亦有忿怒抑郁生热，热盛伤血，亦致筋挛。须按病情治之，必效。切勿惑于市场习通套之用，如木瓜、秦芄、伸筋草、舒筋、灵仙、松节、地黄、乌药、羌活一派。不按阴阳病情，往往误事，不可不知也。[眉批]经曰：脏真散于肝，筋膜之气也。识得真元之气，散于筋膜者，为肝气，则知凡人病筋挛者，皆失真元所养而致。饮安指出四因，逐层阐发阴阳之理，指点驱用仲景之方，皆调燮真元之法，无有不效，可谓神乎技矣。学者细心体会，洞澈源流，治筋挛自有把握。
肾 病 腰 痛
按腰痛一证，有阳虚者，有阴虚者，有外邪闭束者，有
[1] 筋 原本作"经"，据文义改。
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湿气闭滞者。因阳虚而致者，或由其用心过度，亏损心阳；或由饮食伤中，损及脾阳；或由饮食伤中，损及脾阳；或由房劳过度，亏损肾阳。阳衰阴盛，百病丛生，不独腰疾，但腰之痛属在下部，究竟总是一个阳虚，下焦之阴寒自盛，阳微而运转力衰，腰痛立作。其人定见身重畏寒，精神困倦。法宜峻补坎阳，阳旺阴消，腰痛自己。如阳旦汤、术附、羌活、附子汤之类。
阴虚而致者，由肾阳素旺也。旺甚即为客邪，火盛血伤，元阴日竭，则真阳无依，腰痛立作，其人必小便赤而咽干，多暴躁，阳物易挺，喜清凉。法宜养阴，阴长阳消，肾气自摄，腰痛自己。如滋肾丸、地黄汤、封髓丹倍黄柏加全皮之类。
因寒而致者，由外感寒邪，从太阳而入少阴。太阳与少阴为表里。少阴为阴脏，外寒亦阴，入而附之，阴主收束，闭其肾中真阳运行之气机，故腰痛作。其人定见发热畏寒，或兼身痛、咽干不渴、时时欲寐。法宜温经散寒，寒散而腰痛自己。如麻黄附子细辛汤、附羌汤之类。
因湿滞而致者，由其人素禀劳苦，久居湿地深坑，中气每多不足，易感外来之客邪，太阴与肾相连，湿邪不消，流入肾界，阻其运行之机，故腰痛，定见四肢沉重，常觉内冷，天阴雨更甚，腰重如有所系。法宜温经除温，湿去而腰痛自己。如肾着汤、桂苓术甘汤加附子细辛之类。
近来市习，一见腰痛，不究阴阳，不探虚实，便谓房劳过度，伤及肾阴。故所用药品，多以熟地、枣皮、杜仲、枸杞、巴戟、首乌、苁蓉、补骨脂、菟丝、龟胶一派，功专滋阴补水，人人所共信。殊不知肾为至阴之府，先天之真阳寄焉。阴居其二，阳居其一，夫妇交媾，生男育女，《易》云：
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乾道成男，禀父之阳精也。坤道成女。禀母之阴精也。由此观之，男子所亏者，肾中之阳，而非肾中之阴也。所谓阴虚者。指肾为阴脏而说。非专指肾中之水虚，实指肾中之阳虚也。[眉批]知非氏曰：医有恒言阴虚火旺，多伤于房劳，或损及脾胃，法当滋阴泻火。夫阴者何物？火者何物？损之伤者又何物？治之必用一派滋阴补水之药，将滋之补之者又系何物？人往往不能言。知非因之喟然叹矣，不禁睾然思，穆然望曰，人得天地之至精，日以熔炼谷味，取法变化而生气血，其灵贯于百骸，为五脏六腑之本，十二经脉之原，统治群阴，不敢作崇，俾人得安舒无恙者，此一物也，爱彷佛而拟其形容，观其会通，曰：阴者，鬼之灵也。火者，神之灵也。知鬼神为水火，则知阴虚火旺，滋阳补水之说为不通，其法必不效，安能疗[ 1 ]水火之疾病。饮安此按，发明阳衰阴盛，后又指出，亏者，亏肾中之阳，肾虚是肾中之阳虚。阳即火而阴即鬼。藉腰痛一证以传神，补出内外两法，剖明两腰致痛之由，良以太阳[ 2 ]寒水，厥阴风木，少阴君相二火，皆关于肾，知之真，故不觉言之亲切有味，六经之法，通治百病，顾可不亟讲乎，学者其玩索而有得焉可。若不辩明这点机关，但称阴虚，但知滋水，势必阴愈盛而阳愈微，湿愈增而寒愈闭，腰痛终无时已。治人实以害人，救世实以害世。此皆通套之弊，岂忍附和不言，实不得已耳。惟愿同道，抛去此项药品，按定阴阳虚实，外感内伤治之，庶不致遗害焉耳。更有可怪者，今之医家，专以首乌、熟地一派甘寒之品，为补水必用之药，何不将天一生水这句道理，细心推究，试问天一生水，专赖此一派甘寒之品乎！总之，宗旨不明，源头莫澈，仲景而下，罕有了了。[眉批]能辩宗旨源头，方可谓曰知医。
头 痛
按头痛一证，有从外而入者，有从内而出者。从外而入者，风、寒、暑、湿、燥、火，六客之邪干之也。干于三阳，
[1] 疗原作"疾"，据文义改。
[2] 阳原本作"汤"，据文义改。
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俱以表称，干于三阴，俱以里论。此指六客由外入内之谓，非指七情损伤，由内出外之谓。三阳者何？一曰太阳头痛，脉浮项强，发热恶寒恶风是也。自汗恶风，主以桂枝汤。恶寒无汗，主以麻黄汤。是顺其本经之气机也。二曰阳明头痛，额前、眉棱、眼眶胀甚，脉长，恶热，主以葛根汤。是顺其本经之气机也。三曰少阳头痛，而两侧独甚，寒热往来，目眩口苦，主以小柴胡汤。是顺其本经之气机也。三阳之气机顺，邪不至入于内，而三阴不病矣。若三阳之外邪不解，则必传于三阴，三阴者何？四曰太阴。外邪传至太阴，太阴主湿，邪从湿化，湿气上蒸，头痛而重，四肢酸疼而觉冷，腹满呕吐不食，主以理中汤， 是温中除湿之意也。五曰少阴。少阴乃水火交会之区。邪入少阴，若协火而化为热邪，热气上蒸，头痛而咽干便赤，少气懒言，肌肤燥熯，法宜养阴，主以鸡子黄连汤，是润燥救阴之意也。邪若协水而化为阴邪，头痛而脉微欲绝，身重而欲寐懒言，咽干而口不渴，主以麻黄附子细辛汤，是温经散寒，扶阳抑阴之意也。六曰厥阴。邪入厥阴，厥阴主风木，邪从风化为病，风主轻清，头痛而巅项更甚。诸阴之脉至颈而还，惟厥阴脉会顶巅。厥阴又属至阴之所，邪入此，从阴化者亦多。顶痛多兼干呕吐涎，爪甲、唇口青色、肢冷腹痛。主以吴萸四逆汤，是回阳降逆祛阴之意也。[眉批]此论六经头痛。三阳三阴为病， 有界限， 有次第， 有传不传，传者病也。著 眼 论《素 问》云：三阳为父，指太阳；二阳为卫，指阳阴；一阳为纪，指少阳。三阴为母，指太阴，二阴为雌，指少阴，一阴为使，指厥阴。此篇所论，是从六步流行之气机言之也。邪在三阳，法宜升解，不使入内为要。邪在三阴，法宜温固，由内而释，不使伤表为先。[眉批]总结六经。
