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Table of Contents
REVIEW ARTICLE
Year : 2021  |  Volume : 4  |  Issue : 2  |  Page : 107-113

Textual Research on the Eye Diseases Names in Mai Shu (《脉书》 The Book of Pulse) Excavated from Zhangjiashan, China


Department of Classic Literature of Traditional Chinese Medicine, Institute of Science, Technology and Humanities, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China

Date of Submission05-Feb-2020
Date of Acceptance09-Dec-2021
Date of Web Publication30-Jun-2021

Correspondence Address:
Associate Prof. Kai- Hui Yuan
Department of Classic Literature of Traditional Chinese Medicine, Institute of Science, Technology and Humanities, Shanghai University of Traditional Chinese Medicine, Shanghai 201203
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/CMAC.CMAC_11_21

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How to cite this article:
Yuan KH. Textual Research on the Eye Diseases Names in Mai Shu (《脉书》 The Book of Pulse) Excavated from Zhangjiashan, China. Chin Med Cult 2021;4:107-13

How to cite this URL:
Yuan KH. Textual Research on the Eye Diseases Names in Mai Shu (《脉书》 The Book of Pulse) Excavated from Zhangjiashan, China. Chin Med Cult [serial online] 2021 [cited 2021 Jul 27];4:107-13. Available from: https://www.cmaconweb.org/text.asp?2021/4/2/107/320166




  Introduction Top


Since the excavation of Zhangjiashan (张家山) Han bamboo slips of Mai Shu (《脉书》The Book of Pulse), its academic value has aroused extensive attention and high recognition from scholars. Researchers in paleography, history and the Chinese history of medical literature took an active part in interpreting the writing on the slips, publishing a series of erudite works with diverging opinions. The publication of Zhang Jia Shan Han Mu Zhu Jian (247 Hao Mu) (《张家山汉墓竹简【二四七号墓】》 Interpretations of Zhangjiashan Han Bamboo Slips [Tomb 247]) (revised edition) [Figure 1] leaves room for further research about such things as unnoted writings and unreasonable explanations of medical terms. As far as eye diseases are concerned, it is necessary to clarify questions regarding whether Jin (㴆) and Mai Jin (脈㴆) are correlated or regarded as the same disease if Mai Jin refers to a white membrane invading into the eyeball or a cataract or pterygium, and in what exact region Mu Ji (目际) lies.
Figure 1: Zhang Jia Shan Han Mu Zhu Jian (247 Hao Mu) (《张家山汉墓竹简【二四七号墓】》 Interpretations of Zhangjiashan Han Bamboo Slips [Tomb 247])

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  Different Interpretations of Jin (㴆) and Mai Jin (脈㴆) Top


The Book of Pulse records “eyes involved, shedding tears means Jin; and vessels clouding apple of the eye 童 (瞳子) refers to Mai Jin. Eye margins involved, 靡 (erosion, 糜) indicates Nan (赧).” [Figure 2] The author agreed on the sorting team in interpreting 㴆 as 浸. The writings on the bamboo slips involve three disease names – Jin, Mai Jin, and Nan, with Mai Jin being a special category of eye Jin diseases. However, some scholars hold that only two eye diseases are mentioned in this case, deeming Jin and Mai Jin as one. For instance, when he discussed the disease names in Mai Shu “Bing Hou” (《脉书•病候》The Book of Pulse “Disease Manifestations”), Liu Qingyu (刘庆宇) only listed 4 and 5 as the numbers of eye diseases (numbering is the basis for Liu's counting of diseases), taking Jin and Mai Jin as Disease 4 and interpreting it as “like the cataract nowadays.”[1] Such categorization and explanation may date back to discussions by Lian Shaoming (连劭名) and Gao Dalun (高大伦). In 1989, Lian suspected “Mai Jin is cataract,” according to “weeping tears in silence means Qi (泣)” from Shuo Wen (《说文》 Interpretations of Characters). He also quoted “脈 refers to Mu (幕 clouding)” from Shi Ming “Shi Xing Ti” (《释名•释形体》 Interpretations of Names “Interpretations of Physique”) as the main evidence for such an explanation.[2] In his article, Lian did not even mention the name of Jin and its successive use by later traditional Chinese medicine (TCM) doctors, leaving obscure explanation of the relationship between the two names. In 1992, Gao Dalun's Jiang Ling Zhang Jia Shan Han Jian (Mai Shu) Bing Ming Kao Shi (《江陵张家山汉简〈脉书〉病名考释》Textual Research on Disease Names and Collation and Annotation of The Book of Pulse - Han Bamboo Slips from Zhangjiashan of Jiangling)[3],[4] argued that “according to shedding tears and clouding of the eye, Mai Jin refers to a white membrane invading into the eyeball (cataract).” This also confused Jin with Mai Jin. Hereafter many scholars have adopted this theory, Zhou Zuliang (周祖亮) being one of them.
Figure 2: Mai Shu (《脉书》 The Book of Pulse)

