Diminished visual vitality refers to the insufficient radiance in both eyes. In mild cases, individuals may feel a lack of strength in their vision and experience fatigue after prolonged viewing; in severe cases, there may be physical emaciation, a sallow complexion, and unconsciousness.

Shenshi Yaohan states: "Visual vitality refers to the natural essence within the eyes that enables sight. This vitality originates from the life gate, connects to the gallbladder, and emanates from the heart, all of which are functions of fire." Yinhai Jingwei says: "When the qi of the liver and kidney is abundant, the eyes are bright and clear; when the qi of the liver and kidney is deficient, there is dizziness and blurred vision." This discusses the relationship between visual vitality and the essential qi of the zang-fu organs.

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1. Yin-blood Deficiency︰The symptoms include insufficient luster in both eyes, self-perceived blurred vision, and easy fatigue. Dizziness, tinnitus, limb weakness, palpitation, insomnia, tidal fever, night sweats, a red or pale tongue, and a thready-rapid or weak and feeble pulse. The disease causes are:
   1. Excessive mental strain and contemplation, damage to the heart and spleen, deficiency of heart and spleen blood, leading to insufficient nourishment of the eyes.
   2. Trauma, insect or animal bites, or excessive blood loss during childbirth in women, resulting in blood deficiency and inadequate nourishment of the eyes.
   3. Prolonged illness without proper treatment, deficiency of both qi and yin, leading to lack of nourishment for the eyes.
   4. Dietary irregularities, excessive alcohol consumption, indulgence in desires, sexual overexertion damaging the kidneys, deficiency of kidney essence, and inability of essence and blood to ascend and nourish.
   *Jingyue Quanshu* · Eye Diseases Section: "Eye disorders... without redness, swelling, heat, or pain, but with symptoms such as blurriness, dryness, lack of brightness, or middle-aged decline, or excessive indulgence in alcohol and sex, leading to photophobia, dark vision, weak gaze, eye pain as if being gouged, etc., are all due to insufficiency of water." This belongs to mild cases of lifeless vision. The key diagnostic points are insufficient divine light in both eyes, easy fatigue when viewing objects, accompanied by systemic symptoms of yin deficiency and blood deficiency. The treatment should focus on nourishing yin and blood, and the recommended formula is Sanren Wuzi Wan.
2. Decline of Essence and Qi︰The eyes turn inward, vision is dull, pupils are dilated, and the patient fails to recognize people. The body is emaciated with a sallow complexion, breathing is extremely rapid, incontinence of urine and feces occurs, or there is floccillation of both hands, or incoherent speech. This condition is a sign of the tendency of disease approaching a critical stage. Zang-fu organs' essential qi is in decline and cannot ascend to the eyes, leading to inward turning of the eyes and dull vision. The pupils belong to the kidneys; prolonged illness inevitably affects the kidneys. When kidney essence is depleted, the divine light of the pupils naturally disperses. Therefore, the key diagnostic points are inward turning of the eyes, dull vision, dilated pupils, and failure to recognize people. This condition signifies the decline of essential qi and the exhaustion of yin-yang, a critical and severe illness. Treatment should focus on restoring yang to rescue from collapse, and the recommended formula is Cold-Extremities Decoction Plus Ginseng.

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1. Lingshu-Jueqi: "Those with essence desertion disease suffer from deafness; those with qi desertion disease suffer from unclear vision."
2. Suwen-Yuji Zhencang Lun: "Cachexia with withering bones, emaciation with sagging flesh, fullness of qi in the chest, pain in the abdomen, discomfort in the heart, fever in the shoulders and neck, ruptured muscles and loss of flesh, sunken orbits, the appearance of the true viscera, and inability to see people lead to immediate death. Those who can still see people will die when their element becomes unrestricted."
3. Jingyue Quanshu．Eye diseases: "If there is a deficiency of true yin without fire pattern, but only symptoms such as dim vision, dark and tired eyes, these are all due to deficiency of water and blood. It is appropriate to use Ji Yin Rehmannia Pill, Left-Restoring Pill and the like. If there is also a slight fire, it is appropriate to use Eyesight-Improving Rehmannia Pill, Gu Ben Huan Jing Pill, and the like."