医门一十三科，惟眼科最难，而常人无不易之也。岂惟常人易之，即专是科者，亦易之
也。由于烛理不明，究心不到，或不知儒书，或暗于医学，甚至有一字不谙者，或得一方及
得一法，试之稍验，辄自夸耀，以为眼科无出其右，便出治人。而世之愚夫，蒙其害者屡屡
亦各不自知也。若尔人者，是诚以管窥天，所见者不广也。然自古迄今，轩岐之后，明医
世出，如伤寒则有张长沙，杂症则有李东垣，治火则有刘河间，补阴则有朱丹溪，四家之外
名手甚多，然于杂病，则靡不着论立方，以传后世，以开来学。故后之学人，有所根据归，
是以察脉验症，即论视病，按方用药，苟用之当，靡不通神，乘时奋发，驰名遐迩，皆赖古
人所定之方耳。惟眼科岂独今人见易，吾意张、李、朱、刘，亦略于是，皆未见其精详垂论
焉，使后世无所本也。但云血少也，神劳也，肾虚也，风热也，苟执是四者而治，其不陷于
一偏者亦鲜矣。且夫内障之症，不红不紫，非痛非痒，惟觉昏朦，有如薄纱笼者，有如雾露
中者，有如见黑花者，有如见蝇飞者，有如见蛛悬者，有眉棱骨痛者，有头旋眼黑者，皆为
内障，障者遮也，如物遮隔，故云障也。内外障者，一百零八症之总名也。其外障者，乃睛
外为云翳所遮，故云外障。然外障可治者，有下手处也。内障难治者，外不见症，无下手处
也。且内障之人，二目光明，同于无病者，最难分别，惟目珠不动，微可辨耳。先贤俱言脑
脂下垂，遮隔瞳神，故尔失明。惟有金针可以拨之，坠其翳膜于下，能使顷刻复明。予因深
思，眼乃五脏六腑之精华，上注于目而为明，如屋之有天窗也，皆从肝胆发源，内有脉道孔
窍，上通于目，而为光明，如地中泉脉流通，一有瘀塞，则水不通矣。夫目属肝，肝主怒，
怒则火动痰生，痰火阻隔肝胆脉道，则通光之窍遂蔽，是以二目昏朦，如烟如雾。目一昏花
愈生郁闷，故云久病生郁，久郁生病。今之治者，不达此理，俱执一偏之论，惟言肝肾之
虚，止以补肝补肾之剂投之，其肝胆脉道之邪气，一得其补，愈盛愈蔽，至目日昏，药之无
效，良由通光脉道之瘀塞耳。余故譬之井泉，脉道塞而水不流，同一理也。如执定以为肝肾
之虚，余思再无甚于劳瘵者，人虽将危，亦能辨察秋毫。由此推之，因知肝肾无邪，则目决
不病。专是科者，必究其肝肾果无邪而虚耶，则以补剂投之，倘正气虚而邪气有余，必先驱
其邪气，而后补其正气，斯无助邪害正之弊，则内障虽云难治，亦可以少尽病情矣。至于外
障，必据五轮而验症，方知五脏之虚实，而五脏之中，惟肾水神光，深居于中，最灵最贵，
辨析万物，明察秋毫，但一肾水而配五脏之火，是火太有余，水甚不足，肾水再虚，诸火益
炽，因而为云为翳为攀睛为瘀肉。然此症虽重，尚可下手施治，非如内障之无可下手也。然
今之业是科者，煎剂多用寒凉以伐火，暂图取效，点药皆用砒 以取翳，只顾目前。予观二
者皆非适中之治，亦非仁术之所宜也。故治火虽云苦寒能折，如专用寒凉，不得其当，则胃
气受伤，失其温养之道，是以目久病而不愈也。至于药之峻利，夫岂知眼乃至清至虚之府，
以酷烈之药攻之，翳虽即去，日后有无穷之遗害焉，良可慨也！予业岐黄，朝夕承先大人庭
训。附以管见，遂忘固陋，订制煎剂点药，虽非适中之治，然亦不越于规矩准绳之外也。所用
煎剂，惟以宽中开郁，顺气消痰，滋阴降火，补肾疏风为主，点药专以去翳明目为先，然点
药惟用气而不用质，去翳虽不神速，决无后患，其制药之玄妙，诚非世俗所得知也。但药得
于家传，兼以苦心思索有年，幸得其妙，至于目疾危急，万不得已间用砒 ，亦必用药监制
其毒，分两之中，十用其一，毫不敢多也。此予治人之目必抱竞业之心，至病目者，愈当小
心禁戒，即如劳神酒色忿怒诸事，并宜捐弃，否则目愈之后，不能久视，久视则目珠隐隐作
痛，日后决伤于目，是以劳神诸事，俱宜忌也。盖心藏乎神，运光于目，凡读书作字，与夫
妇女描刺，匠作雕銮，凡此皆以目不转睛而视，又必留心内营。心主火，内营不息，则心火
动，心火一动，则眼珠隐隐作痛，诸疾之所由起也。且人未有不亏肾者，夫肾属水，水能克
火，若肾无亏，则水能上升，可以制火，水上升，火下降，是为水火既济，故虽神劳，元气
充足，亦无大害。惟肾水亏弱之人，难以调治，若再加以劳神，水不上升，此目之所以终见
损也。今吾辈治目，务宜先审其邪正之虚实，当首驱其有余之邪气，而后补其不足之正气，
治斯当而病斯愈矣。此治目之次第，至于临症圆机，神而明之，又在乎人，专是业者，宜究
心焉。
