bubble_chart Concept

Head distending pain refers to distending pain in both the head and eyes, usually starting on one side first, but it can also occur simultaneously on both sides. Prolonged illness, lack of treatment, or incorrect treatment can lead to blindness.

This condition is referred to in Michuan Yanke Longmu Lun as "five winds transforming into internal visual obstruction," "bluish wind glaucoma (angle-opening glaucoma)," "green glaucoma (acute angle-closure glaucoma)," and "headache with tinnitus," among others. Zhengzhi Zhunsheng adds terms such as "yellow wind glaucoma" and "left-right migraine syndrome."

This condition is easily confused with "thunder-headache" and "migraine" in internal medicine. Zhengzhi Zhunsheng·Zhutong Men points out that the symptoms of thunder-headache are: "headache accompanied by the formation of lumps; or it is said that the head feels like thunder, caused by wind evil, which produces sound when it moves." Migraine is described as "pain on one side of the head." It is evident that although "thunder-headache" and "migraine" involve distending pain in the head or one-sided headache, they rarely lead to eye damage and should be differentiated.

bubble_chart Pattern Analysis

1. Damp Phlegm︰Headache, distention of eyeball pain, blurred vision, pupil dilation, accompanied by nausea, vomiting of clear saliva, or chest tightness, heavy body, anorexia, thirst without desire to drink, tongue coating greasy or yellow greasy, pulse soggy and thin or slippery and rapid. Mostly seen in individuals with phlegm-fluid retention constitution, or those with irregular diet, injury to the spleen and stomach, weakened spleen yang, dampness trapping the middle earth, turbid dampness rising upward, seven orifices being obscured, yang qi failing to nourish the head and eyes, leading to distending pain in the head and eyes, blurred vision, and pupil dilation. However, phlegm-dampness trapping the middle can transform into heat or cold. Spleen-stomach weakness, middle energizer qi deficiency, or consumption of raw and cold foods can cause dampness to transform into cold, with cold phlegm rising counterflow and obscuring the seven orifices, manifesting as distending pain in the head and eyes. Dysfunction of the spleen in transportation and failure of stomach qi to descend smoothly result in vomiting of clear saliva, white greasy tongue coating, and soggy thin pulse. Treatment should focus on warming the middle to strengthen the spleen, harmonizing the stomach and descending adverse qi, with the formula selection being Evodia Decoction, or modified Regulating the Middle and Tonifying Qi Decoction. If the patient has a constitution of yang exuberance or latent heat in the stomach, dampness may transform into heat, with phlegm-heat rising to obstruct the seven orifices, manifesting as distending pain in the head and eyes. Phlegm-heat obstruction in the middle energizer prevents turbid yin from descending, leading to dizziness, nausea, vomiting, failure of fluids to ascend, thirst without desire to drink, yellow greasy tongue coating, and slippery rapid pulse. Treatment should focus on Coptis RhizomeGallbladder-Warming Decoction with modifications. The differentiation between cold transformation and heat transformation lies in: one presenting with vomiting of clear saliva, headache, white greasy tongue coating, and soggy thin pulse; the other presenting with vomiting, thirst but no desire to drink, dizziness, yellow greasy tongue coating, and slippery rapid pulse. This serves as the basis for differentiation. The main pathology is spleen deficiency with internal obstruction of phlegm-dampness, obscuring the seven orifices and disrupting stomach harmony, hence the disease tendency is relatively mild and not difficult to differentiate.
2. Liver Fire Invading the Stomach︰The headache is particularly severe, with eyeball distending pain, and in extreme cases, the headache feels like splitting, the eyes bulge as if about to burst, the pupils dilate, vision suddenly declines, accompanied by dysphoria, irritability, thirst with a desire to drink, and frequent vomiting. The tongue is red with yellow coating, and the pulse is wiry and slippery. This condition is often seen in individuals with an inherently impatient temperament, where sudden anger damages the liver, leading to excessive liver fire. Rage causes qi to rise, and liver fire scorches the seven orifices upward, resulting in distending pain in the head and eyes, dilated pupils, and sudden vision loss—sometimes only perceiving moving shadows. The liver and gallbladder meridians ascend to the sides of the head, hence the splitting headache and eyeball distending pain as if about to burst. Symptoms often fluctuate with emotional changes, as the liver prefers free flow; emotional disturbances cause liver qi stagnation transforming into fire, frequently triggering the condition during excessive seven emotions. Liver fire transversely invades the stomach, leading to frequent vomiting. A wiry pulse indicates liver involvement, and internal exuberance of liver fire manifests as a red tongue with yellow coating and a wiry, slippery pulse. Treatment should focus on clearing the liver and draining fire, harmonizing the stomach, and descending adverse qi. The recommended formula is Liver-Draining Decoction with modifications.
3. Ascendant Hyperactivity of Liver Yang︰The headache is predominantly one-sided, with distending pain in the eyeball, the pupil may be dilated, and blurred vision may occur, accompanied by rainbow vision, dizziness, nausea, dry mouth, sore throat, soreness and weakness in the lower back and knees, a red tongue with thin coating, and a wiry-thin pulse. This condition is often seen in individuals with an inherent liver-kidney yin deficiency. The liver stores blood, and the kidneys store essence; blood and essence share the same origin, as the liver (Yi) and kidneys (Gui) are of the same source. Liver-kidney yin deficiency leads to water failing to nourish wood, resulting in ascendant hyperactivity of liver yang, which disturbs the seven orifices, hence the appearance of rainbow vision and a dilated pupil. Obstruction of the collaterals causes pain, manifesting as distending pain in the head and eyes. Ascendant hyperactivity of liver yang generates wind due to excessive heat, leading to dizziness and nausea. Depletion of liver yin results in blurred vision. Kidney deficiency causes soreness and weakness in the lower back and knees. Deficiency of yin fluids leads to dry mouth, sore throat, a red tongue with thin coating, and a wiry-thin pulse. Treatment should focus on nourishing yin and subduing yang, calming the liver and improving vision. The recommended formula is Qi Ju Rehmannia Decoction, with appropriate additions of antelope horn, Uncaria, and Gastrodia Tuber.
4. Yin Deficiency︰headache dizziness, eyeball distending pain, pupil may enlarge, blurred vision, rainbow vision may appear, palpitation mental restlessness, disturbed sleep at night, red tongue with scant coating, thin and rapid weak pulse. Mostly due to excessive worry, heart blood depletion, or liver blood insufficiency with yin-blood deficiency, deficiency fire flaming upward, seven orifices being disturbed, hence manifesting as head and eye distending pain, pupil enlargement and rainbow vision; heart-liver blood deficiency failing to nourish the head and eyes, hence dizziness and blurred vision; the heart lacking nourishment, hence palpitation and flusteredness, restless sleep at night, red tongue with scant coating, thin and rapid weak pulse. Treatment should focus on nourishing blood and calming the spirit, nourishing yin and reducing fire, prescription selection: nourishing yin and reducing fireFour Ingredients Decoction with appropriate addition of Plantain Seed, Poria, Platycladi Seed.

