Eyes Handout

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Eye diseases Page 1

Julian Scott

The Acupuncture TreatmentOf

Eye Disorders

Julian Scott


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The Zang-Fu and the eyes"The Liver opens into the eyes".

Old-fashioned viewThe old fashioned view (which is to be found, for example in the Nei Jing) is based on asimple attribution of the parts of the eye on the basis of colour. So we see the followingtable of relations:

Organ Colour Part of eyeKidney Black pupilLiver Green/brown IrisHeart Red Inner canthusSpleen Yellow Eyelids

Lung White Sclera

More recently

The Liver...which opens into the eyes is particularly concerned with the perceptionof light.

Liver blood deficiency can lead to poor colour discrimination; also black spotsin front of the eyes.)

Liver heat conjunctivitis, glaucoma, optic atrophy and so on.

Rage "blinded by rage".

The Heart"the Heart rules the blood vessels" Blood clots, hardening of the arteries, poor blood supplycan all be seen in eye pathologies. In particular we see:

Stagnation of Blood for example in high blood pressure and in stagnation ofblood conditions

Occlusion of the arteries e.g. where allthe arteries of the body are hardenedPoor circulation of blood seen in Heart Yang Xu conditions. Very common in old

age.

Heat in blood retinal bleeding (e.g. diabetic retinopathy)

Perceptionthe recognition of objects, the cognitive aspect of the Shen.

Shen shows in the eyes


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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 eyesexcessive 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 Lungsdry eyes from Lung Yin Xu

excessive tears from Lung Qi Xu

excessive tears from long-term sadness

excessive tears when wind-cold invades the lung - and many other conditions related toeither the lungs or to the Wei Qi.

The lungs also affect the fluid circulation insidethe eye, so that there is a Lung pattern ofglaucoma.

tear production on going from hot to cold

corneal erosion and corneal ulcer, both of which have as one of their syndromes Lung YinXu. Both these conditions are similar to an equivalent skin disease - corneal erosionbeing like flaking eczema and corneal ulcer being similar to an ulcer or rash on the skin.

Grief

KidneysLast, but not least in our discussion of the eye problems come the Kidneys. They are ofsuch importance for the eyes that they come first equal with the Liver. In particular we cansee:

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 to occur in the eyes. Inparticular 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:

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.


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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 Schlemms canal

Fluids in the eyesThe aqueous humour, which fills the eye is thought to be secreted by a part of the ciliarybody which is covered by many folds.

Tearsare produced by lachrymal ducts, and are part of the fluids which lubricated themovement of the eye, and the eyelid.

They are stabilised by a thin oily film of a lipid called meibonium, which is secreted by tinyglands in the eyelids. This oily film prevents rapid evaporation of the tears.

Underneath the wet tear film, next to the conjunctiva, there is a thin film of mucus, which issecreted by the conjunctiva itself.

Drusen

The Optic Nerve


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Cranial nervesThese nerves come out of the cranium near the point Fengchi Gb-20 which explains itseffectiveness in so many eye disorders.

Extraocular musclesinferior, superior, lateral and medial rectus,inferior and superior oblique muscle

Clinical Ophthalmology a synopsis, J.J.Kanski, Butterworth-HeinemannLots of lovely pictures

Outline of Ophthalmology, Coakes and Sellors, Buttersorth-Heinemann

Channels going to the EyesBarrier points

Orthodox testsRetinal imagingShort Coherence Tomography


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Causes of eye diseases


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Causes of eye problems, from Chinese viewJing 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 Overconsumption of garlic canlead to red and sore eyes.

Onions Onions have a similar effect togarlic, but less pronounced. Theycan also increase the need tosleep in some people.

Eggs Overconsumption of eggsincreases the tendency of thebody to produce pus, andencourage acute conjunctivitis.This tendency is morepronounced in children.

Alcohol The effects of alcohol in thefocusing of the eyes, and itsirritating effect on the conjunctivais well known!

