Strabismus refers to the inability of both eyes to look at the target at the same time, which belongs to extraocular muscle disease. It can be divided into two categories: homosexual strabismus and paralytic strabismus. The main clinical characteristics of the former are that the eye position is biased to the temporal side, and the eyeball has no movement disorder and no recovery; Paralytic strabismus has systemic symptoms such as limited eye movement, diplopia, dizziness, nausea and gait instability. The cause of strabismus is complex, and modern western medicine has no ideal method for those with unknown cause except the cause and surgical treatment.
Acupuncture treatment of strabismus, in ancient Chinese medicine literature, did not find the relevant records. See1958 [1] for the early clinical articles of modern acupuncture treatment of strabismus. However, by the end of 1960s, there were few data, and paralytic strabismus was the main treatment. Since the late 1970s and early 1980s, the treatment of this disease has attracted the attention of the acupuncture community. In particular, the incidence of homosexual strabismus in children is high, and modern medicine lacks effective measures, so it has become the focus of acupuncture treatment. Acupuncture is the main treatment. In recent years, plum blossom has been used to treat patients according to syndrome differentiation and classification, and good experience has been obtained. In addition, electroacupuncture, scalp acupuncture, acupoint application, acupoint injection, magnetoelectric therapy and traditional walnut shell moxibustion all have certain curative effects.
Acupuncture has curative effect on paralytic strabismus and homosexual strabismus, and the effective rate is about 80 ~ 90%.
Harm of strabismus (Chengdu Kejian Mei Wei Eye Hospital)
The first is the influence of appearance, which is also the main motivation for patients to seek medical treatment.
More importantly, strabismus affects binocular vision function, and severe cases do not have good stereoscopic vision. Stereo vision is an advanced visual function that only humans and higher animals have, and it is one of the prerequisites for people to engage in fine work. If you don't have good stereoscopic vision, you will be greatly restricted in your study and employment.
Most strabismus patients also suffer from amblyopia. Strabismus patients will lose their useless vision or stop developing because one eye is staring for a long time, even if they wear appropriate glasses in the future, their vision will not reach normal.
Strabismus in childhood will also affect the development of the whole body bones, such as compensatory head position of congenital paralytic strabismus, neck muscle contracture, pathological curvature of spine, asymmetric facial development and so on.
treat cordially
Dermal needle
(1) acupoint selection
Key points: Zheng Guang 1, Zheng Guang 2, Fengchi.
Matching points: selecting points according to syndrome differentiation.
Liver-blood deficiency type: strabismus, the onset of which is related to febrile convulsion, dry eyes, photophobia, impatience and headache, bitter mouth and dreaminess, thin and slightly stringy pulse and thin and white fur.
Ganshu, Danshu, Neiguan and Baihui.
Type of weak temper: squint eyes, blurred vision, pale complexion (white light), listlessness, dizziness and thin body, sometimes loose stool, thin or slow pulse, thin and white fur.
Pishu, Shu Wei, Zhongyu, Baihui, Neiguan and Zusanli.
Kidney deficiency type: squint, mostly onset in childhood, thin diopter, poor vision, dizziness and dryness, pale face, frequent urination, thin or clean fur, pale or sharp red tongue.
Shenshu, Ganshu, Danshu, Dazhui, both sides of lumbar vertebrae, Neiguan.
Conditioning and consolidation: the eye position has been positive or basically restored, and the vision has not reached normal;
Thoracic vertebra 8 ~ 12, both sides of lumbar vertebra, Baihui, Dazhui, Ganshu, Danshu, Pishu, Shenshu and Zhongwan.
(2) treatment
Take the points every time. Acupoints should be added according to syndrome types. On the specific selection point, it is divided into three stages. In the first stage, if you have ametropia, you must first improve your vision and add points; The second stage is to correct strabismus on the basis of the above, so we should add Baihui or Ganshu and Danshu every time; The third stage is the consolidation stage, and the last group of acupoints should be selected as appropriate.
