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Bi Ren-jun (1902–1985), a native of Li County, Hunan, was proficient in ophthalmology and renowned in Hunan and Hubei. He was highly respected and esteemed, being one of the senior figures in the field of Chinese medicine in Hunan Province. He was honored with the title of "Model Worker of Hunan Province" in 1983. With 62 years of clinical experience, he excelled in using attacking and harmonizing formulas to treat eye diseases and was skilled in inspection. His academic experience was unique and distinctive.

1. Preference for Attacking Methods

Attacking methods include inducing sweating, vomiting, purging, clearing heat and detoxifying, promoting blood circulation and removing stasis, bloodletting with acupuncture, and nasal administration of medicine, among other techniques to expel pathogens. The *Neijing* states: "Taiyang disease should be warmed and dispersed, Yangming disease should be purged and cooled, Shaoyang disease should be harmonized, and Shaoyin disease should be cleared." Zhang Zi-he, in treating eye diseases, strongly advocated for attacking pathogens. Based on the nature and location of the pathogens, he established the three methods of sweating, vomiting, and purging to combat them. Zhang stated: "The key to treating diseases lies in expelling pathogens. Once pathogens are removed, the body's normal state is restored. One should not fear attacking methods and allow the disease to persist." "For sudden eye diseases in adults, sweating, purging, and vomiting are appropriate. Since the blood is on the surface, sweating is suitable; since the fire is in the upper part, vomiting is suitable; and since the heat is in the middle, purging is suitable. Bloodletting and sweating, though named differently, achieve the same result." He strongly advocated for using bloodletting to treat eye diseases, stating: "For treating fire, in terms of medicine, salty and cold substances should be used to induce vomiting and purging. In terms of acupuncture, points such as Shenting (GV24), Shangxing (GV23), Xinhui (GV22), Qianding (GV21), and Baihui (GV20) should be bled. Nebula can be immediately reduced, pain can be immediately relieved, blurred vision can be immediately cleared, and swelling can be immediately reduced."

Dr. Bi consistently admired Zhang Zi-he's theory of attacking methods. Through long-term clinical practice, he accumulated a unique set of experiences in treating eye diseases primarily through attacking methods. For example, in treating green glaucoma (acute angle-closure glaucoma), based on the pathological understanding of internal injury from emotional factors, liver fire attacking upward, affecting the stomach, and blood stasis in the collaterals, he often used modified Liver-Draining Decoction (containing Coptis, Skullcap Root, Pepperweed Seed, Trogopterus Dung, Rhubarb Rhizoma, Cimicifuga Rhizome, Mirabilite, White Chrysanthemum, Red Peony Root, Mint, Saposhnikovia Root, Gardenia, Scouring Rush Herb, Dried Tangerine Peel, Asarum, and Licorice Root) or modified Major Bupleurum Decoction (containing Bupleurum, Skullcap Root, Moutan Bark, Gentian Root, Trogopterus Dung, Chinese Angelica, Poria, Immature Orange Fruit, Wine-processed Rhubarb, Pinellia, Peony Root, and Licorice Root) to purge liver and gallbladder, subdue rebellious qi, and regulate the triple energizer. Externally, he used Biyun Powder (containing Small Centipeda Herb, Sichuan Lovage Rhizome, and Indigo) for nasal administration to open the blockage in the head and promote the expulsion of pathogens through tears and nasal discharge. He also used a three-edged needle to bleed points such as Baihui (GV20), Luoque (BL8), Taiyang (EX-HN5), and Shangyang (LI1) to relieve stagnation in the meridians and collaterals and expel excess pathogens from the blood. Using the above formulas, he treated 25 cases of green glaucoma (acute angle-closure glaucoma), with 10 cases cured, 5 cases showing significant improvement, and an overall effective rate of 85%. These formulas were also commonly used to treat fundus diseases.

