内障初患如好眼,生花视物雾烟中,隐隐似翳瞳失彩,久变黄绿黑乌青,黄风雀目
久金色,绿风时见花白红,头旋额鼻目牵痛,黑风见黑绿风同,乌风亦与绿不异,但痛不
旋乃乌风,头旋不痛青风证,瞳黄黄风发脾经,浅绿如白肺经发,黑色黑风肾经名,乌
带浑红心经病,青是青风属肝经。外因头风痛引目,脑脂热注忽失明;内因精伤不上注,
左右相传渐渐盲。或兼外因皆赤痛,内因不足补其精。
【注】内障初患,如同好眼,但视物常见五色花飞,昏而不明,如在雾烟之中。瞳中
隐隐似翳,渐无精彩射人。其瞳色或变黄、白、绿、青、乌、黑,浑红无定,久则成五风内
障之证也。黄风者,初病雀目,日久瞳变黄色,甚而如金,难治之证也。绿风者,初病
眼前时见白花、红花,头旋,两额侠鼻痛牵两目,日久瞳变浅绿如白之色。黑风者,初
病与绿风相同,但时见黑花,日久瞳变昏黑之色。乌风者,初病亦与绿风之证不异,但
头痛而不旋晕,眼前常见乌花,日久瞳变乌带浑红之色。青风者,初病亦与乌风相同,头
虽旋晕而不痛,眼前常见青花,日久瞳变青色。其五风发病之源∶黄风则发于脾经,绿
风则发于肺经,黑风则发于肾经,乌风则发于心经,青风则发于肝经。然风虽有五,其
致病之由则有二∶一曰外因,必因头风,其痛引目,上攻于脑,脑脂与热合邪,下注于
目,而致两目忽然失明也;一曰内因,必因内伤脏腑,精气不上注于目,或先病左目,后
及于右目,或先病右目,后及于左目,左右相传,两目俱损也。外因证属有余,多兼赤
痛,当以除风散热为主;内因证属不足,多不赤痛,当以补精益气为主。
内障病初起时,眼睛外观如同健康的眼球,但视物时眼前出现闪光或飞蚊,视野模糊如在雾烟之中,瞳孔隐约似有翳障而失去神采,病程长久后,瞳色会变为黄色、绿色、黑色或青紫色。其中,黄风症初期表现为雀目(夜盲),日久瞳色变为金色;绿风症时常看见白色、红色和白色的光斑,伴有头晕、前额及鼻根处牵引至眼部的疼痛;黑风症所见与绿风相同,但主要特征是见黑花;乌风症的表现也与绿风无异,区别在于只有头痛而没有头晕,若表现为头晕但不痛,则是青风证。
从脏腑经络辨证来看:瞳色发黄属于黄风,病发于脾经;瞳色浅绿如白属于绿风,病发于肺经;瞳色变黑属于黑风,病名即为黑风,病发于肾经;瞳色乌暗带浑红属于乌风,病发于心经;瞳色变青属于青风,病发于肝经。
关于病因,外因多由头风引起,疼痛牵引眼部,热气上攻于脑,脑脂受热邪侵袭下注于目,导致突然失明;内因则是精气亏损,不能上注于目,病情在左右眼之间相互传变,逐渐导致双目失明。如果兼有外因,则眼睛红肿疼痛;若是内因不足,则应补益精气。
In the early stage of internal obstruction (Neizhang), the eye appears healthy, but vision is impaired by photopsia or floaters, with a blurred field of view as if amidst mist or smoke. The pupil seems to have an obscure opacity and loses its luster. After a long duration, the pupil color may change to yellow, green, black, or cyanotic-blue. Specifically, in Yellow Wind syndrome (Huangfeng), the initial symptom is nyctalopia (night blindness), and over time the pupil turns golden; in Green Wind syndrome (Lüfeng), one frequently sees white, red, or whitish spots, accompanied by vertigo and pain radiating from the forehead and nasal root to the eyes; in Black Wind syndrome (Heifeng), the visual symptoms are similar to Green Wind, but primarily involve seeing black spots; in Wu Wind syndrome (Wufeng), the presentation is also similar to Green Wind, distinguished by headache without vertigo. If the symptom is vertigo without pain, it is classified as Cyan Wind syndrome (Qingfeng).
Regarding Zang-Fu meridian differentiation: Yellow pupil indicates Yellow Wind originating from the Spleen Meridian (Pijing); pale green like white indicates Green Wind originating from the Lung Meridian (Feijing); black pupil indicates Black Wind originating from the Kidney Meridian (Shenjing); dark pupil with muddy redness indicates Wu Wind originating from the Heart Meridian (Xinjing); and cyan pupil indicates Cyan Wind originating from the Liver Meridian (Ganjing).
Etiologically, external causes often stem from Head Wind (Toufeng), where pain radiates to the eyes, heat attacks the brain, and brain fluid infused with heat descends to the eyes, causing sudden blindness. Internal causes result from Essence deficiency, preventing Essence from ascending to nourish the eyes. The condition may transmit between the left and right eyes, gradually leading to bilateral blindness. If external factors are involved, there is typically redness and pain; if due to internal insufficiency, treatment should focus on tonifying Essence and Qi.