Eye diseases
Page 1
The Acupuncture Treatment Of Eye Disorders
Julian Scott
Julian Scott
Page 2
Eye diseases
The Zang-Fu and the eyes "The Liver opens into the eyes".
Old-fashioned view The old fashioned view (which is to be found, for example in the Nei Jing ) is based on a simple attribution of the parts of the eye on the basis of colour. colour. So we see the following table of relations: Organ Kidney Liver Heart Spleen Lung
Colour Black Green/brown Red Yellow White
Part of eye pupil Iris Inner canthus Eyelids Sclera
More recently The Liver ...which opens into the eyes is particularly concerned with the perception of perception of light. light. Liver blood deficiency Liver heat Rage
can lead to poor colour discrimination; also black spots in front of the eyes.) conjunctivitis, glaucoma, optic atrophy and so on. "blinded by rage".
The Heart "the Heart rules the blood vessels" vessels" Blood clots, hardening of the arteries, poor blood blood supply can all be seen seen in eye pathologies. pathologies. In particular we see: see: Stagnation of Blood Occlusion of the arteries Poor circulation of blood Heat in blood
for example in high blood pressure and in stagnation of blood conditions e.g. where all the all the arteries of the body are hardened seen in Heart Yang Xu conditions. Very common in old age. retinal bleeding (e.g. diabetic retinopathy)
Perception the recognition of objects, the cognitive aspect of the Shen. Shen shows in the eyes
Julian Scott
Eye diseases
Page 3
The Spleen ..."controls flesh" – the eye-lids. The Spleen also rules the transportation and transportation of fluids, dry eyes because dampness or phlegm is obstructing the flow of fluids to the eyes excessive production of tears, "bags" underneath the eyes, In Western Medicine, they are a symptom of Bright's disease the aqueous humour may become sticky leading to "open-angle" glaucoma Thick phlegm may lead to drusen
• • • • •
The Lungs dry eyes from Lung Yin Xu excessive tears from Lung Qi Xu excessive tears from long-term sadness excessive tears tears when wind-cold wind-cold invades the lung - and many other conditions related to either the lungs or to the Wei Qi.
• • • •
The lungs also affect the fluid circulation inside the inside the eye, so that there is a Lung pattern of glaucoma. tear production on going from hot to cold corneal erosion and corneal ulcer, both of which have as one of their syndromes Lung Yin Xu. Both these these conditions conditions are similar to an equivalent equivalent skin skin disease disease - corneal erosion erosion being like flaking eczema and corneal ulcer being similar to an ulcer or rash on the skin.
• •
Grief
Kidneys Last, but not least in our discussion of the eye eye problems come the Kidneys. They are of such importance for the eyes that they come first equal with the Liver. In particular we can see: The Retina and Optic Nerve ...are anatomically part of the brain, and as such are ruled by the Kidneys. The Aqueous Humour When the Kidneys are deficient, it is easy for fluid imbalances imbalances to occur in the eyes. In particular one may see: glaucoma (open angle) when the pressure builds up in the eye due to Kidney deficiency
•
the Lens ...could be said to be ruled by the Kidneys. In particular one sees: sees: progressive hardening of the lens in old age, leading to presbyopia cataract, which frequently comes from Kidney Yin deficiency.
• •
The 'glitter', or the force of the Shen is ruled by the Kidneys.
Julian Scott
Page 4
Eye diseases
Western anatomy and physiology The Cornea The Aqueous Humour The Conjunctiva The Sclera The Iris The Lens The Ciliary body The Vitreous Humour The Retina
The choroid The trabeculum and Schlemm’s canal Fluids in the eyes The aqueous humour , which fills the eye is thought to be secreted by a part of the ciliary body which is covered by many folds. Tears are Tears are produced by lachrymal ducts, and are part of the fluids which lubricated the movement of the eye, and the eyelid. They are stabilised by a thin oily film of a lipid called meibonium, meibonium, which is secreted by tiny glands in the eyelids. eyelids. This oily film prevents rapid evaporation of the the tears. Underneath the wet tear film, next to the conjunctiva, there is a thin film of mucus, mucus, which is secreted by the conjunctiva itself. Drusen The Optic Nerve
Julian Scott
Eye diseases
Page 5
Cranial nerves These nerves come out of the cranium near the point Fengchi Gb-20 – which explains its effectiveness in so many eye disorders. Extraocular muscles inferior, superior, lateral and medial rectus, inferior and superior oblique muscle Clinical Ophthalmology a synopsis, J.J.Kanski, Butterworth-Heinemann Lots of lovely pictures Outline of Ophthalmology, Coakes and Sellors, Buttersorth-Heinemann
Channels going to the Eyes Barrier points
Orthodox tests Retinal imaging Short Coherence Tomography
Julian Scott
Page 6
Eye diseases
Causes of eye diseases
Julian Scott
Eye diseases
Page 7
Causes of eye problems, from Chinese view Jing Imbalance of Zang-fu Qi
not enough Qi is reaching eyes
Shen
Qi is being used faster than it is supplied
The 7 Emotions Foods which directly affect the Eyes Garlic Onions
Eggs
Alcohol
Overconsumption of garlic can lead to red and sore eyes. Onions have a similar effect to garlic, but less pronounced. pronounced. They can also increase the need to sleep in some people. Overconsumption of eggs increases the tendency of the body to produce pus, and encourage acute conjunctivitis. This tendency is more pronounced in children. The effects of alcohol in the focusing of the eyes, and its irritating effect on the conjunctiva is well known!
Liver Blueberries (Myrtle)
Strengthen the optic nerve
Carrots
Julian Scott
Page 8
Mercury poisoning Can lead to 1. Accumulation of phlegm 2. Progressive degeneration of the nerves 3. Dysfunction of the excretory excretory function of the kidneys Effect on the eyes Mercury can be behind all problems to do with fluids. In particular: Glaucoma, especially when the intra-ocular pressure is not especially high. Chronic sore eyes, especially when there is a continuous discharge Corneal erosion. Retinal degeneration
Phosphorous The symptoms relating to the eyes are mainly those you would expect from Yin deficiency: Over-sensitivity to light - has to wear sunglasses, even at night. Dry, red eyes Cataract Glaucoma Various sorts of retinal damage.