Liver

Blueberries (Myrtle) Strengthen the optic nerve

Carrots


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Mercury poisoningCan lead to1. Accumulation of phlegm2. Progressive degeneration of the nerves

3. Dysfunction of the excretory function of thekidneys

Effect on the eyesMercury can be behind all problems to do with fluids. Inparticular:

Glaucoma, especially when the intra-ocular pressure is

not especially high.

Chronic sore eyes, especially when there is acontinuous discharge

Corneal erosion.

Retinal degeneration

PhosphorousThe symptoms relating to the eyes are mainly those youwould 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.


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Principles of Treatmentwe see the following imbalances:

1. Marked reduction of Qi in the eyes - local Qi deficiency, often accompanied bygeneral Qi deficiency.

2. Significant Zang-Fu imbalance or weakness - for example Kidney Yang Xu.3. Attitude problems and life problems - for example not wanting to look at relationships

with nearest and dearest. (Other similar examples have already 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.


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Local pointsJingming Bl-11 to 1.5 cun, perpendicularly

All eye problems

Zanzhu Bl-23 to 5 fen perpendicular; or 0.5 to 1 cun towards Jingming Bl-1

Yangbai Gb-14Sore eyes, twitching of eyelid, itching eyelids.

Sibai St-20.2 to 0.3 cunRed eyes, corneal opacity.

Sizhukong SJ-23Transversely, 0.5 to 1 cunRed eyes, ingrowing eyelashes.

Qiu hou1 to 2 cun, first slightly downwards, then slightly upwards.Myopia, inflammation or atrophy of the optic nerve, glaucoma, retinitis pigmentosa,convergent squint

Near pointsTaiyangall eye diseases, red and swollen eyes, sty.

Touwei St-8Blurred vision, pain in the eyes, excessive tears, spasm of eyelid0.5 to 1 cun, upwards or downwards.

Fengchi Gb-20Straight insertion 1 to 1.5 cun; or 2 to 3 cun towards oppositeeye.All eye diseases

Glaucoma #11 cun above SJ-23

Yifeng SJ-17 ("Shielding" wind)2 to 2.5 cun, towards the nearest eye.All eye problems, especially corneal opacity.

Er jian (apex of the ear)Bleed or5 moxa conesPainful eyes, corneal opacity


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Other Related Techniques

Electric Plum Blossom

Traditional Chinese Massage

a) Above the eyes

b) Pinch and press between the eyes(Bl-1)

c) Massage Taiyang point.

d) Massage Fengchi point

e) Massage Hegu point on the hand

The Bates TechniqueThe Bates Method, Peter Mansfield, Vermilion, LondonSeeing well again without your glasses, Christopher Markert,Better Sight without Glasses, Harry BenjaminMeir Schneider, DVD Yoga for your Eyes

www.seeing.org

Other people in the business

Munich UniversityMainly the use of herbsChinesisched Medizin in der Augenheilkunde, Fatrai & Uhrig, Elsevier 2005

Boel familyin Denmark www.akupunktur2000.dkSummary 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 amonth to consolidate. Each session consists of two parts with one hours rest inbetween

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 MedicineG. Guillaume & M ChieuEastsland Press

For more information on the Barrier Points


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Walnut Shell SpectaclesThese are spectacles where each lens has been replaced by a half walnut shell. The

method of use is to soak the shells in a strong decoction of Chrysanthemum flowers overnight before placing them in the frames. Then one inch or so in front of the shells is placeda moxa stick, which warms up the shells. The combination of the warmth from the shellsand 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 andchronic red eyes. It can also be used as a supplemental treatment in all eye conditions.

Microcurrent stimulationRules for microcurrent:Increase the intensity gradually until a slight pricking sensation is felt, then reduce slightlyso that there is no sensation. Best results are obtained when the stimulation is just underthe threshold of perception.


