​The Treatment of Seasonal Conjunctivitis with TCM

​The Treatment of Seasonal Conjunctivitis with TCM

Cara O. Frank, L.OM.

The following is an excerpt from my book, TCM Case Histories: Eye, Ear, Nose and Throat Disorders, published by Peoples Medical Publishing House. 

Springtime is here and with it, allergy season. Aside from common symtpoms of runny and stuffy nose, many people are bothered by red,itchy eyes. This recurrent seasonal allergic conjunctivitis is referred to as Vernal keratoconjunctivitis (VKC), seasonal conjunctivitis or spring catarrh.  The main clinical symptoms of VKC are intense itching in the eyes, large “cobblestone” papillae on the palpebral conjunctiva, and brown or dull red jelly-like thickening of the bulbar conjunctiva. The symptoms usually occur bilaterally. This disease is seasonal, typically occurring during the spring and summer months, with the symptoms diminishing or disappearing during autumn and winter. Generally, the onset of VKC occurs during preadolescence. It is more common among men than women, and those with other inflammatory allergic disorders are at higher risk to have the condition.

In TCM, this condition is associated with a variety of Chinese medical patterns. The most common patterns are a combination of insecurity of lung-wei defensive qi, along with wind-heat attacking the eyes. The surface vacuity allows wind heat to invade and lodge in the striae and interstitial spaces of the eyelid and the canthus.

Other patterns include: damp-heat accumulation in the spleen-stomach coupled with pathogenic wind invasion. In these cases damp and heat are conducted with the clear yang from the spleen stomach and expressed in the eyes, causing a vulnerability to external invasion by wind, which leads to accumulation and stagnation of pathogens in the eyelids and bulbar conjunctiva. Additionally, internal wind can occur due to deficiency of liver blood, which may be exacerbated by seasonal changes in the constitution, or weather.

This disease is predominantly related to the disorders of the lungs, spleen, and stomach. The patterns reflect a state of deficiency, excess, or mixed deficiency and excess.

COMMON CLINICAL PATTERNS AND FORMULAS

External contraction of wind-heat: Modified Xiāo Fēng Săn (Wind-Dispersing Powder)

Damp-heat complex: Modified Chú Shī Tāng (Dampness Eliminating Decoction)

Blood deficiency generating wind: Modified Sì Wù Tāng (Four Substances Decoction)

Spleen deficiency with dampness: Modified Shēn Líng Bái Zhú Săn (Ginseng, Poria and Atractylodes Macrocephalae Powder)

CASE STUDY

Male, age 12. Initial Visit: April 15th, 2006

Chief Complaint: Recurrent redness of the eyes with intense itching over a course of five years.

History: Five years ago the patient started experiencing redness in the eyes with unbearable itching and sticky secretions. His symptoms were worse during spring and summer, but relieved during autumn and winter. He was treated by various doctors and had tried Rifampicin (antibiotic), cortisone acetate and sodium cromoglicate (antihistamine) eye drops, but these had no lasting effects and the disease continued to come on go on a seasonal basis.

Signs and Symptoms: The conjunctiva was a dirty red color, with intense itching and sticky, stringy secretions. He had a sallow complexion, thin body, slightly loose stools, a light red tongue with a thin, white, slightly greasy coating, and a wiry, weak pulse.

Past History: A weak constitution and susceptibility to catching colds. The patient did not smoke or drink.

Ophthalmologic Examination: Bilateral vision 1.2. Bilateral turbid hyperemia of palpebral conjunctiva, with papillae of different sizes packed together forming a rough surface. Dark red bulbar conjunctiva with a jelly-like prominence at the corneal limbus, clear central cornea, normal anterior chamber and pupils. No abnormalities of the fundus.

Pattern Differentiation

The patient historically had a weak constitution and susceptibility to catching colds. He presented with redness and intense itching of the eyes, with very sticky, stringy secretions. The disease was chronic and recurrent for the last five years. His other symptoms included: sallow complexion, thin body, light red tongue with thin, white and slightly greasy coating, and a wiry, weak pulse.

