经曰。五脏六腑之精气。皆上注于目。而为之精。肾藏精。故治目者。以肾为主。目虽肝之窍。
子母相生。肾肝同一治也。
华元化云。目形类丸。瞳神居中而前。如日月之丽东南。而晦西北也。有神膏、神水、神光、真气、真
血、真精。此滋目之源液也。神膏者。目内包涵膏液。此膏由胆中渗润精汁。积而成者。能涵养瞳神。衰则有
损。神水者。由三焦而发源。先天真一之气所化。目上润泽之水是也。水衰则有火胜燥暴之患。水竭
则有目输大小之疾。耗涩。则有昏眇之危。亏者多。盈者少。是以世无全精之目。神光者。原于命门。通于胆。
发于心火之用事也。火衰则有昏瞑之患。火炎则有焚燥之殃。虽有两心而无正输。心君主也。通于大 。故大
赤者。实火也。命门为小心。小心相火也。代君行令。通于小 。故小 赤者。虚火也。若君主
拱默。则相火自然清宁矣。真血者。即肝中升运滋目注络之血也。此血非比肌肉间易行之血。即天一所主之水。
故谓之真也。真气者。即目之经络中往来生用之气。乃先天真一发生之元阳也。真精者。乃先天元气所化精
汁。起于肾。施于胆。而后及瞳神也。凡此数者。一有损。目则病矣。大概目圆而长。外有坚壳数重。中有清
脆肉。包黑稠神膏一函。膏外则白稠神水。水以滋膏。水外则皆血。血以滋水。膏中一点黑莹。是肾胆所聚之
精华。惟此一点。烛照鉴视。空阔无穷者。是曰水输。内应于肾。北方壬癸亥子水也。五输之中。惟瞳神乃
照。或曰瞳神水耶气耶血耶膏耶。曰非气非血非水非膏。乃先天之气所生。后天之气所成。阴阳之妙蕴。水火
之精华。血养水。水养膏。膏护瞳神。气为运用。神即维持。喻以日月。理实同之。男子右目不如
左目精华。女子左目不如右目光彩。此皆各得其阴阳气血之正也。
许学士云。经曰。足少阴之脉。是动则病坐而欲起。目KT KT 如无所见。又曰。少阴所谓起则目KT
KT无所见者。阴内夺。故目KT KT 无所见也。此盖房劳目昏也。左肾阴虚。益阴地黄丸六味
地黄丸。右肾阳虚。补肾丸八味地黄丸。
东垣云。能远视不能近视者。阳有余。阴气不足也。海藏云。目能远视。责其有火。不能近视。责其无
水。秘要云。阴精不足。阳光有余。病于水者。故光华发见散乱。而不能收敛近视。治之在心肾。心肾平。则
水火调而阴阳和。夫水之所化为血。在身为津液。在目为膏汁。若贪淫恣欲。饥饱失节。形脉劳甚。过
于悲泣。能斫耗阴精。阴精亏则阳火盛。火性炎而发见。阴精不能制伏挽回。故越于外而远照。反不能近之而
视也。治之当如何。壮水之主。以镇阳光。东垣云。能近视不能远视。阳气不足。
阴气有余也。海藏云。目能近视。责其有水。不能远视。责其无
火。秘要云。此证非谓禀成近窥之病。乃平昔无病。素能远视。而忽然不能者也。盖阳不足。阴有余。病于火
者。故光华不能发越于外。而畏敛近视耳。治之在胆肾。胆肾足则木火通明。神气宣畅。而精光远达矣。夫火
之所用为气。在身为威仪。在目为神光。若纵恣色欲。丧其元阳。元阳既惫。则云霾阴翳。肾中之阴水。仅足以
回光自照耳。焉能健运精汁。以滋于胆。而使水中之火。远布于空中耶。治之当何如。益火之原。以消阴翳。
以上之证。皆阴弱不能配阳。内障之病。其病无眵泪痛痒羞明紧涩之证。初但昏如雾露中行。渐空中有黑
花。又渐暗。物成二体。久则光不收。遂为废疾。患者皆宜培养先天根本。乘其初时而治之。况此病最难疗。
服药必积岁月。绝酒色淫欲。毋饥饱劳役。驱七情五贼。庶几有效。不然必废。终不复也。世不知
此。始曰目昏无伤。略不经意。及病成。医亦不识。直曰热致。竟用凉药。殊不知凉药伤胃。况凉为秋为金。
肝为春为木。又伤肝矣。往往致废而后已。病者不悟药之过。诿之曰命也。医者亦不自悟。而曰病拙。悲夫。
又有阳虚不能抗阴者。若因饮食失节。劳役过度。脾胃虚弱。下陷于肾肝。浊阴不能下降。清阳不能上
升。天明则日月不明。邪害空窍。令人耳目不明。夫五脏六腑之精。皆禀受于脾土。而上贯于目。此精字乃
饮食所化之精。非天一之元精也。脾者诸阴之首也。目者血气之宗也。故脾虚则五脏之精气。皆失
所司。不能归明于目矣。况胃气下陷于肾肝。名曰重强。相火挟心火而妄行。百脉沸腾。血脉逆上而目病矣。
若两目暗昏。四肢不怠者。用东垣益气聪明汤。若两目紧小羞明畏日者。或视物无力。肢体倦怠。或手足麻
木。乃脾肺气虚。不能上行也。用神效黄 汤。若病后。或日晡。或灯下。不能视者。阳虚下陷也。用
决明夜光丸。或升麻镇阴汤。
张子和云。目不因火则不病。白轮病赤。火乘肺也。肉轮赤肿。火乘脾也。黑水神光被翳。火乘肝与脾
也。赤脉贯目。火自甚也。能治火者。一句可了。但子和一味寒凉治火。余独补水以配火。亦一句可了。至于
六淫七情错杂诸证。详倪仲贤原机启微。此书甚好。而薛立斋又为之参补。深明壮水之主。益火之
原。甚有益于治目者也。
《黄帝内经》说：五脏六腑的精气，都向上灌注于眼睛，从而形成视觉的精华。肾藏精，所以治疗眼病，以补肾为主。眼睛虽然是肝的外窍，但肝肾之间母子相生，因此肾和肝在治疗上是一致的。
