Female, age 35. Initial Visit: September 8th, 2007

Chief Complaint: Redness and dryness in the right eye with photophobia for two weeks.

History: In late August 2007, the patient suffered from redness, dryness and discomfort in her right eye. Afer being treated with ofoxacin eye drops and acyclovir eye drops, her condition was not improved. She came to our hospital for treatment when her symptoms of dryness, redness and photophobia worsened

Signs and Symptoms: Dryness, pain, photophobia and tearing in her right eye, with small granular blisters on the conjunctiva surrounded by tortuous bright red vessels. The mouth and throat were dry; there was dark urine and dry stools. The tongue was red with a thin yellow coating, and the pulse was rapid.

Past History: Unremarkable

Physical Examination: BP 110/70 mmHg, medium build, clear breath sounds in both lungs with no rales, heart rate 88 beats/min, flat and soft abdomen, liver and spleen not palpable.

Ophthalmologic Examination: Right eye vision 1.0, left eye vision 1.2. Bulbar conjunctival hyperemia in the outer canthus of her right eye with bright red color, a movable blister-like swelling. Clear cornea, normal anterior chamber and pupils. No abnormalities of the fundus. Normal lef eye.

Laboratory Examination: Routine blood and urine tests, ECG and chest radiographs showed normal results. Tuberculin sensitivity test showed positive result.

The occurrence of this disease was in autumn. The white of the eye (sclera) belongs to the lungs. Dryness in autumn damages fluids. Dry heat in the lung channel damages the normal descending and dispersion of qi. Lung heat attacking upward to the eyes causes qi and blood stagnation, leading to granular blisters on the conjunctiva, dryness and photophobia. The dry mouth and throat, dark urine and dry stools, the red tongue with a thin yellow coating and a rapid pulse are all signs that support the diagnosis of dry heat in the lung channel.

The disease location is the lungs, and the patern is dry heat in the lung channel. It is an excessive patern.

WM diagnosis: Phlyctenular conjunctivitis (right eye)

TCM diagnosis: Metal gan due to dry heat in the lung channel

Clinical Treatment

This is a case of metal gan caused by dry heat in the lung channel. The treatment principle is to clear lung heat, moisten dryness and dissipate binds. Glucocorticoid eye drops may also be used to keep this disease under quick control.

Principles: Clear lung heat, moisten dryness and dissipate binds.

Formula: Modifed Xiè Fèi Tāng (Lung-Draining Decoction)

[泻肺汤加减]

[Formula Analysis]

Sāng bái pí and huáng qín clear lung heat.

Mài dōng and dì gŭ pí moisten dryness and promote fuid production.

Zhĭ qiào and jié gĕng regulate qi movement.

Shēng dì huáng, mŭ dān pí and chì sháo cool the blood and remove stasis.

Gān căo safeguards the stomach and harmonizes the center.

Local Points: BL 2 ( cuán zhú), ST 2 ( sì bái), SJ 23 (sī zhú kōng), GB 1 ( tóng zĭ liáo) , tàiyáng (EX-HN5), GB 20 ( fēng chí)

Supplementary Points: LI 4 ( hé gŭ), SJ 5 ( wài guān), LI 11 ( qū chí)

Method: Choose 3 local points and 2 supplementary points each time. Needle all points with drainage. Retain the needles for 30 min, once daily. Ten days constitute one course of treatment.

Afer 10 days of treatment, the redness, dryness and photophobia at her right eye were signifcantly relieved. She has normal urination and defecation. But there was still the appearance of granular blisters on the conjunctiva surrounded by light red vessels. Other signs and symptoms included slightly dry mouth and throat, a red tongue with a thin yellow coating and a slightly rapid pulse.

After the above treatment, the dry heat in the lung channel was alleviated, but there were still signs and symptoms of fuid insufciency.

Principles: Clear lung heat, nourish yin and moisten dryness.

Formula: Modifed Sāng Bái Pí Tāng (Mulberry Root-Bark Decoction)

[桑白皮汤加减]

[Formula Analysis]

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

Shēng dì huáng, mài dōng and xuán shēn nourish yin and moisten dryness.

Jú huā and jié gĕng clear the heat in the head and eyes.

Chì sháo cools the blood and removes stasis.

Gān căo safeguards the stomach and harmonizes the center.