这项工作得到了成都中医药大学杏林学者研究促进项目 （MPRC2022012 和 QJJJ2023004） 的支持。

该方案已在成都中医药大学附属医院眼科批准用于临床试验伦理（伦理记录编号：KY2023001）。确保环境清洁无污染，光线充足，环境安静。获得患者的知情同意以使用和发布本文所示的数据。
1. 医生准备
<ol><li>检查患者的基本信息。确保患者符合《 近视防治指南 》中近视的诊断标准，且患有干眼症： （1） 确保患者远距离视力模糊，近视力良好，早期远视力经常波动，看远处物体时眯眼;（2） 通过屈光确定近视并确定程度。</li>
	<li>排除具有以下情况的患者： （1） 晕动病患者;（2） 皮肤溃疡;（3） 血糖控制不佳、血压控制不佳、头晕患者;（4） 凝血功能障碍和严重心功能不全患者;（5） 风湿性心脏病、先天性心脏病、肾衰竭、肝衰竭等;（6） 不配合治疗的患者。</li>
	<li>佩戴医用口罩和医用帽</li>
	<li>用肥皂水和七步洗手法洗手，保持双手干燥，并在取针前使用免洗手消毒液。 注意：手部消毒后避免触摸其他物品。手术前后必须洗手，双手必须保持清洁。</li>
</ol>2. 患者检查
<ol><li>获取患者基本信息：询问患者的姓名、性别、年龄、医生编号、身高、体重、既往病史、主诉等基本信息。</li>
	<li>测试患者的肉眼视力。<ol><li>要求患者距离视力表 5 m;遮盖眼睛的一侧。</li>
		<li>识别视力表上的“E”并检查它，直到它不再可识别。保持标签的方向从上到下。</li>
		<li>阅读视力表左侧的十进制记数法，根据视力表的读数判断患者的视力。</li>
		<li>然后使用相同的方法评估另一只眼睛。与通用视力表 （UCVA） 相比，低于 1.0 的分数被认为是近视。</li>
	</ol></li>
	<li>测试患者的干眼症评分。<ol><li>确保患者有眼睛干涩、异物感、烧灼感、疲劳、不适、眼睛发红和视力波动等主观症状之一。</li>
		<li>对照眼表疾病指数量表 （OSDI） 检查相应的情况：您在过去一周内是否出现过畏光、异物感、眼痛、眼睛刺激、视力模糊或视力丧失？ 总是出现 是 4 分， 经常出现 是 3 分， 一半时间出现 是 2 分， 有时出现 是 1 分， 没有出现 是 0 分。</li>
		<li>使用等式计算分数：0-12 是正常的;13-22 被归类为轻度干眼症;23-32 为中度干眼症;33-100 为重度干眼症。 最终比分 =<img alt="Equation 1" src="/files/ftp_upload/66727/66727eq01.jpg" style="margin: auto;"></li>
		<li>如果患者的 UCVA 评分为 <1.0 且 OSDI 为 ≥13 分，则进行下一步针刺治疗;否则，暂停针头给药。确保皮肤没有受损和溃疡。</li>
	</ol></li>
	<li>测量患者的血压。<ol><li>测量前让患者放松并安静休息 5-10 分钟。</li>
		<li>准备水银血压计;让患者坐着，双脚平放，肘部和前臂舒适地与心脏大致平行。</li>
		<li>打开血压计，将水银柱降至零。</li>
		<li>将血压计袖带系在患者上臂肘关节上方;确保一根手指仍然可以插入袖带和皮肤之间。</li>
		<li>将听诊器放在有动脉搏动的肘关节处，然后慢慢提高血压计内的压力，直到听诊器听不到血管的脉搏为止。现在慢慢放气：收缩压是听到血管脉搏的第一声，而舒张压是听不到声音的时候。</li>
		<li>如果血压正常（收缩压低于 90-140 mmHg，舒张压高于 60-90 mmHg），进行下一步针疗;否则，暂停针头应用。</li>
