Subconjunctival hemorrhage refers to bleeding caused by the rupture of small blood vessels under the conjunctival membrane. It appears bright red, patchy, and with clear boundaries, resembling rouge applied to the skin. Hence, Zhengzhi Zhunsheng mentions it in the section on the seven orifices. Zabing states: "Regardless of the location, if a spot or patch of red blood resembling rouge is seen, it is this condition." Shenshi Yaohan and "Ophthalmic Golden Mirror" both refer to it as "subconjunctival hemorrhage." The "Ophthalmic Manuscript" (author unknown) calls it "blood counterflow eye." Liang Hanfen's "Ophthalmic Lecture Notes" refers to it as "white of the eye congealed fat." Modern "Chinese Ophthalmology" abbreviates it as "subconjunctival hemorrhage."

The condition transitions from bright red to purplish-dark, then to yellowish-brown, with varying sizes and locations, eventually disappearing without leaving a trace. There is usually no discomfort in the eye, though occasional eye swelling or dryness may occur, and it typically resolves within two weeks. Shenshi Yaohan includes this condition in the "red eye" section. Based on clinical observations, conditions such as "epidemic red eye (acute contagious conjunctivitis)," "fulminant wind and invading fever," "hyphemia," "red vessels crossing white eye (angular conjunctivitis)," "spore wheel reddening," "eye star nebula," and "upward rushing of yellow fluid (hypopyon)" all present with red eyes but are accompanied by varying degrees of photophobia, tearing, and pain. Additionally, children with whooping cough and women with vicarious menorrhea often experience "subconjunctival hemorrhage," which is caused by other eye diseases (also manifesting pediatric or gynecological symptoms). These should be differentiated and are discussed in separate sections, not within the scope of this text.

