Female, age 23. Initial Visit: September 19 ^th, 2008

Chief Complaint: A swollen mass that was neither red nor painful presenting on the upper lef lid seven days prior to treatment.

History: For the past three years, the patient has experienced recurrent chalazia on the upper eyelids of both eyes. The symptoms appeared again seven days prior to treatment. The patient visited several optical clinics and was diagnosed with chalazion. Afer undergoing several incisions and curetage, the chalazia persistently returned to both eyes.

Signs and Symptoms: A painless induration appeared on the upper lef eyelid with normal skin color and no adhesion to the skin of the lid. The skin of the corresponding lid was swollen with a purplish-red color. The patient suffered from constant dry mouth and dry stools. She preferred spicy and sweet food. The tongue body was red with a yellowish sticky coating. The pulse was slippery and rapid.

Past History: Myopia for five years.

The patient’s main characteristics were a preference for sweet and spicy food, and reoccurring chalazion in the upper lids of both eyes during the previous three years. The patient’s poor eating habits are associated with spleen-stomach deficiency, as well as weakened wei-defensive qi. At the time of treatment, there was a painless, bulging induration in the upper lid of the lef eye. The skin color was normal with no adhesion of the eyelid skin. The skin of the corresponding eyelid was swollen with a purplish-red color. The patient presented with a dry mouth and dry stools. The tongue was red with a yellowish sticky coating. The pulse was slippery and fast.

Long term consumption of spicy, sweet food resulted in damp-heat congestion in the spleen and stomach. Heat burned the dampness to produce phlegm. Phlegmheat congestion moved upwards to block the collaterals of the upper eyelid causing the accumulation of qi, blood, phlegm and dampness. This accumulation induced chalazia

This disease was located in the eyelid, which belongs to the muscle wheel and is associated with the spleen. It was caused by phlegm-heat congestion and can be categorized as an excessive patern.

WM diagnosis: Chalazion

TCM diagnosis: Phlegm node in eyelid due to phlegm-heat accumulation

This case is categorized as an excessive pattern. The accumulation of phlegmheat blocking the collaterals of the upper eyelid resulted in qi, blood, phlegm and dampness congestion inside the eyelid. The treatment therefore, should focus on the phlegm-heat congestion, and qi and blood stasis.

Principles: Clear heat, transform phlegm and dissipate masses

Formula: Modified Huà Jiān Èr Chén Tāng (Hardness-Resolving Two Matured Substances Decoction)

[化坚二陈汤加减]

[Formula Analysis]

Bàn xià, chén pí and fú líng dry dampness and transform phlegm. The addition of dry-fried jiāng cán and zhè bèi mŭ transforms phlegm and sofens hardness.

Chuān huáng lián, lián qiào, zhú rú and xià kū căo clear heat, transform phlegm, sofen hardness and dissipate masses.

Chì sháo and mŭ dān pí cool blood and move blood stasis.

Gān căo harmonizes all formula medicinals.

Eye drops: 0.5% bear bile eye drops or antibiotic eye drops, 4-6 times daily.

Warm moist compress: 24 hours post surgery, application of a warm moist compress to promote blood circulation.

Incision and curettage: This treatment method can be used due to the large size of the mass in this case.

Four days afer treatment, the induration of the upper lef eyelid was eliminated and the skin had returned to a normal color. The dry stools were resolved, but the dry mouth remained. The tongue body was still red with a slightly yellowish coating. The pulse was slippery and rapid. These remaining symptoms showed that the phlegm heat was mostly resolved, but there was remaining damp heat congestion of the spleen and stomach.

Principles: Clear heat, transform phlegm and dissipate masses

Formula: Modified Huà Jiān Èr Chén Tāng (Hardness-Resolving Two Matured Substances Decoction)

[化坚二陈汤加减]

[Formula Analysis]

This formula is a modified version of the first formula. Since the induration dissipated, jiāng cán and zhè bèi mŭ were eliminated. Although the dry stools were resolved, pathogenic heat can easily injure the yin and the patient still sufered from a dry mouth, so lú gēn was added to clear heat and generate fuids.

The rest of the formula remained unchanged, because the damp heat congestion was not completely resolved, as evidenced by the fact that the tongue was still red with a slightly yellow coating and the slippery rapid pulse was still present.

The eye drops and compresses were continued as before.