若内伤日久，七情过度，阳虚阴虚，亦能作头病，但病形无外感可征，头眩昏晕，十居其八，头痛十仅二三。因阳
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虚日久，不能镇纳浊阴，阴气上腾，有头痛如裂如劈，如泰山压定，有欲绳索紧捆者，其人定见气喘，唇舌青黑，渴饮滚汤，此属阳脱于上，乃系危候。法宜回阳收纲为要，如大剂白通四逆之类。缓则不救。若误用发散，旦夕即亡。因阴虚而头痛者，乃火邪上冲，其人虽无外感可征，多心烦咽干，便赤饮冷，有觉火从脚底而上，火从两腰而上，火从脐下而上，上即头痛，无有定时，非若外感这终曰无已时也。法宜扶阴，如六味、八味之类。此条尚有区分，病人自觉火自下而上时，其人安静，不喜冷饮，咽不干，便不赤，心不烦，唇舌若青，则又是阴气上腾。法宜大辛大甘以守之复之，切不可妄用滋阴降火。一滋阴降火，则阴愈胜而阳愈消，脱证立作矣。[眉批]推论头痛有阳虚阴虚危候，析阴阳于微芒。内外两法，各有攸归，前贤虽称头为诸阳之首，清气所居，高巅惟风可到，治之专以祛风为主，此语近是。予谓凡病头痛之人，每由内之正气不足，不能充周，外之一切风邪，六客即是六风，风字宜活看。内之一切阳虚阴虚，俱能上逆而为病。外邪则按定六经提纲病情为准，内伤则按定喜怒哀忧思恐惧，阳虚阴虚为要，他如诸书所载。有名雷头风者，头响者，头摇者，头重者，偏左偏右者，大头毒者，宿食头痛者，种种名目，亦不可不知。雷头与响者，气挟肝火而聚于上也。火即是风，言其盛也。雷头，主以清震汤。头响者，主以小柴胡加丹、栀。头摇者，风淫于内也，主以养血汤。头重者，湿气蒸于上也，主以祛[1]风散湿汤。偏于左者，血虚风动也，主以四物加风药。偏于右者，气虚而风袭之也，主以四君加风药。左右二证，予常以封髓丹加吴萸、安桂，屡治屡效。大头毒者，外感时行疠气，壅于三阳也，主经普济消毒饮。宿食痛者，饥则安而饱则甚，
[1] 祛原本作"法"，据文义改。
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由胃中浊气上蒸也，主以平胃散加消导药。以上等法，皆前贤所制，亦可择取，姑存之，以便参考。[眉批]提顿开下，搜采无遗，名论不刊，医家上乘。
查近市习，一见头痛，不按阴阳，专主祛风，所用无非川芎、白芷、荆芥、防风、蔓荆、藁本、羌活、天麻、辛夷、苍耳。夫此等药品，皆轻清之品，用以祛三阳表分之风，则效如桴鼓，用以治三阴上逆外越之征，则为害最烈，不可不知也。
目 病
按目病一条，眼科有七十二种之别，名目愈多，学者无从下手。予为之括其要，统以外感、内伤两法判之，易于明白了然。
从外感者，多由染天行时气而作。时气二字，指六气也。看是何邪干于何部，干于肺者，自睛受病。干于心者，两眦受病。干于肝者，黑珠受病。干于肾者，瞳子受病。干于脾者，上下眼皮受病。无论何邪由外入内，初起定见恶风，畏寒，恶热，头痛，红肿胀痛，羞明流泪，赤脉缕缕等情。或失于宣散，过于寒凉，久久不愈，便生翳障赤白等雾，皆是从外而生者也。治之之法，按定时令部位，不外祛风、清热、升散等方而已。余欲按定六客，逐部以论病论方，未免太繁。外形已经说明，学者思之而亦即得之矣。[眉批]分配精确，如然鹂得珠，已扼治目之要，何必他求。
从内伤而得者，则有七情之别。七情者，喜怒悲哀恐惧而已。七情之扰，总属伤神。神者，火也，阳也，气也。[眉批]一语抵人千百，经云得一之精，以知死生。夫神火阳气，一而已矣。过于喜者，损心阳，则心中之阴邪自盛，即为客邪，上乘而生赤
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翳障雾。过于怒者，损肝阳，肝中之阴自盛，即为客邪，上乘而青翳障雾。过于忧思者，损脾阳，脾中之阴自盛，即为客邪，上乘而生黄翳障雾。过于恐惧者，损肾阳，肾中之阴自盛，即为客邪，上乘而生黑翳障雾。过于悲哀者，损肺阳，肺中之阴自盛，即为客邪，上乘而为白翳障雾。此数目疾，定无羞明红肿痛甚，恶热喜冷，其人少气懒言，身重嗜卧，面色青白，脉或虚细浮大中空，种种情形，皆是内伤虚损而生者也。亦有一发而即痛胀欲裂，目赤如榴者，由先天真气附肝而上，欲从目脱也。定见唇口黧黑，或气喘促，喜极热汤水，六脉或暴出如绳，或脉劲如石，或浮大而空，或釜沸者是也。法宜回阳收纳为要。伤于心者，可与补坎益离丹、桂枝龙牡汤。伤于肝者，可与乌梅丸。伤于脾者，可与建中、理中汤。伤于肾者，可与潜阳、真武、封髓等方。伤于肺者，可与姜桂汤、桂苓姜半汤。先天真气暴出者，可与回阳白通汤。备载数方，略陈大意，添减分两，在人变通。设或果有血虚阳亢为殃者，其人定有火邪可征，如六味地黄汤、丹栀四物汤，皆可选用。[眉批]法润机圆。
近来市习，一见目痛，并不察究外内虚实，多用虫退、木贼、红花、菊花、决明、归尾、赤芍、荆芥、防风、薄荷、生地、夜明砂、夏枯草、冬桑叶、谷精草。与夫壮水明目丸、杞菊地黄丸、滋肾养肝丸。如此等方药，治外感风热、血虚，每多立效。若七情损伤，由内出外之目疾，鲜能获效。学者当细心体会内外两法，切勿混淆，方可售世。
耳 病 肿 痛
按耳病肿痛一证，有因肝胆风火而致者，有忿怒捭二而致者，有肾阳虚而阴气上攻者，有肾水衰而火邪上攻者。
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因肝胆风火而致者，由肝胆挟外受之风热，聚而不散，其人两耳红肿痛甚，时见寒热往来，口苦咽干者是也。法宜和解，小柴胡汤倍柴、芩，麦芽、香附治之。
因忿怒仰郁而致者，由忿怒伤肝，抑郁之气结而不散，其人两耳红肿，必见两胁胀痛，时多太息，法宜疏肝理气为主，如生地四物汤倍加柴胡、青皮、麦芽、香附之类。
