东垣治一人。因多食猪肉煎饼。同蒜醋食之。后复饮酒大醉。卧于暖炕。翌日。二瞳子
散。大于黄睛。视物无的实。以小为大。以短为长。卒然见非常之处。行路踏空。百治不效
曰。经云。五脏六腑之精气。皆上注于目而为之精。精之窠为眼。骨之精为瞳子。又云。
筋骨气血之精为脉。并为系。上属于脑。又云。瞳子黑眼法于阴。今瞳子散大者。由食辛热
物太甚故也。辛主散。热则助火。上乘于脑中。其精故散。精散则视物亦散大也。夫精明者
所以视万物者也。今视物不真。精且衰矣。盖火之与气。势不两立。经曰。壮火食气。壮
火散气。手少阴足厥阴所主。上连目系。邪之中人。各从其类。风与热循此道而来攻。故
头目肿闷而瞳子散大。皆由血虚阴弱所致也。当除风热。凉血益血。以收耗散之气。则病愈
矣。用滋阴地黄丸。经云。热淫所胜。平以咸寒。佐以苦甘。以酸收之。以黄芩、黄连大苦
寒。除热邪之盛为君。当归身辛温。生熟地黄苦甘寒。养血凉血为臣。五味酸寒。体轻浮。
上收瞳子之散大。人参、甘草、地骨皮、天门冬、枳壳苦甘寒。泻热补气为佐。柴胡引用为
使。忌食辛辣物助火邪。及食寒冷物捐胃气。药不能上行也。
震按此案讲致病之源流。论用药之道理。最精最当。孟子所谓规矩方圆之至也。
魏夫人目翳暴生。从下而起。其色绿。瞳痛不可忍。东垣曰。翳从下而上。病从阳明来
也。绿非五色之正。此肾肺合而为病。乃以墨调腻粉合之。却与翳色相同。肾肺为病明矣。
乃泻
肾肺之邪。入阳明之药为使。既效矣。他日病复作者三。其所从来之经。与医色各异。因悟
曰。诸脉皆属于目。脉病则目从之。此必经络未调。则目病未已也。因视所不调者治之。疾
遂不作。
震按此辨翳色甚巧。后之复发者三。翳色各异。合以诸脉皆属于目之经文。自当恍然。
虽不载方药。而云视所不调者治之。亦可以意会矣。
省郎中张子敬。年六十七。病眼目昏暗。唇微黑色。皮肤不泽。六脉弦细而无力。一日
出示治眼二方。问可服否。罗谦甫曰。此药皆以黄连大苦之药为君。诸风药为使。夫人年五
十。胆汁减而目始不明。内经云。土位之主。其泻以苦。诸风药亦皆泻土。年近七十。脾胃
虚而皮肉枯。重泻其土。使脾胃之气愈虚。而不能营运荣卫之气。滋养元气。胃气不能上行
膈气吐食。诸病生焉。此药不可服。只宜慎言语。节饮食。惩忿窒欲。此不治之治也。张
以为然。明年春。除关西路按察使。三年致仕还。精神清胜。脉亦和平。此不妄服寒药之效
也。内经曰。诛伐无过。是谓大惑。岂不信哉。
震按专门眼科。常用黄连。观罗公之论。皆当警省。至于不治之治四句。确为明目秘方
若不根据此调理。而仅不服寒药。亦属无益。
丹溪治一老人。目忽盲。他无所苦。以大虚治之。急煎人参膏一斤。服二日。目稍有见
一医与青礞石药。朱曰。今夕死矣。果然。
震按此案。即内经所谓气脱者目不明也。后薛立斋一案。用六味地黄丸加麦冬、五味。
即难经所谓脱阴者目盲也。干二条。一系受湿。一系瘀血。亦皆用补药为君。总由忽然而盲
不因赤昏肿痛所致。及翳障 肉所蔽。则因五脏之精华内竭。不复上聚于目。故非补不可
也。
一壮年。忽早起视物不见。就睡片时。略见而不明。食减倦甚。脉缓大四至之上。重则
散而
无力。意其受湿所致。询之。果卧湿地半月。遂以白术为君。黄 、茯苓、陈皮为臣。附子
为使。十余帖愈。
一人形实。好热酒。忽目盲。脉涩。此热酒伤。胃气污浊。血死其中而然也。以苏木作
汤。调人参末。服二日。鼻及二掌皆紫黑。朱曰。滞血行矣。以四物加苏木、桃仁、红花、
陈皮煎。调人参末服。数日而愈。
吕沧洲治一人。病二目视物皆倒植。屡治不效。曰。视一物为二。视直为曲。古人尝言
之矣。视物倒植。诚所未喻也。愿闻其因。彼曰。某尝大醉。尽吐所饮酒。熟睡达曙。遂病
吕切其脉左关浮促。余部皆无恙。即告之曰。当伤酒大吐时。上焦反复。致倒其胆府。故
视物皆倒植。此不内外因而致内伤者也。法当复吐以正其胆府。遂授藜芦、瓜蒂为粗末。水
煎。俾平旦顿服涌之。涌毕。视物不倒植。
淮安陈吉老。儒医也。有富翁子。忽病视正物皆以为斜。凡几案书册之类。排设整齐。
必更移令斜。自以为正。以至书写尺牍皆然。父母忧之。医者不谙其疾。或以吉老告。遂携
子求治。既诊脉后。令其父先归。留其子设乐开宴。酬劝至醉乃罢。扶病者坐轿中。使人舁
之。高下其手。常令倾倒辗转。久之方令登榻而卧。达旦酒醒。遣之归家。前日斜视之物。
皆理正之。父母跃然而喜。往问治之之方。吉老云。醉中尝闪倒肝之一叶搭于肺上。不能下
故视正物为斜。今复饮之醉则肺胀。展转之间。肺亦垂下矣。药安能治之哉。富翁叹服。
震按吕陈二案。骤闻其说。似无对证。及观其法。着有成验。真可谓隔垣之见矣。量古
人决不造谎。以欺天下后世也。鼻端生赘。脑后下针。世间原有此种仙术。第如余之庸暗。
终在将信将疑之间耳。再考钱仲阳案。方巧而理显。则平淡中之神奇矣。
钱仲阳治一乳妇。因悸而病。既愈。目张不得瞑。钱曰。煮郁李酒饮之使醉。即愈。所
以然者。目系内连肝胆。恐则气结。胆衡不下。郁李能去结。随酒入胆。结去胆下。目能瞑
矣。饮之果验。孙真人奉旨治卫才人眼疼。前众医不能疗。或用寒药。或用补药。加之脏腑
不和。孙诊之。肝脉弦滑。非壅热也。乃年壮血盛。肝血并不通。遂问宫人。月经已三月不
通矣。用通经药经行而愈。
震按肝脉弦滑。能不误认为风痰病眼乎。因肝藏血而知其血盛不通。诚切当矣。然犹问
宫人始得停经三月之信。并不先言据脉当停经也。真人尚如此。奈何讳疾者每不言以责其断
病耶。此正犯东坡所谓我欲困医。而我病亦适为医所困耳。
石山治一妇。年逾四十。两眼昏昧。咳嗽头痛。似鸣而痛。若过饥。恶心。医以眼科治
之。病甚。翁诊脉皆细弱。脾部尤近弦弱。曰。脾虚也。东垣云。五脏六腑。皆禀受于脾。
