瞳神散大为何如，只为火热熏蒸胆，悠悠郁久精汁亏，致使神光皆失散，阴精肾气两衰
虚，相火邪行无管制，好如鸡鸭卵中黄，精气不足热所伤，热胜阴虚元灵损，至死冥冥不见
光。
此症专言瞳神散大，而风轮反为窄窄一周，甚则一周如线也。乃热邪郁蒸，风湿攻击，
以致神膏游走散坏。若初起即收可复，缓则气定膏损，则不复收敛。若未起内障颜色，只散
大者，直收瞳神，瞳神收而光自生矣。散大而有内障起者，于收瞳神药内，渐加内障药治之
如瞳神难收，病既急者，以收瞳神为先，瞳神但得收复，目即有生意。有何内障，或药或
针，庶无失收瞳神之悔。若只攻内障，不收瞳神，瞳神愈散，而内障不退，缓而疑迟不决者
二症皆气定而不复治，终身疾矣。大抵瞳神散大，十有七八，皆因头风痛攻之害，虽有伤
寒疟疾痰湿气怒忧思经产败血等病，久郁热邪火症，而蒸伤胆中所包精汁亏耗，不能滋养目
中神膏，故精液散走，而光华失，水中隐伏之火发。夫水不足，不能制火，火愈胜阴精愈亏
致清纯太和之元气，而皆乖乱，精液随之走失散矣。凡头风攻散者，又难收，非如伤寒疟
疾痰火等热症，炎燥之火，热邪蒸坏神膏，内障来迟，而收亦易敛者。若风攻，则内障即
来，且难收敛，而光亦损矣。宜服∶
羌活退翳丸（一名地黄丸） 治内障，右眼小 青白翳，大 微显白翳，脑疼，瞳子散大
大便涩或时难，小便如常，遇天热暖处，头痛睛胀能食，日没后兼天阴则昏暗，此症亦可
服滋阴地黄丸。
熟地（八钱，焙） 生地（酒制） 当归身（酒制） 茺蔚子 黄柏（酒制） 丹参（各五钱） 黑附
子（炮） 寒水石 柴胡 知母（盐水炒） 牡丹皮（酒洗） 真川芎（酒洗） 羌活（各三钱） 防己
（酒制，二钱） 白芍药（酒制，一两三钱）
上为细末，炼蜜为丸，如小豆大。每服五六十丸，空心白滚汤送下。如宿食未消，候饥
时服之。忌言语，随后以食压之。
东垣《兰室秘藏》方云∶翳在大 ，加葛根、升麻；翳在小 ，加柴胡、羌活是也。
泻肾汤 治因喜食辛辣炙爆之物过多，以致瞳神散大，服此后兼服磁朱丸。
枸杞子（一钱二分） 生地黄 黄柏（酒洗，炒） 知母（酒洗，炒） 麦门冬（去心） 山萸肉
（去核） 白芍 归尾（各一钱） 五味子（七粒） 白茯苓 独活（各八分）
上锉剂。白水二钟，煎至一钟，去渣热服。
调气汤 治因暴怒以致瞳神散大者，服此后兼服磁朱丸。
白芍药 陈皮 生地黄 黄柏（盐水炒） 香附子（醋制） 知母（盐水炒） 当归身（各一钱）
枳壳 白茯苓（各八分） 甘草（用生梢，五分）
上锉剂。白水二钟，煎至一钟，去渣热服。
清痰饮 治因患头风，痰厥头疼，以致瞳神散大，服此∶
陈皮（去白） 半夏（姜制） 天花粉 栀子仁（炒黑） 石膏（ ） 黄芩 白茯苓 胆南星
枳壳（炒，各一钱） 青黛（六分）
上锉剂。白水二钟，煎至一钟，去滓热服。
按∶瞳神散大属肾。若肾水固则气聚而不散，不固则相火炽盛而散大。神水若初变淡绿
淡白色者可治，若纯绿纯白色者，终为废疾矣。
滋阴地黄丸（见卷二） 治血弱阴虚，不能养心，致火旺于阴分，瞳子散大，少阴为君火
主无为不行其令，相火代之，与心胞络之脉，出心系，分三道，少阴相火之体无形，其用
在其中矣。火盛则能令母实，乙木肝旺是也。其心之脉挟目系，肝之脉连目系，况手足少阳
之脉，同出耳中，至耳上角斜起，终于目外小 ，风热之盛，亦从此道来，上攻头目，致偏
头痛闷肿，瞳子散大，视物昏花，血虚阴弱故也。法当养血凉血益血，收火散火，而除风热
则愈矣。
每服百丸，食后茶清送下，日进二服。大忌辛辣之物，恐助火邪，及食寒凉之物，伤其
胃气，药不上行也。又一论云∶瞳子黑眼法于阴，由食辛热之物助火，乘于胸中，其睛故散
睛散则视物大矣。
东垣云∶凡心胞络之脉，出于心中，代心君行事也，与小肠为表里。瞳子散大者，少阴
心之脉挟目系，厥阴肝之脉连目系，心主火，肝主木，此木火之势盛也。其味则宜苦宜酸宜
凉，大忌辛辣热物，是泄木火之邪也，饮食中常知此理可也。以诸辛主散，热则助火，故不
可食。酸主收心气泻木火也，诸苦泻火热则益水也，尤忌食冷水大寒之物，因寒能损胃气，
胃气不行，则元气不生，元气不生，致胃气下陷，胸中三焦之火及心火乘于肺，上入脑灼髓
火主散，故瞳子之散大者以此，大热之物直助火邪，尤为不可食也。药中去茺蔚子，以味
辛及主益肝，是助火也，故去之，加黄芩五钱，黄连三钱。黄连泻中焦之火，黄芩泻上焦肺
火，以酒洗之，乃寒因热用也。亦不可用青葙子，恐助阳火也。更加五味子三钱，以收瞳神
之散大也。且火之与气，势不两立。故经云∶壮火食气，气食少火，少火生气，壮火散气。
诸酸物能助元气。孙真人曰∶五月常服五味子，助五脏气以补西方肺金。又经曰∶以酸补之
以辛泻之。则辛泻气明矣。或曰∶药中有当归，其味亦辛甘，不去之，何也？此一味辛甘