	</ol></li>
	<li>检测患者的脉搏率和血氧饱和度。<ol><li>准备一个夹式血氧仪，将左手或右手的食指放入夹式血氧仪的夹式中，检查夹式血氧仪中的红外灯是否开启。</li>
		<li>保持手指与夹持式血氧仪完全接触，在显示屏上显示测试进度。进入检测状态后，请保持手指稳定。</li>
		<li>显示屏上显示测试结果后，请伸出手指。显示屏顶部的 %SpO2 是血氧指数，屏幕上的 Min 是脉搏率。</li>
		<li>如果脉率正常（60-100 bpm（次/分钟）），进行下一步的针头治疗;否则，暂停针头应用。</li>
	</ol></li>
	<li>测量患者的呼吸频率。<ol><li>让患者保持安静、坐着或平躺，以保持平静的呼吸。</li>
		<li>观察患者的呼吸模式（胸式呼吸或腹式呼吸），并将手放在胸部或腹部。</li>
		<li>用手表或时钟计数，并通过观察胸部或腹腔的起伏来判断每分钟的呼吸频率。</li>
		<li>如果呼吸频率正常（12-20 次/分钟），进行下一步针刺治疗;否则，暂停针头应用。</li>
	</ol></li>
</ol>3. 穴位的识别和消毒
<ol><li>将患者平躺在治疗床上，仰卧位。摘下眼镜（如果有）以露出面部。让医生站在患者的右侧。</li>
	<li>遵循穴位定位：根据标准化穴位定位，穗竹（BL2）、余瑶（Ex-HN04）、四白（ST2）（见 图2）。<ol><li>BL2：定位在脸上，取眉毛内缘（眉毛中间，眶上切迹）的凹陷处。</li>
		<li>Ex-HN04：位于额头上，直视，瞳孔笔直向上;取眉毛的中间。</li>
		<li>ST2：定位于面部，眼睛方正，瞳孔垂直向下;以眶下孔的凹陷为例。 注意： 消毒前询问患者是否对酒精过敏。对酒精和不锈钢过敏的人不应使用它。</li>
	</ol></li>
	<li>取 75% 医用消毒酒精，在穴位喷洒 2-3 次，用一次性医用消毒棉签由内向外、从上到下擦拭;消毒部分的直径约为 2-3 厘米。等待酒精蒸发并确保操作部件干燥。</li>
</ol>4. 针灸手术
<ol><li>检查压针，确保其在保质期内，打开包装，检查压针是否完整，无损坏或变形。</li>
	<li>针灸BL2穴位：用左手拇指和食指固定皮肤，右手用镊子拿起针带，保持针头无菌，将针尖对准穴位，以45°进入皮肤，将针尖完全压入皮肤，左手按压固定带（见 图3）。<ol><li>如果接触血管，请减小针头与皮肤之间的角度，以避免针头进一步插入血管。</li>
	</ol></li>
	<li>针灸 Ex-HN04 穴位：按照步骤 4.2 中概述的程序进行操作（见 图 4）。</li>
	<li>针灸 ST2 穴位：按照步骤 4.2 中概述的程序进行操作（见 图 5）。</li>
	<li>询问患者感觉如何：轻轻按压手指 3 次以应用针头，并询问患者是否有任何酸涩、麻木、肿胀、疼痛和其他刺激。如果有任何感觉，请留下针头;如果没有感觉，调整针灸的方向，直到有感觉，然后离开针头。</li>
	<li>2 天后拔针，休息 1 天，再次涂抹上述穴位。一个疗程持续 2 周;总共进行 2 个疗程的治疗。在保留期内大约每 3 小时进行一次按压，每天 3 次，一次 ~1 分钟。</li>
	<li>取针：用左手的拇指和食指固定皮肤，右手用镊子拿起针带，取出垂直于皮肤的针头，取下后用无菌棉签按压针孔，用酒精棉签局部消毒。</li>
	<li>拔针后，将患者留在治疗室 30 分钟后再离开。</li>
	<li>疗效评价：1 个疗程（2 周）后，根据国际通用视力表 （UCVA） 测量患者的肉眼视力，并在下一个疗程前评估患者干眼评分的改善情况。</li>
</ol>

