《龙木禅师论》曰∶人有双眸，如天之有两曜，乃一身之至宝，聚五脏之精华。其五轮
者，应五行，八廓者，应八卦。凡所患者，或因过食五辛，多啖炙爆，热餐面食，饮
酒不已，房室无节，极目远视，数看日月，频挠心火，夜读细字，月下观书，抄写多能，雕
镂细作，博奕不休，久被烟火，泣泪过多，刺头出血太甚，若此者，俱散明之本。复有驰骋
田猎，冲冒尘沙，日夜不息者，亦伤目之由。又有少壮之时，不自保惜，逮自四旬，以渐昏
蒙。故善卫养者，才至中年，无事常须冥目，勿使他视，非有要事，不宜辄开，则虽老而视
不衰。大抵营卫顺则斯疾无由而生，营卫衰则致病多矣。且伤风冷则泪出，虚烦则昏蒙，劳
力则 赤，白肿则肺家受毒，生疮则风热侵肺，黄乃酒伤于脾，血灌瞳人及赤色，俱是心家
有热，羞明见红花为肝邪，黑花则肾虚，青花胆有寒，五色花是肾虚有热，不可一概为治；
若虚不补而实不泻，亦难收救。然上虚乃肝虚，下虚乃肾虚，肝虚则头晕耳聋目眩，肾虚则
虚壅生花，耳作蝉鸣，大宜补肝益肾。其有热泪交流，两睑赤痛，乃肝之热极；迎风有泪，
为肾虚客热，凉肝泻肾，必得其宜。至于五脏，各以类推。虚则生寒，实则生热，补泻之用
，须在参详，毫厘之差，千里之谬。余则无非有所触动，或大病之后，所患不一。至于暴赤
一证，多因泛热冲上，或眠食失时，饱食近火得之，加以劳役失于调摄，过食毒物，变成恶
证。医者不源本始，但知暴赤属阳，或以散血之剂，或以凉心之药，纵使退散，遂致脾经受
寒，饮食不进，头目虚烦，五脏既虚，因成内障。亦有见其不进饮食，俾更服热药，遂致暴
燥热气上攻，昏涩眵泪，或犯盛怒，辛苦重劳，遂生 肉；心气不宁，风热交并，变为攀睛
；证状不一，是为外障。又加读书博奕，算劳过度，名曰肝劳，不可但投以治肝之剂
，及作他证治之，终于罔效，惟须闭目珍护，不及远视，庶乎疾瘳。
若乎患风疹者，必多眼暗，先攻其风，则暗自去。妇人胎前产后，用药亦须避忌。小儿
所患，切宜善治，惟略加淋洗。若披镰针灸，断不可施，犹戒用手频揉，或因兹睛坏
，至于莫救。以上诸证，专是科者宜留意焉。
杨仁斋曰∶眼者，五脏六腑之精华，如日月丽天而不可掩者也。其大 属心，其白睛属
肺，其乌珠属肝，其上下睑胞属脾，而中之瞳仁属肾。是虽五脏各有证应，然论其所主，则
瞳子之关系重焉。何以言之，夫目者，肝之外候也，肝属木，肾属水，水能生木，子肝母肾
也，焉有子母而能相离者哉？故肝肾之气充，则精彩光明，肝肾之气乏，则昏蒙眩晕。若乌
轮赤晕，刺痛浮浆，此肝热也；燥涩清泪，枯黄绕睛，此肝虚也；瞳人开大，淡白偏斜，此
肾虚也；瞳人集小，或带微黄，此肾热也；一虚一实，以此验之。然肝肾之气，相根据而行，
孰知心者神之舍，又所以为肝肾之副焉，所谓一而二，二而一者也。何则？心主血，肝藏血
，凡血热冲发于目者，皆当清心凉肝，又不可固执水生木之说。夫眼以轻膜裹水，照彻四方
，溯源反本，非天一生水，又孰为之主宰乎？
析而论之，则拘急牵飕，瞳青胞白，痒而清泪，不赤不痛，是谓之风眼。乌轮突起，胞
硬红肿，眵泪湿浆，裹热刺痛，是谓之热眼。眼浑而泪，胞肿而软，上壅朦胧，酸涩微赤，
是谓之气眼。其或风与热并，则痒而浮赤。风与气搏，则痒涩昏沉。血热交聚，故生淫肤、
粟肉、红缕、偷针之类。气血不至，故有眇视、胞垂、雀眼、盲障之形。淡紫而隐红者为虚
热，鲜红而妒赤者为实热。两 呈露生 肉者，此心热血旺，白睛红膜如伞纸者，此气滞血
凝。热证，瞳人内涌，白睛带赤；冷证，瞳人青绿，白睛枯槁。眼热经久，复为风冷所乘则
赤烂；眼中不赤，但为痰饮所注则作疼。肝气不顺而挟热，所以羞明；热气蓄聚而伤饱，所
以饱合。吁！此外证之大概然尔。然五脏不可阙一，脾与肺独无预何也？曰∶白睛带赤，或红
筋者，其热在肺；上胞下胞，或目唇间如疥点者，其热在脾。脾主味也，五味之秀养诸中，
则精华发见于其外。肺主气也，水火升降，营卫流转，非气孰能使之？前所谓五脏各有五证
应者，于此又可推矣。
虽然，眼之为患，多生于热，其间用药，大抵以清心凉肝、调血顺气为先。有如肾家恶
燥，设遇虚证，亦不过以当归、地黄辈润养之，则轻用温药不可也。况夫肺能发燥，肝亦好
润，古方率用杏仁、柿干、饴糖、沙蜜为佐，果非润益之意乎。至于退翳一节，尤关利害。
凡翳起于肺家受热，轻则朦胧，重则生翳。珍珠翳，状如碎米者易散；梅花翳，状如梅花瓣
者难消。虽翳自热生，然治法先退翳而后退热者，去之犹易；若先去赤热，则血为之冰，而
翳不能去。其有赤眼，与之凉药过多，又且涤之以水，不反掌而冰凝。眼特一团水耳，水性
清澄，尤不可规规于点洗。喜怒失节，嗜欲无度，穷役目力，泣涕过伤，冲风凌雾，当暑冒
日，不避烟火，饮啖热多，此皆患生于脏腑者也，专恃点洗可乎哉？惟有静坐澄神，爱护目
力，放怀息虑，心逸日休，调和饮食以养之，斟酌药饵以平之，明察秋毫，断可必矣。
张子和曰∶圣人虽言目得血而能视，然血亦有太过不及也，太过则壅闭而发痛，不及则
目耗竭而失明，故年少之人多太过，年老之人多不及，但年少之人则无不及，年老之人间犹
有太过者，不可不察也。夫目之内 ，太阳经之所起，血多气少。目之锐 ，少阳经也，血
少气多。目之上纲，太阳经也，亦血多气少。目之下纲，阳明经也，血气俱多。然阳明经起
于目两旁交 之中，与太阳、少阳俱会于目，惟足厥阴经连于目系而已。故血太过者，
太阳、阳明之实也，血不及者，厥阴之虚也。故出血者，宜太阳、阳明，盖此二经血多故也
。少阳一经不宜出血，血少故也。刺太阳、阳明出血则愈明，刺少阳出血则愈昏，要知无使
太过不及，以血养目而已。凡血之为物，太多则溢，太少则枯。人热则血行疾而多，寒则血
行迟而少，此常理也。
目者，肝之外候也。肝主目，在五行属木。木之为物，太茂则蔽密，太衰则枯瘁矣。夫
目之五轮，乃五脏六腑之精华，宗脉之所聚，其气轮属肺金，肉轮属脾土，赤脉属心火，黑
水神光属肾水，兼属肝木，此世俗皆知之矣。及有目疾，则不知病之理，岂知目不因火则不
