bubble_chart Concept

Gan nebula refers to the symptoms of gan toxin attacking the eyes, initially manifesting as night blindness, followed by the formation of a nebula white membrane in patches on the black of the eye, or as solidified fat and crab eyes, and in severe cases, the black of the eye may bulge or the eyeball may become sunken.

This condition is more common in children, Michuan Yanke Longmu Lun refers to it as "pediatric malnutrition involving eye (keratomalacia) external ophthalmopathy," Yinhai Jingwei calls it "pediatric gan injury," Yuanji Qiwei refers to it as "the disease of deep gan harm," and it is also known as "malnutrition involving eye (keratomalacia) syndrome," "five gans attacking the eye," or "gan injury internal visual obstruction."

bubble_chart Pattern Analysis

1. Spleen Deficiency with Dampness Retention︰Initially, night blindness, dry and uncomfortable eyes, frequent eyelid blinking, abdominal distension and fullness, emaciation, dull hair, loose stool or diarrhea. The tongue coating is white and greasy, the pulse is soggy and thin. The child dares not move at dusk, often sits quietly and sleeps early, with red, itchy, dry, and dull eyes, frequently blinking. The treatment should focus on invigorating the spleen and resolving dampness. The prescription includes Atractylodes Rhizome alone, either cooked into porridge with rice or used in Dendrobium powder.
2. Food Stagnation Due to Indigestion︰Night vision is impaired, dry eyes and itching, photophobia with frequent blinking, emaciated body, distended abdomen, anorexia, stools are copious and foul-smelling. The tongue coating is thick and greasy, the pulse is slippery. Treatment should focus on invigorating the spleen and promoting digestion, clearing heat and eliminating malnutrition. The prescription used is Four-Ingredient Chubby Child Pill, and in severe cases, Xiao Gan Tui Yun Drink is employed.
3. Worm Accumulation︰At dusk, vision is impaired, with frequent blinking of the upper and lower eyelids, hyperemia of the ocular conjunctiva, dryness, itching, photophobia, and dullness of the black of the eye with white membrane formation. The patient lies face down and grinds their teeth during sleep. There is afternoon tidal fever, and roundworms are often seen in the stool. The tongue coating is thin and white, and the pulse is wiry and thin. This condition mostly arises from food injury (dyspepsia) or food retention. The distinguishing feature of parasitic malnutrition nebula is obvious parasitic symptoms, such as lying face down, grinding teeth during sleep, and frequent presence of roundworms in the stool. Treatment should focus on killing worms and relieving malnutrition, using prescriptions like Xiaogan Powder or Rusheng Pills. For prolonged cases with spleen damage, spleen-tonifying and qi-boosting methods can be added, using prescriptions like Chubby Child Pill.
4. Sinking of Spleen Qi︰The eyes blink due to photophobia, and the patient rubs their nose and pulls their hair. The white of the eye becomes thick, wrinkled, and in severe cases, presents concentric white halos. The black of the eye appears dry, dull, and dark, with a patch of white membrane that may ulcerate, form a congealed fat-like lesion, or develop a crab-eye-like protrusion. The body is emaciated with a distended abdomen, the complexion is shallow yellow, the hair is sparse, and there is frequent loose stool or even prolapse of the rectum. The tongue is pale with a white coating, and the pulse is weak. Both eyes show signs of exhaustion of essence and depletion of fluids: the white of the eye is thick like skin, forming concentric white halos with the black of the eye, while the black of the eye develops a patch of white membrane, appearing dry, dull, and dark, which may ulcerate and rot over time. Treatment should focus on tonifying qi and strengthening the spleen, using formulas such as Ginseng, Poria and White Atractylodes Powder or Poria Drain Dampness Decoction.
5. Spleen-kidney Yang Deficiency︰At night, vision is unclear, with itching, dryness, and photophobia. The white of the eye appears grayish and dull, while the black of the eye develops a white membrane and shows signs of decay. Accompanied by chronic diarrhea that does not stop, cold limbs, listlessness, emaciation, a distended abdomen with visible blue veins, swelling of the hands and feet, a pale-red tongue texture with thin white coating, and a deep, slow, and weak pulse. This condition often occurs after other illnesses or prolonged nebula due to malnutrition, progressing from qi deficiency to yang deficiency. "Yang qi, when refined, nourishes the spirit; when gentle, it nourishes the tendons." Yang deficiency fails to warm and nourish the upper body, leading over time to blurred vision, dryness, itching, photophobia, and decay of the black of the eye. The key diagnostic features are a cold body and timid qi, with cold limbs. Treatment should focus on warming and tonifying the spleen and kidney, using Aconite Lateral Root Decoction for the Middle Burner. In the late stage (third stage), the body becomes emaciated, the spirit listless, and the hands and feet swollen, indicating a critical state of nebula due to malnutrition. Yinhai Jingwei states, "Nine out of ten cases are fatal."

