Purulent keratitis is an acute condition requiring immediate treatment to prevent loss of vision. For this case, the author takes great care walking us through the entire arc of the patient’s history, which includes chronic dacryocystitis. Because her eyes were chronically dry, she was predisposed to eye infection. The physician clearly states that this case must be triaged to treat the acute infection first.

The formula selected is modified Xīn Zhì Chái Lián Tāng. Its actions are to eliminate wind, clear heat, cool the blood and brighten the eyes. It is similar to the modern prepared formula Huáng Lián Shàng Qīng Wán (Coptis Upper-Body-Clearing Pill). Both formulas contain huáng lián, lián qiào, màn jīng zĭ, jīng jiè, huáng qín and shí gāo. Few traditional formulas include màn jīng zĭ. It acts to disperse wind heat, eliminate heat from the eyes, stop pain and reduce the nebula. In addition to its primary actions in the context of this formula, it also acts as an envoy, directing the formula to the eyes. Căo jué míng (Semen Cassiae) is the other medicinal that disperses wind heat and clears the vision. The final medicinal, qiān lĭ guāng, is bitter and cold. It enters the lung, liver and large intestine channels. Its key actions are to clear heat, eliminate toxins, clear liver fire and brighten the eyes. It can be used alone as eyewash or prepared into eye drops for the treatment of corneal ulcers. Although used infrequently, it is often included in ophthalmology formulas.

An external steam and compress is recommended to hasten recovery. When using topical compresses on the eye, care should be taken to strain the medicinals well to ensure that there are no plant particulates on the compress that could inadvertently enter the eye and cause further irritation or infection.

By the second visit, the patient is on the track towards recovery. The treatment strategy is reevaluated to address her root constitution, which is qi and yin deficient, and to continue to support healing of the nebula. The new formula, Hăi Zàng DìHuáng Săn, is discussed above and is straightforward in its actions. It is worth noting that the group of medicinals for the eye, gŭ jīng căo, mù zéi căo and chán tuì, are specifically indicated for reducing nebula. Other medicinals from this category, such as cáo jué míng or qīng xiāng zĭ (Semen Celosiae) clear heat from the eyes and reduce liver fire. Therefore, this second group of medicinals should be selected for the first, acute phase of treatment.