For example, Ms. Han, 41 years old, suffered from high myopia in both eyes complicated by macular hemorrhage. Her vision was reduced to only being able to count fingers at a distance of one foot. She experienced blurred vision, a red shadow covering her visual field, pain in the forehead and back of the neck, chest stuffiness with nausea, coughing up thick phlegm, scanty dark urine, constipation, a dark red tongue with a thin grayish-yellow coating, and a slippery and rapid pulse. She was diagnosed with fog moving before the eyes (vitreous opacity) syndrome, caused by damp-heat in the liver and gallbladder transforming into dryness, accumulating in the stomach and bladder, and attacking the seven orifices. Therefore, it was appropriate to clear and purge the liver and gallbladder, guiding the pathogenic factors downward to expel internal heat. Initially, modified Major Bupleurum Decoction (containing Bupleurum, Trogopterus Dung, Moutan Bark, Bitter Apricot Seed, Gentian Root, Pubescent Angelica, Saposhnikovia Root, Pinellia, Aloes, Immature Orange Fruit, Wine-processed Rhubarb, Skullcap Root, Poria, Achyranthes Root, Gardenia, Talc, and Licorice Root) was prescribed. After four doses, her bowel movements and urination improved, the pain in her forehead and neck decreased, and the red shadow in her vision significantly faded. Later, Minor Bupleurum Decoction combined with aromatic damp-resolving substances and modified Yishen Qi Pill were used. The macular hemorrhage resolved, and her corrected vision recovered to 0.8 in both eyes.

Dr. Bi also favored using modified Liver-Clearing Powder (containing Notopterygium, Sappan Wood, Peach Kernel, Unprocessed Rehmannia Root, Poria, Mulberry Bark, Gentian Root, Coptis, Wine-processed Rhubarb, Skullcap Root, Aloes, Red Peony Root, Chinese Angelica, Licorice Root, and Bitter Apricot Seed) to treat excess fire syndromes in the fundus. He believed that a high dose of Aloes was particularly effective for optic neuritis and retinal hemorrhage.

Blood stasis syndrome is quite common in ophthalmic clinical practice. Stasis means obstruction, and obstruction leads to pain, swelling, bleeding, turbidity, hardening, and atrophy. Blood stasis and obstruction are indeed the pathological basis for eye pain, swelling, bleeding, turbidity, hardening, and atrophy. When blood stasis stagnates in Taiyang (EX-HN5), yangming, or when blood and water accumulate together, it hinders the infusion of zang-fu organ essential qi to the eye connector, preventing the brilliance from shining, leading to bluish blindness (optic atrophy), blurring vision, fog moving before the eye (vitreous opacity) and other internal visual obstruction eye diseases. The mentor often uses Qing Shang Yu Xue Tang (Zhengzhi Zhunsheng formula: Notopterygium, Pubescent Angelica, Sappan Wood, Peach Kernel, Carthamus, Rhubarb, Skullcap Root, Chinese Angelica, Sichuan Lovage Rhizome, Unprocessed Rehmannia Root, Red Peony Root, Liquorice Root, Submature Bitter Orange, Forsythia, Gardenia, Platycodon Root) with modifications for treatment, achieving quite good results.

Tongzhong Pills and Shebing Powder are commonly used effective medicines developed by my mentor. The former is made from Croton Fruit frost and raw Rhubarb Rhizoma powder in a ratio of 1:10, formed into pills the size of soybeans. Strong individuals take 3-5 pills each time, while the elderly or weak take 2-3 pills, adjusted according to the degree of purgation. It treats the upper by addressing the lower, drawing fire from under the cauldron, and is widely adaptable and simple to use. The latter is made from 2g of musk, 30g of flying Cinnabar, 90g of Tianqi powder, 30g of Dragon's Blood Resin, 2g of Mentha brain, and 1g of borneol, all finely ground. Each time, take 1-3g, place it on the tongue, and wait for it to dissolve before swallowing with Chinese medicinal juice or warm water. It usually induces expectoration of phlegm within 2-3 hours, often achieving effects such as resolving cold phlegm, dispersing stagnant qi, dissipating blood stasis, relieving pain, unblocking obstructions, and curing chronic illnesses.

