bubble_chart Concept

Pupil dilation refers to the condition where the pupil is larger than normal, even to the point of losing its ability to contract, remaining dilated and unresponsive, with the iris narrowed to a thin line.

This condition is referred to as "pupil dilation" in Lanshi Micang, called "轆轤展開" in Yinhai Jingwei, and also termed "pupil dilation" in Zhengzhi Zhunsheng. It is also known as "pupil enlargement," "pupil dilation," or "pupil dispersion."

bubble_chart Pattern Analysis

1. Deficiency of Both Qi and Yin︰Seeing objects as if in a mist, suffering from dry and uncomfortable eyes, dizziness and dizzy vision, fatigue and lack of strength, restlessness and insomnia, dry mouth and throat, yellow coating on a red tongue, and a soggy, thin pulse. This is a deficiency pattern, and the treatment should focus on tonifying qi and nourishing yin. The prescription used is Yin-Nourishing Rehmannia Pill.
2. Yin Deficiency︰blurred vision, red eye with eye discharge, tinnitus, deafness, soreness and weakness of the waist and knees, seminal emission, diarrhea, red tongue with scant coating, weak and thready pulse with rapid beats. This is a condition of deficiency in origin and excess in manifestation. The treatment should focus on nourishing yin and reducing fire, using Xie Shen Tang (Kidney-Draining Decoction), along with Magnetite and Cinnabar Pill.
3. Phlegm Syncope︰Blurred vision, distending pain in the eyeballs, forehead, and eyebrows, or localized to one side, fever, thirst, vomiting of frothy saliva, greasy tongue coating, wiry and slippery pulse. $Phlegm syncope head wind with dilated pupils and sudden anger damaging the liver causing pupil dilation! Blood stasis syncope head wind is mostly caused by phlegm-fire ascending upward, where phlegm combines with fire, and the stirring of fire leads to yang rising, hence the dilated pupils and blurred vision. It is often accompanied by distending pain in the eyeballs, forehead, and eyebrows, or localized to one side, as well as symptoms such as fever, thirst, and nausea with vomiting. Sudden anger damaging the liver is mostly caused by rebellious liver qi, where liver depression fails to disperse, and rage causes qi to rise. Hence, the dilated pupils, blurred vision, and mental confusion, often accompanied by facial flushing, red eyes, chest tightness, and hypochondriac pain. Both belong to excess patterns, with phlegm-fire as the pathogenic factor. Treatment should focus on resolving phlegm and clearing fire, using the formula for clearing phlegm-fluid retention. For liver qi stagnation, treatment should regulate liver qi, using the Qi-Regulating Decoction, combined with Magnetite and Cinnabar Pill.
4. Rage Damaging the Liver︰Visual disturbance, mental confusion, red eyes, hypochondriac pain, dysphoria, restlessness, belching, poor appetite, red tongue with thin coating, wiry pulse. $Phlegm syncope head wind with dilated pupils and sudden anger damaging the liver causing pupil dilation! Stasis syncope head wind is mostly caused by phlegm-fire ascending upward, where phlegm combines with fire, stirring yang to rise, hence dilated pupils and blurred vision. It is often accompanied by distending pain in the eyeballs, forehead, and brow ridges, or localized to one side, along with symptoms such as fever, thirst, nausea, and vomiting. Sudden anger damaging the liver is mostly caused by rebellious liver qi, where liver depression fails to disperse, and rage triggers qi uprising. Therefore, it manifests as dilated pupils, visual disturbance, mental confusion, along with red eyes, hypochondriac pain, and other symptoms. Both belong to excess patterns involving phlegm-fire. Treatment should focus on resolving phlegm and clearing fire, using formulas such as Qing Phlegm-Fluid Retention Decoction. For liver qi stagnation, treatment should regulate liver qi, using Regulate Qi Decoction, combined with Magnetite and Cinnabar Pill.
5. External Injury︰Ocular injury due to striking, visual mental confusion, head and eye distending pain, or even hyphemia, eyelid static blood, swelling and pain. Mostly caused by direct or indirect impact on the eyeball, injury to the choroid and iris, vital qi internal depletion, inability to constrict, hence pupil dilation, or deviation from roundness, failing to shrink in bright light. In severe cases, hyphemia, eyelid static blood swelling. Treatment should harmonize the nutrient aspect and resolve stasis, nourish the kidney and benefit essence. The formula uses Rhubarb RhizomaAngelica Powder combined withSix-Ingredient Rehmannia Pill with modifications.

The pupil is generated by innate essence qi and nourished by acquired essence qi. If the essential qi fails to converge and gather, the pupil will become dilated. However, there are cases where the qi is injured and the essence is damaged; where water fails to control fire, leading to deficiency fire flaming upward; or where phlegm-fire, liver qi, or external injuries impair the vital qi. The disease causes and mechanisms of disease vary, and each has distinguishable symptoms. However, this condition is a critical and urgent clinical emergency in ophthalmology, requiring immediate treatment to constrict the pupil and restore the divine light. Otherwise, if the disease persists for a long time, the essential qi will be depleted and difficult to recover, and the pupil will remain dilated and unable to converge, eventually leading to permanent disability. As stated in Zhengzhi Zhunsheng．Seven Orifices: "If it is treated and constricted at the onset, recovery is possible. If delayed, the qi will stabilize and the essence will disperse, making it impossible to recover. If the internal visual obstruction has not yet developed and only the pupil is dilated, constricting the pupil will naturally restore the light. ... In urgent cases, constricting the pupil should be the priority. Once the pupil is constricted, the eye will regain vitality."

bubble_chart Documentation

1. Lanshi Micang．Eye and Nose Gate: "When the pupil is dilated, it indicates that the Shaoyin Heart Meridian is connected to the eye connector, and the Jueyin Liver Meridian is also connected to the eye connector. The heart governs fire, and the liver governs wood, signifying an excess of wood and fire. The appropriate flavors should be bitter, sour, and cool, while spicy and hot foods should be strictly avoided as they can exacerbate the wood and fire pathogens. It is essential to understand this principle in daily diet. Spicy flavors disperse, and heat aids fire, hence they should not be consumed. Sour flavors help to astringe heart qi and drain wood and fire. Bitter flavors drain fire, and heat benefits water. Particularly, avoid consuming cold water and foods associated with the Great Cold (24th solar term), as they can damage stomach qi. If stomach qi does not flow, original qi cannot be generated. If original qi does not flow, stomach qi will descend, and the fire from the triple energizer and heart will invade the lungs, ascending to the brain and scorching the marrow. Fire governs dispersion and overflow, leading to dilated pupils. Extremely hot foods further assist fire pathogens and should be avoided. Among the medicinal herbs, Motherwort Fruit, which is spicy and benefits the eyes, should be removed as its spiciness aids fire. Instead, add Coptis Rhizome and Skullcap Root to drain the fire from the middle energizer. Scutellaria can drain the fire from the upper energizer and lungs. Wash it with wine to use cold against heat. Also, remove feather cockscomb seed as it aids yang fire, and add Schisandra Fruit to astringe the dilated pupil."