Clinic Diary #02 — Eye Twitching and Anxiety, and Liver Yin Deficiency
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Clinical Notes #02
Eyelid Twitching, Anxiety, and Liver Yin Deficiency
"It feels like bugs are crawling in my eyes."
The patient, a woman in her early 60s, looked exhausted as she said this. Her left eyelid had been twitching for three months. She said it didn't stop all day until she lay down to sleep. She had seen an ophthalmologist, but was told there was nothing particularly wrong.
"My eyes aren't out of focus; they just twitch."
There was no pain. Just twitching. But the fact that the twitching had persisted for three months was exhausting her. She said she had to read a lot for her situation but found it difficult to concentrate.
This patient didn't just have eye symptoms. Her anxiety had started a month and a half prior. There was a trigger. Her granddaughter developed a severe condition in her head, and she was told, "She might die at any moment." Before the shock of that subsided, her mother passed away in a traffic accident in front of her home. This happened a month and a half ago.
"I'm scared when I'm alone, and I can't drive."
She couldn't sleep well. Palpitations, which she had experienced before, worsened. Despite eating, she continued to lose weight. She had intermittent hot and cold flashes. Blemishes suddenly appeared on her skin. She had bowel movements 3-4 times a day, needing to use the restroom immediately after meals.
How Donguibogam Interprets This Pathology
In the chapter on eye diseases (Oehyeongpyeon) in Donguibogam, it states:
"When the Liver is deficient, the eyes ache and cold tears flow..."
Here, Liver Deficiency (肝虛, ganheo) refers to a state where the nourishing substances of the Liver, specifically 'Liver Yin (肝陰, ganeum)', are insufficient. The Liver governs the eyes (肝開竅於目, gan gae gyo eo mok). When Liver Yin is deficient, the eyes do not receive proper nourishment, leading to symptoms such as twitching, dryness, and fatigue.
The Naegyeongpyeon (Internal Medicine Chapter) of Donguibogam also explains anxiety and insomnia:
"Igyeongtang (益榮湯) treats palpitations (怔忡症, jeongchungjeung) and mental haziness caused by excessive rumination (思慮過度, saryeogwado) which consumes Heart Blood (心血, simhyeol)."
Excessive rumination (思慮過度, saryeogwado) means that too many thoughts and worries consume the Heart's Blood (血, hyeol). The two traumatic events—her granddaughter's illness and her mother's death—were precisely a case of 'excessive rumination'.
Liver Yin Deficiency and Internal Wind
In Korean Medicine, prolonged stress and psychological trauma are believed to deplete the Liver's Yin (陰, eum). When Liver Yin becomes deficient, various symptoms manifest.
First, Empty Heat (虛熱, heoyeol) arises. When Yin is deficient, Yang becomes relatively exuberant. This Empty Heat overheats the chest, causing anxiety, insomnia, and palpitations. The intermittent hot and cold flashes are also due to this Empty Heat.
Second, Internal Wind (內風, naepung) develops. Quoting from the Japbyeongpyeon (Miscellaneous Diseases Chapter) of Donguibogam, spasms occur due to Stagnant Qi (氣鬱, giul), and when Qi flows well, the spasms cease. Eyelid twitching can be seen as the mildest form of this 'Internal Wind'. If it worsens, it can lead to muscle spasms or tremors.
Third, it over-restrains the Spleen (脾, bi). When Liver Wood (肝木, ganmok) suppresses the Spleen (脾, bi), digestive function weakens. This patient's increased post-meal bowel movements and weight loss fall under this category.
Principles of Treatment: Root and Branch
Treatment was approached along two axes.
One is Extinguishing Wind (熄風, sikpung) — directly calming the symptoms. Eyelid twitching and anxiety are manifestations of Liver Wind Stirring Internally, requiring herbs or treatments that directly control it. When symptoms are active, this Branch (標, pyo) treatment takes precedence.
The other is Nourishing Yin (滋陰, jaeum) — replenishing the root. Replenishing Liver Yin (陰, eum) is necessary to resolve Empty Heat and prevent Internal Wind from recurring. This is based on the principle of replenishing Water (水, su) to nourish Wood (木, mok). To quote Donguibogam, the treatment principle of 'strengthening Water (壯水, jangsu) to suppress Yang Qi and nourish Yin' applies here.
Life Context
What is important in understanding this patient are the two events she experienced: her granddaughter's health crisis and her mother's sudden death. These two events were not just simple stress, but traumas that shook her very existence.
In Korean Medicine, such injuries from the Seven Emotions (칠정, chiljeong) are believed to primarily damage the Liver (肝, gan). 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 subside more slowly.
Treatment is not solely comprised of herbal medicine. Providing a space for the patient to talk about her experiences, and the process of understanding those stories within a medical context, is itself part of the healing.
This article is a clinical essay reconstructed based on actual patient experiences. Patient personal information has been protected, and prescription names and specific treatment details have been anonymized. For individual health conditions, please consult with a professional.