华元化说：眼睛的形状像球体，瞳孔位于中央并向前突出，如同太阳月亮照耀东南方，而晦暗西北方。眼睛中有神膏、神水、神光、真气、真血、真精，这些是滋润眼睛的源头液体。所谓神膏，是指包裹在眼球内部的膏状液体，这种膏是由胆中渗出的精汁积累而成的，能够涵养瞳孔，如果亏损就会造成损伤。所谓神水，起源于三焦，由先天的真一之气所化生，是滋润眼睛表面的水分。如果水不足，就会有火旺导致干燥暴烈的祸患；如果水枯竭，就会导致目输（指瞳孔及眼部结构）大小异常的疾病；如果耗损干涩，就会有视力昏花模糊的危险。亏损的人多，充盈的人少，所以世上没有完全完美的眼睛。所谓神光，源于命门，通达于胆，发用于心火的功能。如果火衰弱，就会有昏沉瞑目的祸患；如果火炎上，就会有焚烧干燥的灾殃。虽然有两个心（指君火与相火），但没有正中的输注通道。心为君主之官，通达于大眦（外眼角），所以大眦发红，是实火；命门被称为“小心”，是小便之火（相火），代替君主行使命令，通达于小眦（内眼角），所以小眦发红，是虚火。如果君主（心）保持静默无为，那么相火自然就会清静安宁。所谓真血，就是肝脏中升运滋养眼睛脉络的血液。这种血不同于肌肉间容易流动的普通血液，它是天一之水所主，所以称为真。所谓真气，就是眼睛经络中往来产生作用的气，是先天真一发生出来的元阳。所谓真精，是先天元气所化生的精汁，起于肾，施用于胆，然后才到达瞳孔。以上几种物质，只要有一种受损，眼睛就会生病。大概眼睛呈圆形且长，外面有几层坚硬的壳，中间有清脆的肉，包裹着黑稠的神膏一团。膏的外面是白稠的神水，水用来滋润膏，水的外面都是血，血用来滋润水。膏中间有一点黑而晶莹的东西，这是肾和胆聚集的精华。只有这一点，能烛照鉴视，空阔无穷，这叫做水输，内应于肾，属于北方壬癸亥子水。在五输穴中，只有瞳孔具有照明的功能。有人问：瞳孔是水、气、血还是膏？回答说：既不是气，也不是血，既不是水，也不是膏，而是由先天之气所生，后天之气所成，是阴阳的微妙蕴藏，水火精华的结合。血滋养水，水滋养膏，膏保护瞳孔，气负责运用，神负责维持。用日月来比喻，道理其实是一样的。男子的右眼不如左眼的精华，女子的左眼不如右眼的光彩，这都是各自得到了阴阳气血的正道。
许学士说：《内经》说：足少阴肾经脉气变动，就会表现为坐着想站起来，眼睛视物模糊看不清。又说：少阴经所说的“站起来就眼睛视物模糊看不清”，是因为阴气内部被夺失，所以眼睛视物模糊看不清。这大概是房劳过度导致的目昏。左肾阴虚，用益阴地黄丸或六味地黄丸；右肾阳虚，用补肾丸或八味地黄丸。
李东垣说：能看得远却看不清近处，是阳气有余，阴气不足。海藏说：眼睛能看远，归咎于有火；不能看近，归咎于无水。《秘要》说：阴精不足，阳光有余，病在水分，所以光华发散散乱，而不能收敛来看近处。治疗在于心和肾，心肾平和，则水火调和而阴阳平衡。水所化生的，在身体里是津液，在眼睛里是膏汁。如果贪恋淫欲，饥饱失调，形体脉象劳累过度，过于悲伤哭泣，都能砍伐消耗阴精。阴精亏损则阳火旺盛，火性炎上而发散显现，阴精不能制约挽回，所以光芒越出体外而向远处照射，反而不能近距离视物。治疗应当怎样？壮水之主，以镇阳光。李东垣又说：能看清近处却看不清远处，是阳气不足，阴气有余。海藏说：眼睛能看近，归咎于有水；不能看远，归咎于无火。《秘要》说：这个病症不是说天生就有近视的病，而是平时没病，素来能看远，突然变得不能看远了。这是因为阳气不足，阴气有余，病在火分，所以光华不能发散于外，而畏缩收敛来看近处。治疗在于胆和肾，胆肾充足则木火通明，神气宣畅，精光就能远达。火所发挥的作用为气，在身体里表现为威仪，在眼睛里表现为神光。如果放纵色欲，丧失元阳，元阳既然疲惫，就会产生云霾阴翳，肾中的阴水仅足以回光自照罢了，怎么能健运精汁，来滋润胆，并使水中的火，远布于空中呢？治疗应当怎样？益火之原，以消阴翳。
以上的证候，都是阴弱不能配合阳，属于内障类的病。其病症没有眼屎、流泪、疼痛、瘙痒、羞明、紧涩等症状。起初只是像走在雾露中一样昏蒙，逐渐觉得空中有黑花，又逐渐变暗，物体看成两个影像，时间久了光线不收摄，最终成为废疾。患者都应该培养先天的根本，趁着初起时治疗。况且这种病最难治疗，服药必须积累岁月，戒绝酒色淫欲，不要饥饱劳役，驱除七情五贼，或许才有效。不然必然致残，最终无法恢复。世人不知道这个道理，开始说目昏没什么伤害，稍微不在意。等到病成了，医生也不认识，直接说是热引起的，竟然用凉药。却不知道凉药伤胃，况且凉对应秋天、金，肝对应春天、木，又伤了肝了。往往导致致残才停止。病人不明白是药的过错，推卸说是命运。医生也不自我反省，说医术拙劣，可悲啊。
又有阳气虚弱不能抵抗阴气的情况。如果因为饮食不节制，劳役过度，脾胃虚弱，下陷于肾肝，浊阴不能下降，清阳不能上升，天亮后日月就不明亮，邪气侵害空窍，让人耳目不明。五脏六腑的精气，都禀受于脾土，而向上贯通于眼睛。这个“精”字，是饮食所化生的精微，不是天一之元精。脾是诸阴之首，眼睛是血气的宗汇。所以脾虚则五脏的精气，都失去主管，不能归明于眼睛了。况且胃气下陷于肾肝，名叫重强，相火挟带心火妄行，百脉沸腾，血脉逆上而导致眼病。如果两眼昏暗，四肢不沉重者，用李东垣的益气聪明汤。如果两眼紧缩小痛、羞明畏日，或者视物无力，肢体倦怠，或者手足麻木，这是脾肺气虚，不能上行。用神效黄芪汤。如果病后，或者傍晚，或者在灯光下，不能视物，这是阳虚下陷。用决明夜光丸，或者升麻镇阴汤。
张子和说：眼睛不因火就不会生病。白睛（白轮）发红，是火乘肺；肉轮（眼睑）赤肿，是火乘脾；黑水神光被翳障覆盖，是火乘肝与脾；赤脉贯穿眼睛，是火气极盛。能治火的，一句话就可以解决。但张子和只用一味寒凉药治火，我唯独用水来配火（补水制火），也是一句话就可以解决。至于六淫七情错杂的各种证候，详见倪仲贤的《原机启微》，这本书很好，薛立斋又为之参补，深刻阐明壮水之主、益火之原的道理，对治疗眼病很有益处。
The *Classic of Difficult Issues* (Jing Yue Quan Shu cites *Huangdi Neijing*) states: The essence and qi of the five zang organs and six fu organs all ascend to pour into the eyes, thereby forming the essence of vision. The Kidney stores essence; therefore, in treating eye diseases, the focus is on the Kidney. Although the eyes are the orifice of the Liver, since the Mother and Child relationship generates each other between the Kidney and Liver, their treatment principles are unified.
