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Source: Xiang Shengjin, Tang Na, Jiang Xiaohan, et al. Exploration of Myopia in Children and Adolescents Based on the Theories of Qi, Blood, and Meridians in Traditional Chinese Medicine. Chinese Journal of Optometry and Visual Science, 2024, 26(4): 249-253.
Abstract
Myopia is a significant public health issue in China and globally, with the myopia rate among Chinese children ranking first in the world. In recent years, Traditional Chinese Medicine (TCM) therapies, especially suitable TCM techniques, have played an increasingly important role in the prevention and control of myopia in children and adolescents. Some scholars have proposed new perspectives on the TCM pathogenesis of myopia in children and adolescents, promoting theoretical innovation and development in TCM for myopia prevention and control. The theory of choroidal and scleral ischemia and hypoxia is a major discovery in modern medicine regarding the formation of myopia. Based on the homogeneity of TCM meridians and modern microvascular medicine, as well as the close relationship between modern ischemia and hypoxia and TCM’s concepts of Qi and blood deficiency, we believe that various causes leading to insufficient Qi and blood in the eyes, and the deficiency of nourishing meridians, result in stagnation over time, causing the muscles and vessels in the eyes to contract and malfunction, preventing the divine light from reaching far distances. This is the core of the TCM pathogenesis of myopia. Accordingly, we propose the hypothesis of “insufficient Qi and blood, and stagnation of the eye meridians” to explore the pathogenesis of myopia from the perspective of Qi, blood, and meridians, aiming to provide new ideas for TCM in preventing and controlling myopia in children and adolescents.
Keywords
Myopia; TCM theoretical exploration; Qi and blood deficiency; stagnation of eye meridians
Funding Project
Zhejiang Province TCM Modernization Special Project (2022ZX013); Zhejiang Province TCM Innovation Team – Innovative Research Team for the Correction of Myopia and Amblyopia in Children and Adolescents
As the incidence continues to rise, myopia has become a serious public health burden in China and globally. According to a survey by the National Health Commission, in 2020, the myopia rate among children in China ranked first in the world, with an estimated 700 million myopic individuals, showing a trend of younger onset, rapid progression, and increasing severity. In recent years, TCM therapies, especially suitable TCM techniques, have played an increasingly important role in the prevention and control of myopia in children and adolescents. Some scholars have proposed innovative viewpoints on the TCM pathogenesis of myopia, such as Hou Xinyue’s theory of “Jing and tendon imbalance” for treating myopia; and Jie Xiaofeng’s theory of “Liver-Kidney-Brain-Eye” for treating myopia, which have all contributed to the understanding of the pathogenesis of myopia in children and adolescents from a TCM perspective. The “Yinhai Jingwei” states: “Those who can see near but not far are due to blood deficiency and insufficient Qi,” indicating that myopia is caused by insufficient Qi and blood. Sun Hongrui and others have also explored the treatment of myopia from the perspective of “prolonged viewing injures blood,” providing a theoretical basis for the prevention and treatment of myopia from the perspective of Qi and blood. Modern research has confirmed that choroidal and scleral ischemia and hypoxia are important mechanisms in the formation of myopia, with decreased choroidal blood flow leading to scleral hypoxia and ischemia, ultimately inducing the development of myopia. This has led to the proposal of theories such as “scleral remodeling” and “choroidal ischemia” regarding the formation of myopia. Based on the homogeneity of TCM meridians and modern microvascular medicine, as well as the close relationship between modern ischemia and hypoxia and TCM’s concepts of Qi and blood deficiency, combined with the theory from the “Huangdi Neijing” that “the eyes are where the meridians converge,” we believe that the rich meridians of the eyes, along with various causes leading to insufficient Qi and blood, result in the deficiency of nourishing meridians, leading to stagnation over time, causing the muscles and vessels in the eyes to contract and malfunction, preventing the divine light from reaching far distances. This is the core of the TCM pathogenesis of myopia. Accordingly, we propose the hypothesis of “insufficient Qi and blood, and stagnation of the eye meridians,” which we will elaborate on as follows.
