瞳神细小，精气俱伤，元阳耗散，欲坠神光，莫使没尽，医术无方。
此症谓瞳神渐渐细小如簪脚，甚则缩小如针也。视尚有光，早治少挽，复故则难。患者
因恣色之故，虽病目亦不忌淫欲，及劳伤气血，思竭心意，肝肾二经俱伤，元气衰弱，不能
升运清汁以滋胆，胆中三合之精有亏，则轮汁亦乏。故瞳神中之精，亦日渐耗损，甚则陷没
俱无，为终身疾矣。亦有头风热症，攻走蒸干精液，而细小者。皆宜乘初早救，不然，悔之
不及也。宜服∶
清肾抑阳丸 治水实而自收，其病神水紧小，小而又小，积渐之至，竟如芥子许，若久
服此丸，则阳平阴常瞳神细小之恙，日后自无虑耳。
寒水石（另研） 黄柏（盐水制） 生地黄 知母（盐水制） 枸杞子 黄连（酒炒） 白茯苓
（各二两） 独活（八钱） 草决明（炒） 当归（酒洗，炒） 白芍药（酒洗，炒，各一两）
上为细末，炼蜜为丸，如梧桐子大。每服三钱。空心滚白汤送下。又宜用∶
抑阳酒连散、还阴救苦汤、 鼻碧云散（以上见卷二）。
怯近症兮视远明，眼前之物反无睛，阴精太涩阳邪见，痰火之人极欠宁。治之之法，补
肾清心。
此症谓目能远视，而不能近视也。盖阴精不足，阳光有余，病于水者，故光华发见散乱
而不能收敛近视，治之止在心肾，心肾平则水火调，而阴阳和畅，则远近发用，各得其宜
夫血之所化为水，在身为精液，其轻清之血，升上在目为膏汁。若贪淫恣欲，饥饱失节，
形体甚劳，极其悲泣，皆斫耗阴精，阴精亏而阳火盛，火性炎而发见，阴精之水，不能制伏
乎火，故火发越于外而远照，不能治火反触激者，内障之患有矣。宜服∶
地芝丸 治目能视远，责其有火，不能近视，责其无水，当宜补肾水疗之。
天门冬（去心） 生地黄（焙干，四两） 枳壳（去穣） 菊花（各三两）
上为细末，炼蜜为丸，如桐子大。每服百丸，食后茶清送下。
六味地黄丸 治脾胃，少年水亏火旺阴虚之症，肝肾血虚，燥热作渴，小便淋秘，痰气
上壅，或风客淫气，瘰 结核，或四肢发搐，眼目运动，或咳嗽吐血，头目眩晕，或咽喉燥
痛，口舌疮裂，或自汗便血，禀赋不足，肢体瘦弱，解颅失音，畏明下窜，五迟五软，肾疳
肝疳，早近女色，精血亏耗。五脏齐损，凡属肾肝诸虚不足之症，宜用此以滋化源，其功不
可尽述。
白茯苓（乳蒸晒干） 丹皮（炒，各两半） 泽泻（微炒，一两） 山药（酒拌，蒸，晒干） 山茱
萸（去核酒蒸焙干，各二两） 熟地（四两，酒、水各半，煮烂捣膏另入）
余共为细末，炼蜜为丸，如桐子大。每服三钱，空心淡盐汤送下。或遗精，加牡蛎，
红水淬，为末，焙干，三两。忌萝卜。
肾者，水脏也。水衰则龙雷之火无畏而亢上，故王启玄曰∶壮水之主，以制阳光也。即
经所谓求其属而衰之。地黄味浓，为阴中之阴，专主补肾填精，故以为君；山茱萸味酸归肝
乙癸同治之义，且肾主闭藏，而酸敛之性，正与之宜也；山药味甘归脾，安水之仇，故用
二味为臣；丹皮亦入肝，其用主宣通，所以佐茱萸之涩也；茯苓亦入脾，其用主通利，所以
佐山药之滞也，且色白属金，能培肺部，又有虚则补其母之义。至于泽泻有三功∶一曰利小
便，以泄相火；二曰行地黄之滞，引诸药速达肾经；三曰有补有泻，诸药无畏恶增气之虞。
故用以为使。此丸为益肾之圣药，而昧者薄其功缓。乃用药者，有四失也∶一则地黄非怀庆
则力浅；一则地黄非自制则不工，且有犯铁之弊；一则疑地黄之滞而减少之，则君主力弱；
一则恶泽泻之渗而减之，则使力微。自蹈四失，而反咎药之无功，毋乃冤乎！
瞳神（瞳孔）变得细小，是精气俱伤、元阳耗散的表现，神光（视觉功能）有即将熄灭的危险，此时若无有效医术，病情难以挽回。
这种病症表现为瞳孔逐渐缩小如发簪脚，严重时甚至缩小如针尖。虽然视力尚存微弱光亮，但若早期治疗尚可挽救，想要恢复原状则非常困难。患者往往因为纵欲过度，即使眼睛已病也不戒除淫欲，加之劳累损伤气血，思虑过度耗竭心意，导致肝肾两经受损，元气衰弱，无法升运清汁以滋养胆腑。胆中“三合”之精（指胆与肝、心等脏腑精气相合之精华）亏损，导致轮汁（眼内维持眼球形态和功能的津液）匮乏。因此，瞳神中的精气也日渐耗损，严重时完全陷没消失，成为终身残疾。也有因头风热症，火热攻冲蒸干精液，导致瞳孔细小的情况。这些情况都应当在初起时尽早救治，否则后悔莫及。适宜服用：