Hua Yuanhua said: The shape of the eye resembles a sphere. The pupil is centered and protrudes forward, similar to how the sun and moon shine upon the southeast while remaining dim in the northwest. Within the eye exist Shen Gao (Divine Paste), Shen Shui (Divine Water), Shen Guang (Divine Light), Zhen Qi (True Qi), Zhen Xue (True Blood), and Zhen Jing (True Essence). These are the source fluids that nourish the eye. "Shen Gao" refers to the paste-like fluid contained within the eyeball. This paste is formed by the accumulation of essence juice seeping from the Gallbladder, capable of nurturing the pupil; if deficient, it causes damage. "Shen Shui" originates from the San Jiao (Triple Burner) and is transformed from the primordial True One Qi of congenital origin; it is the water that moistens the surface of the eye. If water is deficient, there is a risk of fire flourishing leading to dryness and irritability; if water is exhausted, disorders of the size of the eye's aperture (pupil/structures) occur; if consumed and dry, there is danger of dim and blurry vision. Deficiency is common, while fullness is rare; thus, there are no perfectly intact eyes in the world. "Shen Guang" originates from the Ming Men (Gate of Vitality), connects with the Gallbladder, and manifests through the function of Heart Fire. If fire is weak, there is a risk of dimness and blindness; if fire flares upward, there is disaster of burning and dryness. Although there are two hearts (referring to Ministerial Fire and Sovereign Fire), there is no central transmission channel. The Heart is the Sovereign, connecting to the outer canthus (Da Zi); thus, redness at the outer canthus indicates Excess Fire. The Ming Men is called the "Small Heart," representing Ministerial Fire (Xiang Huo), which acts on behalf of the Sovereign, connecting to the inner canthus (Xiao Zi); thus, redness at the inner canthus indicates Deficient Fire. If the Sovereign remains still and silent, Ministerial Fire will naturally be clear and tranquil. "Zhen Xue" is the blood rising and transporting from the Liver to nourish the eye collaterals. This blood differs from ordinary blood flowing easily in the muscles; it is governed by