bubble_chart Concept

Visual distortion refers to the symptom where the appearance of the diseased eye is normal, but objects appear tilted and their forms distorted.

This condition was first mentioned in Zhengzhi Zhunsheng. Zabing Chapter. The symptoms of seeing straight objects as slanted and visual distortion were clearly pointed out: "Objects that are straight are seen as slanted by the eye, which is a sign of yin-yang imbalance and the scattering of divine light.… Straight objects like bowstrings and rulers are seen as curved." The "Yinhai Zhinan. Shenjing Zhubing" also mentions "seeing straight objects as horizontal." Shenshi YaohanZhangshi Yitong "Ophthalmology Essence Record" and others refer to it as "delusional vision," which includes symptoms like "seeing straight as slanted," "seeing small as large," "seeing large as small," "visual distortion," and more. Mujing Dacheng refers to it as "visual confusion." Based on clinical observations, "visual confusion" should be the general term for visual variations, which is now simply called "visual distortion."

bubble_chart Common Symptoms and Signs

1. Liver-kidney yin deficiency visual distortion: manifests as visual distortion, seeing large as small, accompanied by dizziness, dry mouth and eyes, tinnitus, insomnia, sore waist, seminal emission, or five-center heat, night sweating, red tongue with little coating, and thin rapid pulse.
2. Liver qi depression visual distortion: seeing straight as slanted, seeing large as small, headache, eye distension, accompanied by irritability, chest and rib fullness, poor appetite, women's menstrual irregularities or premenstrual breast distension, slightly yellow thin greasy tongue coating, and wiry pulse.
3. Spleen deficiency and weak qi visual distortion: seeing straight as slanted, seeing large as small, continuous headache, poor appetite, loose stools, accompanied by fatigue, shortness of breath, pale and swollen tongue, and deep thin pulse.
4. Deficiency of both heart and spleen visual distortion: seeing large as small, seeing straight as slanted, visual fatigue, weak eyelid strength, palpitations, forgetfulness, poor appetite, restless sleep, pale tongue with thin coating, and thin pulse.
5. Qi stagnation and blood stasis visual distortion: seeing straight as slanted, seeing large as small, symptoms varying in severity, often triggered by fatigue, dark purple tongue or with stasis spots, and thin choppy pulse.

