经义
诸脉者皆属于目。○目得血而能视。○肝病者，虚则目KT KT 无所见。○气脱者目不明。○目内陷者死。瞳子
高者太阳不足，戴眼者太阳已绝。（《素问》）
五脏六腑之精气，皆上注于目而为之睛。精之窠为眼，骨之精为瞳子，筋之精为黑眼，血之精为络，其窠
气之精为白眼，肌肉之精为约束。裹撷筋骨血气之精而与脉并为系，上属于脑，后出于项中。故邪中于项，因
逢其身之虚。其入深则随眼系以入于脑，则脑转。脑转则引目系急，目系急则目眩以转矣。○精散则视歧。○目
外决于面者，为锐 ；在内近鼻者，为内 。上为外 ，下为内 。○足太阳之筋，支者为目上纲；足阳明
之筋，上合于太阳为目下纲；足少阳之筋，支者结于目 为外维。（《灵枢》）
肝气通于目，目和则知黑白矣。○脱阴者目盲。（《难经》）
哲言
人之瞳子黑，故昼见夜不见，阴与阴合也；枭獭之瞳子赤，故夜见昼不见，阳与阳合也；虎、豹、猫、
犬、驴、马之瞳子黄，故昼夜皆见。（《眉公秘笈》）
目之五轮，乃脏腑之精华，宗筋之所聚。白珠属肺，曰气轮；乌珠属肝，曰风轮；两 属心，曰血轮；两
胞属脾，曰肉轮；瞳神属肾，曰水轮。○干为天廓，位两边白睛中间。震为雷廓，位白睛上截小 。兑为泽廓，
位白睛下截大 。坤为地廓，位上下两胞。离为火廓，位大小 。巽为风廓，位乌珠。艮为山廓，位神光。坎
为水廓，位瞳子。○眼昏花者伤气，昏暗者伤血。黑花
者，肾虚也；五色花者，肾虚客热也；青花者，胆虚也；红花者，火盛也；散杳者，瞳人散大视物杳冥也。（《医学入门》）
华元化云∶目形类丸，瞳神居中，有神膏、神水、神光、真血、真气、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，先天真一之气所化，目上润
泽之水也。水衰则有火胜燥暴之患，水竭则有目轮大小之疾，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。心，
君主也。通于大 ，故大 赤者实火也。命门，相火也，通于小 ，故小 赤者虚火也。真血者，即肝中升运
滋目之血，此血非比肌肉间日行之血，即天一所生之水也。真气者，即目中往来运用之气，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，外则白稠神水，水外则皆血。膏中一点黑莹，乃肾、
胆所聚之精华，名曰水轮。五轮之中，惟瞳神乃照。或曰∶瞳神，水耶？气耶？膏耶？血耶？曰∶非气、非血、
非水、非膏，乃先天之气所生，后天之之气所成，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。（《赵氏医贯》）
肝热则肿，心热则眵；火盛则痛，水化则泪；血虚则酸，气虚则涩，精竭则昏，神竭则黑，风胜则痒，热
胜则胀，湿胜则烂。（《绳墨》）
凡脏腑之精华，皆上注于目。然所以能光烛远近者，阳之用也；济之以令光明不竭者，阴之用也。阴阳合
德而为精明，非气血独能充其力也。盖气血止为阴阳之标，非可以称精华。而阴阳实为血气之本，所以能致精
华也。阴亏则热，故病目也红赤暴痛、眼珠刺疼、夜则更甚，然虽肿疼不能开目，若开目则视物能见，
岂非阴虚则热，而邪火乘之，耗其精华，无以为佐助清阳之用。可知阴病而阳不病，是为有火者也。阳虚则寒，
故病目也白翳遮睛、珠不甚痛、但如青盲，虽能开目，而视物则不见，岂非阳虚则寒，而浊阴犯之，遂失其如
天与日之光而不彰乎？此乃阳气自病，是为无火者也。热者补其真阴，寒者补其真阳。如是则阴阳复能合德而
为精明之用矣。请以浅近之理喻之，夫灯之能明者，火也；资其明之用者，膏也。有膏无火，何以能明？有火
无膏，则燎然猛烈。二者废一，便难以成光明之象矣。所谓火中求水，其源不竭；水中求火，其明不灭。一属
有形，一属无形。惟其无形，故能生出有形。盖造化之理，皆生于无也。（《冯氏锦囊》）
生食五辛，乘热饮食，烂头出血，昏夜读书，久处烟火，冒涉风霜，博奕不休，饮酒不已，抄写细字，雕
镂细作，泣泪过多，房室不节，夜视星月，极目瞻视山川、草木，皆丧明之由也。（《千金方》）
《经》言，气脱者，目不明。越人言∶脱阴者目盲。何谓也？气脱者，暴不明而寂无所见；脱阴则以渐而
目昏暗。阳迅速而阴迟滞故也。○暗室置物，因灯而影生。一灯一影，两灯两影。无他，其光分也。人有两目，
而视物唯一，窍分而所以注窍之精不分。若精不相合，则视一为二矣。故曰∶精散则视歧。○人之倒视者，何
气使然？由目精内陷，不能上输于瞳人也。阳燧者，鉴之凹然者也，其形中深边浅，持以照物，无不颠倒。精
不上输于瞳人，则与阳燧无异，故视物亦倒也。其病有二∶因阻塞而精不上输者，可吐而愈；因精亏而不上输
者，非补不愈。（《医参》）
东垣曰∶目能远视不能近视者，阳气不足，阴气有余也。能近视不能远视者，阳气有余，阴气不足也。海
藏曰∶目能远视，责其有火；不能近视，责其无水。目能近视，责其有水；不能远视，责其无火。何二子之言
相反也，岂无是非之辨哉？先儒谓金水内明而外暗，日火外明而内暗。然内明者利于近，外明者利于远。
故凡不能远视者，必阴胜阳也；不能近视者，必阳胜阴也。由此言之，则海藏是而东垣非矣。愚见则但当言其
不足，不必言其有余。不能远视者，阳气不足也；不能近视者，阴气不足也。岂不明显！若东垣以阴气有余、
阳气有余皆谓之火，则凡能视者，皆火病也。海藏云∶能近视责其有水，能远视责其有火，则当责者亦是病也。
此等议论，余则未敢服膺。○凡病目者，非火有余则阴不足耳。但辨虚实，可尽之矣。盖红肿赤痛，及少壮暂得
之病，或因积热而发者，皆属有余。其有既无红肿，又无热痛，而但昏涩，或眩晕无光，或年及中衰，或酒色
过度，以致羞明黑暗、瞻视无力、珠痛如抠等证，则无非水之不足也。虚者当补，实者当泻，此固其辨矣。然
实中亦有兼虚者，此于肿痛中当察其不足。虚中亦有兼实者，又于衰弱内当辨其有余。虚实殊途，自有形气
脉色可诊可辨也。○眼科有风热之说，凡见火证，无论有风、无风、无不称为风热，多从散治。不知风之为义，
最当辨析。夫风本阳邪，然必有外感，方是真风。因风生热者，风去而火自息，此宜散之风也。若本无外感，
止因内火上炎而为痒、为痛者，人亦称为风热。盖木属肝，肝主风，因热极而生风者，热去而风自息，此不宜
散者也。如果风由外感，必见表证，方可兼散。如无表证，但阴火炽上者，则风药皆不可用。虽曰亦有芩、连
清火，然宜升者不宜降，宜降者不宜升。若用药不精，而翳膜损明，无所不至。○眼目之证，当察色以辨虚实。
《经》曰∶黄赤者多热气，青白者少热气。故凡治黄赤者，宜清肝泻火；治青白者，宜壮肾扶阳，此固不易之
法也。至于目黄一证，尤宜辨其虚实，不可谓黄者必由热也。盖有实热而黄者，有虚寒而黄者。实热之黄，如
造曲者然，此亦湿热内蓄，郁蒸而成，热去则黄自退，非清利不可也。若虚寒之黄，则犹草木之调，此以元阳
日剥，津液消索而然。其为病也，既无有余之形气，又无烦热之脉证，惟因干涸，所以枯黄。其衰已甚，使非
温补，何以回生？不可因其色黄，概
认为热，而再加清利，鲜不危矣。○翳障当分虚实，大都外障者，多因赤痛而成。赤痛不已，则或为 肉，或为
瘢HT ，此皆有余之证，治当内清其火，外磨其障。若内障者，外无云翳而内有蒙蔽。《纲目》谓其有翳在黑睛
内遮瞳子而然。《龙木论》又云∶脑脂流下作翳者，足太阳之邪也，肝风冲上作翳者，足厥阴之邪也。治以针
法。闻有巧手，能用金针于黑眼内拨去云翳，取效最捷。此虽闻之，未见其人。又有所谓内障者，察其瞳子则
本无遮隔，惟其珠色青蓝，或兼绿色，或瞳人散大，别无热壅等证，而病目视不明，或多见黑花，此悉由肾气
不足，故致瞳子无光，若有所障，而内实无障也。治当专补肾水，气虚者当兼补其气。（张景岳）
