天关双阖昼而宵，独抱衾 耐寂寥，展转无人堪入眠，一腔热泪湿鲛绡。
此症初起，目赤畏热，一二日两睑渐肿硬，俨如蚌蛤之聚合者是。盖痰燥血滞，脾火上泄，故睑硬。睛固火
炙，未免痛而泣出。经所谓土极似木，非肝病也。必有椒粟生于其内。治当敷软，翻胞开导。若坚实翻不得，或
脑再胀起，痛如劈如钻，此土反克木，巽风已动，结毒之祸，顿起萧墙矣。有病兹不娴开导，睑肿虽愈，疮痍留
内，结成蚬肉。日久坚硬，状如粟壳贝齿。须用月斧逐渐铲去，俟薄而开闭自然，点净星障，准可全清。但必膏
梁子弟，始可尽法施行，盖谚云∶“眠安食美，出得血起”故也。亦治至八分则止，过割恐亡血，又起别病。
是症与上，同一肿胀，治应无别，但缅怀平生所历，不同处尚多。何以见之？上症木土争克，肿极上胞，治
在肝脾；此则痰上蒸溽，两睑平合，治在脾胃。且上症多病左目，虽传右不如左险；此则先发右目，传左亦轻。
入手宜白
虎汤、竹叶石膏汤；不退，三友丸、一味大黄丸，再加开导；肿合消，仍着青睛奚似，对症拣方点服，收效易矣。
博议于此，壹令执事者知所审视，手到厥病减除。
脂非脂，膜非膜，蚀风轮，掩巽廓。金刀具在未全除。血气方刚能再作。
此症始自内 生脉一二缕，缕根生瘀肉赤黄色，状如膏膜而韧，日久积浓，横侵白睛，吞食神珠。有兼锐
俱生者，但枝蔓所传，终不若正受者之多也。凡性躁气逆，恣嗜辛热，劳心劳力之人患者多。间有漫睛皆障，视
亦不见，必内外兼伐，根净则愈，然亦难矣。病由《原机》为奇经客热，其言曰∶奇经客邪非十二经之比，十二
经之外，别有治奇经之法，而所用药亦曰∶“胜奇散”。却只是芎、归、连、草等物，无稽之谈，人谁从同！
《谬刺论》曰∶客邪于足阳跷之脉，令人目病从内 始。近似《瑶函》曰∶肺实肝虚，其肉努起。夫肺实，据轮
言，通睛合努，据肝言，并不在内 之位。且肝虚肺实，木已受金克矣，又用胆草、木贼以伐之，何哉？愚意症
发两 ，乃合太阳少阴而病，肉属脾土，赤黄努起，是火炎者土必燥，水木不能制，祸罹于金。虽在气轮，非肺
经之自病也。起手须如法钩割，点以飞熊丹，内服泻黄、泻白、导赤等散；俟刀口平复，根据心火乘金，既济丸或
滋阴地黄丸一料，治本不治标，其殆庶几。
割法∶用红矾一钱，水泡化，以新羊毫笔蘸水涤患处，其肉自然皱起，不起复涤。将锋利银针穿入简中，两
头于上
下眼胞担定，次用钩钩正，次眉刀或鞋刀从中轻浮搜至神珠攀底，复又从针处搜至 头，近血轮离一粗布线小心
割下。有不必针穿、不藉矾涤、不须钩只用钳、不须刀只用翦者，一听自便。总宜器利手快，看得风、水、血三
轮亲切，不致稍犯，庶不误人。割去处肉白者顺，易奏功，赤者缠延。血出不止，用新棉花蘸顶烟墨涂之立住，
秋夏沃以泉水亦佳。盖红见黑则止，阴阳之自然为偶，血得冷而凝，水火之所以相制也。割后澄心节欲，去酒，
禁椒炙，前方点服弗歇，刀口日平一日，虽未能视如无病，较病中相去天壤耳。假通睛皆肉膜蔽满，下不见风轮
影色，先于中央起手，割开黄豆大一孔，问渠见光亮，微有昏昏黑质，不妨渐次钩割，十中常一二可治。否则神
膏已涸，不消费力。
丸大 有肉珠一块如榴子状，本科呼为血轮，刀烙娱伤，必致溃败成漏，卷首已说，再识于此，不啻耳提，
而面命也。
肉有尖头、齐头二种。齐头浮于风轮，易割易平复，全好，迹象都无；尖头深深蚀入神珠，大难下手，且
分明割去，明日依然在上，非三、五不能净尽。及瘥，其瘢痕至年久始没，但所有昏朦、赤涩、眵泪等病， 肉
去不复再见。倘弗慎口节欲，劳心伤力，到老难免斯疾。
天关（指眼睑）白天开合，夜晚独自抱着被子忍受寂寞，翻来覆去无人可伴难以入眠，满腔热泪打湿了丝织手帕。
这种病症初起时，眼睛发红、怕热，一两天后上下眼睑逐渐肿胀变硬，就像蚌蛤闭合一样。这是因为痰浊燥结、血液停滞，脾经火气上泄，导致眼睑坚硬。眼球如同被火烤灼，难免疼痛并流泪。医经所说“土极似木”，并非肝病。必然会在眼睑内部生出像花椒或粟米大小的颗粒。治疗应当先敷药使组织软化，翻开眼睑进行疏导。如果组织坚实无法翻开，或者头部再次肿胀隆起，疼痛如刀劈钻头般剧烈，这是土反克木，肝风已动，毒邪凝结的灾祸，突然在体内爆发了。患有此病却不擅长进行疏导切开，虽然眼睑肿胀痊愈，但疮口留在内部，结成类似蚬肉的赘生物。日子久了变得坚硬，形状像粟壳或贝齿。必须用月斧（一种手术工具）逐渐铲去，等到变薄后开闭功能自然恢复，再点药清除星障，才可以完全康复。但这必须是生活优裕、身体底子好的子弟，才能完全按照这种方法施行，因为谚语说：“睡眠安稳、饮食美味，才能经得起出血和创伤。”所以治疗到八分程度就停止，过度切割恐怕会导致失血，又引发其他疾病。
这个病症与上一个病症同样表现为肿胀，治疗方法应该没有区别，但我回想平生所经历的病例，不同之处还有很多。怎么看出来的呢？上一个病症是木土相争克制，肿胀主要在上面的眼睑，治疗重点在肝脾；这个病症则是痰湿上蒸潮湿，上下眼睑平直闭合，治疗重点在脾胃。而且上一个病症多发生在左眼，即使传到右眼也不如左眼危险；这个病症则先发于右眼，传到左眼也较轻。入手治疗宜用白虎汤、竹叶石膏汤；如果不退，再用三友丸、一味大黄丸，再加上疏导切开法；肿胀闭合消退后，仍然出现青睛（黑眼球）上的翳障，对症挑选方剂点服，容易见效。在此广泛议论，让执行者知道如何审慎审视，手到病除。
脂肪不是脂肪，膜不是膜，侵蚀黑眼球（风轮），遮蔽眼眶（巽廓）。金刀手术未能完全去除。气血正旺盛时可能复发。
