bubble_chart Concept

Pterygium refers to the condition where a large piece of red flesh grows at the canthus of the eye, resembling a fly's wing, traversing the white of the eye and encroaching towards the black of the eye, sometimes even covering the pupil.

The "Zhubing Yuanhou Lun" mentions "eye nebula" and "eye nebula covering the pupil." The "Michuan Yanke Longmu Lun" refers to it as "pterygium external ophthalmopathy." The "Zhengzhi Zhunsheng" also mentions "horse leech accumulation" and "lung stasis," both of which fall under the scope of this condition.

Additionally, the condition known as "pseudopterygium" also involves the white of the eye encroaching on the black of the eye, resembling pterygium, as described in "Mujing Dacheng" : "This condition does not greatly harm the eye, but in two or three places, it appears like a membrane but not fat, eroding from the qi orbiculus (belonging to lung metal) to the wind orbiculus (belonging to liver wood), hence called pseudopterygium, resembling pterygium but white and thin, and its position is not fixed," and should be distinguished.

bubble_chart Pattern Analysis

1. Heat Accumulation in the Lung Meridian︰Pterygium begins at the canthus, traverses the qi orbiculus, and appears as yellow fat or several red vessels, resembling fly wings. It gradually spreads toward the black of the eye, accompanied by a grade I sensation of dryness and itching, along with a cough and thick phlegm. The tongue coating is thin and yellow, and the pulse is rapid. It is often caused by pathogenic heat invading the lung, leading to lung channel heat stagnation, which scorches and damages body fluids. As a result, body fluids fail to ascend to nourish the head and eyes, leading to the formation of pterygium. Heat stagnating in the lung and evil reaching the upper energizer causes the pterygium to appear pale, with mild dry eyes and itching. Impaired lung dispersion and descent results in a cough with thick phlegm. Treatment should focus on clearing heat and purging the lung. The recommended formulas are Wind-Eliminating Decoction or Lung-Clearing Decoction with modifications. In cases of lung heat cough, the treatment should aim to clear and purge lung heat.
2. Exuberance of Heart Fire︰The canthus area is red and congested, with thick and broad pterygium, a red and inflamed head and body, itching and stabbing pain, accompanied by thirst, restlessness, insomnia, dark urine, constipation, a red tongue tip, thin coating, and a thready, rapid pulse. This is often due to overacting of the five minds, excessive mental exertion, sudden and severe flaring up of heart fire, which consumes body fluids, leading to malnutrition of the eyes and sudden onset of pterygium, along with red eyes and pain. The internal blazing of heart fire disturbs the mind, resulting in thirst, restlessness, and insomnia. When heart fire transfers heat to the small intestine, it causes dark urine. Heat scorches body fluids, drying up intestinal fluids and leading to constipation. Treatment should focus on clearing the heart and reducing fire. The recommended formulas are Heart-Draining Decoction combined with Redness-Removing Powder with modifications, or Mind-Calming Pill supplemented with Coptis Rhizome, Gardenia Fruit, Skullcap Root, Akebia Stem, and Unprocessed Rehmannia Root.
3. Liver Channel Heat Accumulation︰The pterygium is like butter, gradually thickening and enlarging, with red stasis bulging up, resembling piled-up flesh, bright red in color, dry and astringent with stabbing pain, accompanied by hypochondriac pain, bitter taste in the mouth, dry stool, a red tongue with yellow coating, and a wiry and rapid pulse. It is mostly caused by liver depression transforming into fire, with liver fire ascending to attack, harming the eye orifices, hence the red stasis and thickened, swollen pterygium, with itching, astringency, and stabbing pain. The liver governs the free flow of qi; stagnation in the liver channel leads to hypochondriac pain and bitter taste in the mouth. Ascendant hyperactivity of liver yang results in dizziness and blurred vision. Intense internal heat causes dry stool. Treatment should focus on clearing the liver and draining fire, using modified Gardenia Super Miraculous Powder.