上贯于目。脾虚则五脏之精气皆失所司。不能归明于目矣。邪逢其身之虚。随眼系入于脑。
则脑鸣而头痛。心者。君火也。宜静。相火代行其令。劳役运动。则妄行。侮其所胜。故咳
嗽也。医不理脾养血。而以苦寒治眼。是谓治标不治本。乃用参、 各一钱五分。麦冬、贝
母各一钱。归身八分。陈皮、川芎、黄芩各七分。甘草、菊花各五分。麦芽四分。煎服二帖
诸证悉除。
薛己治给事张禹功。目赤不明。服祛风散热药。反畏明重听。脉大而虚。此因劳心过度
饮食失节。以补中益气加茯神、枣仁、山药、山茱萸、五味。顿愈。又劳役复甚。用十全
大补。兼以前药。渐愈。却用补中益气加前药而痊。东垣云。诸经脉络。皆走于面而行空窍
其清气散于目而为精。走于耳而为听。若心烦事冗。饮食失节。脾胃亏损。心火太甚。百
脉沸腾。邪害孔窍而失明矣。况脾为诸阴之首。目为血脉之宗。脾虚则五脏之精气皆失其所
若不理脾胃。不养气血。乃治标而不治本也。
震按此二案。专治脾虚。并不治目而目亦愈。盖治脾虚即所以治目。由于诊脉得其要领
也。惟同用参、 。汪案则佐以麦冬、贝母、川芎、黄芩、菊花。因有咳嗽头痛。尚带一二
分客邪耳。薛案则纯补。兼佐酸收。因曾服祛风散热药。反畏明重听。迨补之得愈。而劳役
复甚。其虚为尤甚耳。
一儒者日晡两目紧涩。不能瞻视。此元气下陷。用补中益气倍加参、 。数剂而愈。
震按楼全善云。阳虚则眼棱紧急。阴虚则瞳子散大。故目紧涩。宜用参、 。东垣有说
可考。但佐使之药。宜辛味疏散。忌芍药、五味之类酸收耳。
一男子年二十。素嗜酒色。两目赤痛。或作或止。两尺洪大。按之微弱。薛谓少年得此
目当失明。翌早索途而行。不辨天日。众皆惊异。与六味地黄丸加麦冬、五味。一剂顿明
一人患眼疾。每睡起则眼赤肿。良久却愈。百治莫效。师曰。此血热。非肝病也。卧则
血归于肝。热血归肝。故令眼赤肿也。良久却愈者。人卧起血复散于四肢故也。遂用生地黄
汁。浸粳米半升。渗干。曝令透骨干。三浸三干。用瓷瓶煎汤一升令沸。下地黄米四五匙。
煎成薄粥汤。放温。食半饱后。饮一二盏即睡。如此两日。遂愈。生地黄汁凉血故也。
一妇病热。目视壁上。皆是红莲花满壁。医用滚痰丸下之。愈。
一人眼前常见禽虫飞走。捉之即无。乃肝胆经为疾。用酸枣仁、羌活、元明粉、青葙子
各一两。为末。每水煎二钱。和渣服。日三服。
赵卿。良医也。有机警。一少年。眼中常见一小镜子。诸医不效。赵诊之。与少年期。
来晨以鱼 奉候。少年及期赴之。延于内。且令从容。俟客退方接。俄而设桌。施一瓯芥醋
更无他味。卿亦未出。迨日中久候不至。少年饥甚。且闻醋香。不免轻啜之。逡巡又啜之
觉胸中豁然。眼花不见。因竭瓯啜之。赵卿方出。少年以啜醋惭谢。卿曰。郎君先因吃
太多。芥醋不快。又有鱼鳞在胸中。所以眼花。适来所备芥醋。只欲郎君因饥以啜之。果愈
此疾。烹鲜之会。乃权诈也。
震按以上四条。皆异疾奇方。可备参考。但眼科证候甚多。所选诸案。十不得一。须以
治目各种书籍。广搜遍阅。方有见解。而手法尤宜从师学习。切戒草率。
一妇人眼中忽有血如射而出。或缘鼻下。但血出多时。即经不行。乃阴虚相火之病。遂
用归尾、生地黄、酒芍。加柴胡、黄柏、知母、条芩、侧柏叶、木通、红花、桃仁水煎。食
前服。数剂而愈。
震按眼衄多是肾阴虚。肝火旺。此却是倒经。由于血出多。即经不行。可以问而知之也
孙东宿治孙如亭令正。年过四十。眼偶赤肿。两太阳疼痛。大便不行者三日。平时泛期
一月仅两日。今行四日未止。眼科余云谷医治逾候。肿赤不消。而右眼内 突生一白泡。
垂与鼻齐。大二寸余。余见而骇走。以为奇疾。莫能措剂。又见其呕吐。眩运。伏于枕上。
略不敢动。稍动则眩愈极。吐愈急。辞不治。孙诊之。两寸关脉俱滑大有力。两尺沉微。孙
曰。此中焦有痰。肝胆有火。必为怒气所触而然。内经云。诸风掉眩。皆属肝木。诸逆冲上
皆属于火。盖无痰不能运也。眼 白泡。乃火性急速。怒气加之。气乘于络。上而不行。
故直胀出眼外也。古壮士一怒而目 裂。与白泡胀出 外理同。肝为血海。故血亦来不止。
治当抑其肝木。清镇痰火。则诸症自瘳。先用姜汁益元丸压其痰火。以止呕吐。再以二陈汤
加酒连、酒芩、天麻、滑石、吴茱萸、竹茹、枳实。一帖眩吐俱定。头稍能动。改用二陈加
芩、连、谷精草、夏枯草、香附、吴茱萸、苡仁。四剂目疾全愈。血海亦净。
震按此案现证甚怪。治法甚稳。因知医病。只要明理。毋庸立异也。
周慎斋治一人。丧子。悲哀太过。两目肿痛。用独参汤而愈。盖悲哀则伤肺。金虚则木
寡于畏。肝火上逆而目痛。人参补肺。肺王则木沉火降也。
震按两目肿痛。用独参汤奇矣。及讲明其理。始知是正非奇。然亦须审兼见之证。与脉
象若何。盖木寡于畏。肝火上逆。目既肿痛而或赤。脉若弦大而且数。口渴内热。投以此方
不虞其痛之丧明乎。
报国澄和尚。患眼疾二年。服祛风清热药过多。致耳鸣嘈嘈不止。大便常苦燥结。近来
左眼上微翳。见灯火则大如斗。视月光则小如萤。询诸方家。俱莫能解。因以质之石顽。石
顽曰。此水亏而阴火用事也。试以格物之理参之。如西洋玻璃眼镜。以十二镜编十二支为一
套。无论老少。其间必有一者能察秋毫。则知人眼有十二种偏胜。故造眼镜者。亦以十二等
铅料配之。取铅以助阴精。料以助阳气也。若铅料之轻重。与眼之偏胜不相当。则得之反加
障碍矣。月乃至阴之精。真水内涸。不能泛滥其光。所以视之甚小。设加之以铅重者。则视
月必大矣。灯本燃膏之焰。专扰乎阴。不能胜其灼烁。所以见之甚大。设加之以料重者。灯
火必愈大矣。合脉参证。知为平昔劳伤心脾。火土二脏过燥。并伤肾水真阴也。遂疏天王补
心丹与之。他如中翰徐燕及。见日光则昏迷如蒙。见灯火则精彩倍常。此平昔恒劳心肾。上