医家共有十三科，其中眼科最为难治，但常人却往往轻视它。不仅常人轻视它，即使是专门从事这一科的医生，也往往轻视它。这是因为他们不明辨事理，用心不够深入，有的不懂儒家经典，有的对医学一知半解，甚至有一字不识的人；或者偶然得到一方或一法，试用后稍有见效，就自我夸耀，认为眼科没有谁能超过自己，便出来给人治病。而世上的愚昧之人，屡屡遭受其害，却各自不自知。像这样的人，真是如同从管子里看天，所见范围狭窄。然而从古至今，在黄帝、岐伯之后，名医辈出，如治疗伤寒有张仲景（张长沙），治疗杂病有李东垣，治疗火热病有刘河间，治疗阴虚有朱丹溪，这四家之外高手很多，但他们对于杂病，无不著书立说、制定方剂，以流传后世，开启后学。所以后来的学习者有所依据和归宿，因此通过诊脉验症来诊断疾病，按照方剂用药，如果运用得当，无不神效，乘时奋发，闻名遐迩，都依赖古人所定的方剂。唯独眼科，难道只有今人觉得容易？我推测张、李、朱、刘这几位大家，对此也是略涉皮毛，都没有见到他们精详的论述流传下来，使得后世无本可依。只是笼统地说血少、神劳、肾虚、风热这四种情况，如果固执地只按这四点来治疗，不陷入偏颇之见的也很少了。
况且内障的症状，眼睛不红不紫，不痛不痒，只觉得昏蒙模糊，有的像被薄纱笼罩，有的像在雾露中，有的看见黑花，有的看见苍蝇飞舞，有的看见蜘蛛悬挂，有的眉棱骨疼痛，有的头晕眼花，这些都称为内障。“障”就是遮蔽的意思，如同物体遮挡视线，所以叫障。内、外障是一百零八种症状的总称。所谓外障，是眼球外部被云翳所遮，所以叫外障。然而外障可治，是因为有下手的地方（即外在表现明显）。内障难治，是因为外表看不出症状，没有下手的地方。而且患内障的人，两眼目光明亮，与无病者无异，最难分辨，只有观察眼珠转动是否灵活，才能略微辨别。先贤都说这是脑脂下垂，遮蔽瞳神，导致失明。只有金针可以拨开它，将翳膜坠到下方，能使眼睛顷刻复明。我因此深思，眼睛是五脏六腑精华汇聚之处，上注于目而成为光明，就像房屋的天窗一样，都发源于肝胆，内部有脉道孔窍，上通于目而为光明，就像地下的泉脉流通，一旦有瘀塞，水就不通了。
目属肝，肝主怒，愤怒则火动痰生，痰火阻隔肝胆脉道，那么通光的窍穴就被遮蔽，所以两眼昏蒙，如烟如雾。眼睛一旦昏花，更加郁闷，所以说久病生郁，久郁生病。现在的医者，不通晓这个道理，都固执于一偏之论，只说是肝肾虚弱，只用补肝补肾的药剂投治，这样肝胆脉道中的邪气，一旦得到补益，反而更盛更蔽，导致眼睛日益昏花，药物无效，确实是由于通光脉道瘀塞的缘故。我把它比作井泉，脉道堵塞而水不流，道理是一样的。如果固执地认为是肝肾虚损，我想再没有比“劳瘵”（肺结核等慢性消耗性疾病）更虚的了，人虽然濒临死亡，也能明察秋毫。由此推断，知道肝肾如果没有邪气，眼睛绝不会生病。专门从事眼科的人，必须究查肝肾究竟是因无邪而虚，还是因有邪而虚？如果是因无邪而虚，则用补剂；倘若正气虚而邪气有余，必须先驱除邪气，然后补益正气，这样才能避免助长邪气伤害正气的弊端，这样即使内障号称难治，也可以稍微尽到探求病情的责任了。
至于外障，必须依据五轮学说（将眼部不同部位对应五脏）来验证症状，才知道五脏的虚实。而在五脏之中，唯有肾水之神光，深居于中，最灵验最珍贵，能辨析万物，明察秋毫。但如果肾水不足而配五脏之火，则是火太有余，水甚不足，肾水再虚，诸火更加炽盛，因而形成云翳、攀睛（翼状胬肉）、瘀肉。然而这些症状虽然严重，尚可下手施治，不像内障那样无可下手。然而现在从事这一科的医生，煎剂多用寒凉药以伐火，暂时图取效验，点眼药都用砒霜之类以去除翳膜，只顾眼前利益。我看这两种方法都不是适中之治，也不是仁术所宜采用的。所以治疗火证，虽然苦寒能折降火势，但如果专用寒凉，不得其当，就会损伤胃气，失去温养之道，因此眼睛久病不愈。至于药物的峻烈，哪里知道眼睛是至清至虚的器官，用酷烈之药攻伐它，翳膜虽然即刻去除，日后会有无穷的遗害，实在令人感慨！
我从事岐黄之术，朝夕承受父亲的教诲。附上我的浅见，不顾固陋，定制了煎剂和点眼药的方法。虽然并非绝对适中之治，但也未超出规矩准绳之外。所用的煎剂，主要以宽中开郁、顺气消痰、滋阴降火、补肾疏风为主；点眼药专以去翳明目为先。然而点眼药只取其气而不取其质，去翳虽不神速，但决无后患，其制药的玄妙，确实不是世俗所能知晓的。但药物得自家传，加上苦心思考多年，侥幸得其奥妙。至于目疾危急，万不得已时偶尔使用砒霜，也必定用药监制其毒性，分量之中，十用其一，丝毫不敢多用。这是我治疗病人眼睛必抱有的谨慎敬业之心。至于患病的人，更应当小心禁戒，比如劳神、酒色、忿怒等事，都应当摒弃，否则眼睛痊愈后，不能久视，久视则眼珠隐隐作痛，日后必然伤目，所以劳神等事都应当禁忌。因为心藏神，运光于目，凡读书写字，以及妇女描绣、工匠雕刻，凡是这样目不转睛地注视，又必须留心内营（精神集中）。心主火，内营不息，则心火动，心火一动，则眼珠隐隐作痛，这是各种疾病产生的根源。
况且人没有不亏损肾脏的。肾属水，水能克火，如果肾不虚亏，则水能上升，可以制约心火；水上升，火下降，这叫水火既济。所以虽然神劳，只要元气充足，也没有大害。只有肾水亏弱的人，难以调治，如果再加以劳神，水不上升，这就是眼睛最终受损的原因。现在我们治疗眼病，务必先审察邪正的虚实，应当首先驱除有余的邪气，然后补益不足的正气，治疗得当，病就能痊愈。这是治疗眼病的次序。至于临证时的随机应变，神而明之，又在于个人的悟性，专门从事这一业的人，应该用心研究。
