何来风毒土金停,化湿为眵作泪倾,时序迁移形不改,医家因以漏睛名。
大 漏多人火旺,时流血水疼而胀,肾曾养也更须升,心已消兮还欲降。
天火上行小 伤,漏缘砭割欠端详,致令血怯神膏损,镇日阴淫视减光。
此症非一时生得如是,乃游风客热停蓄脏腑,传于目系,未能发泄而致。且热,气也,风,亦气也,气以成
形,则变为痰、为液、为脓汁,出于大 上下睑头小孔之中。甚者,内睑近鼻结一核,砭破核则消,而口不合,
脓汁长流。向夕流多曰阴漏、曰龙火;日中病剧曰阳漏、曰肥积。幽郁痰饮及天禀衰薄之人患者多。亦有因蚬肉、
肉,割伤精血,气不流行,而疮口渐冷,冷则凝,凝则无所消化,遂溃腐为脓、为涎,经岁无干。每食毒物、
受风湿,更能痛与胀起,腥秽不堪闻。治当先事木火,清空散、胃风汤、防风散结汤。次及金土,百合固金汤、
白菊清金散、玉屏风散。盖火为毒源,洁其源则流不待澄而自清;风为邪帅,降其帅则众不为祟而潜散。然后以
竹叶泻经、大补黄 、养阴清燥等汤,或升阳益阴、升阳散火,各随气禀浓薄、病症浅深
以投之,殆犹有甚然者,吾斯之未能信。
黄子散步芦汀,有客于林皋小立,两目频眨,皮毛粟粒,虽内无所损,而芝眉诚不堪挹。曰∶噫嘻,悲哉!
斯人斯疾,其由有十∶盖太阳失职;太阴降级;君火上炎;阳明燥急;或 郇厨之酒;或对牛衣之泣;或茶烟冒
多;或菽水不给;月出皎皎兮,幽人独往而冷露淹 ;马鸣萧萧兮,壮士早行而晓风潜袭。至乃新秋病进,此流
火之 金。大寒不退,又木运之交入。故其为状也,睑弦沃丹, 头流汁,烂而微腥,痒而兼涩,手不停搔,巾
裾常湿。补矣哉,裂见鲜血。攻矣哉,肿痛交集。以清温、以和散,何贼邪之难戢。而犹不易平者恐水火未济。
须亿中,书毋泥执。客颇悦服,顾余长揖,欲有求而力不能及。归而私念,中心悒悒,援笔赋之,次于篇什。
此症 睑赤烂,或痒或痛,眵多泣出。致病颇繁,验病亦多端∶大略赤属火,烂属湿,痒属风,痛属热,眵
多气虚,泣出血衰。赤胜烂者,多得于劳心、忧郁、忿悖无形之火;烂胜赤者,多伤于酒食、过哭、冒烟有形之
气。风热蒸,则痒而泣出;湿热淫,则痛而眵多。烂而微肿者责以寒湿;赤而干涩者责以血燥。火盛风起,则生
疮于艮坤,睛亦病而翳焉所主虽在心脾,然要于左右轮廓、阴阳表里、虚虚实实而求之,病情斯得。其有水米不
继,迟眠早起,寒气沁入肌肤,致为痼疾。更宜设身处地,庶有治法。万勿以家贫、日久,置若罔闻。临事先以
眉刀剔去上下睑内外粟粒,蒸化昭容膏不时洗擦。俟干,弦上搽元霜,内点胭脂雪。随发杞菊
饮,赤加黄连、赤芍药,烂加苍术,大剂热服效。否则再剔再洗,对症处方。或以六君子为主,赤加丹皮、丹参,
痛加黄连,痒加防风、薄荷,烂加苍术、石斛,寒湿加附子、干姜。周年半载无间,不怕他不愈。
友人孔荣芳常患厥疾,赤烂无异残风,按法治瘥。制元地一斤,百合粉八两,花椒末四两。杵融蒸极热,为
丸与服。今不发十年矣。药之灵效乃尔,爰附记备用。
为什么会有风毒与土、金之气停滞,化湿为眼屎并导致泪水倾泻?虽然季节更替但症状形态不变,医生因此将其命名为“漏睛”。
大眦漏(大眦漏)多因火旺所致,时常流出血水,伴有疼痛和肿胀感。此时肾气已养足,更需要升提;心火已消退,还需要进一步下降以平衡。
天火上行损伤小眦(小眦),漏症源于砭镰或手术切割不够详尽,导致血气怯弱、神膏受损,整日阴寒湿气浸淫,视力减退。
这种病症不是一时形成的,而是游风与客热停滞蓄积在脏腑,传变至目系,未能发泄所致。且热是气的一种,风也是气的一种,气凝聚成形,就会变为痰、液、脓汁,从大眦上下眼睑头端的小孔中排出。严重的,在内眼睑靠近鼻子处结成一个核,用砭石刺破后核消,但伤口难以愈合,脓汁长期流淌。傍晚流脓多称为“阴漏”或“龙火”;白天病情加重称为“阳漏”或“肥积”。幽郁痰饮及先天禀赋薄弱的人容易患此病。也有因为食用蚬肉、肉类等发物,割伤精血,气机运行不畅,导致疮口逐渐变冷,冷则凝滞,凝滞则无法消化,于是溃烂腐化为脓、为涎,经年不干。每食用有毒食物、感受风湿,更能引起疼痛与肿胀,气味腥秽不堪闻。治疗应当先调理木火,使用清空散、胃风汤、防风散结汤。其次调理金土,使用百合固金汤、白菊清金散、玉屏风散。因为火是毒的源头,清洁了源头则水流不必澄清自然清澈;风是邪气的统帅,降伏了统帅则众邪不会作祟而自行消散。然后再使用竹叶泻经汤、大补黄芪汤、养阴清燥汤等,或者采用升阳益阴、升阳散火的方法,根据患者气禀的厚薄、病症的深浅来投药,这大概还有更深层的道理,我对此尚不敢确信。
