A Case of Korean Herbal Medicine Treatment for Normal Tension Glaucoma using Go-Bang

Gioen Han; Eunjeong Kang; Guenseob Lee; Han, Gioen; Kang, Eunjeong; Lee, Guenseob

doi:10.13048/jkm.23034

JKM > Volume 44(3); 2023 > Article

Han, Kang, and Lee: A Case of Korean Herbal Medicine Treatment for Normal Tension Glaucoma using Go-Bang

Case Report

The Journal of Korean Medicine 2023; 44(3): 102-116.

Published online: September 1, 2023

DOI: https://doi.org/10.13048/jkm.23034

A Case of Korean Herbal Medicine Treatment for Normal Tension Glaucoma using Go-Bang

Gioen Han¹^{, *}

, Eunjeong Kang²

, Guenseob Lee³

¹HYUN-GA Korean Medicine Clinic

²BO-SUNG Korean Medicine Clinic

³Dr Lee’s Clinic Korean Medicine Clinic

Correspondence to: HAN GIOEN, HUNGA Korean Medicine Clinic. 12, 10-gil, SANE-eup, SEJONG-si, Republic of Korea, Tel: +82-10-4422-9902, Fax: +82-0303-3442-1070, E-mail: hangi60@hanmail.net

Received March 27, 2023 Revised May 2, 2023 Accepted August 17, 2023

Abstract

Objectives

To provide a case report of effective use of Korean herbal medicine treatment to reduce the development and progression of normal-tension glaucoma(NTG).

Methods

This case involved a 52-year-old patient who had a history of excimer laser surgery at the age of 25 and was using prescriptions such as Cosopts2 and Xalatan for eye drops. We treated this patient with Korean herbal medicine treatment for 2 years and assessed the progression of NTG based on the optical coherence tomography test results that he recevied at the ophthalmology clinic every 6 months.

Results

During the two years of treatment with Korean herbal medicine, it was observed that the progression of NTG was halted. However, after discontinuing the Korean herbal treatment, the progression resumed.

Conclusion

Korean herbal medicine treatment was found to be effective in treating normal tension glaucoma, and a minimum treatment period of two years is necessary for an accurate evaluation of NTG.

Keywords: Korean medical treatment, normal tension glaucoma, yoga breathing

Tables and Figures

Fig. 1

Apr. 2019. OCT test result report

OCT analysis of RNFL and ONH OU(2019.04.29). OCT, Optical Coherence Tomography; RNFL, Retinal nerve fiber layer; ONH, Optic nerve head; OU, oculus uterque

Fig. 2

Oct. 2019. OCT test result report.

OCT analysis of RNFL and ONH OU(2019.10.08). OCT, Optical Coherence Tomography; RNFL, Retinal nerve fiber layer; ONH, Optic nerve head; OU, oculus uterque

Fig. 3

Apr. 2020. OCT test result report.

OCT analysis of RNFL and ONH OU(2020.04.15). OCT, Optical Coherence Tomography; RNFL, Retinal nerve fiber layer; ONH, Optic nerve head; OU, oculus uterque

Fig. 4

Oct. 2020. OCT test result report.

OCT analysis of RNFL and ONH OU(2020.10.09). OCT, Optical Coherence Tomography; RNFL, Retinal nerve fiber layer; ONH, Optic nerve head; OU, oculus uterque

Fig. 5

May. 2021. OCT test result report.

OCT analysis of RNFL and ONH OU(2021.03.01). OCT, Optical Coherence Tomography; RNFL, Retinal nerve fiber layer; ONH, Optic nerve head; OU, oculus uterque

Fig. 6

Jan. 2022. OCT test result report.

OCT analysis of RNFL and ONH OU(2022.01.08). OCT, Optical Coherence Tomography; RNFL, Retinal nerve fiber layer; ONH, Optic nerve head; OU, oculus uterque

Fig. 7

Jan. 2023. OCT test result report.

OCT analysis of RNFL and ONH OU(2023.01.14). OCT, Optical Coherence Tomography; RNFL, Retinal nerve fiber layer; ONH, Optic nerve head; OU, oculus uterque

Table 1

Vital Record

2019	Apr. 4	May. 4	Jun. 4
Blood pressure(R;L)	132/97; 149/99	126/98; 136/97	118/76; 126/83
EX-HN5(L,R)	37/37.5	37.1/37.4	36.4/37
Hand dorsum temperature	35	36.1	34.7
Pulse rate(R/L)	52/51	73/72	60/60
Respiratory rate	4.5	10	11.5

