World Journal of Acupuncture-Moxibustion (WJAM)
Vol. 26, No.2, 30th Jun. 2016

·37·

Clinical Research
Acupuncture combined with pyonex for xerophthalmia针刺配合揿针治疗干眼症
GAO Hui (高 辉)1, ZHAO Xiao-dong (赵晓东)2, MA Guo-juan (马国娟)1, LI Huan-li (李焕丽)1,
LIU Huai-dong (刘怀栋)1
1. Hebei People’s Hospital, Shijiazhuang 050051, China; 2. Hebei Provincial Institute of Medical
Information（1. 河北省人民医院，石家庄 050051，中国；2. 河北省医学情报研究所）
ARTICLE INFOABSTRACTFirst author:GAO Hui (1978-), male,attending physician.
Research field: ophthalmology in
traditional Chinese medicine.
E-mail: 239094564@qq.com

Objective To compare the clinical efficacy of acupuncture therapy andacupuncture combined with pyonex in treatment of xerophthalmia. Methods
Eighty-eight xerophthalmia patients were randomly divided into group A(periocular acupuncture) and group B (acupuncture combined with pyonex).
The treatment was conducted once a day, twelve days were one course oftreatment, and two courses were needed in total. The changes of symptomscore of eyes, Schirmer I test (SIT) and break-up time (BUT) of patients in thetwo groups before and after treatment were observed. Results The symptomscore of eyes (8.36±2.54 vs. 5.36±2.65), SIT (5.82±4.61 vs. 8.33±4.24) and BUT(5.92±2.03 vs. 6.78±2.46) of patients in the two groups after treatment were
improved when compared with those before treatment. The total effective
rate of group B was superior to that of group A (86.3% vs. 63.6%)(all P<0.05).
Conclusion The efficacy of acupuncture combined with pyonex in treatmentof xerophthalmia is significant, which can effectively improve the symptoms of
xerophthalmia, and is superior to simple periocular acupuncture in terms of
SIT and BUT.

Accepted on November 11, 2015

KEY WORDS: xerophthalmia; keratoconjunctivitis sicca; acupuncture; pyonex;
intradermal needle

Xerophthalmia is a kind of diseases of eyes
discomfort and visual dysfunction caused by lacrimal
film instability and/ or ocular surface lesion due
to the quantity or quality of tear or abnormal fluid
dynamics[1]. The clinical manifestations include eyes
drying, foreign body sensation, itching or burning
sensation, photophobia, red eye, asthenopia, and etc.
Along with the wide application of video terminal
products and contact lenses, and increasingly serious
environmental pollution, xerophthalmia has anincidence increasing year by year, and attacks more
and more young people. In this study, the clinicalefficacy of acupuncture therapy and acupuncture
combined with pyonex in treatment of xerophthalmia
was evaluated through the observation of the two
methods in improving symptom score of eyes,
Schirmer I test (SIT) and break-up time (BUT) of
patients by adopting randomized controlled approach,providing more basis for conventional treatment ofxerophthalmia.

CLINICAL DATA
General data
Eighty-eight patients, 176 eyes in total, whowere in the department of ophthalmology outpatient
service of Hebei People’s Hospital from April
2014 to December 2014 and were diagnosed with
xerophthalmia were randomly divided into group A(44 cases, 88 eyes) and group B (44 cases, 88 eyes).
All the 88 patients finished the study, and there wasno drop-out case. The difference was not statisticallysignificant when compared the gender, age and courseof disease between the two groups (all P>0.05), andthe result was comparable (Table 1).

