Introduction:
Keratoconus is a bilateral corneal disorder that has the characteristic of cone-like steeping associated with irregular stromal thinning and leading to significant loss of vision due to cone-like bulge or protrusion. [1]

All these alterations in the cornea can cause a variable reduction in the visual acuity, leading to sensitivity to glare and light and distorting the images. [1]

It can also be undetected in the beginning and classified as asymmetric oblique astigmatism and for this reason, it remains undetected or subclinical. [1]

The manifestation of symptoms can occur at the puberty and may progress until the third and fourth decade. In some cases, but rarely can manifest following endocrine status such as pregnancy and gestational period. [1]

The etiology and pathogenesis in keratoconus it is still not known and according to Western medicine, keratoconus can be formed in contact lens wear, Down’s syndrome, chronic eyes rubbing, connective tissue disease, tapeto retinal degeneration, atopic disease, etc. [1]

Persistent eye rubbing and hard contact lens use can lead to eye trauma that can associate to progression of keratoconus formation in individuals that has this predisposition. The alteration in the keratocyte can be formed after chronic rubbing altering and causing phenotype response to the mechanical trauma. [1]

In patients where the lens and glasses can no longer give adequate vision, there is an option of surgical intrastromal ring implantation or corneal transplantation. [2]

The diagnosis of this pathology has increased recently due to screening methods such as corneal topography. This exam represents an evolution of the early diagnosis evaluating the topographic map and the map of the corneal elevation and thickness of the posterior cornea with detail follow up of this disease evolution. [3]

This article will be following Hippocrates (c. 460 bce - c. 375 bce) thoughts that said that “foolish the doctor who despises the knowledge acquire by the ancients”. [4]

Another quote for him that I am using to write this article is that “it is more important to treat the patient and not the disease”. [4]

The third quote used to write this article is “it is important to consider other ancient medical traditions prior to the knowledge we have nowadays.” [4]

Purpose:
The purpose of this study is to demonstrate that patients with keratoconus have in common history of chronic rubbing in the eyes and I will demonstrate how is the energy alteration in the five internal massive organs according to TCM and to the five wheels theory that are leading to chronic manifestations of this symptoms (rubbing in the eyes) that could be causing keratoconus formation in both eyes.

Methods:
I used to write this article, articles from Western medicine and from ophthalmology books in traditional Chinese medicine, that can explain which are the energy alterations behind all patients that are suffering from Keratoconus formation. It was used three case reports of patients that were suffering from keratoconus that had in common symptoms of chronic rubbing in the eyes, before developing keratoconus diagnosis.

Case report one:

The first case report is a 53-years-old female patient (A.C). She started wearing glasses at age 10 and was diagnosed with Hyperopia and Astigmatism and since then she had periodic visits to the ophthalmologist, which always increased her grade in both eyes. She told me that she had rubbing in both eyes since the beginning of her symptoms but there was not a lesion in the eyes that was contributing to have that symptom. It was very difficult to wear the glasses, because she could not keep them on for a long time and her parents thought she did not use it out of vanity, and that is what also she ended up believing. She always liked to study, she got good grades, but without realizing it she went losing interest in books.

At the age of 24 (in 1992), she decided to look for an ophthalmologist to wear contact lenses because she could not see anymore, and she was attending her second college. For her surprise, the doctor told her that she had a rare disease called Keratoconus and that the physician was not specialist in that area. It was at that time that she went to a doctor named G.O., specialist in this disease. He took an exam and diagnosed this deficiency, putting her up to date of all the difficulties it causes. At that moment, the glasses would not work in her case, due to the various degrees of the cone and so she was never able to wear glasses. The doctor indicated hard lenses, which were very difficult to adapt due to the curvature of the eye with keratoconus.

Also, the doctor also mentioned that after age 50 she could try to do a transplant if she does not fit with the contact lenses. She managed to adapt to the use of these lens after a lot of insistence and it was a relief to be able to see better, she also noticed that the understanding became clearer.

After four years (in 1996) she became pregnant (when she was 28 years-old), and the lens was rejected. Before pregnancy, she told me that she could wear contact lens but after the pregnancy, the lens was not adapting any more in her eyes (due to the curvature of the corneal surface) and she started using the glasses without much success, accepting that situation. She began to learn how to “see badly”.

She is aware that her illness (keratoconus) was different and that the small print in books at the time made it difficult for her to understand. She spent practically all her school life with this difficulty, always overcoming them without being aware of the real cause of this “genetic problem”, thus discovered years later.