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Watering EyesAetiology & PathologyWind-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 withgreat 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 signs of a lot of mucus, such as

Nasal discharge

Cough

Slippery pulse


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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 eyesLiver blood insufficientThis more or less corresponds to the Western pattern of anaemia.

Liver and Kidney weakThis pattern is common in old age. There is general weakness, but specially Yin Xu, norYang Xu.

Kidney Yin XuThe common time for this pattern to emerge in western patients is the menopause. Theymay not show the malar flush conventionally associated with Yin Xu, but there are oftenmany other characteristic symptoms and signs. Another situation is those undergoingradiation therapy, where the burning radiation has consumed Kidney Yin.

Full heat

These are the people who run hot all the time. They may be seen in short trousers orcotton dress in the middle of winter. Typically they have a red face, and a full, rapid pulseand a red tongue. Sometimes, especially in older people, the face is not so red, but is moreyellow. This happens when the Qi is somewhat weaker, and also when the heat is trappedinside.

Liver Yang risingTypical symptoms include irritability and even outbursts of anger, red or purple tongue witha dirty coat, wiry pulse. Generally these people exude an atmosphere of frustration andpent-up energy. In China, this pattern is usually accompanied by hypochondriac pain. Thissymptom does appear in Western patients, but not always.


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Spleen Qi XuTypical symptoms include poor digestion, tiredness, lack of concentration, a tendency toworry, weak pulse. These people may exude a 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 phlegmThis pattern is rarely mentioned in Chinese texts, but is common in the West. Its root causeis often the combination of many immunisations and suppressed fevers. Commonsymptoms include congested lymph system, dry or dusty skin, or even flaking eczema.

Lung weaknessWe prefer to use the term Lung weakness rather than Yin or Yang Xu because this is how itoften presents in the West. Typically there may be a history of Lung illness, such as

chronic cough, or asthma when young, which at present does not manifest as a lungcondition, but which is nevertheless the major imbalance, and needs to be treated for asuccessful outcome

Special diagnostic pulse:The bean bone pulse is a sure indication that there is lung weakness, even if there are noother symptoms. Normally the pulse can be felt in the first position on the right itrepresents the 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 patientswrist bone, little or no pulse can be felt. However in the bean bone pulse, the pulse can beclearly felt for up to a centimetre beyond the crease of the wrist. On the right it represents

damage to the right lung, and on the left damage to the left lung. The length and strengthof the pulse in this position are an indication of the depth of damage to the lungs.


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Corneal erosion

Common symptomslocalized opacitynearby redness and excess blood vessels

photophobiawatering eyespain similar to that felt with a foreign bodyorFierce pain in eyesirritable 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


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Lung yin deficiency

white face with malar flush

night sweats

thin buildhistory 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


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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 should be tested for mercury and other heavy metal poisoning.

Other treatmentsMicrocurrent stimulationDaily electrical stimulation of the points around the eye with a microcurrent stimulator hasbeen shown to be beneficial.

Dry type is characterised by drusen and possibly growth of blood vesselsWet type is characterised by retinal oedema, retinal bleeding


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Retinal bleedingBlood 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


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Glaucoma (closed angle, acute)Glaucoma is the name given to the symptom of increased pressure in the eye. The normal

pressure in the eye is about 13 to 15 mm of mercury (~25mbar). this is quite a lowpressure, being the pressure you would find at the bottom of a pint jar or bottle(17-20cms ofwater). This pressure is enough to keep the eyeball 'inflated'. In pathological conditions,the pressure can increase drastically - to as much as 75mm (100mbar) - some 5 timesnormal value. It is generally considered to be 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 acharacteristic shape (see fig xx), as a result of damage to the optic nerve. From the point ofview of treatment by acupuncture, the principle and practice of treatment is the same asdamage 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.

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.

ResultsIf the treatment rules given above are followed, there is a good chance that daylighteyesight will be completely restored. There may be some slight reduction of night-timevision in the affected areas.


