In Chinese medicine, epidemic hemorrhagic conjunctivitis is referred to as tiānxíng chì yăn (heaven-current red eye), which means epidemic red eye or epidemic redhot eye.

Scourge epidemics are contagious diseases that can be attributed to contracting epidemic pestilent qi. The two most common paterns are: pestilent qi epidemic toxin hidden in the mó yuán (membrane source) and summerheat epidemic toxin hidden in the stomach. In TCM, epidemic diseases, such as measles, cholera, pertussis and all contagious infectious diseases afect all people in the same way, irrespective of their individual constitutions. That having been stated, there still can be constitutional factors that predispose a person to developing the condition.

In this chapter’s case history, the patient contracted acute conjunctivitis and he had a fondness for spicy food. This is not to infer that only people who consume spicy foods will contract conjunctivitis. Instead it refects a chicken-egg conundrum of Chinese medicine: irrespective of the epidemic and acutely infectious nature of the disease, a disease will still present in alignment with the patient’s constitution. Thus, the patient craves spicy food, he feels hot, and his bìng (disease) is hot. His internal excess combines with the external pathogenic factors, resulting in huŏ dú (fre toxin).

For the treatment of an acute infection with the above presentation, the doctor uses a Wēn Bìng (warm disease) strategy. He selects a hybrid of two formulas: XīJiăo Dì Huāng Tāng, which clears heat in the ying-nutrient level and cools the blood; and Yín Qiào Săn, which treats wei-defensive level paterns. The former prescription was written by Sun Si-miao in Important Formulas Worth a Thousand Gold Pieces forEmergency ( Bèi Jí Qiān Jīn Yào Fāng, 备急千金要方) in the Tang Dynasty, while the later was writen over 1000 years later, in Systematic Differentiation of Warm Diseases ( WēnBìng Tiáo Biàn, 温病条辨).

An alternative interpretation of the doctor’s formula selection is to say that he is using a modification of Qīng Wēn Bài Dú Yĭn (Epidemic-Clearing Toxin-Resolving Beverage). Both formulas contain shuĭ niú jiăo, mŭ dān pí, chì sháo, shēng dì huáng, liánqiào, zhú yè and shēng gān căo. Qīng Wēn Bài Dú Yĭn is the guiding formula to treat summerheat pestilent qi.

This doctor’s selection of formulas emphasizes the dual strategy of blood-cooling medicinals with light medicinals that clear heat without being overly drying. His primary modification of Xī Jiăo Dì Huāng Tāng is the addition of zĭ căo to cool the blood. In this formula, it supports jīng jiè and bò he by venting heat and alleviating rashes. We ofen use zĭ căo in dermatology. For this case, the sclera can be thought of as the skin of the eye.

The external therapies are worth discussing. The eye wash method is easily replicated and clinically effective. One could make a strong case for using topical applications without internal medicinals. This, along with dietary modifications, could be an appropriate treatment method for children.

At the second visit, the symptoms were still strong but reduced. The primary formula was continued with modifcations. There are two surprising elements in the follow-up visit; frst, he chooses to omit zĭ căo to prevent the formula from becoming too cold when there are other, colder agents in the formula, such as shuĭ niú jiăo. The second modification of note is the use of huò xiāng gĕng. The most common form of this medicinal is the whole herb huò xiāng (Herba Agastachis), but in this case, the leaf of the plant is omitted, leaving the stem. This preparation minimizes the exterior-releasing action of the herb while emphasizing its action to regulate qi in the middle jiao, loosening the chest and transforming dampness. The doctor chooses huòxiāng gĕng over other qi-regulating medicinals because it is specific for treating the summerheat diseases.