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.

1. Male, 52 years old. Both eyes were dry, with photophobia and vision fatigue, along with a dry mouth, reduced fuids, soreness of the lower back and knees. The tongue was red with reduced coating. The pulse was thin and wiry.

Select the most appropriate formula:

A . Xiè Fèi Tāng (Lung-Draining Decoction)

B . Sāng Bái Pí Tāng (Mulberry Root Bark Decoction)

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

D . Qĭ Jú Dì Huáng Wán (Lycium Berry, Chrysanthemum and Rehmannia Pill)

E . Qīng Zào Jiù Fèi Tāng (Dryness-Clearing Lung-Rescuing Decoction)

2. Female, 48 years old. The patient suffered from chronic dryness and pain in both eyes, accompanied by a white bubbly discharge in the morning and redness in the sclera. The tongue was red with a yellow greasy coating. The pulse was sof, slippery and fast.

Select the most appropriate formula:

A . Lóng Dăn Xiè Gān Tāng (Gentian Liver-Draining Decoction)

B . Sān Rén Tāng (Three Kernels Decoction)

C . Sāng Bái Pí Tāng (Mulberry Root Bark Decoction)

D . Xiè Fèi Tāng (Lung-Draining Decoction)

E . Xiè Bái Săn (White-Draining Powder)

3. Female, 37 years old. The patient suffered from chronic recurrent dryness in both eyes with persistent blinking and faint red vessels in the sclera. She had a dry mouth and throat, and hard stools. The tongue was red with reduced coating, and the pulse was thin and rapid.

Select the most appropriate formula:

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

B . Qīng Zào Jiù Fèi Tāng (Dryness-Clearing Lung-Rescuing Decoction)

C . Qĭ Jú Dì Huáng Wán (Lycium Berry, Chrysanthemum and Rehmannia Pill)

D . Sāng Bái Pí Tāng (Mulberry Root Bark Decoction)

E . Xiè Fèi Tāng (Lung-Draining Decoction)

1. D

2. B

3. A

The case scenarios provide useful comparisons for pattern differentiation. In case 1, we are not provided with the physician’s diagnosis, however, based on the symptom presentation, the formula selection clues us in. By working backwards from the formula to the differential diagnosis, it can be concluded that because he is given Qĭ Jú Dì Huáng Wán (Lycium Berry, Chrysanthemum and Rehmannia Pill), the patient’s diagnosis is chronic conjunctivitis caused by kidney and liver yin deficiency. The key symptoms to support the formula selection are dry eyes, a dry mouth and sore lower back and knees. The sore back is the key symptom of kidney deficiency. A sore back plus dry eyes equals kidney and liver deficiency. Thus, the diagnosis can be deciphered purely from the formula selection.

In the case 2, the patient presents symptoms of damp heat. The key symptoms are a white bubbly discharge, red eyes, a greasy tongue coating, a slippery pulse as well as the chronic nature of the condition. The formula for this case is Sān RénTāng (Three Kernels Decoction). This is the second formula in this chapter that the physician has selected from the Systematic Differentiation of Warm Diseases. Although the modifcations to the formula are unknown, the actions of Sān Rén Tāng are to clear damp-heat and correct the qi mechanisms.

The case 3 is on a continuum with the primary case and the frst case scenario. The patient’s symptoms are dry eyes, a dry mouth, dry throat and dry stools. She blinks persistently and the sclera appears to have faint red vessels. The physician selects the formula Yăng Yīn Qīng Fèi Tāng (Yin-Nourishing and Lung-Clearing Decoction). Just like the primary formula in this chapter, the frst three medicinals are xuán shēn, màidōng and shēng dì huáng of Zēng Yè Tāng.

Other medicinals are bò he (Herba Menthae), mŭ dān pí (Cortex Moutan) and bái sháo (Radix Paeoniae Alba). This trio is in the formula Jiā Wèi Xiāo Yáo Săn (Supplemented Free Wanderer Powder). As with the frst case scenario, a diagnosis may be inferred by understanding the relationship of individual medicinals to one another as well as the actions and construction of the formula. It can be surmised that this patient’s diagnosis is liver heat with dryness.