《经》云∶五脏六腑之精华，皆上注于目。又云∶目者，肝之窍。肝与胆为表里，肝液、胆汁充足，目乃
能远视。故无论外感、内因，皆与肝胆有关系焉。夫六淫之邪，惟风、火、燥居多，寒、湿亦间有之。内起之
证，肝、胆、心、肾为多，他脏亦间有之。至于论治，则外感之证，必有头痛、寒热、鼻塞、筋骨酸疼，脉见
紧数浮洪，一切表证，方可清散。内因之证，有虚实之殊。实者，肝、胆之风热盛也。凡暴赤肿痛，胀闷难开，
翳膜眵泪，酸涩作痒，皆实证也。当驱风散热。虚者，肾经之水火衰也。凡久病青盲雀目，内障昏 ，五色花
翳，迎风泪出，皆虚候也。治宜壮水益火。若阴血虽亏，而风热未净，则审其缓急，相参而治。若久服寒凉，
虚阳转盛，则当补以甘温，从乎反佐。此内治之大法也。若日久失调，气血凝滞、火热壅结而为赤肿腐烂、翳
膜遮蔽，致成外障。譬之镜受污垢，必当濯磨，须用点药。若但服药，必不能愈。至于内障，但宜服药，点药
徒伤血气，无益有损。更当知目 白珠属阳，故昼痛，点苦寒药可效。瞳子黑睛属阴，故夜痛，点苦寒药反剧。
是外治之法，亦当以阴阳区别也。更有肝阴亏耗，
木火上炎，眼胞红肿、睛珠刺痛、眵泪如脓、白晴如努、目珠上窜、不得寤寐，甚则巅脑如破，此内发之风，
宜育阴熄风、柔肝滋肾。凡羌、防、芎、 等药，皆不可用，失治成痼而不可救。（《临证指南》）
圣人虽言目得血而能视，然血亦有太过、不及。太过则脉壅塞而发痛，不及则目耗竭而失明。热则血行
疾而多，寒则血行迟而少。目者，肝之外候也，在五行属木。木之为物，太茂则蔽密，太衰则枯悴。蔽密则风
不疏通，故多摧拉；枯悴则液不浸润，故无荣华。人之有目，如天之有日月也。目之有翳，如日月之有云雾也。
凡云之兴，未有不因蒸腾而起。隆冬犹然，况炎夏乎？目不因火则不病。气轮变赤，火乘肺也；肉轮赤肿，火
乘脾也；黑水神光被翳，火乘肝与肾也；赤脉贯目，火自甚也。能治火者，一句可了。在药，则咸寒吐之、下
之；在针，则神庭、上星、囟会、前项、百会。翳可立退，痛可立止，昧可立明，肿可立消。小儿水在上，火
在下，故目明；老人火在上，水不足，故目昏。《经》曰∶血实宜决之。虚者补之，实者泻之。（张子和）
张子和云∶目不因火则不病，能治火者，一句可了。余独补水以配火，亦一句可了。（赵养葵）
内障者，不疼不痛、无泪无眵，细观如薄雾之形，久视如轻烟之状。飞蝇散乱，悬虫虚空，日渐月增。脑
脂下结于乌轮，翳障渐生于黑水。（《医方类聚》）
外障易治，内障难治；暴发者为表易治，久病者为里难治。（刘河间）
羞明有二∶热壅则恶热，明光能助邪热，故见明则躁也；血虚胆汁少，则不能运精华以敌阳光，故见明则
怯也。○临诊之际，不拘伤寒、杂证，凡见直视、上视、斜视、眼如盲、眼小、目瞪等候，皆系五脏内败，阴
阳绝竭而征于外者，必死。（林慎庵）
雀目乃肝虚之候。盖木生于亥、旺于寅、绝于申，至于酉戌，
木气衰甚也。宜补肝肾之不足。（《证治汇补》）
阳虚则眼楞紧急，阴虚则瞳子散大。故东垣治眼楞紧急，用参、 补气为君，佐以辛味疏散之。而忌芍药、
五味之类，酸收故也。治瞳子散大，用地黄补血为君，佐以酸味收敛之。而忌茺蔚、青葙之类，辛散故也。（娄全善）
瞳神反背者，因风热搏击其珠而斜翻转侧，治宜通肝散加全蝎、钩藤。虚则神效黄 汤、补中益气汤，皆
可取用。或云∶反背即是发白，北人声韵相似也。安有目系内系而能反背之理？○倒睫拳毛者，由目紧皮缩所致。
久则赤烂，神水不清，每多障结、涩凝、泪出之苦。有拔去、翦去者，得效虽速，不知内病未除，未几复倒。
譬之草木枯槁，则枝叶萎垂，即朝摘黄叶，暮去枯枝，徒伤其本，不若培益水土，则黄者翠而垂者耸矣。此证
内伏火热，而阴气外行，当泻其热，眼皮缓则毛自生，翳膜自退。又有用手法板出内睑向外，以三棱针出血，
立愈。（《张氏医通》）
凡目赤肿痛者，当散湿热；赤而干痛者，当散火毒，赤而多泪者，当散风邪；赤而不痛者，当利小便。○
[Scriptural Principles]
All meridians converge upon the eyes. ○ The eyes can see only when nourished by blood. ○ In liver diseases, deficiency manifests as blurred vision or inability to see. ○ When Qi is depleted, vision becomes unclear. ○ Sunken eyes indicate a fatal condition. Upward deviation of the pupils (high gaze) indicates insufficiency of the Taiyang meridian; fixed upward staring (dai yan) indicates exhaustion of the Taiyang meridian. (*Su Wen*)
The essence and qi of the five zang organs and six fu organs all ascend to the eyes to form vision. The gathering place of essence is the eye; the essence of bone forms the pupil; the essence of sinews forms the iris (black part of the eye); the essence of blood forms the vascular network; the essence of Qi forms the sclera (white part); the essence of muscle forms the eyelids (which constrain opening and closing). These essences wrap around the sinews, bones, blood, and Qi, combining with the vessels to form the optic nerve system, which ascends to connect with the brain and emerges posteriorly at the nape. Thus, if pathogenic factors strike the nape, especially when the body is deficient, deep invasion follows the optic nerve into the brain, causing vertigo. Vertigo pulls on the optic nerve, causing tension, which leads to dizziness and visual rotation. ○ Scattering of essence results in diplopia (seeing double). ○ The outer corner of the eye, deeper on the face, is the lateral canthus; the inner corner near the nose is the medial canthus. The upper aspect is the lateral angle, and the lower aspect is the medial angle. ○ The sinews of the Foot-Taiyang Bladder Meridian branch to form the upper eyelid; the sinews of the Foot-Yangming Stomach Meridian merge with the Taiyang to form the lower eyelid; the sinews of the Foot-Shaoyang Gallbladder Meridian branch and knot at the lateral canthus to serve as the lateral ligament. (*Ling Shu*)