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The statement format of the writings in The Book of Pulse basically follows the detailed narration of disease location, symptoms and disease names. Following are a few such examples:

  • Head involved, 农 (脓 pus) means , sore refers to bald, and itching indicates ;
  • Eyes involved, shedding tears means Jin; and vessels clouding apple of the eye refers to Mai Jin;
  • Eye margins involved, erosion indicates Nan;
  • Nose involved, it is 肍 (鼽 mucous snivel); with sores and pain, it is like being bitten by (Te);
  • Ears involved, it is deafness; with pus discharge, it is浇 (Jiao);
  • Lips involved, it is □(missing);
  • Mouth involved, erosion refers to 篡 (Cuan);
  • Teeth involved, pain means insect caries (蟲龋); and carbuncle refers to blood caries (血龋).


The statement of disease manifestations above complies with the pattern of location, symptoms and disease names, which are the object of “为” (predicate verb). There are 63 sentences of such writings until Ma Jixing(马继兴) added the character “为” to the sentence of “occasional body spasm and foaming at the mouth with sheep sound, (indicating) □□ (missing)” to make a total of 64 diseases narrated this way. And this accounts for the majority of records in The Book of Pulse. To know clearly this format of expression provides valuable information and according to the three verbs of “为 (meaning 'is')” before the names of Jin, Mai Jin, and Nan, it can be deduced that three eye diseases are recorded in the unearthed slips. Gao Dalun agreed with Lian Shaoming's proposal that “Mai Jin is suspected as cataract,” and elucidated that with additional evidence, spreading further the influence of this idea. Later on, the scholars either agreed on it or never questioned it openly. Those who shared similar ideas include Liu Qingyu, Zhou Zuliang, Liu Chunyu (刘春语), Zhang Xiancheng (张显成), and Li Jing (李璟), etc.. Interpretations of Zhangjiashan Han Bamboo Slips (Tomb 247) (revised edition) listed “shedding tears is Jin” and “Mai Jin” separately, annotating the latter as “pupil clouded”[5] based on Lian and Gao's remarks. Zhou Zuliang agreed on those annotations.[6] Liu Chunyu and Zhang Xiancheng regarded Jin and Mai Jin as the same disease with three symptoms of nebula on the eye, shedding tears and clouding of the eyeball, considering it as “cataract due to the invading of blisters from the margin of the pupil.”[7] Li Jing confirmed that and added that “similar symptoms to this (Mai Jin) in ancient medical literature include cataract and glaucomatous cataract.”[8] Ma Jixing doubted this though he never commented.


