Clinical Comparison and Analysis of Decoction of Traditional Chinese Medicine Combined with Ear Acupoint Application and Simple Artificial Tears in the Treatment of Dry Eye Syndrome

Tong Tian (佟 甜), Li Ruoxi (李若溪), Qi Fei (齊 飛), Jiang Xiu (姜 秀), Jiang Yanhua (姜艷華)

Department of Ophthalmology, The 4th People's Hospital of Shenyang, Shengyang 110031, China

ABSTRACT

OBJECTIVE: To study the clinical comparison and analysis of decoction of Traditional Chinese Medicine (TCM)combined with ear acupoint application and simple artificial tears in the treatment of dry eye syndrome. METHODS:A total of 62 patients (124 eyes) with dry eye syndrome treated in the Department of Ophthalmology of The 4th People's Hospital of Shenyang from July 2017 to March 2018 were selected and equally divided into 2 groups according to the admission order. The observation group received the combination therapy of TCM decoction and ear acupoint application, while the control group was given the simple artificial tears. The symptom score after 2 weeks, 4 weeks,and 8 weeks as well as the indicators including break-up time (BUT), Schirmer I test (SIT) and fluorescein (FL) were recorded and compared between groups. RESULTS: The symptom scores had no difference before treatment (P > 0.05),and were better in the observation group than those in the control group after treatment (P < 0.05). At 2 weeks, 4 weeks,and 8 weeks after the treatment, the amelioration level of BUT, SIT, and FL indicators in the observation group was better than that of the control group (P < 0.05). CONCLUSION: Compared with the artificial tears treatment method, the TCM decoction combined with ear acupoint application can significantly ameliorate the tear film stability, tear secretion, and reduce ocular surface damage for dry eye patients.

KEYWORDS: Decoction of tradition Chinese medicine; Ear acupoint application therapy; Artificial tears; Dry eye syndrome

Dry eye syndrome is caused by tear film imbalance and ocular surface damage which resulted from abnormal quality and quantity of tears, severely influencing the patient's visual function and quality of life. And those whose symptoms are aggravated will have symptoms including corneal dryness, dissolution, perforation, etc.[1]In recent years, the incidence of dry eye syndrome has increased due to changes in lifestyle and environment, especially among adolescents[2,3]. In the treatment of dry eye syndrome,artificial tear replacement therapy, lacrimal embolization,anti-inflammatory treatment and subgingival gland transplantation are used currently but different treatments have inadequacies, and the curative efficacy in long-term treatment is poor[4]. In this paper, a clinical comparative study of important TCM decoction combined with ear acupoint application therapy and simple artificial tears in the treatment of dry eye syndrome was conducted. The report is as follows.

TREATMENT AND METHODS

Clinical data

A total of 62 patients (124 eyes) with dry eye syndrome admitted to The 4thPeople's Hospital of Shenyang from July 2017 to March 2018 were enrolled.The patients were divided into the control group and the observation group according to the order of admission,with 31 cases in each group. There were 20 males and 11 females, aged 32-60 years old, with an average age of (52.2 ± 8.7) years old in the observation group. The control group consisted of 19 males and 12 females, aged 30-58 years old, with an average age of (51.7 ± 9.3)years old. Inclusion criteria: (1) subjective symptoms:dryness of the eyes, foreign body sensation, burning sensation, fatigue, discomfort, vision fluctuations;(2) tear-up time (BUT)10 seconds; (3) Schirmer I test (SIT)10 mm/5 min; (4) Fluorescent staining (FL)positive. Exclusion criteria: (1) patients with chronic blepharitis; (3) patients with other eye diseases; (4)patients with severe systemic diseases such as dysfunction of heart, cerebrovascular, liver, kidney and hematopoietic system. There was no significant difference in age, gender and other data between the 2 groups (P > 0.05), which was comparable.

