Li Lin-ping (李琳蘋), Jin Cheng-zhong (金城鐘)

1 Taizhou Hospital of Traditional Chinese Medicine, Zhejiang 318000, China 2 Taizhou Municipal Hospital, Zhejiang 318000, China

Tuina combined with needling distal points for pseudo-myopia in adolescents

Li Lin-ping (李琳蘋)1, Jin Cheng-zhong (金城鐘)2

1 Taizhou Hospital of Traditional Chinese Medicine, Zhejiang 318000, China 2 Taizhou Municipal Hospital, Zhejiang 318000, China

Objective:To observe the clinical effect of tuina combine with needling distal points for pseudo-myopia in adolescents.

Acupuncture Therapy; Ocular Health Tuina; Massage; Myopia; Adolescent

Myopia is a condition of the eye involving refractive error and often affects adolescents. In 2010, the 6th large-scale investigation report of constitution and health for Chinese students showed that poor vision tends to affect younger children[1-2]. Consequently, it’s of great significance to prevent and treat myopia in adolescents. Clinically, there are true and pseudo myopia. Pseudo-myopia refers to intermittent and temporary shift in refraction of the eye due to ciliary muscle strain or fatigue but can restore to normal after rest or using paralysor. However, once pseudo-myopia becomes true myopia, individuals have to wear glasses. We’ve treated pseudo-myopia in adolescents between January 2010 and October 2014 with tuina combined with needling distal points. The results are now summarized as follows.

1 Clinical Data

1.1 Diagnostic criteria

This was based on theDefinition and Categorization Criteria for True and Pseudo-Myopia(Draft) stipulated in the 1st National Academic Conference on OcularRefraction[3]. Pseudo-myopia: far visual acuity is lower than normal, normal near visual acuity, absence of myopia upon ciliary muscle paralysis by atropine and presence of emmetropia or mild hypermetropia. True myopia: the myopia diopter is not decreased or decreased by ＜ 0.50D. Mixed myopia: notable decrease of myopia diopter (≥0.50D) but unable to restore to emmetropia.

1.2 Inclusion criteria

Those who met the above diagnostic criteria for pseudo-myopia (far visual acuity ＜5.00D and normal near visual acuity); absence of or ≤0.50D of astigmatism; aged between 5 and 16 years; and those who could stick to 3 treatment courses and allow for re-examination of far visual acuity and diopter.

1.3 Exclusion criteria

Those who didn’t meet the above diagnostic and inclusion criteria; presence of ＞0.50D astigmatism; and having other eye problems that may cause poor eyesight or used other therapies.

Those who withdrew from the study or failed to complete the treatment courses were considered as dropouts.

1.4 Statistical methods

The SPSS 16.0 version software was used for statistical analysis. Pairedt-test was used for measurement data, which were expressed in the form ofThe Chi-square test was used for enumeration data. APvalue of less than 0.05 indicates a statistical significance.

1.5 General materials

A total of 64 pseudo-myopia (both eyes) adolescents treated between January 2010 and October 2014 were recruited in this study. They were allocated into a treatment group and a control group by the random number table, 32 in each group (64 eyes). Cases in the treatment group were aged between 5 and 16 years. Their duration lasted from 3 to 18 months. The uncorrected visual acuity before treatment was 4.3-4.8. Cases in the control group were aged between 5 and 16 years. Their duration lasted from 3 to 18 months. The uncorrected visual acuity before treatment was 4.3-4.8. There were no between-group statistical differences (P＞0.05) in gender, age, duration and uncorrected eyesight before treatment, indicating that the two groups were comparable (Table 1).

Table 1. Between-group comparison of general materials

2 Treatment Methods

2.1 Treatment group

2.1.1 Tuina therapy[4]

Points: Yintang (GV 29), Cuanzhu (BL 2), Yuyao (EX-HN 4), Sizhukong (TE 23), Taiyang (EX-HN 5), Qiuhou (EX-HN 7), Chengqi (ST 1), Jingming (BL 1), Sibai (ST 2), cervical vertebrae, Fengchi (GB 20), Ganshu (BL 18), Pishu (BL 20), Shenshu (BL 23) and Yongquan (KI 1).

