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.
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
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
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.
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.
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.
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
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.
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.
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.
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.
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.
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.
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.
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). 1985-8.11. 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). 18345-53. 10.1016/j.ohc.2005.04.001
5. Hayreh SS. Progress in the understanding of the vascular etiology of glaucoma. Curr Opin Ophthalmol;(1994). 526-35.
6. Hayreh SS. The blood supply of the optic nerve head and the evaluation of it: myth and reality. Prog Retin Eye Res;(2001). 20563-93. 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). 4811.1512
https://doi.org/10.3341/jkos.2007.48.11.1512
9. Martorina M, & Canerlingo M. A Doppler-sonograpic study in glaucoma. Ophthalmologica;19482-85. (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;16272-276. (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.