例一马××，男，37岁，病历号：71573，初诊日期：1964年4月15日。一409一患者于一年前，先于左下颔出现小片紫红色斑片，叠起鳞屑，不易剥落，有轻微痒感。三个月后，于鼻背偏右又出现二片紫红斑，互相融合成片，表面附有干燥鳞屑，周边见紫红晕。又隔三个月，口唇右外方又起小片类似之皮损，伴午后低烧，体疲肢倦，困乏无力。检查：在鼻右侧可见一片境界清晰5X2厘米大小的表面附有鳞屑之萎缩性红斑。病理诊断：盘状红斑狼疮。脉弦带数，舌质正常，苔薄布。辨证：肝脾失和，气滞血瘀（西医诊断，盆状红斑性狼疮）。治法：舒肝和脾，活血化瘀。方药：当归9克赤白芍各9克柴胡6克茯苓9克炒白术9克丹参9克紫草9克红花6克丹皮6克甘草6克5剂，水煎服。5月8日
（三诊）局部已不痒，精神振作，体重增加，皮损边缘明显缩小。患者要求拟方带回东北继服中药治疗，从前方加香附9克、桃仁9克。7月4日来信：称鼻部皮损逐渐缩小，周围红晕已退，仍嘱继服前方，以竟全功。（《朱仁康临床经验集》）
例二杨某，女，42岁。初诊日期：1974年10月1日。1972年6月面部发生圆形红斑两处，发热，关节痛，经某医院诊为“红斑性狼疮”，曾用激素和中药治疗。1973年春复发日渐加重。现症：两颧有圆形红斑，卧床不起，心累气短，畏寒神怯，自汗乏力，腰身疼，两膝关节疼痛，畏日怕光，晒后则身痛更甚，心烦懊农，肢软浮肿，腹胀纳少，月经量少色淡，面唇指甲淡白，便结溲黄，舌淡苔自，脉细缓。辨证，气血脾肾皆虚，瘀血阻滞经络。治法：益气化瘀、温肾填精，健脾除湿兼清瘀热。方药：①党参30克鸡血藤18克生黄芪60克桑寄生30克菟丝子15克熟附片（先煎二小时）24克补骨脂12克地鳖虫10克地龙15克炒蒲黄10克北五味12克槟榔6克糯米草60至海金砂12克蜈蚣2条鸡内金10克紫草6Q克②草药七味：白花蛇舌草60克半枝莲30克克大年（石见穿）30克无花果60克瞿麦根15克隔山撬15克苦荞头15克以上①②方同煎，每周6剂，连服二周。10月18日
（二诊）：服上方后，能起床散步，已不畏日晒，能步行就诊。上述诸证缓解，舌质红润，苔薄，脉平缓，前方继服一月。11月20日
（三诊）：痛已缓解，精力充沛，仍以原方两月量，制成蜜丸与服，1975年2月经原医院复查未见“红斑性狼疮细胞”，停药恢复原工作。
（冯显逊整理：王渭川运用益气化瘀法的经验，《中医杂志》4112，1981）
【评按】红斑性狼疮是胶原病中的一种，西医作为内科病证对待。临床分局限性盘状和系统型两型。祖国医学一般认为其发病多与“阴虚”有关。
例辨证属肝脾失和，气滞血瘀，用逍遥散加减以疏肝和脾、活血化瘀。据朱氏经验，一411一狼疮红斑明显者，可于方中加凌霄花、鸡冠花；皮肤有瘀斑加仙鹤草、藕节炭；关节痛加乌蛇、秦艽、桑寄生；盗汗加黄芪皮、糯稻根……。方药加减，反映了其辨证明细以及用药之权衡可识。
例二两颧圆形红斑，全身症状重笃，显示脾肾两虚，瘀血阻滞经络，郁而化热，治以益气化瘀，健脾补肾，兼清瘀热。处方一的特点是温、清、补、消并施，而配方中虫类药和草药糯米草的应用，加强了解毒消肿、通瘀活络的效能；处方二所用七味药亦颇有特色，其中如石大年，功能清热解毒，活血镇痛，隔山撬健胃消积、解毒消肿：苦荞头健脾利湿……。方治力求在纷错危重的病况下，各个击破，转危为安。立方遣药反映了王氏独到的经验和胆识。。六、五官、口腔病类医案
（一）凝脂翳
例一华××，男，51岁，门诊号：625332。初诊日期：1958年2月21日。右眼57天来红痛，畏光，流泪并有长期失眠，经西医检查确诊为“进行性匍行性角膜溃疡”，因溃疡未能控制，转中医治疗。检查：右眼视力0．2，近视力耶格表5。球结漠混合充血，角膜鼻侧溃疡，且有脂状附着物。脉弦数，舌色红，苔微黄。辨证：肝肺积热，复感风热毒邪，上乘目窍，而致黑睛凝脂一片。
（右眼凝脂翳）治法：祛风清热为主，平肝退翳为辅。方药：红肿翳障方加减。石决明20克焦白术6克生地10克赤石脂10克生甘草3克赤芍6克蒙花10克白芷6克夏枯草6克川芎6克黄芩6克连翘6克六一散10克（包煎）水煎服，7剂。2月28日
（二诊）：服上方和点药后，眼已能睁开，头眼已不痛，惟汗出多梦，失眠如前。证属风热已解，肝热尚盛，久郁化火，上灼心阴，扰及神明。治宣平肝泻火，养心安神，退翳明目。方药：炒枣仁25克珍珠母25克浮小麦30克柏子仁15克夜交藤15克夏枯草10克蒙花10克白菊花6克蝉衣3克白芷6克甘草3克黄芩5克7剂。知柏地黄丸90克，每日10克。3月4日
（三诊）：自述右眼症状基本消失，右偏侧头部有轻微疼痛。脉象弦细而数，舌色红，苔薄白，治以平肝祛风，退翳明目为主，辅以滋阴益气。方药：生地25克石决明25克蒙花10克川芎6克党参10克连翘10克白芷6克知母10克防风5克白菊花10克蔓荆子10克羌活6克水煎服，17剂。知柏地黄丸，每日10克3月23日
（末诊）：睡眠好转，一切正常。检查：右眼视力0．3，近视力耶格表1。右眼角膜遗有浓厚白斑，以原方去党参、白芷、知母、防风、白菊花、蔓荆子，加柏子仁、炙远志、夜交藤、青葙子、炒栀子各6克，7剂，水煎服，隔日1剂，服完为止。给犀黄散3瓶点眼。1967年5月复查：右眼视力0．5，矫正视力1．5，近视力耶格表1。一直工作，未再复发。（《韦文贵眼科临床经验选》）
例二男，36岁，住院号：12039，入院日期：1958年10月15日。本年9月21日开始右眼红而疼痛，视力减退，兼有流泪及右偏头痛。经检查诊断为右限边缘性角膜溃疡，全身检查均属正常。曾用三氯醋酸烧灼，抗菌素滴眼，施行结膜瓣遮盖术。至10月23日眼部刺激症状加重，结膜瓣收缩，角膜溃疡乃又暴露，溃疡呈陡削如蚕蚀状。染色阳性。诊断为侵蚀性角膜溃疡，即于该日起开始服中药，当时症见：右眼眼胞高肿，流泪刺激痛，风轮凝脂翳四周而起。手厥冷，脉细欲绝，拟益血复脉而驱久寒。全当归9克桂枝3克炒白芍9克炙甘草4．5克木通6克细辛1．5克红枣10个生姜1片。10月26日（二诊）：服上方3剂后，角膜溃疡已改善，刺激症状已大见改善，脸肿退。结膜水肿充血已退去大半，再服3剂。10月29日（三诊）：角膜染色阴性，溃疡已愈，改服下方，于10月31日出院。党参9克焦冬术6克炙黄芪12克全当归9克炙甘草4．5克茯神12克炒远志4．5克酸枣仁9克煨木香1．5克生姜：片红枣5个（陆南山《眼科临证录》）
