| Part IResearch on the Animal experiment and Mechanism of AcupunctureTherapy for dry eyePurpose: Research on the mechanism of acupuncture therapy for dry eye. Methods: By randomly dividing the subjects, rabbits of New Zealand origin, into two groups, one without lacrimal gland and the other with normal lacrimal gland, the following reseach was carried out: 1) The group with lacrimal gland was tested for S1T, corneal fluorescene staining and rose Bengal respectively before and after extirpation of lacrimal gland. The cornea under observation was stained by HE for light microscope examination and obserbed by transmission electron microscope. 2) The two groups with acupuncture therapy were given 10 sessions, 20 minutes each session, three times per week. The needles were inserted into the right eye at the following acupoints: Taiyang ( Extra 1), Zanzhu (BL2) and Sizhukong (SJ23). 3) The S1T value, corneal fluorescence staining and rose Bengal before and after acupuncture therapy were blindly graded. The cornea and lacrimal gland of the normal lacrimal gland group were staining by HE for light microscope examination and observed by transmission electron microscope. 4) The concentration of vasoactive intestinal polypeptide (VIP) and calcitonin gene-related peptide (CGRP) of the normal lacrimal gland before and after acupuncture therapy were tested. Results: 1) After extirpation of lacrimal gland, the S1T showed a statistically significant decrease effect (P=0.0062). The average grade point of the corneal fluorescence staining and rose Bengal is apparently higher than that before the building of the model, the difference of which had significant statistic significance (P <0.0001 in both groups). The variation of the above three testing index indicated that tear deficient dry eye after the excising the lacrimal gland has caused punctate erosions and necrosis of the corneal epithelia. Remarkable changes also took place in the corneal epithelia after the building of the model. Through light microscope examination, it was discovered that the cells of corneal epithelia were not clear. Some of which only had one layer of lamellar cells and the basal cells were not smooth. Through Transmission electron microscope observation, the superficial epithelia cells were found liquidized with the basemembrane broken. The above changes werecharacteristic of dry eye, signifying the successful modeling of dry eye without lacrimal gland. 2) The variation of various indexes of both groups before and after acupuncture. The S1T of the normal acupuncture group was notably higher after acupuncture than before acupuncture, the difference of which had statistic significance (P=0.0002). Three days after the end of the entire treatment, the S1T was remarkably higher than that before the treatment, the difference of which also had statistic significance (P=0.00l), indicating that there was an obvious increase in the secretion of tear after the stimulation acupuncture and the increase of tear secretion was persistent after the stimulation by acupuncture. Meanwhile changes also took place in the morphology of lacrimal gland tissue, after acupuncture which showed its powerful function of synthesis and secretion. While in the group without lacrimal gland, the S1T compared with that before acupuncture immediately after the end of the treatment coruse, the difference had no statistic significance (P=0.719), and was obviously lower than that before modeling (P=0.003). Compared with that before acupuncture, the difference of corneal fluorescence staining immediately after the treatment course had no statistic significance (P=0.444) and was apparently higher than that before modeling (P<0.0001). There was no difference in the points of rose Bengal before and after the treatment course. The above results showed that the effect of acupuncture treatment in dry eye lacking in lacrimal gland was not very obvious and there was no obvious improvement in the damaged corneal epithelia caused by dry eye. Observation on the morphology of cornea also demonstrated the same result. 4) Using Radio immunoassay (RIA) to test the average concentration of VIP and CGRP in normal lacrimal gland tissue before and after acupuncture. The average concentration of VIP in lacrimal gland tissue was notably higher after acupuncture than before acupuncture which had a statistic difference (P=0.0002). Conclusions: 1) The fact that the concentration of VIP was higher after acupuncture than before acupuncture showed that acupuncture can increase the concentratin of VIP in lacrimal gland tissue. The direct interaction between VIP and secretion cells stimulated the secretion of tear (mainly watery fluid) from the gland. The secretion from lacrimal gland was abundant and the exclusion of acinus was obvious. With rich Glogi complex in ultrastructure, rough endoplasmic reticulum vesicular expanded which showed the active function of the gland to synthesiae and secrete. Besides, the effect of acupuncture on the secretion of tear was persistent. 