macular+degeneration

=Macular Degeneration (Qing Mang)= Means: “Clear-Eye Blindness”: Loss of visual acuity without any obvious externally visible changes in the eyes

also known as age-related macular degeneration (ARMD), is a chronic eye disease that occurs when tissue in the macula, the part of your retina that's responsible for central vision, deteriorates.

The leading cause of severe visual loss for those aged 55 and older in the United States, affecting more than 10 million Americans. ARMD affects central vision, but not peripheral vision; doesn't cause total blindness. The loss of clear central vision — critical for reading, driving, recognizing people's faces and doing detail work — greatly affects quality of life. Damage caused by macular degeneration can't be reversed, but early detection and treatment may help reduce the extent of vision loss.

Risk Factors
-Age. In the United States, macular degeneration is the leading cause of severe vision loss in people age 60 and older. -Family history of macular degeneration. -Race. Macular degeneration is more common in whites than it is in other groups, especially after age 75. -Sex. Women are more likely than men are to develop macular degeneration, and because they tend to live longer, women are more likely to experience the effects of severe vision loss from the disease. -Cigarette smoking. -Obesity. Being severely overweight increases the chance that early or intermediate macular degeneration will progress to the more severe form of the disease. -Light-colored eyes. -Exposure to sunlight. It's possible that long-term exposure to ultraviolet light may increase your risk of developing macular degeneration, but this risk has not been proved and remains controversial. -Low levels of nutrients. This includes low blood levels of minerals, such as zinc, and of antioxidant vitamins, such as A, C and E. -Cardiovascular diseases. (e.g., atherosclerosis, HTN)

Types of Macular Degeneration
Dry macular degeneration (a.k.a. atrophic macular degeneration) Wet macular degeneration (a.k.a. exudative or neovascular macular degeneration)

[[image:macular_degeneration_-_dry.png width="305" height="302" align="right"]]Dry Macular Degeneration
Most common form. In fact, macular degeneration almost always starts out as the dry form. May initially affect only one eye but, in most cases, both eyes eventually become involved.

The result of a deterioration of the retinal pigmented epithelium (RPE) brought on by aging. Waste starts to accumulate in the RPE, interfering with its normal function. This causes the light-sensitive cells of the macula (both cones and rods) to degenerate.
 * Pathology**

-Increasing difficulty adapting to low levels of illumination with need for increasingly bright illumination when reading or doing close work -Increasing blurriness of printed words -Decrease in the intensity or brightness of colors -Difficulty recognizing faces -Gradual increase in the haziness of your overall vision -Blurred or blind spot in the center of your visual field combined with a profound drop in your central vision acuity -Normally uniform reddish color of the macula has a mottled appearance because due to loss of pigment. -Drusen, fatty-like deposits that which look like yellow dots, appear under the light-sensing cells in the retina.
 * Signs and Symptoms**

[[image:macular_degeneration_-_wet.png width="215" height="252" align="right" caption="Wet Macular Degeneration"]]Wet Macular Degeneration:
Develops when new blood vessels grow from the choroid underneath the macular portion of the retina. These new vessels are called choroidal neovascularizations (CNVs). CNV’s leak fluid or blood, causing central vision to blur.
 * Pathology**

Visual distortions (e.g., straight lines appearing wavy or crooked, a doorway or street sign that seems askew, or objects appearing smaller or farther away than they should) A decrease in or loss of central vision Central blurry spot Symptoms often progress rapidly Appearance of choroidal neovascularization underneath the macula Signs of the dry form (i.e., drusen and mottled pigmentation of the retina) usually visible
 * Signs and Symptoms**

Laser photocoagulation Photodynamic therapy (cold laser) Injections therapy (anti-vascular endothelial growth factor medications injected directly into the eye)
 * Tx of Wet Macular Degeneration**

Hallucinations (Charles Bonnet syndrome): Some people with macular degeneration may experience visual hallucinations as their vision loss increases. These hallucinations may include unusual patterns, geometric figures, animals or even grotesque-appearing faces. Many people who develop these symptoms are afraid to discuss them with their doctors or friends and families for fear they'll be considered crazy. However, while these hallucinations may be frightening, they're not a sign of mental illness.
 * Important Note**

TCM Etiology
-Aging -Congenital weakness of Liver and Kidney (Blood and Essence) -Enduring illness

TCM Pathomechanisms
ARMD (wet and dry) is most often an exhaustion of the body’s Yin. Decline in central vision indicates a vacuity of Kidney and Liver Yin.