者，以其和血之圣药也。况有甘味，又欲以为向导，为诸药之使，故不去也。宜服熟地黄丸
瞳神散大是怎么回事呢？这是因为火热之邪熏蒸胆腑，长期郁结导致精汁亏损，致使神光全部散失。阴精与肾气双重虚弱，相火（寄居于肝肾的虚火）邪行而无约束，就像鸡鸭蛋黄一样（指瞳孔形态或色泽异常）。精气不足且受热损伤，热盛阴虚则元灵受损，最终陷入黑暗看不见光亮。
此症专门论述瞳神散大，此时风轮（黑睛）反而变得狭窄如一圈，甚至细如一线。这是由于热邪郁积蒸腾，风湿侵袭，导致神膏（晶状体及玻璃体等眼内组织）游走散坏。如果在初起时就能收敛，尚可恢复；若拖延日久，气机定局而神膏受损，则无法再收敛。如果尚未出现内障颜色变化，只是瞳神散大，直接采用收敛瞳神的药物，瞳神收回后视力自然恢复。如果散大同时伴有内障形成，应在收敛瞳神的药物中，逐渐加入治疗内障的药物。如果瞳神难以收敛，病情急迫者，以收敛瞳神为优先，只要瞳神得以收复，眼睛就有生机。无论有何种内障，或用药或针刺，才不至于有错失收敛瞳神的后悔。如果只攻治内障而不收敛瞳神，瞳神会越散越大，而内障也不会消退。若拖延迟疑不决，这两种情况都会因气机定局而无法治愈，成为终身残疾。
大体而言，瞳神散大的病例中，十有七八都是因为头风痛攻击所致。虽然也有伤寒、疟疾、痰湿、气怒、忧思、经产败血等疾病，长期郁结产生热邪火症，蒸伤胆中所包裹的精汁使其亏耗，不能滋养眼中的神膏，导致精液散走，光华丧失，水中隐伏之火发作。因为水不足，不能制约火，火越旺盛，阴精越亏损，导致清纯太和的元气乖乱，精液随之走失散失。凡是因风邪攻击导致的散大，很难收敛，不像伤寒、疟疾、痰火等热症，那是炎燥之火，热邪蒸坏神膏，内障来得晚，收敛也容易。如果是风邪攻击，内障随即而来，且难收敛，视力也会受损。适宜服用：
羌活退翳丸（又名地黄丸），治疗内障，右眼小青白翳，大微显白翳，脑疼，瞳子散大，大便涩滞或有时困难，小便正常，遇到天气炎热暖处，头痛眼胀能进食，日落后兼阴天则昏暗，此症也可服用滋阴地黄丸。
药材组成：熟地黄（八钱，焙干）、生地黄（酒制）、当归身（酒制）、茺蔚子、黄柏（酒制）、丹参（各五钱）、黑附子（炮制）、寒水石、柴胡、知母（盐水炒）、牡丹皮（酒洗）、真川芎（酒洗）、羌活（各三钱）、防己（酒制，二钱）、白芍药（酒制，一两三钱）。
将上述药材研为细末，用炼蜜制成丸药，大小如小豆。每次服用五六十丸，空腹用温开水送服。如果宿食未消，等到饥饿时服用。服药期间忌言语，随后以食物压住药力。
李东垣《兰室秘藏》方说：如果翳障在大眦（外眼角），加葛根、升麻；如果翳障在小眦（内眼角），加柴胡、羌活。
泻肾汤，治疗因喜食辛辣炙烤之物过多，导致瞳神散大，服用此方后兼服磁朱丸。
药材组成：枸杞子（一钱二分）、生地黄、黄柏（酒洗，炒）、知母（酒洗，炒）、麦门冬（去心）、山萸肉（去核）、白芍、归尾（各一钱）、五味子（七粒）、白茯苓、独活（各八分）。
将药材切碎成剂。用水两钟，煎至一钟，去渣热服。
药材组成：白芍药、陈皮、生地黄、黄柏（盐水炒）、香附子（醋制）、知母（盐水炒）、当归身（各一钱）、枳壳、白茯苓（各八分）、甘草（用生梢，五分）。
将药材切碎成剂。用水两钟，煎至一钟，去渣热服。
药材组成：陈皮（去白）、半夏（姜制）、天花粉、栀子仁（炒黑）、石膏、黄芩、白茯苓、胆南星、枳壳（炒，各一钱）、青黛（六分）。
将药材切碎成剂。用水两钟，煎至一钟，去渣热服。
按语：瞳神散大属于肾脏病变。如果肾水坚固，则气聚而不散；如果不坚固，则相火炽盛而散大。神水如果初变淡绿或淡白色者可以治疗，如果纯绿或纯白色者，终将成为废疾。
滋阴地黄丸（见卷二），治疗血弱阴虚，不能养心，导致火旺于阴分，瞳子散大。少阴君火主无为不行其令，相火代之，与心包络之脉，出于心系，分为三道。少阴相火之体无形，其作用在其中。火盛则能使母实，即乙木肝旺。心的脉络挟持目系，肝的脉络连接目系，况且手足少阳的脉络，同出于耳中，上行至耳上角斜起，终于目外小眦。风热之盛，也从此道而来，上攻头目，导致偏头痛闷肿，瞳子散大，视物昏花，这是血虚阴弱的缘故。治法应当养血凉血益血，收火散火，并祛除风热即可痊愈。
每次服用一百丸，饭后用茶清送服，每日进两次。大忌辛辣之物，恐怕助长火邪，以及食用寒凉之物，损伤胃气，导致药力不能上行。另一种理论说：瞳子和黑眼法象于阴，由于食用辛热之物助火，乘于胸中，所以眼睛散大。眼睛散大则视物变大。
