bubble_chart Concept

Weeping refers to the uncontrolled overflow of tears from the eyes.

Suwen. Jiejingwei Lun contains the description "wind causes tears to fall." Shennong Bencao Jing refers to it as "tears flowing" and "tears falling." Zhengzhi Zhunsheng. The seven orifices chapter categorizes it into four types: "cold tearing induced by wind," "heat tearing induced by wind," "frequent cold tearing," and "heat tearing without cause."

Tears caused by emotional changes, such as excessive grief or joy, are considered physiological changes. If caused by wind-cold pathogenic heat or excessive liver-gallbladder fire leading to external ophthalmopathy, fire pathogens agitate the water, resulting in continuous heat tearing. For example, fulminant wind and invading fever cause heat tearing like boiling water, or congealed-fat nebula (purulent keratitis) causes pain, photophobia, and eye discharge with tears like paste, which are not within the scope of this discussion. Additionally, cases of constant tearing due to blocked tear ducts should also be considered separately.

bubble_chart Pattern Analysis

1. Deficiency-Cold of the Liver Channel︰It is known as cold tearing induced by wind, falling under the category of "cold tearing." It commonly occurs in elderly individuals with blood deficiency. The main manifestations include frequent cold tearing when exposed to wind, emaciation, dull complexion, pale lips and nails, pale tongue texture, and a thin pulse. In severe cases, it may be accompanied by cold limbs and body, normal sense of taste, pale tongue texture, white and moist tongue coating, and a deep, slow pulse. This condition often arises from insufficient liver blood, which fails to nourish the eyes, leaving the eye orifices empty. Due to this deficiency, pathogenic factors are attracted, and wind-cold takes advantage of the weakness to invade. The cold pathogen congeals and stagnates, becoming active when exposed to wind, leading to frequent cold tearing. Hence, it is named "cold tearing induced by wind." Shengji Zonglu mentions in "Eye Wind and Tearing": "The liver opens into the eyes, and its fluid is tears. When liver qi is deficient, wind pathogens take advantage, and the fluid cannot be controlled, resulting in constant tearing, which worsens when facing the wind." This condition is often seen in elderly individuals with liver deficiency. Since tears are the fluid of the liver, excessive tearing damages the liver, making it difficult to treat over time. The treatment principle is to nourish blood and dispel cold, using formulas like the Nourish Blood and Expel Cold Decoction. If accompanied by symptoms and signs of liver deficiency and qi weakness, Hejian's Chinese Angelica Decoction may be used. For prolonged cold tearing with blurred vision, Barbary Wolfberry Fruit wine can be taken for regulation.
2. Wind-heat in the Liver Meridian︰It is called wind-induced heat tearing, belonging to the category of "heat tearing." The main manifestations include tearing upon exposure to wind, red and dry eyes, dry mouth and nose, dizziness, and tinnitus. The tongue texture is red with thin white coating, and the pulse is wiry or slightly rapid. It is mostly caused by accumulated heat in the Liver Meridian, combined with external wind pathogens, leading to internal and external pathogens interacting. Wind and heat clash and ascend to attack the eyes, resulting in frequent tearing upon exposure to wind, hence the name "wind-induced heat tearing." If wind transforms into heat-fire, and the fire-heat scorches upward, symptoms such as red and dry eyes, dry mouth and nose, dizziness, and tinnitus may appear. This is distinctly different from the symptoms and signs of tearing due to liver deficiency with wind-cold. For mild cases, treatment should focus on clearing the liver and dispelling wind, using Antelope Horn Powder or modified White Stiff Silkworm Powder. For severe cases, treatment should aim to raise yang and disperse pathogens, nourish yin, and reduce fire, using modified Yang-Raising Fire-Reducing Decoction.
3. Liver and Kidney Deficiency︰It is called frequent cold tearing and also falls under the category of "cold tearing." The main manifestations include frequent cold tearing, which worsens upon exposure to cold. Initially, the tearing may stop as if there were no illness, but over time, cold tearing persists. It is accompanied by symptoms such as blurred vision, unclear sight, tinnitus, deafness, insomnia, seminal emission, soreness and weakness in the waist and legs, a white tongue coating, and a thin, weak pulse. It is often caused by excessive sexual activity leading to depletion of essence and blood, or by excessive grief and crying, which damages yin and depletes fluids, resulting in deficiency of both the liver and kidneys. Yin impairment affects yang, leading to uncontrolled tearing. Clinically, it presents as frequent cold tearing, which becomes more severe in cold conditions, hence the name "frequent cold tearing." The deficiency of both yin and yang also manifests as dryness and discomfort in the eyes, blurred vision, tinnitus, deafness, dizziness, soreness and weakness in the waist and legs, insomnia, and seminal emission. The differentiation of this condition is "distinct from heat tearing with fire symptoms" (Zhengzhi Zhunsheng) and also differs in severity from the symptoms and signs of liver channel deficiency-cold. The treatment should focus on warming and nourishing the liver and kidneys, tonifying and replenishing blood and essence. Recommended formulas include Jujing Wan (Chrysanthemum Eye Pill) and Liver-Kidney Dual Tonification Pill, combined with musk powder for nasal inhalation.
4. Yin Deficiency︰Even without constant heat tearing, it still falls under the category of "heat tearing." The main manifestations include frequent daytime heat tearing, dryness at night, accompanied by dizziness and blurred vision, tongue coating thin white or thin yellow, red tongue body, and a thin, rapid pulse. It is mostly caused by liver-kidney yin deficiency, imbalance of water and fire, and deficiency fire flaming upward. Zhengzhi Zhunsheng states in *Constant Heat Tearing*: "It is due to the depletion of liver-gallbladder and kidney water, leading to deficiency of yin essence, as well as excessive mental exertion and overthinking, which stirs fire and damages fluids. Thus, blood deficiency and insufficient nourishing fluids result; those who cry excessively often suffer from this." The clinical presentation includes frequent daytime heat tearing, hence the name "constant heat tearing." Symptoms such as dizziness, blurred vision, and dry eyes—signs of deficiency heat—can be distinguished from tearing due to wind-heat in the liver channel, which presents with dizziness, tinnitus, dry eyes, bitter taste in the mouth, and dry throat. Treatment should focus on nourishing water to moisten wood and treating yin for yang, using formulas like Jiaobei Wan. If deficiency is mixed with excess, such as concurrent liver-gallbladder fire, modified Angelica Decoction can be used.

The symptom of tearing can be divided into cold tearing and heat tearing. Heat tearing is often caused by "fire"; cold tearing is usually due to "cold". In heat tearing, wind-induced heat tearing is triggered by liver meridian heat accumulation combined with wind pathogen invasion; spontaneous heat tearing is caused by liver-kidney yin deficiency, where water fails to control fire, leading to virtual fire flaming. In cold tearing, wind-induced cold tearing results from insufficient liver blood and external wind-cold invasion; frequent cold tearing is due to deficiency of both liver and kidney, consumption of yin blood, yin impairment affecting yang, leading to unregulated tear secretion.

bubble_chart Documentation

1. Zhubing Yuanhou Lun．The "Juǎn Mù" section states: "Juǎn Mù refers to the condition where wind qi invades the space between the eyelid canthus, clashes with qi, blood, and body fluids, causing itching and tearing at the canthus, and the canthus remains constantly moist. Hence, it is called Juǎn Mù."