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Diagram of the Great Red Veins Transmitting to the Canthus

The syndrome of "Great Red Veins Transmitting to the Canthus" originates at the inner canthus (Da Zi). Its pathogenesis lies in excess Qi of the Heart; this is an invasion of the Liver by Heart pathogenic factors. The Heart belongs to Fire and governs Blood, while the Liver belongs to Wood and governs Sinews. When sinews receive irrigation and traction from Blood, they gradually extend to the cornea (Hei Jing) and spread to the pupil (Tong Ren). In severe cases, vision becomes blurred as if looking through silk gauze, which is caused by the flaming upward of the Ministerial Fire of the San Jiao (Triple Burner). This may result from excessive mental labor or overthinking, reading history books late at night, alcohol consumption, or a preference for consuming the "Five Pungent Spices" (scallion, garlic, leek, wild onion, chives) and fried, roasted, or heat-inducing foods. The treatment principle should be to purge fire and reduce heat, though methods differ between the young and the old. If the condition persists over time, causing the vessels at the inner canthus to become enlarged, it is appropriate to use a small sharp needle to puncture and sever them, allowing toxic blood to flow out, thereby interrupting the red veins. If the red veins appear suddenly upon initial onset, needle puncture is not required. Instead, apply "Yin Er Yang Si" medicine and ingest "Si Shun Ba Zheng Dang Gui San" (Four Smooth Eight Just Angelica Decoction), which has the effect of cooling the Liver. Such illnesses will invariably recover. There are also individuals with violent or unyielding temperaments who present with red veins infusing the eyes; this represents a constitutional sign (ominous physique) and differs from the treatment of the aforementioned syndrome.

Question: Why do patients suffering from red veins transmitting to the inner canthus often experience congestion and astringency at the canthus, along with inaccurate vision?
Answer: This is due to excess heat in the Heart Meridian. Furthermore, the Heart may suffer from mental fatigue due to overthinking or damage from excessive diet, causing heat in the San Jiao and intensifying Heart Fire, thus resulting in frequently red eyes. Although treatment involves attacking the Shaoyin Meridian and clearing Yang Fire from the Pericardium, one should first administer San Huang Wan (Three Yellow Pill) to purge Heart Fire. Subsequently, use Xi Xin San (Wash Heart Powder) to eliminate the pathology. Chang Zhen (regularly stabilize) the effects of San Huang Wan with Gan Lian Wan (Liver-Link Pill). Apply Qing Yuan San (Clear Source Powder) topically. Internally, ingest formulas that clear the Heart and promote urination via the Small Intestine Meridian, focusing on descending fire, such as Ba Zheng San (Eight Rectifications Decoction).

Ba Zheng San (Eight Rectifications Decoction)
Rhubarb Root (Dahuang), Knotweed Herb (Qumai), Akebia Stem (Mutong), Gardenia Fruit (Zhizi), Talcum (Huashi), Licorice Root (Gancao), Persicaria Herba (Bianxu), Plantago Seed (Cheqianzi)
Grind all ingredients into equal parts powder. Take 5 qian per dose, decoct with one zhong of water. Alternatively, add Bamboo Leaves (Zhuye), Juncus Effusus (Dengxincao), and Scallion White (Congtou). Take after meals.

Dao Chi San (Guide Out Redness Decoction)
Akebia Stem (Mutong), Licorice Root (Gancao), Gardenia Fruit (Zhizi), Phellodendron Bark (Huangbai), Rehmannia Root (Shengdihuang), Anemarrhena Rhizome (Zhimu)
Take 4-5 qian of fine powder per dose, decoct with one zhong of water, adding Bamboo Leaves (Zhuye) and Juncus Effusus (Dengxincaogen). Take after meals.

Qi Bao Xi Xin San (Seven Treasures Wash Heart Powder)
Angelica Sinensis Root (Danggui), Red Peony Root (Chishao), Rhubarb Root (Dahuang, 1 liang each), Ephedra Stem (Mahuang, 2 liang), Schizonepeta Spike (Jingjie, 5 fen), Coptis Rhizome (Huanglian, 1 liang), Gardenia Fruit (Zhizi)
Grind into powder. Take 3-4 qian per dose, decoct with water. Take after meals.

San Huang Wan (Three Yellow Pill)
Coptis Rhizome (Huanglian), Scutellaria Root (Huangqin, 1 liang each), Rhubarb Root (Dahuang, 3 liang, soaked in wine then stir-fried)
Grind into powder, mix with refined honey to form pills the size of paulownia seeds. Take 30 pills per dose with warm water.

Gan Lian Wan (Liver-Link Pill)
One lamb liver (Baiyangzi Gan). Do not wash with water. Tie the main tendon securely with thread, hang it high up, and filter off the blood water. Gently scrape off the outer membrane. Place the liver on a flat wooden board and cut the liver flesh into powder using a bamboo knife. Discard the fascia. Mix the liver powder with other ingredients to form pills. Take 50 pills per dose with tea.