目痛有二。一谓目 白眼痛。一谓目珠黑眼痛。盖目 白眼痛属阳。故昼则疼甚。点苦寒药
则效。经所谓白眼赤脉法于阳是也。目珠黑眼痛属阴。故夜则疼甚。点苦寒药反剧。经所谓瞳子
黑眼法于阴故也。
楼全善云。夏枯草散。治目珠痛。至夜则疼甚者神效。血热。本方加当归、芍药。虚人。四
物汤换生地加羌活、香附。下咽则疼减。风热瞳痛甚。泻青丸、洗肝散选用。
白眼痛多有赤脉。若恶寒脉浮为在表。选奇汤。脉实有力。大府闭为在里。泻青丸加薄荷、
甘草。亦有不肿不红。但沙涩昏痛者。 乃脾肺气分隐伏之湿热。秋天多有此患。故俗谓之稻芒赤。
泻青丸加黄 、甘草。
天行赤热证目赤痛。或睥肿头重。怕热羞明。涕泪交流。里巷老幼相传。治法前后不可镰洗。
只用童子小便煎黄连温洗。日三五遍。更用宣胡二连、白矾、雄黄。共研细调。姜汁点大 。通
其恶泪。其痛立止。先服洗心散一剂。次用洗肝散一二服。此证只气候瘴毒之染。全属外因。虽
有赤丝乱脉。赤肿痛甚。终不伤损瞳神也。二七日不愈。必犯本虚之故防变他证。
暴露赤眼证 此证与天行赤热眼同。而天行能传染。此但患一人。而无传染。天行虽痛肿而
无翳。此则痛而生翳。为不同耳。切不可镰洗。亦不可用补。先宜酒煎散发散。次与大黄当归散
疏通血气。洗以黄连、当归、赤芍滚汤泡。乘热熏洗。冷即再温。日三五次。
暴风客热证 卒然而发。其证白仁壅起。包小乌睛。疼痛难开。此肺经受毒风不散。热攻眼
中。致令白睛浮肿。虽有肿胀。治亦易退。非若肿胀如杯之比。宜服泻肺汤。肿湿甚者。稍加麻
黄三四分。赤肿甚者。加黄连半钱。生地黄一钱。
火胀大头证 目赤痛而头目浮肿。夏月多有此患。有湿热风热。湿热多泪而睥烂。风热多胀
痛而憎寒。普济消毒饮随证加减。若失治则血滞于内。虽得肿消。而目必变也。
羞明怕热证 热亮之处。则目痛涩。畏避不能开。火郁于上也。病在心肝脾三经。火燥血热。
偏在阳分。盖己之精光弱而不能敌彼之光者。生料六味丸换生地去山萸。加决明、羌活、芩、连。
若风气攻注。眵泪羞明。密蒙花散。风痛日久。渐变作火而羞明畏热。头目胀痛。若以风药与之
则火愈炽。此风火相煽。选奇汤倍加葱白。怕热皆有余证。羞明有不足证。患久不已。此风从火
化也。还睛丸。若目不赤痛而羞明者。乃血不足。胆汁少也。神效黄 汤。今人皆称怕日羞明。
俗传音近之误。
睑硬睛疼证 不论有障无障。但或头痛者尤急。乃风热痰火。及头风夹攻。血滞于睥内所致。
先用香油调姜粉擦之。稍软翻睥开导。若坚硬之甚。其胀日高。虽治不退不软。此头风欲成毒也。
石膏散加羌活、全蝎。不应。用通肝散。若有障膜。绛雪膏、石燕丹选用。
赤热如邪证 眼不赤不疼。乍痛如神祟者。阴阳升降不和。气血偏胜相攻使然。或有血虚者。
下午痛。大黄当归散。或有气虚火旺者。上昼痛甚。助阳和血汤。
气眼痛 才怒气则目疼。肝火过旺也。石决明、草决明、楮实、香附、木贼、甘草、川芎、
蝉蜕等为末。清茶调下。
珠痛如针证 病属心经实火。若蓦然一二处如针刺。目虽不赤。亦是心经流火。宜洗心散。
然此证多有体疲目劳。营气不上潮于目而如针刺之痛者。宜养其营。若降火则殆矣。
热结膀胱证 目病小便不通利而头疼寒热者方是。若小便清利者非也。宜先利其水。后治其
目。五苓散加车前、滑石之类。血热。导赤散合益元散。
肝风目暗证肝肾虚热。生风疼痛。举发无时。眼睛坠疼。颇有赤涩泪出。眼前多花发。一物
如见两般。白蒺藜散、还睛丸选用。
大小雷头风证 不论偏正。但头痛倏疾而来。疼至极而不可忍。身热头旋。恶心呕吐。目痛
便秘。若失治。祸变不测。目必损坏。轻则HT 凸。重则结白如珠而变内障。清震汤。
左右偏头风证 久则左发损左目。右发损右目。有左损反攻右。右损反攻左而二目俱损者。
若外有赤痛泪热等病。则外证生。若内有昏眇眩晕等病。则内证生矣。痛从内起止于脑。则攻害
迟。痛从脑起止于内。则攻害速。若痛从中发。及眉梁内上星中发者。两目俱害也。从头风例治之。
阳邪风证 额板眉棱骨痛也。发则多于六阳用事之时。元气弱者。则有内证之患。若兼火者。
则有证外之病。选奇汤、清空膏、还睛丸选用。
阴邪风证 脑后枕骨痛也。多发于六阴用事之时。发则虚晕耳鸣。久而不治。内障成矣。三因芎辛汤。