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Open Angle Glaucoma (chronic), ocular hypertensionOrthodox 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 bone1pulse

1Bean-bone pulse is a pulse that can be felt on the radial artery just distal to the wrist line. In a healthy person it should

not be possible to feel this pulse. Its presence indicates injury to the lung organ, for example by whooping cough whenyoung or tuberculosis.


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CataractCataracts occur because there is too much heat in the system. One should not be misledby the symptom of feeling cold. Often patients feel cold because they are weak or tired, orbecause the heat inside does not reach the surface. The very fact of cataract pointstowards heat of some kind.

Syndrome Aetiology Symptoms Tongue Pulse

Liver and Kidneyweak heat

Old-age,exhaustion,overwork

Pale face, pastyor wrinkled skin,tired all the time,dark rings underthe eyes

thin, red dots,cracks on surface

thin, tight;possibly long

Lung dry or YinXu Chronic lungcondition, lungillness early inlife, overwork,exhaustion

White face,history of lungproblems,dreamyexpression

Usually pale, butmay be redtowards the tip

Usually weak, butmay be rapid.Often there is aspecial lungpulse.

We have used the term 'weak heat' in preference to the term Yin Xu, as Western patientsoften 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, evenin winter.

New causes:Exposure to chemicals in youth

Other treatment:Cineraria maritima eye drops (Dr. Reckeweg)


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Short Sight

First of all treat stressThe treatment of stress in children is not really medical work, but is more in the sphere ofcounseling.

Then treat any Qi imbalance:

Prescription for Spleen Qi Xu

St-36 Zusanli

Sp-6 Sanyinjiao

Prescription for Lingering Pathogenic FactorOnce the Spleen deficiency has been overcome, there may still be a Lingering PathogenicFactor. A typical treatment for this would be

Bailao (Extra)

Bl-18 Ganshu

Bl-20 Pishu

Bringing qi to the eyesUndoubtedly 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, microcurrentstimulation.

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, with a rest of 5 days. In practice,they need to be treated three times a week minimum. If you treat less often than this, it isnot worth doing at all, and just involves everyone in frustration and expense.

Self checking. . . is important


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Maintaining qi to the eyes after treatmentThe best way (in fact the only way) to maintain the flow of qi to the eyes is to use them!The child should be encouraged to look carefully at pictures, at scenes, generally to look

carefully at the 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 all the time, spend some time each day withoutspectacles.

Gradually reduce the strength of the spectacles, rather than gradually increasing them.

SquintCrossed eyes which appear in childhood must be treated in childhood. In fact the conditionmust be treated before the age of 8 years at the very latestif there is to be any hope ofsuccess. This is because there is always one dominant eye, and the other eye, the lazyeye gradually falls into disuse. If this eye is not used at all through the 7 to 8 yeartransition, it becomes blind.

Causes of squintMechanical defects1. Shortened muscle

2. Paralysed muscle

Diagnosing squintFor Caucasian children this is usually quite easy, but when diagnosing young babies, andOrientals it is easy to make a mistake, because there is a fold of skin which makes it lookas though the eye is not central, even though it really is.

Energetic causes for shortened muscle

CongenitalNo big problems: the child is born with a squint.

Hot Lingering Pathogenic FactorThe key symptoms and signs are:

child is born with good eyes, and then develops a squint

onset is after a fever on immunisation

swollen glands in neck, under ears or in groin


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some signs or red on the face, such as red cheeks or red lips

maybe red tongue or red tip to the tongue

irritable, restless.

OverexcitementThe key symptoms and signs are:

child is born with good eyes, and then develops a 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.

ParalysisThere are a lot of similarities between this pattern and the second one, LPF, for the simplereason that they are both the result of a fever. In this pattern the fever has gone deeperand caused the paralysis. So one often sees exactly the same symptoms, the onlydifference being in the movement of the eyes.

