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What is called "Ningzhi Yi" (Corneal Ulcer with Greasy Film)? Its morphology is thick and yellowish; blood stagnation damages the Shengao (lens and intraocular tissues); qi stagnation blocks the meridians; heat attacks the brain; a cavity forms on the eyeball; blindness occurs in an instant; who can save life then?

At the onset, the eyes are painful, accompanied by many tortuous red vessels, photophobia, and tight closure of the eyelids. Forcing them open causes tears to gush out. On the Fenglun (cornea), star-like white spots appear, with holes in the center resembling puncture wounds from an awl. Gradually, these enlarge and turn yellow, and the holes expand into cavities. In some cases, the opacity appears yellow from the beginning, large and dense. Treatment follows the following methods: If a gap opens around the periphery, and forceps can be applied, or if it can be completely removed with tweezers, a pit is revealed at the bottom. The membrane at the bottom of this pit is as thin as reed-paper, fragile enough to break with wind, shocking anyone who sees it. In other cases, a dense, large white opacity appears initially, followed by the emergence of a yellow film within the opacity, resembling goose fat, indicating a more urgent condition. If headache and constipation also occur, it will rapidly evolve into a perforated ulcer (Kulou), crab-eye (Xiejing), irregular surface (Aotu), monocular blindness (Miao), or total blindness (Gu), leading to disaster within days. Regardless of the depth of the hole or cavity, as long as the opacity is thick, yellow, floating, brittle, and changes rapidly, one must urgently use Xiao Chengqi Tang combined with Xializhong Wan to purge the interior via bowel movement. Simultaneously, grind Antelope Horn (Lingyangjiao) and mix with Qinggan San to clear the exterior, ensuring the pathogenic factors in both interior and exterior are expelled. Even if the cephalic wind does not stop immediately, the bowels must become unobstructed. Once the bowels are unobstructed, eye redness, pain, and tearing will decrease. Then, use Xiaofeng Huoxue Tang, or Fangfeng Sanjie Tang, or Xijiao Dihuang Tang. After administration, if the condition slightly recedes, proceed according to the fixed prescription for "Lowering Star-Moon Opacity Erosion." Apply appropriate eye drops and washes; if suitable, recovery ensues without need for further elaboration. After healing, a white opacity will inevitably remain, shaped like fish scales or agate, which cannot detach throughout life. However, this is a fortunate outcome amidst misfortune. Investigating the etiology, it is likely due to Wood and Fire consuming themselves, damaging Metal and Earth; Kidney Water (one water) fails to overcome Heart and Liver Fire (four fires), thereby scorching the Shengao. A skilled physician encountering such a case must monitor day and night. If one merely drinks tea, bows, writes a letter, and leaves confidently, when symptoms change as described above, even if the eyeball is saved, it will remain disabled. Students should listen with humility and reverence, greatly advancing their virtue.

In the original case, my friend Ai Xiuzhan suddenly contracted this disease in early summer. Taking wind-dispelling and heat-clearing agents aggravated his condition. Someone suggested inviting Lin Guayuan, who was well-known in the city, for treatment. Upon arrival, Lin observed that the patient's physique was weak and complexion withered and pale. His pulse was fine and rapid. Considering his family was wealthy, Lin suspected excessive sexual indulgence had depleted essence and blood, leaving the body vulnerable to external pathogens. Therefore, acrid-cool herbs were inappropriate. He prescribed Buzhong Yiqi Tang, Siwu Tang, and Liuwei Dihuang Tang. Within a few days, the cornea became fully opaque, causing blindness, accompanied by restlessness. Lin resigned and sent a letter summoning me. I had studied with Ai Xiuzhan; he trusted me and sought my help exclusively. I administered Dachengqi Tang combined with Sanhuang Wan, 5 qian. The first dose yielded no response; the second dose produced slight bowel evacuation, and pain decreased slightly. The next morning, upon opening his eye slightly, his right eye could distinguish black and white. I continued administering two doses daily as before, until severe diarrhea occurred, at which point I stopped. After stopping, the pounding pain in the head and eyes was instantly relieved. Then, I used Bazheng San and Xiaoyao San as powders, and Tuiyun Dan and Jiji Wan as pills. Over a month later, he could walk out to the creek bridge to enjoy the cool air, and by autumn, he had fully recovered. When Lin Guayuan asked for the rationale, I said: Eye pain rising from below and heavy headache at the Taiyang acupoints indicate Yangming meridian overcoming Jueyin meridian; thus, Chengqi decoction is used to unblock. Constipation indicates heat transferring from Zang to Fu organs; thus, Sanhuang Wan is used to descend. Fire clustering in the Qi Lun (sclera/conjunctiva) requires Bazheng San to purge the child organ (via draining damp-heat through urination). Greasy film condensing in the Zhen Kuo (cornea) requires Xiaoyao San to directly resolve stagnation. Tuiyun Dan and Jiji Wan are specifically used to pacify residual pathogens. Lin returned and sighed, saying: The subtlety of medical methods is so divinely effective! It shows that principles do not distance themselves from people; rather, people distance themselves from principles. With round wisdom and bold courage, applying knowledge analogously, one masters the art. Nevertheless, Xiuzhan presented with a weak constitution and pulse, yet received heavy purgatives repeatedly. Fortunately, the effect of aggressive attack on excess pathogens (as advocated by Zhang Congzheng/Dairen) was achieved, but did this not violate Zhang Zhongjing's teaching against purging? This case succeeds only through attacking methods and should not serve as a model.