Liver Qi connects with the eyes; when eye Qi is harmonious, one can distinguish black from white. ○ Depletion of Yin essence leads to blindness. (*Nan Jing*)
[Philosophical Remarks]
Human pupils are black, so we see during the day but not at night; this is the union of Yin with Yin. Owl and otter pupils are red, so they see at night but not during the day; this is the union of Yang with Yang. Pupils of tigers, leopards, cats, dogs, donkeys, and horses are yellow, so they see both day and night. (*Mei Gong Mi Ji*)
The Five Wheels of the eye are the gathering place of the essence of the zang-fu organs and the tendons. The sclera belongs to the Lung and is called the Qi Wheel; the iris belongs to the Liver and is called the Wind Wheel; the canthi belong to the Heart and are called the Blood Wheel; the eyelids belong to the Spleen and are called the Flesh Wheel; the pupil belongs to the Kidney and is called the Water Wheel. ○ Dry represents the Heaven Wheel, located between the whites of the eyes on both sides. Zhen represents the Thunder Wheel, located in the upper small section of the sclera. Dui represents the Lake Wheel, located in the lower large section of the sclera. Kun represents the Earth Wheel, located in the upper and lower eyelids. Li represents the Fire Wheel, located in the medial and lateral canthi. Xun represents the Wind Wheel, located on the iris. Gen represents the Mountain Wheel, located at the center of the pupil (Shen Guang). Kan represents the Water Wheel, located at the pupil. ○ Blurred vision indicates Qi injury; dimness indicates Blood injury. Black spots indicate Kidney deficiency; multi-colored spots indicate Kidney deficiency with exogenous heat; blue spots indicate Gallbladder deficiency; red spots indicate excess Fire; scattered and indistinct vision indicates dilation of the pupil and dim sight. (*Yi Xue Ru Men*)
Hua Yuanhua said: The eye resembles a sphere, with the pupil in the center. There are Divine Paste (Shen Gao), Divine Water (Shen Shui), Divine Light (Shen Guang), True Blood (Zhen Xue), True Qi (Zhen Qi), and True Essence (Zhen Jing), which are the source fluids nourishing the eye. Divine Paste is the paste-like fluid contained within the eye, formed by the accumulation of essence juice seeping from the Gallbladder; it nourishes the pupil, and its decline causes damage. Divine Water is transformed from the primordial True One Qi of congenital origin, providing moisture to the eye. Insufficiency of water leads to excess Fire and dryness; depletion of water leads to disorders of the eye wheels; consumption and astringency lead to the danger of dimness. Losses are many, fullness is rare, hence there are no perfectly fine eyes in the world. Divine Light originates from the Gate of Life (Ming Men), connects with the Gallbladder, issues