The Nest of Essence
Lǐ Dōngyuán on Eye Diseases
Some News
The mulch is being spread worldwide with the inclusion of a piece by yours truly in the latest issue (June 2024) of the Journal of Chinese Medicine. It is a translation and commentary on eye diseases and their treatment with acupuncture from the Zhēn Jiǔ Féng Yuán (Encountering the Origins of Acumoxa) by Lǐ Xuéchuān (1815), a book I have included in numerous posts over the past year or so. It’s really an honor to be included alongside some heavy hitters like Z’ev Rosenberg, Michael Brown, Leo Lok, Eran Even, Sharon Weizenbaum, and others. It’s a fabulous issue, and the digital subscription price is very reasonable, so I encourage everyone reading this to check out the JCM.
The Eyes Have It
As a follow-up to both the JCM article and the last mulch post, I’m continuing along with traditional ophthalmology. Last time we looked at some writings on treating the orifices by Xuē Jǐ, who we noted was strongly influenced by Lǐ Dōngyuán (a.k.a. Lǐ Gǎo), famous for his advocacy of treating the spleen and stomach. So I thought I would go back to the source of the quote Xuē Jǐ referenced in his discussion, and look briefly at a Dōngyuán formula that treats the orifices.
I found the passage Xuē Jǐ cited in Dōngyuán Shì Xiào Fāng [Dōngyuán’s Tested and Effective Formulas, 東垣試効方, from 1266 CE]. My working translation is below:
諸脈者皆屬於目論
The Various Vessels All Pertain to the Eye, A Discourse
《陰陽應象大論》云：諸脈者，皆屬於目。目得血而能視。（《黃帝針經》九卷大惑論第八：）五臟六腑精氣，皆上注於目而為之精。精之窠為眼，骨之精為瞳子，筋之精為黑眼，血之精為絡，其窠氣之精為白眼，肌肉之精則為約束，裹擷筋骨血氣之精而與脈并為系，上屬於腦，後出於項中。故邪中於項，因逢其身之虛，其入深，則即隨眼系入於腦，則腦轉；腦轉則引目系急；目系急則目眩以轉矣。邪中其精，其精所中，不相比也則精散；精散則視歧，故見兩物。
“Yīn Yáng Yīng Xiàng Dà Lùn [Great Discourse on Yīn Yáng Applied to Phenomena] ” says: All vessels pertain to the eye. The eye needs blood so that it is able to see.
(“Huáng Dì Zhēn Jīng” 9th scroll, Dà Huò Lùn [Discourse on the Great Delusion] part 8:) The essence qì of the five zàng and six fǔ all ascend to fill the eyes, and become essence, the eye is the nest of essence, the bone’s essence is the pupil, the sinew’s essence is the black of the eye [cornea and iris], the blood’s essence is the network vessels, its nest [flesh around the eye] qì’s essence is the white of the eye [sclera], the flesh and muscle’s essence is the eyelid, which wraps and gathers the essence of the sinew, bone, blood and qì and combines together with the vessels to form a connection, it ascends to gather at the brain, and it comes out the back within the nape.
Therefore, when evils strike at the nape, if they encounter a body that is vacuous, they will enter deeply, namely they will follow the eye connector to enter the brain, resulting in spinning brain; spinning brain results in pulling and tension of the eye connector; eye connector tension results in visual dizziness because of the spinning. When evil strikes one’s essence, the place of one’s essence is struck, there is no mutual harmony, so the essence scatters; the essence scatters so the sight diverges, therefore one sees double.
Comment: The first quote is from chapter 5 of the Sù Wèn (Simple Questions) and the second (and longer) quote is from chapter 80 of Líng Shū (Spiritual Pivot, a.k.a. Zhēn Jīng or Needle Classic). The correspondence of the various eye structures with the organs, tissues and phases is the foundation of what is called “five wheel” theory, which Kovacs and Unschuld (1999) cite as Indian in origin – as is much of the specialty of ophthalmology in Chinese medicine.
目者，五臟六腑之精、營衛魂魄之氣常營也，神氣之所生也。故神勞則魂魄散，志意亂，是故瞳子黑眼法於陰，白眼赤脈法於陽，故陰陽合傳而為精明也。目者，心之使也；心者，神之舍也，故神散亂而不轉，卒然見非常之處，精神魂魄散不相得，故曰惑也。
The eye is the essence of five zàng and six fǔ, and the common encampment of the qì of the yíng, wèi, hún and pò; it is the place where the essence spirit lives. Therefore, taxation of the spirit will scatter the hún and pò, cause chaos to the zhì and yì. So the pupil and the black of the eye [iris] are yīn in principle, and the white of the eye and red vessels are yáng in principle, therefore when the yīn and yáng unite and disseminate, they become the bright spirit.