1 Myopia is fundamentally based on Qi and blood deficiency and meridian insufficiency
Qi and blood are the material basis for the formation and maintenance of life activities in the human body, generated by the functional activities of the organs, thus playing an important role in maintaining normal life activities. The “Taiping Shenghui Fang – Eye Disorders” states: “The eyes connect to the five organs, and Qi penetrates the five wheels”; the “Suwen – Five Organs Generation” states: “The liver receives blood and can see”; the “Shen Shi Yao Han – The Eye is a Precious Treasure” states: “True blood… nourishes the blood of the eye meridians.” These discussions clearly indicate that the ability of the eyes to see and distinguish colors is based on their own Qi and blood. “All blood belongs to the heart… thus when a person lies down, blood returns to the liver, and the liver receives blood and can see,” indicating that the fullness of blood and the smoothness of the meridians are important conditions for ensuring normal visual function. Various causes, including dysfunction of the organs leading to Qi and blood imbalance, can lead to various eye diseases, including myopia.
The meridians are components of the channels, as stated in the “Jingmai – Meridian Measurement”: “The meridians are internal, while those that branch out and run horizontally are the collaterals, and the branches of the collaterals are the Sun.” Yu Jiayan’s “Medical Law” records: “The twelve meridians give rise to twelve collaterals, which give rise to one hundred and eighty system collaterals, which give rise to one hundred and eighty intertwined collaterals, which give rise to thirty-four thousand Sun collaterals.” Therefore, the meridians are derived from the main channels, subdivided layer by layer, ultimately forming a network throughout the body. The meridians uniquely structure the distribution of Qi and blood that runs linearly in the main channels, allowing Qi and blood to permeate and nourish the internal organs and external muscles. The meridians serve as channels for the flow of Qi and blood, continuously nourishing the entire body, fulfilling their role of “circulating blood and Qi to nourish Yin and Yang, moistening tendons and bones, and benefiting joints.” The eye’s meridians are particularly rich, as stated in the “Ling Shu – Eye Questions”: “The eyes are where the meridians converge.” Furthermore, the “Ling Shu – Pathogenic Qi and Organ Disease Forms” states: “The twelve meridians, three hundred sixty-five collaterals, all ascend to the face and run through the orifices, with the essence and Yang Qi ascending to the eyes to form the pupils,” indicating that the ability of the eyes to see all things and distinguish colors relies on the nourishment and irrigation of the essence and blood from the five organs and six viscera, while the eye’s meridians (eye collaterals) are the pathways for the Qi and blood from the five organs and six viscera to reach the eyes. The eyes are positioned high, gathering the meridians, with deep pathways, intricate channels, and complex structures, referred to as the clear orifices. The Qi and blood running through the eye’s meridians are termed true Qi and true blood. As the pathway for Qi and blood, the eye’s meridians are responsible for distributing and nourishing Qi and blood; thus, when the eyes are rich in Qi and blood, the meridians are well-nourished, allowing the divine light to reach far and perceive all things. Conversely, if the eyes are deficient in Qi and blood, the meridians are insufficiently nourished, leading to a lack of nourishment for the eye orifices, resulting in dim vision. For myopia, insufficient outdoor activity, deficiency of essence and blood; or excessive eye strain, leading to a lack of nourishment for the eyes; or spleen Qi deficiency, leading to insufficient essence, among various causes, result in insufficient Qi and blood in the eyes, and deficiency of nourishing meridians. Over time, this leads to stagnation in the eye meridians, contraction of the muscles and vessels in the eyes, malfunctioning of regulation, and the divine light failing to reach far distances, resulting in myopia. The “Qianjin Yaofang – Seven Orifices Disease” states: “Frequent viewing of the sun and moon, night vision of stars and fire, reading fine print at night, reading under the moonlight, copying for many years, intricate carving, and endless gaming… leads to the loss of brightness,” indicating that prolonged close-up use of the eyes, or using them in insufficient lighting conditions, can lead to visual fatigue and various eye diseases, including myopia. Therefore, the formation of myopia is fundamentally based on Qi and blood deficiency and stagnation of the eye meridians, with the contraction of the muscles and vessels in the eyes and malfunctioning of regulation being the manifestations. However, regarding Qi and blood deficiency and stagnation of the eye meridians, Qi and blood deficiency is the cause, while the stagnation of the meridians due to lack of nourishment is the result.