bubble_chart Pattern Analysis

1. Wind-heat Invading the Lung︰The symptoms include cough with chest pain, expectoration of thick yellow sputum, thirst with desire to drink, fever and headache, slight aversion to wind and cold, sweating, accompanied by sore throat, dry stool, red tongue tip, and floating rapid pulse. This is due to the invasion of wind-heat pathogens externally to the {|###|}skin and hair{|###|}, and internally affecting the lungs, leading to excessive heat and qi stagnation, hence cough with chest pain. The heat forces blood to overflow, accompanied by fever, headache, and sweating. Excessive heat damages fluids, resulting in thirst with desire to drink. The scorching of fluids forms phlegm, and the interaction of phlegm and heat leads to expectoration of thick yellow sputum and sore throat. The lungs and the {|###|}large intestine{|###|} are exteriorly-interiorly related, so when heat transfers to the large intestine, it causes dry stool, straining during defecation, excessive force, and rupture of blood vessels. A red tongue tip and floating rapid pulse are signs of an {|###|}exterior heat pattern{|###|}. Wind-cold attacking the lungs is caused by the invasion of wind-cold pathogens externally to the {|###|}skin and hair{|###|}, and internally affecting the lungs, leading to impaired lung diffusion and descent, inability to regulate and distribute fluids, obstruction of vessels, and blood overflowing outside the vessels, accompanied by cough, chest tightness, and expectoration of thin, clear sputum. Wind-cold externally binds and causes lung-defense stagnation, resulting in aversion to cold with fever, absence of sweating, and head and body pain. A thin white tongue coating and floating tight pulse are signs of an {|###|}exterior cold{|###|} syndrome. The above two syndromes should be differentiated based on the amount and morphology of {|###|}subconjunctival hemorrhage{|###|}, the nature of sputum, and external manifestations. Wind-heat invading the lungs presents with large areas of hemorrhage in the {|###|}white of the eye{|###|} accompanied by a few dot-like hemorrhages, cough with chest pain, expectoration of thick yellow sputum, fever, sweating, floating rapid pulse, and other signs of a {|###|}pattern of common cold due to wind and heat{|###|}. Wind-cold attacking the lungs presents with small areas of hemorrhage in the {|###|}white of the eye{|###|}, cough with chest tightness, expectoration of thin, clear sputum, fever without sweating, floating tight pulse, and other signs of a {|###|}pattern of common cold due to wind-cold{|###|}. For wind-heat invading the lungs, treatment should focus on {|###|}dispersing wind and clearing heat{|###|}, {|###|}ventilating the lung and relieving cough{|###|}. The formula Mulberry Leaf and Chrysanthemum Decoction can be selected, with additions such as Peach Kernel and Carthamus to activate blood and break blood stasis, promoting the absorption of extravasated blood. Alternatively, {|###|}Powder for Treating Red Eye{|###|} can also be used. For wind-cold attacking the lungs, treatment should focus on {|###|}releasing the exterior with pungent-warm{|###|} herbs, {|###|}ventilating the lung and relieving cough{|###|}. The formula Canopy Powder can be selected, with additions such as Tail of Chinese Angelica and Red Peony Root to invigorate blood and resolve stasis. In clinical practice, it is essential to examine the syndrome to identify its cause and differentiate between cold and heat for treatment, which will yield faster results.
2. Wind-cold Invading the Lung︰For cough with chest tightness, expectoration of thin and clear sputum, aversion to cold with fever without sweating, headache and body pain, floating and tight pulse, and thin white tongue coating. $Wind-heat invading the lung and wind-cold attacking the lung subconjunctival hemorrhage! Both are caused by external invasion of pathogenic wind, internal combination with the lung, and lung qi failing to clear, leading to stagnation and disease. However, their cold and heat properties differ, and their disease causes and mechanisms of disease are different. Wind-heat invading the lung is due to external invasion of wind-heat pathogens through the skin and hair, internal combination with the lung, excessive heat causing qi stagnation, hence cough and chest pain; heat forcing blood to overflow is accompanied by fever and headache, sweating; excessive heat damaging fluids leads to thirst and desire to drink; fluids scorched into phlegm, phlegm-heat obstructing each other results in expectoration of yellow and thick sputum, sore throat; the lung and large intestine are internally and externally related, heat transferring to the large intestine causes dry stool, straining during defecation, excessive force, and rupture of blood vessels. Red tongue tip and floating rapid pulse are signs of an exterior heat pattern. Wind-cold attacking the lung is due to external invasion of wind-cold pathogens through the skin and hair, internal combination with the lung, lung failing to diffuse and descend, water and fluids unable to regulate and distribute, blood vessels obstructed, blood not following its normal path and overflowing outside the vessels, accompanied by cough, chest tightness, expectoration of thin and clear sputum. Wind-cold externally binding, lung-defense qi depressed and blocked, hence aversion to cold with fever, without sweating, headache and body pain. Thin white tongue coating and floating tight pulse are signs of an exterior cold pattern. The above two conditions should be differentiated based on the amount of subconjunctival hemorrhage, its morphology, the nature of sputum, and external manifestations. Wind-heat invading the lung manifests as large patches of hemorrhage in the white of the eye with a few dot-like hemorrhages, cough and chest pain, expectoration of yellow and thick sputum, accompanied by fever, sweating, floating rapid pulse, and other signs of common cold due to wind and heat. Wind-cold attacking the lung manifests as small patches of hemorrhage in the white of the eye, cough and chest tightness, expectoration of thin and clear sputum, accompanied by fever without sweating, floating tight pulse, and other signs of common cold due to wind-cold. Wind-heat invading the lung should be treated by dispersing wind and clearing heat, ventilating the lung and relieving cough, with the formula selection Mulberry Leaf and Chrysanthemum Decoction, optionally adding Peach Kernel, Carthamus, and other blood-activating and stasis-breaking ingredients to promote absorption of the extravasated blood. Alternatively, Powder for Treating Red Eye can also be used. Wind-cold attacking the lung should be treated by releasing the exterior with pungent-warm herbs, ventilating the lung and relieving cough, with the formula selection Canopy Powder, optionally adding Tail of Chinese Angelica, Red Peony Root, and other blood-invigorating and stasis-resolving ingredients. In clinical practice, it is essential to examine the symptoms to determine the cause, differentiate and treat based on cold and heat, to achieve faster results.