Tap and prick the needle with ordinary leather needle or electric plum blossom needle. If it is an electric plum blossom needle, connect the special electric plum blossom needle to the transistor therapeutic instrument, and use DC with a voltage of 9 volts and a current with an intensity less than 5 mA, depending on the patient's tolerance. Then tap evenly in the range of 0.5 ~ 1.5 cm in diameter of each acupoint area for 20 ~ 50 times. On both sides of thoracolumbar spine, knock 3 lines from top to bottom. 1 spine of line spacing 1 cm, spine of second line spacing 2 cm, spine of third line spacing 3 ~ 4 cm. If you use an ordinary leather needle, the flapping method is the same as above. Try to use wrist force to bounce and stab, and the strength should be moderate until there is obvious flushing in some areas. Every other day 1 time, 15 times is a course of treatment. After stopping the needle for half a month, continue the next course of treatment. During the treatment, patients insisted on self-massaging both sides of Zheng Guang 1 and Zheng Guang 2 for 50 ~ 100 weeks, twice a day in the morning and evening.
(3) Evaluation of curative effect
This method is mainly used to treat homosexual strabismus, especially for teenagers under 20 years old.
Efficacy standard: recovery: eye position recovered, and visual acuity improved to above 1.0. The effect was remarkable: the eye position recovered or basically recovered, and the vision was improved by 3 lines, but it did not reach1.0; Or the strabismus is reduced by half, and the vision is improved to more than 1.0. Effective: eye position basically recovered, vision improved 1 ~ 2 lines; Or the strabismus is reduced by less than half, but the vision is increased by more than 2 lines. Invalid: there is no improvement or the improvement does not reach the effective standard.
* * * Treatment of homosexual strabismus 103 cases, 180 eyes. According to the above criteria, 57 animals were cured (3 1.0%), ineffective 1 0/animal (55.5%) and ineffective1animal (1.5%). The curative effect of esotropia is better than exotropia, and the effect is better when the strabismus degree is 65438 05 degrees [2].
Body acupuncture plus acupoint application
(1) acupoint selection
Key points: Four Whites, Hegu and Houqiu.
Matching points: internal oblique muscle paralysis: the yang is white through the waist of the fish, and the pupil is {1} through the silk and bamboo; Paralysis of external oblique muscle: bamboo improves eyesight and four white tears.
(2) treatment
Select the key points at a time, and alternately select four points: white point, ball back, Hegu 1 edge. Choose acupoints according to symptoms. Ask the patient to lie down (if the child does not cooperate, it can be held by the family). It is best to accurately touch the four white acupoints, which leads to the feeling of electric shock. The depth of the needle behind the ball is 1.5 inch, which makes the eye socket feel sore obviously and locally suffocate in the valley. Require rapid needle insertion through acupoints and slow needle delivery along the skin. All patients were treated with antidiarrheal method, keeping the needle for 30 minutes and scraping the needle handle for half a minute every 10 minute. For uncooperative children, rapid needle insertion, slight torsion and no needle insertion can be used. After acupuncture, you can take 1 ~ 2 points and apply a piece of nux vomica, fix it with adhesive tape, and keep 12 ~ 24 hours as appropriate. Inject 1 time every day or every other day, 1 time is a course of treatment, and the treatment interval is1week.
Processing of Semen Strychni tablets: soak Semen Strychni in appropriate amount of water for 65438 0.5 hours, then add appropriate amount of mung bean, heat until mung bean blooms, take out Semen Strychni, peel it while it is hot, cut it into thin slices, dry it, and store it in a dry container.
(3) Evaluation of curative effect
This method is mainly used for paralytic strabismus.
Efficacy standard: recovery: eye muscle strength recovered, strabismus disappeared and diplopia disappeared. Effective: partial recovery of eye muscle strength, improvement of strabismus and residual diplopia. Ineffective: no improvement after treatment.
* * * Treating paralytic strabismus 8 1 case, 49 cases were cured (60.5%), 25 cases were effective (30.9%) and 7 cases were ineffective (8.6%), with a total effective rate of 9 1.4% [3 ~ 5].
Acupuncture needle applied to body
(1) acupoint selection
Key points: Divide into 2 groups. 1, esotropia, ① pupil, wind pool, four white, too blunt; ② Behind the ball, the sun, the eye window and the passing ball; 3 silk and bamboo are empty, fish waist, and the head is bright.
2, exotropia, ① bright eyes, eyebrows, fish waist, Hegu; (2) Bamboo, Fengchi, Sibai and Taichong; ③ The lower eye is bright, bright (head), crooked and skinny.
Location of Xiajingming point: 0.2 inch below Jingming point.
