Female, age 59. Initial Visit: August 16 ^th, 2006

Chief Complaint: Frequent recurrence of redness, dryness, pain, tearing and photophobia in the lef eye for six months prior to treatment.

History: During the 6 months prior to treatment, the patient experienced redness, pain, tearing and photophobia in the lef eye. The local hospital diagnosed scleritis in her lef eye. The patient’s condition was somewhat alleviated with cortisone acetate eye drops, diclofenac sodium eye drops, IV administration of dexamethasone, and anti-viral pills. However, all the symptoms returned and became progressively worse each month.

Signs and Symptoms: Chief symptoms included redness, dryness, pain, tearing and photophobia in the lef eye. Other symptoms included reddish-purple nodules in the sclera accompanied by joint soreness, pain and swelling. The tongue was dark red with a slightly yellow greasy coating. The pulse was wiry and soggy.

Past History: Rheumatoid arthritis for more than 20 years. Diabetes for three years. Denied smoking or drinking, no specifc hobbies.

Physical Examination: Blood pressure of 118/76 mmHg, medium body type, normal breath sounds in both lungs, no rale, heart rate of 78 beats/min with normal rhythm. The abdomen was fat and sof, with non-palpable liver and spleen. The joints of the hands and feet were swollen and deformed.

Ophthalmologic Examination: Vision acuity: right 1.0, left 0.6. The right eye appeared normal. The sclera at the lef outer canthus appeared purplish red and fat with bulging nodules and tenderness. The cornea was still clear; the anterior chamber and pupil were also normal. There was no obvious abnormality at the fundus of the eye.

Laboratory Examination: Blood and urine routine tests were normal. Liver and kidney function and EKG were also all normal. ESR 40 mm/h, RF 123 IU/ml.

The main characteristics of this patient are: a history of rheumatoid arthritis for over 20 years, frequent recurrence of redness, dryness, pain, tearing and photophobia in the lef eye for 6 months, reddish-purple nodules in the sclera, joint soreness, pain and swelling, deformed joints of the hands and feet, a dark red tongue with a slightly yellow greasy coating, and a wiry and soggy pulse.

The patient has suffered from bi syndrome. According to TCM theory, winddamp obstructs the channels and transforms to heat. The heat follows the channels to ascend and atack the sclera, causing redness, dryness, pain, tearing and photophobia in the left eye, as well as reddish-purple nodules in the sclera. When wind-damp and heat evil accumulate in the muscles, sinews, bones, channels and collaterals, the qi dynamic is obstructed and the blood fow is inhibited, resulting in joint soreness, pain, swelling, and deformity. Dampness is sticky and stagnating in nature. It causes lingering disease with recurrent symptoms that are difcult to cure. The patient’s dark red tongue with a slightly yellow greasy coating and a wiry soggy pulse are signs of wind-damp and toxic heat atacking the eyes, with qi stagnation and blood stasis.

The location of the disease is in the lungs, also involving in the liver, spleen, and other organs. The patern is identifed as wind-damp and toxic heat atacking the eyes, which is excess.

WM diagnosis: Acute scleritis (lef eye)

TCM diagnosis: Fire rickets due to wind-damp and toxic heat atacking the eyes

This case was due to an attack of wind-damp and toxic heat. In addition to the TCM treatment, glucocorticoid and non-steroidal anti-infammatory eye drops were also administered, combining local and systemic treatment to control and alleviate symptoms quickly.

Principles: Eliminate wind-damp, clear heat, move blood, unblock the collaterals and dissipate nodules

Formula: Modifed Sàn Fēng Chú Shī Huó Xuè Tāng (Wind-Dissipating, Dampness-Eliminating and Blood-Moving Decoction)

[散风除湿活血汤加减]

[Formula Analysis]

Qiāng huó, dú huó, fáng fēng and rĕn dōng téng eliminate wind-damp and unblock the collaterals.

Dāng guī, chì sháo, jī xuè téng and hóng huā move blood, eliminate stasis and unblock the collaterals.

Sāng bái pí and huáng qín clear lung heat.

Zhĭ qiào and yán hú suŏ move qi, invigorate blood and dissipate nodules.

Léi Gōng Téng Piàn (Thunder God Vine Tablets), oral administration, 2 tablets each dose, three doses per day.

Head, face and local eye area points: BL 1 ( jīng míng), BL 2 ( cuán zhú), tài yáng (EX-HN5), SJ 23 ( sī zhú kōng), GB 1 ( tóng zĭ liáo), GB 20 ( fēng chí)

Supplementary body points: LI 4 ( hé gŭ), LI 11 ( qū chí), LU 7 ( liè quē)

Method: Select three local points and two body points. Retain the needles for 30 min, once per day. 10 days constitute one course of treatment.

Techniques: Sedation method.

After 14 days of treatment, the redness, dryness, pain in the left eye and joint soreness and pain throughout the body had reduced significantly. However, the purplish-red nodules in the sclera were still slightly bulging, along with a dry mouth and reddish urine. The tongue was red with a thin yellow greasy coating and the pulse was wiry and soggy.

Through the above treatment, the disease was brought under control and the symptoms reduced, but the damp-heat was not completely cleared, with stasis in the collaterals.

Principles: Clear heat, transform damp, eliminate stasis and unblock the collaterals

Formula: Modifed Xiè Bái Săn (White-Draining Powder) and Sàn Fēng Chú Shī HuóXuè Tāng (Wind-Dissipating, Dampness-Eliminating and Blood-Moving Decoction)

[泻白散合散风除湿活血汤加减]

[Formula Analysis]

Sāng bái pí, dì gŭ pí and huáng qín clear residual heat.

Qiāng huó, fáng fēng, rĕn dōng téng and qín jiāo eliminate wind, transform damp and unblock the collaterals.

Dāng guī, hóng huā and dān shēn nourish and move blood.

Chì sháo and dān pí cool blood and dissipate stasis.