Male, age 36. Initial Visit: October 10 ^th, 2008

Chief Complaints: Dryness and discomfort in both eyes for over three months, after sufering from acute red eyes.

History: In early July 2008, the patient experienced sudden redness and dryness in both eyes accompanied by copious tearing, yellow sticky discharge and photophobia. The patient was diagnosed with acute bilateral catarrhal conjunctivitis by the local hospital. After using ofloxacin eye solution and erythromycin eye ointment, the redness was reduced, but the dryness and discomfort remained despite trying numerous other eye solutions.

Signs and Symptoms: The patient had a sandy blocked sensation in the eyes with dryness and discomfort, vision fatigue, slight photophobia and dry eyes. His mouth and throat were dry. The tongue was red with a thin yellow coating. The pulse was slightly fast

Past History: Otherwise healthy. A non-smoker who drinks alcohol occasionally with no specifc hobbies.

Ophthalmologic Examination: Vision was 1.2 in both eyes. Mild conjunctival hyperemia, clear cornea, positive corneal fuorescein staining test, anterior chamber (-), pupil (-). No abnormalities of the inner eye.

Laboratory Examination: Schirmer test: right eye 2 mm/5 min, left eye 3 mm/5 min.

After contracting conjunctivitis, the redness in the patient’s sclera was reduced, but the dryness and discomfort remained.

Due to lingering heat that was not fully cleared afer contracting fulminate wind and invading fever, the pathogenic factor was retained in the whites of the eyes and resulted in dry eyes. Heat-injured fuids caused dryness and discomfort in the eyes along with a dry mouth and throat. The red tongue with a thin yellow coating and a slightly rapid pulse were also signs of unresolved latent heat.

The location of this case was in the lung and it was categorized as white xerotic syndrome. A differential diagnosis indicated unresolved lingering pathogenic heat and was a combination of excess and defciency.

WM diagnosis: Bilateral chronic conjunctivitis

TCM diagnosis: White dye eye due to lingering evil heat

This case was caused by latent heat injuring fluids, so the treatment principle should focus on clearing the remaining heat, nourishing the yin and moistening dryness. This can be combined with acupuncture to enhance tear secretions and improve the dry eyes.

Principles: Clear latent heat, nourish yin and moisten dryness

Formula: Modifed Sāng Bái Pí Tāng (Mulberry Root Bark Decoction)

[桑白皮汤加减]

[Formula Analysis]

Sāng bái pí, huáng qín and dì gŭ pí clear the remaining heat in the lung channel.

Shēng dì huáng, xuán shēn and mài dōng nourish the yin, generate fluids and moisten dryness.

Jú huā and jié gĕng clear the head and eyes.

Fú líng and gān căo strengthen the spleen and harmonize the center.

Main points: BL 2 ( cuán zhú), yú yāo (EX-HN4), SJ 23 ( sī zhú kōng), GB 1 ( tóng zíliáo), tài yáng (EX-HN5), DU 20 ( băi huì)

Supplementary points: LI 4 ( hé gŭ), SJ 5 ( wài guān), LI 14 ( bì nào)

Method: Select three main points and two supplementary points, once per day. 10 times constitutes one course of treatment.

Techniques: An even method of reinforcing and reducing was applied.

20 days afer the above treatment, the dryness in the eyes and other dry symptoms were reduced, but the eyes were still fatigued. The patient’s reading time was still limited and the mouth was still dry. The tongue was red with a thin yellow coating and the pulse was slightly fast but forceless. The Schirmer’s test revealed: right eye 12 mm/5 min, lef eye 13 mm/5 min.

The above treatment had improved the dry eye symptoms, but qi and yin defciency paterns remained.

Principle: Beneft qi and yin, generate fuids and moisten dryness

Formula: Modified Shēng Mài Săn (Pulse-Engendering Powder) and Sāng Bái PíTāng (Mulberry Root Bark Decoction)

[生脉散合桑白皮汤加减]

[Formula Analysis]

Tài zĭ shēn, mài dōng and wŭ wèi zĭ benefit qi and nourish yin.

Sāng bái pí and dì gŭ pí clear the remaining heat.

Shēng dì huáng and xuán shēn nourish yin, generate fluids and moisten dryness.

Jú huā and jié gĕng clear the head and eyes.

Fú líng and gān căo strengthen spleen and harmonize the center.