病。何以言之？气轮变赤，火乘肺也；肉轮赤肿，火乘脾也；黑水神光被翳，火乘肝与肾也
；赤脉贯目，火自甚也。能治火者，一句可了，故《内经》曰∶热胜则肿。凡目暴赤肿起，
羞明隐涩，泪出不止，暴寒目瞒，皆大热之所为也。治火之法，在药则咸寒吐之、下之，在
针则神庭、上星、囟会、前顶、百会，血之翳者，可使立退，痛者可使立已，昧者可使立明
，肿者可使立消。惟小儿不可刺囟会，为肉分浅薄，恐伤其骨。然小儿水在上，火在下，故
目明。老人火在上，水不足，故目昏。《内经》曰∶血实者宜决之。又曰∶虚者补之，实者
泻之。如雀目不能夜视及内障，暴怒大忧之所致也，皆肝主目血少，禁出血，止宜补肝养肾
。至于暴赤肿痛，皆宜以 针刺前五穴出血而已，次调盐油以涂发根，甚者虽至于再
至于三可也，量其病势，以平为期。子和尝自病目赤，或肿或翳，羞明隐涩，百余日不愈。
眼科张仲安云∶宜刺上星、百会、攒竹、丝空诸穴上出血，又以草茎纳两鼻中，出血约升许
，来日愈大半，三日平复如故，此则血实破之之法也。
李东垣曰∶五脏六腑之精气皆禀受于脾，上贯于目。脾者诸阴之首也，目者血脉之宗也
，故脾虚则五脏之精气皆失所司，不能归明于目矣。心者，君火也，主人之神，宜静而安，
相火代行其令。相火者，胞络也，主百脉，皆荣于目。既劳役运动，势乃妄行，又因邪气所
并而损血脉，故诸病生焉。凡医者不理脾胃，乃养血安神，治标不治本，是不明正理也。若
概用辛凉苦寒之剂，损伤真气，促成内障之证矣。又东垣曰∶能远视不能近视者，阳气不足
，阴气有余也，乃气虚而血盛也。血盛者，阴火有余，气虚者，气弱也，此老人桑榆之象也
。能近视不能远视者，阳气有余，阴气不足也，乃血虚气盛也。血虚气盛者，皆火有余，元
气不足也。火者，元气之贼也。
王海藏曰∶目能远视，责其有火，不能近视，责其无水，宜东垣地黄丸主之。目能近视
，责其有水，不能远视，责其无火，东垣定志丸主之。
愚谓此二子之说，在东垣以不能近视为阳不足，不能远视为阴不足；在海藏以能远视，
不能近视，责其有火无水；能近视，不能远视，责其有水无火，何二子之言相反也？岂无是
非之辨哉？观刘宗浓曰∶阳气者，犹日火也，阴气者，金水也；先儒谓金水内明而外暗，日
火外明而内暗，此自不易之理也。然则内明者利于近，外明者利于远，故凡不能远视者，必
阴胜阳也，不能近视者，必阳胜阴也。由此言之，则海藏是而东垣非矣。若以愚见评之，则
但当言其不足，不必言其有余。故曰∶不能远视者，阳气不足也；不能近视者，阴气不足也
，岂不甚为明显。若东垣以阴气有余，阳气有余，皆谓之火，则能视者皆火病也。海藏云∶
能近视责其有水，能远视责其有火，则当责者亦是病也。此等议论，余则未敢服膺。
王节斋曰∶眼赤肿痛，古方用药，内外不同。在内汤散，则用苦寒辛凉之药以泻其火，
在外点洗，则用辛热辛凉之药以散其邪。故点药莫要于冰片，而冰片大辛热，以其性辛甚，
故借以拔出火邪而散其热气。古方用烧酒洗眼，或用干姜末、生姜汁点眼者，皆此意也。盖
赤眼是火邪内炎，上攻于目，故内治用苦寒之药，是治其本，如锅底之去薪也。然火邪既客
于目，从内出外，若外用寒凉以阻逆之，则火郁内攻不得散矣。故点药用辛热，而洗眼用热
汤，是火郁则发，因而散之，从治法也。世人不知冰片为劫药，而误认为寒，常用点眼，遂
致积热入目而昏暗障翳，故云∶眼不点不瞎者也。又不知外治忌寒凉，而妄将冷水、冷物、
冷药挹洗，致昏瞎者有之。
愚按∶节斋之论，其属有理，然寒凉点眼之法，亦非尽不可用，但用之有宜否耳。盖点
以寒凉，用治火也。若火之微者，其势轻，其邪浅，或偶触烟火风热，或素有标病，邪在肤
腠之间，而热不深者，即用黄连膏之类，暂为清解，亦可去热，浮热去而目自愈，无不可也
。若火之甚者，本于五脏而炽及三阳，欲以一星之寒凉，济此炎炎之盛势，其果能否？此其
解热之功毫无所及，而闭热之害惟目受之矣。故凡病火眼之甚者，点以寒凉，痛必连珠，正
由火郁而然耳。所以，久点寒凉而不效者，未有不致于坏目，此王节斋之论，有不可不察，
而凡治痈疽外证者，亦当并识此义。
薛立斋曰∶前证若体倦少食，视物昏花，或饮食劳倦益甚者，脾胃虚也，用补中益气汤
。眵多紧涩，赤脉贯睛，或脏腑秘结者，用芍药清肝散。若赤翳布白，畏日羞明，或痛如刺
者，上焦风热也，用黄连饮子。若久视生花，畏日，远视如雾者，神气伤也，用神效黄 汤
。大凡午前甚而作痛者，东垣助阳和血汤；午后甚而作痛者，黄连天花粉丸；午后甚而不痛
者，东垣益阴肾气丸主之。
《龙木禅师论》说：人有两只眼睛，就像天上有太阳和月亮一样，是身体中最宝贵的东西，汇聚了五脏的精华。其中的五轮，对应五行；八廓，对应八卦。凡是患眼病的原因，有的因为过量食用葱蒜等五辛食物，多吃烧烤炸物、热烫面食，饮酒无度，房事不节制，长时间极目远眺，频繁观看日月，经常扰动心火，夜间阅读小字，在月光下看书，抄写工作过多，从事精细雕刻，赌博不停，长期处于烟火环境中，哭泣流泪过多，头部放血治疗过于剧烈，像这些情况，都会耗散眼睛的光明。还有骑马打猎，冲撞尘土沙子，日夜不停的人，也是伤眼的缘由。又有年轻力壮时，不懂得保养爱惜自己，等到四十岁以后，视力逐渐昏花模糊。所以善于养生的人，刚到中年，没事时常闭目养神，不要让他视，除非有重要事情，不宜轻易睁眼，这样即使老了视力也不会衰退。大抵营卫之气调和顺畅，这种病就不会产生；营卫之气衰弱，致病就多了。况且受风寒则流泪，虚烦则昏蒙，劳累过度则眼红，白肿则是肺脏受毒，生疮则是风热侵袭肺部，发黄则是酒伤脾脏，血液灌入瞳人及眼色发红，都是心脏有热，怕光见红花是肝邪，黑花则是肾虚，青花则是胆有寒，五色花是肾虚有热，不能一概而论进行治疗；如果虚证不补而实证不泻，也很难挽救。然而上部的虚是肝虚，下部的虚是肾虚，肝虚则头晕耳聋目眩，肾虚则虚壅生花，耳朵像蝉鸣叫，非常应当补肝益肾。如果有热泪交流，两眼睑红肿疼痛，这是肝的热极；迎风流泪，是肾虚客热，清肝泻肾，必须得其适宜。至于五脏，各自可以类推。虚则生寒，实则生热，补泻的运用，必须仔细参详，毫厘之差，千里之谬。其余无非是有触动，或者大病之后，所患不一。至于暴赤这一证候，多因热气泛涌向上，或者睡眠饮食失去规律，饱食后靠近火源得病，加上劳役失于调养摄护，过食有毒食物，变成恶证。医生不探究本源始末，只知道暴赤属于阳证，或者用散血的药剂，或者用凉心的药物，纵使退散，遂导致脾经受寒，饮食不进，头目虚烦，五脏既已虚弱，因而形成内障。也有看见病人不进饮食，便让服用热药，遂致暴躁热气上攻，昏涩眵泪，或者犯大怒，辛苦重劳，遂生胬肉；心气不宁，风热交并，变为攀睛（翼状胬肉）；证状不一，这是外障。又加上读书赌博，算劳过度，名叫肝劳，不可只投以治肝的药剂，以及当作其他证候治疗，最终无效，只有必须闭目珍护，不看远处，或许疾病能痊愈。