Ascendant hyperactivity of liver yang and liver fire invading the stomach are both related to the liver, but one is due to liver yin deficiency, where yin fails to control yang, leading to ascendant hyperactivity of liver yang, with the mechanism of disease being liver-kidney yin deficiency; the other is due to liver qi stagnation, where liver depression transforms into fire, resulting in up-flaming of liver fire, with the mechanism of disease being liver fire invading the stomach. Clinically, it is crucial to distinguish between deficiency and excess.

The symptom of distending pain in the head and eyes is most closely related to the liver in clinical differentiation. Since the liver belongs to wind-wood, liver depression and qi stagnation can lead to the transformation of fire and wind over time, hence headache and eye distension are the main symptoms, and wind-dispelling herbs are often used in treatment. Additionally, because the liver is a firm-characterized zang organ, it often tends to invade the spleen and stomach, affecting their ascending and descending functions, often accompanied by vomiting. Therefore, treatment should also consider the spleen and stomach. It should be combined with miotic agents such as Areca Seed alkaloids and Obtuseleaf Erycibe Stem for eye drops. The prognosis is generally good. However, if there is deficiency, the condition may be delayed, leading to pupil dilation that does not contract, gradual loss of vision, and the risk of blindness.

bubble_chart Documentation

1. Rumen Shiqin："Pain in the forehead, commonly referred to as migraine, is related to the Shaoyang meridian of the foot. If the pain persists for a long time, it can lead to loss of vision."