In TCM, the patern that most closely matches phlyctenular keratoconjunctivitis is jīn gān (金疳, metal gan) which is the term used to describe an eye disease with granular blisters on the conjunctiva surrounded by red vessels. Mild cases may present with dry eyes and photophobia, while severe cases may experience dry painful eyes, photophobia and tearing. In general, if the lesion is limited to conjunctiva, it is referred to as jīn gān (金疳, metal gan). If the lesion is at the cornea with radial neovascular vessels invading, it is called fēng lún chì dòu (风轮赤豆, wind wheel red bean).

Of the three main paterns of metal gan, the frst two, dry heat in the lung channel and lung yin defciency exist on a continuum: Excessive external dry pathogens easily injures the yin, which then generates defciency fre. Despite the similarities between the two correct identifcation of the paterns formula are important to achieve optimal clinical results.

Here’s a comparison chart of the two paterns: ¹

It’s easy to see that the paterns overlap, however the patern of dry heat does not include signs and symptoms of deficiency fire, such as night sweats and five-heart heat.

For the patern of dry heat, the selected formula is modifed Xiè Fèi Tāng (Lung-Draining Decoction).

In the West, most practitioners are familiar with the classical pediatric formula XièBái Săn (White-Draining Powder) from the Key to Diagnosis and Treatment of Children’sDiseases ( Xiăo Ér Yào Zhèng Zhí Jué, 小儿药证直诀) by Qian Yi. This formula contains:

[泻白散]

The formula drains heat from the lungs and calms wheezing. ³ It is commonly used to treat dry croupy coughs with litle phlegm, along with feverishness.

Xiè Fèi Tāng (Lung-Draining Decoction) was originally recorded in the Ming Dynasty text A Close Examination of the Precious Classic [on Ophthalmology] ( Shĕn Shì YáoHán, 审视瑶函) writen by Fu Ren-yu in the Song Dynasty.

[泻肺汤]

The formula is indicated for metal gan due to lung yin defciency or excessive heat in the lung channel.

Both lung-draining formulas contain sāng bái pí and dì gŭ pí. Xiè Fèi Tāng then expands by adding huáng qín which, along with sāng bái pí is a favorite pairing by the author of this book for both eye and sinus conditions that present with paterns of lung and stomach heat. The actions of zhī mŭ address the entire scope of clinical concerns for this condition: it clears heat and drains fre, enriches the yin, moistens dryness and, most importantly for this case, generates fluids. Mài dōng nourishes the yin and generates fuids and then fnally jié gĕng acts as an envoy, directing the formula to the upper body.

The primary case in this chapter presents with metal gan due to dry heat in the lung channel. The formula requires modifcation to efectively treat the patient, so it is modifed with a blood cooling group: dì huáng, chì sháo and mŭ dān pí and then zhĭ qiào which regulates the qi dynamic.

At the second visit, the diagnosis is updated: The signs of heat have reduced. The new formula is modifed Sāng Bái Pí Tāng (Mulberry Root-Bark Decoction) also from A Close Examination of the Precious Classic [on Ophthalmology]. The original ingredients of Sāng Bái Pí Tāng are as below:

[桑白皮汤]

The actions of this formula are to clear the lung and drain dampness, nourish the yin and brighten the eyes. It is indicated for white xerotic syndrome caused by lungspleen damp-heat. These conditions include conjunctival edema, acute contagious conjunctivitis, follicular conjunctivitis and dry eyes caused by lung heat.