盛下虚所致。盖上盛则五志聚于心包。暗侮其君。如权党在位。蒙蔽九重。下虚则相火失职
不能司明察之令。得灯烛相助其力。是以精彩胜于常时。此与婴儿胎寒夜啼。见火则止之
义不殊。未识专事眼科者。能悉此义否。
震按此论实有格物妙义。而于施治方法。殊少发挥。后之阅者。似难则效。然余辑是书
只从旧案拔其精粹。非为对证检方分门寻法者设也。理已讲明。方可会悟。所谓中道而立
能者从之。
Li Dongyuan treated a patient who had consumed excessive pork pancakes with garlic and vinegar, followed by heavy alcohol intoxication, and slept on a warm kang (heated brick bed). The next day, both pupils were dilated, larger than the iris, vision was distorted (seeing small objects as large, short as long), he suddenly perceived unusual phenomena, stepped into empty air while walking, and all treatments failed. Li Dongyuan stated: The *Neijing* (Classic of Internal Medicine) says that the essence of the five zang and six fu organs ascends to the eyes to form visual clarity. The gathering place of this essence is the eye. The essence of bone manifests in the pupil. It also states that the essence of tendons, bones, qi, and blood forms the vessels and merges into the visual system (eye meridians), connecting upward to the brain. Furthermore, the pupil and iris follow the principle of Yin. The current dilation of the pupils is caused by excessive consumption of pungent and hot foods. Pungency promotes dispersion, and heat aids fire. Fire-heat ascends to the brain, causing the essence to scatter. When the essence scatters, vision appears scattered and enlarged. That clear spirit is used to perceive all things. Now, since vision is unclear, the essence has declined. Fire and qi are mutually exclusive. The *Neijing* states: "Excessive fire consumes qi; excessive fire disperses qi." The Heart Meridian of Hand-Shaoyin and the Liver Meridian of Foot-Jueyin connect upward to the visual system. Pathogenic factors invade according to their affinity. Wind and heat attack along this pathway, causing swelling and oppression of the head and eyes, and pupil dilation. All these are caused by blood deficiency and Yin weakness. Treatment should dispel wind-heat, cool the blood, nourish blood, and consolidate dispersed qi for recovery. Use Ziyin Dihuang Wan (Nourishing Yin Rehmannia Pill). The *Neijing* states: "When heat dominates, soothe it with salty-cold substances, assist with bitter-sweet substances, and astringe with sour substances." Huangqin (Scutellariae Radix) and Huanglian (Coptidis Rhizoma), being