Table 2

Vital Record

2019	Jul. 5	Aug. 5	Sept. 5
Blood pressure(R;L)	122/82; 128/90	132/90; 137/85	130/85; 131/84
EX-HN5(L/R)	36.5/36.4	36.6/37.0	36.5/36.9
Hand dorsum temperature	34.8	35.5	35.1
Pulse rate(R/L)	72/65	75/72	61/58
Respiratory rate	10	11	11

Table 3

Vital Record

2019	Oct. 7	Nov. 8	Dec. 7
Blood pressure(R;L)	124/84; 132/88	141/89; 141/94	143/89; 139/87
EX-HN5(L/R)	36.9/37.1	37.3/37.4	36.0/36.7
Hand dorsum temperature	35.2	35.2	Not taken
Pulse rate(R/L)	67/71	57/62	50/49
Respiratory rate	9.5	9	9

Table 4

Vital Record

2020	Jan. 4	Apr. 4	Jul. 4
Blood pressure(R;L)	112/79,123/82	134/91/126/88	125/92,111/86
EX-HN5(L/R)	37.0,37.8	36.7, 36.9	36.9. 37.3
Hand dorsum temperature	Not taken	36.6	35.7
Pulse rate(R/L)	60, 58	57, 55	66, 60
Respiratory rate	9.5	10.5	10.5

Table 5

Vital Record

2020, 2021	Oct. 5	Dec. 4	Mar. 4
Blood pressure(R;L)	139/96, 137/93	127/97, 135/98	155/100, 150/101
EX-HN5(L/R)	36.9, 37.1	37.3, 36.9	Not taken
Hand dorsum temperature	36.1	35.8	Not takne
Pulse rate(R/L)	66, 66	78, 68	66, 59
Respiratory rate	11	12	11

Table 6

Vital Record

2021	Jan. 7	Feb. 8	Mar. 7	Apr. 7
Blood pressure(R;L)	131/82, 116/84	154/95, 144/90	119/90, 131/92	149/99, 136/93
EX-HN5(L/R)	37.3, 37.5	36.1, 36.7	36.9, 37.4	36.5, 36.4
Pulse rate(R/L)	55/52	53, 56	67, 64	54, 53
Hand dorsum temperature	35.2	36.5	34.5	36.7
Respiratory rate	9	10.5	10	9

Table 7

2019 Treatment Prescription

Duration of prescription	Prescription name	Reason for prescription	Dosage instructions	Progress
2019. Apr.	Dae-Ham-Hyung-Tang	To relieve Gyeol-Heung and improve breathing and blood pressure	3 times a day	Despite the improvement in Gyeol-Heung, there has been no change in blood pressure.
2019. May.–Nov.	Sa-Yeok-Ga-Jeo-Dam-Tang	Despite Gyeol-Heung treatment, the diastolic blood pressure has not decreased, thus it is suspected to be caused by a blood clot and this prescription is initiated for anticoagulant therapy	3 times a day	After taking Sa-Yeok-Ga-Jeo-Dam-Tang, the diastolic blood pressure has started to decrease to 90 or below (Table 1, 2, 3). During the regular eye examination in October, the patient received the doctor’s opinion that there seems to be no progression of glaucoma.
2019. Dec.	Cheon-Woong-San-Ryo	Hyperhidrosis in the hands and feet	The patient is instructed to take the medication twice for severe symptoms and once for milder symptoms.	The diastolic blood pressure is generally maintained at 90 or below. Symptoms of hyperhidrosis as well as dyspepsia have improved
2019. Dec.	So-Geun-Jung-Tang	Dyspepsia

Table 8

2020/2021 Treatment Prescription

Duration of prescription	Prescription name	Reason for prescription	Dosage instructions	Progress
2020. Jan.–Mar.	Chi-ja-Si-Tang	Rash on the neck and chest. When entering warm hot spring water, a rash occurs on the fingers and backs of the hands. It’s not itchy.	3 times a day	Improvement of rash
2020. Jan.–Mar.	Dae-Ham-Hyung-Hwan	Gyeol-Heung	1 time after work	Gyeol-Heung has decreased, but the effect is minimal.
2020. Apr.–Sept.	Juk-Yeop-Seok-Go-Tang	BT 37.1°C, tongue fissures and uncoated tongue. Distinct Gal on the forehead. Prescribed to alleviate Gal.	3 times a day	Gal has been relieved. Body temperature has returned to normal.
2020. Apr.–Sept.	Dae-Ham-Hyung-Hwan	Gyeol-Heung	2 times a day	Gyeol-Heung has decreased, but the effect is minimal.
2020. Oct.–Dec.	In-Jin-Ho-Tang	Severe Bal-Hwang on the face and eyelid. A coated tongue is forming, and there is a reduction in tongue fissures	3 times a day	In October, the patient was informed of the eye examination result indicating that there seems to be no progression of glaucoma.
2020. Oct.–Dec.	Gung-Hwang San(Take in the form of pills)	Guryeon in the eye	1 to 2 times a day	Guryeon has decreased, but the effect is minimal.
2021. Jan.–Mar.	Gal-Geum-Ryeon-Tang	External ottis	2 to 3 times a day	The external otitis has been treated.
2021. Jan.–Mar.	Gung-Hwang San-Ryo	Guryeon in the eye	1 to 2 times a day	The patient has received the diagnosis result that there is no progression of glaucoma for the third time, and the scheduled treatment is concluded