  Mai Jin (脈㴆) is not Internal Clouding of the Eye Top


Confusing Jin with Mai Jin and taking them as one disease of cataract can be attributed to misunderstandings of internal clouding. What is the difference between a cataract and a glaucomatous cataract? Modern medicine defines cataract as the protein degeneration and turbidity of the lenses after metabolic disorder caused by factors such as aging, heredity, local nutritional disorder, immune and metabolic abnormalities, trauma, poisoning, and radiation. After suffering from this disease, patients may develop blurred vision since light is disturbed by the opacity of the lenses and cannot be projected onto the retina. The glaucomatous cataract refers to glaucoma named as green blindness in ancient Chinese literature, which is a kind of optic neuropathy due to increased intraocular pressure. In severe cases, corneal edema appears and the eyes seem gray-green. If left untreated, the disease may progress to blindness.[9] The so-called internal clouding reveals the disease location and for cataract-like eye diseases, it is difficult to observe the intraocular lesions from outside. Quoted from Wai Tai Mi Yao “Qing Mang Ji Mang Fang Liu Shou” (《外台秘要•青盲及盲方六首》Confidential and Valuable Recipes by an Offical “Green Blindness and Six Recipes for Blindness”, “The green blindness was said in Bing Yuan (《病源》Disease Causes) not to impair the root of the eyes, with distinct black-white colors of the eyeball and yet loss of vision. The essence of the five Zang and six Fu organs will go up and nourish the eyes. When visceral deficiency and the invading of wind-evil, phlegm and fluid retention coexist, redness with pain will develop in case of heat or internal clouding appears in the absence of heat. This is because the visceral qi and blood fail to nourish the eyes, resulting in no changes being observed from the outside with only deprivation of vision.”[10] In the Sui and Tang dynasties, traditional Chinese medicine began to recognize that with internal clouding, the external conditions of the eyes, pupil, complexion, and physique of a patient are not different from those of healthy people, but this patient will suffer from blurred vision, gradual vision decline and even blindness in the late stage. This theory was still alive in later works on TCM ophthalmology, stressing that the changes within the pupil are like a mantle hanging inside a paper window invisible to ordinary people or common doctors. As Mu Jing Da Cheng “Nei Zhang” (《目经大成•内障》Great Achievements in Ophthalmology “Internal Clouding”) recorded, “This disease involves blindness without obvious causes, as there is clouding over the aqueous fluid (神水) in the eyeball, termed as internal clouding. Those with ordinary medical techniques won't recognize it and will suspect it as fraud, because they don't know that the clouding of the eyes is like a mantle hanging inside the paper window shielded from being seen from the outside.”[11] It is natural to deduce that confusing the eye Jin disease manifested in clouding and shedding tears with cataract is the result of ill-understanding of corresponding ancient medical records and failure to inspect the pathogenesis and symptoms of the disease in the sense of modern medicine.

Taking Jin and Mai Jin as one disease of cataract can also be ascribed to being unfamiliar with ophthalmic diseases and the lack of previous research results. In fact, as early as in 1991, Du Yong (杜勇) wrote an article about the two diseases, in which he stated that “Jin is an eye disease with slight clouding or skin-nebula; Mai Jin is about vessels clouding the pupil, equivalent to later eye diseases of 'red vessels penetrating the eyeball' or 'pterygium'.” His argument is based on the fact that “浸 (immersion) is interchangeable with 侵 (invasion)” and the citation of Duan (Yucai)'s annotation for Interpretations of Characters, “浸 means gradual invasion, so 浸淫 (spreading) is also written as 侵淫.”[12] This did not receive academic attention, maybe because the article was too short in length.