•
• • • •
Julian Scott
Eye diseases
Eye diseases
Page 9
Principles of Treatment we see the following imbalances: 1. 2. 3.
Marked reduction of Qi in the eyes - local Qi deficiency, often accompanied by general Qi deficiency. Significant Zang-Fu imbalance or weakness - for example Kidney Yang Xu. Attitude problems and life problems - for example not wanting to look at relationships with nearest and dearest. (Other similar examples have already been been mentioned)
the basis for our treatments principles which are: 1. Bringing Qi to the Eyes 2. Treating Organ Imbalance 3. Changing the Attitude
Points for the Eyes.
Julian Scott
Page 10
Eye diseases
Local points Jingming Bl-1 1 to 1.5 cun, perpendicularly All eye problems Zanzhu Bl-2 3 to 5 fen perpendicular; perpendicular; or 0.5 to 1 cun towards Jingming Bl-1 Bl-1 Yangbai Gb-14 Sore eyes, twitching of eyelid, itching eyelids. Sibai St-2 0.2 to 0.3 cun Red eyes, corneal opacity. Sizhukong SJ-23 Transversely, 0.5 to 1 cun Red eyes, ingrowing eyelashes. Qiu hou 1 to 2 cun, first slightly downwards, then slightly upwards. Myopia, inflammation or atrophy of the optic nerve, glaucoma, retinitis pigmentosa, convergent squint
Near points Taiyang all eye diseases, red and swollen eyes, sty. Touwei St-8 Blurred vision, pain in the eyes, excessive tears, spasm of eyelid 0.5 to 1 cun, upwards or downwards. Fengchi Gb-20 Straight insertion 1 to 1.5 cun; or 2 to 3 cun towards opposite eye. opposite eye. All eye diseases Glaucoma #1 1 cun above SJ-23 Yifeng SJ-17 ("Shielding" wind) 2 to 2.5 cun, towards the nearest eye. All eye problems, especially corneal corneal opacity. Er jian (apex of the ear) Bleed or 5 5 moxa cones Painful eyes, corneal opacity
Julian Scott
Eye diseases
Page 11
Distal points Back Shu points: Ganshu Bl-18 Pishu Bl-20 Shenshu Bl-23
Yangguang Gb-38 Yanglao Si-6 blurred vision, "green blindness" (moxa
Xingjian Liv-2 Taichong Liv-3
Hegu Li-4
Guangming Gb-37
Zusanli St-36
Yemen Sj-2 Red eyes
Neiting St-44
Zhong zhu SJ-3 Red eyes
Two less-known patterns of Zang-fu Lingering Pathogenic Factor Dreamy Glazed look in eyes eyes Skin oily oily or excessively dry Skin on body is rough rough (like sandpaper) sandpaper) Swollen lymph nodes (and tonsils) Occasional drops in energy Food intolerance
• • • • • • •
Liver and Kidney Weak • • • • •
In younger people Timid, cautious, indecisive Does not use full potential Lumbar back weak Wrinkled and decrepit (In older people)
Julian Scott
Page 12
Eye diseases
Other Related Techniques Electric Plum Blossom Traditional Chinese Massage a) Above the eyes b) Pinch and press between the eyes (Bl-1) eyes (Bl-1) c) Massage Taiyang point . d) Massage Fengchi point e) Massage Hegu point on the hand The Bates Technique The Bates Method, Peter Mansfield, Vermilion, London Seeing well again without your glasses, Christopher Markert, Better Sight without Glasses, Harry Benjamin Meir Schneider, DVD Yoga for your Eyes www.seeing.org
Other people in the business Munich University Mainly the use of herbs Chinesisched Medizin in der Augenheilkunde, Fatrai & Uhrig, Elsevier 2005 Boel family in family in Denmark www.akupunktur2000.dk Summary of the method: A selection of points are given every day for two weeks, then three days a week and so on. After 22-25 sessions, the treatment is finished and the patient comes once a month to consolidate. Each session consists of two parts parts with one hour’s rest in between No special diagnosis needed, The same points are used every time. Tuina on the face once a week (the Boel Points are a bit painful) Sometimes Body acupuncture, Chinese or western herbs, homeopathic remedies for the retina •
• • •
Rheumatology in Chinese Medicine G. Guillaume & M Chieu Eastsland Press For more information on the Barrier Points Julian Scott
Eye diseases
Page 13
Julian Scott
Page 14
Eye diseases
Walnut Shell Spectacles These are spectacles where where each lens has been replaced replaced by a half walnut shell. The method of use is to soak the shells in a strong decoction of Chrysanthemum flowers over night before placing them in the frames. Then one inch or so in front of the shells is placed placed a moxa stick, which warms up the shells. shells. The combination of the warmth from the shells and the vapour from the Chrysanthemum extract is very soothing to the eyes. This method is good for bringing Qi to the eyes, and is of especial use in tired eyes and chronic red eyes. It can also be used as a supplemental supplemental treatment in all eye conditions.
Microcurrent stimulation Rules for microcurrent: Increase the intensity gradually until a slight pricking sensation is felt, then reduce slightly so that there is no sensation. Best results are obtained when the stimulation stimulation is just under the threshold of perception.
Julian Scott
Eye diseases
Page 15
Watering Eyes Aetiology & Pathology Wind-heat Symptoms and signs Eyes are red, sore and watering, possibly with purulent discharge. Patient is quite strong Onset is sudden Pulse rapid full and floating
• • • •
Liver Qi stagnation Symptoms and signs Eyes water in the wind May appear to be very angry or tense, but more often has irritability alternating with great charm. Tendency to high blood pressure Red tongue Wiry pulse
• •
• • •
Lingering Pathogenic Factor Symptoms and signs Watering eyes is seasonal, often in spring time In spite of spring being the worst time, the patient does not seem to be very angry Often a history of lung problems May have signs of thick phlegm Pulse is slippery rather than wiry
• • • • •
Lung and Spleen Qi Xu Symptoms and signs Pale face Quiet voice Poor appetite – or excessive eating Thin and lacking in energy – or overweight Frequent infections Often associated with asthma Weak pulse
• • • • • • •
Additionally these patients may have have signs of a lot of mucus, such as Nasal discharge Cough Slippery pulse • • •
Julian Scott
Page 16
Heart Fire Symptoms and signs Face red Eyes red The inner canthus is especially red, inflamed and painful Restlessness Insomnia Tongue red with thick yellow coat Pulse rapid and slippery
• • • • • • •
Bladder channel Damp-heat Symptoms and signs Stiff back May have slight urinary problems May have to urinate in two goes Ache in occiput.
