神水将枯。视珠外神水干涩不润。如蜒蚰之光。乃火气郁蒸。膏泽内竭之候。凡见此证。必
成内障。若失调理。久久瞳
神紧小。内结云翳。渐成瞽疾。盖瞳神小者。肝热肾虚。瞳神大者。肝虚肾热。此为肝热肾虚。
初起珠头坠痛。大 微红。犹见三光者。六味地黄丸加麦冬、五味。切忌吹点。若小儿素有疳证。
粪如鸭溏而目疾。神将枯者死。热结膀胱证。神水将枯者。盖下水热蒸不清。故上亦不清。澄其
源而流自清矣。
目病六气不和。或有风邪所击。脑筋如拽神珠。不待转运而自蓦然察上。蓦然察下。下之不
能上。上之不能下。或左或右。倏易无时。轻则气定脉偏而珠歪。如神珠将反之状。甚则翻转而
为瞳神反背矣。治用姜汁调香油。摩擦目睥及迎香上星风池风府太阳等穴。若暴起者。宜用里药。
兼升补即愈。如神效黄 汤、补中益气汤并加羌活。风热势盛。通肝散。
神珠将反者。谓目珠不正。虽欲转而不能转。乃风热攻脑。筋络牵急。吊偏神珠。是以不能
运转。甚则其中自闻聒聒有声如响。石膏散、通肝散选用。血分有滞者。目赤肿痛。酒煎散加五
灵脂。失治。有反背之患。
瞳神反背者。因风热搏击其珠。而斜翻转侧。通肝散加全蝎、钩藤。或黄 建中加羌活、归
身、蝎梢。虚则神效黄 、补中益气皆可取用。或云即是瞳神发白。北人声韵相似也。盖发白即
是内障。故宜金针拨之。若前所言。即神珠将反之暴者。非真反背也。安有目系内系而能反背之
理。医者审之。
神水将枯。观察眼球外部，神水（眼内维持透明的液体）干涩且不滋润。光泽如同蜗牛爬行留下的痕迹般暗淡。这是火气郁结蒸腾，导致体内膏泽（滋养眼目的精微物质）内部枯竭的征象。凡是出现这种证候，必然发展为内障（晶状体或玻璃体混浊等内部病变）。如果失去调理，久而久之瞳神（瞳孔及其功能）紧缩变小，内部结成云翳（角膜瘢痕或白内障），逐渐形成失明之疾。大概而言，瞳神缩小者，是肝热肾虚；瞳神散大者，是肝虚肾热。此处所述为肝热肾虚。初起时眼球头部坠痛，轻微发红，尚能看见三光（日、月、星之光，指视力尚存）的，用六味地黄丸加麦冬、五味子。切忌使用吹药或点眼药。若小儿素有疳积证，大便如鸭粪稀溏且患眼疾，神水将枯的，预后不良属死证。
热结膀胱证。神水将枯者，是因为下焦水液受热蒸腾而不清澈，所以上部眼目也不清澈。澄清源头则水流自然清澈。
目病因六气（风、寒、暑、湿、燥、火）不和，或有风邪侵袭。感觉脑筋像被拉扯一样，神珠（眼球）不待转动而突然向上看，突然向下看，想下不能下，想上不能上，或向左或向右，随时变化不定。轻则气机安定但脉象偏斜，眼球歪斜，呈现神珠将要翻转的状态。重则完全翻转成为瞳神反背（瞳孔移位至眼角）。治疗用姜汁调和香油，摩擦眼睑及迎香、上星、风池、风府、太阳等穴位。若是突然发作的，宜用里药，兼用升提补益之法即可痊愈。如神效黄芪汤、补中益气汤并加羌活。若风热势盛，用通肝散。
神珠将反者，是指眼球位置不正，虽然想转动却不能转动，这是风热攻冲脑部，筋络牵拉紧急，吊偏神珠，因此不能运转。严重时其中自己听到嗡嗡作响的声音如回响。选用石膏散、通肝散。血分有瘀滞者，眼球红赤肿痛，用酒煎散加五灵脂。失治，有反背的隐患。
瞳神反背者，因风热搏击眼球，导致斜向翻转侧移。用通肝散加全蝎、钩藤。或用黄芪建中汤加羌活、当归身、蝎梢。虚证则神效黄芪汤、补中益气汤皆可取用。有人说这就是瞳神发白，北方人声音韵母相似罢了。大概发白即是内障，所以适宜用金针拨障术。若前面所说的，就是神珠将反的暴急情况，并非真正的反背。哪有目系（视神经及连接组织）在内部固定却能真正反背的道理。医者需审慎辨别。
Shen Shui Jiang Ku (Impending Depletion of the Divine Water). Observing the exterior of the eyeball, the Shen Shui (divine water, referring to the aqueous humor and vitreous body that maintain ocular transparency) is dry, astringent, and unmoistened. Its luster is dim, resembling the trail left by a slug. This is a sign of fire qi stagnating and steaming, leading to the internal exhaustion of Gao Ze (nutritive essence for the eyes). Whenever this syndrome appears, it will inevitably develop into Nei Zhang (internal cataract or opacity of the lens/vitreous). If proper regulation is neglected, over time the Tong Shen (pupil and its function) will tightly constrict, with cloud-like nebulas forming internally, gradually progressing to blindness. Generally speaking, a constricted pupil indicates Liver Heat and Kidney Deficiency; a dilated pupil indicates Liver Deficiency and Kidney Heat. The case described here involves Liver Heat and Kidney Deficiency. In the initial stage, there is a dragging pain at the head of the eyeball, slight redness, yet vision of the "Three Lights" (sun, moon, stars, indicating residual visual acuity) remains. Treat with Liu Wei Di Huang Wan (Six-Ingredient Rehmannia Pill) added with Mai Dong (Ophiopogon Tuber) and Wu Wei Zi (Schisandra Berry). Strictly avoid using blowing powders or eye drops. If a child has a pre-existing Gan Zheng (infantile malnutrition syndrome), presents with duck-dung-like loose stools, suffers from eye disease, and shows signs of impending depletion of Shen Shui, the prognosis is fatal.