from the Heart, and functions as Fire. Insufficiency of Fire leads to dimness; flaming Fire leads to burning dryness. The Heart is the Sovereign Officer. It connects with the lateral canthus, so redness there indicates Excess Fire. The Gate of Life is Ministerial Fire, connecting with the medial canthus, so redness there indicates Deficient Fire. True Blood is the blood ascending and transporting from the Liver to nourish the eye; this blood differs from the daily circulating blood in muscles and is the Water generated by Tian Yi. True Qi is the Qi moving and operating within the eye, being the primal Yang of congenital origin. True Essence 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 are damaged, the eye becomes diseased. Generally, the eye is round and long, surrounded by several layers of hard shell, containing a clear meat package with thick black Divine Paste, outside which is white-thick Divine Water, and outside that, blood. A spot of black brightness in the paste is the gathered essence of the Kidney and Gallbladder, named the Water Wheel. Among the Five Wheels, only the pupil provides illumination. Some ask: Is the pupil Water? Qi? Paste? Blood? The answer is: Neither Qi, nor Blood, nor Water, nor Paste; it is born from congenital Qi, formed by postnatal Qi, a subtle accumulation of Yin and Yang, and the essence of Water and Fire. Blood nourishes Water, Water nourishes Paste, Paste protects the Pupil. Qi handles operation, Shen maintains. Using the sun and moon as metaphors, the principle is the same. (*Zhao Shi Yi Guan*)
Liver heat causes swelling; Heart heat causes discharge; excess Fire causes pain; Water transformation produces tears; Blood deficiency causes sourness; Qi deficiency causes astringency; Essence exhaustion causes dimness; Shen exhaustion causes darkness; excess Wind causes itching; excess Heat causes distension; excess Dampness causes ulceration. (*Sheng Mo*)
The essence of all zang-fu organs ascends to the eyes. However, the ability to illuminate near and far is due to the function of Yang; assisting it to keep light inexhaustible is the function of Yin. Yin and Yang combine in virtue to produce clear vision; it is not solely the power of Qi and Blood. Qi and Blood are merely the branches of Yin and Yang, not the essence itself. Yin and Yang are truly the root of Qi and Blood, thus producing essence. Yin deficiency generates heat, causing eye disease characterized by redness, acute pain, stabbing pain in the eyeball, worsening at night. Although swollen and painful, preventing eye opening, if opened, vision remains possible. This indicates Yin deficiency generating heat, with evil Fire taking advantage, consuming essence, leaving no support for Clear Yang. Thus, Yin is diseased while Yang is not, indicating the presence of Fire. Yang deficiency generates cold, causing eye disease characterized by white nebula covering the pupil, little pain, resembling blind man's blue cataract. Although eyes can open, vision is lost. This indicates Yang deficiency generating cold, with turbid Yin invading, losing the brilliance of heaven and sun. Thus, Yang is self-diseased, indicating absence of