• • • •
Blood insufficient Symptoms and signs Face gray Hair is dry or brittle Tired Lives off nervous energy Tongue pale
• • • • •
Liver and Kidney weak Symptoms and signs Sore back Weak knees Arthritis Poor memory low in vitality no interest in life
• • • • • •
Julian Scott
Eye diseases
Eye diseases
Page 17
Blocked tear duct the patterns which are likely to underlie blocked tear duct are Heat patterns Liver Qi stagnation Heart fire • •
Phlegm patterns Lingering Pathogenic Factor Bladder channel Damp-heat • •
Deficiency patterns Lung and Spleen Qi Xu Liver and Kidney Weak • •
Dry eyes Liver blood insufficient This more or less corresponds to the Western pattern of anaemia. Liver and Kidney weak This pattern is common in old age. There is general weakness, weakness, but specially Yin Xu, nor Yang Xu. Kidney Yin Xu The common time for this pattern to emerge in western patients is the menopause. They may not show the malar flush conventionally associated with Yin Xu, but there are often many other characteristic characteristic symptoms and signs. signs. Another situation is those those undergoing radiation therapy, where the burning radiation has consumed Kidney Yin. Full heat These are the people who run hot hot all the time. They may be seen in short trousers trousers or cotton dress in the middle of winter. Typically they have a red face, face, and a full, rapid pulse and a red tongue. Sometimes, especially in older people, people, the face is not so red, but is more yellow. This happens when the Qi Qi is somewhat weaker, and also when the heat is trapped inside. Liver Yang rising Typical symptoms include irritability and even outbursts of anger, red or purple tongue with a dirty coat, wiry pulse. pulse. Generally these people people exude an atmosphere of frustration and and pent-up energy. In China, this pattern is usually usually accompanied accompanied by hypochondriac hypochondriac pain. This symptom does appear in Western patients, but not always.
Julian Scott
Page 18
Eye diseases
Spleen Qi Xu Typical symptoms include poor digestion, tiredness, lack of concentration, a tendency to worry, weak pulse. pulse. These people people may exude exude a defeated defeated attitude. In China this pattern is usually accompanied by loose stools, but in the West, irregular stools are more common, possibly loose stools alternating with several days of constipation. Thick phlegm This pattern is rarely mentioned in Chinese texts, texts, but is common in the West. Its root cause is often the combination combination of many immunisations immunisations and suppressed suppressed fevers. Common symptoms include congested lymph system, dry or dusty skin, or even flaking eczema. Lung weakness We prefer to use the term Lung weakness rather than Yin or Yang Xu because this is how it often presents in the West. Typically there may be a history of Lung Lung illness, such as chronic cough, or asthma when young, which at present does not manifest as a lung condition, but which is nevertheless the major imbalance, and needs to be treated for a successful outcome Special diagnostic pulse: The ‘bean bone’ pulse is a sure indication that there is lung weakness, even if there are no other symptoms. Normally the pulse can can be felt in the first position – on the right it represents the lungs, lungs, and on the left the heart. But examining the pulse closer to the wrist, the pulse becomes fainter, so that by the time the practitioner is pressing on the patient’s wrist bone, little or no pulse can be felt. However in the ‘bean bone’ pulse, pulse, the pulse can be clearly felt for up to a centimetre beyond the crease of the wrist. On the right it represents represents damage to the right lung, and on the left damage to the left lung. The length and strength of the pulse in this position are an indication of t he depth of damage to the lungs.
Julian Scott
Eye diseases
Page 19
Corneal erosion Common symptoms localized opacity nearby redness and excess blood vessels photophobia watering eyes pain similar to that felt with a foreign body or Fierce pain in eyes irritable iritis (because toxins reach the iris)
Spleen and Kidney weakness (or Spleen and Kidney yang deficiency) sclera has a ‘muddy’ look patient is tired weak knees sore or weak back pasty complexion tongue may be pale, possibly with red at the edges soggy and weak pulse • • • • • • •
Liver and Gallbladder heat bloodshot eyes possibly a red face, but more often in the West, the face is pale male patients may have blue color along the jawline tense and irritable tendency to high blood pressure wiry pulse purple tongue • • • • • • •
Wind-heat very red, very sore, itchy eyes possibly watery eyes sudden onset signs of an attack of wind-heat possible fever possible thirst pulse is floating and rapid tongue has thin coating and red tip • • • • • • • •
Julian Scott
Page 20
Lung yin deficiency white face with malar flush night sweats thin build history of Lung problems possible history of excessive use of steroids for treating asthma overstimulated pulse is fine and rapid tongue is thin, red at tip or red all over, and maybe peeled • • • • • • • •
Julian Scott
Eye diseases
Eye diseases
Page 21
Optic Atrophy – weak eyes Includes: Macular Degeneration, Retinitis Pigmentosa What are drusen? What is retinal oedema? Orthodox treatment – Lucentis Aetiology and pathology - why are the nerves dying? Not enough nourishment Either the blood is thin, or not enough blood is reaching the retina Or there is a fluid imbalance Damp-heat injures the nerves
Patterns Liver and Kidney weak ( xu-ruo) xu-ruo) Heart Ying weak Spleen and Kidney Yang Xu Stagnation of qi and blood Accumulation of phlegm Damp-heat Lung Qi / Organ weakened
Symptoms and signs Liver and Kidney weak ( xu-ruo) xu-ruo) Patient is old, tired of life No reserves of strength Weak back Maybe incontinence or prostate problems Weak memory
• • • • •
Heart Ying weak Palpitations Insomnia Easily worried Face white or pale purple Maybe hardened arteries • • • • •
Julian Scott
Page 22
Eye diseases
Spleen and Kidney Yang Xu Tired 4 limbs feel heavy Weak digestion Weak back
• • • •
Stagnation of qi and blood Frustration Strong feelings, but maybe hidden under a cheerful face Purple tongue
• • •
Accumulation of phlegm Face is shiny or else looks powdered Tight, compressed feeling in eyes and face Pulse slippery or else deep • • •
Damp-heat Overweight Sweating at night Abdominal distension Tired and heavy feeling Pulse slippery or soggy or weak • • • • •
Lung Qi / Organ weakened White face Quiet voice Dreamy expression Cracks in lung area on tongue Special lung pulse • • • • •
Advice • •
It can be helpful to take mineral and vitamin supplements. The patient patient should should be tested for mercury and and other heavy metal poisoning. poisoning.