II. Skilled in Harmonization

The method of harmonization is essential for treating stagnation syndromes. Stagnation refers to the imbalance between the exterior and interior, yin and yang, qi and blood, nutrient and defense, zang-fu organs, and meridians and collaterals. In the "Treatise on Cold Damage," formulas like Minor Bupleurum Decoction, Cinnamon Twig Decoction, Cold-Limbs Powder, Angelica and Peony Powder, Coptis Decoction, and Pinellia Heart-Draining Decoction are designed to harmonize the exterior and interior, nutrient and defense, liver and spleen, and intestines and stomach. Zhu Dan-xi observed in clinical practice that stagnation syndromes are a crucial pathological phenomenon, with many diseases arising from stagnation. He stated, "When qi and blood are peaceful, all diseases are absent; once stagnation occurs, various diseases arise." He categorized stagnation syndromes into six types: qi stagnation, blood stagnation, phlegm stagnation, fire stagnation, damp stagnation, and food stagnation, proposing corresponding treatments for each.

Shenshi Yaohan notes: "The eyes belong to the liver, and the liver governs anger. Anger stirs fire and generates phlegm, which blocks the liver and gallbladder meridians, obscuring the orifices of vision, leading to blurred vision like smoke or fog. The more the eyes are blurred, the more depression arises. Hence, it is said: prolonged illness leads to stagnation, and prolonged stagnation leads to illness." My mentor has extensively researched stagnation syndromes in ophthalmology, believing that the eyes are closely connected to the zang-fu organs and meridians and collaterals. Dysfunction in any zang-fu organ or meridian and collateral can produce pathological reactions in the eyes, forming various stagnation syndromes. In clinical practice, for eye diseases caused by psychological factors, endocrine disorders, unknown causes, or those resistant to long-term treatment, he advocates using harmonization methods first. Commonly used formulas include Minor Bupleurum Decoction, Bupleurum and Poria Decoction (a combination of Minor Bupleurum Decoction and Five Ingredients with Poria Powder), Qi-Regulating Decoction (composed of Peony Root, Dried Tangerine Peel, Unprocessed Rehmannia Root, Phellodendron Bark, Cyperus, Anemarrhena, Chinese Angelica, Sichuan Lovage Rhizome, Pubescent Angelica, Bupleurum, Peach Kernel, Carthamus, Skullcap Root, Poria, Gentian, and Liquorice Root), and Peony and Gardenia Peripatetic Powder. These formulas share a notable characteristic: they combine attacking and tonifying, clearing and warming.

Additionally, acupuncture therapy also possesses harmonizing effects. Its principle lies in adjusting various internal dysfunctions and metabolic disorders, unblocking meridian stagnation and obstruction, thereby resolving contradictions such as yin-yang imbalance, qi and blood disharmony, and nutrient-defense disharmony, and alleviating pathological states like eye pain, swelling, bleeding, atrophy, and turbidity. The regulating effect is not only multifaceted but also bidirectional, capable of addressing different pathological changes such as cold, heat, deficiency, and excess. Therefore, my mentor often employs it. For example:

A patient, Yang, experienced sudden blindness in both eyes for three days. Upon consultation, the patient had distending pain in both eyeballs, tenderness in the brow bones, irritability, nausea, mental fatigue, lack of strength, shortness of qi, reluctance to speak, poor appetite, dull complexion, a crimson tongue without coating, and a wiry, thin, and rapid pulse. Fundus examination revealed blurred optic disc margins, engorged retinal veins, and scattered retinal hemorrhages. The syndrome was identified as liver and kidney deficiency with rising deficient fire, blocked sweat pores, and impaired qi and blood circulation, preventing the brilliance of vision. Immediate acupuncture therapy was applied to unblock meridians and collaterals and regulate qi and blood. Acupoints used were Jingming (BL1), Qiuhou (EX-HN7), Fengchi (GB20), Hegu (LI4), Guangming (GB37), and Zusanli (ST36). After 30 minutes of needling, vision improved, allowing the patient to see shadows within 5 meters. After 2 hours, the patient could distinguish genders. After five consecutive acupuncture sessions, vision in both eyes recovered to 1.5.