Standardizing Press Needle Treatment for Myopia with Dry Eye

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作者没有什么可披露的。

针灸作为我国古老的传统治疗方法，其疗效在漫长的发展历史中得到了验证，近年来的各种研究成果进一步证明了针灸在改善近视患者视力和干眼症状方面的有效性。这种疗法的有效性主要取决于所选择的穴位。高辉14 等人的研究证实，针灸疗法可以显着改善干眼症的症状，增加泪液分泌量。至于针灸治疗干眼症近视患者的疗效，国内已有大量临床报道得到证实。根据中医经典?...

近视是一种屈光不正;当眼睛处于放松的调整状态时，平行光线穿过屈光视网膜后聚焦在视网膜前方，从而在视网膜上产生清晰的图像，这称为近视。这种疾病的主要表现是近处物体的清晰视力和远处物体的模糊视力1。当正常的眼睛适应到松弛状态时，来自 5 m 外的平行光线穿过眼睛的屈光系统，焦点落在视网膜上，形成清晰的图像。但是，当近视患者看到 5 m 外的远处物体时，平行光线穿过眼球的屈光系统后会聚焦在视网膜前方，因此视力会变得模糊。如果观察 5 m 以内的近处物体，平行光线穿过眼球的屈光系统后会聚焦在视网膜上，效果会更清晰。由于近年来社会经济环境的快速变化，电子屏幕的广泛使用，以及精细化的眼睛使用方法的增加，近视的发病率迅速增加，并呈现年轻化的趋势，对社会健康产生了严重影响。
据统计，到 2050 年，全球近视人数将达到近 50 亿。随着电脑和智能手机的普及，加上之前新型冠状病毒爆发的影响，越来越多的近视患者开始出现干眼症状2。中国有近 4 亿人患有干眼症，近视干眼症的患病率明显高于正视和远视，近视青少年干眼症的发生率约为 20%。泪液不足和泪膜不稳定是导致干眼症的关键因素，近视患者眼睛伸长过程中角膜的变化和眼睑空间的增加会导致泪膜分布不均匀，导致泪膜稳定性下降，从而增加干眼症的风险。
干眼症的特征是泪膜不平衡和眼睛不适。是角膜结膜干燥的慢性炎症反应，主要表现为对外界环境敏感、泪液不足、眼感异物。可导致角膜结膜病变和视力障碍，进而影响患者的生活质量和视力3。干眼症的病因很复杂;主要原因是泪液的质量、数量和动力学异常，导致泪膜不稳定或眼表微环境失衡。疾病的具体起病与患者的眼表泪膜渗透压变化、免疫炎症反应、泪膜过度氧化、感觉神经麻痹和细胞凋亡有关，病理过程涉及 MAPK、NF-κB、Wnt、TLR、PI3K/AKT 等信号通路 4,5。
中医认为，近视患者干眼症的主要发病机制是肝肾功能不全。在 黄帝的内经苏温中记载“五脏六腑渗入眼内”，由此可见内脏功能障碍、滋润眼睛的液体产生不足或输液不良是重要的病原。 银海精微 明确指出：“泪水少负责肝肾虚”——肝脏的主要血液是眼睛的外部，肝血充足，肝气调理，将细微物质注入眼表以产生泪水。肾脏的主要水是体液的源头，肾充足，肾气充盈，全身源头充足。肝肾精华和血液是同源且相互关联的，因此肝肾功能不全是一个重要的发病机制6。目前，干眼症的临床治疗主要以人工泪液、维生素、神经生长因子和热脉冲疗法为主，短期效果良好，但长期效果仍然有限。中医治疗以中医内服为主，针灸、热敷熏蒸、耳压丸等。疗效持久性好，但手术较复杂，患者依从性不强。
压针是一种皮内针灸，在临床上应用广泛，主要用于治疗面瘫、失眠、痛经等疾病，近年来逐渐扩展到眼科疾病，具有疗效持久、操作简便、成本低、患者依从性好等特点7.具体来说，将一根特殊的小针（0.2-0.3 厘米长）插入并固定在穴位区域或皮下进行长时间埋葬。埋针时无需立即产生空气感，只有埋针后才能调节空气。本疗法结合了穴位理论和中医皮肤理论，采用“久静不动”的古老理念，结合传统针灸和埋线的优点，对皮肤进行长时间的持续刺激，达到防病的目的。
压针可以改善肉眼远视力，改善视觉疲劳状态，减少屈光，延缓近视患者的轴向生长，这已被临床研究证实 8,9,10。按压针可以改善干眼症，在改善干眼症患者泪膜稳定性、泪液分泌和角膜上皮损伤程度方面优于单独使用透明质酸钠滴眼液 11,12,13。按压针联合耳压豆、中医雾化熏蒸、按摩治疗干眼症的效果更为显著，这可能与调控MAPK、NF-kB、Wnt、TLR、PI3K/AKT等多条信号通路有关。
基于中医穴位和皮肤虫理论，本研究采用压针治疗（图 1），旨在改善干眼症症状、改善视觉功能和生活质量。按压针是一种持久、易于操作且价格低廉的中医治疗方法。综上所述，有必要提出一个关于如何正确操作针灸治疗干眼症近视的标准方案。本文介绍了如何正确使用压针治疗近视患者的干眼症。

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press needle: a traditional chinese medicine therapy for myopia patients with dry eye