Other treatments Microcurrent stimulation Daily electrical stimulation of the points around the eye with a microcurrent stimulator has been shown to be beneficial. Dry type is characterised by ‘drusen’ and possibly growth of blood vessels Wet type is characterised by retinal oedema, retinal bleeding
Julian Scott
Eye diseases
Page 23
Retinal bleeding Blood heat Red face Red tongue Rapid pulse • • •
Spleen does not hold blood Overweight (in the West) Bloating after meals Food intolerances Varicose veins • • • •
Weak heart and vessels Easily tired Palpitations Other Heart signs Pale or purple tongue Irregular pulse • • • • •
Julian Scott
Page 24
Eye diseases
Glaucoma (‘closed angle’, ‘acute’) Glaucoma is the name given to the symptom symptom of increased pressure in the eye. eye. The normal pressure in the eye eye is about 13 to 15 mm of mercury (~25mbar). this is quite a low pressure, being the pressure you would find at the bottom of a pint j ar or bottle(17-20cms of water). This pressure pressure is enough to keep the eyeball 'inflated'. In pathological pathological conditions, the pressure can increase drastically - to as much as 75mm (100mbar) - some 5 times normal value. It is generally considered considered to be glaucoma glaucoma if the pressure rises to 25mm (33mbar), but some glaucoma symptoms have been reported at pressures as low as 19mm (25mbar).
Treatment of after effects The after effects of acute glaucoma are likely to be partial blindness, often in a characteristic shape (see fig xx), as a result result of damage to the optic nerve. From the point of view of treatment by acupuncture, the principle and practice of treatment is the same as damage to any nerve, such as numbness in the leg due to a damaged sciatic nerve. The following rules apply: Intensive treatment needs to be given. given. This intensity of treatments needs to be carried out for about 100 treatments. Treatment is much more successful if started within 3 months of the nerve injury. injury. Results If the treatment rules given above are followed, there is a good chance that daylight eyesight will be completely completely restored. There may be some slight reduction of night-time vision in the affected areas.
Julian Scott
Eye diseases
Page 25
Open Angle Glaucoma (chronic), ocular hypertension Orthodox Treatment – drops, trabeculotomy, stent
Liver Yang rising • • • • •
Patient is under stress Frequent strong headaches Pale or purplish face Purple tongue Wiry pulse
Kidney weak • • • •
• •
Patient looks old or tired Hair is thinning Face colour may be pale, or may be bright red Sore or weak back Arthritis Pulse may be weak, but more often is long, characteristic of hardening arteries
Spleen Qi deficiency • • • • • •
Gray face Tendency to overweight Difficulties over food – diet does not seem to help May overeat Pale tongue, possibly coated, or possibly with stringy saliva Pulse slippery
Phlegm obstruct flow of fluids • • • • • •
Gray face Tendency to eczema/dry flaky skin Food intolerance/allergies Tendency to stone formation Pale tongue, possibly coated, or possibly with stringy saliva Pulse slippery or wiry
Lung Qi Xu • • • • • •
Pale or white face Quiet voice May have history of asthma or other lung illness Possibly frequent infections Often a dip or discoloration in the lung area of the tongue May have ‘bean bone’1 pulse
1
Bean-bone pulse is a pulse that can be felt on the radial artery just distal distal to the wrist line. In a healthy person it should not be possible to feel this pulse. Its presence indicates injury injury to the lung organ, for example by whooping cough when young or tuberculosis. tuberculosis.
Julian Scott
Page 26
Eye diseases
Cataract Cataracts occur because there there is too much heat in the system. One should not be misled by the symptom of feeling cold. Often patients feel cold because they they are weak or tired, or because the heat inside does does not reach the surface. The very fact of cataract points towards heat of some kind. Syndrome
Aetiology
Symptoms
Tongue
Pulse
Liver and Kidney Old-age, weak heat exhaustion, overwork
Pale face, pasty or wrinkled skin, tired all the time, dark rings under the eyes
thin, red dots, thin, tight; cracks on surface possibly long
Lung dry or Yin Xu
White face, history of lung problems, dreamy expression
Usually pale, but Usually weak, but may be red may be rapid. towards the tip Often there is a special lung pulse.
Chronic lung condition, lung illness early in life, overwork, exhaustion
We have used the term 'weak heat' in preference to the term Yin Xu, as Western patients often do not exhibit the typical symptoms of Yin Xu of night sweats, and five centres hot. There nearest they may get is often that they have to sleep with their feet uncovered, even in winter. New causes: Exposure to chemicals in youth Other treatment: Cineraria maritima eye drops (Dr. Reckeweg)
Julian Scott
Eye diseases
Page 27
Short Sight First of all treat stress The treatment of stress in children is not really medical work, but is more in the sphere of counseling. Then treat any Qi imbalance: Prescription for Spleen Qi Xu St-36 Zusanli Sp-6 Sanyinjiao
• •
Prescription for Lingering Pathogenic Factor Once the Spleen deficiency has been overcome, there may still be a Lingering Pathogenic Factor. A typical treatment for this would be Bailao (Extra) Bl-18 Ganshu Bl-20 Pishu • • •
Bringing qi to the eyes Undoubtedly the best way is for the child to do the self-massage techniques described, because these can be done three times a day. There are other ways - straight acupuncture, electric plum blossom needle, microcurrent stimulation. Prescription of points to bring qi to the eyes Zanzhu Bl-2 Yuyao (Extra) Tongziliao SJ-23 Yangbai St-2 Fengchi Gb-20 Hegu Li-4 Neiguan Pc-6 (optional)
• • • • • • •
Ideally these points are treated every day for 10 days, days, with a rest rest of 5 days. In practice, they need to be treated three times a week minimum. If you treat less often than than this, it is not worth doing at all, and just involves everyone in frustration and expense. Self checking . . . is important
Julian Scott
Page 28
Eye diseases
Maintaining qi to the eyes after treatment The best way (in fact the only way) to maintain the flow of qi to the eyes is to t o use them! The child should be encouraged to look carefully at pictures, at scenes, generally to look carefully at the surroundings. surroundings. The very act of looking brings qi to the eyes.