这种病症开始从内眼角生出脉络一二缕，缕根生长出赤黄色的瘀肉，形状像膏膜但有韧性，日子久了积聚脓液，横向侵犯白眼球，吞食黑眼球（神珠）。有兼带锐角一起生长的，只是枝蔓传播的，终究不如直接受病的那么多。凡是性情急躁气逆，放纵嗜好辛辣热气，用心劳力的人患病较多。间或有整个眼睛都被翳障覆盖，看不见东西的，必须内外兼治，根部清理干净才能痊愈，但也很难了。病因《原机微论》说是奇经受客热所致，它说：“奇经受邪不同于十二正经，十二经之外，别有治疗奇经的方法，所用药物也说：‘胜奇散’。”但那只是川芎、当归、黄连、甘草等物，是无稽之谈，谁人听从！《素问·缪刺论》说：“客邪侵入足阳跷脉，使人目病从内眼角开始。”这近似《银海精微》的说法：“肺实肝虚，其肉努起。”所谓肺实，据黑眼球而言，通睛合并努起，据肝脏而言，并不在内眼角的位置。况且肝虚肺实，木已经受金克制了，又用龙胆草、木贼来伐它，为什么呢？我的意见是，病症发于两内眼角，乃是太阳经和少阴经合病，肉属于脾土，赤黄色努起，是火炎土必燥，水木不能制约，灾祸连累到金（肺）。虽然在气轮（白眼球区域），并非肺经自身的病变。起手必须依法钩割，点用飞熊丹，内服泻黄散、泻白散、导赤散等；等到刀口平复，根据心火乘金（火克金）的原理，服用既济丸或滋阴地黄丸一料，治本不治标，大概就可以了。
切割方法：用红矾一钱，用水泡化，用新的羊毫笔蘸水洗涤患处，赘肉自然会皱起，不皱起再洗。将锋利的银针穿入线中，两头在上下的眼睑固定住，其次用钩子钩正，其次用眉刀或鞋刀从中轻轻浮搜至黑眼球攀附的底端，再从针处搜至内眼角，靠近血轮（内眼角充血处）离一根粗布线小心割下。有不必穿针、不必借矾水洗、不必用钩只用钳、不必用刀只用剪的，听凭自己方便。总之宜器具锋利手法快，看清风轮、水轮、血轮三个部位，不致稍加触犯，才不误人。割去处肉白色的是顺证，容易奏效，红色的是缠绵难愈。血出不止，用新棉花蘸顶烟墨涂抹，立刻止血，秋天夏天浇泉水也很好。因为红见黑则止，这是阴阳自然的配合，血得冷而凝固，是水火相互制约的道理。割后清心节欲，戒酒，禁食椒麻炙烤之物，前方点服不停歇，刀口一天比一天平复，虽然不能视若无病，比起生病时相差天壤之别。假若通睛全部被肉膜遮蔽，下面看不见黑眼球影色，先在中央起手，割开黄豆大一孔，问他是否看见光亮，微有昏昏黑质，不妨渐渐钩割，十人中常有一二人可治。否则神膏已枯竭，不值得费力。
大眦（外眼角）有肉珠一块像石榴籽状，本科称为血轮，刀烙娱伤，必定溃败成漏管，卷首已说过，再记于此，无异于耳提面命。
肉赘有尖头、齐头两种。齐头浮在黑眼球表面，易割易平复，全好，迹象全无；尖头深深侵蚀进入黑眼球，大难下手，而且分明割去，明天依然在上面，非三、五次不能净尽。等到痊愈，其瘢痕直到年久才消失，但所有昏朦、赤涩、眼屎眼泪等疾病，肉赘去掉后不再复发。倘若不慎口腹、节制欲望，劳心伤力，到老难免此疾。
The Tian Guan (eyelids) open and close during the day, but at night one embraces the quilt alone, enduring loneliness; tossing and turning with no companion to share sleep, a chest full of hot tears wets the silk handkerchief.
This condition begins with redness and heat intolerance in the eyes. Within one or two days, both upper and lower eyelids gradually become swollen and hard, resembling the closed shell of a clam. This is due to phlegm-dryness stagnation and blood stasis, with Spleen Fire leaking upward, causing eyelid hardness. The eyeballs feel as if scorched by fire, inevitably leading to pain and tearing. As the classics state, "Earth extreme resembles Wood," this is not a Liver disease. There will inevitably be granules like peppercorns or millet grains growing inside. Treatment should involve applying medication to soften the tissue, then everting the eyelid for guidance/drainage. If the tissue is too firm to evert, or if the head swells again with pain like splitting or drilling, this indicates Earth counter-attacking Wood, with Xun Wind (Liver