She recently visited an ophthalmologist who is specialized in specific lenses for Keratoconus. She was thrilled to see everything with colors and clarity, but she did not adapt to putting them alone because the lenses are large and in a cone shape.

She said that still have hope of getting a cure or a technique that would fit in her eyes and finally able to see better.

She went to my clinic in 2019 to try to reduce weight due to obesity using Chinese tools such as Chinese dietary counseling, auricular acupuncture with apex ear bloodletting, systemic acupuncture and she was submitted to the measurement of the energy of the five internal massive organs (Liver, Heart, Spleen, Lungs, Kidney) and told me all her past history of keratoconus disease in this consultation and the results and the treatment used in her case you can see in the result section.

Case report two:

The second case report is L.C.M., 55 years old, Brazilian, born in “Vila dos Civis” at the AFA – Air Force Academy in the city of Pirassununga-Sao Paulo, in a family of 2 more brothers (he is the oldest son). His mother had 3 miscarriages, two before him and one after him, and his mother already thought she would never have children again due to previous losses and attempts made.

The patient was born with vision problems that soon needed treatment to stick needles in the tear duct after birth and after three years, he had to continue the treatment, because his eyes watered a lot and the tear duct did not normalize this until 6 years that he started using glasses. He was diagnosed with keratoconus eye deformation with astigmatism and very high myopia, and he must wear glasses for the entire life and, if possible, undergo surgery at age 23 for myopia that he did not have. Since then, he has always used glasses for far vision in both the left and right eyes, with the highest degree being in the left. At the age of 40 (in 2007), he felt a change in his eyes and he had to go to the ophthalmologist who diagnosed that there was no more degree for his problem, that he had nowhere else to change the lenses and that a surgical procedure would be necessary because of the keratoconus, referring him to the specialist who did all the exams and said he would have two options to put corrective lenses in surgery for the treatment of Keratoconus.

He wore ceramic (hard) contact lenses at age 25, but there was no adaptation. And nowadays, he continued to wear prescription glasses.

Intrastromal ring treatment for Keratoconus that was done (in 2019) but did not improve his vision condition.

He spent almost a year away after the surgery and after going back to the doctor he told him that this procedure (intrastromal ring treatment) still just palliative for a moment that he would need to do the cornea transplant later on.

He started acupuncture before (because he was constantly feeling fatigue symptoms and low back pain) and after the insertion of the ring in order to try to restore and improve his vision without having to undergo a corneal transplant. He still feels weakness in vision and that reflects in the whole body a tiredness, sometimes he wakes up with dry eyes, sensitive to light, photophobia and burning eyes in need of eye drops.

He was submitted to the measurement of the internal five massive organs energy using radiesthesia procedure and I will show the results of this measurement and the treatment done in the results section.

Case report three:

The third case report is C., a 39-years-old female patient with history of always had myopia problem since she was 13 years old, so much so that today (2022) her myopia degree is high. She has five degrees in both eyes and when she was 18 to 19- years-old, she went to her doctor, that was her uncle (her father's cousin) and he saw that she already had a deformation in the cornea and he sked for an exam, because that he needs to have to follow up because she always wants to do the myopia surgery to do not need to wear glasses anymore.

But the ophthalmology doctor said that he has to follow up to see if he could do the surgery on myopia. His suggestion was that she wait to get older because according to him, there comes a time when myopia stops.

When she got pregnant of her first child, she was thirty years old. Before she became pregnant (from twenty-nine to thirty), she went to the ophthalmologist again, to another doctor in Ribeirão Preto city to search for the myopia surgery. The doctor asked for the mapping exam, and found keratoconus in both eyes. He said that she cannot do myopia surgery because the keratoconus alteration led to a very thin cornea and there is no way to do the surgery because it would not work.

The doctor asked if she itched her eye a lot and how she have been using the contact lens since she was thirteen years old and she thinks the lens already gives her eye a sensitivity. So, she was really obsessed with the eye, but she thinks it was due to irritation, sometimes dust that sticks to the lens, the eye is more sensitive. So, she always scratched her eyes a lot. And the doctor said that it could even be a genetic factor.

But until then she had five degrees of myopia, she could see well so she did not feel the keratoconus problem until then.

After she got pregnant with her first child at thirty-two years-old, from thirty-one to thirty-two years old, she felt her eye already losing a little focus but she thought it was the degree of the glasses. But then, after the conception of her third child (2018), she felt a sudden worsening. In her left eye, even with the contact lens, she can already see it blurry. The lens can no longer correct the stage of keratoconus. So much so that the degree remains the same since her early twenties she has five degrees of myopia. The myopia was stagnated, and it did not advance any further. What is now degenerating was the worsening of keratoconus. During the pregnancy she felt that her vision got worse and that she lost the sharpness and the focus. Even with the lens, she cannot see properly. So, she felt this worsening in pregnancy, especially now (in 2022) after her third pregnancy, she is already having trouble seeing from a far even with the myopia corrective lens because of the left eye, the right eye is still not good.

