伤寒直视者。盖视物而目睛不转动者是也。水之精为志。火之精为神。目者心之使也。
神所
为眼
骨。血气之精与脉。并为系上属于脑。五脏血气调和。精气充荣。则目和而明矣。伤
视者。邪气壅盛。冒其正气。使神志不慧。五脏之精气不上荣于目。则为之直视。伤
直视。为邪气已极。证候已逆。多难治。经曰。衄家不可发汗。汗则额上陷。脉息紧
视不能 。不得眠。以肝受血而能视。亡血家肝气已虚。目气已弱。又发汗亡阳。则
虚所致也。此虽错逆犹未甚也。逮乎狂言反目直视。又为肾绝。直视摇头又为心绝。
脱绝也。直视谵语喘满者死。下利者亦死。又剧者。发则不识人。寻衣摸床。惕而不安
喘直视。皆邪气盛而正气脱也。其或有目中不了了。睛不和。无表里证。大便难。身有
者。是非直视也。此为内实也可用大承气汤、大柴胡汤下之。直视为不治之疾。目中不
为可治之候。二者形证相近。宜熟视之。
歌曰。直视无神不转睛。衄兼少血汗犹轻。遗溺喘泄摇头证。脉涩寻衣并猝倾。
又论云。水之精为志。火之精为神。五脏六腑之精皆上注于目。病患邪气极盛。冒其正
气。
此
发
不
惕
脉
大
仁柔也。不仁谓不柔和也。痒不知也。痛不知也。寒不知也。热不知也。任其屈伸灸刺
不知
曰。
痹而
郁
为不知痛痒。不得为尸厥之厥。即经曰。少阴脉不至。肾气微。精气少。奔气促迫。上入胸
膈。宗气反聚。血结心下。阳气退下。热归阴股。与阴相动。令身不仁。此为尸厥。其乘寒
之厥。郁冒不仁。即此尸厥可知矣。若越人入虢。诊太子为尸厥。以郁冒为不仁。为可治。
刺之而得痊。实神医之诊也。呜呼。设或脉浮而涩。身汗如油。喘而不休。水浆不下。形体
不仁。此又为命绝。虽有越人其能起之欤。
歌曰。不仁口腹及肤皮。痛痒寒温总不知。正气重为邪气伏。营虚卫弱厥如尸。经曰。
乘寒
痒不
气绝
用。
令
伤寒病出现直视症状的，是指眼睛注视物体而眼球不转动。肾精称为志，心精称为神。眼睛是心的外使。神所主的眼骨（此处指眼之结构），以及血气之精与脉络，共同上行连属于脑。若五脏的血气调和，精气充盈荣润，则眼睛和顺明亮。
如果邪气壅盛，蒙蔽正气，导致神志昏昧，五脏的精气不能上荣于目，就会出现直视。伤寒病见直视，说明邪气已至极点，证候已逆乱，大多难以治疗。医经说：经常鼻出血的人不可发汗，若误发其汗，会导致额部凹陷、脉搏紧张、眼睛直视不能转动、无法安睡。因为肝受血滋养才能视物，亡血之人肝气已虚，目气已弱，再发汗导致亡阳，这是由虚损所致。这种情况虽然错逆但尚未达到极严重程度。
等到出现胡言乱语、反张直视，这是肾气绝的表现；直视伴摇头，这是心气绝的表现，均为脱绝之象。直视伴谵语、气喘胸满者死；下利者亦死。病情更重的，发作时不认识人，手在衣被床帐间摸索，惊恐不安，气喘直视，这都是邪气盛而正气脱失的表现。
如果有的人眼中感觉模糊不清，眼球运动不和调，没有表证也没有里证，大便困难，身体有微热，这不属于直视。这是内实之证，可以用大承气汤、大柴胡汤攻下。直视是不治之疾，而“目中不了了”则是可治的征候。这两种形证相近，应当仔细辨别。
歌诀说：直视无神不转睛，衄家兼少血汗犹轻。遗尿喘泄摇头证，脉涩寻衣并猝倾。
又论述说：肾精为志，心精为神。五脏六腑的精气都上注于目。病人邪气极盛，蒙蔽正气，导致神志恍惚惊恐。
“不仁”意为柔和度丧失。所谓不仁，是指感觉迟钝或丧失。痒不知晓，痛不知晓，冷不知晓，热不知晓。任凭肢体屈伸、艾灸针刺，都毫无知觉。这就是痹症郁滞导致不知痛痒。这种状态不是尸厥那种完全失去意识的厥证。即医经所说：少阴脉不至，肾气微弱，精气不足，奔豚之气急促迫促，向上冲入胸膈，宗气反过来聚结在心下，阳气退下，热气归于阴股，与阴气相互激荡，导致身体不仁。这叫做尸厥。如果是因寒邪侵袭导致的厥证，伴随郁冒和不仁，从这种尸厥的情况就可以知道了。
如果像扁鹊诊治虢国太子那样，诊断太子为尸厥，以郁冒为不仁，那是可以治疗的，通过针刺得以痊愈，这确实是神医的诊断啊。唉！假如脉象浮而涩，身体出汗如油，气喘不停，水浆不进，形体不仁，这又是命绝之兆，即使有扁鹊那样的神医，又能救活他吗？
歌诀说：不仁涉及口腹及皮肤，痛痒寒温总不知。正气重为邪气伏，营虚卫弱厥如尸。医经说：因乘受寒邪……
In the context of Cold Damage (Shanghan), "fixed gaze" (Zhishi) refers to the condition where the eyes stare at an object without moving. The essence of Water is called Zhi (Will/Intent), and the essence of Fire is called Shen (Spirit). The eyes are the emissaries of the Heart. The bony structure associated with the Shen, along with the essence of Qi and Blood and the meridians, ascend and connect to the brain. When the Qi and Blood of the Five Zang Organs are harmonious and their Essence is abundant and nourishing, the eyes are smooth and bright.