the Water of Tian Yi (Heavenly One), hence called "True." "Zhen Qi" is the qi circulating and functioning within the eye's meridians, being the primal Yang generated from the primordial True One of congenital origin. "Zhen Jing" is the essence juice transformed from congenital Yuan Qi, originating in the Kidney, applied to the Gallbladder, and then reaching the pupil. If any of these few substances are damaged, the eye becomes diseased. Generally, the eye is round and elongated, surrounded externally by several layers of hard shell, containing internally crisp flesh wrapping a mass of black, dense Shen Gao. Outside the paste is white, dense Shen Shui; water nourishes the paste. Outside the water is all blood; blood nourishes the water. In the center of the paste is a spot of black brilliance, which is the gathered essence of the Kidney and Gallbladder. Only this spot illuminates and inspects, boundlessly vast; this is called Shui Shu (Water Aperture), corresponding internally to the Kidney, belonging to the North, Ren-Gui, Hai-Zi Water. Among the Five Shu points, only the pupil possesses the function of illumination. Some ask: Is the pupil water, qi, blood, or paste? The answer is: It is neither qi, nor blood, nor water, nor paste. It is born of congenital qi and formed by postnatal qi, embodying the subtle mystery of Yin and Yang, and the essence of Water and Fire. Blood nourishes water, water nourishes paste, paste protects the pupil, qi governs operation, and spirit maintains. Using the sun and moon as a metaphor, the principle is indeed the same. In men, the right eye is less essential than the left; in women, the left eye is less brilliant than the right. This is because each obtains the correct balance of Yin, Yang, Qi, and Blood.
Scholar Xu said: The Classics state: When the Foot-Shaoyin (Kidney) meridian undergoes change, disease manifests as sitting but wanting to stand, and the eyes seeing nothing clearly like KT-KT (blurred vision). It also states: What Shaoyin calls "rising leads to blurred vision where one sees nothing" is due to internal depletion of Yin, causing blurred vision. This is likely eye dimness caused by sexual exhaustion. For Left Kidney Yin deficiency, use Yi Yin Di Huang Wan (Benefit-Yin Rehmannia Pill) or Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill). For Right Kidney Yang deficiency, use Bu Shen Wan (Tonify-Kidney Pill) or Ba Wei Di Huang Wan (Eight-Ingredient Rehmannia Pill).
