In TCM, scleritis is referred to as huŏ gān (fire rickets). Because scleritis is associated with autoimmune diseases, treatment involves consideration of more than just ophthalmic conditions. Practitioners should consider integrating bi syndrome, fve wheels eye anatomy and constitutional patern diferentiation to accurately diagnosis the case and then formulate an efective treatment strategy. Moreover, because there is a known relationship between scleritis and menstrual diseases, when treating female patients, the practitioner should be familiar with blood patern diferentiation/ identifcation and integrate that information if applicable. Inquire if fare-ups occur around menstruation and ovulation and, if so, ask about the quality of menstruation. Symptoms of blood stasis and blood heat can be coordinated with observation of the scleritis. If the scleritis is red, then the diagnosis might tilt more towards blood heat. If the scleritis is purpler, then consider if there are signs of blood stasis.

For this case, the patient has a known history of rheumatoid arthritis and diabetes. The patient was having recurrent, worsening fare-ups of scleritis, which is common for this disease. The patient’s constitution reflects kidney-liver deficiency. That said the treatment strategy and formula selection focus on the branch paterns, which are wind-damp and toxic heat evil atacking the eye.

When analyzing the formula and its application, it is immediately obvious that there are no medicinals in the formula to suggest it is treating an eye disease. The formula selected is modified Sàn Fēng Chú Shī Huó Xuè Tāng, a modern formula writen in 1976 by Pang Zan-xiang in TCM Ophthalmology in Clinical Practice ( ZhōngYī Yăn Kē Lín Chuáng Shí Jiàn, 中医眼科临床实践). The formula features classic, wellused pairings of medicinals as well as some unusual inclusions. Note the use of jī xuèténg and rĕn dōng téng. Both are vines and thus they have an afnity for the channels and collaterals. Vines are mobile and dynamic medicinals. Jī xuè téng is warm, acrid and sweet. It nourishes and invigorates the blood, relaxes the sinews and quickens the collaterals. Rĕn dōng téng is cold and sweet, acting to clear heat, expel toxins and clear wind-damp-heat from the channels and collaterals. This is an efective combination for dispelling wind, invigorating the blood and unblocking the collaterals to relieve joint pain.

The physician also recommends the prepared medicine Léi Gōng Téng Piàn. This is a pill made from an herb commonly called thunder god vine, it acts powerfully to reduce inflammation. It is not recommended to use this medicinal without proper training and experience, as it is extremely toxic.

By the second visit, the scleritis has improved; however, the lesion is purple. The formula is modifed with dān pí and dān shēn to eliminate blood stasis and harmonize the blood.