痰核痰核，湿热两般蒸结。暖红新剥鸡头，风 破为血流。流血流血，胡乱清平不得。
此症艮廓内生一核，大如芡实，按之坚而不痛，只外观不雅。间亦有生于下睑者。盖食火、痰饮酝酿而成。
为治，翻转眼胞，必有形迹，一圆一点，色紫或黄，就于此中砭针。尽法劫夺，挤尽脓液。碾清气化痰丸，淡姜
薄酒调一两，徐徐呷之，刻日平复如初。若以无别苦，不治无碍。恣啖热物，则火愈燥，人而附 垂疣，变为重
疾，经年溃腐不痊。语曰∶涓涓不断，将成江河，此之谓也。
原案∶邑痒某，年六十，体肥善饮。秋时上睑得一核，绝不经意。明年春，其核自破，色红紫微疼。或按
《瑶函》用清胃散结等汤，十数剂稍痊。弥月复发，复投。核渐大，状如荔，外胞绽开。日夜流血不止，遂束手
无策，卒而下世。愚意学人必劳心，癖酒一定有色。心劳者神慢，过饮则脾胃受伤，浊气上蒸，故核大而破。加
以入房太甚，水木俱惫矣。水竭火盈，故血妄行而不归经，乃尔长流。此时急用烙治其标，烙已，以归脾、养荣、
七福、十补培其本，庶几内外两得。此人思不出此，屡以疏风降火，虚其虚而损其损，气衰痰盛之人，有不速其
毕命者乎。书此案，以为食古不化者警。
从来倒睫最蹊跷，病有根苗，症有规条。太阴衰老少阳骄，坏了脂膏，损了皮毛。翳如云雾泪如潮，丹也徒
烧，药也空调。知非手法不能疗，夹又防HT ，烙又愁焦。
此症皆由患疾，妄称时眼，不以为意。或酒、或欲、或风霜，全不禁忌。致风邪深入，久而不瘳。然后内急
外弛，皮宽弦紧，睫渐拳倒，未免泪出。频频拭擦不已，毛愈刺入，遂扫成云翳。目疾所有者，皆具日积月累，
必至失明，治难见效，任灵药不能起睫。睫不起，翳终不净，而泪亦不止。不得已，用法夹之，令毛向外方妥。
夹落再为调护，可保无虞。若仍前纵恣，身子疲极，一有感冒，两目交病，病必肿，肿一次则皮松一次，依然还
元，其功费矣。李东垣谓攀出内睑向外，速以三棱针出热血，以左手大指甲迎右针锋，立急。倪仲贤亦从此治，
且曰∶夹治之法徒为苦耳，切勿施也。但以防风蔓荆饮、决明益阴丸、搐鼻碧云散主之，则紧缩渐弛，宽纵自愈。
李时珍言石燕磨水涂之，睫毛自出之。三人之法，原从乌有先生学来，今失其传。再有教拔去拳毛，以虱子血点
者，以木鳖子、自然铜为条搐鼻者，以锻石扫落毛者，以鱼胶胶紧皮者，以药师医魔，可直偕无是公入 都治鬼，
毋矣绝倒。
夹法∶用老竹一片，长寸许，广一分，正中平破，不可削尖锋。先扎定一头，一头斜侧放开，将患眼上皮安
置其中，丝线络住。教渠载闭载瞪，仔细看真，睫毛毫无倒入，方着力扯紧。其夹外之肉，碾生半夏、生远志，
油调浓涂，则易痿不痛，血气虚衰人不必。然须看两头线缝，稍松一发大，便
过血，务加缚紧。不尔，决肿而溃。俟七日，肉干作痒。拆去夹，将利剪剪落。所着睑之痂，切不可损动，听其
自脱。既脱，以香膏不时于痕上搽抹，久之肉色如旧。药煎竹叶、石膏、麦冬、沙参汤，上、下午调救睛散三钱，
再则黑神散日四钱。夹痂落后，眼内有故，仍如本经燮理。
痰核，是由湿热两种邪气蒸腾郁结而成的。它像刚剥壳的暖红鸡头米（芡实），一旦风邪侵袭导致破裂，就会流血不止。这种出血情况，胡乱使用清平类药物是无法控制的。
此症在眼睑边缘内部长出一个硬结，大小如芡实，按压时坚硬但不疼痛，只是外观不雅观。也有少数生长在眼睑下方的。这通常是由于饮食积热、痰饮内蕴酝酿而成。
治疗时，翻转眼睑，必能发现明显的痕迹，呈圆形或点状，颜色紫暗或发黄，就在此处用砭针刺破。尽力排尽脓液。将清气化痰丸碾成细粉，用淡姜汤和薄酒调服一两，慢慢饮用，不久即可恢复如初。如果患者没有其他的痛苦，不治疗也无大碍。但如果恣意食用辛辣燥热食物，则火气更盛，导致眼睑下垂长出赘疣，演变成重症，长年溃烂腐败无法痊愈。俗话说：“涓涓细流不断，终将汇成江河”，说的就是这种情况。
原案：县学的一位生员，六十岁，身体肥胖且喜好饮酒。秋季时上眼睑长了一个硬结，完全没在意。第二年春天，硬结自行破裂，颜色红紫且微痛。有人参考《眼科龙木论》（瑶函）使用清胃散结等汤药，服用十几剂后稍有好转。一个月后复发，再次投药。硬结逐渐增大，形状像荔枝，眼睑外侧绽开。日夜流血不止，最终束手无策，去世。我认为学习者必须用心思考，嗜好饮酒的人一定伴有房事过度。心神劳损则神气怠慢，过量饮酒则脾胃受伤，浊气上蒸，所以硬结变大并破裂。再加上房事过度，肾水与肝木都疲惫衰竭。肾水枯竭而心火旺盛，导致血液妄行而不归经，于是长时间流淌。此时急需采用烙法治疗其标证，烙治之后，再用归脾汤、养荣汤、七福饮、十补丸来培补根本，这样内外兼顾才有望治愈。此人思虑不到这一点，屡次使用疏风降火的药物，使虚者更虚，损者更损，对于气衰痰盛的人来说，难道不是加速死亡吗？记录此案，以警示那些食古不化的人。
倒睫向来最奇怪，病有根源，症有规律。太阴肺脾衰老，少阳胆火骄横，破坏了脂膏，损伤了皮毛。眼翳如云雾遮蔽，泪水如潮水般涌出，即使烧丹炼药也徒劳，用药也无效。知道非手法不能治疗，夹治又担心不适，烙治又愁焦灼。