The last time she was seen by an ophthalmology physician, he did a computerized exam and he asked her if she knew if she had keratoconus and also asked if she was in line for a corneal transplant. She said that she was not in the line for corneal transplant. She said she knew that in the future she would have to look for it. But she did not know it was a thing for now (2022). Then the ophthalmologist guided her to look for another ophthalmologist to get her to join the SUS (single health service in Brazil) for a corneal transplant.  At this moment, she feels that her left eye got worse.

On April 2022, she went to my clinic due to severe abdominal pain and she was using so many anti-inflammatory medications with no improvement of her clinical condition, only worsening day-by-day.

I measured her internal massive organs energy, measuring the energy of the chakras’ energy centers through radiesthesia procedure. The results of this measurement and the treatment instituted I will show in the results section.

Results:

The results of the measurement of the energy of the internal five internal massive organs (of all three patients reported in this article) that corresponds to the chakras’ energy centers in Ayurvedic medicine, is that all the internal five massive organs (Liver, Heart, Spleen, Lungs and Kidney) were in lowest level of energy, rated one out eight, with exception of the seventh chakra (that was normal, rated in eight).

The treatment of all of them (the three patients reported in this article) consisted in using Chinese dietary counseling, auricular acupuncture with apex ear bloodletting, systemic acupuncture and replenishing the internal energy of the five massive organs using highly diluted medications according to the theory created by myself entitled Constitutional Homeopathy of the Five Elements Based on Traditional Chinese Medicine was used to treat the patient and not the disease itself. The treatment of the energy alterations presented by the patients that was suffering from Keratoconus is the major importance to treat the cause (that comes from energy deficiency, mainly Liver Blood deficiency) in the energy level, invisible by the naked eyes.

The Chinese dietary orientations consisted in avoiding the ingestion of dairy products, sweets, Cold water and raw food (because all these foods can reduce the energy of the Spleen and pancreas energy (fifth chakra), responsible for the absorption of nutrients from the foods ingested by the patient to promote the formation of Blood, that is one of most important type of energy among the four main energies to keep our health in harmony (Yin, Yang, Qi and Blood). The deficiency of Blood energy is one of the causes of formation of rubbing in the eyes, and I will explain the physiopathology of formation of these symptoms, in the discussion section.

The second group of foods that it is important to avoid is the ingestion of soft drinks, coffee, and matte tea (because these drinks have the potential to reduce the energy of the Kidney, responsible for the formation of Yin and Yang energy, as they are very important to keep health and they compose the two important energies of the four forces of Yin, Yang, Qi and Blood). The Kidney is also important to keep health to the vision process, because it is responsible for nerve conduction and refractive system, that I will show and demonstrate in the discussion section.

The third and last group of foods to orientate them was to avoid the ingestion of fried foods, eggs, honey, coconut, chocolate, melted cheese and alcoholic beverages (because these foods can imbalance the Liver and Gallbladder energy meridian or first chakra), responsible for the cornea in the eye, and also, if the patient continue the ingestion of all these foods, could worsen the rubbing in the eyes, causing the worsening of lesion in the corneal tissue and it will be explained carefully in the discussion section.

The second step in their treatment were the use of auricular acupuncture associated with apex ear bloodletting and systemic acupuncture, always with the intention to balance the four forces of Yin, Yang, Qi and Blood. The auricular acupuncture, systemic points and the apex ear bloodletting procedure used in the treatment of all these patients will be showed in the discussion section.

The last step in the treatment was the use of highly diluted medications to replenish the energy of the five internal massive organs, mainly the Liver and Spleen energy, but as one internal organ is interconnected by the energy flow, and one organ depends on the energy of the other organ, I will explain to you the reason to treat all organs, to treat the Liver (responsible for the eyes and vision and the cornea integrity) and Spleen (responsible for the production of Blood) and the function of each internal organ influencing the health of the individual’s vision.

These medications are homeopathies created by Hahnemann (1755 - 1843) but they were used according to the theory created by myself (2020) entitled Constitutional Homeopathy of the Five Elements Based on Traditional Chinese Medicine and crystal-based medications.

