积者，重叠不解之貌。热为阳，阳平为常，阳淫为邪，常邪则行，行则病易见，易见则
易治。此则前篇淫热之病也。深邪则不行，不行则伏，因伏而又伏，日渐月聚，势不得不为
积也。积已久，久积必溃，溃始病见，病见则难治。难治者，非不治也。为邪积久，比溃已
深。何则？溃犹败也。知败者，庶可以救。其病隐涩不自在，稍觉 ，视物微昏，
内穴开窍如针目，按之则沁沁脓出。有两目俱病者，有一目独病者，目属肝，内 属膀胱
，此盖一经积邪之所致也。故曰热积必溃之病，又曰漏睛眼者是也。竹叶泻经汤主之。大便
不硬者，减大黄，为用蜜剂解毒丸主之。不然，药误病久，终为枯害。
或问曰∶人有昼视通明，夜视罔见，虽有火光月色，终为不能睹物者，何也？答曰∶此
阳衰不能抗阴之病，谚所谓雀盲者也。问曰∶何以知之？答曰∶《黄帝生气通天论》曰∶自
古通天者，生之本，本于阴阳，天地之间，六合之内，其气九州九窍，五脏十二节，皆通乎
天气。又曰∶阴阳者，一日而主外，平旦人气生，日中而阳气隆，日西而阳气已虚，气门乃
闭。又曰∶阳不胜其阴，则五脏气争，九窍不通，故知也。问曰∶阳果何物耶？答曰∶凡人
之气，应之四时者，春夏为阳也；应之一日者，平旦至昏为阳也；应之五脏六腑者，六腑为
阳也。问曰∶阳何为而不能抗阴也？答曰∶人之有生，以脾胃中州为主也。《灵兰秘典》曰
∶脾胃者，仓廪之官，在五行为土，土生万物，故为阳气之原。其性好生恶杀，遇春夏乃生
长，遇秋冬则收藏，或有忧思恐怒，劳役饥饱之类，过而不节，皆能伤动脾胃。脾胃受伤，
则阳气下陷，阳气下陷，则于四时一日五脏六腑之中，阳气皆衰。阳气既衰，则于四时一
日五脏六腑之中，阴气独盛。阴气既盛，故阳不能抗也。问曰∶何故夜视罔见？答曰∶目为
肝，肝为足厥阴也。神水为肾，肾为足少阴也。肝为木，肾为水，水生木，盖亦相生而成也
。况怒伤肝，恐伤肾，肝肾受伤，亦不能生也。昼为阳，天之阳也；昼为阳，人亦应之也。
虽受忧思恐怒劳役饥饱之伤，而阳气下陷，遇天之阳盛阴衰之时，我之阳气虽衰，不得不应
之而升也，故犹能昼视通明。夜为阴，天之阴也；夜为阴，人亦应之也。既受忧思恐怒劳役
饥饱之伤，而阳气下陷，遇天阴盛阳衰之时，我之阳气既衰，不得不应之时伏也。故夜视罔
所见也。问曰∶何以为治？答曰∶镇阴升阳之药，决明夜灵散主之。问曰∶病见富贵乎？贫贱
者乎？答曰∶忧思恐怒，劳役饥饱，富贵者甚乎？惟其贫贱者，不能免甚也。问者称善。
积，是指邪气重叠郁结、不能解散的状态。热属于阳，阳气平和是常态，阳气过亢则成为邪气，常态与邪气都能运行，运行则病证容易显现，容易显现就容易治疗。这是前一篇所说的淫热之病。如果邪气深重则运行不畅，运行不畅则潜伏，因为潜伏而又进一步潜伏，日积月累，形势上不得不形成“积”。积存在久了，久积必然溃破，溃破后病证才显现，病证显现后就难以治疗。所谓难治，并不是不可治，而是因为邪气积聚日久，等到溃破时病位已经深入。为什么呢？因为“溃”类似于腐败。知道它是腐败性质的，或许还可以挽救。这种病症表现为眼部隐涩不适，稍微感觉模糊，视物轻微昏暗，内眼角（睛明穴处）如针孔般张开，按压时有脓液渗出。有的双眼都患病，有的单眼患病。眼睛归属于肝，内眼角归属于膀胱，这大概是一条经脉中积聚了邪气所致。所以称之为“热积必溃之病”，又叫做“漏睛眼”，主要用竹叶泻经汤治疗。如果大便不硬，减少大黄用量，改用蜜剂解毒丸为主进行治疗。否则，用药失误且病程长久，最终会导致枯槁损害。
有人问道：有的人白天视力清晰明亮，夜晚却完全看不见东西，即使有火光或月光，终究无法看清物体，这是为什么呢？回答说：这是阳气衰弱不能抵抗阴气的病证，也就是谚语所说的“雀盲”（夜盲症）。问道：怎么知道的呢？回答说：《黄帝内经·生气通天论》说：自古以来通晓天道的人，认为生命根本在于阴阳。天地之间，六合之内，其气机贯通于九州和九窍，五脏和十二关节，都与天气相通。又说：阴阳在一日之中主司外应，平旦时人气生发，日中时阳气隆盛，日落时阳气已虚，汗孔（气门）关闭。又说：阳气不能胜过阴气，则五脏之气争乱，九窍不通，因此知道这是阳气不足导致的。问道：阳气到底是什么呢？回答说：凡人的气，顺应四季变化，春夏为阳；顺应一日变化，从平旦到黄昏为阳；顺应五脏六腑，六腑为阳。问道：为什么阳气不能抵抗阴气呢？回答说：人的生存，以脾胃的中州部位为主。《灵兰秘典论》说：脾胃是仓廪之官，在五行中属土，土能生养万物，所以是阳气的源头。它的本性喜好生长而厌恶杀戮，遇到春夏就生长，遇到秋冬就收藏。如果有忧愁、思虑、恐惧、愤怒，以及劳累、饥饿、饱食等情况，过度而不节制，都会损伤脾胃。脾胃受伤，则阳气下陷；阳气下陷，则在四季、一日、五脏六腑之中，阳气都衰弱。阳气既然衰弱，那么在四季、一日、五脏六腑之中，阴气就独自强盛。阴气既已强盛，所以阳气不能抵抗。问道：为什么夜晚看不见呢？回答说：眼睛归属于肝，肝是足厥阴经。神水（房水等眼内液体）归属于肾，肾是足少阴经。肝属木，肾属水，水生木，这也是相生而成的关系。况且愤怒伤肝，恐惧伤肾，肝肾受伤，也不能相互滋生。白天属阳，是天之阳；白天属阳，人也与之相应。虽然受到忧思恐怒、劳役饥饱的损伤，导致阳气下陷，但遇到天之阳气盛、阴气衰的时候，我身的阳气虽然衰弱，也不得不随之升发，所以还能白天视力清晰。夜晚属阴，是天之阴；夜晚属阴，人也与之相应。既然受到忧思恐怒、劳役饥饱的损伤，导致阳气下陷，遇到天之阴气盛、阳气衰的时候，我身的阳气既已衰弱，不得不随之潜伏。所以夜晚就看不见了。问道：如何治疗？回答说：用镇阴升阳的药物，以决明夜灵散为主治疗。问道：这个病多见于富贵人还是贫贱人？回答说：忧思恐怒、劳役饥饱，是富贵人更严重吗？其实贫贱人也无法避免同样严重的情况。提问者表示赞同。