III. Proficient in Inspection

"To know by observation is called divine," with observation being the foremost among the four examinations. The Lingshu·Lunji Zhenchi chapter states: "For eye pain, if the red vessels extend from above to below, it is a Taiyang disease; if they extend from below to above, it is a Yangming disease; if they extend from the outside inward, it is a Shaoyang disease." This provides a theoretical basis for the differentiation of syndromes in ophthalmology based on meridians and collaterals. "The orbiculi are diagnosed by the overall shape and color, while the regions are diagnosed by the blood vessels and silk-like collaterals on the orbiculi." Books such as Zhengzhi Zhunsheng, Shenshi Yaohan, and "Yinhai Zhinan," which advocate the theory of five orbiculi and eight regions, all place ocular inspection in the first position. Building on the experience of predecessors, our mentor has refined and deepened the study of the relationship between the eyes and the zang-fu organ meridians and collaterals. He attributes the upper and lower eyelids to the foot Taiyin spleen meridian (SP) and the foot Yangming stomach meridian (ST), respectively. He believes that a yellow face with red eyes and moist, ulcerated palpebral margins are mostly due to damp-heat in the spleen and stomach meridians; swollen eyelids with frequent sores, photophobia, and tearing are mostly due to excess fire in the spleen and stomach; and puffy or drooping eyelids are mostly caused by spleen deficiency, blood deficiency, or stagnation of the meridians and collaterals.

The inner and outer canthus are respectively attributed to the hand shaoyin heart meridian (HT) and the hand taiyang small intestine meridian (SI). Red vessels appearing in the inner and outer canthus indicate pericardium fire invading the lung. Dark purple vessels suggest stagnant heat in the heart, deep dark purple indicates prolonged invasion of blood heat, and dry dark purple signifies excessive heat in the heart, small intestine meridian, and yang qiao, damaging body fluids. Frequent bleeding from the outer canthus or pus discharge from the inner canthus often indicates heart meridian fire toxin. Specifically, the inner canthus belongs to the heart meridian, and redness there signifies excessive heart fire; the outer canthus belongs to the small intestine meridian, and redness there indicates insufficient heart fire. The inner canthus is also a convergence point for the foot taiyang, hand yangming meridians, as well as the yang qiao, yin qiao, and governor vessel (GV), making it prone to excess heat. The outer canthus is connected to the hand and foot taiyang meridians and the pericardium, where qi is abundant but blood is scarce, so redness in the outer canthus often indicates blood deficiency.

The white of the eye belongs to the hand taiyin lung meridian (LU) and the hand yangming large intestine meridian (LI). Hyperemia of the ocular conjunctiva, swelling, and eye discharge indicate heart fire invading lung metal. Yellowing of the white of the eye with tearing and itching suggests spleen and stomach damp-heat stagnating in the lung. Blue whites of the eye (late-stage scleritis) indicate liver and gallbladder pathogenic heat stagnating in the lung. Dryness and pain in the white of the eye suggest latent heat in the lung. Purple veins resembling worms indicate intense wind-heat fire. Bright red and shallow vessels are associated with new diseases and are easier to treat, while deep dark purple vessels indicate prolonged illness with blood stasis. The black of the eye belongs to the foot jueyin liver and gallbladder damp-heat. Pure yellow color with wateriness suggests excessive spleen damp-heat entering the gallbladder. Yellow color like brown sugar often results from alcohol toxicity. Turbid and dull black of the eye indicates heart fire scorching lung fluids and liver yin. A dark black of the eye with blurred boundaries with the pupil, accompanied by headache and blurred vision, often indicates stagnant blood accumulating in the eye. Intense liver and gallbladder heat attacking the eyes most easily causes star-like nebula in the black of the eye.