李东垣说：凡是心包络的脉络，出于心中，代心君行事，与小肠互为表里。瞳子散大者，是因为少阴心之脉挟持目系，厥阴肝之脉连接目系，心主火，肝主木，这是木火之势旺盛。口味应该宜苦、宜酸、宜凉，大忌辛辣热物，这是泄木火之邪的方法，饮食中常知晓这个道理即可。因为诸辛味主发散，热则助火，所以不可吃。酸味主收敛心气，泻木火，诸苦味泻火热则有益水，尤其忌讳食用冷水和大寒之物，因为寒能损伤胃气，胃气不行，则元气不生，元气不生导致胃气下陷，胸中三焦之火及心火乘于肺，上入脑灼髓。火主散，所以瞳子散大是由于这个原因。大热之物直接助长火邪，尤为不可吃。药中去掉茺蔚子，因为其味辛且主益肝，是助火的，所以去掉，加入黄芩五钱，黄连三钱。黄连泻中焦之火，黄芩泻上焦肺火，用酒洗之，这是寒因热用的方法。也不可用青葙子，恐怕助长阳火。再加五味子三钱，以收敛瞳神的散大。而且火与气，势不两立。所以经文说：壮火食气，气食少火，少火生气，壮火散气。诸酸物能助元气。孙真人说：五月常服五味子，助五脏气以补西方肺金。又经文说：以酸补之，以辛泻之。那么辛泻气就很明显了。有人问：药中有当归，其味也是辛甘，为什么不除去呢？这一味辛甘的药，是和血的圣药。况且有甘味，又想作为向导，作为诸药的使药，所以不去除。适宜服用熟地黄丸。
What is the condition of pupillary dilation? It occurs because heat-fire pathogens steaming and fumigating the Gallbladder channel, over a long period of depression leading to the depletion of essence fluids, causing the divine light (Shen Guang) to scatter completely. Both Yin essence and Kidney Qi are severely deficient; ministerial fire (Xiang Huo, a pathogenic fire residing in the Liver and Kidney) runs wild without control, resembling the yolk of a chicken or duck egg (referring to abnormal pupil morphology or color). With insufficient essence and Qi damaged by heat, excessive heat and Yin deficiency damage the primal spirit (Yuan Ling), eventually resulting in darkness and blindness.
This section specifically discusses pupillary dilation, where the Wind Wheel (Hei Jing, cornea and iris) becomes abnormally narrow, even as thin as a thread. This is caused by heat pathogens stagnating and steaming, combined with wind-dampness attacking, leading to the dispersion and destruction of the Shen Gao (aqueous humor, lens, and vitreous body). If收敛 (convergence/retraction) can be achieved at the onset, recovery is possible; if delayed until Qi stabilizes and Shen Gao is damaged, retraction will no longer be effective. If there are no signs of internal cataracts (Nei Zhang) yet, only pupillary dilation, directly using drugs to retract the pupil will restore vision once the pupil returns to normal. If dilation accompanies the formation of internal cataracts, gradually add cataract-treating herbs to the pupillary-retracting formula. If the pupil is difficult to retract and the