Understanding eye health
We ask a lot of our eyes these days. Long hours peering at screens, lifestyles that lack sufficient rest or are perhaps overly sedentary, high stress levels, increased exposure to environmental pollutants and diets that may be lacking in the nutrients needed to nourish them all have an impact on our eye health and vision.
Likewise, conditions that affect the eyes such as hypertension, obesity and diabetes are on the rise. The most common eye conditions are age related macular degeneration (AMD), glaucoma, diabetic retinopathy, cataracts and retinitus pigmentosa. Of these, diabetic retinopathy is the leading cause of sight loss for those under fifty in the UK and AMD the chief for the over sixties (1). While genetic factors play an important part in many eye pathologies, there is still so much we can do to support our eye health and TCM can be a wonderful adjuvant to this.
How does eye health work in TCM?
In traditional Chinese medicine, the eyes reflect the state of the mind, body and spirit and provide valuable diagnostic information to the TCM practitioner.
The classics state,‘the eyes are made from the essence of the five viscera [the heart, liver, kidneys, lung and spleen] and then are empowered by their qi’ and that ‘the essence from the…organs flows upwards to irrigate the eyes’. (2 p124) They are, therefore, under the influence of and windows in to the state of all of the organs, but in particular the liver, kidneys and heart.
The state and flow of our qi, blood and body fluids also impacts our eyes in TCM as do environmental factors.
Understanding the root
‘gan kai qiao yu mu’ – ‘The liver opens in to the orifice of the eyes’ (2 p38)
In TCM, the eyes are the sense organ relating to the liver. The liver supports our eye health and also governs our capacity for vision in our lives, our sense of direction and the ability to see where we are going and make plans.
Liver blood nourishes the eyes and when liver blood is deficient we may suffer from blurred vision, myopia (short-sightedness), floaters (dots or lines in your vision that move about as you move your eyes), impaired night vision or colour blindness. Accompanying liver blood deficiency signs and symptoms can include dizziness, insomnia (trouble getting to sleep), pallor, light or absent periods, muscle spasms and brittle nails with a pale tongue (especially the sides as these relate to the liver) and a thin radial pulse on palpation. Liver blood can be weakened by poor diet or impaired digestion, bleeding as in haemorrhage, heavy periods or in the postpartum and is an especially common pattern for women.
The yin energy of the liver also provides nourishment to the eyes. When liver yin is weak, we will see many of the opthalmalogical symptoms above, but also dry eyes which can be a hallmark feature (3). Accompanying symptoms can include nightsweats, tinnitus, insomnia (hard to stay asleep), a red tongue with little or no coat and a rapid, fine pulse. Liver yin can become depleted via ongoing liver blood deficiency and as usually combined with kidney yin deficiency which stems from overwork, chronic illness, excessive sexual activity or exercise, depletion of body fluids from febrile disease or overuse of yang tonics.
Conditions of excess in the liver also affect the eyes. The liver meridian passes through the eyes on the way to the top of the head. Liver yang (if not anchored by liver yin), heat or fire can rise or flare upwards via this channel leading to glaucoma, a feeling of pressure in the eyes, protruding eyeballs, blurred vision, bloodshot, painful, burning or severely itchy eyes. This will typically present with concurrent irritability, headache, dizziness, red complexion, thirst, dark urine, sleep disturbance, a red tongue (especially the sides) with a yellow coat and a full, rapid pulse. Heat in the liver is often generated by repressed or ongoing anger, frustration or resentment and from overconsumption of heating substances such as alcohol, red meats and fried foods. Constrained emotions also lead to liver blood stagnation which may result in eye pain, strabismus, dark spots on the sclera and be paired with a dark complexion, darkness under the eyes and a purple tongue.
In TCM we often speak of internally generated ‘wind’. Wind can be described as an energetic pathogen that is moving in nature (think muscle tics, itches, moving pains etc) and fills empty space created by deficiency, often of the blood or yin. It can also be created by yang rising and excessive heat like the kinetic wind force above an open fire. The liver, being prone to blood and yin deficiency, ascendant yang energy and heat, is readily affected by wind and this can manifest in eye conditions such as strabismus, nystagmus, protruding eyeballs and a feeling of distension in the eyes. Accompanying symptoms may include vertigo, tics or tremors, spasms, numbness of the limbs (liver blood deficiency leading to wind) and liver heat signs as above (liver heat turning to wind). A deviated and, or, quivering tongue are also signs of internal wind.