【评按】凝脂翳系因风热毒邪侵犯黑睛，以致目痛羞明，泪出如流，目翳色黄缘如凝脂，故名。例一证属肝肺积热，复感风热毒邪，上乘子目而致。治以法风清热为主，辅以平肝退翳，方用红肿翳方（经验方）加减而获效。韦氏体会赤石脂能促进溃疡愈合，石决明能消除翳障，故每遇角膜翳障多加用之。例二风轮凝脂翳四周而起，两手厥冷，脉细欲绝，反用当归四逆之辈，益血复脉、温经散寒而获效。两例相较，虚实寒热证治迥然。
（二）花翳白陷
例一男，40岁，门诊号：168428，初诊日期：1958年7月8日。左眼发病，时发时愈已一年余。经检查诊为树枝状角膜溃疡，曾用多种西药治疗未愈。症见左眼气轮赤络微布，风轮凝脂侵及瞳神，流泪刺痛，脉弦。辨证：肝风气郁所致，清阳之气不升则内郁不解，发为花翳白陷。治法：散风热而调和气血，升清阳而开诸郁。方药：嫩钩藤9克蝉衣3克当归9克川芎3克炒白芍9克制香附12克服上方14剂后炎症消退。
（陆南山《眼科临证录》
例二鲍××，女，11岁，门诊号：126626。初诊日期：1966年1月26日。右眼30天前开始充血、涩痛、畏光、流泪，经调“调医院诊断为“右眼树枝状角膜溃疡”，给予对症治疗和散瞳。患者五年前右眼曾患同样病变。用碘酒烧灼后，角膜遗有瘫痕。检查：右眼视力0．1+1，近视力耶格表2-3，右眼角膜近瞳孔7～8点处，有一灰白色深层树枝状浸润，直径约2毫米，萤光素染色阳性，上方有陈旧薄翳。脉细，舌质红，舌苔薄白。辨证：肝肺火盛，外感邪毒，内外合邪，上犯目窍。（右眼花翳白陷；右眼冰瑕翳）治法：法风清热，活血滋阴，退翳明目。方药：
（1）红肿翳障方：生地12克赤芍10克蒙花6克白芷10克石决明15克（先煎）赤石脂10克（包煎）炒川芎3克夏枯草6克炙甘草5克水煎服，5剂。
（2）犀黄散一瓶点患眼，一日三次。1月31日
（二诊）：服药后症状明显减轻，溃疡已趋平坦，白睛仍有红赤。脉细数，苔薄白，仍守原方加减：炒川芎3克、生地12克、赤芍10克、蒙花6克、白芷10克、桑皮15克、木通5克、炙草6克、地骨皮10克水煎服5剂。继续以犀黄散点眼。2月5日
（末诊）：眼痛消失，稍有畏光流泪。脉细数、舌苔薄白，舌质淡红。改用祛风清肝，退翳明目之法。龙胆草6克连翘10克夏枯草6克草决明10克蒙花10克、荆芥5克白菊花6克水煎服12剂。继续以犀黄散点眼。服药后，上述症状消失，角膜溃疡愈台。（《韦文贵眼科临床经验选》）
【评按】花翳白陷系指眼部黑睛白翳状如花瓣树枝，见有羞明多泪，磨擦疼痛等症。树枝状角膜溃疡属于本证范畴。例一因肝风气郁而致。治以散风热而调气血，升清阳而开诸郁，药少而力专，效果良好。例二证属肝肺火盛，外感邪毒，内外合邪，上犯目窍，使用韦氏红肿翳障方，标本兼顾，药性平和。本方是治疗各种角膜炎、角膜溃疡的经验方。
（三）瞳神干缺
例一徐××，男，28岁，初诊日期：1942年4月25日。双目瞳神干缺，黄液潜伏，视糊晴痛，舌糜口疮，腿部红块，阴部糜烂，得病五载，此起彼伏，反复发作频繁，脉来弦数，舌苔黄腻症由湿热流注，病在心脾肝肾。《素问》云：“诸痛津疮，皆属于心”，“诸湿肿满皆属于脾。”心主血，脾主肉，血热而内湿，湿热相合，热毒下传，入肝经而生阴疮，入脾经而为肉疡，人心经而致舌糜，入肾经而致瞳神干缺。其病浸淫不休，溃败肌肤，后果堪忧。龙胆草炒栀子黄芩柴胡车前子木通当归尾苍术米仁生地甘草竹叶2剂后，原方增损连服10剂，红肿退去，黄液消失，目视恢复，诸痛及疮痒皆除，惟过二月，目疾又发。复诊：前经治疗，红退，黄液消失，目视放明，惟未隔二月，旧病复起，且形寒烦热，胸腹不利，脉濡，舌苔浊腻：是亦湿热蒸蒸，浊邪上逆所致。治以利湿化浊，清热解毒。茯苓苍术猪苓泽泻黄芩炒栀子米江滑石甘露消毒丹（包煎）三剂以后，又连服5剂，目疾又愈。
（姚芳蔚等整理：眼科姚和清的学术经验，《上海中医药杂志》3：1，1964）
例二张××，男，28岁，初诊日期：1959年6月12日。左眼得病二旬，眼红，视糊，睛痛，并牵连头部胀痛，经西医检查诊断为左眼急性虹膜睫状体炎
（视力0．2）。患者面色红润，口干引饮，舌赤，苔黄，脉数。证属瞳神干缺，血贯瞳神。茺蔚子赤芍元参麦冬知母生石膏黄芩生甘草五灵脂2剂后，疼痛减轻，左眼红肿减退，前房出血消失，混浊减轻。原方去石膏、五灵脂、甘草，加地骨皮，又3剂后，左眼红肿消失，视力增至0．5，续服原方6剂，左眼充血消失，视力增至1．0。
（姚芳蔚等整理，姚和清老大夫治疗前房出血经验简介《浙江中医杂志》4：23，1965）
【评按】瞳神干缺常为重症凝脂翳之后遗症，瞳神失去正圆，边缘如锯齿或形如梅花，故名。
例一除瞳神干缺外，兼见湿热流注等证，病在心脾肝肾。治以龙胆泻肝汤加减，十剂获效而月后旧病复发，证势反重，此乃湿热蒸蒸，浊邪上逆。治以利湿化浊、清热解毒，重在“去邪”，邪去正安而获治愈。
例二不仅瞳神干缺，复见血贯瞳神。治从整体出发，着重治内，由于肝经血热，血瘀络阻，故以行血活血为治，又须凉血清热，以治其本。
（四）视瞻昏渺
[Background Information]
Book: Compilation of Verified Cases by Famous Doctors in Modern Times Chapter: Main Text (49/53) Category: Medical Discussion