Diagnostic criteria
The criteria were established by reference toWorld Journal of Acupuncture-Moxibustion (WJAM)
Vol. 26, No.2, 30th Jun. 2016·38·
Table 1Comparison of general information of patients(x±s)
with xerophthalmia in the two groups

GroupsPatients

Gender(female/male)Age(years)Course ofdisease (years)

A

44

17/27

41.5 ± 8.84

1.18 ± 0.94

B

44

16/28

42.1 ± 7.18

1.21 ± 0.91

Criteria of Diagnosis and Therapeutic Effect ofDiseases and Syndromes in Traditional Chinese
Medicine issued by State Administration of Traditional
Chinese Medicine[2]. ① Patients with one or more
subjective symptoms including eyes drying, foreign
body sensation, photophobia, burning sensation,asthenopia, and etc.; ② SIT＜10 mm/5 min;③ BUT<10 s. Patients conforming to all thethree items were diagnosed with xerophthalmia.
Xerophthalmia was classified into three types
according to ophthalmology of traditional Chinese
medicine[3]: (1) lung yin insufficiency: eyes drying
and discomfort, less tear, easy asthenopia, blurredvision, normal white of the eye or slight hyperemiaof the conjunctiva, and fine spot on dark of the eye,concurrent with dry cough, dry throat, constipation,
thin and white tongue coating, less fluid, threadypulse and weakness; (2) spleen and stomach dampheat: eyes drying and dull pain, light hyperemia of the
conjunctiva, miliary vesicles inside the eyelid, weighdown of eyelid, concurrent with sticky sensation in
the mouth and bad breath, constipation and dark urine,
yellow and greasy tongue coating, and soggy and rapid
pulse; (3) liver-kidney yin deficiency: eyes drying
and photophobia, frequent blink, dim eyesight, light
red of white of the eye, concurrent with soreness andweakness of waist and knees, dizziness and tinnitus,
profuse dreaming, red tongue, less fluid, thin tongue
coating and thready pulse.

Inclusive criteria① The patients conforming to the above
diagnostic criteria of xerophthalmia and syndrome
differentiation of traditional Chinese medicine;② with age from 18 to 70 years old; ③ drug
withdrawal for two or more weeks; ④ voluntarily
accepting and persisting in treatment, and signing
informed consent form.

Exclusive criteria① The patients with eye diseases such as
conjunctiva disorder, keratopathy, obstruction of
lacrimal passage and severe trachoma; ② within six
months after ophthalmologic operation; ③ patientswith combined dry mouth, dry skin and joint sore, whowere considered as sjogren syndrome; ④ patients withcombined severe primary diseases such as diseasesof heart, liver, kidney and hematopoietic system, or
mental disorder; ⑤ suspicion or determination of drug
abuse; ⑥ pregnant and lactating women; ⑦ patientsconcurrent with other severe diseases or patients notsuitable for acupuncture and moxibustion; ⑧ patients
accepting other methods to treat xerophthalmia at thesame time. Patients conforming to one of the above
criteria were excluded.

Removing criteria① The patients terminating treatment due tofainting during acupuncture treatment or other adverse
effects caused by acupuncture; ② patients terminating
treatment due to other non-treatment factors.

METHODSGroup ABǎihuì (百会 GV 20), Chéngqì (承泣ST 1),
Cuánzhú (攒竹 BL 2), Fēngchí (风池 GB 20),
Tàiyáng (太阳 EX-HN 5) and Sīzhúkōng (丝竹空TE 23) were selected as main acupoints. Disposable
sterile acupuncture needles (0.30 mm×40 mm
filiform needle) were applied at GB 20 and ST 1, and0.25 mm×25 mm filiform needles were applied atother acupoints. At ST 1, the needle was inserted
into skin perpendicularly without twirling, deqi was
obtained; slight twirling and lifting and thrusting wereconducted at TE 23, and the needle was retained afterneedling sensation was obtained; BL 2 was inserted
upwards to Jīngmíng (睛明 BL 1) with the depth ofabout 80% of the length of needle; at other acupoints,
deqi was obtained. The needle was retained for
30 min. The treatment was conducted once a day,twelve days were one course of treatment, and twocourses were needed. Two days were free fromtreatment between two courses.

