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For itching caused by wind pathogen, use Qu Feng Yi Zi San (Wind-Dispersing One-Character Powder). For itching caused by fire pathogen, seek fire-descending formulas in the chapter on Redness and Pain. For itching caused by blood deficiency, use Si Wu Tang (Four Substances Decoction).

[Itching Like Insect Crawling Syndrome] This symptom is not like the mild itching of usual times, but feels as if insects are crawling, with unbearable itching. The causes vary; one must examine whether there are morphological lesions on the eye surface to determine the progression or regression of the disease. For instance, whether or not there is an opacity (nebula), extreme itching can occur, and its etiology is not singular. Some cases involve itching due to wind pathogen, some due to qi disturbance from blood deficiency, some due to deficient fire invading the collaterals with active pathogenic factors, and some due to the resolution of pathogens and fire, allowing qi and blood to flow smoothly and meridians to unblock. Generally, eyes suffering from disease that itch spontaneously without treatment will worsen with each episode of itching. If itching occurs after medical treatment, it indicates that the pathogen will be expelled quickly. If the itching is extremely severe, frequent, and accompanied by a sensation of sunken eyeballs, life expectancy is short. If extreme itching leads to eyeball prolapse, death is imminent. Itching with excessive tearing indicates blood deficiency combined with fire. Broadly speaking, pain belongs to excess syndromes, while itching belongs to deficiency syndromes; even if fire is present, it is a pathogenic fire entering due to deficiency, not the root nature of the disease.

Obscuring darkness outside the pupil. *Nei Jing* (Inner Canon) states regarding eye pain: red vessels descending from above indicate Taiyang disease; ascending from below indicate Yangming disease; moving from outside inward indicate Shaoyang disease. According to this theory, the distinction between exterior and interior opacities is clear. Applying this to treatment is as accurate as drumbeats responding to drumsticks. Whenever red vessels and opacities initially descend from above, they belong to the Taiyang channel. Since Taiyang governs the exterior, the symptoms inevitably involve pain in the supraorbital ridge, vertex of the head, or unilateral head swelling and pain. The treatment method should employ warming and dispersing. Warming can be achieved by decocting equal parts of aged tea and salt-processed Chuan Fu Zi (Aconiti Lateralis Radix Praeparata) orally for immediate cure. Xue Lizhai once treated this syndrome with one qian of Chuan Fu Zi per dose, resulting in immediate recovery. Another formula consists of Ban Liang of Fu Zi (Aconiti Radix), a large pinch of bud tea, one qian of Bai Zhi (Angelicae Dahuricae Radix), and half a qian each of Xi Xin (Asari Radix), Chuan Xiong (Ligustici Chuanxiong Rhizoma), Fang Feng (Saposhnikoviae Radix), Qiang Huo (Notopterygii Rhizoma et Radix), and Jing Jie (Schizonepetae Herba), decocted and taken orally with miraculous effect. Dispersing methods include Xia Ku Cao San (Prunellae Spica Powder) from *Jian Yao* (must be taken concurrently with Tui Yun Wan [Cloud-Removing Pill]), Dong Yuan's Xuan Qi Tang (Selecting Marvelous Decoction), Qiang Huo Chu Yi Tang (Qiang Huo Opacity-Removing Decoction), etc. When red vessels and opacities initially ascend from below or emerge from inside outward, they all belong to the Yangming channel. Since Yangming governs the interior, the syndromes are mostly heat-related, or accompanied by constipation. The treatment method should employ purging and cooling. Purging can utilize Ju Fang Liu Qi Yin (Bureau Formula Flow-Qi Decoction), Qian Shi Xie Qing Wan (Child Master's Draining-Green Pill), Ju Fang Wen Bai Wan (Bureau Formula Warm-White Pill), added with Huang Lian (Coptidis Rhizoma) and Huang Bo (Phellodendri Cortex), which have proven effective repeatedly. Cooling can be achieved with Yi Wei Huang Lian Yang Gan Wan (Single-Ingredient Coptidis Rhizoma Sheep Liver Pill), etc. (Lou Quanshan said: My wife's niece was obese and developed eye disease upon reaching adulthood, recurring every month or two. During attacks, her eyes were red, swollen, dry, painful, and difficult to open. This persisted for three years. After taking wind-dispersing and heat-clearing agents and ordinary eye drops, her left eye developed a stubborn opacity spreading from the inner canthus to cover the pupil, and her right eye developed an opacity ascending from below. The classic states: moving from outside inward is Shaoyang disease; ascending from below is Yangming disease. I believe this indicates accumulation in the Shaoyang and Yangming channels. The pulse was short, slippery, and excess, appearing shorter in the morning. Jiegu said: A short pulse indicates accumulation obstructing the zang-fu organs, requiring purging. Thus, I used Wen Bai Wan, reducing Chuan Xiong and Fu Zi by two-thirds, and adding Long Dan Cao (Gentianae Radix) and Huang Lian. Following Dong Yuan's five-accumulation method, starting with two pills daily, increasing by one pill each day until significant diarrhea occurred, then reducing the dosage. Starting again from two pills, suddenly one day, black clots of blood resembling ink, large and hard, were passed in stool. From then on, she gradually recovered, and the opacities completely disappeared.) When red vessels and opacities initially enter from outside inward, it is Shaoyang disease. Since Shaoyang governs the half-exterior and half-interior, the treatment method should harmonize. Suitable formulas include Shen Xian Tui Yun Wan (Immortal Cloud-Removing Pill), Qiang Huo Tui Yi Tang (Qiang Huo Opacity-Removing Decoction), Xiao Yi San (Opacity-Resolving Powder), etc.

