Of all the diseases discussed in this book, none have been so completely focused on presentations of heat and fire. Iridocyclitis is an urgent condition, therefore, every formula, whether treating endogenous or exogenous pathogens is structured around bitter, cold, drying medicinals.

The primary case in this chapter discusses a case of contracted pupil due to liver and gallbladder damp-heat. The patient’s extensive history of alcohol abuse results in liver and gallbladder damp-heat. This predisposes him to develop diseases that present with patterns of liver and gallbladder damp-heat. His constitution is his imbalance. Thus, in accordance with the saying yì bìng tóng zhì—different diseases, same treatment, this gentleman could have developed any number of diseases including conjunctivitis, herpes zoster, prostatitis or hypertension, as long as it presented in alignment with his constitutional imbalances.

Lóng Dăn Xiè Gān Tāng only needs a minor tweaking to craft an effective treatment to resolve his iridocyclitis. The physician modifies the formula shrewdly: He omits dampness seeping mù tōng (Caulis Akebiae) from the formula and replaces it with damp-heat draining tŭ fú líng and bì xiè. Large doses of chăo gŭ yá and chăo mài yá are then added to protect the digestion from the drying effects of the formula. This treatment is combined with local atropine eye drops to the affected eye to dilate the pupil.

Because iridocyclitis can easily affect the zang-fu, there may be constipations. If so, then modify the formula with dà huáng (Radix et Rhizoma Rhei) 6g and máng xiāo (Natrii Sulfas) 5g to relieve constipation and drain heat.

If the infection causes severe turbidity of the aqueous humor, or if there is yellow exudate, add pú gōng yīng (Herba Taraxaci) 15g, bài jiàng căo (Herba Patriniae) 15g, lián qiào (Fructus Forsythiae) 10g, wĕi jīng (Phragmitis Rhizoma) 30g, yì yĭ rén (Semen Coicis) 15g, dōng guā rén (Semen Benincasae) 20g, and táo rén (Semen Persicae) 5g to resolve toxin, expel pus and drain dampness.

If exuberant heat damages the collaterals, resulting in hyphema of the anterior chamber, then omit the dāng guī (Radix Angelicae Sinensis) and add dān pí (Cortex Moutan) 10g, chì sháo (Radix Paeoniae Rubra) 10g and shēng pú huáng (Pollen Typhae) 12g to cool blood, stop bleeding and invigorate the blood.

As expected, the patient responds well and the treatment is now staged to ensure his complete recovery. The extreme heat has injured the yin, yet there are still signs of damp-heat. Thus, a formula is needed that can simultaneously nourish the yin, clear residual fire, and moisten dryness. Gān Lù Yĭn incorporates this nuanced dynamic.

Not to be confused with the Yi Tian-shi’s similarly named Gān Lù Xiāo Dú Dān (Sweet Dew Toxin-Removing Elixir), which treats damp-warmth febrile disorders, Gān Lù Yĭn is a formula that nourishes the yin, clears heat, resolves dampness and diffuses the lungs. The formula is used when there is residual heat in yangming following a febrile disorder, resulting in fluid damage. Traditional indications for the formula include swollen gums, mouth ulcers, bad breath and a sore throat; all signs of stomach heat. To reframe this in the context of eye diseases: the whites of the eye belong to the qi wheel, and are associated with the stomach and the lungs. The stomach channel originates at the eye. Thus Gān Lù Yĭn can be used for eye diseases with this presentation. The author of the text has made the following modifications: yīn chén (Herba Artemisiae Scopariae) and pí pá yè (Folium Eriobotryae) are omitted and zhī zĭ is added.