Kidney yin and jing (our inherited, constitutional ‘essence’) also nourish the eyes. Congenital eye conditions such as myopia and strabismus, chronic eye diseases and eye problems in the elderly, especially glaucoma and cataracts, are often due to insufficient or declining Kidney yin or jing.Accompanying symptoms for kidney yin deficiency are similar to, but perhaps more pronounced than, those for liver yin deficiency (indeed, the two pathologies often occur together), but here we will also see signs of general kidney deficiency such as sore low back and knees, poor memory, possible hearing impairment, tinnitus and nocturnal emissions. Deficient kidney jing may also display signs of greater kidney weakness including poor bone development in children, greying hair, hair loss, senility and loose teeth. Puffiness under the eyes is often a sign of kidney weakness. Kidney jing can be a constitutional deficiency or come about from aging or excessive sexual activity.
The classics state that ‘the spirit and the essence of the heart gather in the eyes’ (3 p77). The state of our spirit (our shen which resides in the heart) shines through our eyes. When the eyes are bright and sparkling, we know that a person is thriving in their emotional, mental and spiritual lives. Observation of the eyes is, therefore, very important in TCM to ascertain the degree of a presenting mental or emotional disturbance but also whether or not the shen has been impacted by or perhaps even stands as the underlying cause of a physiological complaint.
Like liver blood, heart blood also nourishes the eyes and as the heart channel also flows to the eyes, pathologies of the heart can often transfer to them. In particular, to the inner and outer corners of the sclera. If heart blood is deficient these will be pale and paired with symptoms such as diminished visual acuity, blurred vision, a tendency to startle easily, anxiety, insomnia, palpitations and a pale face and tongue. Heart blood becomes deficient via the same mechanisms as liver blood deficiency, but also from prolonged anxiety or worry. Heat in the heart stemming from emotional factors can lead to pain, burning, redness and itching of the eyes, especially the corners as well as typical heart heat signs such as insomnia and vivid dreams , palpitations, ulcers on the tongue, mental restlessness, heat sensations, a red face, bitter taste in the mouth, thirst, a red tongue (especially the tip) with a yellow coat and a rapid pulse.
In addition to organ disharmonies, the eyes are also affected by environmental factors. In particular, they are prone to invasion from Wind. This presents with acute symptoms with a sudden onset such as red, intensely itchy, streaming, sticky yellow discharge, swollen eyelids perhaps with a boil are generally from external wind-heat. These will be accompanied by an aversion to cold and a fever. External dryness can lead to dry, itchy, red eyes and dampness can create swelling and mucus.
Signs and symptoms
- Eye dryness
- Blurred vision
- Red eyes
- Inflamed eyes
- Itchy eyes
- Painful eyes
- Streaming eyes
- Feeling of distension in the eyes
- Decreased visual acuity
- Colour blindness
- Astigmatism – abnormally-shaped lens or cornea leading to visual impairment
- Nyctalopia – decreased night vision
- Myopia – short-sightedness
- Hyperopia – far-sightedness
- Nystagmus – involuntary movement of the eyeballs
- Strabismus – ‘squint’, eyes point in different directions
- Floaters – dots or lines ‘floating’ in vision
- Conjunctivitis – conjunctiva irritation from allergies or infection
- Diabetic – retinopathy – central vision loss from diabetes
- Age-related macular degeneration (AMD) – loss of central vision due to macular damage
- Glaucoma – hereditary vision loss from damage to optic nerve from fluid build up in the eye
- Retinitis pigmentosa – genetic disorder causing slow loss of vision
- Cataracts – cloudy patches on the lens affecting vision
Chinese herbal medicine tends not to use herbs individually but in synergistic formulae. It is important to consult a qualified TCM practitioner as they must be carefully prescribed and modified to match the individual’s presenting symptoms, environment and constitution.
