Eyes Handout

Eye diseases Page 1
Julian Scott

The Acupuncture Treatment
Of
Eye Disorders

Julian Scott
Page 2 Eye diseases

Julian Scott
The Zang-Fu and the eyes
"The Liver opens into the eyes".

Old-fashioned view
The old fashioned view (which is to be found, for example in the Nei Jing) is based on a
simple attribution of the parts of the eye on the basis of colour. So we see the following
table of relations:

Organ Colour Part of eye
Kidney Black pupil
Liver Green/brown Iris
Heart Red Inner canthus
Spleen Yellow Eyelids
Lung White Sclera

More recently

The Liver
...which opens into the eyes is particularly concerned with the perception of light.

Liver blood deficiency can lead to poor colour discrimination; also black spots
in front of the eyes.)
Liver heat conjunctivitis, glaucoma, optic atrophy and so on.
Rage "blinded by rage".

The Heart
"the Heart rules the blood vessels" Blood clots, hardening of the arteries, poor blood supply
can all be seen in eye pathologies. In particular we see:

Stagnation of Blood for example in high blood pressure and in stagnation of
blood conditions
Occlusion of the arteries e.g. where all the arteries of the body are hardened
Poor circulation of blood seen in Heart Yang Xu conditions. Very common in old
age.
Heat in blood retinal bleeding (e.g. diabetic retinopathy)

Perception
the recognition of objects, the cognitive aspect of the Shen.

Shen shows in the eyes

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Julian Scott
The Spleen
..."controls flesh" the eye-lids.
The Spleen also rules the transportation and transportation of fluids,
dry eyes because dampness or phlegm is obstructing the flow of fluids to the eyes
excessive production of tears,
"bags" underneath the eyes, In Western Medicine, they are a symptom of Bright's disease
the aqueous humour may become sticky leading to "open-angle" glaucoma
Thick phlegm may lead to drusen

The Lungs
dry eyes from Lung Yin Xu
excessive tears from Lung Qi Xu
excessive tears from long-term sadness
excessive tears when wind-cold invades the lung - and many other conditions related to
either the lungs or to the Wei Qi.

The lungs also affect the fluid circulation inside the eye, so that there is a Lung pattern of
glaucoma.

tear production on going from hot to cold
corneal erosion and corneal ulcer, both of which have as one of their syndromes Lung Yin
Xu. Both these conditions are similar to an equivalent skin disease - corneal erosion
being like flaking eczema and corneal ulcer being similar to an ulcer or rash on the skin.

Grief

Kidneys
Last, but not least in our discussion of the eye problems come the Kidneys. They are of
such importance for the eyes that they come first equal with the Liver. In particular we can
see:

The Retina and Optic Nerve
...are anatomically part of the brain, and as such are ruled by the Kidneys.
The Aqueous Humour
When the Kidneys are deficient, it is easy for fluid imbalances to occur in the eyes. In
particular one may see:
glaucoma (open angle) when the pressure builds up in the eye due to Kidney deficiency

the Lens
...could be said to be ruled by the Kidneys. In particular one sees:

progressive hardening of the lens in old age, leading to presbyopia
cataract, which frequently comes from Kidney Yin deficiency.

The 'glitter', or the force of the Shen is ruled by the Kidneys.

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Julian Scott
Western anatomy and physiology

The Cornea

The Aqueous Humour

The Conjunctiva

The Sclera

The Iris

The Lens

The Ciliary body

The Vitreous Humour

The Retina

The choroid

The trabeculum and Schlemms canal

Fluids in the eyes
The aqueous humour, which fills the eye is thought to be secreted by a part of the ciliary
body which is covered by many folds.

Tears are produced by lachrymal ducts, and are part of the fluids which lubricated the
movement of the eye, and the eyelid.

They are stabilised by a thin oily film of a lipid called meibonium, which is secreted by tiny
glands in the eyelids. This oily film prevents rapid evaporation of the tears.

Underneath the wet tear film, next to the conjunctiva, there is a thin film of mucus, which is
secreted by the conjunctiva itself.

Drusen

The Optic Nerve

Eye diseases Page 5

Julian Scott
Cranial nerves
These nerves come out of the cranium near the point Fengchi Gb-20 which explains its
effectiveness in so many eye disorders.

Extraocular muscles
inferior, superior, lateral and medial rectus,
inferior and superior oblique muscle

Clinical Ophthalmology a synopsis, J.J.Kanski, Butterworth-Heinemann
Lots of lovely pictures
Outline of Ophthalmology, Coakes and Sellors, Buttersorth-Heinemann

Channels going to the Eyes
Barrier points

Orthodox tests
Retinal imaging
Short Coherence Tomography
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Julian Scott

Causes of eye diseases

Eye diseases Page 7

Julian Scott
Causes of eye problems, from Chinese view
Jing Imbalance of Zang-fu

Qi not enough Qi is reaching eyes

Shen Qi is being used faster than it is supplied

The 7 Emotions

Foods which directly affect the Eyes

Garlic Overconsumption of garlic can
lead to red and sore eyes.
Onions Onions have a similar effect to
garlic, but less pronounced. They
can also increase the need to
sleep in some people.
Eggs Overconsumption of eggs
increases the tendency of the
body to produce pus, and
encourage acute conjunctivitis.
This tendency is more
pronounced in children.
Alcohol The effects of alcohol in the
focusing of the eyes, and its
irritating effect on the conjunctiva
is well known!
Liver

Blueberries (Myrtle) Strengthen the optic nerve
Carrots

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Julian Scott
Mercury poisoning
Can lead to
1. Accumulation of phlegm
2. Progressive degeneration of the nerves

3. Dysfunction of the excretory function of the
kidneys

Effect on the eyes
Mercury can be behind all problems to do with fluids. In
particular:

Glaucoma, especially when the intra-ocular pressure is
not especially high.

