Syndrome Differentiation and Treatment

Since the disease is of either sthenia or asthenia type, or of a mixed type sometimes, it is clinically classified into the syndromes of upward invasion of turbid pathogenic factor, damp stagnation due to spleen deficiency, qi stagnation and blood stasis and deficiency of the liver and kidney. The treadment methods, depending on the different syndromes, should respectively include removing heat and dampness, nourishing the spleen to relieve dampness, removing heat and soothing liver, and benefiting the liver and kidney.

1. Syndrome of Upward Invasion of Turbid Pathogenic Factor

Main Symptoms and Signs  Blurred vision or chromaopsia, micropsia, metamorphopsia; optic fudus findings including edema and exudation in the macular part and the absence of light reflex of central fovea; accompanied by the general symptoms of chest distress, poor appetite, a bitter taste in the mouth and scanty yellowish urine; yellowish greasy tongue coating and slippery rapid pulse.

Therapeutic Methods  Removing heat and promoting diuresis

Recipe  The modified Sanren Decoction: Xingren ( Semen Armeniacae Amarum ) 10 g, Baikouren ( Semen Amomi Rotundus ) 6 g, Yiyiren ( Semen Coicis )  10 g, Huashi (Talcum) 10 g, Houpo (CortexMagnoliae Officinalis ) 6 g, Banxia ( Rhizoma Pinelliae ) 9 g, Cheqianzi (Semen Plantaginis, bagged) 10 g, Chong weizi (Semen Leonuri) 10 g, Zexie (Rhizoma Alismatis) 10 g, and Zhike (Fructus Aurantii) 6 g.

Modification  In the cases with severe damp-heat, 10 g of Huangqin ( Radix Scutellariae ) and 6 g of Shanzhizi ( Fructus Gardeniae) are added.

2. Syndrome of Damp Stagnation due to Spleen Deficiency

Main Symptoms and Signs  The same ocular symp- toms as the above one, often accompanied by anorexia, loose stool, sallow and dim complexion and lassitude; whitish tongue with whitish coating.

Therapeutic Methods   Nourishing the spleen to benefit qi, excreting dampness to remove stagnation.

Recipe  The modified Shenling Baizhusan Decoction:
Dangshen (Radix Codonopsis Pilosulae) 10 g, Huangqi (Radix Astragali seu Hedysari) 12 g, Shanyao (Rhizoma Dioscoreae ) 10 g, Baizhu ( Rhizoma Atractylodis
Macrocephalae ) 10 g, Chenpi ( Pericarpium Citri Reticulatae) 6 g, Yiyiren (Semen Coicis) 10 g, Jiegeng (Radix Platycodi ) 6 g, Zexie ( Rhizoma Alismatis ) 10 g,
and Zhike (Fructus Aurantii) 6 g.

Modification  In the cases of serious edema and exudation in the macular part, 10 g of Zhuling (Polyporus) and 10 g of Zelan (Herba Lycopi) and 6 g of Niuxi (Ra-
dixAchyranthis Bidentatae) are added; in the cases of deficiency of spleen yang and glossy tongue coating, 10 g of Guizhi (Ramulus Cinnamomi ) and 6 g of Ganjiang
( Rhizoma Zingiberis ) are added.

3. Syndrome of Qi Stagnation and Blood Stasis

Main Symptoms and Signs  The same ocular symptoms as the above, accompanied by emotional discomfort, chest distress, stenagma, dizziness, hypochondriac pain, bitter taste in the mouth and dry throat; thready, thin and rapid pulse.

Therapeutic Methods  Removing heat to disperse stagnated liver and promoting flow of qi to activate blood circulation.

Recipe  The modified Danzhi Xiaoyaosan Decoction. Chaihu (Radix Bupleuri) 6 g, Baishaoyao (Radix Paeoniae Alba ) 10 g, Danggui (Radix Angelicae Sinensis )
10 g, Fuling (Poria) 12 g, Baizhu (RhizomaAtractylodis Macrocephalae ) 10 g, Mudanpi ( Cortex Moutan Radicis) 10 g, Shanzhizi ( Fructus Gardeniae ) 10 g, Zexie ( Rhizoma Alismatis ) 10 g, Danshen ( Radix Salviae Miltiorrhizae ) 15 g, Yujin (Radix Curcumae ) 10 g, and Chongweizi (Semen Leonuri) 10 g.

Modification  In the cases of distending pain in chest and hypochondrium, 10 g of Chuanlianzi (Fructus Toosendan) is added.

4. Syndrome of Deficiency of Liver and Kidney

Main Symptoms and Signs  The same ocular symptoms as the above, other accompanying symptoms at the late course including dizziness, tinnitus, lassitude in loin  and legs, dreaminess, thin pulse.

Therapeut ic Method  Nourishing the liver and kidney.

Recipe  The modified Qiju Dihuangwan Decoction.. Gouqizi (Fructus Lycii) 12 g, Juhua (Flos Chrysanthe mi) 9 g, Shudihuang (Radix Rehmanniae) 10 g, Zexie
 (Rhizoma Alismatis ) 10 g, Shanyao ( Rhizoma Dioscoreae ) 10 g, Heshouwu (Radix Polygoni Multiflori) 10 g, Shanzhuyu (Fructus Corni) 10 g, Danshen (Radix Salviae Miltiorrhizae ) 15 g, and Zhike ( Fructus Aurantii) 6 g.

Modification  In the cases of excessive exudation and pigment in the fundus, 10 g of Danggui (Radix Angelicae Sinensis) and 10 g of Niuxi (Radix Achyranthis
 Bidentatae) are added; in the cases of poor vision, 10 g of Tusizi ( Semen Cuscutae ) and 6 g of Shichangpu (Rhizoma Acori Graminei) are added; in the cases of hyper-
 activity of fire due to yin deficiency, 10 g of Zhimu (Rhizoma Anemarrhenae ) and 10 g of Huangbai ( Cortex Phellodendri) are added.

Other Treatments

1. Chinese Patent Drugs

(1) Danzhi Xiaoyao Pill  5 g each time, twice a  day, applicable to the syndrome of qi stagnation and blood stasis.
(2) Qiju Dihuang Pill  8 pills each time, twice a day, applicable to the syndrome of deficiency of the liver and kidney.
(3) Jiajian (modified) Zhujing Pill   5 g each time, twice a day, applicable to the syndrome of deficiency of the liver and kidney.
(4) Shenling Baizhu Pill  5 g each time, twice a day, applicable to the syndrome of damp stagnation due to spleen deficiency.

2. Simple and Proved Recipes

(1) The recipe consists of the following ingredients: Xiakucao ( Spica Prunellae) 15 g, Yimucao (Herba leonuri) 9 g, Fuling (Poria) 9 g, Huangqi (Radix Astragali seu Hedysari ) 12 g, and Cheqianzi (Semen Plantaginis, bagged) 9 g, which are decocted with water for oral taking one dose a day, and it is applicable to the
disease at the edema stage.
(2) The ingredients in the recipe are: Tusizi (Semen Cuscutae ) 12 g, Cheqianzi ( Semen Plantaginis, bagged) 15 g, Shudihuang (Rhizoma Rehmanniae Praeparata) 30 g, and Gegen (Radix Puerariae) 25 g, which are all decocted with water one dose a day for oral taking and it is applicable to the disease in the recovery stage.