condition is acute, prioritize retracting the pupil first; once the pupil is restored, the eye retains vitality. Regardless of the type of internal cataract, whether treating with medicine or acupuncture, one avoids the regret of missing the opportunity to retract the pupil. If one only attacks the internal cataract without retracting the pupil, the pupil will dilate further, and the cataract will not recede. Procrastination and indecision in these two scenarios lead to stabilized Qi that cannot be treated, resulting in lifelong disability.
Generally, 70-80% of pupillary dilation cases are caused by Head Wind pain attacks. Although conditions such as Cold Damage (Shang Han), malaria, phlegm-dampness, anger, worry, postpartum blood stasis, etc., can cause long-term depression generating heat-fire pathogens that steam and damage the essence fluids wrapped in the Gallbladder, depleting them so they cannot nourish the Shen Gao in the eye, causing essence fluids to scatter and divine light to fail, with hidden fire in Water erupting. Because Water is insufficient to control Fire, as Fire prevails, Yin essence decreases further, disrupting the pure and harmonious Yuan Qi, causing essence fluids to scatter. Cases caused by Wind attack are difficult to retract, unlike heat conditions from Cold Damage, malaria, or phlegm-fire, where炎燥 (scorching dryness) heat damages Shen Gao; in those cases, internal cataracts appear late and are easier to retract. If attacked by Wind, internal cataracts appear immediately, are hard to retract, and vision is impaired. Suitable prescription:
Qianghuo Tuiyi Wan (also known as Dihuang Wan): Treats internal cataracts, small blue-white nebula in the right eye, large faint white nebula, headache, pupillary dilation, constipation or difficulty defecating, normal urination. Headache and eye distension occur in hot weather or warm places; vision dims after sunset on cloudy days. This condition may also take Ziyin Dihuang Wan.
