Burning, Gritty, and Paradoxically Watery
Dry eye is one of the most common complaints in ophthalmology and one of the most misunderstood. The name suggests simple dryness — but the presentation is often counterintuitive: burning, grittiness, a foreign-body sensation, light sensitivity, and, paradoxically, excessive tearing. That reflexive tearing is the eye’s emergency response to chronic surface dryness — the lacrimal glands flooding the eye with thin, unstable tears that evaporate almost immediately, leaving the surface no better off than before.
Conventional medicine recognizes two main types: aqueous-deficient dry eye, where the lacrimal glands simply produce insufficient tear volume, and evaporative dry eye, the more common form, where meibomian gland dysfunction (MGD) leads to a deficient lipid layer that allows tears to evaporate too quickly. The distinction matters clinically — and it maps, with some precision, onto the Chinese medicine pattern framework. Here is how classical medicine reads what is happening in the tear film and what it offers as a parallel support layer.
When Conventional Care Has Limits
Prescription eye drops, artificial tears, punctal plugs, warm compresses, and meibomian gland expression are all useful tools. Cyclosporine and lifitegrast address the inflammatory component of dry eye. Intense pulsed light (IPL) therapy for MGD has shown meaningful results in clinical trials.
And yet: millions of people cycle through these treatments with incomplete or temporary relief. Dry eye is a systemic condition for many patients — connected to sleep, stress, hormonal shifts, diet, screen exposure, and constitutional terrain that topical treatments address only at the surface. Classical Chinese medicine, which has always understood dry eye as a whole-body fluid metabolism disorder rather than a local eye-surface problem, offers a different entry point into the same clinical picture.
Three TCM Patterns in Dry Eye Disease
Chinese medicine identifies dry eye through three primary pattern categories, often layered in the same patient:
Liver Yin Deficiency (Gān Yīn Xū, 肝阴虚)
This is the foundational pattern for dry eye in classical medicine. The Liver “opens to the eyes” — Gān Kāi Qiào Yú Mù (肝開竅於目) — meaning that Liver Qi and Liver Yin directly nourish the visual apparatus. When Liver Yin is insufficient — from age, overwork, chronic stress, insufficient sleep, or constitutional depletion — the fluid substrate that moistens the eyes is inadequate at its source. This pattern presents with dry, tired, and burning eyes that worsen in the evening; visual blurring with prolonged use; and a broader clinical picture of Yin depletion: night sweats, warm hands and feet, difficulty sleeping, and a constitution that runs thin rather than robust. It corresponds most closely to aqueous-deficient dry eye — the fluid generation side of the equation.
Lung-Spleen Qi Deficiency (Fèi Pí Qì Xū, 肺脾气虚)
The Lung governs the skin and the body’s fluid secretion onto surfaces — including the conjunctiva and the ocular surface. When Lung Qi is deficient, the body’s capacity to secrete and distribute fluids at the surface layer is impaired. The Spleen, which governs the transformation and upward distribution of fluids absorbed from food, is the pump that delivers fluid to where the Lung disperses it. When either is deficient, the delivery system fails even when the Yin substrate exists. This pattern corresponds most closely to meibomian gland dysfunction and evaporative dry eye — not a shortage of Yin, but a failure of distribution and secretion. Clinically, these patients often show general fatigue, digestive weakness, and a pale complexion alongside their eye symptoms.
Yin Deficiency with Empty Heat (Yīn Xū Huǒ Wàng, 阴虚火旺)
When Yin deficiency is prolonged, the cooling, moistening counterbalance to Yang is insufficient. Yang — no longer anchored by adequate Yin — generates a smoldering “empty Heat” that rises and inflames without the acute quality of true Fire. In the eyes, this presents as a burning, redness, and heat sensation that is chronic and low-grade rather than acute and intense. It is the inflammatory component of dry eye expressed through the deficiency lens: not inflammation from excess pathogen invasion, but the heat of a body running dry. Patients describe feeling like they have something irritating in their eye, sensitivity to light, and an unrelenting sensation of heat that worsens as the day progresses.