Chronic sore eyes, especially when there is a
continuous discharge

Corneal erosion.

Retinal degeneration

Phosphorous
The symptoms relating to the eyes are mainly those you
would expect from Yin deficiency:

Over-sensitivity to light - has to wear sunglasses,
even at night.
Dry, red eyes
Cataract
Glaucoma
Various sorts of retinal damage.

Eye diseases Page 9

Julian Scott

Principles of Treatment
we see the following imbalances:

1. Marked reduction of Qi in the eyes - local Qi deficiency, often accompanied by
general Qi deficiency.
2. Significant Zang-Fu imbalance or weakness - for example Kidney Yang Xu.
3. Attitude problems and life problems - for example not wanting to look at relationships
with nearest and dearest. (Other similar examples have already been mentioned)

the basis for our treatments principles which are:

1. Bringing Qi to the Eyes

2. Treating Organ Imbalance

3. Changing the Attitude

Points for the Eyes.

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Julian Scott
Local points
Jingming Bl-1
1 to 1.5 cun, perpendicularly
All eye problems

Zanzhu Bl-2
3 to 5 fen perpendicular; or 0.5 to 1 cun towards Jingming Bl-1

Yangbai Gb-14
Sore eyes, twitching of eyelid, itching eyelids.

Sibai St-2
0.2 to 0.3 cun
Red eyes, corneal opacity.

Sizhukong SJ-23
Transversely, 0.5 to 1 cun
Red eyes, ingrowing eyelashes.

Qiu hou
1 to 2 cun, first slightly downwards, then slightly upwards.
Myopia, inflammation or atrophy of the optic nerve, glaucoma, retinitis pigmentosa,
convergent squint

Near points
Taiyang
all eye diseases, red and swollen eyes, sty.

Touwei St-8
Blurred vision, pain in the eyes, excessive tears, spasm of eyelid
0.5 to 1 cun, upwards or downwards.

Fengchi Gb-20
Straight insertion 1 to 1.5 cun; or 2 to 3 cun towards opposite eye.
All eye diseases

Glaucoma #1
1 cun above SJ-23

Yifeng SJ-17 ("Shielding" wind)
2 to 2.5 cun, towards the nearest eye.
All eye problems, especially corneal opacity.

Er jian (apex of the ear)
Bleed or 5 moxa cones
Painful eyes, corneal opacity
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Julian Scott
Distal points

Back Shu points:
Ganshu Bl-18
Pishu Bl-20
Shenshu Bl-23

Xingjian Liv-2
Taichong Liv-3

Guangming Gb-37

Yemen Sj-2
Red eyes

Zhong zhu SJ-3
Red eyes

Yangguang Gb-38

Yanglao Si-6
blurred vision, "green blindness" (moxa

Hegu Li-4

Zusanli St-36

Neiting St-44

Two less-known patterns of Zang-fu

Lingering Pathogenic Factor
Dreamy
Glazed look in eyes
Skin oily or excessively dry
Skin on body is rough (like sandpaper)
Swollen lymph nodes (and tonsils)
Occasional drops in energy
Food intolerance
Liver and Kidney Weak
In younger people
Timid, cautious, indecisive
Does not use full potential
Lumbar back weak
Wrinkled and decrepit (In older people)


Julian Scott
Other Related Techniques

Electric Plum Blossom

Traditional Chinese Massage

a) Above the eyes

b) Pinch and press between the eyes (Bl-1)

c) Massage Taiyang point
.
d) Massage Fengchi point

e) Massage Hegu point on the hand

The Bates Technique
The Bates Method, Peter Mansfield, Vermilion, London
Seeing well again without your glasses, Christopher Markert,
Better Sight without Glasses, Harry Benjamin
Meir Schneider, DVD Yoga for your Eyes

www.seeing.org

Other people in the business
Munich University
Mainly the use of herbs
Chinesisched Medizin in der Augenheilkunde, Fatrai & Uhrig, Elsevier 2005

Boel family in Denmark www.akupunktur2000.dk
Summary of the method:
A selection of points are given every day for two weeks, then three days a week and
so on. After 22-25 sessions, the treatment is finished and the patient comes once a
month to consolidate. Each session consists of two parts with one hours rest in
between
No special diagnosis needed, The same points are used every time.
Tuina on the face once a week (the Boel Points are a bit painful)
Sometimes Body acupuncture, Chinese or western herbs, homeopathic remedies for
the retina

Rheumatology in Chinese Medicine
G. Guillaume & M Chieu
Eastsland Press
For more information on the Barrier Points

Julian Scott

Julian Scott

Walnut Shell Spectacles
These are spectacles where each lens has been replaced by a half walnut shell. The
method of use is to soak the shells in a strong decoction of Chrysanthemum flowers over
night before placing them in the frames. Then one inch or so in front of the shells is placed
a moxa stick, which warms up the shells. The combination of the warmth from the shells
and the vapour from the Chrysanthemum extract is very soothing to the eyes.

This method is good for bringing Qi to the eyes, and is of especial use in tired eyes and
chronic red eyes. It can also be used as a supplemental treatment in all eye conditions.

Microcurrent stimulation
Rules for microcurrent:
Increase the intensity gradually until a slight pricking sensation is felt, then reduce slightly
so that there is no sensation. Best results are obtained when the stimulation is just under
the threshold of perception.