Advice to parents • • • •
•
Always have good light when reading or doing close work. Don't watch TV or do computer games. Sit in a good position when doing close work. If the child is wearing spectacles spectacles all the time, spend some some time each day day without spectacles. Gradually reduce the the strength of the spectacles, rather than gradually increasing them.
Squint Crossed eyes which appear appear in childhood must be treated in childhood. childhood. In fact the condition must be treated before the age of 8 years at the very latest if if there is to be any hope of success. This is because there is always always one dominant eye, and the other other eye, the lazy eye gradually falls into disuse. If this eye is not used at all through the 7 to 8 year transition, it becomes blind.
Causes of squint Mechanical defects 1. Shortened muscle 2. Paralysed muscle Diagnosing squint For Caucasian children this is usually quite easy, but when diagnosing young babies, and Orientals it is easy to make a mistake, because there is a fold of skin which makes it look as though the eye is not central, even though it really is.
Energetic causes for shortened muscle Congenital No big problems: problems: the child is born with a squint. Hot Lingering Pathogenic Factor The key symptoms and signs are: child is born born with good eyes, and then develops a squint squint onset is after a fever on immunisation swollen glands in neck, under ears or in groin
• • •
Julian Scott
Eye diseases
• • •
Page 29
some signs or red on the face, such as as red cheeks or red lips maybe red tongue or red tip to the tongue irritable, restless.
Overexcitement The key symptoms and signs are: child is born born with good eyes, and then develops a squint squint squint is worse when overtired or overexcited often red cheeks lower back is often weak child is shy at first, then playful and overexcited tongue may be red, or may be pale pulse rate varies with excitement. • • • • • • •
Paralysis There are a lot of similarities between this pattern and t he second one, LPF, for the simple reason that they they are both the result of a fever. In this pattern the fever has has gone deeper deeper and caused the paralysis. So one often sees exactly the same symptoms, the only difference being in the movement of the eyes. However, one does sometimes see an alternative pattern, that of qi xu; in which case one will see the following symptoms and signs; pale face tired, floppy poor appetite sleeps a lot dull spirit in the eyes.
• • • • •
Conjunctivitis Other treatments: Eye drops: Euphrasia (Weleda) Calendula (Weleda) Euphrasia and Vaccinium (Vizulize)
Recovery after surgery Very simple points can be of use – the basic points for bringing Qi to the eyes, such as: Zanzhu Bl-2 Fengchi Gb-20 Hegu Li-4 Guangming Gb-37 Can make a great difference in the rate of recovery, maybe even making the difference between a successful operation and one which fails.
• • • •
Julian Scott
Page 30
Eye diseases
CASE NUMBER 1 Mr N Aged 78 years years Appearance:. Appearance:. Square face, engaging smile, Well preserved. Face colour colour is red. both eyes slightly watery. Behaviour :. :. Seems to be in a hurry every time he comes. comes. Likes to take control. Wants to know everything about sterilization and safety procedures. Main complaint: complaint: Blocked tear duct, duct, It has been there there on and off for two years. He has been offered surgery, but is unwilling to go down that route, because because of health risks. risks. (A close friend died recently on the operating table)
Don't turn over until you have answered the first few questions What are the possible syndromes for blocked tear duct, and for high blood pressure? Blocked tear duct
High blood pressure
Which syndrome is most likely? Now turn over and study the rest of the symptoms. Suggest a treatment.
What stages are there there in treatment. i.e. what will you treat first, and what would you you expect to happen?
What results would you expect from treatment, and how soon?
Julian Scott
Eye diseases
Page 31
SECTION B Answers to 10 questions Head and body: Used to be very dizzy, until he was found to have high blood pressure. Since taking medication he does does not get these attacks. However, he once had a mild stroke when he got while telling a story in the local pub. Food and Taste: keeps on on going on diets. Mostly he tries to avoid cholesterol, so he he does not eat eggs – except when he goes on an all-egg diet. Stools and urine: has has to get up 3 times in night to urinate. Stools are OK. Sleep: wakes one or two times, but is very heavy in the morning. Drink and thirst: nothing special. Likes to drink drink wine every every night. Says it helps to prevent stroke Life: Still active. active. Goes jogging jogging every day Pulse: slippery-hard, 84 per minute. Tongue: dull red-purple, with a rough coat.
Julian Scott
Page 32
Eye diseases
CASE NUMBER 2 Mrs. J aged 58 Appearance: Appearance: Dull coloured face, slightly yellow, significantly overweight: pasty complexion Behaviour : rather heavy footed Main complaint: complaint: Corneal erosion, especially especially the left eye. On waking the eye eye is painful and watery, feels like grit in the eye, pain may last for an hour or two before subsiding. subsiding. Recently has had actual erosion, with fierce pain. This may occur occur in the middle of the night. Eyes are often blurred, in spite of spectacles (cannot wear contacts) Eyes feel tired all the time. Digestion: Digestion: some indigestion with flatulence, worse when rushing around too fast Sleep: Sleep: used to sleep very well, until this happened. happened. Now often wakes at 3.30 to 4.00am Energy: Energy: is OK. Appetite: Appetite: OK Life. Life. Happily married, but fed up with work, and is looking forward to retiring in a year and a half. Her hobby is writing writing books (she has has published about about 20) Pulse: Pulse: 72 slippery-soggy, quite strong, except both 3rd positions Tongue: Tongue: slightly pointed, red a tip, slight rough r ough coat. What are the syndromes for corneal erosion?