Method: The patient took a supine lying position. The practitioner sat facing the patient’s head and applied the following manipulation by sequence: 50 times of Kai-opening Tianmen [also named Tui-pushing Cuanzhu (BL 2)], (Figure 1) and Tui-pushing Kangong (superciliary arch), (Figure 2) respectively; approximately 10 min of Rou-kneading Yintang (GV 29) (Figure 3), Cuanzhu (BL 2), Yuyao (EX-HN 4), Sizhukong (SJ 23), Taiyang (EX-HN 5) and Sibai (ST 2), (Figure 4) using the index and middle fingers and An-pressing and Rou-kneading Jingming (BL 1) using the thumb on both eyes alternately (Figure 5); 3-5 times of Wa-rubbing medial sides of the eye sockets (Figure 6) and approximately 2 min of Anpressing and Rou-kneading Chengqi (ST 1), Qiuhou (EX-HN 7), Rou-kneading Tianzhugu (cervical vertebrae), (Figure 7), and An-pressing and Rou-kneading Fengchi (GB 20), (Figure 8). Then the patient took a prone lying position. The practitioner stood on the right side of the patient and applied 2-3 min of An-pressing and Roukneading to Ganshu (BL 19), (Figure 9), Pishu (BL 20), Shenshu (BL 23) and Yongquan (KI 1) and concluded by 4-6 times of Nie-pinching the spine (Figure 10).

Figure 1. Kai-opening Tianmen

Figure 2. Tui-pushing Kangong (superciliary arch)

Figure 3. Rou-kneading Yintang (GV 29)

Figure 4. Rou-kneading Sibai (ST 2)

Cautionary notes: The practitioner needs to concentrate his/her attention and apply gentle manipulation to avoid patient’s nervousness.

2.1.2 Acupuncture therapy[5]

Points: Hegu (LI 4), Taichong (LR 3), Xingjian (LR 2), Zusanli (ST 36), Guangming (GB 37), Taixi (KI 3) and Sanyinjiao (SP 6) on both sides.

Figure 5. Rou-kneading Jingming (BL 1)

Figure 6. Wa-rubbing the eye socket

Figure 7. Rou-kneading Tianzhugu (the cervical vertebrae)

Method: The patient took a supine lying position. After routine sterilization, the above points were punctured with filiform needles of 0.25 mm in diameter and 40 mm in length, followed by even reinforcing and reducing manipulation upon arrival of qi. The needles were retained for 30 min.

Figure 8. Rou-kneading Fengchi (GB 20)

Figure 9. Rou-kneading Ganshu (BL 18)

The patients were treated with tuina first and then acupuncture. The treatment was done once a day for 10 d as a course. They were treated for a total of 3 courses. There was a 2-day interval between two courses.

During the treatment, the patients were encouraged to conduct more outdoor physical exercise, see more green plants and avoid poor eye-care habits.

2.2 Control group

Cases in the control group were treated with the same tuina method (points, manipulation and treatment course) as the treatment group.

Figure 10. Nie-pinching the spine

3 Treatment Effects

3.1 Therapeutic efficacy criteria

This was based on the Diagnosis and Therapeutic Efficacy Assessment for Common Diseases (Criteria)[6], using the standard logarithmic visual acuity chart to examine uncorrected far visual acuity.

Short-term recovery: Absence of all or major clinical symptoms, ＞1.0 of far visual acuity, absence of diopter by retinophotoscopy and presence of emmetropia.

Marked effect: Almost absence of all or major clinical symptoms, far visual acuity increased by 3 or more lines and noticeably decreased (≥1.00D) diopter by retinophotoscopy.

Improvement: Alleviated clinical symptoms, far visual acuity increased by 2 lines and decreased (≥0.50D) diopter by retinophotoscopy.

Failure: Somewhat improved or unchanged clinical symptoms, far visual acuity increased by 1 line and decreased (＜0.50D) diopter by retinophotoscopy.

3.2 Treatment results

After treatment, the total effective rate was 92.2% in the treatment group, versus 82.8% in the control group, showing a statistical significance (P＜0.05) and indicating a better effect in the treatment group than that in the control group.

Table 2. Between-group comparison of clinical effects (case)

4 Discussion

Myopia is characterized by blurry distance vision, but generally good near vision. Other than poor visual environment (including light pollution), near range and long hours of reading, myopia is also associated with factors such as environment, heredity, development and insufficient sleep[7-10]. In Chinese medicine, factors contributing to myopia include congenital deficiency, maldevelopment, qi and blood deficiency of the heart, liver and kidney and poor eye care. These factors can cause malnourishment of the eyes and lead to myopia.

