In TCM, this condition is referred to as bái sè zhèng (white dry eye or white xerotic syndrome).

In the case presented above, the patient has a history of acute conjunctivitis from which he does not fully recover. This leads to chronic conjunctivitis that causes a dry, grity feeling in the eyes, with tiredness and light sensitivity. His throat and tongue are dry and his pulse is slightly fast. These symptoms, the physician concludes, are indicative that the heat that caused the initial condition is not fully resolved. The pathogenic factor that remains injures the fluids and resulting in chronic conjunctivitis.

The sclera belongs to the lungs. The case is a mixed patern of excess and defcient symptoms. The treatment principles are to clear defciency-heat and moisten dryness.

The use and modification of Sāng Bái Pí Tāng warrants discussion: originally recorded in the Ming Dynasty text A Close Examination of the Precious Classic [onOphthalmology] ( Shĕn Shì Yáo Hán,审视瑶函), Volume Ⅲ. Its actions are to clear the lungs and disinhibit dampness. It is indicated for lung-spleen damp-heat fuming and steaming manifesting as rough dry eyes with no redness or swelling, which is referred to as white dry eye syndrome. Modern indications include chronic conjunctivitis and phlyctenular conjunctivitis that are associated with lung-spleen damp-heat.

Several sub-formulas can be referenced that are built into this larger, aggregate formula. First is Xiè Bái Săn (White-Draining Powder). The primary medicinals in this formula are sāng bái pí and dì gŭ pí. This Song Dynasty formula from the classic Qian’sKey to Diagnosis and Treatment of Children’s Diseases ( Qián Shì Xiăo Ér Yào Zhèng Zhí Jué,钱氏小儿药证直诀) uses sweet medicinals to clear lung fre and eliminate defciency heat. Xuán shēn, mài dōng and shēng dì huáng create the formula Zēng Yè Tāng (Humor-Increasing Decoction). First recorded in the Systematic Differentiation of Warm Diseases ( Wēn Bìng Tiáo Biàn, 温病条辨), it employs the visually striking combination of two black medicinals with one white one to generate fuids and alleviate dryness. This is the classical formula that “floats the boat” to treat constipation caused by dryness The formula combines salty, sweet, biter and cold medicinals to nourish the yin and generate fuids.

Sāng bái pí, jié gĕng, fú líng, huáng qín and gān căo are all included in Qīng FèiTāng (Lung-Clearing Decoction). The formula’s actions are to resolve phlegm, stop coughing and improve the condition of the throat. The relationships of the medicinals in the formula construction illustrate that clearing lung heat is a key treatment strategy for resolving chronic conjunctivitis. Jú huā and mài dōng are paired in several formulas that moisten the eyes, including Shí Hú Yè Guāng Wán (Dendrobium Night Vision Pill).

At the follow up appointment, the treatment strategy and formula are revised to focus on benefting the qi and yin. It is striking that the diagnosis of qi defciency is hinged on the patient’s symptom of tired eyes leading to difculty reading and not on more systemic symptoms of fatigue.

The formula combines Shēng Mài Săn, Sāng Bái Pí Tāng and Zēng Yè Tāng to strengthen spleen and harmonize the formula.