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Sores caused by excess heat. The severity of pain and itching varies. In severe cases, the sores are elevated and filled with thick pus, appearing purple with bloody purulent decay, emitting a foul odor similar to blood stasis syndromes; the exudate is turbid and muddy, often flowing onto the eyelids (Pi) to form ulcers. If the blood disperses and the sore heals spontaneously without other painful swelling symptoms, it is mild and harmless. However, if fire-heat is excessive causing sores that are piled up, heavy, and accompanied by pain and swelling, urgent treatment is required to prevent turbid qi from entering internally and affecting the eyeball (Zhu). Treatment should focus on draining Heart Fire and resolving heat toxicity. For areas with sores, opening and guiding wash/drop methods should still be used. Jiao Chuang (Pepper Sores) occur inside the eyelids, appearing as clusters like peppercorns, red and firm, causing a gritty sensation difficult to open, with excessive tearing and pain. People today mistakenly call this Su Chuang (Millet Sores), which is incorrect. Su Chuang also occurs on the eyelids but is yellow, soft, and easily dissipates. In contrast, Jiao Chuang is hard and difficult to dissipate. Physicians have achieved success using bleeding therapy with dragon whiskers. In severe cases, they cluster into sheets with uneven nodules, necessitating drainage when unavoidable; stop once the disease is addressed. If it recurs after subsiding, it indicates internal blood stasis, requiring repeated drainage and administration of wind-heat dispelling herbs to treat the interior. Su Chuang appears on both eyelids as fine, yellow, and soft granules. If eye disease is accompanied by headache, there must be transformation of the syndrome, indicating damp-heat stagnating in the Spleen/Earth division, requiring damp-heat clearing herbs. If phlegm nodules appear on the eyelids, it is due to phlegm binding with fire-stagnation, mostly occurring on the upper eyelid; many cases heal spontaneously without treatment. However, those who indulge in spicy, hot-toxic foods, alcohol, and sexual excess may, over time, develop serious conditions like Ying Lou (Goiter/Fistula).

Mu Gan Syndrome (Wood Galactophore/Corneal Ulcer): Mostly arises on the Wind Wheel (Feng Lun, cornea). Its color is blue, green, cyan, or azure. There are deficiency and excess patterns. Deficiency presents as large and blurry vision; excess presents as small and aching/painful. Unlike Xie Jing (Crystal Pupil/Iris Prolapse) which results from corneal perforation, Mu Gan grows naturally. Sizes vary, growing according to changes. Excess pattern uses Xie Qing Wan (Drain Green Pill); deficiency pattern uses Tong Gan San (Unblock Liver Powder).

Huo Gan Syndrome (Fire Galactophore/Scleral Nodule): Arises on the eyelids (Pi) and Qi Wheel (Qi Lun, sclera). When on the Qi Wheel, fire pathogen attacks Metal (Lung), causing particularly urgent harm. Initially, it resembles a single pepper-like nodule, small and round like a red bean, gradually enlarging. Pain is common, absence of pain is rare. Do not mistake it for a benign red-bean-like spot on the wheel that is easy to resolve; this condition originates internally. Treat with San Huang Tang (Three Yellows Decoction) and Dao Chi San (Guide Out Red Powder), differentiating between deficiency and excess.

Tu Gan Syndrome (Earth Galactophore/Stye): Refers to toxins arising on the eyelids, commonly called Tou Zhen Yan (Stealing Needle Eye). It may affect one eye then the other, or only one eye. Some resolve mildly without pus or blood; others, triggered by spicy, hot, dry, or greasy foods, or exposure to wind, sand, smoke, and fire, transform into fistulas or ptosis. Use Xie Huang San (Drain Yellow Powder). At onset, roll the medication into a thin strip and insert it into the inner canthus lacrimal punctum. Once tears flow, it resolves, ensuring immediate cure.

Jin Gan Syndrome (Metal Galactophore/Conjunctival Follicle): Initially resembles Yu Li (Jade Grain), arising inside the eyelids, obstructing the eyeball causing grittiness and pain, leading to nebula formation. When arising on the Qi Wheel (sclera/conjunctiva), it causes eyeball pain and tearing. Symptoms worsen during Zi hour to noon (Yang phase, Qi rising) and alleviate after noon entering Yin phase. Long-term neglect or violation of dietary/lifestyle restrictions risks transformation into a fistula. Use Xie Fei Tang (Drain Lung Decoction).

Shui Gan Syndrome (Water Galactophore/Episcleral Nodule): A sudden nodule arises, mostly between the eyelids and Qi Wheel (sclera). If on the Feng Lun (cornea), the eye will likely be damaged. There are differences in deficiency/excess and size. Excess is small and very painful; deficiency is large and less painful. Shape resembles a black bean, sometimes horizontally elongated and round. Patients with chronic headaches often suffer from this. Selectively use Qing Kong Gao (Clear Sky Ointment) or Shen Xiong Wan (Divine Achyranthes Pill). This syndrome is similar to Mu Gan but differs slightly in location and color. Black belongs to Water; blue/green/cyan/azure belongs to Wood. Long-term neglect inevitably leads to fistula formation. Due to prolonged wind stagnation overcoming the body, essence and fluid scatter, following injured collaterals, stagnating to form Gan, where damp-heat intertwines to create fistulas.