  Jin (㴆) is the Onset of External Clouding of the Eye Top


What kind of eye diseases does Jin or Mai Jin really refer to? Disease Manifestations of the Book of Pulse noted, “Eyes involved, shedding tears means Jin; and vessels clouding the apple of the eye refers to Mai Jin.” Guang Ya “ Shi Yan” (《广雅•释言》 Guang Ya “ Interpretation of Words”) recorded, “泣 means tears.” Therefore, shedding tears is a prominent symptom of Jin. According to Interpretations of Diseases from Interpretations of Names, “skin nebula invading into the eye is called Jin; 浸 is the same as 侵, so 侵明 (impair of vision) is like successive invasion and gradual proliferation.” “眸 means 目童子 (pupil),” according to the explaination by Shuo Wen Xin Fu “Mu Bu” (《说文新附•目部》Addition to Interpretations of Characters “Radical Eye”). That is to say, 眸 refers to the center of the pupil. Yu Pian “Rou Bu” (《玉篇•肉部》Yu Pian “Radical Flesh”) and Guang Yun “Yu Yun” (《广韵•虞韵》General Rhymes “Rhyme Yu”) both documented that “肤 means skin.” In ancient medical books there would be successively written phrases of “肤翳 skin-nebula” and “肤肉 skin and flesh.” In Zhu Bing Yuan Hou Lun “Mu Bing Zhu Hou” (《诸病源候论•目病诸侯》Treatise on the Causes and Manifestations of Diseases “Manifestations of Eye Diseases”), “肤翳 refers to the fly-wing-like thing on the eye,” revealing its thin and transparent features; “skin-nebula appears and invades into the pupil,”[13] meaning there appears a skin-thin membrane clouding and invading into the pupil. Combining the records of Interpretation of Names with the writings in The Book of Pulse, the eye disease of Jin can be characterized as the gradual invasion of a skin-thin membrane into the pupil in addition to the shedding of tears. Ming Mu Shen Yan Fang “Yu Yi Wai Zhang” (《明目神验方•玉翳外障》Miraculous Recipes for Vision-brightening “External Clouding and Nebula”) ascribed this to “accumulated heat in the spleen and lungs; also as in the poetry of ‘Red vessels stretching through the canthi, with occasional pain and tear-shedding; the disease is due to heat in the spleen and lungs, and the nebula gradually impairs both pupils.’”[14] So it is clear that the shedding of tears is a major symptom at the beginning phase of the external eye clouding. The disease of eye Jin (目浸) is also analyzed in many medical works. For one thing, Ling Shu “Re Bing” (《灵枢•热病》 Miraculous Pivot “Heat Diseases”) says “lame legs and eye Jin are due to tendon disorders of the liver.” It is a kind of febrile eye disease, featuring the continuous shedding of tears. Volume 25 of Tai Su “Re Bing” (《太素•热病》Supreme Simplicity “Heat Diseases”) documented, “躄 refers to tendon contracture; and eye Jin is about tears out of canthi.” The needling manipulation for heat diseases from Lei Jing “Zhen Ci Lei” (《类经•针刺类》Classified Classic “Needling Category”) also noted, “筋躄 refers to failure of the feet to walk; and eye Jin involves the shedding of tears. They both can be attributed to the liver, which pertains to wood and is related to the tendons. So the treatment should involve the tendons and ultimately the liver.” As Liu Chunyu and Zhang Xiancheng said, “skin-nebula on the eye and invading into the pupil” is the reason for the shedding of tears. Guo Aichun remarked, “Jin is the clouding of the eyes, commonly called Yi (瞖 nebula),”[15] which reflects the intention of medical literature. The First of Eye Diseases in Volume 6 from Bei Ji Qian Jin Yao Fang (《备急千金要方》Valuable Prescriptions for Emergency) recorded “the formula to treat eye clouding and pain with tear-shedding due to flaming heat.” Heat-caused eye diseases are often accompanied by nebula on the eye and pain with the shedding of tears. This corresponds to the records from Miraculous Pivot, Interpretation of Names and The Book of Pulse. In addition, Wai Tai Mi Yao “Mu Fu Yi Fang” (《外台秘要•目肤翳方》Confidential and Valuable Recipes by an Official “Recipe for Eye Skin-nebula”) noted, “Disease Causes held that 'yin and yang qi will reach the eyes; if evil wind and phlegm chronically attacks the eyes taking advantage of inharmonious visceral qi, clouding will appear and linger on the eyes, developing into fly-wing-like skin-nebula;. the skin-nebula lingers and gradually clouds the pupils.”[16] Clouding of the eyes is a chronic process, and will “invade into the pupils” as is said in Interpretation of Names. The prescriptions such as Formula for Heat Clouding over Eyes from Bei Ji Qian Jin Yao Fang “Mu Bing” (《备急千金要方•目病》Valuable Prescriptions for Emergency “ Eye Diseases”), Formula for Black Skin-nebula over Pupils and Formula for White Clouding over Pupils and Loss of Vision from Confidential and Valuable Recipes by an Official are all suitable for the case.

In summary, Jin is one kind of heat-caused eye disease, characterized by skin-nebula on the eye and continuous tear-shedding, which in later medical works resembles the mild cases of external clouding concerning the pupil instead of cataract or glaucoma. In literature, Jin was often annotated as the shedding of tears, external skin-nebula or the onset of skin-nebula.


