Myopia Progression and the Spleen's Role: An Integrative Interpretation through Traditional Chinese Medicine

Journal of Complementary Therapies in Health ISSN 2975-9323 |eISSN 2975-9552 Journal of Complementary Therapies in Health 2025:3(3). doi:10.5281/zenodo.17437032 institutoptc.com/journal-complementary-therapies Insight perspective Myopia Progression and the Spleen’s Role: An Integrative Interpretation through Traditional Chinese Medicine. Diogo Augusto Ribeiro1* , Ana Carolina Gomes1, Angie Paola Estupiñan1, Bruna Pereira dos Santos1, Ana Rita Gonçalves1, and Samuel Magalhães1. 1 IPN – Portuguese Institute of Naturology, Porto, Portugal. * Correspondence: diogo[email protected]m Abstract Myopia, a refractive condition of increasing global prevalence, is traditionally addressed by Western medicine through factors such as excessive screen use and limited exposure to natural light. This review explores the influence of the Spleen on myopia progression from a Traditional Chinese Medicine perspective, presenting a complementary and holistic view. According to Traditional Chinese Medicine, the energetic imbalance of the Spleen, caused by factors like excessive studying, exaggerated worry, inadequate diets (cold, processed, and sugary foods), and exposure to cold, compromises the production of Blood (Xue) and its circulation. These factors generate dampness and phlegm which, by making the blood more viscous and causing inflammation, impair the nutrition and oxygenation of the eye’s microvessels. The deficiency of Blood and poor circulation directly affect the nutrition of the ocular muscles, contributing to the axial elongation of the eyeball, one of the main factors of myopia. Traditional Chinese Medicine offers strategies aimed at strengthening the Spleen and the Xue, harmonising the energetic system to improve overall Xue circulation and, consequently, ocular health. Keywords: Myopia; Cold; Muscles; Spleen; Traditional Chinese Medicine; Stress; Diet. 1. Introduction The prevalence of refractive errors, namely myopia, has been increasing significantly over the years 1. The conventional approach points to poor dietary habits and the constant use of electronic devices, such as computers, tablets, and mobile phones, as the main factors in the development of this condition 2,3. In Traditional Chinese Medicine, this view is acknowledged but is complemented by the exploration of internal factors, given that the body is understood as an integral system, where the imbalance of one part affects the whole 4,5. Curiously, the progression of myopia does not follow a strictly linear logic (where 1+1=2). The cause and development of myopia raise important questions, such as the fact that not all individuals who spend long hours in front of screens develop the condition 6. If the use of screens were cited as the primary and exclusive cause for the increase in myopia in the global population, one would expect all intensely exposed individuals to require optical correction, or conversely, that children who frequently play outdoors would be immune to these refractive errors 7. These inconsistencies leave a significant space for new perspectives. Therefore, this research aims to explore the relationship between myopia and the Spleen in Traditional Chinese Medicine, analysing how the energetic imbalance of this organ can manifest in ocular refraction and influence the progression of myopia, with a special emphasis on Xue circulation and nutrition. Citation: Ribeiro D.A., Gomes A.C., Estupiñan A.P., dos Santos B.P., Gonçalves A.R., Magalhães S. Myopia Progression and the Spleen’s Role: An Integrative Interpretation through Traditional Chinese Medicine. Journal of Complementary Therapies in Health. 2025;3(3) 10.5281/zenodo.17437032 Academic Editor: Jorge Rodrigues Received: 29 August 2025 Reviewed: 10 September 2025 Revised: 28 September 2025 Revised: 17 October 2025 Accepted: 19 October 2025 Published: 24 October 2025 Publisher’s Note: IPTC stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. Copyright: ©2025 by the authors. Submitted for open access publication under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Journal of Complementary Therapies in Health 2025: 3(3). 2 of 8 Ribeiro D.A., Gomes A.C., Estupiñan A.P., dos Santos B.P., Gonçalves A.R., Magalhães S. Myopia Progression and the Spleen’s Role: An Integrative Interpretation through Traditional Chinese Medicine doi:10.5281/zenodo.17437032 2. The Connection of the Spleen to Ocular Health in Traditional Chinese Medicine In Traditional Chinese Medicine, ocular health is directly linked to the balance of various organs, with the Liver being the most commonly associated. Myopia is a condition that arises from Liver Xue deficiency or Liver or Kidney Yin deficiency, considering that the basis of Yin is Xue and that the Liver only stores and distributes it. Therefore, it makes perfect sense to focus treatment on improving the quality of the Xue 8. The Spleen plays a fundamental role, as it is primarily responsible for the digestion and assimilation of food, generating the “pure essence” (Gu Qi) that is the basis for the formation of Xue 9. A deficient Spleen compromises the production of Xue and its circulation 9, which affects the nutrition of the entire body, including the eyes. Additionally, the Spleen is considered the “governor of the muscles,” being responsible for their nutrition and tone 9. Axial myopia, characterised by the elongation of the eyeball 10,11, is a structural change that is under the influence of the Spleen, as the Spleen is responsible for structural changes 9, indicating a direct connection between its imbalance and the progression of myopia. Organ prolapse, such as the uterus and stomach, is also associated with Spleen Qi deficiency 9,12, which reinforces its influence on the support of bodily structures, including the ocular musculature. 