The Dzung 5 Regions Lens: Sclera and Eyelids
Two of Dr. Dzung’s five organ-region mappings are particularly relevant to dry eye:
- Sclera → Lung (Qi Wheel, 氣輪) — the white of the eye, including the conjunctival surface, is the Lung’s domain; the Lung governs fluid secretion onto surfaces; when Lung Qi is deficient, the conjunctival and corneal surfaces lose their fluid distribution
- Eyelids → Spleen (Flesh Wheel, 肉輪) — the eyelids are governed by the Spleen; the meibomian glands, embedded in the eyelid margins, depend on Spleen function for their secretory capacity; MGD in classical terms is often a Spleen Qi deficiency picture
This mapping explains why the M48 protocol for dry eye targets Lung and Spleen pathways alongside the Liver — the organ-anatomy correspondence tells us which channel systems are involved in the tear film and the ocular surface.
Acupuncture for Dry Eye: M48 and the Drying Protocol
MA48 (Micro Acupuncture 48), Makari’s specialty protocol for degenerative eye disease, classifies dry eye in the “Drying” category — conditions characterized by Liver and Kidney Yin deficiency leading to fluid insufficiency. Andy Rosenfarb, ND, LAc, developed MA48 on the ECIWO holographic mapping developed by Professor Yingqing Zhang: the insight that organ systems can be influenced through precisely located distal points on the hands and feet. For dry eye, the protocol addresses both the Yin substrate failure and the Lung-Spleen delivery failure:
- LR-A (Liver sensory/distal) — the primary Liver point in the MA48 system; Liver Yin deficiency drives the foundational dry-eye picture; LR-A addresses the functional sensory dimension of Liver deficiency
- LU-A (Lung sensory/distal) — Lung governs fluid secretion and the skin/surface layer; LU-A addresses the secretory failure component; particularly relevant for the MGD / evaporative picture where the Lung-Spleen delivery failure is primary
- SP-B (Spleen structural/proximal) — B points address the constitutional, chronic, deficiency dimension; SP-B is indicated when Spleen Qi root deficiency underlies the fluid distribution failure; strengthens the delivery layer from its constitutional base
Needles are 34-gauge, half-inch, inserted at approximately 45° angle onto the periosteum, 30-minute retention. Response is typically noticed within 1–4 treatments. The degree of improvement in dry eye varies with the severity of the constitutional deficiency — long-standing Yin and Qi depletion requires a longer treatment course than a more acute presentation.
Scalp Acupuncture and Periorbital Adjuncts
The Scalp Vision Area is less central to dry eye than to conditions with more prominent optic nerve or retinal involvement. For dry eye patients, we more commonly employ periorbital adjunct points to enhance local fluid secretion and ocular surface support:
- BL-2 (Zanzhu) — at the medial end of the eyebrow; classic local point for eye problems; influences the lacrimal drainage system and periorbital circulation
- SJ-23 (Sizhukong) — at the lateral end of the eyebrow; Triple Jiao channel governs fluid metabolism; SJ-23 supports periorbital Qi and fluid distribution
When electro-stimulation is applied to these periorbital points, we use 1–4 Hz — the chronic-degeneration range appropriate for Yin-deficiency and Qi-deficiency presentations — to gently enhance local fluid secretion and periorbital microcirculation without over-stimulating a constitution that is already depleted.
