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

Article information

J Korean Med. 2023;44(3):102-116
Publication date (electronic) : 2023 September 1
doi : https://doi.org/10.13048/jkm.23034
Gioen Han1,orcid_icon, Eunjeong Kang2orcid_icon, Guenseob Lee3orcid_icon
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 2023 March 27; Revised 2023 May 2; Accepted 2023 August 17.

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
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

Vital Record

Vital Record

Vital Record

Vital Record

Vital Record

Vital Record

2019 Treatment Prescription

2020/2021 Treatment Prescription

Treatment Prescriptions and the Pharmacological Properties of Key Medications

Total RNFL& Average C/D

References

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

Article information Continued

Fig. 1

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

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

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

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

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

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

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

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