巅顶风证 顶骨内痛极如锤如钻也。夹痰湿者。每痛多眩晕。若痛连及目珠而胀急瘀赤者。
外证之恶候。若昏眇则内证成矣。外证用羌活胜风汤。内证冲和养胃汤。痰湿。礞石滚痰丸。
卒脑风证 太阳内如槌似钻而痛也。若痛及目珠。珠外有赤脂纵贯及瘀滞者。外证之恶候也。
若珠不赤痛。自觉视如云遮雾障渐渐昏眇者。内证成矣。治法如巅顶风证。急早治之。以免后虑。
游风证 头风痛无常位。一饭之顷。游易数遍。若痛缓而珠赤。必变外障。痛甚而肿胀紧急
者。必有瘀滞之患。久而失治。不赤痛而昏眇者。内证成矣。
邪风证 人素有头风。因而目病。内经所谓风入系头则为目风眼寒是也。发则头痛目亦病。
目病头亦痛。轻则一年数发。重则连绵不已。先用羌活胜风汤。次与还睛丸。目中常若风吹状者。
此火气内伏。阳气不行于外也。大追风散。若无赤痛而止内胀昏眇者。内证成矣。
Ocular pain presents in two forms. One is pain in the white part of the eye (sclera), and the other is pain in the black part of the eye (cornea and iris). Generally, pain in the white part belongs to Yang patterns; thus, it worsens during the day, and application of bitter-cold eye drops is effective. This corresponds to the *Classic of Internal Medicine* stating that "red vessels in the white sclera follow the principles of Yang." Pain in the black part belongs to Yin patterns; thus, it worsens at night, and application of bitter-cold eye drops exacerbates it. This corresponds to the *Classic of Internal Medicine* stating that "the pupil and black part follow the principles of Yin."
Lou Quanshan stated that Xiakucao San (Prunella Decoction) is miraculously effective for treating black-eye pain, especially when pain worsens at night. If caused by blood heat, add Danggui (Angelicae Sinensis Radix) and Shaoyao (Paeoniae Radix) to this formula. For deficient individuals, replace Shengdi (Rehmanniae Radix) in Siwu Tang (Four Substances Decoction) with Shudi (Prepared Rehmanniae Radix) and add Qianghuo (Notopterygii Rhizoma et Radix) and Xiangfu (Cyperi Rhizoma). If pain decreases upon swallowing [Note: Textual anomaly], for severe wind-heat causing pupil pain, choose Xieqing Wan (Drain the Liver Pill) or Xiogan San (Wash the Liver Powder).