因肾阳虚而致者，由肾阳日衰，不能镇纳僭上之阴气，其人两耳虽肿，皮色如常，即痛亦微，唇舌必淡，人必少神。法宜扶阳祛阴，如封髓丹倍砂仁加安桂、吴萸；或潜阳丹加吴萸；或阳旦汤加香附、麦芽之类。
因肾水虚而邪火上攻者，其人两耳仲痛，腰必胀，口多渴，心多烦，阳物易挺。法宜滋阴降火，如六味地黄汤加龟板、五味、白芍；或滋肾丸倍知、柏之类。
也有因愤怒或抑郁导致体内生热，热邪过盛损伤血液，进而引起筋脉拘挛的情况。必须根据具体的病情进行治疗，必定有效。切勿被市场上流行的通用套路所迷惑，盲目使用木瓜、秦艽（注：原文“秦芄”为误字，据文义及中医常识修正）、伸筋草、舒筋草、威灵仙、松节、地黄、乌药、羌活这一类药物。如果不辨别阴阳病情的虚实寒热，往往会耽误治疗，这一点不可不知道。[眉批]《内经》说：脏真之气散布于肝，表现为筋膜之气。如果认识到真元之气散布在筋膜中，属于肝气的作用，就会知道普通人患筋脉拘挛的病，都是因为失去了真元的滋养所致。饮安指出了四种病因，层层阐发阴阳的道理，指点使用张仲景的方剂，都是调理真元的方法，没有不有效的，可以说是技艺神妙了。学者们要细心体会，透彻理解源流，治疗筋脉拘挛自然就有把握。
关于腰痛这一证候，有阳虚引起的，有阴虚引起的，有外邪闭阻束滞引起的，有湿气闭阻停滞引起的。因阳虚而导致的，有的是因为用心过度，亏损了心阳；有的是因为饮食损伤脾胃，损及脾阳；有的是因为房事过度，亏损了肾阳。阳气衰微，阴气旺盛，百病丛生，不仅仅是腰部疾病，但腰部的疼痛属于下部，归根结底总是一个阳虚的问题，下焦的阴寒自然旺盛，阳气微弱且运转力量衰退，腰痛立刻发作。这种人一定伴有身体沉重、畏寒、精神困倦的表现。治法应当峻补坎宫之阳，阳气旺盛则阴气消退，腰痛自然痊愈。如使用阳旦汤、术附汤、羌活附子汤之类的方剂。
因阴虚而导致的，是因为肾阳原本就旺盛。旺盛到了极点就成了客邪，火盛伤血，真阴日渐枯竭，那么真阳就没有依附，腰痛立刻发作。这种人一定有小便赤红、咽干、容易暴躁、阴茎易勃起、喜欢清凉环境的表现。治法应当滋养阴液，阴液增长则阳气消退，肾气自然摄纳，腰痛自然痊愈。如使用滋肾丸、地黄汤、封髓丹加倍黄柏并加入全皮之类的方剂。
因寒邪而导致的，是因为外感寒邪，从太阳经传入少阴经。太阳与少阴互为表里。少阴是阴脏，外来的寒邪也是阴邪，进入后依附于少阴，阴主收束，闭塞了肾中真阳运行的气机，所以腰痛发作。这种人一定伴有发热畏寒，或者兼有身体疼痛、咽干但不想喝水、经常想睡觉的表现。治法应当温通经脉、散除寒邪，寒邪散去则腰痛自然痊愈。如使用麻黄附子细辛汤、附羌汤之类的方剂。
因湿邪停滞而导致的，是因为这个人平素劳累辛苦，久居湿地深坑，中气大多不足，容易感受外来的客邪，太阴与肾相连，湿邪不能消除，流入肾脏领域，阻碍了其运行的气机，所以腰痛。这种人的典型表现是四肢沉重，常觉得内部寒冷，阴雨天气时症状更严重，腰部沉重好像被东西束缚一样。治法应当温通经脉、祛除湿邪（注：原文“除温”据文义应为“除湿”），湿邪去除则腰痛自然痊愈。如使用肾着汤、桂苓术甘汤加附子、细辛之类的方剂。
近来市井医风，一见到腰痛，不探究阴阳，不探求虚实，就说是房事过度，损伤了肾阴。所以使用的药物，多以熟地、枣皮（山茱萸）、杜仲、枸杞、巴戟天、首乌、肉苁蓉、补骨脂、菟丝子、龟胶这一类药物为主，功效专门在于滋阴补水，这是大家都深信不疑的。却不知道肾是至阴之府，先天之真阳寄寓在其中。阴占两份，阳占一份，夫妇交媾，生男育女，《易经》说：乾道成就男性，禀受父亲的阳精；坤道成就女性，禀受母亲的阴精。由此看来，男子亏损的是肾中的阳，而不是肾中的阴。所谓阴虚，是指肾作为阴脏而言，并不是专指肾中的水虚，实际上是指肾中的阳虚。[眉批]知非氏说：医学上有恒定的说法认为阴虚火旺，多因房劳损伤，或损及脾胃，治法应当滋阴泻火。但是，阴是什么东西？火是什么东西？损伤的是什么东西？治疗时必须用一派滋阴补水的药物，那么用来滋补的又是什么呢？人们往往说不出个所以然。知非因此感叹不已，不禁肃然深思，穆然远望说：人得到天地间的至精之气，每天熔炼谷物的味道，取法变化而产生气血，其灵性贯通全身骨骼，成为五脏六腑的根本，十二经脉的源头，统率群阴，不敢作祟，使人得以安舒无恙的，就是这一个东西。我仿佛描绘它的形态，观察它的会通之处，说道：阴，是鬼的灵性；火，是神的灵性。知道鬼神对应水火，就知道阴虚火旺、滋阳补水的说法是不通的，那种方法必定无效，怎么能治疗水火相关的疾病呢？饮安的这段按语，阐发了阳衰阴盛的机理，后又指出亏损的是肾中之阳，肾虚即是肾中之阳虚。阳就是火，阴就是鬼。借腰痛这一证候来传达神韵，补充出内治和外治两种方法，剖明两种腰痛致痛的原因，确实因为太阳寒水、厥阴风木、少阴君相二火，都与肾有关，认识得真切，所以不觉说得亲切有味。六经之法，可以通治百病，难道可以不亟需讲求吗？学者们要玩味探索从而有所收获。如果不能辩明这个关键机关，只称阴虚，只知道滋水，势必导致阴更盛而阳更微，湿更增而寒更闭，腰痛最终没有停止的时候。治病实际上是害人，救世实际上是害世。这都是通用套路的弊端，怎么忍心附和而不说话，实在是不得已罢了。只希望同道中人，抛弃这类药品，按照阴阳虚实，区分外感和内伤来治疗，才不至于遗留祸害。更有奇怪的是，现在的医家，专门以首乌、熟地这一类甘寒的药物，作为补水必用的药，为什么不将“天一生水”这个道理，细心推究？试问天一生水，专门依赖这一类甘寒的药物吗？总之，宗旨不明，源头不清，自张仲景以下，很少有明白清楚的。[眉批]能辩明宗旨和源头，才可以称为懂医。
