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What is the condition of pupillary dilation? It occurs because heat-fire pathogens steaming and fumigating the Gallbladder channel, over a long period of depression leading to the depletion of essence fluids, causing the divine light (Shen Guang) to scatter completely. Both Yin essence and Kidney Qi are severely deficient; ministerial fire (Xiang Huo, a pathogenic fire residing in the Liver and Kidney) runs wild without control, resembling the yolk of a chicken or duck egg (referring to abnormal pupil morphology or color). With insufficient essence and Qi damaged by heat, excessive heat and Yin deficiency damage the primal spirit (Yuan Ling), eventually resulting in darkness and blindness.

This section specifically discusses pupillary dilation, where the Wind Wheel (Hei Jing, cornea and iris) becomes abnormally narrow, even as thin as a thread. This is caused by heat pathogens stagnating and steaming, combined with wind-dampness attacking, leading to the dispersion and destruction of the Shen Gao (aqueous humor, lens, and vitreous body). If收敛 (convergence/retraction) can be achieved at the onset, recovery is possible; if delayed until Qi stabilizes and Shen Gao is damaged, retraction will no longer be effective. If there are no signs of internal cataracts (Nei Zhang) yet, only pupillary dilation, directly using drugs to retract the pupil will restore vision once the pupil returns to normal. If dilation accompanies the formation of internal cataracts, gradually add cataract-treating herbs to the pupillary-retracting formula. If the pupil is difficult to retract and the condition is acute, prioritize retracting the pupil first; once the pupil is restored, the eye retains vitality. Regardless of the type of internal cataract, whether treating with medicine or acupuncture, one avoids the regret of missing the opportunity to retract the pupil. If one only attacks the internal cataract without retracting the pupil, the pupil will dilate further, and the cataract will not recede. Procrastination and indecision in these two scenarios lead to stabilized Qi that cannot be treated, resulting in lifelong disability.

Generally, 70-80% of pupillary dilation cases are caused by Head Wind pain attacks. Although conditions such as Cold Damage (Shang Han), malaria, phlegm-dampness, anger, worry, postpartum blood stasis, etc., can cause long-term depression generating heat-fire pathogens that steam and damage the essence fluids wrapped in the Gallbladder, depleting them so they cannot nourish the Shen Gao in the eye, causing essence fluids to scatter and divine light to fail, with hidden fire in Water erupting. Because Water is insufficient to control Fire, as Fire prevails, Yin essence decreases further, disrupting the pure and harmonious Yuan Qi, causing essence fluids to scatter. Cases caused by Wind attack are difficult to retract, unlike heat conditions from Cold Damage, malaria, or phlegm-fire, where炎燥 (scorching dryness) heat damages Shen Gao; in those cases, internal cataracts appear late and are easier to retract. If attacked by Wind, internal cataracts appear immediately, are hard to retract, and vision is impaired. Suitable prescription:

Qianghuo Tuiyi Wan (also known as Dihuang Wan): Treats internal cataracts, small blue-white nebula in the right eye, large faint white nebula, headache, pupillary dilation, constipation or difficulty defecating, normal urination. Headache and eye distension occur in hot weather or warm places; vision dims after sunset on cloudy days. This condition may also take Ziyin Dihuang Wan.

Ingredients: Shu Di Huang (Rehmanniae Radix Praeparata, 8 qian, roasted), Sheng Di Huang (Rehmanniae Radix, wine-processed), Dang Gui Shen (Angelicae Sinensis Radix, wine-processed), Chong Wei Zi (Ecliptae Fructus), Huang Bai (Phellodendri Cortex, wine-processed), Dan Shen (Salviae Miltiorrhizae Radix, each 5 qian), Hei Fu Zi (Aconiti Lateralis Radix Praeparata, processed), Hanshui Shi (Natrii Sulfas), Chai Hu (Bupleuri Radix), Zhi Mu (Anemarrhenae Rhizoma, salt-water fried), Mu Dan Pi (Moutan Cortex, wine-washed), Zhen Chuan Xiong (Ligustici Chuanxiong Rhizoma, wine-washed), Qiang Huo (Notopterygii Rhizoma et Radix, each 3 qian), Fang Ji (Stephaniae Tetrandrae Radix, wine-processed, 2 qian), Bai Shao Yao (Paeoniae Radix Alba, wine-processed, 1 liang 3 qian).

Grind into fine powder, make pills with refined honey, size of small beans. Take 50-60 pills per dose, swallowed with warm water on an empty stomach. If undigested food remains, take when hungry. Avoid speaking during treatment, follow with food to settle the medicine.

According to Li Dongyuan's *Lanshi Micang*: If the nebula is in the outer canthus (Da Yu), add Ge Gen (Puerariae Lobatae Radix) and Sheng Ma (Cimicifugae Rhizoma); if in the inner canthus (Xiao Yu), add Chai Hu and Qiang Huo.

Xie Shen Tang: Treats pupillary dilation caused by excessive consumption of spicy and roasted foods. Take Ci Zhu Wan (Magnetitum et Cinnabaris Pilula) concurrently after taking this formula.

Ingredients: Gou Qi Zi (Lycii Fructus, 1 qian 2 fen), Sheng Di Huang, Huang Bai (wine-washed, fried), Zhi Mu (wine-washed, fried), Mai Men Dong (Ophiopogonis Tuber, heart removed), Shan Yu Rou (Corni Fructus, pitted), Bai Shao, Gui Wei (Angelicae Sinensis Radix tail, each 1 qian), Wu Wei Zi (Schisandrae Fructus, 7 grains), Bai Fu Ling (Poria, each 8 fen), Du Huo (Angelicae Pubescentis Radix, each 8 fen).

