Case Report Creative Commons, CC-BY
A case of Hordeolum in Lactating Women Treated with Centro-square Needling
*Corresponding author:Pu Jianping, Department of Ophthalmology, Anning First People’s Hospital Affiliated to Kunming University of Science and Technology, China.
Received:December 08, 2022;Published:April 20, 2023
This paper introduces a case of lactating styloma, Li, 26, who went to the doctor because of “local redness, swelling and pain of the lower eyelid of the right eye for 3 days”, accompanied by itching and burning sensation. The method of raising puncture was used for treatment. The specific operation is as follows: one needle is directly punctured at the center of the lesion, and then one needle is punctured at the top, bottom, left and right respectively. After acupuncture, apply a small amount of tobramycin and dexamethasone eye ointment on the outside of the diseased tissues of the eyelids to seal the eyes, and order hot water bags to be applied 4 times a day, 15 minutes each time, and once every other day, for a total of 2 times. Later, because of fear of acupuncture, the acupuncture treatment was abandoned, and the local hot compress method was used. After 2 days of hot compress, the patient was returned to the hospital, and recovered in 5 days. Up to now, the patient’s condition has not been repeated. According to the literature and ancient books, up to now, we have not seen the treatment method of Centro-square Needling to treat wheat swelling. This method is the first to treat this disease, which provides new ideas and methods for the treatment of Hordeolum. which provides new ideas and methods for the treatment of Hordeolum. Which provides new ideas and methods for the treatment of wheat swelling.
Keywords: Centro-square Needling, Hordeolum, Puncture and bleed, Lactating women
Li, female, 26 years old, breastfeeding, went to the doctor for the first time on May 10, 2022, because of “local redness, swelling and pain on the lower eyelid of the right eye for 3 days”. 3 days ago, there was no obvious inducement, and the localized swelling of the lower eyelid of the right eye suddenly appeared, with severe itching, reddish, burning around the lower eyelid, pain and refusal to press. Specialist examination: VOD: 0.6, VOS: 1.0, swelling and compression of the bulbar conjunctiva near the puncta of the inner canthus of the right lower eyelid, redness around the lower eyelid, swelling, high skin temperature, palpable induration, and obvious tenderness (Figure 1), No pustular ulceration, hyperemia on the nasal side of the bulbar conjunctiva, transparent cornea, middle deep anterior chamber, atrial flash (-), round pupil, about 3*3mm, sensitive to direct light reflex, transparent crystal, optic papilla color positive side clear, C/D=0.3, the fovea reflex exists, the retina is flat, the left eye is (-), the tongue is red, the fur is thin and yellow, and the pulse is floating. Past history: breastfeeding for 3 months. Diagnosis of western medicine: right eyelid gland inflammation; diagnosis of traditional Chinese medicine: awn of wheat in the right eye (wind-heat guest eyelid syndrome). Pathogenesis: windheat evil first invades the eyelids, stays in the local veins, qi and blood are not smooth, and the hair is the main disease. Therapeutic principles: dispelling wind and clearing heat, reducing swelling and dissipating stagnation. Acupuncture method: local centro-square needling, Exercise acupuncture method in TaiYang acupiont.
The specific operation is as follows:
a) Flush: 0.9% sodium chloride injection 100ML, flush the conjunctival sac.
b) Disinfection: Povidone-iodine is used for local routine disinfection, and the inside and outside of the eyelids must be strictly disinfected.
c) Acupuncture operation: wear sterile gloves, use a needle of 0.30mm×25mm, and a temple of 0.30mm×40mm.
1) Superficial needling for bleeding: First, puncture 1needle directly in the center of the lesion, withdraw the needle quickly, with the bleeding as the degree, then insert 4needles obliquely around the lesion toward the center of the lesion, and withdraw the needle quickly to ensure bleeding after each needle exit, wipe off the blood with a sterile dry cotton swab.
2) Puncture 1 needle straight in the center of the lesion, the needle tip should pierce the induration base, retain the needle after degassing, and then puncture one needle obliquely in the upper, lower, left, and right sides of the lesion, the needle tip should pierce the induration base, so that the tips of the four surrounding needles all point to the center Stitch 1.
3) Exercise Acupuncture Method in Tai Yang Acupiont: ask the patient to open and close the eyelids while needling. 4) Needle withdrawal: After retaining the needle for 30 minutes, use the “shaking method”, that is, twist the handle of the needle with your fingers, shake the needle body, and withdraw the needle while shaking.
5) Encapsulation: If the needle can bleed, the curative effect is better, remember to squeeze, disinfect with iodine again and wipe the blood, and apply a small amount of tobramycin and dexamethasone on the outside of the lesion tissue.
