Case Study - Retinitis Pigmentosa

[Guest guest]

Hi everyone,

 

I need help with a case I have. I have been trying to

do some research, but I'm having trouble locating

material. Here is the case:

 

Man, age 50

 

Came to see me because his eyesight is deteriorating,

he is getting night blindness and tunnel vision. He

was diagnosed by a medical doctor with " Retinitis

Pigmentosa " approximately 10 years ago. He said he

has had problems with his eyes all his life, but it

only got bad recently.

 

His left pulse is generally deep and his right pulse

is generally rolling and fast.

 

Gums pale, lips thin and dry and he has trouble with

his teeth.

 

Purplish pink tongue proper, crack running down the

center, thin yellowish coating, thick tongue.

 

Stomach bothering him a little bit wouldn't elaborate.

 

 

His face is flushed, his eyes tired looking with

clusters of red veins in the whites of the eyes. He

advised me that he had white phlegm coming from the

corners of his eyes but since he starting taking

vitamins " A " , " C " , " E " , Beta Carotene and a Multi

Vitamin recently (he wasn't sure the dosage) the

discharge had stopped.

 

Said he felt fine otherwise.

 

He also advised me that he had gone to an

acupuncturist a couple of years ago but did not get

any results, but wanted to try again.

 

Your thoughts and input would be greatly appreciated.

 

 

Maria Dias

 

 

 

 

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[Guest guest]

Maria

 

Cases like this often involve blood stasis in addition to whatever

other major patterns present. You indicate a few signs that may

confirm this (listed below). I am curious about the underside of

the tongue (distended purple sublinguals?), abdomen (spider

veins?). Other purples (nailbeds, conjunctiva, lower eyelids?)

 

etiological factors like poor diet, lack of exercise, smoking?

 

If you can make a case for blood stasis, then I would treat this

strongly. NOTE: this type of blood stasis does not involve pain.

 

which raises an interesting question. How can stasis not

involve pain?

 

We know that pain is due to lack of free flow. but apparently, lack

of free flow does not necessarily cause pain.

 

In fact, the often pain free state of paralysis may involve some

form of stasis (consider the formula bu yang huan wu tang).

 

However, I have heard a more conservative argument made that

blood stasis must involves pain. One of my colleagues

dismissed the blood stasis pattern in sionneau volume 6 under

hematuria as " the author's poor translation or

misunderstanding " . I find this very unlikely. Philippe is

particularly careful in delineating the symptoms of less common

textbook patterns, such as blood stasis. the absence of pain in

a blood staiss pattern is not something that would be glossed

over without further research. any thoughts?

 

 

, Maria Dias <qiofdias>

wrote:

 

> Came to see me because his eyesight is deteriorating,

> he is getting night blindness and tunnel vision.

 

> Purplish pink tongue proper,

 

> his eyes tired looking with

> clusters of red veins in the whites of the eyes.

[Guest guest]

Thank you Todd for your reply.

 

With respect to the underside the tongue, it is very

red and yes he has distended purple sublinguals. His

conjunctiva appears normal, but I don't recall his

eyelids, nailbeds or abdomen.

 

I would like to add one more thing that I neglected to

mention and that is he has bloody stool. He indicated

that this is a recent occurrence and he has never had

a bloody stool before. Also he is not a smoker.

 

I do agree with you about blood stasis. However, he

has no pain whatsoever and that confused me, because I

always thought there was some kind of pain when blood

stasis was involved.

 

Maria

 

 

 

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[Guest guest]

 

Maybe helpful info about Retinitis Pigmentosa:

 

I was recently in a clinic that was successfully (?) treating Retinitis Pigmentosa with hyperbaric oxygen treatment and I.V. glutamine. (this is a tx that puts a patient in a pressure chamber and pressures it up to three (I think) atmospheres of pure oxygen) The treatment is non-conventional and controversial, but I met grateful patients with impressive improvements. This treatment is said to increase blood flow and oxygenation in tissues that are hypoxic.

It seems you could make an argument that blood movers might increase blood flow in tissues that have recently lost circulation, and blood tonics might offer increased oxygen delivery to tissues.

I am also intreged by the TCM connection between the liver, and blood and the eyes.

 

Maybe relevant, Maybe not.

 

Mark Costello

[Guest guest]

Mark:

 

I am interested in hearing more about this clinic and your experience

there. Can you email me at Mbuyze to discuss as this

would be off topic.

 

To begin, where are you? where is the clinic? and is someone doing

TCM work there?

 

My intest stems from an MD I work with who broke ground for just such

a clinic last week.

 

Michael Buyze, L.Ac.