Among the thirteen departments of medicine, ophthalmology is the most difficult, yet it is often underestimated by laypeople. Not only do laypeople underestimate it, but even specialists in this field tend to do so. This stems from a lack of clarity in reasoning and insufficient dedication; some are unfamiliar with Confucian classics, others have superficial knowledge of medicine, and some cannot even read a single character. They may obtain a prescription or method, test it with slight success, and then boast that no one surpasses them in ophthalmology, proceeding to treat patients. The ignorant public suffers repeatedly from such practitioners without realizing it. Such individuals are indeed like looking at the sky through a tube, seeing only a narrow view. However, since ancient times, following Huangdi (Yellow Emperor) and Qibo, renowned physicians have emerged continuously. For example, Zhang Zhongjing (Zhang Changsha) treated *Shanghan* (Cold Damage), Li Dongyuan treated miscellaneous diseases, Liu Wansu treated fire-heat disorders, and Zhu Danxi treated yin deficiency. Besides these four masters, there were many other experts who wrote treatises and formulated prescriptions for miscellaneous diseases to transmit to posterity and guide future learners. Thus, later students had a foundation to rely on; by examining pulses and symptoms, diagnosing diseases, and applying formulas appropriately, they achieved miraculous results, gaining fame far and wide, all relying on the formulas established by the ancients.
Why is ophthalmology considered easy only by modern people? I suspect that Zhang, Li, Zhu, and Liu also had only superficial understanding of it, as no detailed and refined discussions from them on this subject have survived, leaving later generations without a basis. They merely mentioned blood deficiency, mental fatigue, kidney deficiency, and wind-heat. If treatment is rigidly confined to these four aspects, few would avoid bias.