The medication used to treat the lack of energy in the Liver was Phosphorus. The medication used to treat the Heart was Sulphur. The medication used in the treatment of Spleen was Calcarea carbonica and the medication to treat the Lung, I used Silicea. Finally, the medication used to treat the Kidney was Natrum muriaticum. They all will be showed in the discussion section.

The potency used in the treatment started on 30 CH and after, 200 CH. Them, it was used in 1000 CH, then 10,000 CH and latter, 50.000 CH.

Each medication could be used in a single dose of each potency taking 20 drops of medications diluting it in 20 ml of water (the first, second, third, fourth and fifth medication) used in the first, second, third, fourth and fifth day of treatment respectively, once a month.

In the second month, the potency of medication should be increased to 200 CH.

In the third month, the potency of the medication should be at 1000 CH.

In the fourth month, the medication should be used in 10.000 CH and finally, in the fifth month, the potency of medication should be at 50.000 CH. After reaching this last potency, the remedies, should be used for each six or eight weeks for the entire life and the reason for this action will be explained in the discussion section.

In the case report one, she told me that her episodes of rubbing of the eyes reduced very much with the treatment done.

In the second case report, he told me that he has been feeling good with the treatment done and he hope to have a recovery and improvement of his eyes (because till the end of this manuscript, it was not possible to do another reevaluation in the Ophthalmologist to see if the alterations in the corneal tissue improved or not).

In the third case report, I only include her case in this article to demonstrate the energy alterations in patients with history of having keratoconus and the worsening of this condition in the gestational period because all have in common, this energy alterations that were causing propensity to have disease in the corneal tissue, and I will explain better in the discussion section. In her case, the history of worsening her case during gestational period is very well explained by the energy alterations caused by the pregnancy due to excessive energy consumption to the growth of the fetus formation and affecting in this case, the vision and all tissues in the eyes, responsible for the good vision.

Discussion:
Western medicine’s focus in the treatment of patients with keratoconus is usually a localized treatment. In this case, they orientate the patients to use contact lens to reduce the alterations in the corneal surface but not all patients can benefit from this measurement because they can have alterations in the angle of the cornea that cannot receive the contact lens. The second option in the treatment is to use an intrastromal ring (that consisted an inert acrylic polymer) inside the corneal tissue performed under local anesthesia in the surgical room. The function of this ring is to make the anterior surface of the cornea smoother reducing the irregularity of corneal astigmatism. Using this kind of therapy, they thought that has less complication than transplants and has the possibility of removing this ring if has some complications. [5]

The indication to do corneal transplantation is when the curvature or the transparence of cornea is very altered compromising the normal vision. It is used in the cases of severe form of keratoconus. This measurement usually requires the replacement of the altered cornea with a donor cornea. One of the complications of this procedure is the rejection of cornea transplantation and for this reason, it is considered the last alternative for the treatment of patients with keratoconus. The rejection usually occurs in the first year of transplant but can occur in any stage of the evolution of this disease. [6]

The reasoning used to write this article was following one specific patient that I treated in 2006 and this history is described in all articles write by myself in all disease formation and I will briefly tell you his history to you to understand how was the level of treatment that I am telling in this case of treatment of patients with keratoconus formation [7]

This patient was a 70-years-old male patient with history of pain in the legs with no improvement of his condition only using anti-inflammatory medications. He went to my clinic to try another kind of treatment. As I was trained in Western medicine but also specialized in traditional Chinese medicine since 1997, I looked at his internal energy alteration instead of only treating his symptoms (pain in the legs). His diagnosis in traditional Chinese medicine (TCM) was Kidney Yang deficiency (because he feels colder in his lower limbs) and I started using Chinese dietary counseling, auricular acupuncture with apex ear bloodletting and systemic acupuncture. [7]

After 10 acupuncture sessions, he returned to be re-evaluated and told me that his leg pain improved but also, he improved from another condition that I was not aware. He told me that he was treating glaucoma for the last 40 years with no improvement only using eye-drops and for the first time of his life, his intra-ocular pressure reduced from 40 to 17 mmHg. [7]

This result in this patient became the cornerstone of all my treatments nowadays, demonstrating the importance to treat the energy imbalances (in the root of the tree) and not just the symptoms, in the leaf of the tree. The metaphor of the tree is demonstrated in the Figure 1, showing the different viewpoints between Western and traditional Chinese medicine. [7, 8]

Figure 1: The tree metaphor showing the different viewpoints between Western and traditional Chinese medicine.

