Visual distortion refers to a condition where the appearance of the eye is normal, but the objects seen are skewed and their forms are distorted.

This symptom was first mentioned in Zhengzhi Zhunsheng. Zabing chapter. The "Seeing Straight as Slanted" syndrome and visual distortion syndrome clearly state, "The object is straight, but the eye sees it as slanted, which is a sign of yin-yang imbalance and the spirit light about to scatter... Straight objects like bowstrings and rulers are seen as hooks." The "Yinhai Zhinan. Shenjing Zhubing" also mentions "seeing straight as horizontal." Shenshi YaohanZhangshi Yitong "Ophthalmology Essence Record" and others refer to it as "false vision," which includes "seeing straight as slanted," "seeing small as large," "seeing large as small," "visual distortion," and other symptom names. Mujing Dacheng refers to it as "visual confusion." Based on clinical observations, "visual confusion" should be the general term for visual variations, which is simply called "visual distortion" in modern times.

bubble_chart Pattern Analysis

1. Liver-kidney Yin Deficiency︰It manifests as visual distortion, seeing big as small, accompanied by dizziness, dry mouth and eyes, tinnitus, insomnia, sore waist, seminal emission, or vexing heat in the chest, palms, and soles, night sweat, red tongue with scant coating, and thready rapid pulse. It is mostly caused by excessive sexual activity depleting essence and mental exhaustion damaging blood, leading to deficiency of essence and blood, which fails to nourish the seven orifices, resulting in visual abnormalities. The key points of differentiation are dizziness, tinnitus, and dry mouth and eyes in the upper body, and sore waist and seminal emission in the lower body. Yin deficiency leading to internal heat manifests as vexing heat in the chest, palms, and soles, night sweat, bitter taste in the mouth, and mental restlessness. The treatment should focus on nourishing water to moisten wood, with prescriptions such as Lycium and Chrysanthemum Rehmannia Decoction or Eyesight-Improving Rehmannia Pill, supplemented with Gordon Euryale Seed and Cherokee Rose Fruit to tonify the kidneys and secure essence. For cases of yin deficiency with effulgent fire, the treatment should aim to nourish yin and reduce fire, nourish blood, and activate blood circulation, using prescriptions such as Yin-Nourishing and Fire-Reducing Decoction or Anemarrhena and Phellodendron Rehmannia Decoction with modifications. Visual distortion due to liver-kidney yin deficiency versus visual distortion due to liver qi stagnation—one is a deficiency pattern, caused by yin deficiency with effulgent fire, malnourishment of the seven orifices, and disturbance by fire; the other is an excess pattern, caused by liver stagnation transforming into fire, which ascends to harass the eye orifices. The two are not difficult to distinguish.
2. Liver Qi Depression︰Looking at straight and slanted lines as if they were large or small, headache and eye distension, accompanied by mental irritability and susceptibility to anger, chest and hypochondriac distension, poor appetite, women with menstrual irregularities or premenstrual breast distension, slightly yellow and thin greasy tongue coating, and wiry pulse. Mostly caused by mental stimulation, emotional depression, constraining of liver qi, and malnourishment of the eye orifices; the liver meridian traverses the chest and hypochondrium, and stagnation of qi and blood in the liver meridian leads to chest and hypochondriac distension; stomach failing to descend and harmonize results in poor appetite; qi depression transforming into fire and ascending counterflow causes headache, eye distension, mental irritability, and susceptibility to anger; liver failing to free and regulate leads to menstrual irregularities. Treatment should focus on soothing the liver and relieving depression, and the formula of choice is Peony and Gardenia Peripatetic Powder minus Fresh Ginger Rhizome, with appropriate additions of Motherwort Fruit and Cassia Seed. $Liver-kidney yin deficiency causing visual distortion versus 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 harass the eye orifices. The two are not difficult to distinguish.
3. Spleen Qi Deficiency︰Seeing straight as slanted and large as small, persistent headache, poor appetite with loose stool, accompanied by mental fatigue and shortness of breath, pale and swollen tongue texture, deep and thin pulse. Mostly caused by impaired spleen function, failure to transform water-dampness, sinking of clear yang, and turbid yin taking advantage of weakness to accumulate in the eye orifices; or by water-dampness ascending to the eyes. The key diagnostic points are poor appetite with loose stool, mental fatigue and shortness of breath, shallow yellow 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 strengthening the stomach. The recommended formulas are Middle-Tonifying Qi-Replenishing Decoction or Cyperus, Amomum and Six Gentlemen Decoction with stir-fried coix seed to invigorate the spleen and drain dampness. This is a case of qi deficiency.
4. Deficiency of Both Heart and Spleen︰To regard the large as small, to see straight as oblique, visual fatigue, eyelid lack of strength, palpitation and forgetfulness, poor appetite, restless sleep at night, pale tongue with thin coating, and thin pulse. Mostly caused by overexertion injuring the heart and spleen, deficiency of qi and blood, emptiness of the collaterals, and blood failing to nourish the eyes. The key points of pattern identification are: visual fatigue, eyelid weakness, poor appetite, palpitation and forgetfulness, insomnia and dreamfulness, and loose stools. Treatment should focus on tonifying and replenishing the heart and spleen. The prescription selection is Returning to Spleen Decoction with modifications, or the Yang-Assisting and Blood-Activating Decoction with modifications. For cases of dual deficiency of qi and blood, leading to symptoms such as palpitation and forgetfulness due to blood failing to nourish the heart, differentiation should be made.
5. Qi Stagnation and Blood Stasis︰Looking at straight and slanted lines as the same, perceiving large as small, and experiencing intermittent heaviness, often occurring with fatigue, a purplish-dark tongue texture or ecchymosis, and a thin, choppy pulse. Mostly caused by trauma or chronic illness, stagnation of qi in the collaterals, impeded blood flow, and pain due to obstruction. The key diagnostic points are distending pain in the head and eyes, visual distortions, and generally a prolonged course. Treatment should focus on activating blood and breaking blood stasis, with prescriptions such as Blood House Stasis-Expelling Decoction or Peach Kernel, Carthamus and Four-Ingredient Decoction, supplemented with Prunella, Sparganium Rhizome, Zedoary Rhizome, and other herbs for softening hardness and dissipating masses. If residual pathogens remain and healthy qi has not recovered, consider adding Tangshen, heterophylly falsestarwort root, raw Astragalus Root, and other qi-tonifying and blood-activating herbs to reinforce healthy qi and eliminate pathogenic factors.

