目赤有三。一曰风助火郁于上。二曰火盛。三曰燥邪伤肝。戴复庵云。赤眼有三。有气毒。
有热壅。有时眼。无非血壅肝经所致。属表者。羌活胜风汤。属里者。泻肝散等药。赤久生翳膜
者。春雪膏、蕤仁膏选用。并用碧云散吹鼻。目赤肿。足寒者。必用时时温洗其足。并详赤脉处
属何经治之。王节斋云。眼赤肿痛。古方用药。内外不同。在内汤散。用苦寒辛凉之药以泻火。
在外点洗。用辛热辛凉之药以散邪。故点药莫要于冰片。而冰片大辛大热。因其性辛甚。故
借以拔出火邪而散其热气。世俗不知冰片为劫药。误认为寒。常用点药。遂致积热入目。昏暗障
翳。又不知忌寒凉而妄将寒凉冷药挹洗。常致昏暗者。比比皆是。赤眼肿痛。脾虚不能饮食。肝
脉盛。脾脉弱。用凉药治肝则脾愈虚。暖药暖脾则肝益甚。惟于平和药中。倍加肉桂杀肝而益脾。
一举两得。经云。木得桂而枯。更以芍药制之。散热存阴之捷法也。人乳点眼。久病昏暗极效。
以乳与血液同源。目得血而能视也。凡赤而肿痛者。当散湿热。赤而干痛者。当散火毒。赤而多
泪者。当散风邪。赤而不痛者。当利小便。先左赤而传右者。为风热挟火。散风为主。勿兼凉药。凉
能郁火也。先右赤而传左者。痰湿挟热。泻火药中。必兼风药。风能胜湿也。凡赤甚肿痛。于上
睥开出恶血。则不伤珠。
瘀血灌睛证 此证为病最毒。若人偏执己见。不用开镰者。其目必坏。初起不过红赤。次后
紫胀。及后则白珠皆胀起。在睥则肿胀如杯。在珠则白轮涌起。失治必有青黄牒出HT 凸之祸。
凡见白珠赤紫。睥肿虬筋紫胀。传点不退。必有瘀滞在内。可翻睥内视之。若睥内色晕。泛浮椒
疮。或粟疮者。皆用导之。导后服宣明丸。
血灌瞳神证 因毒血灌入金井瞳神水内也。清浊相混。时痛涩。红光满目。 如隔绢。看
物若烟雾中。此证有三。者肝肾血热灌入瞳神者。多一眼先患。后相牵俱损。最难得退。有撞损
血灌入者。虽甚而退速。有针内障。失手拨着黄仁。瘀血灌入者。三证治法颇同。用大黄当归散。
有翳退翳。活法治之。
赤脉贯睛证 不论粗细多少。但贯到风轮。经过瞳外接连气轮者。最不易治。细者稍轻。粗
者尤重。贯过者有变证。丝粗及有傍丝虬乱者有变证。凡各障外有此等脉罩者。虽在易退之证。
亦退迟也。贯虽未连。而侵入风轮。皆不易退。起于大 者。心之实火也。宜洗心散。筋脉大者。
用小锋针挑拨。起于小 者。心之虚火也。宜导赤散。不必挑。又
有暴横嗜酒之人。赤脉灌睛。乃生相也。不在此例。
赤丝乱脉证 病生在气轮白珠上。有丝脉纵横。或稀密粗细不等。有痛不痛。有泪无泪。羞
明不羞明。但常常如是。久而不愈也。非若天行客风暴壅。赤脉贯睛之比。当验其大脉从何部分
而来。或穿连其位。即别其所患在何经络以治之。治外者。细脉易退。大脉虬紫者。退迟。必须
耐久去尽。庶无再来之患。不然。他日犯禁。其病复发。凡丝脉沿到风轮上者。病最重而能变。
凡见丝脉虬紫。内服外点。点时细缩。不点即胀。久久亦然。及因而激动病变者。珠虽不紫。睥
虽不肿。亦有积滞在络中幽深之处。揭开上睥深处看之。其内必有不平之色在焉。略略导之。不
可过。过则有伤真血。水亏膏涩。目力昏弱之患。点以石燕丹。服用大黄当归散、酒煎散之类。
白睛黄赤证 人有白睛渐渐黄赤者。皆为酒毒。脾经湿伤。肝胆邪火上溢肺经故也。五苓散
加茵陈。甚则黄连解毒加山栀、胆草。
目赤（眼睛发红）有三种情况。一是风邪助长火气，郁结于上部；二是火气过盛；三是燥邪损伤肝脏。戴复庵说，赤眼也有三种：有因气毒引起的，有因热邪壅滞引起的，有时行疫气引起的，无非都是血瘀壅滞在肝经所致。属于表证的，用羌活胜风汤；属于里证的，用泻肝散等药物。如果赤眼日久生出翳膜，可选用春雪膏、蕤仁膏，并配合使用碧云散吹入鼻腔。眼睛红肿且脚冷的，必须经常温水洗脚，并详细查看红脉所在的经络进行针对性治疗。王节斋说，眼睛红肿疼痛，古方用药内外有别。内服汤剂散剂，用苦寒、辛凉的药物以泻火；外用点眼或清洗，用辛热、辛凉的药物以疏散邪气。所以点眼药没有比冰片更重要的了，而冰片性质大辛大热，因其辛味极重，所以借其性拔出火邪并散发热气。世俗之人不知道冰片是劫夺病邪的药，误认为它是寒性的，常用它点眼，导致积热进入眼睛，造成视力昏暗、障翳。又有人不知道忌用寒凉药，胡乱用寒凉冷药清洗眼睛，常导致视力昏暗的，比比皆是。对于赤眼肿痛，若脾虚不能饮食，肝脉盛而脾脉弱，用凉药治肝则脾更虚，用暖药暖脾则肝火更甚。只有在平和的药物中，加倍加入肉桂以抑制肝火并补益脾气，一举两得。《内经》说：“木得桂而枯”，再加上芍药来制约它，这是散热存阴的快捷方法。人乳点眼，对久病视力昏暗极为有效，因为乳汁与血液同源，眼睛得到血液滋养才能视物。凡是眼睛红且肿痛者，应当疏散湿热；红且干痛者，应当疏散火毒；红且多泪者，应当疏散风邪；红但不痛者，应当通利小便。先左眼红传至右眼的，是风热挟火，以疏散风邪为主，不要兼用凉药，因为凉性能使火气郁结。先右眼红传至左眼的，是痰湿挟热，在泻火药中必须兼用风药，因为风能胜湿。凡是红得非常严重且肿痛，在上眼睑挑出恶血，就不会损伤黑睛（眼球）。
瘀血灌睛证 此证病情最毒。如果患者偏执己见，不用手术开镰放血，眼睛必然毁坏。初起只是红赤，随后变成紫胀，后来白珠全部胀起，眼睑肿胀如杯状，黑睛周围白轮涌起。失治必有青黄色脓液流出、眼球凸出的祸患。凡是见到白珠赤紫，眼睑肿胀、血管迂曲紫胀，经过点药治疗不退的，必定有瘀滞在内，可以翻开眼睑向内观察。如果眼睑内颜色晕染，泛浮椒疮或粟疮，都应用导引法排出瘀血。导引后服用宣明丸。