This tree is symbolizing the human body. This tree has a trunk with several branches and coming out of each branch, you can see many leaves. Each branch means one medical specialty (for example, ophthalmology, endocrinology, gastroenterology, etc..) and each leave represents one symptom treated by each medical specialty. [7, 8]

In this tree, you can see that the tree had two different parts, the part above the earth and the part below the earth. The part above the earth is the part that Western medicine can see and is treating nowadays, in the leaf level. But according to the Chinese medicine’s reasoning, all clinical manifestations of disease formation (represented in the leaf level) is not in the leaf but it is in the root of the tree, also showed in the Figure 1. The cause of energy imbalances in the root can be from two different pathways. The first cause are the emotions and according to TCM, all disease has one emotion in the background that is starting the energy imbalances, leading to the disease formation in the energy level. The second reason to imbalance the root is the wrong eating habits, and for this reason, the first step in all kinds of disease treatment, I usually perform the Chinese dietary counseling, orientating what each patient needs to ingest or not ingest, depending on the type of energy alterations presented by each patient (if it has Yin or Yang or Qi or Blood or a combination of these four forces energy imbalances), as you can see how to evaluate the energy imbalances of each patient doing some questions, demonstrated in the Table 1. [8-10] 

Question	Does the patient have a daily bowel movement?	Does the patient have excessive sweating during day?	Does the patient feel cold in the extremities of the body? (Cold feet or hands)	Does the patient feel hot in the extremities?	Does the patient has dry mouth, bleeding gums, bad breath, acne and / or redness in the skin, abdominal pain, micro hematuria, or itching?
Meaning	The lack of daily bowel movements can mean Blood deficiency. *	This could be a symptom of Qi deficiency.	Commonly, this is a sign of Yang deficiency.	Commonly a sign of Yin deficiency.	Commonly this is a sign of Heat retention.

Table 1: Questions that I usually perform in all my patients to evaluate the energy situation.

In the root of the tree, there are two theories in TCM, that are Yin and Yang theory and the Five Elements Theory, as you can see in the Figure 2, 3 and 4. [8, 9]

Figure 2: Yin and Yang symbol.

Yin and Yang are two energy forces that exists in our universe in all the things, including the human body. For example, we can see these energies of Yin and Yang showing the differences in man and women, day and night, summer and winter, sun and moon, etc. [7]

Figure 3: Yin and Yang in the same height in the left and the different alterations between them evolving to disease formation.

To Yin and Yang flow inside the body, there is the necessity of having two more forces that are Qi and Blood and their interconnection and relationship is crucial for the health of the patient and for the whole system to work properly, as you can see in the Figure 4. [9, 10]

Figure 4: Yin, Yang, Qi and Blood.

The deficiency in one or a combination of energy deficiencies between them can induce the formation of internal Fire, as you can see in the Figure 5. In all cases reported in this article, they have alterations in the formation of these four energies, because the internal organs that are responsible for the production of these energies were very compromised, showed through the radiesthesia procedure and the rubbing symptoms presented in all these patients were caused by the formation of the internal Fire, generated by the energy deficiency of all these energies. [8]

Figure 5: Yin, Yang, Qi and blood and formation of internal Fire.

The different energy imbalances between Yin and Yang can lead to diverse clinical manifestations in the leaf level of the tree. For example, Yin deficiency and formation of internal Heat can lead to diabetes formation in the leaf level and also, can cause other disease such as women in menopause, feeling hot flashes and irritability. [ 10, 12]

In the other hand, we can have different energy imbalances leading to the formation of the same symptom in the leaf level, as I am demonstrating in the article I wrote (2021) entitled Energy Alterations and Chakras’ Energy Deficiencies and Propensity to SARS-CoV-2 Infection. Patients with the same diagnosis in Western medicine can come from different energy imbalances in the root of the tree, so the same diagnosis in Western medicine cannot demonstrate that these patients belong to the same group because they can come from different energy imbalances. [12]

Another situation is that the patient can have different disease but can be caused by the same energy imbalances in the root of the tree. [13]

Figure 6: Five Elements Theory.

The second most important theory in TCM is the five elements theory. The five elements are composed by Wood, Fire, Earth, Metal and Water and all the things in this universe can be represented by these five elements. In the human body, they represent the five internal massive organs, such as Liver, Heart, Spleen, Lungs and Kidney respectively, as you can see in the Figure 6. Each internal massive organ is responsible for the formation of internal energy, important to keep our health in harmony and the disequilibrium between the production of these energies are responsible for the formation of diverse disease, in the leaf level of the tree, showed in the Figure 1. Each internal massive organ are responsible for the formation of one eye structure (cornea, conjunctiva, retina, stroma, lens, etc..) as explained in the five wheels of traditional Chinese medicine. [8, 10]