Li Dongyuan said: Being able to see far but not near indicates Excess Yang and Insufficient Yin. Haizang said: Ability to see far is blamed on Fire; inability to see near is blamed on lack of Water. The *Secret Essentials* (Mi Yao) states: Insufficient Yin essence and excessive Solar Light cause disease in Water, so the luminous light scatters and cannot converge for near vision. Treatment focuses on the Heart and Kidney; when Heart and Kidney are balanced, Water and Fire harmonize, and Yin and Yang integrate. What Water transforms into is Jin Ye (Body Fluids) in the body, and Gao Zhi (Paste Juice) in the eyes. If one indulges in lust, suffers irregular eating and drinking, experiences severe physical and pulse fatigue, or weeps excessively, one chops away and consumes Yin essence. When Yin essence is depleted, Yang Fire flourishes. Fire nature is flaming and manifesting outward; Yin essence cannot restrain or retrieve it, so it escapes outward to illuminate far distances, rendering the ability to see near impossible. How should it be treated? Strengthen the Master of Water to suppress Solar Light. Li Dongyuan also stated: Being able to see near but not far indicates Insufficient Yang and Excess Yin. Haizang said: Ability to see near is blamed on having Water; inability to see far is blamed on lacking Fire. The *Secret Essentials* states: This condition does not refer to a congenital myopia, but rather a person who was previously healthy and could see far, suddenly losing that ability. This is due to Insufficient Yang and Excess Yin, disease in Fire, so the luminous light cannot emerge outward and instead shrinks inward for near vision. Treatment focuses on the Gallbladder and Kidney; when Gallbladder and Kidney are sufficient, Wood and Fire become bright, Shen Qi flows freely, and Jing Guang reaches far. The function of Fire is Qi; in the body, it manifests as demeanor; in the eyes, it is Shen Guang. If one indulges in sexual desires, losing Yuan Yang, once Yuan Yang is exhausted, cloud-haze and yin shadows arise. The Yin Water in the Kidney is barely enough to reflect light upon itself; how can it vigorously transport essence juice to nourish the Gallbladder and make the Fire within Water spread far into the air? How should it be treated? Benefit the Source of Fire to dissipate Yin Shadows.
