Conjunctivitis

Clinical  Acute: There is subjective itching with photophobia,

Manifestations stabbing pain, lacrimation, the sensation of a foreign
body in the eye, and burning sensations.
In the early and mild case, it's marked by slight swelling
of the eyelid, severe congestion of the palpebral
conjunctiva and the fornix (inside of eyelids) and mild
congestion of the bulbar conjunctiva (thin protective
coating over sclera). Additionally, there can be a sticky
secretion.
Features of a severe case include palpebral redness and
swelling, obvious congestion of bulbar conjunctiva
possibly accompanied with petechial hemorrhages and
increase of mucus secretions at the inner canthus.
Usually, conjunctivitis will reach its climax in 3 to 4 days,
and then it will be relieved and recover in about 10 to 14
days.
This is a kind of acute infectious opthalmopathy due to
bacterial or viral infection. It's mainly characterized by
an highly infectious condition and obvious conjunctival
congestion.
 Chronic: Dry itchy eyes leading to pain.
Usually takes a long time to occur

Treatment  Varies depending on the specific pattern (Exterior Wind

Principle Heat Attack, Hyperactivity of Liver Yang and Gallbladder
with exterior Wind Heat attack, Heat in Lung and
Stomach, Hyperactivity of Liver Fire and Gallbladder, etc)

Herb Formulas  Chinese Patent Medicines:

Bi Yan Pian
Eye drops: Zhen Zhu Ming Mu Di Yan Ye

Points 1. GB-3, GB-14, GB-15, GB-20, LI-4, LIV-2, PC-8, SI-3, SI-
18, SJ-3, SJ-5, SJ-23, ST-8, ST-44, UB-1, UB-10
2. GB-20, GB-37, LI-4, Taiyang, UB-1, UB-2
3. DU-12, DU-14, GB-1, GB-4, GB-14, GB-20, GB-42, LI-
4, LI-5, LI-20, PC-7, SJ-23, ST-2, UB-1, UB-10, UB-
18, UB-20
4. Taiyang, bleed the ear apex.
5. Ear: Temple, Apex, Low Back Pain Groove, and the
Posterior Auricular Veins
 2. Eye, Vision #2

Tam Healing and Tong Ren Therapy for Lazy Eye

The areas and points listed below are those that are commonly found blocked in adults and
children with "Lazy Eye" and related issues. The system focuses on the scalp
and Huatuojiaji points along the spine. You may use acupuncture, massage and/or the tong ren
to focus on the following areas for healing. For details about the system consider reading the Tom
Tam Healing System textbook. A full list of conditions with treatment points is available in A Lazy
Bum's Healing: Tong Ren Therapy Cross Reference - both are available in our book store

With regards to acupuncture treatments within this style, generally these points would be
combined with some more traditional points based on their overall diagnosis in Chinese
Medicine terms. Generally we combine qi gong, acupuncture and tuina along most of the major
points in the neck and spine as appropriate.

Main Points: C3 huatuo, SI 17, LI 18, GV 23, GB 8, GB 12

Secondary Points: LI 4, Yintang, Taiyang

CATARACTS

Prevention and Treatment-with Reference to Chinese Medicine

by Subhuti Dharmananda, Institute for Traditional Medicine, Portland, Oregon

Cataract is the term for clouding of the lens of the eye; if the cloudiness is sufficient to
inhibit transmission of images to the retina, then vision is partly or fully obstructed. Mild
cloudiness, the most common condition associated with cataracts, does not need
surgical intervention for correction, but can often be compensated for by using
corrective lenses; more severe cloudiness is usually treated by surgery, removing the
original lens and replacing with an artificial lens.

Cataract surgery is part of ancient medical arts; it was one of the earliest of surgical
procedures, even in the Orient, traced back over 2,000 years. It is likely that the reliance
on surgery had the effect of limiting efforts to develop non-surgical treatment methods;
similarly, it is likely that non-surgical methods that had been tried were relatively
unsatisfactory, making surgery seem an appropriate alternative. Therefore, when
examining suggested non-surgical treatments, one should be careful about expectations
for dramatic effects on vision. Further, when reviewing treatment options, cataracts
should be differentiated from "nebulae" which are described as clouding the vision but
refer to films that form on the surface of the eye (cornea).

Cataracts occur most often in the elderly-sometimes referred to as senile cataracts

which affect 25% of those over the age of 65. They are especially common in those with
diabetes. Some drug therapies induce cataract formation. Nearly 1.5 million cataract
surgeries are performed in the U.S. each year.