Chinese Herbal Support for Dry Eye
The herbal approach to dry eye targets the Yin deficiency root and the fluid-delivery failure simultaneously. Classical choices include:
- Mai Men Dong (Mài Mén Dōng, 麦门冬) — ophiopogon tuber; the primary Yin-nourishing and fluid-generating herb; nourishes Lung-Stomach Yin and promotes fluid secretion; directly addresses both the Lung delivery failure and the Yin substrate deficiency
- Sha Shen (Shā Shēn, 沙参) — glehnia root; fluid-generating and Lung-moistening; a gentle but sustained Yin tonic with specific affinity for the secretory surfaces; used alongside Mai Men Dong for the Lung-Yin and surface-moisture picture
- Ju Hua (Jú Huā, 菊花) — chrysanthemum; the classical eye herb; cools Liver Heat, brightens the eyes, and addresses the empty-Heat burning component of Yin deficiency dry eye
- Gou Qi Zi (Gǒu Qǐ Zǐ, 枸杞子) — wolfberry; nourishes Liver and Kidney Yin and Blood; a classical tonic specifically for the eye-moistening and visual-brightening functions of Liver-Kidney Yin
- Bai He (Bǎi Hé, 百合) — lily bulb; nourishes Lung Yin and moistens dryness; addresses the surface-secretion failure of the Lung Qi deficiency picture; a gentle, food-grade herb that supports the fluid-distribution layer without heavy tonification
Formula design integrates these according to which pattern layer is most prominent. A Liver-Yin-deficiency-primary formula looks different from a Lung-Spleen-Qi-deficiency formula, though both address “dry eye” in the Western sense. The pattern determines the formula.
Functional Medicine Support Layer
Functional medicine research on dry eye converges on two well-supported targets:
- Omega-3 fatty acids: EPA and DHA directly influence meibomian gland function and the lipid layer of the tear film. Multiple clinical trials have examined omega-3 supplementation for evaporative dry eye, with findings suggesting meaningful support for meibomian gland secretion quality and tear-film stability. This aligns precisely with the Lung-Spleen delivery pattern in classical medicine — omega-3 supports the lipid secretion function that classical medicine addresses through the Lung-governing-surfaces channel.
- Antioxidant support: Chronic ocular surface inflammation is driven in part by oxidative stress. Vitamins C and E, lutein and zeaxanthin, and astaxanthin have been examined for anti-inflammatory and antioxidant effects at the ocular surface. These map to the Yin-deficiency empty-Heat pattern — supporting the body’s cooling, anti-inflammatory capacity when the constitutional Yin substrate is depleted.
We integrate functional supplementation with the classical pattern diagnosis rather than as a parallel stack. The nutrients that best address the Liver-Yin or Lung-Spleen picture are selected in coordination with the herbal formula and the acupuncture protocol.
What the Research Shows
A 2026 systematic review in Frontiers in Medicine by Bautista-Hernández MA and colleagues examined clinical evidence on acupuncture for ocular conditions. Their conclusion: current evidence is insufficient for definitive claims — heterogeneous studies, small sample sizes, variable methodology. This is not a verdict against acupuncture; it is a call for more rigorous integrative research. Frontiers in Medicine, 2026.
For dry eye specifically, there are promising findings around acupuncture’s effects on lacrimal gland function and ocular surface inflammation, but the evidence is preliminary. We are honest with every patient about what we know and what remains to be studied. What we can say with confidence is that many patients with chronic dry eye — particularly those with identifiable Yin-deficiency or Lung-Spleen constitutional patterns — report meaningful improvement with integrative care. Not because we promised an outcome, but because the pattern was read correctly and the treatment was matched to it.
Curious? Let’s Talk.
If you or someone you love is navigating dry eye disease and wondering what integrative acupuncture and herbal support might look like, we’d love to have that conversation.
The M48 protocol isn’t a promise — it’s a conversation. One grounded in classical theory, clinical experience, and an honest engagement with the evolving science.
Makari Wellness — Michael Woodworth, M.S., L.Ac. (established 2005)
Specializing in degenerative eye disease via the M48 protocol
Call us: (888) 871-8889
Book online: makariwellness.com/book-appointment
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This content is educational and does not constitute medical advice. Acupuncture and herbal medicine are not replacements for conventional ophthalmologic care. Always continue your care with your ophthalmologist.