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Anger and pathogenic factors invade the Liver horizontally; once in the Liver, the sinews and vessels are already damaged and impaired, leading to strabismus with protrusion (Tongjing) that is unsightly. Indulgence in sexual activities depletes essence and blood, while frequent drinking causes coldness in the stomach lining; generally, one should consider these causes leniently when addressing this disaster.

The shape of the eye resembles both a ball and an orange, with a stalk-like attachment at the lower end allowing for extreme mobility. If primordial Qi is deficient and sinews are lax, suddenly encountering pathogenic factors can cause the "orange stalk" (the eyeball) to hang long, resulting in this strange disease.

This condition involves the sudden protrusion of the eyeball outside the orbit, which differs from fish-eye conditions where swelling rises slowly due to stagnation. The causes are numerous: some are squeezed out by severe itching from deficiency-wind causing rubbing; some are forced out by violent vomiting after excessive drunkenness; some swell out due to heat diseases causing obstruction (Guan Ge); some strain out from furious roaring. Ultimately, all stem from declining Kidney water and deteriorated essence, making the vessels brittle and scorched. When pathogenic fire becomes hyperactive and cannot be discharged internally, it rushes upward through the orifices. Since discharge is insufficient, it swells and erupts. Cases of sudden protrusion due to trauma/blows are not discussed here. If the eyeball has not completely detached from the eyelids and the patient's spirit remains unchanged, it can be pressed back in while applying heat. However, since the sinews and vessels have been damaged, vision will ultimately be lost. Protruding eyes still contained within the socket are easy to reduce, and vision may remain intact. If the eye hangs suspended like a bell and the ocular fluid transforms into flesh and blood, it cannot be saved. In cases where, unknowingly, the eyeball protrudes completely, hanging long to the nose without retracting, the world calls it "Liver Distension." This is unknown as a sign of impending loss of soul and spirit; erroneously treating it as Liver Distension inevitably leads to the use of wind-dispersing herbs, which is adding insult to injury. Why? The Liver stores the Soul (Hun), and the Heart consolidates the Spirit (Shen). When primordial Qi is severely deficient, the Soul and Spirit become disordered, resulting in bizarre symptoms. Furthermore, the Liver governs sinews, and the Heart governs vessels. When Spirit departs and Soul is lost, sinews and vessels scatter and relax. During this scattering and relaxing state, pathogens reach the orifices and exit, falling downward at will. The patient is startled, observers are horrified, and physicians are at a loss. Yet, given the situation, even if unfamiliar, there is no need for fear. Wrap the eye in soft cloth, carefully place it back into the orbit, instruct the patient to close their eyelids and sit quietly. Decoct Da Bu Yuan Tang (Great Tonification of Primordial Qi Decoction) and Wen Jing Yi Yuan San (Warm Meridians and Benefit Primordial Qi Powder), and sip them warm. Simultaneously, quench magnetite in vinegar and steam the vapors toward the nose. The Liver, receiving the strong sour aroma, will contract scattered elements. Wait until slight sweating is about to occur, then unbutton the clothes and occasionally spray cool spring water on the chest and back. This stimulates the skin and contracts the vessels, stabilizing the condition within a day and night. Then, nourish according to emotional needs, perhaps achieving a slim chance of recovery.

A woman surnamed Wu from the eastern neighbor was embroidering shoes by the window at night when her vision suddenly failed. Initially thinking the lamp had fallen, she looked up and felt something on her cheekbone; touching it, she found her eyeball. She beat her chest in great grief. Her family cried out in alarm, and I also rose to look. At that time, the weather was bitterly cold, and the eyeball had stiffened. Using a small basin with warm water, I soaked the eyeball for a moment before placing it back into the eyelid. Treating with the aforementioned methods, she recovered after a month. However, the divine light was faint, beyond description by beautiful words.

I have seen many cases of eyeball protrusion in my life, including two more bizarre and severe types not recorded in medical texts. I hereby append them to the end of the symptoms section to enlighten future learners. First, a child’s right eye just began to show illness; the pupil dispersed immediately, and the black cornea gradually enlarged and elevated, resembling the image of Zhang Xun (Zhang Suiyang) who died and became a vengeful ghost killing thieves. After one night, it stood high like a wine cup, straight out for about two cun, crying day and night. Subsequently, the eyeball ruptured, discharging not pus but blood. Numerous renowned surgeons were invited but could do nothing, and the child eventually died. Second, a scholar, for no reason, had his left eye protrude with strabismus, measuring one and a half cun wide. The upper part was round and hard, the lower part slightly pointed and flat, hanging down almost level with the nose, yet he could see without pain. Later, within the Qi wheel (white sclera) near the outer canthus, another toxic growth emerged, hard as stone, resembling an olive wrapped in membrane, pushing the black cornea to one side. He initially suffered dizziness and pain, intolerable photophobia, and finally, the entire eyeball ulcerated and rotted, with pain radiating to the head, inability to eat or sit up, a condition destined to end in death. In summary, these two cases change irrationally, and their organ affiliations contradict normal principles. Why? Generally, even severe and dangerous diseases require wind generating fire, and fire generating wind; only when wind and fire are fierce does the eye fail. No disease causes immediate explosive protrusion. Moreover, wind and fire combine in the Heart and Liver regions; how could disaster affect the Spleen and Lungs? The Jin wheel (white sclera) drooping without cause indicates Qi collapse, yet here it is swollen and solid, plus toxic accumulation. This suggests Spleen and Lung fire accumulating sequentially; it should damage the right eye, why destroy the left? If claiming depletion of true essence, the child had no knowledge. If claiming karmic retribution, what evil did the scholar commit? Facing ineffective medicines and waiting for death, alas! The Way of Heaven is subtle and obscure, human affairs are inexplicable. Medical formulas cannot be fully trusted, as evidenced by this.