3. Factors of Spleen Imbalance and the Impact on Circulation Various factors of modern life weaken the Spleen and the Xue, with a direct impact on Xue circulation. 3.1. Cold and Inadequate Diet The Spleen prefers warmth for effective digestion. Exposure to cold (whether environmental or through cold and raw foods and drinks) depletes the Spleen's Yang Qi, slowing down the digestive process and causing stagnation of Qi and Xue 9,13. Cold causes the contraction of muscles and blood microvessels 9,12, hindering the supply of nutrients and oxygen to the eyes. In this regard, evidence indicates a sharp increase in myopia in winter compared to summer 14,15. 3.2. Educational Pressure and the Impact on Myopia Progression The Spleen is the "residence of thought" (Yi). Excessive studying and mental pressure consume the Spleen Qi, leading to the depletion of Xue 9,12. There is a higher prevalence of myopia in urban areas compared to rural areas. A study conducted on young Jewish adults attending Orthodox schools in Israel shows that the prevalence of myopia (81.3%) and high myopia (20.4%) are as high as those observed in young adults in East and Southeast Asia (where educational pressure is quite high and their students rank at the top of international assessments), with these rates being much higher compared to those of young people attending secular schools in Israel 15. The prevalence of myopia is generally lower in rural areas, especially those with less access to education 15. 3.3. Diet Rich in Sugars and Processed Foods The consumption of refined sugar weakens the Spleen, promoting the accumulation of dampness and phlegm 9. High blood sugar levels increase blood viscosity and make circulation difficult in microvessels. These factors can impair the nutrition and oxygenation of ocular structures. A molecular mechanism that may be related to this lack of oxygen was described in a scientific article, “The role of retinal histone lactylation in myopia” development shared by the journal Cell Metabolism. If the eye does not have enough oxygen (hypoxia), this increases how it processes sugar. In other words, when there is little oxygen, the cells of the sclera begin to use more sugar for obtain energy, creating a byproduct called lactate 16,17. Journal of Complementary Therapies in Health 2025: 3(3). 3 of 8 Ribeiro D.A., Gomes A.C., Estupiñan A.P., dos Santos B.P., Gonçalves A.R., Magalhães S. Myopia Progression and the Spleen’s Role: An Integrative Interpretation through Traditional Chinese Medicine doi:10.5281/zenodo.17437032 3.4. Worry, the Emotion that Imbalances the Spleen Worry is the emotion that consumes the energy of the Spleen 18. When we are in a state of "pre-occupation," our brain, which consumes a significant amount of Xue, becomes exhausted trying to solve or control every situation we wish to avoid. In the same way that the Spleen has the function of controlling and holding all the body's structures in place, it also attempts to control situations or potential events. The Spleen is intrinsically linked to the need for control, and this dominance can generate chronic stress 18,19. The attempt to control and predict events can, in turn, give rise to other feelings, such as fear, irritability, or frustration, which ultimately generate stress that is highly inflammatory for the body. Stress hormones (such as cortisol and adrenaline) cause the Liver to release more glucose (sugar) into the bloodstream, as the body is preparing for a "fight-or-flight" situation and needs rapid energy 19. If the stress is constant, these sugar levels can remain elevated, exhausting the energy of the Spleen, which will constantly attempt to regulate these levels in the bloodstream. The excessive stimuli we are exposed to today by living in urban areas, the educational pressure imposed on us, and professional competitiveness are factors that generate significant stress 20. 4. Therapeutic and Preventive Approaches of Traditional Chinese Medicine Traditional Chinese Medicine offers a range of interventions to strengthen the Spleen and improve circulation, mitigating the progression of myopia. 4.1. Acupuncture The treatment aims to tonify Qi and nourish Xue. The following points are frequently used 21: • Bladder 20 (Pishu, Figure 1): Used to powerfully strengthen the Spleen and promote its function of transformation and transportation of nutrients, thereby increasing the production of Qi and Xue. Figure 1. Bladder 20 localisation according to the World Health Organization 22. Journal of Complementary Therapies in Health 2025: 3(3). 