Case 1 Ma XX, Male, 37 years old, Medical Record No.: 71573, Initial Visit Date: April 15, 1964. One year ago, the patient first developed small purplish-red patches on the left mandible, layered with scales that were difficult to peel off, accompanied by slight itching. Three months later, two purplish-red patches appeared on the right side of the nasal bridge, merging into a larger patch, covered with dry scales, and surrounded by a purplish-red halo. Another three months passed before similar small lesions appeared on the right outer side of the lips, accompanied by low-grade fever in the afternoon, physical fatigue, weakness in limbs, and general lassitude. Examination: A well-defined atrophic erythematous patch measuring 5x2 cm with scales on the surface was visible on the right side of the nose. Pathological Diagnosis: Discoid Lupus Erythematosus (DLE). Pulse was wiry and rapid; tongue body was normal with a thin coating. Syndrome Differentiation: Disharmony between Liver and Spleen, Qi stagnation and Blood stasis (Western Medicine Diagnosis: Discoid Lupus Erythematosus). Treatment Principle: Soothe the Liver and harmonize the Spleen, invigorate Blood and resolve stasis. Prescription: Dang Gui (Angelicae Sinensis Radix) 9g, Chi Shao (Red Peony Root) and Bai Shao (White Peony Root) 9g each, Chai Hu (Bupleuri Radix) 6g, Fu Ling (Poria) 9g, Chao Bai Zhu (Stir-fried Atractylodis Macrocephalae Rhizoma) 9g, Dan Shen (Salviae Miltiorrhizae Radix) 9g, Zi Cao (Arnebiae Radix seu Lithospermi Radix) 9g, Hong Hua (Carthami Flos) 6g, Mu Dan Pi (Moutan Cortex) 6g, Gan Cao (Glycyrrhizae Radix et Rhizoma) 6g. 5 doses, decocted in water and taken orally. May 8
(Third Visit): Local itching had ceased, spirit was revitalized, weight increased, and the edges of the skin lesions shrank significantly. The patient requested a prescription to take back to Northeast China for continued Traditional Chinese Medicine (TCM) treatment. Xiang Fu (Cyperi Rhizoma) 9g and Tao Ren (Persicae Semen) 9g were added to the previous formula. Letter received on July 4 stated: Nasal lesions gradually shrank, surrounding red halos receded. Advised to continue taking the previous formula to complete the cure. (From "Clinical Experience Collection of Zhu Rengkang")
Case 2 Yang XX, Female, 42 years old. Initial Visit Date: October 1, 1974. In June 1972, two circular erythematous patches appeared on the face, accompanied by fever and joint pain. Diagnosed as "Lupus Erythematosus" by a certain hospital; treated with hormones and TCM. Relapsed in Spring 1973 and worsened progressively. Current Symptoms: Circular erythematous patches on both malar regions, bedridden, palpitations and shortness of breath, aversion to cold, timidity, spontaneous sweating, fatigue, pain in waist and body, pain in both knee joints, photophobia, worsening body pain after sun exposure, vexation and restlessness, soft limbs and