Male, age 48. Initial Visit: November 15 _th, 1998

Chief Complaint: Recurrent redness and pain of the right eye for eight years, aggravated for one month.

History: Eight years prior to the treatment, the patient experienced sudden redness and pain of the right eye with mild decline in vision after drinking alcohol He was diagnosed with acute iridocyclitis (right eye) in a local hospital. After treated with oral prednisone and 1% atropine eye drops, the redness and pain of the right eye were alleviated and his vision was recovered. Thereafter, he had recurrent attacks of the symptoms, which were relieved after treatment, but gradually his vision declined. One month ago, redness and pain of the right eye recurred after drinking alcohol, with symptoms especially worse at night, along with significant decline in vision.

Signs and Symptoms: Redness and pain of the right eye, photophobia, excessive tearing and blurred vision; a bitter taste in the mouth, dry throat, agitation, irascibility a red tongue with a thin yellow coating, and a rapid pulse.

Past History: The patient was irritable, with a history of alcohol consumption for over 20 years.

Physical Examination: Unremarkable

Ophthalmologic Examination: Vision acuity: right 0.5, left 1.0. The right eye showed mixed hyperemia, keratic precipitates (KP) (++), turbid aqueous humor, unclear texture of the iris, a round pupil with a diameter of about 8 mm dilated by mydriatic eye drops, and a normal fundus.

Laboratory Examination: Unremarkable.

The patient was irritable and had a history of alcohol consumption for over 20 years, which caused damp-heat to accumulate in the liver and gallbladder that harasses the upper body and affects the clear orifices, resulting in redness, swelling and pain of the right eye. Intense heat caused qi congestion and blood stagnation, leading to pupil contraction and unclear texture of the iris. Damp-heat steamed the spirit water (aqueous humor), causing turbidity and keratic precipitate. A bitter taste in the mouth, dry throat, agitation, irascibility, a red tongue with a thin yellow coating and a rapid pulse were all indications of intense fire in the liver and gallbladder.

The disease was located in liver and gallbladder, and it belonged to an excess pattern of liver and gallbladder damp-heat.

WM diagnosis: Iridocyclitis (right eye)

TCM diagnosis: Contracted pupil due to liver and gallbladder damp-heat

This case is caused by liver and gallbladder damp-heat attacking upward to affect the eye. The root cause is damp-heat, while the branch signs are the turbid aqueous humor and pathological changes in the iris. The treatment, therefore, should focus on treating the branch symptoms and the root cause simultaneously. Mydriatic agents should also be used to prevent synechia, which may lead to pathological pupillary changes.

Principles: Clear and drain damp-heat from the liver and gallbladder

Formula: Modified Lóng Dăn Xiè Gān Tāng (Gentian Liver-Draining Decoction)

[龙胆泻肝汤加减]

[Formula Analysis]

Lóng dăn căo, huáng qín and zhī zĭ clear heat and drain fire.

Chái hú, dāng guī and shēng dì soothe the liver, invigorate blood and nourish yin.

Chăo gŭ yá and chăo mài yá regulate qi and eliminate stagnation, and also prevent the bitter and dry fire-draining medicinals from damaging yin.

Zé xiè and chē qián zĭ clear damp-heat through urine.

Tŭ fú líng and bì xiè clear and drain damp-heat.

Apply 1% atropine eye drops to the affected eye to dilate the pupil, 2 to 3 times daily.

Points: LV 3 ( tài chōng), GB 20 ( fēng chí), BL 1 ( jīng míng), tài yáng (EX-HN5), yìntáng (EX-HN3)

Method: Needle the distal points with a reducing method. Retain all the needles for 20-30 minutes after getting the sensation of qi arrival, once daily. 10 days constitute one course of treatment.

After 10 days of treatment, the symptoms of the right eye were alleviated, and the vision was signifcantly improved, with no systemic symptoms. Then the original formula was continued for another 6 days. Afterward, all symptoms subsided. The patient had a normal appetite, regular urination and defecation, a light red tongue with scanty coating and a wiry thready pulse, indicating that there was still residual heat in the body along with damage to yin fuids. Therefore, the next step in treatment plan was to nourish yin and clear heat.

Principles: Nourish yin and clear heat

Formula: Modifed Gān Lù Yĭn (Sweet Dew Beverage)

[甘露饮加减]

[Formula Analysis]

Shēng dì and shú dì huáng nourish yin, clear heat, supplement kidney and enrich essence.

Mài dōng and tiān dōng moisten the lung and nourish yin.

Shí hú engenders fluids and nourishes stomach.

Z hĭ qiào moves qi and regulates qi movement.

Huáng qín and zhī zĭ clear and resolve the residual heat.

Gān căo harmonizes all the other medicinals.

Apply 1% atropine eye drops to the affected eye to dilate the pupil, 2 to 3 times daily.