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BLEPHARITIS

GENERAL

Clinical Manifestations	An eye condition characterized by chronic inflammation of the eyelid, the severity and time course of which can vary. Onset can be acute, resolving without treatment within 2–4 weeks (this can be greatly reduced with lid hygiene), but more generally is a long standing inflammation varying in severity. It may be classified as seborrheic, staphylococcal, mixed, posterior or meiobomitis, or parasitic. Inflammation of the lid margins Redness of the eyelids Drooping of upper eye lid Thickening and faking of skin on the lids Crusting at the lid margins, generally worse on waking Cysts at the lid margin (hordeolum) Red eye Burning Debris in the tear film, seen under magnification (improved contrast with use of fluorescein drops) Gritty sensation of the eye or foreign-body sensation Reduced vision Photophobia, Tearing Eye itching Severe cases: Ulcerations Burning Redness Pain Crusting Ulcerative blepharitis: Congestion S welling Scales at the base of lashes Ulcers may be present when the scales are removed The lashes may be glued together and easily lost but they are not replaced Painful sensation Photophobia and Lacrimation Scaly blepharitis: Congestion of lid margin There are whitish scales in the bases of the lashes, which are easily lost but not replaced Canthal blepharitis: The inflammatory reaction usually occurs in the canthal margin of the lid Congestion Ulceration Itching
Treatment Principle
Herb Formulas	Blepharitis #1 Zi Shen Ming Mu Tang For severe itch in the canthus area: San Huang Xie Xin Tang Dao Chi San
Points	Sedate LI-4, SJ-10, UB-2, tonify LIV-13 GB-3, LI-2, SI-4, SJ-10, ST-36 GB-1, ST-2, UB-1, UB-2 SI-4, LI-2 LI-4, SJ-21 + Upper lid: Yuyao, UB-2, SJ-23 Lower lid: LI-20 Lateral canthus: GB-1 Medial canthus: UB-1 Mid-dorsal interphalangeal joint of the thumb, Mid-dorsal interphalangeal joint of the little finger, prick eyelids until Blood flows

YANG MING FU WITH BLOOD STAGNATION

Clinical Manifestations	High fever (sometimes rises and falls) Great thirst Profuse perspiration Aversion to Heat Abdominal pain (worse with pressure) Abdominal distension Foul breath Red face Dryness Constipation (hard dry knots) Dislikes pressure Restlessness Irritability Mental disturbance: Mentally unclear Delirious speech T: Red and dry, or black and moist C: Thick yellow or dry yellow P: Deep, strong and forceful
Treatment Principle	Purge
Herb Formulas	Tao He Cheng Qi Tang
Points	For Heat: DU-14, LI-4, LI-11, SJ-5, ST-44 For Stagnation: REN-12, ST-34, ST-36, ST-37, ST-39 For Constipation: SJ-6, ST-25, UB-25

WIND-HEAT

Clinical Manifestations	Red eyes Yellow thick eye discharge Suppuration with severe chills Dry, itchy eyes Aggravated by Heat Photophobia Headache Inflammation Swelling Pain Congestion Fever Sore throat Nasal discharge T: Red tip or C: Thin and yellow or white or P: Superficial and rapid or
Treatment Principle	Expel Wind Clear Heat Detoxify
Herb Formulas	Sang Ju Yin
Points	DU-14, DU-16, GB-20, LI-4 + LU-7 or LI-4 + SJ-5, LU-5, LU-10, LU-11, UB-12, UB-13

TOXIC WIND-HEAT

Clinical Manifestations	Red eyes Yellow thick eye discharge Suppuration with severe chills Dry, itchy eyes Aggravated by Heat Photophobia Headache Inflammation Swelling Pain Congestion Fever Sore throat Nasal discharge T: Red tip or C: Thin and yellow or white or P: Superficial and rapid or
Treatment Principle	Expel Wind Clear Heat Detoxify
Herb Formulas	Niu Huang Shang Qing Wan
Points	GB-8, GB-20, LI-4, Taiyang, UB-1

