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The pupil (pupil) becomes small, indicating damage to both essence and qi, dissipation of primordial yang, and the imminent danger of extinguishing Shen Guang (visual function). Without effective medical intervention, the condition is difficult to reverse.

This syndrome manifests as the pupil gradually shrinking like the tip of a hairpin, and in severe cases, becoming as small as a needle point. Although some light perception remains, early treatment may salvage the vision, but restoring it to its original state is difficult. Patients often indulge in sexual excesses; even when eye disease is present, they do not abstain from lust. Combined with fatigue damaging qi and blood, and excessive mental exertion depleting the mind, both the Liver and Kidney meridians are injured. The primordial qi becomes weak and fails to ascend and transport clear fluids to nourish the Gallbladder. The "Sanhe" essence (referring to the refined essences combining the Gallbladder with the Liver, Heart, etc.) within the Gallbladder becomes deficient, leading to a scarcity of Lunzhi (fluids maintaining the globe's shape and function). Consequently, the essence within the pupil is day by day depleted. In severe cases, it sinks and disappears completely, resulting in lifelong disability. There are also cases where head wind-heat attacks and steams dry up the essence fluids, causing the pupil to shrink. All such conditions should be treated early at onset; otherwise, regret will come too late. It is suitable to take:

Qingshen Yiyang Wan (Clear Kidney and Suppress Yang Pill): Used to treat spontaneous contraction of the pupil caused by water excess (accumulation of damp-heat or renal water imbalance). The pathology involves tightness and progressive constriction of Shenshui (aqueous humor), eventually shrinking to the size of a mustard seed. Long-term use of this pill can balance yang and preserve yin, naturally resolving the issue of the small pupil.

Ingredients: Hanshuishi (Calcitum, prepared separately), Huangbai (Phellodendri Cortex, processed with salt water), Shengdihuang (Rehmanniae Radix), Zhimu (Anemarrhenae Rhizoma, processed with salt water), Gouqizi (Lycii Fructus), Huanglian (Coptidis Rhizoma, stir-fried with wine), Baifuling (Poria, two taels each), Duhuo (Angelicae Pubescentis Radix, eight qian), Caojueming (Cassiae Semen, stir-fried), Danggui (Angelicae Sinensis Radix, washed with wine and stir-fried), Baishaoyao (Paeoniae Radix Alba, washed with wine and stir-fried, one tael each).

Preparation and Administration: Grind the above ingredients into fine powder. Form pills using refined honey, sized like paulownia seeds. Take three qian per dose, administered on an empty stomach with boiling plain water. Additionally, the following formulas are suitable: Yi Yang Jiu Lian San, Huanyin Jiuku Tang, Bi Yun San (see Volume II for details).

"Timid near-sightedness yet clear distance vision, objects before eyes lack focus; Yin essence too stagnant, Yang pathogen appears, Phlegm-fire individuals are extremely restless." The treatment method is to tonify the Kidney and clear the Heart.

This syndrome is characterized by the ability to see far but inability to see near. This is due to insufficient Yin essence and excess Yang (deficiency fire). The pathology lies in the Water organ (Kidney); thus, the visual brilliance scatters and cannot converge for near vision. Treatment focuses on balancing the Heart and Kidney. When Heart and Kidney are balanced, Water and Fire harmonize, and Yin and Yang flow smoothly, allowing proper function for both near and far vision.

Blood transforms into fluid, which in the body is known as essence fluid. The lighter and clearer part of the blood ascends to the eyes to form ointment-like fluids. Indulgence in lust, irregular eating habits, extreme physical labor, or intense weeping all consume Yin essence. When Yin essence is deficient and Yang fire becomes hyperactive, the fiery nature causes emission outward. The Yin essence-water cannot control the fire, so the fire flares outward, illuminating distant objects but failing to control the internal heat. Those who fail to control the fire and instead provoke it develop internal cataracts. It is suitable to take:

Dizhi Wan (Eucommia and Rehmannia Pill): Treats the ability to see far, attributed to fire; and inability to see near, attributed to lack of water. Treatment should focus on tonifying Kidney water.