3. Dryness-heat Damaging Lung︰It manifests as dry eyes, headache, body heat, general soreness, thirst, dry throat, dry cough with little or no phlegm, or sticky phlegm, red tongue tip, and a floating, thin, rapid pulse. This is due to the combination of dryness and pathogenic heat invading the body surface, also known as warm dryness syndrome. Both dryness and pathogenic heat damage body fluids, leading to lung dryness, collateral injury, and heat forcing blood to overflow. The key diagnostic points include spotted bleeding in the white of the eye, varying in size, accompanied by thirst, dry throat, and scant body fluids on the tongue. Lung dryness and fluid injury result in a dry cough with little or no phlegm, or thick phlegm. The invasion of pathogens into the body surface causes headache, body heat, general soreness, a red tongue tip, thin white coating with scant moisture, and a floating, rapid pulse. Treatment should focus on relieving dryness and moistening the lungs, using prescriptions such as Mulberry Leaf and Apricot Kernel Decoction or Coastal Glehnia Root and Ophiopogon Tuber Drink with modifications. Additional herbs like Unprocessed Rehmannia Root, Scrophularia Root, Moutan Bark, and Carthamus can be added to cool the blood, stop bleeding, and activate blood circulation to break stasis. Addressing both the root and the symptoms often yields excellent results.
4. Up-flaming of Liver Fire︰headache, eye distension, flushed face, vertigo, bitter taste in mouth, tinnitus, stabbing pain in the chest and hypochondrium, dysphoria, irritability, yellow urine, wiry and rapid pulse, red tongue with yellow coating. Commonly seen in hypertensive patients. $up-flaming of liver fire subconjunctival hemorrhage and yin deficiency with effulgent fire subconjunctival hemorrhage! Both are caused by pathogenic fire-heat, as fire tends to flare upward and force blood to extravasate, with pathogens affecting the facial orifices. However, the disease cause and mechanism of disease differ, leading to distinct symptoms. The liver governs anger, and sudden rage damages the liver, resulting in liver stagnation and heat, which over time transforms into fire, leading to up-flaming of liver fire and forcing blood to extravasate. The key diagnostic points are large patches of hemorrhage in the white of the eye, accompanied by flushed face, vertigo, headache, eye distension, bitter taste in mouth, tinnitus, dysphoria, and irritability. Commonly seen in hypertensive patients. Treatment should focus on clearing the liver and draining fire, with minor additions to pacify the liver and subdue yang, cool blood, and resolve stasis. The recommended formula is Gentian Liver-Draining Decoction, optionally supplemented with Abalone Shell, Sophora Flower, and Sanqi powder (separately packaged for ingestion). Yin deficiency with effulgent fire subconjunctival hemorrhage often arises from excessive visual strain, mental overwork, insufficiency of heart yin, yin deficiency leading to fire agitation, up-flaming of heart fire, boiling of the hundred vessels, reckless movement of blood due to heat, and pathogens affecting the facial orifices. The key diagnostic points are speckled hemorrhage in the white of the eye. Yin deficiency generates interior heat, and excessive heat further damages yin fluids, leading to recurrent hemorrhage in the white of the eye. Excessive heart fire disturbs mental activity, causing restlessness and insomnia. Fluid damage results in dry mouth and a desire to drink, with a red tongue and rapid pulse. Commonly seen in mental workers. The heart and small intestine are interior-exteriorly related, so excessive heart fire transfers heat to the small intestine, leading to short, dark, burning, and painful urination. Treatment should focus on clearing and draining heart fire, using the formula Redness-Removing Powder supplemented with lalang grass rhizome. Alternatively, Yin-Nourishing and Fire-Reducing Decoction can be used to clear heat and purge fire, while activating blood and breaking stasis.
5. Yin Deficiency︰It manifests as irritability and insomnia, dry mouth with a desire to drink, a red tongue, and a rapid pulse. It is often caused by excessive visual strain, mental overwork, insufficiency of heart yin, yin deficiency leading to fire stirring, up-flaming of heart fire, boiling of all vessels, reckless movement of blood due to heat, and pathogens affecting facial orifices. The key diagnostic points are speckled hemorrhages in the white of the eye. Yin deficiency generates interior heat, and excessive heat further damages yin fluids, leading to recurrent hemorrhages in the white of the eye. When heart fire is excessive and disturbs mental activity, it results in irritability and insomnia. Fluid damage causes dry mouth with a desire to drink, a red tongue, and a rapid pulse. This condition is commonly seen in mental workers. The heart and small intestine are internally and externally related; excessive heart fire transfers heat to the small intestine, causing scanty, dark, burning, and painful urination. Treatment should focus on clearing and draining heart fire, using Redness-Removing Powder with lalang grass rhizome. Alternatively, Yin-Nourishing and Fire-Reducing Decoction can be used to clear heat and purge fire, as well as activate blood circulation and break blood stasis.
6. Impact Trauma︰headache Eye distension, wiry and rapid pulse, slightly red tongue with thin white coating. This condition includes ocular contusion injuries (i.e., eye contusion), as well as damage to the collaterals caused by excessive depth of acupuncture at Qiuhou or Jingming points. Additionally, persistent vomiting or excessive alcohol consumption can also lead to collateral damage and extravasation of blood. The key points of differentiation are: in mild cases, extensive subconjunctival hemorrhage, and in severe cases, the entire white of the eye appearing red as if filled with blood. Furthermore, due to blood stasis and qi stagnation, external pathogens often take advantage of the deficiency to invade, often accompanied by headache and eye distension. Treatment should focus on nourishing blood and activating blood circulation, dispelling wind to relieve pain. The recommended formula is Wind-Eliminating Impairment-Repairing Decoction with modifications: replacing Unprocessed Rehmannia Root with Prepared Rehmannia Root to cool blood and stop bleeding, and replacing Peony Root with Red Peony Root to activate blood circulation and resolve stasis. If the subconjunctival hemorrhage changes from bright red to purplish-dark, switch to nourishing blood and activating blood circulation, breaking blood stasis and unblocking collaterals. The recommended formula is Peach Kernel, Carthamus and Four-Ingredient Decoction with the addition of dried Earthworm.

bubble_chart Documentation

1. Mujing Dacheng-Blood Stasis Flooding the Eye: "Also, when a patch or spots resembling red charcoal or crimson clouds appear on the white of the eye—whether above, below, left, or right—and by the next day the color turns turbid, shifting to blue-purple, with the patches or spots enlarging, this is due to reckless movement of hot blood lodging between the pulmonary membranes. In some cases, it arises from coughing—all are manifestations of unsettled qi."