Pine eye ointment, wrapped in gauze. Advise daily hot water bag hot compress 4 times, 15 minutes each time. 1 time every other day, total treatment after 2 times, because I was afraid of acupuncture treatment, I went home and continued the application of acupuncture and moxibustion in eye diseases. Apply, follow-up consultation after 2 days, fully recovered in 5 days altogether. So far, the condition has not been repeated.
Figure 1 Before the treatment of Mr. Li (at the arrow), localized swelling of the lower eyelid of the right eye was seen. The area around the lower eyelid was reddish, swollen, and the skin temperature was high. Induration was palpable, and the pain refused to be pressed (Figure 1). Figure 2 (at the arrow). On the second day after the treatment, the follow-up visit showed that the mass had shrunk significantly, and it was only limited to the punctum of the lower eyelid. The swelling of the lower eyelid subsided significantly (Figure 2).
In Figure3 (at the arrow), the patient received acupuncture once every other day. After the second acupuncture session (that is, on the fourth day), the patient was referred for a follow-up visit. There was slight redness and swelling near the punctum of the lower lid of the right eye, and there was no induration when pressed (Figure 3). Figure 4 (at the arrow), the follow-up visits on the 5th day, the lower eyelids of both eyes are symmetrical, no tumor is seen, the skin colour is normal, and it has completely recovered (Figure 4).
Hordeolum, known as “awn of wheat “, in traditional Chinese medicine, refers to a furuncle on the edge of the eyelid, shaped like a grain of wheat, red, swollen, itchy, and prone to pus and ulceration. The name of the disease can be found in “Zheng Zhi Zhun Sheng·Zabing·Qi Qiao Men”, and its symptoms are described concisely in “Zhu Bing Yuan HouLun·Mu Bing Zhu Hou”, Blisters form, and pus will develop within three to five days, and the world calls it “stealing needles” . The eyelids belong to the meat wheel of the Five Wheels theory, and the interior should relate to the spleen, and the spleen and stomach are in phase, so when the eyelids are sick, the spleen and stomach are mostly responsible . Traditional Chinese medicine believes that  the disease is mostly caused by wind-heat pathogens in the eyelids, stagnation of the local veins, poor flow of Qi and blood, and furuncles, or excessive consumption of spicy and roasted foods, accumulation of heat in the spleen and stomach, and fiery toxins. Attack, gather on the eyelids, and send out boils; or remaining pathogens are not cleared, or the spleen is weak, the defense is not solid, and the pathogenic wind and heat are re-infected, resulting in swelling and pain. The general pathogenesis is summarized as the pathogenesis of internal and external pyretic toxins.
Needle eye is equivalent to facial adenitis in Western medicine, also known as stye, eyelash hair follicle or attached sebaceous gland infection is called outer stye, and meibomian gland infection is called inner stye . Hordeolum is mostly caused by bacterial (commonly Staphylococcus) infection . In terms of treatment, the purpose of relieving symptoms and promoting inflammation subsidence, early topical antibiotic eye drops, local hot compress treatment, some can be cured or relieved, mid-late stage abscess Ulceration can be incised and drained, and the method is relatively limited, especially the operation needs to be performed under local anesthesia, which is painful and easy to leave scars, especially for children, pregnant women, and lactating women, because of their particularity, tolerance is limited , and affect the normal operation of the operation, it is easy to cause deformation of the eyelid and affect the function and appearance of the eye . If the treatment is not timely or appropriate, it may lead to eyelid cellulitis, and even serious complications such as sepsis or cavernous sinus thrombosis, which are life-threatening .
The basic principle of TCM treatment of hordeolum is: if pus is not formed, internal and external work should be performed concurrently to promote its dissipation; if pus has formed, incision and drainage should be performed . There are many methods of treating this disease in traditional Chinese medicine, mainly as follows: acupuncture therapy, moxibustion therapy, pricking therapy, bloodletting therapy (pricking bloodletting, pricking, and cupping), auricular point therapy, (ear acupuncture treatment, auricular point placement therapy), Other therapies (such as scraping therapy, hot compress therapy, massage therapy, ligation therapy, etc.) .
After consulting literature and ancient books, no acupuncture treatment has been seen so far. Treatment for stye. Centro-square Needling belongs to the “partial multi-acupuncture method”, which is stated in “Lin Shu▪Guan Zhen” : “Those who raise the thorns, face the inner one, and float it next to the inner four, so as to cure the coldness.” Specific method of operation: First, puncture directly at the center of the lesion (where the pain is significant)1Needle, keep the needle after De Qi, and then puncture obliquely towards the center of the lesion or along the skin at the top, bottom, left, and right sides of the main needle, that is, next to the lesion.1Needle. Although this method is used for diseases caused by pain, numbness, and local swelling caused by stagnation of cold evil, I refer to ancient methods to treat superficial diseases caused by heat evil and can also achieve good therapeutic effects. Sickness should not be too constrained by books but can also be flexible.