The patient’s spleen deficiency and insufficiency of qi and blood contributed to his sallow complexion and thin body. Spleen deficiency failing to effectively transport fluids resulted in pathogenic dampness brewing internally, which accumulated and attacked upward affecting the eyes, leading to the red conjunctiva, intense itching and secretions. Spleen deficiency with dampness brought about slightly loose stools, light red tongue with thin white and slightly greasy fur, thready and weak pulse.

This disease is primarily an issue of the spleen, but also involves the liver and lungs. It belongs to a pattern of spleen deficiency and weakness of the qi, with damp accumulation. This is a mixed case of root deficiency and branch excess.

Diagnosis

WM diagnosis: Vernal conjunctivitis

TCM diagnosis: Seasonal eye itching due to spleen deficiency and qi weakness with damp accumulation

Clinical Treatment

The clinical manifestations in this case showed a root deficiency and branch excess. The treatment principle, therefore, should focus on treating the root and branch simultaneously by fortifying the spleen and boosting qi, dispelling dampness and relieving itching. In addition, anti-histamine eye drops can be used to stop itching and prevent this disease from recurring.

Principles: Fortify the spleen and boost qi, dispel dampness and relieve itching Formula: Modified Bŭ Zhōng Yì Qì Tāng (Center-Supplementing and Qi-Boosting Decoction)

[补中益气汤]

党参 dăng shēn 15g Radix Codonopsis
黄芪 huáng qí 15g Radix Astragali
白术 bái zhú 10g Rhizoma Atractylodis Macrocephalae
柴胡 chái hú 6g Radix Bupleuri
当归 dāng guī 6g Radix Angelicae Sinensis
陈皮 chén pí 6g Pericarpium Citri Reticulatae
苦参 kŭ shēn 6g Radix Sophorae Flavescentis
蛇床子 shé chuáng zĭ 6g Fructus Cnidii
白鲜皮 bái xiān pí 10g Cortex Dictamni
地肤子 dì fū zĭ 10g Fructus Kochiae
升麻 shēng má 6g Rhizoma Cimicifugae
甘草 gān căo 3g Radix et Rhizoma Glycyrrhizae
[Formula Analysis]Dăng shēn, bái zhú and huáng qí fortify the spleen and boost qi.

Dāng guī regulates the liver and nourishes the blood.

Chái hú and shēng má raise the clear yang.

Chén pí andgān căo rectify qi and harmonize the center.

Kŭ shēn, shé chuáng zĭ, bái xiān pí and dì fū zĭ dispel dampness and relieve itching.

Acupuncture

Local points:ST 1 (chéng qì), BL 2(cuán zhú), SJ 23(sī zhú kōng), EX-HN5(tài yáng), GB 20 (fēng chí),

Supplementary points: LI 4 (hé gŭ), SJ 5 (wài guān), ST 36 (zú sān lĭ), SP 6 (sān yīn jiāo)

Manipulation: Choose 3 local points and 2 supplementary points each time. Needle all points with even technique. Retain the needles for 30 min, once daily. Ten days constitute one course of treatment.

Second Visit

After 20 days of treatment, the patient’s itching was significantly relieved with decreased secretions in his eyes. The redness in the eyes subsided. But he still had a sallow complexion, thin body, light red tongue with thin white and slightly greasy fur, and a wiry, weak pulse.

After treatment, his symptoms were alleviated, meaning that branch excess symptoms were relieved, but, while the spleen deficiency was improved, the deficiency of qi and blood and pathogenic dampness still remained.

Principles: Supplement and nourish qi and blood, dispel dampness.