Table 9

Treatment Prescriptions and the Pharmacological Properties of Key Medications

Prescription name	Prescription composition (g)	Pharmacological properties of key medications3
Chi-ja-Si-Tang	Gardenia Fruit 6, Hyang-Si 8	Hyang-Si: It primarily treats feelings of inner distress and unease. Additionally, it can address heartache and a sense of fullness and restlessness in the chest. Gardenia Fruit: It primarily treats restlessness of the heart. Additionally, it can address jaundice.
Juk-Yeop-Seok-Go-Tang	Gypsum 32, Liriope Tuber 20, Oryzae Semen 20, Pinellia Tuber 12 Ginseng 6, Lophatheri Herba 6, Licorice 4
In-Jin-Ho-Tang	Artemisiae Capillaris Herba 12, Gardenia Fruit 6, Rhubarb 4	Artemisiae Capillaris Herba: It primarily treats jaundice. Gardenia Fruit: It primarily treats restlessness of the heart. Additionally, it can address jaundice.
Gal-Geum-Ryeon-Tang	Pueraria Root 16, Scutellaria Root 4, Coptis Rhizome 6, Licorice 4	Pueraria Root: Primary function-Treats stiffness in the neck and back. Secondary function-Treats wheezing with sweating. Coptis Rhizome: Primary function: Treats restlessness and palpitations in the heart. Secondary function: Treats discomfort in the upper abdomen, vomiting, and abdominal pain. Scutellaria Root: Primary function: Treats discomfort in the upper abdomen. Secondary function: Treats fullness and vomiting in the chest area, vomiting, and diarrhea. Licorice: Primary function: Treats urgent conditions. It treats internal urgency, acute pain, and spasms. Secondary function: Also treats extreme coldness, restlessness, and rebellious qi among other urgent conditions.
Dae-Ham-Hyung-Hwan	Rhubarb, Jeong-ryeok, Natrii Sulfas, Apricot Kernel, Gamsu	Honey: Primary function: Treats urgent pain due to toxin accumulation, and enhances the effects of other herbs. Jeong-ryeok: Primary function: Treats water retention disease. Secondary function: Treats lung abscess and chest congestion. Apricot Kernel: Primary function: Treats stagnation of water in the chest area. It treats wheezing and coughing. Secondary function: Treats shortness of breath, chest congestion, chest pain, and generalized swelling.
Gung-Hwang San-Ryo	Cnidium Rhizome, Rhubarb(equally divided)	Cnidium Rhizome: The text mentions its usage in a formula by Zhang Zhongjing involving Danggui and Chuanxiong. Its primary and secondary functions are not explicitly mentioned.
So-Geun-Jung-Tang	Cinnamon Bark 8, Peony Root 12, Raw Ginger 6, Jujube 6, Licorice 6 Sacchrum Granorum 16–20	Sacchrum Granorum: The text mentions that its function is similar to licorice and honey, relieving urgent conditions. Peony Root: Primary function: Treats stiffness and spasms. Secondary function: Treats abdominal pain, headache, numbness in the body, pain, abdominal fullness, coughing, rebellious qi, and abscesses. Raw Ginger: Primary function: Treats nausea. It also treats dry retching, hiccup, and rebellious qi. Jujube: Primary function: Treats cramps, pulling sensations, and urgency. Secondary function: Treats wheezing with sweating.
Gal-Geum-Ryeon-Tang	Pueraria Root 16, Scutellaria Root 4, Coptis Rhizome 6, Licorice 4	Pueraria Root: Primary function-Treats stiffness in the neck and back. Secondary function-Treats wheezing with sweating. Coptis Rhizome: Primary function: Treats restlessness and palpitations in the heart. Secondary function: Treats discomfort in the upper abdomen, vomiting, and abdominal pain. Scutellaria Root: Primary function: Treats discomfort in the upper abdomen. Secondary function: Treats fullness and vomiting in the chest area, vomiting, and diarrhea. Licorice: Primary function: Treats urgent conditions. It treats internal urgency, acute pain, and spasms. Secondary function: Also treats extreme coldness, restlessness, and rebellious qi among other urgent conditions.
Dae-Ham-Hyung-Hwan	Rhubarb, Jeong-ryeok, Natrii Sulfas, Apricot Kernel, Gamsu	Honey: Primary function: Treats urgent pain due to toxin accumulation, and enhances the effects of other herbs. Jeong-ryeok: Primary function: Treats water retention disease. Secondary function: Treats lung abscess and chest congestion. Apricot Kernel: Primary function: Treats stagnation of water in the chest area. It treats wheezing and coughing. Secondary function: Treats shortness of breath, chest congestion, chest pain, and generalized swelling.
Gung-Hwang San-Ryo	Cnidium Rhizome, Rhubarb(equally divided)	Cnidium Rhizome: The text mentions its usage in a formula by Zhang Zhongjing involving Danggui and Chuanxiong. Its primary and secondary functions are not explicitly mentioned.
So-Geun-Jung-Tang	Cinnamon Bark 8, Peony Root 12, Raw Ginger 6, Jujube 6, Licorice 6 acchrum Granorum 16–20	Sacchrum Granorum: The text mentions that its function is similar to licorice and honey, relieving urgent conditions. Peony Root: Primary function: Treats stiffness and spasms. Secondary function: Treats abdominal pain, headache, numbness in the body, pain, abdominal fullness, coughing, rebellious qi, and abscesses. Raw Ginger: Primary function: Treats nausea. It also treats dry retching, hiccup, and rebellious qi. Jujube: Primary function: Treats cramps, pulling sensations, and urgency. Secondary function: Treats wheezing with sweating.