2 Analyzing the Physiological and Pathological Aspects of Myopia from Qi and Blood Deficiency and Stagnation of the Eye Meridians
The “Yinhai Jingwei” states: “Those who can see near but not far are due to blood deficiency and insufficient Qi,” clearly establishing the connection between Qi and blood deficiency and myopia. Qi and blood flow through the eye meridians to nourish the eyeball, ensuring the normal functioning of visual capabilities. If Qi is deficient and blood is scarce, the eye meridians will be insufficiently filled, preventing the divine light from reaching far distances. Since the lungs govern Qi, the kidneys are the root of Qi, and the spleen is the source of Qi and blood production, blood is generated in the spleen, transported by the heart, and stored in the liver, Qi and blood deficiency is related to all five organs, but particularly closely related to the liver, spleen, heart, and kidneys. The liver opens to the eyes, and the liver meridian connects to the eye system, making the relationship between the eyes and the liver particularly close. The liver stores blood, which is its essence; the liver Qi flows to the eyes, which is its function. Vision relies on the smooth flow of liver Qi and the nourishment of liver blood. Qi cannot function without blood, and blood cannot circulate without Qi. When the liver’s function of smooth flow is normal, the complex meridian system in the eyes will have smooth Qi flow and blood circulation, allowing the eyes to distinguish colors. The heart governs blood vessels, and the “Ophthalmology Hundred Questions” states: “Why do young people have myopia? It is due to excessive worry consuming heart blood, thus they cannot see far,” indicating the importance of the heart’s blood supply for maintaining the visual function of the eyes. At the same time, the heart governs the spirit and promotes “Yang Qi.” The degree of change in vision in children and adolescents also depends on the sufficiency of “Yang Qi” within their bodies. The spleen is the source of Qi and blood production and governs the upward movement of clear Yang Qi. The “Lan Shi Mi Zang” states: “The essence and Qi of the five organs and six viscera are all received by the spleen and ascend to the eyes… thus if the spleen is deficient, the essence and Qi of the five organs will all lose their function and cannot return to nourish the eyes.” Therefore, the spleen’s ability to transport the essence of the five organs and six viscera to nourish the eyeball is an important condition for maintaining its ability to see and distinguish colors, which is closely related to the formation of myopia. The kidneys store essence and nourish the five organs, serving as the root of Qi and blood in the body. The “Eye Classic” states: “Spleen and kidney deficiency leads to leakage, resulting in myopia,” indicating the important role of kidney essence and kidney Yang in myopia, especially in pathological myopia.
Regarding the causes of myopia due to Qi and blood deficiency and stagnation of the eye meridians, it can be attributed to both insufficient generation of Qi and blood and excessive consumption of Qi and blood. Insufficient generation can be attributed to the heart and spleen, or even congenital insufficiency, where essence does not transform into blood; excessive consumption can be due to overwork and lack of movement, staying up late, or emotional instability. Currently, children and adolescents spend long hours studying indoors, overusing their eyes, leading to blood depletion and Qi exhaustion, ultimately resulting in myopia. The “Ling Shu – Great Confusion” describes: “Desires cannot exhaust the eyes”; the “Shen Shi Yao Han” states: “Prolonged viewing injures the eyes, leading to myopia.” Heavy academic burdens, reduced outdoor activities, and prolonged Yang Qi deficiency lead to an imbalance of Yin and Yang in the eyes. Heavy academic burdens, staying up late, or excessive worry can darkly consume Yin blood, leading to insufficient Yin blood, causing the eyes to lose nourishment, resulting in myopia. Irregular or excessive dietary habits can damage the spleen and stomach, leading to insufficient Qi and blood production; or spleen and stomach weakness can prevent the essence and Qi of the organs from ascending to nourish the eyes, also leading to myopia. The eyes rely on the essence and Qi of the organs, and insufficient kidney essence can scatter vision; or congenital insufficiency can lead to deficiency of original Yang, failing to nourish the spirit, resulting in weakened divine light and inability to see far, leading to myopia from a young age. The “Ling Shu – Great Confusion” states: “The essence and Qi of the five organs and six viscera all ascend to the eyes and become the essence… when the essence scatters, vision is impaired.” Therefore, various causes leading to Qi and blood deficiency, loss of nourishment for the eye orifices, and inability of the divine light to reach far distances; or Qi and blood deficiency, loss of nourishment for the eye meridians, and poor circulation of Qi and blood, over time lead to stagnation in the eye meridians, contraction of the muscles and vessels in the eyes, malfunctioning of regulation, and inability of the divine light to reach far distances, resulting in myopia.
