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(Blurred Vision and Fixed Gaze)

Cheng Wuji's Commentary: "Fixed gaze" (Zhishi) refers to the condition where the eyes stare at an object without moving. If the eyeballs can move, it is not this syndrome. The essence of the Kidney is Zhi (Will), and the essence of the Heart is Shen (Spirit). The eyes are the messengers of the Heart, the abode of the Spirit, and the external manifestation of the Liver; spirit and essence nourish them here. The *Zhen Jing* (Needle Classic) states: The qi of the five zang organs and six fu organs all ascend to the eyes to form their essence. (The eye socket is the nest of essence; the essence of bone forms the pupil; the essence of sinew forms the black part [iris/cornea]; the essence of blood forms the vessels; the essence of qi forms the white part [sclera]; the essence of muscle forms the constraints [eyelids].) When the qi and blood of the five zang organs are harmonious and essence is abundant and nourishing, the eyes are clear and bright. When pathogenic factors are excessive and overwhelm the healthy qi, mental clarity is impaired; when the essence-storing qi of the zang organs fails to ascend and nourish the eyes, fixed gaze occurs. In Shanghan disease, fixed gaze indicates that pathogenic factors have reached their extreme; such syndromes are mostly difficult to treat. (Manic speech with fixed gaze indicates exhaustion of Kidney qi; fixed gaze with head shaking indicates exhaustion of Heart qi; fixed gaze with manic speech and wheezing/fullness in the chest leads to death; those with diarrhea also die. In severe cases, during attacks, the patient does not recognize people, picks at clothes and bedsheets, feels terrified and uneasy, has slight wheezing and fixed gaze; if the pulse is wiry, there is hope for survival; if the pulse is choppy, death ensues. These are all signs of excessive pathogenic factors and exhaustion of healthy qi.) The *Classic* states: Those prone to epistaxis should not undergo sweating therapy. If sweating is induced erroneously, the supraorbital region may become sunken, the pulse becomes tight, the eyes are fixed and unable to blink, and sleep is impossible. (This is because the Liver receives blood to enable vision; those who have lost blood have deficient Liver qi and weak Wood qi. Inducing sweating further causes loss of Yang, resulting in deficiency of both Yin and Yang.) Although this is a adverse condition, it is not yet the most severe. Furthermore, "fixed gaze" and "blurred vision" (Muzhongbuliaoliao) appear similar, but one is treatable while the other is not.

Taiyang Chapter: Those prone to epistaxis should not undergo sweating therapy. If sweating is induced erroneously, the supraorbital region becomes sunken, the pulse is tight, the eyes are fixed and unable to blink, and sleep is impossible. (See detailed notes on Epistaxis). After sweating, if the body remains burning hot, it is called Fengwen (Wind-warmth). The pulse is floating at cun, guan, and chi positions simultaneously; there is spontaneous sweating, heaviness of the body, somnolence, and difficulty speaking. If erroneously treated with purgation, it results in difficulty urinating, fixed gaze, and involuntary defecation/urination. (See detailed notes on Wind-warmth).

Yangming Chapter: After Shanghan disease has been treated with vomiting or purging methods, the pathogen remains unresolved. There is no bowel movement for over ten days. In the late afternoon (You hour), tidal fever appears. There is aversion to cold absent, but the patient speaks alone as if seeing ghosts. In severe cases, during attacks, the patient does not recognize people, picks at clothes and bedsheets, feels terrified and uneasy, has slight wheezing and fixed gaze; if the pulse is wiry, there is hope for survival; if the pulse is choppy, death ensues.

Fixed gaze with manic speech and wheezing/fullness in the chest leads to death; those with diarrhea also die.

In Shanghan disease, after six or seven days, if the vision is blurred and unclear, but the eyeballs move freely, with neither exterior nor interior syndromes present, difficulty in defecation, and slight body heat, this is an excess syndrome. Urgent purgation is required; Da Chengqi Tang (Major Order the Qi Decoction) is indicated.

Wu Qian's Commentary: If the eyes roll upward (Daiyan) and the body arches backward (opisthotonos), this is an upper visual exhaustion syndrome. Cold sweat emerges like large beads strung together and does not flow; this is Bladder exhaustion syndrome. "Muzhongbuliaoliao" (blurred vision/unclarity) refers to the ability to see objects but only half of them, missing the other half, accompanied by delirium and nonsensical speech. If there is internal excess with constipation, purgation is appropriate; if there is internal deficiency, treatment is mostly difficult.