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Shen Shui Jiang Ku (Impending Depletion of the Divine Water). Observing the exterior of the eyeball, the Shen Shui (divine water, referring to the aqueous humor and vitreous body that maintain ocular transparency) is dry, astringent, and unmoistened. Its luster is dim, resembling the trail left by a slug. This is a sign of fire qi stagnating and steaming, leading to the internal exhaustion of Gao Ze (nutritive essence for the eyes). Whenever this syndrome appears, it will inevitably develop into Nei Zhang (internal cataract or opacity of the lens/vitreous). If proper regulation is neglected, over time the Tong Shen (pupil and its function) will tightly constrict, with cloud-like nebulas forming internally, gradually progressing to blindness. Generally speaking, a constricted pupil indicates Liver Heat and Kidney Deficiency; a dilated pupil indicates Liver Deficiency and Kidney Heat. The case described here involves Liver Heat and Kidney Deficiency. In the initial stage, there is a dragging pain at the head of the eyeball, slight redness, yet vision of the "Three Lights" (sun, moon, stars, indicating residual visual acuity) remains. Treat with Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) added with Mai Dong (Ophiopogon Tuber) and Wu Wei Zi (Schisandra Berry). Strictly avoid using blowing powders or eye drops. If a child has a pre-existing Gan Zheng (infantile malnutrition syndrome), presents with duck-dung-like loose stools, suffers from eye disease, and shows signs of impending depletion of Shen Shui, the prognosis is fatal.

Re Jie Chang Bang Zheng (Syndrome of Heat Accumulation in the Bladder). Regarding the depletion of Shen Shui: because the water in the lower jiao is steamed by heat and becomes turbid, the upper part (eyes) also becomes turbid. Clarifying the source ensures the flow becomes clear.

Eye diseases arise from the disharmony of the Six Qi (Wind, Cold, Summerheat, Dampness, Dryness, Fire), or attack by Wind Evil. The sensation is as if the brain nerves are being pulled; the Shen Zhu (eyeball) suddenly looks up without intention to rotate, then suddenly looks down; unable to look down when desired, unable to look up when desired; moving left or right, changing unpredictably. Mild cases present with stabilized Qi but deviated pulse, causing the eyeball to tilt, resembling the state of the Shen Zhu about to invert. Severe cases result in complete inversion, becoming Tong Shen Fan Bei (inversion/dislocation of the pupil). Treatment involves mixing Ginger Juice with Sesame Oil and massaging the eyelids and acupoints Ying Xiang, Shang Xing, Feng Chi, Feng Fu, and Tai Yang. For acute onset, interior-regulating herbs should be used, combined with lifting and tonifying methods for recovery. Formulas include Shen Xiao Huang Qi Tang (Miraculous Efficacy Astragalus Decoction) or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) both added with Qiang Huo (Notopterygium Rhizome). If Wind-Heat is vigorous, use Tong Gan San (Liver-Penetrating Powder).

Shen Zhu Jiang Fan refers to the abnormal position of the eyeball, where rotation is attempted but impossible. This is caused by Wind-Heat attacking the brain, causing spasms and tension in the meridians and collaterals, pulling the Shen Zhu to one side, thus preventing movement. In severe cases, a buzzing sound like an echo may be heard internally. Selectively use Shi Gao San (Gypsum Powder) or Tong Gan San. For blood stasis in the Blood Division, presenting with red, swollen, and painful eyes, use Jiu Jian San (Wine-Decoction Powder) added with Wu Ling Zhi (Trogopterus Feces). Failure to treat properly carries the risk of inversion.

Tong Shen Fan Bei occurs due to Wind-Heat battling the eyeball, causing it to slant and invert sideways. Use Tong Gan San added with Quan Xie (Scorpion) and Gou Teng (Uncaria Ramulus cum Uncis). Alternatively, use Huang Qi Jian Zhong Tang (Astragalus Decoction for Building the Middle) added with Qiang Huo, Dang Gui Shen (Angelica Sinensis Root Tip), and Xie Shao (Scorpion Tail). For deficiency patterns, Shen Xiao Huang Qi Tang or Bu Zhong Yi Qi Tang are applicable. Some claim this is identical to Tong Shen Fa Bai (Whitening of the Pupil), attributing the similarity to northern dialect pronunciation. Essentially, whitening refers to Nei Zhang (internal cataract), which is appropriately treated with Jin Zhen Bo Zhang (Golden Needle Cataract Extraction). What was previously described as the acute phase of Shen Zhu Jiang Fan is not true Fan Bei. How could the Eye System (optic nerve and connecting tissues), which is anchored internally, truly invert? Physicians must examine this carefully.