OM301 

Anatomy and Physiology of the Nose

►1. Nasal obstruction

► 2. Nasal discharge

It is a common clinical symptom caused by many reasons and happening in various diseases. In mild cases, only nasal discharge is mixed with blood, and in severe cases it would endanger the patient’s life. In Chinese medicine, it is called “Bi Nu”

Clinical Manifestations

In mild cases, there is bloody nasal discharge or slight nasal bleeding. In severe cases, there is gushing nasal bleeding, very often at sudden onset. The blood can flow out from the anterior nostrils and also can flow into the throat via posterior nasal nostrils. The nasal bleeding can be intermittent, recurrent and continuous, and can happen in one nostril and also can happen in both nostrils.

Type and Treatment

(1) HEAT PREPONDERANCE IN LU MERIDIAN

Symptoms and Signs:

Dry nostrils, dry mouth, sore throat, a little nasal bleeding, nasal blood drops or bloody nasal discharge, cough, a little sputum, red tongue, thin and white tongue coating, rapid pulse.

Therapeutic Method: Expelling wind and clarifying heat for cooling blood and stopping bleeding.

SANG JU YIN

Sang Ye 7.5 g

Ju Hua 3 g

Xing Ren 6 g

Lian Qiao 5 g

Bo He 2.5 g

Jie Geng 6 g

Gan Cao 2.5 g

Lu Gen 6 g

Plus: Bai mao gen, Xue yu tang

(2) HYPERACTIVE HEAT IN THE STOMACH

Symptoms and Signs:

Profuse and gushing nasal bleeding, dry mouth, foul breath, thirst, preference in drinking water, constipation, yellowish urine, red tongue, yellow tongue coating, full and rapid pulse.

Therapeutic Method: Clearing the stomach and reducing fire for cooling blood and stopping bleeding.

QING WEI SAN

• Dang gui 10g

• Huang lian 12g

• Shen di 20g

• Mu dan pi 10g

• Sheng ma 10g

• Plus: Jin yin hua, lian qiao, Bai mao ge

(3) ASCENSION OF LIVER FIRE Symptoms and Signs: Profuse nasal bleeding, frequent reoccurance, headache, dizziness, irritability, frustration, bitter taste in the mouth, dry throat, red tongue, yellow tongue coating, wiry and rapid pulse. Therapeutic Method, Clarifying the liver and reducing fire for cooling blood and stopping bleeding.

LONG DAN XIE GAN TANG

•LONG DAN CAO 6 G

•HUANG QIN 9 G

•ZHI ZI 9 G

•ZE XIE 12 G

•MU TONG * 9 G

•CHE QIAN ZI 9 G

•DANG GUI 3 G

•SHENG DI HUANG 9 G

•CHAI HU 6 G

•SHENG GAN CAO 6 G

(4) YIN DEFICIENCY IN LIVER AND KD Symptoms and Signs: Nasal bleeding in light red color, intermittent occurrence, dizziness, blurring of vision, tinnitus, palpitation, warm sensation in five centers, red and dry tongue, scanty tongue coating, thready and rapid pulse. Therapeutic Method: Nourishing the liver and kidney for tonifying blood and stopping bleeding.

ZHI BAI DI HUANG WAN

•ZHIMU10 G

•HUANGBAI 10G

•SHENG DI HUANG 15G

•SHAN ZHU YU 10G

•SHAN YAO 10G

•FU LING 10G

•ZE XIE 10G

•MU DAN PI 6G

(5) DEFICIENCY OF SPLEEN QI

Symptoms and Signs: 

Bloody exudate of the nose in light red color, pale and lustrousless complexion, poor appetite, lassitude, pale tongue, thin and white tongue coating, slow and feeble pulse.

Therapeutic Method: Strengthening the spleen and benefiting Qi for tonifying blood and stopping bleeding.

GUI PI TANG

•DANG SHEN 15 G

•HUANG QI 12 G

•BAI ZHU 9 G

•ZHI GAN CAO 8 G

•FU SHEN 9 G

•SUAN ZAO REN 30 G

•LONG YAN ROU 12 G

•DANG GUI 12 G

•YUAN ZHI 12 G

•MU XIANG 9 G

•SHENG JIANG 6 G

•DA ZAO 3–5 PIECES

►It refers to the condition in which pathogenic factor in nasal mucosa lingers and is unable to be expelled for a long time.