edema, abdominal distension and poor appetite, scanty and pale menstrual flow, pale complexion/lips/nails, constipation and yellow urine, pale tongue with white coating, fine and slow pulse. Syndrome Differentiation: Deficiency of Qi and Blood, deficiency of Spleen and Kidney, Blood stasis obstructing collaterals. Treatment Principle: Tonify Qi and resolve stasis, warm Kidney and fill essence, strengthen Spleen and drain dampness, simultaneously clear stasis-heat. Prescription: ① Dang Shen (Codonopsis Radix) 30g, Ji Xue Teng (Spatholobi Caulis) 18g, Sheng Huang Qi (Astragali Radix) 60g, Sang Ji Sheng (Taxilli Caulis) 30g, Tu Si Zi (Cuscutae Semen) 15g, Shu Fu Pian (Prepared Aconiti Lateralis Radix Praeparata - decocted first for 2 hours) 24g, Bu Gu Zhi (Psoraleae Fructus) 12g, Di Bie Chong (Eupolyphaga Seu Steleophaga) 10g, Di Long (Pheretima) 15g, Chao Pu Huang (Typhae Pollen) 10g, Bei Wu Wei Zi (Schisandrae Chinensis Fructus) 12g, Bing Lang (Arecae Semen) 6g, Nuo Mi Cao (Herba Siegesbeckiae Orientalis) 60g, Hai Jin Sha (Spora Lygodii) 12g, Wu Gong (Scolopendra) 2 pieces, Ji Nei Jin (Gavis Periostracum) 10g, Zi Cao 6g; ② Seven Herbal Medicines: Bai Hua She She Cao (Hedyotis Diffusa Herba) 60g, Ban Zhi Lian (Scutellaria Barbadensis Herba) 30g, Shi Jian Chuan (Prunellae Spica) 30g, Wu Hua Guo (Ficus Carica Fruit) 60g, Qu Mai Gen (Dianthi Radix) 15g, Ge Shan Qiao (Radix Stephaniae Tetrandrae or similar local herb) 15g, Ku Qiao Tou (Tartary Buckwheat Rhizome) 15g. Decoct formulas ① and ② together, 6 doses per week, taken continuously for two weeks. October 18
(Second Visit): After taking the above prescription, able to get up and walk, no longer afraid of sun exposure, able to walk to clinic. Above symptoms alleviated, tongue body reddish, coating thin, pulse smooth and moderate. Continue previous prescription for one month. November 20
(Third Visit): Pain alleviated, energy充沛 (abundant). Prepare two months' supply of the original prescription into honey pills for oral administration. In February 1975, re-examination at the original hospital showed no "Lupus Erythematosus cells"; stopped medication and resumed original work.
(Organized by Feng Xianxun: Wang Weichuan's Experience in Applying Qi-Tonifying and Stasis-Resolving Method, *Journal of Traditional Chinese Medicine*, 4112, 1981)
[Commentary] Lupus Erythematosus is a type of collagen disease, treated internally in Western medicine. Clinically divided into localized discoid and systemic types. Traditional Chinese Medicine generally believes its pathogenesis is mostly related to "Yin Deficiency".