Opacities (nebulae) appear when wind-heat is heavy, or when macules enter the eye; this is liver qi flourishing manifesting at the exterior. Once opacities are formed, indicating an exterior location, they should be dispersed and eliminated. If one instead uses draining and purging methods, pathogenic factors will sink inward, deepening the opacity. Pathogens that are unsettled are called "Heat Opacities" and float; settled pathogens are called "Ice Opacities" and sink; firmly entrenched and deep pathogens are called "Sunken Opacities." One should use dispersing agents to reactivate the pathogens, causing the opacities to float, then assist with opacity-resolving drugs so they may disappear naturally. Chronic conditions cannot be cured quickly and require months or years to resolve. For newly formed opacities requiring dispersion, use Dong Yuan's Qiang Huo Chu Yi Tang. For those with heat, use Tui Yun Wan. To disperse sunken opacities, use Ling Yang Jiao San (Antelope Horn Powder) from *Bao Ming Ji*, adjusted according to individual constitution; for yin deficiency with heat, combine with Shen Xian Tui Yun Wan. Dong Yuan stated: When yang cannot overcome yin, it is yin excess and yang deficiency, leading to obstruction of the nine orifices, causing green-white opacities to appear at the outer canthus. This results from stagnation in the Foot-Taiyang and Foot-Shaoyin channels, preventing Foot-Jueyin Liver channel qi from ascending to the eyes, thus blocking green-white opacities internally. One should tonify yang qi in the Liver via the Nine Origins below the Taiyang and Shaoyin channels, first tonifying yang, then clearing yin-fire from the Liver channel at the Biao points of Taiyang and Shaoyin. *Nei Jing* says: In yin excess and yang deficiency, one must first tonify yang, then drain yin; this is the correct treatment principle. Take Bu Yang Tang (Tonify-Yang Decoction) on an empty stomach early in the morning, Sheng Yang Xie Yin Wan (Raise-Yang Drain-Yin Pill) well after meals, and Lian Bai Yi Yin Wan (Coptis-Phellodendron Nourish-Yin Pill) before bed. Do not take these during weather changes, severe cold/wind, overexertion, poor diet the previous day, mental fatigue, or weak qi. Wait for physical balance and normal weather. First tonify yang to allow yang qi to ascend through the Liver channel endings, clearing the hollow orifices of the eyes. Lady Wei Bangyan developed sudden opacities rising from below, green in color, with unbearable swelling and pain. My predecessor said: Opacities rising from below indicate Yangming disease. Green is not one of the five cardinal colors; it likely represents combined pathology of Lung and Kidney, resembling the color mixed by painters using ink and basic lead carbonate. Careful observation confirms the opacity matches this color, confirming Lung-Kidney pathology. Thus, we drained Lung-Kidney pathogens using Yangming channel guiding herbs. It was effective, but relapsed three times. The originating channels and opacity colors varied, so I adjusted based on intuition, stating: All vessels connect to the eyes; vessel pathology follows them. This must be meridian disharmony, so eye disease persists. Inquiry confirmed this. Treating the disharmonious meridians stopped the disease. Opacities cleared, but recurred on specific dates, monthly or bi-monthly, indicating accumulated pathology. If the pulse is slippery, use Wen Bai Wan added with Huang Lian and Long Dan Cao, following Dong Yuan's five-accumulation method. Ni Zhongxian discussed diseases where wind-heat is unconstrained: Opacities like clouds/mist, like silk threads, like scales. Opacities like scales are single or multiple dots expanding to dozens. Opacities like snail shells result from prolonged disease, improper treatment, and extremity, often due to excessive cold-cooling herbs damaging Spleen-Stomach, preventing vital qi from ascending. One must understand meridians to achieve efficacy. Opacities emerging from the inner canthus indicate Hand-Taiyang and Foot-Taiyang pathogen invasion, treated in Small Intestine and Bladder