The eye is the envoy of the heart; the heart is the abode of the spirit, therefore when the spirit scatters chaotically and does not transport, and one suddenly sees an unfamiliar place, the qì, spirit, hún and pò have scattered and cannot distinguish, so one is said to be confused.
Comment: This section is the conclusion of the quote from Líng Shū. The yíng, wèi, hún and pò refer to provisioning or nutritive qì, defensive qì, ethereal and corporeal souls; zhì and yì refer to will and thought. So the eyes are connected to the five spirits, and the provisioning and defensive qì, as well as the essence of the organs. This is in addition to the brain connection mentioned above. But what of the channels and vessels? Lǐ Dōngyuán continues:
夫十二經脈，三百六十五絡，其血氣皆上走於面而走空竅，其精陽氣上散於目而為精，其氣走於耳而為聽。因心事煩冗，飲食失節，勞役過度，致脾胃虛弱，心火大盛，則百脈沸騰，血脈逆行，邪害空竅，天明則日月不明矣。夫五臟六腑之精氣，皆秉受於脾，上貫於目。脾者，諸陰之首也。目者，血脈之宗也。故脾虛則五臟之精氣皆失，所司不能歸明於目矣。心者君火也，主人之神，宜靜而安，相火代行其令。相火者包絡也，主百脈皆榮於目。既勞役運動，勢乃妄行，又因邪氣所并而損血脈，故諸病生焉。凡醫者不理脾胃及養血安神，治標不治本，是不明正理也。
The 12 channels and vessels, the 365 networks, their blood and qì all move upward to the face and to the empty orifices. One’s essential yáng qì ascends and disperses at the eyes and becomes essence, and its qì goes to the ears and becomes hearing.
If the heart becomes vexed by unnecessary tasks, one loses restraint in eating and drinking. If there is excessive physical taxation, it causes the spleen and stomach to be vacuous and weakened. Heart fire becomes greatly exuberant, causing the hundred vessels to be agitated so the blood in the vessels moves counterflow, and evils harm the empty orifices; at daybreak the sun and moon will not be seen.
The essential qì of the five zàng and six fǔ, all hold and receive from the spleen, and ascend and link up at the eyes. The spleen is the chief of all the yīn. The eyes are the ancestral blood vessels. So if spleen vacuity results in a loss of essential qì of all the five zàng and six fǔ, its office is not able to return sight to the eye.
The heart is the sovereign fire, it governs the human spirit, it should be calm and tranquil; the minister fire moves to command in its place. The minister fire is the bāo luò [pericardium], it governs the hundred vessels and all provisioning of the eyes. Once physical taxation moves and stirs, it tends to move recklessly, then causes the evil qì alongside it to harm the blood vessels; this is how many diseases develop.
All doctors who do not regulate spleen and stomach as well as nourish blood to calm the spirit are treating the branch and not treating the root; indeed they do not understand the correct principles.
Comment: This is the full passage which Xuē Jǐ paraphrased and that we translated in the previous mulch post. As I mentioned in the earlier post, when discussing ophthalmology Lǐ Dōngyuán tended to downplay the role of the liver in favor of emphasizing the spleen’s ability to build the blood, which is the material basis of eyesight. This section is a good example of the rigorous application of Lǐ’s foundational pathomechanisms of taxation-depleted earth and yīn fire. It is followed by a selection of formulas for the orifices, the first of which is featured here.
益氣聰明湯
Yì Qì Cōng Míng Tāng [Qì-Boosting Sharp and Clear Decoction]
治飲食不節，勞役形體，脾胃不足，得內障耳鳴，或多年目昏暗，視物不能，此藥能令目廣大，久服無內外障、耳鳴耳聾之患，又令精神過倍，元氣自益，身輕體健，耳目聰明。
黃耆 甘草（各半兩） 人參（半兩） 升麻 葛根（各三錢） 蔓荊子（一錢半） 芍藥（一錢） 黃蘗（一錢，酒製，銼，炒黃）
Treats lack of restraint in food and drink, excessive taxation of the physical body, spleen and stomach insufficiency, resulting in internal obstruction and tinnitus, or dim and clouded vision over many years, and inability to look at things.
These medicinals can widen one’s vision. Taking them long-term will not cause any internal or external harm nor contraction of tinnitus and deafness. Furthermore it makes a manifold increase in essence-spirit, which will naturally boost the original qì, so the body will be light and healthy, and the ears and eyes will be sharp and clear.
