Library

The Tian Guan (eyelids) open and close during the day, but at night one embraces the quilt alone, enduring loneliness; tossing and turning with no companion to share sleep, a chest full of hot tears wets the silk handkerchief.

This condition begins with redness and heat intolerance in the eyes. Within one or two days, both upper and lower eyelids gradually become swollen and hard, resembling the closed shell of a clam. This is due to phlegm-dryness stagnation and blood stasis, with Spleen Fire leaking upward, causing eyelid hardness. The eyeballs feel as if scorched by fire, inevitably leading to pain and tearing. As the classics state, "Earth extreme resembles Wood," this is not a Liver disease. There will inevitably be granules like peppercorns or millet grains growing inside. Treatment should involve applying medication to soften the tissue, then everting the eyelid for guidance/drainage. If the tissue is too firm to evert, or if the head swells again with pain like splitting or drilling, this indicates Earth counter-attacking Wood, with Xun Wind (Liver Wind) stirring up, causing sudden disaster from internal toxic accumulation. If this disease is treated without skill in eversion and drainage, although eyelid swelling may subside, sores remain internally, forming fleshy growths like clam meat. Over time, they become hard, resembling millet husks or shell teeth. One must use a Moon Axe (a surgical tool) to gradually shave them off. Once thin enough, natural opening and closing will return; clearing star-like opacities with drops can lead to full recovery. However, this method can only be fully applied to young men of wealthy backgrounds who are well-nourished, as the proverb says: "Only with good sleep and diet can one withstand blood loss and trauma." Therefore, treatment should stop at 80% intensity; over-cutting risks excessive blood loss and new diseases.

This condition presents with swelling similar to the previous one, and treatment principles should be alike. Yet, reflecting on my clinical experience, there are many differences. How do I know? In the previous condition, Wood and Earth contend and overcome each other, with swelling primarily in the upper eyelid; treatment focuses on the Liver and Spleen. In this condition, Phlegm-Dampness steams upward, causing both eyelids to lie flat and close; treatment focuses on the Spleen and Stomach. Furthermore, the previous condition often affects the left eye first; even if it spreads to the right, it is less dangerous than affecting the left initially. This condition starts in the right eye; spreading to the left is milder. Initial treatment should employ Bai Hu Tang (White Tiger Decoction) or Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction); if unresolved, use San You Wan (Three Friends Pill) or Yi Wei Da Huang Wan (Single Herb Rhubarb Pill), combined with drainage techniques. Once swelling subsides, if corneal opacities persist, select appropriate formulas for topical application, yielding easy results. These broad discussions aim to guide practitioners to examine carefully, ensuring effective cure.

It is neither fat nor membrane; it erodes the Feng Lun (Cornea/Black Pupil) and covers the Xun Kuo (Eye Orbit). Surgical removal may not be complete. Recurrence is possible while Qi and Blood are vigorous.

This condition originates from the inner canthus, where one or two vessels emerge. At the root of these vessels, reddish-yellow fleshy growths form, resembling tough membranes. Over time, pus accumulates, invading the Bai Jing (Sclera/White Eye) and engulfing the Shen Zhu (Pupil/Cornea). Some cases present with sharp extensions, though these branches are fewer than primary lesions. It commonly affects those with irritable temperaments, rebellious Qi, indulgence in spicy/hot foods, and mental or physical overexertion. Occasionally, the entire eye is obscured, causing blindness; internal and external treatments are required, and healing is difficult only after roots are cleared. According to *Yuan Ji Wei Lun*, this is caused by pathogenic heat in the Extraordinary Vessels. It states: "Pathogens in Extraordinary Vessels differ from the Twelve Regular Meridians; there are specific methods for treating them, using 'Sheng Qi San' (Superior Wonder Powder)." However, this powder merely contains Chuan Xiong, Dang Gui, Lian Qiao, and Gan Cao—nonsense that few follow. *Su Wen · Miao Ci Lun* states: "Pathogens invading the Foot Yang Qiao Mai cause eye diseases starting from the inner canthus." This aligns with *Yin Hai Jing Wei*: "Lung Excess and Liver Deficiency cause fleshy protrusions." Regarding Lung Excess, referring to the Cornea, it involves strabismus and protrusion; referring to the Liver, it does not originate in the inner canthus. Moreover, if Liver is deficient and Lung excess, Wood is already controlled by Metal; why use Long Dan Cao and Mu Zei to attack further? My view is that onset at both inner canthi involves simultaneous Tai Yang and Shao Yin disease. Flesh belongs to Spleen Earth; reddish-yellow protrusion indicates Fire blazing, making Earth dry, unable to be controlled by Water and Wood, thus harming Metal (Lung). Although located in the Qi Lun (Scleral region), it is not a primary Lung meridian pathology. Initial treatment requires hook-and-cut surgery, topical Fei Xiong Dan, and internal administration of Xie Huang San, Xie Bai San, or Dao Chi San. After wound healing, based on Heart Fire overcoming Metal, administer Ji Ji Wan or Zi Yin Di Huang Wan for one course. Treating the root rather than the branch is likely successful.

Surgical Method: Use one qian of Hong Fan (Red Alum), dissolve in water, and wash the lesion with a new sheep-hair brush until the flesh wrinkles. Repeat if necessary. Thread a sharp silver needle through the base, securing it to the upper and lower eyelids. Align with a hook. Using an eyebrow knife or shoe knife, gently dissect from the center towards the base of the corneal attachment, then back to the inner canthus. Carefully cut near the Xue Lun (Blood Wheel/Inner Canthus vascular area), leaving a coarse thread for safety. Some cases require no needle, alum, hook, or knife/scissors only, depending on convenience. Generally, sharp instruments and skilled hands are essential. Accurate identification of Feng Lun, Shui Lun, and Xue Lun prevents error. White flesh indicates favorable prognosis; red flesh indicates lingering difficulty. If bleeding persists, apply fresh cotton soaked in top-grade lampblack ink to stop it instantly. Spring water is also beneficial in autumn and summer. Red meets black to stop bleeding, following natural Yin-Yang pairing; cold coagulates blood, demonstrating Water-Fire mutual restraint. Post-operation, maintain mental clarity, regulate desires, avoid alcohol, and ban spicy/fried foods. Continue topical and internal medications daily. Wounds heal progressively. Though vision may not return to normal, it is vastly improved compared to the diseased state. If total ptosis obscures the cornea, start centrally, cutting a bean-sized hole. Ask if light is perceived; if slight darkness remains, gradual dissection may save 1-2 out of 10 cases. Otherwise, the Shen Gao (Divine Fluid) is exhausted, and effort is futile.

At the outer canthus, a fleshy nodule like a pomegranate seed forms, termed Xue Lun in this specialty. Injury from knives or cautery leads to ulceration and fistula formation, as noted in the preface. Reiterating here serves as earnest advice.

Fleshy growths come in two types: blunt-tipped and pointed. Blunt tips float on the Feng Lun, are easy to cut and heal completely with no trace. Pointed tips deeply erode the Shen Zhu, making surgery difficult. Even if removed, they recur the next day, requiring three to five sessions for clearance. Scars fade only after years. However, symptoms like blurriness, redness, dryness, and discharge cease after removal. Neglecting diet and sexual moderation, along with mental/physical strain, ensures recurrence in old age.