Case 1 is Discoid Lupus Erythematosus, known in TCM as "Ya Dan Chuang" (Crow-Bitten Sore), traditionally considered difficult to treat. This case's syndrome differentiation belongs to Disharmony between Liver and Spleen, Qi stagnation and Blood stasis. Xiao Yao San (Free and Easy Wanderer Powder) was modified to soothe the Liver, harmonize the Spleen, invigorate Blood, and resolve stasis. According to Dr. Zhu's experience, if lupus erythema is obvious, add Ling Xiao Hua (Campsis Grandiflora Flos) and Ji Guan Hua (Celosia Cristata Flos); if skin ecchymosis exists, add Xian He Cao (Agrimoniae Herba) and Ou Jie Tan (Charred Node of Nelumbinis Rhizomatis); if joint pain occurs, add Wu She (Zaocys) Qin Jiao (Gentianae Macrophyllae Radix), Sang Ji Sheng; if night sweats occur, add Huang Qi Pi (Pericarpium Astragali) and Nuo Dao Gen (Rhizoma Imperatae). Modifications of herbs reflect detailed syndrome differentiation and careful consideration of medication.
Case 2 presents circular erythema on both malar regions with severe systemic symptoms, indicating Spleen-Kidney Dual Deficiency, Blood stasis obstructing collaterals,郁 (stagnation) transforming into heat. Treatment focuses on tonifying Qi and resolving stasis, strengthening Spleen and tonifying Kidney, while clearing stasis-heat. Prescription 1 features simultaneous application of warming, clearing, tonifying, and reducing methods. The use of insect drugs and the herbal medicine Nuo Mi Cao enhances detoxification, swelling reduction, unblocking stasis, and activating collaterals. The seven herbs in Prescription 2 are also distinctive; for example, Shi Da Nian (Shi Jian Chuan) clears heat and detoxifies, invigorates Blood and relieves pain; Ge Shan Qiao strengthens Stomach, resolves accumulation, detoxifies, and reduces swelling; Ku Qiao Tou strengthens Spleen and promotes dampness drainage... The treatment strategy aims to break through difficulties one by one in complex and critical conditions, turning danger into safety. Formulating and prescribing reflects Mr. Wang's unique experience and courage.
VI. Otorhinolaryngology and Oral Disease Cases
(I) Ning Zhi Yi (Corneal Ulcer with Purulent Exudate)
Case 1 Hua XX, Male, 51 years old, Outpatient No.: 625332. Initial Visit Date: February 21, 1958. Right eye red and painful for 57 days, photophobia, tearing, and long-term insomnia. Diagnosed by Western medicine as "Progressive Marginal Corneal Ulcer". Due to inability to control the ulcer, transferred to TCM treatment. Examination: Right eye visual acuity 0.2, near vision Jaeger chart 5. Mixed congestion of bulbar conjunctiva, corneal ulcer on the nasal side with greasy exudate. Pulse wiry and rapid, tongue red, coating slightly yellow. Syndrome Differentiation: Accumulated Heat in Liver and Lung, compounded by Wind-Heat-Toxic Evil attacking upwards to the Eye Orifice, resulting in a patch of purulent exudate on the Black Cornea (Hei Jing).
(Right Eye Ning Zhi Yi) Treatment Principle: Dispel Wind and Clear Heat as primary, calm Liver and eliminate nebula as secondary. Prescription: Modified Hong Zhong Yi Zhang Fang (Red Swelling Nebula Obstruction Formula). Shi Jue Ming (Haliotidis Concha) 20g, Jiao Bai Zhu (Charred Atractylodis Macrocephalae Rhizoma) 6g, Sheng Di Huang (Rehmanniae Radix) 10g, Chi Shi Zhi (Kaolin) 10g, Sheng Gan Cao (Raw Glycyrrhizae Radix et Rhizoma) 3g, Chi Shao 6g, Meng Hua (Memfloris Flos) 10g, Bai Zhi (Angelicae Dahuricae Radix) 6g, Xia Ku Cao (Prunellae Spica) 6g, Chuan Xiong (Chuanxiong Rhizoma) 6g, Huang Qin (Scutellariae Radix) 6g, Lian Qiao (Forsythiae Fructus) 6g, Liu Yi San (Six-to-One Powder) 10g (wrapped and decocted). Decoct in water, 7 doses. February 28
(Second Visit): After taking the above prescription and using eye drops, eyes could open, head and eye pain ceased, but sweating, frequent dreams, and insomnia persisted as before. Syndrome: Wind-Heat resolved, Liver Heat still abundant, long-standing stagnation transforming into Fire, scorching Heart Yin upwards, disturbing Shen (Spirit). Treatment: Calm Liver and purge Fire, nourish Heart and calm Spirit, eliminate nebula and brighten eyes. Prescription: Chao Zao Ren (Ziziphus Spinosa Seed) 25g, Zhen Zhu Mu (Margarita) 25g, Fu Xiao Mai (Tritici Levis Frumentum) 30g, Bai Zi Ren (Biota Orientalis Seed) 15g, Ye Jiao Teng (Polygoni Multiflori Caulis) 15g, Xia Ku Cao 10g, Meng Hua 10g, Bai Ju Hua (Chrysanthemi Flos) 6g, Chan Yi (Bombyx Batryticatus) 3g, Bai Zhi 6g, Gan Cao 3g, Huang Qin 5g. 7 doses. Zhi Bai Di Huang Wan (Anemarrhenae, Phellodendri et Rehmanniae Pill) 90g, 10g daily. March 4