Fire. For heat, tonify True Yin; for cold, tonify True Yang. Thus, Yin and Yang can recombine in virtue to function as clear vision. Use a simple analogy: The brightness of a lamp is Fire; the substance fueling it is Oil (Paste). With oil but no fire, how can it shine? With fire but no oil, it burns fiercely. Lacking either makes bright imagery difficult. Seeking Water in Fire ensures the source is inexhaustible; seeking Fire in Water ensures the light does not extinguish. One is有形 (form/have shape), one is 无形 (formless). Because formless, it generates form. The principle of creation arises from the formless. (*Feng Shi Jin Nang*)
Raw consumption of the Five Pungent herbs, hot food/drink, head ulcers with bleeding, reading at night, long-term exposure to smoke/fire, exposure to wind/frost, endless gambling, excessive drinking, copying small text, fine carving, excessive crying/tearing, immoderate sexual activity, viewing stars/moon at night, straining eyes to view mountains/rivers/trees/grass—all are causes of blindness. (*Qian Jin Fang*)
The Classics state: "When Qi is depleted, vision is unclear." Yue Ren (Bian Que) stated: "Depletion of Yin leads to blindness." What does this mean? Qi depletion causes sudden blurriness and silence/no vision; Yin depletion causes gradual dimness. This is because Yang is rapid and Yin is sluggish. ○ Placing objects in a dark room creates shadows due to light. One lamp, one shadow; two lamps, two shadows. No other reason, just light division. Humans have two eyes but see one image; orifices are divided, but the essence entering them is undivided. If essence does not combine, one object is seen as two. Hence: "Scattering of essence leads to diplopia." ○ Why do some people see things upside down? What Qi causes this? It is because eye essence sinks inward and cannot ascend to the pupil. Yang Sui (concave mirror) is deep in the middle and shallow at edges; reflecting objects causes inversion. If essence does not ascend to the pupil, it is like Yang Sui, so vision is inverted. Two types of pathology: Obstruction preventing ascent can be cured by emesis; Essence deficiency preventing ascent requires tonification. (*Yi Can*)
Li Dongyuan said: Ability to see far but not near indicates insufficient Yang and excess Yin. Ability to see near but not far indicates excess Yang and insufficient Yin. Hai Zang said: Seeing far blames Fire; not seeing near blames lack of Water. Seeing near blames Water; not seeing far blames lack of Fire. Why are their words contradictory? Isn't there a distinction? Confucian scholars say Metal and Water are bright inside and dark outside; Sun and Fire are bright outside and dark inside. Inner brightness favors near vision; outer brightness favors far vision. Thus, inability to see far implies Yin overcoming Yang; inability to see near implies Yang overcoming Yin. Therefore, Hai Zang is correct, Li Dongyuan incorrect. My view is to speak only of insufficiency, not excess. Inability to see far is Yang insufficiency; inability to see near is Yin insufficiency. Is this not obvious? If Li Dongyuan considers excess Yin and excess Yang as Fire, then all vision is a Fire disease. Hai