此症皆因患病时，妄称是时疫眼病，不加重视。或者饮酒、纵欲、受风霜侵袭，完全不忌口。导致风邪深入体内，久治不愈。然后内部急迫外部松弛，眼皮宽弛而睑弦紧绷，睫毛逐渐卷曲倒向眼球，难免流泪。频繁擦拭不停，睫毛更加刺入眼中，遂形成云翳。目疾所具有的，都是日积月累形成的，必然导致失明，治疗难以见效，任凭灵药也不能让睫毛竖起。睫毛不起，翳膜终不净，泪水也不止。不得已，采用夹法，使睫毛向外才稳妥。夹落后再进行调理护理，可保无虞。如果仍然放纵恣意，身体极度疲乏，一有感冒，双眼交相生病，病情必然肿胀，肿一次则眼皮松一次，依然回到原点，之前的功夫白费了。李东垣说将内睑翻出向外，迅速用三棱针放出恶血，用左手大拇指指甲迎着右针锋，立即操作。倪仲贤也从此法治疗，并且说：“夹治之法徒增痛苦，切勿施行。”但主张用防风蔓荆饮、决明益阴丸、搐鼻碧云散为主进行治疗，则紧缩逐渐松弛，宽纵自然痊愈。李时珍说用石燕磨水涂抹，睫毛自然会出来。这三个人的方法，原本是从乌有先生那里学来的，如今失传了。还有教人拔掉卷曲的睫毛，用虱子血点眼的；用木鳖子、自然铜做成条状塞鼻的；用锻石扫落睫毛的；用鱼胶粘紧眼皮的；这些如同药师驱魔，简直可以带着无是公去都城治鬼，令人绝倒。
夹法：用老竹一片，长约一寸，宽一分，正中剖开，不可削尖锋。先固定一头，另一头斜侧放开，将患眼上眼睑安置其中，用丝线缠绕固定。让患者睁眼闭眼交替，仔细看真，睫毛完全没有倒向眼球，方才用力扯紧。夹外之肉，碾碎生半夏、生远志，用油调成浓汁涂抹，则容易萎陷且不痛，气血虚衰的人不必如此。但须查看两头线缝，稍微松了一发丝粗细，就会过血，务必加缚紧。不然，必定肿胀溃烂。等到七天，肉干作痒。拆去夹子，用利剪剪落睫毛。附着在眼睑上的痂皮，切不可损坏，听其自然脱落。既脱落后，以香膏不时在疤痕上搽抹，久而久之肉色如旧。药煎竹叶、石膏、麦冬、沙参汤，上下午调服救睛散三钱，再则黑神散日服四钱。夹痂落后，眼内有宿疾，仍按照本经调理。
Tan He (Phlegm Nodule)
Tan He (Phlegm Nodule) is formed by the steaming and knotting of damp-heat (Damp-Heat). It resembles a freshly peeled, warm red *Euryale Seed* (Qianshi), but once broken by wind-pathogen, it bleeds. This bleeding cannot be arbitrarily controlled with clearing and cooling agents.
This condition manifests as a nodule growing inside the eyelid margin, sized like an *Euryale Seed*. It is hard to the touch but painless, merely unsightly. Occasionally, it may also occur on the lower eyelid. It is generally caused by the fermentation of dietary fire (Food Heat) and phlegm-fluids (Phlegm-Rheum).
For treatment, evert the eyelid; a visible trace will appear, round or dot-like, purple or yellow in color. Puncture this spot with a bi needle (Bian Zhen). Exhaustively drain the pus. Grind *Qingqi Huatan Wan* (Clear Qi and Resolve Phlegm Pill), mix one tael with light ginger decoction and thin wine, and sip slowly. Recovery will occur within days. If there are no other sufferings, leaving it untreated causes no harm. However, indulging in hot/spicy foods will intensify the fire, leading to ptosis and warts, evolving into a severe disease that ulcerates and rots for years without healing. As the saying goes: "Unstopped trickles become rivers," which refers to this situation.