Clinical Manifestations

1. Intermittent, alternative or continuous nasal obstruction.

2. Swelling or hypertrophy of nasal mucosa, which is as big as mulberry fruit and in dark-red colour, especially in inferior nasal concha.

3. Mucous excretion in nasal cavity, difficult to be blown out.

Type and Treatment

• 1) Qi deficiency of the lung and spleen, with lingering evils in the nose

►Symptoms and Signs, Alternative or intermittent nasal obstruction aggravated by cold, scanty white nasal discharge,

►accompanied by cough, thin sputum, poor appetite, loose stool, pale tongue, thin and white tongue coating, slow and feeble pulse.

►Therapeutic Method, Nourishing the lung and spleen. Removing the evils and opening the orifice.

SI JUN ZI TANG + CANG ER ZI SAN

•DANGSHEN15G ,

•BAIZHU 10 G

•FULING 10G

•GANCAO 3G

•CANG ER ZI 10G

•XINYI 6 G,

•BAI ZHI 10G

•BO HE6G

Modification, swelling of the nasal mucosa with pale colour. Add Gui zhi 6g

(2) Syndrome of stagnated heat of lung meridian

Main Symptoms And Signs: Intermittent Nasal Obstruction, Speaking In Low Voice, Yellowish And Thick Nasal Discharge With Sticky Quality And Scanty Quantity, Pain And Distension Of Head, Dry Throat, Cough, Yellow, Thick And Scanty Sputum Which Is Not Easily Expectorated, Breathing With Opening Mouth In Severe Cases And Restlessness Which Affects Sleeping, Enlargement Of Inferior Nasal Conchae And Edema Of Mucosa With Reddish Colour Found During Examination, •Reddish Tongue With Yellowish Fur, Rapid Pulse. •Therapeutic Methods: Dispelling Wind And Dispersing The Lung, Clearing Away Heat And Removing Obstruction of The Orifice.

CANGERZI SAN MODIFIED

•Cangerzi10 G ,

•Xinyi 6 G,

•Baizhi10 G ,

•Bohe 6 G,

•Juhua 10 G,

•Jinyinhua 10 G ,

•Huangqin 6 G ,

 •Gancao 3 G Modification:

 •Fangfeng10 G

In the case of severe heat and yellowish nasal discharge, add Jinyinhua10g, Pugongying 10 g and Daqingye15 g; in the case of headache, add 6 g of Chuanxiong; in the case of cough and profuse sputum, add Chuanbeimu3 g, Qianhu10 g.

(3) Syndrome of excessive dampness due to asthenia of the spleen

•Main Symptoms And Signs, Nasal Obstruction, Speaking In Low Voice, Profuse And Thick Nasal Discharge, Longer Course Of Illness, Hyposmia, Anorexia, Loose Stool, Thoracic And Epigastric Distension With Tightness, Lassitude, Fatigue, Pale Tongue With Whitish And Greasy Fur And Soft Pulse.

•Therapeutic Methods: Strengthening The Spleen To Remove Dampness, Eliminating Turbidity To Dredge Orifice.

modified Shen ling Bai zhu San

REN SHEN 10 G

•BAI ZHU 10 G

•FU LING 10 G

•SHAN YAO 10 G

•ZHIGAN CAO 10 G

•BAI BIANDOU 7.5 G

•YI YIREN 5 G

•LIAN ZI 5 G

•SHA REN 5 G

•JIEGENG5 G

•SHICHANGPU 6 G

• XINYI 6 G,

•CANGZHU 6 G

•GANCAO 3 G .

modified Shen ling Bai zhu San Modification: In summer, add Huoxiang10 g, Peilan10 g of and Xiangru10 g; in the case of aversion to cold, add Guizhi10 g of and Xixin3 g

Page 226

Male 25

CC: Yellow nasal discharge for more than 10 years

This patient was diagnosed with nasoshinusitis, previous treatment was not satisfactory.

Examination: Thin tongue coating, slightly slow pulse

Page 228

Female 55

CC: Nasal obstruction with thick and stick discharge for seven years

This patient has nasal obstruction with think and stick discharge for seven years; treatment by Chinese and western medicine was not very effective. She had a dark complexion, her nose was obstructed with thick and stick discharge that was made worse with repeated exposure to cold or without obvious reason. She had coughing with an aversion to cold, lacrimation, and wheezing when the attack was serious.