血灌瞳神证 因毒血灌入金井（瞳孔）内的神水之中。清浊之气相混，时常疼痛涩滞，满眼红光，看东西好像隔着绢纱，如在烟雾中一般。此证有三种：一种是肝肾血热灌入瞳神的，多是一只眼先患病，后来牵连双眼都受损，最难消退。一种是撞击损伤导致血灌入的，虽然症状严重但消退快。一种是针刺内障时，失手拨动黄仁（虹膜），导致瘀血灌入的。这三种证候的治疗方法大致相同，用大黄当归散。若有翳膜则退翳，灵活施治。
赤脉贯睛证 不论血管粗细多少，只要贯穿到风轮（黑睛），经过瞳神外侧接连气轮（白睛）的，最不容易治疗。细的稍轻，粗的尤其严重。贯穿过去的会有变证，血管粗且有旁支迂曲混乱的会有变证。凡是各种障外有此等血管覆盖的，即使在容易消退的证候中，消退也缓慢。贯穿虽未连接，但侵入风轮的，都不易消退。起于大络的，是心之实火，宜用洗心散。筋脉粗大的，用小锋针挑拨。起于小络的，是心之虚火，宜用导赤散，不必挑刺。又有暴戾横蛮、嗜酒的人，出现赤脉灌睛，那是生相（凶兆），不在此例。
赤丝乱脉证 病生在气轮白珠上，有丝状血管纵横交错，或疏密粗细不等，有痛或不痛，有泪或无泪，怕光或不怕光，只是常常如此，久而不愈。不像天行客风暴壅（急性传染性眼病）和赤脉贯睛那样严重。应当查验大血管从何部分而来，或者穿连其位置，从而辨别所患在哪条经络进行治疗。治疗外障的，细血管容易消退，大血管迂曲紫红的，消退缓慢，必须耐心彻底去除，才不会再复发。否则，日后触犯禁忌，疾病会复发。凡是丝状血管延伸到风轮上的，病情最重且能发生变证。凡是见到丝状血管迂曲紫红，内服外点，点药时血管细缩，不点药即膨胀，久而久之也是如此。以及因此激动病变的，虽然黑睛不紫，眼睑不肿，也有瘀滞积聚在络脉幽深之处，揭开上眼睑深处观看，里面一定有不平的颜色存在。稍微导引一下即可，不可过度，过度则会损伤真血，导致水亏膏涩、视力昏弱的祸患。点以石燕丹，服用大黄当归散、酒煎散之类的药物。
白睛黄赤证 有人白睛渐渐变黄赤的，都是因为酒毒，脾经湿气受伤，肝胆邪火上溢至肺经所致。用五苓散加茵陈。严重的，用黄连解毒汤加山栀、胆草。
Redness of the eyes (Mu Chi) presents in three forms. First, wind aids fire, causing stagnation in the upper body; second, excessive fire; third, dryness pathogen injuring the Liver. Dai Fu'an stated that red eyes also have three types: those caused by Qi toxicity, those caused by heat stagnation, and epidemic eye diseases. All are essentially due to blood stagnation and congestion in the Liver Meridian. For exterior syndromes, use Qianghuo Shengfeng Tang (Notopterygium Decoction for Overcoming Wind); for interior syndromes, use Xiegan San (Liver-Draining Powder) and similar formulas. If redness persists and leads to the formation of corneal opacity (Yi Mo), select Chunxue Gao (Spring Snow Ointment) or Ruren Gao (Buckthorn Seed Ointment), and apply Biyun San (Green Cloud Powder) insufflated into the nasal cavity. For swollen and red eyes accompanied by cold feet, frequent warm foot baths are essential, and treatment should be targeted according to the meridian where the red vessels are located. Wang Jiezhai stated that for red, swollen, and painful eyes, ancient prescriptions differentiate between internal and external treatments. Internally, decoctions and powders use bitter-cold and acrid-cool herbs to drain