WIND-DAMP

Clinical Manifestations	Excessive discharge Weepy, itchy, red skin lesions Lesions may range over a large portion of the body Thirst Rashes Lesions may be worse in hot weather Severe itching T: Pink C: Yellow or White P: Superficial, forceful and rapid or Soft and rapid
Treatment Principle	Disperse Wind Eliminate Dampness Clear Heat Cool the Blood Nourish the Blood Stop itch
Herb Formulas	Xiao Feng San modified
Points

WEI STAGE: SUMMERHEAT WITH DAMPNESS

Clinical Manifestations	Fever and chills, fever more pronounced or Tidal fever Abdominal distention Thirst Sweat Stifling sensation in the chest Restlessness Gastric disturbances: Heaviness Nausea Severe diarrhea Scanty urine T: Red tip and edges C: Greasy white or yellow P: Rapid and soft
Treatment Principle	Disperse Wind Clear Heat Resolve Damp
Herb Formulas	Bi Yu San
Points	Bleed UB-40, needle DU-14, DU-23, DU-24, GB-20, LI-4, LI-11, REN-9, SJ-5, SP-6, SP-9, ST-8, ST-28, Taiyang, UB-12, UB-20 + general points

SPLEEN QI DEFICIENCY

Clinical Manifestations	Sallow complexion Fatigue Anorexia Four limbs feel tired and heavy Abdominal and epigastric distention after eating Maybe acid regurgitation or vomiting Loose stools Shortness of breath T: Pale and flabby - may have teethmarks C: White P: Even, forceless and Deficient
Treatment Principle	Strengthen the Spleen Benefit Qi
Herb Formulas	Bu Zhong Yi Qi Tang modified
Points	LIV-13, REN-12, SP-3, SP-5, SP-6, ST-36, UB-20

SPLEEN DEFICIENCY DAMPNESS

Clinical Manifestations	Slight redness Discharge Itchy Little or no pain Pain in low back and knees Weakness or atrophy of lower extremities Scanty yellow urine Red, hot, swollen and painful feet or knees Edema in lower legs Leukorrhea (thick, yellow, foul-smelling) Sores on lower extremities due to Damp Oliguria Eczema T: Normal C: Yellow and greasy P: Soft and and rapid
Treatment Principle	Eliminates Heat and Dampness
Herb Formulas	Er Miao San
Points

DAMP HEAT INJURES THE SPLEEN AND STOMACH

Clinical Manifestations	Blepharitis Jaundice Anorexia Abdominal distention and discomfort Suffocating sensation in the chest Epigastric mass Maybe abdominal pain on palpation Yang jaundice (sclera and skin are bright yellow) Dislike of oily foods Nausea Vomiting Lassitude Scanty, dark urine Maybe thirst or thirst with no desire to drink Diarrhea with foul smell or Constipation Fever Sweet sticky taste or bitter taste in mouth T: Pink C: Thick, yellow and greasy (maybe sticky) P: Soft and rapid
Treatment Principle	Clear Heat Benefit Dampness
Herb Formulas	Gan Lu Yin
Points	LI-11, REN-12, SP-9, ST-36, ST-44, UB-20

LIVER FIRE

Clinical Manifestations	Severe, splitting headaches with dizziness Sudden tinnitus or deafness Flushed face Red, swollen, painful eyes Irascibility with violent angry outbursts Dry mouth Bitter taste in mouth Thirst Vomiting sour or bitter liquid Insomnia Restlessness Constipation or dry stools Maybe rib pain T: Red tip and edges C: Thick, yellow, dry and rough P: Wiry, Shi and rapid
Treatment Principle	Clear the Liver Purge Fire
Herb Formulas	Xie Qing Wan
Points	GB-12, GB-34, GB-37, LIV-2, UB-18, UB-19 GB- 20, KI-1, LIV-2, bleed Taiyang, UB-2