There are many TCM herbs and formulas used to benefit the eyes. This is a small selection of examples.
gou qi zi, Lycium barbarum, Goji berries, are a popular sweet blood and yin tonic with antipyretic properties widely used in TCM to support eye health. Zeaxanthin is a carotenoid (pigment) that accumulates in fatty tissues, especially of the macula, that is believed to protect the macula from oxidative stress and degeneration. Gou qi zi is considered one of the best food sources of zeaxanthin (4) and its ability to prevent macular degeneration and pathology has been demonstrated in clinical research where it benefitted retinitis pigmentosa and AMD. Preclinical studies suggest it may also prevent damage from glaucoma (5) With the appropriate presentation, it may be used to treat dry eyes, blurred vision, photosensitivity, night-blindness and reduced visual acuity (6).
ju hua, Chrysanthemum morifolium, Chrysanthemum flowers, is a sweet, bitter, pungent, cool herb with antipyretic, anti-inflammatory, antihypertensive and diaphoretic properties that ‘releases the exterior’ in cases of wind-heat and is often paired with gou qi zi in simple teas and herbal formulas for the eyes. It also clears liver heat from both excess and deficiency, soothes the eyes and has a calming action on the liver and, therefore, shen. It is indicated for red, painful, dry eyes, tearing, blurry vision, floaters. bai ju hua (white chrysanthemum) is better at supporting diminishing vision from liver and kidney deficiency, whereas huang ju hua (yellow chrysanthemum) is better at clearing red eyes from external wind-heat (7). Lutein is another carotenoid found in the macula that provides similar protection to zeaxanthin and is a component of huang ju hua (4).
qi ju di huang wan, lycium fruit, Chrysanthemum and rehmannia pill, is a derivative of the classic yin tonic formula, liu wei di huang wan, where gou qi zi and bai ju hua have been added to direct the formula to eye pathologies such as dry eyes with reduced visual clarity, photophobia, tearing from wind or painful eyes stemming from liver and kidney yin deficiency.
ming mu di huang wan, Improve vision pill with rehmannia, is another variant of liu wei di huang wan, where chai hu (Bupleurum), dang gui (Chinese Angelica) and wu wei zi (Schisandra) have been added to strongly nourish the liver and kidneys and improve the vision. It is believed to be more effective in this regard than the above formula and is used in cases of optic neuritis, optic nerve atrophy and central retinitis (8).
bo he, Mentha haplocalyx, mint, is another cooling, pungent, diaphoretic herb for clearing wind-heat with red eyes, sore throat and headache. It also clears liver heat, calms the liver and soothes the mind. It must be added towards the end of a decoction to preserve its properties.
bo he is combined with cooling, diaphoretic sang ye (Mulberry leaf) and ju hua in sang ju yin, Mulberry Leaf and Chrysanthemum Decoction, a classic 8-herb formula for releasing exterior wind-heat that can alleviate acute conjunctivitis. To this end, bai ji li (Tribulus) , jue ming zi (Cassia) and xia ku cao (Prunella) will also be added.
xiao yao san, rambling powder, is a popular formula for stress and tension leading to liver qi stagnation. Where liver qi stagnation has led to heat and affected the eyes, we may use the variation jia wei xiao yao san. Bitter and cold mu dan pi (Peony root cortex) and zhi zi (Gardenia) are added to the original formula to support bo he in cooling heat and ascending Liver fire. Mu dan pi and zhi zi are a classic herb combination for dry, scratchy eyes from liver blood deficiency.
long dan cao, Gentiana spp., Gentian, is a very cold and bitter herb with antibacterial, antihypertensive and antiinflammatory properties used in cases of extreme liver heat with red, swollen and painful eyes. This herb is at risk of becoming endangered so only the cultivated plant should be used (6).
long dan xie gan tang, Gentiana Longdancao decoction to drain the Liver, is a ten-herb formula featuring long dan cao as its chief medicinal and including zhi zi that cools excessive liver heat and may be used in cases of red and sore eyes from liver heat. With the corresponding signs and symptoms, it can be used in cases of uveitis, conjunctivitis, corneal ulcers, acute glaucoma and central retinitis (8). This is a very cold formula. As such, gan cao is included to protect the ‘middle burner’ (spleen and stomach) from cold but it still cannot be used for long periods or in those with digestive deficiency.
