东垣云。能远视不能近视者。阳气有余。阴气不足。少年穷役眼神所致也。海藏云。目能远
视。知其有火。不能近视。责其无水。法当补肾。加减地芝丸。或六味丸加减。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。若贪淫恣欲。饥饱
失节。形体甚劳。过于悲泣。皆斫丧阴精。精亏则阳火盛。火性炎而发见。阴精不能制伏挽回。
故越于外而远照不收。治之而反触激者。有内障之患。
东垣云。能近视不能远视者。阳气不足。阴气有余。此老人桑榆之象也。海藏云。目能近视。
知其有水。不能远视。责其无火。治当补心。加味定志丸、八味丸。早暮间服。秘要云。此证非
谓禀受生成近觑之病。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。而偎敛近视耳。治之在胆肾。若耽酒嗜燥。头风痰火。忿怒暴悖者。必伤损
神气。阴阳偏胜。而光华不能发达矣。
素问云。夫精明者。所以视万物。别黑白。审长短。以长为短。以白为黑。如是则精衰矣。
人之目者。心之使也。心者神之
舍也。故精神乱而不转。卒然见非常处。精神魂魄。散不相得。故曰惑也。如神光自见。则每如
电闪。黑夜精明。则晦冥之中。倏忽见物。视正反邪。则物本正而目见为邪。视定反动。则物本
定而目见为动。视物颠倒。则观物皆振动倒植。视一为二。则一物而目视为二。视瞻有色。则常
见萤星云雾及大片青绿蓝碧之色。视赤如白。则视物却非本色。或视粉墙如红如碧。或看黄纸似
绿似蓝之类。光华晕大。则视日与灯烛皆生红晕而大。此阴精亏损。阳光飞越之候。总补养为主。
如加减驻景丸、益气聪明汤之类。久而不治。不无内障之虞。
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
有微翳。见灯火则大如斗。视月光则小如萤。尝询诸方家。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。人但知宜于老人。不知原为望气者
而设。其最精者。咸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。少年气血本
旺。原无藉此。若铅料之轻重。与眼之偏胜不相当。则得之反加障碍矣。老人气血皆衰。但借此
以笼住其光。不使散漫。不必论其铅料之孰重孰轻也。即如所言视月甚小者。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。见灯火甚大者。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。见日光则昏眯如蒙。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。
Li Dongyuan stated: The condition of being able to see distant objects clearly but not near ones is due to an excess of Yang Qi and a deficiency of Yin Qi. This results from the excessive use of eyesight in youth.
Wang Haizang stated: The ability to see far indicates the presence of Fire (Yang heat); the inability to see near is attributed to the absence of Water (deficiency of Yin essence). The treatment method should focus on tonifying the Kidney, using Jiajian Dizhi Wan (Modified Lizhi Pill) or Liuwei Wan (Six-Ingredient Rehmannia Pill) with modifications. *Zhenjiu Mibao* (Secrets of Acupuncture and Moxibustion) states: When Yin essence is insufficient and Yang light (Yang heat) is relatively excessive, the pathology lies in Water (Kidney Yin), causing the "light" of the eye to manifest outwardly, scattering and failing to converge for near vision. Treatment should address the Heart and Kidney. Indulgence in lust, irregular eating habits, extreme physical fatigue, and excessive weeping all damage Yin essence. When essence is depleted, Yang fire becomes hyperactive. Since fire nature is flaming and outward-rising, and Yin essence cannot restrain or retrieve it, the light scatters outward and fails to focus on near objects. If treatment provokes or irritates this condition further, there is a risk of developing internal cataracts.
Li Dongyuan also stated: The condition of being able to see near objects clearly but not distant ones is due to a deficiency of Yang Qi and an excess of Yin Qi. This is a sign of declining vitality in the elderly.
Wang Haizang stated: The ability to see near indicates the presence of Water (Yin essence); the inability to see far is attributed to the absence of Fire (deficiency of Heart Yang/Mingmen Fire). The treatment method should focus on tonifying the Heart, administering Jiawei Dingzhi Wan (Additive Dingzhi Pill) or Bawei Wan (Eight-Ingredient Pill) taken alternately in the morning and evening. *Zhenjiu Mibao* states: This syndrome is not a congenital myopia, but rather a sudden loss of distance vision in someone who was previously healthy and could see far. It occurs because Yang is deficient and Yin is excessive, with pathology lying in Fire (Heart Yang/Mingmen Fire), causing the eye's "light" to fail to radiate outward, instead converging inward for near vision. Treatment should address the Gallbladder and Kidney. Indulgence in alcohol, preference for dry/hot foods, head wind with phlegm-fire, or anger and暴悖 (violent temper) will inevitably damage Shen Qi (Spirit Qi), leading to Yin-Yang imbalance and preventing the eye's light from flourishing.