Original Case: A county scholar, aged sixty, was obese and fond of drinking. In autumn, a nodule appeared on his upper eyelid, which he ignored completely. The following spring, the nodule ruptured spontaneously, appearing reddish-purple with slight pain. Someone consulted *Yao Han* (Classic of Ophthalmology) and used formulas like *Qingwei Sanjie Tang* (Clear Stomach and Dissipate Knot Decoction). After more than ten doses, there was slight improvement. One month later, it relapsed, and medication was repeated. The nodule gradually enlarged, resembling a lychee, with the outer eyelid splitting open. Bleeding continued day and night without cessation, leading to helplessness and eventual death. I believe students must think deeply. Those addicted to alcohol likely have excessive sexual activity. Mental exhaustion leads to sluggish spirit; excessive drinking damages the spleen and stomach, causing turbid qi to steam upward, thus enlarging and rupturing the nodule. Coupled with excessive intercourse, both Kidney Water and Liver Wood become exhausted. With water depleted and fire abundant, blood wanders recklessly and fails to return to its vessels, resulting in continuous flow. At this moment, cauterization should urgently be used to treat the branch (symptoms). After cauterization, use *Guipi Tang* (Restore the Spleen Decoction), *Yangrong Tang* (Nourish the Vigor Decoction), *Qifu Yin* (Seven Blessings Drink), and *Shibu Wan* (Ten Tonics Pill) to nourish the root (constitution). Only then can both interior and exterior be addressed. This patient failed to consider this, repeatedly using wind-dispelling and fire-descending drugs, further depleting the deficient and damaging the damaged. For a person with qi deficiency and phlegm abundance, is this not hastening their demise? Recording this case serves as a warning to those who rigidly adhere to ancient texts without understanding.
