Eye Swelling and Pain:
A Chinese Herbal Case Study
||Take a look at the real thing. If you're new to Chinese
Herbal Medicine, this case study will show you the detail
and complexity involved in Chinese Medical diagnosis and prescription.
If you're a Chinese Medical practitioner, you might consider
using this prescription in the appropriate situation.
30 year old female presents with upper and lower eyelid swelling
on the right side. This is an occasional symptom in the last 6
months. Normally, only her upper eyelid swells. The swelling is
worse in the morning, better after standing for a while, and there
is a sharp shooting pain when she moves her eye (looks around).
Her eye was checked by an MD, who said it was ok, but there was
some nystagmus. Cognitive abilities are ok and there is no dizziness
or vertigo. She also has dry mouth, and stool that breaks up.
She just finished her period, which was scant and dark, and during
which she feel a dull, distending, downbearing pain. She also
had a new facial rash which was red and not swollen.
Pulse and Tongue
The pulse was slightly rapid. Both proximal positions were deficiency
and the left was floating and thready. The right middle position
was soft. The pulse may have been choppy, but I cannot yet confidently
identify that quality. The tongue was swollen, tremulous, and
dusky with a thin white coating.
The patient has lupus. My wife and I have treated her off and
on through the PCOM clinic for 11 months. Normally she feels best
at the beginning of her cycle; this time she felt she had gotten
no relief from her period. Her baseline diagnosis has been Spleen deficiency damp and Liver qi stagnation heat, both of which combine at times into
damp-heat skin rashes.
Discussion and Diagnosis
- The swelling could be due to dampness, heat, and/or
- Symptoms worse in the AM can be due to yang deficiency.
On the other hand, fluids may collect in the head at night and
move elsewhere after standing due to the effects of gravity.
Regardless, there is fluid and/or blood outside of its normal
- Sharp, shooting pain indicates blood stagnation.
- Pain that is worse with movement is usually due to
- Nystagmus is a jerky movement typical of CNS problems.
There is no corroborating evidence of CNS dysfunction. Perhaps
minor nystagmus can be an expression of qi stagnation. It is
possible that since the eye muscles have been deprived of nourishment
(blood), the qi stagnated, leading to a movement dysfunction.
- Dry mouth indicates heat, and stool that breaks up
is either Spleen deficiency or dryness (heat).
- The period appears to have been incomplete. The dark
scanty blood indicates blood stagnation.
- The dull, distending, downbearing pain is qi stagnation
and/or Spleen qi sinking. However, if Spleen qi were sinking,
you would expect more - not less - bleeding during the period.
Perhaps the downbearing was the normal movement of the qi, but
the blood stagnation obstructed the blood flow. But then you
would expect sharp pain- not dull. Since the Liver blood stagnation
has manifested in the upper jiao (eyes), perhaps the stagnant
blood did not reach the lower jiao in sufficient quantity to
cause all the typical blood stagnation symptoms.
In the past I have treated her successfully for painless upper
eyelid swelling with a diagnosis of Spleen deficiency damp. This time, however,
there was clear evidence of Liver blood stagnation.
The diagnosis was Liver blood stagnation heat, and the case corresponded
to the Chinese Medical diagnoses swollen eyelids (mu bao zhong
zhang) and distention in the eyes (mu zhang) [I couldn't find
an 'eye pain' disease]. The breaking up stool was qi deficiency
and blood stagnation heat drying the fluids. Associated constitutional
diagnosis included Spleen deficiency and Liver qi stagnation.
The treatment was herbs only. Since I could not find a reference
text that included Liver blood stagnation within the scope of my disease diagnoses,
I had to get creative. Besides relieving the blood stagnation in the eyes,
I wanted to use herbs that addressed menstruation, since that
was part of the etiology. I also included herbs that treated the
The prescription was Tao Ren 9g, Hong Hua 9g, Chi Shao 6g, Ze
Lan 6g, Dang Gui 9g, Bai Zhu 12g, Cang Zhu 3g, Dang Shen 15g,
Gan Cao 3g, Huang Qin 9g, Zhi Zi 6g, Qing Pi 3g, Yan Hu Suo 6g,
Xiang Fu 6g
Discussion of Formula
- Blood moving herbs: Tao Ren moistens the intestines.
Hong Hua relieves rashes. Chi Shao clears heat and cools the
blood, and clears Liver fire from the eyes (although this was
not the pattern responsible for the eye problem, it does demonstrate
that the herb has an affinity for the eyes, so I expected it
to be something of a medicine horse. Plus, there was some heat
from the blood stagnation which it would clear.) Ze Lan unblocks
the menses (the etiology of eye problem was blood stagnation
from incomplete menstruation). Dang Gui can tonify and move
the blood (she has a history of blood deficiency too), and moistens
the intestines. Yan Hu Suo relieves pain and is specific for
- Blood tonifying herbs: Ye Jiao Teng was used to nourish
the blood, calm the shen, and it also relieves rashes. (see
Dang Gui above)
- Spleen tonifying herbs: Bai Zhu, Dang Shen, and Cang
Zhu tonify the Spleen and dry dampness (I wanted to protect
the Spleen, plus Cang Zhu treats night-blindness and so was
also used as a medicine horse).
- Heat clearing herbs: Huang Qin clears heat from the
upper jiao and Liver and descends Liver yang (can clear the
excess yang from the Liver, including the eyes) [In retrospect,
Mu Dan Pi might have been better than Huang Qin]. Zhi Zi clears
heat from all 3 jiaos, cools the blood, and treats hot and blood
- Qi moving herbs: Xiang Fu moves the Liver qi, regulates
menstruation, and relieves pain.
The patient reported significant improvement after the first
dose, and the swelling and pain were gone by the next day.
The patient has since used the formula on an as-needed basis.
However, for that use she probably needs a formula that focuses
a bit more on the Spleen, dampness, and fluid metabolism. This
formula was heavy on the blood movers, and meant to be used for
this acute blood stagnation problem. She could continue to use
it if the eye swelling and pain manifests after her period, but
would need another formula for use mid and late cycle.
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