UNDERSTANDING THE CAUSE OF CATARACTS AND PROGRESSION OF CATARACTS

The lens of the eye is a small oval structure consisting of a thin, clear capsule enveloping
a fluid protein. The protein is clear and colorless at birth, but over the years it discolors
and clouds gradually. It first yellows, then turns brown, and finally, cloudy. Often, it is
not diagnosed until the fluid becomes so cloudy that it interferes with vision, but, in
fact, the process is usually gradual (rapid development may be induced by elevation of
blood sugar or use of some drugs). A cataract is not a growth, nor is it a film over the
eye.

Initially, the cataract changes the focusing power of the eye-by dispersing the light that
passes through it-so that a change of corrective lenses can satisfactorily improve vision.
However, clarity will gradually decline if the condition progresses so that vision becomes
increasingly difficult despite the best possible corrective lenses; this is when surgery is
recommended.

Diagram of cataracts
In a normal eye (left) the lens is clear, allowing light to focus properly on the retina.
When a cataract occurs (right), the lens becomes clouded, causing light rays to scatter.
The discoloration and clouding of the lens protein fluid arises from a number of
processes. One is cross-linking of the proteins, which converts them to thicker, darker
colored materials. Cross-linking of proteins is caused by exposure to UV light, by
oxidative chemical reactions, and by addition of glucose to the proteins (glycosylation)
that promotes cross-linking. Therefore, using good quality UV-blocking sunglasses to
protect the eyes, having an antioxidant-rich diet (and avoiding smoking, which increases
oxidation reactions), taking additional antioxidants, and keeping blood sugar well-
regulated can all help slow the development of cataracts. Topical application of
antioxidants has been tried in many countries as a means of preventing further
development of cataracts and even reversing them; these methods are rarely used in
the U.S. in routine ophthalmology care. In addition to protein cross-linking, breakdown
of the normal proteins of the lens may also occur, especially if calcium levels in the lens
increase (the cause of such change in calcium is not yet established). A calcium-
activated protease can break down the proteins into smaller units, rearranging the
protein matrix and scattering the incoming light. Enzyme inhibitors are considered
potentially useful in preventing and treating cataracts: inhibitors of aldose reductase
may slow cataract formation in diabetics by preventing glycosylation of the proteins and
protease inhibitors may prevent the breakdown of the lens protein. Such inhibitors have
been derived from herbs and developed as new drugs. As examples of herbs of potential
use, salvia and licorice are potent inhibitors of aldose reductase; the flavonoids from
pueraria and scute also serve this function (1).

It is difficult to reverse the clouding of the lens that has already occurred, but there may
be mechanisms within the lens that help restore the protein fluid so that if the
destructive processes cease, some degree of improvement may occur. Efforts should be
made to begin prevention measures early: as soon as cataracts can be detected (during
routine eye exams) and even sooner where risk factors can be identified (high exposure
to UV light; diabetes). The previously-mentioned preventive practices-sunglasses, good
diet, not smoking, taking antioxidants, regulating blood sugar-should be standard for
people over the age of 40. Wearing sunglasses to protect the eyes can also slow
development of floaters; other therapies, such as relying on antioxidants, may similarly
be useful for restraining formation of floaters, which also involve changes in the protein
fluid (in the central portion of the eye ball; see: Floaters and their treatment with
Chinese herbs).

Below, some herb formulas will be mentioned as potentially helpful for preventing and
treating cataracts; many of the ingredients are used in "anti-aging" formulations and
could be taken regularly as part of a program of preventive health care that might help
preserve vision.

RECENT CHINESE EXPERIENCE TREATING CATARACTS

It is estimated (by Pro Ro Nata, Inc., a consulting firm) that traditional Chinese medicine
products for eye disorders accounted for 41 million dollars (U.S.) of business in 2002,
with 80% sold over the counter in pharmacies, the rest prescribed at hospitals and
clinics. Cataracts are a major target of therapy, with 40% of the ophthalmic drug market
(including non-TCM therapies). Unfortunately, little is known about the success rate for
these treatments. Both internal and topical therapies are used.