channels, adding Man Jing Zi (Vittariae Spora) and Cang Zhu (Atractylodis Rhizoma), primarily using Qiang Huo Sheng Feng Tang (Qiang Huo Wind-Overcoming Decoction). Entering from the outer canthus/Kechuren point indicates Foot-Shaoyang, Hand-Shaoyang, and Hand-Taiyang invasion, treated in Gallbladder, Sanjiao, and Small Intestine channels, adding Long Dan Cao and Gao Ben (Ligustici Sinensis Rhizoma), with small amounts of Ren Shen (Ginseng Radix et Rhizoma), primarily using Qiang Huo Sheng Feng Tang. Descending from the eye system indicates Foot-Jueyin Liver and Hand-Shaoyin Heart invasion, treated in Liver and Heart channels, adding Huang Lian and doubling Chai Hu (Bupleuri Radix), primarily using Qiang Huo Sheng Feng Tang. Ascending from Diguo point indicates Hand-Taiyang invasion, treated in Small Intestine channel, adding Mu Tong (Akebiae Caulis) and Wu Wei Zi (Schisandrae Fructus), primarily using Qiang Huo Sheng Feng Tang. For severe heat, combine with anti-heat-drunk medicines, and use Bi Yun San (Green Cloud Powder) insufflated into the nose. These treat the above conditions generally like opening a pot; insufflation works instantly, though potency is low and sharp, so use occasionally to concentrate strength. Although initial recovery is easy and prolonged is difficult, gradual recurrence and recovery are acceptable. Rushing recovery leads to untreatable conditions. Some modern doctors use grinding opacity medicines or manual removal techniques. Alas! Opacities are like ulcers; how can they heal instantly? This is not only useless but harmful. Regarding diseases of odd vessels invaded by pathogens: The five zang organs are like the Five Sacred Mountains of heaven and earth. The six fu organs are like the Four Great Rivers. The odd vessels are like additional rivers beyond the four great rivers. Pathogens invading odd vessels are not treated by the twelve regular channels' methods. There are separate treatments for odd vessels outside the twelve channels. *Miao Ci Lun* states: Pathogens invading the Foot-Yangqiao vessel cause eye pain starting from the inner canthus. Wang Bing noted: Since this vessel originates in the foot, ascends to the head, and connects to the inner canthus, pathology causes eye pain starting from the inner canthus. *Zhen Jing* states: The Yin-Qiao vessel enters the nasal cavity, connects to the inner canthus, and merges with the Taiyang Yang-Qiao to ascend. Thus, when Yang-Qiao is invaded, the inner canthus becomes red, vessels form like threads, thread roots generate fleshy growths (pterygium), fleshy growths produce yellow-red lipid, lipid horizontally invades the cornea, gradually eroding the aqueous humor. This is the sequence of Yang-Qiao pathology. Cases involving the outer canthus occur because it merges with Taiyang. The outer canthus is the Hand-Taiyang Small Intestine vessel. Outer canthus pathology is milder than inner canthus pathology because collateral transmission is less than primary involvement. Commonly called Pterygium, this is the disease. Treatments include Huan Yin Jiu Ku Tang (Restore-Yin Save-Bitterness Decoction), Bo Yun Tui Yi Wan (Cloud-Dispelling Opacity-Removing Pill), Zhi Zi Sheng Qi San (Gardenia Marvelous-Uniqueness Powder), Wan Ying Chan Hua San (Myriad-Responses Cicada-Flower Powder), Mo Zhang Ling Guang Gao (Grinding-Obstruction Spirit-Light Ointment), Xiao Yi Fu Ming Gao (Opacity-Resolving Vision-Restoring Ointment), Xiao Shi Huang Lian Lu Gan Shi Pao San (Saltpeter-Coptis Reed-Arsenic Trioxide Soaked Powder). When medications fail, manual treatment is suitable: wash with cold water first, similar to cataract surgery technique, hold firmly with left hand, slightly use a small eyebrow knife tip to scrape off lipid/fleshy tissue, wash again with cold water, then administer previous medicines. This is the method for treating odd vessel pathogens, hence including their meridian origins. Diseases of Seven Emotions, Five Thieves, labor, hunger/fullness (see Eye Pain section). Internal tension and external relaxation diseases (see Inverted Eyelashes/Hair section).

