经曰。五脏六腑之精气。皆上注于目。而为之精。肾藏精。故治目者。以肾为主。目虽肝之窍。
子母相生。肾肝同一治也。
华元化云。目形类丸。瞳神居中而前。如日月之丽东南。而晦西北也。有神膏、神水、神光、真气、真
血、真精。此滋目之源液也。神膏者。目内包涵膏液。此膏由胆中渗润精汁。积而成者。能涵养瞳神。衰则有
损。神水者。由三焦而发源。先天真一之气所化。目上润泽之水是也。水衰则有火胜燥暴之患。水竭
则有目输大小之疾。耗涩。则有昏眇之危。亏者多。盈者少。是以世无全精之目。神光者。原于命门。通于胆。
发于心火之用事也。火衰则有昏瞑之患。火炎则有焚燥之殃。虽有两心而无正输。心君主也。通于大 。故大
赤者。实火也。命门为小心。小心相火也。代君行令。通于小 。故小 赤者。虚火也。若君主
拱默。则相火自然清宁矣。真血者。即肝中升运滋目注络之血也。此血非比肌肉间易行之血。即天一所主之水。
故谓之真也。真气者。即目之经络中往来生用之气。乃先天真一发生之元阳也。真精者。乃先天元气所化精
汁。起于肾。施于胆。而后及瞳神也。凡此数者。一有损。目则病矣。大概目圆而长。外有坚壳数重。中有清
脆肉。包黑稠神膏一函。膏外则白稠神水。水以滋膏。水外则皆血。血以滋水。膏中一点黑莹。是肾胆所聚之
精华。惟此一点。烛照鉴视。空阔无穷者。是曰水输。内应于肾。北方壬癸亥子水也。五输之中。惟瞳神乃
照。或曰瞳神水耶气耶血耶膏耶。曰非气非血非水非膏。乃先天之气所生。后天之气所成。阴阳之妙蕴。水火
之精华。血养水。水养膏。膏护瞳神。气为运用。神即维持。喻以日月。理实同之。男子右目不如
左目精华。女子左目不如右目光彩。此皆各得其阴阳气血之正也。
许学士云。经曰。足少阴之脉。是动则病坐而欲起。目KT KT 如无所见。又曰。少阴所谓起则目KT
KT无所见者。阴内夺。故目KT KT 无所见也。此盖房劳目昏也。左肾阴虚。益阴地黄丸六味
地黄丸。右肾阳虚。补肾丸八味地黄丸。
东垣云。能远视不能近视者。阳有余。阴气不足也。海藏云。目能远视。责其有火。不能近视。责其无
水。秘要云。阴精不足。阳光有余。病于水者。故光华发见散乱。而不能收敛近视。治之在心肾。心肾平。则
水火调而阴阳和。夫水之所化为血。在身为津液。在目为膏汁。若贪淫恣欲。饥饱失节。形脉劳甚。过
于悲泣。能斫耗阴精。阴精亏则阳火盛。火性炎而发见。阴精不能制伏挽回。故越于外而远照。反不能近之而
视也。治之当如何。壮水之主。以镇阳光。东垣云。能近视不能远视。阳气不足。
阴气有余也。海藏云。目能近视。责其有水。不能远视。责其无
火。秘要云。此证非谓禀成近窥之病。乃平昔无病。素能远视。而忽然不能者也。盖阳不足。阴有余。病于火
者。故光华不能发越于外。而畏敛近视耳。治之在胆肾。胆肾足则木火通明。神气宣畅。而精光远达矣。夫火
之所用为气。在身为威仪。在目为神光。若纵恣色欲。丧其元阳。元阳既惫。则云霾阴翳。肾中之阴水。仅足以
回光自照耳。焉能健运精汁。以滋于胆。而使水中之火。远布于空中耶。治之当何如。益火之原。以消阴翳。
以上之证。皆阴弱不能配阳。内障之病。其病无眵泪痛痒羞明紧涩之证。初但昏如雾露中行。渐空中有黑
花。又渐暗。物成二体。久则光不收。遂为废疾。患者皆宜培养先天根本。乘其初时而治之。况此病最难疗。
服药必积岁月。绝酒色淫欲。毋饥饱劳役。驱七情五贼。庶几有效。不然必废。终不复也。世不知
此。始曰目昏无伤。略不经意。及病成。医亦不识。直曰热致。竟用凉药。殊不知凉药伤胃。况凉为秋为金。
肝为春为木。又伤肝矣。往往致废而后已。病者不悟药之过。诿之曰命也。医者亦不自悟。而曰病拙。悲夫。
又有阳虚不能抗阴者。若因饮食失节。劳役过度。脾胃虚弱。下陷于肾肝。浊阴不能下降。清阳不能上
升。天明则日月不明。邪害空窍。令人耳目不明。夫五脏六腑之精。皆禀受于脾土。而上贯于目。此精字乃
饮食所化之精。非天一之元精也。脾者诸阴之首也。目者血气之宗也。故脾虚则五脏之精气。皆失
所司。不能归明于目矣。况胃气下陷于肾肝。名曰重强。相火挟心火而妄行。百脉沸腾。血脉逆上而目病矣。
若两目暗昏。四肢不怠者。用东垣益气聪明汤。若两目紧小羞明畏日者。或视物无力。肢体倦怠。或手足麻
木。乃脾肺气虚。不能上行也。用神效黄 汤。若病后。或日晡。或灯下。不能视者。阳虚下陷也。用
决明夜光丸。或升麻镇阴汤。
张子和云。目不因火则不病。白轮病赤。火乘肺也。肉轮赤肿。火乘脾也。黑水神光被翳。火乘肝与脾
也。赤脉贯目。火自甚也。能治火者。一句可了。但子和一味寒凉治火。余独补水以配火。亦一句可了。至于
六淫七情错杂诸证。详倪仲贤原机启微。此书甚好。而薛立斋又为之参补。深明壮水之主。益火之
原。甚有益于治目者也。
The *Classic of Difficult Issues* (Jing Yue Quan Shu cites *Huangdi Neijing*) states: The essence and qi of the five zang organs and six fu organs all ascend to pour into the eyes, thereby forming the essence of vision. The Kidney stores essence; therefore, in treating eye diseases, the focus is on the Kidney. Although the eyes are the orifice of the Liver, since the Mother and Child relationship generates each other between the Kidney and Liver, their treatment principles are unified.
Hua Yuanhua said: The shape of the eye resembles a sphere. The pupil is centered and protrudes forward, similar to how the sun and moon shine upon the southeast while remaining dim in the northwest. Within the eye exist Shen Gao (Divine Paste), Shen Shui (Divine Water), Shen Guang (Divine Light), Zhen Qi (True Qi), Zhen Xue (True Blood), and Zhen Jing (True Essence). These are the source fluids that nourish the eye. "Shen Gao" refers to the paste-like fluid contained within the eyeball. This paste is formed by the accumulation of essence juice seeping from the Gallbladder, capable of nurturing the pupil; if deficient, it causes damage. "Shen Shui" originates from the San Jiao (Triple Burner) and