CHINESE HERBAL RECOMMENDATIONS FOR CATARACTS

In the English-Chinese Encyclopedia of Practical Traditional Chinese Medicine (2), there
is a chapter on diseases of the lens. Three basic formulations (well-known traditional
prescriptions) are recommended for senile cataract on the basis of differential diagnosis
of syndromes, as follows (the number of grams used for a daily dose of decoction is
indicated in parentheses after the common names of the herbs):

Liver/Kidney Deficiency Spleen Qi Deficiency Yin Deficiency and Damp Heat

Qi Ju Dihuang Tang Yiqi Congming Tang Ganlu Yin
Rehmannia (24)
Cornus (12)
Dioscorea (12)
Alisma (9)
Hoelen (9)
Moutan (9)
Lycium (9)
Chrysanthemum (9) Vitex (12)
Phellodendron (9)
Peony (9)
Astragalus (6)
Ginseng (6)
Baked Licorice (3)
Pueraria (3) Eriobotrya (24)
Asparagus (12)
Ophiopogon (12)
Rehmannia (9)
Rehmannia, raw (9)
Dendrobium (9)
Scute (9)
Ching-hao (9)
Licorice (6)
According to the text: "Medication [referring to these herb therapies] may be effective
in the incipient stage [of cataract]; when there is notable opacity of the lens, medication
will not work, and so surgical treatment should be considered." In the book Traditional
Chinese Treatment for Senile Diseases (3), the etiology of cataracts is described as based
in deficiency, leading to inadequate nourishment of the eyes. It is evident from the
wording of the text that its contents are derived primarily from the same sources as that
used for the above-mentioned Encyclopedia. The three formulas described above are
listed (with slight variation on the dosage of individual ingredients), along with two
other formulas for additional diagnostic categories:

Liver/Kidney Yin Deficiency Liver Deficiency and Spleen Damp

Buyin Bushen Tang Siwu Tang + Erchen Tang
Rehmannia (24)
Black sesame (12)
Cassia seed (12)
Morus fruit (12)
Lycium (12)
Tang-kuei (10)
Dioscorea (10)
Alisma (10)
Hoelen (10)
Moutan (10)
Schizandra (10) Rehmannia (18)
Tang-kuei (10)
Peony (10)
Cnidium (10)
Citrus (10)
Pinellia (10)
Plantago (10)
Licorice (10)
Both texts also mention the use of eye drops, two items being listed are Phacolysin and
Catalin. Catalin is a brand name for the drug pirenoxine sodium (see illustration and
explanation below), which is probably the most widely-used eye drop for early stage
cataracts, with more than 50 years of use and distribution in 40 countries. It is produced
by 20 manufacturers in China; the brand Catalin is made in Japan. Phacolysin (also called
Phacolin) is a complex anti-oxidant (see structure diagram left); it has been used both
topically and internally as a therapy for eye disorders.

pirenoxine sodium
In addition to Pirenoxine eye drops, the main OTC cataract products in China include
Zhangyanming Tablets (there are several of these, including Zhangyan Mingmu Pian,
Neizhang Yanming Pian, etc.; they are tonics for kidney and liver with herbs for
nourishing the eyes and promoting circulation) and Shihu Yeguang Wan (produced by
many factories; the item entering the U.S. is called Dendrobium Night Sight Pills). These
products are indicated for early and mid-stage cataracts, as well as for nebulae.

In Japan, Rehmannia Eight Formula (Bawei Dihuang Wan, also called Jingui Shenqi Wan)
is recommended for treatment of several disorders of aging, including diabetes and
cataracts. The modified version, Achyranthes, Plantago, and Rehmannia Formula
(Rehmannia Eight Formula with achyranthes, niuxi, and plantago seed, cheqian, added,
called Niu Che Shenqi Wan; in Japan, called Goshajinkigan) is especially used for
complications of diabetes, such as diabetic neuropathy and cataracts. The formula
appears to be effective for reducing corneal sensitivity in diabetes patients, indicating an
influence on the eye (4).

A CASE OF SUCCESSFUL CATARACT TREATMENT IN A DIABETIC WOMAN

In an article from Japan, published in the American Journal of Chinese Medicine (5),
three physicians report on a successful case of cataract treatment with a traditional
herb formula. This involved a 68-year-old woman with diabetes having a cataract in one
eye. The cataract had been present for more than four years at the time of treatment
with the herb formula. She was given Achyranthes, Plantago, and Rehmannia Formula.
She had been taking Catalin eye drops and Tathion eye drops (glutathione eye drops,
another antioxidant strategy), with only slight effect, but when she began taking the
herb formula, her vision began to rapidly improve within 10 days, and continued to
improve over three months of therapy. The affected eye then remained in improved
condition thereafter, with continued use of the herbs (dried extract granules, 7.5 grams
per day).