However, one does sometimes see an alternative pattern, that of qi xu; in which case onewill see the following symptoms and signs;

pale face

tired, floppy

poor appetite sleeps a lot

dull spirit in the eyes.

ConjunctivitisOther treatments:Eye drops: Euphrasia (Weleda) Calendula (Weleda) Euphrasia and Vaccinium (Vizulize)

Recovery after surgeryVery 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-37Can make a great difference in the rate of recovery, maybe even making the differencebetween a successful operation and one which fails.


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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 not get these attacks. However, he once had a mildstroke when he got while telling a story in the local pub.

Food and Taste: keeps on going on diets. Mostly he tries to avoid cholesterol, so he doesnot eat eggs except when he goes on an all-egg diet.

Stools and urine: 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 wine every night. Says it helps to prevent

stroke

Life: Still active. Goes jogging every day

Pulse: slippery-hard, 84 per minute.

Tongue: dull red-purple, with a rough coat.


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CASE NUMBER 2Mrs. J aged 58Appearance: Dull coloured face, slightly yellow, significantly overweight: pasty complexion

Behaviour: rather heavy footedMain complaint: Corneal erosion, especially the left eye. On waking the eye is painful andwatery, feels like grit in the eye, pain may last for an hour or two before subsiding. Recentlyhas had actual erosion, with fierce pain. This may 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: some indigestion with flatulence, worse when rushing around too fastSleep: used to sleep very well, until this happened. Now often wakes at 3.30 to 4.00amEnergy: is OK.

Appetite: OKLife. Happily married, but fed up with work, and is looking forward to retiring in a year and ahalf. Her hobby is writing books (she has published about 20)

Pulse: 72 slippery-soggy, quite strong, except both 3rdpositionsTongue: slightly pointed, red a tip, slight rough 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 isjust helpful.


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CASE NUMBER 3Master O Aged 16 yearsAppearance:. Tall, well built, pale face, droopy posture

Behaviour: Quiet, dull voice.Main complaint: Retinitis pigmentosa, Diagnosed one month ago after 2 year history of

increasing night blindness. Field vision test at routine appt. alerted theoptician to peripheral vision loss and he made referral. Hospital has said thereis no tx. for the condition however through internet search they have foundthat Vitamin A is prescribed for this condition in the US. Mum has foundmedical herbalist who is prescribing it to them along with chromium, gingkoand 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 in treatment. i.e. what will you treat first, and what would you expectto happen?

What results would you expect from treatment, and how soon?


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Sweating Doesnt 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. Triggeredby exercise, especially bad when he had an important match to play. Rathersketchy about exact symptoms, no real visual disturbances, couldnt saywhether they were one sided or not, just like a very bad headache- somenausea. Migraines ceased after tx. by herbalist.

Food & taste Wont really eat fruit or vegetables, likes the usual teen diet but Mumtries to keep him on track with home cooked stuff. He thinks he has a goodappetite but Mum begs to differ. Also eats a lot of chocolate at least onemedium bar of galaxy milk chocolate a day, sometimes more, plus minstrels.

Hates the taste of salt & vinegar.

Drink & thirst Drinks very little, doesnt feel thirsty, often forgets to drink unless prompted.This runs in family, Mum is the same but has trained herself to drink more.Doesnt drink at night but wakes up v. thirsty and drinks a lot first thing in themorning. 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 moveabout whilst fast asleep. Friends have witnessed it at sleep-overs and familytell 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 couldnt get Mum to sayexactly what the reaction was. When the time came for the next one, GP splitthem up and gave whooping cough separately. Mum is quite suspicious ofvaccinations since younger child developed autism.

Occiput Felt very soft, certainly no tightness or tension. If anything it was unusually

soft. No glands that I could feel.GB 20 Felt squashy like a marsh

Liv 14 -Taiyang pt. -

Face No tenderness, nothing unusual struck me. No tenderness on any of the localpoints around the eyes.

