目虽肝之窍,而实五脏六腑之精气皆上注于目,故其赤脉属心,瞳子属肾,白珠属肺,
黑珠属肝,裹约属脾。又太阳为上网,阳明为下网,少阴循外 ,太阳出内 ,此其部分各
有所主,故可因证以察其本也。然痘疮之病目而为障为翳者,多由火炎于内而热以生风,风
热散于诸经,因多红赤肿痛之患。故治此者,亦当察其所属而因证以调之也。
一、戴眼证,凡痘疮灌脓之后,或大汗大泻之后,多有目睛上吊,或露白者,谓之戴眼。
此精气为脓血汗液所耗,乃太阳少阴真阴亏竭大虚之证。盖太阳为上网,血枯则筋急,所以上吊
也,速宜大补气血,以六物煎、六气煎,或十全大补汤之类主之。其有以此为风热而散之解
之者,是皆速其死也。若七日以前见此者多不治,或无魂失志,不省人事者亦不治。
一、痘疮目赤肿痛翳障等证,无不谓之风热,故古方亦多用清火散风等剂。夫痘疮之火由中
生,目为肝窍,肝主风木而病在目,故云风热,实以风生于火由内热也。所以凡治目赤目
痛者,不必治风,但治其火,火去则风自息矣。何也?盖内生之风与外感之风不同,外感
之风,升之散之则解散而去,内生之风而再加升散,则火愈炽而热愈高矣。常见治目多难救而
寒凉反以伤脾者,正以升降相杂,而用药有不精耳。经曰∶高者抑之,果
何谓乎。今如古方之治火眼,凡用洗肝散,及洗肝明目散、芍药清肝散之类,总不如《良方》
龙胆泻肝汤,而《良方》泻肝汤又不如加味龙胆泻肝汤之为得宜也。
一、痘疮眼中流浪赤痛,或多眼眵,此肝火之盛也,宜清解之,以加味龙胆泻肝汤或抽
薪饮,加木贼、蝉蜕之类主之;若大便结闭不通者,亦可少加大黄。
一、痘疮入眼肿痛,或痘后生翳膜者,宜蒺藜散、蝉菊散,或通神散,外以秦皮散洗之。
一、痘疮目病,热少风多而昏暗涩痛,眵泪羞明翳障者,宜密蒙花散,亦以秦皮散洗之。
一、痘后眼闭泪出不敢见明者,此内火不清而阳光烁之,故畏明也,宜洗肝明目散。
一、痘后眼皮风毒赤烂,或痛或痒,燥涩羞明多眵泪者,秦皮散洗之。
一、痘疮靥后,精血俱耗,而眼涩羞明,光短倦开,或生翳障者,宜四物汤,甚者六
物煎加木贼、蝉蜕、白蒺藜。
一、痘斑入眼,在白珠上者不必治,久当自去,惟在黑珠上宜治之,当清肝火。
一、凡病目热者,最宜忌酒及椒、姜、牛、羊、鸡、鹅、鸭一应热物,并鸡鹅鸭蛋皆
不可用,以防连绵不愈之患。
一、痘疮热毒伤目,凡必用之药,如生地、芍药、麦门冬、山栀、玄参、草决明、连翘、
黄芩、黄运,肝热者龙胆草,阳明实热者石膏、石斛,肾火盛者黄柏、知母,三阴俱热者地骨皮,
火浮不降者木通、泽泻,翳障不去者木贼草、蝉蜕、白蒺藜,气虚者人参、黄 ,血虚者当归、
熟地。但火炎于上者不宜升,阴虚于下者不宜泄,是皆治眼之大法。
一、痘疮护眼法,宜钱氏黄柏膏为佳,从耳前眼皮上下颧面间,日涂三四次,可以护
眼稀痘。
一、用点药者,凡目中生痘,或食发物,或热毒太盛,上蒸目窍,以致热毒或生翳障,
切不可妄用一切点药。盖其非毒即冷,必致寒热相激,反以为害。惟余之金露散乃为相宜,
可间用之以解热毒之急。
徐氏曰∶痘之毒瓦斯自里达表,故有目病,治宜活血解毒而已。活血不至热,解毒不至寒,
但得血活毒散,则目疾自愈。
眼睛虽然是肝的窍道,但实际上五脏六腑的精气都向上灌注于眼睛,所以眼部的赤脉归属于心,瞳孔归属于肾,白珠(巩膜)归属于肺,黑珠(角膜和虹膜)归属于肝,包裹眼球的眼睑肌肉归属于脾。另外,足太阳膀胱经构成眼睑的上网,足阳明胃经构成眼睑的下网,足少阴肾经循行于外侧,足太阳膀胱经出于内侧,这些部位各有其主治范围,因此可以通过症状来考察疾病的根本原因。然而,痘疮病导致眼部出现障蔽和翳膜的,多是由于火邪在内炎上,热极生风,风热散播到各条经络,因而常出现红、赤、肿、痛等病患。所以治疗这类疾病,也应当考察其所属脏腑,并根据症状进行调理。
一、戴眼证:凡是痘疮化脓之后,或者大汗、大泻之后,经常出现眼球上吊,或者露出眼白的情况,称为“戴眼”。这是因为精气被脓血、汗液、津液所耗损,属于太阳经和少阴经真阴亏竭、极度虚弱的证候。因为太阳经构成上网,血液枯竭则筋脉拘急,所以眼球会上吊。此时应迅速大补气血,以六物煎、六气煎,或十全大补汤之类的方剂为主治。那些将此症误认为是风热而使用发散解表药物的人,都是在加速病人的死亡。如果在发病七日以前出现这种情况的,大多无法治愈;或者出现失魂丧志、不省人事的,也无法治愈。
一、痘疮引起的目赤、肿痛、翳障等症状,无不被认为是风热所致,所以古方也多采用清火散风的方剂。痘疮的火邪由内生发,眼睛是肝的窍道,肝主风木且病变表现在眼睛,所以说这是风热,实际上风是由内热产生的。因此,凡是治疗目赤、目痛的,不必专门治风,只要治疗火邪,火邪去除则风自然平息。为什么呢?因为内生的风与外感的风不同,外感的风,通过升提、发散的方法就可以解散排出;如果是内生的风,再加以升提发散,就会使火更旺、热更高。常见治疗眼病多难治愈,反而因寒凉药物损伤脾胃的情况,正是由于升降治法混杂,用药不够精当的缘故。《内经》说:“高者抑之”,这是什么意思呢?如今像古方治疗火眼,凡是用洗肝散,以及洗肝明目散、芍药清肝散之类的,总不如《良方》中的龙胆泻肝汤,而《良方》的泻肝汤又不如加味龙胆泻肝汤更为适宜。
一、痘疮眼中流泪、红肿疼痛,或者眼屎多的,这是肝火旺盛的表现,宜用清热解毒的方法,以加味龙胆泻肝汤或抽薪饮,加入木贼、蝉蜕之类的药物为主治;如果大便干结不通的,也可以少量加入大黄。