ILLUSTRATIONS OF TOPICAL PREPARATIONS FOR CATARACT

Sample of pirenoxine eyedrops
Sample of pirenoxine eyedrops (a modified phenoxazine carboxylic acid, see structure
diagram, right) for cataract; this is labeled Catalin (in Japan); it is also sold as Clarvisan,
Clarvisor, and under other names; a Chinese version is called Baineiting.

phenoxazine carboxylic acid

Can-C
N-acetylcarnosine, is an antioxidant provided as an eye drop; the pictured product is
called Can-C; carnosine is also sold as Bright Eyes and NuEyes, and under other names.
Carnosine is a dipeptide (alanine-histidine) researched mainly in Russia as a treatment
for cataracts. In one study (6), it was claimed that after 6 months, 89% of all eyes
treated with the drops had an improvement of glare sensitivity; 41% had improvement
of the transmissivity of the lens, and 90% of the eyes showed improvement in visual
acuity. The improvements were said to be retained during two years of follow-up with
continued use of the eye drops. Carnosine may specifically inhibit glycosylation of the
lens proteins.

Quinax
A Swiss product called Quinax (dihydroazapentacen or azapentacene polysulfonate) is
used as a treatment for cataracts. According to one research report from Poland (7): "An
observation of (on average) 5 years duration showed that systematic application of the
drug prevents the development of early senile cataract and distinctly slows down the
progress of the condition in the group of patients without the risk factors. Non
systematic application of the compound also slows down the progress of the condition
in the group of early cataract. The drug was ineffective in patients with an advanced
diabetic cataract."

REFERENCES
Zhang JQ and Zhou YP, Inhibition of aldose reductase from rat lens by some Chinese
herbs and their components, Journal of Chinese Herb Drugs 1989; 14(9): 557-559, 576.
Xu Xiangcai (chief editor), The English-Chinese Encyclopedia of Practical Traditional
Chinese Medicine, vol. 17: Ophthalmology, 1994 Higher Education Press, Beijing.
Hou Jinglun and Geng Xiu'e (chief editors), Traditional Chinese Treatment for Senile
Diseases, 1997 Academy Press, Beijing.
Yasunori Nagaki, et al., Effects of Goshajinkigan on corneal sensitivity, superficial
punctate keratopathy and tear secretion in patients with insulin-dependent diabetes
mellitus, American Journal of Chinese Medicine 2003; 31 (1): 103-109.
Yoshie Usuki, et al., Successful treatment of a senile diabetic woman with cataract with
Goshajinkigan, American Journal of Chinese Medicine 1991; 19 (3-4): 259-263.
Babizhayev MA, et al., N-Acetylcarnosine, a natural histidine-containing dipeptide, as a
potent ophthalmic drug in treatment of human cataracts, Peptides 2001; 22(6): 979-
994.
Stankiewicz A, et al., Evaluation of the effectiveness of Quinax in the prevention of the
development of senile cataract, Clinical Ophthalmology 1990; 92(3-4): 52-54.
January 2004

GLAUCOMA

Glaucoma is a multifactorial neurodegenerative disease characterized by

damage to the optic nerve and the nerve fiber layer of the retina secondary to
increased intraocular pressure. This disease is irreversible and in its beginnings it
does not usually present any type of symptoms, so that early prevention is vital to
be able to avoid blindness.

Thanks to the medical treatment and the appropriate ophthalmological

examinations, it is possible to preserve the sight.

In general, glaucoma does not present symptoms although in the less frequent
varieties it can be perceived:

Nausea

Eye pain

Blurry visión

Headache

Sight loss
General Eyecare Guides

Observation of the eyes: As Acupuncture Physicians, we should pay close

attention to our patients eyes in order to help to prevente eyes disorders.

1) WATCH THE "SHEN" OF THE EYE:

If the eye is clear, shiny and hydrated, little legaña and good vision, with the
possibility of movements in all directions = This corresponds to an eye with
"SHEN" and if you have any disease, it can be treated easily. (When the eye has
a lot of legaña, it indicates excess internal heat).

The opposite is an eye without "SHEN" = Having an illness is harder to treat.

The ocular disease, when it appears, itches with itching and when cured it also
goes with itching. (The eye is the door of the liver, this is always attacked by the
wind and the wind always produces itching).

If the eye is dry, insufficient blood or Liver YIN.

Sensation of sand in the eyes = Moisture in spleen or weak spleen.

2) EYE COLOR:

If the lacrimals are very red = Fire in the Heart.

If the Sclerotic has an extremely red color = Fire in Lung; if it is yellow, humidity
and internal heat.

If the whole eye is red and inflamed = wind and heat in the meridian of the Liver.

If the lacrimals are pale = Blood insufficiency.

3) EYE SHAPE:
Exophthalmos = Mostly a symptom of Thyroids disorder.

Exophthalmos without thyroid disorders= Fire in Liver.

