Eye pain includes pain at the eyelid, orbit, canthus, eyeball, and over the whole eye. It may occur in one or in both eyes. The types of eye pain include distending pain, sour pain, stabbing pain, severe pain, slight pain, constant pain and intermittent pain.
According to TCM, the following pathogenic factors may cause eye pain: invasion of External pathogenic factors, stagnation of Qi or Blood, Flaring up of Liver-Fire, hyperactivity of Liver-Yang, deficiency of Qi, deficiency of Blood in the Liver and deficiency of Yin of the Liver and Kidney.
Eye pain may be attributed to any of the following diseases in Western medicine: haematop-sia, xerophthalmia, posterior staphyloma, blepharospasm, ophthalmospasm, orbital neuralgia, endophthalmitis, herpes zoster on the eyelid, dacryocystitis, conjunctivitis, scleritis, keratitis, iritis, trachoma and glaucoma.
Aetiology and pathology
Invasion of External pathogenic factors
Overexposure to strong Wind, Cold, Heat or Dryness may cause an invasion of pathogenic factors to the eyes, leading to stagnation of Qi and Blood in the eye, and causing eye pain as a consequence.
Furthermore, working for too long in bright sunlight, studying for too long in artificial light that is too strong, or not strong enough, staring for too long at a TV or VDU screen, or working or walking in fog, may weaken the eyes and bring about the slowing of Qi and Blood circulation. This leaves the eyes vulnerable to the invasion of External pathogenic factors, causing eye pain.
Emotional disturbance
The eye is related with the interior Zang-Fu organs. If there is persistent emotional disturbance this leads to stagnation of Qi and Blood, causing a slowing down of the circulation of Qi and Blood in the eye, and so eye pain follows. For instance, excessive anger, stress and frustration will cause the Qi of the Liver to stagnate, inhibiting the Liver’s function in opening the orifice. So stagnation of Qi in the eye develops and eye pain follows. Also, where there is excessive grief with a lot of crying, the Lung-Qi stagnates, leading to a stagnation of Qi in the eyes because the Lung fails to disperse Qi to the eyes, causing eye pain.
Moreover, when Qi stagnation persists in the body for a long time, excessive Fire is generated, causing Fire to flare up the eyes, which causes eye pain—for example, Liver-Qi stagnation may generate Liver-Fire, which could flare up to disturb the eye and eye pain follows. Long-lasting stagnation of Liver-Qi and flaring up of Liver-Fire can also cause a failure to comfort the Liver- Yang, leading to eye pain due to hyperactivity of Liver-Yang.
Unhealthy diets
The eye needs to be nourished by Qi and Blood. The Spleen and Stomach are the centres for production of Qi and Blood. Overconsumption of fatty, sweet and pungent food, or of alcohol, causes injury to the Spleen and Stomach, which causes food to accumulate in the body, generating Damp-Heat and forming Damp-Phlegm. In contrast, overconsumption of raw and cold food causes Cold-Damp to form in the Spleen and Stomach so that, instead of sending Qi and Blood to the eye, the Spleen sends Damp-Phlegm, Damp-Heat, or Cold-Damp up to the eye. This causes blockage in the eye and eye pain will be the result. Moreover, disturbance of the Spleen and Stomach may cause a poor production of Qi and Blood, leading to malnourish-ment of the eye, and eye pain follows.
Overstrain or prolonged sickness
The eye is connected with the five interior Zang organs. If there is dysfunction of the interior Zang-Fu organs, the eye is not sufficiently nourished by the Qi and Blood, and eye pain of the deficient type follows. Too much physical work, too much study and mental work, or too much sex may cause consumption of the Qi and Blood, leading to deficiency of Kidney-Essence.
Also, prolonged sickness or congenital weakness may cause an insufficiency of Qi, Blood and Essence in the eye, and eye pain follows. Finally, if there is deficiency of Kidney-Yin then the Liver is not properly nourished, which leads to hyperactivity of Liver-Fire, and again eye pain follows.
Treatment based on differentiation
Differentiation
Differentiation of External or Internal origin
— Acute onset of eye pain, mild in intensity, accompanied by External symptoms, such as an aversion to cold, fever, muscle pain, runny nose, cough, or superficial pulse, is usually caused by invasion of External factors.
— A chronic history of eye pain, mild or severe in intensity, and association of the pain with diet, emotion and other physical conditions, is usually caused by disorders of the Internal Zang-Fu organs.
Differentiation of character of the pain
— Acute sharp eye pain, together with External symptoms, such as an aversion to cold, slight fever, muscle pain or absence of thirst, is usually caused by invasion of Wind-Cold.
— Acute sharp eye pain with a burning sensation, a thin and yellow tongue coating, together with some external symptoms, is usually caused by invasion of Wind-Heat.
— Chronic sharp eye pain, which is related to the emotional state, is usually caused by stagnation of Qi
— Stabbing eye pain, which worsens at night, with a purplish colour of the tongue, is usually caused by stagnation of Blood.
