Case study: Eye disorder

This case study outlines one specific case of treatment for conjunctivitis, or 'pinkeye'. It is for practitioners to illustrate my method of point selection and for patients to help understand the process.

Case study: Eye disorder

Acupuncture treatment of conjunctivitis

A note on diagnosis and 'pinkeye'

Strictly speaking this ought to be called a treatment for "pinkeye" since I am not a medical doctor, and it could be argued therefore that I cannot make this diagnosis. However the manifestation of redness itching and feeling of heat in the eyeball indicates an inflammation of the conjunctiva, the outer membrane of the eye, hence conjunctivitis.

Case History

The patient a 38 year old woman was under ongoing treatment for a variety of issues including an old ankle injury still causing problems, frequent waking in the night, pre menstrual tension and a sluggish digestion getting worse around her period. She was also experiencing persistent low phlegm cough.

Her tongue was pink with pale edges and tooth marks and a red tip, and her pulse was wiry in the middle (guan) position, and forceless in the upper (cun) position.

The diagnosis of her pathology I was working under was of Spleen Qi deficiency and Liver blood deficiency leading to stagnant Liver Qi which invades the Spleen, further compounding the situation. The weakness in the Spleen led to the accumulation of damp which in time engendered phlegm, then stored in the lungs.

Previous acupuncture treatment for digestive and menstrual irregularity

I had been treating her to tonify the Spleen and stomach to nourish the blood, tonifying the lung Qi and smoothing stagnant Liver Qi using a selection of point drawing from the following depending on her presentation that day:

  • St36 Zusani
  • St40 Fenglong
  • Sp6 Sanyinjiao
  • Sp3 Taibai
  • Lu9 Taiyuan
  • Liv5 Ligou
  • Liv3 Taichong
  • Liv8 Ququan
  • Ren6 Qihai with moxa

Largely the treatment was successful leading to a reduction in pre menstrual symptoms, better sleep, more energy and a more consistent digestion, although still less regular than daily.

On her sixth treatment she had woken that morning with a very red sore left eye, itchy and with the feeling of heat. She had a history of conjunctivitis but hadn’t experienced it for a long time (around 2-3 years). She hadn’t slept well that night waking 6 times but not recalling dreams, she felt restless and “not in a calm space”.

She admitted her diet had been "abysmal" and she had also been having some emotional problems involving her relationship. She had been mentally erratic, apathetic and craving salty and sweet snacks with constant hunger and thirst for cold drinks. She was on day 21 of her menstrual cycle.

Her tongue that day was still pale with puffy and paler edges indication the predominance of Spleen Qi and Liver blood deficiency but her pulse was full, wiry and rapid indicating heat and Liver Qi stagnation.

Chinese medicine diagnosis of conjunctuvitis

My diagnosis was of Liver invading the stomach causing stomach heat which had transmitted to the stomach channel affecting the eye. The aetiology I felt came from a combination of emotional stress heating the Liver and her diet of sweet foods weakening the Spleen and stomach allowing further aggression by the Liver. Her craving for salty snacks and emotional situation on top of her previous pattern indicated a Kidney yin deficiency underlying.

Acupuncture Treatment for conjunctivitis (pinkeye)

My prescription on that day was:

  • Kid6 Zhaohai
  • & He7 Shenmen to calm her shen, harmonise Heart and Kidney and help her sleep.
  • Liv14 Qimen to harmonise Liver and Stomach
  • Du20 Baihui to calm the shen and benefit the eyes
  • On the left:
  • St2 Sibai
  • & St44 Neiting to clear heat from the eye and the stomach channel
  • On the right
  • Liv2 Xingjian to clear heat from the Liver

This was a departure from the previous treatments by including a Heart and Kidney balancing formulation, but it seemed appropriate due to what she had told me about her emotional state.

The result was that her eye had grown significantly less sore by the end of the treatment and was noticeably pink rather than angry red. Apparently it was barely noticeable three hours after the treatment and was completely gone by the end of the day. She slept “really well” after the treatment and felt like there was “a weight lifted”. Her cravings went and she was eating healthier again.

Second Occurence of conjunctivits

Two sessions later (37 days) her left eye was bad again, red and swollen; she could hardly open it. She reported that both times it had flared up suddenly after being angry with somebody, and that this had always been the case in the past. This time she was on her period and had had bad pains when it started 5 days previously. She had also had a cold the week before which had included a headache around the left eye. Her tongue was the same but with tooth marks indicating more Spleen Qi deficiency, and her pulse was more deficient and slippery reinforcing this interpretation and showing the presence of dampness.

The headache in the eye area told me that is was still a weak area and the fact that anger was a factor confirmed that the Liver was a causative factor in her conjunctivitis, but other signs led me to focus more on strengthening the Spleen and stomach this time.

Acupuncture points used for conjunctivitis treatment

My prescription was:

  • Liv8 Ququan to nourish the Liver blood and yin
  • GB34 Yanglingquan to smooth the Qi and clear heat from the Liver system
  • Ren4 Guanyuan to Nourish the Kidneys and fortify the Spleen
  • On the left:
  • St2 Sibai to clear heat from the eye
  • St44 Neiting to clear heat from the stomach channel
  • On the right:
  • St36 Zusanli to tonify the Spleen and stomach
  • Sp3 Taibai to tonify the Spleen and drain damp

The result this time was that the eye was able to open more after treatment although still red and sore and the problem had cleared up the next morning after treatment. She has not to my knowledge had a recurrence.

My decision to do contralateral needling in both cases was to keep the number of points down as the client was quite sensitive to the needles.

Comments

I have to say I was surprised by how quickly the acupuncture treated this problem which usually takes a course of antibiotics to clear. I think this serves as an example of how effective acupuncture can be for eye diseases (especially since this was years ago and I was relatively inexperienced at the time).

It also demonstrates the efficiency of treating something early, 'nipping it in the bud'. The fact that both times the onset of the conjunctivitis was the same day or one day before the treatment will also have helped in her speedy recovery