[Yellow Membrane Upward Rushing Syndrome] Between the lower edge of the Wind Wheel (cornea) and the Kan position, inside the Divine Paste (aqueous/vitreous humor), an opacity arises yellow in color, resembling the white lunula of a young person's fingernail. It shares the same qi-meridian connection as Coagulated Fat Opacity, but Coagulated Fat Opacity forms outside the wheel and can be removed by topical medication; this forms within the paste, steamed by internal heat, and cannot be removed by topical application. If it spreads to cover the pupil, the eyeball will surely be damaged. Do not mistake this for a condition where surging waves can be slowed; this is extreme blockage of meridians, Sanjiao Guan Ge (closure/blockage), and excess-true fire-earth pathogens. Hence, severe constipation, dysuria with heat sensation, and steaming heat cause pus formation and rupture from within the paste. Failure to treat leads to eyeball protrusion. (Selectively use Tong Pi Xie Wei Tang, Shen Xiao San, Zao Jiao Wan, Xi Jiao Yin).

[Red Membrane Drooping Syndrome] Initially very thin, later becoming very large. Large ones indicate acute disease, characterized by red opacities, mostly with red vessels penetrating the white sclera downwards. A patch of opacity rises on the upper half of the black cornea near the white border, still connected by red filaments. If the opacity is large, filaments thick, redness severe, tearing dry, eyeball painful, and headache present, the disease is acute and changing. If filaments are fine, few, slightly red, eyeball not painful, and no headache, the disease is slow and unchanged. Also, if the eyeball is not painful and there is no headache, without other symptoms; or only dryness/redness with thin opacity, still connected by fine filaments on the opacity; or several star-like spots arising under the filaments at the opacity edge, these stars are also minor signs of Coagulated Fat. These are all manifestations of internal fire stagnation, relatively mild, and should be treated well. Formless fire secretly潜入 into the paste causes this disease, unlike severe tangible blood-heat. If filaments exist on the opacity, and stars arise at filament tips, these are slow-to-regress diseases because they connect with the vital qi in the filament vessels, making them easy to generate but hard to retreat. Although slow to regress, if opacities are thin, filaments fine, and redness not severe, gentle elimination suffices. For severe cases, forced guidance is不得已. Generally, if red vessels rise on the upper half of the white sclera and droop onto the black cornea, regardless of quantity, if there is pain and coiled redness, it is an ominous sign. Even if filaments are few and redness slight, if they fall from above, regression is slow, requiring durable treatment. If penetrating the pupil, regardless of thickness or continuity, regression is slow. This syndrome involves damp-heat in the brain, hidden fire deeply潜伏 in collaterals, causing red vessels. Although no stasis blood surrounds it, deep accumulation exists. Because stagnation is deep and fire is latent, it is not yet severe. Once triggered, the disaster erupts, and the disease becomes intense. Internally no stagnation, externally no such disease: mild cases dissipate, severe cases are guided. This is the fixed rule. (Internally take Zhi Gan San. Externally apply Zi Jin Gao. Then take Tong Gan San, Shen Xiao San, Zao Jiao Wan).

