bubble_chart Concept

Internal visual obstruction refers to the turbidity of Solomonseal Rhizome within the pupil, gradually developing into a nebula obstruction, affecting vision, and even leading to blindness. It is named as such because it obscures from within. Mujing Dacheng said: "This condition is characterized by the loss of vision without any apparent eye disease, with a nebula obstructing the aqueous humor within the golden well, known as internal visual obstruction." It is commonly seen in the elderly, but can also be caused by congenital factors or external trauma.

The term internal visual obstruction is mentioned in Michuan Yanke Longmu Lun, which categorizes it into internal visual obstruction and external ophthalmopathy, with 23 conditions under internal visual obstruction, including diseases within the pupil. The "internal visual obstruction" recorded in the Yuanji Qiwei as a disease where yin is too weak to match yang, refers to conditions like "round nebula cataract (senile cataract)". The Yixue Gangmu was the first to clearly distinguish "internal visual obstruction" from other pathologies within the pupil, stating: "Internal visual obstruction first affects one eye, then sequentially leads to damage in both eyes, all due to a nebula within the black of the eye, covering the pupil."

Additionally, the condition of "bluish blindness (optic atrophy)" also causes visual mental confusion, but the external appearance remains normal, with no discernible changes in color or form, and should be differentiated from "internal visual obstruction".

bubble_chart Pattern Analysis

1. Spleen Deficiency︰Blurred vision, inability to sustain prolonged vision, aching pain upon prolonged viewing, gradually leading to blindness. Accompanied by a pale complexion, fatigue in the limbs, timidity and reluctance to speak, poor appetite and anorexia, pale tongue, and weak, thin pulse. Often caused by irregular eating habits, overstrain, improper diet, injury to the spleen and stomach, spleen deficiency leading to weak qi, dysfunction in ascending and descending, and failure of clear yang to nourish the pupils, resulting in blurred vision and aching pain in the eyes upon prolonged viewing. Additionally accompanied by a pale complexion, fatigue in the limbs, shortage of qi and reluctance to speak, pale tongue, and thin pulse, indicating deficiency of middle qi. Treatment should focus on strengthening the spleen and tonifying the middle, replenishing qi and raising yang. Prescriptions include Middle-Tonifying Qi-Replenishing Decoction, Qi-Replenishing and Brightening Decoction, or Stomach-Nourishing Decoction for Peace.
2. Yin Deficiency︰Initially, there is visual blurring, often seeing black flowers floating in the air, followed by double vision, perceiving objects as two. The pupil appears pale white or pale yellow, gradually turning completely white and leading to blindness. Accompanied by dizziness, tinnitus, soreness and weakness in the waist and knees. The tongue coating is yellow, the tongue body is red, and the pulse is thin and weak. This is often due to advanced age and physical weakness, or excessive sexual activity, which depletes the essence and fails to nourish the eyes, hence the initial visual mental confusion; frequently seeing black flowers in the air, followed by double vision, perceiving one as two. Lingshu. Dahuo Lun states: "When the essence scatters, double vision occurs, hence seeing two objects." It is often accompanied by dizziness, tinnitus, soreness and weakness in the waist and knees, a thin tongue coating, a red tongue body, and a thin, weak pulse, indicating deficiency of both the liver and kidney. Treatment should focus on nourishing the liver and benefiting the kidney, enriching yin and improving vision. The recommended formula is Wolfberry and Chrysanthemum Rehmannia Pill.
3. Excessive Fire︰Blurred vision, with flies and butterflies dancing before the eyes, or like hanging spiderwebs, or like thin mist and light fog, painless and non-itchy, gradually worsening until blindness occurs. Accompanied by bitter taste in mouth, dry throat, irritability, insomnia, and dreamful sleep. The tongue is red, and the pulse is thin and rapid. Often caused by overexertion of the mind, excessive consumption of pungent and hot foods, sudden anger or pent-up depression, imbalance of liver-wood, and internal retention of heart-fire, which scorches the aqueous humor and vitreous humor, leading to turbidity of Solomonseal Rhizome within the pupil. Hence, blurred vision occurs, with the sensation of flies' wings fluttering before the eyes, gradually progressing to blindness. Additionally, it is accompanied by bitter taste in mouth, dry throat, irritability, insomnia, red tongue texture, and a thin, rapid pulse—signs of blazing heart-liver heat. Treatment should focus on clearing the liver and draining the heart, nourishing yin and discharging heat, using the formula Yin-Nourishing Rehmannia Pill.
4. Fetal Affliction︰The infant is unable to distinguish objects immediately after birth, with the pupil appearing turbid due to Solomon's seal rhizome and a white nebula in the aqueous humor obstructing the pupil. It is often accompanied by other intraocular pathologies or congenital malformations. The condition is mostly caused by improper maternal diet during pregnancy, excessive consumption of spicy or rich foods, poor rest, other illnesses, or fright, which affect fetal development and result in internal visual obstruction at birth. Early detection is difficult, but careful observation may reveal the infant's lack of speech, laughter, or visual responsiveness. Clinical treatment is often ineffective.
5. Fright Shock︰The eyeball suffers a contusion injury, and the pupil gradually becomes turbid with Solomonseal Rhizome, leading to visual mental confusion, or even the ability to only distinguish the three lights. This condition is often caused by external trauma, which disturbs the aqueous humor and vitreous humor, damaging the Solomonseal Rhizome and causing turbidity, hence the visual mental confusion. Treatment should focus on promoting blood circulation and resolving stasis, using the Jingxiao Powder.