至于患风疹的人，必然多有眼暗，先攻其风邪，那么眼暗自然去除。妇人胎前产后，用药也必须避忌。小儿所患眼病，切宜妥善治疗，只需略加淋洗。如果用镰刀割治或针灸，绝对不可施行，还要戒除用手频繁揉搓，如果因此眼睛毁坏，到了无法救治的地步。以上各种证候，专门从事眼科的人应当留意。
杨仁斋说：眼睛，是五脏六腑的精华，像日月挂在天空一样不可掩盖。其中黑珠属心，白睛属肺，乌珠（黑眼球）属肝，上下眼睑属脾，中间的瞳仁属肾。这虽然是五脏各有证候相应，然而论述其所主，瞳子的关系最为重要。为什么这样说呢？眼睛，是肝的外候，肝属木，肾属水，水能生木，肝为子，肾为母，哪有子母能够分离的呢？所以肝肾之气充盛，则精彩光明，肝肾之气匮乏，则昏蒙眩晕。如果乌轮（黑眼球周围）赤晕，刺痛浮浆，这是肝热；燥涩清泪，枯黄绕睛，这是肝虚；瞳人开大，淡白偏斜，这是肾虚；瞳人集小，或带微黄，这是肾热；一虚一实，以此验证。然而肝肾之气，相互依靠而行，谁知道心是神的居所，又是肝肾的辅助，所谓一分为二，二合为一。为什么呢？心主血，肝藏血，凡是血热冲发于眼睛的，都应当清心凉肝，又不可固执于水生木的说法。眼睛以轻膜包裹水液，照彻四方，溯源反本，如果不是天一生水，又有谁主宰它呢？
分析来说，拘急牵飕，瞳青胞白，痒而清泪，不赤不痛，这叫作风眼。乌轮突起，胞硬红肿，眵泪湿浆，裹热刺痛，这叫作热眼。眼浑而泪，胞肿而软，上壅朦胧，酸涩微赤，这叫作气眼。如果风与热并，则痒而浮赤。风与气搏，则痒涩昏沉。血热交聚，所以生淫肤、粟肉、红缕、偷针之类。气血不至，所以有眇视、胞垂、雀眼、盲障之形。淡紫而隐红者为虚热，鲜红而妒赤者为实热。两睑呈露生胬肉者，这是心热血旺，白睛红膜如伞纸者，这是气滞血凝。热证，瞳人内涌，白睛带赤；冷证，瞳人青绿，白睛枯槁。眼热经久，复为风冷所乘则赤烂；眼中不赤，但为痰饮所注则作疼。肝气不顺而挟热，所以羞明；热气蓄聚而伤饱，所以饱合。唉！这是外证的大概情况。然而五脏不可缺其一，脾与肺唯独没有参与吗？回答说：白睛带赤，或有红筋者，其热在肺；上胞下胞，或目唇间如疥点者，其热在脾。脾主味，五味之秀滋养诸中，则精华发见于其外。肺主气，水火升降，营卫流转，不是气谁能使之？前面所说的五脏各有五证相应，在这里又可以推知了。
虽然如此，眼睛患病，多生于热，其间用药，大抵以清心凉肝、调血顺气为先。比如肾脏厌恶燥，如果遇到虚证，也不过用当归、地黄之类润养它，那么轻用温药是不可以的。况且肺能发燥，肝也好润，古方通常用杏仁、柿干、饴糖、沙蜜作为佐使，果然不是润益的意思吗？至于退翳这一节，尤其关系利害。凡是翳起于肺家受热，轻则朦胧，重则生翳。珍珠翳，状如碎米者易散；梅花翳，状如梅花瓣者难消。虽然翳自热生，然而治法先退翳而后退热的，去除它还容易；如果先去赤热，则血为之冰凝，而翳不能去除。那些有赤眼，给予凉药过多，又用水洗涤，不一会儿就冰凝。眼睛特一团水而已，水性清澄，尤其不可以拘泥于点洗。喜怒失节，嗜欲无度，穷尽目力，泣涕过伤，冲风凌雾，当暑冒日，不避烟火，饮啖热多，这些都是患生于脏腑的，专恃点洗可以吗？只有静坐澄神，爱护目力，放怀息虑，心逸日休，调和饮食来养它，斟酌药饵来平它，明察秋毫，断然可以必得。
张子和说：圣人虽然说眼睛得到血才能视物，然而血也有太过和不及。太过则壅闭而发痛，不及则目耗竭而失明，所以年轻人大多太过，老年人大多不及，但是年轻人则没有不及，老年人中间还有太过的，不可不考察。眼睛的内眦，是太阳经所起之处，血多气少。眼睛的外眦，是少阳经，血少气多。眼睛的上纲，是太阳经，也是血多气少。眼睛的下纲，是阳明经，血气俱多。然而阳明经起于目两旁交睫之中，与太阳、少阳俱会于目，只有足厥阴经连于目系而已。所以血太过者，是太阳、阳明的实证，血不及者，是厥阴的虚证。所以出血疗法，适宜用于太阳、阳明，因为这两经血多缘故。少阳一经不宜出血，因为血少缘故。刺太阳、阳明出血则视力更明，刺少阳出血则视力更昏，要知道不要使太过不及，以血养目罢了。凡血这东西，太多则溢，太少则枯。人热则血行疾而多，寒则血行迟而少，这是常理。
眼睛，是肝的外候。肝主目，在五行属木。木这种东西，太茂盛则蔽密，太衰败则枯瘁了。眼睛的五轮，是五脏六腑的精华，宗脉之所聚，其气轮属肺金，肉轮属脾土，赤脉属心火，黑水神光属肾水，兼属肝木，这是世俗都知道的了。等到有眼疾，却不知道病的道理，岂知眼睛不因火则不病。为什么这样说？气轮变赤，火乘肺也；肉轮赤肿，火乘脾也；黑水神光被翳，火乘肝与肾也；赤脉贯目，火自甚也。能治火者，一句可了，所以《内经》说：热胜则肿。凡是眼睛暴赤肿起，羞明隐涩，泪出不止，暴寒目瞒，都是大热所为。治火的方法，在药则咸寒吐之、下之，在针则神庭、上星、囟会、前顶、百会，血之翳者，可使立即消退，痛者可使立即停止，昧者可使立即明亮，肿者可使立即消除。只有小儿不可刺囟会，因为肉分浅薄，恐怕伤及其骨。然而小儿水在上，火在下，所以目明。老人火在上，水不足，所以目昏。《内经》说：血实者宜决之。又说：虚者补之，实者泻之。如雀目不能夜视及内障，是暴怒大忧所致，都是肝主目血少，禁止出血，只宜补肝养肾。至于暴赤肿痛，都适宜用针刺前五穴出血而已，其次调盐油涂发根，严重的甚至再至于三也可以，量其病势，以平为期。子和曾经自己患目赤，或肿或翳，羞明隐涩，百余日不愈。眼科张仲安说：适宜刺上星、百会、攒竹、丝空诸穴上出血，又以草茎纳两鼻中，出血约升许，来日好大半，三日平复如故，这是血实破之的方法。
