Although it is not painful or dangerous in any way, excessive tearing is a constant nuisance that afects everyday quality of life. Epiphora is defned as watering of the eyes due to a blockage of the lacrimal ducts or the excessive secretion of tears.

The primary case presents an elderly woman with kidney deficiency. There are several notable points to the diagnosis, formula selection and modifcation of this case study: The fact that the patient is not diagnosed as being either yin or yang defcient is deliberate. The focus is the overarching deficiency of the kidneys’ function of stabilizing fuids. The physician emphasizes that the lacrimal orifces are loose. This key phrase brings to our atention the importance of using astringing or stabilizing medicinals to modify the formula. An additional distinction is that modified ZuŏGuī Yĭn is selected instead of the more commonly used Liù Wèi Dì Huáng Wán (Six-Ingredient Rehmannia Pill). Both formulas beneft the kidneys and nourish the yin, however Liù Wèi Dì Huáng Wán contains three ingredients that tonify and three that drain. Zuŏ Guī Yĭn contains only medicinals that tonify and none that are draining. Based on this comparison, where there is leakage of body fuids, modifed Zuŏ Guī Yĭn is the superior formula to stabilize the condition.

Within the formula, wŭ wèi zĭ supports shān zhū yú astringent action. Examples of how this sour favored pair stabilizes the liver and kidneys, is illustrated by referring formulas such as Dū Qì Wán (Qi-Restraining Pill) and Míng Mù Dì Huáng Wán (Eye Brightener Rehmannia Pill). Jú huā has a relationship with gŏu qĭ zĭ in Qĭ Jú Dì HuángWán. The pair is also included in Shí Hú Yè Guāng Wán (Dendrobium Night Vision Pill) and Xĭ Gān Míng Mù Tāng (Liver-Washing Eye-Brightening Decoction) along with bái jí lí and fáng fēng to eliminate wind, clear heat and clear the vision. Fáng fēng and wŭ wèi zĭ stabilize the exterior to prevent leakage and to eliminate wind.

By far, the most intriguing modifcation is the addition of shí liú pí: this medicinal is also in the category of medicinals that stabilize and bind, however, it is usually used to treat diarrhea. Based on that, we can surmise that it is astringent to all body fuids, including tears.

According to the Essentials from the Silver Sea ( Yín Hăi Jīng Wēi, 银海精微), if there is kidney vacuity, then liver wood is not engendered. Due to the resultant liver defciency, the channel is weakened and thus, the wood (liver) is stirred which results in tearing when facing or being exposed to wind. In contrast, epiphora is not caused or exacerbated by exterior wind.

There are two passages in the Essentials from the Silver Sea that discuss tearing: Passage 45 discusses Lacrimation Due To Intrusion of Wind, while the topic of passage 64 is Lacrimation when Facing the Wind. The chapters are similar, but the chief patern in the former passage is internal wind generated by the liver, while the chief patern in the later passage centers on external pathogenic factors.

The book continues to discuss different species of tears: Hot tears should be treated with Chuān Xiōng Chá Tiáo Săn (Tea-Mix and Chuanxiong Powder) while tears caused by liver wind are treated with Cāng Zhú Săn (Atractylodes Rhizome Powder). Tears from liver deficiency are treated with Zhĭ Lèi Bŭ Gān Săn (Tear-Checking and Liver-Supplementing Powder). Cold tears are treated using Rŭ Xiāng ChuānWū Wán (Frankincense Aconite Main Tuber Pill). The recipe involves peeling and pounding aconite and then forming pills with míng fán (Alumen) and pig’s bile. These are formed into pills the size of millet and embedded in the inner canthus, which essentially cauterizes the tear duct.

What is not discussed in the Essentials from the Silver Sea is the relationship of excessive tearing with the inner canthus. All lacrimation originates from the canthus, and thus has a close relationship to the heart. The heart is associated with fire and governs the blood and vessels. Heart fre faming upward will result in qi congestion, which in turn obstructs the fow of tears. Thus, in addition to the paterns of liver and kidney deficiency and external wind, heart fire may also be a factor in lacrimation patern.

Formula: Chuān Xiōng Chá Tiáo Săn (Tea-Mix and Chuanxiong Powder) (from the Essentials from the Silver Sea)

[川芎茶调散]

[Method]

Take one liăng of each and pulverize. Each dose consists of 2-3 qián. Swallow with tea afer meals.

Formula: Cāng Zhú Săn (Atractylodes Rhizome Powder) (from the Essentials fromthe Silver Sea)

[苍术散]

[Method]

Take equal amounts of each and pulverize. Each dose consists of 2-3 qián. Swallow with green tea or wine.

Formula: Zhĭ Lèi Bŭ Gān Săn (Tear-Checking and Liver-Supplementing Powder) (from the Essentials from the Silver Sea)

[止泪补肝散]

[Method]

Take equal amounts of each and pulverize. Each dose consists of 2-3 qián. Swallow with green tea.

[Modifications]

For blood deficiency, remove xià kū căo (Spica Prunellae) 30g.