TCM diet tips
- In cases where heat and, or, yin deficiency is present it is important to avoiding warming foods and stimulating substances. These include spices (think chilli, pepper, garlic, cinnamon etc), red meat (especially lamb), fried foods, sugar, caffeine and alcohol. Incorporate more cooling foods such as greens, celery, cucumber, daikon radish, spinach, apples, watermelon, mint, mint tea, chrysanthemum tea, fish (ocean).
- In cases of liver blood deficiency, increase blood nourishing foods such as dark leafy greens, liver, beef, lamb, bone marrow, bone broths (chicken/ beef – aim for a cup a day), eggs, sardines, oysters, mussels, beetroot, kelp, shiitake mushroom, parsley, avocado, nettle tea, raspberry leaf, almonds, molasses, dried apricot and fig.
- ju hua and gou qi zi are often made in a tea for eye health. The soaked gojis may be eaten at the end and the chrysanthemum flowers placed over the eyes as a cooling compress for tired, sore or inflamed eyes.
- Mint tea is also lovely for brightening the eyes, clearing the mind and lifting the mood, especially in the warmer months.
- Consume foods rich in Vit C, E, Zinc, selenium and copper
- Eat an abundance of antioxidant foods
Especially beneficial are:
- broad leafy greens
- brightly coloured fruit and vegetables such as corn, carrots, orange and peppers
- oily fish such as salmon, tuna and mackerel
- eggs (9)
- Take regular breaks from looking at screens
- Decrease alcohol consumption
- Maintain a healthy wait and exercise regularly
- Quit smoking. After aging, smoking is the biggest risk factor for developing macular degeneration and increases risk of cataracts (9)
- Avoid sun exposure to the eyes
- Have regular sight tests
- Get adequate rest
- Adopt relaxation techniques
Acupuncture and ‘eye qi gong’
Acupuncture and moxibustion have a long history of treating eye conditions. ‘Eye qi gong’ is the name given to self-massage and acupressure stimulation of the eye area by TCM paediatrician and eye specialist, Julian Scott. Instructions for his eye qi gong may be found here.
Scott also advocates ‘yoga for the eyes’ and directs us to sequences by Meir Schneider that may be found here. (10,11)
- Common Eye Conditions. Sight Concern. Accessed June 10 2022. https://www.sightconcern.co.uk/supporting-you/information-and-advice/common-eye-conditions/
- Flaws B. Statements of Fact in Traditional Chinese Medicine. 9th ed. Boulder: Blue Poppy Press; 2010.
- Maciocia G. Diagnosis in Chinese Medicine: A Comprehensive Guide. Edinburgh: Elsevier Ltd; 2004.
- Dharmananda S. Lycium Fruit: Food and Medicine. Published Aug 2007. Accessed 1 June 2022. http://www.itmonline.org/arts/lycium.htm
- Bokelmann J. Medicinal Herbs in Primary Care: An Evidence-Guided Reference for Healthcare Providers. Philadelphia: Elsevier; 2022.
- Tierra L. Healing with the Herbs of Life. New York: Crossing Press; 2003.
- Bensky D, Gamble A. Chinese Herbal Medicine: Materia Medica. 2nd ed. Washington: Eastland Press; 1993.
- Barolet R, Bensky D. Chinese Herbal Medicine: Formulas and Strategies. Washington: Eastland Press Inc.; 1990.
- Vision Matters. Looking After Your Eyes. Accessed June 10 2022. https://www.visionmatters.org.uk/looking-after-your-eyes/looking-after-your-eyes
- Scott J. Treating Dry Macular Degeneration with Acupuncture. Accessed June 10 2022. https://www.jadeinstitute.com/posts/treating-dry-macular-degeneration-with-acupuncture/
- Scott J. Eyebright Massage. Accessed June 10 2022. http://www.eyebright.me.uk/wp/wp-content/uploads/delightful-downloads/2015/09/Eyebright-massage.mp4