In TCM, hordeolum is discussed under the category of eyelid diseases. According to the English-Chinese Encyclopedia of Practical Traditional Chinese Medicine:Ophthalmology ¹, eyelid diseases are called yăn bì (eyelid block). The specific term for hordeolum is mài lì zhŏng (wheat grain swelling).

Hordeola and all eyelid diseases have a close exterior/interior relationship. The eyelids correspond to the spleen and stomach. They are especially vulnerable to external pathogenic factors. The condition is usually caused by qi and blood stagnation in the eyelids that combines with external wind-heat. Alternately, toxic fire affects the yangming channels of the eyes leading to hordeola. This is usually a consequence of over consumption of spicy or greasy foods, alcohol and overeating in general. Underlying spleen qi deficiency is also a significant causative factor in the disease progression of the case history presented here.

A stye or hordeolum is commonly thought of as a localized fire-toxin. In this case history, the stye was slow to suppurate and resolve, and was recurrent in nature. These factors, combined with the patient’s poor appetite, frequent colds and overall physical presentation lead to the diagnosis of qi deficiency. Spleen and stomach qi deficiency leads to wei qi deficiency. This, in turn, leads to the retention of latent pathogens as the body is not robust enough to expel pathogenic factors.

The physician’s treatment strategy was stratified to expel first the pathogenic factor, and subsequently treat the root deficiency. In fact, the selected formula treats both the root and branch simultaneously.

Huáng qí, dry-fried bái zhú, chén pí and gān căo are used together in Bŭ Zhōng YìQì Tāng (Center-Supplementing and Qi-Boosting Decoction). It is apparent that the physician is focused on strengthening the spleen and raising yang. A noteworthy action of huáng qí in relation to this case is that it also expels pus making it an excellent choice for this and all cases of infection with underlying qi defciency.

Bái zhú, fú líng, yì yĭ rén and jié gĕng are components of the formula Shēn LíngBái Zhú Săn (Ginseng, Poria and Atractylodes Macrocephalae Powder), which treats spleen and lung qi deficiency. We usually select this formula when there are loose stools from spleen qi defciency. In this case, yì yĭ rén has a dual role for both its spleen strengthening function, as well as its ability to resolve abscesses. Lián qiào and jīn yínhuā also serve two functions. They are key ingredients for clearing heat in the wei level and resolve fre-toxins making them an ideal combination for treating hordeolum.

Jīn yín huā and pú gōng yīng are used together in Wŭ Wèi Xiāo Dú Yĭn (Five Ingredients Toxin-Removing Beverage). Both medicinals clear toxic fire and reduce nodulation.

Lái fú zĭ pairs with chén pí to regulate the qi and resolve food stagnation. Chì sháo, zào jiăo cì, chén pí are used together in the formula Xiān Fāng Huó Mìng Yĭn (Immortal Formula Life-Giving Beverage). This formula clears toxic fre, reduces fever, cools and moves the blood, and reduces early-stage sores and carbuncles illustrating why this group is used to treat hordeola.

Thus, we see how a physician can employ key medicinal relationships from various formulas to craf a harmonious treatment strategy.

At the follow-up visit, the acute symptoms had resolved, but the patient still had defcient spleen qi and wei-defensive qi. The physician was primarily concerned with supplementation. Shēn Líng Bái Zhú Săn was modified in the following ways: The patient’s tongue was still tender red and the pulse was still thready and rapid, thus tài zĭ shēn was used, which is cooler and more moistening than dăng shēn (Radix Codonopsis) or rén shēn (Radix et Rhizoma Ginseng); by adding fēng fáng (Radix Saposhnikoviae) in concert with bái zhú, a modifcation of the formula Yù Píng FēngSăn (Jade Wind-Barrier Powder) is created, stabilizing the exterior, stopping sweating and supplementing the qi. Lián qiào and chì sháo remain from the frst formula to clear heat, reduce nodulation and move blood.