Group B
Acupoint selection and acupuncture manipulation
were the same as Group A. Pyonex therapy was
combined with acupuncture. Sānyīnjiāo (三阴交 SP 6), Zúsānlǐ (足三里 ST 36), Nèiguān (内关PC 6) and Tàichōng (太冲 LR 3) were selected as
main acupoints. Combined acupoints: ① lung yin
insufficiency: Fèishū (肺俞 BL 13) and Hégǔ (合谷 LI4); ② spleen and stomach damp-heat: Píshū (脾俞 BL20) and Fēnglóng (丰隆 ST 40); ③ liver-kidney yin
deficiency: Gānshū (肝俞 BL 18) and Shènshū (肾俞BL 23).
Seirin pyonex (SEIRIN CORPORATION), withthe diameter of 0.2 mm, and length of 0.3–1.5 mm,
was applied. 0.2 mm×1.5 mm pyonex wasWorld Journal of Acupuncture-Moxibustion (WJAM)
Vol. 26, No.2, 30th Jun. 2016

adopted at SP 6, ST 36 and ST 40, and 0.2 mm×0.9 mm pyonex was adopted at PC 6, LR 3, LI 4, BL
20, BL 18 and BL 23. Pyonex was withdrawn after
embedment for three days, and was embedded again
on the next day at the same acupoint. After embedment
for four times, two days were free from embedment,
and embedment for another four times was conducted.

Observational indices(1) Symptom score of xerophthalmia
Five common symptoms were scored by reference
to Guidelines of Clinical Research on Chinese
New Herbal Medicine [4], the sum of results was theaggregate score of symptoms. The five symptoms
included eyes drying, foreign body sensation,asthenopia, burning sensation and photophobia. Botheyes were evaluated according to the severity ofsymptom. The grades of eyes drying included mild
(2 points), moderate (4 points) and severe (6 points),
and the scores of other symptoms were 1, 2 and3 points. The proposed scoring standard was seen in
Table 2.
(2) BUT>10 s was normal.
(3) SIT<10 mm indicated that reflection secretion
decreased.
All the above examinations were finished byprofessional personnel of ophthalmology.

Efficacy criteria
The efficacy criteria were established byreference to Guidelines of Clinical Research on
Chinese New Herbal Medicine. Symptom efficacy
index = [(symptom score before treatment – symptomscore after treatment)/symptom score before
treatment]×100%.
Markedly effective: after treatment, clinicalsymptoms improved obviously, symptom efficacy
index >70%, and SIT and BUT were normal. Effective:
after treatment, clinical symptoms improved, symptom
Table 2·39·
efficacy index was 30%–70%, and SIT and BUT was
improved. Ineffective: symptom efficacy index ＜30%,
and all the indices were not improved.

Statistical analysis
Data were analyzed by adopting SPSS17.0
statistical package, and measurement data wereexpressed as mean ± standard deviation (x±s);
measurement data conforming to normal distribution
were analyzed through t-test, and the ones notconforming to normal distribution were analyzed
through non-parametric test; enumeration data wereanalyzed by chi-square test or rank sum test.

RESULTS
Comparison of improvement of single
symptom of xerophthalmia patients in thetwo groups before and after treatment(Table 3)
There was no difference between the two groups
in occurrence rate of symptom before treatment(P>0.05); after treatment, the symptoms, such as
foreign body sensation and asthenopia, were improved,
and the difference was not significant (P>0.05).
Group B was superior to group A in other symptoms
improvement (P<0.05).

Comparison of SIT and BUT of
xerophthalmia patients in the two groups
before and after treatment
In group A, the differences in SIT and BUT,
when compared with those before treatment, were
statistically significant after treatment for one month(P<0.05), and each index was improved obviously.
In group B, the differences in SIT and BUT, whencompared with those before treatment, were markedly
statistically significant after treatment for one month(P<0.01), and each index was improved obviously. In
the two groups after treatment, the two indices of SIT
and BUT in group B were superior to those in group A,
and the differences were statistically significant (bothP<0.05). The details were shown in Table 4.