黄子(作者自称)在芦汀散步,有一位客人在林皋小立,两目频繁眨眼,皮肤起粟粒状鸡皮疙瘩,虽然体内没有损伤,但眉毛确实令人不忍直视。说:唉,可悲啊!这个人这个病,其原因有十种:大概是太阳经失职;太阴经降级;君火上炎;阳明经燥急;或者是享受厨房的美酒;或者是对着牛衣哭泣(指贫贱生活);或者是茶烟吸入过多;或者是饮食供给不足;月亮皎洁之时,隐士独自前往而冷露沾身;马鸣萧萧之时,壮士早行而晓风潜袭。到了新秋病情进展,这是流火克金的时节。大寒不退,又是木运交接进入的时候。所以它的症状表现是:睑弦红肿如涂丹砂,眼角流汁,糜烂且微带腥味,瘙痒兼涩,手不停搔抓,巾裙常湿。补益则裂开见鲜血;攻伐则肿痛交集。用清热温散、调和疏散的方法,为何贼邪如此难平息。而且仍然不易平复的原因,恐怕是水火未济。需要灵活变通,书本知识不要拘泥固执。客人颇为悦服,回头向我长揖,想有所求但力不能及。回家后私下思量,心中忧郁,提笔赋诗,附于篇章之中。
这种病症表现为睑部赤烂,或痒或痛,眼屎多且流泪。致病原因颇繁杂,验证病症也有很多方面:大致来说,赤属火,烂属湿,痒属风,痛属热,眼屎多属气虚,流泪出血属血衰。赤胜烂者,多因劳心、忧郁、忿怒产生的无形之火所致;烂胜赤者,多因酒食、过度哭泣、冒烟产生的有形之气所伤。风热蒸腾,则痒而流泪;湿热浸淫,则痛而眼屎多。糜烂而微肿者归责于寒湿;红赤而干涩者归责于血燥。火盛风起,则在艮坤部位(指眼部特定区域)生疮,眼睛也患病而有翳障。虽然主要责任在心脾,但要在于左右轮廓、阴阳表里、虚虚实实等方面去探求,才能掌握病情。如果有水米不继,晚睡早起,寒气沁入肌肤,导致成为顽固疾病。更应该设身处地为患者考虑,才会有治疗方法。千万不要因为家贫、日久,就置之不理。临证处理前先以眉刀剔除上下眼睑内外的粟粒,蒸化昭容膏不时清洗擦拭。待干燥后,在睑弦上涂抹元霜,内部点胭脂雪。随症服用杞菊饮,红赤加黄连、赤芍药,糜烂加苍术,大剂量热服见效。否则再次剔除清洗,对症处方。或者以六君子汤为主,红赤加丹皮、丹参,疼痛加黄连,瘙痒加防风、薄荷,糜烂加苍术、石斛,寒湿加附子、干姜。坚持半年一年不间断,不怕它不好。
友人孔荣芳常患这种顽疾,赤烂如同残风,按照法治愈。制作生地一斤,百合粉八两,花椒末四两。捣碎融合蒸至极热,制成丸药服用。如今十年未发作。药物的灵验效果竟然如此,于是附带记录以备后用。
Why do wind-toxin and Earth/Metal qi stagnate, transforming dampness into eye discharge (Machi) and causing tears to pour? Although the seasons change, the physical manifestation remains unaltered; hence, physicians name this condition "Leaking Eyes" (Lou Jing).
Large canthus leaking (Da Zi Lou) is mostly due to excessive fire, often bleeding with fluid, accompanied by pain and distension. When Kidney qi has been nourished, it requires ascending; when Heart fire has subsided, it requires descending further for balance.
Heavenly fire ascending damages the small canthus (Xiao Zi); the leakage originates from inadequate or improper scarification/surgery, leading to blood deficiency and spirit-gum (Shen Gao) damage, resulting in daily yin-dampness infiltration and reduced vision.
