东垣云。能远视不能近视者。阳气有余。阴气不足。少年穷役眼神所致也。海藏云。目能远
视。知其有火。不能近视。责其无水。法当补肾。加减地芝丸。或六味丸加减。秘要云。阴精不
足。阳光有余。病于水者。故光华发见。散乱而不能收敛近视。治之在心肾。若贪淫恣欲。饥饱
失节。形体甚劳。过于悲泣。皆斫丧阴精。精亏则阳火盛。火性炎而发见。阴精不能制伏挽回。
故越于外而远照不收。治之而反触激者。有内障之患。
东垣云。能近视不能远视者。阳气不足。阴气有余。此老人桑榆之象也。海藏云。目能近视。
知其有水。不能远视。责其无火。治当补心。加味定志丸、八味丸。早暮间服。秘要云。此证非
谓禀受生成近觑之病。乃平昔无病。素能远视而忽然不能者也。盖阳不足阴有余。病于火者。故
光华不能发越于外。而偎敛近视耳。治之在胆肾。若耽酒嗜燥。头风痰火。忿怒暴悖者。必伤损
神气。阴阳偏胜。而光华不能发达矣。
素问云。夫精明者。所以视万物。别黑白。审长短。以长为短。以白为黑。如是则精衰矣。
人之目者。心之使也。心者神之
舍也。故精神乱而不转。卒然见非常处。精神魂魄。散不相得。故曰惑也。如神光自见。则每如
电闪。黑夜精明。则晦冥之中。倏忽见物。视正反邪。则物本正而目见为邪。视定反动。则物本
定而目见为动。视物颠倒。则观物皆振动倒植。视一为二。则一物而目视为二。视瞻有色。则常
见萤星云雾及大片青绿蓝碧之色。视赤如白。则视物却非本色。或视粉墙如红如碧。或看黄纸似
绿似蓝之类。光华晕大。则视日与灯烛皆生红晕而大。此阴精亏损。阳光飞越之候。总补养为主。
如加减驻景丸、益气聪明汤之类。久而不治。不无内障之虞。
报国澄和尚患眼疾二年。服祛风清热药过多。致耳鸣嘈嘈不止。大便常苦燥结。近来左眼上
有微翳。见灯火则大如斗。视月光则小如萤。尝询诸方家。俱莫能解。因以质之石顽。石顽曰。
此水亏而阴火用事也。试以格物之理参之。如西洋玻璃眼镜。人但知宜于老人。不知原为望气者
而设。其最精者。咸以十二镜编十二支为一套。无论老少。其间必有一者。能察秋毫。则知人眼
有十二种偏胜。故造眼镜者。亦以十二等铅料配之。取铅以助阴精。料以助阳气也。少年气血本
旺。原无藉此。若铅料之轻重。与眼之偏胜不相当。则得之反加障碍矣。老人气血皆衰。但借此
以笼住其光。不使散漫。不必论其铅料之孰重孰轻也。即如所言视月甚小者。月乃至阴之精。真
水内涸。不能泛滥其光。所以视之甚小。设加之以铅重者。则视月必大矣。见灯火甚大者。灯本
燃膏之焰。专扰乎阴。不能胜其灼烁。所以见之甚大。设加之以料重者。灯火必愈大矣。合脉参
证。知为平昔劳伤心脾。火土二脏过燥。并伤肾水真阴也。遂疏天王补心丹与之。他如中翰徐燕
及。见日光则昏眯如蒙。见灯火则精彩倍常。此平昔恒劳心肾。上盛下虚所致。盖上盛则五志聚
于心包。暗侮其君。如权党在位。蒙蔽九重。下虚则相火失职。不能司明察之
令。得灯烛相助其力。是以精彩胜于常时。此与婴儿胎寒夜啼。见火则止之义不殊。未识专事眼
科者。能悉此义否。
李东垣说：能看清远处却看不清近处，是因为阳气有余，阴气不足。这是少年时期过度用眼所致。
王海藏说：眼睛能看清远处，说明体内有火（阳热）；看不清近处，责任在于无水（阴精亏虚）。治疗方法应当补肾，使用加减地芝丸，或者对六味丸进行加减化裁。《针灸秘要》说：阴精不足，阳光（阳热）相对有余，病变在于水（肾阴），所以眼内的光华显现出来，散乱而不能收敛以看清近处。治疗需要从心、肾入手。如果贪恋淫欲，饮食饥饱无常，身体极度疲劳，或者过度悲伤哭泣，都会耗伤阴精。精血亏损则阳火亢盛，火性炎上而外越，阴精不能制约和挽回，所以光芒向外发散而无法聚焦于近处。如果在治疗时反而受到刺激激惹，可能会引发内障的隐患。
李东垣又说：能看清近处却看不清远处，是因为阳气不足，阴气有余。这是老年人精力衰退的象征。
王海藏说：眼睛能看清近处，说明体内有水（阴精）；看不清远处，责任在于无火（心阳/命门火不足）。治疗方法应当补心，服用加味定志丸或八味丸，早晚交替服用。《针灸秘要》说：这种病症并不是指先天禀赋导致的近视病，而是平时没有疾病，原本能看清远处，突然变得不能看清的情况。这是因为阳气不足而阴气有余，病变在于火（心阳/命门火），所以眼内的光华不能发散到外部，只能向内收敛以看清近处。治疗需要从胆、肾入手。如果沉溺于饮酒，嗜好燥热食物，或者有头风痰火，或者愤怒暴躁，必定会损伤神气，导致阴阳偏胜，从而使眼内光华不能发达。
