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복시의 한방치료 Could Acupuncture be helpful for Diplopia?

Recently, we have been treating a patient at our clinic for about three months who has been showing improvement with diplopia as the main symptom. Therefore, we are looking for some related papers to introduce this case and share our experience. 최근에 저희 병원에서 복시를 주증상으로 3개월 가량 치료를 하면서 호전을 보이고 있는 환자분이 계셔서 소개도 할겸, 관련된 논문을 몇가지 찾아보고 있습니다. 아래의 논문은 "후천성 마비사시"라는 안구 운동이 제한되는 질환에 대한 연구입니다. 이 질환은 안구를 움직이는 근육들 중 어떤 이유로 인해 마비가 생겨서 발생합니다.


이 중에서도 가장 흔한 원인은 외전신경마비라고 하는데, 이는 혈관성 위험 인자나 동맥류, 종양, 두부 외상 등이 원인이 될 수 있습니다.


한의학에서는 이러한 안구 운동 장애를 "神珠將反", "瞳神反背", "墜睛", "仰視" 등으로 표현하며, "風牽偏視"라는 용어로도 사용됩니다. 한의학에서는 이 질환을 다양한 증상과 함께 고혈압, 간의 문제, 비장의 문제, 신장의 문제, 체력 부족 등의 원인으로 볼 수 있습니다.


외전신경마비가 발생하면 수평 복시 증상이 동반되어서 보기 어렵고 보행 장애 등의 문제가 발생할 수 있습니다. 이러한 환자들은 치료 없이는 제대로 활동을 할 수 없기 때문에, 이 논문에서는 한의학 치료를 통해 환자의 증상이 호전되는 것을 확인하고자 하였습니다.


The following research is a study on a condition called "acquired paralysis of eye movement," which limits the movement of the eye muscles. This condition occurs when one or more of the muscles that move the eye become paralyzed for various reasons.

The most common cause of this condition is called abducens nerve palsy, which can be caused by vascular risk factors, aneurysms, tumors, head trauma, and other factors.

In traditional Korean medicine, this eye movement disorder is expressed as "神珠將反," "瞳神反背," "墜睛," "仰視," or "風牽偏視." This condition can be attributed to various causes, such as high blood pressure, liver problems, spleen problems, kidney problems, and lack of physical strength.


Abducens nerve palsy can cause horizontal diplopia, making it difficult to see and causing problems with walking. Without proper treatment, patients with this condition cannot perform their daily activities. Therefore, this research aimed to confirm the improvement of patients' symptoms through traditional Korean medicine treatment.




Case 1:

Patient name: Kim OO Medical history: 28-year-old male, experienced non-rotatory nystagmus and headache after exercise on May 4, 2016. Developed diplopia after exertion on May 10, followed by worsening of diplopia and left eye abduction palsy on May 11. Diagnosed with CN VI palsy and intracranial hypotension by brain MRI at Yangsan Pusan National University Hospital on May 12. Discharged after 8 days of hospitalization and admitted to our hospital on May 23, 2016.

Initial examination findings:

  1. Ocular motility: Scott and Kraft score of -3 for left lateral gaze (left eye abduction at 40% of normal) (Fig. 1). The distance at which diplopia occurred was 13.2 cm from the midline.

  2. Other symptoms: Headache accompanied by eye pain occurred when looking, and dizziness occurred when active for more than 20 minutes, requiring bed rest.

  3. Fundus examination: Fundus examination (TRC-NW8, Topcon corporation) was performed at our hospital to exclude other ophthalmic diseases (Fig. 2).

Treatment Method:

  1. Acupuncture treatment: The patient was treated with a disposable stainless steel needle (0.25×40 mm) around the left eye, at the following acupoints: 絲竹空, 太陽, 瞳子髎, 承泣, 睛明, 攒竹, 魚要, and 球后. The treatment was carried out twice a day for 20 minutes each session.

  2. Herbal medicine treatment: The patient was prescribed with a combination of 供辰丹 (Table 1) and 四六湯 (Table 2) to be taken orally.

  • 供辰丹 : The patient took 1 pill (4.01g) once a day, 30 minutes before breakfast.

  • 四六湯 : The patient took 1 pack (120 ml) three times a day, 30 minutes after meals.


Treatment Progress:

The patient's progress was observed through photographs to assess the restriction of eye movement, and the distance at which blurred vision occurred was measured daily. According to the left gaze photograph, the Scott and Kraft score improved from -3 upon admission to -2 upon discharge (Fig. 3). The distance at which blurred vision occurred improved from 13.2 cm to 0 cm, indicating complete recovery. Additionally, the patient's headache accompanied by eye pain disappeared, as reflected by a visual analog scale (VAS) score of 0, while the VAS score for blurred vision improved to 0.6 (Fig. 4).






Case 2

Name: Lee OO

Presenting complaint: diplopia

Onset date: July 27, 2018

Past medical history:

  1. Enteritis: abdominal pain and diarrhea occurred for three days due to a hospital infection on July 20, 2018, and the patient lost 7 kg of weight compared to before.

Present medical history:

The patient is a 37-year-old male who presented with diplopia and external ophthalmoplegia on July 27, 2018. He was diagnosed with idiopathic right abducens nerve palsy after a neurological examination and brain MRI showed no specific findings. He was hospitalized for 3 days and then transferred to the current hospital on July 30, 2018.

Initial findings:

  1. Ocular movement: When looking to the right, the right eye could not cross the midline, and the Scott and Kraft score was -4 (Figure 5). The distance at which diplopia occurred from the midline was 47.5 cm.

  2. Other symptoms: The patient complained of eye fatigue in both eyes and worsening dizziness when not covering his right eye. He also complained of a decreased sense of touch in the tip of his nose and chin and numbness in the upper lip.

  3. Fundus examination: An ophthalmic examination (TRC-NW8, Topcon corporation) was performed to exclude other ophthalmic diseases (Figure 6).

Treatment:

  1. Acupuncture: Acupuncture was performed once a day for 20 minutes using a 0.25x40mm stainless steel needle at the following acupoints around the right eye: 絲竹空, 太陽, 瞳子髎, 承泣, 睛明, 攒竹, 魚要, and 球后.

  2. Herbal medicine: The patient was prescribed different herbal medicines according to his condition.

Treatment period: The patient was treated from July 30 to August 13, 2018 (a total of 15 days).

Treatment progress:

The patient's ocular movement was monitored using photographs, and the distance at which diplopia occurred was measured daily. The Scott and Kraft score improved from -4 on admission to -2 on discharge (Figure 7). The distance at which diplopia occurred decreased from 47.5 cm to 37.5 cm, indicating some improvement. The patient's eye pain, numbness, and other sensory symptoms improved, and the VAS score for eye fatigue decreased to 0. The patient's symptoms were completely resolved on discharge.






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