1. Liver-kidney yin deficiency visual distortion: mostly caused by excessive sexual activity damaging essence, mental exhaustion damaging blood, leading to essence and blood deficiency, unable to nourish the seven orifices, resulting in visual variations. The key points of differentiation are dizziness, tinnitus, dry mouth and eyes above, and sore waist, seminal emission below. Yin deficiency leading to internal heat manifests as five-center heat, night sweating, bitter mouth, and irritability. Treatment should focus on nourishing water to moisten wood, using formulas like Lycium and Chrysanthemum Rehmannia Decoction or Eyesight-Improving Rehmannia Pill, with additions like Gordon Euryale Seed and Cherokee Rose Fruit to benefit the kidneys and secure essence. If yin deficiency with effulgent fire, treatment should focus on nourishing yin and reducing fire, nourishing blood and activating blood, using formulas like Yin-Nourishing and Fire-Reducing Decoction or Anemarrhena and Phellodendron Rehmannia Decoction with modifications.
2. Liver qi depression visual distortion: mostly caused by mental stimulation, emotional depression, constraining of liver qi, leading to poor nourishment of the eye orifices; the liver meridian distributes to the chest and ribs, liver meridian qi and blood stagnation causes chest and rib fullness; stomach disharmony causes poor appetite; qi depression transforming into fire ascending causes headache, eye distension, irritability; liver failing to disperse causes menstrual irregularities. Treatment should focus on soothing the liver and relieving depression, using formulas like Peony and Gardenia Peripatetic Powder minus Fresh Ginger Rhizome, with additions like Motherwort Fruit and Cassia Seed.
3. Liver-kidney yin deficiency causing visual distortion and liver qi depression causing visual distortion: one is a deficiency pattern, due to yin deficiency with effulgent fire, malnourishment of the seven orifices, and disturbance by fire; the other is an excess pattern, due to liver depression transforming into fire, which ascends to disturb the eye orifices. The two are not difficult to distinguish.
4. Spleen deficiency leading to weak qi and distorted vision: Often caused by impaired spleen function, failure to transform dampness, sinking of clear yang, and turbid yin accumulating in the eye orifices; or dampness rising to the eyes. Key diagnostic points include poor appetite, loose stools, fatigue, shortness of breath, sallow complexion, and persistent headache due to insufficient nourishment of the seven orifices. Treatment should focus on tonifying qi and raising yang, regulating the spleen and stomach. Recommended formulas are Middle-Tonifying Qi-Replenishing Decoction or Cyperus, Amomum and Six Gentlemen Decoction with fried coix seed to invigorate the spleen and drain dampness.
5. Deficiency of both heart and spleen causing distorted vision: Often due to overexertion damaging the heart and spleen, leading to qi and blood deficiency, empty meridians, and insufficient blood to nourish the eyes. Key diagnostic points include visual fatigue, weak eyelid muscles, poor appetite, palpitations, forgetfulness, insomnia, and loose stools. Treatment should focus on tonifying and replenishing the heart and spleen. Recommended formulas are Returning to Spleen Decoction with modifications or Yang-Assisting and Blood-Activating Decoction with modifications.
6. Spleen qi deficiency causing weak vision and distorted vision versus deficiency of both heart and spleen causing distorted vision: The former is due to qi deficiency, while the latter involves both qi and blood deficiency, leading to symptoms like palpitations and forgetfulness due to insufficient blood nourishing the heart. These should be differentiated.
7. Qi stagnation and blood stasis causing distorted vision: Often caused by trauma or chronic illness, leading to qi stagnation in the meridians, poor blood circulation, and pain due to obstruction. Key diagnostic points include distending pain in the head and eyes, distorted vision, and a prolonged course of illness. Treatment should focus on activating blood and breaking blood stasis. Recommended formulas are Blood House Stasis-Expelling Decoction or Peach Kernel, Carthamus and Four-Ingredient Decoction, with additions like Prunella, Sparganium Rhizome, and Zedoary Rhizome to soften hardness and dissipate masses. If residual pathogenic factors remain and healthy qi is not restored, consider adding Tangshen, heterophylly falsestarwort root, and raw Astragalus Root to tonify qi, activate blood, and reinforce healthy qi while eliminating pathogenic factors.

bubble_chart Literary Supplement

1. Lingshu. Dahuo Lun: "When the heart has joy and the spirit has aversion, sudden interaction causes essential qi to become chaotic, leading to visual errors and confusion."
2. Zhengzhi Zhunsheng. Zabing Chapter. "Seeing the correct as incorrect pathogenic factor pattern": "When objects are correct but the eyes perceive them as incorrect, it is due to yin-yang imbalance, with the spirit light about to scatter. Yang excess over yin is caused by indulgence in spicy food and alcohol, anger, head wind, and phlegm-fire qi damage. Yin excess over yang is caused by excessive sexual activity, crying, and dietary imbalances, leading to blood damage from menstruation or childbirth. This internal stagnation of sweat pores causes qi to be heavier on one side, resulting in biased and incorrect fire. Treatment involves nourishing the root and addressing the branch."
3. "Ophthalmic Golden Mirror. Seeing Big as Small Syndrome": "Caused by prolonged stagnation of pathogenic heat in the liver and kidneys. The liver governs the eye orifices, and the kidney governs the eye essence. Anger damages the liver, fear damages the kidney, and damage to these two organs, combined with heat scorching true yin, causes seeing big as small. For example, a large fire casts a small shadow, while a small fire casts a large shadow. Treatment involves clearing heat and enriching yin."