Examination: tongue tip is red, coating thick sticky and yellow in the middle, pulse wiry, proximal(Chi) position weak.

Page 229

Male 28

CC: Runny nose in the morning and evening for one year

This patient had a runny and itchy nose in the morning and evening, aversion to cold, and easily came down with the common cold. He was diagnosed with allergic rhinitis and was treated in the ENT department with anti- allergic drugs, but it was not effective.

Examination: Pale tongue, white coating, thready pulse

Anatomy and Physiology of the Nose

Vision change

Pain and Itching

Redness and Swelling

Secretion and Tears

Blepharospasm is blinking or other eyelid movements, like twitching, that you can’t control.

Eyelid twitching usually goes away on its own. But people with blepharospasm can develop severe and chronic (long-term) eyelid twitching.

Clinical Manifestations

 Blinking or twitching eyelid.

Type and Treatment

1. Blood deficiency generate wind

Main Symptoms and Signs

Blinking or twitching eyelid, which can’t control.

Pale face, tire, dizziness, poor memory

Pale tongue, whitish thin coating, deep thin pulse

Therapeutic Methods Nourishing blood, distinguish wind

.

Si Wu Tang

Dang gui 15g

 Chuan xiong 15g

 Bai shao 15g

 Shu Di 15g

 plus, Tian ma, gou teng

2. Blood and Qi deficiency generate wind

Blinking or twitching eyelid, which can’t control.

 Pale face, tire, dizziness, poor memory, short of breath, poor appetite. Loss stool

 Pale tongue, whitish thin coating, deep weak pulse

 Therapeutic Methods tonify Qi, Nourishing blood, distinguish wind

Gui pi tang

Dang Shen 15 g

Huang Qi 12 g

Bai Zhu 9 g

Zhi Gan Cao 8 g

Fu Shen 9 g

Suan Zao Ren 30 g

Long Yan Rou 12 g

Dang Gui 12 g

Yuan Zhi 12 g

Mu Xiang 9 g

Sheng Jiang 6 g

Da Zao 3–5 pieces

 Plus Tian ma, Gou teng

The disease means there are difficulties in raising the upper eyelid that affect vision because the dropping eyelid covers the pupil partly or completely.

 The disease is classified into two types: congenital and acquired.

 The acquired type is usually due to injury to the levator muscle of the upper eyelid or oculomotor nerve or due to myasthenia gravis (weak muscles) of unknown etiology.

Clinical Manifestations

The eyelid is loosely dropping, and the patient finds it difficult to raise the eyelid.

 The disease may affect one eye or both eyes.

 In mild cases, the pupil is half covered. In severe cases, the upper eyelid entirely loses its ability to raise itself and covers the whole cornea.

 The patient usually takes a characteristic posture with the head thrown back in seeing things.

Type and Treatment

(1) Type of insufficiency of the spleen-Qi.

Main Symptoms and Signs

It usually both the upper eyelids are dropping. The dropping is mild in the morning but gradually becomes severe. It becomes mild after resting but worse after working. In some cases , the disease may be accompanied by disturbance in eye movement.

 Other symptoms include lassitude, general weakness, pale and thick tongue with tooth print, thin and white fur, small and weak pulse.

 Therapeutic Method: Strengthening the spleen and benefit eyes.

.

Bu zhong Yi qi Tang

Ren Shen 9 g

Huang Qi 12 g

Bai Zhu 9 g

Zhi Gan Cao 3 g

Dang Gui 6 g

Chen Pi 6 g

Sheng Ma 3 g

Chai Hu 3 g

(2) Invasion of channels and vessels by pathogenic wind.

Symptoms and Signs:

 Sudden onset and obvious dropping of upper eyelid, which usually affects one eye. There is hypoesthesia or anesthesia in the eyelid skin, with disturbance in eye movement, headache, and feeling of fullness in the head.

 The tongue is pink with thin white fur and the pulse floating.

 Therapeutic Method: Expelling wind, regulating blood flow and removing obstruction in the channels

Jing fang bai du san Modified

Plus: Bai zhu 10g, Dang gui 10g, Bai shao10g

Stye(external Hordeolum) is a kind of acute inflammatory infection of the glands of the eyelids.