  Mai Jin (脈㴆) is Red Vessels Clouding the Pupil Top


“Vessels clouding the pupil refers to Mai Jin.” First, Gao Dalun and other scholars read 脈 as 幎 (Ming), and interpreted it as covering or clouding. In fact, the character 脈 should be pronounced as it is. Recorded in Radical Yong (永) of Interpretations of Characters and Words, “脈 is where blood and interstices are separated to move around the body.” As a variant character of 脉, the word 脈 denotes the blood vessels throughout the body, which can also mean collaterals or refer to both. “脈”[17] was documented in the Mawangdui Silk manuscript of Prescriptions for Fifty-two Diseases and in “bleeding first is called 脈”[18] from The Book of Pulse. Both refer to vessel hemorrhoid, featuring bleeding of bright red blood first during defecation, which is related to lesions of the vessels and collaterals. Yin Hai Jing Wei (《银海精微》Essential Subtleties on the Silver Sea) noted the disease names of “red vessels invading into the eyeball from the inner (and outer) canthus;” so were “clustered red-thread vessels” from Shen Shi Yao Han (《审视瑶函》A Valuable Manual on Ophthalmology), “red vessels penetrating the eyeball” from Yuan Ji Qi Wei “Yin Re Fan Ke Zhi Bing” (《原机启微•淫热反克之病》Revealing the Mystery of Medical Origin “Diseases due to Counter-restraint by Excessive Heat”) and “strip-vessels” from Qi Jing Ke Xie Zhi Bing (《奇经客邪之病》Diseases due to Evils in the Extraordinary Channels) of the same book, and “strips of red vessels” from Yan Ke Long Mu Lun (《眼科龙木论》Treatise on Eye Diseases by Dragon Tree Buddha). Therefore, it is clear that 脈 (Mai) refers to vessels and usually is recorded as “red vessels” in TCM works on eye diseases.

Second, “蔽” means shielding or clouding, since the chronic accumulation and crawling of vessels may cause them to invade into the center of the pupil and prevent light from entering.

Third, “童子” refers to the pupil. Mai Jin in The Book of Pulse pertains to a subtype of eye Jin disease. Jin is about external skin - nebula while Mai Jin is its progression into a severe case with accumulated clustered vessels. The unearthed bamboo slips said “vessels clouding the pupil refers to Mai Jin” and in the Shi Ming “Shi Ji Bing” (《释名·释疾病》Interpretations of Names “Interpretations of Diseases” there was “skin nebula invading into the eyeball is called Jin (浸) which is the same as 侵, so 侵明 (impairment of vision) is like successive invasion and gradual proliferation.” Here, 童子 and 眸子 both mean eyeballs. The disease location of Mai Jin should be the surface of the pupil. The recognition of 肤 by ancient people is the proof that the diseases involve the surface of eyeballs. Radical Flesh of Yu Pian and Rhyme Yu of General Rhymes both documented “肤 means skin.” The skin-thin flesh membrane on the surface of eyeballs is called 肤 or 肤翳 (skin-nebula). The skin-nebula over the pupil was also named 膜 (membrane) in TCM ophthalmology, with subtypes of white and red membranes. Treatise on Eye Diseases by Dragon Tree Buddha discussed external clouding of the drooping red membrane, “when the disease occurs, the eye becomes dry and painful, with itching and rubbing of the eyeball; a nebula appears over the pupil until a red membrane (color of rosy clouds) droops and covers the eyeball.” In the same book, there is also a record of external clouding of an uprising yellow membrane, “when the eye is affected, there will be pain in the eye alternating with tear shedding; a yellow membrane develops which covers the pupil and makes one unable to see things.” The red and white membranes are also taken as red and white nebulas in medical works of Sui and Tang dynasties. According to Shang Han Gong Mu Sheng Chuang Jian Chi Bai Yi Fang Liu Shou (《伤寒攻目生疮兼赤白翳方六首》Cold-damage and Sore in the Eyes with Six Recipes for Red and White Nebulas) from Confidential and Valuable Recipes by an Official, “Disease Causes recorded, 'eyes converge essence of Zang and Fu organs and are the external manifestation of the liver; when heat evil obstructs and steams the liver, the eyes will be affected and become red with pain; the exuberance of toxin will bring about nebula over the eyes.' It also mentioned that 'the liver opens into the eyes, so heat will over-restrain liver deficiency and cause pain with redness of the eyes, and in severe cases, produce sore and nebula, white membrane and polyp.”[19] Hence, 童子 and 眸子 mentioned above should refer to the whole eyeball rather than the pupils.