White-eye pain often presents with red vessels. If accompanied by aversion to cold and a floating pulse, the pathogen is in the exterior; choose Xuanqi Tang (Select Extraordinary Decoction). If the pulse is excess and forceful, and the bowels are constipated, the pathogen is in the interior; choose Xieqing Wan (Drain the Liver Pill) with Bohe (Menthae Haplocalycis Herba) and Gancao (Glycyrrhizae Radix et Rhizoma). There are also cases without swelling or redness, but with gritty, blurred, and painful sensations. These are due to latent damp-heat in the Qi aspect of the Spleen and Lung meridians, common in autumn, hence commonly called "Rice Husk Red Eye" (Dao Mang Chi). Choose Xieqing Wan (Drain the Liver Pill) with Huangqin (Scutellariae Radix) and Gancao (Glycyrrhizae Radix et Rhizoma).
Tianxing Chire Zheng (Epidemic Red Heat Syndrome) manifests as red and painful eyes, or swollen eyelids with heavy head, aversion to heat, photophobia, and flowing nasal discharge and tears. It spreads among people in neighborhoods, affecting both old and young. Treatment should not involve scraping or washing with blades. Instead, wash with Huanglian (Coptidis Rhizoma) decocted in child's urine, warm, three to five times daily. Additionally, mix Xuanhu Er Lian (likely a specific compound preparation involving Scutellaria and Coptis), Baifan (Alumen), and Xionghuang (Realgar), grind into fine powder, and apply with ginger juice to the outer canthus to promote drainage of foul tears, stopping pain immediately. First, administer Xixin San (Cleanse the Heart Powder) for one dose, then Xiogan San (Wash the Liver Powder) for one or two doses. This syndrome is solely due to climatic miasma toxins, entirely an external cause. Although there may be chaotic red filaments and severe swelling and pain, it ultimately does not damage the pupil spirit. If unresolved after fourteen days, it is due to underlying deficiency, and one must guard against transformation into other syndromes.
Baolu Chiyan Zheng (Exposed Red Eye Syndrome) is similar to Tianxing Chire Yan (Epidemic Red Heat Eye), but unlike the epidemic form which is contagious, this affects only one person without transmission. While the epidemic form causes swelling and pain without pterygium, this form generates pterygium, which is the difference. Do not scrape with blades, nor use tonification. First, use Jiu Jian Sanfa San (Wine-Steamed Dispersing Powder) to disperse, followed by Dahuang Danggui San (Rhubarb and Angelica Powder) to unblock Qi and Blood. Wash with Huanglian (Coptidis Rhizoma), Danggui (Angelicae Sinensis Radix), and Chishao (Paeoniae Radix Rubra) soaked in boiling water, fumigate and wash while hot, rewarming if cooled, three to five times daily.
Baofeng Kere Zheng (Violent Wind-Heat Syndrome) occurs suddenly. Symptoms include bulging of the white sclera enveloping the black cornea, severe pain preventing eye opening. This is due to toxic wind invading the Lung Meridian failing to disperse, with heat attacking the eye, causing scleral edema. Although swollen, treatment resolves it easily, unlike severe cup-like swelling. Take Xiefei Tang (Drain the Lung Decoction). For severe swelling and dampness, add Mahuang (Ephedrae Herba) 3-4 fen; for severe redness and swelling, add Huanglian (Coptidis Rhizoma) half qian, and Shengdi (Rehmanniae Radix) 1 qian.
Huozhang Datou Zheng (Fire Swelling Big Head Syndrome) presents with red, painful eyes and swollen head and eyes, common in summer. It involves damp-heat or wind-heat. Damp-heat presents with excessive tearing and eyelid erosion; wind-heat presents with distending pain and aversion to cold. Use Puji Xiaodu Yin (Puji Detoxifying Decoction) modified according to symptoms. If untreated, blood stasis occurs internally; even if swelling subsides, the eye will deform.