4. Dampness-heat of Spleen and Stomach︰The pterygium appears red, grows rapidly, with a pointed and thin tip, thick and elevated in the middle, resembling piled-up leeches lying horizontally, surrounded by red vessels. It is accompanied by severe constipation, abdominal distension and fullness, a yellow and greasy tongue coating, and a wiry, slippery pulse. This condition is often caused by dietary irregularities, excessive consumption of spicy foods, alcohol, and rich flavors, leading to internal accumulation of dampness-heat in the spleen and stomach. The dampness-heat steams upward, affecting the eyes, resulting in a thick and raised pterygium that obscures the pupil. The accumulation of dampness-heat in the middle energizer causes abdominal distension and fullness; heat accumulation in the stomach leads to obstruction of bowel qi, resulting in severe constipation. Treatment should focus on purging the spleen and unblocking the bowels, supplemented with resolving dampness. The prescription may include Xiepi Chu Re Yin with additions such as Poria and Alisma. The characteristic features of pterygium due to spleen-stomach dampness-heat include symptoms such as internal accumulation of dampness-heat in the spleen and stomach, abdominal distension and fullness, constipation, a yellow and greasy tongue coating, and a wiry, slippery pulse, which make it easily distinguishable from other symptoms and signs.
5. Deficiency Fire of the Kidney Meridian︰The pterygium is pale red in color, sometimes mild and sometimes severe, accompanied by soreness and weakness in the lower back and knees, vexing heat in the chest, palms, and soles, a red tongue with scant coating, and a thin, wiry or wiry and rapid pulse. It is often caused by constitutional yin deficiency or excessive sexual activity, leading to insufficient kidney yin. When water fails to control fire, deficient fire scorches internally, harming the eye orifices and gradually giving rise to pterygium, which appears pale red. Kidney deficiency results in emptiness of the lumbar region, hence soreness and weakness in the lower back and knees. Yin deficiency generates internal heat, hence vexing heat in the chest, palms, and soles. Kidney deficiency also leads to fluid depletion, hence dry mouth. The treatment should focus on nourishing kidney yin and subduing deficient fire, using the formula Modified Anemarrhena, Phelloendron and Rehmannia Pill. This belongs to the pattern of deficiency-fire, with the disease located in the kidneys.
6. Recurrent Postoperative︰After pterygium excision, recurrence is frequent, with rapid regrowth of the pterygium forming uneven accumulations that pull on the eyeball, restricting its movement. In severe cases, the pterygium contracts, pulling the eyeball toward the affected side. The tongue appears pale, and the pulse is thin, weak, and feeble. This is often due to insufficient healthy qi after surgical incision therapy, with unresolved pathogenic factors such as heart fire, liver fire, or dampness-heat of the spleen and stomach. As a result, deficiency-type pathogens prevail, causing the pterygium to regrow after removal. Repeated surgeries lead to contracture of the pterygium, restricting eyeball movement and pulling it toward the affected side. Prolonged illness injures qi and blood, manifesting as a pale tongue and a thin, weak pulse. Treatment should focus on tonifying and replenishing qi and blood, using modified Eight Precious Ingredients Decoction. Once healthy qi gradually recovers, further therapeutic strategies can be considered.

Pterygium is primarily caused by excessive internal heat and deficiency of yin fluids, leading to the loss of nourishment in the eyes. Pathogenic heat is the main culprit, and the condition is relatively complex. Clinically, it should be diagnosed and treated based on the differentiation of the five zang-organs, identifying the cause and applying appropriate treatment.

bubble_chart Documentation

1. Mujing Dacheng．Pterygium: "There are two types of pterygium: one with a pointed tip and one with a flat tip. The flat-tipped pterygium floats on the wind orbiculus, making it easy to cut and heal completely, leaving no trace. The pointed-tipped pterygium deeply erodes into the divine pearl, making it very difficult to handle. Even if it is clearly cut away, it will reappear the next day, and it cannot be completely removed without three to five days of treatment. Once healed, the scar will take years to fade. However, all symptoms such as mental confusion, redness, eye discharge, and tearing will disappear once the pterygium is removed and will not recur. If one does not take care with diet and desires, and overworks the mind and body, it is difficult to avoid this disease in old age."