Zang says seeing near blames Water, seeing far blames Fire, implying the blamed factors are also pathological. I cannot accept such arguments. ○ All eye diseases are either excess Fire or insufficient Yin. Differentiating deficiency and excess covers it all. Redness, swelling, pain, and acute onset in youth, or due to accumulated heat, belong to excess. Lack of redness/swelling/pain, but with dimness/astringency, dizziness/no light, middle age decline, or alcohol/sex excess leading to photophobia/darkness, weak vision, eyeball pain like digging—these are all Water (Yin essence) insufficiency. Deficiency requires tonification; excess requires purging. This is the differentiation. However, excess may combine with deficiency (observe insufficiency amidst swelling/pain); deficiency may combine with excess (differentiate excess amidst weakness). Different paths, yet diagnosable via form, Qi, pulse, and color. ○ Ophthalmology speaks of Wind-Heat. Any Fire syndrome is called Wind-Heat regardless of actual Wind, treated mostly with dispersal. One must analyze Wind carefully. Wind is a Yang pathogen, but true Wind requires external contraction. Wind generating Heat: once Wind goes, Fire rests; this is suitable for dispersal. If no external contraction, but internal Fire flaring causing itch/pain, also called Wind-Heat. Wood belongs to Liver, Liver governs Wind; extreme Heat generating Wind: once Heat goes, Wind rests; this is NOT suitable for dispersal. If Wind is truly external, manifesting exterior symptoms, dispersal can be combined. Without exterior symptoms, only Yin Fire blazing upward, Wind drugs are contraindicated. Although Huang Qin and Huang Lian clear Fire, ascending vs. descending matters. Imprecise medication leads to nebula damaging vision. ○ Eye syndromes require observing color to differentiate deficiency/excess. Classics: Yellow/Red indicates much Heat; Blue/White indicates little Heat. Treat Yellow/Red by clearing Liver and purging Fire; treat Blue/White by strengthening Kidney and supporting Yang. This is unchangeable law. Regarding Jaundice of the eye, differentiate deficiency/excess; do not assume Yellow always means Heat. There is Excess Heat Jaundice and Deficient Cold Jaundice. Excess Heat Jaundice is like brewing yeast, caused by internal damp-heat stagnation; clearing heat resolves jaundice, requiring clearing/draining. Deficient Cold Jaundice is like withered grass, caused by daily erosion of Primordial Yang and depletion of fluids. Pathologically, lacking excess form/Qi and烦热 (restless heat) pulses/symptoms, it is dry and withered/yellow. Severe decline requires warming/tonifying to restore life; assuming heat and adding clearing/draining is dangerous. ○ Nebula/blockage must differentiate deficiency/excess. Mostly, exterior blockages result from redness/pain. Persistent redness/pain leads to pterygium or scars, all excess syndromes; treat by clearing internal Fire and grinding external blockage. Interior blockages have no external cloudiness but internal obscuration. *Ben Cao Gang Mu* says nebula blocks pupil inside black cornea. *Long Mu Lun* says brain fat flowing down causes nebula (Foot-Taiyang