Julian Scott
Watering Eyes
Aetiology & Pathology
Wind-heat

Symptoms and signs
Eyes are red, sore and watering, possibly with purulent discharge.
Patient is quite strong
Onset is sudden
Pulse rapid full and floating

Liver Qi stagnation

Symptoms and signs
Eyes water in the wind
May appear to be very angry or tense, but more often has irritability alternating with
great charm.
Tendency to high blood pressure
Red tongue
Wiry pulse


Symptoms and signs
Watering eyes is seasonal, often in spring time
In spite of spring being the worst time, the patient does not seem to be very angry
Often a history of lung problems
May have signs of thick phlegm
Pulse is slippery rather than wiry

Lung and Spleen Qi Xu

Symptoms and signs
Pale face
Quiet voice
Poor appetite or excessive eating
Thin and lacking in energy or overweight
Frequent infections
Often associated with asthma
Weak pulse

Additionally these patients may have signs of a lot of mucus, such as
Nasal discharge
Cough
Slippery pulse

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Heart Fire

Symptoms and signs
Face red
Eyes red
The inner canthus is especially red, inflamed and painful
Restlessness
Insomnia
Tongue red with thick yellow coat
Pulse rapid and slippery

Bladder channel Damp-heat

Symptoms and signs
Stiff back
May have slight urinary problems
May have to urinate in two goes
Ache in occiput.

Blood insufficient

Symptoms and signs
Face gray
Hair is dry or brittle
Tired
Lives off nervous energy
Tongue pale

Liver and Kidney weak

Symptoms and signs
Sore back
Weak knees
Arthritis
Poor memory
low in vitality
no interest in life


Julian Scott
Blocked tear duct

the patterns which are likely to underlie blocked tear duct are

Heat patterns
Liver Qi stagnation
Heart fire

Phlegm patterns
Bladder channel Damp-heat

Deficiency patterns
Lung and Spleen Qi Xu
Liver and Kidney Weak

Dry eyes
Liver blood insufficient
This more or less corresponds to the Western pattern of anaemia.

Liver and Kidney weak
This pattern is common in old age. There is general weakness, but specially Yin Xu, nor
Yang Xu.

Kidney Yin Xu
The common time for this pattern to emerge in western patients is the menopause. They
may not show the malar flush conventionally associated with Yin Xu, but there are often
many other characteristic symptoms and signs. Another situation is those undergoing
radiation therapy, where the burning radiation has consumed Kidney Yin.

Full heat
These are the people who run hot all the time. They may be seen in short trousers or
cotton dress in the middle of winter. Typically they have a red face, and a full, rapid pulse
and a red tongue. Sometimes, especially in older people, the face is not so red, but is more
yellow. This happens when the Qi is somewhat weaker, and also when the heat is trapped
inside.

Liver Yang rising
Typical symptoms include irritability and even outbursts of anger, red or purple tongue with
a dirty coat, wiry pulse. Generally these people exude an atmosphere of frustration and
pent-up energy. In China, this pattern is usually accompanied by hypochondriac pain. This
symptom does appear in Western patients, but not always.


Julian Scott
Spleen Qi Xu
Typical symptoms include poor digestion, tiredness, lack of concentration, a tendency to
worry, weak pulse. These people may exude a defeated attitude. In China this pattern is
usually accompanied by loose stools, but in the West, irregular stools are more common,
possibly loose stools alternating with several days of constipation.

Thick phlegm
This pattern is rarely mentioned in Chinese texts, but is common in the West. Its root cause
is often the combination of many immunisations and suppressed fevers. Common
symptoms include congested lymph system, dry or dusty skin, or even flaking eczema.

Lung weakness
We prefer to use the term Lung weakness rather than Yin or Yang Xu because this is how it
often presents in the West. Typically there may be a history of Lung illness, such as
chronic cough, or asthma when young, which at present does not manifest as a lung
condition, but which is nevertheless the major imbalance, and needs to be treated for a
successful outcome

Special diagnostic pulse:
The bean bone pulse is a sure indication that there is lung weakness, even if there are no
other symptoms. Normally the pulse can be felt in the first position on the right it
represents the lungs, and on the left the heart. But examining the pulse closer to the wrist,
the pulse becomes fainter, so that by the time the practitioner is pressing on the patients
wrist bone, little or no pulse can be felt. However in the bean bone pulse, the pulse can be
clearly felt for up to a centimetre beyond the crease of the wrist. On the right it represents
damage to the right lung, and on the left damage to the left lung. The length and strength
of the pulse in this position are an indication of the depth of damage to the lungs.


Julian Scott
Corneal erosion

Common symptoms
localized opacity
nearby redness and excess blood vessels
photophobia
watering eyes
pain similar to that felt with a foreign body
or
Fierce pain in eyes
irritable iritis (because toxins reach the iris)

Spleen and Kidney weakness (or Spleen and Kidney yang deficiency)
sclera has a muddy look
patient is tired
weak knees
sore or weak back
pasty complexion
tongue may be pale, possibly with red at the edges
soggy and weak pulse

Liver and Gallbladder heat
bloodshot eyes
possibly a red face, but more often in the West, the face is pale
male patients may have blue color along the jawline
tense and irritable
tendency to high blood pressure
wiry pulse
purple tongue

Wind-heat
very red, very sore, itchy eyes
possibly watery eyes
sudden onset
signs of an attack of wind-heat
possible fever
possible thirst
pulse is floating and rapid
tongue has thin coating and red tip


Julian Scott
Lung yin deficiency
white face with malar flush
night sweats
thin build
history of Lung problems
possible history of excessive use of steroids for treating asthma
overstimulated
pulse is fine and rapid
tongue is thin, red at tip or red all over, and maybe peeled


Julian Scott
Optic Atrophy weak eyes
Includes:
Macular Degeneration,
Retinitis Pigmentosa
What are drusen?

What is retinal oedema?