(Third Visit): Reported right eye symptoms basically disappeared, slight pain on right lateral head. Pulse wiry, fine, and rapid; tongue red, coating thin white. Treatment: Calm Liver and dispel Wind, eliminate nebula and brighten eyes as primary, nourish Yin and tonify Qi as secondary. Prescription: Sheng Di Huang 25g, Shi Jue Ming 25g, Meng Hua 10g, Chuan Xiong 6g, Dang Shen 10g, Lian Qiao 10g, Bai Zhi 6g, Zhi Mu (Anemarrhenae Rhizoma) 10g, Fang Feng (Saposhnikoviae Radix) 5g, Bai Ju Hua 10g, Man Jing Zi (Vittariae Fructus) 10g, Qiang Huo (Notopterygii Rhizoma et Radix) 6g. Decoct in water, 17 doses. Zhi Bai Di Huang Wan, 10g daily. March 23
(Final Visit): Sleep improved, everything normal. Examination: Right eye visual acuity 0.3, near vision Jaeger chart 1. Dense white opacity remaining on right cornea. Remove Dang Shen, Bai Zhi, Zhi Mu, Fang Feng, Bai Ju Hua, Man Jing Zi from original prescription; add Bai Zi Ren, Zhi Yuan Zhi (Polygalae Radix), Ye Jiao Teng, Qing Xin Zi (Phytolaccae Fructus), Chao Zhi Zi (Gardeniae Fructus) each 6g. 7 doses, decoct in water, 1 dose every other day until finished. Provide Xi Huang San (Calculus Bovis Powder) 3 bottles for eye instillation. Re-examination in May 1967: Right eye visual acuity 0.5, corrected visual acuity 1.5, near vision Jaeger chart 1. Continued working, no recurrence. (From "Selected Clinical Experience of Wei Wengui in Ophthalmology")
Case 2 Male, 36 years old, Hospitalization No.: 12039, Admission Date: October 15, 1958. Right eye red and painful since September 21 this year, decreased vision, accompanied by tearing and right hemicrania. Diagnosed as Right Marginal Corneal Ulcer upon examination; systemic examination normal. Previously treated with trichloroacetic acid cauterization, antibiotic eye drops, and conjunctival flap coverage. By October 23, ocular irritation symptoms worsened, conjunctival flap contracted, exposing corneal ulcer again; ulcer steep like moth-eaten. Staining positive. Diagnosed as Eroding Corneal Ulcer. Started TCM medication from that day. Symptoms at that time: Right eyelid high swelling, tearing and irritating pain, Feng Lun (Wind Wheel/Cornea) Ning Zhi Yi arising around. Hands and feet cold, pulse fine almost imperceptible. Plan: Benefit Blood, restore pulse, and drive out long-standing Cold. Quan Dang Gui (Angelicae Sinensis Radix) 9g, Gui Zhi (Cinnamomi Ramulus) 3g, Chao Bai Shao 9g, Zhi Gan Cao (Honey-fried Glycyrrhizae Radix et Rhizoma) 4.5g, Mu Tong (Akebiae Caulis) 6g, Xi Xin (Asari Radix et Rhizoma) 1.5g, Hong Zao (Jujubae Fructus) 10 pieces, Sheng Jiang (Zingiberis Rhizoma Recens) 1 slice. October 26 (Second Visit): After 3 doses of above prescription, corneal ulcer improved, irritation symptoms greatly alleviated, facial swelling subsided. Conjunctival edema and congestion receded by more than half. Take another 3 doses. October 29 (Third Visit): Corneal staining negative, ulcer healed. Change to following prescription, discharged on October 31. Dang Shen 9g, Jiao Bai Zhu 6g, Zhi Huang Qi (Honey-fried Astragali Radix) 12g, Quan Dang Gui 9g, Zhi Gan Cao 4.5g, Fu Shen (Poria with Hostwood) 12g, Chao Yuan Zhi (Polygalae Radix) 4.5g, Suan Zao Ren (Ziziphus Spinosa Seed) 9g, Wei Mu Xiang (Aucklandiae Radix) 1.5g, Sheng Jiang 1 slice, Hong Zao 5 pieces. (Lu Nanshan *Ophthalmology Clinical Records*)
[Commentary] Ning Zhi Yi is caused by Wind-Heat-Toxic Evil invading the Black Cornea (Hei Jing), causing eye pain, photophobia, flowing tears, and yellow corneal opacity resembling congealed fat, hence the name. Case 1 syndrome belongs to Accumulated Heat in Liver and Lung, compounded by Wind-Heat-Toxic Evil attacking upwards to the eye. Treatment focuses on dispelling Wind and clearing Heat, assisted by calming Liver and eliminating nebula. Effect achieved by modifying Hong Zhong Yi Fang (Empirical Formula). Dr. Wei's experience indicates Chi Shi Zhi promotes ulcer healing, Shi Jue Ming eliminates nebula obstruction, so they are frequently added when encountering corneal nebula. Case 2 Feng Lun Ning Zhi Yi arising around, hands and feet cold, pulse fine almost imperceptible, surprisingly treated with Dang Gui Si Ni Tang (Cinnamon Twig Decoction with Angelica) type prescriptions, benefiting Blood, restoring pulse, warming meridians, and dispersing Cold, achieving effect. Comparing the two cases, deficiency/excess and cold/heat treatments are completely different.
