AcupunctureCase HistoriesInternal MedicineUncategorized

Treating Dry Macular Degeneration with Acupuncture

By December 27, 2017 September 23rd, 2019 No Comments

December 27, 2017 | by Julian Scott

Chinese medicine is superior to orthodox Western medicine in the treatment of many conditions, including eye diseases. It is often quicker, cheaper, and more long lasting in its effect. There are, of course, some situations when Western medicine is preferable to Chinese medicine, though these are relatively few.

The key to the effective treatment of eye disease is an idea that appears in the Nei Jing, where associations are assigned between parts of the eye and the internal organs. While the eye as a whole belongs to the Liver, it is stated that the pupil belongs to the Kidney, the iris to the Liver, the inner canthus to the Heart, the eye lids to the Spleen and the sclera to the Lungs. At the time the Nei Jing was compiled, these associations were based primarily on the colour of the respective part of the eye. Any practitioner of Chinese medicine is so used to the idea that it is easy to forget how revolutionary it is. It still has not been accepted today in orthodox medicine.

th-4Nowadays, with the knowledge that we have of the anatomy and physiology of the eye, we can make more detailed associations. We know, for example, that the eye is filled with fluids, and so problems such as elevated intra-ocular pressure and glaucoma are intimately affected by the three organs that are connected with body fluids – the Kidneys, the Spleen and the Lungs. We now know that iritis is more often than not caused by an autoimmune disease such as rheumatoid arthritis, and consequently responds to the same medicines. When it comes to the retina, in ancient times, it was not even recognised as a separate part of the anatomy. Now we know it is anatomically part of the brain and nervous system. Consequently spontaneous degeneration of the retina has a similar aetiology and pathology to spontaneous degeneration of the brain and peripheral nerves.

Regarding macular degeneration, from the point of view of Chinese medicine, the brain is related to the Kidney, so it follows that the root cause of this disorder is Kidney weakness. Moreover, in the ensuing discussion, you will see that the syndromes of macular degeneration are very similar to that of diseases like peripheral neuropathy, which come under the category of Wei syndrome (paralysis).

In clinical practice there is another type of Kidney weakness affecting the eyes, which is not really weakness at all, but is due to an inability to engage in the world. This inability can affect the flow of Jing to the eyes, and is a significant component of macular degeneration. This is something that is not described in Chinese texts, but is nevertheless very real. A person may have plenty of will power, but for some reason they are unable to use it. The Kidney “will” does not permeate the body, and does not find expression in the body. It may be seen, for example, in people who are profoundly affected by grief. Their thoughts may always with their lost partner, month after month, year after year, and they have no real enthusiasm or interest in the world.

These people can react to stimuli, and can respond, but their source of enjoyment (which belongs to the Kidneys) is lost, and it can be almost impossible for them to throw themselves into the hurly-burly of life. Although they may have enough Jing overall, their mental attitude causes them to be susceptible to degenerative diseases such as peripheral neuropathy and macular degeneration. In some patients this is really a major factor in their disease.

 

Liver and Kidney Weak (Xu-ruo) – a ‘new’ pattern

Before looking at the patterns commonly seen in macular degeneration, we need to introduce a new pattern. This pattern is not actually new, but it is not commonly given in general elementary textbooks. However it is commonly given in Chinese medicine books on eye diseases. This ‘new’ pattern has some of the elements of Liver and Kidney Yin Xu, and Spleen and Kidney Yang Xu, but is neither Yin xu nor Yang Xu. There are no special signs of heat nor of cold; and yet the body is clearly exhausted. The pattern is common in old age.

This is a pattern that everyone has seen at one time or another, possibly in an aged relative. In itself, the pattern may not give rise to any significant illness. The person is simply weak, almost to the point of being tired of life. They may no longer have the energy to keep their house tidy, they may have irrational fears, or they may have lost their spirit of adventure.

Typical symptoms include:

  • Dark colour round the eyes, almost to the point of being black
  • Easily tired
  • Easily overwhelmed by social interaction
  • Back a bit stiff and a bit weak
  • Knees weak
  • Slow to heal from minor illnesses

 

The Syndromes

Macular degeneration is caused by insufficient Jing reaching the retina. The basis for this is usually Liver and Kidney weak (Xu-ruo) which underlies all the other patterns. These secondary patterns represent additional factors that further reduce the flow of Jing to the retina.