Orthodox treatment Lucentis

Aetiology and pathology - why are the nerves dying?
Not enough nourishment
Either the blood is thin, or not enough blood is reaching the retina
Or there is a fluid imbalance
Damp-heat injures the nerves

Patterns
Liver and Kidney weak (xu-ruo)
Heart Ying weak
Spleen and Kidney Yang Xu
Stagnation of qi and blood
Accumulation of phlegm
Damp-heat
Lung Qi / Organ weakened
Symptoms and signs

Liver and Kidney weak (xu-ruo)
Patient is old, tired of life
No reserves of strength
Weak back
Maybe incontinence or prostate problems
Weak memory

Heart Ying weak
Palpitations
Insomnia
Easily worried
Face white or pale purple
Maybe hardened arteries

Julian Scott

Spleen and Kidney Yang Xu
Tired
4 limbs feel heavy
Weak digestion
Weak back

Stagnation of qi and blood
Frustration
Strong feelings, but maybe hidden under a cheerful face
Purple tongue

Accumulation of phlegm
Face is shiny or else looks powdered
Tight, compressed feeling in eyes and face
Pulse slippery or else deep

Damp-heat
Overweight
Sweating at night
Abdominal distension
Tired and heavy feeling
Pulse slippery or soggy or weak

Lung Qi / Organ weakened
White face
Quiet voice
Dreamy expression
Cracks in lung area on tongue
Special lung pulse

Advice
It can be helpful to take mineral and vitamin supplements.
The patient should be tested for mercury and other heavy metal poisoning.

Other treatments
Microcurrent stimulation
Daily electrical stimulation of the points around the eye with a microcurrent stimulator has
been shown to be beneficial.

Dry type is characterised by drusen and possibly growth of blood vessels
Wet type is characterised by retinal oedema, retinal bleeding


Julian Scott

Retinal bleeding
Blood heat
Red face
Red tongue
Rapid pulse

Spleen does not hold blood
Overweight (in the West)
Bloating after meals
Food intolerances
Varicose veins

Weak heart and vessels
Easily tired
Palpitations
Other Heart signs
Pale or purple tongue
Irregular pulse


Julian Scott
Glaucoma (closed angle, acute)
Glaucoma is the name given to the symptom of increased pressure in the eye. The normal
pressure in the eye is about 13 to 15 mm of mercury (~25mbar). this is quite a low
pressure, being the pressure you would find at the bottom of a pint jar or bottle(17-20cms of
water). This pressure is enough to keep the eyeball 'inflated'. In pathological conditions,
the pressure can increase drastically - to as much as 75mm (100mbar) - some 5 times
normal value. It is generally considered to be glaucoma if the pressure rises to 25mm
(33mbar), but some glaucoma symptoms have been reported at pressures as low as 19mm
(25mbar).

Treatment of after effects
The after effects of acute glaucoma are likely to be partial blindness, often in a
characteristic shape (see fig xx), as a result of damage to the optic nerve. From the point of
view of treatment by acupuncture, the principle and practice of treatment is the same as
damage to any nerve, such as numbness in the leg due to a damaged sciatic nerve.

The following rules apply:
Intensive treatment needs to be given.

This intensity of treatments needs to be carried out for about 100 treatments.

Treatment is much more successful if started within 3 months of the nerve injury.

Results
If the treatment rules given above are followed, there is a good chance that daylight
eyesight will be completely restored. There may be some slight reduction of night-time
vision in the affected areas.


Julian Scott
Open Angle Glaucoma (chronic), ocular hypertension
Orthodox Treatment drops, trabeculotomy, stent

Liver Yang rising
Patient is under stress
Frequent strong headaches
Pale or purplish face
Purple tongue
Wiry pulse

Kidney weak
Patient looks old or tired
Hair is thinning
Face colour may be pale, or may be bright red
Sore or weak back
Arthritis
Pulse may be weak, but more often is long, characteristic of hardening arteries

Spleen Qi deficiency
Gray face
Tendency to overweight
Difficulties over food diet does not seem to help
May overeat
Pale tongue, possibly coated, or possibly with stringy saliva
Pulse slippery

Phlegm obstruct flow of fluids
Gray face
Tendency to eczema/dry flaky skin
Food intolerance/allergies
Tendency to stone formation
Pale tongue, possibly coated, or possibly with stringy saliva
Pulse slippery or wiry

Lung Qi Xu
Pale or white face
Quiet voice
May have history of asthma or other lung illness
Possibly frequent infections
Often a dip or discoloration in the lung area of the tongue
May have bean bone
1
pulse

1
Bean-bone pulse is a pulse that can be felt on the radial artery just distal to the wrist line. In a healthy person it should
not be possible to feel this pulse. Its presence indicates injury to the lung organ, for example by whooping cough when
young or tuberculosis.

Julian Scott
Cataract
Cataracts occur because there is too much heat in the system. One should not be misled
by the symptom of feeling cold. Often patients feel cold because they are weak or tired, or
because the heat inside does not reach the surface. The very fact of cataract points
towards heat of some kind.

Syndrome Aetiology Symptoms Tongue Pulse
Liver and Kidney
weak heat
Old-age,
exhaustion,
overwork
Pale face, pasty
or wrinkled skin,
tired all the time,
dark rings under
the eyes
thin, red dots,
cracks on surface
thin, tight;
possibly long
Lung dry or Yin
Xu
Chronic lung
condition, lung
illness early in
life, overwork,
exhaustion
White face,
history of lung
problems,
dreamy
expression
Usually pale, but
may be red
towards the tip
Usually weak, but
may be rapid.
Often there is a
special lung
pulse.

We have used the term 'weak heat' in preference to the term Yin Xu, as Western patients
often do not exhibit the typical symptoms of Yin Xu of night sweats, and five centres hot.
There nearest they may get is often that they have to sleep with their feet uncovered, even
in winter.

