A case history analysis originally published in the Journal of Chinese Medicine

The forty year old man who came to my office at the beginning of June 1994 seemed desperate. He was a police captain with no previous health problems. His job was very demanding, and for many years he had spent most of his time at work. Two weeks preceding our appointment, Mr. A (the patient) had a terrible quarrel with his superiors, after which he immediately felt intense heat rushing up to his head. Right after this he experienced a flash-like sensation in his left eye, followed by a stabbing pain inside the eye and loss of vision.

Alarmed and in pain he went to see the police physician who referred him to an eye specialist at a nearby hospital. Pictures of the fundus of the eye were taken, and the diagnosis was severe rupture of blood capillaries, causing internal hemorrhage and accumulation of blood which prevented vision. The specialist suggested a laser operation in order to repair the ruptured capillaries. This could only be performed after the blood had been reabsorbed, which would probably take at least six months. Thus, seeing only blurs with his left eye, and with such a depressing prognosis, Mr. A fell into a state of severe depression, fear and Anxiety.

When I examined him on his first visit his pulse was slightly fast (around 6 beats per respiration), the left cun position was slightly elevated, hard and tense, his left guan position was strong and wiry, and the chi (Kidney) position on both wrists was deep and barely palpable. His tongue was pale, lifeless and had a blue-purplish hue. Both inner eyelids had red-purple blood congestion stains.

Suspecting a tendency to sudden flaring up of Liver yang based on some Kidney yin deficiency, I questioned Mr. A who admitted that on occasions, especially when he became irritated, he felt that his entire head heated up and began to perspire. Thus, a fast and wiry pulse in the Heart and Liver positions indicated Liver qi stagnation, resulting in ascending yang which speeded up heart rate and pushed blood towards the head. The trauma to his eye happened as a result of a sudden and intense rage which had set the mechanism described above into motion. This was presumably the "last straw" for already weakened capillaries. This picture is supported by the observation of the blood congestion pattern within the inner lid. As in most cases of this pattern, the foundation is Kidney deficiency, in this case weakened by many strained working hours over many years. Additional signs such as occasional lower back pain, tenderness at left Jingmen GB-25, and a distended lower abdomen all confirmed this observation. If combined with very strenuous working conditions and anger (he was a police-officer), this may put into motion the Liver yang activity that further exhausts Kidney yin, making a vicious circle that is bound to end in a crisis. The reason why this accident had happened in the left eye, rather than in the right, was because in the majority of acute crises, where yang qi abundance, or excessive yang movement is the cause, the left side is more likely to be affected. This is stated in the classics "... all the yang qi goes to the left, while the yin qi goes to the right ...". My first treatment was designed to calm the patient, relieve his Anxiety and relax his tension. I therefore assured him that with Chinese medicine his prognosis was very favorable, and that he should refrain from heating foods (spices, coffee, alcohol, etc.), take a month's vacation and come for daily treatments. I then needled the following points:

• Shenmen HE-7
• Neiguan P-6
• Taiyang (Extra) left
• Baihui DU-20
• Taichong LIV-3
• Guangming GB-37 left
• Sanyinjiao SP-6

Shenmen HE-7, Neiguan P-6 and Sanyinjiao SP-6 form a fast acting, efficient formula to reduce Heart fire, calm the Shen and relax the nervous system.

Taichong LIV-3, Baihui DU-20 and Sanyinjiao SP-6 is also a renowned and efficient formula to sedate the Liver, subdue its yang, and assist in calming the Heart.

Taiyang (Extra) and Guangming GB-37 were chosen to treat the left eye. The combination of these points, one local and one distal, is able to reduce heat, circulate qi in the eye and brighten the eye.

Taiyang (Extra), Taichong LIV-3, and Guangming GB-37 together are able to resolve qi stagnation via the Liver system. The combination of Taichong LIV-3 and Guangming GB-37 is based on the principle of combining the Yuan-Source point on the primarily affected channel with the Luo-Connecting point of its interiorly-exteriorly paired channel.

All points were manipulated by reducing technique i.e. counter clockwise rotation, forceful lifting and slow thrusting the needles on the extremities were directed against the direction of flow of energy in the channels.

In less than 10 minutes Mr. A reported that he felt very sleepy and that he had a comfortable feeling in his left eye. The needles were removed after 30 minutes and he was asked to come back the next day when his pulse rate was only five beats per respiratory cycle, and his left cun and guan positions had lost their hard and wiry quality. He reported that he had slept heavily for ten hours that night, and that his mood and overall feeling had radically improved.

Mr. A's second treatment began with left Fengchi GB-20 point, maneuvered first by dispersing technique, then immediately followed by the "Dragon Wags its Tail" technique which is effective to move qi rather forcefully. The handle of the needle is wagged to and fro with one hand while the other hand massages the channel in the direction chosen to propagate the sensation. Thus, Mr. A felt the needle sensation climbing up his skull and ending deep in his left eye. In subsequent treatments, however, there was no need to massage the channel route. Maneuvering the needle at Fengchi GB-20 was enough to cause the same effect. As soon as the needle sensation reached the left eye (usually after 10 to 15 seconds), the patient was asked to lie supine with the Fengchi GB-20 needle in situ (and with a pillow to support the head). The other points were then punctured in the following order (all on the left side):

• Hegu L.I.-4
• Quchi L.I.-11
• Taiyang (Extra)
• Qiuhou (Extra) to be alternated every other
• treatment with Chengqi ST-1
• Zusanli ST-36
• Taichong LIV-3 bilaterally
• Guangming GB-37

Hegu L.I.-4, Quchi L.I.-11, Chengqi ST-1 and Zusanli ST-36 form a chain of points situated on the left hand and leg yangming channel. This channel has an abundance of qi and blood, and is therefore usually used to resolve stagnation and accumulation of qi and blood. Moreover, all of these points have a strong effect on disorders of the head region.

