Liu Jian, Xu Si-wei, Zhang Ren

1 Department of Acupuncture, Branch of Shanghai First People’s Hospital, Shanghai 200081, China

2 Shanghai First People’s Hospital, Shanghai 200080, China

3 Shanghai Literature Institute of Traditional Chinese Medicine, Shanghai 200020, China

Clinical Study on Point-toward-Point Needling for Asthenopia

Liu Jian1, Xu Si-wei2, Zhang Ren3

1 Department of Acupuncture, Branch of Shanghai First People’s Hospital, Shanghai 200081, China

2 Shanghai First People’s Hospital, Shanghai 200080, China

3 Shanghai Literature Institute of Traditional Chinese Medicine, Shanghai 200020, China

Objective: To observe the effect of point-toward-point needling on asthenopia.

Methods: A total of 60 asthenopia cases were randomized into an observation group and a control group, 30 cases in each group. Pointtoward-point needling was used in the observation group; whereas point injection was used in the control group. The signs and symptoms including visual tasks and eye fatigue were observed before and after treatments. This was followed by an inter-group comparison of eye discomfort symptom score and therapeutic effects.

Results: After treatment, the symptoms and signs in both groups were significantly improved, showing a statistical significance (P＜0.01) and inter-group difference (P＜0.01). The total effective rate of the observation group was 96.7%, versus 69.0% in the control group, showing a statistical difference (P＜0.01).

Conclusion: Both treatment protocols can help alleviate the clinical symptoms of asthenopia; point-toward-point needling can obtain better effect than point injection.

Point-toward-point Method; Acupuncture Therapy; Hydro-acupuncture; Asthenopia

Asthenopia or eyestrain is a common ophthalmological condition that manifests itself through nonspecific symptoms. It is also known as asthenopia syndrome because of its association with organic and mental (psychological) factors[1]. Symptoms often occur after tedious visual tasks, including a shorter period of near vision, blurred vision, fatigue and pain in or around the eyes, a heavy down-bearing sensation of the eyelids, photophobia, lacrimation and occasional double vision. In severe cases, vertigo, headache, nausea, vomiting, soreness and pain in the neck and shoulder and insomnia may also be present. Dr. Zhang Ren, an experienced acupuncturist for eye problems, advocates point-toward-point needling for eyestrain. We’ve made a preliminary observation on the clinical effect of point-toward-point needling for eyestrain. The results are now given as follows.

1 Clinical Data

1.1 Inclusion criteria

Presence of eyestrain symptoms upon intense visual tasks, such as a shorter period of focusing on a book or computer monitor, blurred vision, distension, pain and a sensation of having a foreign body in the eyes, eyelid spasm,dizziness, headache and neck rigidity. In addition, organic eye and systemic conditions have been ruled out. All cases have normal mental state.

1.2 General materials

A total of 60 outpatients were randomly allocated into an observation group and a control group according to their visiting sequence and random digits table. Of 30 cases in the observation group, 17 were males and 13 were females; age ranged from 18 to 62 years old; disease duration ranged from 2 months to 3 years. Of 30 cases in the control group, 19 were males and 11 were females; age ranged from 20 to 55 years old; and disease duration ranged from 1.5 months to 2 years. Statistical management showed there were no statistical differences between the two groups in terms of gender, age and duration (P＞0.05), indicating that the two groups were comparable.

The flow chart of clinical management was shown in Fig.1.

Fig.1 Flow chart of clinical management

2 Treatment Methods

2.1 Observation group

Acupoints: Cuanzhu (BL 2) toward Shangjingming [Extra, locates 0.2 cun above Jingming (BL 1)], Sizhukong (TE 23) toward Yuyao (EX-HN 4), Xinming I [Extra, locates at 0.5 cun anterior and superior to Yifeng (TE 17)] towards Xiaguan (ST 7).

Method: Ask the patient to sit upright and form a 30° angle between the needle and skin. Puncture Cuanzhu (BL 2) 15-25 mm towards Shangjingming (Extra) perpendicularly. Puncture Sizhukong (TE 23) towards Yuyao (EX-HN 4) subcutaneously using a filiform needle of 50 mm in length. Puncture Xinming I (Extra) using a filiform needle of 0.30 mm in diameter and 50 mm in length towards the outer canthus and then down to the deep layer of Xiaguan (ST 7), approximately 25-35 mm in depth. Since the needle tips of all three pairs were all directed towards the eyes, during inserting needles, it is advisable to use gentle manipulation to enable the needling sensation to radiate towards the eye socket or canthus until the appearance of lacrimation or an intense soreness or distension in or around the eyes. After this, apply fast small-amplitude twirling approximately 1 min for each point at the frequency of 200 times per min. For Xinming I (Extra), combine lifting and thrusting of 1-2 mm with small-amplitude twirling.