New causes:
Exposure to chemicals in youth

Other treatment:
Cineraria maritima eye drops (Dr. Reckeweg)

Julian Scott
Short Sight

First of all treat stress
The treatment of stress in children is not really medical work, but is more in the sphere of
counseling.

Then treat any Qi imbalance:

Prescription for Spleen Qi Xu
St-36 Zusanli
Sp-6 Sanyinjiao

Prescription for Lingering Pathogenic Factor
Once the Spleen deficiency has been overcome, there may still be a Lingering Pathogenic
Factor. A typical treatment for this would be
Bailao (Extra)
Bl-18 Ganshu
Bl-20 Pishu

Bringing qi to the eyes
Undoubtedly the best way is for the child to do the self-massage techniques described,
because these can be done three times a day.

There are other ways - straight acupuncture, electric plum blossom needle, microcurrent
stimulation.

Prescription of points to bring qi to the eyes
Zanzhu Bl-2
Yuyao (Extra)
Tongziliao SJ-23
Yangbai St-2
Fengchi Gb-20
Hegu Li-4
Neiguan Pc-6 (optional)

Ideally these points are treated every day for 10 days, with a rest of 5 days. In practice,
they need to be treated three times a week minimum. If you treat less often than this, it is
not worth doing at all, and just involves everyone in frustration and expense.

Self checking
. . . is important


Julian Scott
Maintaining qi to the eyes after treatment
The best way (in fact the only way) to maintain the flow of qi to the eyes is to use them!
The child should be encouraged to look carefully at pictures, at scenes, generally to look
carefully at the surroundings. The very act of looking brings qi to the eyes.

Advice to parents
Always have good light when reading or doing close work.
Don't watch TV or do computer games.
Sit in a good position when doing close work.
If the child is wearing spectacles all the time, spend some time each day without
spectacles.
Gradually reduce the strength of the spectacles, rather than gradually increasing them.

Squint
Crossed eyes which appear in childhood must be treated in childhood. In fact the condition
must be treated before the age of 8 years at the very latest if there is to be any hope of
success. This is because there is always one dominant eye, and the other eye, the lazy
eye gradually falls into disuse. If this eye is not used at all through the 7 to 8 year
transition, it becomes blind.

Causes of squint

Mechanical defects
1. Shortened muscle

2. Paralysed muscle

Diagnosing squint
For Caucasian children this is usually quite easy, but when diagnosing young babies, and
Orientals it is easy to make a mistake, because there is a fold of skin which makes it look
as though the eye is not central, even though it really is.

Energetic causes for shortened muscle

Congenital
No big problems: the child is born with a squint.

Hot Lingering Pathogenic Factor
The key symptoms and signs are:
child is born with good eyes, and then develops a squint
onset is after a fever on immunisation
swollen glands in neck, under ears or in groin

Julian Scott
some signs or red on the face, such as red cheeks or red lips
maybe red tongue or red tip to the tongue
irritable, restless.

Overexcitement
The key symptoms and signs are:
child is born with good eyes, and then develops a squint
squint is worse when overtired or overexcited
often red cheeks
lower back is often weak
child is shy at first, then playful and overexcited
tongue may be red, or may be pale
pulse rate varies with excitement.

Paralysis
There are a lot of similarities between this pattern and the second one, LPF, for the simple
reason that they are both the result of a fever. In this pattern the fever has gone deeper
and caused the paralysis. So one often sees exactly the same symptoms, the only
difference being in the movement of the eyes.

However, one does sometimes see an alternative pattern, that of qi xu; in which case one
will see the following symptoms and signs;
pale face
tired, floppy
poor appetite
sleeps a lot
dull spirit in the eyes.

Conjunctivitis
Other treatments:
Eye drops: Euphrasia (Weleda) Calendula (Weleda) Euphrasia and Vaccinium (Vizulize)

Recovery after surgery
Very simple points can be of use the basic points for bringing Qi to the eyes, such as:
Zanzhu Bl-2
Fengchi Gb-20
Hegu Li-4
Guangming Gb-37
Can make a great difference in the rate of recovery, maybe even making the difference
between a successful operation and one which fails.


Julian Scott
CASE NUMBER 1
Mr N Aged 78 years
Appearance:. Square face, engaging smile, Well preserved. Face colour is red. both eyes
slightly watery.
Behaviour:. Seems to be in a hurry every time he comes. Likes to take control. Wants to
know everything about sterilization and safety procedures.
Main complaint: Blocked tear duct, It has been there on and off for two years. He has
been offered surgery, but is unwilling to go down that route, because of health risks. (A
close friend died recently on the operating table)

Don't turn over until you have answered the first few questions
What are the possible syndromes for blocked tear duct, and for high blood pressure?

Blocked tear duct High blood pressure

Which syndrome is most likely?

Now turn over and study the rest of the symptoms.

Suggest a treatment.

What stages are there in treatment. i.e. what will you treat first, and what would you expect
to happen?

What results would you expect from treatment, and how soon?


Julian Scott
SECTION B Answers to 10 questions

Head and body: Used to be very dizzy, until he was found to have high blood pressure.
Since taking medication he does not get these attacks. However, he once had a mild
stroke when he got while telling a story in the local pub.

Food and Taste: keeps on going on diets. Mostly he tries to avoid cholesterol, so he does
not eat eggs except when he goes on an all-egg diet.

Stools and urine: has to get up 3 times in night to urinate. Stools are OK.

Sleep: wakes one or two times, but is very heavy in the morning.

Drink and thirst: nothing special. Likes to drink wine every night. Says it helps to prevent
stroke

Life: Still active. Goes jogging every day

Pulse: slippery-hard, 84 per minute.

Tongue: dull red-purple, with a rough coat.