Ingredients: Shu Di Huang (Rehmanniae Radix Praeparata, 8 qian, roasted), Sheng Di Huang (Rehmanniae Radix, wine-processed), Dang Gui Shen (Angelicae Sinensis Radix, wine-processed), Chong Wei Zi (Ecliptae Fructus), Huang Bai (Phellodendri Cortex, wine-processed), Dan Shen (Salviae Miltiorrhizae Radix, each 5 qian), Hei Fu Zi (Aconiti Lateralis Radix Praeparata, processed), Hanshui Shi (Natrii Sulfas), Chai Hu (Bupleuri Radix), Zhi Mu (Anemarrhenae Rhizoma, salt-water fried), Mu Dan Pi (Moutan Cortex, wine-washed), Zhen Chuan Xiong (Ligustici Chuanxiong Rhizoma, wine-washed), Qiang Huo (Notopterygii Rhizoma et Radix, each 3 qian), Fang Ji (Stephaniae Tetrandrae Radix, wine-processed, 2 qian), Bai Shao Yao (Paeoniae Radix Alba, wine-processed, 1 liang 3 qian).
Grind into fine powder, make pills with refined honey, size of small beans. Take 50-60 pills per dose, swallowed with warm water on an empty stomach. If undigested food remains, take when hungry. Avoid speaking during treatment, follow with food to settle the medicine.
According to Li Dongyuan's *Lanshi Micang*: If the nebula is in the outer canthus (Da Yu), add Ge Gen (Puerariae Lobatae Radix) and Sheng Ma (Cimicifugae Rhizoma); if in the inner canthus (Xiao Yu), add Chai Hu and Qiang Huo.
Xie Shen Tang: Treats pupillary dilation caused by excessive consumption of spicy and roasted foods. Take Ci Zhu Wan (Magnetitum et Cinnabaris Pilula) concurrently after taking this formula.
Ingredients: Gou Qi Zi (Lycii Fructus, 1 qian 2 fen), Sheng Di Huang, Huang Bai (wine-washed, fried), Zhi Mu (wine-washed, fried), Mai Men Dong (Ophiopogonis Tuber, heart removed), Shan Yu Rou (Corni Fructus, pitted), Bai Shao, Gui Wei (Angelicae Sinensis Radix tail, each 1 qian), Wu Wei Zi (Schisandrae Fructus, 7 grains), Bai Fu Ling (Poria, each 8 fen), Du Huo (Angelicae Pubescentis Radix, each 8 fen).
Cut into pieces. Decoct with 2 zhong of water until 1 zhong remains, remove dregs, and take hot.
Tiao Qi Tang: Treats pupillary dilation caused by sudden anger. Take Ci Zhu Wan concurrently after taking this formula.
Ingredients: Bai Shao Yao, Chen Pi (Citri Reticulatae Pericarpium), Sheng Di Huang, Huang Bai (salt-water fried), Xiang Fu Zi (Cyperi Rhizoma, vinegar-processed), Zhi Mu (salt-water fried), Dang Gui Shen (each 1 qian), Zhi Ke (Aurantii Fructus Immaturus), Bai Fu Ling (each 8 fen), Gan Cao (Glycyrrhizae Radix et Rhizoma, use raw tip, 5 fen).
Cut into pieces. Decoct with 2 zhong of water until 1 zhong remains, remove dregs, and take hot.
Qing Tan Yin: Treats pupillary dilation caused by head wind, phlegm-jue headache. Take this formula:
Ingredients: Chen Pi (pith removed), Ban Xia (Pinelliae Tuber, ginger-processed), Tian Hua Fen (Trichosanthis Radix), Zhi Zi Ren (Gardeniae Fructus, black-fried), Shi Gao (Gypsum Fibrosum), Huang Qin (Scutellariae Radix), Bai Fu Ling, Dan Nan Xing (Arisaomatis Cum Bile), Zhi Ke (fried, each 1 qian), Qing Dai (Indicum, 6 fen).