Fourthly, based on the record of Interpretations of Diseases from Interpretations of Names, the word 浸 means both invasion and gradual proliferation. The “膏侵” in Zhu Bing Er (《诸病二》Second of Various Diseases) from Laoguanshan medical slips (No. 625) means ever-growing severe fatty mass.[20] The Book of Pulse also documented “Region inferior to the ankle involved, carbuncle refers to 㾛 (Qin).”[18] 浸, while 侵 and 㾛 share the same phonetic element of , possesses similar meanings of invasion and proliferation. Mai Jin involves a pathological change of invasion from the white part of the eye into the pupil, with the growing of the nebula and increasing severity. Many disease names conform to the manifestation such as pterygium crawling over the eyeball, red vessels penetrating the eyeball, white membrane invading into the eyeball, prominence and microtube on the eyeball, red prominence on the pupil, falling curtain nebula, and blood nebula wrapping the eyeball. Considering the feature of “vessels clouding the pupil,” Mai Jin should refer to red vessels penetrating the eyeball, white membrane invading into the pupil, pterygium crawling over the eyeball and drooping red membrane in later documentation. Yan Re Chen Tong Chi Zhong Fang San Shou (《眼热碜痛赤肿方三首》Three Recipes for Redness, Swelling and Rubbing Pain of Eyes) from Confidential and Valuable Recipes by an Official discussed red vessels on the eye, saying “Shan Fan (《删繁》Simplification) noted 'to treat hotness and redness of the eyes, with red vessels and polyp, failure to open eyes, and acute prickling and rubbing pain.”[21] Miraculous Recipes for Vision-brightening explained deep nebula of red vessels, also known as red vessels invading or spreading or penetrating into the pupil, in “red vessels penetrating from the white eye into the pupil, with unbearable rubbing pain, itching, and avoidance of light.”[22] The typical manifestation of crawling over the eyeball is pterygium, first seen on the white part of the eye, transversely crawling over (invading into) the center of the pupil, as is recorded in Essential Subtleties on the Silver Sea, “pterygium crawling over the eyeball is similar to the symptom of red vessels on the inner canthus; the pterygium gradually invades into the pupil.”[23] The white membrane covering the eyeball was discussed in the Upper Part of Volume 2 in Great Achievements in Ophthalmology, “at the beginning, the disease was mild; then began redness with rubbing pain and tear-shedding; nebula appeared and stretched to cover the whole eyeball, with clustered vessels and gum in the eyes; chronically, all regions of the eyes were affected, and the patient could walk yet reflect no shadows in the pupil; the nebula was attached to the outside of the eyes like mini-sized dog penis and was thus called a membrane.”[24] Clustered vessels and increased discharge of the eyes are the main features of white membrane invading into the pupil. Falling curtain nebula is also known as drooping external clouding, falling curtain membrane, or drooping red membrane characterized by clustered red vessels on the eyes drooping from the superior margin to the center of the pupil until there is clouding of the whole part. As is quoted in Volume 6 of Treatise on Eye Diseases by Dragon Tree Buddha, “when the eye was first attacked, there was redness with rubbing pain, tear-shedding and itching; then nebula began to crawl over the pupil until the red membrane drooped to cover the whole eyeball.”[25] The severe case of drooping red membrane is named blood nebula wrapping the eyeball since the pupil is totally covered by the membrane. Generally, it is regarded as resulting from trachoma, so it is formally called trachomatous corneal pannus. Consequently, distinct symptoms of dry and painful eyes with tears can be seen in both cases.

All these have proved that Mai Jin is a specific category of Jin disease, characterized by nebula and vessels clouding the pupil in addition to the shedding of tears, corresponding to red vessels penetrating the eyeball, pterygium crawling over the eyeball, a white membrane invading into the eyeball, drooping red membrane, and falling curtain nebula in later literature. Compared with eye Jin, Mai Jin poses more threats to the deprivation of vision or even to blindness. Since Mai Jin shared with Jin some symptoms and was the progression of the former in a disease course, Zhangjiashan bamboo slips discussed them in comparison to highlight the relationship and difference between them.