Wind) stirring up, causing sudden disaster from internal toxic accumulation. If this disease is treated without skill in eversion and drainage, although eyelid swelling may subside, sores remain internally, forming fleshy growths like clam meat. Over time, they become hard, resembling millet husks or shell teeth. One must use a Moon Axe (a surgical tool) to gradually shave them off. Once thin enough, natural opening and closing will return; clearing star-like opacities with drops can lead to full recovery. However, this method can only be fully applied to young men of wealthy backgrounds who are well-nourished, as the proverb says: "Only with good sleep and diet can one withstand blood loss and trauma." Therefore, treatment should stop at 80% intensity; over-cutting risks excessive blood loss and new diseases.
This condition presents with swelling similar to the previous one, and treatment principles should be alike. Yet, reflecting on my clinical experience, there are many differences. How do I know? In the previous condition, Wood and Earth contend and overcome each other, with swelling primarily in the upper eyelid; treatment focuses on the Liver and Spleen. In this condition, Phlegm-Dampness steams upward, causing both eyelids to lie flat and close; treatment focuses on the Spleen and Stomach. Furthermore, the previous condition often affects the left eye first; even if it spreads to the right, it is less dangerous than affecting the left initially. This condition starts in the right eye; spreading to the left is milder. Initial treatment should employ Bai Hu Tang (White Tiger Decoction) or Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction); if unresolved, use San You Wan (Three Friends Pill) or Yi Wei Da Huang Wan (Single Herb Rhubarb Pill), combined with drainage techniques. Once swelling subsides, if corneal opacities persist, select appropriate formulas for topical application, yielding easy results. These broad discussions aim to guide practitioners to examine carefully, ensuring effective cure.
It is neither fat nor membrane; it erodes the Feng Lun (Cornea/Black Pupil) and covers the Xun Kuo (Eye Orbit). Surgical removal may not be complete. Recurrence is possible while Qi and Blood are vigorous.
