Red, Blurry Eyes Made Worse by Cooling Herbs?

The opening: red eyes make everyone reach for cooling herbs — this time it made things worse

Your eyes turn red, things look fuzzy. What’s the first thing almost everyone does? “It’s heat, obviously!” So on go the wind-clearing, heat-dispersing herbs — clear the fire and the eyes should recover, right? But the patient in today’s case, treated by Doctor Xue Lizhai, the head of the Ming dynasty’s Imperial Medical Academy, was tripped up precisely by that “of course.” After taking the wind-clearing, heat-dispersing herbs, his eyes did not improve. They became more sensitive to light — and now his ears joined in, ringing and buzzing.

💬 Note from Doctor Luo: Doctor Xue Lizhai left more than three thousand case records. His range was unusually wide — gynecology, surgery, especially surgery — and Doctor Luo says he values Doctor Xue’s teaching precisely because Doctor Xue fits modern people so well: the patients in his case records live lives startlingly similar to ours. Today’s case will interest many listeners, because people constantly ask him: what about ear problems, eye problems, nose problems — these illnesses of the “openings,” the sense organs? What is really going on?

Who was the patient: Zhang Yugong the censor — a title Doctor Luo has never quite figured out

The patient was Zhang Yugong, whose official title was “geishi” (给事), also called “geishizhong” (给事中). Doctor Luo says that when he recorded his Lecture Room (百家讲坛) episodes years ago, he came across this title and puzzled over it for a long time — was it pronounced “ji” or “ji”? He searched many ancient texts and never settled it; when he finds reliable documentation he will tell everyone. In any case, this gentleman served in the imperial court.

💬 Note from Doctor Luo: Official titles appear constantly in classical case records; recognizing roughly what they mean is enough. The key is the illness. The geishizhong was a remonstrance official whose job was to review memorials and supervise court business — reviewing documents and worrying about state affairs all day. That is precisely a high-risk occupation for “overthinking and overexerting the heart” (lao xin guo du).

How sick was he: red, blurry eyes; cooling herbs only brought light sensitivity and ringing ears

The case record describes Mr. Zhang’s illness in four characters: mu chi bu ming (目赤不明) — red eyes, vision no longer bright or clear. His sight was failing. Everyone looked and said: red eyes — isn’t that fire? So he was given wind-clearing, heat-dispersing herbs — dispel wind, clear heat, it all seemed right on target.

And the result? Fan wei ming zhong ting (反畏明重听).

💬 Note from Doctor Luo: “Wei ming” means afraid of light — before, he could only see unclearly; now even light bothered him, so the eye condition had actually worsened. “Zhong ting” does not mean deafness; it means hearing with an echo, as if speaking inside a cave, everything buzzing. A problem in the eye, and now a problem in the ear — the illness suddenly looked much more frightening. If you have ever had that “hearing everything with an echo” feeling, that is zhong ting.

So the family urgently summoned Doctor Xue Lizhai.

A large but empty pulse: it looks strong, but it is weak

Doctor Xue felt the pulse: large and empty (mai da er xu).

Was this excess or deficiency? The pulse was “large” — it looked as if the upright qi were struggling against the pathogen, putting up a fight, full of vigor. But press down, and it was hollow. The largeness is a mask; the emptiness is the truth — this man’s upright qi was insufficient, and the body was trying hard to recover, which was exactly why it was beating out this big pulse.

💬 Note from Doctor Luo: Doctor Luo says he has some experience treating ear conditions and has seen a great many tinnitus patients, so he feels qualified to say: most of today’s ear and eye diseases are deficiency. They have to be built up slowly. Doctor Xue Lizhai grasped the essence at the first touch of the pulse — deficiency.

The cause: overthinking plus rich food — too much worry, too good a diet

Doctor Xue listed the causes. First: lao xin guo du — overexerting the heart with thought. Thinking about things all day — what does that consume? Heart blood. And worry and brooding also wound the spleen qi — everyone knows the saying: brooding injures the spleen. Day after day of scheming how to advance oneself, climb higher, make that next fortune — the upright qi is quietly burned away.

