A Case Report of a Patient with Normal tension glaucoma

Han gioen; Kang Eunjeong; Han, gioen; Kang, Eunjeong

doi:10.13048/jkm.25011

JKM > Volume 46(1); 2025 > Article

gioen and Eunjeong: A Case Report of a Patient with Normal tension glaucoma

Case Report

The Journal of Korean Medicine 2025; 46(1): 154-166.

Published online: March 01, 2025

DOI: https://doi.org/10.13048/jkm.25011

A Case Report of a Patient with Normal tension glaucoma

Han gioen¹^{, *}

, Kang Eunjeong²

¹Hunga Korean Medicine Clinic

²Risam Korean Medicine Clinic

Correspondence to: Han gioen, Hunga Korean Medicine Clinic. Sane, 10-gil, Jochiwon-eup, Seojong-si, Republic of Korea, Tel: +82-10-4422-9902, Fax: +82-0303-3442-1070, E-mail: hangi60@hanmail.net

Received October 3, 2024 Revised December 24, 2024 Accepted February 14, 2025

Abstract

This is a case report on a patient in their early 60s who had been experiencing progressive normal-tension glaucoma in the left eye for 10 years. From June 2022, the patient was treated with prescriptions based on the Sanghanlon(Treatise on Sanghan) for two years. Six months after beginning treatment with this approach, the patient started receiving diagnoses from a local ophthalmology clinic indicating no further progression of glaucoma. This outcome was confirmed four times until May 2024, showing that the progression of glaucoma had stopped.

Keywords: Normal tension glaucoma(NTG), Go-bang, Torticollis, Sclera, Neovacular glaucoma(NVG), OCT, Primary Open-Angle Glaucoma

Fig. 1

OCT reports

OCT, Optical Coherence Tomography; ONH, Optic nerve head; OU, oculus uterque,; GCIPL, Ganglion cells inner plexiform layer

Fig. 2

Neovacular glaucoma

Fig. 3

Eye of patient with early glaucoma intraocular pressure26

Fig. 4

dry eye syndrome pupils suffering for many years

Fig. 5

Images of the Conjunctiva

Table 1

2022 Treatment Prescription

Prescription period	Prescription name	Reason for prescription	Dosage instructions	Progress
June	Chijahubak-tang Bongnyeongeum	Bloodshot eyes Chest discomfort Glucose instability	Each medicine, twice daily, for a total of four doses.	Ocular foreign body sensation and vitreous floaters improved by 90%.
Jul. to Sep.	Chijahubak-tang Gyulpidaehwangbakcho-tang	Bloodshot eyes Chest discomfort	Chijahubak-tang: 3 times a day Gyulpidaehwangbakcho-tang: Once a day(before bed time)	The ocular foreign body sensation resolved. Vitreous floaters in the right eye diminished. The erythema and visible blood vessels on the left cheek nearly disappeared.
Oct.to Dec.	Sohamhyung-tang Gyulpidaehwangbakcho-tang	Dyspepsia Bloodshot eyes Chest discomfort	Each medicine, twice daily, for a total of four doses.	Glare in the left eye decreased.

Table 2

2023 Treatment Prescription

Prescription period	Prescription name	Reason for prescription	Dosage instructions	Progress
Jan. to Feb.	Sogunjung-tang Gyulpidaehwangbakcho-tang	Recurrent discharge in the right eye Abdominal muscle rigidity Hang-bae-gang Gyeol-hyung Dry eye syndrome	Sogunjung-tang: 3 times a day Gyulpidaehwangbakcho-tang: Once a day	The glare is present. Dryness in the eyes remains.
Mar. to May	Sogunjung-tang Bongnyeongeum	Morning lacrimation Glare in the left eye occurs when tired Hyeop-ha-bi Abdominal muscle rigidity	Sogunjung-tang: Twice a day Bongnyeongeum: Once a day	The glare in the left eye worsened and then decreased. Rigidity of the left masseter and temporalis muscles, Hang-bae-gang persist.
Jun.	Sogunjung-tang Bongnyeongeum	Rigidity of the left masseter and temporalis muscles Hang-gang	Sogunjung-tang: Twice a day Bongnyeongeum: Once a day	Rigidity of the left masseter and temporalis muscles, Hang-gang persist. The glare is present.
Jul.	Gejigajakyak-tang Taeksa-tang	Pain and swelling in the lower abdomen during activities.	Each medicine, twice daily, for a total of four doses.	The glare and the blurred vision in the eyes decreased.
Aug.	Taeksa-tang Gyejigahubakhaengja-tang	Rigidity of the left masseter and temporalis muscles	Each medicine, twice daily, for a total of four doses.	The pain and swelling in the lower abdomen decreased. Urine output increased. The glare is almost gone. The blurred vision remains.
Oct.	Gyejigahubakhaengja-tang Gyejigagalgeun-tang Daehamhyunghwan	Blurred vision Hang-bae-gang Gyeol-hyung	Gyejigahubakaengja-tang: Twice a day Gyejigagalgeun-tang: Once a day Daehamhyunghwan: Once a day	Night pain and swelling in the lower abdomen recurred.
Nov.	Taeksa-tang Gyejigagalgeun-tang Daehamhyunghwan	Pain and swelling in the lower abd Hang-bae-gang Gyeol-hyung	Taeksa-tang: Twice a day Gyejigagalgeun-tang: Once a day Daehamhyunghwan: Once a day	The pain and swelling in the lower abdomen resolved. The blurred vision decreased
Dec.	Daehamhyung-tang Sogunjung-tang	Hang-bae-gang Gyeol-hyung Tearing in cold places Hyup-ha-bi	3 times a day	Gyeol-hyung decreased. Tearing decreased.