 

, neuromatrix@a... wrote:

>

>

> Maybe helpful info about Retinitis Pigmentosa:

>

> I was recently in a clinic that was successfully (?) treating

Retinitis

> Pigmentosa with hyperbaric oxygen treatment and I.V. glutamine.

(this is a

> tx that puts a patient in a pressure chamber and pressures it up to

three (I

> think) atmospheres of pure oxygen) The treatment is non-

conventional and

> controversial, but I met grateful patients with impressive

improvements.

> This treatment is said to increase blood flow and oxygenation in

tissues

> that are hypoxic.

>

> It seems you could make an argument that blood movers might

increase blood

> flow in tissues that have recently lost circulation, and blood

tonics might

> offer increased oxygen delivery to tissues.

>

> I am also intreged by the TCM connection between the liver, and

blood and

> the eyes.

>

> Maybe relevant, Maybe not.

>

> Mark Costello

[Guest guest]

Mark:

 

Sorry about the email address, it won't let me post it. My eamil is

at hotmail. (You know... mbuyze at hotmail).

 

Hopefully this works.

 

Michael Buyze, L.Ac.

 

, " mbuyze " <mbuyze@h...> wrote:

> Mark:

>

> I am interested in hearing more about this clinic and your

experience

> there. Can you email me at Mbuyze@h... to discuss as this

> would be off topic.

>

> To begin, where are you? where is the clinic? and is someone doing

> TCM work there?

>

> My intest stems from an MD I work with who broke ground for just

such

> a clinic last week.

>

> Michael Buyze, L.Ac.

>

> , neuromatrix@a... wrote:

> >

> >

> > Maybe helpful info about Retinitis Pigmentosa:

> >

> > I was recently in a clinic that was successfully (?) treating

> Retinitis

> > Pigmentosa with hyperbaric oxygen treatment and I.V. glutamine.

> (this is a

> > tx that puts a patient in a pressure chamber and pressures it up

to

> three (I

> > think) atmospheres of pure oxygen) The treatment is non-

> conventional and

> > controversial, but I met grateful patients with impressive

> improvements.

> > This treatment is said to increase blood flow and oxygenation in

> tissues

> > that are hypoxic.

> >

> > It seems you could make an argument that blood movers might

> increase blood

> > flow in tissues that have recently lost circulation, and blood

> tonics might

> > offer increased oxygen delivery to tissues.

> >

> > I am also intreged by the TCM connection between the liver, and

> blood and

> > the eyes.

> >

> > Maybe relevant, Maybe not.

> >

> > Mark Costello

[Guest guest]

atmospheres of pure oxygen

>>>No usually pressurize air

Alon

[Guest guest]

Maria,

 

As far as I can tell, in Chinese medical ophthalmology (yan ke),

retinitis pigmentosa corresponds to the traditional Chinese disease

categories of high wind sparrow vision (gao feng que mu) and high wind

internal obstruction (gao feng nei zhang). The problem is that the

Chinese do not seem to use the term " retinitis pigmentosa " but prefer

shi wang mo se su bian xing (pigmentary degeneration of the retina).

However, in The Merck Manual, retinitis pigmentosa is described as a

degenerative disease of the tapetoretina. Taber's Cyclopedic Medical

Dictionary also seems to imply that these two Western disease

categories are synonymous.

 

If this is, indeed, true, then the disease causes listed in Zhong Yi

Yan Ke Xue (Chinese Medical Ophthalmology), the basic text on

ophthalmology used in CM colleges in China, are:

 

1. Liver-kidney insufficiency with essence blood consumption and

deteriment

 

2. Heart constructive depletion detriment wwith spirit qi vacuity and

consumption

 

3. Enduring disease vacuity exhaustion with spleen yang devitalization

failing to transform the finest essence

 

4. Emotional depression and binding resulting in the liver's loss of

spreading with qi and blood depression and blockage

 

5. Former heaven natural endowment insufficiency with spleen-kidney

dual vacuity

 

6. External injury to the head or internal tumor pressing and pushing

resulting in qi stagnation and blood stasis

 

The patterns this text lists under this disease include:

 

1. Liver-kidney yin vacuity: Qi Ju Di Huang Wan

 

2. Spleen-kidney yang vacuity: Fu Gui Ba Wei Wan plus Li Zhong Tang

 

3. Spleen qi vacuity weakness: Bu Zhong Yi Qi Tang

 

4. Qi and blood insufficiency: Ren Shen Yang Rong Tang

 

5. Liver qi depression and binding: Xiao Yao San

 

6. Qi and blood stasis and stagnation: Tao Hong Si Wu Tang

 

The text says that any of the above Rx's would need to be modified

with additions and subtractions depending on the case.