关于头痛这一证候，有从外部侵入的，有从内部发出的。从外部侵入的，是风、寒、暑、湿、燥、火这六种客邪干扰它。干扰在三阳经，都称为表证；干扰在三阴经，都称为里证。这里指的是六种客邪由外向内，不是指七情损伤，由内向外发的情况。什么是三阳？一是太阳头痛，脉浮、项强、发热、恶寒、恶风，如果有自汗、恶风，主治用桂枝汤；如果恶寒、无汗，主治用麻黄汤。这是顺应本经的气机。二是阳明头痛，前额、眉棱骨、眼眶胀痛厉害，脉长，恶热，主治用葛根汤。这是顺应本经的气机。三是少阳头痛，两侧特别厉害，寒热往来，目眩口苦，主治用小柴胡汤。这是顺应本经的气机。三阳的气机顺畅，邪气就不会进入内部，三阴也就不会生病了。如果三阳的外邪不解，就一定传变到三阴。什么是三阴？四是太阴。外邪传到太阴，太阴主湿，邪气随湿而化，湿气上蒸，头痛且沉重，四肢酸痛且感觉冷，腹部胀满呕吐不想吃东西，主治用理中汤，这是温中除湿的意思。五是少阴。少阴是水火交会的地方。邪气进入少阴，如果协同火而化为热邪，热气上蒸，头痛且咽干小便赤，气短懒言，肌肤干燥焦热，治法应当养阴，主治用鸡子黄连汤，这是润燥救阴的意思。邪气如果协同水而化为阴邪，头痛且脉微欲绝，身体沉重想睡觉懒言，咽干口不渴，主治用麻黄附子细辛汤，这是温经散寒、扶阳抑阴的意思。六是厥阴。邪气进入厥阴，厥阴主风木，邪气随风而化为病，风主轻清，头痛且头顶项部更厉害。诸阴的经脉走到颈部就返回，只有厥阴脉会合于头顶巅顶。厥阴又属于至阴之所，邪气进入这里，从阴化的情况也很多。头顶痛多兼有干呕吐涎沫，指甲、嘴唇、口唇青色，四肢冷腹痛。主治用吴茱萸四逆汤，这是回阳降逆祛阴的意思。[眉批]这篇论述六经头痛。三阳三阴发病，有界限，有次第，有传变和不传变，传变的就是病。着眼点论《素问》说：三阳为父，指太阳；二阳为卫，指阳明；一阳为纪，指少阳。三阴为母，指太阴；二阴为雌，指少阴；一阴为使，指厥阴。本篇所论，是从六步流行之气机的角度说的。邪气在三阳，治法应当升散解表，不让邪气入内是关键。邪气在三阴，治法应当温固，由内而解，不让伤害体表为先。[眉批]总结六经。
如果是内伤日久，七情过度，阳虚或阴虚，也能引起头痛，但病形没有外感的征象，头晕昏晕，十个人里有八个，头痛十个人里只有两三个。因阳虚日久，不能镇纳浊阴，阴气上腾，有头痛像撕裂、像劈砍、像泰山压顶、像绳索紧捆的感觉，这种人一定伴有气喘，嘴唇舌头青黑，口渴想喝滚烫的水，这属于阳气脱失于上，是危重的证候。治法应当回阳收纲为主要手段，如大剂量的白通汤、四逆汤之类。如果迟缓就不能救治。如果误用发散药物，早晚就会死亡。因阴虚而头痛的，是火邪上冲，这种人虽然没有外感征象，但多心烦咽干，小便赤红想喝冷水，有的感觉火从脚底向上，火从两腰向上，火从脐下向上，上来后就头痛，没有固定时间，不像外感那样整天不停。治法应当扶持阴液，如六味地黄丸、八味地黄丸之类。这一条还有区分，病人自觉火从下往上时，如果其人安静，不喜欢冷饮，咽不干，小便不赤，心不烦，嘴唇舌头若发青，那又是阴气上腾。治法应当用大辛大甘的药物来守持恢复，切不可妄用滋阴降火。一旦滋阴降火，则阴更胜而阳更消，脱证立刻发作。[眉批]推论头痛有阳虚阴虚的危重证候，在细微处辨析阴阳。内外两种治法，各有归属，前贤虽然称头为诸阳之首，清气所居，高处的巅顶只有风能到达，治疗专门以祛风为主，这话接近正确。我认为凡是患头痛的人，多由于内部的正气不足，不能充盈周遍，外部的一切风邪，六客也就是六风，“风”字应该灵活看待。内部的一切阳虚阴虚，都能上逆而为病。外邪则按照六经提纲的病情为准，内伤则按照喜怒哀乐思恐惧，阳虚阴虚为主要依据，其他如各种书籍所载，有名雷头风的，头响的，头摇的，头重的，偏左偏右的，大头毒的，宿食头痛的，种种名目，也不可不知道。雷头和头响的，是气挟带肝火聚集在上部。火就是风，形容火势盛大。雷头风，主治用清震汤。头响的，主治用小柴胡汤加丹皮、栀子。头摇的，是风淫于内部，主治用养血汤。头重的，是湿气蒸腾于上部，主治用祛风散湿汤。偏于左侧的，是血虚风动，主治用四物汤加风药。偏于右侧的，是气虚风袭，主治用四君子汤加风药。左右两个证候，我经常用封髓丹加吴茱萸、安桂（肉桂），屡治屡效。大头毒的，是外感时行疠气，壅塞在三阳经，主治用普济消毒饮。宿食痛的，是饿了就缓解饱了就加重，由胃中浊气上蒸引起，主治用平胃散加消导药。以上这些方法，都是前贤制定的，也可以择取参考，暂且保存于此，以便参考。[眉批]提顿开启下文，搜集采录无遗漏，名言论述不可刊落，是医家的上乘之作。
查考近来的市井医风，一见到头痛，不按阴阳，专门主张祛风，所使用的无非是川芎、白芷、荆芥、防风、蔓荆子、藁本、羌活、天麻、辛夷、苍耳子。这些药物，都是轻清之品，用来祛除三阳表分的风邪，则效果如桴鼓相应（极快），但如果用来治疗三阴上逆外越的征象，则为害最烈，不可不知道。
关于目病一条，眼科有七十二种的区别，名目越多，学者无从下手。我为他概括要点，统归为外感、内伤两种方法来判别，易于明白了然。
从外感得来的，多由感染天行时气而发作。“时气”二字，指六气。看是何种邪气干扰哪个部位，干扰肺的，自睛（眼白）受病；干扰心的，两眦（眼角）受病；干扰肝的，黑珠（黑眼球）受病；干扰肾的，瞳子（瞳孔）受病；干扰脾的，上下眼皮受病。无论何种邪气由外入内，初起一定有恶风、畏寒、恶热、头痛、红肿胀痛、羞明流泪、赤脉缕缕等情况。或者失于宣散，过于寒凉，久久不愈，便生出翳障赤白等雾状物，都是从外而生成的。治疗的方法，按时令部位，不外乎祛风、清热、升散等方剂而已。我想按照六种客邪，逐部论述病症和方剂，未免太繁琐。外形已经说明，学者思考一下也就得到了。[眉批]分配精确，如同黄鹂得到珍珠，已扼住治疗眼病的要领，何必再求其他。