3 The Consistency of Qi and Blood Deficiency, Stagnation of the Eye Meridians, and the Theory of Choroidal Ischemia and Hypoxia
In recent years, research has found that the choroid plays an important role in the occurrence and development of myopia. The choroid actively regulates its thickness to control the position of the retina for clear reception of images. If the choroidal function declines and cannot compensate by adjusting its thickness to change the position of the retina, or if irreversible thinning occurs, myopia will form. Studies have shown that myopia leads to thinning of the choroidal thickness (Choroidal thickness, ChT), most significantly in high myopia, and the main reason for changes in ChT is the alteration of choroidal blood flow (Choroidal blood flow, ChBF). The choroid is the main source of oxygen and nutrients for the outer layer of the retina and sclera; reduced ChBF not only leads to relative hypoxia of the retina but also accelerates the progression of myopia and elongation of the eyeball. Wu et al.’s research indicates that after the onset of myopia, the choroid and sclera thin, leading to reduced ChBF, resulting in insufficient oxygen and nutrient supply to the sclera; after scleral hypoxia, hypoxia-inducible factor expression is upregulated, causing remodeling of the scleral extracellular matrix, promoting elongation of the eyeball, thus accelerating the development of myopia. Simultaneously, when choroidal blood flow is insufficient, its thickness decreases, accelerating the progression of myopia. Zhou et al. further studied the bidirectional relationship between ChBF and ChT with the development and recovery of myopia, indicating that increasing ChBF can alleviate scleral hypoxia, thus inhibiting the progression of myopia. Therefore, choroidal ischemia and hypoxia can lead to the growth of myopia, while increasing choroidal blood flow can reduce the development of myopia.
The choroid is a highly vascularized tissue, falling under the category of TCM meridians. The function of choroidal blood vessels in providing oxygen and nutrients to the outer layer of the retina and sclera is a specific manifestation of the meridian function of “dispersing the linear flow of Qi and blood from the main channels throughout the body, achieving the permeation and nourishment of the internal organs and external muscles.” Both Qi and blood are the most basic nutrients for maintaining life activities in the human body; blood is the mother of Qi, and Qi is the commander of blood, accompanying each other, working together with the Qi and blood of the eyes to achieve the upward nourishment of the essence and Qi from the organs to the eye orifices. When the eyes are rich in Qi and blood, the eye meridians (choroid) are normally filled, and the tissues of the eye orifices (retina, sclera) can receive the essence and subtle substances from the five organs and six viscera, allowing the divine light to reach far distances. If Qi and blood are deficient, the eye meridians are undernourished, leading to poor Qi flow and stagnation over time, ultimately resulting in contraction of the muscles and vessels in the eyes, malfunctioning of regulation, and inability of the divine light to reach far distances, resulting in myopia. Existing studies have confirmed that extracts of Astragalus membranaceus (Huang Qi) with Qi-tonifying effects and extracts of Rhodiola rosea (Hong Jing Tian) with meridian-unblocking effects can improve the expression of hypoxia-inducible factors and increase choroidal blood flow, thus reversing the occurrence and development of myopia. Therefore, regarding the formation of myopia, the TCM pathogenesis hypothesis of “Qi and blood deficiency, and stagnation of the eye meridians” is consistent with the modern medical theory of “choroidal ischemia and hypoxia.”
4 Qi and Blood Deficiency, Stagnation of the Eye Meridians, and Understanding Myopia from TCM Qi and Blood Theory
TCM believes that the etiology and pathogenesis of myopia are closely related to Qi and blood, Yin and Yang, meridians, and genetic factors, involving multiple organs such as the heart, liver, spleen, and kidneys. The national higher education planning textbook “TCM Ophthalmology” summarizes the etiology and pathogenesis of myopia as weak heart Yang, Yin excess and Yang deficiency, preventing the divine light from reaching far distances; excessive use of the eyes, consuming Qi and injuring blood, preventing the divine light from reaching far distances; congenital insufficiency, liver and kidney deficiency, weakening the divine light, preventing the light from reaching far distances. Based on this, contemporary scholars have proposed various theories on the formation of myopia from different perspectives, such as the “Jing and tendon imbalance” hypothesis, which explores the cyclical changes in the pathogenesis of myopia from the perspectives of “Jing” and “imbalance,” indicating that imbalances in Qi and blood and tendon function lead to pathological manifestations such as ischemia of the choroid and hypoxia of the sclera. Other scholars have explored the treatment of myopia from the perspective of “prolonged viewing injures blood,” providing new ideas for the prevention and control of myopia in children and adolescents. We explore the formation of myopia from the perspective