Treating Macular Degeneration with Acupuncture & Chinese Medicine

Treating Macular Degeneration with Acupuncture & Chinese Medicine
By Andy Rosenfarb, MTOM, Dipl. Ac., Dipl. C.H.
October 23, 2007

Macular Degeneration (ARMD-Aged Related Macular Degeneration) is the slow deterioration of the cells in the macula, a tiny yellowish area near the center of the retina. The macula functions to give us clear central vision and fine detailed images. The deterioration of the macula affects an individual’s central vision – the ability to read, write, drive and recognizing faces – among other visual abnormalities.

There are two types of macular degeneration, wet and dry. Ninety percent of people with macular degeneration have the dry-type in which small, yellow spots called Drusen form underneath the macula. Drusen are believed to be metabolic waste products that accumulate and cause cellular damage. It has been suggested that Drusen slowly breaks down the cells of the macula, causing distorted vision.

Dry macular degeneration can progress into the second, more severe type, called wet-type macular degeneration. The cause of this progression is unknown to conventional medicine. In wet-type ARMD, new, abnormal blood vessels begin to grow toward the macula, causing rapid and severe vision loss. These weak blood vessels can rupture and bleed, thus “wet-type” ARMD. Both wet and dry ARMD are diagnosed by an ophthalmologist and there is currently no safe and effective conventional treatment.

Individual risk factors for macular degeneration have been identified as contributing factors to the development and progression of ARMD. These include: female gender, smoking (increase risk by 200-300%), diabetics, high blood pressure (uncontrolled) and family history of macular degeneration.

Chinese Medicine and Macular Degeneration

In my experience Chinese Medicine can offer a very effective treatment for both types of ARMD. Although this kind of treatment will not help every single ARMD case presented, my personal success rate has been at least 80%. By success I mean that there are either subjective and/or objective measurable improvements in a person’s vision after a series of treatment. There are many simple ways to test vision that are well within our scope of practice as acupuncturists; two being Visual Acuity Test (eye chart) and an Amsler Grid Test.

The clinical objective in treating ARMD is to treat the root cause of the disease pattern. The branch treatment or temporary solution can be to activate the blood circulation in order to resolve stagnation. Visual capacity may be improved by promoting the circulation in choroids and retina, preventing cell death, and reversing the inability to absorb and circulate vital nutrients for healthy vision.

ARMD (wet and dry) is most often an exhaustion of the body’s Yin. The Yin aspect of the visual field is the central vision, and the peripheral vision is more Yang in nature. When the central vision goes, it indicates a “burn-out” of Kidney and Liver Yin, so using Chinese herbs that nourish Yin seems to work best.

The function of the Spleen (supported by the Kidney) is to transform and transport nourishment that is ingested. When working towards generating Yin in the body, it is essential that the Earth element (spleen-pancreas and stomach) be in a state of optimal function. The process of breaking down food into usable nourishment for the cells of the body requires a digestive system. It has been stated in the Pi Wei Lun by Li Ding Yuan that as we age, our earth element (digestive function) weakens. When the body’s capacity to break down food becomes less efficient, the ability to replenish Yin and Blood can compromised as a result of poor digestion. Again, ARMD is generally seen as Yin deficiency cause by a “starvation” with an impaired transformation and transportation function.

The yin deficiency typically leads to a progressive dry-stagnation of Qi and Blood – the later stages in the development of ARMD. The blood vessels of the eye often become so dry and brittle that they can leak blood or burst altogether, thus giving rise to the less common “wet ARMD.” One of the key ways to observe if a patient with dry-type ARMD is susceptible to developing wet-type ARMD is to see if they tend to bruise easily. If they do in fact bruise easily (and have a history of bleeding disorders or have been over-dosed on blood thinners), they have a higher probability of developing wet-type ARMD. If bleeding occurs the following steps should be taken AFTER the patient has been stabilized by their ophthalmologist.

In cases of wet ARMD, if the bleeding is severe they will need laser treatment to arrest the bleeding. If the bleeding is light and the patient has previously seen their ophthalmologist, you cab suggest snail shell moxa techniques – developed by Shmuel Halevi in Isreal.

Once the bleeding has stopped, the next step is to nourish the Yin and invigorate the Qi and blood with acupuncture and Chinese herbal medicine. An herb like Chinese Notoginseng (Sanqi) would be a good choice for wet ARMD, whereas Dan Shen based formulas work better for dry ARMD. You can then follow up with digestive tonic formulas and yin-nourishing formulas, based on the dominating TCM pattern. These formulas should be taken long term (6-12 months), as it can take time to build the Central Qi, and generate Yin.