4 of 8 Ribeiro D.A., Gomes A.C., Estupiñan A.P., dos Santos B.P., Gonçalves A.R., Magalhães S. Myopia Progression and the Spleen’s Role: An Integrative Interpretation through Traditional Chinese Medicine doi:10.5281/zenodo.17437032 • Bladder 17 (Geshu, Figure 2): Known as the Influential Point of the Xue, it is used to invigorate and harmonise the Xue. Since the eye relies on sufficient Blood for nutrition, this point is crucial. Figure 2. Bladder 17 localisation according to the World Health Organization 22. • Spleen 4 (Gongsun, Figure 3): Harmonises the Stomach and regulates the Penetrating Vessel. It is particularly effective at eliminating facial oedema or swelling. This action improves circulation in the face, which makes it a point of great importance for controlling the progression of myopia. Figure 3. Spleen 4 localisation according to the World Health Organization 22. Journal of Complementary Therapies in Health 2025: 3(3). 5 of 8 Ribeiro D.A., Gomes A.C., Estupiñan A.P., dos Santos B.P., Gonçalves A.R., Magalhães S. Myopia Progression and the Spleen’s Role: An Integrative Interpretation through Traditional Chinese Medicine doi:10.5281/zenodo.17437032 • Spleen 6 (Sanyinjiao, Figure 4): This point is vital as the meeting point of the three Leg Yin channels (Spleen, Liver, and Kidney). It powerfully nourishes Xue and Yin, making it essential for systemic nutrition, which directly benefits ocular tissues. Figure 4. Spleen 6 localisation according to the World Health Organization 22. • Gallbladder 39 (Xuanzhong, Figure 5): Influential Point of the Marrow. As the Marrow is strongly linked to Blood production, this is a fundamental point in cases of Liver Xue Deficiency, important for structural stability. Figure 5. Gallbladder 39 localisation according to the World Health Organization 22. Journal of Complementary Therapies in Health 2025: 3(3). 6 of 8 Ribeiro D.A., Gomes A.C., Estupiñan A.P., dos Santos B.P., Gonçalves A.R., Magalhães S. Myopia Progression and the Spleen’s Role: An Integrative Interpretation through Traditional Chinese Medicine doi:10.5281/zenodo.17437032 • Governing Vessel 20 (Baihui, Figure 6): An essential point for ascending the Spleen Yang and directing Qi and clear energy to the head and face, positively influencing ocular health. Figure 6. Governing Vessel 20 localisation according to the World Health Organization 22. 4.2. Herbal Medicine In herbal medicine, Ginkgo biloba is a valuable strategy, especially in winter, as its action in tonifying the Xue and improving blood circulation helps combat viscosity and stagnation caused by the cold 23. For issues of stress and nervousness, the formula Yang Xin Ning Shen Wan can be used to nourish the Heart and Xue and calm the mind 24. 4.3. Diet Therapy and Lifestyle This approach emphasises maintaining a balanced and easily digestible diet while avoiding cold, raw, processed, and sugary foods that may impair digestive function and Qi circulation. From a traditional Chinese medicine perspective, such foods can weaken the Spleen and contribute to internal dampness or stagnation 25. In parallel, stress reduction through practices such as Qigong and Taijiquan is considered essential to regulate emotional balance, harmonise the flow of Qi, and promote mental calmness 26-29. 5. Conclusion Myopia can be seen by Traditional Chinese Medicine as a manifestation of a systemic imbalance with a strong influence from the health of the Spleen. The weakening of this organ, induced by factors such as cold, mental stress, and diets rich in sugars, compromises the production and circulation of Xue. This poor circulation, characterised by viscosity and inflammation, impairs the nutrition and oxygenation of the eye, contributing to the axial elongation of the eyeball. Traditional Chinese Medicine may offer an integrative approach that complements the Western approach, emphasising the importance of strengthening the Spleen to prevent and manage the progression of myopia. Journal of Complementary Therapies in Health 2025: 3(3). 7 of 8 Ribeiro D.A., Gomes A.C., Estupiñan A.P., dos Santos B.P., Gonçalves A.R., Magalhães S. Myopia Progression and the Spleen’s Role: An Integrative Interpretation through Traditional Chinese Medicine doi:10.5281/zenodo.17437032 Credit author statement: Conceptualisation, D.A.R.; Methodology, D.A.R.; Validation, D.A.R.; Formal analysis, D.A.R., A.C.G., and A.P.E.; Investigation, D.A.R.; Writing - Original Draft, D.A.R.; Writing - Review & Editing, D.A.R., A.P.E., A.C.G., B.P.S., S.M. and A.R.G.; Visualisation, D.A.R.; Project administration, D.A.R. All authors have read and agreed to the published version of the manuscript. Funding: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Conflict of Interest: The authors declare that there are no conflicts of interest. Institutional Review Board Statement: Not applicable. Informed Consent Statement: Not applicable. Data Availability Statement: The original contributions presented in this study are included in the article. Further inquiries can be directed to the corresponding author. References 1. Liang J, Pu Y, Chen J, Liu M, Ouyang B, Jin Z, et al. Global prevalence, trend and projection of myopia in children and adolescents from 1990 to 2050: a comprehensive systematic review and meta-analysis. Br J Ophthalmol. 2025;109(3):362-71. doi: https://doi.org/10.1136/bjo-2024-325427 2. Ha A, Lee YJ, Lee M, Shim SR, Kim YK. Digital Screen Time and Myopia: A Systematic Review and Dose-Response MetaAnalysis. 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