of changes in Qi and blood and meridian function, focusing on the pathological changes of Qi and blood deficiency and meridian insufficiency leading to stagnation. This is because: ① From the disease course perspective, the occurrence of myopia is a slow and long-term process, consistent with the TCM pathological characteristics of “long illness leads to deficiency” and “long illness enters the meridians.” ② From the etiology perspective, excessive use of the eyes, overexertion, insufficient sleep, and reduced outdoor activities primarily consume the body’s Qi and blood, thus the formation of myopia is fundamentally based on deficiency. ③ From the pathological perspective, Qi and blood deficiency, with weak Qi unable to promote, can lead to meridian deficiency and subsequently stagnation, but stagnation is predicated on deficiency of Qi and blood, Yin and Yang, meaning that deficiency is the root cause, while stagnation is the manifestation. Therefore, although meridian deficiency and stagnation can be mutually causal, in terms of the formation of myopia, it is the result of deficiency leading to stagnation. ④ From the clinical manifestation perspective, even in the early stages of myopia, the primary symptoms of blurred vision and fatigue due to muscle contraction and malfunctioning of regulation still fundamentally stem from Qi and blood deficiency and stagnation of the eye meridians. ⑤ From the perspective of the correspondence between TCM and modern medicine, the concepts of Qi and blood deficiency and choroidal ischemia and hypoxia are consistent. ⑥ From the treatment perspective, understanding the pathogenesis of myopia as “Qi and blood deficiency, and stagnation of the eye meridians” lays the theoretical foundation for using Qi-tonifying, blood-nourishing, and meridian-unblocking methods to prevent and control myopia in children and adolescents. As previously mentioned, extracts of Astragalus membranaceus and Rhodiola rosea can reverse the occurrence and development of myopia, further validating the correctness of this theory. Next, we will apply TCM herbal formulas that tonify Qi and nourish blood, and meridian-unblocking techniques guided by this theory, to clinically and experimentally validate the correctness of this hypothesis.
5 Conclusion and Outlook
Based on the theories of Qi and blood and meridians, we have explored the core of myopia formation as Qi and blood deficiency and stagnation of the eye meridians, considering how various environmental factors such as overexertion and reduced outdoor activities lead to dysfunction of the organs, resulting in myopia. We aim to provide new ideas for TCM to guide the prevention and control of myopia in children and adolescents. Since the eye’s meridians serve as the pathways for the flow of Qi and blood, when Qi and blood are sufficient, the meridians are well-nourished; when Qi and blood are deficient, the meridians are undernourished. Thus, the core of the pathogenesis of “Qi and blood deficiency, and stagnation of the eye meridians” is Qi and blood deficiency. Nevertheless, attention must also be paid to the pathological changes leading to muscle contraction and malfunctioning of regulation due to Qi and blood deficiency and stagnation of the eye meridians, meaning that myopia fundamentally arises from Qi and blood deficiency and stagnation of the eye meridians, while muscle contraction and malfunctioning of regulation are the manifestations. In treatment, it is also essential to address both the root cause and the symptoms. A large number of studies have confirmed that TCM external treatment methods, such as auricular acupuncture, have good efficacy in preventing and controlling myopia in children and adolescents. Therefore, auricular acupuncture, massage, and acupressure may effectively improve the symptoms of muscle contraction and malfunctioning of regulation—manifestations of myopia—while oral TCM may be more beneficial for addressing the root cause of myopia—Qi and blood deficiency and stagnation of the eye meridians. By addressing both the root cause and the symptoms, combining internal and external treatments, we aim to better achieve the goal of preventing and controlling myopia in children and adolescents.
Conflict of Interest Statement No conflicts of interest.
Author Contributions Statement Xiang Shengjin: Article topic design, revision of the article, and review based on editorial comments. Tang Na: Drafting the initial article, obtaining technical support materials; revising based on editorial comments. Jiang Xiaohan: Drafting the initial article, obtaining technical support materials; revising based on editorial comments. Lü Fan: Article topic design, revision, and review of the paper, modifying key results and conclusions in the paper.
Author Affiliation: Wenzhou Medical University Affiliated Eye Hospital, Wenzhou 325027
First Author: Xiang Shengjin, Email: [email protected]
Corresponding Author: Lü Fan, Email: [email protected]
Citation:
Xiang Shengjin, Tang Na, Jiang Xiaohan, et al. Exploration of Myopia in Children and Adolescents Based on the Theories of Qi, Blood, and Meridians in Traditional Chinese Medicine. Chinese Journal of Optometry and Visual Science, 2024, 26(4): 249-253.
DOI: 10.3760/cma.j.cn115909-20240116-00032.
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