In this study, distal points below the elbow and knee joints were selected based on the theory that ‘treating problems of the upper body from the lower body’. The root of meridian qi lies in four extremities. Needling these points can stimulate meridian qi, regulate Zang-fu organs, unblock flow of meridian qi around the eyes, harmonize qi and blood and thus benefit the eyes and improve myopia. Of the points selected, Sanyinjiao (SP 6), a crossing point of the Liver, Spleen and Kidney Meridians, can circulate blood, tonify the liver and kidney and help with transportation and transformation; Taichong (LR 3), the Shu-Stream and Yuan-Primary point of the Liver Meridian, can harmonize qi and blood, unblock meridians, and benefit the eyes when used in combination with Zusanli (ST 36), Guangming (GB 37), Sanyinjiao (SP 6) and Hegu (LI 4); and Guangming (GB 37) is a common point for eye problems. Other points for eye problems include Yintang (GV 29), Cuanzhu (BL 2), Taiyang (EX-HN 5), Qiuhou (EX-HN 7), Chengqi (ST 1), Jingming (BL 1) and Sibai (ST 2). Application of tuina to these points can improve blood circulation of the eyes, alleviate ciliary muscle spasm and eliminate eye fatigue[11-14]. Acupuncture combined with tuina can enhance the function of harmonizing qi and blood and improve eyesight.

Based on the previous studies[14-16], this study used tuina combined with needling distal points for pseudo-myopia in adolescents and obtained better effect than conventional tuina. Since we primarily use tuina and supplement with needling distal points, this method is easy to be accepted among adolescents and worthy of further clinical application.

We’ve also found that the treatment effect is associated with pre-treatment eyesight and age. Those with better eyesight obtained better effects than those with poor eyesight. Those with a younger age (＜10 years old) tend to have better effects than those with an older age. Consequently, early intervention is important for myopia.

Conflict of Interest

The authors declared that there was no conflict of interest in this article.

Statement of Informed Consent

The informed consent was obtained from all individual participants included in this study.

Received: 5 December 2014/Accepted: 12 January 2015

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Translator:Han Chou-ping (韓丑萍)

推拿結(jié)合遠(yuǎn)道取穴針刺治療青少年假性近視

目的: 觀察推拿結(jié)合遠(yuǎn)道取穴針刺治療青少年假性近視的臨床療效。方法: 將 64名青少年假性近視患者按隨機(jī)數(shù)字表隨機(jī)分為治療組和對照組, 每組32例(64只眼)。治療組采用推拿結(jié)合遠(yuǎn)道取穴針刺治療, 對照組采用單純推拿治療, 推拿手法、推拿部位及治療時間均與治療組相同。每日治療1次, 連續(xù)10次為1療程, 休息2 d后繼續(xù)下一個療程, 共治療3個療程。兩組患者均在接受3療程治療后進(jìn)行標(biāo)準(zhǔn)對數(shù)視力表檢測裸眼遠(yuǎn)視力和散瞳后檢影驗光近視屈光度檢測, 觀察其近期療效。結(jié)果: 治療3個療程后, 兩組患者視力均較治療前有改善;治療組總有效率為92.2%, 對照組為82.8%, 兩組總有效率差異有統(tǒng)計學(xué)意義(P＜0.05), 提示治療組療效優(yōu)于對照組。結(jié)論: 推拿結(jié)合遠(yuǎn)道取穴針刺治療青少年假性近視療效顯著, 而且沒有針刺眼周穴位帶來的恐懼, 易于被青少年接受, 值得在臨床上推廣應(yīng)用。

針刺療法; 眼保健推拿; 按摩; 近視; 青少年

R244.1 【

】A

Author: Li Lin-ping, bachelor, attending physician.

E-mail: 1302528567@qq.com

Methods:A total of 64 adolescents with pseudo-myopia were allocated into a treatment group and a control group by the random number table, 32 cases in each group (64 eyes). Cases in the treatment group were treated with tuina combined with needling distal points, whereas cases in the control group were treated with the same tuina method (manipulations, treatment area and time) as those in the treatment group. The treatment was done once a day for 10 d as a treatment course. They were treated for 3 courses and there was a 2-day interval between two courses. After 3 treatment courses, all cases were re-examined for the short-term effect on uncorrected eyesight using the logarithmic visual acuity chart and on diopter using retinophotoscopy.

Results:After 3 treatment courses, the visual acuity in both groups was improved. The total effective rate was 92.2% in the treatment group, versus 82.8% in the control group, showing a statistical significance (P＜0.05) and indicating a better effect in the treatment group than that in the control group.

Conclusion:Tuina combined with needling distal points is remarkably effective for pseudo-myopia in adolescents. Since it doesn’t cause fear (from needling local points around the eyes), it’s easy to be accepted by adolescents and worthy of further clinical application.