Lumbar Areas directly over each kidney felt squashy (esp. on L side) but everywhereelse felt stiff like a board.


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Other Impressions Has always been very physical and sporty. As a child he was alwaysahead of physical milestones. Apparently a bit of a risk taker as a childbordering on the hyperactive.

Considering how sporty he is supposed to be, his frame, posture and energydont give a sense of being particularly robust or sturdy. Posture looks morelike a teenager who sits in his room watching TV or playing guitar. Quitegangly, like someone who has grown too fast and body cant quite keep up.Mum alludes to ill health generally in the family and gets a bit defensive whenI question him around Fear. She thinks I think he is anxious. She leaps in tosay that he is the most normal of us all- in fact when the rest of us are allgetting anxious about things, he is the one who holds us all together andkeeps our feet on the ground. I cant help wondering whether he feels underpressure to be responsible for the whole family in this way. Perhaps Im wayoff the mark but something felt a bit weird, there was a dynamic that felt tense

at that point.

Pulse Floating on all positions, also slippery on the right side. * radial artery on RHSis on dorsal surface of arm.

Tongue Normal colour, no coat, quite wet.


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CASE NUMBER 4Mrs. D Aged 57 yearsAppearance:. Tall, well built, pale face, a distinguished and fine nose, red lips

Behaviour: Quiet, measured tones in her voice.Main complaint: Macular degeneration, It is in its early stages, and she can still readquite small print, though she is noticing things going fuzzy.

Also she has a chronic cough. This has been going on for nearly a year. In the summer itgets a bit better, and in the winter a bit worse. The cough is worse when she lies down atnight, though it is there in the day too. When she coughs she brings up some thick greenphlegm.

What are the possible syndromes for macular degeneration and for chronic cough?

Macular degeneration Chronic cough






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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 up in Scotland)

Life: Housewife. Has a daughter and grandchildren living nearby.

Pulse: wiry in all positions. More full, and wiry-slippery in the lung position

Tongue: Red-purple. More red at the tip. A hollow area just posterior to the tip. Peeledtowards the root

Periods: finished. Used to be rather painful


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CASE NUMBER 5Miss T Aged 26Appearance Smiling face, red cheeks slightly yellowish skin, slightly green around the

mouthBehaviour: Easy to get on with. Charming.Main complaint: Glaucoma, for one year. It started with headaches and sparks in front ofthe eyes, especially early in the morning, just after waking. Since the diagnosis she hasbeen putting drops in her eyes morning and night. These are effective in keeping thepressure down in her eyes, and so she does not see any sparks. But she still gets lots ofheadaches.

Don't turn over until you have answered the first few questions

What are the possible syndromes for glaucoma?

Which syndrome is it?


Will you treat?

If so, what will you aim to do with the treatment.



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CASE NUMBER 6Miss T Aged 6 yearsAppearance: Pale face with red hair, Some pink in her cheeks. Her left eye turns in

markedly, and is obviously not used. She has crusts under her nose.Behaviour: rather shy. Quiet.Main complaint: Squint, for three years. Three years ago she had a bad attack ofbronchitis, with very high fever, and the eye has not been well since then. According totests at the eye hospital, there is actually some use in the left eye, and she doesoccasionally use it.

Also she has a chronic cough. Every winter she gets three or four really bad coughs, andhas 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 questionsWhat 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?




What advice are you going to give the parents?


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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. Fond of peanut butter and bananasandwiches.

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 besidethe bed, so that she can drink when she wakes.

Life:

Pulse: slippery rapid. Lung position is very full. There is a 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 sideof the neck.

Capillary: broad, dark!


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Questions: What examinations would you do?

What is your diagnosis?

What advice would you give?

What treatment would you give?

What is the prognosis?


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CASE NUMBER 8Mrs W Aged 67 yearsAppearance: Slightly overweight, wrinkly face, yellowish.