For example, according to the article written by Dong Lai1 et al. (2020) entitled Broad extension of the Five-wheel theory, they are describing the relationship between each component of the eyes and correlation to each internal massive organ or Zang-Fu in traditional Chinese medicine. [14]

In this article, they are saying that the Spleen (fifth chakra) is responsible for controlling all muscle outside and inside the eyes. Also, it is responsible for the secretion of glands. [14]

The Liver (first chakra) is responsible for all soft tissue represented by the suspensory ligaments of the lens, sclera, cornea, retina and uvea (except the blood vessels components). [14]

The Heart is responsible for controlling the Blood vessels inside and outside the eyes (represented by middle retinal artery). [14]

The Kidney is responsible for the water and visual pathway represented by aqueous humor and tears and including the nerve conduction and refractive system. [14]

The Lung is responsible for the coordination of the visual pathway and refractive system. [14]

Figure 7: Chakras’ energy centers and their correspondence to the internal five massive organs in traditional Chinese medicine and the energy that each organ is responsible for production.

I am explaining briefly the theory in traditional Chinese medicine to you to understand that the manifestation of keratoconus has an energy cause in the back ground and what I found in all patients with this type of diagnosis was that all have history of rubbing in the eyes, that is leading in the future for the formation of this alteration in the cornea. Also, they all have deficiency in the energy of the first chakra, that corresponds to the Liver, responsible for the corneal tissue in the eyes and for this reason, they could be having alteration in the corneal and having more propensity to have Keratoconus. You can see that not only the lack of energy is leading to this problem but the lack of energy of the other internal massive organs are causing such it because the Liver depends on the energy of Kidney. And the Kidney depends on the energy of the Lungs. The Lungs depends on the energy of the Spleen that also depends on the energy of the Heart. All this information you can see in the Figure 6, of the Generation cycle of the Five Elements theory. [7, 8, 15]

To understand the meaning of Keratoconus and rubbing in the eyes, in the energy point of view, we need to understand that all clinical manifestation in the leaf (in this case keratoconus and rubbing inside the eyes) is not in the eye but the real problem is on the root of the tree, that are usually not visible by the naked eye. As I said in the article wrote by myself (2020) entitled Constitutional Homeopathy of the Five elements Based on Traditional Chinese Medicine, all disease formation came from the energy imbalances of the Five Elements theory and also, considering the external pathogenic factors.  [10, 16]

All internal massive organs in traditional Chinese medicine have internal energy of Yin, Yang, Qi and Blood and the lack of energy or a combination of reduced energy in all these organs can induce the formation of internal Fire or Heat inside the body, as I am showing these energy alterations in many articles wrote by myself such as in the article entitled Can We Treat Atopic Dermatitis Without Using Corticosteroids? also showed in the Figure 5. [16]

In all these articles, there are the same energy imbalances in the root of the tree leading to different clinical manifestation in the leaf level. [16]

In the case of patients with rubbing in the eye, the problem could be related to the Liver energy (with reduced Blood inside the Liver that is responsible for the storage of blood inside the human body). [16]

When the energy inside the Liver is reduced, there is a formation of internal Fire that can induce the formation of internal Wind, responsible for the rubbing symptoms in the eyes (leaf level), because the organ that the Liver (root level) is commanding is the eyes and the cornea, as you can see in the Table 2. [13]

Table 2: Five elements and the internal five massive organs and the correspondence of these organs.

To balance the internal organs energy, I usually use in the first step, the alterations in the food eating habits. These orientations are following Chinese dietary counseling that is studying the energy of each food to treat the energy imbalances presented by each patient. This type of orientation is different from Western nutrition perspectives where they usually orientate the patient according to the balance between the ingestion of carbs, protein, lipids, vitamins, etc. [9]

The second step in my treatment aims to balance the internal energy of production of Yin, Yang, Qi and Blood using auricular acupuncture associating with apex ear bloodletting, as you can see in the Figure 8 and 9. [9, 16]

Figure 8: Auricular acupuncture points used in the treatment of patients with keratoconus.

Figure 9: Apex ear bloodletting.