After needling, connect two acupoints on the same side with G6805 electric stimulation, using sparse-dense wave for 30 min. The intensity was supposed to make eyelid twitching but within the patient’s tolerance.

The treatment was conducted once every other day, 3 times a week, 10 times for one course of treatment. There was no interval between two courses. The therapeutic efficacy was observed after 2 courses of treatment.

2.2 Control group

Acupoints: Bilateral Ganshu (BL 18), Taichong (LR 3) and Yiming (EX-HN 14).

Method: After routine skin disinfection, extract 2 mL compound Dan Shen (Salviae Miltiorrhiza) injection using disposable No. 6 syringe, aim at the skin of the point, slowly insert for arrival of qi, pump back to make sure there is no backflow of blood. Then inject 1 mL into Ganshu (BL 18) on both sides. For Yiming (EX-HN 14) and Taichong (LR 3), perform even reinforcing-reducing manipulation after arrival of qi, and connect two acupoints on the same side with G6805 electric stimulator using sparse-dense wave for 30 min. The treatment was conducted once every other day, 3 times a week. The therapeutic efficacy was statistically analyzed after 20 treatment sessions.

3 Observation on Therapeutic Efficacy

3.1 Eyestrain scoring standard

The eyestrain scoring was evaluated on observation indexes including signs and symptoms such as pain, soreness or distension around the eyes, blurred vision, a heavy down-bearing sensation and spasm of the eyelid, light sensitivity, lacrimation, dizziness and headache.

0 point: Absence of eye discomfort symptoms coupled with ability to focus on reading or video for over 3 h.

0-1 point: Occasional eye discomfort symptoms that can be alleviated after rest, coupled with focusing on reading or video for over 2 h.

1-2 points: Occasional eye discomfort symptoms that affect work and study, coupled with focusing on reading or video no less than 2 h.

2-3 points: Frequent eye discomfort symptoms that affect the work and quality of life, coupled with focusing on reading or video no less than 1 h.

＞3 points: Persistent presence of eye discomfort symptoms that greatly affect work and quality of life, coupled with an inability to focus on visual tasks.

3.2 Therapeutic efficacy criteria

Basic recovery: Ability to focus on reading or video for over 3 h, absence of eye discomfort symptoms and eyestrain scored 0.

Marked effect: The time of focus on reading or video is 2 h longer than that before treatment, and significant alleviation of eye discomfort and systemic symptoms.

Improvement: The time of focus on reading or video is 1 h longer than that before treatment, and alleviation of at least one symptom of the eye discomfort and systemic symptoms.

Failure: The eye discomfort and systemic symptoms remain unchanged after treatment.

3.3 Treatment results

Of 30 cases in the observation group, there were no dropout cases; and 1 of the 30 cases in the control group dropped out. The between-group clinical efficacy including immediate effect (improvement of the eyestrain symptoms and signs before and after the first treatment) was compared before treatment, after the 1st treatment and after 2 courses of treatment, using intraand inter-group scores before and after treatment as observation indexes.

3.3.1 Between-group comparison of eyestrain scores before and after treatments

Before treatment, t-test showed that there was no statistical difference between the two groups (P＞0.05). After the first treatment, there was a statistical difference between the two groups, indicating that the treatment protocol of the observation group had noticeable immediate effect. After 2 courses of treatment, the symptoms in both groups were significantly improved (P＜0.01). Also, there was a statistical difference between the two groups (P＜0.01), indicating that the eyestrain in the observation group obtained better recovery than that in the control group (table 1).

Table 1. Between-group comparison of eye discomfort symptom score before and after treatments (, point)

Table 1. Between-group comparison of eye discomfort symptom score before and after treatments (, point)

Note: Compared with the pre-treatment results of the same group, 1) P＜0.01; compared with the control group, 2) P＜0.01

Observation 30 2.70±0.12 1.97±0.17 1.01±0.481)0.73±0.192)1.69±0.482)Control 29 2.68±0.14 2.50±0.21 1.77±0.541)0.18±0.16 0.91±0.54

3.3.2 Between-group comparison of therapeutic efficacy

The therapeutic efficacy in the observation group was better than that in the control group, showing a statistical significance (χ2=8.04, P＜0.01), (table 2).

Table 2. Comparison of therapeutic efficacy between the two groups (case)

3.4 Case study

A 30-year-old company clerk first visited on October 10, 2005.

