Male, age 25. Initial Visit: July 16 ^th, 2009.

Chief Complaint: Dryness, itching and stabbing pain in the right eye with profuse sticky discharge and conjunctival redness for one day.

History: One day ago, with no obvious causes the patient suddenly felt dry, itching and stabbing pain in his right eye with conjunctival redness. When he woke up this morning, he saw profuse sticky discharge in the right eye but sought no treatment.

Signs and Symptoms: Dryness, itching, stabbing pain, photophobia, tearing, conjunctival redness in his right eye with profuse sticky discharge and slightly swollen eyelid. Other signs and symptoms include a stufy nose, aversion to wind, a red tongue with a slightly yellow coating, a foating and rapid pulse.

Past History: Unremarkable.

The patient sufered from this disease for only one day. The afected eye presented with dryness, itching, stabbing pain, photophobia, tearing, profuse sticky discharge, conjunctival redness and slightly swollen eyelid. These are manifestations of external contraction of pathogenic wind. The stufy nose, aversion to wind, a red tongue with a thin white coating, and a foating rapid pulse are signs of pathogenic wind atacking the surface with only mild internal heat.

The disease location is in the white of the eye, which referred to as qi wheel and belongs to the lung. This is a case of external contraction of wind-heat with wind outweighing heat. It is an excessive patern.

WM diagnosis: Acute bacterial conjunctivitis (right eye)

TCM diagnosis: Fulminant wind and invading fever due to contraction of windheat with wind outweighing heat

This is a case of external contraction of wind-heat with wind outweighing heat. The root of etiology is externally contracted wind-heat stagnating in the lung channel and atacking upward to afect the white of the eye. The treatment principle, therefore, should focus on dispelling externally contracted wind-heat.

Principles: Scater wind and clear heat

Formula: Modifed Yín Qiào Săn (Lonicera and Forsythia Powder)[银翘散]

[Formula Analysis]

Lián qiào and jīn yín huā scatter wind, clear heat and resolve toxins.

Bò he and niú bàng zĭ scatter wind and dissipate heat, clear the head and eyes.

Lú gēn and zhú yè clear heat and promote fluid production.

Jīng jiè releases the exterior and dissipates evil to assist in venting pathogens through the exterior.

Jié gĕng diffuses the lung.

Mŭ dān pí and chì sháo cool the blood and eliminate the redness.

Gān căo clears heat and resolves toxins. In addition, it harmonizes all the formula medicinals.

Eye drops: 0.5% bear bile eye drops, 6 times per day. Antibiotic eye drops may also be used.

Eye wash methods: Decoct pú gōng yīng (Herba Taraxaci) 30g, yĕ jú huā (Flos Chrysanthemi Indici) 30g, huáng lián (Rhizoma Coptidis) 10g and other heat-clearing and toxin-resolving herbs to fumigate and steam the afected eye, 2-3 times per day.

Main Points: LI 4 ( hé gŭ), GB 20 ( fēng chí), BL 2 ( cuán zhú), SJ 23 ( sī zhú kōng)

Supplementary Points: LI 11 ( qū chí), BL 1 ( jīng míng), tài yáng (EX-HN5), SJ 5 ( wàiguān)

Method: Select 2 main points every day along with 2-3 supplementary points, alternating the points every other day. Needle all points with drainage. Retain the needle for 20 min afer arrival of qi. Bloodleting therapy can also be used. Prick méigōng (superciliary arch), méi jiān (tip of eyebrow), tài yáng (EX-HN5) and ĕr jiān (EXHN6) to squeeze out several drops of blood. Once daily.

After 4 days of treatment, the patient’s conjunctival redness was significantly relieved with decreased discharge. But his eye was still a litle itching, dry and tearful. There were no obvious systemic symptoms. He had a red tongue with a thin white coating and a rapid pulse.

Afer treatment, his symptoms were alleviated, indicating that the pathogenic wind-heat in the lung channel was generally eliminated. However, conjunctival redness and eye discharge were not completely cleared, indicating that there were residual pathogens. Therefore, the previous formula was modifed. Niú bàngzĭ and jié gĕng were removed, while jú huā 15g was added to clear heat and improve vision.