 Clinically the mainly the symptoms of swelling, pain and induration (hardness) in the infected part of the eyelids.

Clinical Manifestations

 At the early stage, there is pain in the eyelids which is followed by local swelling and redness. Nodule may be palpated with tenderness.

 In the later stage yellow or yellowish pustule is formed at the part of the eyelash roots.

Type and Treatment

1. Pathogenic Wind-heat Invasion of Eyelid

Main Symptoms and Signs

  Main Symptoms and Signs:

  Local slight redness, swelling and itching of the eyelid with a palpable induration at the initial stage,

 often accompanied by headache and fever; thin yellowish tongue coating and floating rapid pulse.

 Therapeutic Method: Removing pathogenic wind-heat.

The Modified Yin Qiao San

Jin Yin Hua 9 g

Lian Qiao9 g

JieGeng6 g

Bo He 6 g

Zhu Ye 4 g

Niu Bang Zi 9 g

Gan Cao 5 g

Jing Jie5 g

Dan Dou Chi 5 g

All herbs are cooked with Lu Gen

Modification

 severe pathogenic wind, Sangye 10g and of Juhua10g are added;

 severe pathogenic heat, more Jinyinhua and Lianqiao are applied plus 10 g of Huangqin;

 pain is serious, of Ruxiang 6g and of Moyao 6g

2. Syndrome of Pathogenic Heat Invasion of Eye

Main Symptoms and Signs:

  Local redness, swelling and severe pain in the eyelid, larger palpebral induration with a burning sensation, tender pain and a visible yellow-white pus head,

 often accompanied with fever, thirst, constipation and yellowish urine; yellowish tongue coating and rapid pulse.

 Therapeutic Methods: Removing noxious heat and purging fire.

The modified Huang lian Jie du Tang

Huanglian 6 g, Huangqin 10 g, Huangbai 10 g, Zhi Zi 10g

 Plus: Pugongying 15 g, Zihuadiding 15 g, Danggui 10 g, and Mudanpi 10 g.

 Modification

 constipation Dahuang 6 g

 with thirsty feeling, Tianhuafen 10 g;

 local eyelid being purple and dark Ruxiang 6 g of and Moyao 6g

 if the pus is not ruptured(broken), Zaojiaoci 6 g

3. Syndrome of Latent Pathogenic Heat in Spleen and Stomach

Main Symptoms and Signs:

  Mild redness, swelling and pain in the eyelid and a small induration which does not rupture for a long time or ruptures without any healing.

 Therapeutic Method: Strengthening Spleen qi to eliminate pathogen heat.

The modified Bu Zhong  Yi Qi Tang

Ren Shen 9 g

Huang Qi 12 g

Bai Zhu 9 g

Zhi Gan Cao 3 g

Dang Gui 6 g

Chen Pi 6 g

Sheng Ma 3 g

Chai Hu 3 g

Plus: Zaojiaoci 6 g, Jinyinhua 10 g, Huangqin 10 g, Fangfeng 6 g.

 Modification

 If the redness and swelling is obvious, Pugongying 15 g  and Lianqiao 10 g are added.

4. Syndrome of Asthenia of Spleen and Stomach

Main Symptoms and Signs：

 Common attack in children with redness, swelling and mild pain of the eyelid, a small induration and easy recurrence, accompanied by dim complexion, tired, anorexia and loose stool; pale tongue and thin pulse.

 Therapeutic Methods: Strengthening the spleen and nourishing qi removing pathogen.

The Modified Shen ling Bai zhu san

Ren Shen 10 g

Bai Zhu 10 g

Fu Ling 10 g

Shan Yao 10 g

Zhi Gan Cao 10 g

Bai Bian Dou 7.5 g

Yi Yi Ren 5 g

Lian Zi 5 g

Sha Ren 5 g

Jie Geng 5 g

Plus: Fangfeng 6 g, Jingjie 6 g, Lianqiao 10 g, and Jinyinhua 10 g.

Modification

 For the indigestion, Shenqu 10 g, Shanzha 10 g, Maiya 10 g and Ji nei jin 6 g

 stagnant pathogenic heat, Zhimu10 g and Huangqin 10 g are added.

