Male, age 51. Initial Visit: March 12 ^th, 2007

Chief Complaint: Stinging pain in the right eye with decreased vision acuity for 6 days prior to treatment.

History: 6 days prior to treatment, a small object became lodged in the patients right eye. The object was removed at the hospital. Subsequently, the patient experiences stinging pain and decreased visual acuity. Due to a heavy workload, he was unable to go to the hospital for treatment. Tearing and photophobia appeared, causing increased aggravation to the eye as well as eye pain radiating to the same side of the head with an inability to open the eye due to continual hot tearing. Due to the severe pain, the patient sought treatment from his company’s clinic and was given intravenous administration of Yán Hú Níng (Potassium Sodium Dehydroandroan Drographolide Succinate for Injection). The symptoms, however, did not signifcantly improve afer 3 days of treatment.

Signs and Symptoms: Headache and eye pain, photophobia, an inability to open the eye, continual hot tearing, and blurred vision. Other symptoms included a slightly red swollen eyelid, turbid hyperemia of the conjunctiva, a nebula in the cornea with a sunken center with elevated sides, and a contracted pupil. Accompanying symptoms included a dry and biter taste in the mouth, yellow urine, a red tongue with a thin yellow coating, and a rapid and slightly foating pulse.

Past History: A history of smoking and alcohol consumption. 7 year history of superfcial gastritis.

Ophthalmologic Examination: Examination showed right eye visual acuity at 0.6 and lef eye at 1.5. A slightly red swollen eyelid, turbid hyperemia of the conjunctiva, and ulceration of the outer canthus of the cornea with a sunken centre and elevated sides were confrmed. A fuorescein staining test revealed strong positive results, with clear aqueous humor and a contracted pupil. A light reflection test showed normal results.

This condition began with an injury to the cornea. The cornea is associated with the liver, which represents the wind wheel of the Five Wheels. In this case, external wind heat toxin invaded the lung-defensive layer, and then progressed internally along the liver channel. Intense lung-liver fre burned the cornea resulting in a nebula. The remaining heat congestion transformed the fluid into phlegm and then caused phlegm heat stasis. Blood stagnation became rotten and formed pus, leading to a white nebula with a sunken center. The nebula presenting in the cornea blocked the passage of light, hence the blurred vision. The upward atack of toxic heat resulted in the headache and eye pain; and stagnant blood fow in the eye collaterals lead to the turbid hyperemia of the conjunctiva; the rising of fre heat lead to photophobia, the inability to open the eye and constant hot tearing; congestion of internal fre heat gave rise to the dryness and biter taste in the mouth and yellow urine. The red tongue with a thin yellow coating and the rapid and slightly foating pulse were signs of wind heat invading internally, indicating a dual exterior and interior condition.

The location of this condition was in the cornea. It belonged to an excessive patern of heat accumulation in the liver and lung.

WM diagnosis: Corneal ulcer (right eye)

TCM diagnosis: Petaloid nebula with a sunken center due to heat accumulation in the liver and lung

The cause of this case was injury to the cornea. Toxic wind heat evil invaded internally via the lung defense transformed into fire causing accumulation of heat in the lung and liver. Fire heat evil ascended and subsequently burned the cornea. This resulted in the nebula, turbid hyperemia of the conjunctiva, and the contracted pupil. Wind heat evil invaded inwards without the initial resolution of surface heat, so the treatment should focus on clearing the liver and draining the lung, combining medicinals to eliminate wind and abate nebula, accompanied with some medicinals to dispel wind and abate screens along with local application of antibiotics and mydriatic drops.

Principles: Clear the liver, drain the lung, dispel wind and abate nebula.

Formula: Modifed Jiā Wèi Xiū Gān Săn (Supplemented Liver-Repairing Powder)

[加味修肝散加减]

[Formula Analysis]

Zhī zĭ, căo jué míng, huáng qín and sāng bái pí clear and drain the heat in the liver and lung.

Lián qiào and dàn zhú yè clear heat, resolve toxin, and outthrust evil outward.

Chì sháo clears and invigorates the blood and abates redness.

Chē qián zĭ clears heat, promotes urination and guides heat downward.

Mù zéi căo and bò he dispel wind, clear heat and abate nebula.

Eye steaming treatment and hot-wet compress: Decoct jīn yín huā (Flos Lonicerae Japonicae) 15g, pú gōng yīng (Herba Taraxaci) 15g, huáng lián (Rhizoma Coptidis) 10g, xìng rén (Semen Armeniacae Amarum) 10g and jīng jiè (Herba Schizonepetae) 10g, and strain the dregs to steam the eyes and apply a hot-wet compress, once a day.

After 25 days of treatment, the symptoms of stinging pain in the right eye, photophobia and tearing decreased dramatically. Visual acuity also increased markedly. At this stage the presenting complaints were dryness in the eye, a slight biter taste in the mouth and slightly yellow urine. The tongue was red with yellow coating, and the pulse was slightly rapid. Eye examination showed visual acuity in the right eye as 1.0, slight ciliary hyperemia, nebula in the cornea with a smooth surface and a negative result in fuorescein staining test.

As a result of the treatment, the turbidity in the cornea was eliminated, leaving a thin nebula remaining, which is indicative of lingering heat and yin damage. The treatment should now focus on clearing the lingering heat and eliminating the nebula.

Principles: Clear heat, enrich yin, abate the nebula and brighten the eye.

Formula: Zī Yīn Tuì Yì Tāng (Yin-Enriching Nebula-Abating Decoction)

[滋阴退翳汤]

[Formula Analysis]

Dān pí, zhī zĭ, xuán shēn, huáng jīng and zhī mŭ clear lingering heat in the liver and lung, nourish yin, and moisten dryness.

Căo jué míng, qīng xiāng zĭ, mì méng huā and chán tuì enter liver channel, clear heat, eliminate nebula and brighten the eyes.

The overall formula simultaneously is focused on clearing heat, nourishing yin, eliminating nebula and brightening the eyes.