从内伤得来的，则有七情的区别。七情，就是喜、怒、哀、悲、恐而已。七情的扰乱，总属伤神。神，就是火，就是阳，就是气。[眉批]一句话抵得上千百句，《内经》说：得一之精，可以知晓生死。夫神火阳气，是一体的。过于喜悦的，损伤心阳，则心中的阴邪自然旺盛，就成为客邪，上乘而生赤色翳障雾。过于愤怒的，损伤肝阳，肝中的阴自然旺盛，就成为客邪，上乘而生青色翳障雾。过于忧思的，损伤脾阳，脾中的阴自然旺盛，就成为客邪，上乘而生黄色翳障雾。过于恐惧的，损伤肾阳，肾中的阴自然旺盛，就成为客邪，上乘而生黑色翳障雾。过于悲哀的，损伤肺阳，肺中的阴自然旺盛，就成为客邪，上乘而生白色翳障雾。这些眼疾，一定没有羞明红肿痛甚、恶热喜冷的表现，这种人少气懒言，身体沉重嗜睡，面色青白，脉象或虚细浮大中空，种种情形，都是内伤虚损而生的。也有一种一发出来就痛胀欲裂，眼睛红得像石榴一样的，是由于先天真气依附肝脏而上，想要从眼睛脱失出去。一定伴有嘴唇口唇黧黑，或者气喘急促，喜欢极热的汤水，六脉或暴出如绳，或脉劲如石，或浮大而空，或像釜沸（脉搏急促无序）的情况。治法应当回阳收纳为主要手段。伤于心的，可以用补坎益离丹、桂枝龙牡汤。伤于肝的，可以用乌梅丸。伤于脾的，可以用建中汤、理中汤。伤于肾的，可以用潜阳丹、真武汤、封髓丹等方。伤于肺的，可以用姜桂汤、桂苓姜半汤。先天真气暴出的，可以用回阳白通汤。备载这几个方子，略陈大意，增减分量，在于人的变通。如果果真有血虚阳亢为害的，这种人一定有火邪的征象，如六味地黄汤、丹栀四物汤，都可以选用。[眉批]法度圆润，机理圆通。
近来市井医风，一见到眼痛，并不察究外内虚实，多用蝉蜕、木贼、红花、菊花、决明子、归尾、赤芍、荆芥、防风、薄荷、生地、夜明砂、夏枯草、冬桑叶、谷精草。以及壮水明目丸、杞菊地黄丸、滋肾养肝丸。像这样的方药，治疗外感风热、血虚，每多立即见效。如果是七情损伤，由内出外的眼疾，很少能获效。学者当细心体会内外两种方法，切勿混淆，才可以行医于世。
关于耳病肿痛这一证候，有因肝胆风火而导致的，有因愤怒抑郁而导致的，有因肾阳虚而阴气上攻的，有因肾水衰而火邪上攻的。
因肝胆风火而导致的，是由肝胆挟带外受的风热，聚积不散，这种人两耳红肿痛厉害，时常出现寒热往来，口苦咽干的情况。治法应当和解，用小柴胡汤加倍柴胡、黄芩，加麦芽、香附治疗。
因愤怒抑郁而导致的，是由愤怒伤肝，抑郁之气结聚不散，这种人两耳红肿，一定伴有两胁胀痛，时常叹气，治法应当疏肝理气为主，如生地四物汤加倍加柴胡、青皮、麦芽、香附之类的方剂。
因肾阳虚而导致的，是由肾阳日渐衰微，不能镇纳僭越上行的阴气，这种人两耳虽然肿，皮色如常，即使痛也很轻微，嘴唇舌头一定淡白，人一定精神萎靡。治法应当扶阳祛阴，如封髓丹加倍砂仁加安桂、吴茱萸；或者潜阳丹加吴茱萸；或者阳旦汤加香附、麦芽之类的方剂。
因肾水虚而邪火上攻的，这种人两耳肿痛，腰部一定胀，口中多渴，心中多烦，阴茎易勃起。治法应当滋阴降火，如六味地黄汤加龟板、五味子、白芍；或者滋肾丸加倍知母、黄柏之类的方剂。
There are also cases where anger or depression generates heat, and excessive heat damages the blood, leading to tendon spasms. Treatment must be based on the specific condition, which will surely be effective. Do not be confused by the market's common routine practices, such as blindly using a group of herbs including *Fructus Papaveris* (Mu Gua), *Radix Gentianae Macrophyllae* (Qin Jiao), *Herba Lycopi Japonici* (Shen Jin Cao), *Herba Siegesbeckiae* (Shu Jin), *Herba Saposhnikoviae* (Ling Xian), *Ramulus Pini* (Song Jie), *Radix Rehmanniae Praeparata* (Di Huang), *Rhizoma Linderae* (Wu Yao), and *Radix Notopterygii* (Qiang Huo). Failing to distinguish the yin-yang nature of the condition often leads to errors in treatment, a point that must not be ignored. [Marginal Note] The *Classic of Internal Medicine* states: "The vital essence of the zang organs disperses into the liver, manifesting as the qi of the sinews." Recognizing that the primordial qi disperses into the sinews as liver qi allows one to understand that tendon spasms in ordinary people result from a loss of nourishment by the primordial essence. Yin An points out four causes, elaborating layer by layer on the principles of yin and yang, and directing the use of formulas from Zhang Zhongjing. These are all methods for regulating the primordial essence, and none fail to be effective; this can be called divine skill. Students should carefully contemplate and thoroughly understand the source and flow, so that treating tendon spasms will naturally be within grasp.