Re Jie Chang Bang Zheng (Syndrome of Heat Accumulation in the Bladder). Regarding the depletion of Shen Shui: because the water in the lower jiao is steamed by heat and becomes turbid, the upper part (eyes) also becomes turbid. Clarifying the source ensures the flow becomes clear.
Eye diseases arise from the disharmony of the Six Qi (Wind, Cold, Summerheat, Dampness, Dryness, Fire), or attack by Wind Evil. The sensation is as if the brain nerves are being pulled; the Shen Zhu (eyeball) suddenly looks up without intention to rotate, then suddenly looks down; unable to look down when desired, unable to look up when desired; moving left or right, changing unpredictably. Mild cases present with stabilized Qi but deviated pulse, causing the eyeball to tilt, resembling the state of the Shen Zhu about to invert. Severe cases result in complete inversion, becoming Tong Shen Fan Bei (inversion/dislocation of the pupil). Treatment involves mixing Ginger Juice with Sesame Oil and massaging the eyelids and acupoints Ying Xiang, Shang Xing, Feng Chi, Feng Fu, and Tai Yang. For acute onset, interior-regulating herbs should be used, combined with lifting and tonifying methods for recovery. Formulas include Shen Xiao Huang Qi Tang (Miraculous Efficacy Astragalus Decoction) or Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) both added with Qiang Huo (Notopterygium Rhizome). If Wind-Heat is vigorous, use Tong Gan San (Liver-Penetrating Powder).
Shen Zhu Jiang Fan refers to the abnormal position of the eyeball, where rotation is attempted but impossible. This is caused by Wind-Heat attacking the brain, causing spasms and tension in the meridians and collaterals, pulling the Shen Zhu to one side, thus preventing movement. In severe cases, a buzzing sound like an echo may be heard internally. Selectively use Shi Gao San (Gypsum Powder) or Tong Gan San. For blood stasis in the Blood Division, presenting with red, swollen, and painful eyes, use Jiu Jian San (Wine-Decoction Powder) added with Wu Ling Zhi (Trogopterus Feces). Failure to treat properly carries the risk of inversion.
Tong Shen Fan Bei occurs due to Wind-Heat battling the eyeball, causing it to slant and invert sideways. Use Tong Gan San added with Quan Xie (Scorpion) and Gou Teng (Uncaria Ramulus cum Uncis). Alternatively, use Huang Qi Jian Zhong Tang (Astragalus Decoction for Building the Middle) added with Qiang Huo, Dang Gui Shen (Angelica Sinensis Root Tip), and Xie Shao (Scorpion Tail). For deficiency patterns, Shen Xiao Huang Qi Tang or Bu Zhong Yi Qi Tang are applicable. Some claim this is identical to Tong Shen Fa Bai (Whitening of the Pupil), attributing the similarity to northern dialect pronunciation. Essentially, whitening refers to Nei Zhang (internal cataract), which is appropriately treated with Jin Zhen Bo Zhang (Golden Needle Cataract Extraction). What was previously described as the acute phase of Shen Zhu Jiang Fan is not true Fan Bei. How could the Eye System (optic nerve and connecting tissues), which is anchored internally, truly invert? Physicians must examine this carefully.