pathogen); Liver Wind rushing up causes nebula (Foot-Jueyin pathogen). Treat with acupuncture. Heard of skilled hands using gold needle to remove nebula from iris, very effective. Never seen such person. Another interior blockage: pupil has no obstruction, but eyeball is blue-green or pupil dilated, without heat stagnation, yet vision is unclear or sees black spots. All due to Kidney Qi insufficiency, causing pupil lack of light, appearing obstructed but internally clear. Treat by specifically tonifying Kidney Water; if Qi deficient, tonify Qi. (Zhang Jingyue)
Classics: Essence of five zang and six fu ascends to eyes. Eyes are the aperture of the Liver. Liver and Gallbladder are interior-exterior partners; sufficient Liver fluid and Gallbladder bile allow far vision. Thus, both external and internal causes relate to Liver/Gallbladder. Six Evils: Wind, Fire, Dryness are common; Cold, Damp occur occasionally. Internal causes: Liver, Gallbladder, Heart, Kidney are common; others occasional. Treatment: External causes must have headache, chills/fever, nasal congestion, bone/joint ache, tight/fast/floating/full pulse, all exterior symptoms, before clearing/dispersing. Internal causes differ in deficiency/excess. Excess: Liver/Gallbladder Wind-Heat. Sudden redness/swelling/pain, distension/closed eyes, nebula/discharge/tears, sourness/itch—all excess. Dispel Wind, scatter Heat. Deficiency: Kidney Water/Fire decline. Long-term blind man's blue cataract, night blindness, interior blockage, dimness, multi-colored nebula, wind-triggered tearing—all deficiency. Strengthen Water, benefit Fire. If Yin Blood deficient but Wind-Heat not cleared, judge urgency and treat jointly. If long-term cold/cool drugs cause deficient Yang to surge, use sweet/warm tonification, employing counter-assistance. This is major internal method. If long-term imbalance causes Qi/Blood stagnation, Fire/Heat congestion leading to redness/swelling/ulceration/nebula, becoming exterior blockage. Like mirror dirt, must wash/polish, using eye drops. Oral medicine alone fails. For interior blockage, oral medicine only; drops harm Qi/Blood. Know: White sclera is Yang, hurts by day, bitter-cold drops work. Pupil/black cornea is Yin, hurts by night, bitter-cold drops worsen it. External treatment also distinguished by Yin/Yang. More: Liver Yin consumption, Wood Fire flaring, eyelid redness/swelling, eyeball stabbing pain, pus-like discharge, sclera bulging, eyeball rolling up, insomnia, even head pain like breaking—this is internal Wind, nurture Yin, extinguish Wind, soften Liver, nourish Kidney. Qiang Huo, Fang Feng, Chuan Xiong, Bai Zhu etc. are contraindicated; mistreatment becomes incurable chronic disease. (*Lin Zheng Zhi Nan*)
