Zhang Bao, Peng Li, Zhou Li-zhi, Mu Jing-ping, Cheng Jian-ming

Taihe Hospital Affiliated to Hubei Medical College, Shiyan 442000, China

Observation on Therapeutic Effect of Mild Moxibustion plus Acupoint Injection for Optic Atrophy

Zhang Bao, Peng Li, Zhou Li-zhi, Mu Jing-ping, Cheng Jian-ming

Taihe Hospital Affiliated to Hubei Medical College, Shiyan 442000, China

Objective: To observe the clinical effect of mild moxibustion plus acupoint injection for optic atrophy.

Methods: Ninety-four patients with optic atrophy were divided into a treatment group (51 cases) and a control group (43 cases). The treatment group was treated with mild moxibustion plus acupoint injection,and the control group was treated with medications. After three courses, the change of vision was observed.

Results: The total effective rate was 82.4% in the treatment group and 41.9% in the control group, with a statistical difference between the two groups (P＜0.05).

Conclusion: Moxibustion plus acupoint injection is an effective method to treat optic atrophy.

Acupuncture-moxibustion Therapy; Moxibustion Therapy; Hydroacupuncture; Moxa Stick Moxibustion; Optic Atrophy

Optic atrophy is the end results of any disease that damages the post-retinal receptor, ganglion cells and their axons, and serious visual dysfunction induced by loss of the optic nerve fibers and gliosis, mainly manifested by decreased vision and light and pale color of the optic nerve head, and is one of the clinically encountered conditions to cause blindness. Because of its complex etiology and difficult recovery, it belongs to an intractable disease in the ophthalmic clinic. We treated 51 cases of this disease with moxa roll moxibustion plus acupoint injection, with 43 cases treated with medications for comparison between October of 2002 and September of 2010.

1 Clinical Materials

1.1 Diagnostic criteria

The diagnostic criteria were established based upon the Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[1]. The fundus examination showed light, pale or grey white color, harmed visual functions, and declined vision unable to be corrected. The visual field examination showed dark spots in the center or defect in the visual field. The visual evoked potential text was positive. For those with unknown reasons, cranial Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) was used to exclude intracranial or intraorbital occupying lesions.

1.2 General data

Ninety-four patients with optic atrophy were the outpatients or inpatients of our hospital and divided into a treatment group or a control group based upon the patient’s choice for therapeutic protocol. Of the 51 cases in the treatment group (57 eyes), there were 26 males and 25 females, with the age ranging from 10 to 71 years old, at the average age of 38, and with the duration ranging from 4 months to 13 years, at the average duration of 16 months, including 9 cases of traumatic injury (9 eyes), 18 cases of optic neuritis (18 eyes), 13 cases of ischemic condition (18 eyes), 5 cases of post-operative condition of occupying lesions (5 eyes), 4 cases of glaucoma (5 eyes), and 2 cases of unknown reason (2 eyes). Of the 43 cases in the control group (46 eyes), there were 24 males and 19 females, with the age ranging from 8 to 68 years old, at the average age of 36, and with the duration ranging from 2 months to 11 years, at the average duration of 13 months, including 12 cases of traumatic injury (12 eyes), 10 cases of optic neuritis (10 eyes), 5 cases of ischemic condition (7 eyes), 5 cases of post-operative condition of occupying lesions (5 eyes), 7 cases of glaucoma (8 eyes), and 4 cases of unknown reason (4 eyes).

In comparison of age, pathogenic factors, duration and situation of the patients between the two groups, the differences were not statistically significant (P＞0.05), indicating that they were comparable.

All the patients understood the contents of this study and signed the informed consent. Please see Fig.1 for the clinical process of the patients in the two groups.

Fig.1 Clinical process in the two groups

2 Therapeutic Methods

2.1 Treatment group

2.1.1 Moxibustion therapy

Acupoints: Bilateral Chengqi (ST 1) and Fengchi (GB 20).

Operation: The patient took a sitting position. After the acupoints were located and marked, one moxa roll was ignited to aim at the acupoint for mild moxibustion, 10-20 min for each acupoint, till the local skin of the acupoints became slightly red. The treatment was given once every day, and 20 sessions made up one course, for totally three courses.

2.1.2 Acupoint injection

Acupoints: Taiyang (EX-HN 5) and Qiuhou (EX-HN 7).