[Coagulated Fat Opacity] This syndrome is the most acute, arising from various causes, leading to blindness in 70-80% of cases. It presents as spots on the Wind Wheel (cornea), initially star-like, white in color with central pustules (HT), growing larger and turning yellow after needle-prick-like injury, with pustules enlarging into ulcers. Some start star-like, white without pustules, later enlarging, turning yellow, and developing pustules. Some start goose-yellow with or without pustules, gradually enlarging. Some start as a large, dense patch, white and tender, or pale yellow, with or without pustules, changing accordingly. Some have an opacity, then develop a yellow-lipid-like mass inside. Some have scar-pustules first, then develop a sheet of coagulated fat. Variations differ, but the disaster is one. The general rule: regardless of star-opacities, if upon onset they are plump, floating, brittle, tender, capable of enlarging, yellow in color, prone to rapid change and fast growth, it is this syndrome. Initially tiny, later enlarging, severely becoming ulcers, leaks, or Crab-Pupil, internally destroying essence-paste, externally becoming withered/protruding. Or gas accumulates with sound, bursting thick fluid and rupturing. All result from extreme stagnation, steaming/scorching Liver-Gallbladder collaterals, damaging clear qi, spreading to destroy divine paste. Though delayed, damage to the pupil occurs within ten days. If stasis surrounds the area, it is due to blood blocking pathways, preventing clear fluids from ascending. If no severe red stasis surrounds it, deep internal collaterals must be blocked. Upon seeing this syndrome, urgent day-and-night treatment is required. If delayed until it covers the entire cornea, even if the eyeball is saved, it remains diseased. After resolution, white opacities like fish scales or round peripheral opacities remain on the eyeball, never detaching for life. If centered, vision becomes dim. Any eye disease with this syndrome, accompanied by headache, eyeball pain, and dry/constipated bowels/bladder, is extremely acute. If bowels/bladder are smooth, disaster is slightly slower. Having either is still terrifying.

[Floral Opacity White Depression Syndrome] Due to fire scorching internal collaterals, paste fluid steamed/damaged, coagulated fat rising from surroundings to flood the divine pearl, causing the Wind Wheel to be all white or slightly yellow, looking similar to mixed opacity but tender. General rule: Disease begins at the white wheel boundary, spreading from all sides, gradually thickening and widening. If the center remains blue/unfilled, the pupil is visible, but surroundings are high and center low; this is Metal overcoming Wood disaster. Or a yellow membrane arises from the lower side of the fat, these two syndromes attacking together are especially acute. Also, upward/downward generation named Shun-Ni Obstruction, internally transforming into this syndrome. This is Fire-Earth stagnation disaster. Also, not starting from edges, but self-generating from coagulated fat opacity yellow or non-yellow, initially small then large, thin strips like opacity, or fine grains like stars, arising here and there, scattering, then enlarging and intertwining to harm the eye; this is Wood-Fire disaster. The above three must have stagnation; treatment should find the source and dredge the flow. Mild cases cool/clear, severe cases guide/open. If disease floods the pupil, not too thick/heavy, quick rescue may reverse it, but it will never return to original health. For severe diseases, even if the pupil is faintly visible internally, it cannot save the healthy state, only prevent protrusion. (Zhi Mu Yin Zi, Sang Bai Pi Tang).