bubble_chart Documentation

1. Lingshu-Dahuo Lun: "When the heart is pleased and the spirit is averse, sudden mutual influence causes the essential qi to become disordered, leading to visual errors and confusion."
2. Zhengzhi Zhunsheng-Zabing Chapter．Visual Inversion Pathogenic Factor Pattern: "When objects are inherently upright but the eyes perceive them as inverted, it is a sign of yin-yang imbalance and the spirit light's tendency to scatter. In cases where yang overcomes yin, it is due to indulgence in spicy foods and alcohol, leading to recurrent headaches and phlegm-fire qi injuries. When yin overcomes yang, it is due to excessive sexual desire, weeping, and consumption of rich flavors, leading to blood injuries from menstruation and childbirth. This internal stagnation of sweat pores causes a bias, and the qi becomes heavier on one side, resulting in a skewed and improper manifestation of fire. Treatment involves nurturing the root and addressing the symptoms."
3. Ophthalmic Golden Mirror．Visual Distortion Syndrome: "This is caused by prolonged stagnation of pathogenic heat in the liver and kidneys. The liver is the orifice of the eyes, and the kidneys are the essence of the eyes. Anger damages the liver, and fear damages the kidneys. When both the liver and kidneys are injured, and true yin is scorched by heat, one sees large objects as small. For example, a large flame casts a small shadow, while a small flame casts a large shadow. Treatment involves using heat-clearing and yin-enriching formulas."