The pupil is attributed to the kidney and bladder meridians. The kidney governs bones, and the essence of bones forms the pupil, which is the condensation of the essence of the five zang-organs and six fu-organs. It contains vitreous humor, aqueous humor, divine light, true blood, and vital qi, nourished by true essence, enabling it to distinguish black and white, judge length, observe fine details, and see far and near. Damage to the pupil leads to internal visual obstruction. Based on inspection, internal visual obstruction can be divided into two categories: overt and covert. Changes in color or shape of the pupil indicate overt internal visual obstruction, while no changes indicate covert internal visual obstruction. Both types involve varying degrees of vision loss, such as seeing through a veil, walking in fog, black flies flying, spider silk floating, seeing straight as crooked, seeing stillness as movement, seeing red as white, seeing objects upside down, flashes, and sudden blindness. To thoroughly examine pupil pathologies, my mentor learned fundus examination in the 1930s. Through long-term clinical observation, he concluded that the fundus (retina) is most closely related to the triple energizer and pericardium. The triple energizer governs qi, and the pericardium governs blood; they are internally and externally connected, regulating the circulation of qi and blood, and the balance of water and fire. If the heart spirit is disturbed, water and fire clash, sweat pores become blocked, qi and blood stagnate, leading to the loss of brilliance. A fundus with full vessels, accompanied by punctate hemorrhages or gray-white exudates, indicates yin deficiency with internal heat, where water is scarce and fire is abundant. Dark purple vessels suggest intense liver and gallbladder fire with qi stagnation and blood stasis. Blocked vessels indicate blood stasis. Thin and yellow vessels often result from excessive liver yang, kidney yin deficiency, or insufficient qi and blood. Fundus edema is often caused by triple energizer ministerial fire, steaming water into qi, ascending with cold water, or impaired qi movement. A turbid fundus often results from excessive triple energizer heat transforming into dryness, damaging fundus vessels, and causing body fluids to overflow. The eye connector (optic nerve) is most closely related to the kidney, heart, and liver. A deep red eye connector with blurred boundaries often indicates heart fire flaring up or intense liver and gallbladder fire. A waxy yellow or pale eye connector with thin fundus vessels often suggests insufficient kidney essence and liver blood deficiency. A pale yellow or turbid eye connector often indicates excessive ministerial fire, boiling heat, and damage to the eye connector.

In addition to the three aspects mentioned above, the academic experience of our mentor also includes the characteristics of phased treatment and the preference for combining multiple formulas. Taking the treatment of internal visual obstruction eye disease as an example, the early stage generally focuses on harmonization, the middle stage on promoting blood circulation and removing stasis, and the later stage on nourishment. Initially, a decoction is taken to improve symptoms, followed by pills to consolidate the therapeutic effect. For external ophthalmopathy eye disease, the approach often starts with aggressive treatment, followed by harmonization or nourishment. In terms of formulating prescriptions and selecting medications, he prefers to combine drugs from several aspects or merge two or more formulas, resulting in a relatively large number of selected medications, typically between 12 to 18, but with lighter dosages, which is basically similar to the number of ingredients in the main formula created by Yuanji Qiwei. Rooted in the Neijing and the "Treatise on Cold Damage Diseases," he boldly applied the theories of Zhang Zi-he and Zhu Dan-xi to ophthalmic practice, drawing on the academic essence of renowned ophthalmologists such as Ni Wei-de and Fu Ren-yu. I believe this is the reason for our mentor's achievements in ophthalmology.