Formula:Bā Zhēn Tāng(Eight Gem Decoction)

[八珍汤]

党参 dăng shēn 15g Radix Codonopsis
茯苓 fú líng 10g Poria
白术 bái zhú 10g Rhizoma Atractylodis Macrocephalae
当归 dāng guī 10g Radix Angelicae Sinensis
白芍 bái sháo 10g Radix Paeoniae Alba
川芎 chuān xiōng 6g Rhizoma Chuanxiong
苦参 kŭ shēn 10g Radix Sophorae Flavescentis
蛇床子 shé chuáng zĭ 10g Fructus Cnidii
陈皮 chén pí 6g Pericarpium Citri Reticulatae
甘草 gān căo 3g Radix et Rhizoma Glycyrrhizae
[Formula Analysis]Dăng shēn, bái zhú, fú língand gān căo supplement and fortify the spleen and boost qi.

Dāng guī, bái sháo and chuān xiōng regulate the liver and nourish the blood.

Chén pí rectifies qi and harmonizes the center.

Kŭ shēn and shé chuáng zĭ dispel dampness and stop itching.

COMMENTARY AND DISCUSSION

In TCM, vernal keratoconjunctivitis is referred to as shí fù mù yăng (时复目痒, seasonal eye itching) as well as “yăng ruòchóng xíng zhèng” (Itching like worm crawling, 痒若虫行症).

The primary case in this chapter centers on a presentation that commonly encountered in clinical practice. Innumerable patients suffer with recurrent seasonal allergic symptoms. And, frequently, the majority of them present in just this way: with spleen deficiency and dampness along with an external pathogen. The key to effective and successful treatment is based on integrating a treatment strategy that strengthens the root and simultaneously alleviates the branch manifestations. One might even say that treatment with steroidal and antihistamine drops are a branch treatment and while they are effective for managing symptoms, Chinese medicine’s ability to weave together a holistic strategy that boosts a patient’s health while simultaneously managing the symptoms is the very best method.

Because the patient has a mixed presentation of excess and deficiency, the physician uses a root-branch treatment strategy: Bŭ Zhōng Yì Qì Tāng is modified with a well-known group of medicinals that alleviate itching. Of this group, kŭ shēn, bái xiān pí and dì fū zĭ are all cold, bitter and draining, while shé chuáng zĭ is warm, acrid and supplementing. After 3 weeks of treatment, he is improved, but his constitution is still weak. The formula is reassessed and now, he is given a different tonic formula Bā Zhēn Tāng(Eight Gem Decoction) to shift the emphasis towards blood tonification. Additionally, the itch-relieving medicinals are reduced—now only using kŭ shēn and shé chuáng zĭ.

STUDY QUESTIONS

1. What is the prognosis of this disease?

2. What are the manifestations of qi and blood insufficiency and lingering pathogenic dampness present on his second visit?

3. In terms of prevention and nursing, what should one pay attention to?

Answers

1.The patient had a recurrent disease for five years. It was a case of mixed deficiency and excess with its root in deficiency and branch excess. If differentiated and treated properly, the disease may be cured, but a full recovery and prevention of recurrence would require a longer course of treatment than simply eliminating the present symptoms. If differentiated incorrectly, and treated improperly, such as considering the case pure damp-heat, overuse of bitter and cold medicinals could aggravate the damage of stomach and spleen and makes it difficult to resolve the condition.

2.The patient’s itching was substantially relieved with reduced eye secretions, but he still had a sallow complexion, thin body, irritated conjunctiva, a light red tongue with a thin white and slightly greasy coating, and a wiry, weak pulse. These symptoms show his relatively deep insufficiency of qi and blood, the tongue coating being the main indication of lingering pathogenic dampness.

3.The incidence of this disease is closely related to the patient’s constitution and seasonal changes. At the onset of symptoms it is important to avoid exposure to wind, sand, dust, smoke and strong light. It is recommended to wear sunglasses to protect the eyes and avoid direct irritation. Avoiding spicy, fatty or cold foods will prevent additional overwhelming of the spleen, and accumulation of dampness, and the formation of damp-heat. During the remitting stage, it’s important to secure the root by fortifying the spleen, boosting qi, and nourishing the blood to prevent the reoccurrence of the condition.