— Slight eye pain, which is intermittent, or aggravated by exertion and during the day, with poor vision, tiredness, an aversion to cold, cold hands and feet, a pale tongue with a thin, white and slight greasy coating, and a thready and weak pulse, is usually caused by deficiency of Qi.
— Chronic eye pain with a burning sensation, restlessness, nervousness, irritability, a bitter taste in the mouth, thirst, constipation, a red tongue with a yellow and dry coating, and a wiry, forceful and rapid pulse, is usually caused by hyperactivity of Liver-Fire.
— Chronic eye pain with slight burning and a sensation of dryness, thirst, night sweating, dry mouth and throat, a red tongue with a thin coating, and a deep, thready, rapid and weak pulse, is usually caused by deficiency of the Yin of Liver and Kidney.
— Eye pain with poor vision, dryness of the eyes, a pale complexion, dry hair, loss of hair and skin, tiredness, dry stools, a pale tongue with a thin coating and a thready and weak pulse, is usually caused by deficiency of Blood in the Liver.
Treatment
EYE PAIN CAUSED BY EXTERNAL FACTORS INVASION OF WIND-COLD
Symptoms and signs
Acute onset of eye pain, aggravation of eye pain with exposure to wind and cold, no redness or swelling of the eyelids, a slight fever, an aversion to wind and cold, headache with a contracting sensation that is referred to the neck and the back of the body, an absence of thirst, accompanied by stuffiness of the nose with a nasal discharge, a thin and white tongue coating and a superficial and tense pulse.
Principle of treatment
Dispel Wind and eliminate Cold.
HERBAL TREATMENT
Prescription
CHUAN XIONG CHA TIAO SAN
Ligiisticum-Green Tea Regulating Powder
Chuan Xiong Rhizoma Ligustici Chuanxiong 6 g
Jing Jie Herba Schizonepcta 6 g
Fang Feng Radix Ledcbourieilac 6 g
Bai Zhi Radix Angelicae Daimrieae 6 g
Xi Xin Herba Asari 3 g
Gan Cao Radix Glycyrrhizae 5 g
Qiang Huo Rhizoma seu Radix Notopterygii 6 g
Cha Ye Folium CameIIiae Sinensis 3 g
Explanations
• Chuan Xiong and Qiang Huo dispel Wind, relieve the eye pain and sedate the headache.
• Bai Zhi and Xi Xin work as assistants to relieve the eye pain and headache.
• Jing Jie and Fang Feng dispel Wind and release the External symptoms.
• Cha Ye dispels Wind, calms the Mind and benefits the eye.
• Gan Cao is used to harmonise the actions of the other herbs.
Modifications
1. If there is fever caused by Wind-Cold invasion, add Chai Hu Radix Bupleuri 5 g and Gui Zhi Ramulus Cinnamomi 10 g to eliminate Wind-Cold and reduce the fever.
2. If there is a stiff neck due to stagnation of Qi in the Bladder channels, add Ge Gen Radix Puerariae 10 g to regulate Qi circulation and relieve the stiff neck.
3. If there is a blocked nose, add Cang Er Zi Fructus Xanthii 10 g and Xin Yi Flos Magnoliae 10 g to dispel Wind and clear the nose.
4. If there is a headache, add Wu Zhu Yu Fructus Evodiae 5 g to warm channel, dispel Wind-Cold and relieve the headache.
Patent remedy
Chuan Xiong Cha Tiao Wan Ligusticum-Green Tea Regulating Pill
ACUPUNCTURE TREATMENT
BL-2 Zanzhu, ST-2 Sibai, ST-3 Juliao, Li-4 Hegu, TE-5 Waiguan, GB-20 Fengchi and LU-7 Lieque. Reducing method is used on these points. When puncturing at GB-20, the tip of the needle should point to the opposite eye.
Explanations
• BL-2, ST-2 and ST-3 the local points, dispel Wind-Cold, promote circulation in the collateral of the eye and relieve the eye pain.
• LI-4, the Source point, and LU-7, the Connecting point, are indicated in complaints of the face and eyes. They can open the skin pores and promote sweating so that Wind-Cold is expelled. LI-4 also regulates the Qi and Blood circulation in the eye, enhancing the effect of reducing the eye pain.
• TE-5, the Connecting point, dispels Wind-Cold and harmonises the Lesser Yang channel and the collateral of the Triple Burner. Besides this it connects with the Yang Linking Vessel, which dominates the superficial parts of the body. When TE-5 is punctured with a reducing method, the Yang Linking Vessel is stimulated, which diminishes the External symptoms due to invasion of Wind-Cold.
• GB-20 dispels Wind-Cold out of the head. Since the tip of the needle points towards the opposite eye, this strongly enhances the effect of dispelling Wind-Cold.
Modifications
1. If there is pain at the eye orbit, add Extra Yuyao and GB-14 to harmonise the collateral and sedate eye pain.
2. If there is pain at the external eye corner, add Extra Taiyang and TE-23 to dispel Wind-Cold and relieve the pain.
3. If there is eye pain at the inner eye comer, add BL-I and Extra Yintang to relieve Wind-Cold in the collateral and stop the pain.
