Color Changes In Scleral Capillaries And Their Clinical Significance Holmes Keikobad, MD
ABSTRACT Scleral capillary invasion is a fairly common clinical sight. It is one of the most graphic validations of the Five-Elements iconography. Scleral capillaries readily suggest their own remedy and become, when the treatment is correct, the vivid monitors of a favorable prognosis by becoming entirely regressed and invisible. KEY WORDS Scleral Capillaries, Five-Elements Acupuncture
INTRODUCTION The Sixty-First Difficult Issue in the Nan-Ching places great emphasis on the diagnostic value of color changes in the face.1 This article discusses the often seen and frequently missed color changes in the scleral capillaries, which form an integral part of the canvas of the face, and which deliver a wealth of information to the astute diagnostician.
Common Underlying Pathology A common underlying pathology is Fire oppressing Metal, and is the one under discussion herein. Figure 1 lists the elemental qualities of the parts of the eye involved and the natural colors they are related to.
Configuration of the Illness
Pupil – Water element, dark black, deep, recessed, unsubstantial
Iris – Wood element, active, moving, changing like the wind, often green or blue
Sclera – Metal element, white, malleable, gives structure to eye, opaque
Cornea – Metal element, continuation of sclera; when invaded, shows white
Upper eyelid – LV, because of GB 14 superiorly, and GB 1 at outer canthus
Lower eyelid – ST, because of the ST Line from ST 1 to ST 4 inferiorly
Aqueous humor – Water element, watery, holds no shape
Conjunctiva covering insides of eyelids – Fire element, laced with capillaries
Scleral capillaries – Fire element, blood vessels, carry blood, red.
Figure 1. Five Elements Qualities of the Visible Parts of the Eye
The invasion of the white sclera by the red of the capillaries is one of the most graphic validations of the Five-Elements iconography in its oppressive Ko cycle character.
Figure 2. Natural Bielemental Progression of Scleral Invasion
Figure 2 follows the natural progression of the illness which, if followed step-by-step, leads to an inescapable diagnosis and a made-to-order treatment protocol. Of particular note is the final and pernicious extension by the same dynamics of the process into the cornea – resulting in blinding opacities, a serious condition with unpleasant prognosis and meriting immediate attention.
The Fire Yin is consumed by an overwhelming or ongoing episode of sadness or fear or both.
This causes an internal Fire element imbalance, which results in an exuberant Fire Yang, which is basically an SI excess.
The excess in Fire in time oppresses Metal by the Ko cycle connection and erodes the integrity of that element.
A weak Fire element imbalance is unable to nourish the son Earth, which in turn cannot support its son Metal – all setting the stage for a serious and concerted invasion of Fire into the white scleral matrix of Metal.
The Metal element in time dissociates in its unity and causes its Yin LU to depress and Yang particle LI to register an excess.
This induces a dryness of the fluid on the sclera and a raised tendency to Heat.
In this matrix, HT Fire invades with a proliferation of capillaries that contain the essence of Fire, its Blood.
The central focus of sclera is the cornea, and the capillaries tend toward it.
In time and without treatment, the cornea is invaded and becomes opaque; the scleral invasion of capillaries is complete.
Symptoms Accompanying the Scleral Invasion The presence of scleral capillaries signifies a situation in which Fire has oppressed Metal by the Ko cycle relationship and has entered its substance. Initial symptoms will be those of a depressed HT Yin and a resultant rising Fire Yang, and may present as palpitation, arrhythmias, hypertension, insomnia, and the typical neck and shoulder pain along the track of SI channel at the medial border of the scapulae.1 Later, the Ko invasion shifts the arena of pathology to Metal, where a Yin deficiency surfaces coupled with a Yang excess in LI presenting as colitis, polyps, hemorrhoids that occasionally bleed, and/or chronic constipation. The skin is overly dry and may present a trademark lack of sensible perspiration, a tendency to precancerous growth, and if untreated, frank lesions of squamous cell carcinoma, or worse. The tongue renders useful and dependable changes:
In afflicted HT Qi, there is a linear, midline fissure, along the whole length of the tongue, or on part thereof. Another sign is that the tip is often bilobular, with each portion of it protruding well beyond the median apex.
In LU, there is a typical narrowing of the anterior third, which signifies constrained LU Qi or a restrained chest, which houses the lungs. Another common sign is the presence of 2 fissures or 2 small linear depressions, laid anteroposteriorly on each side of the midline in the anterior 4/5th of the tongue, just short of the tip.
Deducing Color Changes in Capillaries on Sclera The interplay of colors is between a white matrix and a red overlay, the white changing by the color mixtures in it, and the red according to its dynamic status – which may vary from free flowing to stagnated, and from anemic to nearly clotted.