清肾抑阳丸：用于治疗水实（肾水过盛或湿热蕴结）导致的瞳孔自发性收缩。其病机为神水（房水）紧小，且越来越小，积渐而成，最终如芥子大小。若长期服用此丸，可使阳气平和、阴气常守，瞳神细小的毛病日后自然无忧。
药材组成：寒水石（另研）、黄柏（盐水制）、生地黄、知母（盐水制）、枸杞子、黄连（酒炒）、白茯苓（各二两）、独活（八钱）、草决明（炒）、当归（酒洗，炒）、白芍药（酒洗，炒，各一两）。
制法用法：以上药物研为细末，用炼蜜制成梧桐子大小的丸剂。每次服用三钱，空腹时用滚开的白开水送服。另外适宜使用：抑阳酒连散、还阴救苦汤、鼻碧云散（以上方剂见卷二）。
怯近症兮视远明，眼前之物反无睛，阴精太涩阳邪见，痰火之人极欠宁。治之之法，补肾清心。
这种病症表现为眼睛能看清远处，而不能看清近处。这是因为阴精不足，阳光（虚火）有余，病变在于水脏（肾），所以光华发散混乱而不能收敛以视近物。治疗关键在于调理心肾，心肾平衡则水火调和，阴阳畅达，远近视物功能各得其宜。
血液所化生的液体称为水，在体内即为精液。其中轻清部分的血，上升于目化为膏汁。如果贪恋淫欲，饮食饥饱无常，形体极度劳累，或者极度悲伤哭泣，都会耗损阴精。阴精亏虚而阳火亢盛，火性炎上而发散，阴精之水不能制约火势，故火发散于外而远照，不能制约火势反而激惹者，便产生了内障疾病。适宜服用：
地芝丸：治疗眼睛能视远，责之于有火；不能视近，责之于无水。应当通过补肾水来治疗。
药材组成：天门冬（去心）、生地黄（焙干，四两）、枳壳（去瓤）、菊花（各三两）。
制法用法：以上药物研为细末，用炼蜜制成桐子大小的丸剂。每次服用一百丸，饭后用茶清送服。
六味地黄丸：治疗脾胃相关病症，以及少年时期水亏火旺、阴虚的症状；肝肾血虚，燥热作渴，小便淋沥秘涩，痰气上壅，或风邪客于淫气，瘰疬结核，或四肢抽搐，眼目转动异常，或咳嗽吐血，头目眩晕，或咽喉干燥疼痛，口舌疮裂，或自汗便血，禀赋不足，肢体瘦弱，解颅失音，畏光下窜，五迟五软，肾疳肝疳，早近女色导致精血亏耗。五脏皆损，凡属肝肾诸虚不足的病症，适宜用此方以滋生化之源，其功效不可尽述。
药材组成：白茯苓（乳蒸晒干）、丹皮（炒，各一两半）、泽泻（微炒，一两）、山药（酒拌，蒸，晒干）、山茱萸（去核酒蒸焙干，各二两）、熟地黄（四两，酒、水各半，煮烂捣膏另入）。
制法用法：其余药物共研为细末，用炼蜜制成桐子大小的丸剂。每次服用三钱，空腹用淡盐汤送服。若有遗精症状，加牡蛎（红水淬，研末，焙干，三两）。忌食萝卜。
肾是水脏。水衰则龙雷之火（相火）无所畏惧而亢逆上行，正如王启玄所说：“壮水之主，以制阳光。”即《内经》所说的“求其属而衰之”。地黄味道浓厚，属于阴中之阴，专门主治补肾填精，所以作为君药；山茱萸味道酸，归肝经，体现乙癸同源同治的道理，且肾主闭藏，酸的收敛特性正与之相宜，所以作为臣药；山药味道甘，归脾经，能安顿水之仇敌（土克水，此处指健脾以制水湿或培土制水），所以也用这两味药作为臣药；丹皮也入肝经，其作用主要是宣通，用来佐助山茱萸的涩性，防止其过于收敛；茯苓也入脾经，其作用主要是通利，用来佐助山药的滞性，防止其滋腻碍胃，且茯苓色白属金，能培补肺部，又有“虚则补其母”（金生水，肺为肾之母）的道理。至于泽泻有三重功效：一是利小便，以泄相火；二是行地黄之滞，引导诸药迅速到达肾经；三是具有补中有泻的特点，使诸药没有畏恶增气的担忧。所以用泽泻作为使药。此丸是益肾的圣药，但愚昧的人轻视它功效缓慢。这是用药者的四种过失：第一，地黄若非怀庆产则药效浅薄；第二，地黄若非自制炮制则不精工，且有犯铁器变色的弊端；第三，怀疑地黄滋腻而减少用量，则君药力量减弱；第四，厌恶泽泻渗利而减少用量，则使药力量微弱。自己陷入这四种过失，反而责怪药物无效，岂不是冤枉！
The pupil (pupil) becomes small, indicating damage to both essence and qi, dissipation of primordial yang, and the imminent danger of extinguishing Shen Guang (visual function). Without effective medical intervention, the condition is difficult to reverse.