The ear is considered a microsystem in traditional Chinese medicine and there are some other studies such as the point of view by auricular acupuncture of French physician such as the Paul Nogier. [17]

According to the book Ophthalmology in Chinese Medicine, written by Wei Qi-Ping et al. (2011), acupuncture is the best procedure to treat all kinds of ophthalmology disease because the eyes is concentrating all energy from all over the body. [18]

The last step used by myself to treat the patients with keratoconus is to replenish the energy of the internal five massive organs using highly diluted medications such as homeopathies according to the theory created by myself ( 2020)  when I began to study homeopathy in Brazil in 2015. This theory is entitled Constitutional Homeopathy of the Five Elements Based on Traditional Chinese Medicine. [10]

When I began homeopathy course, I realize that this type of medication is the medication of choice to treat the new type of population that we are having nowadays, because the energy of the majority of people nowadays, are very weak, as I am demonstrating in Table 3 and in the article wrote by myself entitled Energy Alterations and Chakras’ Energy Deficiencies and Propensity to SARS-CoV-2 Infection. [12]

Ages Chakras	2-19	20-59	60-79
7	8	8	8
6	1	1	1
5	1	1	1
4	1	1	1
3	1	1	1
2	1	1	1
1	1	1	1
Total of Patients	26	170	86
Main Western diagnoses	Anxiety	Anxiety	Anxiety
	Depression	Headache	Knee pain
Main Oriental Diagnoses	Yin/Yang	Yin	Yin
	Yin/Blood	Yin/Yang	Yin/Internal Heat
			Yin/Yang/Internal Heat

Table 3: Research in my clinic in Brazil, showing that 90% of my patients do not have any energy inside the Five internal massive organs.

The energy alterations are usually caused by the influence of the modernization of the telecommunication and implementation of the 5G technology, causing the reduction in all these energies found in our patients nowadays. [12]

The medications used in the treatment of the majority of my patients nowadays are remedies to treat the energy deficiency inside the five internal massive organs and the treatment to replenish the energy of the five internal massive organs needs to be done for the whole life because the influences of this electromagnetic radiation in our life should be continuous for the rest of our life, as I am showing the in the article What Is Behind All the Pulmonary Thromboembolism That We Need to Know?” [19]

These findings are not studied by the majority of physicians because of the implementation of Flexner report in 1910, changing the medical curriculum and saying that they will only consider “scientific” what they could proof by laboratorial or radiological exams. [20]

For this reason, we can say that all the diagnosis in Western medicine is delayed because before having alteration in the laboratory exams, there are alterations in the energy level that is occurring 5 or 10 years before the onset of alterations in the laboratory exams, as you can see in the Table 4. [8, 21]

Progression from Health to Disease
	Organ	Exams	Energy Reserve	Symptoms
Phase 1	Slowing down of organ functions	Normal	Energy Reserves-normal	Without clinical symptoms
Phase 2	Slowing down of organ functions	Normal	Consumption of internal Energy Reserves	With symptoms in other organ
Phase 3	Slowing down of organ functions	Normal	Consumption of external Energy Reserves	With symptoms in same organ
Phase 4	Reversible cellular lesion	Little alternation	Consumption of blood Reserves	Curable disease
Phase 5	Irreversible cellular lesion	Excessive alteration	Metabolic exhaustion	Incurable disease

Table 4: Evolution from health to disease.

According to the renewed physics Albert Einstein (1879 - 1955), all the things that exists in our universe is composed by energy. [8]

And according to some studies found in the Western medicine’s literature, the formation of keratoconus can be formed after alterations caused by chronic itchiness in the eyes and leading to the deformation in the cornea surface. [22]

I do not know if the treatment after evolving to keratoconus formation can reduce or normalize the deformities because all cases reported in this article, they are not doing the treatment anymore because of the COVID-19 pandemic and also, due to irregular intake of the medications recommended in this article to show the improvement or not of this condition after treatment. [12]

The use of surgical procedure in the case 2 was not successful because they are not treating the energy alterations that was in the back ground of the patient and for this reason, it is important to integrate the teaching of two kinds of medicine to understand in the deepest level what could be happening in all these patients that are having keratoconus formation, as I am demonstrating in the Figure 10 of Yin and Yang metaphor of traditional Chinese medicine and Western medicine. They are opposites but complementary, when one ends the other begin. [7, 12]

Figure 10: Yin and Yang metaphor of traditional Chinese medicine and Western medicines’ symbol.

