Eyelid swelling refers to the discomfort caused by the swelling of the upper and lower eyelids.

This condition, Lingshu refers to as "puffiness of eyelid" Suwen Ping Rebing Lun refers to as "swelling under the eyes." The "Jin Yao Lue: Abnormal Pulse Syndrome and Treatment" refers to it as "slight swelling on the eye socket." Zhubing Yuanhou Lun calls it "symptom of wind swelling in the eyes." Yinhai Jingwei refers to it as "peach-like swelling of eyelid." Zhengzhi Zhunsheng then calls it "swelling like a cup" and "spleen deficiency like a ball," the former being due to external ophthalmopathy excess pathogen, and the latter caused by qi deficiency. Later generations of physicians mostly follow this theory, and refer to "swelling like a cup" as "clam closure," and "spleen deficiency like a ball" as "hanging ball." Since both primarily involve eyelid swelling and are both disorders of the flesh orbiculus, they are now discussed together.

bubble_chart Pattern Analysis

1. Lung-Spleen Heat Accumulation︰It belongs to the category of "swelling like a cup." The main clinical symptoms include redness and pain in the eyes first, heat tearing with frequent discharge, and photophobia. Subsequently, the eyelid becomes swollen, red, and inflamed like a peach, painful to the touch, with pain radiating to the forehead, sometimes accompanied by aversion to cold with fever. The tongue is red, and the pulse is rapid. It is mostly caused by pathogenic heat entering the interior, or improper diet, leading to accumulated heat in the lungs and spleen, which rises aggressively, with dry fire intruding as a pathogen, excessive heat in the blood aspect, and heat accumulating in the eyelid, resulting in the disease. Yinhai Jingwei states in *Peach-like Swelling of the Eyelid*: "This is due to the accumulated heat in the spleen and lungs, Xieke in the striae and interstice, causing peach-like swelling of the upper and lower eyelids, accompanied by pain, astringency, and tearing." Since it is caused by accumulated heat, the key diagnostic features of this condition are redness, swelling, heat, and pain in the eyelid, resembling a peach or a cup, with tenderness upon pressure. Treatment should focus on clearing fire, dispersing wind, and removing toxins. The recommended formula is the Heat-Dissipating and Toxin-Removing Decoction.
2. Spleen Deficiency with Dampness Retention︰It belongs to the category of "spleen deficiency like a ball." The main clinical symptoms include swelling of the upper eyelid, puffiness like a ball, a preference for pressing the affected area, slight flattening upon wiping, recurrence shortly afterward, absence of redness or pain in the eye, and possibly accompanied by eye itching. The pulse is weak, and the tongue is swollen with a thin white coating. It is mostly caused by spleen and stomach qi deficiency, insufficient middle qi, impaired transportation and transformation, leading to water-dampness retention in the eyelid. Due to deficiency-induced swelling, pressing does not cause pain, and the water-dampness in the affected area disperses slightly, reducing the eyelid swelling temporarily, but the water-dampness soon reaccumulates, causing the swelling to recur—this is the key diagnostic point. Wind is the qi of the liver, and spleen deficiency makes it easier for wind pathogens to invade. If accompanied by wind pathogens, itching may occur. "Clinical Essentials of Chinese Medicine" states: "Floating and puffy swelling of the upper eyelid, like a ball, slightly flattening upon wiping but recurring shortly afterward, is attributed to spleen deficiency combined with dampness-fire." Treatment should focus on tonifying the middle and replenishing qi, invigorating the spleen and draining dampness. Recommended formulas include Shenxiao Astragalus Decoction or Zhuyang Huoxue Decoction.

bubble_chart Documentation

1. Puji Fang．Eye Disorders: "When liver qi has heat, it rushes to the canthus, causing sudden swelling of the eyelid flesh. When wind-cold takes advantage of this, it congeals and does not disperse, leading to severe swelling that may grow as large as a plum or apricot kernel, hence it is called wind toxin."
2. Shenshi Yaohan, Spleen Disorders: "This condition refers to the swelling of the eye spleen like a ball, rising emptily. There are no other diseases on the eye initially, but over time, red threads and chaotic vessels may appear. If the fire is severe, the skin may turn red, but the eye does not hurt. If damp phlegm and fire are combined, there may be tears and red ulceration diseases. This is a deficiency pattern of fire in the qi aspect, and should not be mistaken for the excess disease of swelling like a cup in the blood aspect. If you rub your palms until they are hot and then wipe them, it will slightly calm, but soon return to its original state, showing that the blood is insufficient and the deficient fire is congested in the qi."
3. Leizheng Zhicai．Eye Symptoms: "Eye swelling. Swelling can be different between swelling of the eyelid and swelling of the eyeball. Swelling of the eyelid is mostly due to dampness, swelling of the eyeball is like fire, sudden wind intruding pathogen, swelling of the eyelid like a cup."