This syndrome manifests as the pupil gradually shrinking like the tip of a hairpin, and in severe cases, becoming as small as a needle point. Although some light perception remains, early treatment may salvage the vision, but restoring it to its original state is difficult. Patients often indulge in sexual excesses; even when eye disease is present, they do not abstain from lust. Combined with fatigue damaging qi and blood, and excessive mental exertion depleting the mind, both the Liver and Kidney meridians are injured. The primordial qi becomes weak and fails to ascend and transport clear fluids to nourish the Gallbladder. The "Sanhe" essence (referring to the refined essences combining the Gallbladder with the Liver, Heart, etc.) within the Gallbladder becomes deficient, leading to a scarcity of Lunzhi (fluids maintaining the globe's shape and function). Consequently, the essence within the pupil is day by day depleted. In severe cases, it sinks and disappears completely, resulting in lifelong disability. There are also cases where head wind-heat attacks and steams dry up the essence fluids, causing the pupil to shrink. All such conditions should be treated early at onset; otherwise, regret will come too late. It is suitable to take:
Qingshen Yiyang Wan (Clear Kidney and Suppress Yang Pill): Used to treat spontaneous contraction of the pupil caused by water excess (accumulation of damp-heat or renal water imbalance). The pathology involves tightness and progressive constriction of Shenshui (aqueous humor), eventually shrinking to the size of a mustard seed. Long-term use of this pill can balance yang and preserve yin, naturally resolving the issue of the small pupil.
Ingredients: Hanshuishi (Calcitum, prepared separately), Huangbai (Phellodendri Cortex, processed with salt water), Shengdihuang (Rehmanniae Radix), Zhimu (Anemarrhenae Rhizoma, processed with salt water), Gouqizi (Lycii Fructus), Huanglian (Coptidis Rhizoma, stir-fried with wine), Baifuling (Poria, two taels each), Duhuo (Angelicae Pubescentis Radix, eight qian), Caojueming (Cassiae Semen, stir-fried), Danggui (Angelicae Sinensis Radix, washed with wine and stir-fried), Baishaoyao (Paeoniae Radix Alba, washed with wine and stir-fried, one tael each).
Preparation and Administration: Grind the above ingredients into fine powder. Form pills using refined honey, sized like paulownia seeds. Take three qian per dose, administered on an empty stomach with boiling plain water. Additionally, the following formulas are suitable: Yi Yang Jiu Lian San, Huanyin Jiuku Tang, Bi Yun San (see Volume II for details).
"Timid near-sightedness yet clear distance vision, objects before eyes lack focus; Yin essence too stagnant, Yang pathogen appears, Phlegm-fire individuals are extremely restless." The treatment method is to tonify the Kidney and clear the Heart.
This syndrome is characterized by the ability to see far but inability to see near. This is due to insufficient Yin essence and excess Yang (deficiency fire). The pathology lies in the Water organ (Kidney); thus, the visual brilliance scatters and cannot converge for near vision. Treatment focuses on balancing the Heart and Kidney. When Heart and Kidney are balanced, Water and Fire harmonize, and Yin and Yang flow smoothly, allowing proper function for both near and far vision.