李东垣说：五脏六腑的精气都禀受于脾，上贯于目。脾是诸阴之首，眼睛是血脉之宗，所以脾虚则五脏的精气都失去主管，不能归明于目了。心是君火，主人之神，宜静而安，相火代行其令。相火是胞络，主百脉，都荣于目。既然劳役运动，势乃妄行，又因邪气所并而损血脉，所以诸病生焉。凡是医生不调理脾胃，不养血安神，治标不治本，是不明正理。如果一概用辛凉苦寒的药剂，损伤真气，促成内障之证了。又李东垣说：能远视不能近视者，阳气不足，阴气有余，是气虚而血盛。血盛者，阴火有余，气虚者，气弱，这是老人桑榆之象。能近视不能远视者，阳气有余，阴气不足，是血虚气盛。血虚气盛者，皆火有余，元气不足。火，是元气的贼。
王海藏说：眼睛能远视，责其有火，不能近视，责其无水，适宜用东垣地黄丸主治。眼睛能近视，责其有水，不能远视，责其无火，东垣定志丸主治。
我认为这两个人的说法，在东垣那里，把不能近视为阳不足，不能远视为阴不足；在海藏那里，把能远视不能近视，责其有火无水；能近视不能远视，责其有水无火，为什么两人的话相反呢？难道没有是非之辨吗？看刘宗浓说：阳气者，犹日火也，阴气者，金水也；先儒谓金水内明而外暗，日火外明而内暗，这是不易之理。然而内明利于近，外明利于远，所以凡不能远视者，必定阴胜阳也，不能近视者，必定阳胜阴也。由此说来，则海藏是对的而东垣是错的。若以我见解评价，则只应当说其不足，不必说其有余。所以说：不能远视者，阳气不足也；不能近视者，阴气不足也，岂不是非常明显。如果东垣认为阴气有余，阳气有余，都称为火，则能视的都是火病。海藏说：能近视责其有水，能远视责其有火，则当责者也是病。这种议论，我不敢信服。
王节斋说：眼赤肿痛，古方用药，内外不同。在内汤散，则用苦寒辛凉的药以泻其火，在外点洗，则用辛热辛凉的药以散其邪。所以点药莫要于冰片，而冰片大辛热，以其性辛甚，所以借以拔出火邪而散其热气。古方用烧酒洗眼，或用干姜末、生姜汁点眼者，都是这个意思。盖赤眼是火邪内炎，上攻于目，所以内治用苦寒的药，是治其本，如锅底之去薪。然而火邪既客于目，从内出外，若外用寒凉以阻逆之，则火郁内攻不得散矣。所以点药用辛热，而洗眼用热汤，是火郁则发，因而散之，从治法也。世人不知道冰片为劫药，而误认为寒，常用点眼，遂致积热入目而昏暗障翳，所以说：眼不点不瞎者也。又不知道外治忌寒凉，而妄将冷水、冷物、冷药挹洗，致昏瞎者有之。
我按：节斋的论断，其属有理，然而寒凉点眼之法，也并非完全不可用，只是用之有宜否罢了。盖点以寒凉，用治火也。如果火之微者，其势轻，其邪浅，或偶触烟火风热，或素有标病，邪在肤腠之间，而热不深者，即用黄连膏之类，暂为清解，亦可去热，浮热去而目自愈，无不可也。如果火之甚者，本于五脏而炽及三阳，想以一星之寒凉，济此炎炎之盛势，果真能否？这其解热之功毫无所及，而闭热之害惟目受之矣。所以凡病火眼之甚者，点以寒凉，痛必连珠，正由火郁而然耳。所以，久点寒凉而不效者，未有不致于坏目，这是王节斋的论断，有不可不察，而凡治痈疽外证者，也应当并识此义。
薛立斋说：前证若体倦少食，视物昏花，或饮食劳倦益甚者，脾胃虚也，用补中益气汤。眵多紧涩，赤脉贯睛，或脏腑秘结者，用芍药清肝散。若赤翳布白，畏日羞明，或痛如刺者，上焦风热也，用黄连饮子。若久视生花，畏日，远视如雾者，神气伤也，用神效黄芪汤。大凡午前甚而作痛者，东垣助阳和血汤；午后甚而作痛者，黄连天花粉丸；午后甚而不痛者，东垣益阴肾气丸主治。
The *Treatise by Chanter Longmu* states: Humans have two eyes, akin to the sun and moon in the heavens; they are the supreme treasures of the body, gathering the essence of the five Zang organs. The Five Wheels correspond to the Five Elements, and the Eight Palaces correspond to the Eight Trigrams. Causes of eye diseases include excessive consumption of the "Five Pungents" (garlic, chives, leeks, onions, shallots), frequent intake of roasted or fried foods and hot noodles, uncontrolled alcohol consumption, irregular sexual activity, prolonged intense gazing, frequent observation of the sun and moon, constant agitation of Heart Fire, reading small characters at night, reading under moonlight, excessive copying work, intricate carving, endless gambling, long-term exposure to smoke and fire, excessive crying and tearing, excessive bloodletting from the head, and