and then add water to decoct it again. Put together the extract obtained at 3 times. Boil 500g of black Chinese date in the extract until they are thoroughly done. When the remaining extract is thickened, add 500g of honey and mix them thoroughly. Put the mixture in bottle for later use. Take 15g each time, once a day.
  10. Soak rutabaga seed 1000g in spirits for a night and take it out, and then steam it over the boiling water for 20 minutes. Dry it under the sunlight and grind it into fine powder. Make pills as big as soybeans by mixing the powder with honey. Take 6g each time, twice a day.
  11. Have carrot washed clean, cut into slices and steamed. Take as much as one pleases.