Scoring standard of the five common symptoms of xerophthalmia

Symptome

Mild

Moderate

Eyes drying

Eyes drying occasionallyEyes drying frequently

Foreign body sensation

SevereUnbearable and continuous eyes drying

Foreign body sensation and blink Foreign body sensation and blink frequently,
Foreign body sensation occasionallyfrequently
tend to rub the eyes

Burning sensation

Burning sensation occasionally

Burning sensation frequently

Happens daily and the eyes sting

Photophobia

Photophobia and intend to squint

Photophobia and squint

Photophobia and not able to open the eyes

Asthenopia

Asthenopia happens occasionally

Shorten watching duration

The eye lid tend to close and could not
watch

World Journal of Acupuncture-Moxibustion (WJAM)
Vol. 26, No.2, 30th Jun. 2016·40·
Table 3Comparison of scores of single symptom of xerophthalmia patients in the two groups
Group A (n=44)

Items

Group B (n=44)

Markedly
Total effective
Markedly
Patients
Effective Ineffective
Patients
effective
rate (%)
effective

Eyes drying

44

10

19

cases

15

65.9

44

14

Effective

Ineffective

Total effective
rate (%)

24

6

86.31)

Foreign body sensation

37

9

14

14

62.1

39

12

16

11

71.9

Burning sensation

34

6

13

15

55.8

41

10

23

8

80.41)

Photophobia

26

7

9

10

61.5

32

11

16

5

84.31)

Asthenopia

25

8

11

6

76.0

31

11

15

5

83.8

1)

   Note: compared with the same item in group A, P<0.05.

Table 4

GroupsPatients

A

44

B

44

Comparison of SIT and BUT of xerophthalmia patients in the two groups
before and after treatment
Eyes
88
88

SIT (mm)
Before treatment
3.25 ± 2.32
3.41 ± 2.17(x±s)

BUT (s)After treatment

Before treatment

After treatment1)

4.23 ± 1.73

5.92 ± 2.031)

2) 3)

4.52 ± 2.11

6.78 ± 2.462) 3)

5.82 ± 4.61

8.33 ± 4.24   Notes: compared with that before treatment, 1) P<0.05, 2) P<0.01; compared with the group A after treatment, 3) P<0.05.

Comparison of clinical efficacy of
xerophthalmia patients in the two groups
In group A, the difference in symptom scoresof eyes, when compared with that before treatment,
was statistically significant after treatment (P<0.05),
and in group B, the difference in symptom scoresof eyes, when compared with that before treatment,
was markedly statistically significant after treatment(P<0.01). In the two groups after treatment, thesymptom scores of eyes in group B were superior tothose in group A, and the differences were statisticallysignificant (P<0.05). The details were shown in
Table 5.
Table 5Symptom scores of eyes of xerophthalmia
patients in the two groups

GroupsPatients

Before treatment

After treatment

A

44

11.25 ± 3.27

8.36 ± 2.541)

B

44

11.61 ± 3.57

5.36 ± 2.65 2) 3)   Notes: compared with that before treatment, 1) P<0.05, 2) P<0.01;
compared with group A after treatment, 3) P<0.05.

The total effective rate was 63.6% in group A,
and 86.3% in group B; according to rank sum test,
the difference of efficacy of the two groups was
statistically significant (P<0.05), indicating that theefficacy of group B was superior to that of group A.
The details were shown in Table 6.

DISCUSSION
At present, the incidence of xerophthalmia ison the rise. According to investigation, the incidenceof xerophthalmia is 30.05% in Shanghai [5] , andTable 6Comparison of clinical efficacy of xerophthalmia
casespatients in the two groups

Groups Patients

Markedly
Total effective
Effective Ineffective
effective
rate (%)

A

44

5

23

16

63.6

B

44

7

31

6

86.31)   Note: compared with that in group A, 1) P<0.05.