If and/or when...the capillaries are few and clearly red, the invasion is recent, and the illness, an HT Yang excess, is in an acute phase; the capillaries are more numerous and somewhat of darker hue, the condition has become chronic, and the illness entrenched; the capillaries have a clear dark purple discoloration, the illness involves an element of HT and BL stagnation; capillaries show a breakage and extravasations of blood onto the sclera, apart from the root pathology, the SP is also deficient and cannot keep the BL within the vessels; the extravasated blood shows a yellowish tinge, an SP deficiency is confirmed; the extravasated blood is reddish or pinkish, the breakage is recent; the extravasated blood is purplish or darkish, the breakage is of a longer duration; the extravasated blood is frankly black, the disturbed Fire-Water axis is tipping toward Water, i.e., a consumed HT Qi; the capillaries show a kinking or narrowing in some sectors, again, the SP is in disarray and has allowed the vessel walls to cave in; the capillaries are thick at the origin, the illness is of long duration and may prove difficult though not impossible to treat; the capillaries are tortuous, the illness has run a long course, where the invasion has encountered at times, a valiant resistance from Metal; the capillaries have invaded the cornea, the illness is well advanced and needs immediate attention; capillaries crisscross and have many branches, there may be an almost unrestrained emotional vacillation between sadness and grief; the capillaries are blurred or flaked, the clearly marked elemental integrity between Fire and Metal is disintegrating; and if there is a brownish spot on or removed from the capillaries, the Metal is dry to the point of pathological Heat.
The Logical Treatment Protocol This is a bielemental illness, with deficiency on Fire element and an excess on LI; the HT should be toned with a Mother Wood point and reduce the Metal with a Son Water point.
An efficient way to do this is to use 5-Shu specialized points on whichever channel is "open" at the time on the 24-Hour Horary Clock.2 Table 1 gives the points that can be applied during the usual clinic hours. A more detailed study of the whole 5-Shu grid spread on the Horary Clock gives more choice of points and latitude of application.
Table 1. Time-specific Wood-Mother and Water-Son Points
Mother Point For Toning Fire
Son Point For Reducing Metal
11 am-1 pm
Table 2. Check nearest match for the capillary profile and read finding
Check Appropriate Box
Read Match Finding
Capillaries are of a darker hue
The HT Yang excess has turned chronic.
HT, BL, and Qi ar
Capillaries are darkish purplee in a state of stagnation.
Capillaries are bleeding
Apart from the root pathology, into the sclerathe SP is deficient.
Exuded BL is yellowish
An SP deficiency is confirmed.
Exuded BL is purplish
An SP deficiency is coupled with BL stagnation.
Exuded BL is frankly black
An HT Qi consumed is leaning to Water element.
Capillaries are kinked and narrowed
An SP deficiency is indicated.
Capillaries are tortuous
The illness has had a long course and is chronic.
Capillaries have invaded cornea
An HT into Metal invasion is confirmed.
These are element-specific, time-sequenced 5-Shu points that tone a deficient HT Yin and reduce an excess Metal Yang at any particular time during the day. They should be used exclusively within their specific time frames. Other auxiliary points may become necessary to contain emergent symptoms.
Checklist of Scleral Capillary Changes Scleral capillary invasion is a fairly common sight in the clinic. In Table 2, match the changes that apply, check the column alongside, and integrate the inferences in the diagnosis. The list is open-ended and can be appended with other capillary configurations and hues.
DISCUSSION Rarely does one see the supporting and restraining connections of the Five-Elements grid so apparently displayed and, even less frequently, does one see these so clearly pre-empting a diagnosis and treatment protocol.
CONCLUSION Scleral capillaries, though vitiated in their role, readily suggest their own remedy and become, as a final gesture when the treatment is correct, the vivid monitors of a favorable prognosis by becoming entirely regressed and invisible.
Unsschuld PU. On Illness, The Sixty-First Difficult Issue. University of California Press; 1986:586. Nan-Ching: The Classic of Difficult Issues. Part II.
Keikobad H. Point Locator Chart for Time-Specific High Energy 5-Shu Toning & Reducing Points. Scottsdale, AZ: TruSelf Inc; 2002.
AUTHOR INFORMATION Dr Holmes Keikobad is a medical officer working with field care for entire cities, setting up healthcare systems and clinics for various populations, including an entire medical operation for a port city. His special interests include helping cross-cultural and indigenous populations in various settings, and was on the team of physicians that originally eradicated smallpox in the field, and has worked as a Senior Medical Officer with epidemics, providing quarantine and other services necessary under extreme and emergency situations.
Holmes Keikobad, MD, MBBS, DPH Ret, DipAc, NCCAOM, LicAc* Community Acupuncture Clinic 4120 N Goldwater Blvd, #213 Scottsdale, AZ 85251 Phone: 480-99-HELIX • E-mail: email@example.com *Correspondence and reprint requests