Julian Scott
CASE NUMBER 2
Mrs. J aged 58
Appearance: Dull coloured face, slightly yellow, significantly overweight: pasty complexion
Behaviour: rather heavy footed
Main complaint: Corneal erosion, especially the left eye. On waking the eye is painful and
watery, feels like grit in the eye, pain may last for an hour or two before subsiding. Recently
has had actual erosion, with fierce pain. This may occur in the middle of the night.

Eyes are often blurred, in spite of spectacles (cannot wear contacts)
Eyes feel tired all the time.

Digestion: some indigestion with flatulence, worse when rushing around too fast
Sleep: used to sleep very well, until this happened. Now often wakes at 3.30 to 4.00am
Energy: is OK.
Appetite: OK
Life. Happily married, but fed up with work, and is looking forward to retiring in a year and a
half. Her hobby is writing books (she has published about 20)

Pulse: 72 slippery-soggy, quite strong, except both 3
rd
positions
Tongue: slightly pointed, red a tip, slight rough coat.

What are the syndromes for corneal erosion?

Which syndrome is uppermost?

Why do you think she has developed this condition?

What do you think needs to change in order for her to get better?

What treatments and advice are you going to give her to achieve that change?
Be specific in the aim of treatment, a typical prescription, how long you think she will have
to come for treatment

In advice, please be specific in the advice which she MUST follow, and the advice which is
just helpful.

Julian Scott
CASE NUMBER 3
Master O Aged 16 years
Appearance:. Tall, well built, pale face, droopy posture
Behaviour: Quiet, dull voice.
Main complaint: Retinitis pigmentosa, Diagnosed one month ago after 2 year history of
increasing night blindness. Field vision test at routine appt. alerted the
optician to peripheral vision loss and he made referral. Hospital has said there
is no tx. for the condition however through internet search they have found
that Vitamin A is prescribed for this condition in the US. Mum has found
medical herbalist who is prescribing it to them along with chromium, gingko
and omega oils which he is already taking for migraines.

What are the possible syndromes for optic atrophy?



to happen?



Julian Scott

Sweating Doesnt really sweat, even with sports. Is big on sporting activities.

Head & Body Severe migraines which can last up to 3 days. Started 2-3 yrs ago. Triggered
by exercise, especially bad when he had an important match to play. Rather
sketchy about exact symptoms, no real visual disturbances, couldnt say
whether they were one sided or not, just like a very bad headache- some
nausea. Migraines ceased after tx. by herbalist.

Food & taste Wont really eat fruit or vegetables, likes the usual teen diet but Mum
tries to keep him on track with home cooked stuff. He thinks he has a good
appetite but Mum begs to differ. Also eats a lot of chocolate at least one
medium bar of galaxy milk chocolate a day, sometimes more, plus minstrels.
Hates the taste of salt & vinegar.

Drink & thirst Drinks very little, doesnt feel thirsty, often forgets to drink unless prompted.
This runs in family, Mum is the same but has trained herself to drink more.
Doesnt drink at night but wakes up v. thirsty and drinks a lot first thing in the
morning. Drinks mainly milk or water.

Sleep Very restless. Has difficulty falling asleep. Sometimes it takes hours,
occasionally quite quick. Also talks a lot in sleep and will sit up and move
about whilst fast asleep. Friends have witnessed it at sleep-overs and family
tell him about it, but he is unaware.

Life Lives with Mum, Dad brother and sister. Sister has autism. School is ok,
works hard at school but not much work at home. Likes maths & sports.

Immunisations Had a bad reaction to first triple vaccine but I couldnt get Mum to say
exactly what the reaction was. When the time came for the next one, GP split
them up and gave whooping cough separately. Mum is quite suspicious of
vaccinations since younger child developed autism.

Occiput Felt very soft, certainly no tightness or tension. If anything it was unusually
soft. No glands that I could feel.
GB 20 Felt squashy like a marsh

Liv 14 -
Taiyang pt. -

Face No tenderness, nothing unusual struck me. No tenderness on any of the local
points around the eyes.

Lumbar Areas directly over each kidney felt squashy (esp. on L side) but everywhere
else felt stiff like a board.


Julian Scott
Other Impressions Has always been very physical and sporty. As a child he was always
ahead of physical milestones. Apparently a bit of a risk taker as a child
bordering on the hyperactive.
Considering how sporty he is supposed to be, his frame, posture and energy
dont give a sense of being particularly robust or sturdy. Posture looks more
like a teenager who sits in his room watching TV or playing guitar. Quite
gangly, like someone who has grown too fast and body cant quite keep up.
Mum alludes to ill health generally in the family and gets a bit defensive when
I question him around Fear. She thinks I think he is anxious. She leaps in to
say that he is the most normal of us all- in fact when the rest of us are all
getting anxious about things, he is the one who holds us all together and
keeps our feet on the ground. I cant help wondering whether he feels under
pressure to be responsible for the whole family in this way. Perhaps Im way
off the mark but something felt a bit weird, there was a dynamic that felt tense
at that point.

Pulse Floating on all positions, also slippery on the right side. * radial artery on RHS
is on dorsal surface of arm.
Tongue Normal colour, no coat, quite wet.


Julian Scott
CASE NUMBER 4
Mrs. D Aged 57 years
Appearance:. Tall, well built, pale face, a distinguished and fine nose, red lips
Behaviour: Quiet, measured tones in her voice.
Main complaint: Macular degeneration, It is in its early stages, and she can still read
quite small print, though she is noticing things going fuzzy.

Also she has a chronic cough. This has been going on for nearly a year. In the summer it
gets a bit better, and in the winter a bit worse. The cough is worse when she lies down at
night, though it is there in the day too. When she coughs she brings up some thick green
phlegm.

What are the possible syndromes for macular degeneration and for chronic cough?

Macular degeneration Chronic cough



to happen?