If pathogenic factors are excessive and obstruct the Healthy Qi, causing the Spirit and Will to become dull, and the Essence of the Five Zang Organs fails to ascend to nourish the eyes, fixed gaze occurs. In Cold Damage, fixed gaze indicates that pathogenic factors have reached their extreme and the syndrome pattern has become inverted; it is generally difficult to treat. The Classics state: "Patients who frequently suffer from epistaxis should not undergo sweating therapy." If sweating is induced in error, it leads to depression of the forehead, tight pulse, fixed gaze with inability to move the eyes, and insomnia. This is because the Liver receives Blood to enable vision; in patients who have lost blood, Liver Qi is already deficient and Eye Qi is weak. Further inducing sweating causes loss of Yang, resulting from deficiency. Although this inversion is serious, it is not yet at the most critical stage.
However, if delirious speech, opisthotonos with fixed gaze occur, this indicates the exhaustion of Kidney Qi; if fixed gaze is accompanied by shaking of the head, this indicates the exhaustion of Heart Qi, representing a state of collapse and exhaustion. Fixed gaze accompanied by delirium, wheezing, and chest fullness indicates death; diarrhea also indicates death. In more severe cases, the patient becomes unrecognizable, gropes at clothes and beds, feels terrified and restless, suffers from wheezing and fixed gaze; all these indicate that pathogenic factors are excessive while Healthy Qi is exhausted.
If a patient experiences blurred vision ("mumu liao liao") and disordered eye movement, without exterior or interior syndromes, difficulty in defecation, and slight body heat, this is not fixed gaze. This is an internal excess condition, which can be treated with Da Cheng Qi Tang (Major Order the Qi Decoction) or Da Chai Hu Tang (Major Bupleurum Decoction) to purge the bowels. Fixed gaze is considered an untreatable disease, whereas "blurred vision" is a treatable sign. These two conditions appear similar but must be carefully distinguished.
The verse states: Fixed gaze lacks spirit and eyes do not turn; for those with epistaxis and blood deficiency, sweating is still mild. Incontinence, wheezing, diarrhea, and head-shaking signs; thready pulse, groping at clothes, and sudden collapse.
Furthermore, it is discussed that the essence of Water is Zhi, and the essence of Fire is Shen. The essence of the Five Zang and Six Fu Organs all ascends to the eyes. When a patient's pathogenic factors are extremely excessive and obscure the Healthy Qi, it leads to mental confusion and fright.
"Bu Ren" (Insensibility) means the loss of softness and responsiveness. Insensibility implies a lack of sensation: unawareness of itching, pain, cold, or heat. Regardless of limb flexion/extension, moxibustion, or acupuncture, there is no perception. This is due to Bi Syndrome (Painful Obstruction) stagnation causing unawareness of pain and itch. This state is not the complete unconsciousness of Shi Jue (Corpse-like Collapse). As stated in the Classics: "When the Shaoyin pulse is absent, Kidney Qi is faint, and Essence and Qi are scarce, Ben Qi (Rushing Qi) becomes urgent and presses upward into the chest and diaphragm. Zong Qi (Gathering Qi) gathers inversely below the heart. Yang Qi retreats downward, heat returns to the inner thighs, interacting with Yin, causing insensibility of the body. This is called Shi Jue." If the collapse is caused by cold invasion, accompanied by depression/fullness and insensibility, this can be understood through the case of Shi Jue.
For instance, when Bian Que diagnosed the Crown Prince of Guo as suffering from Shi Jue and interpreted depression/fullness as insensibility, it was treatable, and he recovered through acupuncture, demonstrating the skill of a divine physician. Alas! If the pulse is floating and thready, sweat flows like oil, wheezing does not cease, food and fluids cannot be taken, and the body is insensible, this indicates the extinction of Life Qi. Even with a physician like Bian Que, could he revive him?
The verse states: Insensibility affects the mouth, abdomen, and skin; pain, itch, cold, and warmth are all unknown. Healthy Qi is heavily suppressed by pathogenic factors; Ying (Nutritive) deficiency and Wei (Defensive) weakness lead to collapse resembling corpse-like stillness. The Classics state: Due to cold invasion...