Methods

The control group was given artificial tear treatment alone, and the polyethylene glycol eye drops were administered to the eyes 1 to 2 drops once and 4 times a day. The observation group was given important TCM decoctions combined with ear acupoint application therapy. Most of the traditional Chinese medicine decoctions were mainly used herbs with functions of nourishing yin for moistening dryness, clearing heat and promoting diuresis, and nourishing blood and benefiting qi, such as Fructus Lycii, Flos Chrysanthemi, Radix Rehmanniae Recens, Radix Scrophulariaceae, and Radix Ophiopogon, Herba Dendrobii, Semen Cassiae, Flos Buddlejae. A prescription was boiled in water 2 times in the morning and evening of a day and was taken 300 mL each time for a course of treatment. Ear acupoint application:the Vaccariasegetalis Garcker seeds with appropriate size were selected and with the square medical tapes(0.8 cm×0.8 cm) they were made into the ear acupoint plaster. The cotton ball was used to draw 75% methanol to disinfect the auricle, and the plaster was pressed properly on the acupoint so that the patient would feel soreness and heat. After pressing the ear, the patient was told to press it 3-5 times a day and 30 seconds each time,and to stop when the auricle was hot and red. And the ears were alternately pressed, and were replaced once every 3 days, 2 times a week, during which time 1 day of interval was required. The patients had 4 2-week courses totally.

Observation indexes

The dry eye symptoms and tear breakup time(BUT), Schirmer I test (SIT), and fluorescence labeling(FL) tests were compared between the 2 groups before treatment and at the 2 weeks, 4 weeks, and 8 weeks of treatment. Questionnaire survey was used to assess dry eye symptom scores, including dryness, foreign body sensation, burning sensation, visual fatigue,photophobia, and blurred vision. The scores were scored according to degree 0-10, among which 0 was asymptomatic, and 10 was the most serious.

BUT examination was taken in a light-friendly examination room. A small amount of sodium fluorescein solution in the glass rod was dropped into the conjunctival sac, and the patient was informed to blink several times and then to naturally look straight ahead, and the first time of the broken tear film was observed.

SIT inspection: the filter paper strip (produced by Tianjin Jingming Co., Ltd.) was folded back and put in the middle and outer third of the lower conjunctiva,and the other end is naturally drooping. The patient was informed to naturally blink with the length of 5 minutes,and then the filter paper strip was removed to measure the natural crease where the filter paper is wetted by tears.

FL examination: the cornea was divided into 4 quadrants. The staining of each quadrant was none, light,medium and severe, with the score of 0-3 points, and the staining score of the whole cornea 0-12 points.

Statistical methods

The data of this observation were analyzed by SPSSP18.0 statistics, and the percentage was used as the counting data, and the chi-square test was performed. The measurement data was expressed as mean ± average and subjected to t-test. P < 0.05 indicated that the difference is statistically significant.

RESULTS

Comparison of dry eye symptom scores at different time before and after treatment in 2 groups of patients

There were no significant differences in the symptoms of dry eye symptoms between the 2 groups before and after treatment (P > 0.05). The symptoms of both groups improved after 2 weeks, 4 weeks, and 8 weeks of treatment, and the treatment effect was better in the observation group than that in the control group.The difference was statistically significant (P < 0.05). See Table 1.

Comparison of BUT between different groups of patients before and after treatment

There was no significant difference in BUT between the 2 groups before and after treatment (P > 0.05). BUT in the observation group was significantly longer than that in the control group after 2, 4 and 8 weeks of treatment. The difference was statistically significant (P < 0.05). See Table 2.

Table 1. Comparison of dry eye symptom scores at different time before and after treatment in 2 groups of patients

Table 2. Comparison of BUT between different groups of patients before and after treatment

Table 3. Comparison of SIT between different groups of patients before and after treatment

Table 4. Comparison of FL scores between different groups of patients before and after treatment

Comparison of SIT between different groups of patients before and after treatment

There was no significant difference in the SIT between the 2 groups before and after treatment (P > 0.05).The SIT values in the observation group were significantly increased after 2 weeks, 4 weeks, and 8 weeks of treatment,which were superior to the control group. There was statistical significance (P < 0.05). See Table 3.

Comparison of FL scores between different groups of patients before and after treatment

There were no significant differences in FL scores between the 2 groups before and after treatment (P > 0.05).The FL scores of the observation group were significantly lower than those of the control group at 2 weeks, 4 weeks,and 8 weeks after treatment. The difference was statistically significant. (P < 0.05). See Table 4.

DISCUSSION

In traditional Chinese medicine, dry eye syndrome is called that "the water of spirit will be dry". According to its clinical manifestation, it belongs to the category of "dry astringent eye disease" of traditional Chinese medicine ophthalmology. TCM believes that this disease is due to lingering pathogenic heat, lacking of lung yang,and accumulation of heat in the spleen and stomach, liver and kidney yin deficiency, lack of yin blood, which cause that the eyes are not nourished. Dry eye syndrome is a kind of eye disease caused by the stagnation of qi turning into heat, which contribute to loss of body fluid and tears which have the function of nourishing the eyes[5-7].

