bubble_chart Concept

The upward rushing of yellow fluid (hypopyon) refers to the symptom where a yellow purulent fluid, resulting from decay, accumulates between the black of the eye and the iris, rising upward to cover the pupil.

This condition is referred to as "upward rushing of yellow fluid (hypopyon) external ophthalmopathy" in Michuan Yanke Longmu Lun. The Qing dynasty text Mujing Dacheng states: "In reality, it is not a membrane but a fluid," hence it was renamed "upward rushing of yellow fluid (hypopyon)". The "Ophthalmology Simplified and Illuminated Secret Manuscript" directly calls it "upward rushing of yellow pus (hypopyon)".

Another condition, "surging wave nebula," originates from the lower edge outside the black of the eye and grows upward. It should be distinguished from the "upward rushing of yellow fluid (hypopyon)", which rises from within the black of the eye and is characterized by acute and severe symptoms. As Zhengzhi Zhunsheng．seven orifices chapter》 states: "The obstruction grows from the outer rim upward, hence it is called surging wave. It is not comparable to the upward rushing of yellow fluid (hypopyon) which arises from within and is extremely urgent in emetic therapy."

bubble_chart Pattern Analysis

1. Spleen-Stomach Excess Heat︰The onset is sudden, with unbearable pain, photophobia, reluctance to open the eyes, and tears as hot as boiling water, but no eye discharge. The ocular conjunctiva shows turbid hyperemia or a purplish-red hue, and pus gradually accumulates below the junction of the black of the eye and the iris, spreading upward to form a fluid level resembling the crescent-shaped white area at the base of a fingernail. In severe cases, it may even cover the pupil. Associated symptoms include a bitter taste in the mouth, dry throat, chest tightness, anorexia, scanty dark urine, dry stool, a red tongue with yellow, greasy, and dry coating, and a slippery, rapid pulse. This condition often arises from habitual dietary indiscretion, excessive consumption of spicy, fried, or rich foods, and alcohol, leading to the accumulation of heat in the spleen and stomach. Pathogenic heat then ascends to attack the eyes, steaming and rotting the aqueous and vitreous humors as well as the iris, resulting in internal pus formation. The onset is typically abrupt, with symptoms such as pain, photophobia, and spreading yellow pus that may even obscure the pupil. Heat stagnation in the spleen and stomach scorches body fluids, causing a bitter taste in the mouth and dry throat. Intense internal heat disrupts qi movement, leading to chest tightness, anorexia, dark yellow urine, constipation, a yellow, greasy, and dry tongue coating, and a slippery, rapid pulse. Treatment should focus on clearing and purging excess fire from the Yangming to preserve body fluids. The recommended formula is the Decoction for Clearing Heat from the Spleen and Stomach, with raw gypsum substituted for processed gypsum and raw rhubarb rhizome for processed rhubarb rhizome. For severe heat, add Natrii Sulfas Exsiccatus. If accompanied by excessive liver and gallbladder fire, with the black of the eye showing congealed fat and the pupil constricted, treatment should aim to clear and purge excess fire from the liver and gallbladder, using a modified version of the Four Agents Cooling Beverage.
2. Spleen and Stomach Yang Deficiency︰The onset is slow, with mild pain or no pain, no photophobia, and no eye discharge. There is only a faint red ring around the black of the eye. Inside the black of the eye, in front of the iris, a small amount of pale yellow pus accumulates from below, forming a horizontal level. Associated symptoms include a dull complexion, or vomiting and diarrhea, abdominal distension and fullness, poor appetite, a pale tongue with white coating, and a deep, thin, or slow pulse. This is often due to habitual dietary irregularities, excessive consumption of raw or cold foods, damage to the spleen and stomach, internal obstruction of cold-dampness, cold congealing in the middle energizer, and weakened spleen yang, leading to impaired transportation and transformation. As a result, the essence of water and grains fails to be distributed upward to nourish the eyeball, causing cold congealing in the collaterals and the formation of yellow pus. The onset is usually slow, with mild pain and no photophobia, and the pus is pale yellow and scant. Cold evil obstructing the middle causes stomach qi to ascend counterflow, resulting in vomiting. Spleen-stomach weakness and deficient transportation lead to abdominal distension and fullness, poor appetite, diarrhea, a pale tongue with white coating, and a deep, thin pulse. Treatment should focus on warming the middle and dissipating cold, as well as tonifying the spleen and stomach. The recommended formula is Middle-Regulating Decoction supplemented with Cyperus and Dried Tangerine Peel.

Spleen and stomach excess heat and deficiency-cold of the spleen and stomach are both pathological changes of the spleen and stomach. However, one is excess heat, so the onset is sudden, with pain and photophobia, and the yellow fluid is thick and viscous, the tendency of the disease is severe, and there is a risk of damage to the eye and sinking of the eyeball. The other is deficiency-cold, so the onset is slow, with mild pain and no photophobia, and the yellow fluid is clear and thin, the tendency of the disease is relatively mild, but it often lingers and does not heal.

bubble_chart Documentation

1. Michuan Yanke Longmu Lun．Eye upward rushing of yellow fluid (hypopyon) external ophthalmopathy: "At the initial onset of this eye condition, there is intermittent pain. During episodes, there is redness, astringency, and tearing, gradually developing a yellow membrane. It directly covers the black of the eye, making it difficult to distinguish people and objects. This is all due to wind-cold in the kidneys and extreme heat in the gastrointestinal system."