Table 10

Total RNFL& Average C/D

Examination month	Total RNFL (μm)		C/D Area Ratio

	Right eye	Left eye	Right eye	Left eye
2019. Apr.	46	59	0.99	0.83
2019. Oct.	46	56	0.96	0.88
2020. Apr.	37	57	0.95	0.85
2020. Oct.	41	57	0.96	0.84
2021. May.	41	60	0.95	0.84
2022. Jan.	60	60	0.87	0.77
2023. Jan.	64	60	0.90	0.80

참고문헌

1. Shields MB. Normal-tension glaucoma: is it different from primary open-angle glaucoma? Curr Opin Ophthalmol. 2008; 19:85–8.11. 10.1097/ICU.0b013e3282f3919b

2. Yongyeon Kim, Younghoon Hwang. All About Glaucoma: New Diagnostics and Treatment. korea uni. publishing house;2020. p. 23–24.

3. Yakjing Yoshimasu todo original. Kim, Jong-oh Mulgogisup. 2021; 35–386.

4. Harris A, Rechtman E, Siesky B, et al. The role of optic nerve blood flow in the pathogenesis of glaucoma. Ophthalmol Clin North Am. 2005; 18:345–53. 10.1016/j.ohc.2005.04.001

5. Hayreh SS. Progress in the understanding of the vascular etiology of glaucoma. Curr Opin Ophthalmol. 1994; 5:26–35.

6. Hayreh SS. The blood supply of the optic nerve head and the evaluation of it: myth and reality. Prog Retin Eye Res. 2001; 20:563–93. 10.1016/s1350-9462.01.004-0

7. Chang-joon Park, Nam-ho Lee, Chang-shik Kim. Differences in 24-hour ambulatory blood pressure between normal tension glaucoma and primary open angle glaucoma. jkos. 2007; 48:11.1512 https://doi.org/10.3341/jkos.2007.48.11.1512

8. Rajanpongpun P, Drance SMM, Orrison BJ. Ophthalmic artery flow velocity in glaucomatous & normal subjects. Br J Ophthalmol. 77:25–29. 1993; 10.1136/bjo.77.1.25

9. Martorina M, Canerlingo M. A Doppler-sonograpic study in glaucoma. Ophthalmologica. 194:82–85. 1987; 10.1159/000309740

10. Galassi F, Nuzzaci G, Sodi A, Casi P, Vielmo A, Casi P, Vielmo A. Color Dopper imaging in evaluation of optic nerve blood supply in normal &glaucomatous subjects. Int Ophthalmol. 16:272–276. 1992; 10.1007/BF00917974

11. Lee Young Ghee, Kim Tae Hyung, Chan Yun Kim, Hong Young Jae. Comparison of optic nerve and peripapillary retinal blood flow in normal eyes, primary open-angle glaucoma, and normal tension glaucoma. jkos. 1999; 40:7. 1934–1943.

12. Hyung-Rae Jo, Hwangbo Min. Four Cases of Tinnitus with Sudden Sensorineural Hearing Loss Treated by Daehamhyung-tang. J Korean Med Ophthalmol Otolaryngol Dermatol. 2015; 28:3. 145–160p. 1738-6640. 2234-4020.