External Therapies

(1) Damp-heat Compress: For initial hordeolum or cases without suppuration, this hot-moistening compress is applied to the affected eye with hot water or the hot solution from the dregs of the oral decoction.

 (2) The infectious eye put with the Xiong Huang powder mixed with vinegar.

 (3) For hordeolum at the initial stage, a proper amount of Pugongying is pounded and compressed on the sick part of the eye.

 Dry eyes is a lacrimal film abnormality caused by decreased lacrimal secretions, or hyperactive lacrimal evaporation.

 The condition is present with symptoms of discomfort in the eye which may accompany ocular surface diseases.

 If patients have isolated symptoms of dry eyes, they may recover with rest or short-term use of artificial tears.

 If there is no presence of ocular surface damage and/or any other local or systemic causes, it is called simple dry eyes.

Clinical Manifestations

Common ocular symptoms include sensation of foreign bodies in the eyes, dryness, burning, swelling, photophobia, redness, and so on.

 If there are symptoms, patients should be asked in detail their history, in order to find the underlying cause.

 Dry eye may not affect the visual acuity in early stages, and at later stages, lead to a corneal ulcer, corneal thinning, perforation, and in some cases a secondary bacterial infection.

Type and Treatment

(1) Insufficiency of Lung Yin

 Main Symptoms and Signs：

 Dry eyes, unable to see for an extended time, mild hyperemia of the conjunctiva, point lesions of the corneal superficial layer, relapse and poor recovery,

 dry cough, dry pharynx and constipation, red tongue, and dry, thready rapid pulse.

 Treatment Principle:

 Enrich yin and moisten the lung, nourishing eyes

Yang Yin Qing Fei Tang

Mu  dan pi 10g

 Bai shao 10g

 Gan cao10g

 Sheng di 15g

 Bo he 6g

 Xuan shen 10g

 Mai men dong 15g

 Bei mu 10g

 Tai zi shen 15g

With dry throat and mouth add bei sha shen 15g and shi hu 10g

With constipation add jue ming zi 15g

Main Symptoms and Signs：

 Dry eyes with discomfort, photophobia, symptoms increased after prolonged use, dry mouth with scant saliva,

 lumbago, weak and/or painful knees, dizziness and tinnitus, insomnia with profuse dreams, red tongue with little coating, thready pulse.

 Treatment Principle

 Nourish the liver and kidney, nourishing eyes

QI Ju Di Huang Wan

Gou qi zi 15g

 Ju hua 10g

 Shu di 10g

 Shangzhuyu 10g

 Shangyao 15g

 Ze xie 19g

 Fu ling 10g

 Mu dan pi 10g

With dry mouth add mai men dong 10g, xuan shen 10g

With hyperemia of conjunctive add sang bai pi 9g , di gu pi 10g

Dysfunction of the lacrimal apparatus without any organic pathologic change of the lacrimal passage.

 When the lacrimal passage is douched, the fluid passes freely.

Clinical Manifestations

No red or swelling eye, time to time tearing ,which may become worse when the eye is exposed to wind, but with no photophobia.

Type and Treatment

(1) liver Blood deficiency with wind attacking

Symptoms and Signs:

 tearing time to time ,which may become worse when the eye is exposed to wind,

 blurred vision, dizziness, pale face

 deep and thready pulse, pale tongue.

tonifying the liver, dispersing wind arresting of secretion and controlling tears.

Shu di 10g

 Chuang xiong 10g

 Bai shao 12g

 Dang gui 12g

Bai zhi 10g

(2) Type of Qi and blood deficiency.

Tearing time to time, thin and clear, eyes tired when use longtime

 blurred vision, dizziness, pale face, short of breath,

 pale tongue, deep and thready pulse,

 tonifying Qi and blood, arresting of secretion and controlling tears.

Ba zhen Tang

Ren shen 10g

Bai zhu 12g

Fu ling 10g

Zhi Gan cao 6g

Shu di 10g

Chuan xiong 10g

Bai shao 12g

Dang gui 12g

If tearing worse when the eye is exposed to wind, adding Bai zhi 10g, fang feng,10, Juhua 8g

 If more cold, adding Xi xin, Guizhi, Ba ji tian

(3) Type of Kidney and liver deficiency.