Sages say eyes see via Blood, but Blood has excess/deficiency. Excess causes vessel blockage and pain; deficiency causes eye exhaustion and blindness. Heat speeds blood flow (more); Cold slows it (less). Eyes are Liver's external manifestation,五行属 Wood. Wood: too lush blocks ventilation (breaks easily); too withered lacks moisture (no glory). Human eyes are like heavenly sun/moon. Eye nebula is like sun/moon clouds. Clouds rise from evaporation. Winter yes, summer more so. Eyes do not get sick without Fire. Qi Wheel red: Fire attacking Lung. Flesh Wheel red/swollen: Fire attacking Spleen. Black Water/Shen Guang obscured: Fire attacking Liver/Kidney. Red vessels crossing eye: Fire excessive. Treating Fire solves it in one sentence. Herbs: Salty/Cold induce vomiting/purging. Acupuncture: Shen Ting, Shang Xing, Xi Hui, Qian Ding, Bai Hui. Nebula retreats, pain stops, dimness clears, swelling消. Children: Water above, Fire below, eyes bright. Elderly: Fire above, Water insufficient, eyes dim. Classics: "Excess Blood should be drained." Deficiency tonify, Excess purge. (Zhang Zihe)
Zhang Zihe: Eyes do not get sick without Fire; treating Fire solves it. I uniquely tonify Water to match Fire, also solves it in one sentence. (Zhao Yangkui)
Interior blockage: No pain, no tears/discharge, looks like thin mist, long viewing like light smoke. Flies scattering, worms hanging in void, increasing day by day. Brain fat knots under Iris, nebula grows in Black Water. (*Yi Fang Lei Ju*)
Exterior blockage easy to treat, interior hard. Acute exterior easy, chronic interior hard. (Liu Hejian)
Photophobia has two types: Heat stagnation dislikes heat, bright light aids evil heat, so bright causes irritability. Blood deficiency/bile scarcity cannot transport essence to resist sunlight, so bright causes fear. ○ Clinical practice, regardless of Cold Damage or miscellaneous diseases, fixed gaze, upward gaze, oblique gaze, blind-looking eyes, small eyes, staring eyes—all indicate internal failure of five zang, exhaustion of Yin/Yang manifesting externally, fatal. (Lin Shen'an)
Night blindness (Que Mu) is Liver deficiency. Wood born in Hai, prosperous in Yin, extinct in Shen, extremely weak in You/Xu months. Tonify Liver/Kidney insufficiency. (*Zheng Zhi Hui Bu*)
Yang deficiency causes tight eyelids; Yin deficiency causes dilated pupils. Li Dongyuan treats tight eyelids with Ginseng/Astragalus (Qi tonification) as sovereign, acrid dispersants as assistants, avoiding Sour/astringent Shaoyao/Wuweizi. Treats dilated pupils with Rehmannia (Blood tonification) as sovereign, Sour/astringent收敛 agents as assistants, avoiding acrid-dispersant Chongwei/Qiangxiang. (Lou Quanshan)
Pupil reversal/backwards: Wind-Heat combats eyeball, causing tilt/rotation. Treat with Tong Gan San plus Quan Xie, Gou Teng. Deficiency uses Shen Xiao Huang Qi Tang or Bu Zhong Yi Qi Tang. Some say reversal is whiteness (phonetic similarity). How can internal optic nerve reverse? Inverted eyelashes: caused by tight eyes/shrinking skin. Long term causes redness/ulceration, unclear Divine Water, blockage/astringency/tearing. Pulling/cutting works fast but internal disease remains, recurs quickly. Like withered plants, picking leaves harms root; better to enrich soil/water, green uprights. This syndrome has internal latent Fire, external Yin Qi flow; purge Heat, eyelids relax, lashes grow, nebula recedes. Manual eversion of lid + three-edged needle bleeding cures instantly. (*Zhang Shi Yi Tong*)
Eye redness/swelling/pain: Disperse Damp-Heat. Red/dry/pain: Disperse Fire-Toxin. Red/tearing: Disperse Wind-Evil. Red/no pain: Promote urination. ○