Ji (accumulation) refers to the state where pathogenic factors overlap and stagnate without resolving. Heat belongs to Yang. When Yang Qi is balanced, it is normal; when Yang is excessive, it becomes pathogenic. Both normal and pathogenic states allow for movement; movement makes diseases easier to manifest, and easier manifestation makes them easier to treat. This describes the condition of excessive heat mentioned in the previous chapter. If the pathogen is deep, it does not move freely; lack of movement leads to concealment. Concealment upon concealment accumulates day by day and month by month, inevitably forming an accumulation. Long-standing accumulations must eventually ulcerate; only after ulceration do symptoms become apparent, making treatment difficult. "Difficult to treat" does not mean untreatable, but rather that because the pathogen has accumulated for a long time, the disease depth increases after ulceration. Why? Because "ulceration" implies decay. Understanding it as a decaying nature allows for potential rescue. The symptoms include a sensation of hidden discomfort and dryness in the eyes, slight blurring of vision, and the inner canthus (Jingming acupoint area) opening like a needle puncture, exuding pus upon pressure. It may affect both eyes or just one eye. The eyes are associated with the Liver, and the inner canthus is associated with the Bladder. This is caused by pathogenic accumulation in a single meridian. Hence, it is called "Heat Accumulation Ulceration Disease" or "Leaking Pupil Eye Disease," primarily treated with Zhuye Xiejing Tang (Bamboo Leaf Decoction for Draining the Eye Meridian). If the stool is not hard, reduce the dosage of Dahuang (Rhubarb Root) and use Miji Jiedu Wan (Honeyed Pill for Detoxification) as the primary treatment. Otherwise, medication errors combined with prolonged illness will ultimately lead to atrophy and damage.