Julian Scott

Chills and Fevers: Has always been hot at night

Sweating: not much

Head and body:

Sleep: goes to sleep easily, but often is wide awake between 1.30 and 2.30 a.m..

Drink and thirst: Normal. Likes a glass of whisky at night time (was brought up in Scotland)

Life: Housewife. Has a daughter and grandchildren living nearby.

Pulse: wiry in all positions. More full, and wiry-slippery in the lung position

Tongue: Red-purple. More red at the tip. A hollow area just posterior to the tip. Peeled
towards the root

Periods: finished. Used to be rather painful


Julian Scott
CASE NUMBER 5
Miss T Aged 26
Appearance Smiling face, red cheeks slightly yellowish skin, slightly green around the
mouth
Behaviour: Easy to get on with. Charming.
Main complaint: Glaucoma, for one year. It started with headaches and sparks in front of
the eyes, especially early in the morning, just after waking. Since the diagnosis she has
been putting drops in her eyes morning and night. These are effective in keeping the
pressure down in her eyes, and so she does not see any sparks. But she still gets lots of
headaches.

What are the possible syndromes for glaucoma?

Which syndrome is it?


Will you treat?

If so, what will you aim to do with the treatment.



Julian Scott

Head and body: headaches are mainly at the temples, going through to the eyes.

Food and Taste: does not like greasy food. Sometimes even the thought of it makes her
feel nauseous.. No appetite in the morning breakfast is black coffee and an apple.

Stools and urine: Stools are always dry, and difficult to pass. Gets cystitis from time to
time, for which she takes cornsilk tea, except when it gets bad, when she takes antibiotrics.

Sleep: sleeps the sleep of the dead

Drink and thirst: rather a thirsty child, liking to drink a lot. She likes a glass of water beside
the bed, so that she can drink when she wakes.

Life: works as a post-office counter clerk. Since the introduction of time-and-motion
studies, there is always a queue. If she makes a mistake with the money, she has to make
up the shortfall out of her own wages.

Exercise: does not like taking much exercise, though she walks to work, and in the summer
she likes to go swimming.

Pulse: not very strong. Tight..

Tongue: bright red.

Periods: every 25 or 26 days. Usually painful on the first two days. Usually has to take a
painkiller, but sometimes she has to stay off work


Julian Scott
CASE NUMBER 6
Miss T Aged 6 years
Appearance: Pale face with red hair, Some pink in her cheeks. Her left eye turns in
markedly, and is obviously not used. She has crusts under her nose.
Behaviour: rather shy. Quiet.
Main complaint: Squint, for three years. Three years ago she had a bad attack of
bronchitis, with very high fever, and the eye has not been well since then. According to
tests at the eye hospital, there is actually some use in the left eye, and she does
occasionally use it.

Also she has a chronic cough. Every winter she gets three or four really bad coughs, and
has to take antibiotics each time. Even during the summer she sounds a bit chesty.

What are the possible syndromes for squint?

Which syndrome is it?

Comment on the pulse

Comment on thirst

Comment on capillary

How urgent is the treatment?


to happen?


What advice are you going to give the parents?

Julian Scott

Chills and Fevers: rather a hot child. Especially hot at night

Sweating:

Head and body:

Thorax and abdomen: lots of coughs!

Food and Taste: drinks lots of milk, eats lots of cheese. Fond of peanut butter and banana
sandwiches.

Stools and urine: Generally no problem, though the stools tend to be loose.

Sleep: wakes one or two times, but is very heavy in the morning.

Drink and thirst: rather a thirsty child, liking to drink a lot. She likes a glass of water beside
the bed, so that she can drink when she wakes.

Life:

Pulse: slippery rapid. Lung position is very full. There is a pronounced special lung pulse.

Tongue: dull colour, with a red tip.

Immunisations: "All the usual"

Glands: very swollen under jaw. There are even some small pea shaped ones on the side
of the neck.

Capillary: broad, dark!


Julian Scott
Case Number 7
Mr.J aged 54 yrs
Main complaint: Retinal bleeding, and retinal
arterial occlusion.
The left eye has now very little vision, after
arterial occlusion. The vision was suddenly
impaired by arterial occlusion. Laser
treatment was unsuccessful and made him
totally blind in this eye. There is fairly good
vision in the right eye, but there has also
been bleeding there, and the vision is hazy,
and is getting worse. He is understandably
reluctant to have further laser treatment.

Appearance. On first few visits, colour was
somewhat yellow, in later visits it is showing
red.

Digestion
He has always had slight heartburn, but since last Christmas the stomach has been very
painful. It has been diagnosed as acid reflux and inflamed oesophagus. He has always
had a lot of burping. All this better if he takes tablets.

Limbs in good condition, generally. Some arthritis in knee from an old injury. He is a
carpenter and works mainly constructing roofs.

More about vision: is hazy, worse in morning, worse in darkness. Has lost some of upper
field of vision. Inspection of picture of retina shows where there are blood clots and also
where it has escaped.

Pulse a bit slow. LH a bit deep and slightly muddy, a bit weaker in He.
RH a bit slippery, more full in lung position, and very much so distal to the cun position, on
the wrist bone, which is the 'special lung pulse'. Not especially full in the stomach position.

Tongue: Colour good, a little pale, large cracks.
BP was reported to be 150/88


Julian Scott
Questions: What examinations would you do?

What is your diagnosis?

What advice would you give?

What treatment would you give?

What is the prognosis?


Julian Scott
CASE NUMBER 8
Mrs W Aged 67 years
Appearance: Slightly overweight, wrinkly face, yellowish.
Behaviour: Moves rather heavily, groans from time to time.
Main complaint: Fierce pain in L eye, for five days. Ten days ago she had an operation
for detached retina. Healing was going well until five days ago, on Friday afternoon.