greatly bitter and cold, eliminate rampant heat pathogens and serve as the Sovereign drug. Danggui Shen (Angelicae Sinensis Radix), being acrid-warm, and Shengdihuang (Rehmanniae Radix) and Shudihuang (Rehmanniae Radix Preparata), being bitter-sweet and cold, nourish and cool the blood, serving as Ministers. Wuweizi (Schisandrae Fructus), being sour-cold and light in texture, ascends to astringe the dilated pupil. Renshen (Ginseng Radix), Gancao (Glycyrrhizae Radix), Digupi (Lycii Cortex), Tiandong (Asparagi Radix), and Zhike (Aurantii Fructus), being bitter-sweet and cold, purge heat and tonify qi, serving as Assistant drugs. Chaihu (Bupleuri Radix) guides the action, serving as an Envoy drug. Avoid pungent-spicy foods that aid fire-pathogens and cold foods that damage Stomach qi, otherwise the medicine cannot ascend.
Yu Zhen commented: This case explains the origin and flow of disease and discusses the rationale of medication with utmost precision. As Mencius said, it represents the ultimate standard of rules and compasses.
Lady Wei developed sudden epicanthal opacity (pterygium-like growth) rising from below, green in color, with unbearable pupil pain. Li Dongyuan said: Opacity rising from below indicates the pathogen comes from the Yangming channel. Green is not one of the five proper colors; this indicates a combined pathology of Kidney and Lung. He prescribed ink mixed with Nifen (calamine or similar mineral powder), which matched the opacity's color, confirming Kidney-Lung pathology. He purged the pathogens of the Kidney and Lung, using herbs entering the Yangming channel as Envoys. It was effective. The condition recurred three times later, with different meridians involved and different opacity colors. He realized: "All vessels belong to the eye; if vessels are diseased, the eye follows." This must be due to unharmonized meridians, so eye disease would persist. He treated the unharmonized meridians, and the disease ceased.
Yu Zhen commented: Differentiating the opacity color in this case was very clever. The subsequent three recurrences had different colors. Combined with the *Neijing* text "all vessels belong to the eye," one should naturally have a sudden realization. Although no prescription is recorded, saying "treat what is unharmonized" allows for intuitive understanding.