fire. Externally, eye drops and washes use acrid-hot and acrid-cool herbs to disperse pathogens. Therefore, among eye drops, none is more important than Bingpian (Borneolum Syntheticum). Bingpian is extremely acrid and hot; due to its intense acridity, it helps extract fire pathogen and dissipate heat. Laypeople do not know that Bingpian is a "robbery" herb (a strong agent that rapidly eliminates pathogens) and mistakenly consider it cold. Frequent misuse leads to accumulated heat entering the eyes, causing dim vision and opacities. Furthermore, ignorance of avoiding cold herbs leads to the reckless use of cold washes, often resulting in dim vision, which is common. For red, swollen, and painful eyes with Spleen deficiency manifesting as poor appetite, if the Liver pulse is excess and the Spleen pulse is weak, using cold herbs to treat the Liver further damages the Spleen, while warming herbs to tonify the Spleen exacerbates Liver fire. The solution is to add a doubled dose of Rougui (Cinnamomi Cortex) to mild harmonizing herbs to suppress Liver fire and benefit the Spleen, achieving two goals with one action. The Classic states: "Wood withers when it meets Cinnamon." Combined with Shaoyao (Paeoniae Radix Alba) to restrain it, this is an efficient method for clearing heat and preserving Yin. Human milk applied to the eyes is highly effective for long-term dim vision, as milk shares the same source as blood, and the eyes see only when nourished by blood. For redness with swelling and pain, disperse damp-heat; for redness with dryness and pain, disperse fire-toxin; for redness with excessive tearing, disperse wind-pathogen; for redness without pain, promote urination. If redness starts in the left eye and spreads to the right, it is wind-heat carrying fire; prioritize dispersing wind and avoid cold herbs, as cold nature causes fire stagnation. If redness starts in the right eye and spreads to the left, it is phlegm-dampness carrying heat; include wind-dispersing herbs in fire-draining formulas, as wind can overcome dampness. In cases of severe redness, swelling, and pain, puncturing the upper eyelid to release bad blood prevents damage to the eyeball (Zhu).