On the next day she phoned the hospital where the surgery was performed, opnly to find
that the surgeon had just gone on holiday.

Other symptoms and signs
Confesses to being a worrier. I worry about not having anything to worry about

Often bloated after meals. Has to be careful about what she eats.

Knees very swollen. Give her trouble in cold and damp weather

Tongue pale

Pulse: tight in all positions

What would you do?


Julian Scott
Case Number 9
Miss S Aged 15 years

Appearance: Pale face, attractive look. Shiny skin on the face, with mild acne

Behaviour: polite; does not feel comfortable sitting up straight prefers to slouch

Main complaint: Coats syndrome: Coats disease is a serious condition of the eye,
where the small arteries enlarge, and start to leak. There is also exudation i.e. the
formation of a whitish yellowish substance over the retina. If untreated, this leads gradually
to blindness, at first locally, then, as the condition worsens, it can lead to glaucoma and
retinal detachment. It can be present as leukoria (a wide appearance of the pupil).
Aetiology unknown. Usually, only one eye affected. Treatment: sometimes laser
coagulation.

She has been noticing some loss of vision in the upper R quadrant, which has slowly
increased over the past year.

She has always problems with her throat, high tension of the muscles in the neck,

Don't turn over until you have answered the following questions
What are the conditions (in Chinese medicine) which give rise to blood leaking out of the
vessels?

What are the conditions which give rise to greasy deposits?

Now turn over and answer the following questions.

What imbalances do you think there are?

What is the significance of the cracking noise from the jaw?

What is the significance of the rough skin?

Why do you think the problem occurs in teenage?

Do you think you can help? If so, how long will it take before you see any improvement?

What character changes might you see during healing?

what do you think she has to do in the way of treatment and changes in life style?


Julian Scott

SECTION B answers to 10 questions

Chills and fevers: nothing special Sweating: nothing special

Head and Body:
Recurrent headaches, pain in the eye,
Loud cracking noise from the right jaw; when she moves her jaw up and down, there
is a sound like a large twig snapping
Tight and painful throat;
Tenderness at Fengchi Gb-20 and Yifeng SJ-17;
always has cold hands and feet
Rough skin on the body (like sandpaper),
Weak lumbar back

Thorax and Abdomen: Unexplained abdominal aches

Food and Taste: Poor appetite

Stools and Urine: tends to constipation with hard dark stools

Sleep: Takes time to get to sleep at night

Drink and Thirst: not much thirst. Likes sweet drinks also lemon juice

Energy: Unexplained periods of tiredness, lasting an hour or two

Life: teenager!

Menstruation: Menstruation is irregular, shorter than 28 days, mostly every 3 weeks, the
blood is dark , not clotted

Tongue: looks normal, she has a very thin crack in the middle (heart crack ) but no coating
in it, there are no signs of blood stagnation

Pulse: Slippery-tight


Julian Scott
CASE NUMBER 10
Mr. G aged 68 was still very active, and although he had officially retired, he was, if
anything busier than before. He had had glaucoma since his early 40's, which had been
treated with drops. Unfortunately, as time went on, his body became more and more
accustomed to the drops, and they more or less stopped working. Consequently, about 20
years ago he had a trabeculotomy. However, even this did not produce lasting relief. The
pressure continued to rise.

By the time he came to me, there was damage in both eyes, severe in the left eye, so much
so that he was obliged to give up his driving licence. He still had (just about) enough sight
to continue what he was doing, but it was deteriorating.

Appearance: tall, thin, wiry body; thinning white hair, slightly purple face; bright eyes,
enthusiastic

Examination: energy in back was weak; tender at SJ-17 Yifeng point, especially on the left;
slightly tender at Gb-20 Fengchi

Past history: 2 years ago was diagnosed as having high cholesterol. Otherwise nothing
abnormal, except last year had a period of bad diarrhoea. He had to get out of bed in the
morning to pass stools. This is better now.

Pulse: Left side: wiry, tending to long, though stronger in 3
rd
position
Right side: more slippery than wiry, stronger in 3
rd
position
Speed: when he first came in it was 60, but the speed gradually slowed to 54

Tongue: a bit red, surface is slightly rough, some sticky saliva on tongue

What do you think is the main pattern?

What treatments would you give?

Will they work? If so, how soon?

What would you expect to happen?

Julian Scott
CASE NUMBER 11

Ms A Aged 43

Appearance: Strong build, slightly overweight, red face

Behaviour: quite voice, rather submissive behaviour, in spite of obviously being strong

Main complaint: Macular degeneration, wet type. Foggy central vision, like a gray cloud.
Had laser treatments 5 to 6 times over last year, to close off rogue blood vessels and stop
them leaking. This was successful, but keeps on needing to be done, as the blood vessels
return.

She has had short sight (6 dioptres) since 7 years old

Don't turn over until you have answered the following questions

What causes blood to leak out of the vessels?

What are the syndromes for macular degeneration?

..

..

..

..

Now turn over and answer the following questions.
Does the short sight have any relevance to your treatment?

What treatment will you give, based on the syndrome you have chosen?

Why do you think a person of this age and this state of health has a degenerative disease?

How does this affect your treatment, advice and prognosis?


Julian Scott

SECTION B answers to 10 questions

Chills and fevers: nothing special

Sweating: nothing special

Head and Body: easily gets tense in head, neck and sholders

Thorax and Abdomen: chest is fine, but abdomen somewhat large

Food and Taste: good appetite. Easily puts on weight. Family history if old-age diabetes.

Stools and Urine: OK No problems

Sleep: OK

Life: alternative medicine practitioner and teacher

Pulse: soft/slightly slippery. Not very strong. Weaker in left side middle position. Both 3
rd

position (chi) very weak.

Tongue: enormous central crack. Dry, greasy coat

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