瞳神散大者。风热所为也。火性散。挟风益炽。神光怯弱不能支。亦随而散漫。犹风起而水
波也。亦有过服辛散而致者。治宜苦宜酸宜凉。如四物去川芎。加芩、连、甘草、五味。或六味
丸加五味、石决明。大忌辛热。当泻木火之邪。饮食中常如此理。尤忌食冷水大寒之物。能损胃
气也。药中不可用茺蔚、青葙、川芎、蔓荆之类。以味辛反助火也。当归味亦辛甘。而不去者。
以其和血之圣药也。又有瞳神散大而风轮反窄。甚则一周如线者。乃邪热郁蒸。风湿攻激。以致
神膏走散。若初起收放不常者易敛。缓则气定膏散。不可复收。未起内障。止是散大者。直收瞳
神。而光自生。散大而有内障起者。于收瞳神药内量加攻内障药。如补肾磁石丸、补肾丸、千金
磁朱丸之类。大抵瞳神散大。因头风攻痛者多。乃水中伏火之发。最难收敛。如他证伤寒疟疾痰
火等热邪。蒸坏神膏。内障来迟。而收亦易敛。若风攻则内障即
来。且难收敛。而光亦损耳。亦有常人因劳役。或触热而偶然瞳神觉大者。勿误呼为散大也。
瞳神渐渐细小如簪脚。或如芥子。又有神水外围。相类虫蚀。渐觉 臊羞涩。视尚有光。极
难调理。早治可以挽住。经久则难。因病目不忌淫欲。相火强搏肾水。肝肾俱伤。元气衰弱。不
能升运精汁。以滋于胆。胆中之精有亏。所输亦乏。故瞳神亦日渐耗损。甚则陷没俱无。而终身
疾矣。治当抑阳缓阴。先与黄连羊肝丸数服。次与六味地黄丸换生地加二冬。兼进滋肾丸。不应。
加熊胆。亦有头风热证攻走。蒸干津液而细小者。皆宜乘初早救。以免噬脐之悔也。
瞳神散大，是由风热邪气引起的。火性具有发散的特性，若挟带风邪则火势更加炽盛，导致神光怯弱无法支撑，也随之散漫开来，就像风起时水面泛起波纹一样。也有因为过服辛散药物而导致的。治疗应当使用苦味、酸味和凉性的药物。例如四物汤去掉川芎，加入黄芩、黄连、甘草、五味子。或者六味丸加入五味子、石决明。特别忌讳辛热性质的药物，应当清泻肝木与心火的邪气。饮食方面也要按照这个原则调理，尤其忌讳食用冷水和大寒的食物，因为这些会损伤胃气。药物中不可使用茺蔚子、青葙子、川芎、蔓荆子等，因为它们味辛反而助长火势。当归虽然味道也是辛甘的，但不去是因为它是调和血液的圣药。又有瞳神散大但黑睛（风轮）反而变窄，甚至整个黑睛边缘细如线条的情况，这是邪热郁结蒸腾，风湿相互攻激，导致神膏走散。如果在初起阶段收放不规律，还容易收敛；如果拖延久了，气机安定后神膏散开，就不可再收回了。如果没有并发内障，仅仅是瞳神散大的，直接收敛瞳神，视力自然恢复。如果散大并伴有内障发生，则在收敛瞳神的药物中酌情加入治疗内障的药物，如补肾磁石丸、补肾丸、千金磁朱丸之类。大抵瞳神散大，因头风攻痛引起的居多，这是水中伏火发作所致，最难收敛。如果是其他病症如伤寒、疟疾、痰火等热邪，蒸坏神膏，内障来得晚，那么收敛也相对容易。如果是风邪攻击，则内障随即而来，且难以收敛，视力也会受损。也有普通人因劳累过度，或受热后偶然感觉瞳神变大，不要误认为是瞳神散大症。
瞳神渐渐细小如针脚，或者像芥菜籽大小，又有神水外围看起来像被虫蛀蚀一样，逐渐感到眼睛臊涩羞明，看东西还有光亮，极难调理。早期治疗可以挽回，时间久了就难治了。这是因为患眼病期间不禁忌房事，相火强盛搏击肾水，导致肝肾俱伤，元气衰弱，不能升运精汁来滋养胆腑。胆中的精气有亏损，所输布的精微物质也匮乏，所以瞳神也日渐耗损，严重时陷没消失，终身患病。治疗应当抑制阳热、缓和阴亏。先服用黄连羊肝丸几次，接着用六味地黄丸替换生地黄，并加入天冬、麦冬。同时进服滋肾丸。如果无效，加入熊胆。也有因头风热证攻冲，蒸干津液而导致瞳神细小的，都应当在初起时尽早救治，以免留下悔恨。
Dilation of the pupil (Tongshen) is caused by wind-heat. The nature of fire is dispersing; when combined with wind, it becomes even more intense, causing the divine light (Shenguang) to become weak and unable to sustain itself, thus dispersing aimlessly, similar to how ripples form on water when the wind rises. It can also be caused by excessive consumption of acrid-dispersing herbs. Treatment should employ bitter, sour, and cooling agents. For example, Siwu Tang (Four Substances Decoction) with Chuanxiong Rhizoma (Chuanxiong) removed, plus Scutellariae Radix (Huangqin), Coptidis Rhizoma (Huanglian), Glycyrrhizae Radix et Rhizoma (Gancao), and Schisandrae Fructus (Wuweizi). Alternatively, Liuwei Wan (Six-Ingredient Pill with Rehmannia) with added Wuweizi and Heteroconcha Halionis (Shijueming). Acrid-warm substances are strictly contraindicated; one must purge the pathogenic factors of Wood-Fire. Dietary management should follow this principle as well. Consumption of cold water and excessively cold foods is especially forbidden, as they damage Stomach Qi. Herbs such as Ecliptae Herba (Chongwei), Celosiae Semen (Qingxiang), Chuanxiong Rhizoma (Chuanxiong), and Viticis Fructus (Manjing) should not be used in prescriptions because their acrid flavor may inadvertently assist fire. Danggui (Angelicae Sinensis Radix) is also acrid and sweet, but it is retained because it is a supreme herb for harmonizing blood. In cases where the pupil is dilated but the cornea (Fenglun) appears narrowed, or