Second: yin shi shi jie — disordered diet. Eating had gone wrong. In Doctor Xue’s era the Ming dynasty was strong and people lived well; in his case records, a great many patients had simply eaten too richly and wrecked their spleen and stomach — exactly as the Huang Di Nei Jing (Yellow Emperor’s Inner Classic) says: “when diet exceeds measure, the spleen and stomach are injured” (饮食自倍，脾胃乃伤).

💬 Note from Doctor Luo: Doctor Luo jokes that modern people eat better than emperors — the emperor never had lobster; you can have lobster. Day after day of rich, fatty, sweet food — how could the spleen and stomach stay healthy? Think about the people around you: how many truly have strong digestion? Not many. Once the spleen and stomach are injured, upright qi falls short, and the body starts to malfunction. Mr. Zhang had both causes: a remonstrance official who wore out his mind, and a diet far too rich — and both wounded the spleen.

The prescription: Bu Zhong Yi Qi Tang as the base, plus four herbs to nourish blood and strengthen the spleen

Doctor Xue’s formula: Bu Zhong Yi Qi Tang (Tonify the Middle and Augment Qi Decoction), plus fu ling (poria), suan zao ren (sour jujube seed), shan yao (Chinese yam), shan zhu yu (cornus fruit), and wu wei zi (schisandra).

Bu Zhong Yi Qi Tang supplements the qi of the spleen and stomach and lifts the qi upward. Fu ling drains dampness — it unloads the burden of dampness so that clear yang can rise; fu ling looks like a diuretic that pushes water downward, but what it really does is lift the clear qi. Suan zao ren nourishes the blood and calms the spirit, nourishing the blood of the heart and liver. Shan yao (Huai yam) strengthens the spleen — and the lungs and kidneys as well. Shan zhu yu nourishes liver yin and the channel blood of the heart and liver. Wu wei zi supplements all five viscera and has a sour, astringent, gathering action.

💬 Note from Doctor Luo: The logic of this formula is clear: Bu Zhong Yi Qi Tang is in charge of “supplementing qi and lifting,” and the four added herbs are in charge of “nourishing blood and strengthening the spleen.” The eyes have an especially intimate relationship with blood — when blood is sufficient, vision slowly recovers. Blood is yin; when heart yin is moistened, heart fire does not blaze so fiercely, the blood vessels do not boil, and the openings — ears and eyes — naturally settle down.

The relapse: better at once, worse again after overwork — enter Shi Quan Da Bu Tang

The medicine brought dun yu (顿愈) — immediate recovery. The eyes and ears were both well.

But the illness returned: lao yi fu zuo (劳逸复作) — after exertion, it flared up again.

💬 Note from Doctor Luo: Remember this rule: whenever an illness worsens after exertion, in most cases it is deficiency. Work overtime for a week and the complaint suddenly surfaces — a little expenditure, some upright qi consumed, and the illness appears. That is deficiency.

This time Doctor Xue prescribed Shi Quan Da Bu Tang (All-Inclusive Great Tonifying Decoction), taken together with the earlier formula. What is Shi Quan Da Bu Tang? Si Jun Zi Tang (Four Gentlemen Decoction — the classic qi-tonifying formula) plus Si Wu Tang (Four Substances Decoction — the classic blood-tonifying formula) — the two great formulas for supplementing both qi and blood, together — with huang qi (astragalus) and rou gui (cinnamon bark) added. Tonify both qi and blood, combine it with the earlier Bu Zhong Yi Qi Tang plus fu ling, suan zao ren, shan yao, shan zhu yu, wu wei zi approach, and let it build slowly — and the illness resolved.

Li Dongyuan said it long ago: when clear yang rises, the eyes and ears work properly

Doctor Xue then laid out the theory. Li Dongyuan (李东垣) said: the qi of the channels all travels to the face and moves through the openings — it all moves upward. Clear qi is skilled at reaching the eyes and becoming sight; it reaches the ears and becomes hearing. When clear yang rises and the openings are unobstructed, their functions are normal.

But if a person broods too heavily, wounds the spleen and drains heart blood, then qi and blood run short; the spleen and stomach are injured and deficient, and heart fire instead blazes too strongly, so fluids become insufficient and the blood vessels boil — evil qi harms the openings and sight is lost (邪害空窍而失明). The eyes break down.