similar factors that all dissipate the brightness of the eyes. Others who ride and hunt, rushing through dust and sand day and night, also injure their eyes. Furthermore, those who fail to protect themselves in their youth often experience gradual dimness and blurriness after age forty. Therefore, those skilled in health preservation should keep their eyes closed frequently when idle upon reaching middle age, avoid unnecessary looking, and not open them unless for essential matters; thus, even in old age, vision will not decline. Generally, if Ying and Wei Qi flow smoothly, such diseases do not arise; if Ying and Wei Qi decline, many diseases occur. For instance, wind-cold causes tearing, deficiency-fire causes dimness, overwork causes redness, white swelling indicates toxicity in the Lung, sores indicate wind-heat invading the Lung, yellowing indicates spleen injury from alcohol, blood flooding the pupil and redness indicate Heat in the Heart, fear of light with red flowers indicates Liver pathogenic factors, black flowers indicate Kidney deficiency, blue flowers indicate Cold in the Gallbladder, and flowers of five colors indicate Kidney deficiency with Heat; these cannot be treated uniformly. If deficiency is not tonified and excess is not purged, rescue is difficult. Upper deficiency refers to Liver deficiency, lower deficiency to Kidney deficiency; Liver deficiency causes dizziness, deafness, and vertigo, while Kidney deficiency causes visual floaters and tinnitus like cicadas, requiring strong tonification of the Liver and Kidney. Profuse hot tears and swollen, painful eyelids indicate extreme Heat in the Liver; tearing in the wind indicates deficient Kidney with guest Heat; clearing the Liver and draining the Kidney must be appropriate. The Five Zang can be inferred similarly. Deficiency generates Cold, Excess generates Heat; the use of tonification and purgation requires careful deliberation, as a slight error leads to great deviation. Other causes involve external triggers or sequelae of major illnesses. Sudden acute redness (Bao Chi) is often due to heat surging upward, irregular sleep and diet, eating full then near fire, combined with labor without proper care, or consuming toxic foods, turning into severe syndromes. Physicians who do not trace the origin may mistakenly treat sudden redness solely as Yang excess, using blood-dispersing agents or Heart-cooling medicines; although symptoms may subside, this