Medical Diary #02 — Eye Trembling, Anxiety, and Liver Yin Deficiency
Table of Contents
Clinical Note #02
Eye Tremors and Anxiety, and Ganeum (Liver Yin Deficiency)
"It feels like bugs are crawling in my eye."
The patient's expression looked exhausted as she said this. A woman in her early 60s. Left eyelid twitching that had started 3 months ago. She said it wouldn't stop until she lay down to sleep all day long. She had visited an ophthalmologist and been examined, but was told there were no particular abnormalities.
"It's not that my eyes can't focus—it's just trembling."
There was no pain. Simply trembling. But the fact that this trembling had been going on for 3 months was what exhausted her. She said she had to read a lot, but couldn't concentrate.
This patient didn't only have eye symptoms. Anxiety had started 1 month and a half ago. There was a trigger. Her granddaughter developed serious symptoms and she was told her granddaughter "could die at any time." Before that shock had even faded, her mother passed away in a traffic accident right in front of their house. This was an event from one and a half months ago.
"I'm scared when I'm alone, and I can't drive either."
She couldn't sleep well. Palpitations had existed before but got worse. She was eating but kept losing weight. There was intermittent cold-heat sensations. Age spots suddenly appeared on her skin. Bowel movements were 3-4 times a day, and she always had to use the bathroom after meals.
Donguibogam: How This Pathology Is Read
The section on eye diseases in Donguibogam (External Forms chapter) states:
"When the liver is deficient, the eyes ache and cold tears flow..."
Here, Ganeum (肝虛, liver deficiency) refers, in modern terms, to a state where the nutritional substances of the liver, that is 'Ganeum (肝陰, liver yin)' are deficient. The liver governs the eyes (肝開竅於目). When liver yin is deficient, the eyes cannot receive proper nourishment, and symptoms such as tremors, dryness, and fatigue result.
The Internal Medicine section of Donguibogam also explains anxiety and insomnia:
"Ickyoung-tang (益榮湯) treats palpitations (怔忡症) and mental confusion caused by excessive worry (思慮過度) that has depleted heart blood (心血)."
Saryeo gwado (思慮過度, excessive worry) means that too many thoughts and worries have exhausted the blood (血) of the heart. The two traumatic events—her granddaughter's illness and her mother's death—were truly the very definition of 'excessive worry.'
Ganeum (Liver Yin Deficiency), and Naepung (Internal Wind)
In Korean medicine, prolonged stress and emotional shock are understood to deplete the liver's yin. When liver yin becomes deficient, various symptoms appear.
First, Heoyeol (虛熱, deficient heat) develops. When yin is deficient, yang becomes relatively stronger. This deficient heat inflames the chest, triggering anxiety, insomnia, and palpitations. The intermittent cold-heat sensations are also due to this deficient heat.
Second, Naepung (內風, internal wind) occurs. To borrow the words from the Miscellaneous Diseases chapter of Donguibogam, convulsions occur due to Giyeol (氣鬱, qi stagnation), and when qi flows well, convulsions stop. Eyelid tremors can be viewed as the mildest form of this 'internal wind.' In more severe cases, it can lead to muscle spasms or tremors.
Third, the spleen (脾) is counteracted (克). When Geomok (肝木, liver wood) oppresses the spleen (脾), digestive function weakens. The patient's increased post-meal bowel movements and weight loss correspond to this.
Treatment Principles: Surface (標) and Root (本)
Treatment was approached along two axes.
One is Sikpung (熄風, extinguishing wind) — directly calming the symptoms. Eye tremors and anxiety agitations are expressions of liver wind and internal movement, so medicinal herbs or treatments that directly control these are needed. When symptoms are active, this surface (標) treatment takes priority.
The other is Ja-eum (滋陰, nourishing yin) — replenishing the fundamental cause. Liver yin must be replenished so that deficient heat is controlled and internal wind does not recur. This is the principle of nourishing Wood (木) by supplementing Water (水). To borrow Donguibogam's expression, the treatment principle of 'suppressing yang qi by strengthening water (壯水) and nourishing yin' applies here.
Life Context
An important point in understanding this patient is the two events she experienced. Her granddaughter's health crisis and her mother's sudden death. These two events were not simply stress but trauma that shook her very existence.
In Korean medicine, damage from Chiljeong (七情, the seven emotions) is understood to injure the liver (肝) first. This is because the liver is the organ that governs the flow of emotions. When liver yin is depleted, emotional waves arise more easily and take longer to settle.
Treatment is not made up of medicinal herbs alone. A space where the patient can talk about her experiences, and the process of understanding those stories within a medical context, is itself part of treatment.
This article is a clinical essay reconstructed based on actual clinical experience. Patient personal information has been protected, and prescription names and specific treatment details have been anonymized. Please be sure to consult with a specialist regarding your personal health condition.
