东垣曰夫眼生倒睫拳毛者两目紧急皮缩之所致也盖内复热致阴气外行当去其内热并火邪
眼皮缓则眼毛立出翳膜亦退用手法攀出内脸向外速以三棱针出血以左手爪甲迎其针锋立愈
目眶岁久赤烂俗呼为赤瞎是也当以三棱针刺目眶外以泻湿热而愈
按以上所论可谓深达病情然是证亦多是血热阴虚火动所致盖血所以滋经脉养毛发者也故
当外治以泻其瘀热内治以杜绝其源可也
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血虚气盛者皆火有余元
气不足火者元气谷气真气之贼也元气来也徐而和细细如线邪气来也紧而强如巨川之水不可遏
谨按阳气者犹日火也阴气者金水也先儒所谓金水内明而外暗日火内暗而外明者也然人目
眼备
脏腑五行精华相资而神明故能视即此理之常也虽经曰目得血而能视殊不言气者盖血得气为水
火之交而能神明之也否则阴虚不能视远阳乏不能视近是为老人桑榆之渐然学人于目病能求诸
此则思过半矣
陈无择云病者喜怒不节忧思兼并致脏气不平郁而生涎随气上厥逢脑之虚侵淫眼系荫注于
目轻
则昏涩重则障翳眵泪 肉白膜瞒睛皆内所因或数冒风寒不避暑湿邪中于项乘虚循系以入于脑
故生外翳医论中所谓青风绿风紫风黑风赤风白风白翳黄翳等随八风所中变生诸证皆外所因
或嗜欲不节饮食无时生食五辛热啖炙爆驰骋田猎冒涉烟尘劳动外情丧明之本皆不内外因治之
按论中所言致证之因至为详悉惜乎其方多本于风热及水脏阳虚处治而未备学人当自为通
变矣
李东垣说：眼睛长出倒睫和拳曲的睫毛，是由于两眼眼睑紧急、皮肤收缩所致。这是因为内部有热导致阴气外行，应当清除体内的热邪以及火邪。眼皮松弛后，睫毛就会直立伸出，翳膜也会消退。治疗方法是用手法将内眼睑向外翻起，迅速用三棱针点刺出血，左手拇指指甲抵住针尖方向，即可立即痊愈。
眼眶长期红肿溃烂，俗称“赤瞎”，应当用三棱针刺破眼眶外部以泻除湿热，即可痊愈。
按语：以上论述可谓深刻洞察病情，然而此证也多是由血热、阴虚、虚火妄动所致。血液是用来滋养经脉、濡养毛发的。因此，应当采用外治法以泻除瘀滞之热，内治法以杜绝病源，这样就可以了。
李东垣说：能够看得远但不能看得近的人，是阳气不足、阴气有余的表现，也就是气虚而血盛。血盛意味着阴火有余，气虚意味着气弱。这是老年人如同夕阳西下般的生理现象。能够看得近但不能看得远的人，是阳气有余、阴气不足的表现，也就是血虚而气盛。血虚气盛都是因为火有余、元气不足。火是元气、谷气、真气的贼害之物。元气到来时缓慢而平和，细细如线；邪气到来时紧促而强劲，像巨大的河水奔涌不可遏制。
谨按：阳气就像太阳之火，阴气就像金与水。先儒所说的“金水内明而外暗，日火内暗而外明”就是这个道理。人的眼睛具备脏腑五行精华的资助而产生神光，所以能视物，这是常理。虽然经典说“目得血而能视”，却很少单独谈论气，大概是因为血需要气的参与才能成为水火相交的状态，从而产生神明的作用。否则，阴虚就不能看远，阳乏就不能看近，这就是老年人视力逐渐衰退的迹象。然而学习中医的人在治疗眼病时如果能探求这些原理，那么对疾病的理解就已经超过一半了。
陈无择说：病人喜怒没有节制，忧愁与思虑兼并，导致脏气不平衡，郁结而生出涎沫，随着气机上逆，遇到脑部的虚弱，浸淫侵入眼系，灌注于眼睛。轻则昏花干涩，重则形成障翳、眼屎流泪、肉膜遮盖黑睛等症，这些都是内因所致。或者多次遭受风寒，不避暑湿，邪气中伤项部，乘虚沿着眼系进入脑部，所以生成外翳。医书论述中所谓的青风、绿风、紫风、黑风、赤风、白风、白翳、黄翳等，随着八风所中的不同而变化产生各种证候，这都是外因所致。或者是嗜欲没有节制，饮食没有定时，生吃五辛，热食烧烤，骑马打猎，冒涉烟尘，劳累情志，这些都是导致失明的根本原因，属于不内外因。
按语：论中所言导致病症的原因非常详细，可惜其方剂多基于风热及水脏阳虚进行处治，还不够完备。学习者应当自行通晓变通。
Li Dongyuan stated: The occurrence of trichiasis (inverted eyelashes) and curled eyelashes is caused by the tension of the eyelids and skin contraction. This results from internal heat causing Yin Qi to move outward; therefore, one must eliminate the internal heat and Fire pathogenic factors. Once the eyelid skin relaxes, the eyelashes will stand upright, and nebulae (corneal opacities) will recede. The treatment involves manually eversion of the inner eyelid, followed by rapid pricking with a three-edged needle to bleed. By using the left thumb nail to guide the needle tip, immediate cure can be achieved.