《素问》说：精明之气，是用来观察万物，辨别黑白，审视长短的。如果把长的看成短的，把白的看成黑的，这就说明精气衰败了。人的眼睛，是心的使者。心，是神的居所。所以精神混乱而不运转，突然看到不寻常的景象，精神魂魄离散而不能协调，这就叫做“惑”（视物迷惑）。比如神光自见，就像闪电一样；在黑夜中视力异常明亮，则在昏暗之中忽然看见物体；看正的东西觉得邪，则是物体本是正的，但眼睛看成了邪的；看静止的东西觉得动，则是物体本是静止的，但眼睛看成了动的；看东西颠倒，则是观察物体都觉得振动倒置；看一个东西成两个，则是一个物体，但眼睛看成了两个；视瞻有色，则是经常看见萤火虫、星星、云雾以及大片青、绿、蓝、碧等颜色；视赤如白，则是看物体却不是本色，比如看粉墙像红色或绿色，看黄纸像绿色或蓝色等等；光华晕大，则是看太阳和灯烛都产生红色的光晕且显得很大。这些都是阴精亏损，阳光飞越的征候。总的治疗原则以补养为主，比如加减驻景丸、益气聪明汤之类。如果长期不治疗，难免有患内障的忧虑。
报国澄和尚患有眼疾两年，因为服用了过多的祛风清热药物，导致耳鸣声嘈杂不止，大便常常苦于干燥结滞。近来左眼上方有一层微薄的翳膜，看灯火时觉得大如斗，看月光时觉得小如萤火虫。曾经咨询各位医生，都不能解释清楚。于是向我（张璐，字石顽）请教。我说：这是肾水亏虚而阴火妄行的表现。试着用格物的道理来分析。比如西洋玻璃眼镜，人们只知道适合老人使用，却不知道它原本是为视力调节者设计的。其中最精密的，是用十二种镜片编入十二地支的一套中。无论老少，其中必有一种适合，能看清毫毛般的细微之物。由此可知人的眼睛也有十二种偏胜的情况，所以制造眼镜的人，也用十二种不同重量的铅料来配制，取铅来辅助阴精，取其他材料来辅助阳气。少年气血本来旺盛，原本不需要借助眼镜。如果铅料的轻重与眼睛的偏胜情况不相适应，得到后反而会增加障碍。老人气血都已衰退，只是借此来笼住其目光，不让其散漫，不必讨论铅料的孰轻孰重。就拿所说的看月亮特别小的情况来说，月亮是至阴的精气，真水在内枯竭，不能泛滥其光芒，所以看起来很小。如果加上较重的铅镜，那么看月亮一定会变大。看灯火特别大的情况，灯火本是燃烧油脂的火苗，专门扰动阴分，不能胜过其灼热的光芒，所以看起来很大。如果加上较轻的材料（助阳之料），灯火一定会显得更大。结合脉象参证，知道这是平时劳伤心脾，火（心）、土（脾）两脏过于燥热，并伤了肾水的真阴。于是开具天王补心丹给他服用。又如中翰徐燕及，看日光时昏花眯眼如同蒙蔽，看灯火时神采比平常加倍。这是平时恒常劳伤心肾，导致上盛下虚所致。上面盛则五志聚集于心包，暗中欺侮君主（心），如同权臣当位，蒙蔽九重天；下面虚则相火失职，不能执行明察的命令。得到灯烛的帮助其力量，所以神采胜过平常时候。这与婴儿胎寒夜啼，见到火光就停止哭泣的道理没有区别。不知道专门从事眼科的人，能否通晓这个道理呢？
Li Dongyuan stated: The condition of being able to see distant objects clearly but not near ones is due to an excess of Yang Qi and a deficiency of Yin Qi. This results from the excessive use of eyesight in youth.
Wang Haizang stated: The ability to see far indicates the presence of Fire (Yang heat); the inability to see near is attributed to the absence of Water (deficiency of Yin essence). The treatment method should focus on tonifying the Kidney, using Jiajian Dizhi Wan (Modified Lizhi Pill) or Liuwei Wan (Six-Ingredient Rehmannia Pill) with modifications. *Zhenjiu Mibao* (Secrets of Acupuncture and Moxibustion) states: When Yin essence is insufficient and Yang light (Yang heat) is relatively excessive, the pathology lies in