4. If there is headache due to an invasion of Wind-Cold, add GB-8 and GV-23 to harmonise the collateral and relieve the headache.
5. If there is an aversion to cold and general body pain, add BL-58 and BL-63 to dispel Wind-Cold, harmonise the collateral and relieve the pain.
6. If there is a runny nose, cough and expectoration of white phlegm, add LU-5, the Sea point and BL-13, the Back Transporting point of the Lung, to dispel Wind-Cold and relieve the cough.
7. If there is a fever, add GV-14 to dispel Wind and reduce the fever.
8. If there is a blocked nose, add LI-20 to dispel Wind-Cold and clear the blockage in the nose.
INVASION OF WIND-HEAT
Symptoms and signs
Acute occurrence of eye pain, redness and swelling of the eye with a burning sensation, aggravation of pain on exposure to wind and heat, formation of pus in the eye, fever, an aversion to cold, thirst, a distending headache, constipation, a red tip to the tongue, a yellow tongue coating and a superficial and rapid pulse.
Principle of treatment
Dispel Wind and clear Heat.
HERBAL TREATMENT
Prescription
XIE Pl CHU RE YIN
Reduce the Spleen and Clear Heat Decoction Chong Wei Zi Fructus Leorturi 10 g Fang Feng Radix Ledebouriellae 6 g Huang Qin Radix Scutellariae 10 g Xuan Shen Radix Scrophulariae 10 g Zhi Zi Fructus Gardeniae 10 g Shi Gao Gypsum Fibrosum 18 g Da Huang Radix et Rhizoma Rhei 6 g Zhi Mu Rhizoma Anemarrhenae 6 g Huang Bai Cortex Phellodendri 6 g Ju Hua Flos Chrysanthemi 6 g
Explanations
• Chong Wei Zi and Huang Qin clear Wind-Heat in the Liver channels to improve the eyesight and stop the eye pain.
• Fang Feng and Zhi Zi eliminate Wind-Heat and relieve pain and itching in the eyes.
• Shi Gao and Zhi Mu clear Heat in the Upper Burner.
• Xuan Shen nourishes the Liver-Ym and clears Heat.
• Huang Bai and Ju Hua clear Liver-Fire.
• Da Huang eliminates Internal Heat by promoting defecation.
Modifications
1. If there is pus in the eye, add Pu Gong Ying Herba Taraxaci IOg and Ye Ju Hua Flos Chrysanthemi Indici 10 g to clear Heat and eliminate the Toxin.
2. If there is a headache caused by Wind-Heat, add Chuan Xiong Rhizoma Ligustici Chuanxiong IOg and Bo He Herba Menthae 5 g to clear Wind-Heat and relieve the headache.
3. If there is fever, add Chai Hu Radix Bupleuri 5 g and Ban Lan Gen Radix lsatidis 10 g to clear Heat and lower the fever.
4. If there is constipation, add Lu Hui Pasta Aloes and Mang Xiao Natrii Sulfas to clear the Heat and promote defecation.
Patent remedies
Yin Qiao Jie Du Pian Honeysuckle and Forsythia Tablet to Overcome Toxins
Ym Qiao Pian Honeysuckle and Forsythia Tablet
ACUPUNCTURE TREATMENT
BL-2 Zanzhu, ST-2 Sibai, Extra Taiyang, LI-2 Erjian, LI-4 Hegu, LU-7 Lieque, TE-2 Yemen, LI-5 Yangxi and GB-20 Fengchi. A reducing method is used on these points. The bleeding method is used on LI-2 and ΤΈ-2. When needling GB-20, the tip of the needle should point towards to the opposite eye.
Explanations
• BL-2, ST-2 and Extra Taiyang, the local points, dispel Wind, clear Heat, promote the circulation of the collateral in the eye and relieve the pain.
• LI-2 and TE-2, the Spring points, clear Heat, relieve redness, reduce swelling and stop the pain.
• LI-4, the Source point, and LU-7, the Connecting point, promote sweating and dispel Wind-Heat in the face and eye.
• TE-5, the Connecting point, dispels Wmd-Heat and harmonises the Lesser Yang channel and the collateral of the Triple Burner, and relieves External symptoms.
• GB-20 dispels Wind-Heat out of the head and sedates the eye pain.
Modifications
I. If there is pain at the eye orbit, add Extra Yuyao and GB-14 to harmonise the collateral and sedate the pain.
2. If there is pain at the external eye comer, add Extra Taiyang and TE-23 to dispel Wind-Heat and relieve the pain.
3. If there is eye pain at the inner eye corner, add BL-I and Extra Yintang to relieve Wind-Cold in the collateral and stop the pain.
4. If there is a headache due to the invasion of Wind-Heat, add GB-8 and GV-23 to harmonise the collateral and relieve the headache.
5. If there is a high fever, add GV-14 and LI-Il to clear Heat and reduce the fever.
6. If there is a runny nose, cough and expectoration of yellow phlegm, add LU-5, the Sea point, and LU-10, the Spring point, to dispel Wind-Heat and relieve the cough.
7. If there is a blocked nose, add LI-20 to dispel Wind-Heat and clear the blockage in the nose.
