bubble_chart Concept

The term "fish bladder" refers to the white of the eye, where the eyeball protrudes, neither red nor purple, or appears white, resembling the belly of a fish, hence the name.

This condition was first mentioned in Zhengzhi Zhunsheng as "a condition resembling a fish bladder," Zhangshi Yitong described it as "resembling a fish swim bladder," Mujing Dacheng referred to it as "qi distension."

There is also a condition of the white of the eye described as "shrimp seat," where the white of the eye swells but with a reddish hue, caused by severe stagnation, where blood distension has no outlet, leading to a bulging qi orbiculus, resembling a shrimp seat, and in severe cases, it may protrude outside the eyelid, indicating a more urgent condition, unlike the more gradual qi aspect of the fish bladder. (Zhengzhi Zhunsheng．Seven Orifices Gate) It should be distinguished accordingly.

bubble_chart Pattern Analysis

1. Wind-Heat in the Lung Meridian︰The white of the eye is partially or entirely swollen, generally appearing white, with a grade I sensation of grittiness and irritation. It may be accompanied by aversion to wind and cough, a white and greasy tongue coating, and a soggy and rapid pulse. Treatment should focus on dispersing wind and draining the lung. The recommended formula is Mulberry Leaf and Chrysanthemum Decoction.
2. Lung Fire Flaming Upward︰The white of the eye is swollen and congested, appearing red with creeping red vessels, and in severe cases, it may obscure the black of the eye, protruding outward, making it difficult to open the eyelid. There is itching, a gritty sensation, stabbing pain, and excessive eye discharge with tears. Accompanied by dry mouth and throat, severe constipation, a yellow and greasy tongue coating, and a rapid pulse. The treatment should focus on clearing lung heat and purging fire. The recommended formula is Lung-Draining Decoction or Scrophularia Root Drink, with external use of a green tangerine peel decoction for eye washing.
3. Yin Deficiency︰The white of the eye is partially or entirely raised, but the swelling is not severe, with a pale red color and a grade I burning sensation. There is little eye discharge that does not crust. Symptoms include restlessness, insomnia, mouth and tongue sores, a red tongue with scant coating, and a thin, rapid pulse. The treatment should focus on enriching yin and clearing heat. The prescription includes Six-Ingredient Rehmannia Decoction, combined with Four Ingredients Decoction, plus Forsythia, Red Peony Root, and other herbs.
4. Qi Sinking︰The white of the eye is swollen, not red but purplish, like the white membrane in a fish's belly. The eyelids are weak and often droop, unable to endure prolonged viewing, which causes soreness and pain. The complexion is pale, with mental fatigue and lack of strength, reduced appetite (anorexia), a pale tongue, and a thin, weak pulse. Treatment should focus on tonifying qi and raising yang, supplemented by activating blood circulation. The recommended formula is Four Gentlemen Decoction combined with the Yang-Supporting and Blood-Activating Decoction.

The white of the eye, known as "fish bladder syndrome," Bingben originates in the lungs and manifests externally in the white of the eye, with distinctions between deficiency and excess. The excess type is caused by wind-heat invading the lungs and lung fire flaring upward. The deficiency type results from liver and kidney yin deficiency, the lungs being scorched by fire, and spleen deficiency with qi sinking, leading to the failure of earth to generate metal. Clinically, it is essential to differentiate between deficiency and excess, and to apply pattern differentiation and treatment.

bubble_chart Documentation

1. Zhangshi Yitong: "The syndrome resembling a fish bladder: The qi orbiculus is swollen and distended, neither purple nor red, resembling a fish bladder. This is a syndrome of qi aspect caused by the conflict between metal and fire. There is no need for drainage; it will dissipate on its own with cooling methods, such as Lung-Draining Decoction. If there is slight redness and red vessels, a slight incision can be made on the upper eyelid. If there is headache, hot tears, and internal dryness with many red vessels, beware of a deteriorated pattern. It should be drained early to prevent future complications."