Ingredients: Tianmendong (Asparagi Radix, heart removed), Shengdihuang (Rehmanniae Radix, baked dry, four taels), Zhike (Aurantii Fructus, pith removed), Juhua (Chrysanthemi Flos, three taels each).

Preparation and Administration: Grind into fine powder. Form pills using refined honey, sized like sesame seeds. Take one hundred pills per dose, administered after meals with tea infusion.

Liujun Dihuang Wan (Six-Ingredient Pill with Rehmannia): Treats Spleen and Stomach disorders, as well as symptoms in youth such as water deficiency with hyperactive fire and Yin deficiency; Liver and Kidney blood deficiency, dryness-heat with thirst, dysuria and retention, phlegm-qi obstruction upward, wind pathogens invading excessive qi, scrofula and lymphatic nodules, limb convulsions, abnormal eye movements, coughing with hemoptysis, dizziness, dry and painful throat, mouth and tongue ulcers, spontaneous sweating and bloody stool, congenital insufficiency, emaciation, fontanelle delay and aphonia, photophobia and downward gaze, five delays and five softnesses, Kidney and Liver Gan syndromes, early sexual activity leading to essence and blood depletion. Damage to all five Zang organs; suitable for any deficiency syndrome of the Liver and Kidneys. Use this formula to nourish the source of transformation; its merits are incalculable.

Ingredients: Baifuling (Poria, steamed with milk, dried, one and a half taels each), Danpi (Moutan Cortex, stir-fried, one and a half taels each), Zexie (Alismatis Rhizoma, lightly stir-fried, one tael), Shanyao (Dioscoreae Rhizoma, mixed with wine, steamed, dried), Shanzhuyu (Corni Fructus, pitted, steamed with wine, baked dry, two taels each), Shudihuang (Prepared Rehmanniae Radix, four taels, boiled in half wine and half water until soft, mashed into paste and added separately).

Preparation and Administration: Grind the remaining ingredients into fine powder. Form pills using refined honey, sized like sesame seeds. Take three qian per dose, administered on an empty stomach with light salt water. For patients with spermatorrhea, add Li Shell (Ostreae Concha, quenched in red water, powdered, baked dry, three taels). Avoid radishes.

The Kidney is the Water organ. When water is deficient, Dragon-Lei Fire (Ministerial Fire) rises unchecked without fear. As Wang Qixuan stated: "Strengthen the master of water to control the sunlight." This corresponds to the Classic saying: "Seek its affiliation to diminish it." Rehmannia has a rich flavor and belongs to Yin within Yin; it specifically tonifies the Kidney and fills essence, thus serving as the Sovereign drug. Corni has a sour taste and enters the Liver meridian, reflecting the principle of treating Liver and Kidney together (Yi-Gui same treatment). Since the Kidney governs storage, the astringent property of sour flavors is appropriate, making it a Minister drug. Dioscorea has a sweet taste and enters the Spleen meridian, helping to stabilize the element that controls water (Earth controls Water), also serving as a Minister drug. Moutan also enters the Liver meridian; its function is primarily to promote circulation, assisting Corni’s astringency by preventing excessive stagnation. Poria also enters the Spleen meridian; its function is primarily diuretic and draining, assisting Dioscorea’s potential stagnation. Moreover, Poria is white and belongs to Metal, nourishing the Lung, embodying the principle of "tonifying the mother when deficient" (Metal generates Water, Lung is the Mother of Kidney). Zexie has three functions: first, promotes urination to drain Ministerial Fire; second, resolves the stagnation of Rehmannia and guides other herbs rapidly to the Kidney meridian; third, possesses both tonifying and draining properties, avoiding the risk of adverse interactions or excessive Qi generation among other herbs. Thus, it serves as the Envoy drug. This pill is a sacred remedy for tonifying the Kidney, but ignorant people despise it for its slow action. This reflects four errors in prescription: First, if Rehmannia is not from Huaqing, its efficacy is shallow; Second, if Rehmannia is not self-prepared, it lacks craftsmanship and may react with iron vessels; Third, reducing the dosage due to suspicion of Rehmannia’s cloying nature weakens the Sovereign drug; Fourth, reducing Zexie due to aversion to its draining nature weakens the Envoy drug. Falling into these four errors and then blaming the medicine for ineffectiveness is unjust!