一、痘疮侵入眼睛引起肿痛,或者痘后生成翳膜的,宜用蒺藜散、蝉菊散,或通神散,外用秦皮散清洗。
一、痘疮引起的眼病,热象少而风象多,表现为视物昏暗、涩痛、眼屎多、流泪、畏光、有翳障的,宜用密蒙花散,也用秦皮散清洗。
一、痘后眼睛闭合、流泪不敢见光的,这是内火不清而被阳光灼烧,所以畏惧光亮,宜用洗肝明目散。
一、痘后眼皮出现风毒、红肿溃烂,或者疼痛、瘙痒,干燥涩滞、畏光、眼屎泪多的,用秦皮散清洗。
一、痘疮结痂后,精血俱耗,导致眼睛干涩、畏光、视力短浅、容易疲倦睁不开眼,或者生成翳障的,宜用四物汤,严重的用六物煎加入木贼、蝉蜕、白蒺藜。
一、痘斑进入眼睛,位于白珠上的不必治疗,久了自然会消退;只有在黑珠上的才需要治疗,应当清泻肝火。
一、凡是患有眼热的病人,最应该忌食酒类以及花椒、生姜、牛肉、羊肉、鸡肉、鹅肉、鸭肉等一切热性食物,鸡鹅鸭蛋也都不可食用,以防病情缠绵不愈。
一、痘疮热毒伤害眼睛,凡必须使用的药物,如生地、芍药、麦门冬、山栀、玄参、草决明、连翘、黄芩、黄连,肝热者用龙胆草,阳明实热者用石膏、石斛,肾火盛者用黄柏、知母,三阴经俱热者用地骨皮,火浮不降者用木通、泽泻,翳障不去者用木贼草、蝉蜕、白蒺藜,气虚者用人参、黄芪,血虚者用当归、熟地。但是,火炎于上的不宜用升提药,阴虚于下的不宜用泄下药,这些都是治疗眼病的大法。
一、痘疮护眼的方法,以钱乙的黄柏膏为佳,从耳前、眼皮上下及颧面之间,每天涂抹三四次,可以保护眼睛并稀疏痘疹。
一、使用点眼药的,凡是眼中生出痘疮,或者食用了发物,或者热毒太盛,向上熏蒸目窍,导致热毒或生成翳障的,切不可妄用所有的点眼药。因为这些药要么有毒,要么是冷性的,必然导致寒热相互激荡,反而造成危害。只有我的金露散才比较适宜,可以间歇使用以解除热毒的急症。
徐氏说:痘疮的毒气自里达表,所以会出现眼病,治疗宜活血解毒而已。活血不至于过热,解毒不至于过寒,只要能使血活毒散,那么眼疾自然痊愈。
Although the eyes are the orifices of the Liver, in reality, the essence and qi of all five zang organs and six fu organs ascend and pour into the eyes. Therefore, the red vessels belong to the Heart (Xin), the pupils belong to the Kidney (Shen), the white part (sclera) belongs to the Lung (Fei), the black part (cornea and iris) belongs to the Liver (Gan), and the eyelids/muscles wrapping the eye belong to the Spleen (Pi). Furthermore, the Taiyang channel forms the upper net, the Yangming channel forms the lower net, the Shaoyin channel circulates on the outside, and the Taiyang channel emerges from the inside; each part has its specific governance, so one can investigate the root cause by observing symptoms. However, when measles-rubella (or smallpox-like eruptions) affect the eyes causing obstructions and nebulae, it is mostly due to fire blazing internally and heat generating wind. The wind-heat scatters through various channels, often resulting in redness, swelling, and pain. Thus, treating this condition requires examining the affected organ system and regulating according to symptoms.
1. Daiyan Syndrome (Eyes fixed upward): After the pustule stage of eruptions, or following severe sweating or diarrhea, patients often exhibit eyes fixed upward or showing the whites of the eyes, known as "Daiyan." This occurs because essence and qi are depleted by pus, blood, sweat, and fluids, representing a syndrome of extreme deficiency and