Retinitis Pigmentosa and Chinese Medicine

By Makari Wellness, updated September 5, 2026

A Diagnosis That Changes Everything

Retinitis pigmentosa (RP) is one of the most challenging diagnoses in ophthalmology — not because it is acutely life-threatening, but because it arrives with a long sentence attached: progressive, hereditary, and without a disease-modifying pharmacological therapy available for the vast majority of genotypes. Rod photoreceptors in the peripheral retina begin dying first, narrowing the visual field inward like a closing iris. As the disease progresses, cone photoreceptors in the macula may eventually become involved, threatening central vision as well. The pace varies considerably by genotype and individual constitution — some patients remain functionally sighted well into their sixth and seventh decades; others experience significant peripheral loss in their twenties and thirties.

Gene therapy trials are advancing. Voretigene neparvovec (Luxturna) is now available for certain RPE65 mutations — the first structural intervention in RP to demonstrate meaningful visual recovery. For the majority of RP genotypes, however, current medicine offers monitoring, low-vision rehabilitation, and watchful waiting. It is in the space between diagnosis and the horizon of gene therapy that classical Chinese medicine has something meaningful — and honestly positioned — to offer.

What Conventional Care Provides (and Where It Ends)

Ophthalmologic monitoring of RP includes visual field testing, electroretinography (ERG), and OCT imaging of the retinal nerve fiber layer and outer nuclear layer. The ERG is the most sensitive indicator of rod photoreceptor function and its progressive decline. Supplemental vitamin A palmitate was studied in large longitudinal trials with mixed results and carries hepatotoxicity risk at sustained high intakes. Dark-adaptation aids and night-vision devices help with practical function in dim environments. For most patients, the ophthalmology visit is a progress check on a trajectory that cannot currently be altered by pharmacological means.

The open question — the one that brings patients to our practice — is whether constitutional support may influence the rate of Jing depletion, support the mitochondrial and antioxidant environment in which remaining photoreceptors operate, and address the secondary patterns (Liver Blood deficiency, Kidney Yang deficiency) that, in classical terms, accelerate the condition's progression. We cannot promise that it does. This requires honest framing from the outset, and we provide it.

The Classical Picture: RP as a Jing-Depletion Condition

Kidney Jing Deficiency (Shèn Jīng Xū, 腎精虛)

Kidney Jing deficiency (Shèn Jīng Xū, 腎精虛) is the classical root of retinitis pigmentosa. Jing (精) is constitutional essence — the inherited deep reserve that governs structural development, reproductive capacity, and the body's regenerative potential. Unlike Qi, which can be replenished daily through food and rest, Jing is finite and non-renewable in large quantities. In classical terms, every chronic depletion — excessive work, insufficient sleep, constitutional stress — draws down Jing, and every herb and practice that conserves it helps preserve the reserve.

When Kidney Jing declines below the threshold required to sustain a metabolically demanding tissue — and few tissues in the body are more metabolically demanding than the photoreceptor outer segment — structural deterioration begins. RP, in the classical frame, is precisely this: a hereditary insufficiency of Jing expression at the retinal level. The rod photoreceptors of the peripheral retina fail first because, in this reading, they represent the most Jing-dependent reach of the visual system — the periphery is the furthest extension of the constitutional resource, and when that resource is insufficient, the periphery fails first. The retina runs dry from the outside in.

Liver Blood Deficiency (Gān Xuè Xū, 肝血虚)

Liver Blood deficiency (Gān Xuè Xū, 肝血虚) is the secondary pattern in RP, and it compounds the Jing-depletion picture considerably. In Chinese medicine, the Liver Blood nourishes the eyes and the visual channels generally. When Liver Blood is insufficient, tissue already operating on insufficient Jing receives less nourishment in addition — a compounding deficit. Jing depletion weakens Liver Blood production; Liver Blood insufficiency deepens the shortfall. Both must be addressed in any serious formula design for this condition.

Yang Deficiency in Advanced Stages (Shèn Yáng Xū, 腎陽虛)

In later-stage RP — particularly in patients who have been depleting Jing over decades — Kidney Yang deficiency (Shèn Yáng Xū, 腎陽虛) frequently emerges alongside the Yin-Jing picture: cold extremities, nocturia, early-morning fatigue, pallor, and an overall loss of the warming and activating function that Yang provides. This stage represents a transformation from pure Yin-Jing depletion into a mixed Yin-Yang deficiency, and the formula must shift to address Yang alongside Jing and Blood.

The Organ Lens: Pupil, Periphery, and the Kidney

A modern five-region model of the eye maps the pupil to the Kidney (Water element). The rod-dominant peripheral retina — the retinal tissue most vulnerable in RP — represents the Kidney's expression in the visual field. As Kidney Jing depletes, the periphery, which sits furthest from the constitutional center and is most Jing-dependent, fails first. This is the clinical map that organizes every treatment decision.

