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

1. A male patient, age 27, photophobia with severe pain in his lef eye along with profuse sticky yellow discharge, hot tears, red swollen eyelids, conjunctival redness and swelling, aversion to heat, thirst with desire for drink, dry stools, short and yellow urination, a red tongue with a yellow coating and a rapid pulse.

What is the preferred formula for this disease?

A. Modifed Yín Qiào Săn (Lonicera and Forsythia Powder)

B. Modifed Sāng Jú Yĭn (Mulberry Leaf and Chrysanthemum Beverage)

C. Modifed Fáng Fēng Tōng Shèng Săn (Ledebouriella Sage-Inspired Powder)

D. Modifed Xiè Fèi Yĭn (Lung-Clearing Beverage)

2. A female patient, age 30, suffered from burning pain, itching, photophobia and conjunctival redness and swelling in her right eye with hot tears and very sticky discharge. Other signs and symptoms included headache, a stufy nose, aversion to cold, fever, thirst with desire for drink, constipation, dark urine, a red tongue with a yellow coating and a rapid pulse.

What is the preferred formula for this disease?

A. Modifed Yín Qiào Săn (Lonicera and Forsythia Powder)

B. Modifed Sāng Jú Yĭn (Mulberry Leaf and Chrysanthemum Beverage)

C. Modifed Fáng Fēng Tōng Shèng Săn (Ledebouriella Sage-Inspired Powder)

D. Modifed Xiè Fèi Yĭn (Lung-Clearing Beverage)

3. A female patient, age 18, presented with dryness, itching, stabbing pain, photophobia, tearing, profuse sticky discharge, conjunctival redness, and slightly swollen eyelid in her lef eye a day ago. The tongue was red with a thin and slightly yellow coating, and the pulse was foating and rapid.

What is the best treatment for this disease?

A. scater wind, clear heat and eliminate redness.

B. clear heat, scater wind and eliminate redness.

C. scater wind and clear heat to release exterior and interior

D. clear heat, drain fire and resolve toxins.

1. D

2. C

3. A

Two case scenarios are presented to expand our understanding of the treatment of bacterial conjunctivitis. The frst case centers on a presentation of wind heat with fre toxin. The implied treatment principle, therefore, is to clear heat and toxins, dissipate wind heat pathogen and alleviate pain.

The formula is modified Xiè Fèi Yĭn (Lung-Draining Beverage). The similarly named Xiè Fèi Tāng (Lung-Clearing Decoction) is discussed in the chapter on Phlyctenular Keratoconjunctivitis.

Formula: Xiè Fèi Yĭn (Lung-Draining Beverage) ³

[泻肺饮]

Modifications for this formula includes the following:

● For cases with marked conjunctival congestion and edema add jié gĕng (Radix Platycodonis) 10g, tíng lì zĭ (Semen Lepidii) 10g, shēng dì (Radix Rehmanniae) 10g and mŭ dān pí (Cortex Moutan) 10g.

● For cases with constipation add dà huáng (Radix et Rhizoma Rhei) 10g.

Xiè Fèi Tāng was recorded in the Ming Dynasty classic A Close Examination of thePrecious Classic [on Ophthalmology] ( Shĕn Shì Yáo Hán, 审视瑶函), while Xiè Fèi Yĭn was recorded hundreds of years later in the Qing Dynasty classic the Compilation ofOphthalmology ( Yăn Kē Zuăn Yào, 眼科纂要). This creates a historical framework for observing the clinical applications and efcacy of the sāng bái pí and huáng qín. The paring has been combined for the treatment of eye diseases, at the very least, for 7 millennia. The formulas then veer of in diferent directions.

Xiè Fèi Tāng also includes dì gŭ pí, mài dōng and jié gĕng. It treats metals gan due to lung yin defciency or excessive heat in the lung channel. In contrast, Xiè Fèi Yĭn uses cold and draining shí gāo and zhī zĭ, light, dispersing lián qiào, jīng jiè and fáng fēng, and fragrant pain-relieving bái zhĭ and qiāng huó.

The key to understanding the presentation in the second case is the juxtaposition of interior/exterior excess. The aversion to cold and fever are clear signs of exterior cold pathogen, while the thirst, dark urine, constipation and the red tongue with yellow coating are clear signs of interior excess. For these reasons, Modifed Fáng FēngTōng Shèng Săn (Ledebouriella Sage-Inspired Powder) is selected. The actions of the formula are to disperse wind, release the exterior, drain heat and unblock the bowels. Based on the narrative in this chapter, the modifcations might be the addition of sāngbái pí and huáng qín.