even reduced to a thin line around the circumference, this results from pathogenic heat stagnation and steaming, with wind-dampness attacking and stimulating, causing the Shen Gao (vitreous humor) to scatter. If treated early while the constriction and dilation are irregular, it can still be gathered back; if delayed until the Qi stabilizes and the Shen Gao has dispersed, it cannot be recovered. If no internal cataract (Neizhang) has developed and only pupillary dilation exists, directly gathering the pupil will restore vision naturally. If dilation occurs alongside an internal cataract, anti-cataract formulas should be added in measured amounts to the pupil-gathering prescription, such as Bushen Cishi Wan (Kidney-Nourishing Magnetite Pill), Bushen Wan (Kidney-Nourishing Pill), or Qianjin Cizhu Wan (Thousand-Gold Magnetite and Cinnabar Pill). Generally, pupillary dilation accompanied by headache due to head-wind is common; this is the eruption of latent fire within Water and is the most difficult to收敛 (gather/contract). If the heat pathogen comes from other conditions like Shanghan (Cold Damage), malaria, or phlegm-fire damaging the Shen Gao, the internal cataract appears late, making contraction easier. However, if attacked by wind, the internal cataract appears immediately, is hard to contract, and vision is impaired. There are also ordinary people who, due to overwork or exposure to heat, occasionally feel their pupils appear larger; this should not be mistaken for pathological dilation.
The pupil gradually becomes small, like the tip of a hairpin or a mustard seed. The aqueous humor surrounding it may resemble insect-eaten patterns. The patient gradually experiences eye soreness, itching, and photophobia, yet retains some vision. This condition is extremely difficult to manage. Early treatment can reverse it; prolonged duration makes it hard to cure. This occurs because patients fail to abstain from sexual activity during ocular disease. Ministerial Fire (Xianghuo) aggressively attacks Kidney Water, injuring both Liver and Kidney. Yuan Qi (Original Qi) becomes deficient and fails to ascend and transport essence fluids to nourish the Gallbladder. The essence in the Gallbladder is depleted, and its transmission is insufficient, causing the pupil to deteriorate day by day. Severe cases lead to complete sinking and disappearance of the pupil, resulting in lifelong blindness. Treatment should suppress Yang and soothe Yin. Initially administer Huanglian Yanggan Wan (Coptis and Sheep Liver Pill) for several doses. Then switch to Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill), replacing Shu Di Huang with Sheng Di Huang, and adding Dongguaren (Tian Dong) and Maidong (Mai Dong). Concurrently administer Zishen Wan (Kidney-Nourishing Pill). If ineffective, add Xiongdan (Bear Bile). In cases where head-wind heat syndrome attacks and evaporates body fluids, causing pupillary constriction, early intervention is essential to avoid regretful outcomes.