  Nan (赧) Refers to Redness and Erosion of the Margins of the Eyelaid Top


“Eye margins involved, erosion means 赧 (Nan).” 目际 refers to the margins of the eye, or precisely the margins of the eyelid, as Shi Changyong (史常永) pointed it out that “目际 was called as 眼弦 (eye margin) or commonly known as 眼边 (eye border), the same as 睑缘 (eyelid edge).” However, his remarks of “redness and pain of eyes and sores in canthi pertain to the range of Nan disease”[26] do not comply with the record of “erosion” in the slips. The ulceration of the margin of the eyelid in later documents, marked by redness, erosion, and prickly pain with itching, is the only one that corresponds to the description of disease location and symptom, called “wind-induced eroded eye margins” in Confidential and Valuable Recipes by an Official, “wind-induced redness and erosion of margins” and “wind-induced eroded margins” in Essential Subtleties on the Silver Sea, “redness and erosion of canthus margins”[27] and common names of “wind-induced eroded margins,” “eroded eye borders,” (or “wind-induced redness of eye margins,” “redness and erosion along the orbit,” “wind-induced eroded eye border,” and “wind-induced redness and erosion”) from Great Achievements in Ophthalmology, etc.. Manifestations of Eye Diseases from Treatise on the Causes and Manifestations of Diseases said if the redness and erosion were localized in the canthi, it was called red eyes with eroded canthi or 勚 (Yi). According to Interpretations of Diseases from Interpretations of Names, “redness in the canthus is called Yi, which means extremity, denoting the lesion lies at both extremities of the eyes.” When an infant suffers from that, it is named fetal-wind redness and erosion. The disease is basically equivalent to marginal blepharitis, involving both eyes with a long course, varying severity, and of a refractory nature.

It is inappropriate that Zhou Zuliang regarded 目际 as eye socket, which was influenced by Gao Dalun's remarks of “目际 means eye socket, termed as eye canthus in history.” 眼眶 refers to the socket formed by the eye bones, according to the Upper Volume of Treatise on Eye Diseases by Dragon Tree Buddha, it is also called “目眶 (eye orbit)” in Yi Zong Jin Jian “Ci Jiu Xin Fa Yao Jue” (《医宗金鉴•刺灸心法要诀》The Golden Mirror of Medicine “The Manipulation Essentials of Needling and Moxibustion”), “目匡 (eye orbit)” in Su Wen “Yu Ji Zhen Zang Lun” (《素问•玉机真脏论》Basic Questions “ On Essentials of Vital Zang-organs”), “orbital bone” in Zheng Zhi Yao Jue (《证治要诀》Essentials to Diagnosis and Treatment), “eyelid border” in Treatise on Eye Diseases by Dragon Tree Buddha, “眼楞 (eye beam)” in the upper volume of Revealing the Mystery of Medical Origin, and “eye border” or “out-vision border” in the Zheng Zhi Zhun Sheng “Za Bing Qi Qiao Men” (《证治准绳•杂病•七窍门》The Golden Mirror of Medicine “ Section of Seven Orifices of Miscellaneous Diseases”), etc., In The Manipulation Essentials of Needling and Moxibustion from The Golden Mirror of Medicine (Volume 80), it is recorded that目眶 refers to the “bones to make the eye socket.”[28] The eyepit lies deep beneath the facial skin and muscles, and there won't be visible erosion. Therefore, Zhou's opinion of “Nan referring to redness and erosion of the orbit” is unsubstantiated.


  Conclusions Top


In conclusion, the three eye diseases of Jin, Mai Jin, and Nan are discussed in the Zhangjiashan Han bamboo slips of The Book of Pulse. According to the medical documentation, they all pertain to heat-induced diseases. Eye Jin is characterized by the shedding of tears and by skin-nebula over the eyes in the early stage of external eye clouding, which is called red and white skin-nebula in the Sui-Tang medical books. Mai Jin, featuring vessels and nebula clouding the pupil, lies in the critical stage, involving conditions of red vessels penetrating the eyeball, pterygium crawling over the eyeball, white membrane invading into the eyeball, drooping red membrane and falling curtain nebula in ancient medical literature. And Nan, with erosion as its main manifestation, is equivalent to the redness and ulceration of the margins of the eyelid. Only by looking through and examining works on TCM ophthalmology in combination with knowledge and skill regarding philology and exegesis can one recognize what the eye disease names in The Book of Pulse refer to precisely.

Translator: Ying-Shuai Duan (段英帅)

Funding

This study was financed by grants from the Major Program of National Philosophy and Social Science Research of China (No. 19ZDA195); the Youth Fund Program of Humanities and Social Science Research Foundations Supported by Ministry of Education of China (No. 19YJC740112); General Program of Shanghai Municipal Philosophy and Social Science Foundation (No. 2018BTQ004).

Ethical approval

The author has no ethical conflicts to disclose.

Conflicts of interest

None.



 
  References Top

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