Originally published in the Journal of Chinese Medicine in England.

Since my previous article on this subject, I've received quite a few phone calls from interested acupuncturists in different countries asking me to elaborate on the subject. Indeed, during the past year I have treated five more patients suffering from the same eye disease, in various degrees of severity. These patients were referred to my clinic either by a "chain reaction" from patient to patient or by eye specialists who had heard about he case which I discussed in my previous article. In all these five cases the clinical success was excellent, ranging from marked improvement to complete cure. Being convinced that this snail shell technique is promising for a significant number of patients, and considering the interest this case has raised, I decided to write a few more lines and elaborate as much as possible on this technique.

DATA REGARDING THE OTHER CASES

It is not in the scope of this article to give a full account of the other patients who were treated in the past year for this illness. Nevertheless here is some general information which has direct linkage to the understanding of the possible diversities of this disease.

• AGE: patients age ranged from 40 to 64.
• DURATION: from few weeks duration up to two years.
• SEVERITY: from a complete blur and undeciphered picture to a broken or twisted image, mostly described as looking through half a glass of water.
• SEX: all males.
• NUMBER OF TREATMENTS: 7 - 24 sessions.
• W.M.DIAGNOSIS: Internal hemorrhage and/or thrombosis.
• C.M.DIAGNOSIS: all patients had a primary diagnosis of internal eye hemorrhage. The aetiologies were as follows:
  • Three patients due to exuberance of Liver Yang/Fire causing rupture to the minute eye capillaries.
  • One patient had an underlying Kidney Qi deficiency and Spleen Yang Xu as the main cause, and Liver Blood deficiency as a secondary cause.
  • Another patient had a damp stagnation (an obese molluscous person), with subsequent watery and puffy eyes.

CLINICAL CONSIDERATIONS

The first and foremost consideration while treating this disorder, is regardless the underlying condition whether Xu or Shih, the main objective of the treatment is to disperse and recirculate the extravasculated blood inside the eye.

Dispersing techniques are usually applied in Shih conditions, and this internal eye hemorrhage is absolutely a Shih state, despite the fact that it may be a culmination of a basic Xu condition. (For instance Spleen Yang Xu hindering its ability to hold the blood in the blood vessels). These dispersing techniques must be applied mostly by points in the eye vicinity, using also secondary points which have strong blood moving capability in general.

The underlying cause, either exuberance of Liver Yang or Kidney and Spleen Qi xu, must of course also be addressed, but with less emphasis. This aspect of the treatment is administered as a support to the main course which is, as said before, the dispersion of blood stasis. Still, in cases where an underlying Xu condition is predominant, and the patient is generally very weak, strengthening methods should be applied in the first place and only then the main problem should be addressed.

After an improvement has occurred and the patient can see better, a gradual shifting of the treatment focus towards the underlying imbalance must take place. After the eyesight has been restored to the maximum degree possible, the remains of the underlying imbalance should be eliminated by all means possible (herbs, acupuncture, diet management, etc.).

The snail shell can be applied in all cases regardless the basic imbalance, except in one event. When a patient has an underlying state of either Liver or Heart Fire with symptoms of flushed face, very red inner eye lids, hypertension and unambiguous dislike of heat, snail shell therapy is contraindicated until this inner imbalance is resolved.

POINTS SELECTION

The main points for this disorder are as follows: Bl-1 Jingming:

Is possibly the most potent point to treat any eye disease. It is actually suitable for any possible imbalance, whether Yin or Yang deficiency in the eye, or stagnation of Wind, Heat, Damp, Blood or Cold. It is the cross point of the Yin-heel and Yang-heel extra meridians which greatly influence the eye.

St-1 Chengqi:

This is also a very potent point practically for any eye disease. It is situated in the intersection of the Ren-mai, Stomach and Yang-heel meridians. Being a stomach System point makes it even superior to B-1 Jingming to Blood and/or Heat stasis.