The above conditions are all cases where Yin is weak and cannot match Yang, constituting internal cataract diseases. These diseases present without discharge, tearing, pain, itching, photophobia, or tightness/astringency. Initially, vision is merely dim as if walking in fog or dew; gradually, black flowers appear in the visual field; then darkness increases; objects appear double; eventually, light does not gather, leading to disability. Patients should cultivate the congenital root and treat during the early stage. Moreover, this disease is hardest to cure; medication requires accumulation over years. One must abstain from alcohol, sex, and lust, avoid irregular eating and labor, and drive away the Seven Emotions and Five Thieves. Only then might there be efficacy. Otherwise, disability is inevitable, and recovery is impossible. The world does not understand this. At first, they say eye dimness is harmless and pay little attention. By the time the disease forms, doctors do not recognize it, directly attributing it to Heat and using cooling medicines. They do not realize that cooling medicines damage the Stomach. Furthermore, Cooling corresponds to Autumn and Metal, while the Liver corresponds to Spring and Wood; thus, the Liver is also injured. Often, this leads to disability before stopping. The patient does not comprehend the error of the medicine, blaming fate. The doctor does not self-reflect, claiming poor skill. How sad!
There are also cases of Yang deficiency unable to resist Yin. If caused by irregular diet, excessive labor, and Spleen-Stomach weakness, sinking into the Kidney and Liver, Turbid Yin fails to descend, and Clear Yang fails to ascend. Like the sun and moon becoming obscured at dawn, evil harms the empty orifices, causing deafness and blindness. The essence of the five zang and six fu organs is all derived from Spleen Earth and ascends to penetrate the eyes. This "essence" refers to the refined substance transformed from food and drink, not the Primordial Essence of Tian Yi. The Spleen is the head of all Yins; the eyes are the congregation of Blood and Qi. Therefore, Spleen deficiency causes the essence qi of the five zang organs to lose their governance, failing to bring clarity to the eyes. Moreover, if Stomach Qi sinks into the Kidney and Liver, named "Zhong Qiang" (Heavy Rigidity), Ministerial Fire joins Heart Fire in reckless action, boiling the hundred vessels, reversing blood flow upward, and causing eye disease. If both eyes are dim and dark but limbs are not heavy, use Li Dongyuan's Yi Qi Cong Ming Tang (Qi-Supporting Brightness Decoction). If both eyes are tight, small, photophobic, and fearful of sunlight, or vision is weak, limbs are fatigued, or hands and feet are numb, this is Spleen-Lung Qi deficiency failing to ascend. Use Shen Xiao Huang Qi Tang (Miraculous Effect Astragalus Decoction). If after illness, or in the late afternoon, or under lamplight, one cannot see, this is Yang deficiency with sinking. Use Jue Ming Ye Guang Wan (Clear-Bright Night-Light Pill) or Sheng Ma Zhen Yin Tang (Cimicifuga Stabilizing-Yin Decoction).
Zhang Zihe said: Eyes do not become diseased unless due to Fire. Redness of the White Wheel (Sclera) indicates Fire attacking the Lung. Redness and swelling of the Meat Wheel (Eyelids) indicate Fire attacking the Spleen. Obscuration of the Black Water and Divine Light indicates Fire attacking the Liver and Spleen. Red vessels penetrating the eye indicate Fire is extreme. To treat Fire, one sentence suffices. But Zhang Zihe uses only cold-cooling medicines to treat Fire. I alone use Water to match Fire (nourishing Water to control Fire), which also suffices in one sentence. As for various syndromes mixed from Six Evils and Seven Emotions, refer to Ni Zhongxian's *Yuan Ji Qi Wei* (Origins of Mechanisms Unveiled). This book is excellent, and Xue Lizhai supplemented it further, deeply elucidating strengthening the Master of Water and benefiting the Source of Fire, greatly benefiting the treatment of eye diseases.