2) Using acupuncture to increase the secretion of tear without lacrimal gland didn't seemto be effective in improving the damage of cornea in dry eye caused by the lack of lacrimal gland. 3) The effect of acupuncture was achieved through lacrimal gland, the target organ, to adjust the secretion of tear ( mainly watery fluid).Part IIObservation of Clinical Efficacy and Safty of Acupuncture Therapyin dry eyePurpose: By observing the variation of symptoms and signs of dry eye before and after acupuncture, a comparison was made between the acupuncture treatment group and the control group to know about the exact efficacy and safety of acupuncture in treating dry eye.Methods: Clinical research on 44 cases of dry eye by random and parallel contrast. The 44 cases were divided into acupuncture treatment group (20 cases) and control group (24 cases). The acupuncture treatment group was given 10 sessions of acupuncture treatment, three times per week (once every other day), a total of 21days in one treatment course. The following acupoints were chosen for acupuncture: Jingming (BL1), Zanzhu (BL2), Sizhukong (SJ23), Yangbai (GB14), Taiyang (Extra 1), Sibai (ST2), Hegu (L14), Guangming (GB37), Sanyinjiao (SP6), Taichong (LR.3) and Fengchi (GB20). Artificial tear eyedrops - Systane manufactured by Alcon Company in America was applied four times per day, one drop each time, to conjunctival sac, the total treatment course of which was 21 days. One hour after treatment as well as three weeks after treatment , the subjects were checked again respectively. Observatin and evaluation were made of the efficacy index and side effects.Results: 1) The average age of patients chosen for the treatment group was older than that of the control group, the difference of which had statistic significance. The total average points of the treatment group were higher than those of the control group, the differenceof which also had statistic significance (P=0.0046). Therefore, at this baseline, the condition of patients in the treatment group was more serious than that of the control group. 2) One hour after treatment, the general efficacy was evaluated. After rectification of the baseline, age and sex, the difference of decreased total points between the two groups had no statistic significance (P=0.489) one hour aftertreatment. The efficiency rate of the treatment group was 45% while that of the control group was 50%, the difference between the two had no statistic significance (P=0.785). 3) Three weeks after the treatment, the general efficacy was evaluated. The total points decrease value of the treatment group was greater than that of the control group, and the difference of which had statistic significance (P=0.003). The efficiency rate of the treatment group was 40% while that of the control group was 4.55%. The efficiency rate of the treatment group was much higher than that of the control group, and the difference of which had statistic significance (P=0.008). 4) S1T: One hour after treatment, the average SIT value of both groups all had increased, and the difference between the two had no statistic significance (P=0.484). However, three weeks after treatment, the increase rate of the average S1Tof the treatment group was higher than that of the control group, and the difference between the two had statistic significance (P=0.011). BUT: One hour after treatment, the increase rate of the average BUT of the control group was higher than that of the treatment group, and the difference of which had statistic significance (P=0.025). Three weeks after treatment, the average BUT of the treatment group still remained at the same level as the one that was attained one hour after the treatment, while the average BUT of the control group had somewhat decreased, and the difference between the two had no statistic significance (P=0.106). Rose Bengal: One hour after treatment as well as three weeks after treatment, the average rose Bengal points of the treatment group decreased to a lower level than when they were at the baseline, while those of the control group had no significant change. 5) Acupuncture had no statistic significance in improving the condition of patients with dry eye caused either by internal or external causese. 6) There have been no local and general side effects of patients during this research and no single case has been reported to have decreased eyesight. 2 cases with artificial tear exit because of side effects.Conclusion: 1) The result of clinical observation show that acupuncture is effective in treating dry eye. Compared with artificial tear, acupuncture has the same effect. But after treatment stops, the persistent efficacy of acupuncture is much greater than that of artificial tears. 2) It is safe to treat dry eye with acupuncture.
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