Qiuhou (extra):

This is a wonder point in all afflictions of the optic nerve. It is therefore used whenever a marked deterioration of eyesight is a main symptom.

The secondary points which may be used are:

G-20 Fengchi:

Fengchi intersects the meridians of the Gallbladder, Triple burner and the Yang-linking. All these meridians either embark or terminate in the eye vicinity. G-20 Fengchi is indicated for all eye diseases, and is especially appropriate for dispersal purposes of Qi, Blood, Wind, Heat etc.

Li-4 Hegu:

is the strongest distant point to use for eye afflictions whenever a strong Qi moving effect is desired. This point is used in the contra lateral side of the diseased eye.

Sp-6 Sanyinjiao:

This point has a strong effect on either the quality and/or the state of the blood in general. Sanyinjiao can tonify and circulate the blood systematically and help in various bleeding disorders. It is thus a perfect distant point to assist the main points.

K-6 Zhaohai:

Zhaohai is used due to its role as the confluent point of the Yin-heel vessel. It is also the first point of this extra meridian, while B-1 Jingming is the last point. It is said that puncturing the last and the first points of an extra meridian may drain its excess. So, excess of Yin or Blood in the eye region may be reabsorbed or dispersed via this point. Being also a Kidney channel point grants this point the ability to deal with fluids in any case.

NEEDLE TECHNIQUE

As mentioned above the main objective of the treatment is to disperse extravasculated blood which pooled within the eye depth as a result of various aetiologies. This disorder is situated in the most delicate anatomical region and it calls for a very skillful needle technique.

B-1 Jingming and St-1 Chengqi are inserted slowly and smoothly perpendicularly to a depth of 1.5 Cun, while the other hand is pushing gently the eyeball leftward or upward respectively. The needle is pushed inside until the patient experiences Deqi. The most common Qi sensations here are tingling, numbness and pressure which surrounds the eye. Also Qiuhou (extra) is punctured in the same manner apart from being directed medially rather than perpendicularly. It usually gives the sensation of slight electrical shock or a pressure behind the eyeball. After the Qi has been obtained, the needle should be flicked rapidly but gently with the finger nail, so as to strengthen the Qi sensation and enhance the dispersal effect. Other types of manipulations are prohibited. Now and then, in some patients, a hematoma may develop as a result of micro bleeding due to needle injury. A black-eye is thus not a very rare outcome of the procedure. In case this happens the patient should be calmed and ensured that beside the temporary esthetic inconvenience there is nothing to be afraid of. The needles surrounding the eye may remain in situ at least 20 minutes.

In my previous article I described in detail the manipulation technique of G-20 Fengchi. In short, the needle sensation should be made to travel across the skull until it reaches the eye. If possible, also Li-4 Hegu sensation should travel proximally until the affected eye.

SNAIL SHELL APPLICATION

In general, the size of the snail shell must be fitting to cover the whole eye, i.e.: the upper and lower lids while the eye is closed.

The shell is laid over the eye after the surrounding needles have been withdrawn, and either the patient himself or the practitioner supports the edges of the shell with his fingers, and presses it lightly against the skin. A moxa cone of about 1 cubic cm is being laid on its top and ignited. Practitioners who have had some experience with the application of indirect moxa (over ginger or garlic) should have no difficulties with this technique. After a few minutes the patient usually experiences the heat penetrating the eye, and some of them even feel the heat reaching as far as the nape of the neck. To most of the patients the procedure is extremely enjoyable and relaxing.

During each session 2 moxa cones should be used, and one snail shell may be used as much as during three sessions.

The patient must be warned not to open his eyes while the treatment is ongoing, and he would better lie with closed eyes for a few minutes even after the shell have been removed.

TREATING THE UNDERLYING IMBALANCE

As discussed in the beginning of this paper, in many instances there exists an underlying systemic imbalance which is the basic cause of the eye disorder. Here is a brief account of the most frequently seen syndromes associated with this disease, and the most significant symptom for each pattern.