Exophthalmos and Asthma = Inflammation of the lungs.

Exophthalmos in one eye = Severe disease.

Stye = Attack of wind and heat to the eyelid, mostly caused by patient having a
lot of heat in the Stomach and Spleen.

Gray and bulging bags under the eye= Kidney Qi insufficiency.

Infections and inflammations in the eyelids = Fire and Spleen.

4) EYE MOVEMENT:

When sleeping, patient does not close the eyelids completely = Spleen
insufficiency or in children, they have parasites.

Dilated pupil = Loss of kidney JING QI.

Pupil contracted: Mostly due to either:

 Fire of the liver and gall bladder.

 Overwork leading to fire due to Yin defienciency (liver and kidney),
causing fire due to YIN insufficiency.
 Toxic substances (drug intoxication).

Diferenciacion de Sintomas y Signos

Signo Sintomas asociados Sindrome
Viento Calor
Visión borrosa, externo Fuego de
turbia, pterigion Hígado y Vesícula
Biliar
Insuficiencia de
Yin. Insuficiencia
Disminución lenta de Sangre.
Estancamiento de
Capacidad visual Qí.
Insuficiencia de yin
Nictalopía
de Hígado y Riñón
Calor por
Miodesopsias
insuficiencia
Agresión por
Disminución
Viento Fuego y
brusca o ceguera
Tan

Como punzante,
enrojeci-miento,
secreciones Viento Calor
abundantes y
viscosas
En párpados con
Fuego en
inflamación,
Yangming.
estreñimiento.
Dolor Insuficiencia de
Al leer o con el
Bazo, Riñón, Qí o
trabajo ocular
Esencia.
Estancamiento de
Distensivo Qí. Estasis de
Sangre.

Sequedad ocular y Insuficiencia de

conjuntivitis leve Yin.

Ataque por Viento Calor

 Acumulación de
Inflamación y
Calor y Humedad
enrojecimiento de
en Bazo y
párpados
Estómago.
Insuficiencia de
Prurito Edema con brillo Yang de Bazo o
en la piel sin Riñón. Ascenso
eritema patológico de los
Líquidos.
Aparición
Ataque por Viento
repentina.

Edemas Con eritema leve y Ataque por Viento.

lagrimeo.
Eritema muy rojo
Conjuntivitis, lagrimeo y
secreciones abundantes
Calor por exceso en Pulmón
o San Jiao.
Ataque por Viento Calor

General Clinical  Acute: There is subjective itching with photophobia,

Manifestations stabbing pain, lacrimation, the sensation of a foreign
body in the eye, and burning sensations.
In the early and mild case, it's marked by slight swelling
of the eyelid, severe congestion of the palpebral
conjunctiva and the fornix (inside of eyelids) and mild
congestion of the bulbar conjunctiva (thin protective
coating over sclera). Additionally, there can be a sticky
secretion.
Features of a severe case include palpebral redness and
swelling, obvious congestion of bulbar conjunctiva
possibly accompanied with petechial hemorrhages and
increase of mucus secretions at the inner canthus.
Usually, conjunctivitis will reach its climax in 3 to 4 days,
and then it will be relieved and recover in about 10 to 14
days.
This is a kind of acute infectious opthalmopathy due to
bacterial or viral infection. It's mainly characterized by
an highly infectious condition and obvious conjunctival
congestion.
 Chronic: Dry itchy eyes leading to pain.
Usually takes a long time to occur

Treatment  Varies depending on the specific pattern (Exterior Wind

Principle Heat Attack, Hyperactivity of Liver Yang and Gallbladder
 with exterior Wind Heat attack, Heat in Lung and
Stomach, Hyperactivity of Liver Fire and Gallbladder, etc)

Herb Formulas  Chinese Patent Medicines:

Bi Yan Pian
Eye drops: Zhen Zhu Ming Mu Di Yan Ye

Points 6. GB-3, GB-14, GB-15, GB-20, LI-4, LIV-2, PC-8, SI-3, SI-
18, SJ-3, SJ-5, SJ-23, ST-8, ST-44, UB-1, UB-10
7. GB-20, GB-37, LI-4, Taiyang, UB-1, UB-2
8. DU-12, DU-14, GB-1, GB-4, GB-14, GB-20, GB-42, LI-
4, LI-5, LI-20, PC-7, SJ-23, ST-2, UB-1, UB-10, UB-
18, UB-20
9. Taiyang, bleed the ear apex.
10. Ear: Temple, Apex, Low Back Pain Groove, and the
Posterior Auricular Veins
2. Eye, Vision #2