Liver and Kidney weak (xu-ruo)

  • Patient is old, tired of life
  • No reserves of strength
  • Weak back
  • Maybe incontinence or prostate problems
  • Weak memory

Heart Ying (nutrient level) weak

  • Palpitations
  • Insomnia
  • Easily worried
  • Face white or pale purple
  • Maybe hardened arteries

Spleen and Kidney Yang Xu

  • Tired
  • 4 limbs feel heavy
  • Weak digestion
  • Weak back

Lung Qi / Organ weakened

  • White face
  • Quiet voice
  • Dreamy expression
  • Cracks in lung area on tongue
  • Special lung pulse[1]

 

Comment: Patients don’t always give you a direct answer

The picture given above of Liver and Kidney weak describes possible symptoms, and is fairly accurate. However, patients when they come into the clinic may disguise their symptoms: they may not appear tired of life. The stimulus of coming to see you, the practitioner, may be enough to give them a temporary interest in life.

Patients may express their dwindling reserves of strength in such ways as ‘I have to be careful what I take on these days’, just as the symptom of a weak back may come out in sentences such as ‘I have to get my son to take the heavy things upstairs’. They may not be quite direct in their answers.

 

Case History

Heart Ying weak – The Scotsman

The traditional breakfast for a Scotsman is porridge made from oats. It has to be cooked for at least two hours, preferably overnight. This particular man made his porridge once a week. He liked it salty – so salty that many of his visitors could not eat it. He came to me specifically for his macular degeneration. Could I help him? I was not at all sure, as he had a history of atrial fibrillation and had quite severe oedema in the legs, in spite of taking diuretics. His was a clear case of heart weakness. It turned out that indeed I could not help him: over the course of a few treatments, his dietary habits emerged. Besides having his porridge salty in the first place, he would add another heaped teaspoon (about 10gms/1/3oz) of salt to his daily bowl. He was suffering from salt poisoning affecting the heart.

In principle, the first step in treatment would be for him to stop taking any salt at all in his food. However, such a move would not be safe for an elderly person as they may not have the reserves of strength to cope with a significant detoxification reaction. Even eliminating salt from the diet would take six months to a year to take effect. Time was not on his side. The age of a person may not be best measured by the number of years lived, but whether they appear old. Sometimes a 60 year old appears older than another 70 year old.

 

Case History

Also from the Highlands

This woman had been diagnosed with early stage macular degeneration at the comparatively young age of 56. When she came to me, she certainly did not fit the typical pattern of Liver and Kidney weak, and indeed this pattern was only secondary to her lung problem. As with so many patients, when asked whether she had any other health problems, now or in the past, she replied ‘None’. However, her face was gleaming white, while her tongue was a full red colour, and she had the special lung pulse described above. Even when pressed about lung complaints, it took her some time to remember that every winter she had such a severe cough that she would need to spend two weeks in bed!

Once I had obtained the information regarding the state of her lung, the principle of treatment was clear – to clear Lung heat. What was particularly interesting about her case was her underlying attitude that became apparent after a few treatments when she felt more relaxed in my presence. Although on the physical level she did not have the symptoms and signs of Liver and Kidney weak, she had the attitude which went with that pattern, which was one of caution and not being quite in this world, always dreaming of somewhere else. In her case she was always dreaming of a return to her beloved Highlands, something that was unlikely to happen as long as she remained married.

 

What does it take for an eye disease to develop?

What is it that turns a syndrome such as Liver and Kidney weak into an eye disease, rather than, for example, peripheral neuropathy? As with other illnesses there is a local weakness. Causes of local weakness in the eyes include:

  • Hereditary tendency (eye diseases often run in families)
  • Life style factors, such as spending many hours in front of a computer screen.
  • Poisons that specifically affect the eyes, such as alcohol, or orthodox medication that the patient is taking for another condition.
  • Bad habits in using the eyes: many people get into bad habits of using the eyes at a very early age. They often strain the eyes unnecessarily, screwing them up even when there is no reason to do so. These habits often arise during childhood, and may be the result of reading in a poor light, or being made to read too young. It also happens to children who have a teacher or parent who causes them to be afraid. Sometimes fear around reading itself is enough to cause bad eye habits.

 

Treatment Principles

There are two distinct aspects to treatment: treating the symptom and treating the cause.

