Senile cataract is a common eye disease in the old people. It refers to the case in which the crystalline lens itself gradually becomes aged, denatured and opaque without other systemic or local pathogenic causes. It usually occurs in two eye but the affections of the two eyes may differ in time, degree and progressive speed. Clinically only cortical senile cataract and nuclear senile cataract are common. In addition, there exists a capsular senile cataract as a complication of mature or hypermature stage of cortical cataract. The disease belongs to the category of "yuanyi neizhang" "ruyin neizhang" or "baiyi huangxin neizhang" (cataract) in TCM.

Main Points of Diagnosis

1. At the early stage, blurred vision or fixed black shadow before the eye or monocular diplopia or monocular polyopia may occur. In the daytime, the patient can not see things as clearly as at night. In the advanced stage, the patient's eyesight becomes gradually weakened until only light sensation exists.

2. Cortical cataract: At the initial stage cortical peripheral opacity of the lens in a zigzag shape can be seen. In the expansive stage, the crystalline lens becomes completely opaque and swollen. The anterior chamber becomes shallow and iridic projection results; at the mature stage, the crystalline lens becomes completely as white as ice, the depth of the anterior chamber remains normal and the projection image of iris disappears; at the hypermature stage, there is opaque crystalline lens, decomposed or dissolved fibra, loosened cyst membrane, sunken lens nucleus and deepened anterior chamber.

3. Nuclear cataract: At the initial stage embryonic nucleus becomes opaque, and then the opacity spreads gradually to the adult nucleus, further to the senile nucleus and the color turns from yellow to dark brown, even to brownish black color.

4. Capsular cataract: It complicates at the mature and hypermature stage of cortical cataract. It is manifested as opacity of cyst membrane of the pupillary collar part, slightly elevated with uneven surface of presence of plicae.

Differentiation and Treatment of Common Syndromes

1. Internal Treatment

1) The Type of Deficiency of Liver-Yin and Kidney-Yin

Main Symptoms and Signs: This disease belongs to early cataract characterized by senile debility, dizziness, tinnitus, soreness of the loins, red tongue with scanty fur or absence of tongue fur, thready and rapid pulse.

Therapeutic Principle: Nourishing the kidney and liver.

Recipe: Decoction for Nourishing Yin and Supplementing the Kidney.

prepared rehmannia root,Chinese yam,dogwood fruit,moutan bark,alisma rhizome,poria,schisandra fruit,Chinese angelica root,sesame seed,mulberry fruit,cassia seed,wolfberry fruit

All the above herbs are to be decocted in water for oral administration.

2. The Type of Deficiency of the Liver-Yin and Dampness of the Spleen.

Main Symptoms and Signs: The disease is manifested as early cataract, plump constitution, mental fatigue and lassitude, swollen lower limbs in the afternoon or in fatigue, pale tongue and feeble pulse.

Therapeutic Principle: Tonifying the liver, reinforcing the spleen and eliminating dampness.

Recipe: Decoction of Four Ingredients and Decoction of Two Old Herbs.

prepared rehmannia root,Chinese angelica root,ligusticum root,white peony root,red tangerine peel,prepared pinellia,licorice root,plantain seed (wrapped in a piece of cloth before decocted with other herbs),areca seed,chrysanthemum flower,pleione rhizome,poria

All the above herbs are to be decocted in water for oral administration.

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