Zhang Zijing, a Provincial Secretary, aged 67, suffered from dim vision, slightly black lips, lusterless skin, and wiry-thin, powerless pulses in all six positions. He showed two eye prescriptions to Luo Qianfu, asking if they could be taken. Luo Qianfu said: Both prescriptions use Huanglian (Coptidis Rhizoma), a greatly bitter herb, as the Sovereign, and various wind-dispelling herbs as Envoys. At age fifty, gallbladder bile decreases, and vision begins to dim. The *Neijing* states: "For disorders of the Earth element, purge with bitter." Various wind herbs also purge Earth. Near seventy, Spleen-Stomach are deficient, and flesh is withered. Heavy purging of Earth will further weaken Spleen-Stomach qi, preventing the circulation of Ying and Wei qi and the nourishment of Yuan qi. Stomach qi fails to ascend, Diaphragm qi rebels causing vomiting, and various diseases arise. These medicines should not be taken. One should only guard speech, regulate diet, restrain anger, and curb desires. This is the treatment of non-treatment. Zhang agreed. The following spring, he was appointed Inspector-General of Guanxi Road. Three years later, he retired and returned home, his spirit clearer than before, and his pulse peaceful. This was the effect of not recklessly taking cold medicines. The *Neijing* says: "Punishing the innocent is called great confusion." Is this not true?
Yu Zhen commented: Specialized ophthalmology often uses Huanglian. Luo Gong's arguments should serve as a warning. The four phrases "treatment of non-treatment" are indeed a secret recipe for brightening eyes. Without adhering to this regulation, merely avoiding cold medicines is useless.
Zhu Danxi treated an elderly man who suddenly went blind, with no other discomforts, treating it as severe deficiency. He urgently decocted one jin (approx. 500g) of Renshen Gao (Ginseng Paste). After two days, the patient could see slightly. Another doctor administered Qingmengshi (Fluorite) medicine. Zhu Danxi said: "He will die tonight." It happened as predicted.
Yu Zhen commented: This case corresponds to the *Neijing* statement: "Qi collapse results in unclear vision." Later, Xue Lizhai's case used Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) plus Maidong (Ophiopogonis Radix) and Wuweizi (Schisandrae Fructus), corresponding to the *Nanjing* statement: "Yin collapse results in blindness." In these two cases, one was due to dampness, the other to blood stasis, yet both used tonifying herbs as Sovereigns. Generally, sudden blindness not caused by redness, swelling, pain, or obstruction by opacity/pterygium is due to the exhaustion of the essence of the five zang organs, which no longer gather in the eyes. Therefore, tonification is essential.
A young adult suddenly could not see upon waking in the morning. After lying down for a while, he could see slightly but unclearly. Appetite decreased, fatigue was severe. Pulse was slow and large, exceeding four beats per breath, and scattered/powerless when pressed heavily. Suspecting dampness, he was asked if he had slept on wet ground for half a month. He confirmed this. Baizhu (Atractylodis Macrocephalae Rhizoma) was used as Sovereign, Huangqi (Astragali Radix), Fuling (Poria), and Chenpi (Citri Reticulatae Pericarpium) as Ministers, and Fuzi (Aconiti Lateralis Radix Preparata) as Envoy. After more than ten doses, he recovered.
A robust man who enjoyed hot wine suddenly went blind. Pulse was choppy. This was injury from hot wine, causing turbid Stomach qi and dead blood within. Su Mu (Sappan Lignum) was decocted, and Renshen (Ginseng Radix) powder was mixed in. After two doses, his nose and palms turned purple-black. Zhu Danxi said: "The stagnant blood is moving." Siwu Tang (Four Substance Decoction) was added with Su Mu (Sappan Lignum), Taoren (Persicae Semen), Honghua (Carthami Flos), and Chenpi (Citri Reticulatae Pericarpium), decocted with Renshen (Ginseng Radix) powder. He recovered in several days.
Lu Cangzhou treated a patient whose vision in both eyes was inverted. Treatments failed repeatedly. Lu said: Seeing one object as two, or straight as curved, has been discussed by ancients. Seeing objects inverted is truly incomprehensible. I wish to hear the cause. The patient said: "I once drank heavily, vomited all the alcohol, slept soundly until dawn, and then became ill." Lu palpated the pulse: Left Guan position was floating and rapid, others normal. He told him: "During heavy drunkenness and vomiting, the Upper Jiao reversed, causing the Gallbladder organ to invert, hence inverted vision. This is an internal injury caused by non-internal/external factors." The method should be to induce vomiting again to correct the Gallbladder. He prescribed Licui (Veratris Rhizoma) and Gouti (Melongenae Fructus) ground coarse, decocted in water, to be taken in one dose at dawn to induce vomiting. After vomiting, vision was no longer inverted.