Treating the symptom

The best results in treating the symptom are obtained by intensive treatment. A course consists of ten treatments given in a one week, with one course given about every 6 months. A program of this kind seems to be more effective than the same number of treatments given weekly, or even twice a week. Experience also indicates that the method chosen for treatment is less important than the frequency of treatment.

This is what other practitioners in the field also find.  For example, Dr. Yang in Vancouver uses strong needling in points around the eyes, Dr. Boel in Denmark uses a special form of ear acupuncture, and Dr. Chopra in Delhi uses a special form of hand acupuncture. All of these doctors claim that their method is superior and gets better results. What they have in common is intensive treatment – sometimes as many as four treatments in a day. Besides being the most effective way of treatment, it is quite practical, as it means that people can travel from far away and stay for a week. Many people are prepared to do this once every six months, if it means saving their eyesight.

My own favoured treatment is as follows:th-7

  1. Before the treatment starts, first give the patient some sort of visual field test. It does not matter exactly which test. For AMD, the simple Snellen rows of letters is good enough. Set up a chart at a suitable distance, and check their eyesight.
  1. Needle the points Qiuhou[2] and/or Jingming Bl-1

See below for a description of the difficulties encountered in needling these points. Often stagnation will be seen when treatment is first started, then later on in the day, or half way through the week, when the stagnation has been moved, it may be necessary to tonify.

  1. Needle Gb-20
  1. Follow up the local needling with microcurrent stimulation. I normally do about 16 points around the eye, with a sensation that can just be felt. If possible, the patient should self-administer daily treatment with microcurrents[3] using a machine such as the Microstim iLE, after the course of treatment is completed. This will help to preserve their eyesight.
  1. At the end of each day, it can be helpful to repeat the eye test that you gave before treatment began.

 

Results

What one can hope for is restoration of the eyesight to the state it was some 6 months earlier. The part of the retina that has stopped working lies dormant for about 6 months before slowly dying off, and it can usually be resuscitated. However, parts of the field of vision that have been blind for two or more years are unlikely to recover.

Treating the underlying condition

The treatment and likely outcome will, of course, vary from patient to patient. My own practice is to treat a patient’s underlying condition once a week for an extended period, with occasional courses of intensive treatment as needed. While one cannot reverse the march of old age, one can change the general health and above all, the attitude of a patient. The person who was tired of life can become more optimistic, and the level of energy appropriate for their age can be restored. If this can happen as a result of treatment, then there is a real possibility of stopping the disease in its tracks.

Details of follow-up treatment

There is no need to explain details of treatment of the different patterns. Any qualified acupuncture practitioner could fill them in. Suffice to say that simple points, such as the back Shu points, and the Yuen-source points can be very effective, particularly when combined with points that bring Qi to the eyes.

Advice

Advice is normally specific to each patient, but often includes doing traditional Chinese massages for the eye (a pamphlet on how to do these is available for download from my web site www.eyebright.me.uk), using the Bates technique, and giving up alcohol.

 

Needling Points Around the Eye

St-1 Chengqi, Qiuhou and Bl-1 Jingming

th-5Acupuncture is one of the best therapies for treating macular degeneration. This is because by needling points around the eye, the Qi in the eye itself is regulated. Excess conditions can easily be dispersed, deficient conditions can easily be strengthened and stagnant conditions easily moved.

However, many practitioners feel anxiety about needling points close to the eye. This is natural, for there is an instinctive fear of injuring the eye. But In fact, there is little likelihood of injury, provided simple rules are followed. The eye itself is very robust, with the sclera being harder than the average fingernail. The worst that is likely to happen when using a normal acupuncture needle of about 32 gauge (0.30mm diameter) is for the eyeball to be scratched, or if the needle is angled too far away from the eyeball, it may be possible for the orbit to be scratched or bruised. Provided that the practitioner is reasonably sensitive, and does not push hard against the obstacle, it is almost impossible to do damage.

There is one exception, and that is when needling very deeply (more than 1.5 inches), there is the possibility of inserting the needle all the way to the back of the socket. Here the bones are paper-thin and extremely vulnerable.

 

Needle sensation

The sensation that the patient feels when needling eye points varies, and depends on the state of Qi in the eye. It varies from patient to patient, and can vary in the same patient from day to day. The following sensations are commonly experienced:

A prick or superficial sensation on first inserting the needle. Sometimes this is very painful, in which case the needle should be withdrawn and repositioned slightly before being reinserted. This painful sensation has little or no therapeutic value.