Which syndrome is uppermost? Why do you think she has developed this condition? What do you think needs to change in order for her to get better? What treatments and advice are you going to give her to achieve that change? Be specific in the aim of treatment, a typical prescription, how long you think she will have to come for treatment In advice, please be specific in the advice which she MUST follow, and the advice which is just helpful.
Julian Scott
Eye diseases
Page 33
CASE NUMBER 3 Master O Aged 16 years Appearance:. Appearance:. Tall, well built, pale face, f ace, droopy posture Behaviour : Quiet, dull voice. Main complaint: complaint: Retinitis pigmentosa, pigmentosa, Diagnosed one month ago after 2 year history of increasing night blindness. Field vision test at routine appt. alerted the optician to peripheral vision loss and he made referral. Hospital has said there is no tx. for the condition however through internet search they have found that Vitamin A is prescribed for this condition in the US. Mum has found medical herbalist who is prescribing it to them along with chromium, gingko and omega oils which he is already taking for migraines.
What are the possible syndromes for optic atrophy?
Now turn over and study the rest of the symptoms. Suggest a treatment.
What stages are there there in treatment. i.e. what will you treat first, and what would you you expect to happen?
What results would you expect from treatment, and how soon?
Julian Scott
Page 34
Eye diseases
SECTION B Answers to 10 questions Sweating
Doesn’t really sweat, even with sports. Is big on sporting activities.
Head & Body Severe migraines which can last up to 3 days. Started 2-3 yrs ago. Triggered by exercise, especially bad when he had an important match to play. Rather sketchy about exact symptoms, no real visual disturbances, couldn’t say whether they were one sided or not, just like “a very bad headache”- some nausea. Migraines ceased after tx. by herbalist. Food & taste Won’t really eat fruit or vegetables, likes the usual teen diet but Mum tries to keep him on track with home cooked stuff. He thinks he has a good appetite but Mum begs to differ. Also eats a lot of chocolate – at least one medium bar of galaxy milk chocolate a day, sometimes more, plus minstrels. Hates the taste of salt & vinegar. Drink & thirst Drinks very little, doesn’t feel thirsty, often forgets to drink unless prompted. This runs in family, Mum is the same but has tr ained herself to drink more. Doesn’t drink at night but wakes up v. thirsty and drinks a lot first thing in the morning. Drinks mainly milk or water. Sleep
Very restless. Has difficulty falling asleep. Sometimes it takes hours, occasionally quite quick. Also talks a lot in sleep and will sit up and move about whilst fast asleep. Friends have witnessed it at sleep-overs and family tell him about it, but he is unaware.
Life
Lives with Mum, Dad brother and sister. Sister has autism. School is ok, works hard at school but not much work at home. Likes maths & sports.
Immunisations Had a bad reaction to first triple vaccine but I couldn’t get Mum to say exactly what the reaction was. When the time came for the next one, GP split them up and gave whooping cough separately. Mum is quite suspicious of vaccinations since younger child developed autism. Occiput GB 20
Felt very soft, certainly no tightness or tension. If anything it was unusually soft. No glands that I could feel. Felt “squashy” like a marsh
Liv 14 Taiyang pt. Face
No tenderness, nothing unusual struck me. No tenderness on any of the local points around the eyes.
Lumbar
Areas directly over each kidney kidney felt squashy (esp. on L side) but everywhere everywhere else felt stiff like a board.
Julian Scott
Eye diseases
Page 35
Other Impressions Has always been very physical and sporty. As a child he was always ahead of physical milestones. Apparently a bit of a risk taker as a child “bordering on the hyperactive”. Considering how sporty he is supposed to be, his frame, posture and energy don’t give a sense of being particularly robust or sturdy. Posture looks more like a teenager who sits in his room watching TV or playing guitar. Quite gangly, like someone who has grown too fast and body can’t quite keep up. Mum alludes to ill health generally in the family and gets a bit defensive when I question him around Fear. She thinks I think he is “anxious”. She leaps in to say that “he is the most normal of us all- in fact when the rest of us are all getting anxious about things, he is the one who holds us all together and keeps our feet on the ground”. I can’t help wondering whether he feels under pressure to be responsible for the whole family in this way. Perhaps I’m way off the mark but something felt a bit weird, there was a dynamic that felt tense at that point. Pulse Tongue
Floating on all positions, positions, also slippery on the right side. * radial artery on RHS is on dorsal surface of arm. Normal colour, no coat, quite wet.
Julian Scott
Page 36
Eye diseases
CASE NUMBER 4 Mrs. D Aged 57 years Appearance:. Appearance:. Tall, well built, pale face, f ace, a distinguished and fine nose, red lips Behaviour : Quiet, measured tones in her voice. Main complaint: complaint: Macular degeneration, degeneration, It is in its i ts early stages, and she can still read quite small print, though she is noticing things going fuzzy. Also she has a chronic cough. This has been going going on for nearly a year. In the summer it gets a bit better, and in the winter a bit worse. The cough is worse when she she lies down at night, though it is there in the day too. When she coughs she she brings up some thick green phlegm.
What are the possible syndromes for macular degeneration and for chronic cough? Macular degeneration
Chronic cough
Now turn over and study the rest of the symptoms. Suggest a treatment.
What stages are there there in treatment. i.e. what will you treat first, and what would you you expect to happen?
What results would you expect from treatment, and how soon?
Julian Scott
Eye diseases
Page 37
SECTION B Answers to 10 questions Chills and Fevers: Has always been hot at night Sweating: not much Head and body: Sleep: goes to sleep easily, but often is wide awake between 1.30 and 2.30 a.m.. Drink and thirst: Normal. Likes a glass of whisky at night time (was brought brought up in Scotland) Life: Housewife. Has a daughter daughter and grandchildren living nearby. Pulse: wiry in all positions. positions. More full, and wiry-slippery in the lung position Tongue: Red-purple. Red-purple. More red at the tip. A hollow area just posterior to the tip. Peeled Peeled towards the root Periods: finished. Used to be rather painful
Julian Scott
Page 38
Eye diseases
CASE NUMBER 5 Miss T Aged 26 Appearance Smiling face, red cheeks slightly yellowish skin, slightly green around the mouth Behaviour : Easy to get on with. Charming. Main complaint: complaint: Glaucoma, Glaucoma, for one year. It started with headaches headaches and sparks in front of the eyes, especially early in the morning, morning, just after waking. Since the diagnosis she has has been putting drops in her eyes morning morning and night. These are effective in keeping the pressure down in her eyes, and so so she does not see any sparks. sparks. But she still gets lots of headaches.
