bubble_chart Concept

The term "eye star nebula" refers to the symptom of small star-like spots appearing on the black of the eye, gradually forming a nebula obstruction.

As early as Shennong Bencao Jing, there are records of using ash bark and other medicines to treat eye nebula. Zhubing Yuanhou Lun states: "There is a nail inside the eye," Michuan Yanke Longmu Lun describes it as "deep-rooted nail nebula external ophthalmopathy," "fulminant red eye with acute nebula (epidemic keratoconjunctivitis)," and "petaloid nebula with a sunken center (ulcerative keratitis) external ophthalmopathy." Zhengzhi Zhunsheng．Seven Orifices Gate provides a more detailed explanation of star nebula, supplementing conditions such as "star-shaped nebula," "clustered stars nebula (herpes simplex keratitis)," and "congealed-fat nebula (purulent keratitis)." "Eye star nebula" is often confused with "eye cloudy nebula." "Star nebula" is either floating and tender or sunken, accompanied by pain, photophobia, and tearing; whereas "cloudy nebula" has a smooth surface without the pain and photophobia, and should be distinguished accordingly.

bubble_chart Pattern Analysis

1. Wind-heat in the Liver Meridian︰A star nebula appears on the black of the eye, showing a bluish-white color. Initially, it is slightly raised, then ulcerates and becomes depressed, with mild pain, photophobia, and tearing. The tongue coating is thin and yellow, and the pulse is wiry and rapid. **Wind-heat of the Liver Channel Star Nebula vs. Excessive Heat Toxin Star Nebula!** The black of the eye belongs to the liver. When pathogenic heat ascends along the liver channel and scorches the eye, a star nebula forms on the black of the eye. In **wind-heat of the liver channel**, there is accumulated heat in the liver combined with external contraction of wind pathogens. Wind and heat clash and attack the eyes, resulting in a small, bluish-white star nebula that is slightly raised at first, then ulcerates and becomes tender, accompanied by photophobia and tearing. Treatment should focus on **dispersing wind and clearing heat**, as well as **dissolving the nebula and improving vision**. The prescription used is **Cicada Slough and Chrysanthemum Flower Powder**, with the addition of **Puncturevine Caltrop Fruit** and **Buerger Pipewort Flower**. If the star nebula persists for a long time, the **Ferula nasal insufflation method** can be employed. In cases of **excessive heat toxin**, heat toxin and fire pathogens combine and fill the triple energizer. The star nebula may appear clustered, scattered, thread-like, or branched, resembling congealed fat. It is large and yellow, with severe pain, photophobia, and tearing. In extreme cases, upward rushing of yellow fluid (hypopyon) may occur, and the black of the eye may ulcerate, leading to protrusion like a crab's eye. Treatment should focus on **clearing heat and purging fire**, as well as **cooling blood to remove toxins**. Prescriptions such as **Four-Ingredient Cooling Beverage Decoction** or **Red Swelling Nebula and Obstruction Formula** can be used.
2. Heat Toxin Exuberance︰Black of the eye develops fine star nebula, appearing gray-white or slightly yellow, with indistinct edges, central depression, or flat elevation. It may arise successively or all at once, covering the entire eye, either clustered or scattered. Some resemble silk threads or tree branches, while others coalesce into patches with a yellow membrane resembling congealed fat. As the condition progresses, the black of the eye may ulcerate and protrude like a crab’s eye, accompanied by pain, photophobia, and hot tears like boiling water. The tongue coating is yellow, the tongue body red, and the pulse wiry, slippery, and rapid. **Wind-heat in the Liver Channel Star Nebula vs. Heat Toxin Congestion Star Nebula** The black of the eye belongs to the liver. When pathogenic heat ascends along the liver channel, it scorches the black of the eye, leading to star nebula. In cases of wind-heat in the liver channel, accumulated liver heat combines with externally contracted wind pathogens. Wind and heat clash and attack the eyes, resulting in small, bluish-white star nebula that initially appear slightly raised before ulcerating and becoming tender. Symptoms include photophobia and tearing. Treatment should focus on dispersing wind and clearing heat to dissolve nebula and improve vision. The prescription used is **Cicada Slough and Chrysanthemum Flower Powder**, supplemented with **Puncturevine Caltrop Fruit** and **Buerger Pipewort Flower**. If the star nebula persists, **Ferula Nasal Insufflation** may be applied. In cases of heat toxin congestion, heat toxin and fire pathogens bind together, flooding the triple energizer. The star nebula may cluster, scatter, resemble silk threads or tree branches, or appear like congealed fat—large, yellow, and extremely painful, with severe photophobia and tearing. In severe cases, upward rushing of yellow fluid (hypopyon) occurs, and the black of the eye ulcerates, forming a crab-eye protrusion. Treatment should focus on **clearing heat and purging fire, cooling blood to remove toxins**. Prescriptions include **Four Agents Cool and Clear Beverage** or **Red Swelling Nebula Obstruction Formula**.
3. Kidney Yin Deficiency︰Star nebula inward invasion, red and dull with slight photophobia, no obvious pain or tearing, dizziness and dizzy vision, soreness and weakness of the waist and knees, nocturnal emission efflux diarrhea, red tongue with scant coating, thready and rapid pulse. Due to yin deficiency failing to nourish the eyes, with lingering deficient heat, symptoms such as dizziness and dizzy vision, soreness and weakness of the waist and knees, nocturnal emission efflux diarrhea, etc., are observed. The treatment should focus on tonifying the kidneys and enriching yin, removing nebula and improving vision. The prescription uses Six-Ingredient Rehmannia Pill with the addition of buerger pipewort flower, Puncturevine Caltrop Fruit, Plantain Seed, etc.
4. Deficiency of Both Qi and Blood︰The nebula is sunken, with mild redness, pain, photophobia, and tearing. The body is weak, the complexion is pale, there is shortage of qi and reluctance to speak, the tongue is pale with thin coating, and the pulse is thin and weak. Due to spleen-stomach weakness, the source of generation and transformation is insufficient, and qi and blood fail to rise and nourish, leading to symptoms such as a pale face, emaciation, shortage of qi, and reluctance to speak. The treatment should focus on tonifying qi, strengthening the spleen, nourishing the nutritive level, and tonifying blood. The recommended formula is Eight Precious Ingredients Decoction with modifications.