Stye can appear in any part of the upper and lower eyelids, and there is no fixed source, so the method of “taking pain as the acupoint” is adopted, and there is no fixed acupoint and meridian. If the doctor is afraid of direct acupuncture at the center of the lesion causing infection, he can also treat the meridians and acupoints according to the location of the eyelid tumor. “LinShu- JinJin” mentions that “the sun is the upper eye hill, and Yangming is the lower eye hill.” Therefore, the Bladder Meridian of Foot- Taiyang is more responsible for the lesions of the upper eyelid, and the Stomach Meridian of Foot-Yangming is more responsible for the lesions of the lower eyelid. According to “Lin Shu-Shi Zhong” mentioned that “the disease lies in the head, and the foot is taken from it”, and “where the meridian passes, the indications reach”, the stye of the lower eyelid can be pricked at the Lidui point with a three-edged needle to bleed, and the stye of the upper eyelid It can be pricked at Zhiyin point to bleed.
The “shaking method” is an auxiliary acupuncture technique of the filiform needle when the needle is withdrawn. The shaking method is a method of shaking the needle handle to promote qi or relieve the excess when the needle is released. “Zhen Jing Zhi Nan” states: “If you want to get out the needle when you have diarrhea, you must shake it out.” Twist the handle of the needle, shake the needle body, and withdraw the needle while shaking. Then the method of rushing out the needle . In addition, acupuncture at temples, using exercise acupuncture , is a treatment method that can mobilize the patient’s own potential, also known as interactive acupuncture, acupuncture “Tai Yang acupiont”, has the function of dispelling wind and clearing heat, promoting blood circulation, and relieving pain.
Bleeding from shallow pricking is a kind of pricking bloodletting therapy. This method can quickly relieve pain, redness and swelling, and has the functions of clearing heat, purging fire, detoxifying, stimulating menstruation and relieving pain . “Lin Shu·Guan Zhen” says: “stinger, stinger The blood also. “ “Su Wen Zhen Jing” said:» Wan Chen will get rid of it, and there will be bad blood” . This method has the function of dredging the evil and dispersing its stagnant heat . When sealing the eyes, apply a small amount of tobramycin and dexamethasone eye ointment (code Bishu eye ointment) has the characteristics of strong anti-inflammatory and quick onset, and is the most effective drug for treating ocular inflammation. It plays an anti-infective role by inhibiting the infiltration of inflammatory cells and the release of inflammatory factors and promoting the apoptosis of inflammatory cells . According to the principle of “fire stagnation of hair”, pricking and bloodletting therapy is the treatment method under the guidance of this principle, and incision and drainage of pus in Western medicine also belong to the treatment method of “fire stagnation of hair”.
The key to the treatment of stye with acupuncture is bloodletting. Compared with the traditional treatment of stye, this method is not limited by the time of onset. It can be in the early or acute stage, and it is not necessary to wait until the lump softens before incision and drainage of pus. It is especially suitable for children, breastfeeding, and pregnant women who cannot use drugs. According to the cases collected recently, it is unnecessary to take oral antibiotics after acupuncture. More importantly, it can significantly relieve the pain of the patient and shorten the recovery time. The average recovery time is generally about 6 days. Once a day; if you are worried about pain, you can take it every other day. If you want to achieve faster results, or Western medicine doctors do not know how to use acupuncture, I try to use a 1ml syringe needle or a three-edged needle to prick the bloodletting, and the effect seems to be better. The author is currently collecting more cases to verify. This method also seems to reduce the number of recurrent attacks, but more pathogenesis and follow-up time are still needed. The disadvantage of this method is that it is prone to subcutaneous bleeding and bruising around the skin. Those who love beauty should be informed in advance. In addition, it involves pricking bleeding, so aseptic operation and strict disinfection are very important.
Breastfeeding women are a special group. During this period, the disease is afraid of medication affecting the child. They prefer conservative treatment and hot compress. They hope that the stye can be cured quickly without any medicine, relieve pain, and improve the appearance.
The treatment of stye with acupuncture can effectively shorten the treatment time, improve the cure rate, and reduce the recurrence rate and infection rate. The author hopes to promote this treatment to clinical practice through this case and provide new ideas and methods for the treatment of stye.
Conflict of Interest
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