The condition known as internal visual obstruction is caused by the clouding of the Solomonseal Rhizome within the pupil. In its early stages, the degree of clouding is mild and often obscured by the iris, making it difficult to detect. It generally does not affect vision initially, and the pupil must be dilated to observe it. The appearance and color vary, with shapes resembling jujube flowers, crowns, or sword ridges, and colors ranging from bluish-white, yellow-centered, to brownish-brown. As the internal visual obstruction progresses, it gradually obscures the pupil, leading to a decline in vision. Eventually, the pupil becomes fully obstructed, leaving only the ability to discern the movement of people and objects, as well as the light of the sun, moon, and fire. The pupil remains flexible, contracting in bright light and dilating in dim light. Regardless of the specific symptoms and signs, treatment should involve the golden needle technique for removing the obstruction or other surgical methods. As stated in the Michuan Yanke Longmu Lun: "At this stage, medication is ineffective, and rest often fails to help. Over time, complete darkness ensues, specifically named internal visual obstruction of both pupils. The condition is divided into sixteen types, as deduced by the sage Longmu. Spiritual remedies are equally ineffective, but the golden needle technique can clear the obstruction, restoring vision as bright as daylight."

bubble_chart Documentation

1. Zhangshi Yitong: "The condition of internal visual obstruction is all caused by the invasion of deficiency-type pathogens, the uprising of liver qi, and the inability to expel externally, leading to coagulation and formation. Therefore, it often afflicts those who are irritable and prone to anger. At the initial stage, there is no pain or itch, but vision becomes slightly blurred, or hazy like light smoke or thin fog. Subsequently, black spots often appear in the air, or like flies flying or ants hanging, seeing one as two, the pupil gradually changes color, leading to blindness. Initially, one eye is affected first, then the other follows, and those who can still perceive the three lights can be treated. If the three lights are already extinguished, even if Longshu were to reappear, it would be difficult to reverse. Although the ancients established many names, they ultimately did not go beyond the distinction of having water or not. If there is water and the luster is clear and bright, it is easy to treat; if there is no water and it is not bright, it is difficult to treat. If it suddenly becomes large or small, contracting and expanding like steam, acupuncture will immediately clear it; if it remains fixed and unmoving after prolonged observation, it is a dead nebula, and even if the water is not dried up, it is difficult to fully recover. Nebula that is white or tinged with blue, or like furnace ash, or rough rice color is easy to treat; if it is truly green or pure yellow, it is incurable. Regardless of the color of the nebula, if it has edges and corners, it is difficult to remove by scraping; if the nebula is broken and scattered, and the center is dense, it cannot be removed by scraping. If the patient can still see, the nebula is still tender and should not be needled. Wait until the nebula matures, then needle it. There is also a type of nebula that, although the color is correct, and even if the water is not dried up, the eyeball is soft and collapsed, this is certainly incurable, and the golden needle should not be used lightly. If one eye becomes dark first, and the three lights are already extinguished, and the other eye subsequently becomes affected, it is also difficult to treat with acupuncture. If the pupil is dilated, or tightly constricted, or completely black, or changes color without obstructive nebula, and cannot perceive the three lights, this is due to internal water deficiency and is not within the scope of treatment."