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

Female, age 16, presented with a sudden dry, burning sensation in the left eye one day prior to treatment with photophobia, tearing and thin discharge. Upon examination, there was slight redness in the left eyelid and the sclera. Systemic symptoms included fever, headache, a stufy nose with clear nasal discharge, palpable swollen nodules anterior to the ear and below the jaw, a red tongue with a thin yellow coating and a foating and fast pulse.

1. Select the most appropriate diagnosis:

A. Epidemic hemorrhagic conjunctivitis due to early stage epidemic pestilential qi invasion

B. Epidemic hemorrhagic conjunctivitis due to heat accumulation in the lung and stomach

C. Epidemic hemorrhagic conjunctivitis due to pestilent heat injuring the collaterals

D. Epidemic hemorrhagic conjunctivitis due to the pattern of heat overriding wind

E. Epidemic hemorrhagic conjunctivitis due to the pattern of wind overriding heat

2. Select the best formula:

A. Modified Sāng Jú Yĭn (Mulberry Leaf and Chrysanthemum Beverage)

B. Modified Pŭ Jì Xiāo Dú Yĭn (Universal Relief Toxin-Removing Beverage)

C. Modified Qū Fēng Sàn Rè Yĭn Zĭ (Wind-Expelling and Heat-Dissipating Drink)

D. Modified Yăng Yīn Qīng Fèi Tāng (Yin-Nourishing and Lung-Clearing Decoction)

E. Modified Xiè Huáng Săn (Yellow-Draining Powder)

1. A

2. C

In the primary case, a constellation of symptoms centered on blood heat was presented. For the case scenarios, the key symptoms were swollen lymph nodes, fever, headache and a red tongue with a thin, yellow coating. The key causative factor for this patient’s case of conjunctivitis is early stage epidemic pestilent qi, which is equivalent to a disease on a wei defensive level patern.

Formula: Modifed Qū Fēng Sàn Rè Yĭn Zĭ (Wind-Expelling and Heat-Dissipating Drink)

[祛风散热饮子加减]

The actions of the formula are to dispel wind, clear heat from the exterior, resolve toxins, drain heat from the yangming and cool the blood.

Within the formula, lián qiào, jīn yín huā, niú bàng zĭ and bò he are used together in the Yín Qiào Săn (Lonicera and Forsythia Powder) formula. They act to reduce fever and clear heat from the throat. Qiāng huó serves as an envoy, guiding the formula to the throat to relieve the patient’s swollen glands. Qiāng huó and chuān xiōng relieve headache. Mù zéi clears heat from the eyes. Zhī zĭ and dà huáng drain heat through the urine and stool to clear interior heat. Chì sháo, dāng guī and chuān xiōng cool and move the blood. In contrast to the formula used in the primary case, this formula focuses more on clearing superfcial heat and less on resolving fre-toxins, but there is overlap in these functions. The value of this comparison case is to demonstrate how even epidemic and contagious diseases can be differentiated based on both the patients constitution and the presenting signs and symptoms.