Cut into pieces. Decoct with 2 zhong of water until 1 zhong remains, remove dregs, and take hot.

Tiao Qi Tang: Treats pupillary dilation caused by sudden anger. Take Ci Zhu Wan concurrently after taking this formula.

Ingredients: Bai Shao Yao, Chen Pi (Citri Reticulatae Pericarpium), Sheng Di Huang, Huang Bai (salt-water fried), Xiang Fu Zi (Cyperi Rhizoma, vinegar-processed), Zhi Mu (salt-water fried), Dang Gui Shen (each 1 qian), Zhi Ke (Aurantii Fructus Immaturus), Bai Fu Ling (each 8 fen), Gan Cao (Glycyrrhizae Radix et Rhizoma, use raw tip, 5 fen).

Cut into pieces. Decoct with 2 zhong of water until 1 zhong remains, remove dregs, and take hot.

Qing Tan Yin: Treats pupillary dilation caused by head wind, phlegm-jue headache. Take this formula:

Ingredients: Chen Pi (pith removed), Ban Xia (Pinelliae Tuber, ginger-processed), Tian Hua Fen (Trichosanthis Radix), Zhi Zi Ren (Gardeniae Fructus, black-fried), Shi Gao (Gypsum Fibrosum), Huang Qin (Scutellariae Radix), Bai Fu Ling, Dan Nan Xing (Arisaomatis Cum Bile), Zhi Ke (fried, each 1 qian), Qing Dai (Indicum, 6 fen).

Cut into pieces. Decoct with 2 zhong of water until 1 zhong remains, remove dregs, and take hot.

Note: Pupillary dilation belongs to the Kidney. If Kidney Water is solid, Qi gathers and does not scatter; if not solid, ministerial fire flares up causing dilation. If Shen Shui (ocular fluid) initially turns pale green or pale white, it is treatable; if purely green or purely white, it results in permanent disability.

Ziyin Dihuang Wan (see Volume 2): Treats weak blood and Yin deficiency failing to nourish the Heart, causing fire to flourish in the Yin aspect, leading to pupillary dilation. Shaoyin (Heart-Kidney axis) Jun Huo (Monarch Fire) acts non-actionally, replaced by Xiang Huo (Ministerial Fire). The meridians of the Pericardium emerge from the Heart connection, dividing into three paths. Shaoyin Xiang Huo has no form but its function exists within. Excessive fire causes the mother element to become excess, i.e., Wood (Liver) flourishing. The Heart meridian connects to the eye system, and the Liver meridian links to the eye system. Furthermore, the Hand and Foot Shaoyang meridians emerge from the ear, ascend to the upper ear angle, slant down to the outer canthus (Xiao Yu). Excessive wind-heat travels this path, attacking the head and eyes, causing unilateral headache, swelling, pupillary dilation, and blurred vision due to blood deficiency and Yin weakness. The method should involve nourishing, cooling, and benefiting blood, gathering and dispersing fire, and eliminating wind-heat for cure.

Take 100 pills per dose, swallowed with clear tea after meals, twice daily. Strictly avoid spicy foods to prevent aiding fire pathogens, and cold/cool foods to protect Stomach Qi, ensuring medicinal action ascends. Another theory states: The pupil and black eye correspond to Yin. Consumption of spicy-hot foods aids fire, which overwhelms the chest, causing the eye to dilate. Dilated pupils cause objects to appear larger.

Li Dongyuan stated: The Pericardium meridian emerges from the Heart, acting on behalf of the Monarch, and is exterior-interior related to the Small Intestine. In pupillary dilation, the Shaoyin Heart meridian connects to the eye system, and the Jueyin Liver meridian links to the eye system. Heart governs Fire, Liver governs Wood; thus, Wood-Fire energy is excessive. The taste should be bitter, sour, and cool. Strictly avoid spicy-hot foods to drain Wood-Fire pathogens. One should understand this principle in diet. Acrid flavors disperse, and heat aids fire, so they should be avoided. Sour flavors gather Heart Qi and drain Wood-Fire; bitter flavors drain heat-fire and benefit Water. Especially avoid cold water and extreme cold foods, as cold damages Stomach Qi. If Stomach Qi fails to move, Yuan Qi is not generated. Lack of Yuan Qi leads to sinking of Stomach Qi, allowing Sanjiao and Heart fire to overwhelm the Lung, enter the brain, and scorch marrow. Fire governs dispersion, hence pupillary dilation. Extreme heat foods directly aid fire pathogens and must be avoided. Remove Cong Wei Zi from the formula because its acrid nature benefits the Liver, thereby aiding fire. Add Huang Qin (5 qian) and Huang Lian (3 qian). Huang Lian drains Middle Jiao fire; Huang Qin drains Upper Jiao Lung fire. Wine-washing makes them "cold used with heat." Do not use Qing Xiang Zi (Celosiae Semen) as it may aid Yang fire. Add Wu Wei Zi (3 qian) to retract pupillary dilation. Fire and Qi are mutually exclusive. As the classics say: Strong fire consumes Qi; Qi feeds mild fire. Mild fire generates Qi; strong fire scatters Qi. Sour substances assist Yuan Qi. Sun Simiao said: Take Wu Wei Zi regularly in May to assist the Five Zang Qi and tonify Western Lung Metal. The classics state: Tonify with sour, drain with acrid. Thus, acrid drains Qi clearly. Some ask: Why keep Dang Gui, which is acrid and sweet? It is a supreme herb for harmonizing blood. Moreover, its sweet nature serves as a guide and envoy for other herbs, so it is retained. It is suitable to take Shu Dihuang Wan.