The classical Water Wheel (Shuǐ Lún, 水輪) of the Five Wheels (Wǔ Lún, 五輪) framework agrees: the Water Wheel governs the pupil and deep visual function — the Kidney's domain. RP is the archetypal Water Wheel failure: deep, constitutional, slow, and rooted in the hereditary Jing substrate. Few conditions in the classical ophthalmology canon present this picture as purely as RP does.

Acupuncture for Retinitis Pigmentosa: The M48 Protocol

At Makari Wellness, RP treatment centers on M48 (Micro Acupuncture 48), combined with scalp acupuncture, Master Tung's points and electro-stimulation when appropriate. Michael is M48 (Micro Acupuncture 48) certified by Dr. Andy Rosenfarb. M48 is a 48-point distal microsystem of 24 hand points and 24 foot points, based on the ECIWO holographic principle (Embryo Contains Information of the Whole Organism). In the M48 classification, RP falls in the "Drying" category — specifically in the most serious structural sub-category of that group — reflecting Kidney Jing and Liver-Kidney Yin-Blood depletion driving progressive photoreceptor atrophy. This is the category of conditions where the M48 protocol is working at the deepest constitutional register.

The M48 point protocol for RP reflects the Kidney-primary, Liver-secondary constitutional picture:

• KI-B (Kidney proximal, Yin point): The most important point in the RP protocol. This Kidney structural and constitutional point is used to address the root Jing depletion at the level of essence and structure. It is used in every session. In the M48 A/B polarity system, B points address structural, constitutional, and chronic deficiency patterns; KI-B reaches the deepest layer of Kidney Jing insufficiency accessible within the microsystem.
• KI-A (Kidney distal, Yang point): The functional and sensory dimension of Kidney Qi. While KI-B addresses the structural Jing root, KI-A is added to support the functional expression of remaining Kidney-mediated visual function — the day-to-day sensory output that depends on the Jing foundation.
• LR-B (Liver proximal, Yin point): The Liver structural and Blood-nourishing point. Addresses the Liver Blood deficiency that compounds Jing depletion. Used in most sessions to address the secondary pattern.
• BL-A / BL-B (Bladder — Kidney's paired organ): The Bladder-Kidney pairing governs Yang-Qi regulation at the constitutional level. BL-A and BL-B are added when the Yang-deficiency picture of advanced RP emerges — supporting the warming and activating function that progressive Jing depletion erodes.
• BL-1 (Jingming, 睛明): The local periorbital adjunct, used alongside the distal M48 work to support residual visual function. Retained simultaneously with the distal points for the 30-minute session.

RP is a lifetime treatment proposition for most patients, and the M48 protocol is designed for sustained engagement. We agree a block of visits up front and re-check before continuing. We have this conversation directly at the initial consultation, and we return to it at every milestone. There are no shortcuts in constitutional medicine for hereditary disease.

Scalp Acupuncture and Electro-Stimulation

The Occipital Vision Area (枕上視覺區) — 1 cm lateral to the external occipital protuberance, 4 cm superior — is added as a regular component of the RP protocol. The Visual Three Needles (Shì Sān Zhēn, 視三針) are used to stimulate the cortical visual pathway. Dense-disperse wave electro-stimulation — the Pulling Qi Method (Chōu Qì Fǎ, 抽気法) — is thought to work through improved retinal blood flow and cortical visual pathway stimulation.

For RP specifically, electro-acupuncture at 1–4 Hz — the chronic degeneration frequency range — is calibrated for sustained tissue support and parasympathetic regulation, not acute anti-inflammatory effect. The goal is long-term neuro-optic support for the residual retinal tissue, and a healthier micro-vascular and neuronal environment for the remaining rod and cone photoreceptors. We are explicit with every RP patient about the distinction between supporting residual function and undoing degeneration that has already occurred. Both deserve honest language.

What the Research Shows

A 2026 systematic review in Frontiers in Medicine by Bautista-Hernández MA and colleagues assessed existing evidence for acupuncture in retinal degenerative conditions. The conclusion: heterogeneous studies, small sample sizes, insufficient evidence for definitive claims. We share this assessment and present it directly to every RP patient at consultation. The evidence base for M48 in RP is clinical and observational at this stage — not randomized controlled-trial data. That is the honest position, and it is the one we take. Frontiers in Medicine, 2026.

