The following cases present variations of this condition. After familiarizing yourself with the possible common paterns in presentation and appropriate formulas for treatment, use the following exercises to test your overall understanding of the condition.

1. Male, 28 years old, presented with redness, swelling and pain of the upper right margin of the eyelid for 3 days. In one day, the condition worsened signifcantly. The local skin color became dark red with a discharge of pus. The patient also complained of headache, fever and hypersomnia. The tongue was scarlet in color with a dry yellowish coating. The pulse was fooding.

Select the best treatment strategy:

A. Clear heat, generate fuids, purge accumulation and reduce swelling

B. Dispel wind and clear heat, drain fre and clear toxins

C. Drain fre and clear toxins, purge accumulation and reduce swelling

D. Strengthen the spleen and supplement qi, promote the discharge of pus

E. Nourish yin and clear heat, promote the discharge of pus

2. Female, 22 years old, presented with slight redness and swelling of the margin of the upper left eyelid lasting for one day, alternating between itchy and painful sensations. There was localized induration that was aggravated by touch. The tongue had a red tip and thin yellowish coating. The pulse was foating and rapid.

Select the formula that best matches the patient’s presentation:

A. Modifed Yín Qiào Săn (Lonicera and Forsythia Powder)

B. Modifed Má Huáng Tāng (Ephedra Decoction)

C. Modifed Sāng Jú Yĭn (Mulberry Leaf and Chrysanthemum Beverage)

D . Èr Chén Tāng (Two Matured Substances Decoction)

E. Modifed Chú Shī Tāng (Dampness-Eliminating Decoction)

3. A patient presented with recurrent hordeola with limited redness and swelling of the right eyelid close to the lid margin. There was a small induration, a yellowish complexion and fatigue. The tongue was pale with a white and slightly sticky coating. The pulse was thin and rapid.

Select the best treatment formula and modifcations:

A . Yín Qiào Săn (Lonicera and Forsythia Powder) plus huáng qín (Radix Scutellariae) and pú gōng yīng (Herba Taraxaci)

B . Xiè Huáng Săn (Yellow-Draining Powder) plus Táo Huā Tāng (Peach Blossom Decoction)

C . Liù Wèi Dì Huáng Wán (Six-Ingredient Rehmannia Pill) plus shí gāo (Gypsum Fibrosum) and zhī mŭ (Rhizoma Anemarrhenae)

D . Liù Jūn Zĭ Tāng (Six Gentlemen Decoction) plus pú gōng yīng (Herba Taraxaci) and zào jiăo (Spina Gleditsiae)

E . Mài Wèi Dì Huáng Wán (Ophiopogon, Schisandra, and Rehmannia Pill) plus púgōng yīng (Herba Taraxaci) and lián qiào (Fructus Forsythiae)

1. C

2. A

3. D

The frst case scenario’s patient exhibits clear signs of toxic fre. His symptoms are acute and hot in nature. The treatment principle in this case is to clear toxic fre, as the patient’s eye is red and swollen, he is feverish, his tongue is scarlet with a yellowish dry coating and his pulse was fooding. A secondary treatment principle was to purge accumulation, meaning to open and drain the abscess.

The patient in the second case scenario presents with only slight redness. One distinct feature is that her eyelid alternates between itchy and painful. The tongue is less red than in the first case and the tongue coating is not as dry. Although the physician does not diagnose the case, the diagnosis is implied by his selection of Modifed Yín Qiào Săn (Lonicera and Forsythia Powder). The selection of this formula suggests a more superficial presentation than the first case scenario. Modified YínQiào Săn is used to release the exterior and expel wind heat. It treats fevers and sore throat, and can be used to treat sores and boils. Although it is not stated explicitly, based on the formula for this chapter’s primary case, the formula might be modifed with medicinals such as pú gōng yīng and chì sháo.

The final case scenario describes recurrent hordeola. Here, the redness and swelling are mild, the patient is fatigued and the tongue is pale with a white coating. The only suggestion of heat is the thready and rapid pulse.

The physician treats this case simply and directly by using Sì Jūn Zĭ Tāng (Four Gentlemen Decoction) with pú gōng yīng and zào jiăo cì to supplement the qi and resolve fire poison nodules. This strategy is refreshing in its simplicity and directness, reflecting current trends in the study and use of classical formulas. In this instance the physician is deeply focused on the patient’s’ constitution in the purest way.