 

The acupuncture treatment described includes the standard points

around the eyes plus the standard points for the various patterns

described above. Nothing particularly noteworthy. Instructions say to

choose 3-4 points each visit and to needle daily. Another option is to

seven star hammer the optic line on the scalp once per day for 10-15

days. Then allow a 3-5 day rests before doing another course of

treatment. This is something that a patient's family could, at least

in theory, do at home.

 

The Zhong Guo Zhong Yi Mi Fang Da Quan (Great Complete [Collection] of

Chinese National Chinese Medical Secret Formulas), meaning published

research formulas includes four Rx's for shi wang mo se su bian xing:

1) for spleen-kidney yang vacuity complicated by blood vacuity and

blood stasis, 2) for kidney yin vacuity, 3) for spleen--liver-kidney

yin and yang vacuity complicated by qi stagnation and blood stasis;

and 4) for qi and yin dual vacuity complicated by qi stagnation and

blood stasis. Two research reports claimed total effectiveness rates

of 75%. A third claimed a total effectiveness rate of 95% in 22 cases

treated with full strength Chinese herbs daily for four months. Of

these, 17 only got " some effect, " four got a marked effect, and no one

was claimed to be cured. Some effect meant some improvement in night

vision and some enlargement in field of vision.

 

Because you do not really give adequate S & S for determining this

patient's pattern, I recommend going back and doing a thorough job of

gathering S & S by the four examinations to fill in the gaps. I also

recommend making a working hypothesis of which of the above patterns

is most likely given the patient's age, sex, physique, facial

coloring, etc. and then question and examine to confirm or deny that

hypothesis. Be sure that any answers the patient gives you in terms of

S & S are followed up until you are sure his S & S conform to the S &

S Chinese say make up a given pattern. That means you may have to

reframe some of the patient's initial answers and question more

carefully than you may be doing so far.

 

As Todd has suggested, it is highly likely that blood stasis is

playing a complicating part in this case. However, judging from the

research reports mentioned above (which are usually more realistic

than textbook discussions), blood stasis tends to be only a

complicating factor unless there is a history of traumatic injury. My

guess is that you could make a case for a liver-spleen disharmony

complicated by blood stasis at the very least. Then I would determine

if there was an accompanying yin vacuity, yang vacuity, or yin and

yang vacuity. If the patient is obese, you would also need to factor

in phlegm dampness and turbidity. I would also look for any signs of

heat which might be damaging and consuming yin. Bottom line, whatever

the patient's patterns turned out to be, I would write an herbal Rx

for that, making sure as I did so that at least some of the meds in

the Rx are empirically known to " brighten the eyes. "

 

I don't know if any of this is any help, but good luck and best

wishes.

 

Bob

 

, Maria Dias <qiofdias> wrote:

> Hi everyone,

>

> I need help with a case I have. I have been trying to

> do some research, but I'm having trouble locating

> material. Here is the case:

>

> Man, age 50

>

> Came to see me because his eyesight is deteriorating,

> he is getting night blindness and tunnel vision. He

> was diagnosed by a medical doctor with " Retinitis

> Pigmentosa " approximately 10 years ago. He said he

> has had problems with his eyes all his life, but it

> only got bad recently.

>

> His left pulse is generally deep and his right pulse

> is generally rolling and fast.

>

> Gums pale, lips thin and dry and he has trouble with

> his teeth.

>

> Purplish pink tongue proper, crack running down the

> center, thin yellowish coating, thick tongue.

>

> Stomach bothering him a little bit wouldn't elaborate.

>

>

> His face is flushed, his eyes tired looking with

> clusters of red veins in the whites of the eyes. He

> advised me that he had white phlegm coming from the

> corners of his eyes but since he starting taking

> vitamins " A " , " C " , " E " , Beta Carotene and a Multi

> Vitamin recently (he wasn't sure the dosage) the

> discharge had stopped.

>

> Said he felt fine otherwise.

>

> He also advised me that he had gone to an

> acupuncturist a couple of years ago but did not get

> any results, but wanted to try again.

>

> Your thoughts and input would be greatly appreciated.

>

>

> Maria Dias

>

>

>

>

> Y! Web Hosting - Let the expert host your web site

> http://webhosting./

[Guest guest]

Hi Bob,

 

Thank you for your help. You have given me a lot of

information to work with and I appreciate it. You are

right, I should have given you more information, such

as he is of average build (not overweight but not

skinny either), he is of even temperment etc.

 

Thank you.

 

Maria Dias

 

 

 

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