大多数近视患者患有干眼症，这已被证明会对近视患者的眼部症状、近视进展和生活质量产生不利影响。针刺已被证明可有效缓解近视和干眼症患者的症状。压针是一种持久、易于操作且价格低廉的中医治疗方法。针头插入的标准做法对于治疗近视和干眼症非常重要。具体步骤包括选择合适的穴位，用合适的针刺穿，固定在穴位皮肤或皮下，埋 2 天，休息 1 天;治疗过程持续 2 周。具体来说，评估了以下指标： 未矫正视力和眼表疾病指数。本文将解释如何规范按压针在治疗近视和干眼症中的操作。

Myopia is a refractive error; when the eye is in a relaxed state of adjustment, parallel light rays are focused in front of the retina after passing through the refractive retina, resulting in a clear image on the retina, which is called myopia. The main manifestations of this disease are clear vision of near objects and blurred vision of distant objects1. When the normal eye adjusts to a relaxed state, the parallel light rays from 5 m away pass through the refractive system of the eye, and the focus falls on the retina, forming a clear image. However, when a myopic patient sees a distant object 5 m away, the parallel light rays are focused in front of the retina after passing through the refractive system of the eyeball, so the vision will be blurred. If you look at a near object within 5 m, the parallel light rays will be focused on the retina after passing through the refractive system of the eyeball, and it will be clearer. Due to the rapid changes in the socio-economic environment in recent years, the widespread use of electronic screens, and the increase of refined eye use methods, the incidence of myopia has increased rapidly, and it is showing a trend of younger age, which has a serious impact on social health.
According to statistics, the number of myopic people in the world will reach nearly 5 billion in 2050. With the spread of computers and smartphones, coupled with the impact of the previous novel coronavirus outbreak, more and more myopic patients are beginning to have comorbid dry eye symptoms2. Nearly 400 million people in China suffer from dry eye, and the prevalence of dry eye in myopia is significantly higher than that in emmetropia and hyperopia, and the incidence of dry eye in myopic adolescents is about 20%. Tear deficiency and tear film instability are key factors that lead to dry eye, and changes in the cornea and increased eyelid space during eye elongation in myopia patients can cause uneven tear film distribution, resulting in decreased tear film stability, which increases the risk of dry eye.
Dry eye syndrome is characterized by an imbalance of tear film and eye discomfort. It is a chronic inflammatory reaction of corneal conjunctival dryness, which is mainly manifested by sensitivity to the external environment, insufficient tear fluid, and foreign eye sensation. It can lead to corneal conjunctival lesions and visual impairment, and then affect the quality of life and vision of patients3. The etiology of dry eye is complex; the main cause is the abnormal quality, quantity, and dynamics of tears, resulting in tear film instability or imbalance of ocular surface microenvironment. The specific onset of the disease is related to the patient&#39;s ocular surface tear film osmotic pressure changes, immune inflammatory response, tear film hyperoxidation, neuroparesthesia, and apoptosis, and the pathological process involves MAPK, NF-&#954;B, Wnt, TLR, PI3K/AKT, and other signaling pathways4,5.
Traditional Chinese medicine believes that the main pathogenesis of dry eye in myopia patients is liver and kidney insufficiency. In the Yellow Emperor&#39;s Neijing-Su Wen, it is recorded that &#34;the five internal organs and six internal organs are infiltrated into the eyes&#34;, which shows that the dysfunction of the internal organs, the insufficient production of the fluid to moisturize the eyes, or the poor infusion are important pathogeneses. Yinhai Subtlety clearly states: &#34;Tears are less responsible for the deficiency of liver and kidney&#34;-the main blood of the liver is the outer part of the eye, the liver blood is enough, and the liver qi is regulated, and the subtle substances are injected on the surface of the eye for tears. The main water of the kidney is the source of the fluid, and the kidney is sufficient, the kidney qi is full, and the source of the whole body is sufficient. The liver and kidney essence and blood are homologous and interconnected, so liver and kidney insufficiency is an important pathogenesis6. At present, the clinical treatment of dry eye is mainly based on artificial tears, vitamins, nerve growth factor, and thermal pulse therapy, which has good short-term effects, but the long-term effects are still limited. Traditional Chinese medicine treatment is mainly based on the internal administration of traditional Chinese medicine, acupuncture, hot compress fumigation, auricular pressure pills, etc. The durability of the curative effect is good, but the operation is more complicated, and the patient&#39;s compliance is not strong.
Press needle is a kind of intradermal acupuncture, which is widely used in clinical practice, mainly used for the treatment of facial paralysis, insomnia, dysmenorrhea, and other diseases, and has gradually expanded to ophthalmic diseases in recent years, with the characteristics of long-lasting effect, easy operation, low cost, and good patient compliance7. Specifically, a special small needle (0.2-0.3 cm long) is inserted and fixed in the acupoint area or subcutaneously for a long period of burial. There is no need to immediately produce a sense of air when burying the needle, and the air can be adjusted only after the needle is buried. This therapy combines the theory of acupoints and the skin theory of traditional Chinese medicine, adopts the ancient idea of &#34;staying still for a long time&#34;, combines the advantages of traditional acupuncture and thread embedding, and has a long period of continuous stimulation of the skin, to achieve the purpose of preventing and treating diseases.
Press needles can improve unaided distance vision, improve the state of visual fatigue, reduce refraction, and delay the axial growth of myopia patients, which has been confirmed by clinical studies8,9,10. Press needle can improve dry eye and is better than sodium hyaluronate eye drops alone in improving the stability of the tear film, tear secretion, and the degree of corneal epithelial damage in patients with dry eye11,12,13. The effect of press needle combined with auricular pressure beans, traditional Chinese medicine atomization fumigation, and massage in the treatment of dry eye is more significant, which may be related to the regulation of multiple signaling pathways such as MAPK, NF-kB, Wnt, TLR, and PI3K/AKT.
Based on the theory of acupoints and dermatozoa in traditional Chinese medicine, this study was treated with a press needle (Figure 1), aiming to improve the symptoms of dry eye, improve visual function, and quality of life. A press needle is a long-lasting, easy-to-operate, and inexpensive traditional Chinese medicine treatment. To sum up, it is necessary to propose a standard scheme on how to correctly operate acupuncture for the treatment of myopia with dry eye. This article explains how to properly use a press needle to treat dry eye in patients with myopia.