Don't turn over until you have answered the first few questions What are the possible syndromes for glaucoma?
Which syndrome is it? Now turn over and study the rest of the symptoms.
Will you treat? If so, what will you aim to t o do with the treatment.
What results would you expect from treatment, and how soon?
Julian Scott
Eye diseases
Page 39
SECTION B Answers to 10 questions Head and body: headaches are mainly at the temples, temples, going through to the eyes. Food and Taste: does not like greasy greasy food. Sometimes even the thought of it makes her feel nauseous.. No appetite in the morning – breakfast is black black coffee and an apple. Stools and urine: Stools Stools are always dry, and difficult to pass. Gets cystitis from time to time, for which she takes cornsilk tea, except when it gets bad, when she takes antibiotrics. Sleep: sleeps the sleep of the dead Drink and thirst: rather a thirsty child, liking to drink a lot. She likes a glass of water beside the bed, so that she can drink when she wakes. Life: works as a post-office counter counter clerk. Since the introduction of time-and-motion studies, there is always a queue. If she makes a mistake with the money, she she has to make up the shortfall out of her own wages. Exercise: does not like taking much exercise, exercise, though she walks to work, and in the summer summer she likes to go swimming. Pulse: not very very strong. strong. Tight.. Tongue: bright red.
Periods: every 25 or 26 days. Usually painful on the first two days. Usually has to take a painkiller, but sometimes she has to stay off work
Julian Scott
Page 40
Eye diseases
CASE NUMBER 6 Miss T Aged 6 years Appearance: Appearance: Pale face with red hair, Some pink in her cheeks. Her left eye turns in markedly, and is obviously obviously not used. used. She has crusts under her nose. Behaviour : rather shy. Quiet. Main complaint: complaint: Squint, Squint, for three years. Three years ago ago she had a bad attack of bronchitis, with very high fever, and the eye has has not been well since then. According to tests at the eye hospital, there is actually some use in the left eye, and she does occasionally use it. Also she has a chronic cough. Every winter she gets three or four really bad coughs, and and has to take antibiotics each time. Even during the summer she sounds a bit chesty.
Don't turn over until you have answered the first few questions What are the possible syndromes for squint?
Which syndrome is it? Now turn over and study the rest of the symptoms. Comment on the pulse Comment on thirst Comment on capillary How urgent is the treatment? Suggest a treatment. What stages are there there in treatment. i.e. what will you treat first, and what would you you expect to happen? What results would you expect from treatment, and how soon? What advice are you going to give the parents?
Julian Scott
Eye diseases
Page 41
SECTION B Answers to 10 questions Chills and Fevers: rather a hot child. Especially hot at night Sweating: Head and body: Thorax and abdomen: lots of coughs! Food and Taste: drinks lots of milk, eats lots of cheese. cheese. Fond of peanut butter and banana banana sandwiches. Stools and urine: Generally no problem, though the stools tend to be loose. Sleep: wakes one or two times, but is very heavy in the morning. Drink and thirst: rather a thirsty child, liking to drink a lot. She likes a glass of water beside the bed, so that she can drink when she wakes. Life: Pulse: slippery rapid. Lung position is very full. There is a pronounced pronounced special lung pulse. Tongue: dull colour, with a red tip. Immunisations: "All the usual" Glands: very swollen under jaw. There are even some small pea shaped ones on the side of the neck. Capillary: broad, dark!
Julian Scott
Page 42
Eye diseases
Case Number 7 Mr.J aged 54 yrs Main complaint: complaint: Retinal bleeding, and retinal arterial occlusion. The left eye has now very little vision, after arterial occlusion. The vision was suddenly suddenly impaired by arterial arterial occlusion. occlusion. Laser treatment was unsuccessful and made him totally blind in this eye. There is fairly good vision in the right eye, but there has also been bleeding there, and the vision is hazy, and is getting worse. He is understandably reluctant to have further laser treatment. Appearance. Appearance. On first few visits, colour was somewhat yellow, yellow, in later visits it is showing red. Digestion He has always had slight heartburn, but since last Christmas the stomach has been very painful. It has been diagnosed as acid reflux and and inflamed oesophagus. oesophagus. He has always always had a lot of burping. All this better if he takes takes tablets. Limbs – Limbs – in good condition, condition, generally. Some arthritis in knee from an old injury. He is a carpenter and works mainly constructing roofs. More about vision: vision: is hazy, worse in morning, worse in darkness. Has lost some of upper field of vision. Inspection of picture of retina shows where where there are blood clots and also where it has escaped. Pulse a Pulse a bit slow. LH a bit deep and slightly muddy, a bit weaker in He. RH a bit slippery, more full in lung position, and very much so distal to the cun position, on the wrist bone, which is the 'special lung pulse'. Not especially full in the stomach position. Tongue: Tongue: Colour good, a little pale, large cracks. BP was reported to be 150/88
Julian Scott
Eye diseases
Page 43
Questions: What examinations would you do? What is your diagnosis? What advice would you give? What treatment would you give? What is the prognosis?
Julian Scott
Page 44
Eye diseases
CASE NUMBER 8 Mrs W Aged 67 years Appearance: Appearance: Slightly overweight, wrinkly face, yellowish. Behaviour : Moves rather heavily, groans from time to time. Main complaint: complaint: Fierce pain in L eye, eye, for five days. Ten days ago ago she had an operation for detached retina. Healing was going well until five days ago, ago, on Friday afternoon. afternoon. On the next day she phoned the hospital where the surgery was performed, opnly to find that the surgeon had just gone on holiday. Other symptoms and signs Confesses to being being a worrier. “I worry about not having having anything to worry worry about” Often bloated after meals. Has to be careful about what she eats. eats. Knees very swollen. swollen. Give her trouble in cold and damp weather Tongue pale Pulse: tight in all positions What would you do?