Now the artificial tears are used in clinical practice for dry eye syndrome. Due to the large amount of preservatives in artificial tears, long-term use is easy to cause damage to the ocular surface, and artificial tears have limitations in treating dry eye syndrome.At present, for patients with lipid-deficient dry eye syndrome, artificial tears that mimic the lipid layer have not been obtained at this stage, so the curative effect is weak[8,9]. Lacrimal embolization is through the artificial obstruction of the lacrimal passage to achieve the accumulation of tear in the eye. Even if it is sustainable and effective, the lacrimal obstruction will dissect the normal physiological structure of the ocular tear, weaken the function of tear flow, and reduce the prevention from ocular surface bacteria and inflammatory mediator.The long-term treatment will produce the possibility of lacrimal infection, and can also cause a significant rate of tears overflow[10-12]. Local anti-inflammatory treatment is mainly based on drugs such as hormones and cyclosporine. Long-term treatment of hormones can induce a large number of complications, and cyclosporine is highly irritating, and a large number of complications will occur in long-term application. Moreover, the secretion of subgingival gland from the traumatic surgery of subgingival gland transplantation is significantly different from that of the natural lacrimal gland, so it is difficult to apply in clinical practice[13-15].

Traditional Chinese medicine treatment of dry eye syndrome is mainly based on acupuncture and moxibustion and TCM decoction combined with ear acupoint application. In the clinical treatment of traditional Chinese medicine, all the treatments are based on the principle of nourishing yin to produce body fluid and dredge the collateral to remove excess heat, which can make the secretion of eye normal and optimize the secretion of tears[17]. Dry eye is the disease with symptoms of dry eyes caused by the lack of tear secretion. The eye condition is related to every viscera in the body, and the dry eye syndrome is caused by the deficiency of yin and essence of visceral, so it is always treated with traditional Chinese medicine decoctions which mainly uses herbs with functions of nourishing yin and increasing body fluid and supplemented with ear acupoint application.The ear acupoint is where the meridians of the whole body are concentrated. A large number of vascular nerves are distributed in the auricle, which is closely related to the body function. Ear acupoint application is a kind of acupuncture therapy through stimulating ear acupoint to achieve the same effect as acupuncture with lower operation difficulty, less pain, higher safety,and no side effects. Compared with acupuncture, there are more advantages in the ear acupoint application treatment. Traditional Chinese medicine decoction combined with ear acupoint application treatment can improve the symptoms of eye discomfort, increase the amount of tear secretion, promote the lacrimal gland to actively secrete tears, and is the key method of expelling the pathogenic causes, which can also further increase the treatment efficiency and cure rate and reduce the recurrence rate[18-20]. In this paper, the clinical efficacy of traditional Chinese medicine decoction combined with ear acupoint application therapy and simple artificial tears in the treatment of dry eye syndrome was compared. There was no significant difference between the 2 groups before treatment (P > 0.05). After 2 weeks, 4 weeks and 8 weeks of treatment, the symptoms of dry eye in the 2 groups were significantly improved, and the dry eye score of the observation group was better than that of the control group,the difference was significant (P < 0.05). After 2 weeks,4 weeks, and 8 weeks of treatment, the improvement of BUT, SIT, and FL indexes in the observation group was significantly better than that of the control group.The difference was statistically significant (P < 0.05).The effects of traditional Chinese medicine decoction combined with ear acupoint application on tear film stability in dry eye syndrome patients was better than that of artificial tear treatment alone, and the SIT value of Chinese herbal decoction combined with ear acupoint application treatment was significantly prolonged, which could significantly increase the amount of tear secretion in patients with dry eye syndrome and improve dry eye symptoms and ocular surface damage. Traditional Chinese medicine decoction combined with ear acupoint application treatment was more advantageous than simple artificial tears.

In summary, the traditional Chinese medicine decoction combined with ear acupoint application is better than simple artificial tear treatment, and the recurrence rate is low, the safety is high, and it can stimulate the lacrimal gland to secrete automatically, and the effects are continuing, and the curative effect is remarkable, which is a better method to treat eye disease and is worthy of promotion.