Chief complaint and history of present illness: Binocular distension, soreness and pain, lacrimation, light sensitivity, heavy sensation of eyelids and blurred vision due to long-term focus on computer. The symptoms exacerbate no less than 1 h after exposing to videos. Other symptoms include dizziness, headache, nausea and soreness and pain in the neck and shoulder. Since he could not perform his normal working duty, the patient went to different doctors for treatment. After examination, organic eye conditions were ruled out and the patient was diagnosed with eyestrain. As there were no specific Western medical therapies, the patient came for acupuncture treatment.

Diagnosis: Eyestrain.

Treatment: The patient was treated with abovementioned point-toward-point needling method. His eyestrain symptoms disappeared right away after the first treatment. However, after 2 h of exposing to computer the following day, his symptoms reappeared. Then, the patient received treatment once every other day for 2 courses of treatment. Afterwards, he could focus on video and computer for 3 h successively. In order to facilitate the treatment effect, the patient still received treatment at least once a week. The follow-upobservation showed that the patient could work with computer for successively 5 h. Although eye discomfort still occurred after fatigue or long-time visual tasks, the eyestrain did not affect the patient’s normal work and life and could be relieved by acupuncture or rest.

4 Discussion

Over the recent years, along with the continuous development of scientific technology and information exchange as well as widespread application of video terminal, people tend to experience eyestrain from more intensive visual tasks. Since eyestrain directly affects people’s study, life and work efficiency, it has become a common issue on how to prevent and treat eyestrain.

In traditional Chinese medicine (TCM), eyestrain falls under the category of “overstrain of the liver”. The expression “overstrain of the liver” was first recorded in the Qian Jin Yao Fang (Essential Prescriptions Worth a Thousand Gold), referring to distension or pain around the eyes and dizziness after continuous intensive visual tasks. Based on the theory of ‘the liver opens into the eyes’, these symptoms were described by Sun Si-miao (a famous doctor in the Tang Dynasty) as “overstrain of the liver”. TCM holds that the eyes rely on essential qi of the Zang-fu organs to see all things and distinguish colors. Blood is dominated by the heart and stored in the liver. Abundant heart- and liver-blood, free flow of liver-qi, and normal transportation and transformation of lung-qi and spleen qi enable essential qi stored in the kidney to ascend to the eyes and function under the guidance of heart-mind. Apparently, normal vision depends on the guidance of heart-mind and nourishment of essence, qi, blood and body fluids. Dysfunctions of the Zang-fu organs may result in failure of essential qi to ascend to the eyes, causing visual impairment. As a result, eyestrain is mainly attributed to deficiency of the liver and kidney, weakness of the spleen and stomach and stagnation of qi and blood. Intensive visual tasks and mental overstrain are inducing factors.

According to TCM theory of “the liver opens into the eyes” and “meridians are indicated for problems along their pathways”, Ganshu (BL 18), Taichong (LR 3) and Yiming (EX-HN14) were selected in the control group to reinforce the liver and kidney, regulate qi and blood and nurture the eyes. Clinical results have shown that this method also alleviates eyestrain.

Point-toward-point needling (an acupuncture method to needle in different directions, by diverse angels and depths towards two or more acupoints using one needle) was used in the observation group. The intense needling sensations of this method can strengthen the connection between the exterior-interior connected meridians to dredge meridians and promote circulation of qi and blood[2-5]. This study adopted three pairs of acupoints in three different directions: Cuanzhu (BL 2) toward Shangjingming (Extra), Sizhukong (TE 23) toward Yuyao (EX-HN 4) and Xinming (Extra) toward Xiaguan (ST 7). This can reinforce the liver and kidney, fill up essence and marrow, circulate qi and blood, and nourish the eyes, thus alleviating eyestrain[6-11]. Constant regular stimulation and frequency of electroacupuncture further enhanced the treatment effect[12]. Since eyestrain reoccurs repeatedly after long-time intensive visual tasks and may take some time to restore the normal function, it is advisable to receive at least 20 times of treatment. Even after the symptoms are alleviated, 1-2 treatments are still required to facilitate the effect.

In this study, the therapeutic efficacy in the observation group was better than that in the control group. Furthermore, an immediate effect was obtained after the first point-toward-point needling: patients had the feelings of brightness, relaxation and comfort. These feelings can enable the patients to be more confident about overcoming the eyestrain and thus benefit the treatment effect.

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Translator: Han Chou-ping

R246.82

A

Date: December 18, 2012

Author: Liu Jian, associate chief physician. E-mail: fyrsk@yahoo.com.cn