is transformed from the primordial True One Qi of congenital origin; it is the water that moistens the surface of the eye. If water is deficient, there is a risk of fire flourishing leading to dryness and irritability; if water is exhausted, disorders of the size of the eye's aperture (pupil/structures) occur; if consumed and dry, there is danger of dim and blurry vision. Deficiency is common, while fullness is rare; thus, there are no perfectly intact eyes in the world. "Shen Guang" originates from the Ming Men (Gate of Vitality), connects with the Gallbladder, and manifests through the function of Heart Fire. If fire is weak, there is a risk of dimness and blindness; if fire flares upward, there is disaster of burning and dryness. Although there are two hearts (referring to Ministerial Fire and Sovereign Fire), there is no central transmission channel. The Heart is the Sovereign, connecting to the outer canthus (Da Zi); thus, redness at the outer canthus indicates Excess Fire. The Ming Men is called the "Small Heart," representing Ministerial Fire (Xiang Huo), which acts on behalf of the Sovereign, connecting to the inner canthus (Xiao Zi); thus, redness at the inner canthus indicates Deficient Fire. If the Sovereign remains still and silent, Ministerial Fire will naturally be clear and tranquil. "Zhen Xue" is the blood rising and transporting from the Liver to nourish the eye collaterals. This blood differs from ordinary blood flowing easily in the muscles; it is governed by the Water of Tian Yi (Heavenly One), hence called "True." "Zhen Qi" is the qi circulating and functioning within the eye's meridians, being the primal Yang generated from the primordial True One of congenital origin. "Zhen Jing" is the essence juice transformed from congenital Yuan Qi, originating in the Kidney, applied to the Gallbladder, and then reaching the pupil. If any of these few substances are damaged, the eye becomes diseased. Generally, the eye is round and elongated, surrounded externally by several layers of hard shell, containing internally crisp flesh wrapping a mass of black, dense Shen Gao. Outside the paste is white, dense Shen Shui; water nourishes the paste. Outside the water is all blood; blood nourishes the water. In the center of the paste is a spot of black brilliance, which is the gathered essence of the Kidney and Gallbladder. Only this spot illuminates and inspects, boundlessly vast; this is called Shui Shu (Water Aperture), corresponding internally to the Kidney, belonging to the North, Ren-Gui, Hai-Zi Water. Among the Five Shu points, only the pupil possesses the function of illumination. Some ask: Is the pupil water, qi, blood, or paste? The answer is: It is neither qi, nor blood, nor water, nor paste. It is born of congenital qi and formed by postnatal qi, embodying the subtle mystery of Yin and Yang, and the essence of Water and Fire. Blood nourishes water, water nourishes paste, paste protects the pupil, qi governs operation, and spirit maintains. Using the sun and moon as a metaphor, the principle is indeed the same. In men, the right eye is less essential than the left; in women, the left eye is less brilliant than the right. This is because each obtains the correct balance of Yin, Yang, Qi, and Blood.