Operation: The skin test needle was used to extract 1 mL Compound Anisodine Injection. After the needle was inserted into the acupoint obliquely and no blood could be extracted, the injection was pushed into the acupoint slowly, 0.5 mL for each acupoint. The treatment was given once every other day and 10 sessions made up one course, for totally three courses.

2.2 Control group

The patients in this group were treated by intravenous infusion of Tian Ma (Rhizoma Gastrodiae) injection and Monosialoganglioside. The dose was decided upon the pathological situation and age. The treatment was given once every day and 20 sessions made up one course, for totally three courses.

3 Observation of Therapeutic Effects

3.1 Criteria of therapeutic effects

The criteria of therapeutic effects were stipulated based on the Criteria of Diagnosis and Therapeutic Effects of Diseases and Syndromes in Traditional Chinese Medicine[1].

Remarkable Effect: The vision is improved by over three lines, and the scotoma in the center of visual field shrinks or absolute scotoma changes into relative scotoma.

Effect: The vision is improved by two lines.

Failure: No improvement and even deterioration is revealed in vision and visual filed.

3.2 Statistical methods

The data were processed by SPSS 17.0 software package. All the counting materials were expressed by mean ± standard deviation (). The comparison within the group was processed by t-test. The grading materials were analyzed by Ridit analysis. The statistical difference was expressed by P＜0.05.

3.3 Therapeutic results

The total effective rate was 82.4% in the treatment group and 41.9% in the control group, with the statistical significance in comparison of the difference between the two groups (P＜0.05), indicating that the effective rate was better in the treatment group than that in the control group (table 1).

In the treatment group, the vision was mostly below 4.3 before the treatment, and was 4.4-5.0 after the treatment. There was no obvious change in the vision distribution before and after the treatments (table 2).

Table 1. Comparison of clinical effects between the two groups (case)

Table 2. Comparison of vision distribution before and after treatments between the two groups (case)

4 Discussion

Optic atrophy belongs to the scope of glaucoma in traditional Chinese medicine (TCM). It is believed in TCM that this disease is induced by traumatic injury or seven emotional factors, leading to dysfunction of yin and yang, disharmony of qi and blood, dysfunction of qi activities, and failure of essence and blood to flow upward and nourish the eye aperture. The retina is the nervous ending tissues of the brain to extend outward and its blood vessel belongs to the terminal blood vessels. When those blood vessels are narrowed or obstructed, or there is imbalance between the perfusion pressure of the ciliary artery and intraocular pressure, ischemic infarction of the optic papilla or optic atrophy will be induced. In the atrophic process, some optic nerve fiber stays in the reversible status of various degrees. If blood supply is restored promptly, the functions of the nerve fiber in this part can be possibly restored[2-5]. In the treatment group, Chengqi (ST 1), a crossing acupoint of Foot Yangming Meridian, Yang Heel Vessel and Conception Vessel, can be used to warm up and dredge the meridians to help the meridian qi and blood to flow upward to the eyes, and can directly dilate the blood vessels in the ocular region and improve blood supply in the ocular region. Fengchi (GB 20), a crossing acupoint of Foot Shaoyang Meridian and Yang Link Vessel, in an interior-exterior connection with the Liver Meridian, can be used to soothe the liver, brighten the eyes, regulate blood supply of the brain, so as to improve blood circulation in the ocular region and restore the partial functions of the optical nerve fibers. Taiyang (EX-HN 5) and Qiuhou (EX-HN 7) are around the eyes, and thus can be used to regulate the functions of the meridians in the ocular region and functions of Zang-fu organs. The main ingredients of Compound Anisodine injection are Ammonium Bromated Anisodine, Hydrochloric Procaine, and Vitamin B12. Via acupoint injection, the medications are able to stimulate the nervous endings of the adjacent subcutaneous vegetative nerves of the peripheral superficial temporal artery, adjust the choroidal autonomic activities, improve choroidal blood flow, reduce vasospasm, regulate the ocular vasomotor functions, improve blood supply to the ocular tissues, and enhance vision and restore the visual functions. Moxibustion plus acupoint injection can maintain the balance between yin and yang, harmonize qi and blood, refill essential qi and smoothen the meridians, and nourish the eyes, so as to restore the vision[6-9]. It is shown in the clinical observation that this therapy is simple, painless and has better therapeutic effect for patients with optic atrophy to restore the vision.

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Translator: Huang Guo-qi

R246.82

A

Date: January 6, 2013

Author: Zhang Bao, attending physician.

Mu Jing-ping, M.D., associate chief physician. E-mail: mjpll@sohu.com