(II) Hua Yi Bai Xian (Flower-like Corneal Opacity)
Case 1 Male, 40 years old, Outpatient No.: 168428, Initial Visit Date: July 8, 1958. Left eye onset, recurring intermittently for over a year. Diagnosed as Dendritic Corneal Ulcer upon examination; treated with various Western medicines without success. Symptoms: Left eye Qi Lun (Qi Wheel/Sclera) shows slight red vessels, Feng Lun (Wind Wheel/Cornea) Ning Zhi invading Tong Shen (Pupil), tearing and stabbing pain, pulse wiry. Syndrome Differentiation: Caused by Liver Wind Qi Stagnation; when Clear Yang Qi does not ascend, internal stagnation fails to resolve, manifesting as Hua Yi Bai Xian. Treatment Principle: Dispel Wind-Heat and harmonize Qi and Blood, ascend Clear Yang and open various stagnations. Prescription: Nen Gou Teng (Uncariae Ramulus cum Uncis) 9g, Chan Yi 3g, Dang Gui 9g, Chuan Xiong 3g, Chao Bai Shao 9g, Zhi Xiang Fu (Cyperi Rhizoma) 12g. After taking above prescription for 14 doses, inflammation subsided.
(Lu Nanshan *Ophthalmology Clinical Records*)
Case 2 Bao XX, Female, 11 years old, Outpatient No.: 126626. Initial Visit Date: January 26, 1966. Right eye started congesting, gritty pain, photophobia, tearing 30 days ago. Diagnosed as "Right Eye Dendritic Corneal Ulcer" by Tiao Hospital, given symptomatic treatment and mydriasis. Patient suffered same lesion in right eye five years ago. After iodine tincture cauterization, corneal scar remained. Examination: Right eye visual acuity 0.1+1, near vision Jaeger chart 2-3, gray-white deep dendritic infiltration near pupil at 7-8 o'clock position on right cornea, diameter approx 2mm, fluorescein staining positive, old thin nebula above. Pulse fine, tongue body red, coating thin white. Syndrome Differentiation: Excessive Fire in Liver and Lung, external contraction of Pathogenic Evil, internal and external pathogens combining, attacking upwards to Eye Orifice. (Right Eye Hua Yi Bai Xian; Right Eye Bing Xia Yi/Ice-Glint Nebula) Treatment Principle: Dispel Wind and Clear Heat, invigorate Blood and nourish Yin, eliminate nebula and brighten eyes. Prescription:
(1) Hong Zhong Yi Zhang Fang: Sheng Di Huang 12g, Chi Shao 10g, Meng Hua 6g, Bai Zhi 10g, Shi Jue Ming 15g (decoct first), Chi Shi Zhi 10g (wrapped and decocted), Chao Chuan Xiong 3g, Xia Ku Cao 6g, Zhi Gan Cao 5g. Decoct in water, 5 doses.
(2) Xi Huang San one bottle for instillation into affected eye, three times daily. January 31
(Second Visit): Symptoms significantly reduced after taking medicine, ulcer tended to flatten, Bai Jing (White Sclera) still red. Pulse fine and rapid, coating thin white. Stick to original prescription modifications: Chao Chuan Xiong 3g, Sheng Di Huang 12g, Chi Shao 10g, Meng Hua 6g, Bai Zhi 10g, Sang Pi (Mori Cortex) 15g, Mu Tong 5g, Zhi Cao 6g, Di Gu Pi (Lycii Cortex) 10g. Decoct in water, 5 doses. Continue Xi Huang San instillation. February 5
(Final Visit): Eye pain disappeared, slight photophobia and tearing. Pulse fine and rapid, coating thin white, tongue body pale red. Change to dispelling Wind, clearing Liver, eliminating nebula, and brightening eyes method. Long Dan Cao (Gentianae Radix) 6g, Lian Qiao 10g, Xia Ku Cao 6g, Cao Jue Ming (Cassiae Semen) 10g, Meng Hua 10g, Jing Jie (Schizonepetae Spica) 5g, Bai Ju Hua 6g. Decoct in water, 12 doses. Continue Xi Huang San instillation. After taking medicine, above symptoms disappeared, corneal ulcer healed. (From "Selected Clinical Experience of Wei Wengui in Ophthalmology")
[Commentary] Hua Yi Bai Xian refers to white corneal opacity resembling flower petals or tree branches, presenting with photophobia, excessive tearing, friction pain, etc. Dendritic corneal ulcer falls within this syndrome category. Case 1 caused by Liver Wind Qi Stagnation. Treatment dispels Wind-Heat, harmonizes Qi and Blood, ascends Clear Yang, opens stagnations; few herbs but potent effect, good results. Case 2 syndrome belongs to Excessive Fire in Liver and Lung, external contraction of Pathogenic Evil, internal and external pathogens combining, attacking upwards to Eye Orifice. Used Wei's Hong Zhong Yi Zhang Fang, addressing both root and branch, mild drug properties. This formula is an empirical formula for treating various keratitis and corneal ulcers.