If the needle was not inserted at quite the correct position, or is being introduced at a slightly wrong angle, it is possible to feel some resistance as the needle gets too close to the bones of the orbit. The patient will normally tell you of this pain, and the pain will correlate directly with the resistance that you feel. When this happens, withdraw the needle slightly, and change the angle slightly, to follow the inside of the eye, away from the bone. This pain also is of little or no therapeutic value.

 

Qi sensations

The Qi sensations in the eye are similar to those in any other part of the body, but are often more intense. In particular:

In a full condition, the sensation will be very strong. When there is excess Qi and it is stagnant, there will be a strong sensation when the needle has reached a depth of as little as 5mm to 10mm. The patient may experience the sudden release of Qi as an electric sensation or as a bolt of lightning. In other patients, the sensation is like that of a knife being stuck right through the eyeball. This is disconcerting for both patient and practitioner, however this is in fact a therapeutic sensation, just as the sensation of electricity going down the leg when treating the point Yanglingquan Gb-34 is a sign of effective treatment.

In these circumstances, obtaining a Qi sensation is usually enough, and then you can withdraw the needle. However, in acute cases, when there is a sense of urgency about obtaining a result, one should manipulate the needle gently but repeatedly, until the stabbing sensation has finally dispersed. This can be somewhat difficult for the patient, but the discomfort is obviously worth it when the treatment may save the patient’s sight.

When the Qi is deficient, the situation is completely different. It may be necessary to insert the needle to a depth of up to 50mm before any type of Qi sensation is felt. Once the Qi has arrived, and there is a mild sensation, a tonifying method of needle manipulation should be used, producing a pleasant sensation of warmth at the back of the eye. It is this ability to bring Qi directly to where it is needed which is the special advantage of acupuncture.

 

Case history

The Artist

This patient was in his mid 50’s, and had early stage dry macular degeneration. There seemed to be a good reason for the underlying body condition as he was regularly being overwhelmed by paint fumes. He had lost his sense of smell in a bicycle accident in his late 20’s, and since then he had never bothered to open the window of his studio and ventilate it. He was completely unaware of the build up of the fumes from his oil paints. However, it still surprised me that it should affect his eyes so soon. The reason became clear when I needled the point Qiuhou. I only inserted the needle to a depth of 3mm (1/4inch) before he felt a powerful stabbing pain throughout the whole of the eye, described as “like a red-hot dagger.” This is a common reaction to stagnation of Qi in the eyes due to bad habits in the use of the eyes. I had thought that being an artist, he would have exceptional use of his eyes, but no. He would screw his eyes up (unnecessarily) in order to focus on fine detail that he was painting.

It was not possible for him to come for an intensive course of treatment, but he was able to come on a weekly basis. This was enough to halt the deterioration while he learnt to relax his eyes by means of the Bates technique. The treatments also helped to detox the hydrocarbons. It also meant that I could keep reminding him to ventilate his studio. After about a year of treatment he found a week when he could come for intensive treatment, and this had a noticeable effect in improving his eyesight.

 

Self-help

When there is either deficiency or stagnation of Qi in the eyes, there are two self-help techniques that are particularly effective: Eye Qigong, and the Bates Technique. Eye Qigong is the name given to self-massage of the local eye area and the points that affect the eyes. This is very effective in bringing Qi to the eyes, and in relaxing any tension. When patients have to spend long periods of time in front of a computer screen, I always advise them to take at least 5 minutes off every hour to do either massages or the Bates technique. The computer screen is so detrimental to the eyes that they need some refreshment on an hourly basis. A description of the massages can be downloaded from my web site by following this link: http://www.eyebright.me.uk/downloads/

The Bates technique concentrates more on developing good habits for the eyes. Bates himself suffered from progressive short sight, and he found that this was due primarily to the way he used his eyes, and the consequent tension. He developed a series of eye exercises to help overcome the habits. There are now numerous books on the subject, and also a particularly good video available on YouTube by Meir Schneider called Yoga for your Eyes.

th-2For those who are too tired at the end of the day to do the massages or exercises, the technique of palming from the Bates technique is very helpful. In this exercise, one covers the eyes with the palms, so that no light reaches the eyes. Instead of shutting the eyes and daydreaming, one should keep their eyes open and look at the blackness in front of the eyes. (Many people do not see just blackness, but to begin with see all sorts of crawling worms and flashing dots. After a few minutes these gradually disappear). Bates considered that the colour black was very refreshing and healing to the eyes.