can damage the Spleen channel with cold, leading to poor appetite, mental restlessness, and internal cataracts due to Zang deficiency. Seeing poor appetite, some prescribe hot medicines, causing violent heat to attack upward, resulting in blurry vision, sticky discharge, or anger-induced strain leading to pterygium (fleshy growth); Heart Qi unrest with wind-heat transforms into pterygium. These varied symptoms constitute external obstructions. Additionally, excessive mental labor from reading or gambling is called Liver Fatigue; treating only the Liver or other syndromes is ineffective. One must rest the eyes and avoid distant viewing for recovery.
For those with wind-rash, eye darkness often occurs; attacking the wind first resolves the darkness. Medication for women before and after childbirth requires caution. Pediatric eye conditions require gentle treatment, mainly involving washing. Scalpel surgery or acupuncture is strictly forbidden, as is frequent rubbing, which may cause irreversible eye damage. Specialists in ophthalmology should pay close attention to these cases.
Yang Renzhai states: The eyes are the essence of the Six Fu and Five Zang organs, shining like the sun and moon in the sky. The iris belongs to the Heart, the sclera to the Lung, the cornea/pupil area to the Liver, the eyelids to the Spleen, and the pupil itself to the Kidney. Although each Zang has corresponding signs, the pupil is paramount. Why? The eyes are the external manifestation of the Liver (Wood); the Kidney is Water. Water generates Wood; Liver is the child, Kidney is the mother. Can child and mother be separated? When Liver and Kidney Qi are abundant, vision is bright; when deficient, vision is dim and dizzy. Red halos around the cornea with stinging pain indicate Liver Heat; dryness, tearing, and yellowish rings indicate Liver Deficiency. Dilated, pale, deviated pupils indicate Kidney Deficiency; constricted, slightly yellow pupils indicate Kidney Heat. This distinguishes deficiency and excess. Liver and Kidney Qi support each other, but the Heart houses the Spirit and assists the Liver and Kidney, representing unity in diversity. The Heart governs Blood, the Liver stores Blood; for blood-heat attacking the eyes, one must clear the Heart and cool the Liver, not rigidly adhering to "Water generates Wood." The eye is water wrapped in membrane, illuminating all directions; ultimately governed by Heaven's generation of Water.