Kidney Disease: Lower Back Pain
Regarding lower back pain, there are cases caused by yang deficiency, yin deficiency, external pathogens causing closure and constraint, and dampness causing stagnation. Cases caused by yang deficiency may arise from overuse of the mind, damaging heart yang; from dietary injury to the middle jiao, damaging spleen yang; or from excessive sexual activity, damaging kidney yang. When yang declines and yin flourishes, myriad diseases arise. It is not just lower back issues; however, since lower back pain belongs to the lower part of the body, it ultimately stems from yang deficiency. The cold-yin of the lower jiao naturally becomes excessive, and with weak yang and diminished transportive power, lower back pain arises immediately. Such individuals will definitely exhibit heavy body, aversion to cold, and mental fatigue. The method should be to vigorously tonify the yang of Kan (the Kidney/Water element). When yang flourishes and yin recedes, the lower back pain will resolve itself. Formulas such as Yang Dan Tang, Shu Fu Tang, or Qiang Huo Fu Zi Tang may be used.
Cases caused by yin deficiency occur when kidney yang was originally robust. Extreme robustness becomes an exogenous pathogen; excessive fire damages blood, and true yin is daily exhausted, leaving true yang without attachment, causing immediate lower back pain. Such individuals will definitely have red urine, dry throat, irritability, easy erection of the penis, and a preference for coolness. The method should be to nourish yin. As yin grows and yang recedes, kidney qi will naturally secure itself, and the lower back pain will resolve. Formulas such as Zi Shen Wan, Di Huang Tang, or Feng Sui Dan with doubled Huang Bo and added Quan Pi may be used.
Cases caused by cold occur due to external cold pathogens entering from the Taiyang channel into the Shaoyin channel. Taiyang and Shaoyin are exterior-interior pairs. Shaoyin is a yin zang organ, and external cold is also yin; upon entering, it attaches to Shaoyin. Yin governs contraction, closing off the qi mechanism of true yang operation in the kidney, thus causing lower back pain. Such individuals will definitely have fever and aversion to cold, possibly accompanied by body ache, dry throat but no desire to drink, and frequent drowsiness. The method should be to warm the channels and scatter cold. Once the cold scatters, the lower back pain will resolve. Formulas such as Ma Huang Fu Zi Xi Xin Tang or Fu Qiang Tang may be used.
Cases caused by damp stagnation occur because the individual is constitutionally prone to laborious work, has lived long in wetlands or deep pits, resulting in frequent insufficiency of middle qi, making them susceptible to exogenous pathogens. The Taiyin channel connects with the kidney; if dampness does not dissipate, it flows into the kidney realm, obstructing its transportive mechanism, causing lower back pain. Typical signs include heavy limbs, a constant feeling of internal cold, worsening on cloudy/rainy days, and a sensation of heaviness in the waist as if bound. The method should be to warm the channels and remove dampness. Once dampness is removed, the lower back pain will resolve. Formulas such as Shen Zhuo Tang or Gui Ling Zhu Gan Tang with added Fu Zi and Xi Xin may be used.
In recent times, medical practice has fallen into a habit: upon seeing lower back pain, practitioners do not investigate yin-yang or deficiency-excess, but immediately attribute it to excessive sexual activity damaging kidney yin. Consequently, they use drugs like Shu Di Huang, Shan Zhu Yu, Du Zhong, Gou Qi Zi, Ba Ji Tian, He Shou Wu, Rong Rou, Gu Su Zhi, Tu Si Zi, and Gui Jiao. Their function is specifically to nourish yin and replenish water, a belief shared by everyone. However, they do not know that the kidney is the mansion of extreme yin, where the primordial true yang resides. Yin accounts for two parts, and yang for one part. In marital intercourse, producing sons and daughters, the *I Ching* says: "The way of Heaven forms the male, inheriting the father's yang essence. The way of Earth forms the female, inheriting the mother's yin essence." From this perspective, what men lose is the yang in the kidney, not the yin. When "yin deficiency" is mentioned, it refers to the kidney as a yin zang organ, not specifically to a deficiency of kidney water, but actually to a deficiency of kidney yang. [Marginal Note] Zhi Fei said: There is a constant saying in medicine that yin deficiency with fire hyperactivity is often caused by sexual fatigue or damage to the spleen and stomach, and the method should be to nourish yin and purge fire. But what is yin? What is fire? What is damaged? And what exactly is being nourished and supplemented by a batch of yin-nourishing and water-replenishing medicines? People often cannot explain this. Zhi Fei sighed deeply at this, thinking solemnly and gazing afar, saying: Humans receive the utmost essence of heaven and earth, refining grain flavors daily to generate qi and blood through transformation. This spirituality penetrates all bones, serving as the root of the five zang and six fu organs and the source of the twelve meridians. It rules over all yin, preventing them from causing harm, allowing humans to remain safe and comfortable. This single entity... I attempt to describe its form and observe its connections, stating: Yin is the spirit of ghosts; Fire is the spirit of gods. Knowing that ghosts and gods correspond to water and fire, one understands that the theory of yin deficiency with fire hyperactivity requiring yin-nourishing and water-replenishing is illogical, and such methods will certainly fail. How can they treat diseases related to water and fire? Yin An's commentary here elucidates the mechanism of yang decline and yin flourishing, pointing out later that what is lost is the yang in the kidney, and kidney deficiency is actually kidney yang deficiency. Yang is fire, and yin is ghost. Borrowing the case of lower back pain to convey profound meaning, supplementing both internal and external methods, and clarifying the causes of different types of lower back pain, it is indeed because Taiyang Cold Water, Jueyin Wind Wood, and Shaoyin Ministerial Fire are all related to the kidney. With true knowledge, one speaks intimately and interestingly. The Six Channels method can treat all diseases; why is it not urgently studied? Students should ponder and derive benefits from it. If this key mechanism is not clarified, and one only claims yin deficiency and knows only to nourish water, yin will become more abundant while yang becomes weaker, dampness will increase, and cold will close further, and lower back pain will never cease. Treating people in this way actually harms them; saving the world actually harms it. These are the drawbacks of routine practices. How can one bear to附和 (echo) without speaking? It is truly unavoidable. I only hope my colleagues will discard these medications, determine yin-yang and deficiency-excess, and treat according to external contraction and internal injury, thereby avoiding lingering harm. Even more strange is that modern physicians exclusively use Gan Han (sweet and cold) substances like He Shou Wu and Shu Di Huang as essential medicines for replenishing water. Why do they not carefully investigate the principle of "Heaven One Generates Water"? I ask, does Heaven One Generating Water rely solely on this batch of sweet and cold substances? In short, if the main principle is unclear and the source is not penetrated, few after Zhang Zhongjing are clear about it. [Marginal Note] Only by distinguishing the main principle and source can one be called a knowledgeable physician.