(2) treatment
According to the symptoms, take 1 group of acupoints at a time, and use 3 groups of acupoints in turn. Binocular strabismus is bilateral and monocular strabismus is unilateral. The acupoints in the orbit should be pricked slowly, and don't twist greatly. When acupuncture Fengchi point, the tip of the needle is aimed at the opposite eyeball, and the strong stimulation makes the needle feel directly to the eyeball. The child quickly pierced and twisted for about half a minute, and then the needle came out. After the rest of the needles were filled with gas, they were treated with the method of reinforcing and purging, and the needles were kept for 30 minutes, 15 minutes/time. Every day or every other day 1 time, 12 times is a course of treatment. The treatment interval is 5 ~ 7 days.
(3) Evaluation of curative effect
This method is suitable for patients with homosexual strabismus and paralytic strabismus.
* * * 230 cases were cured, 25 cases were cured/kloc-0, 35 cases were markedly effective, 43 cases were effective and 27 cases were ineffective, and the total effective rate was 88.3% [6,7].
Main references
Hu Zheng. Two cases of esotropia treated by acupuncture and moxibustion. Journal of traditional chinese medicine1958; (9):27。
[2] Zhong Meiquan. According to syndrome differentiation and classification, plum blossom needle was used to treat homosexual strabismus 103 cases. China Acupuncture1984; 4(2): 1 1。
[3] Yang Yuande. Acupuncture treatment of paralytic strabismus. Liaoning journal of traditional chinese medicine1988; (5):37。
[4] Nie Hanyun. 42 cases of paralytic strabismus treated by acupuncture combined with acupoint application. Sichuan Traditional Chinese Medicine1987; (6):49。
[5] Liu Shian. Observation on therapeutic effect of acupuncture on strabismus 10 cases. Fujian Traditional Chinese Medicine1981; 1( 1):32。
Gao Wanxiang, et al. Observation on therapeutic effect of acupuncture on strabismus 176 cases. Shanxi Traditional Chinese Medicine1985; 1( 1):48。
Qin Ronghua et al. Clinical observation on 54 cases of paralytic strabismus treated by acupuncture. China Acupuncture1997; 17(6):368。
Clinically, the separation of binocular visual axes caused by abnormal eyeball position or movement is called strabismus, which is a common ophthalmic disease. Strabismus can be divided into * * * rotational strabismus and non * * * rotational strabismus according to whether the patient has extraocular muscle dysfunction. * * * rotational strabismus, also known as * * * homosexual strabismus, is a person with normal extraocular muscle function and unobstructed eye movement in all directions but separated visual axes. According to the nature of staring eyes, it can be divided into unilateral and binocular alternation; According to the time of strabismus, it can be divided into intermittent, persistent or periodic. Non-rotational strabismus, also known as paralytic strabismus, is caused by nerve conduction or dysfunction of extraocular muscles, which leads to paralysis of one or more extraocular muscles and separation of visual axes. Due to ophthalmoplegia, the affected eyes are inevitably accompanied by eye movement disorders in one or more directions. After confirming whether strabismus patients are * * * rotational strabismus or non * * * rotational strabismus, rotational strabismus can be divided into esotropia, exotropia and vertical strabismus according to the deviation direction of eye position. Paralytic strabismus is named after nerve paralysis or dysfunction of extraocular muscles, such as oculomotor nerve paralysis and superior oblique muscle paralysis. The mechanism of strabismus is complicated because there are many extraocular muscles that dominate eye movements and participate in binocular visual coordination movements. To understand strabismus, we must first make clear the formation mechanism of binocular eye muscle coordinated movement and binocular monocular vision.
Each eye has six extra-ocular muscles, which dominate eye movements. They are four rectus muscles and two oblique muscles. According to their attachment position on the eyeball, they are called medial rectus, lateral rectus, superior rectus, inferior rectus, superior oblique and inferior oblique respectively. Among them, the function of the internal and external rectus muscle is relatively simple, which plays a role in dominating the horizontal movement of the eyeball. The attachment points of the upper and lower rectus muscle and the upper and lower oblique muscle deviate from the vertical direction of the eyeball, and their functions are complicated. In addition to jointly controlling the vertical movement of the eyeball, they also have the function of rotating the eyeball inside and outside, so that the eyeball can look at all directions in front. The position and main direction of action of each eye muscle are shown in figs. 28 and 29.