Julian Scott
Eye diseases
Page 45
Case Number 9 Miss S Aged 15 years Appearance: Appearance: Pale face, attractive look. look. Shiny skin on the the face, with mild acne Behaviour : polite; does not feel comfortable sitting up straight – prefers to slouch Main complaint: complaint: Coat’s syndrome: syndrome: Coats’ disease is a serious condition of the eye, where the small arteries enlarge, and start to leak. There is also ‘exudation’ ‘exudation’ i.e. the formation of a whitish yellowish yellowish substance over the retina. If untreated, this leads gradually to blindness, at first locally, then, as the condition worsens, it can l ead to glaucoma and retinal detachment. It can be present as leukoria (a wide appearance of the pupil). Aetiology unknown. Usually, only only one eye affected. Treatment: sometimes laser coagulation. She has been noticing some loss of vision in the upper R quadrant, which has slowly increased over the past year. She has always problems with her throat, high tension of the muscles in the neck, Don't turn over until you have answered the following questions What are the conditions (in Chinese medicine) which give rise to blood leaking out of the vessels? What are the conditions which give rise to greasy deposits?
Now turn over and answer the following questions. What imbalances do you think there are? What is the significance of the cracking noise from the jaw? What is the significance of the rough skin? Why do you think the problem occurs in teenage? Do you think you can help?
If so, how long will it take before you see any improvement?
What character changes might you see during healing? what do you think she has to do in the way of treatment and changes in life style?
Julian Scott
Page 46
Eye diseases
SECTION B answers to 10 questions Chills and fevers: fevers: nothing special Sweating: Sweating: nothing special Head and Body: Body: Recurrent headaches, pain in the eye, Loud cracking cracking noise from the right jaw; when when she moves her jaw up and down, there is a sound like a large twig snapping Tight and painful throat; Tenderness at Fengchi Gb-20 and Yifeng SJ-17; always has cold hands and feet Rough skin on the body (like sandpaper), Weak lumbar back • •
• • • • •
Thorax and Abdomen: Abdomen: Unexplained abdominal aches Food and Taste: Taste: Poor appetite Stools and Urine: Urine: tends to constipation constipation with hard dark stools stools Sleep: Sleep: Takes time to get to sleep at night Drink and Thirst: Thirst: not much thirst. Likes sweet drinks also lemon juice Energy: Unexplained periods of tiredness, lasting an hour or two Life: Life: teenager! Menstruation: Menstruation is irregular, shorter than 28 days, mostly every 3 weeks, the blood is dark , not clotted Tongue: Tongue: looks normal, she has a very thin crack in the middle (heart crack ) but no coating in it, there are no signs of blood stagnation Pulse: Pulse: Slippery-tight
Julian Scott
Eye diseases
Page 47
CASE NUMBER 10 Mr. G aged 68 was 68 was still very active, and although he had officially retired, he was, if anything busier than before. He had had glaucoma since glaucoma since his early 40's, which had been treated with drops. Unfortunately, as time went on, his body became more and more accustomed to the drops, and they more or less stopped working. Consequently, about 20 years ago he had a trabeculotomy. However, even this did not not produce lasting lasting relief. The pressure continued to rise. By the time he came to me, there was damage in both eyes, severe in the left eye, so much so that he was obliged to give up his driving licence. He still had (just about) enough sight to continue what he was doing, but it was deteriorating. Appearance: Appearance: tall, thin, wiry body; thinning t hinning white hair, slightly purple face; bright eyes, enthusiastic Examination: Examination: energy in back was weak; tender at SJ-17 Yifeng point, especially on the left; slightly tender at Gb-20 Fengchi Past history: history: 2 years ago was diagnosed as having high cholesterol. Otherwise nothing abnormal, except last year had a period period of bad diarrhoea. He had to get out of bed in the morning to pass pass stools. This is better better now. Pulse: Pulse: Left side: wiry, tending to long, though t hough stronger in 3rd position Right side: more slippery than wiry, stronger in 3rd position Speed: when he first came in it was 60, but the speed gradually slowed to 54 Tongue: Tongue: a bit red, surface is slightly rough, r ough, some sticky saliva on tongue What do you think is the main pattern? main pattern? What treatments would you give? Will they work? If so, how how soon? What would you expect to happen?
Julian Scott
Page 48
Eye diseases
CASE NUMBER 11 Ms A
Aged 43
Appearance: Appearance: Strong build, slightly overweight, red face Behaviour : quite voice, rather submissive behaviour, in spite of obviously being strong Main complaint: complaint: Macular degeneration, degeneration, wet type. Foggy central central vision, like a gray cloud. Had laser treatments 5 to 6 times over last year, to close off ‘rogue’ blood vessels and stop them leaking. This was successful, successful, but keeps on needing to be done, done, as the blood vessels return. She has had short sight (6 dioptres) since 7 years old
Don't turn over until you have answered the following questions What causes blood to leak out of the vessels? What are the syndromes for macular degeneration? ………………………………….. ………………………………….. ………………………………….. …………………………………..
Now turn over and answer the following questions. Does the short sight have any relevance to your treatment?
What treatment will you give, based on the syndrome you have chosen?
Why do you think a person of this age and this state of health has a degenerative disease?
How does this affect your treatment, advice and prognosis?
Julian Scott
Eye diseases
Page 49
SECTION B answers to 10 questions Chills and fevers: fevers: nothing special Sweating: Sweating: nothing special Head and Body: Body: easily gets tense in head, neck and sholders Thorax and Abdomen: Abdomen: chest is fine, fine, but abdomen abdomen somewhat large Food and Taste: Taste: good appetite. Easily puts on weight. Family history if old-age old-age diabetes. Stools and Urine: Urine: OK No problems Sleep: Sleep: OK Life: Life: alternative medicine practitioner and teacher Pulse: Pulse: soft/slightly soft/slightly slippery. slippery. Not very very strong. strong. Weaker in left side middle position. Both 3rd position (chi) very weak. Tongue: Tongue: enormous central crack. Dry, greasy coat
Julian Scott