EXUBERANCE OF LIVER YANG OR FIRE

The most important symptom in regard to this pattern is anger and irritability. The most frequently seen signs are very red inner lids along with a wiry and fast pulse. Suggested prescription to be used along with the main points is:

• Liv-2 Xinjian
• G-37 guangming
• Taiyang (extra)
• G-20 Fengchi

KIDNEY QI XU

The most relevant symptoms here are dizziness or vertigo. In this pattern the patient usually complains that his sight worsens significantly after exertion. Signs may include deficient chi pulse of both hands and a pale lower segment of the inner lids. Points are:

• K-3 Taixi
• Ren-4 Guanyuan
• B-10 Tianzhu

KIDNEY AND/OR SPLEEN YANG XU

Beside other symptoms and signs relevant to this syndrome, our interest should focus on symptoms such as vertigo and possibly pain in the eye region, accompanied with a cold sensation. A history of bleeding disorders may also exist. Main sign: a pale and wet tongue. Our points prescription would thus be:

• B-23 Shenshu
• Du-4 Mingmen with direct moxa
• Du-14 Dazhui with direct moxa
• St-36 Zusanli with moxa

BLOOD STAGNATION

A sharp and stabbing pain in the eye region is our prime symptom, usually with a complete or almost complete sight loss. Our main sign is most often a wiry and choppy pulse, and congested purplish veins in the inner eye lids. In order to properly assign a useful prescription to treat this pattern, one should differentiate whether the blood stagnation is the result of Blood Xu, Heat in the blood or else. Points that may be used for various blood disorders are:

• B-17 Geshu
• B-16 Dushu
• Sp-6 Sanyinjiao
• Sp-10 Xuehai
• P-6 Neiguan

DAMP STAGNATION

When this pattern affects the eyes to the extent that blood or fluids extravasate inside the eye, the main symptom is usually very damp and watery eyes. The main sign is a puffy and big tongue with a thick slippery fur. Also a thin and very wet tongue may be seen.

• Sp-6 Sanyinjiao
• Sp-9 Yinlingchuan
• Bl-22 Sanjiaoshu
• Tb-23 Sizhukong

RECOMMENDATIONS

Despite the fact that the moxibustion takes an essential role in this treatment, it is very important to perform a very skillful needle technique especially on the points surrounding the eye. These points are very close to the disease focus and therefore have an immediate effect. Being so called "dangerous points" in acupuncture, deters many practitioners from using them, or while used they are poorly dealt with. It is a pity because these points usually yield excellent results in many eye diseases. The needle used for these points must be fine, g 32 is quite suitable. Its tip must penetrate the skin very rapidly with one short thrust to a depth of 1 mm. When this has been done the needle is pushed further deeper and deeper, "going with the needle" in the desired direction. If the needle is unable to proceed, or there is a feeling of an obstacle, it should be lifted slightly, redirected, and pushed down again. In approximately 1-1.5 Cun depth, a true type Qi sensation is usually felt, and then the needle handle should be gently flicked several times, as mentioned before.

In order to propagate the needle sensation along the route of the meridian from a distant point, I found that participating the patient in this process enhances the effect dramatically. Thus, while manipulating the needle with one hand, and massaging its route with the other hand, usually brings a Qi traveling sensation within few seconds. Right after this occurs, the patient is requested to concentrate his mind, and pull (or push) the sensation toward the disease focus with his imagination. In some instances (and most frequently with children) I even ask the patients to massage their own skin while I manipulate the needle, from the place where they feel that the Qi has arrived toward the desired focus. When this technique is performed one is astonished to see how often the Qi sensation from K-6 Zhaohai is able to reach up to Bl-1 Jingming.

About the author:

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
25147 ISRAEL
Tel: 972-4-9973480
Fax: 972-4-9571789
HaleviS@AcuMedico.com
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