Xiuming Paire Zheng (Photophobia and Aversion to Heat Syndrome) involves eye pain and dryness in bright places, fear of light preventing opening. This is fire郁 (stagnation) in the upper jiao. The disease involves the Heart, Liver, and Spleen meridians, with fire dryness and blood heat biased toward the Yang aspect. Essentially, the eye's essence and light are weak and cannot resist external brightness. Use Shengliao Liuwei Wan (Raw Six-Ingredient Pill) replacing Shengdi (Rehmanniae Radix) with Shudi (Prepared Rehmanniae Radix), removing Shanzhuyu (Corni Fructus), and adding Juemingzi (Cassiae Semen), Qianghuo (Notopterygii Rhizoma et Radix), Huangqin (Scutellariae Radix), and Huanglian (Coptidis Rhizoma). If wind pathogens attack, causing discharge, tearing, and photophobia, use Mimenghua San (Buddleja Flower Powder). If wind pain persists long-term, transforming into fire causing photophobia and heat aversion with head/eye distending pain, using wind-dispelling herbs will intensify the fire (wind-fire stirring each other); choose Xuanqi Tang (Select Extraordinary Decoction) with doubled Congbai (Allii Fistulosi Bulbus). Aversion to heat indicates excess syndromes; photophobia includes deficiency syndromes. Chronic cases where wind transforms from fire use Huanjing Wan (Restore Vision Pill). If eyes are not red/painful but photophobic, it is blood deficiency and insufficient gallbladder bile; use Shenxiao Huangqi Tang (Miraculous Astragalus Decoction). Modern terms "fear of sun/photophobia" are phonetic errors of folk traditions.
Jianying Jingteng Zheng (Hard Eyelid and Painful Pupil Syndrome) regardless of pterygium presence, if accompanied by headache, it is urgent. This is due to wind-heat, phlegm-fire, and head-wind attacking together, causing blood stasis in the eyelid. First, rub with sesame oil mixed with ginger powder. Once softened, evert the eyelid to drain. If extremely hard and swelling increases daily despite treatment, indicating head-wind turning into toxin, use Shigao San (Gypsum Powder) with Qianghuo (Notopterygii Rhizoma et Radix) and Quanxie (Scorpio). If ineffective, use Tonggan San (Unblock Liver Powder). If pterygium exists, choose Jiangxue Gao (Crimson Snow Ointment) or Shiyan Dan (Swallowstone Pill).
Chire Ru Xie Zheng (Red Heat Like Evil Spirit Syndrome) eyes are not red or painful, but sudden pain feels like spiritual possession. This is disharmony in Yin-Yang ascending/descending, with Qi/Blood excess attacking each other. For blood deficiency causing afternoon pain, use Dahuang Danggui San (Rhubarb and Angelica Powder). For Qi deficiency with hyperactive fire causing morning pain, use Zhuyang Hexue Tang (Support Yang and Harmonize Blood Decoction).
Qi Yan Tong (Qi Eye Pain) occurs immediately after anger due to hyperactive Liver Fire. Use Shijueming (Haliotidis Concha), Caojueming (Cassiae Fructus), Chushizi (Acanthopanacis Senticosi Fructus), Xiangfu (Cyperi Rhizoma), Muzei (Equiseti Herba), Gancao (Glycyrrhizae Radix et Rhizoma), Chuanxiong (Ligustici Chuanxiong Rhizoma), and Chantui (Cicadae Periostracum) ground into powder, taken with clear tea.
Zhutong Ruzhen Zheng (Pupil Pain Like Needle Prick Syndrome) belongs to Excess Fire of the Heart Meridian. Sudden needle-like pain in one or two spots, even without redness, indicates flowing fire from the Heart Meridian. Use Xixin San (Cleanse the Heart Powder). However, this syndrome often results from physical fatigue and eye strain, where Ying Qi fails to ascend to moisten the eyes, causing needle-like pain. Tonify Ying Qi; reducing fire is dangerous.
Rejie Pangguang Zheng (Heat Knot Bladder Syndrome) applies to eye disease with difficult urination, headache, and chills/fever. If urination is clear and free, it is not this syndrome. First promote diuresis, then treat the eyes. Use Wuling San (Five-Ingredient Powder with Poria) with Cheqianzi (Plantaginis Semen) and Huashi (Talcum). For blood heat, combine Daochi San (Guide Out Redness Powder) and Yiyuan San (Benefit Prime Powder).
