1. What were the main characteristics of this case in relation to the disease name and its clinical manifestation? How should this case be differentiated from punctate keratitis and purulent keratitis?

2. In this case, how did the bloody vessels form and what details warrant attention with regard to the herbal prescription?

3. During the follow-up consultations, what clinical manifestations were indicative of the patterns of yin deficiency and fire excess? What details warrant attention when applying the yin-nourishing treatment?

1. The name of this disease is based on the presentations of a grayish-white nebula in the deep layer of the cornea, which is moist, glassy, cloudy and unclear. The surface of the cornea was smooth and unbroken with a negative corneal fluorescein staining test. The major difference between this disease and punctate keratitis, keratomalacia and purulent keratitis is that they are named for the shape of the nebula in the cornea, which has a broken surface and a positive corneal fluorescein staining test.

2. The main characteristics of this disease were the appearance of blood vessels entering the cornea at the junction of the cornea and the sclera. According to TCM theory, broken vessels are due to stagnation of toxic heat in the liver and lung channels, and qi and blood stasis. The foundational treatment principle is to clear the liver, while also focusing on clearing heat and sedating the lungs by using huáng qín (Radix Scutellariae) and sāng bái pī (Cortex Mori). Secondly, chì sháo (Radix Paeoniae Rubra) and yù jīn (Radix Curcumae) were used to move blood, cool blood and eliminate redness.

3. In this case, the patient’s symptoms of dry and stinging pain in the eye, photophobia and tearing were reduced. However, the dry eyes with dull pain, dry mouth and throat, red tongue with a reduced coating and a thin, rapid pulse remained, indicating the patterns of yin deficiency and fire excess. When applying the treatment principle, attention should be paid to nourishing the yin as the root treatment and sedating ministerial fire as a supportive treatment. Medicinals such as mài dōng (Radix Ophiopogonis) and shā shēn (Radix Adenophorae seu Glehniae), which enter the lung and nourish yin, should be added to support the yin-nourishing methods, as toxic heat injures not only liver and kidney yin but also lung yin.