The eye is unique in traditional Chinese medicine (TCM) as it has its own unique diagnostic tool called the five-wheel pattern differentiation.

According to Shanghai Traditional Chinese Medicine Hospital, China, associate chief physician Dr Song Yi, the five wheels consist of the wind, qi, blood, flesh and water wheels, which correspond to particular parts of the eye. (See pg1)

Each wheel is in turn related to a particular zang-fu organ, from which TCM practitioners believe comes the disorder that causes the symptoms in the eye.

Explains Dr Song, who has a PhD in TCM ophthalmology: “In clinical practice, five-wheel pattern differentiation is a method to assess zang-fu health based on observing the ocular symptoms.

“Examining the eyes can give indications about the health of the corresponding organs, similar to how we use tongue and pulse diagnosis.”

The concept of zang-fu organs is one of the central tenets of TCM.

These organs do not strictly refer to an anatomical structure, but are more like conceptual systems within the body with their own particular functions, and are commonly referred to as functional units.

There are five zang organs, which are considered to be yin in nature, and six fu organs, which are yang.

The organs related to the eye are the zang organs: Liver (related to the wind wheel), Lung (qi), Heart (blood), Spleen (flesh) and Kidney (water). (These are written with a first capital letter to differentiate them from the anatomical structure.)

Dr Song assesses Nawals pulse at the beginning of the consultation. Because of the limitations of the five-wheel pattern differentiation, other diagnostic methods like tongue and pulse assessment need to be used when diagnosing eye problems in TCM.

Dr Song assesses Nawals pulse at the beginning of the consultation. Because of the limitations of the five-wheel pattern differentiation, other diagnostic methods like tongue and pulse assessment need to be used when diagnosing eye problems in TCM.

However, Dr Song notes that as the five-wheel pattern differentiation method has its limitations, it must be used in conjunction with other TCM methods of diagnosis.

Diabetic retinopathy

Speaking to Fit for life at the start of her two-week stint as visiting lecturing clinician at IMU Healthcare – the healthcare arm of the International Medical University in Bukit Jalil, Kuala Lumpur – last month, Dr Song shares how TCM can help complement allopathic treatments for diabetic retinopathy.

Diabetic retinopathy is the most common, and direct, eye complication of diabetes.

This is where long-term uncontrolled high blood sugar levels damage the small blood vessels, or capillaries, that supply the retina. The retina is where nerve impulses from the eye to the brain are generated.

The damaged capillaries will start leaking fats and fluids, including blood, leading to diabetic macula oedema, or swelling in the macula, which is the area of the retina that provides our sharpest vision.

As these capillaries become too scarred and damaged to function, new and abnormal blood vessels will start to grow rapidly within the eye.

As these new capillaries tend to be too fragile, they will leak fats and fluids more easily, and become damaged and scarred more quickly.

Explains Dr Song: “When you’ve had diabetes for a while, blood vessels can form scar tissue and pull the retina away from the back of your eye.

“This can lead to severe vision loss, and even blindness.”

From the TCM point of view, she says: “The main pathogenesis is associated with yin deficiency, dryness and heat, or deficiency of both the Spleen and Liver.”

Treatment principles for diabetic retinopathy include moistening the Lung, strengthening the Spleen and nourishing the Kidney.

In addition, TCM practitioners will prescribe treatment to stop the bleeding in the eye, drain the fluid, resolve the “stasis” of the blood and restore smooth movement of the qi through the body (as stagnant qi leads to disease).

Complementary treatments

Dr Song emphasises that patients with diabetic retinopathy need to seek both allopathic and TCM treatment.

“Western medicine is necessary. We suggest patients use Western medicine and Chinese medicine treatment at the same time,” she says.

Dr Song does acupuncture on diabetic patient Nawal Ali at her first clinic in IMU Healthcare. Because diabetics are prone to infection and bleeding, TCM practitioners must be careful not to lift, thrust or rotate the needles during acupuncture. — Photos: LOW LAY PHON/The Star

Dr Song does acupuncture on diabetic patient Nawal Ali at her first clinic in IMU Healthcare. Because diabetics are prone to infection and bleeding, TCM practitioners must be careful not to lift, thrust or rotate the needles during acupuncture. — Photos: LOW LAY PHON/The Star

For TCM, the main treatment methods for diabetic retinopathy are herbs and acupuncture.

“We look at each patient’s constitution and prescribe herbs on an individual basis, according to their body’s needs,” she says.

Some of these remedies include:

• A soup with winter melon (including the skin), barley and meat to help reduce water retention and swelling (oedema).

• A tea with chrysanthemum, mai dong, goji berries and mu hu die, to help treat dry eyes, nourish the yin, improve vision (goji berries), and strengthen the Liver and Kidney (goji berries).

• A tea with the herb shi hu to treat the yin deficiency and strengthen the immune system.

• The Chinese herbal formulations zhi bai di huang wan and jin gui shen qi wan, which are available in pill form, to strengthen the Kidney and Liver, nourish the yin and remove “heat” or “fire” from the body.

The remedies can also be used to treat the body before and after procedures like vitrectomy and laser surgery that are used to treat diabetic retinopathy.

For acupuncture, the main idea behind the treatment is to “activate” the blood and remove the “stasis”.

However, Dr Song says: “Because diabetics have poor resistance, great caution should be taken in order to prevent infection when needling.

“For example, we cannot lift, thrust or rotate when puncturing the intraorbital space, so as not to damage the vessels behind the eyeball and cause bleeding.”

sfitx_anr_2808_wheelofeyes.PDFTui na, or Chinese therapeutic massage, is an alternative for acupuncture, especially for patients who are afraid of needles.

This method involves exerting pressure on, and kneading, the acupuncture pressure points of the body with the fingers.

Another advantage to tui na is that, unlike acupuncture, which must be done by a qualified TCM practitioner, tui na can be taught to patients to do on themselves.

Dr Song also stresses that anyone with diabetes is at risk for diabetic retinopathy and needs to go for a yearly eye check-up.

She adds: “The longer you have diabetes, maybe a check-up once between six months to one year is necessary.

“And if your vision is blurred, you need to see the doctor at once.”

The steps to preventing diabetic retinopathy are the same as those to control diabetes, i.e. controlling blood sugar levels, blood pressure and blood cholesterol levels. This can be done by controlling food intake, getting regular exercise, limiting alcohol and stopping smoking, among others, she says.

In addition, from the TCM point of view, there are seven emotions that when experienced in excess, can lead to the stagnation of qi in the body, which leads to disease.

These emotions are joy, anger, worry, sadness, fear, shock and obsessiveness.

So, emotional stability is also important in preventing disease.

Note: IMU Healthcare Chinese Medicine Centre clinical director Dr Liew Sook Mee and senior Chinese physician Prof Dr Lin Xun assisted in translation between Mandarin and English during the interview.