Ganfeng Mu'an Zheng (Liver Wind Dim Vision Syndrome) involves Kidney/Liver deficiency heat generating wind and pain, occurring unpredictably. Eyes feel heavy and painful, with redness, dryness, and tearing. Patients see multiple images (diplopia). Choose Bajieli San (Tribulus Powder) or Huanjing Wan (Restore Vision Pill).
Daxiao Leitou Feng Zheng (Big/Small Thunder Head Wind Syndrome) involves sudden, unbearable headache (central or lateral), fever, dizziness, nausea/vomiting, eye pain, and constipation. Untreated, it leads to unpredictable disasters and eye damage. Mild cases cause exophthalmos; severe cases lead to leukocoria and internal cataracts. Use Qingzhen Tang (Clear and Shake Decoction).
Zuoyou Pian Tou Feng Zheng (Left/Right Lateral Head Wind Syndrome) chronically damages the left eye if left-sided attacks occur, and the right eye if right-sided. Cross-damage can occur. External signs (redness, pain, tearing, heat) indicate external syndromes; internal signs (blurred vision, dizziness) indicate internal syndromes. Pain originating internally and ending in the brain progresses slowly; pain originating in the brain and ending internally progresses rapidly. Pain originating from the center, Meiliang, Neiting, or Shangxing acupoints affects both eyes. Treat according to Head Wind protocols.
Yangxie Feng Zheng (Yang Pathogen Wind Syndrome) involves frontal bone and eyebrow ridge pain. Attacks often coincide with the dominance of the Six Yang meridians. In those with weak Yuan Qi, internal syndromes may arise. If combined with fire, extra-symptomatic diseases appear. Choose Xuanqi Tang (Select Extraordinary Decoction), Qingkong Gao (Clear Sky Paste), or Huanjing Wan (Restore Vision Pill).
Yinxie Feng Zheng (Yin Pathogen Wind Syndrome) involves occipital bone pain. Common during the dominance of the Six Yin meridians. Attacks cause dizziness and tinnitus; untreated, internal cataracts form. Use Sanyin Xiongxin Tang (Three Causes Ligusticum and Asarum Decoction).
Dianding Feng Zheng (Vertex Wind Syndrome) involves extreme vertex pain like hammering or drilling. With phlegm-dampness, frequent dizziness occurs. If pain extends to the eyeball with distension, urgency, and cyanosis, it is a malignant external syndrome. If blurred vision occurs, it becomes an internal syndrome. External syndrome uses Qianghuo Shengfeng Tang (Notopterygium Victory Over Wind Decoction); internal syndrome uses Chonghe Yangwei Tang (Harmonize and Stomach-Nourishing Decoction). Phlegm-dampness uses Mengshi Tun Tan Wan (Malachite Rolling Phlegm Pill).
Cu Naofeng Zheng (Sudden Brain Wind Syndrome) involves temple/internal pain like hammering/drilling. If pain extends to the eyeball with red membranes traversing externally and stasis, it is a malignant external syndrome. If the eyeball is not red/painful but vision gradually dims like clouds/fog, it becomes an internal syndrome. Treat as Vertex Wind Syndrome; treat urgently to avoid complications.
Youfeng Zheng (Wandering Wind Syndrome) involves head wind pain with no fixed location, shifting several times within a meal. If pain subsides but the eyeball is red, it will transform into an external opacity. Severe pain with urgent swelling indicates stasis. Untreated chronic cases without redness/pain but with dim vision become internal syndromes.
Xiefeng Zheng (Evil Wind Syndrome) occurs in those with chronic head wind who develop eye disease. As stated in the *Inner Classic*, "Wind entering the connecting channels of the head causes Eye Wind and Eye Cold." Attacks cause headache and eye disease reciprocally. Mild cases occur several times a year; severe cases persist continuously. First use Qianghuo Shengfeng Tang (Notopterygium Victory Over Wind Decoction), then Huanjing Wan (Restore Vision Pill). Constant sensation of wind in the eyes indicates latent fire and blocked Yang Qi; use Da Zhuifeng San (Great Wind-Chasing Powder). Without redness/pain but with internal distension and dim vision, it is an internal syndrome.