The following cases present variations of this condition. After familiarizing yourself with the possible common patern presentations and appropriate formulas for treatment, use the following exercises to test your overall understanding of the condition.

1. Female, 25 years old. Blood spillage into the superficial layer of the bulbar conjunctiva of the left eye, bright red in color, accompanied by a cough with yellow phlegm, a dry mouth and throat, yellow urine and dry stools. The tongue was red with a yellow coating and the pulse was rapid.

Select the most appropriate formula:

A. Sāng Jú Yĭn (Mulberry Leaf and Chrysanthemum Beverage)

B. Tuì Chì Săn (Redness-Abating Powder)

C. Yăng Yīn Qīng Fèi Tāng (Yin-Nourishing and Lung-Clearing Decoction)

D. Zhī Băi Dì Huáng Wán (Anemarrhena, Phellodendron and Rehmannia Pill)

E. Sāng Bái Pí Tāng (Mulberry Root Bark Decoction)

2. Male, 18 years old. The right eye was struck by a basketball a week prior to treatment resulting in a purplish color and swelling of the eyelid. There was a large dark red patch of bloody macules on the superficial layer of the bulbar conjunctiva. The appetite, bowel movements and urination were normal. The tongue was red with a white coating and the pulse was wiry.

Select the most appropriate formula:

A . Tuì Chì Săn (Redness-Abating Powder)

B . Xiè Fèi Tāng (Lung-Draining Decoction)

C . Xuè Fŭ Zhú Yū Tāng (Blood Mansion Stasis-Expelling Decoction)

D . Dān Zhī Sì Wù Tāng (Moutan and Gardenia Four Substances Decoction)

E . Zhī Băi Dì Huáng Wán (Anemarrhena, Phellodendron and Rehmannia Pill)

1. B

2. C

The case scenarios illustrate other causes of bleeding. In the first scenario, the hemorrhage is caused by heat that injures the collaterals in the eye. The patient has symptoms of dryness, heat and phlegm. The guiding formula is Tuì Chì Săn (Redness-Abating Powder). This formula warrants a brief discussion as it is infrequently seen in English language literature.

Formula: Tuì Chì Săn (Redness-Abating Powder)

[退赤散]

This formula appears in the Ming Dynasty classical text A Close Examinationof the Precious Classic [on Ophthalmology] ( Shĕn Shì Yáo Hán,审视瑶函). The formula clears the lung heat and dissipates blood stasis. There are several easily recognizable herbal pairs within the formula. Huáng qín and sāng bái pí are used again and again in formulas that clear lung heat. Tiān huā fěn, guā lóu rén and jié gĕng are used together in Bèi Mŭ Guā Lóu Săn (Fritillaria and Trichosanthes Powder), which clears lung heat and moistens the lungs. Jié gĕng and gān căo beneft the throat. Mŭ dān pí, dāng guī wěi and chì sháo clear heat from the blood level and eliminate blood stasis. Even though the case is summarized very briefy, it is apparent that formula addresses the patient’s entire constellation of signs and symptoms.

Another formula, by the same name appears in the Essentials from the Silver Sea ( Yín Hăi Jīng Wēi, 银海精微). However, it uses diferent medicinals. One could make a strong argument for the use of this formula to treat the case as well.

Tuì Chì Săn (Redness-Abating Powder) from Essentials from the Silver Sea

[退赤散]

Huáng qín, huáng lián and zhī zĭ are from the formula Huáng Lián Jiĕ Dú Tāng (Coptis Toxin-Resolving Decoction). Its actions are to stop bleeding from fre and to clear heat in the upper jiao. Dāng guī and chì sháo cool and harmonize the blood to eliminate blood stasis.

Mù tōng and sāng bái pí drain heat through urination. Sāng bái pí also clears heat from the eyes when it affects the sclera. This is because sāng bái pí enters the lung channel and the sclera belongs to the qi wheel of the eyes, which is governed by the lungs. This version of Tuì Chì Săn was originally indicated for the treatment of hordeolum. Keeping in mind that hordeolum is a kind phlegm nodule; consider eliminating bái zhĭ and lián qiào from the formula.

The second case scenario is bleeding caused by trauma. The guiding formula is Xuè Fŭ Zhú Yū Tāng (Blood Mansion Stasis-Expelling Decoction). This is Wang Qingren’s classic formula from Correction of Errors in Medical Works ( Yī Lín Găi Cuò, 医林改错). The formula invigorates the blood, dispels blood stasis, regulates the qi and unblocks the channels, making it an excellent choice for acute trauma. Consider modifying the formula with medicinals specifc to the head and eyes. A good starting point would be to look at a related formula, also writen by Wang: Tōng Qiào Huó XuèTāng (Orifce-Freeing Blood-Quickening Decoction). This formula is indicated for the treatment of head trauma. Single medicinal modifcations could include chuān xiōng (Rhizoma Chuanxiong) to move blood, scaters wind and relieve head pain; or tián sānqī, which staunches bleeding and eliminates blood stasis.