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[Chapter 27: Eye / Chapter 28: Suspended Ball / Chapter 29: Inverted Cup]

In the skin of the eyelids, the vessels are tortuous and messy like a tumbleweed; Qi is not harmonious, and Blood is insufficient. This is not caused by external Wind pathogen. In severe cases, it even pulls the corners of the mouth and the canthi, with continuous trembling and jumping without cessation, causing children to cry in terror and old men to laugh in mockery, making the facial expression difficult to restore.
This condition is called "Suspended Ball" (Xuanqiu), referring to the eyelid pulling and vibrating spontaneously, independent of voluntary opening and closing. It arises because the Ying (Nutrient) and Wei (Defensive) Qi of the Foot-Taiyin Spleen Meridian and Foot-Jueyin Liver Meridian are disordered. Disorder leads to stagnation; long-term stagnation generates internal Wind, and long-term Wind transforms into Heat, leading to this condition. The treatment is primarily based on Quan Zhen Yi Qi Tang (Complete True One Qi Decoction), Shi Wei Yi Rong Jian (Ten-Flavor Nourishing Nutrient Decoction), and Ai Ren Li Xue Tang (Mugwort Man Regulating Blood Decoction), which will stop the symptoms shortly. If mistakenly considered as wandering Wind and excessive Heat, and treated with cooling and dispersing methods, it may cause muscle relaxation and tendon traction, potentially leading to facial paralysis or deviation. Otherwise, the eyelid may pull to the left or right, along with the mouth corner twitching upwards intermittently, shaking and fluttering like a carpenter's ink line or a hunter's smoking pipe. People seeing it cannot help but feel amused; it truly becomes a lifelong signboard for ridicule.

Why does the upper eyelid swell? It is due to Yang deficiency and wandering Dampness. Inside, there is merely Qi stagnation, and externally it looks like a ball. The color has not fully changed; how long can Wind-Cold remain? Treatment with acrid-warm methods should be used; if ineffective, one should give up.
This condition presents with no redness or pain in the eyes, but the upper eyelid is vacuously swollen like a ball. After a long time, signs of Fire may appear, with the eyelid becoming red or developing internal vessels. If Damp-Phlegm and Fire explode together, tears will flow and the eyelid will ulcerate. This is a self-disease caused by changes in Spleen and Lung Yang, and must not be mistaken for the excess pathogens of "Inverted Cup" (Fubei) or "Clam Closing" (Benghe). Try rubbing hands warm and wiping the area; the swelling will subside slightly but return to normal shortly after, indicating insufficiency of True Yuan (Original Qi) and congestion of deficient Fire in the muscle tissue. Treatment uses Yi Gong San (Yi Gong Powder), Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction), Shen Xiao Huang Qi Tang (Miraculous Efficacy Astragalus Decoction), and Zhu Yang Huo Xue Tang (Assist Yang and Invigorate Blood Decoction), resulting in immediate recovery.