Tearing time to time, thin and clear

 blurred vision, dizziness, tinnitus, pale face, low back soreness,

 pale tongue, deep and thready pulse,

 tonifying kidney and liver, arresting of secretion and controlling tears.

Zuo gui wan

Shu Di Huang 24g 

Shan Yao  12g 

Gou Qi Zi  12g 

Shan Zhu Yu 12g 

Chuan Niu Xi 12g 

Tu Si Zi 12g 

Lu Jiao Jiao 12g 

Gui Ban Jiao 12g

If more Tearing add wu wei zi and fangfeng

 If more cold feeling, add ba ji tian, rou cong rong

 Strabismus can be divided into congenital strabismus and acquired strabismus. Due to congental hypogenesis, congenital strabismus is mainly treated with surgical operation.

 This chapter will only discuss the acquired strabismus. Because of the injuries to the nerves and muscles, acquired strabismus is characterized by limited eye movement, deviation of the eye and diplopia(double vision).

Clinical Manifestations

 It usually has a sudden onset, deviation of the eye, and limited movement of the eyeball. In most cases, it attacks one of the eyes.

 The patient experiences diplopia caused by sudden damage of binocular(both eyes) vision, dizziness, nausea or vomiting.

 After a period of time, the eyes may return to normal, and diplopia may disappear.

Type and Treatment

(1) Type of invasion into the collaterals by pathogenic wind.

Symptoms and Signs:

 Sudden deviation of the eyeball, limited eye movement, diplopia, headache, aversion to cold, fever, thin and whiteish fur, and floating pulse

 Therapeutic Methods: Dispersing pathogenic wind and dredging the channel

Yu Ping Feng San and Qian Zheng San

 Huang qi

 Bai zhu

 Fang Feng

 Quan xie

(2) wind-phlegm blocking the collaterals

Symptoms and Signs:

 Eye syndromes is similar to the above condition, may be accompanied by shortness of breath, nausea and vomiting, poor appetite, vomiting sputum,

 white-greasy coating, wiry slippery pulse.

 Treatment Principle:

 Dispel wind and eliminate dampness, resolve phlegm and dredge collaterals.

Qiang Huo Sheng Shi Tang and Qian Zheng San

Qiang huo

 Du Huo

 Gao ben

 Fang Feng

 Man jing zi

 Chuan xiong

 Gan Cao

(3) Stasis and Obstruction of the Channels and Collaterals

Syndrome Characteristics

 Most of the causes are associated with head and face direct trauma, direct injury to the eye or stroke. double vision, dark red tongue with ecchyrnosis, thin white coating, wiry rapid pulse.

 Treatment Principle

 Invigorate blood and move qi, resolve stasis and dredge collaterals.

Tao Hong Si Wu Tang

 Tao ren 15g

 Hong hua 15g

 Dang gui 15g

 Shu di 15g

 Bai shao 15g

 Chuan xiong 15g

(4) Yin-Deficiency With Yang Hyperactivity

Syndrome Characteristics

 Chronic, gradual onset, often presents with a history of hypertension, dizziness, eye movement disorder, double vision, red tongue with thin coating, thready rapid pulse.

 Treatment Principle

 Nourish yin and subdue yang, calm the liver and extinguish wind.

Zuo gui wan  modified

Shu Di Huang 24g 

 Shan Yao  12g 

 Gou Qi Zi  120g 

 Shan Zhu Yu 12g 

 Chuan Niu Xi 12g 

 Tu Si Zi 12g 

 Lu Jiao Jiao 12g 

 Gui Ban Jiao 12g

 Mu li 30g

Acute conjunctivitis is a common ocular disease as a result of bacterial infection. The disease is very infective and often epidemic in the warm seasons of a year.

Clinical Manifestations

( 1) The symptoms in mild cases include itching and uncomfortable feeling of the affected eye. In severe cases, there is photophobia with a burning and heavy sensation of the eyelid.

( 2) Congestion occurs, even with edema, swelling of the lid and large amount of mucous and purulent secretion in the conjunctival sac. In some cases, there may be hemorrhage.

(3) The disease is usually of bilateral type or one eye after another.

Usually, a mild start comes to its utmost in 3 to 4 days and relieves in 8 to 14 days.