exhaustion of true yin in the Taiyang and Shaoyin channels. Since the Taiyang channel forms the upper net, blood depletion leads to tendon tension, causing the eyes to fix upward. Immediate vigorous supplementation of qi and blood is required, primarily using Liuwu Decoction (Six-Ingredient Decoction), Liuqi Decoction (Six-Qi Decoction), or Shiquan Dabu Tang (Ten Significant Tonifying Decoction). Those who mistakenly treat this as wind-heat and use dispersing methods only accelerate death. If this appears within seven days, it is generally incurable; similarly, cases with loss of spirit/consciousness and unresponsiveness are incurable.
2. Symptoms such as redness, swelling, pain, and nebulae caused by eruptions affecting the eyes are invariably attributed to wind-heat, so ancient formulas often employ agents that clear fire and disperse wind. The fire in eruptions originates internally. Since the eyes are the orifice of the Liver, and the Liver governs wind and wood with pathology manifesting in the eyes, it is termed wind-heat; however, wind actually arises from internal heat. Therefore, when treating red and painful eyes, one need not specifically treat wind; rather, treat the fire. Once the fire is eliminated, the wind naturally subsides. Why? Because internally generated wind differs from externally contracted wind. Externally contracted wind can be dispersed via ascending and releasing methods. However, applying ascending and releasing methods to internally generated wind intensifies the fire and raises the heat. It is common to see difficult-to-treat eye conditions where cold-natured herbs damage the Spleen; this is precisely due to the mixed use of ascending and descending therapies and imprecise medication. As the Classics state: "For those high up, suppress them." What does this mean? Regarding ancient treatments for fire-eye, formulas like Xigan San (Liver-Washing Powder), Xigan Mingmu San (Liver-Washing Brightening-Eye Powder), and Shaoyao Qinggan San (Peony Clearing-Liver Powder) are inferior to Longdan Xiegan Tang (Gentian Draining-Liver Decoction) from *Liangfang*, and Longdan Xiegan Tang is itself inferior to Jiawei Longdan Xiegan Tang (Modified Gentian Draining-Liver Decoction) in appropriateness.