Behaviour: Moves rather heavily, groans from time to time.Main complaint: Fierce pain in L eye, for five days. Ten days ago she had an operationfor detached retina. Healing was going well until five days ago, on Friday afternoon.

On the next day she phoned the hospital where the surgery was performed, opnly to findthat the surgeon had just gone on holiday.

Other symptoms and signsConfesses to being a worrier. I worry about not having anything to worry about

Often bloated after meals. Has to be careful about what she eats.

Knees very swollen. Give her trouble in cold and damp weather

Tongue pale

Pulse: tight in all positions

What would you do?


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SECTION B answers to 10 questions

Chills and fevers: nothing special Sweating: nothing special

Head and Body:

Recurrent headaches, pain in the eye,

Loud cracking noise from the right jaw; when she moves her jaw up and down, thereis 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: Unexplained abdominal aches

Food and Taste: Poor appetite

Stools and Urine: tends to constipation with hard dark stools

Sleep: Takes time to get to sleep at night

Drink and Thirst: not much thirst. Likes sweet drinks also lemon juice

Energy: Unexplained periods of tiredness, lasting an hour or two

Life: teenager!

Menstruation: Menstruation is irregular, shorter than 28 days, mostly every 3 weeks, theblood is dark , not clotted

Tongue: looks normal, she has a very thin crack in the middle (heart crack ) but no coatingin it, there are no signs of blood stagnation

Pulse: Slippery-tight


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CASE NUMBER 10Mr. G aged 68was still very active, and although he had officially retired, he was, ifanything busier than before. He had had glaucomasince his early 40's, which had been

treated with drops. Unfortunately, as time went on, his body became more and moreaccustomed to the drops, and they more or less stopped working. Consequently, about 20years ago he had a trabeculotomy. However, even this did not produce lasting relief. Thepressure continued to rise.

By the time he came to me, there was damage in both eyes, severe in the left eye, so muchso that he was obliged to give up his driving licence. He still had (just about) enough sightto continue what he was doing, but it was deteriorating.

Appearance: tall, thin, wiry body; thinning white hair, slightly purple face; bright eyes,enthusiastic

Examination: energy in back was weak; tender at SJ-17 Yifeng point, especially on the left;slightly tender at Gb-20 Fengchi

Past history: 2 years ago was diagnosed as having high cholesterol. Otherwise nothingabnormal, except last year had a period of bad diarrhoea. He had to get out of bed in themorning to pass stools. This is better now.

Pulse: Left side: wiry, tending to long, though stronger in 3rdpositionRight side: more slippery than wiry, stronger in 3rdpositionSpeed: when he first came in it was 60, but the speed gradually slowed to 54

Tongue: a bit red, surface is slightly rough, some sticky saliva on tongue

What do you think is the mainpattern?

What treatments would you give?

Will they work? If so, how soon?

What would you expect to happen?


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CASE NUMBER 11

Ms A Aged 43

Appearance: Strong build, slightly overweight, red face

Behaviour: quite voice, rather submissive behaviour, in spite of obviously being strong

Main complaint: Macular degeneration, wet type. Foggy central vision, like a gray cloud.Had laser treatments 5 to 6 times over last year, to close off rogue blood vessels and stopthem leaking. This was successful, but keeps on needing to be done, as the blood vesselsreturn.

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?


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SECTION B answers to 10 questions

Chills and fevers: nothing special

Sweating: nothing special

Head and Body: easily gets tense in head, neck and sholders

Thorax and Abdomen: chest is fine, but abdomen somewhat large

Food and Taste: good appetite. Easily puts on weight. Family history if old-age diabetes.

Stools and Urine: OK No problems

Sleep: OK

Life: alternative medicine practitioner and teacher

Pulse: soft/slightly slippery. Not very strong. Weaker in left side middle position. Both 3rd

position (chi) very weak.

Tongue: enormous central crack. Dry, greasy coat

Eyes Handout

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