Dao Jie (Trichiasis/Inverted Eyelashes)
Dao Jie (Trichiasis) has always been most peculiar; the disease has roots, and the symptoms have patterns. When Taiyin (Lung/Spleen) declines and Shaoyang (Gallbladder) becomes arrogant, the lipid essence is destroyed, and the skin and hair are damaged. Opacity arises like clouds and mist, tears flow like a tide. Burning cinnabar is futile, and medication is ineffective. It is known that manual techniques are required for cure; clamping causes discomfort, and cauterization causes anxiety about burning.
This condition arises from neglecting illness, falsely claiming it is an epidemic eye disease, and paying no attention. Whether through wine, lust, or exposure to wind and frost, no taboos are observed. This allows wind-pathogens to penetrate deeply, remaining uncured for a long time. Subsequently, internal tension and external laxity occur; the skin becomes loose while the eyelid margin tightens, causing lashes to curl inward. Tears inevitably flow. Frequent wiping causes lashes to pierce deeper, eventually forming cloud-like opacity. Eye diseases accumulate over time, inevitably leading to blindness. Treatment is difficult to see results; even miraculous medicines cannot restore lash position. If lashes do not rise, opacity remains, and tears do not stop. Desperately, the clamping method is used to turn lashes outward, which is appropriate. After removal, proper care ensures safety. If indulgence continues, the body becomes extremely fatigued. Upon catching a cold, both eyes suffer; swelling occurs, and each swelling episode loosens the skin further, returning to the original state, rendering previous efforts useless. Li Dongyuan stated that everting the inner eyelid and quickly pricking with a three-edged needle to release bad blood, holding the left thumb nail against the right needle tip, achieves immediate results. Ni Zhongxian also treated this way, stating: "Clamping only causes suffering; do not perform it." Instead, he advocated using *Fangfeng Manjing Yin* (Saposhnikovia and Vitex Drink), *Jueming Yiyin Wan* (Cassia and Yin-Nourishing Pill), and *Chubi Biyun San* (Snuffing Jade Cloud Powder) to gradually relax tension and restore normalcy. Li Shizhen said grinding *Shiyan* (Stone Swallow) in water and applying it would cause lashes to emerge naturally. These three methods were originally learned from Mr. Wuyou (a fictional/non-existent master) and are now lost. Others taught plucking curled lashes and applying louse blood, inserting bars of *Mubiezi* (Spurge Seed) and *Ziran Tong* (Natural Copper) into the nose, sweeping off lashes with calcined stone, or tightening skin with fish glue. These are like exorcisms, fit only for accompanying Wu Shigong to the capital to fight ghosts, causing laughter.
Clamping Method: Use a piece of old bamboo, about one cun long and one fen wide, split down the center, ensuring the edges are not sharpened. Fix one end, leave the other end slanted and open. Place the affected upper eyelid within it and bind with silk thread. Instruct the patient to blink and stare alternately, observing carefully until lashes are completely everted, then pull tight. Apply a thick paste of raw *Banxia* (Pinellia Rhizome) and *Yuanzhi* (Polygala Root) mixed with oil to the flesh outside the clamp to facilitate easy detachment without pain; this is unnecessary for those with qi and blood deficiency. Check the knots at both ends; if they loosen by even a hair's breadth, blood flow will be obstructed, so tighten firmly. Otherwise, swelling and ulceration will occur. Wait seven days until the flesh dries and itches. Remove the clamp and cut off the lashes with sharp scissors. Do not damage the scab attached to the eyelid; let it fall off naturally. Once fallen, apply fragrant ointment to the scar occasionally. Over time, the skin color will return to normal. Decoct *Zhuye* (Bamboo Leaf), *Shigao* (Gypsum), *Maidong* (Ophiopogon Tuber), and *Shashen* (Adenophora Root) as soup. Take three qian of *Jiu Jing San* (Save the Eye Powder) in the morning and afternoon, and four qian of *Hei Shen San* (Black Divine Powder) daily. After the clamp scab falls off, if there are residual eye issues, continue regulating according to the main text.