The disaster of Earth (Spleen) originates from the construction of Wind-Wood (Liver). Accumulation causes the orbital rim to swell like an inverted cup. Enduring pain and photophobia, acupuncture and herbs must be used simultaneously, without worrying about priority. One might expect that the Qing Jing (Clear Eye/Globe) would not accept dust/cataracts, but how can it withstand the sudden rain and rapid clouds (acute progression)? When phoenix wax burns and the mirror reflects, the scene is completely different from before.
This condition begins with eye redness, pain, and excessive tearing, followed by gradual swelling and hardening of the eyelids, resembling an inverted wine cup placed on the orbit. This is because Liver Wood fails to exercise virtue, allowing Wind to overcome Dampness. Wind overcoming leads to Fire generation. Fire, affected by Wind pathogen, invades Earth (Spleen), causing Dampness to turn scorched and dry, thus becoming hard and red. If caused by external Wind-Heat, the disaster is slightly slower. However, extreme swelling inevitably leads to Blood stasis, which may flood into the eye globe; what then? One must use Ka Dao (Opening Guidance/Bloodletting) and Fu Zhi (External Application). If external application reduces swelling but it recurs, or if bloodletting resolves it but it reappears, or if swelling increases higher, this indicates Wind-Phlegm attacking jointly, and the condition changes unpredictably. Without precise Four Examinations (Si Zhen), it is indeed tricky. Zhang Zihe said: "The eye does not become diseased unless affected by Fire." Redness of the Bai Lun (White Wheel/Sclera) indicates Fire attacking the Lung; redness and ulceration of the Rou Lun (Flesh Wheel/Eyelid) indicate Fire attacking the Spleen; opacity of the Hei Shui Shen Zhu (Black Water Divine Pearl/Iris/Pupil area) indicates Fire attacking the Liver and Kidney; red vessels penetrating the eye indicate Fire is extremely abundant. The Classics state: "Excess Heat causes swelling." Any sudden eye redness and swelling, photophobia, astringency, pain, continuous tearing, and burning heat sensation are disasters caused by Fire. However, treatment methods vary: there is cold-cooling to descend Fire, water-nourishing to match Fire, oil-adding to assist Fire, ash-filling to nourish Fire, Yin-nourishing to control Fire, Wood-cultivating to generate Fire, firewood-pulling to retreat Fire, water-pouring to extinguish Fire, Yang-raising to scatter Fire, bloodletting with Bian needles to seize Fire, and moxibustion to divert Fire pain. Thus, Zhang Zihe also said: "Those who can treat Fire can resolve it in one sentence." Must one necessarily use great bitter-cold herbs, dispersing above and purging below, to be considered appropriate? For such conditions combined with the next chapter, Bian needle (bloodletting) and Chou Xin (Pulling Firewood/Purgation) methods should be used. Bian needle is Ka Dao; Chou Xin is Xia Duo (Lower Purging). The *Ben Jing* calls this "Gong" (Attack); Tong Qi Li Zhong (Qi-regulating and Middle-promoting formulas), San Cheng Qi Tang (Three Inherited Qi Decoctions), and San Hua Shen Wan (Three Flowers Divine Pills) can all be used. Alternatively, Qing Wei San (Clear Stomach Powder), Liang Ge San (Cool Diaphragm Powder), or Pu Ji Xiao Du Yin (Universal Benefit Detoxification Decoction) may be used. Wait until swelling subsides, then assess if the eye globe is damaged before further management. Some say the above drugs are too harsh; treating the branch urgently is acceptable. However, for the elderly, postpartum women, or those with constitutionally weak Yuan Qi, Bitter Salt (Mang Xiao/Mirabilite) and Da Huang (Rhubarb Root) must be removed, adding Ren Shen (Ginseng Root), Huai Shan Yao (Chinese Yam Rhizome), Sheng Jiang (Fresh Ginger Rhizome), and Da Zao (Jujube Fruit) to aid decoction. This is indeed sound advice, but one must understand that the disease bears the medicine; although harsh, it causes no harm. This embodies the principle of "Courageous in胆 (Boldness) but small in Xin (Caution)."
Whenever I encounter acute conditions requiring Sweating, Vomiting, or Purgation methods, I administer large doses frequently until the disease is cured, then stop. Yet, when prescribing for others, I repeatedly admonish and remind, fearing that junior practitioners may be careless and bold, killing patients in the bamboo stove and clay pot without realizing it. A certain scholar in the city called himself a famous doctor; he did not visit unless offered fifty taels of silver by wealthy families. Observing his prescriptions, he used Liu Wei Di Huang Wan (Six-Ingredient Pill with Rehmannia) and Bu Zhong Yi Qi Tang for all diseases, weighing each herb personally, totaling less than three qian. Contemporary scholars admired his steadiness and caution. Alas! To call this steady and cautious... Huang Tingjing is unworthy of mention; Mr. Zhang Zhongjing's books could simply be used to cover wine jars or burned to ashes. Hehe!