Acupuncture Treatment:

Body Points:
Distal: Li-3, Si-3, Ht-8, SJ-3, Sp-3, Ki-1, Sp-6, St-36
Local: UB-2 (same effect as UB-1), Yuyao, GB-14, Yintang

Ear Points: Adrenal, Pt. Zero, & Corpus Callosum
Electro-acupuncture:
E-Stim #1: UB-2 to Alt Point – 1 finger medial to St-2
E-stim #2: SJ-23, Tongming ( ½ cun below GB-1)

Note: I recommend using a Pantheon 4C E-Stim Device, where the points are stimulated at a constant 2Hz for 20-30 min.

Caution: Retinal Bleeding

Please DO NOT use local electro-acupuncture on patients with retinal bleeding or elevated inter-ocular pressure (IOP)/ glaucoma. It can cause bleeding in weak vessels and raise IOP.

Use snail shell moxa treatment for light retinal bleeding.
Snail shell moxa can be done daily of every other day for 1-2 weeks with the presence of retinal bleeding. The patient should feel the warmth of the moxa burning.

Chinese Herbal Medicine – Base Formulas:

Wet ARMD
1. Yunnan Paiyao or Sanqi Powder (dissolve 2 g 2x/day in water)
2. Ming Mu Di Huang Tang (Bright Eye Tea)
3. Shu Gan Tang + Erchen Tang (Soothe the Liver Tea + Two Aged Tea)
4. Xiao Yao San
5. Bu Zhong Yi Qi Tang

 

Dry ARMD
1. Ming Mu Di Huang Tang (Bright Eye Tea)
2. Shu Gan Tang (Soothe the Liver Tea) + Er Chen Tang ( Two Aged Tea)
3. Dan Shen Pain
4. BuZhing Yi Qi Tang

NOTE: These are suggested base formulas. Chinese herbal formulas are most effective when tailored to each patients needs based on your TCM diagnosis.

* Andy Rosenfarb specializes in treating degenerative eye conditions and is the author of “Healing Your Eyes with Chinese Medicine.”

Treating Chronic Open-Angle Glaucoma with Acupuncture & Chinese Medicine

Treating Chronic Open-Angle Glaucoma with Acupuncture & Chinese Medicine
By Andy Rosenfarb, MTOM, Dipl. Ac., Dipl. C.H.
January, 2007
This article has been published in Acupuncture.com, April 2007
Over the last 10 years, in my practice I have specialized in TCM Ophthalmology. I have made quite a few significant clinical observations through diagnostic testing, treatment and direct feedback from my patients. In my clinical practice, I incorporate TCM with nutrition and “functional medicine.” Functional medicine uses methods to measure how weak (yin) or stressed (yang) the body’s organs, glands, and systems may be. Among these include blood sugar, adrenals, thyroid, pituitary, oxidation, hydration, ATP-energy production, etc. Both TCM and functional medicine look to uncover patterns of disharmony. The idea is to relate the patient’s symptoms (glaucoma in this case), to the underlying disease pattern.

Chronic open-angle glaucoma is a very common condition affecting about 3 million Americans¹. In my experience, it can be successfully treated with nutrition, acupuncture and Chinese medicine. In chronic open-angle glaucoma, the intraocular pressure (IOP) gradually increases because the eye’s drainage canals have gradually become congested. This build-up of fluid in the eyes can eventually damage the retina and optic nerve. Early glaucoma can be easily detected with regular eye exams. A “tonometer” will measure IOP and a vision field test will detect any peripheral vision loss.

In the early stages, the person will usually be unaware of increasing IOP. Often, by the time open-angle glaucoma progresses, some vision loss may be present whereas conventional medicine will usually recommend eye drops. The drops are used to lower the IOP in an attempt to keep the eye pressure down. The objective of the medication is to lower the IOP as to not cause damage to the optic nerve or retina and, thus, preserve vision. Many patients using these eye drops report that the drops burn and irritate their eyes and causing blurry vision. So conventional medicine offers a solution to lower the IOP, where the side-effects of the medication may be decreased vision… go figure?