SPLEEN AND KIDNEY YANG DEFICIENCY

Clinical Manifestations	Body cold Limbs icy Complexion white and shiny Low back, knees and abdomen feel cold and painful Lower abdomen feels cold and painful Loose stools containing undigested food “Cock-crow” diarrhea (occurs at about 5 am) Edema of face and limbs Dysuria T: Pale, moist and swollen C: Thin and white or White and greasy P: Deep, thready, weak and maybe slow
Treatment Principle	Warm and Reinforce the Spleen and Kidneys
Herb Formulas	Si Jun Zi Tang + You Gui Wan
Points	Moxa or moxa needle REN-4, REN-12, SP-6, SP-9, ST-36, UB-20, UB-23

LIVER AND KIDNEY YIN DEFICIENCY

Clinical Manifestations	Blepharitis Conjunctivitis Eye fatigue Night blindness Photophobia Lacrimation when exposed to wind or drafts Ocular pain Facial complexion pale and sallow Both cheeks slightly red Dizziness Dry eyes Blurred vision Spots before the eyes Numbness or spasms of limbs Flaccid paralysis (Wei syndrome), weakness May be long term tremors of the hand, leg, jaw or tongue Tinnitus, deafness Forgetfulness Low back and knees sore and painful Throat dry and painful	Five sole heat Low-grade fever Night sweats Headache Irritability Insomnia Dream disturbed sleep Stools difficult to pass Constipation Poor memory Depression Emaciation Dry skin Restlessness Men: Spermatorrhea Women: Irregular menses or Scanty menses or Amenorrhea Vaginal discharge T: Red or Red an dry C: Little or none P: Thready and rapid or Thready, wiry , rapid and deep
Treatment Principle	Nourish Yin Nourish and reinforce the Liver and Kidneys Benefit the eyes
Herb Formulas	Qi Ju Di Huang Wan
Points	UB-18, UB-23, LIV-3, KI-3 UB-23, UB-18, REN-4, KI-3, KI-6, LIV-3, LIV-8, LU-7, HT-7 With anxiety: PC-6, Yintang

LIVER AND KIDNEY YIN AND BLOOD DEFICIENCY

Clinical Manifestations	Blepharitis Conjunctivitis Dry eyes Eye fatigue Night blindness Photophobia Dizziness Headache Hot palms and soles Insomnia Irritability Lacrimation when exposed to Wind or drafts Ocular pain Restlessness T: Red C: Little or none P: Thready and Rapid or Thready , Rapid and Wiry
Treatment Principle	Nourish Yin and Blood of the Liver and Kidneys Improve vision
Herb Formulas	Ming Mu Di Huang Wan
Points

LIVER AND KIDNEY YIN DEFICIENCY WITH HEAT

Clinical Manifestations	Blepharitis Cataract Conjunctivitis Glaucoma Night blindness Ocular pain Poor vision Red eyes Ocular disease following surgery T: Red C: Little or none P: Thready and Rapid or Thready , Rapid and Wiry
Treatment Principle	Nourish Yin and Blood of the Liver and Kidneys Clear Heat Improves vision Tonifies Qi and Blood Moves Qi and Blood
Herb Formulas	Nei Zhang Ming Yan Wan
Points

BLOOD STAGNATION

Clinical Manifestations	Dysmenorrhea Headache Sinus congestion Constipation Excess weight in the pelvis Lower back ache Irregular menstruation Nervousness Fatigue Fetal instability Skin eruptions Scanty menstrual flow Scaly, dry skin Retention of lochia Headache Shoulder stiffness Vertigo Cold low body and feet Flushed face Protruding abdomen T: Dark purple or with echymoses or petechiae or pale with purplish spots C: White P: Choppy or Tense and deep and slow
Treatment Principle	Invigorate the Blood Transform Blood Stasis
Herb Formulas	Gui Zhi Fu Ling Wan
Points

TOXIC DAMP-HEAT

Clinical Manifestations	Painful, red, swollen, eye Stinky discharge from the eye Local inflammation with pus Deep-rooted, hard and painful boils Erythema Swelling Heat Carbuncles Furuncles Fever and chills Pain T: Red C: Yellow and greasy P: Rapid
Treatment Principle	Clear Heat Purge Fire Relieve toxicity Cool the Blood Reduce swelling
Herb Formulas	Wu Wei Xiao Du Yin Huang LIan Jie Du Tang
Points