Analyzing further: tightness and pulling with blue pupils and white eyelids, itching with clear tears, no redness or pain, is Wind Eye. Protruding cornea, hard/swollen/red eyelids, sticky discharge, heat/stinging pain is Heat Eye. Cloudy eyes with tears, soft/swollen eyelids, upper obstruction/dimness, sourness/dryness/mild redness is Qi Eye. Wind and Heat together cause itching and floating redness. Wind and Qi struggle causes itching/dryness/dimness. Blood-heat aggregation causes skin flaps, millet-like bumps, red threads, or hordeolum. Lack of Qi and Blood causes blind spots, drooping eyelids, night blindness, or total blindness. Pale purple with hidden red indicates deficient Heat; bright red with jealousy indicates excess Heat. Fleshy growths on exposed eyelids indicate Heart Blood-Heat; red membranes on sclera like umbrella paper indicate Qi stagnation and Blood coagulation. Heat syndromes show bulging pupils and red sclera; Cold syndromes show green/blue pupils and withered sclera. Chronic eye heat attacked by wind-cold causes red/rotten eyes; non-red eyes with phlegm-fluid cause pain. Unsmooth Liver Qi with Heat causes photophobia; accumulated Heat damaging digestion causes postprandial closure. These are general external signs. However, why exclude Spleen and Lung? Red sclera or red veins indicate Lung Heat; eyelid or mouth-corner acne-like spots indicate Spleen Heat. The Spleen governs taste; flavors nourish the interior, manifesting externally. The Lung governs Qi; it directs Water/Fire circulation and Ying/Wei flow. Thus, the five syndromes per Zang can be deduced.
Although eye diseases mostly stem from Heat, treatment prioritizes clearing the Heart, cooling the Liver, regulating Blood, and smoothing Qi. Since the Kidney dislikes dryness, deficiency cases use moistening herbs like Dang Gui (Angelicae Sinensis Radix) and Di Huang (Rehmanniae Radix); warm herbs should be used lightly. The Lung generates dryness, and the Liver prefers moisture; ancient formulas use Xing Ren (Armeniacae Semen Amarum), dried persimmon, maltose, and honey as adjuncts for moistening. Removing nebulae is critical. Nebulae from Lung Heat range from mild cloudiness to severe opacity. Pearl nebulae (like rice grains) disperse easily; plum blossom nebulae (like petals) are hard to resolve. Although nebulae arise from Heat, removing nebulae before clearing Heat is easier; clearing Heat first may freeze the Blood, preventing nebula removal. Overuse of cooling meds and water washing on red eyes causes freezing. Eyes are essentially water; water is clear, so reliance on drops/washing is limited. Emotional imbalance, excessive desire, eye strain, excessive weeping, wind/fog exposure, summer sun, smoke/fire avoidance failure, and hot diets cause internal organ pathology; drops alone are insufficient. One must sit quietly, calm the spirit, protect vision, relax the mind, regulate diet, and balance medication for clear vision.
Zihe He states: While sages say eyes see via Blood, Blood can be excessive or deficient. Excess causes blockage and pain; deficiency causes exhaustion and blindness. Youth often have excess; elders often have deficiency. However, youth rarely have deficiency, and elders may still have excess; this must be noted. The inner canthus is the start of the Taiyang Channel (more Blood, less Qi). The outer canthus is the Shaoyang Channel (less Blood, more Qi). The upper eyelid margin is Taiyang (more Blood, less Qi). The lower eyelid margin is the Yangming Channel (more Blood and Qi). Yangming starts between the eyes, meeting Taiyang and Shaoyang there. Only the Jueyin Channel connects to the eye system. Blood excess relates to Taiyang/Yangming Excess patterns; blood deficiency relates to Jueyin Deficiency. Bleeding therapy suits Taiyang/Yangming due to high Blood volume; it is unsuitable for Shaoyang due to low Blood volume. Bleeding Taiyang/Yangming improves vision; bleeding Shaoyang worsens it. The goal is balancing Blood to nourish the eyes. Too much Blood overflows; too little dries up. Heat speeds Blood flow (more); Cold slows it (less).