The TCM classics say that in most cases chronic open angle glaucoma falls under liver-kidney yin deficiency with liver yang rising. Acupuncture points are suggested to sedate the liver and stomach channels. In my experience, this is most often the correct treatment for acute closed-angle glaucoma, NOT chronic open-angle glaucoma. Of course, you will always want to do your TCM evaluation (tongue, pulse, four-pillar, etc.) to be certain of the dominant pattern. I have personally found that most cases of open-angle glaucoma are due to a weak/deficient Gall Bladder and Kidney. This pattern is often coupled with an underlying Yang weakness.

Through using the principles of Chinese medicine, we can determine the origins of most diseases. In many cases, we can help the patient recover from many forms of illness. The TCM condition(s) of vision loss should first be distinguished with Yin-Yang theory. Looking at the Taiji Yin-Yang symbol, we can learn a lot about the nature of vision loss and how to treat it. Conditions like glaucoma and diabetic retinopathy will usually manifest with peripheral vision loss. The Yin aspect of the Taiji symbol mimics a loss of peripheral vision (dark outer and bright inner); therefore, the condition must be yin dominant and yang deficient. In cases like macular degeneration where the central vision is lost, the opposite condition is present. There is brightness on the periphery and darkness in the center. This means that the condition must be of a yang nature with yin deficiency. Please take a minute to observe this as it is a very simple yet important consideration into understanding the TCM pathogenesis of central and peripheral vision loss. Once this has been determined, you can do your other TCM exams to determine the channels and organs are being most affected.

In terms of treatment, I tend to treat the UB, ST and GB channels. GB being a yang channel delivers the Yang-Qi from the liver to the upper body and eyes. The UB is the yang channel of the water element that delivers the Yang-Qi of the kidney to the upper body and eyes. Stomach channel points are also important to deliver the spleen nutritive Yang-Qi to the eyes. A basic point prescription for Gall Bladder & Kidney weakness is:

Treatment:

GB-1 (local), GB- 20 (move Qi to the eyes), GB-21 (move Qi in GB), GB-30 (move Qi in GB), GB-37 (special eye point), GB-40 (source), GB-43 (tonification), UB-2 (local), UB-64 (source), UB-67 (tonification) St-2 (local), St-36 (horray), St-41 (tonification)

Extra Glaucoma points:

Extra Glaucoma #1 – I cun superior to SJ-23; and one finger-width lateral. In the tender spot, needle posterior until a strong “de-Qi” sensation is obtained.

Extra Glaucoma #2 – ½ cun anterior to St-5; needle superior in tender area as to obtain a strong “de-Qi” sensation.

Eye Exercises to Reduce IOP – Using the middle finger apply pressure below the eyeball, pressing in and up for 10 second, then rest for 10 seconds. Do this 3 times in a row 3 times each day.

As far as Chinese herb formulas go, for this pattern I usually combine and slightly modify two traditional formulas: Wen Dan Tang and You Gui Wan. The therapeutic goal is to mobilize the Qi and Yang of the Kidney, Stomach, and Gall Bladder. Sometimes I will add Er Chen Tang to help clear a path for the clear-yang to ascend to the eyes.

Moxa is also a great adjunctive therapy for glaucoma patients presenting with this kind of deficiency pattern. Use moxa on St-36, CV-12, UB-20, UB- 19, UB-22, and UB-23. Massaging clove oil or cinnamon oil into the GB and UB meridians can also be another effective way of activating the Yang-Qi in the channels.

Very briefly, in terms of functional medicine, I have found that chronic open-angle glaucoma is due to too low oxidation (Qi and yang deficiency) and diminished ATP cellular output (also Qi and yang deficiency). Using oxidants (not anti-oxidants) will help stimulate the metabolism and move the fluids in the eye, which may lower the IOP. Anti-oxidants slow down the fast -catabolic metabolism which we do not want to do. This may contradict most naturopathic and nutritional “antioxidant eye protocols.” A high dose of cod-liver oil (6000-9000 iu/day) is a great oxidant to help patients with open-angle glaucoma. Sterol fats like milk, cream, butter, cheese, etc. can potentially make this condition much worse.

Some herbs that can help boost ATP (Qi) production for open-angle glaucoma are Siberian Ginseng root, Astragalus, Ginkgo Biloba, Cat’s Claw, Capsicum, Colus Forscholi and Clove. These boost the Qi to increase circulation of the stagnant fluid in the eye. Once catabolic activity (Yang-Qi) is activated, the fluid may begin to drain through the eye, lowering the IOP and potentially lowering the risk of optic nerve and retinal degeneration.

NOTES:
1- Glaucoma Research Foundation, October 2006.