In all possibilities of correlations between the formation of keratoconus and other disease such with atopic disease. In the article that I wrote (2019) Can We Treat Atopic Dermatitis Without Using Corticosteroids? I am explaining in this article, that patients that are having atopic dermatitis symptoms have in common, energy deficiency inside the five internal massive organs ( liver, Heart, Spleen, Lungs and Kidney) that are causing the formation of internal “ Fire” and causing itchiness in the skin and the treatment rebalancing and replenishing the energy of these organs is of paramount importance to treat the cause of the formation of the disease and not only treating the symptoms ( that is the allergy itself). [16]

If you analyze the symptoms presented by each patient reported in these three case reports, they all have in common, symptoms that are demonstrating the energy deficiencies in the five internal massive organs, that are not producing the energy necessary to keep our health in harmony. [10]

For example, in the case one, the patient went to my clinic to treat obesity and I am showing in the article I wrote (2021) entitled Energy Alterations in Obese Patients that all patients with obesity have energy deficiency inside the five internal massive organs (that is the same energy imbalances leading to the Keratoconus formation in the energy level). [23]

In the case report two, he is complaining the symptoms of “dry eyes and burning sensation in the eyes”. All these symptoms are related to energy deficiencies and formation of internal Fire, causing the consumption of internal water and causing the symptoms of “dry eyes” and the burning sensations are also caused by the internal “Fire” and leading to this “burning” sensation in the eyes. These alterations is very well explained in the article I wrote (2020) entitled Chakras’ Energy Deficiencies as One of the Causes of Sjögren’s Syndrome. [24]

When some article are saying about the “ genetic factors” involving the formation of Keratoconus formation, we cannot dismiss that energy deficiencies can also transmit from generations and for this reason, not all patients that has energy imbalances and deficiencies, can transmit this energy alterations to he next generation and for this reason, there is the necessity of treating the couples ( replenishing them with homeopathic medications according to the theory Constitutional Homeopathy of the Five Elements Based on traditional Chinese Medicine) before they get pregnant because they can have less chance to have sons and daughter with keratoconus (reducing the chance to have rubbing in the eyes and causing deformities in the corneal tissue of the eyes). [10]

In the case report three, the patient complained that the symptoms in the eyes worsened after the third child (lack of focus) or after the gestational period. This can be explained by the high energy consumption during this period (mainly energy of Kidney and Blood) and causing reduced the vital energy of the internal massive organs, causing in this case, the worsening of vision symptoms because the eyes and corneal tissue is commanded by the Liver (first chakra) that was proofed very low when I measured her internal massive organs energy using the radiesthesia procedure. As I showed in the five wheels theory, the focus is a function governed by the Kidney, responsible for the refractive system in the eyes function. [14]

The treatment of all patients that has energy deficiency inside the five internal massive organs could be one of the preventive measurements that we could do in all patients nowadays, to prevent the formation of all chronic infectious and non-infectious diseases such as I am demonstrating in the article entitled Why is Homeopathy the Medication of Choice in the Treatment of All Kinds of Diseases Nowadays? and also, in the article Constitutional Homeopathy of the Five Elements Based on Traditional Chinese Medicine. In this last article, I am saying that the treatment of the five elements could treat all disease at the same time, even the doctor does not know that the patient has such symptoms. [10, 25]

Using this kind of therapy, the patient can prevent the formation of all kinds of disease because all disease is formed by the imbalances in the internal energy, in this case that we are facing nowadays, due to the influences of the electromagnetic radiation in our lives, reducing drastically our internal energy of the five internal massive organs, that are responsible for the normal functioning of all external sensorial organs, as I am showing in the Table 2. [25]

To understand in the deepest level what is occurring in patients with keratoconus, we need to understand what is happening in the energy level, as I am showing in the article Constitutional Homeopathy of the Five Elements based on Traditional Chinese Medicine. The translation of the meaning of each symptom presented by the patient in the root of the tree, is the major importance to understand what could be the prevention and treatment of this disease, as it is not known until today, the mechanism and physiopathology of the formation of keratoconus. [10]

To finalize this article, I would like to say that all tools used in this article to treat the energy disharmony of the patients reported in this article such as homeopathy and acupuncture are both considered medical specialties by the Brazilian Federal Medical Council since 1980 and 1995. [26]

Conclusion:
The conclusion of this study is that patients with keratoconus has in the background energy deficiencies inside the five internal massive organs (Liver, Heart, Spleen, Lungs and Kidney), mainly in the Liver, that is responsible for the eyes and corneal tissue. The treatment rebalancing and replenishing the internal energy of all these organs, using ancient medical tools such as Chinese dietary counseling, auricular acupuncture with apex ear bloodletting and replenishing them using highly diluted medications such as homeopathies remedies according to the theory Constitutional Homeopathy of the Five Elements Based on Traditional Chinese Medicine is the major importance nowadays to treat the cause of disease formation and not just the symptoms, as I am showing in this article. All these findings in this article are only the initial step to do more studies in this field to see if the treatment including the energy alterations in the “root” of the tree can benefit the patients with keratoconus formation reducing or stopping the alterations inside the corneal surface that is causing all alterations in the vision of these patients.