Author Spotlight: Exploring Press Needle Efficacy and Underlying Molecular Pathways

压针：干眼症近视患者的中医疗法

Our research focuses on using traditional Chinese medicine to prevent and treat eye diseases. Specifically, we are developing a standard operation plan for the treatment of myopia and dry eyes. Press needles can improve the stability of tear film, tear secretion, and corneal athenia injury in patients with dry eyes and is better than sodium, high neural rate eyedrops alone.It may be related to the regulation of MAPK, LFP, B, WNT, TLR, PI3, KAKT, and other signaling pathways. We have observed significant improvement in the dry eye symptoms of myopia patients after acupuncture treatment and leading to improved vision in some cases.

在本研究中，共有 8 名符合标准的患者参加并完成了试验，在此过程中没有一人出院或被排除在外。OSDI 和 UCVA 评分用作该试验的主要评价指标，数据来自患者在治疗前后完成的量表评分。使用配对 t 检验比较治疗前后的自我控制。
表 1 比较了患者治疗前后的 OSDI 评分。将 OSDI 评分分为轻度症状≤ 21~45 分为中度症状，≥46 分为重度症状。治疗后患者 OSDI 评...

Read this Scientific Article Protocol about Author Spotlight: Exploring Press Needle Efficacy and Underlying Molecular Pathways at JoVE.com

在这里，我们提出了一种方案，以标准化针灸治疗干眼症近视的操作。

Most patients with myopia have dry eye, which has been shown to adversely affect ocular symptoms, myopia progression, and quality of life in patients with ...

我们的研究重点是使用中医预防和治疗眼病。具体来说，我们正在制定治疗近视和干眼症的标准手术计划。按压针可以提高干眼症患者泪膜、泪液分泌和角膜雅典损伤的稳定性，比单独使用钠、高神经率滴眼液更好。可能与 MAPK、LFP、B、WNT、TLR、PI3、KAKT 和其他信号通路的调节有关。我们观察到针灸治疗后近视患者的干眼症状有显着改善，并导致某些病例的视力得到改善。

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Research

JoVE Journal

Medicine

Press Needle: A Traditional Chinese Medicine Therapy for Myopia Patients with Dry Eye

699 次观看.  Eye School of Chengdu University of Traditional Chinese Medicine. 我们的研究重点是使用中医预防和治疗眼病。具体来说，我们正在制定治疗近视和干眼症的标准手术计划。按压针可以提高干眼症患者泪膜、泪液分泌和角膜雅典损伤的稳定性，比单独使用钠、高神经率滴眼液更好。可能与 MAPK、LFP、B、WNT、TLR、PI3、KAKT 和其他信号通路的调节有关。我们观察到针灸治疗后近视患者的干眼症状有显着改善，并导致某些病例的视力得到改?...