The eyes are the external manifestation of the Liver (Wood). Wood, if too lush, blocks light; if too weak, withers. The Five Wheels gather essence and meridians: Qi Wheel (Lung/Metal), Flesh Wheel (Spleen/Earth), Red Veins (Heart/Fire), Black Water/Spirit Light (Kidney/Water, also Liver/Wood). Everyone knows this, yet ignores the role of Fire in eye disease. Qi wheel redness = Fire insulting Lung; Flesh wheel red/swelling = Fire insulting Spleen; Nebula on Black Water = Fire insulting Liver/Kidney; Red veins across eye = Self-excessive Fire. Treating Fire solves it quickly. *Neijing* states: "Excess heat causes swelling." Sudden red/swollen eyes, photophobia, tearing, cold-induced dimness are all due to Great Heat. Treatment: Herbs should be salty/cold to induce vomiting/purging. Acupuncture points: Shenting, Shangxing, Xinhui, Qian Ding, Baihui. Bleeding here clears nebulae, stops pain, restores vision, reduces swelling immediately. Do not needle Xinhui in children due to thin tissue/bone risk. Children have Water above/Fire below, hence clear vision. Elders have Fire above/Water deficiency, hence dim vision. *Neijing*: "Resolve Blood Excess." "Tonify Deficiency, Purge Excess." Night blindness/internal cataracts from anger/sorrow involve Liver Blood deficiency; prohibit bleeding, only tonify Liver/Kidney. Sudden red/swollen/painful eyes: bleed the first five points, apply salt/oil to hair roots; repeat if necessary until balanced. Zihe He once had red/swollen/nebulous eyes for 100 days. Zhang Zhong'an advised bleeding Shangxing, Baihui, Cuanzhu, Sikong, and inducing nosebleeds with grass stems (~1 sheng); improved significantly next day, fully recovered in three days. This is the method for breaking Blood Excess.
Li Dongyuan states: Essence of Five Zang/Six Fu derives from Spleen, ascending to eyes. Spleen is head of Yin; eyes are root of Blood vessels. Spleen deficiency loses control over essence, failing to illuminate eyes. Heart is Ministerial Fire (ruler's spirit), quiet and stable; Ministerial Fire (Pericardium) executes orders, governing vessels, nourishing eyes. Labor/agitation causes erratic flow; evil qi damages vessels, causing disease. Physicians ignoring Spleen/Stomach and Blood/Spirit, treating symptoms only, miss the root. Using acrid-cool/bitter-cold drugs damages True Qi, promoting internal cataracts. Li also states: Far-sightedness but near-blindness indicates insufficient Yang/excess Yin (Qi deficiency/Blood excess). Blood excess implies Yin Fire excess; Qi deficiency implies weak Qi (elderly state). Near-sightedness but far-blindness indicates excess Yang/insufficient Yin (Blood deficiency/Qi excess). Blood deficiency/Qi excess implies Fire excess/Original Qi deficiency. Fire is the thief of Original Qi.
Wang Haizang states: Far-sightedness implies Fire presence, near-blindness implies Water absence; treat with Dongyuan Dihuang Wan. Near-sightedness implies Water presence, far-blindness implies Fire absence; treat with Dongyuan Dingzhi Wan.
I argue these views contradict. Dongyuan sees near-blindness as Yang deficiency, far-blindness as Yin deficiency. Wang sees far-sightedness as Fire/Water lack, near-sightedness as Water/Fire lack. Liu Zongnong says: Yang is Sun/Fire; Yin is Metal/Water. Metal/Water are bright inside/dark outside; Sun/Fire are bright outside/dark inside. Inner brightness aids near vision; outer brightness aids far vision. Thus, far-blindness is Yin overcoming Yang; near-blindness is Yang overcoming Yin. Wang is correct, Dongyuan wrong. However, I suggest stating only deficiency: Far-blindness is Yang deficiency; near-blindness is Yin deficiency. If Dongyuan calls excess Yang/Yin "Fire," then normal vision is a Fire disease. If Wang attributes near-sightedness to Water and far-sightedness to Fire, then the attributed factors are pathological. I cannot accept these arguments.
Wang Jiezhai states: For red/swollen/painful eyes, internal decoctions use bitter-cold/acrid-cool to drain Fire; external washes use acrid-hot/acrid-cool to disperse Evil. Borax (Bing Pian) is best for drops; it is acrid-hot, using its pungency to draw out Fire Evil and disperse heat. Ancient methods used wine washing or ginger juice drops for this reason. Internal redness is Fire Evil rising; internal bitter-cold treats the root (removing fuel from pot bottom). External cold blocks Fire from escaping, causing internal stagnation. Thus, acrid-hot drops and hot water washes allow Fire to vent (following the path). People mistake Borax as cold, using it frequently, causing heat accumulation and blindness. External treatment forbids cold; using cold water/items causes blindness.
I note: Wang's theory has merit, but cold drops are not entirely unusable, depending on appropriateness. Cold drops treat Fire. Mild Fire (shallow, occasional wind-heat/smoke) can be cleared temporarily with Huanglian Gao (Coptis Ointment); floating heat clears, eyes heal. Severe Fire (originating in Zang, spreading to Three Yang) cannot be cured by a drop of cold; it fails to clear heat and traps it, harming the eye. Severe Fire eyes treated with cold drops suffer continuous pain due to trapped Heat. Long-term cold drop use ruins eyes. Wang's warning is crucial; surgeons treating carbuncles/sores must also understand this.
Xue Lizhai states: For previous syndromes with fatigue, poor appetite, blurry vision, or worsening with diet/labor: Spleen/Stomach Deficiency; use Buzhong Yiqi Tang. Sticky discharge, tightness, red veins across pupil, constipation: Use Shaoyao Qinggan San. Red nebula on white, photophobia, stabbing pain: Upper Jiao Wind-Heat; use Huanglian Yinzi. Floaters after long viewing, photophobia, foggy distance vision: Spirit/Qi injury; use Shenxiao Huangqi Tang. Pain worse in morning: Dongyuan Zhuyang Hexue Tang. Pain worse in afternoon: Huanglian Tianhuafen Wan. No pain but worse in afternoon: Dongyuan Yiyin Shenqi Wan.