Chen Jilao from Huai'an, a Confucian physician, treated the son of a wealthy man who suddenly saw upright objects as slanted. Neatly arranged tables and books appeared slanted to him, and he adjusted them to look slanted to feel they were straight. Writing letters was affected. Parents were worried. Doctors did not understand the disease. Someone suggested Chen Jilao. Chen examined the pulse, sent the father home first, kept the son, hosted a banquet with music, and drunk him to intoxication. The sick boy was placed in a sedan chair, carried up and down, tilted and rolled around for a long time, then allowed to sleep. By dawn, sober, he was sent home. Objects previously seen as slanted now appeared upright. Parents rejoiced and asked for the prescription. Chen Jilao said: "In drunkenness, a lobe of the liver likely slipped onto the lung, preventing it from descending, causing upright objects to appear slanted. Now, drinking him drunk causes lung expansion. During rolling, the lung descends. How can medicine treat this?" The wealthy man sighed in admiration.
Yu Zhen commented: Lu and Chen's cases seem off-target initially, but their methods yielded results. Truly like seeing through a wall. Ancients certainly do not lie to deceive posterity. Nose tip warts treated by needling the back of the neck—such immortal arts exist. But for someone mediocre like me, doubt remains. Re-examining Qian Zhongyang's case, the formula is clever and the principle obvious, representing magic in the mundane.
Qian Zhongyang treated a nursing woman who fell ill due to fright. After recovery, her eyes remained open and she could not close them. Qian said: "Boil Yuli Jiu (Prunus Armeniaca Wine) and drink until drunk, and she will recover." The reason is that the visual system connects internally to the Liver and Gallbladder. Fear causes qi stagnation, and Gallbladder qi fails to descend. Yuli removes stagnation. Following the wine into the Gallbladder, the stagnation clears, Gallbladder qi descends, and eyes can close. It worked. Sun Simiao, ordered to treat Concubine Wei's eye pain, found previous doctors ineffective. Some used cold herbs, some tonics, plus organ disharmony. Sun diagnosed a wiry-slipping Liver pulse, not congestion-heat, but abundant blood in youth with blocked Liver blood. He asked palace maids if menstruation had stopped for three months. Using blood-invigorating/menses-regulating herbs, menstruation resumed, and she recovered.
Yu Zhen commented: Wiry-slipping Liver pulse avoids misdiagnosis as wind-phlegm eye disease. Knowing Liver stores blood, recognizing blood abundance and blockage is appropriate. Yet, he still had to ask the maid to confirm three months of amenorrhea, not stating it based on pulse alone. Even Sun Zhenren did this. Why do patients hide symptoms and blame doctors for misdiagnosis? This falls into Su Shi's trap: "I wanted to confound the doctor, but my illness confounded me too."
Shi Shan treated a woman over forty with dim vision, cough, headache, tinnitus-like pain, nausea when hungry. Ophthalmological treatment worsened the condition. Weng diagnosed fine-weak pulses, especially wiry-weak in the Spleen position. He said: "Spleen deficiency." Li Dongyuan said: "Five zang and six fu organs receive Qi from the Spleen, ascending to the eyes. Spleen deficiency causes loss of control over zang essence, failing to clarify vision." Pathogens enter the brain via the visual system due to body deficiency, causing brain noise and headache. Heart is Ministerial Fire, preferring stillness. Labor and movement cause Ministerial Fire to act recklessly, insulting its conquered element, causing cough. Treating eyes with bitter-cold without nourishing Spleen and blood treats symptoms, not root. Prescription: Renshen (Ginseng Radix) and Huangqi (Astragali Radix) 1.5 qian each, Maidong (Ophiopogonis Radix) and Beimu (Fritillariae Bulbus) 1 qian each, Danggui Shen (Angelicae Sinensis Radix) 0.8 qian, Chenpi (Citri Reticulatae Pericarpium), Chuanxiong (Ligustici Chuanxiong Rhizoma), Huangqin (Scutellariae Radix) 0.7 qian each, Gancao (Glycyrrhizae Radix) and Juhua (Chrysanthemi Flos) 0.5 qian each, Maiya (Hordei Fructus Germinatus) 0.4 qian. Decocted. Two doses eliminated all symptoms.
Xue Ji treated Zhang Yugong, a Censor, with red, unclear eyes. After taking wind-dispersing and heat-clearing herbs, he became photophobic and deaf. Pulse was large and empty. Caused by mental overwork and irregular diet. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) was added with Fushen (Poria with Hostwood), Zaoren (Ziziphi Spinosae Semen), Shanyao (Dioscoreae Rhizoma), Shanzhuyu (Corni Fructus), and Wuweizi (Schisandrae Fructus). Immediate recovery. Later, severe labor relapsed. Shiquan Dabu Wan (Ten Great Tonics Pill) was used, combined with previous herbs, leading to gradual recovery. Finally, Bu Zhong Yi Qi Tang with previous herbs cured him. Li Dongyuan said: "Meridians run to the face and orifices. Clear qi scatters to eyes for vision, to ears for hearing. Mental worry, irregular diet, Spleen-Stomach damage, excessive Heart fire, boiling hundred vessels, pathogens harming orifices cause blindness. Spleen is head of all Yin, eyes are clan of blood vessels. Spleen deficiency loses zang essence. Not regulating Spleen-Stomach and nourishing qi-blood treats symptoms, not root."