Under normal circumstances, binocular movement must be coordinated so that both eyes can stare at a single target at the same time. This function can only be accomplished by the coordinated movement of the extraocular muscles of both eyes. The coordinated movement of extraocular muscles is a complex coordinated movement. Take the horizontal movement of the eyes as an example: when looking to the right, the right lateral rectus muscle and the left lateral rectus muscle contract, while the right lateral rectus muscle and the left lateral rectus muscle relax to make the eyes rotate to the right, and their rotation angles should be kept equal. The upper and lower rectus muscles and the upper and lower oblique muscles should also have a certain tension to help the eyeball rotate and keep the eyeball horizontal. In this process, a pair of eye muscles (right eye external rectus and left eye internal rectus) that pull the eye movement direction are called companion muscles, and a pair of eye muscles (right eye internal rectus and left eye external rectus) that play a major antagonistic role are called antagonistic muscles. When the eyeball moves in the vertical direction, there are many groups of extraocular muscles involved in the movement, not only the partner muscles, but also the cooperative muscles to assist the movement direction, and there are also direct antagonistic muscles and indirect antagonistic muscles in the opposite direction, which makes the coordinated movement more complicated. The partner muscles and antagonistic muscles of eye movements in all directions are shown in Table 4. The cooperative movement of the extraocular muscles of both eyes follows two laws: one is that the contraction of an extraocular muscle must be accompanied by its direct antagonism to the relaxation of the muscle, otherwise the eyeball cannot rotate flexibly, which is the so-called Sherrington's law. Secondly, the nerve impulses from the central nervous system that make the eyes turn must reach both eyes at the same time and in the same amount, otherwise the eyes can't look at the same target. This is the so-called Hering's Law. Because of these eye movements, it forms the basis of human binocular monocular vision.
Binocular monocular vision refers to the process that both eyes gaze at a single object at the same time, so that the object is focused and imaged in the macula of both eyes and transmitted to the visual center of the brain to overlap into a complete three-dimensional single object image. This function is unique to primates. In the process of biological evolution, people's eyes move forward to the parallel position in front of their faces, and most of their fields of vision overlap, which has the basis of binocular monocular vision. After birth, due to the interest in the surrounding environment, they often roll their eyes and use gaze and gaze reflex. This repetitive and coordinated binocular movement makes the images at the corresponding points of the retina of both eyes often merge into an object image in the visual center of the brain, which forms conditioned reflex for a long time and produces binocular monocular function. So binocular monocular vision is gradually formed after birth. Binocular monocular function can be divided into three levels. First, two eyes can feel the same thing at the same time.
Prevent children from strabismus;
Strabismus can be divided into esotropia, exotropia, esotropia and paralytic strabismus.
According to clinical observation, the main eye disease that causes children to squint when watching TV is monocular entropion, that is, the gaze is fixed on one side. Because of the great difference in vision between the two eyes, they often stare with the eyes with good vision, and the eyes with poor vision turn into varus.
Prevention points:
The prevention of strabismus should start from infancy, and parents should pay attention to carefully observing the development and changes of children's eyes.
When infants have fever, rash and weaning, parents should strengthen nursing, and often pay attention to the coordination function of eyes to observe whether there is any abnormality in eye position.
Always pay attention to children's eye hygiene or eye hygiene. For example, the lighting should be appropriate, neither too strong nor too weak, and the printed pictures should be legible. Don't read books while lying down, watch TV, play games or computer for a long time, and don't look at stereoscopic pictures.
Children with a family history of strabismus, even if there is no strabismus in appearance, should be examined by an ophthalmologist at the age of 2 for hyperopia or astigmatism.
When watching TV, besides keeping a certain distance, children should not be allowed to sit in the same position every time, especially in the position diagonally opposite the TV. You should always change seats from left to right, or your child will always look in one direction and head to one side in order to watch TV. After a long time, the development and tension of the six eye muscles are different, and the original function of adjusting balance is lost. One muscle is always in a state of tension, and the other muscle is slack, which will cause strabismus.
How to prevent neonatal strabismus
Strabismus is the disharmony of eyes. Transient strabismus (also known as physiological strabismus) often occurs in early newborns due to poor eye muscle adjustment. If it is not corrected in time, it may develop into strabismus after a long time.
The following methods can prevent neonatal strabismus:
1, pay attention to the position of the head and don't let it lean to one side for a long time.
2. Children are sensitive to red reaction. A noisy red toy can be hung above the middle of the crib and shaken regularly to combine hearing and vision, which is beneficial to the coordinated training of bilateral eye muscle movements of newborns, thus preventing strabismus.