This condition does not arise overnight but results from wandering wind and guest-heat stagnating in the zang-fu organs, transmitting to the ocular system without being vented. Heat is a form of qi, and wind is also a form of qi; when qi condenses into form, it transforms into phlegm, fluids, and pus, exiting through the small pores at the head of the upper and lower eyelids near the large canthus. In severe cases, a nodule forms in the inner eyelid near the nose; piercing it with a bi stone causes the nodule to dissipate, but the wound fails to close, leading to continuous pus flow. Profuse evening discharge is called "Yin Leakage" or "Dragon Fire"; worsening during the day is called "Yang Leakage" or "Fei Ji". Those with stagnant phlegm-fluids and weak congenital constitution are prone to this disease. It may also result from consuming clams or meat, injuring essence and blood, causing qi stagnation, leading to cold sores that fail to heal, congealing and rotting into pus and saliva for years. Consumption of toxic foods or exposure to wind-dampness exacerbates pain and swelling, producing foul odors. Treatment should first regulate Wood and Fire using Qing Kong San, Wei Feng Tang, or Fang Feng San Jie Tang. Subsequently, regulate Metal and Earth using Bai He Gu Jin Tang, Bai Ju Qing Jin San, or Yu Ping Feng San. Since fire is the source of toxicity, cleansing the source clears the flow naturally; since wind is the commander of pathogens, subduing the commander disperses the pathogens. Thereafter, use Zhu Ye Xie Jing Tang, Da Bu Huang Qi Tang, or Yang Yin Qing Zao Tang, or employ methods like Sheng Yang Yi Yin or Sheng Yang San Huo, tailored to the patient's constitutional strength and disease depth. I remain uncertain if this covers all profound aspects.
While walking by the reeds, Huang Zi saw a gentleman standing briefly in the woods, blinking frequently, with goosebumps on his skin. Though internally undamaged, his eyebrows were truly distressing to behold. He sighed: Alas, how sad! This person’s illness has ten causes: Sun Taiyang channel dysfunction; Taiyin channel degradation; Sovereign Fire flaming upward; Yangming dryness and urgency; indulgence in kitchen wines; weeping over coarse clothes (poverty); excessive tea smoke inhalation; insufficient nutrition; exposure to cold dew while walking alone under the bright moon; or exposure to morning winds while traveling early like a warrior. In early autumn, disease progresses due to Liuhuo overcoming Metal. If Great Cold persists, it marks the transition of Wood qi. Thus, symptoms include red eyelid margins like cinnabar, fluid discharge from the eyes, mild odor, itching with dryness, constant scratching, and wet handkerchiefs. Tonification causes bloody fissures; purgation causes swelling and pain. Why are pathogenic factors so hard to quell despite clearing heat, warming, harmonizing, and dispersing? Persistent difficulty suggests Water and Fire are not interacting. Flexibility is required; do not rigidly adhere to texts. The guest was satisfied, bowed deeply, and wished to ask for help but lacked the means. Returning home, feeling depressed, I wrote this poem to append to the chapter.
This condition presents as red and ulcerated eyelids, with itching or pain, abundant discharge and tearing. Etiologies are complex, and diagnostic signs vary: Generally, redness indicates Fire, ulceration indicates Dampness, itching indicates Wind, pain indicates Heat, abundant discharge indicates Qi deficiency, and tearing/bleeding indicates Blood deficiency. Redness dominating ulceration stems from invisible fire caused by mental labor, depression, or anger. Ulceration dominating redness stems from visible qi caused by alcohol, food, excessive crying, or smoke inhalation. Wind-heat steaming causes itching and tearing; damp-heat infiltrating causes pain and discharge. Mild swelling with ulceration blames Cold-Damp; redness with dryness blames Blood Dryness. Excessive Fire generating Wind causes sores in Gen/Kun areas (specific eye regions), leading to nebulae. Although primarily involving Heart and Spleen, diagnosis must consider left/right contours, Yin/Yang exterior-interior relations, and deficiency/excess patterns. Chronic late sleeping and early rising with cold invasion can cause stubborn diseases. One must empathize with patients to find treatments. Do not ignore cases due to poverty or chronicity. Clinically, first remove eyelid granules with an eyebrow knife, wash with steamed Zhao Rong Gao. After drying, apply Yuan Shuang to the lid margin and Yan Zhi Xue internally. Administer Qi Ju Yin decoction: add Huang Lian and Chi Shao Yao for redness, Cang Zhu for ulceration, taken hot in large doses. Otherwise, repeat cleaning and prescribe based on symptoms. Base treatment on Liu Jun Zi Tang: add Dan Pi and Dan Shen for redness, Huang Lian for pain, Fang Feng and Bo He for itching, Cang Zhu and Shi Hu for ulceration, Fu Zi and Gan Jiang for Cold-Damp. Consistent treatment for half a year ensures recovery.
My friend Kong Rongfang suffered from this stubborn disease, with redness and ulceration resembling residual wind, cured by following these methods. I prepared one jin of Di Huang, eight liang of Bai He powder, and four liang of Hua Jiao powder. Pounded, mixed, steamed until very hot, and formed into pills. He has remained symptom-free for ten years. The efficacy of medicine is indeed remarkable; thus, I record this for future reference.