There are several important features to this case that warrant attention. The first feature hinges largely on the differentiation between hordeolum and chalazion. The second feature is the integrated treatment using Western medicine and TCM. The third feature are the modifications to the formula.

Hordeola and chalazion are similar conditions that cause eyelid lumps or swelling at a similar location on the muscle wheel of the eye. Both formulas used to treat these conditions include fú líng, chén pí, chì sháo and lián qiào. However, hordeolum is an infectious disease; thus, the treatment strategy for that particular case focused on strengthening the spleen qi and consolidating wei qi. For the chalazion case, the doctor differentiated an excessive pattern characterized by stagnation of qi, blood and phlegm heat.

The original formula, Huà Jiān Èr Chén Tāng, expands on Èr Chén Tāng’s (Two Matured Substances Decoction) phlegm-resolving actions by adding medicinals that clear heat and reduce masses. This formula is a variation of Huáng Lián Wēn Dăn Tāng (Coptis Gallbladder-Warming Decoction) with zhĭ shí (Fructus Aurantii Immaturus) omitted. The combination of Chì sháo, mŭ dān pí and lián qiào are featured together in the formula Qīng Wēn Bài Dú Yĭn (Epidemic-Clearing Toxin-Resolving Beverage), illustrating the formula’s efcacy for resolving swellings that are caused by heat and blood stasis. Dry-fried jiāng cán and chuān huáng lián are paired in the formula DàHuó Luò Dān (Major Channel-Activating Elixir), which demonstrates the historical usage of this combination in formulas that clear heat and invigorate the channels and collaterals. Xià kū căo and zhè bèi mŭ are used to resolve phlegm-heat nodules. Ofen this pair is featured in formulas that treat goiter, scrofula or breast lumps. In this case, the chalazia present also with patern of phlegm heat.

The physician then uses an integrated approach, combining an herbal formula with eye drops, warm compresses and possible lancing of the chalazion to hasten its resolution. For legal and ethical reasons, the use of bear bile eye drops is not recommended.

The chalazia resolve quickly and at the follow-up visit, the doctor focuses on recovery and prevention of recurrence. He removes zhè bèi mŭ and jiāng cán, and focuses on protecting the yin fuids of the body by adding lú gēn. This illustrates the function of resolving phlegm and simultaneously generating fuids to protect yin. There are numerous examples in material medica’s exhibiting this dual function. For example, the formula Bèi Mŭ Guā Lóu Săn (Fritillaria and Trichosanthes Powder) both resolves phlegm and generates fluids to clear phlegm heat. Other examples of medicinals with seemingly contradictory functions include tián qī (Radix et Rhizoma Notoginseng), which simultaneously stops bleeding but prevents blood stasis, and tiān huā fĕn (Radix Trichosanthis), which clears phlegm heat and relieves thirst. Thus, the physician is able to treat the root and the branch simultaneously.