Additional Commentary

Patterns of damp-heat present with the itching, the exudate from the eyes, along with the greasy tongue coating and a soggy pulse..

The formula is modified Chú Shī Tāng (Dampness-Eliminating Decoction) from the Compilation of Ophthalmology (Yăn Kē Zuăn Yào, 眼科纂要) written by Qing Dynasty doctor Huang Yan.

Formula:Chú Shī Tāng (Dampness-Eliminating Decoction)

[除湿汤]

连翘 lián qiào 10 g Fructus Forsythiae
滑石 huá shí 10 g Talcum
车前子 chē qián zĭ 10 g Semen Plantaginis
枳壳 zhĭ qiào 10 g Fructus Aurantii
黄连 huáng lián 10 g Rhizoma Coptidis
黄芩 huáng qín 10 g Radix Scutellariae
木通 mù tōng 10 g Caulis Akebiae
甘草 gān căo 10 g Herba Schizonepetae
陈皮 chén pí 10 g Pericarpium Citri Reticulatae
荆芥 jīng jiè 10 g Herba Schizonepetae
茯苓 fú líng 10 g Poria
防风 fáng fēng 10 g Radix Saposhnikoviae

The actions of the formula are to clear heat and resolve dampness, dispel wind and arrest itching. It is indicated for the treatment of red ulceration of the palpebral margin, wind red sore and itching eyes. The formula can be used to treat disease such as herpes zoster of the eyelid.

There are several familiar groupings of medicinals within the formula: lián qiào, jīng jiè and fáng fēng form the core wind-dispelling trio. The group is featured in at least a dozen formulas to dispel wind and clear heat, including Jīng Jiè Lián Qiào Tāng (Schizonepeta and Forsythia Decoction).

What is especially interesting is that when this group is also used in concert with huáng lián and huáng qín in several formulas that clear heat, alleviate fire toxin as well as resolve interior-exterior excessive patterns. These include the popular prepared formulas Huáng Lián Shàng Qīng Wán (Coptis Upper-Body-Clearing Pill), Qīng Shàng Fáng Fēng Tāng (Upper-Body-Clearing Saposhnikovia Decoction) and Niú Huáng Shàng Qīng Wán (Bovine Bezoar Upper-Body-Clearing Pill), demonstrating how well this group is coordinates.

Huá shí, chē qián zĭ and mù tōng clear heat and drain dampness. This trio is combined in the formula Bā Zhèng Săn (Eight Corrections Powder)from the Song Dynasty classic Beneficial Formulas from the Taiping Imperial Pharmacy (Tài Píng Huì Mín Hé Jì Jú Fāng, 太平惠民和剂局方). Chén pí, fú líng and gān căo strengthen the spleen regulate the qi and harmonize the formula. Moreover, this group forms the core of the phlegm-damp transforming formula Èr Chén Tāng (TwoMatured Substances Decoction), also from the Tài Píng Huì Mín Hé Jì Jú Fāng.


Cara Frank, L.OM. was raised by in a health food store in Brooklyn NY. When she was 8 she cartwheeled 5 miles from Greenwich Village through Soho and Chinatown and across the Brooklyn Bridge. For over 30 years she has had the same crazy passion for Chinese medicine. At 17 she had her first acupuncture treatment. At 20 she enrolled in acupuncture school. 1n 1998 she went to China to study where she fell deeply in love with herbs and has never recovered.

Cara is the founder of Six Fishes Healing Arts and Six Fishes Neighborhood Acupuncture in Philadelphia where she maintains a busy acupuncture practice and acts as the head fish of the office. She is also the president of China Herb Company. You can read her full bio or schedule an appointment.

Leave Your Comments

blog comments powered by Disqus

“I am in significantly less pain after my massage with Leigh. I appreciate her ability to do her work with such presence and intuition about what my body needs in that moment. She has a gift.”

L.C., Licensed Acupuncturist