Yu Zhen commented: These two cases specifically treat Spleen deficiency, curing eyes without directly treating them. Treating Spleen deficiency is treating eyes, achieved by grasping the pulse key. Both used Renshen (Ginseng Radix) and Huangqi (Astragali Radix). Wang's case added Maidong (Ophiopogonis Radix), Beimu (Fritillariae Bulbus), Chuanxiong (Ligustici Chuanxiong Rhizoma), Huangqin (Scutellariae Radix), Juhua (Chrysanthemi Flos) due to cough/headache, retaining slight external pathogens. Xue's case was purely tonifying with sour astringents, because previous wind-heat herbs caused photophobia/deafness. After tonification recovered him, severe labor made deficiency worse.
A scholar suffered tight, dry eyes every afternoon, unable to look around. This was sinking of Yuan qi. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) with doubled Renshen (Ginseng Radix) and Huangqi (Astragali Radix) cured him after several doses.
Yu Zhen commented: Lou Quanshan said: Yang deficiency causes tight eye margins, Yin deficiency causes dilated pupils. Thus, tight/dry eyes suit Renshen (Ginseng Radix) and Huangqi (Astragali Radix). Li Dongyuan's theory supports this. However, assistant/envoy herbs should be acrid and dispersing, avoiding Sour-astringents like Shaoyao (Paeoniae Radix) and Wuweizi (Schisandrae Fructus).
A twenty-year-old man, habitually indulging in alcohol and sex, had red, painful eyes, intermittent. Chi pulses were flooding but weak on pressure. Xue Ji said: A youth with this pulse should go blind. Next morning, he walked feeling his way, unable to distinguish day from night. Everyone was shocked. Liuwei Dihuang Wan (Six-Ingredient Pill with Rehmannia) plus Maidong (Ophiopogonis Radix) and Wuweizi (Schisandrae Fructus) restored sight in one dose.
A patient with eye disease had red, swollen eyes upon waking, resolving after a long time. Treatments failed. The Master said: "This is Blood Heat, not Liver disease. When lying down, blood returns to the Liver. Hot blood returning to the Liver causes redness/swelling. Resolving later occurs because blood disperses to limbs upon rising." Prescription: Shengdihuang (Rehmanniae Radix) juice soaked Jingmi (Oryza Sativa Germen) half sheng, dried, sun-dried thoroughly. Soaked and dried three times. Decocted in porcelain pot with one sheng water until boiling. Add four-five spoons of Rehmannia-rice mixture. Boil into thin gruel soup. Warm, drink one-two cups after half-full meal, then sleep. Two days cured. Shengdihuang (Rehmanniae Radix) juice cools blood.
A woman with heat disease saw red lotus flowers covering the walls. Doctor used Guntan Wan (Rolling Phlegm Pill) to purge, and she recovered.
A man constantly saw birds and insects flying before his eyes, disappearing when caught. This was Liver-Gallbladder meridian disease. Suanzaoren (Ziziphi Spinosae Semen), Qianghuo (Notopterygii Rhizoma et Radix), Yuanmingfen (Mirabilite), and Qingxiangzi (Celosiae Semen) each 1 liang, ground to powder. Decoct 2 qian in water, take with dregs, three times daily.
Zhao Qing, a skilled and alert physician, treated a youth who saw a small mirror in his eyes. Doctors failed. Zhao Qing consulted the youth, inviting him for fish and mustard vinegar breakfast next morning. Youth arrived, was seated inside, told to wait calmly until guests left. Table set with one bowl of mustard vinegar, nothing else. Zhao Qing did not appear. By noon, youth was hungry, smelled vinegar, tasted it. Chest felt open, vision cleared. He drank the whole bowl. Zhao Qing emerged. Youth apologized for drinking vinegar. Zhao Qing said: "You ate too much earlier, mustard vinegar wasn't enough, and fish scales were stuck in chest causing vision issues. I prepared vinegar for you to drink when hungry. Cooking fish was a stratagem."
Yu Zhen commented: The above four cases are strange diseases and miraculous formulas, worth referencing. But ophthalmological syndromes are numerous; selected cases represent less than one-tenth. One must extensively search eye-treatment books to gain insight. Techniques must be learned from teachers. Avoid rashness.
A woman suddenly had blood shooting from her eyes, sometimes flowing down the nose. When bleeding was heavy, menstruation stopped. This was Yin deficiency with Ministerial Fire. Prescription: Guiwei (Angelicae Sinensis Radix Tail), Shengdihuang (Rehmanniae Radix), Jiubaishao (Paeoniae Radix Alba prepared with wine), Chaihu (Bupleuri Radix), Huangbai (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma), Tiaohuangqin (Scutellariae Radix), Cebaiye (Platycladi Cacumen), Mutong (Akebiae Caulis), Honghua (Carthami Flos), Taoren (Persicae Semen). Decocted in water, taken before meals. Several doses cured.