Regarding internal obstructions (*Neizhang*), the eyes are neither red nor purple, neither painful nor itchy, but feel dim and blurred. Vision may be obscured like being covered by thin gauze, seen through fog or dew, seeing black spots, seeing flies flying, seeing spider webs hanging, pain in the supraorbital ridge, dizziness, and darkening of vision. All these are termed internal obstructions. "Obstruction" means blocking, as if an object blocks the view. Internal and external obstructions are collective terms for 108 types of symptoms. External obstructions (*Waizhang*) refer to the eye surface being blocked by nebulae or opacities, hence the name. External obstructions are treatable because there are visible signs to guide intervention. Internal obstructions are difficult to treat because there are no external manifestations, making it hard to find a point of entry. Patients with internal obstructions often have bright gaze similar to healthy individuals, making differentiation difficult; only by observing whether the eyeball moves freely can one distinguish them slightly. Ancient sages stated that brain fluid descends and blocks the pupil, causing blindness. Only gold needles could displace the opacity downward, restoring vision instantly.
I have deeply reflected on this: the eyes are the essence of the five zang and six fu organs, ascending to the eyes to provide brightness, like skylights in a house. They originate from the Liver and Gallbladder, with meridians and orifices connecting upwards to the eyes, akin to underground springs flowing. If blocked, water flow stops. The eyes belong to the Liver; the Liver governs anger. Anger causes fire to stir and phlegm to generate. Phlegm-fire obstructs the Liver-Gallbladder meridians, blocking the orifices of light transmission, resulting in dim vision like smoke or fog. Once vision blurs, depression increases, hence "long illness generates stagnation, long stagnation generates illness."