Scholar Xu said: The Classics state: When the Foot-Shaoyin (Kidney) meridian undergoes change, disease manifests as sitting but wanting to stand, and the eyes seeing nothing clearly like KT-KT (blurred vision). It also states: What Shaoyin calls "rising leads to blurred vision where one sees nothing" is due to internal depletion of Yin, causing blurred vision. This is likely eye dimness caused by sexual exhaustion. For Left Kidney Yin deficiency, use Yi Yin Di Huang Wan (Benefit-Yin Rehmannia Pill) or Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill). For Right Kidney Yang deficiency, use Bu Shen Wan (Tonify-Kidney Pill) or Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill).
Li Dongyuan said: Being able to see far but not near indicates Excess Yang and Insufficient Yin. Haizang said: Ability to see far is blamed on Fire; inability to see near is blamed on lack of Water. The *Secret Essentials* (Mi Yao) states: Insufficient Yin essence and excessive Solar Light cause disease in Water, so the luminous light scatters and cannot converge for near vision. Treatment focuses on the Heart and Kidney; when Heart and Kidney are balanced, Water and Fire harmonize, and Yin and Yang integrate. What Water transforms into is Jin Ye (Body Fluids) in the body, and Gao Zhi (Paste Juice) in the eyes. If one indulges in lust, suffers irregular eating and drinking, experiences severe physical and pulse fatigue, or weeps excessively, one chops away and consumes Yin essence. When Yin essence is depleted, Yang Fire flourishes. Fire nature is flaming and manifesting outward; Yin essence cannot restrain or retrieve it, so it escapes outward to illuminate far distances, rendering the ability to see near impossible. How should it be treated? Strengthen the Master of Water to suppress Solar Light. Li Dongyuan also stated: Being able to see near but not far indicates Insufficient Yang and Excess Yin. Haizang said: Ability to see near is blamed on having Water; inability to see far is blamed on lacking Fire. The *Secret Essentials* states: This condition does not refer to a congenital myopia, but rather a person who was previously healthy and could see far, suddenly losing that ability. This is due to Insufficient Yang and Excess Yin, disease in Fire, so the luminous light cannot emerge outward and instead shrinks inward for near vision. Treatment focuses on the Gallbladder and Kidney; when Gallbladder and Kidney are sufficient, Wood and Fire become bright, Shen Qi flows freely, and Jing Guang reaches far. The function of Fire is Qi; in the body, it manifests as demeanor; in the eyes, it is Shen Guang. If one indulges in sexual desires, losing Yuan Yang, once Yuan Yang is exhausted, cloud-haze and yin shadows arise. The Yin Water in the Kidney is barely enough to reflect light upon itself; how can it vigorously transport essence juice to nourish the Gallbladder and make the Fire within Water spread far into the air? How should it be treated? Benefit the Source of Fire to dissipate Yin Shadows.
