张介宾曰。凡治伤寒。先看两目。或赤或黄。赤者。为阳症。若兼六脉洪大有力。或燥而渴者。
其热必盛。轻则三黄石膏汤。重则大承气汤之类。凡目色青白。而无昏冒闪烁之意者。多非火症。
不可轻用凉药。眼眵多结者。必因有火。盖凡有火之候。目必多液。液干而凝。所以为眵。即如
肺热甚。则鼻涕出。是亦目液之类也。
【纲】仲景曰。风湿为病。脉阴阳俱浮。自汗出。身重。多眠。鼻息急。必鼾。语言难出。若
被下者。小便不利。直视失溲。若被火者。微发黄色。剧则如惊痫。时螈 。
【目】危亦林曰。本条风湿。法当汗解。而医反下之。大便利。则小便必不利。肺之气化不宣。
胃家之关门不利。脾土之承制不行。故直视失溲也。
【纲】仲景曰。若汗出发润。喘不休者。此为肺先绝也。阳反独留。形体如烟熏。直视摇头者。
此为心绝也。唇吻反青。四肢 习者。此为肝绝也。环口黧黑。柔汗发黄者。此为脾绝也。溲便
遗失。狂言。反目直视者。此为肾绝也。
【目】楼英曰。夫至脏气脱绝。其错逆为不可救矣。
柯琴曰。五脏相生。一脏受灾。四脏不救。阴阳相须。彼气先绝。此气不存。医者可不调于未
灾未绝之先乎。
【纲】仲景曰。伤寒六七日。目中不了了。睛不和。无表里症。大便难。身微热者。此为
实也。急下之。宜大承气汤。
【目】吴绶曰。目中不了了者。能视物。但见一半而不见一半。有所谵妄而胡言者是也。其内
实不大便者。宜下之。内
虚者。多难治也。若戴眼反折者。此为上视。绝汗乃出。大如贯珠不流。此膀胱绝也。
杨士瀛曰。直视。与目中不了了。形症相近。一可治。一不可治也。
Zhang Jiebin said: In general, when treating Shanghan (Cold Damage), one should first observe the patient's eyes. If they are red or yellow, redness indicates a Yang syndrome. If accompanied by six pulses that are surging, large, and forceful, or if there is dryness and thirst, the internal heat must be severe. For mild cases, use Sanhuang Shigao Tang (Three-Yellow Gypsum Decoction); for severe cases, use formulas such as Dachengqi Tang (Major Order the Qi Decoction). Whenever the eye color is blue-white and lacks signs of dizziness or flickering vision, it is mostly not a Fire syndrome. One should not lightly use cold-cooling medicines. When there is much discharge and crusting in the eyes, it is certainly due to Fire. Generally, whenever there are signs of Fire, the eyes will have excessive secretions. When the fluids dry and coagulate, they form eye discharge. Just as excessive lung heat causes nasal mucus to flow, this is also a type of ocular fluid.
[Gang] Zhongjing said: In Wind-Dampness disease, the pulse at Yin and Yang positions is floating on both sides. There is spontaneous sweating, heaviness of the body, somnolence, rapid breathing, and inevitably snoring. Speech is difficult to produce. If treated with purgation, urination becomes difficult, the eyes stare fixedly, and there is incontinence of urine and feces. If treated with fire therapy, jaundice may appear mildly; severely, the patient resembles epilepsy with convulsions.
[Mu] Wei Yilin said: The Wind-Dampness described in this clause should be resolved through sweating. However, the physician incorrectly used purgation. This leads to frequent bowel movements, causing urination to become difficult. The Qi transformation of the Lung fails to circulate freely; the closing function of the Stomach is impaired; and the controlling mechanism of Spleen Earth does not function. Therefore, fixed staring and incontinence occur.
[Gang] Zhongjing said: If sweat wets the hair and panting continues without cessation, this indicates the exhaustion of Lung Qi first. Yang Qi remains alone while Yin is lost; the body appears dark like smoke-stained, with fixed staring and head shaking; this indicates the exhaustion of Heart Qi. The lips and corners of the mouth turn cyanotic, and the limbs twitch involuntarily; this indicates the exhaustion of Liver Qi. The area around the mouth turns dark black, with soft sweat that is yellowish; this indicates the exhaustion of Spleen Qi. Incontinence of urine and feces, delirious speech, and fixed staring eyes indicate the exhaustion of Kidney Qi.
[Mu] Lou Ying said: When Zang Qi reaches the point of depletion and exhaustion, the resulting disorder and reversal are incurable.
Ke Qin said: The Five Zang organs generate each other; if one organ suffers disaster, the other four cannot be saved. Yin and Yang depend on each other; if the Qi of one side perishes first, the Qi of the other side cannot survive. Should not physicians regulate the condition before disaster and exhaustion occur?
[Gang] Zhongjing said: After six or seven days of Shanghan, the eyes appear dim and unclear, and the eyeballs move stiffly. Without obvious exterior or interior syndromes, but with difficulty in defecation and slight fever, this is an Excess syndrome. Urgent purgation is required. Dachengqi Tang (Major Order the Qi Decoction) is appropriate.
[Mu] Wu Shou said: "Muzhongbuliaoliao" refers to the ability to see objects, but only seeing half and missing the other half, accompanied by delirium and nonsensical speech. If caused by internal excess and constipation, purgation should be used. If caused by internal deficiency, it is difficult to treat. If the eyes roll upward and the body arches backward, this is called "Daiyan" (staring upward). Absolute sweat emerges, large like beads and not flowing; this indicates the exhaustion of Bladder Qi.
Yang Shiying said: "Fixed staring" and "Muzhongbuliaoliao" have similar morphological symptoms, but one is treatable, while the other is not.