凡观气色。当视精明。精明者目也。五脏六腑之精也。营卫魂魄之所常营。神气之所生也。心之使也。肝之
官也。宗脉之所聚也。阴阳之所会也。气之清明者也。灵枢曰。五脏六腑之精气。皆上注于目而为之精。精
之窠为眼。骨之精为瞳子。筋之精为黑眼。血之精为络。其窠气之精为白眼。肌肉之精为约束。裹撷筋骨
血气之精。而与脉并为系。上属于脑。后出于项中。夫筋骨血气肌肉者。五脏之所属也。是故以眼分五脏。
血络属心。黑珠属肝。白珠属肺。瞳子属肾。约束属脾。赤脉从上下者。太阳病。从下上者。阳明病。从外走内
者。少阳病。从内 始者。阳跷病。瞳子黑眼。法于阴。白眼赤脉。法于阳。阴阳合传而精明也。此脏腑之部。阴
阳之分也。由是而观。有形焉。有容焉。有气焉。有色焉。分而论之。所以明其理。合而诊之。所以通其变。形也。
容也。气也。色也。无往而非脏腑之征。亦无往而非阴阳之理也。脏腑阴阳。形容气色。有诸中。形诸外。要皆
以神为本也。寤则神栖于目。寐则神处于心。神也者。视瞻平正。黑白分明。容色精爽。光彩清莹。朗朗然。不
可须臾离也。神之昭着于目者盖如此。至若目之五轮。睛之八廓。名虽附于羲黄。实则乖夫体用。殊不知
眼科诊目之法。当遵圣人诊目之法。若附会圣人之法以立法。则附会圣人之法即非法。然则求眼科之
法者。其知所以法乎。
凡是观察气色,应当注视眼睛的精明之气。所谓精明,指的就是眼睛。它是五脏六腑精气的汇聚之处,是营气、卫气、魂、魄经常游行的地方,也是神气产生的根源。它是心的外使,肝的外候,是众多经脉汇聚的部位,是阴阳交会之所,是清气清明显现的地方。《灵枢》说:五脏六腑的精气,都向上灌注于眼睛而形成视觉的精华。精气聚集的地方称为眼,骨之精表现为瞳仁,筋之精表现为黑眼球(角膜及虹膜),血之精表现为血络,气之精聚集处为白眼(巩膜),肌肉之精表现为眼睑(约束)。这些包裹着筋骨血气肌肉之精的组织,与脉道共同构成目系,向上连接于脑,向后出于项部。
既然筋骨血气肌肉分别归属于五脏,因此可以通过眼睛的不同部位来划分五脏归属:血络归属于心,黑珠归属于肝,白珠归属于肺,瞳仁归属于肾,眼睑(约束)归属于脾。如果赤色的脉络从上向下延伸,属于太阳病(Taiyang disease);从下向上延伸,属于阳明病(Yangming disease);从外向内走窜,属于少阳病(Shaoyang disease);从内部起始向外扩散,属于阳跷病(Yangqiao disease)。瞳仁和黑眼球,其法则对应于阴;白眼和赤色脉络,其法则对应于阳。阴阳结合传递,从而形成眼睛的精明状态。这是脏腑的部位划分,也是阴阳的区分。由此观察,眼睛有形、有容、有气、有色,分别论述它们,是为了阐明其中的道理;综合诊断它们,是为了通晓其变化规律。形、容、气、色,无处不是脏腑的征象,也无处不是阴阳的道理。脏腑阴阳通过形容气色表现出来,内在的情况必然反映在外部,但这一切都以“神”为根本。
人醒时,神栖息于眼睛;人睡时,神安居于心。所谓神,表现为视物瞻望平正,黑白分明,容貌神色精爽,光彩清莹,明亮清晰,片刻也不能离开。神在眼睛中的昭著表现大致如此。至于所谓的“五轮”、“八廓”,虽然名义上附会于伏羲、黄帝,但实际上违背了体用的真实原则。殊不知眼科诊察眼睛的方法,应当遵循圣人(古代医家)诊察眼睛的方法。如果附会圣人的方法来制定规则,那么这种附会圣人的方法就不是真正的方法。那么,想要探究眼科方法的人,应该知道如何效法了吗?
When observing the complexion and qi color, one must gaze at the "Jing Ming" (Vivid Spirit/Clarity of Vision) of the eyes. "Jing Ming" refers to the eyes themselves. They are the gathering place of the essence of the five zang organs and six fu organs, the habitual residence of Ying Qi (Nutritive Qi), Wei Qi (Defensive Qi), Hun (Ethereal Soul), and Po (Corporeal Soul), and the source from which Shen Qi (Spiritual Qi) arises. They serve as the external envoy of the Heart, the external manifestation of the Liver, the convergence point of numerous meridians, the intersection of Yin and Yang, and the place where clear and bright Qi manifests. The *Ling Shu* states: "The essence and qi of the five zang organs and six fu organs all ascend into the eyes to form their vivid spirit." The cavity where essence gathers is called the eye; the essence of Bone manifests as the pupil; the essence of Tendon manifests as the black part of the eye (cornea and iris); the essence of Blood manifests as the blood vessels; the essence of Qi gathered in the cavities manifests as the white part of the eye (sclera); and the essence of Muscle manifests as the eyelids (restraints). These structures, which envelop the essence of bone, tendon, blood, qi, and muscle, merge with the meridians to form the optic nerve system, connecting upward to the brain and exiting posteriorly through the neck.
Since bone, tendon, blood, qi, and muscle belong to the five zang organs, the eyes can be divided according to the five zang organs: blood vessels belong to the Heart, the black part belongs to the Liver, the white part belongs to the Lung, the pupil belongs to the Kidney, and the eyelids belong to the Spleen. If red vessels extend from top to bottom, it indicates Taiyang disease (Disease of the Taiyang Channel); if they extend from bottom to top, it indicates Yangming disease (Disease of the Yangming Channel); if they move from outside inward, it indicates Shaoyang disease (Disease of the Shaoyang Channel); if they originate from within and spread outward, it indicates Yangqiao disease (Disease of the Yang Qiao Vessel). The pupil and the black part follow the principles of Yin; the white part and red vessels follow the principles of Yang. When Yin and Yang combine and transmit, the vivid spirit of the eye is formed. This constitutes the regional division of the zang organs and the differentiation of Yin and Yang. From this observation, there is form, appearance, qi, and color. Discussing them separately clarifies their underlying principles; diagnosing them comprehensively allows one to understand their variations. Form, appearance, qi, and color are everywhere signs of the zang organs and everywhere manifestations of the principles of Yin and Yang. The zang organs and Yin-Yang are described through qi and color; what exists internally manifests externally. Ultimately, all of these rely on "Shen" (Spirit) as the root.
When awake, Shen resides in the eyes; when asleep, Shen dwells in the Heart. Shen is characterized by steady and correct vision, clear distinction between black and white, refined facial expression, and clear, lustrous radiance. It is bright and clear, and cannot be separated for even a moment. Thus, the manifestation of Shen in the eyes is as follows. Regarding the so-called "Five Wheels" and "Eight Palaces" of the eye, although their names are attributed to Fuxi and the Yellow Emperor, in reality, they deviate from the true relationship between substance and function. One should not fail to realize that the method for ophthalmological diagnosis should follow the method of ancient sages for diagnosing the eyes. If one attempts to establish rules by attaching them to the methods of the sages, then such attached methods are not true methods. Therefore, those who seek the methods of ophthalmology should know how to properly emulate them.