27.70% in some community in Shijiazhuang based on
sampling survey[6]. The incidence of xerophthalmia
is closely related to the living environment and lifestyle in modern times. The incidence of xerophthalmia
may be increasingly high due to aging of population,
increasingly serious air pollution, eye operation, longterm ophthalmic administration, popularization ofcomputer and extensive use of contact lenses[7].
The principle of western medicine treatment forxerophthalmia is to re-establish lacrimal film withnormal quality, and relieve eyes discomfort. Tear
fluid replacement therapy is the main method which
can take effect at the beginning of treatment, but its
efficacy cannot be maintained for a long time. Manypatients consider that taking eyedrops for a long time
can cause other discomforts. While operation may
cause greater risk. Therefore, clinical physicians arealways looking for a safe and effective therapeutic
method.
Xerophthalmia belongs to “white xerotic
syndrome” and “dry eye syndrome” in traditional
Chinese medicine, which believes that it is mostclosely related to liver, kidney and spleen. Livercan generate tear fluid, and restrain tear fluid fromWorld Journal of Acupuncture-Moxibustion (WJAM)
Vol. 26, No.2, 30th Jun. 2016

overflowing. It was said in Sùwèn (《素问》, Plain
Questions) that “Five kinds of thick fluids are relatedwith the five viscera, and tear is liver fluid.” In CHAO
Yuan-fang’s Zhubing Yuanhou Lun (《诸病源候论》, Discussion on Pathogenesis and Syndrome of
Diseases), “Eye is the manifestation of liver, essenceof viscera and bowels, confluence of all vessels,
and the channel of fluids. If the fluid exhausted, theeyes may be dry and obscure”, which indicated thateyes drying and tear fluid hyposecretion may berelated with liver blood deficiency. Kidney is very
important in metabolism and distribution of waterhumor in human body. Liver-kidney depletion, yinblood insufficiency and eyes malnutrition may cause
xerophthalmia. Spleen is the channel of essential qi
upwards to eyes, spleen qi rising can promote andunblock eyes and orifices, spleen-stomach weakness
may cause qi-blood metaplasia and insufficiency,
so that eyes malnutrition may cause xerophthalmia.
Therefore, during clinical treatment, acupoint selection
is closely related with liver, kidney and spleen.
Acupuncture and moxibustion in treatment ofxerophthalmia can protect patients’ visual function,
suppress inflammatory response on ocular surface,and restore normal structure and function of ocularsurface. Periocular acupoint selection can promotetear secretion, effectively enhance the stability oflacrimal film, and be free of intervention and toxicity
of exogenous chemicals. The efficacy is safe andreliable[8-9]. At present, most xerophthalmia patientsare people suffering from asthenopia and menopause
women, who need long-term treatment. At one time,“four-acupoint and eight-needle”[10], established by
Mr. PANG Zan-xiang, was applied for treatment
clinically; according to observation, this method can
improve the symptoms of xerophthalmia effectively,
but the efficacy cannot be maintained for a longtime. Therefore, pyonex and traditional acupuncture
were combined, and scalp “four-acupoint and eightneedle” was applied in periocular acupoint selection,
including ST 1, EX-HN 5, BL 2 and GB 20. ST 1
is an intersecting point of foot-yangming stomach
meridian, yang heel vessel and conception vessel, withthe functions of scattering wind and quickening thecollaterals, and opening the orifices and improving
vision. EX-HN 5 can scatter wind and dissipate heat,and clear head and improve vision. BL 2 belongs to
the foot-taiyang bladder meridian, with the functionsof discharging qi, and quickening the collaterals andimproving vision. GB 20 is an intersecting pointof hand-shaoyang three energizer meridian, footshaoyang gallbladder meridian and yang link vessel
with the functions of unblocking the meridians and·41·
quickening the collaterals, regulating and harmonizing
qi and blood, scattering wind and dissipating heat,clearing head and opening the orifices, and improving
vision and boosting brain. Combined use of the four
acupoints can accelerate periocular blood circulation,
free and regulate qi and blood, and enrich yin and clear
heat. Acupoint selection with pyonex was performedon the whole body, including ST 36, SP 6, LR 3 andPC 6, which were the four acupoints in body “fouracupoint and eight-needle”. ST 36 is a he-sea pointof stomach meridian, with the functions of boostingqi and fortifying the spleen; SP 6 is an intersecting
point of three yin meridians of the foot, with thefunctions of unblocking the meridians and quickening
the collaterals, and regulating and harmonizing yinyang. LR 3 is a shu-stream point and yuan-source
point of liver meridian, with the functions of soothing
the liver and rectifying qi, and invigorating blood andunblocking the collaterals; PC 6 is a luo-connecting
point of pericardium meridian, with the functions ofboosting qi and nourishing the blood, and rectifying qi
and directing counterflow downward. BL 13 and LI 4
were selected for lung yin insufficiency to regulatelung qi, and unblock the meridians and quicken thecollaterals; BL 20 and ST 40 were selected for spleenand stomach damp-heat to remove water-dampness andassist transportation and transformation; BL 18 andBL 23 were selected for liver-kidney yin deficiency tosoothe the liver and promote gallbladder function, andenrich and nourish kidney yin. Combined use of all
the acupoints can regulate and harmonize qi and bloodand the functions of zang-fu organs, supplement qi
and blood and body fluid in eyes. The use of pyonex
showed the academic characteristics of “four-acupointand eight-needle”, and obtained good clinical efficacy
in treatment of xerophthalmia.
Pyonex, needle-embedding therapy, is one of
the methods of superficial acupuncture. It reduces
acupuncture pain by superficial needling but longterm needle retention, prolong the effective time ofacupuncture, so as to improve efficacy. It was saidin Plain Questions that “the one who is good attreating diseases may treat diseases by superficial
acupuncture”. Intradermal needling can prevent
diseases through superficial acupuncture based on
the theory of twelve cutaneous regions. It was also
said in Plain Questions that “The needle should be
inserted into skin when inhaling, qi counterflow
should be avoided when needling, and needle should
be retained until deqi”. Needle retention aims to waitqi or regulate qi, so as to regulate and harmonize qi
and blood, and balance yin-yang. Needle retention
should be conducted for a long time for some diseases