The above conditions are all cases where Yin is weak and cannot match Yang, constituting internal cataract diseases. These diseases present without discharge, tearing, pain, itching, photophobia, or tightness/astringency. Initially, vision is merely dim as if walking in fog or dew; gradually, black flowers appear in the visual field; then darkness increases; objects appear double; eventually, light does not gather, leading to disability. Patients should cultivate the congenital root and treat during the early stage. Moreover, this disease is hardest to cure; medication requires accumulation over years. One must abstain from alcohol, sex, and lust, avoid irregular eating and labor, and drive away the Seven Emotions and Five Thieves. Only then might there be efficacy. Otherwise, disability is inevitable, and recovery is impossible. The world does not understand this. At first, they say eye dimness is harmless and pay little attention. By the time the disease forms, doctors do not recognize it, directly attributing it to Heat and using cooling medicines. They do not realize that cooling medicines damage the Stomach. Furthermore, Cooling corresponds to Autumn and Metal, while the Liver corresponds to Spring and Wood; thus, the Liver is also injured. Often, this leads to disability before stopping. The patient does not comprehend the error of the medicine, blaming fate. The doctor does not self-reflect, claiming poor skill. How sad!
There are also cases of Yang deficiency unable to resist Yin. If caused by irregular diet, excessive labor, and Spleen-Stomach weakness, sinking into the Kidney and Liver, Turbid Yin fails to descend, and Clear Yang fails to ascend. Like the sun and moon becoming obscured at dawn, evil harms the empty orifices, causing deafness and blindness. The essence of the five zang and six fu organs is all derived from Spleen Earth and ascends to penetrate the eyes. This "essence" refers to the refined substance transformed from food and drink, not the Primordial Essence of Tian Yi. The Spleen is the head of all Yins; the eyes are the congregation of Blood and Qi. Therefore, Spleen deficiency causes the essence qi of the five zang organs to lose their governance, failing to bring clarity to the eyes. Moreover, if Stomach Qi sinks into the Kidney and Liver, named "Zhong Qiang" (Heavy Rigidity), Ministerial Fire joins Heart Fire in reckless action, boiling the hundred vessels, reversing blood flow upward, and causing eye disease. If both eyes are dim and dark but limbs are not heavy, use Li Dongyuan's Yi Qi Cong Ming Tang (Qi-Supporting Brightness Decoction). If both eyes are tight, small, photophobic, and fearful of sunlight, or vision is weak, limbs are fatigued, or hands and feet are numb, this is Spleen-Lung Qi deficiency failing to ascend. Use Shen Xiao Huang Qi Tang (Miraculous Effect Astragalus Decoction). If after illness, or in the late afternoon, or under lamplight, one cannot see, this is Yang deficiency with sinking. Use Jue Ming Ye Guang Wan (Clear-Bright Night-Light Pill) or Sheng Ma Zhen Yin Tang (Cimicifuga Stabilizing-Yin Decoction).
Zhang Zihe said: Eyes do not become diseased unless due to Fire. Redness of the White Wheel (Sclera) indicates Fire attacking the Lung. Redness and swelling of the Meat Wheel (Eyelids) indicate Fire attacking the Spleen. Obscuration of the Black Water and Divine Light indicates Fire attacking the Liver and Spleen. Red vessels penetrating the eye indicate Fire is extreme. To treat Fire, one sentence suffices. But Zhang Zihe uses only cold-cooling medicines to treat Fire. I alone use Water to match Fire (nourishing Water to control Fire), which also suffices in one sentence. As for various syndromes mixed from Six Evils and Seven Emotions, refer to Ni Zhongxian's *Yuan Ji Qi Wei* (Origins of Mechanisms Unveiled). This book is excellent, and Xue Lizhai supplemented it further, deeply elucidating strengthening the Master of Water and benefiting the Source of Fire, greatly benefiting the treatment of eye diseases.