Blood transforms into fluid, which in the body is known as essence fluid. The lighter and clearer part of the blood ascends to the eyes to form ointment-like fluids. Indulgence in lust, irregular eating habits, extreme physical labor, or intense weeping all consume Yin essence. When Yin essence is deficient and Yang fire becomes hyperactive, the fiery nature causes emission outward. The Yin essence-water cannot control the fire, so the fire flares outward, illuminating distant objects but failing to control the internal heat. Those who fail to control the fire and instead provoke it develop internal cataracts. It is suitable to take:
Dizhi Wan (Eucommia and Rehmannia Pill): Treats the ability to see far, attributed to fire; and inability to see near, attributed to lack of water. Treatment should focus on tonifying Kidney water.
Ingredients: Tianmendong (Asparagi Radix, heart removed), Shengdihuang (Rehmanniae Radix, baked dry, four taels), Zhike (Aurantii Fructus, pith removed), Juhua (Chrysanthemi Flos, three taels each).
Preparation and Administration: Grind into fine powder. Form pills using refined honey, sized like sesame seeds. Take one hundred pills per dose, administered after meals with tea infusion.
Liujun Dihuang Wan (Six-Ingredient Pill with Rehmannia): Treats Spleen and Stomach disorders, as well as symptoms in youth such as water deficiency with hyperactive fire and Yin deficiency; Liver and Kidney blood deficiency, dryness-heat with thirst, dysuria and retention, phlegm-qi obstruction upward, wind pathogens invading excessive qi, scrofula and lymphatic nodules, limb convulsions, abnormal eye movements, coughing with hemoptysis, dizziness, dry and painful throat, mouth and tongue ulcers, spontaneous sweating and bloody stool, congenital insufficiency, emaciation, fontanelle delay and aphonia, photophobia and downward gaze, five delays and five softnesses, Kidney and Liver Gan syndromes, early sexual activity leading to essence and blood depletion. Damage to all five Zang organs; suitable for any deficiency syndrome of the Liver and Kidneys. Use this formula to nourish the source of transformation; its merits are incalculable.
Ingredients: Baifuling (Poria, steamed with milk, dried, one and a half taels each), Danpi (Moutan Cortex, stir-fried, one and a half taels each), Zexie (Alismatis Rhizoma, lightly stir-fried, one tael), Shanyao (Dioscoreae Rhizoma, mixed with wine, steamed, dried), Shanzhuyu (Corni Fructus, pitted, steamed with wine, baked dry, two taels each), Shudihuang (Prepared Rehmanniae Radix, four taels, boiled in half wine and half water until soft, mashed into paste and added separately).
Preparation and Administration: Grind the remaining ingredients into fine powder. Form pills using refined honey, sized like sesame seeds. Take three qian per dose, administered on an empty stomach with light salt water. For patients with spermatorrhea, add Li Shell (Ostreae Concha, quenched in red water, powdered, baked dry, three taels). Avoid radishes.
The Kidney is the Water organ. When water is deficient, Dragon-Lei Fire (Ministerial Fire) rises unchecked without fear. As Wang Qixuan stated: "Strengthen the master of water to control the sunlight." This corresponds to the Classic saying: "Seek its affiliation to diminish it." Rehmannia has a rich flavor and belongs to Yin within Yin; it specifically tonifies the Kidney and fills essence, thus serving as the Sovereign drug. Corni has a sour taste and enters the Liver meridian, reflecting the principle of treating Liver and Kidney together (Yi-Gui same treatment). Since the Kidney governs storage, the astringent property of sour flavors is appropriate, making it a Minister drug. Dioscorea has a sweet taste and enters the Spleen meridian, helping to stabilize the element that controls water (Earth controls Water), also serving as a Minister drug. Moutan also enters the Liver meridian; its function is primarily to promote circulation, assisting Corni’s astringency by preventing excessive stagnation. Poria also enters the Spleen meridian; its function is primarily diuretic and draining, assisting Dioscorea’s potential stagnation. Moreover, Poria is white and belongs to Metal, nourishing the Lung, embodying the principle of "tonifying the mother when deficient" (Metal generates Water, Lung is the Mother of Kidney). Zexie has three functions: first, promotes urination to drain Ministerial Fire; second, resolves the stagnation of Rehmannia and guides other herbs rapidly to the Kidney meridian; third, possesses both tonifying and draining properties, avoiding the risk of adverse interactions or excessive Qi generation among other herbs. Thus, it serves as the Envoy drug. This pill is a sacred remedy for tonifying the Kidney, but ignorant people despise it for its slow action. This reflects four errors in prescription: First, if Rehmannia is not from Huaqing, its efficacy is shallow; Second, if Rehmannia is not self-prepared, it lacks craftsmanship and may react with iron vessels; Third, reducing the dosage due to suspicion of Rehmannia’s cloying nature weakens the Sovereign drug; Fourth, reducing Zexie due to aversion to its draining nature weakens the Envoy drug. Falling into these four errors and then blaming the medicine for ineffectiveness is unjust!