Qiuhou (Extra) and/or Chengqi ST-1 brighten and benefit the eye, dispel wind and clear heat.

This point prescription was aimed at forcefully moving qi and blood via the yangming channel in the left portion of the hand in general, and in the left eye in particular. In addition, the Liver as the main cause of the disorder had to be further sedated, utilising points that have an effect both on the Liver and the eye. After obtaining deqi, all the points on yangming channel were manipulated in the same fashion as Fengchi GB-20. Hegu L.I.-4, Quchi L.I.-11 and Zusanli ST-36 were very responsive, and always gave rise to a distinct sensation traveling proximally and terminating around or inside the left eye. While Zusanli ST-36 was manipulated, Mr. A could track the flow of sensation across his thigh, abdomen and chest, and usually pointed with his right finger to Touwei ST-8 as the last station of the traveling sensation. Guangming GB-37 was manipulated by the same technique. Taiyang (Extra) was manipulated by simple lifting-thrusting with small amplitude movements, and initially gave a sensation of a deep stabbing sensation inside the eye, which subsequently changed to round waves encircling the inside of the eye. For Chengqi ST-1 and Qiuhou (Extra), the patient was asked to roll his eyeballs upwards and the needles were quickly inserted to a depth of approximately 1 cun, until a pressure was felt behind the eye. All points were left in situ for 30 minutes each time.

At the end of a course of ten treatments (12 days), Mr. A could read freely, except for very small letters, and could drive his car. He regained his confidence, slept well and enjoyed his enforced vacation. Nevertheless, he could not differentiate colors at this stage. Even though he experienced remarkable deqi with needling, I decided at this point to apply moxa to his eye in order to promote blood and fluid dispersion within the eye in a more vigorous way. Some years ago I read about a renowned Chinese physician who used an empty walnut shell, soaked in herbal tea, as a heating device (with moxa) to treat eye I disorders. I devised my own version by utilising for the same purpose an empty and sterilized snail shell of approximately the size of a human eye. A snail shell has some unique qualities, which make it superior, in my opinion, to a walnut shell. It conveys heat in a very moderate and tolerable way, is quite resistant to intense heat and does not crack easily. Its conch-like shape allows the heat, stemming from its top, to concentrate and conduct itself through the inner tunnel, until it reaches and penetrates the eye. Another feature of this shell may be an ability to soothe and descend Liver yang. Even though, as far as I know, snail shell is not a substance used in the Chinese materia medica, it resembles in shape and quality other substances which are. Substances such as Shi Jue Ming (Concha Haliotidis), Zhen Zhu (Margarita) and Mu Li (Concha Ostreae) are all known for their ability to subdue Liver yang, and many of them are used specifically for eye diseases associated with Liver yang disturbance. Assuming that substances similar in shape and construction usually bear parallel energetic qualities, it was reasonable to expect promising results. Thus, 10 minutes after needles were inserted at Taiyang (Extra) and Chengqi ST-1, I withdrew the needles, and laid the snail shell over the left eye, covering the whole eye region, and pressing gently against the skin. Over the top of the shell I ignited a moxa cone the size of one cubic centimeter, and let it burn to the end. This procedure was repeated three times in each session. The outcome of this technique was quite remarkable. Mr. A reported an extraordinary feeling and movement engulfing his eye, giving him a relaxed and pleasant sensation that he had never experienced before. Right after the first session his colour differentiation improved, and his eyesight brightened even more. After two more sessions with the snail moxibustion he was able to distinguish colors normally. This treatment was continued twice a week, substituting Jingming BL-1 for Chengqi ST- 2. This was done in order to enhance fluid absorption in the eye fundus. Jingming BL-1, being the last point of the Yin Qiao Mai, is capable of absorbing excessive yin around the eye. Thus, it is often used to treat somnolence, excessive lacrimation, glaucoma, etc. In addition, and in order to affect this goal even more radically, Zhaohai KID-6, being the master and first point of the Yin Qiao Mai, was occasionally punctured bilaterally. Mr. A was discharged after 20 treatments, and had regained his eyesight almost as it was before the accident.

References

1. Essentials of Contemporary Chinese Acupuncturists'' Clinical Experiences, Foreign Languages Press, Beijing.

If you like what you've read so far, you might want to take a look at part two of this article.

About the author: Shmuel Halevi Ph.D

Shmuel Halevi Ph.d has practiced Chinese medicine in Israel since 1980. He studied Chinese medicine in the U.S.A and in Taiwan, and obtained his Ph.D degree in the U.S.A.

Shmuel has written many articles concerning Chinese medicine, in the past 20 years. Most of his articles have been published in the Journal of Chinese Medicine in England. He has also contributed a case-study article to the book: "Acupuncture In Practice " (Case history insights from the west - compiled by Ted Kaptchuk and Hugh MacPherson, Churchill Livingstone 1997).

Shmuel is the author of the book: Chopsticks Acupuncture (Trafford Publishing, B.C. Canada Jan. 2003). In this book he presents a totally new self-treatment technique by chopsticks, devised especially for the lay person.

For more details please visit: http://www.acumedico.com

Shmuel Halevi Ph.D

Expert of Chinese Medicine
P.O.Box 159 Kfar Veradim
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