·42·
so that efficacy can be obtained. With simple operation
and without needling sensation, fainting during
acupuncture treatment or side effects, pyonex isparticularly suitable for patients who need long-term
therapy. According to statistics [11], pyonex has been
widely applied in various diseases, including insomnia,
hypertension, menstrual irregularities and arthritis,
since its improvement in the 1950s. Traditional
pyonex has been applied not frequently for the strong
discomfort when the thick needle was embedded inskin. Seirin pyonex is a kind of new intradermal needle
without pain, and patients can accept it easily. It is
used safely and conveniently. Acupuncture combinedwith pyonex can enhance clinical efficacy relying on
the combination of short-term stimulation and longterm needle retention.
According to syndrome differentiation andtreatment for xerophthalmia patients, on the basis ofperiocular acupuncture, individual pyonex treatment
for xerophthalmia patients with different symptoms
obtained good efficacy. The total effective rate was
63.6% in simple acupuncture group, and is up to
86.3% in acupuncture combined with pyonex group, so
were BUT and SIT, which reflected the improvementof the visual function. In conclusion, Acupuncture
combined with pyonex in treatment of xerophthalmia
can effectively improve symptoms and visual function,with the efficacy superior to simple acupuncture.

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ABSTRACT IN CHINESE[摘 要] 目的：比较针刺疗法和针刺配合揿针疗法治疗干眼症的临床疗效。方法：将88例干眼症患者随机分为A组（眼周针刺）和B组（针刺配合揿针），每天治疗1次，12天为1个疗程，共治疗2个疗程。观
察两组患者治疗前后眼部症状积分、泪液分泌试验、泪膜破裂时间的变化。结果：两组患者于治疗后
眼部症状积分（8.36±2.54 vs. 5.36±2.65）、泪膜破裂时间（5.92±2.03 vs. 6.78±2.46）、泪液分泌试验（5.82±4.61 vs. 8.33±4.24）均有明显改善，A组总有效率优于B组（63.6% vs. 86.3%，均P＜0.05）。结
论：针刺配合揿针治疗干眼症疗效显著，可有效改善干眼病症状，在泪膜破裂时间、泪液分泌试验方面
优于单纯眼周针刺治疗。
[关键词] 干眼症 角结膜干燥症 针刺 揿针 皮内针