Water (Kidney Yin), causing the "light" of the eye to manifest outwardly, scattering and failing to converge for near vision. Treatment should address the Heart and Kidney. Indulgence in lust, irregular eating habits, extreme physical fatigue, and excessive weeping all damage Yin essence. When essence is depleted, Yang fire becomes hyperactive. Since fire nature is flaming and outward-rising, and Yin essence cannot restrain or retrieve it, the light scatters outward and fails to focus on near objects. If treatment provokes or irritates this condition further, there is a risk of developing internal cataracts.
Li Dongyuan also stated: The condition of being able to see near objects clearly but not distant ones is due to a deficiency of Yang Qi and an excess of Yin Qi. This is a sign of declining vitality in the elderly.
Wang Haizang stated: The ability to see near indicates the presence of Water (Yin essence); the inability to see far is attributed to the absence of Fire (deficiency of Heart Yang/Mingmen Fire). The treatment method should focus on tonifying the Heart, administering Jiawei Dingzhi Wan (Additive Dingzhi Pill) or Bawei Wan (Eight-Ingredient Pill) taken alternately in the morning and evening. *Zhenjiu Mibao* states: This syndrome is not a congenital myopia, but rather a sudden loss of distance vision in someone who was previously healthy and could see far. It occurs because Yang is deficient and Yin is excessive, with pathology lying in Fire (Heart Yang/Mingmen Fire), causing the eye's "light" to fail to radiate outward, instead converging inward for near vision. Treatment should address the Gallbladder and Kidney. Indulgence in alcohol, preference for dry/hot foods, head wind with phlegm-fire, or anger and暴悖 (violent temper) will inevitably damage Shen Qi (Spirit Qi), leading to Yin-Yang imbalance and preventing the eye's light from flourishing.