Yu Zhen commented: Eye epistaxis is mostly Kidney Yin deficiency and Liver Fire. This was retrograde menstruation. Heavy bleeding caused amenorrhea, known by inquiry.
Sun Dongsu treated Lady Sun, wife of Sun Rutting, over forty. Occasional eye redness/swelling, temporal pain, constipation for three days. Normally menstruation lasted two days per month, now lasted four days. Ophthalmologist Yu Yungui treated for a long time without reducing redness/swelling. Right eye suddenly developed a white blister, hanging level with nose, over two cun wide. Yu fled in horror, calling it a rare disease, unable to prescribe. Patient also vomited, dizzy, lying on pillow, afraid to move. Sun Dongsu diagnosed slippery-large-forceful pulses in Cun/Guan, deep-micro pulses in Chi. Sun said: "Phlegm in Middle Jiao, Fire in Liver-Gallbladder, triggered by anger. *Neijing*: 'All wind, tremors, dizziness belong to Liver Wood.' 'All rebellious upward movements belong to Fire.' No phlegm, no movement. White blister is rapid Fire nature, aggravated by anger, qi attacking collaterals, blocking upward flow, swelling out of eye. Ancient strong men burst eyes from anger; same logic. Liver is Sea of Blood, hence bleeding continues. Treatment: Suppress Liver Wood, clear/settle Phlegm-Fire." First, Jiangzhi Yiyuan Wan (Ginger Juice Yiyuan Pill) to settle Phlegm-Fire and stop vomiting. Then Erchen Tang (Two-Aged Decoction) plus Jiu Lian (Coptidis Rhizoma prepared with wine), Jiu Huangqin (Scutellariae Radix prepared with wine), Tianma (Gastrodiae Rhizoma), Huashi (Talcum), Wuzhuyu (Evodiae Fructus), Zhuru (Bambusae Caulis in Taenia), Zhishi (Aurantii Fructus Immaturus). One dose settled dizziness/vomiting, head could move slightly. Changed to Erchen Tang plus Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Gujingcao (Euphrasiae Herba), Xiakucao (Prunellae Spica), Xiangfu (Cyperi Rhizoma), Wuzhuyu (Evodiae Fructus), Yiren (Coicis Semen). Four doses cured eye disease, Sea of Blood purified.
Yu Zhen commented: Present symptoms were strange, treatment steady. Medical practice requires understanding principles, not seeking novelty.
Zhou Shenzhai treated a man grieving excessively for his son, causing swollen/painful eyes. Du Shen Tang (Single Ginseng Decoction) cured him. Grief injures Lung Metal. Metal deficiency means Wood lacks restraint. Liver Fire rebels upward causing eye pain. Renshen (Ginseng Radix) tonifies Lung. Lung Qi prosperous, Wood sinks, Fire descends.
Yu Zhen commented: Du Shen Tang for swollen/painful eyes seems miraculous. Explaining the principle reveals it is orthodox, not magical. However, concurrent symptoms and pulse must be assessed. If Wood lacks restraint, Liver Fire rebels, eyes swollen/red, pulse wiry-large-rapid, thirst/internal heat, this formula risks causing blindness from pain.
Monk Denghe of Boguo Temple suffered eye disease for two years, took too many wind-dispersing/heat-clearing herbs, causing continuous tinnitus, dry constipation. Recently, slight opacity on left upper eye. Saw lamps as huge, moon as tiny. Experts couldn't explain. Asked Shiwan. Shiwan said: "Water deficiency, Yin Fire acting. Consider 'Gewu' (investigation of things). Western glass lenses: twelve lenses match twelve branches. Regardless of age, one fits perfectly. Human eyes have twelve types of bias. Lens makers use twelve lead grades. Lead aids Yin Essence, material aids Yang Qi. Mismatch causes obstruction. Moon is extreme Yin essence. True Water dried, light cannot flood, so moon looks small. Adding heavy lead makes moon look big. Lamp is burning fat flame, disturbing Yin, scorching, so lamp looks big. Adding heavy material makes lamp look bigger. Combining pulse/symptoms: chronic Heart-Spleen labor, Fire-Earth dryness, injuring Kidney True Yin." Prescribed Tianwang Buxin Dan (Heavenly Emperor Heart-Nourishing Pill). Xu Yanji, Hanlin Academician, saw sunlight as blinding fog, lamplight as brilliant. Chronic Heart-Kidney labor, Upper Excess/Lower Deficiency. Upper Excess: Five Emotions gather in Pericardium, secretly insulting Sovereign (Heart), like corrupt officials obscuring the throne. Lower Deficiency: Ministerial Fire fails duty of illumination, aided by lamp light, appearing brighter. Similar to infant colic relieved by fire. Do eye specialists know this?
Yu Zhen commented: This discussion has profound philosophical meaning but little therapeutic development. Readers may find it hard to emulate. I compiled this book extracting essence from old cases, not for symptom-based formula searching. Principles explained allow comprehension. "Stand in the middle path, the capable follow."