The function of the Spleen (supported by the Kidney) is to transform and transport nourishment that is ingested. It has been stated in the Pi Wei Lun by Li Dong Yuan that as we age, our Earth element (digestive function) weakens. When working towards generating Yin in the body, it is essential that the Earth element be in a state of optimal function.

When the body’s capacity to break down food becomes less efficient, the ability to replenish Yin and Blood can be compromised as a result of poor digestion. Again, ARMD is generally seen as Yin deficiency exacerbated by the impaired transformation and transportation function of the Spleen. These basic mechanisms are almost always complicated by Qi stagnation and Blood stasis.

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.” Note: 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.

Liver and Kidney Vacuity
[Shu Di Huang 12g, Sheng Di Huang 6g, Shan Yao 6g, Shan Zhu Yu 6g, Ze Xie 6g, Fu Shen 6g, Mu Dan Pi 6g, Chai Hu 6g, Dang Gui 6g, Wu Wei Zi 6g] Quicken and nourish Blood (Dry ARMD): + Dan Shen Quicken Blood and stop bleeding (Wet ARMD): +San Qi Nourish Blood, enrich Yin, brighten eyes: + Gou Qi Zi Clear Liver and brighten the eyes: + Ju Hua
 * Symptoms:** decreased visual acuity, dry eyes, tinnitus, dizziness, low back and knee soreness and weakness, malar flush, 5 center heat, insomnia, night sweats
 * Tongue:** red with scanty coating
 * Pulse:** thready, rapid pulse
 * Treatment Principles:** Supplement the Liver and Kidneys, brighten the eyes
 * Herbal Treatment:** Ming Mu Di Huang Wan
 * Modifications:**

Qi and Blood Dual Vacuity
[Ren Shen 9g, Huang Qi 15g, Bai Zhu 12g, Gan Cao 3g, Dang Gui 12g, Chen Pi 6g, Sheng Ma 3g, Chai Hi 6g] Supplement Liver and Kidneys, nourish Blood: + Bai Shao, Gou Qi Zi, Shu Di Huang Quicken the Blood, transform stasis: + Dan Shen/San Qi, Yu Jin, Mu Dan Pi, Chi Shao, Tao Ren Transform Phlegm, opens the orifices: + Shi Chang Pu (Note: Bu Zhong Yi Qi Tang + above additions – Gan Cao = Yi Qi Sheng Yang Bu Xue Tang)
 * Symptoms:** decreased visual acuity, fatigue, shortness of breath, disinclination to speak, dizziness and vertigo, palpitations, insomnia, poor memory, decreased appetite, loose stools
 * Tongue:** pale with thin white coating, weak
 * Pulse:** thready
 * Treatment Principles:** Boost the Qi, nourish the Blood, brighten the eyes
 * Herbal Treatment:** Bu Zhong Yi Qi Tang
 * Modifications**

Qi, Blood, Yin and Yang Vacuity
[Ji Xue Teng 30g, Dang Shen 20g, Shu Di 15g, Tu Su Zi 15g, Lu Lu Tong 15g, Mi Meng Hua 15g, Nu Zhen Zi 12g, Gou Qi Zi 12g, Zhi Fu Zi 12g, Ba Ji Tian 12 g, Chong Wei Zi 12g, Dang Gui 9g, Bai Shao 9g, Tao Ren 9g, Hong Hua 9g, Sheng Ma 9g, Gan Cao 3g]
 * Symptoms:** decreased visual acuity which is worse at night and when fatigued, pale, possibly sallow yellow facial complexion, fatigue, lack of strength, shortness of breath on slight exertion, dry skin, brittle nails, low back and knee pain, soreness or weakness, tinnitus, dizziness, impaired memory, decreased auditory acuity, low libido, cold hands and feet, aversion to cold, nocturia, possible seminal emission, constipation, visible varicosities on the skin surface, age spots on the skin
 * Tongue:** pale, puffy or puffy, red, dry with scanty coating
 * Pulse:** fine, deep, weak
 * Treatment Principles:** Strengthen the Kidneys and invigorate the Yang, nourish Blood and boost Qi, quicken the Blood and free the flow of the collaterals
 * Herbal Treatment:** Wang Yi Jian