Headache
Regarding headache, some originate from external invasion, and some from internal emergence. External invasions involve the six exogenous pathogens: wind, cold, summer-heat, dampness, dryness, and fire. When interfering with the Three Yang channels, it is classified as an exterior syndrome; when interfering with the Three Yin channels, it is classified as an interior syndrome. This refers to the six exogenous pathogens moving from outside to inside, not referring to emotional injuries emerging from inside to outside. What are the Three Yang? First, Taiyang headache: pulse is floating, nape is stiff, with fever, aversion to cold, and aversion to wind. If there is spontaneous sweating and aversion to wind, the primary formula is Gui Zhi Tang. If there is aversion to cold and no sweating, the primary formula is Ma Huang Tang. This follows the qi mechanism of the respective channel. Second, Yangming headache: severe distending pain in the forehead, brow ridge, and eye sockets, with a long pulse, aversion to heat, treated primarily with Ge Gen Tang. This follows the qi mechanism of the respective channel. Third, Shaoyang headache: pain is most severe on the sides, with alternating chills and fever, vertigo, and bitter taste, treated primarily with Xiao Chai Hu Tang. This follows the qi mechanism of the respective channel. If the qi mechanisms of the Three Yang are smooth, pathogens will not enter internally, and the Three Yin will not be diseased. If external pathogens in the Three Yang are not resolved, they will necessarily transmit to the Three Yin. What are the Three Yin? Fourth, Taiyin. When external pathogens transmit to Taiyin, Taiyin governs dampness, and the pathogen transforms with dampness. Damp qi steams upward, causing heavy headache, sore and cold-feeling limbs, abdominal fullness, vomiting, and anorexia, treated primarily with Li Zhong Tang, representing the intent to warm the middle and remove dampness. Fifth, Shaoyin. Shaoyin is the intersection of water and fire. If pathogens enter Shaoyin and combine with fire to transform into heat pathogens, heat steams upward, causing headache, dry throat, red urine, shortness of breath, reluctance to speak, and dry, hot skin. The method should be to nourish yin, treated primarily with Ji Zi Huang Lian Tang, representing the intent to moisten dryness and save yin. If pathogens combine with water to transform into yin pathogens, causing headache with a faint pulse nearing extinction, heavy body, drowsiness, reluctance to speak, dry throat but no desire to drink, treated primarily with Ma Huang Fu Zi Xi Xin Tang, representing the intent to warm channels, scatter cold, support yang, and suppress yin. Sixth, Jueyin. When pathogens enter Jueyin, Jueyin governs wind-wood, and the pathogen transforms with wind. Wind is light and clear, causing headache that is worse at the vertex and nape. All yin meridians return at the neck, except the Jueyin meridian which meets at the vertex. Jueyin also belongs to the place of extreme yin, so many cases transform with yin. Vertex pain is often accompanied by dry heaving and spitting saliva, cyanosis of nails/lips/mouth, cold limbs, and abdominal pain. Treated primarily with Wu Zhu Yu Si Ni Tang, representing the intent to restore yang, direct rebellious qi downward, and dispel yin. [Marginal Note] This discusses Six Channel headaches. Diseases of the Three Yang and Three Yin have boundaries, sequences, and patterns of transmission. Regarding the *Su Wen*: "Three Yang is Father," referring to Taiyang; "Two Yang is Guard," referring to Yangming; "One Yang is Discipline," referring to Shaoyang. "Three Yin is Mother," referring to Taiyin; "Two Yin is Female," referring to Shaoyin; "One Yin is Envoy," referring to Jueyin. This chapter discusses the qi mechanism of the six stages of circulation. For pathogens in the Three Yang, the method should be ascending and resolving, prioritizing preventing internal entry. For pathogens in the Three Yin, the method should be warming and consolidating, prioritizing releasing from within without damaging the exterior. [Marginal Note] Summary of the Six Channels.
If internal injury lasts long, and emotions are excessive, leading to yang or yin deficiency, headaches can also occur. However, unlike external contractions, these present mostly with dizziness and vertigo (80%), with actual headache being rare (20-30%). Due to prolonged yang deficiency, turbid yin cannot be anchored and suppressed, so yin qi ascends. Headaches may feel like tearing, splitting, pressing down like Mount Tai, or being tightly bound by ropes. Such individuals will definitely have panting, blackish-blue lips and tongue, and a desire to drink boiling water. This belongs to yang collapse upwards, a critical condition. The method should prioritize restoring yang and gathering the纲 (guiding principle), using large doses of Bai Tong Tang or Si Ni Tang. Delayed treatment is incurable. Misusing dispersing agents will lead to death within a day or two. Headaches caused by yin deficiency result from fire pathogens rushing upward. Although lacking external signs, patients often have vexation, dry throat, red urine, and desire for cold drinks. Some feel fire rising from the soles of the feet, from the loins, or from below the umbilicus, leading to unpredictable headaches, unlike external contractions which last all day. The method should support yin, using formulas like Liu Wei Di Huang Wan or Ba Wei Di Huang Wan. There is a distinction here: if the patient feels fire rising from below, but remains calm, dislikes cold drinks, has no dry throat, normal urine, no vexation, and blueish lips/tongue, this is yin qi ascending. The method should use pungent-hot and sweet-warm medicines to guard and restore. Never recklessly use yin-nourishing and fire-purging methods. Doing so makes yin stronger and yang weaker, leading immediately to collapse. [Marginal Note] Deducing critical conditions of yang/yin deficiency in headaches, distinguishing yin and yang in subtle details. Internal and external methods have their respective places. While ancients called the head the "head of all yang," dwelling place of clear qi, where only wind can reach the high vertex, and treatment focused mainly on dispelling wind—this view is partially correct. I believe that for anyone suffering from headache, it is often due to insufficient righteous qi internally, failing to fill and circulate. All external wind pathogens, the "six guests" are essentially "six winds"; the character "wind" should be viewed flexibly. Internally, all yang and yin deficiencies can rebel upward and cause disease. For external pathogens, base diagnosis on the Six Channel提纲 (outline) conditions; for internal injuries, base it on joy, anger, sorrow, happiness, worry, fear, and yin/yang deficiency. Other books mention names like Thunder Head Wind, Resounding Head, Shaking Head, Heavy Head, Left/Right sided Headaches, Big Head Toxicity, and Food Stagnation Headache. These various names must also be known. Thunder Head and Resounding Head are caused by qi carrying liver fire accumulating above. Fire is wind, describing its intensity. Thunder Head Wind is treated with Qing Zhen Tang. Resounding Head is treated with Xiao Chai Hu Tang plus Dan Pi and Zhi Zi. Shaking Head is caused by wind rampant internally, treated with Yang Xue Tang. Heavy Head is caused by dampness steaming upward, treated with Qu Feng San Shi Tang. Left-sided headache is blood deficiency with wind stirring, treated with Si Wu Tang plus wind-dispelling herbs. Right-sided headache is qi deficiency with wind invasion, treated with Si Jun Zi Tang plus wind-dispelling herbs. For left and right cases, I often use Feng Sui Dan plus Wu Zhu Yu and An Gui (Rou Gui), achieving repeated success. Big Head Toxicity is caused by epidemic pestilence qi externally contracting and blocking the Three Yang, treated with Pu Ji Xiao Du Yin. Food Stagnation Pain occurs when hunger brings relief and fullness worsens pain, caused by turbid qi steaming upward from the stomach, treated with Ping Wei San plus digestive aids. The above methods were formulated by ancients and can be selected for reference. [Marginal Note] Transitioning to the next section, collecting comprehensively without omission, famous theories are unchangeable, representing the highest level for physicians.
