目之白睛变青蓝色者。病在至急。盖气轮本白。被郁邪蒸逼。走散珠中膏汁。游出在气轮之
内。故色变青蓝。瞳神必有大小之患。羌活除翳汤去麻黄、川椒、薄荷、荆芥。加升麻、川连、
甘草、桔梗。然当各因其病而治其本。如头风者。风邪也。因毒者。毒瓦斯所攻也。余仿此。
肿胀如杯证 水火之邪。传脾土而为炎燥之病。其珠必疼。而睥方急硬。若暴风客邪作肿者。
必然泪多而珠疼稍缓。然风热外感。治之易愈。若水火内自攻击。重则疼滞闭塞。血灌睛中。而
变证不测矣。轻则敷治而退。重则必须开导。敷治不退。开导不消。消而复发。痛连头脑。而肿
愈高睥愈实者。此风热欲成毒也。洗肝散、龙胆饮选用。胀有胞胀珠胀不同。胞胀多属湿胜。治
其湿热为主。珠胀多属火淫。治当去火为先。故治珠胀。虽挟风邪。不宜轻用麻黄、木贼之类。
恐有乌珠胀裂之患。不可不慎。
形如虾座证 有半边胀起者。有通珠俱被胀起盖定乌珠者。又有大 内近鼻柱处。胀出一片。
如皮如肉。状似袋者。乃血胀从额中落来。不可割。为血英。在此处误割者。为漏为瞽。不可不
辨。急宜开导。血渐去而皮渐缩。小 胀出如袋者亦然。在肺部是重。久则移传于肝。而风轮有
害也。宣明丸。
状如鱼脬证 气轮努胀。不紫不赤。状如鱼脬。乃气分之证。金火相搏所致。不用镰导。惟
以清凉自消。泻肺汤。若有微红及赤脉者。略略于上睥开之。若头痛泪热。及内燥而赤脉多者。
防有变证。宜早导之。庶无后患。
鹘眼凝睛证 此骤然而起。五脏皆受热毒。致五轮壅起。头疼面赤。目胀不能转动。若鹘之
睛。乃三焦阳邪亢极之害。先用香油调姜粉汁。于额脸项上摩擦。急服酒煎散。覆盖出汗。其眼
即活动。而用灯火烧断风路。其迎香太阳两睥上星等要隘处。并举而劫治之。此证多是小儿急惊。
大人少有此患。
因风成毒证 初发时乃头风湿热。瘀血灌睛。睑硬睛疼等病。失于早治。或治不得其法。遂
至邪盛。搏夹成毒。睥与珠胀出如拳。连珠带脑。痛不可当。先从乌珠烂起。后烂气轮。有烂沿
上下睑并脑。及颧上肉尽空而死。若患头疼肿胀珠凸等证。治退复发。再治再发。痛胀如前者。
即成此患。若已成者。虽治之胀少退。痛少止。决又发。发时再治。至于数四。终当一发。不复
退矣。惟初起时。急用石膏散加羌活、细辛、川芎、薄荷、赤芍。若至珠烂。治无及矣。
旋胪泛起证 气轮自平。水轮自明。惟风轮泛起也。或半边泛起者。亦因半边火盛。火郁风
轮。故随火胀起。服用凉膈散。点用石燕丹。非旋螺突起。已成证而顶尖俱凸。不可医治之比也。
旋螺突起证 乌珠高而绽起如螺。为肝热盛。必有瘀血。急宜石燕丹、绛雪膏点之。或调鳝
血点尖处。若年久须用锋针对瞳神量浅深横入。放出恶水。纸封避风。忌口数日。先服守真双解
散。后以六味丸加知、柏急救少阴伏匿之邪。若初起失于正治之法。则瘀虽退而气定。膏不复平矣。
神珠自胀证 此阴峻利害之证。因五脏毒风所蕴。热极充服。与旋螺突起不同。初起麻木疼
痛泪出。其势莫测。急投大黄当归散。宜退五脏热毒。捣葱、艾熨五轮之突起。洗以白芷、细辛、
麻黄、防风、羌活。未可与点。或突起高寸许者。须锋针针出恶水。疼方得止。
珠突出眶证 此乌珠忽然突出眶也。与鹘眼证因滞而漫漫胀出者不同。有因精华衰败。痒极
揩擦而出者。其人不久必死。有酒醉怒甚。及呕吐极而绽出者。有因患火证热盛。关格亢极而胀
出者。有因打扑而出者。凡此虽离两睑而脉皮未断者。乘热捺入。虽入。脉络损动。终是光损。
须用清凉膏。若突出阁在睑中而含者易入。光不损。若离
睑。脉络皮俱断者不救。
When the white part of the eye (Qi Lun, corresponding to the sclera/conjunctiva) turns blue-green, the condition is extremely urgent. The Qi Lun is originally white; when constrained by pathogenic factors that steam and force it, the essence fluid within the eyeball scatters and migrates into the Qi Lun, causing the color to change to blue-green. At this time, the pupil (Tong Shen) will inevitably exhibit abnormalities in size. Treatment may employ Qianghuo Chuyi Tang (Notopterygium Decoction for Removing Cataracts), removing Ephedrae Herba (Mahuang, 麻黄), Zanthoxyli Pericarpium (Chuanjiao, 川椒), Menthae Haplocalycis Herba (Bohe, 薄荷), and Schizonepetae Spica (Jingjie, 荆jie), and adding Cimicifugae Rhizoma (Shengma, 升麻), Coptidis Rhizoma (Chuanlian, 川连), Glycyrrhizae Radix et Rhizoma (Gancao, 甘草), and Platycodonis Radix (Jiegeng, 桔梗). However, one must treat the root cause according to the specific disease. For instance, Head Wind (Touteng) is caused by Wind pathogen; diseases caused by toxins are attacked by toxic vapors. Other conditions follow this pattern.