The *Suwen* (Basic Questions) states: Jingming (Essence and Brightness) is used to perceive all things, distinguish black from white, and judge length. If one perceives long as short and white as black, it indicates that Jing (Essence) has declined. The human eye is the envoy of the Heart. The Heart is the residence of Shen (Spirit). Therefore, when Spirit is chaotic and unresponsive, and one suddenly sees extraordinary phenomena, the Spirit, Hun, and Po scatter and lose coordination; this is called "Huo" (Confusion/Delusion). For example, seeing self-generated light like lightning; having abnormally bright vision at night, seeing objects suddenly in darkness; perceiving upright objects as crooked (the object is upright but seen as crooked); perceiving stationary objects as moving (the object is still but seen as moving); seeing inverted objects (all observed objects appear vibrating or upside down); diplopia (seeing one object as two); colored hallucinations (frequently seeing fireflies, stars, clouds, or large patches of cyan, green, blue, or emerald); erythropsia/albopsia (seeing objects in wrong colors, such as a white wall appearing red or green, or yellow paper appearing green or blue); enlarged halos (seeing the sun and candles with large red halos). These are signs of Yin essence depletion and the flight of Yang light. The general treatment principle is tonification and nourishment, such as Jiajian Zhujing Wan (Modified Zhujing Pill) or Yiqi Congming Tang (Qi-Boosting and Hearing/Vision-Enhancing Decoction). If left untreated for a long time, there is a danger of internal cataracts.
Monk Bao Guocheng suffered from eye disease for two years. Due to taking too many Wind-dispelling and Heat-clearing medicines, he developed continuous buzzing tinnitus and chronic constipation with dry stool. Recently, a slight opacity appeared on his upper left eye. He perceived lantern lights as large as a bushel and moonlight as small as a firefly. He consulted various physicians, but none could explain it. He then sought advice from Shiwen (Zhang Lu, courtesy name Shiwen). I said: This is a case of Kidney Water deficiency with the dominance of Yin Fire. Let us analyze it using the principles of investigating things. Consider Western glass eyeglasses: people know they suit the elderly, but originally they were designed for visual adjustment. The most precise sets consist of twelve lenses corresponding to the twelve Earthly Branches. Regardless of age, one pair will always fit perfectly to see fine hairs. Thus, we know the human eye has twelve types of bias/excess. Manufacturers therefore create glasses with twelve weights of lead materials, using lead to assist Yin essence and other materials to assist Yang Qi. Young people have robust Qi and Blood and do not need these aids. If the weight of the lead does not match the eye's bias, wearing them will cause obstruction. Elderly people have declining Qi and Blood and use glasses merely to contain their scattered light, so the specific weight of lead is less critical. Regarding the complaint of seeing the moon very small: the moon is the essence of supreme Yin. When True Water is dried up internally, its light cannot overflow, so it appears small. Adding heavy lead lenses would make the moon appear larger. Regarding seeing lantern lights very large: lantern fire is flame burning fat/oil, which disturbs Yin and cannot withstand its own scorching brightness, so it appears large. Adding lighter (Yang-assisting) materials would make the lantern appear even larger. Correlating with pulse diagnosis, I determined this was caused by chronic overwork damaging the Heart and Spleen, leading to excessive dryness in the Fire (Heart) and Earth (Spleen) organs, and damaging the True Yin of Kidney Water. I prescribed Tianwang Buxin Dan (Heavenly Emperor Heart-Nourishing Pill). Another case: Xu Yanji, a Hanlin Academician, experienced dimness and blinding when looking at sunlight, but heightened visual acuity when looking at lantern lights. This was due to chronic overwork of the Heart and Kidney, resulting in Upper Excess and Lower Deficiency. Upper Excess means the Five Emotions gather in the Pericardium, secretly insulting the Monarch (Heart), like powerful ministers obscuring the throne. Lower Deficiency means Ministerial Fire loses its function and cannot execute the command of clear vision. With the assistance of candlelight, the visual acuity surpasses normal levels. This is no different from the principle that infants with fetal cold cry at night but stop when exposed to fire. I wonder if those specializing in ophthalmology fully understand this meaning?