Huáng Qí [Rx Astragali], Gān Cǎo [Rx Glycyrrhizae] (each 0.5 liǎng); Rén Shēn [Rx Ginseng] (0.5 liǎng); Shēng Má [Rz Cimicifugae], Gé Gēn [Rx Puerariae] (each 3 qián); Màn Jīng Zi [Fr Viticis] (1.5 qián); Sháo Yào [Rx Paeoniae] (1 qián); Huáng Bò [variant name for Huáng Bǎi, Cx Phellodendri] (1 qián, prepared with wine, grate, fry until yellow).
Comment: The formula has a great deal in common with Bǔ Zhōng Yì Qì Tāng (Center-Supplementing Qi-Boosting Decoction), which is Lǐ’s flagship formula. The combination of Huáng Qí and Rén Shēn to supplement the spleen, and the addition of the cool acrid ascending herbs (Shēng Má – a little Dōngyuán signature ingredient - and Gé Gēn). Gé Gēn also releases the exterior evils from the nape to prevent their penetration to the eye connector. Màn Jīng Zi ascends to treat the head and brighten the eyes and sour Sháo Yào nourishes the blood. A key difference here from Bǔ Zhōng Yì Qì Tāng is the inclusion of Huáng Bǎi, which Lǐ addresses a little more in the following section.
上㕮咀，每服秤三錢，水二盞，煎至一盞，去滓，熱服，臨臥，近五更再煎服之，得睡更妙。如煩悶或有熱，漸加黃蘗，春夏加之，盛暑夏月倍之。若此一味多，則不效。如脾胃虛去之，有熱者少用之。如舊有熱，麻木，或熱上壅頭目，三兩服之後，其熱皆除。治老人腰以下沉重疼痛如神。此藥久服，令人上重，乃有精神，兩足輕浮，不知高下。若如此，空心服之，或少加黃蘗，輕浮自減。若治倒睫，去黃蘗、芍藥及忌煙火酸物。
Cut up the preceding [herbs], weigh out 3 qián for each dose, with 2 cups of water, simmer down to 1 cup, remove the dregs, take the decoction while hot, lie down for a while. At around 5th watch [pre-dawn], decoct and take again, and sleep will improve.
If there is vexation and oppression, or there is heat [effusion], add Huáng Bò by degrees, adding [a little] more in spring and summer, and adding double in the midsummer months. If there is too much of this ingredient, it will be ineffective. Omit it if there is spleen and stomach vacuity, use only a little in cases with heat.
If there is longstanding heat, tingling and numbness, or rising heat obstructing the head and eyes, after taking 3 liǎng the heat will be completely eliminated. It cures elderly people’s heaviness, cold and pain below the waist as if by magic.
Taking these medicinals long-term will give a person a considerable lift, so they are energetic and both feet feel light and floating, and they don’t know high from low. If it is like this, take [the prescription] on an empty stomach, or slightly augment the Huáng Bò, and the lightness and floating will naturally be reduced. If treating ingrown eyelashes [trichiasis], remove Huáng Bò and Sháo Yào, and avoid smoke and fire and acidic substances.
Comment: 煙火 yān huǒ “smoke and fire” can also mean “cooked food”, but I suspect that is not what he means here. Trichiasis is a condition in which the eyelash grows inward and is constantly rubbing against the surface of the eye, creating a nebulous screen 雲翳 yún yì. I suspect exposure to smoke would further irritate the eye, thus the prohibition.
So where Xuē Jǐ in his orifices discussion warned people against using Huáng Bǎi, his inspirational ancestor Lǐ had a somewhat different approach. Huáng Bǎi here could be said to function a little like a counterweight to the lifting action of the Huáng Qí, Shēng Má and Gé Gēn, as well as any undue warming by the supplementing ingredients. It is obvious that Lǐ was very careful in his approach, and that too much Huáng Bǎi would spoil the effects of the prescription; nevertheless it is a very useful idea, even beyond the scope of this formula.
Like Bǔ Zhōng Yì Qì Tāng, Yì Qì Cōng Míng Tāng is available in prepared form, in granules (from the usual manufacturers) and at least one tablet producing company (Blue Poppy). It can be also be found under the name Ginseng, Astragalus & Pueraria Combination.
Okay, that’s all I’ve got for now. Thanks for reading.
Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Kovacs, J., & Unschuld, P.U. (1999). Essential subtleties on the silver sea: The yin-hai jing-wei: A Chinese classic on ophthalmology. University of California Press: Berkeley.
Lǐ, G. (1266). Dōngyuán Shì Xiào Fāng. Retrieved March 15, 2024 from https://jicheng.tw/tcm/book/%E6%9D%B1%E5%9E%A3%E8%A9%A6%E6%95%88%E6%96%B9/index.html