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Dilation of the pupil (Tongshen) is caused by wind-heat. The nature of fire is dispersing; when combined with wind, it becomes even more intense, causing the divine light (Shenguang) to become weak and unable to sustain itself, thus dispersing aimlessly, similar to how ripples form on water when the wind rises. It can also be caused by excessive consumption of acrid-dispersing herbs. Treatment should employ bitter, sour, and cooling agents. For example, Siwu Tang (Four Substances Decoction) with Chuanxiong Rhizoma (Chuanxiong) removed, plus Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Glycyrrhizae Radix et Rhizoma (Gancao), and Schisandrae Fructus (Wuweizi). Alternatively, Liuwei Wan (Six-Ingredient Pill with Rehmannia) with added Wuweizi and Heteroconcha Halionis (Shijueming). Acrid-warm substances are strictly contraindicated; one must purge the pathogenic factors of Wood-Fire. Dietary management should follow this principle as well. Consumption of cold water and excessively cold foods is especially forbidden, as they damage Stomach Qi. Herbs such as Ecliptae Herba (Chongwei), Celosiae Semen (Qingxiang), Chuanxiong Rhizoma (Chuanxiong), and Viticis Fructus (Manjing) should not be used in prescriptions because their acrid flavor may inadvertently assist fire. Danggui (Angelicae Sinensis Radix) is also acrid and sweet, but it is retained because it is a supreme herb for harmonizing blood. In cases where the pupil is dilated but the cornea (Fenglun) appears narrowed, or even reduced to a thin line around the circumference, this results from pathogenic heat stagnation and steaming, with wind-dampness attacking and stimulating, causing the Shen Gao (vitreous humor) to scatter. If treated early while the constriction and dilation are irregular, it can still be gathered back; if delayed until the Qi stabilizes and the Shen Gao has dispersed, it cannot be recovered. If no internal cataract (Neizhang) has developed and only pupillary dilation exists, directly gathering the pupil will restore vision naturally. If dilation occurs alongside an internal cataract, anti-cataract formulas should be added in measured amounts to the pupil-gathering prescription, such as Bushen Cishi Wan (Kidney-Nourishing Magnetite Pill), Bushen Wan (Kidney-Nourishing Pill), or Qianjin Cizhu Wan (Thousand-Gold Magnetite and Cinnabar Pill). Generally, pupillary dilation accompanied by headache due to head-wind is common; this is the eruption of latent fire within Water and is the most difficult to收敛 (gather/contract). If the heat pathogen comes from other conditions like Shanghan (Cold Damage), malaria, or phlegm-fire damaging the Shen Gao, the internal cataract appears late, making contraction easier. However, if attacked by wind, the internal cataract appears immediately, is hard to contract, and vision is impaired. There are also ordinary people who, due to overwork or exposure to heat, occasionally feel their pupils appear larger; this should not be mistaken for pathological dilation.

The pupil gradually becomes small, like the tip of a hairpin or a mustard seed. The aqueous humor surrounding it may resemble insect-eaten patterns. The patient gradually experiences eye soreness, itching, and photophobia, yet retains some vision. This condition is extremely difficult to manage. Early treatment can reverse it; prolonged duration makes it hard to cure. This occurs because patients fail to abstain from sexual activity during ocular disease. Ministerial Fire (Xianghuo) aggressively attacks Kidney Water, injuring both Liver and Kidney. Yuan Qi (Original Qi) becomes deficient and fails to ascend and transport essence fluids to nourish the Gallbladder. The essence in the Gallbladder is depleted, and its transmission is insufficient, causing the pupil to deteriorate day by day. Severe cases lead to complete sinking and disappearance of the pupil, resulting in lifelong blindness. Treatment should suppress Yang and soothe Yin. Initially administer Huanglian Yanggan Wan (Coptis and Sheep Liver Pill) for several doses. Then switch to Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), replacing Shu Di Huang with Sheng Di Huang, and adding Dongguaren (Tian Dong) and Maidong (Mai Dong). Concurrently administer Zishen Wan (Kidney-Nourishing Pill). If ineffective, add Xiongdan (Bear Bile). In cases where head-wind heat syndrome attacks and evaporates body fluids, causing pupillary constriction, early intervention is essential to avoid regretful outcomes.