Spleen deficiency with dampness retention and spleen deficiency qi sinking are both spleen qi deficiency pattern. They are caused by improper diet, injury to the spleen and stomach, and the inability of the essence of water and grain to nourish the eyes. Common accompanying symptoms include loose stools, abdominal distension, and dull hair. However, the nebula of the two syndromes is different.

Food injury (dyspepsia) and retention of food, as well as parasitic accumulation, are both excess pattern. Improper care of children, overconsumption of greasy and hard-to-digest foods, retention of food in the stomach and intestines, and deficient generation and transformation of qi and blood, leading to the inability to nourish the eyes, are also common causes of nebula. Compared to the two, food injury leads to stagnation, retention of food leads to parasitic infestation, and parasites consume qi and blood, causing the eyes to lose nourishment and resulting in abnormal vision. Therefore, parasitic accumulation nebula often arises from food injury (dyspepsia) and retention of food. Both syndromes present with symptoms such as daytime vision, night blindness, and dry eyes. The difference is that parasitic accumulation nebula has obvious symptoms of parasitic infestation, such as lying face down, grinding teeth during sleep, and frequent presence of roundworms in the stool.

The symptom of nebula is commonly seen in children. Children have delicate zang - fu organs, with the spleen often being insufficient, and they are frequently injured by diet. Injury to the spleen leads to deficient production of fluids and blood, causing the eyes to lose nourishment and resulting in nebula. It often progresses from excess to deficiency, from the spleen to the kidney, with most cases being complex in deficiency and excess. In the late stage [third stage], it becomes a difficult-to-treat condition of extreme deficiency. Therefore, it is important to understand the mechanism of the disease and take early preventive measures to avoid the occurrence of critical conditions.

bubble_chart Documentation

1. Zhengzhi Zhunsheng．Exhaustion of Aqueous Humor》: "If a child has long suffered from infantile malnutrition, with feces like duck's slop, and eye disease of exhaustion of aqueous humor, death will follow."
2. Shenshi Yaohan: "Malnutrition syndromes are all caused by irregular diet and improper hunger and satiety, leading to a swollen abdomen and yellow complexion. In severe cases, it can be fatal; in mild cases, it harms the eyes. For those suffering from this, do not treat the eyes but treat the malnutrition, and the eye disease will heal itself. Avoid oily foods and roasted items.
3. Note: For children with malnutrition involving the eye (keratomalacia), regardless of whether they are fat or thin, if the white part of the eye first turns yellow with white wrinkles, then slightly red with eye discharge, fear of light and reluctance to open the eyes, frequent blinking of the eyelids, and a white membrane forming a circle on the black part of the eye, with a white halo and a black and white pattern inside the halo, it is undoubtedly malnutrition involving the eye (keratomalacia). But for infantile malnutrition involving the spleen, the stool resembles bean dregs. For thin malnutrition, the stool is small like foxtail millet, hard and dry. This is infantile malnutrition with accumulation affecting the eyes, attacking the liver meridian, and is also difficult to treat. If a child with malnutrition involving the eye (keratomalacia) becomes hoarse, their life is nearing its end."