 

Case history

Housebound

An elderly woman was brought to me by her caregiver for help with glaucoma. The pressure was building up in her eyes to such an extent that it was beginning to cause damage. Although she would normally use orthodox eye drops, she found she was allergic to all the medications that the ophthalmologist had to offer. Every one she tried gave her intensely painful, red eyes. When she came to me, it was clear what was wrong: she was suffering from Liver and Kidney weak, together with some build up of environmental toxins.

Obviously, I suggested acupuncture, and held out a good prognosis for her; but she could not easily come for regular acupuncture. The burden on her caregivers would be too much. As a second best option to acupuncture treatment, I recommended taking herbs; but no, herbs would not do. She had experienced so many allergic reactions to things suggested by both doctors and well-wishers that she was not prepared to try anything new. The only thing that I had left to offer her was the eye Qigong. She thought this was a very good idea, and started doing the massages as soon as she got home. I was very pleased to hear from her some 3 weeks later that the massages on their own had made a significant change to the pressure in her eyes; so much so that she was now out of danger.

 

* * STOP PRESS * * *

At the time of writing I have just come across an advance in the treatment of AMD using infrared radiation. This method goes under the name of Medlouxx and has been pioneered in Paderborn University, Germany. The results are very promising. I will follow this up, and if the editor permits, report back in a year’s time.

 

________________________

Notations 

Macular degeneration is divided into two types – dry and wet.  The dry type is characterized by gradual loss of vision due to degeneration of the retina itself.  Loss of vision in the wet type is due to fluid build up – either behind the retina, pushing it out of shape, or from the leakage of blood or from leakage of blood or fluid from abnormal blood vessels (neovascularization). The dry type is truly a degenerative disease much like other degenerative diseases of old age, and there is no treatment for it in orthodox medicine. The wet type is a disease of fluids and, as such, can be reversed. The treatment in orthodox medicine is based on injecting the eye with drugs originally developed to treat neovascularization in cancers.

 

(1) Special diagnostic pulse:  The ‘bean bone’ pulse is an indication of Lung weakness. A ‘bean bone’ pulse can be clearly 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 strength of the pulse in this position are an indication of the depth of damage to the lungs.

(2) Qiuhou is just lateral to St-1 Chengqi, and is chosen as it has the same function, but is easier to needle.

(3) A note about microcurrent stimulation. When electrical stimulation of points and areas was first used in acupuncture, it was thought that a stimulation with more current would be better than one with less current. Consequently one should turn the dial to the maximum the patient would tolerate. Over the last 30 or so years it has become clear that in many situations much smaller currents give better results. It has been found that currents that are just below the threshold of perception can be the most effective. This has led to the development of microcurrent equipment that gives a controlled current of between 25µA and 250 µA. At the time of writing there are two machines that are especially useful: the Accu-o-matic which is designed for practitioner use and is good for stimulating individual points; and the Microstim which has been developed more for patient use. The Microstim iLE has been developed specially for patients with macular degeneration

 

___________________________________________

 

J74We are most grateful to Julian for this article, which does not appear in any of his published materials to date.  We remember the years he spent teaching in Seattle fondly and were very fortunate to have both he and Teresa Barlow share their wisdom and experience with practitioners here in Seattle.

Julian Scott obtained a PhD in low temperature physics at Cambridge, and followed it by research in semiconductors. He then went on to study acupuncture at ICOM in East Grinstead, England, completing in 1976; then in Nanjing, China in 1982. He has always had a special interest in eye diseases, and is the author of Acupuncture for the Eyes. He also has a special interest in treating children and is the author, with Teresa Barlow, of Acupuncture in the Treatment of Children and other books. He has given courses in many countries in Europe and elsewhere. He is a fellow of the British Acupuncture Association and member of the Unified Register of Herbal Practitioners. At present he has a practice in Bath, England.
Cover small

 

His most recent publication is Autism and Acupuncture, published by Portway Press, and available through all good bookstores, particularly JCM Books.

Julian can be found in Bath, England, via his web site www.eyebright.me.uk