Blood Pouring into the Eye Syndrome (Xue Guan Jing Zheng) This condition is most toxic. If patients insist on their own views and refuse surgical incision (opening the vein), the eye will surely be destroyed. Initially, there is only redness; subsequently, purple swelling occurs; later, the sclera (white part) swells up, the eyelids swell like a cup, and the limbus bulges. Without proper treatment, there is a risk of yellow-green discharge and proptosis. Whenever white sclera appears red-purple, eyelids are swollen with tortuous purple vessels, and point-treatment fails to resolve it, there must be internal blood stasis. The eyelid can be everted for inspection. If the inner eyelid shows discoloration, floating papillae (Jiao Chuang) or follicles (Su Chuang), drainage methods should be used. After drainage, administer Xuanming Wan.
Blood Pouring into the Pupil Syndrome (Xue Guan Tong Shen Zheng) This occurs when toxic blood pours into the Shen Water within the pupil (Jin Jing). Clear and turbid energies mix, causing intermittent pain and astringency, full-field red glow, blurred vision as if looking through silk or in smoke. There are three types: 1. Liver-Kidney blood heat pouring into the pupil, usually starting in one eye and spreading to both, making recovery difficult. 2. Traumatic blood infiltration, which resolves quickly despite severity. 3. Iatrogenic injury during cataract surgery, where accidental manipulation of the iris causes blood infiltration. Treatment for all three is similar: use Dahuang Danggui San. Treat opacities flexibly.
Red Vessels Penetrating the Eye Syndrome (Chi Mai Guan Jing Zheng) Regardless of thickness or number, if vessels penetrate the Wind Wheel (cornea), passing outside the pupil to connect with the Qi Wheel (sclera), it is very difficult to treat. Thin vessels are milder; thick ones are severe. Penetration leads to complications; coarse vessels with tortuous branches indicate complications. Any vascular coverage over various opacities, even in easily resolvable cases, heals slowly. Penetration into the Wind Wheel, even if not connected, is hard to resolve. Originating from large collaterals indicates Heart Excess Fire, treated with Xixin San. Large tendons/vessels require pricking with a small sharp needle. Originating from small collaterals indicates Heart Deficiency Fire, treated with Daochi San, no need for pricking. Violent, alcohol-abusing individuals presenting with red vessels pouring into the eye exhibit a malignant sign, excluded from these standard examples.
Chaotic Red Threads Syndrome (Chi Si Luan Mai Zheng) Pathology arises on the Qi Wheel (sclera) with crisscrossing thread-like vessels, varying in density and thickness. Symptoms include pain or lack thereof, tearing or absence thereof, photophobia or lack thereof. It persists chronically without healing, unlike epidemic acute conjunctivitis or Red Vessels Penetrating the Eye. One must trace the origin of the main vessel to identify the affected meridian for treatment. For external disorders, thin vessels resolve easily; tortuous purple thick vessels resolve slowly and require persistent treatment to prevent recurrence. Otherwise, violating dietary/lifestyle taboos will cause relapse. Thread-like vessels extending to the Wind Wheel indicate severe pathology prone to transformation. Tortuous purple threads respond to internal and external treatment: application shrinks them, withdrawal causes dilation. Even without black cornea discoloration or eyelid swelling, deep stasis may exist in the collaterals. Inspect the deep upper eyelid for irregular coloration. Mild drainage suffices; excessive drainage injures true blood, leading to Yin deficiency, dry eye, and visual impairment. Apply Shiyan Dan internally/externally; take Dahuang Danggui San or Jiu Jian San.
White Sclera Yellow-Red Syndrome (Bai Jing Huang Chi Zheng) Gradual yellow-red discoloration of the white sclera is due to alcohol toxin damaging the Spleen Meridian's dampness, allowing Liver-Gallbladder evil fire to overflow into the Lung Meridian. Use Wuling San with Yinchen (Artemisiae Scopariae Herba). Severe cases use Huanglian Jiedu Tang with Zhizi (Gardeniae Fructus) and Dachangcao (Scutellariae Barbatae Herba).