Spleen and Kidney Yang Vacuity
Gui Fu Ba Wei Wan (modified): [Shan Zhu Yu 15g, Shu Du 15g, Shan Yao 9g, Fu Ling 9g, Ze Xie 9g, Mu Dan Pi 9g, Rou Gui 9g, Zhi Fu Zi 6g, Mi Meng Hua 15g] Li Zhong Wan (modified): [Ren Shen 6g, Bai Zhu 9g, Zhi Gan Cao 6g]
 * Symptoms:** decreased visual acuity, cold body and cold limbs, aversion to cold, shortness of breath on slight exertion, faint were weak voice, fatigue, bodily weakness, nocturia, loose stools, possible early morning diarrhea, low back in the pain, weakness, or soreness, tinnitus, dizziness
 * Tongue:** pale, puffy with white coating
 * Pulse:** deep, fine and weak
 * Treatment Principles:** Warm and supplement the Spleen and Kidneys and brighten the eyes
 * Herbal Treatment:** Gui Fu Ba Wei Wan + Li Zhong Wan

A Note About ARMD and Blood Stasis: Blood stasis usually plays a role in all diseases affecting the elderly. According to Andy Rosenfarb, L.Ac., San Qi is a good addition for wet ARMD, whereas Dan Shen is a good addition for dry ARMD, regardless of the pattern.

Acupuncture and Moxibustion Treatment
Modification Based on Pattern:
 * Main Points:** BL 1, BL 2, ST 1, Qiu Hou, LV 3, GB 37
 * LV/KI Yin Vacuity** – BL 18, BL 23, KI 3, KI 6, KI 7, SP 6
 * Qi and Blood Vacuity** – BL 17, BL 20, ST 36, SP 6
 * Qi, Blood, Yin and Yang Vacuity** – BL 17, BL 20, ST 36, SP 3, SP 6, BL 18, BL 23, KI 3, KI 6, KI 7, CV 4, GV 4
 * Spleen and Kidney Yang Vacuity** – BL 20, BL 23, ST 36, SP 6, CV 4, GV 4
 * To Move Qi and Blood:** 4 Gates, BL 17, SP 10, LV 8, SP 6

Supplements for Macular Degeneration
The National Eye Institute's Age-Related Eye Disease Study (AREDS) found that taking a specific high-dose formulation of antioxidants and zinc significantly reduces the risk of advanced ARMD and its associated vision loss. Slowing ARMD's progression from the intermediate stage to the advanced stage will save the vision of many people.

Daily dosages of the AREDS formulation: -500 milligrams of vitamin C -400 International Units of vitamin E -15 milligrams of beta-carotene (equivalent to 25,000 International Units of pro-vitamin A) -80 milligrams of zinc as zinc oxide -2 milligrams of copper as cupric oxide (added to prevent copper deficiency anemia, a condition associated with high levels of zinc intake)

-Other Carotenoids (lutein, lycopene, zeaxanthin): supplementation with 5-10 mg of lutein and 5 mg of zeaxanthin qd is crucial for ARMD -Flavonoids (quercetin, rutin, resveratrol) -Bilberry extract (25% anthocyandin content): 80 mg tid -Grape Seed Extract (95% proanthocyanodolic content): 150-300 mg qd -Gingko biloba extract (24% ginkgo flavonglycosides): 40-80 mg tid -Taurine: 500-1,000 mg qd

Herbs For Eye Disorders
Bo He Chan Tui Chi Shao Che Qian Cao/Zi Chi Shao || Chong Wei Zi Ci Shi Da Huang Gou Qi Zi Gu Jing Cao Hei Zhi Ma || Jiang Can Ju Hua Jue Ming Zi Ling Yang Jiao Man Jing Zi Mu Zei || Nu Zhen Zi Sang Shen Zi Sang Ye Shi Jue Ming Zhen Zhu Mu Xia Ku Cao || Andy Rosenfarb, L.Ac. specializes in the treatment of eye disorders using a new procedure called Micro AcupunctureTM that involves the use of 48 newly discovered acupuncture points located only on the hands and feet, and not associated with any other acupuncture system. His website is: http://www.acupuncturehealth.net/index.html
 * Bai Ji Li

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Recommended Minerals
-Zinc - prevention

Orthomolecular Treatment
-Beta-carotene - prevention -Lutein