Current practitioners fail to understand this principle, adhering to biased theories that attribute everything to Liver-Kidney deficiency, using only tonifying herbs for the Liver and Kidney. This exacerbates the pathogenic factors in the Liver-Gallbladder meridians, leading to worsening vision and ineffective treatment, truly due to the blockage of light-transmitting meridians. I compare this to a well spring: if the channel is blocked, water does not flow. If one insists it is merely Liver-Kidney deficiency, consider consumption disease (*Laozhi*); even when patients are near death, they can still see fine details. Thus, if the Liver and Kidneys have no pathogenic factors, the eyes will not become diseased. Specialists must investigate whether the deficiency is due to absence of pathogens or presence of pathogens. If pure deficiency, use tonics; if righteous qi is deficient and pathogenic factors excess, first expel the pathogens, then tonify the righteous qi, avoiding the harm of aiding pathogens. In this way, even difficult internal obstructions can be managed.
For external obstructions, one must examine symptoms according to the Five Wheels theory (*Wulun*) to determine the deficiency or excess of the five zang organs. Among them, the Kidney Water and Divine Light reside deep within, being the most spiritual and precious, capable of distinguishing all things. However, if Kidney Water is insufficient while Fire of the five zang is excessive, Fire becomes too strong and Water too weak. Further depletion of Kidney Water intensifies the fires, leading to nebulae, pterygium (*Pan Jing*), and fleshy growths. Although severe, these are treatable, unlike internal obstructions. Yet, current practitioners use cold-cooling decoctions to suppress fire for temporary effect, and apply arsenic-containing drops to remove opacities, caring only for immediate results. Neither approach is balanced or benevolent. While bitter-cold herbs can subdue fire, overuse damages Stomach Qi and loses warmth-nourishing functions, causing chronic eye issues. Harsh drugs attack the eyes, which are organs of utmost purity and emptiness; although opacities may clear, infinite sequelae may follow, which is lamentable.
I practice medicine under my father's guidance. Prescribing decoctions and drops based on my limited insight, though not perfectly balanced, adheres to principles. Decoctions focus on relaxing the middle jiao, resolving stagnation, regulating qi, eliminating phlegm, nourishing yin, descending fire, tonifying the Kidney, and dispersing wind. Drops prioritize removing opacities and brightening the eyes, using only the qi of herbs rather than their substance. Though slow, they have no aftereffects. Their subtlety is unknown to the secular world. Medicines are family secrets, refined through years of thought. In emergencies, arsenic may be used sparingly (one part in ten), strictly controlled to mitigate toxicity. This reflects my cautious attitude. Patients must also be careful, avoiding mental strain, alcohol, sexual indulgence, and anger. Otherwise, vision may not last, and prolonged viewing may cause dull eye pain and future damage. Mental strain should be avoided because the Heart houses the Spirit and projects light to the eyes. Activities requiring intense focus (reading, writing, embroidery, carving) keep the mind engaged. The Heart governs Fire; continuous mental engagement stirs Heart Fire, causing eye pain and initiating disease.
Everyone tends to deplete the Kidneys. The Kidney belongs to Water, which controls Fire. If the Kidney is not depleted, Water ascends to control Fire; Water ascends, Fire descends, achieving the state of "Water and Fire both complete" (*Shui Huo Ji Ji*). Thus, even with mental strain, sufficient Yuan Qi prevents major harm. However, those with weak Kidney Water are hard to treat; adding mental strain prevents Water ascent, leading to permanent eye damage. Therefore, treating eye diseases requires first assessing the deficiency or excess of pathogenic and righteous factors. One must first expel excess pathogens, then tonify deficient righteous qi. With proper treatment, recovery follows. This is the sequence of treatment. Clinical flexibility and divine illumination depend on individual wisdom; specialists should study this diligently.