Type and Treatment

1 . Syndrome of Pathogenic Wind Exceeding Pathogenic Heat

Main Symptoms and Signs

 Slight swelling of the lid, mild redness of the bulbar conjunctiva with itching and unsmooth feeling, photophobia and more tears, headache and stuffy nose, fever and aversion to wind; thin and whitish or light yellowish tongue coating and floating pulse.

 Therapeutic Method Expelling wind -heat.

The modified Qiang huo Sheng Shi Tang

Qiang Huo 6 g

Du Huo 6 g

Fang Feng 3 g

Gao Ben 3 g

Chuan Xiong 3 g

Man Jing Zi 2 g

 Zhi Gan Cao 3 g

Plus:

Jingjie 6 g,

Chaihu  6 g,

Bohe 6 g,

Baizhi 6 g,

Chuanxiong 6 g,

Modification

 In the cases of less pathegenic wind, Qianghuo and Duhuo are removed

 obvious pathogenic heat,  add Jinyinhua , Lianqiao10 g and Juhua 6.

2. Syndrome of Pathogenic Heat Exceeding Pathogenic Wind

Main Symptoms and Signs

 Serious redness and swelling of the bulbar conjunctiva with hot tears and mucopurulent secretion, eye lids swelling, restlessness and thirst, yellowish urine and constipation; red tongue with yellowish coating and rapid strong pulse.

 Therapeutic Method

 Removing pathogenic heat and fire accompanying dispelling wind.

The modified Xie Bai San

Di gu pi 10g

 Sang Bai pi 10g

 Gan Cao  3 g

Plus Shigao 20 g,

Huang qin 10 g,

Lian qiao 10 g,

Jing jie 6g,  

Modification

In the cases of excessive toxic heat, Jinyinhua10 g and Pugongying15 g and Yuxingcao 15 g are added;

 in the cases of serious constipation, Dahuang 10g of and Mangxiao6 g are added.

Fumigation-washing Method

20 g of Yejuhua and 60 g of Pugongying , Cheqiancao , Zihuadiding , all the ingredients are decocted with water for the fumigation and washing of the eye once or twice every day.

 It is applicable to the severe cases of the disease.

Glaucoma

Glaucoma is an ocular disease caused by increase of intraocular pressure leading to the injury of the visual function.

It is classified into three categories.

They are primary glaucoma, congenital glaucoma and secondary glaucoma.

The first two categories involve both eyes while the secondary one occurs mainly in one eye.

Page218

Female 40

CC: Congestion, swelling and pain of the eyes for four days

The patient’s eyes are congested, swollen and painful due to photophobia畏光 and lacrimation it is difficult for her to open them. She had blurred vision for four days already. Gentamy intramuscular injection and choromycetin eye drops did not help.

Examination: Swelling of the eyelids, seriously congested palpebral眼睑  conjunctiva, big paths of bleeding at the bulbar conjunctive on the temporal side of the eyeballs, and a large amount of sticky discharge. Red tongue, wiry rapid pulse.

Page 221

Female 31

CC: Decline of vision for 22years, worse in the past four years

Twenty-two years ago, this patient suffered from acute hepatitis. After it was cured, she noticed that her vision began to decline and gradually became worse. Tongren Hospital diagnosed her myopia. Four years ago after giving birth, her vision in both eyes was 0.1 and there were excess secretions. Appetite and sleep are normal.

Examination: Pale dark tongue with a thin white coating, thready pulse

Page 222

Male 9

CC: Poor distance vision for 4 years

He could not see distant objects clearly, sometimes he had double vision and the eyes were easily fatigued. He had worn glasses for one year. In the past, he had a bad habit of reading at a very short distance. His appetite is good, urination and defections are normal.

Examination: Examination showed the myopia近视of right eye -1.50 And astigmatism散光  + 1.50; the myopia of the left eye -2.00 and astigmatism +0.75, and the corrected vision of both eyes 1.2. At both sides of the first cervical vertebra, there are nodules and rope-like objects felt along with tenderness. The tip of the tongue is red, costing thin, and pulse thready and wiry.

Page 225

Female 28

CC: Mild blurred vision for four months

This patient was engaged in mental work for a long time and very often worked overtime. Due to eyestrain she had blurred vision and visual fatigue. She was listless with poor appetite and slept poorly.

Examination: Pale tongue, white coating, thready weak pulse