Chronic redness and ulceration of the eye socket, commonly known as "Chi Xia" (Red Blindness), should be treated by pricking the exterior of the eye socket with a three-edged needle to drain Damp-Heat, leading to recovery.
Commentary: The above discussions deeply understand the pathology. However, this condition is mostly caused by Blood Heat, Yin Deficiency, and Hyperactivity of Empty Fire. Blood serves to nourish the meridians and hair follicles. Thus, external treatment should be used to drain Stagnant Heat, while internal treatment should be employed to cut off the source of the disease.
Li Dongyuan stated: The ability to see far but not near indicates insufficient Yang Qi and excess Yin Qi, which signifies Qi Deficiency and Blood Excess. Blood Excess implies excess Yin Fire, while Qi Deficiency implies weak Qi. This is a physiological phenomenon akin to the setting sun in the elderly. Conversely, the ability to see near but not far indicates excess Yang Qi and insufficient Yin Qi, signifying Blood Deficiency and Qi Excess. Both Blood Deficiency and Qi Excess stem from excess Fire and insufficiency of Yuan Qi (Original Qi). Fire is the thief of Yuan Qi, Gu Qi (Grain Qi), and Zhen Qi (True Qi). When Yuan Qi arrives, it is slow and harmonious, fine as a thread; when Pathogenic Qi arrives, it is tight and strong, like an unstoppable great river.
In strict accordance with principles: Yang Qi is like the Sun and Fire; Yin Qi is like Metal and Water. As the Confucian scholars of old stated, "Metal and Water are bright inside and dark outside, while Sun and Fire are dark inside and bright outside." The human eye possesses the essence of the Zang-Fu organs and Five Elements, which generate Shen Guang (Spiritual Light), enabling vision; this is the normal principle. Although classics state that "the eyes can see when they receive Blood," they rarely discuss Qi alone, likely because Blood requires Qi to become an intersection of Water and Fire, thereby generating spiritual function. Otherwise, Yin Deficiency prevents seeing far, and Yang Insufficiency prevents seeing near, marking the gradual decline of vision in the elderly. However, if students of medicine seek these principles when treating eye diseases, their understanding will have progressed significantly.
Chen Wuzhai stated: Unregulated emotions such as anger and joy, combined with sorrow and overthinking, lead to disharmony of Zang-Qi. Depression generates Phlegm-Saliva, which rises with Qi. Encountering deficiency in the brain, it infiltrates the eye system and pours into the eyes. Mild cases present with blurred and dry vision; severe cases result in visual obstructions (nebulae), discharge, tearing, and fleshy membranes covering the pupil. These are all due to internal causes. Alternatively, repeated exposure to Wind-Cold or failure to avoid summer dampness allows pathogens to strike the neck, entering the brain via the eye system through deficiency, thus generating external nebulae. Medical texts refer to conditions such as Qing Feng (Green Wind), Lv Feng (Emerald Wind), Zi Feng (Purple Wind), Hei Feng (Black Wind), Chi Feng (Red Wind), Bai Feng (White Wind), Bai Yi (White Nebula), and Huang Yi (Yellow Nebula), which vary according to the Eight Winds and constitute external causes. Furthermore, unregulated desires and irregular diet, consumption of raw pungent spices, hot roasted foods, strenuous hunting, exposure to smoke and dust, and emotional labor are root causes of blindness, classified as neither internal nor external causes.
Commentary: The causes of pathology described in the treatise are extremely detailed. Unfortunately, the prescriptions often focus on Wind-Heat and Yang Deficiency of the Water Organ (Kidney), lacking comprehensiveness. Students should apply flexible adaptation to these treatments.