3. For eruptions causing tearing, redness, swelling, pain, or excessive ocular discharge in the eyes, this indicates excessive Liver fire. It should be cleared and resolved using Jiawei Longdan Xiegan Tang (Modified Gentian Draining-Liver Decoction) or Chouyin Yin (Firewood-Drawing Drink), added with Equisetum Herba (Muzei) and Bombyx Batryticatus (Chantui). If constipation is present, Rhizoma et Rhizoma Rhei (Dahuang) may be added in small amounts.
4. For eruptions invading the eyes causing swelling and pain, or nebulae forming after eruptions, use Jili San (Tribulus Powder), Chanju San (Cicada-Chrysanthemum Powder), or Tongshen San (Spirit-Unblocking Powder), and wash externally with Qinpi San (Fraxinus Bark Powder).
5. For eye diseases post-eruption characterized by less heat and more wind, presenting as dim vision, astringency, pain, excessive discharge, tearing, photophobia, and nebulae, use Mimenghua San (Buddleja Flower Powder), also washing with Qinpi San (Fraxinus Bark Powder).
6. For eyes closed with tears after eruptions, unable to tolerate light, this is due to unclear internal fire being scorched by sunlight, causing photophobia. Use Xigan Mingmu San (Liver-Washing Brightening-Eye Powder).
7. For wind-toxin causing redness and ulceration of eyelids after eruptions, with pain, itching, dryness, astringency, photophobia, and excessive discharge, wash with Qinpi San (Fraxinus Bark Powder).
8. After eruptions crust over, if essence and blood are depleted leading to dry eyes, photophobia, short-sightedness, fatigue in opening eyes, or nebulae formation, use Siwu Tang (Four-Substance Decoction). In severe cases, use Liuwu Decoction (Six-Ingredient Decoction) added with Equisetum Herba (Muzei), Bombyx Batryticatus (Chantui), and Fructus Tribuli (Baibaili).
9. If eruption spots enter the eye on the sclera (white part), no treatment is needed as they will resolve spontaneously; however, if on the cornea/iris (black part), treatment is required to clear Liver fire.
10. Patients with eye heat must strictly avoid alcohol, pepper, ginger, beef, mutton, chicken, goose, duck, and all other hot-natured foods, including chicken and goose eggs, to prevent lingering illness.
11. For eruptions' heat-toxin damaging the eyes, necessary herbs include Radix Rehmanniae Preparata (Shengdi), Radix Paeoniae Alba (Shaoyao), Bulbus Ophiopogonis (Maidong), Fructus Gardeniae (Shanzhi), Radix Scrophulariae (Xuanshen), Semen Cassiae (Juemingzi), Flos Forsythiae (Lianqiao), Radix Scutellariae (Huangqin), and Rhizoma Coptidis (Huanglian). For Liver heat, use Radix Gentianae (Longdancao); for Yangming excess heat, use Gypsum Fibrosum (Shigao) and Radix Dendrobii (Shihu); for exuberant Kidney fire, use Cortex Phellodendri (Huangbai) and Radix Anemarrhenae (Zhimu); for heat in all three Yin channels, use Cortex Lycii (Digupi); for floating fire not descending, use Akebia Caulis (Mutong) and Alisma Rhizoma (Zexie); for persistent nebulae, use Equisetum Herba (Muzei), Bombyx Batryticatus (Chantui), and Fructus Tribuli (Baibaili); for qi deficiency, use Radix Ginseng (Renshen) and Radix Astragali (Huangqi); for blood deficiency, use Radix Angelicae Sinensis (Danggui) and Radix Rehmanniae Preparata (Shudi). However, for fire blazing upward, ascending herbs are contraindicated; for yin deficiency below, draining herbs are contraindicated. These are the general principles for treating eye diseases.
12. For protecting eyes during eruptions, Qian's Huangbai Gao (Phellodendron Ointment) is excellent. Apply to the area between the ear front, upper/lower eyelids, and cheekbones 3-4 times daily to protect eyes and reduce eruption density.
13. When using eye drops, if eruptions form in the eyes, or if triggering foods are consumed, or if heat-toxin is excessive and steams upward to the eye orifices causing heat-toxin or nebulae, do not recklessly use any eye drop preparations. These are either toxic or cold-natured, likely causing cold-heat conflict and harm. Only Jinlu San (Golden Dew Powder) is suitable; it may be used intermittently to relieve acute heat-toxin.
Mr. Xu stated: The toxin of eruptions moves from interior to exterior, hence eye disease occurs. Treatment should focus on invigorating blood and resolving toxin. Invigorating blood avoids excessive heat; resolving toxin avoids excessive cold. Once blood circulation is restored and toxin dissipates, the eye disease heals spontaneously.