(III) Tong Shen Gan Que (Irregular Pupil / Atrophy of Iris)
Case 1 Xu XX, Male, 28 years old, Initial Visit Date: April 25, 1942. Bilateral Tong Shen Gan Que, hidden yellow fluid (hypopyon), blurred vision and eye pain, tongue ulceration and mouth sores, red patches on legs, genital erosion. Sick for five years, rising and falling, frequent recurrent episodes. Pulse wiry and rapid, tongue coating yellow and greasy. Syndrome caused by Damp-Heat flowing and depositing, disease located in Heart, Spleen, Liver, Kidney. *Su Wen* states: "All pain and sores belong to the Heart," "All dampness, swelling, and fullness belong to the Spleen." Heart governs Blood, Spleen governs Flesh. Blood Heat combined with internal Dampness, Damp-Heat merging, Heat-Toxin transmitting downwards, entering Liver Meridian generating Yin sores, entering Spleen Meridian generating flesh ulcers, entering Heart Meridian causing tongue ulceration, entering Kidney Meridian causing Tong Shen Gan Que. Disease infiltrates ceaselessly, destroying skin and flesh, consequences worrying. Long Dan Cao, Chao Zhi Zi, Huang Qin, Chai Hu, Che Qian Zi, Mu Tong, Dang Gui Wei (Tail of Angelicae Sinensis Radix), Cang Zhu, Mi Ren (Coix Seed), Sheng Di, Gan Cao, Zhu Ye. After 2 doses, modify original prescription and take continuously for 10 doses, redness and swelling receded, yellow fluid disappeared, vision restored, all pain and sore itching removed. However, after two months, eye disease recurred. Follow-up visit: Previous treatment, redness receded, yellow fluid disappeared, vision clarified. But less than two months later, old disease returned, plus chills and vexatious fever, chest and abdomen discomfort, pulse soggy, tongue coating turbid and greasy: Also caused by steaming Damp-Heat and turbid Evil ascending. Treatment: Promote dampness drainage and transform turbidity, clear Heat and detoxify. Fu Ling, Cang Zhu, Zhu Ling, Ze Xie, Huang Qin, Chao Zhi Zi, Mi Ren, Hua Shi (Magnesii Silicas), Gan Lu Xiao Du Dan (Sweet Dew Detoxication Powder - wrapped and decocted). After 3 doses, then take continuously for 5 doses, eye disease cured again.
(Organized by Yao Fangwei et al.: Academic Experience of Yao Heqing in Ophthalmology, *Shanghai Journal of Traditional Chinese Medicine* 3:1, 1964)
Case 2 Zhang XX, Male, 28 years old, Initial Visit Date: June 12, 1959. Left eye sick for ten days, eye red, blurred vision, eye pain, radiating to head distending pain. Diagnosed by Western medicine as Left Acute Iridocyclitis (Visual Acuity 0.2). Patient ruddy complexion, dry mouth craving drink, red tongue, yellow coating, rapid pulse. Syndrome belongs to Tong Shen Gan Que, Blood penetrating Tong Shen. Chong Wei Zi (Leonuri Fructus), Chi Shao, Yuan Shen (Scrophulariae Radix), Mai Dong (Ophiopogonis Radix), Zhi Mu, Sheng Shi Gao (Gypsum Fibrosum), Huang Qin, Sheng Gan Cao, Wu Ling Zhi (Trogopterori Faeces). After 2 doses, pain reduced, left eye redness and swelling decreased, anterior chamber hemorrhage disappeared, turbidity reduced. Remove Shi Gao, Wu Ling Zhi, Gan Cao from original prescription, add Di Gu Pi. After another 3 doses, left eye redness and swelling disappeared, vision increased to 0.5. Continue original prescription for 6 doses, left eye congestion disappeared, vision increased to 1.0.
(Organized by Yao Fangwei et al., Brief Introduction of Old Doctor Yao Heqing's Experience in Treating Anterior Chamber Hemorrhage, *Zhejiang Journal of Traditional Chinese Medicine* 4:23, 1965)
[Commentary] Tong Shen Gan Que is often a sequelae of severe Ning Zhi Yi. Tong Shen loses perfect roundness, edges like sawteeth or plum blossom shape, hence the name.
Case 1 besides Tong Shen Gan Que, also presents Damp-Heat flowing and depositing syndromes, disease in Heart, Spleen, Liver, Kidney. Treatment uses modified Long Dan Xie Gan Tang (Gentian Liver-Draining Decoction), effective after 10 doses, but old disease recurred a month later with worse severity. This is due to steaming Damp-Heat and turbid Evil ascending. Treatment focuses on promoting dampness drainage, transforming turbidity, clearing Heat, and detoxifying, emphasizing "expelling Evil", Evil expelled, Zheng (Healthy Qi) safe, thus cured.
Case 2 not only Tong Shen Gan Que, but also Blood Penetrating Tong Shen. Treatment starts from the whole body, focusing on internal treatment. Due to Liver Meridian Blood Heat, Blood stasis blocking collaterals, treatment uses moving and invigorating Blood, and must cool Blood and clear Heat to treat the root.
(IV) Shi Zhan Hun Miao (Amblyopia / Vision Blurring)