Table 3

2024 Treatment Prescription

Prescription period	Prescription name	Reason for prescription	Dosage instructions	Progress
Jan.	Daehamhyung-tang Sogunjung-tang	Gyeol-hyung Tearing in cold places	3 times a day Table	Gyeol-hyung, tearing in cold places remain.
Feb.	Gyejigagalgeun-tang Daehwangmokdanpi-tang	Hang-bae-gang Pain and swelling in the lower abdomen	Gyejigagalgeun-tang: Twice a day Daehwangmokdan-tang: Once a day	Hang-bae-gang, the pain and the swelling in the lower abdomen decreased.
Mar.	Sogunjung-tang Daehwangmokdan-tang	Increased tearing in the left eye	Sogunjung-tang: Twice a day Daehwangmokdanpi-tang: Once a day	The tearing remains. The swelling in the lower abdomen resolved.
Apr.	Daehwangmokdan-tang	Swelling in the lower abdomen	3 times a day	Repetitive swelling in the lower abdomen.
Jun.	Daehwangmokdan-tang Baekduong-tang	Gyeol-hyung Abodomen pain	Daehwangmokdanpi-tang: Once a day Baekduong-tang: Twice a day	Right abdomen pain decreased.

Table 4

Composition of the Prescription

Prescription Name	Ingredients of Herbal Medicine Prescribed (g/1 day)
Chijahubag-tang	Gardeniae Fructus 6, Magnoliae Cortex 8, Ponciri Fructus Immaturus 8g
boglyeong-eum	Ginseng Radix 6, Poria Sclerotium 6, Atractylodis Rhizoma 6, Ponciri Fructus Immaturus 4, Aurantii Fructus Immaturus 5, Zingiberis Rhizoma Recens 8g
Gyulpidaehwangchoseog-tang	Aurantii Fructus Immaturus 2, Rhei Radix et Rhizoma 2, Natrii Sulfas 4g
Sohamhyung-tang	Coptidis Rhizoma 3, Pinelliae Tuber 5, richosanthis Fructus 8g
Sogunjung-tang	Cinnamomi Ramulus 8, Glycyrrhizae Radix et Rhizoma 6, Zizyphi Fructus 6, Paeoniae Radix 12, Oryzae Gluten20g
Gyejigajagyag-tang	Cinnamomi Ramulus 8, Paeoniae Radix 12, Glycyrrhizae Radix et Rhizoma 4, Zingiberis Rhizoma Recens 6, Zizyphi Fructus 6g
Gyejigahubaghaengja-tang	Cinnamomi Ramulus 8, Paeoniae Radix 6, Glycyrrhizae Radix et Rhizom 4, Zingiberis Rhizoma Recens 6, Zizyphi Fructus 6, Magnoliae Cortex 4, Armeniacae Semen 6g
Gyejigagalgeun-tang	Cinnamomi Ramulus 8, Paeoniae Radix 12, Glycyrrhizae Radix et Rhizom 4, Zingiberis Rhizoma Recens 6, Zizyphi Fructus 6, uerariae Radix 40g
Taegsa-tang	Alismatis Rhizoma 10, Atractylodis Rhizom12g
Daehamhyung-tang	Rhei Radix et Rhizoma16, Natrii Sulfas 10, Euphorbiae Kansui Radix 1g
Daehamhyung-hwan	Euphorbiae Kansui Radix, Rhei Radix et Rhizoma, Lepidii seu Descurainiae Semen, Natrii Sulfas, Armeniacae Semen
Daehwangmokdan-tang	Rhei Radix et Rhizoma 8, Moutan Radicis Cortex 3, Persicae Semen 6, Natrii Sulfas 8, Benincasae Semen 10g
Baekduong-tang	Pulsatillae Radix 4, Coptidis Rhizoma 6, Phellodendri Cortex 6, Fraxini Cortex 6g

Table 5

Body Heat(°C)

Time	Jun. 2022	Nov. 2022	Apr. 2023	Dec. 2023	Jun. 2024

Meridian
L-eye(closed)	36.9	36.7	36.4	35.8	36.1

R-ye(closed)	36.7	36.5	36.4	35.8	36.1

L-Taeyang	37	36.8	36.4	36.3	36.4
EX-HN5

R- Taeyang	36.8	36.6	36.4	36.3	36.4
EX-HN5

L-Wangol	37.8	37.5	37	36.4	36.7
GB12

R- Wangol	37	37	36.4	36.8	36.6
GB12

Table 6

C/D Ratio&Total RNFL results of Right eye

	Mar. 2018	Apr. 2020	Jun. 2021	May. 2023	Jun. 2024
Average c/d ratio	0.80	0.85	0.79	0.80	0.84
Vertical c/d ratio	0.83	0.82	0.82	0.80	0.81
AverageRNFL Thickness	73	68	70	71	70
RNFL Symmetry	69	71	53	78	69

C/D ratio, Cup/Disc ratio; RNFL, Retinal nerve fiber layer

Table 7

C/D Ratio&Total RNFL results of Left eye

	Mar. 2018	Apr. 2020	Jun. 2021	May. 2023	Jun. 2024
Average c/d ratio	0.81	0.80	0.82	0.80	0.78
Vertical c/d ratio	0.83	0.84	0.83	0.81	0.77
Average RNFL Thickness	72	73	71	72	72
RNFL Symmetry	69	71	53	78	69

C/D ratio, Cup/Disc ratio; RNFL, Retinal nerve fiber layer

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