💬 Note from Doctor Luo: Doctor Xue also said: the spleen is the head of all the yin organs, and the eye is the ancestor of the blood vessels — the eye needs blood to see, and eye disease is intimately tied to blood. The spleen and stomach absorb the essence of food and drink and transform it into qi and blood; when the spleen is deficient, the essence of all five viscera has no source. At that point, if you do not regulate the spleen and stomach and nourish blood, but only clear heat and drain liver fire, you are treating the branch and ignoring the root. Of course, suddenly appearing eye disease can involve liver fire — but most chronic problems are deficiency, insufficient upright qi.

Doctor Luo’s modern observation: most tinnitus is deficiency

Doctor Luo says the Huang Di Nei Jing states: “when the nine openings are out of harmony, it originates in the stomach and intestines” (九窍不和，皆肠胃之所生). Today, people automatically think of kidney deficiency when they hear of tinnitus — and kidney-deficiency tinnitus certainly exists; liver-gallbladder fire can cause it too. But liver-gallbladder fire is mostly temporary — a genuine great blaze of fire is not that common. Of the tinnitus he sees, deficiency is enormously common — it really is worn out by exhaustion.

💬 Note from Doctor Luo: Doctor Luo gives two examples. One was an elderly father who had a child late in life and spent an afternoon chasing his grandchild — children can run, you cannot catch them — and came home when the tinnitus struck with a sudden “buzz,” very severe. Another was a business owner, exhausted day after day — running a company is no simple matter — and the more he tired himself, the more the tinnitus came, tormenting him terribly. Look at those cases and you can see: deficiency. If it flares up with every drain and every bout of fatigue, it is deficiency.

Where do you treat deficiency from? Some doctors start from the kidneys — for kidney yin deficiency, nourish kidney yin. But many of the cases Doctor Luo sees really are spleen deficiency — and that emphasis of Doctor Xue’s is exactly right. The spleen and stomach are the pivot that generates clear and sends down turbid: clear yang rises, turbid yin descends. If clear yang does not rise and turbid yin does not descend, the qi mechanism is thrown into disorder; turbid qi sits up top, and the openings malfunction — that is “the nine openings out of harmony.” Usually people speak of the seven openings (two eyes, two nostrils, two ears, and the mouth); careful physicians count nine by adding the pharynx and larynx.

💬 Note from Doctor Luo: So regulating the spleen and stomach — restoring their power to generate clear and send down turbid — is the single most important approach to illnesses of the nine openings. For deficiency-type tinnitus, Gui Pi Wan (Spleen-Restoring Pill) and Bu Zhong Yi Qi Tang are commonly used; where kidney qi or kidney yin is insufficient, add a little Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) to nourish kidney yin; where kidney yang is insufficient, add Jin Gui Shen Qi Wan (Kidney Qi Pill from the Golden Cabinet). But the main direction must always be regulating the spleen and stomach. When you treat patients, look at the big picture: among ten patients, which pattern is most common? In this era it is spleen-stomach injury — because people eat too well and exhaust themselves too much, and upright qi is damaged.

What to take away

Doctor Luo says the thing he most admires about Doctor Xue Lizhai: his case records seem to go round and round the same few formulas — Bu Zhong Yi Qi Tang, Shi Quan Da Bu Tang, Liu Wei Di Huang Wan — but Doctor Xue was after the root. In his era, a large share of illness came from spleen and kidney trouble — from deficiency. He listed these cases one after another, unafraid of repetition, precisely so people would see: how many patients really are like this.

💬 Note from Doctor Luo: Doctor Xue’s case records are a specimen collection of the health conditions of the Ming dynasty. We borrow from them today because our situation is similar — life is good, and illness comes from spleen-stomach deficiency. The moment someone mentions an ear or eye complaint, rushing to drain fire may not touch the real root: some fire is excess, some fire is deficiency. Chronic, long-running complaints of the five-sense organs — eyes, nose, ears, mouth, throat — very often connect to insufficient upright qi and deficiency of qi and blood. Nourishing upright qi, nourishing qi and blood, and regulating the spleen and stomach at the same time — that is the key.

Compiled from Doctor Luo Dalun’s lecture series on Doctor Xue Lizhai’s case records, from Xue’s Case Records (《薛氏医案》).