[Crab-Pupil Syndrome] Refers to damage of true eye paste, destruction of Wind Wheel by coagulated fat opacity, divine paste bursting out as black granules. Small like crab pupils, large like black beans, severely damaging the pupil, internally viewing the pupil like almond/jujube pits, extremely severe becoming tiny/non-existent, utmost becoming green-yellow protrusions. This syndrome resembles Black Opacity Like Pearl, but treatment differs greatly. Black Opacity Like Pearl originates from within the paste, unlike this one which bursts out due to rupture, hence vastly different. However, there are Deficiency and Excess syndromes. Deficiency is soft, painless, late onset, fast resolution. Excess is hard, painful, fast onset, slow resolution. Vision has two types, treatment is one. Even with skilled hands, scarring is unavoidable.

[Macule Fat Opacity Syndrome] Color white with black, or green, or scorched yellow, or slightly red, or covered by fine red vessels/filaments. With filaments, there is risk of disease flare-up. Discussing non-flaring cases: mostly powder-green,结 at the edge of the Wind Wheel. Large ones cover the pupil; covering the pupil reduces light. Even with divine hands, it cannot be removed. Treatment aims to stabilize non-drooping/non-flaring. Internal and external combined treatment is necessary. Once qi-blood stabilizes long-term and scars firm up, it hopefully won't recur. If treatment is insufficient or indulged, macule traces emit fine blisters, appearing/disappearing, or large blisters appearing persistently, or pain at the site, or new opacities along filaments, or Crab-Pupil re-emerging. This disease is Crab-Pupil retracting, forming scars at the Wind Wheel side, unlike Agate internal injury where internal qi-blood damage結 externally, which still has dissipation potential, hence treatment differs.

[Yellow Butter Syndrome] Arises in Qi Wheel (sclera), lipid-like, pale yellow, floating, tender, representing Metal receiving Earth's damp-heat. No swelling/pain, vision not blurred, so people don't seek treatment, no other disasters, remaining so until old age. Slight eye disease flare-ups make this the beginning of other diseases. Lifting upper eyelid, yellow butter on upper Qi Wheel indicates damp-heat descending from brain, eye disease certain, not comparable to lateral mild cases. May have head wind disorder, but this disease is mild, easy to treat. But untreated, fear future disasters, so should protect oneself and remove it. Leprosy eyes with this are heavier, different from normal people.

[Shape Like Hanging Gallbladder Syndrome] Opacity descending from above, penetrating pupil, green or macular, pointed top, large bottom, thin, round-long, shaped like hanging gallbladder, hence named. Brain has stasis-heat, Liver-Gallbladder paste juice damaged, acute transformation symptom, requires urgent treatment. If eyes carry fine purple-swollen red vessels, especially acute; headaches especially bad. Internal stagnation certain, urgently seek stagnation around and dredge it, to avoid damage disaster.

[Jade Particles Divided by Meridians] This syndrome arises in eyelids or Qi Wheel. Arising in Qi Wheel indicates Metal-Fire hyper-reception, dry-heat dominant. Arising in eyelids indicates damp-heat dominant, due to Earth dry-stagnation. Shape round-small, grains hard, pale yellow or white-meat color. Must differentiate birth part for treatment, hence named Jade Particles Divided by Meridians. Initially painless, treatment easy to retreat,