Swelling like a Cup Syndrome: Water and Fire pathogens transmit to the Spleen Earth, transforming into inflammatory and dryness diseases. The eyeball will necessarily be painful, and the eyelids will become square, tense, and hard. If swelling is caused by sudden wind and external pathogens, there will be excessive tearing and slightly relieved eyeball pain. External contraction of Wind-Heat is easy to cure. However, if Water and Fire pathogens attack from within, severe cases involve painful stagnation and blockage, with blood flooding into the eyeball, leading to unpredictable complications. Mild cases can be resolved with topical applications; severe cases require drainage or incision. If topical treatment fails, drainage does not resolve it, or it recurs after subsiding, with pain radiating to the head and higher swelling accompanied by firmer eyelids, this indicates Wind-Heat is about to transform into toxicity. Xigan San (Liver-Washing Powder) or Longdan Yin (Gentian Drink) should be selected. Swelling differs between Eyelid Swelling (Bao Zhang) and Eyeball Swelling (Zhu Zhang). Eyelid swelling mostly belongs to excess Dampness, treated primarily by clearing Heat and draining Dampness. Eyeball swelling mostly belongs to excessive Fire, treated primarily by eliminating Fire. Therefore, when treating Eyeball swelling, even if accompanied by Wind pathogen, one should not lightly use herbs like Ephedrae Herba (Mahuang, 麻黄) or Equiseti Herba (Muzei, 木贼), lest it cause the rupture of the black cornea (Wu Zhu). Caution is essential.
Shape Like a Seated Shrimp Syndrome: Some present with half-side swelling, some have the entire eyeball covered by swelling obscuring the black cornea, and others have a swelling near the inner canthus close to the nasal bridge, resembling skin or flesh, shaped like a bag. This is Blood Swelling falling from the middle of the forehead. It must not be cut; it is called Blood Ying (Blood Hero/Entity). Mistakenly cutting here leads to fistula or blindness, so differentiation is crucial. Urgent drainage is required; as blood gradually dissipates, the skin shrinks. The same applies to small canthus swelling resembling a bag. This condition is heavy in the Lung, and over time transmits to the Liver, harming the Wind Wheel (black cornea). Use Xuanming Wan.
Shape Like a Fish Bladder Syndrome: The Qi Lun swells distendedly, neither purple nor red, resembling a fish bladder. This is a Qi-level syndrome caused by the conflict between Metal and Fire. Do not use scalpel drainage; let it subside naturally with cooling methods. Use Xiefei Tang (Lung-Draining Decoction). If there is slight redness and red vessels, make a slight incision on the upper eyelid. If accompanied by headache, hot tears, internal dryness, and numerous red vessels, prevent complications by early drainage to avoid future troubles.
Hawk-Eye Fixed Gaze Syndrome: This arises suddenly. Heat-toxin affects all five zang organs, causing congestion and swelling of the Five Wheels. Symptoms include headache, flushed face, and swollen eyes unable to rotate, resembling a hawk's eye. This is the harm of extreme hyperactivity of Yang pathogens in the Triple Burner. First, rub sesame oil mixed with ginger powder juice on the forehead, eyelids, and neck. Urgently administer Jiu Jian San (Alcohol-Boiled Powder), cover to induce sweating, and the eye movement will recover. Then, use moxa burning to sever the Wind pathways, applying aggressive treatment at key acupoints such as Yingxiang (LI20), Taiyang (EX-HN5), and Shangxing (GV23) on both eyelids. This syndrome is common in children with acute convulsions but rare in adults.