The condition known as "nebula" in the eye is relatively common among eye diseases, and it can be differentiated into deficiency and excess types. The excess type is caused by heat, wind, or toxins, and is characterized by pain, tearing, photophobia, aversion to heat, and identifiable local morphological changes. Wind-heat in the Liver Meridian causes small, star-like nebulas, often one or two in number, which are easy to dissipate. When heat toxins are excessive, the nebulas may cluster, form interconnected strands resembling tree branches, or appear large and resemble solidified fat, indicating an acute and severe condition. The deficiency type is often due to kidney yin deficiency or dual deficiency of qi and blood, leading to inward invasion of the nebula, which persists for a long time. It can be easily distinguished by accompanying systemic symptoms, making differentiation straightforward.

bubble_chart Documentation

1. Suwen Bingji Qiyi Baomingji．Eye Theory: "When there is excessive wind-heat, or spots enter the eye, this is due to the exuberance of liver qi, manifesting on the surface. Once the nebula membrane has formed, it is evident on the surface and should be dispersed and removed; if treated incorrectly with purgatives, the pathogenic qi will contract internally, causing the nebula to deepen. When the pathogenic qi is unsettled, it is called a floating heat nebula; when the pathogenic qi is settled, it is called a sinking ice nebula; when the pathogenic qi is firmly settled and sinking, it is called a sunken nebula, and should be treated with substances that expel pathogens from the exterior, causing the pathogenic qi to move again, allowing the nebula membrane to float, assisted by medications that reduce the nebula, enabling it to recede on its own. Chronic conditions cannot be quickly resolved and should be treated over time."