Chinese Herbs: Building the Jing Foundation

The herbal formulary for RP works at the deepest constitutional level — Jing building, Liver Blood nourishing, and Yang warming in later stages. In Chinese medicine terms this is constitutional rather than symptomatic work, following the pattern as it evolves. Key herbs in this context include:

• Tu Si Zi (Tú Sī Zǐ, 菟丝子) — dodder seed. The classical herb for night blindness and visual failure from Kidney deficiency. Classical texts note Tu Si Zi specifically for "seeing in the dark" — a suggestive correspondence with rod photoreceptor function, the primary cell type lost in RP. It tonifies both Kidney Yin and Kidney Yang, making it a balanced Jing-building herb suitable for extended use across different constitutional phases of RP.
• Lu Jiao Jiao (Lù Jiǎo Jiāo, 鹿角胶) — deer antler gelatin. One of the strongest Jing and Yang tonics in the classical materia medica. It builds deep essence at the constitutional level, warms Kidney Yang, and replenishes Jing simultaneously. Indicated when Yang deficiency signs emerge in advanced RP — the cold, the nocturia, the pallor that signals the transformation from pure Yin-Jing depletion into mixed territory.
• Gou Qi Zi (Gǒu Qǐ Zǐ, 枸杞子) — wolfberry. The classical Liver-Kidney Yin-Blood tonic and the traditional "eye herb" — noted in classical texts for brightening the eyes and nourishing the visual substrate from the Liver-Kidney axis. Used throughout the course of RP treatment as a foundational Liver Blood tonic alongside the deeper Jing-building herbs.
• Shu Di Huang (Shú Dì Huáng, 熟地黄) — cooked rehmannia. The quintessential Kidney Jing-building herb in the classical materia medica. Classical formulas for essence depletion — particularly for visual decline from Kidney root deficiency — anchor on Shu Di Huang as the primary tonic substance. Rich, sweet, and deeply nourishing, it builds Kidney Jing and Blood simultaneously and is the Yin-axis counterpart to Tu Si Zi's balanced Yin-Yang building action.

Any herbal approach for RP is individualized by a licensed practitioner and reassessed regularly, shifting the emphasis between Jing-building, Blood-nourishing and Yang-warming as the pattern evolves.

Nutrition and Functional Medicine, Through the Pattern

The photoreceptor outer segment is among the most metabolically active tissues in the body, heavily dependent on mitochondria. In RP, this metabolic demand is compounded by the energy requirements of the rhodopsin cycle occurring in cells that are, in classical terms, already under Jing-depletion stress. Read through the pattern, the nutrition conversation centers on this metabolic environment:

• Acetyl-L-carnitine: Participates in mitochondrial energy production, which the photoreceptor layer depends on heavily. In classical terms this belongs to the Water/Kidney sphere.
• Astaxanthin: A carotenoid antioxidant found in salmon, shrimp and other seafood, notable for crossing the blood-retinal barrier. The retinal pigment epithelium carries a high oxidative load in RP as it manages shed outer-segment material from dying photoreceptors.
• Lutein and zeaxanthin: Carotenoids from leafy greens and egg yolk that form the macula's protective pigment layer. As RP progresses toward central vision, these become increasingly relevant to the cone photoreceptors that remain functional longer than the rod periphery.
• Omega-3 fatty acids (DHA/EPA): DHA, found in oily fish, is the dominant fatty acid in the photoreceptor outer-segment membrane, making up about half of its fatty acid content. EPA participates in the body's regulation of inflammation. Both are relevant to the membrane structure of the photoreceptors that remain.

Which of these matter most is read from the pattern, the same way the herbs are chosen.

An Honest Word on What Chinese Medicine Can and Cannot Do for RP

Herbal medicine cannot alter the genetic trajectory of retinitis pigmentosa. Gene therapy trials — particularly for RPE65, RPGR, and CNGB3 mutations — offer the most promising structural intervention for certain genotypes, and we encourage every RP patient we see to understand their mutation and monitor clinicaltrials.gov for trial availability. The classical approach aims at something different and more modest: supporting the constitutional terrain, aiming to slow the rate of Jing depletion, and supporting retinal function within the limits of the hereditary condition.

The hope is stabilization — periods where visual field progression slows or plateaus. Whether that happens is individual, cannot be predicted at intake, and requires genuine long-term commitment. We cannot promise it. What we offer is a clinically rigorous, honest, long-term partnership in the management of this condition — a partnership that treats the whole person, addresses the constitutional root, and does not pretend that addressing the root is the same thing as undoing the hereditary fact.

Curious? Let's Talk.

If you or someone you love is navigating retinitis pigmentosa and wondering what integrative acupuncture and herbal support might look like, we'd love to have that conversation.

The M48 protocol isn't a promise — it's a conversation. One grounded in classical theory, clinical experience, and an honest engagement with the evolving science.

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Acupuncture and herbal medicine are not replacements for conventional ophthalmologic care. Always continue your care with your ophthalmologist.

Nutrients are discussed as food and general physiology, with no products, brands or doses. Talk to your practitioner before starting any supplement.

This is general wellness information, not medical advice.

Formulas here illustrate how pattern diagnosis shapes treatment. They are not recommendations; a practitioner selects and adjusts formulas for the individual.

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