aliases: [vesicular conjunctivitis,]
Golden chancre refers to an eye disease characterized by the appearance of small vesicle-like nodules on the superficial layer of the sclera, surrounded by dilated red vessels, also known as golden ulcer. The term “golden chancre” first appeared in “Zhengzhi Zhunsheng · Miscellaneous Diseases · Seven Orifices Chapter,” which described its symptoms and affected locations: “Golden chancre, initially resembles a nodule, but eventually causes trouble… when it occurs in the qi wheel area, there is severe eye pain and tearing.” This disease mostly affects one eye but can also involve both eyes.
This condition is similar to vesicular conjunctivitis in Western medicine.
Etiology and Pathogenesis
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Lung meridian dryness and heat, failure of dissemination function, excessive lung fire ascending to the eyes, leading to qi and blood stagnation.
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Lung yin deficiency, virtual fire flaring upward affecting the sclera.
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Dysfunction of spleen and stomach, earth failing to generate metal, lung metal losing nourishment, and impaired lung qi.
Clinical Manifestations
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Subjective symptoms: only discomfort and foreign body sensation in the eyes.
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Eye examination: gray-white or nodule-like small vesicles visible on the superficial layer of the sclera, mostly single and varying in size, painless when pressed, with red vessels surrounding the vesicles (see color plate 10-6). Vesicles may rupture and heal spontaneously without leaving scars.
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Laboratory and special examinations: some patients show positive tuberculin test.
【Diagnostic Criteria】
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Gray-white small vesicles observed on the superficial sclera, surrounded by red vessels.
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Eye discomfort and foreign body sensation.
【Treatment】
- Syndrome differentiation and treatment
(1) Lung meridian dryness-heat syndrome
Symptoms: eye discomfort and pain, hot tears and sticky secretions; small vesicles on the superficial sclera with enlarged red vessels around; may have thirst, dry nose, constipation, dark urine; red tongue with thin yellow coating; rapid pulse.
Analysis: Dryness-heat in the lung meridian attacks the eyes, causing marked discomfort and pain, and red vessels around vesicles. Other ocular and systemic symptoms as well as tongue and pulse signs indicate lung meridian dryness-heat.
Treatment principle: Clear lung heat and disperse nodules.
Prescription: Modified Xie Fei Tang (Lung-Clearing Decoction) [74]. Often added with Red Peony Root (Chi Shao), Moutan Cortex to cool blood, activate blood, and reduce redness; Forsythia (Lian Qiao) to enhance heat clearing and nodule-resolving effects; if vesicles locate at the limbus, add Prunella (Xia Ku Cao) and Cassia Seed (Jue Ming Zi) to clear liver and reduce fire; if constipation is present, add Rhubarb (Da Huang) to purge heat and clear bowels.
(2) Lung yin deficiency syndrome
Symptoms: mild discomfort and pain, dry sticky secretions, small vesicles on the sclera with light red surrounding vessels, recurrent episodes; may have dry cough and sore throat; red tongue with little or no coating; thin rapid pulse.
Analysis: Lung yin deficiency leads to virtual fire flaring upward, characterized by mild discomfort and light red vessels around vesicles. Other symptoms and tongue/pulse signs reflect lung yin deficiency.
Treatment principle: Nourish yin and moisten lungs.
Prescription: Modified Yang Yin Qing Fei Tang (Nourish Yin and Clear Lung Decoction) [88]. Often added with Prunella (Xia Ku Cao) and Forsythia (Lian Qiao) to enhance heat clearing and dispel pathogens.
(3) Lung and spleen deficiency syndrome
Symptoms: mild red vessels surrounding scleral vesicles, prolonged course with difficulty in healing or frequent recurrence; fatigue, lack of strength, poor appetite, abdominal distension; pale tongue with thin white coating; thin and weak pulse.
Analysis: Due to deficiency of lung and spleen, pathogen is not strong, so ocular symptoms are mild and recurrent; systemic symptoms and tongue/pulse signs indicate lung and spleen deficiency.
Treatment principle: Boost qi and strengthen spleen.
Prescription: Modified Shen Ling Bai Zhu San (Ginseng, Poria and Atractylodes Powder) [81]. May add Mulberry Bark (Sang Bai Pi) and Red Peony Root (Chi Shao) to ease eye redness and relieve eye pain.
- External treatment
0.5% Bear bile eye drops can be used 3 to 6 times daily; simultaneously, 0.5% Prednisolone acetate eye drops or 0.025% Dexamethasone eye drops may be used. Antibiotics are also optional.
Prevention and Care
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Avoid spicy and inflammable foods to prevent aggravating heat and injuring yin. Appropriately supplement various vitamins.
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Strengthen exercise to improve physical fitness.