Male, age 9. Initial Visit: September 15 ^th, 2008

Chief Complaint: Redness, swelling and tenderness of the upper right eyelid for five days.

History: Approximately one year prior to treatment, the patient frequently experienced redness, swelling and pain in his right eye. During this time, the patient received three drainage surgeries after which the localized redness and swelling would gradually reduce. Several hospitals diagnosed him with an external hordeolum of the right eye. The symptoms recurred five days prior to the frst visit.

Signs and Symptoms: Localized redness and swelling close to the margin of the upper right eyelid with palpable induration and tenderness with no pus formation. The patient was a picky eater with a poor appetite, dry mouth, pale complexion, hard stools and frequent colds. The tongue body was tender with a thin sticky yellowish coating; his pulse was thin and rapid.

Past History: Frequent upper respiratory infections.

The patient’s poor eating habits are associated with spleen-stomach defciency, as well as weakened wei-defense. The poor appetite, hard stools, dry mouth, thin sticky yellowish tongue coating and thin rapid pulses are all signs of food stagnation in the spleen-stomach transforming into heat. The pale face and frequent colds are both signs of spleen-stomach defciency and weakened wei-defense.

Lingering pathogens and unresolved heat ascended to attack the eyelid leading to frequent recurrence of the hordeolum. Due to an inability of the wei defensive qi to ward of external pathogens, the condition remained persistent, although the redness and swelling were not severe.

The location of the disease is the eyelid. According to traditional Chinese eye anatomy the eyelid belongs to the “muscle wheel”, which is associated with the spleen, thus confrming the diagnosis.

This is a case of spleen defciency with excessive signs and symptoms. The root symptoms are defcient with branch excess at the surface.

WM diagnosis: Hordeolum

TCM diagnosis: Needle eye due to spleen defciency with qi stagnation and weidefense weakness

The clinical manifestations of this case showed a root deficiency with excessive symptoms manifesting at the surface, along with unresolved pathogenic heat ascending to atack the eyelid. According to the treatment principle of frst treating the branch in acute-stage cases, treatment should start by addressing the unresolved pathogenic heat. Afer the heat is resolved, treatment should then focus on correcting the root defciency.

Principles: Strengthen the spleen to supplement qi and promote the discharge of pus

Formula: Modified Tuō Lĭ Xiāo Dú Săn (Interior-Drawing and Toxin-Removing Powder)

[托里消毒散]

[Formula Analysis]

Huáng qí supplements yang qi of the spleen and stomach to ascend and disperse pathogenic factors. It is combined with bái zhú, fú líng, yì yĭ rén and gān căo to supplement qi and strengthen the spleen.

Chén pí regulates qi, clears obstruction and relieves qi stagnation.

Lái fú zĭ regulates qi to resolve food stagnation.

Jié gĕng circulates the lung qi, opening and regulating the waterways. While nourishing Earth and generating Metal, it guides the effects of the other medicinals upward.

Chì sháo cools the blood and dissipates redness.

Lián qiào, jīn yín huā and pú gōng yīng clear heat and toxic fire to treat the superficial excessive manifestations, while also draining accumulated heat.

Eye drops: 0.5% bear bile eye drops or antibiotic eye drops, 4-6 times per day.

Warm compresses: To invigorate the blood and help dissipate infammation.

Main points: yìn táng (EX-HN3), BL 1 ( jīng míng), BL 2 ( cuán zhú), SP 10 ( xuè hăi), LV 3 ( tài chōng)

Supplementary points: GB 20 ( fēng chí), LI 4 ( hé gŭ), SJ 23 ( sī zhú kōng)

Method: Select two main points and 2-3 supplementary points for daily treatment, using alternate points every other day. Afer obtaining the needling sensation, retain all needles for 20 min. 10 sessions constitute one course of treatment.

Techniques: During recurrences with aggravated redness and swelling, needle with drainage; supplementation and even methods should be applied between onsets.

After five days of treatment, the redness and swelling at the lid margins were almost resolved, and the area was less tender although the induration remained. The patient’s appetite and dry mouth improved. The constipation was completely resolved. The tongue body appeared with a thin white coating. The pulse was thin and rapid.

The reduced redness and swelling showed that the excess branch manifestations had improved. The root pattern of spleen-stomach deficiency and wei-defense weakness remained.

Principles: Strengthen the spleen, supplement qi, support the upright qi and eliminate pathogens

Formula: Modified Shēn Líng Bái Zhú Săn (Ginseng, Poria and Atractylodes Macrocephalae Powder)

[参苓白术散加减]

[Formula Analysis]

Tài zĭ shēn, fú líng and dry-fried bái zhú supplement qi and strengthen the spleen. Combined with fáng fēng, tài zĭ shēn and bái zhú, they supplement qi and consolidate the surface.

Yì yĭ rén, biăn dòu and chén pí support bái zhú and fú líng to strengthen the spleen, harmonize the stomach and regulate qi to resolve dampness.

Jié gĕng circulates lung qi and benefits qi, opens and regulates water passages, directs the other medicinals upwards and nourishes Earth to generate Metal.

Chì sháo and lián qiào invigorate blood, clear heat and resolve stagnation to eliminate lingering pathogens.

Zhì gān căo supplements the spleen and stomach and harmonizes the other medicinals.