This condition originates from the inner canthus, where one or two vessels emerge. At the root of these vessels, reddish-yellow fleshy growths form, resembling tough membranes. Over time, pus accumulates, invading the Bai Jing (Sclera/White Eye) and engulfing the Shen Zhu (Pupil/Cornea). Some cases present with sharp extensions, though these branches are fewer than primary lesions. It commonly affects those with irritable temperaments, rebellious Qi, indulgence in spicy/hot foods, and mental or physical overexertion. Occasionally, the entire eye is obscured, causing blindness; internal and external treatments are required, and healing is difficult only after roots are cleared. According to *Yuan Ji Wei Lun*, this is caused by pathogenic heat in the Extraordinary Vessels. It states: "Pathogens in Extraordinary Vessels differ from the Twelve Regular Meridians; there are specific methods for treating them, using 'Sheng Qi San' (Superior Wonder Powder)." However, this powder merely contains Chuan Xiong, Dang Gui, Lian Qiao, and Gan Cao—nonsense that few follow. *Su Wen · Miao Ci Lun* states: "Pathogens invading the Foot Yang Qiao Mai cause eye diseases starting from the inner canthus." This aligns with *Yin Hai Jing Wei*: "Lung Excess and Liver Deficiency cause fleshy protrusions." Regarding Lung Excess, referring to the Cornea, it involves strabismus and protrusion; referring to the Liver, it does not originate in the inner canthus. Moreover, if Liver is deficient and Lung excess, Wood is already controlled by Metal; why use Long Dan Cao and Mu Zei to attack further? My view is that onset at both inner canthi involves simultaneous Tai Yang and Shao Yin disease. Flesh belongs to Spleen Earth; reddish-yellow protrusion indicates Fire blazing, making Earth dry, unable to be controlled by Water and Wood, thus harming Metal (Lung). Although located in the Qi Lun (Scleral region), it is not a primary Lung meridian pathology. Initial treatment requires hook-and-cut surgery, topical Fei Xiong Dan, and internal administration of Xie Huang San, Xie Bai San, or Dao Chi San. After wound healing, based on Heart Fire overcoming Metal, administer Ji Ji Wan or Zi Yin Di Huang Wan for one course. Treating the root rather than the branch is likely successful.
Surgical Method: Use one qian of Hong Fan (Red Alum), dissolve in water, and wash the lesion with a new sheep-hair brush until the flesh wrinkles. Repeat if necessary. Thread a sharp silver needle through the base, securing it to the upper and lower eyelids. Align with a hook. Using an eyebrow knife or shoe knife, gently dissect from the center towards the base of the corneal attachment, then back to the inner canthus. Carefully cut near the Xue Lun (Blood Wheel/Inner Canthus vascular area), leaving a coarse thread for safety. Some cases require no needle, alum, hook, or knife/scissors only, depending on convenience. Generally, sharp instruments and skilled hands are essential. Accurate identification of Feng Lun, Shui Lun, and Xue Lun prevents error. White flesh indicates favorable prognosis; red flesh indicates lingering difficulty. If bleeding persists, apply fresh cotton soaked in top-grade lampblack ink to stop it instantly. Spring water is also beneficial in autumn and summer. Red meets black to stop bleeding, following natural Yin-Yang pairing; cold coagulates blood, demonstrating Water-Fire mutual restraint. Post-operation, maintain mental clarity, regulate desires, avoid alcohol, and ban spicy/fried foods. Continue topical and internal medications daily. Wounds heal progressively. Though vision may not return to normal, it is vastly improved compared to the diseased state. If total ptosis obscures the cornea, start centrally, cutting a bean-sized hole. Ask if light is perceived; if slight darkness remains, gradual dissection may save 1-2 out of 10 cases. Otherwise, the Shen Gao (Divine Fluid) is exhausted, and effort is futile.
At the outer canthus, a fleshy nodule like a pomegranate seed forms, termed Xue Lun in this specialty. Injury from knives or cautery leads to ulceration and fistula formation, as noted in the preface. Reiterating here serves as earnest advice.
Fleshy growths come in two types: blunt-tipped and pointed. Blunt tips float on the Feng Lun, are easy to cut and heal completely with no trace. Pointed tips deeply erode the Shen Zhu, making surgery difficult. Even if removed, they recur the next day, requiring three to five sessions for clearance. Scars fade only after years. However, symptoms like blurriness, redness, dryness, and discharge cease after removal. Neglecting diet and sexual moderation, along with mental/physical strain, ensures recurrence in old age.