The *Suwen* (Basic Questions) states: Jingming (Essence and Brightness) is used to perceive all things, distinguish black from white, and judge length. If one perceives long as short and white as black, it indicates that Jing (Essence) has declined. The human eye is the envoy of the Heart. The Heart is the residence of Shen (Spirit). Therefore, when Spirit is chaotic and unresponsive, and one suddenly sees extraordinary phenomena, the Spirit, Hun, and Po scatter and lose coordination; this is called "Huo" (Confusion/Delusion). For example, seeing self-generated light like lightning; having abnormally bright vision at night, seeing objects suddenly in darkness; perceiving upright objects as crooked (the object is upright but seen as crooked); perceiving stationary objects as moving (the object is still but seen as moving); seeing inverted objects (all observed objects appear vibrating or upside down); diplopia (seeing one object as two); colored hallucinations (frequently seeing fireflies, stars, clouds, or large patches of cyan, green, blue, or emerald); erythropsia/albopsia (seeing objects in wrong colors, such as a white wall appearing red or green, or yellow paper appearing green or blue); enlarged halos (seeing the sun and candles with large red halos). These are signs of Yin essence depletion and the flight of Yang light. The general treatment principle is tonification and nourishment, such as Jiajian Zhujing Wan (Modified Zhujing Pill) or Yiqi Congming Tang (Qi-Boosting and Hearing/Vision-Enhancing Decoction). If left untreated for a long time, there is a danger of internal cataracts.
Monk Bao Guocheng suffered from eye disease for two years. Due to taking too many Wind-dispelling and Heat-clearing medicines, he developed continuous buzzing tinnitus and chronic constipation with dry stool. Recently, a slight opacity appeared on his upper left eye. He perceived lantern lights as large as a bushel and moonlight as small as a firefly. He consulted various physicians, but none could explain it. He then sought advice from Shiwen (Zhang Lu, courtesy name Shiwen). I said: This is a case of Kidney Water deficiency with the dominance of Yin Fire. Let us analyze it using the principles of investigating things. Consider Western glass eyeglasses: people know they suit the elderly, but originally they were designed for visual adjustment. The most precise sets consist of twelve lenses corresponding to the twelve Earthly Branches. Regardless of age, one pair will always fit perfectly to see fine hairs. Thus, we know the human eye has twelve types of bias/excess. Manufacturers therefore create glasses with twelve weights of lead materials, using lead to assist Yin essence and other materials to assist Yang Qi. Young people have robust Qi and Blood and do not need these aids. If the weight of the lead does not match the eye's bias, wearing them will cause obstruction. Elderly people have declining Qi and Blood and use glasses merely to contain their scattered light, so the specific weight of lead is less critical. Regarding the complaint of seeing the moon very small: the moon is the essence of supreme Yin. When True Water is dried up internally, its light cannot overflow, so it appears small. Adding heavy lead lenses would make the moon appear larger. Regarding seeing lantern lights very large: lantern fire is flame burning fat/oil, which disturbs Yin and cannot withstand its own scorching brightness, so it appears large. Adding lighter (Yang-assisting) materials would make the lantern appear even larger. Correlating with pulse diagnosis, I determined this was caused by chronic overwork damaging the Heart and Spleen, leading to excessive dryness in the Fire (Heart) and Earth (Spleen) organs, and damaging the True Yin of Kidney Water. I prescribed Tianwang Buxin Dan (Heavenly Emperor Heart-Nourishing Pill). Another case: Xu Yanji, a Hanlin Academician, experienced dimness and blinding when looking at sunlight, but heightened visual acuity when looking at lantern lights. This was due to chronic overwork of the Heart and Kidney, resulting in Upper Excess and Lower Deficiency. Upper Excess means the Five Emotions gather in the Pericardium, secretly insulting the Monarch (Heart), like powerful ministers obscuring the throne. Lower Deficiency means Ministerial Fire loses its function and cannot execute the command of clear vision. With the assistance of candlelight, the visual acuity surpasses normal levels. This is no different from the principle that infants with fetal cold cry at night but stop when exposed to fire. I wonder if those specializing in ophthalmology fully understand this meaning?