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Li Dongyuan stated: The occurrence of trichiasis (inverted eyelashes) and curled eyelashes is caused by the tension of the eyelids and skin contraction. This results from internal heat causing Yin Qi to move outward; therefore, one must eliminate the internal heat and Fire pathogenic factors. Once the eyelid skin relaxes, the eyelashes will stand upright, and nebulae (corneal opacities) will recede. The treatment involves manually eversion of the inner eyelid, followed by rapid pricking with a three-edged needle to bleed. By using the left thumb nail to guide the needle tip, immediate cure can be achieved.

Chronic redness and ulceration of the eye socket, commonly known as "Chi Xia" (Red Blindness), should be treated by pricking the exterior of the eye socket with a three-edged needle to drain Damp-Heat, leading to recovery.

Commentary: The above discussions deeply understand the pathology. However, this condition is mostly caused by Blood Heat, Yin Deficiency, and Hyperactivity of Empty Fire. Blood serves to nourish the meridians and hair follicles. Thus, external treatment should be used to drain Stagnant Heat, while internal treatment should be employed to cut off the source of the disease.

Li Dongyuan stated: The ability to see far but not near indicates insufficient Yang Qi and excess Yin Qi, which signifies Qi Deficiency and Blood Excess. Blood Excess implies excess Yin Fire, while Qi Deficiency implies weak Qi. This is a physiological phenomenon akin to the setting sun in the elderly. Conversely, the ability to see near but not far indicates excess Yang Qi and insufficient Yin Qi, signifying Blood Deficiency and Qi Excess. Both Blood Deficiency and Qi Excess stem from excess Fire and insufficiency of Yuan Qi (Original Qi). Fire is the thief of Yuan Qi, Gu Qi (Grain Qi), and Zhen Qi (True Qi). When Yuan Qi arrives, it is slow and harmonious, fine as a thread; when Pathogenic Qi arrives, it is tight and strong, like an unstoppable great river.

In strict accordance with principles: Yang Qi is like the Sun and Fire; Yin Qi is like Metal and Water. As the Confucian scholars of old stated, "Metal and Water are bright inside and dark outside, while Sun and Fire are dark inside and bright outside." The human eye possesses the essence of the Zang-Fu organs and Five Elements, which generate Shen Guang (Spiritual Light), enabling vision; this is the normal principle. Although classics state that "the eyes can see when they receive Blood," they rarely discuss Qi alone, likely because Blood requires Qi to become an intersection of Water and Fire, thereby generating spiritual function. Otherwise, Yin Deficiency prevents seeing far, and Yang Insufficiency prevents seeing near, marking the gradual decline of vision in the elderly. However, if students of medicine seek these principles when treating eye diseases, their understanding will have progressed significantly.

Chen Wuzhai stated: Unregulated emotions such as anger and joy, combined with sorrow and overthinking, lead to disharmony of Zang-Qi. Depression generates Phlegm-Saliva, which rises with Qi. Encountering deficiency in the brain, it infiltrates the eye system and pours into the eyes. Mild cases present with blurred and dry vision; severe cases result in visual obstructions (nebulae), discharge, tearing, and fleshy membranes covering the pupil. These are all due to internal causes. Alternatively, repeated exposure to Wind-Cold or failure to avoid summer dampness allows pathogens to strike the neck, entering the brain via the eye system through deficiency, thus generating external nebulae. Medical texts refer to conditions such as Qing Feng (Green Wind), Lv Feng (Emerald Wind), Zi Feng (Purple Wind), Hei Feng (Black Wind), Chi Feng (Red Wind), Bai Feng (White Wind), Bai Yi (White Nebula), and Huang Yi (Yellow Nebula), which vary according to the Eight Winds and constitute external causes. Furthermore, unregulated desires and irregular diet, consumption of raw pungent spices, hot roasted foods, strenuous hunting, exposure to smoke and dust, and emotional labor are root causes of blindness, classified as neither internal nor external causes.

Commentary: The causes of pathology described in the treatise are extremely detailed. Unfortunately, the prescriptions often focus on Wind-Heat and Yang Deficiency of the Water Organ (Kidney), lacking comprehensiveness. Students should apply flexible adaptation to these treatments.