bubble_chart Concept

Sudden blindness refers to a symptom of internal visual obstruction where there is a rapid decline in vision in one or both eyes, leading to vision loss.

This condition is mentioned in Zhengzhi Zhunsheng under the chapter "Seven Orifices," which states: "Sudden blindness: usually occurs without any prior illness, with no external injury to the eye's structure and no internal damage to the pupil, yet suddenly one becomes blind and cannot see."

Sudden blindness and "bluish blindness (optic atrophy)" both result in blindness with a normal external appearance of the eye and no visible nebula or obstruction within the pupil. However, "bluish blindness (optic atrophy)" is characterized by a gradual decline in vision or blindness due to other internal visual obstruction eye diseases. The two conditions are distinct and therefore do not fall within the scope of this discussion.

bubble_chart Pattern Analysis

1. Heat Entering the Nutrient-Blood Level︰High fever, dry mouth, sudden blindness in both eyes, unconsciousness, delirious speech, or the appearance of macula and papule. The tongue is deep red with peeled coating, and the pulse is thready and rapid. This condition often occurs in the late stage (third stage) of sexually transmitted diseases, where warm-heat pathogens invade the nutrient-blood level, obstruct sweat pores, and cause reckless movement of blood heat rushing upward to the head and eyes, damaging the eye connectors and resulting in sudden blindness. Excessive heat in the nutrient aspect disturbs mental activity, leading to high fever, unconsciousness, and delirious speech. Pathogenic heat scorches body fluids, causing thirst. Reckless movement of blood heat spills into the skin, manifesting as macula and papule. Pathogenic heat lingers in the nutrient-blood level, depleting body fluids internally, hence the deep red tongue, peeled coating, and thready, rapid pulse. Treatment should focus on clearing the nutrient level to remove toxins and cooling blood to stop bleeding. - If the pathogen is in the nutrient aspect, with a red tongue and scant coating, use Nutrient-Clearing Decoction. - If the pathogen enters the blood aspect, with external manifestations of macula and papule, a crimson tongue, and peeled coating, use Rhinoceros Horn and Rehmannia Decoction. - If the pathogen invades the pericardium, causing unconsciousness, high fever, and delirious speech, use Peaceful Palace Bovine Bezoar Pill, Supreme Treasured Pill, or Purple Snow Bolus. Both conditions exhibit signs of yin-fluid deficiency, but the primary issue is pathogenic heat, presenting as heat damaging yin-fluid (dry mouth), often accompanied by high fever and unconsciousness, indicating different syndromes.
2. Up-flaming of Liver Fire︰Dysphoria, irritability, sudden blindness in one or both eyes, eyeball pain, dizziness with headache, facial flushing, red eyes, hypochondriac pain, bitter taste in the mouth, red tongue with yellow coating, wiry and rapid pulse. Often caused by rage and violent emotions, as anger leads to the upward flare of qi-fire, damaging the divine pearl (eye) and resulting in sudden blindness, commonly seen as unilateral or bilateral vision loss. Excessive liver fire ascends to disturb the seven orifices, causing headache, red eyes, and facial flushing; stagnation of liver heat and failure of wood to disperse lead to hypochondriac pain and bitter taste in the mouth; disturbance of the heart-mind results in dysphoria and restlessness, while intense fire and scorching heat manifest as a red tongue with yellow coating and wiry, rapid pulse. Treatment should focus on clearing the liver and draining fire, with the formula selection being Gentian Liver-Draining Decoction with modifications. Sudden blindness due to ascending liver fire and sudden blindness due to heat entering the nutrient-blood level! Both are caused by excess heat attacking the eye connectors. The former arises from emotional internal damage, with liver fire ascending, presenting as headache, hypochondriac pain, bitter taste in the mouth, and wiry, rapid pulse—treatment targets the liver. The latter stems from contraction of warm-heat pathogens that penetrate the nutrient-blood level, forcing reckless bleeding, presenting as high fever, unconsciousness, delirious speech, macules and papules, a deep red tongue with peeled coating, and thin, rapid pulse. The two are easily distinguishable.
3. Yin Deficiency︰Dizziness and dizzy vision, with a sensation of wispy smoke rising before the eyes, gradually dispersing into a red glow, followed by blindness. Flushed cheeks, tidal fever, palpitation, night sweats, vexing heat in the chest, palms, and soles, a red tongue with scant coating, and a thin, rapid, weak pulse. Often caused by constitutional insufficiency of yin-blood or excessive mental exertion depleting heart yin, leading to insufficiency of heart yin and exuberant heart fire, which damages the spirit-pearl (eyes) and results in sudden blindness. Insufficient yin-blood fails to nourish the heart, hence palpitation; blood failing to ascend and nourish leads to dizziness and dizzy vision; yin deficiency generates internal heat, hence flushed cheeks, tidal fever, and vexing heat in the chest, palms, and soles; yin deficiency with effulgent fire manifests as a red tongue with scant coating and a thin, rapid, weak pulse. Treatment should focus on nourishing yin and reducing fire, nourishing the heart and tranquilizing the mind. The formula Coptis and Ass Hide Glue Decoction may be modified for use. If accompanied by kidney yin deficiency, with symptoms like soreness in the waist and nocturnal emission, the formula Modified Anemarrhena, Phellodendron, and Rehmannia Pill is recommended. This is primarily for cases dominated by yin deficiency, presenting symptoms of yin deficiency with effulgent fire such as tidal fever and vexing heat in the chest, palms, and soles.
4. Qi Stagnation and Blood Stasis︰Transient monocular blindness with headache, bitter taste in the mouth, thin tongue coating, and fine astringent pulse. Mostly caused by irritability, excessive alcohol consumption, or spicy food intake, leading to upward rebellion of qi-fire that invades the eye connectors, resulting in obstruction of the intraocular collaterals, impeded qi flow, and static blood stagnation, leading to malnourishment of the seven orifices. Obstruction causes pain, hence manifesting as headache, bitter taste in the mouth, thin tongue coating, and fine wiry or fine astringent pulse. Treatment should focus on {|###|}invigorating blood and resolving stasis{|###|}, {|###|}moving qi to relieve stuffy orifices{|###|}. The recommended formula is Orifice-Opening Blood-Activating Decoction supplemented with Puncturevine Caltrop Fruit, Prunella, and Abalone Shell. The presence of obstructed or occluded vessels within the eye aids in pattern identification.

Sudden blindness is a condition that should be clinically differentiated into heat, fire, deficiency, and blood stasis. Due to its abrupt onset, it is crucial to identify the disease cause and symptoms, and take proactive measures for treatment. As stated in Shenshi Yaohan: "The condition is extremely rapid and unusual... prompt treatment can lead to recovery, but delay results in the stabilization of qi and renders treatment ineffective."

bubble_chart Documentation

1. Rumen ShiqinVolume 6: "Blindness: Dai Ren's maid went to Xihua, and her eyes suddenly became blind and could not see. Dai Ren said: This is ministerial fire, transmitted from greater yang to yangming, with both qi and blood being excessive. He then punctured her nose, the Zan Zhu point, and the five points in front of the crown, causing significant bleeding, and her vision immediately returned."
2. Zabing Yuanliu Xizhu: "Hejian said: Heat qi is stifled, sweat pores are blocked, leading to qi, liquid, blood vessels, nutrient-defense, and spirit being unable to ascend, descend, exit, or enter. Each follows the degree of stagnation, resulting in the severity of the illness. Therefore, heat stagnation in the eyes causes blindness."