bubble_chart Concept

Photophobia refers to the symptom of eye pain and difficulty in opening the eyes when exposed to bright and warm environments.

This condition is also known as "fear of the sun photophobia," but Zhengzhi Zhunsheng , in the chapter on the seven orifices, corrected this: "Photophobia is the fear of heat pattern, which means that in bright and hot places, the eyes hurt and avoid opening. ... Nowadays, people commonly refer to it as fear of the sun photophobia due to a popular mispronunciation. The sounds of 'sun' and 'heat' are similar, and the misnomer has been used for so long that people no longer consider the logic, thus losing the correct term, and only discussing it as fear of heat photophobia. The logic is clearly evident. The term 'brightness' already encompasses a wide range, so why add the word 'sun'? If the word 'sun' is specifically used to refer to sunlight, then the condition of fear of heat would have no place to belong."

bubble_chart Pattern Analysis

1. External Contractionwind-cold︰The eyes are slightly red, painful, and dry, with excessive sticky discharge, photophobia, aversion to heat, tangled eyelashes, swollen eyebrows, aversion to wind and cold, and nasal congestion with runny nose. The tongue coating is thin and white, and the pulse is floating and tight. The pathogenic wind-cold invades the skin and hair, internally affecting the lungs, leading to disharmony of the lung-defense system, hence aversion to wind and fear of cold, nasal congestion, and runny nose. The lungs govern qi, and the essence of the lungs ascends to the white of the eyes. Stagnation of lung qi obstructs the collaterals, resulting in slightly red eyes, mild pain, dryness, photophobia, fear of heat, and difficulty opening the eyes. Treatment should focus on releasing the exterior with pungent-warm herbs, assisted by promoting blood circulation and resolving stasis. The recommended formula is the Vision-Improving Asarum Decoction.
2. Qi Deficiency Wind-heat︰Red eye aversion to light, pain and difficulty in opening, canthus tightness, tearing in the wind, blurred vision with prolonged viewing. Pale tongue, thin and rapid pulse. Qi deficiency leads to weak striae and interstice, susceptibility to wind-heat invasion, which ascends to the eye orifices. Hence red eye aversion to light, pain and difficulty in opening, canthus tightness, intolerance to prolonged viewing, blurred vision with prolonged viewing—all due to constitutional qi deficiency, lack of nourishment to the eyes, insufficient brightness, compounded by external wind-heat pathogens. Treatment should focus on tonifying qi to support healthy qi, dispersing pathogens and clearing heat, using the formula Forsythia Drink.
3. Deficiency of Both Qi and Yin︰Blurred vision, preference for closing the eyes, photophobia, aversion to heat, white of the eye grade I redness and pain, dizziness, tinnitus, dry mouth and throat, loose stools, fear of cold in the lower limbs. Tongue coating thin and white, pulse thready. Deficiency of qi and yin fails to nourish the seven orifices, hence blurred vision, preference for closing the eyes, deafness or ringing; insufficient body fluids lead to dry mouth and throat. Water failing to nourish wood results in wood fire scorching metal, up-flaming of heart fire, hence white of the eye redness and pain, photophobia, aversion to heat. Treatment should focus on tonifying qi and nourishing yin, clearing heat and purging fire, using the formula Yin-Nourishing Rehmannia Pill. If loose stools and fear of cold in the lower limbs are present, it indicates qi deficiency and yang decline, failing to warm the body. Treatment should focus on tonifying qi and warming yang, using the formula Normal Circuit Qi Hezhong Decoction.

Photophobia and heat intolerance are common symptoms in ophthalmology, but they can be differentiated into deficiency and excess patterns. Sudden onset of photophobia and heat intolerance is often accompanied by redness, swelling, and a gritty sensation, with the patient unable to open their eyes, indicating an excess pattern. In cases of prolonged deficiency of both qi and blood due to pestilent qi, or damage to both yin and yang, the essence cannot be transported to nourish the eyes. Although there may be no symptoms such as redness, pain, or tearing, photophobia and aversion to light may still occur. Therefore, Zhengzhi Zhunsheng．Seven Orifices Gate states: "Heat intolerance is not a sign of deficiency, but photophobia can be a sign of deficiency. If the eyes are not red or painful but are sensitive to light, this is a sign of deficiency, due to insufficient blood, weak gallbladder and liver meridians, and the inability to transport essence to resist sunlight." This can serve as a reference for pattern identification.

bubble_chart Documentation

1. "Golden Mirror of Ophthalmology: Photophobia": "A child has suffered from photophobia since birth. At the age of eight, he could not bear sunlight or lamplight, and was extremely fearful. When he came to me for treatment, I observed that his face was pale, his body weak, and his eyes lacked luster. This was a case of congenital deficiency and depletion of essence and blood... After taking more than ten doses of medicine to assist yang and harmonize blood, he began to play in the sunlight and gradually recovered."