A question was asked: "Some people see clearly during the day but cannot see anything at night; even with firelight or moonlight, they cannot perceive objects. Why?" The answer was: "This is a disease of Yang Qi deficiency failing to resist Yin, commonly known as 'sparrow blindness' (Nyctalopia)." The questioner asked: "How do you know this?" The answer was: "The *Suwen* (Basic Questions) chapter 'Shengqi Tongtian Lun' states: Since ancient times, those who understand the Heavenly Way recognize that life's root lies in Yin and Yang. Within heaven and earth, within the six directions, the Qi connects to the nine regions and nine orifices, five Zang organs, and twelve joints, all communicating with Heavenly Qi. It also states: Yin and Yang govern the exterior within a day. At dawn, human Qi generates; at noon, Yang Qi is robust; at sunset, Yang Qi is deficient, and the pores (Qi gates) close. Furthermore: If Yang cannot overcome Yin, the Qi of the five Zang organs becomes disordered, and the nine orifices become blocked. Thus, we know this." The questioner asked: "What exactly is Yang Qi?" The answer was: "Human Qi corresponds to the four seasons: Spring and Summer are Yang. It corresponds to a day: Dawn to dusk is Yang. It corresponds to the Zang and Fu organs: The Fu organs are Yang." The questioner asked: "Why can Yang not resist Yin?" The answer was: "Human existence relies primarily on the Spleen and Stomach in the central region. The *Linglan Midian Lun* states: The Spleen and Stomach are the officials of granaries, belong to Earth in the Five Elements, generate all things, and thus are the source of Yang Qi. Their nature favors growth and dislikes killing; they grow in Spring and Summer and store in Autumn and Winter. However, emotions such as worry, thought, fear, and anger, as well as overwork, hunger, and overeating, if excessive and unregulated, all damage the Spleen and Stomach. When the Spleen and Stomach are injured, Yang Qi sinks downward. When Yang Qi sinks, it becomes deficient in the four seasons, the day, and the Zang and Fu organs. Once Yang Qi is deficient, Yin Qi becomes predominant in the four seasons, the day, and the Zang and Fu organs. Since Yin Qi is strong, Yang cannot resist it." The questioner asked: "Why is there no vision at night?" The answer was: "The eyes belong to the Liver, which is the Foot Jueyin meridian. The Shen Shui (spiritual water/fluids of the eye) belongs to the Kidney, which is the Foot Shaoyin meridian. Liver is Wood, Kidney is Water; Water generates Wood, facilitating mutual generation. Moreover, anger injures the Liver, and fear injures the Kidney. If the Liver and Kidney are injured, they cannot generate each other. Day is Yang, the Heaven's Yang; humans correspond to it. Although damaged by worry, anger, overwork, etc., causing Yang Qi to sink, when encountering the time of Heaven's abundant Yang and deficient Yin, our deficient Yang Qi must still rise in response, allowing clear daytime vision. Night is Yin, the Heaven's Yin; humans correspond to it. Having been damaged by emotional and physical stress leading to sinking Yang Qi, when encountering Heaven's abundant Yin and deficient Yang, our already deficient Yang Qi must lie dormant in response. Therefore, vision is lost at night." The questioner asked: "How should it be treated?" The answer was: "Use herbs that anchor Yin and raise Yang, primarily Jueming Yeling San (Cassia Seed and Bat Dropping Powder)." The questioner asked: "Does this disease affect the rich or the poor more?" The answer was: "Are worry, anger, overwork, and dietary irregularities worse among the rich? Actually, the poor cannot escape their severity either." The questioner approved.