Toxicity Formed by Wind Syndrome: Initially, it presents as head wind-damp-heat, blood stasis flooding the eye, hard eyelids, and eyeball pain. Due to delayed treatment or incorrect methods, pathogens become excessive, combining into toxicity. Eyelids and eyeballs swell out like fists, connecting the eyeball to the head, with unbearable pain. Rotting begins at the black cornea, then spreads to the Qi Lun. If rotting extends to upper and lower eyelids, head, and causes the cheek muscles to hollow out completely, death ensues. If headaches, swelling, and protruding eyeballs recur repeatedly despite treatment, forming this condition, even if treatment temporarily reduces swelling and pain, recurrence is inevitable. Repeated treatments will eventually fail to resolve it. Only at the onset should Shigao San (Gypsum Powder) be urgently used with additions of Notopterygii Rhizoma (Qianghuo, 羌活), Asari Radix (Xixin, 细辛), Ligustici Chuanxiong Rhizoma (Chuanxiong, 川芎), Menthae Haplocalycis Herba (Bohe, 薄荷), and Paeoniae Radix Rubra (Chishao, 赤芍). Once the eyeball rots, treatment is futile.
Xunlu Fanqi (Whorl-Like Rising) Syndrome: The Qi Lun is flat, the Water Wheel (pupil) is clear, only the Wind Wheel rises. Half-side rising is due to excessive fire in that half, where fire constrains the Wind Wheel, causing it to rise with the fire. Take Liangge San (Cooling Chest Powder) and apply Shiyan Dan (Swallowstone Pill). This is distinct from Xuanlu Tūqǐ (Whorl-Protrusion) Syndrome, where the peak is fully convex and incurable.
Xuanlu Tūqǐ (Whorl-Protrusion) Syndrome: The black cornea is high and protrudes like a whorl, indicating excessive Liver Heat and必有 blood stasis. Urgently apply Shiyan Dan (Swallowstone Pill) and Jiangxue Gao (Crimson Snow Ointment). Alternatively, apply eel blood to the tip. For long-standing cases, use a sharp needle to penetrate horizontally into the pupil based on depth, drain foul fluid, seal with paper to avoid wind, and observe dietary restrictions for several days. First take Shouzhen Shuangjie San (Shouzen's Dual-Resolution Powder), then use Liuwei Wan (Six-Ingredient Pill) plus Anemarrhenae Rhizoma (Zhimu, 知母) and Phellodendri Cortex (Huangbai, 黄柏) to rescue the hidden pathogens of Shaoyin. If initial correct treatment is missed, although stasis recedes, Qi becomes fixed, and the cornea will not flatten again.
Shenzhu Zizhang (Divine Pearl Self-Swelling) Syndrome: This is a severe Yin pathology caused by accumulation of toxic wind in the five zang organs, with extreme heat. It differs from Whorl-Protrusion. Initial symptoms include numbness, pain, and tearing, with unpredictable progression. Urgently administer Dahuang Danggui San (Rhubarb and Angelica Powder) to clear heat-toxin from the five zang organs. Apply compresses of crushed garlic and mugwort to the swollen Five Wheels. Wash with Angelicae Dahuricae Radix (Baizhi, 白芷), Asari Radix (Xixin, 细辛), Ephedrae Herba (Mahuang, 麻黄), Saposhnikoviae Radix (Fangfeng, 防风), and Notopterygii Rhizoma (Qianghuo, 羌活). Do not use eye drops initially. If swelling exceeds one cun, puncture with a sharp needle to drain foul fluid to stop pain.
Eyeball Protruding from Orbit Syndrome: The black cornea suddenly protrudes from the orbit. This differs from Hawk-Eye syndrome where slow swelling occurs due to stagnation. Causes include exhaustion of essence and fluids with severe itching from rubbing, leading to imminent death. Others result from drunken anger or extreme vomiting. Some arise from extreme heat in Fire syndromes or extreme hyperactivity of Guan Ge (obstruction and reversal). Others result from trauma. If the eyeball leaves the eyelids but vessels and skin remain intact, press it back in while warm. Although repositioned, vessel damage results in permanent vision loss; use Qingliang Gao (Cooling Ointment). If the protruded eye is trapped within the eyelids, it is easier to reposition without vision loss. If the eye is completely detached with severed vessels and skin, it is incurable.