Cut into pieces. Decoct with 2 zhong of water until 1 zhong remains, remove dregs, and take hot.
Note: Pupillary dilation belongs to the Kidney. If Kidney Water is solid, Qi gathers and does not scatter; if not solid, ministerial fire flares up causing dilation. If Shen Shui (ocular fluid) initially turns pale green or pale white, it is treatable; if purely green or purely white, it results in permanent disability.
Ziyin Dihuang Wan (see Volume 2): Treats weak blood and Yin deficiency failing to nourish the Heart, causing fire to flourish in the Yin aspect, leading to pupillary dilation. Shaoyin (Heart-Kidney axis) Jun Huo (Monarch Fire) acts non-actionally, replaced by Xiang Huo (Ministerial Fire). The meridians of the Pericardium emerge from the Heart connection, dividing into three paths. Shaoyin Xiang Huo has no form but its function exists within. Excessive fire causes the mother element to become excess, i.e., Wood (Liver) flourishing. The Heart meridian connects to the eye system, and the Liver meridian links to the eye system. Furthermore, the Hand and Foot Shaoyang meridians emerge from the ear, ascend to the upper ear angle, slant down to the outer canthus (Xiao Yu). Excessive wind-heat travels this path, attacking the head and eyes, causing unilateral headache, swelling, pupillary dilation, and blurred vision due to blood deficiency and Yin weakness. The method should involve nourishing, cooling, and benefiting blood, gathering and dispersing fire, and eliminating wind-heat for cure.
Take 100 pills per dose, swallowed with clear tea after meals, twice daily. Strictly avoid spicy foods to prevent aiding fire pathogens, and cold/cool foods to protect Stomach Qi, ensuring medicinal action ascends. Another theory states: The pupil and black eye correspond to Yin. Consumption of spicy-hot foods aids fire, which overwhelms the chest, causing the eye to dilate. Dilated pupils cause objects to appear larger.
Li Dongyuan stated: The Pericardium meridian emerges from the Heart, acting on behalf of the Monarch, and is exterior-interior related to the Small Intestine. In pupillary dilation, the Shaoyin Heart meridian connects to the eye system, and the Jueyin Liver meridian links to the eye system. Heart governs Fire, Liver governs Wood; thus, Wood-Fire energy is excessive. The taste should be bitter, sour, and cool. Strictly avoid spicy-hot foods to drain Wood-Fire pathogens. One should understand this principle in diet. Acrid flavors disperse, and heat aids fire, so they should be avoided. Sour flavors gather Heart Qi and drain Wood-Fire; bitter flavors drain heat-fire and benefit Water. Especially avoid cold water and extreme cold foods, as cold damages Stomach Qi. If Stomach Qi fails to move, Yuan Qi is not generated. Lack of Yuan Qi leads to sinking of Stomach Qi, allowing Sanjiao and Heart fire to overwhelm the Lung, enter the brain, and scorch marrow. Fire governs dispersion, hence pupillary dilation. Extreme heat foods directly aid fire pathogens and must be avoided. Remove Cong Wei Zi from the formula because its acrid nature benefits the Liver, thereby aiding fire. Add Huang Qin (5 qian) and Huang Lian (3 qian). Huang Lian drains Middle Jiao fire; Huang Qin drains Upper Jiao Lung fire. Wine-washing makes them "cold used with heat." Do not use Qing Xiang Zi (Celosiae Semen) as it may aid Yang fire. Add Wu Wei Zi (3 qian) to retract pupillary dilation. Fire and Qi are mutually exclusive. As the classics say: Strong fire consumes Qi; Qi feeds mild fire. Mild fire generates Qi; strong fire scatters Qi. Sour substances assist Yuan Qi. Sun Simiao said: Take Wu Wei Zi regularly in May to assist the Five Zang Qi and tonify Western Lung Metal. The classics state: Tonify with sour, drain with acrid. Thus, acrid drains Qi clearly. Some ask: Why keep Dang Gui, which is acrid and sweet? It is a supreme herb for harmonizing blood. Moreover, its sweet nature serves as a guide and envoy for other herbs, so it is retained. It is suitable to take Shu Dihuang Wan.