Investigating recent medical habits, upon seeing headache, practitioners do not analyze yin-yang but focus solely on dispelling wind, using herbs like Chuan Xiong, Bai Zhi, Jing Jie, Fang Feng, Man Jing Zi, Gao Ben, Qiang Huo, Tian Ma, Xin Yi, and Cang Er Zi. These are light and clear substances. Used to dispel wind in the exterior of the Three Yang, they are effective as quickly as a drumstick striking a drum. But used to treat signs of rebellion and outward floating from the Three Yin, they are extremely harmful. This must be known.
Eye Diseases
Regarding eye diseases, ophthalmology lists seventy-two types. The more names there are, the harder it is for students to begin treatment. I summarize the essentials, categorizing them into external contraction and internal injury methods for clarity.
External contractions are mostly caused by catching epidemic seasonal qi. "Seasonal qi" refers to the six qi. Determine which pathogen affects which part: affecting the Lung causes disease in the white of the eye (Jing); affecting the Heart causes disease in the canthi; affecting the Liver causes disease in the black pupil (Hei Zhu); affecting the Kidney causes disease in the pupil (Tong Zi); affecting the Spleen causes disease in the upper and lower eyelids. Regardless of the pathogen entering from outside to inside, initial signs definitely include aversion to wind, cold, and heat, headache, redness, swelling, pain, photophobia, tearing, and thread-like red vessels. If neglected dispersing and treated with excessive cold-cooling herbs, chronic non-healing conditions may develop, forming cataracts, white/red films, or foggy obstructions, all generated from the outside. Treatment methods, based on season and location, generally involve formulas for dispelling wind, clearing heat, and ascending/dispersing. I intended to discuss diseases and formulas for each part according to the six exogenous pathogens, but it would be too tedious. The external aspects are already explained; students should think and understand. [Marginal Note] Precise allocation, like a oriole finding a pearl, grasping the essentials of treating eyes; why seek elsewhere?
Internal injuries arise from the seven emotions: joy, anger, sorrow, grief, and fear. Disturbance by the seven emotions always damages the Spirit (Shen). Spirit is fire, yang, and qi. [Marginal Note] One word counters thousands. The Classic says: "Knowing the essence of One, one knows life and death." Spirit-fire and yang-qi are one. Excessive joy damages Heart Yang, causing yin pathogens in the heart to flourish, becoming exogenous pathogens that ascend to produce red films/fog. Excessive anger damages Liver Yang, causing yin in the liver to flourish, becoming exogenous pathogens that ascend to produce green films/fog. Excessive worry/thought damages Spleen Yang, causing yin in the spleen to flourish, becoming exogenous pathogens that ascend to produce yellow films/fog. Excessive fear damages Kidney Yang, causing yin in the kidney to flourish, becoming exogenous pathogens that ascend to produce black films/fog. Excessive grief/sorrow damages Lung Yang, causing yin in the lung to flourish, becoming exogenous pathogens that ascend to produce white films/fog. These eye diseases definitely lack photophobia, redness, swelling, severe pain, aversion to heat, and preference for cold. Patients have shortness of breath, reluctance to speak, heavy body, drowsiness, bluish-white complexion, and pulses that may be deficient, fine, floating, large, or hollow. These situations all stem from internal injury and deficiency. There is also a case where pain and swelling burst forth immediately, with eyes red like pomegranates, caused by primordial true qi attaching to the liver and ascending, attempting to escape through the eyes. Signs include blackish lips/mouth, panting, preference for very hot soups/water, and pulses that suddenly emerge like a rope, are hard like stone, are floating-large and empty, or boil like a cauldron. The method should prioritize restoring yang and receiving/gathering. For Heart injury, use Bu Kan Yi Li Dan or Gui Zhi Long Mu Tang. For Liver injury, use Wu Mei Wan. For Spleen injury, use Jian Zhong Tang or Li Zhong Tang. For Kidney injury, use Qian Yang Dan, Zhen Wu Tang, or Feng Sui Dan. For Lung injury, use Jiang Gui Tang or Gui Ling Jiang Ban Tang. For sudden emergence of primordial true qi, use Hui Yang Bai Tong Tang. Several formulas are listed to outline the general idea; dosage adjustments depend on clinical flexibility. If there are truly cases of blood deficiency with yang hyperactivity causing harm, signs of fire pathogens will be present, such as in Liu Wei Di Huang Tang or Dan Zi Si Wu Tang, which can be selected. [Marginal Note] Methods are moist and mechanisms are round.
Recent medical habits show that upon seeing eye pain, practitioners do not investigate external/internal or deficiency/excess, but frequently use Chan Tui, Mu Zei, Hong Hua, Ju Hua, Jue Ming Zi, Gui Wei, Chi Shao, Jing Jie, Fang Feng, Bo He, Sheng Di Ye, Ye Ming Sha, Xia Ku Cao, Dong Sang Ye, and Gu Jing Cao, along with Zhuang Shui Ming Mu Wan, Qi Ju Di Huang Wan, and Zi Shen Yang Gan Wan. Such prescriptions are often effective for external wind-heat and blood deficiency. However, for eye diseases arising from internal injury due to emotional disturbance, they rarely succeed. Students should carefully contemplate the internal and external methods and avoid confusion to practice successfully.
Ear Disease: Swelling and Pain
Regarding ear swelling and pain, causes include wind-fire in the Liver and Gallbladder, anger and depression, kidney yang deficiency with attacking yin qi, and kidney water deficiency with attacking fire pathogens.
Caused by wind-fire in the Liver/Gallbladder: The Liver/Gallbladder carries external wind-heat, which gathers and does not disperse. Patients have severely swollen, red, and painful ears, with alternating chills and fever, bitter taste, and dry throat. The method should be harmonizing, using Xiao Chai Hu Tang with doubled Chai Hu and Qin, plus Mai Ya and Xiang Fu.
Caused by anger and depression: Anger injures the Liver, and depressive qi knots and does not disperse. Patients have swollen, red ears, with distending pain in the hypochondrium and frequent sighing. The method should prioritize soothing the Liver and regulating qi, using Si Wu Tang with Sheng Di, doubled Chai Hu, Qing Pi, Mai Ya, and Xiang Fu.
Caused by kidney yang deficiency: Kidney yang declines daily, failing to anchor and suppress rebellious yin qi. Patients have swollen ears with normal skin color, mild pain, pale lips and tongue, and listlessness. The method should support yang and dispel yin, using Feng Sui Dan with doubled Sha Ren plus An Gui and Wu Zhu Yu; or Qian Yang Dan with Wu Zhu Yu; or Yang Dan Tang with Xiang Fu and Mai Ya.
Caused by kidney water deficiency with fire pathogens attacking: Patients have swollen and painful ears, distending lower back, thirst, and vexation, with easy erection. The method should nourish yin and descend fire, using Liu Wei Di Huang Tang with Gui Ban, Wu Wei Zi, and Bai Shao; or Zi Shen Wan with doubled Zhi Mu and Huang Bo.