此眼初患之时。忽因疼痛发歇。作时难忍。夜卧不得睡。即瞳人干缺。或上或下。或东或西。常不圆正。不辨三光。
久后俱损。大人多患。其瞳人或白黑不定。白者脑脂流下为患。黑者胆热。肾脏俱劳。肝风为患。宜服泻肝汤、镇肝丸。
立效。
诗曰∶
瞳人干缺水金无 或黑或白作形模 白即脑脂来闭塞 黑即其中本自虚
此状必须疼痛后 胆家风热作劳劬 名医拱手无方救 堪叹长年暗室居
泻肝汤
麦门冬 黑参 黄芩 知母 地骨皮（各一两） 赤芍药 茺蔚子（各一两半）
上为细末，以水一盏。散一钱。煎至五分。食后去渣温服。
镇肝丸
车前子 人参 茯苓 石决明 五味子 细辛（各一两半） 干山药（二两）
上为末。每日空心米汤调下一钱。
此眼初患之时。疼痛发歇。作时赤涩泪出。渐生黄膜。直覆黑睛。难辨人物。皆因肾脏风冷。胃家极热。切宜镰钩
熨烙。然后宜点曾青膏。服通脾泻胃汤立效。
诗曰∶
黑睛从下生黄膜 脾胃含风热与并 疼痛发时多计较 门冬犀角便能征
或镰或点根据轻法 若用邪巫不用争 若用烧炙无效后 再来求疗为施行
曾青膏
曾青 秦皮 细辛 白芷 乳头香 龙脑（各一分） 黄连（五分） 诃子 木香（各一两）
上为末。研令匀细。以水二碗浸三日后。煎至一盏。以束绵滤渣后。更入蜜四两。同煎为膏。盛瓷瓶中封之。勿
令
泄气。用之点眼立效。
通脾泻胃汤
麦门冬 茺蔚子（各一两） 防风 大黄 黑参 知母（各一两） 天门冬 黄芩（各一两五钱）
上为末。研令匀细。以水一盏。散一钱。煎至五分。食后去渣温服。
这段文字描述了两种眼科外障疾病：瞳人干缺外障和眼黄膜上冲外障。
第一种情况是瞳人干缺外障。此病初发时，患者忽感疼痛，发作时难以忍受，夜间无法入睡，导致瞳孔变形、残缺，或向上、向下、向左、向右偏移，不再圆润端正，且无法分辨三光（日光、月光、灯光）。病程日久后双眼均会受损，多见于成年人。此时瞳孔颜色可能黑白不定：若呈白色，是因脑脂流下造成危害；若呈黑色，则是胆热与肾脏劳损所致，兼有肝风为患。治疗宜服用泻肝汤、镇肝丸，可立竿见影。
诗曰：
瞳人干缺水金无，或黑或白作形模。
白即脑脂来闭塞，黑即其中本自虚。
此状必须疼痛后，胆家风热作劳劬。
名医拱手无方救，堪叹长年暗室居。
【泻肝汤】
麦门冬、黑参、黄芩、知母、地骨皮（各一两）、赤芍药、茺蔚子（各一两半）。
以上药材研为细末，每次取一钱药散，加水一盏，煎至五分，饭后去渣温服。
【镇肝丸】
车前子、人参、茯苓、石决明、五味子、细辛（各一两半）、干山药（二两）。
以上药材研为末，每日空腹时用米汤调服一钱。
第二种情况是眼黄膜上冲外障。此病初发时，疼痛间歇发作，发作时眼部红涩流泪，逐渐生出黄膜，直接覆盖在黑睛（角膜）上，难以辨认人物。这都是因肾脏受风冷侵袭，而胃家极热所致。治疗切需使用镰钩切割烙烫，然后宜点曾青膏，并服用通脾泻胃汤，可立效。
诗曰：
黑睛从下生黄膜，脾胃含风热与并。
疼痛发时多计较，门冬犀角便能征。
或镰或点根据轻法，若用邪巫不用争。
若用烧炙无效后，再来求疗为施行。
【曾青膏】
曾青、秦皮、细辛、白芷、乳头香、龙脑（各一分）、黄连（五分）、诃子、木香（各一两）。
以上药材研为末，研磨均匀细腻。以水二碗浸泡三日后，煎至一盏，用束绵过滤去渣，再加入蜂蜜四两，共同煎制成膏。盛于瓷瓶中密封，勿使漏气。用时点眼，可立效。
【通脾泻胃汤】
麦门冬、茺蔚子（各一两）、防风、大黄、黑参、知母（各一两）、天门冬、黄芩（各一两五钱）。
以上药材研为末，研磨均匀细腻。每次取一钱药散，加水一盏，煎至五分，饭后去渣温服。
This text describes two types of external obstructions in ophthalmology: "Dry and Irregular Pupil External Obstruction" (Tongren Ganque Waizhang) and "Yellow Membrane Rushing Up to Cover the Eye External Obstruction" (Yan Huangmo Shangchong Waizhang).
The first condition is Dry and Irregular Pupil External Obstruction. At the onset, the patient suddenly experiences pain that is unbearable during attacks, preventing sleep at night. This leads to a dry, irregular pupil shape, which may be displaced upwards, downwards, leftwards, or rightwards, losing its roundness and regularity. The patient becomes unable to distinguish the "Three Lights" (sunlight, moonlight, and lamp light). If the disease persists, both eyes will eventually be damaged; it is more common in adults. The pupil's color may vary between white and black: if white, it is caused by brain fluid (nasal mucus metaphorically referred to as brain fat) flowing down and causing harm; if black, it results from Gallbladder Heat combined with Kidney exhaustion and Liver Wind pathogenesis. Treatment should involve administering Xiegan Tang (Liver-Draining Decoction) and Zhenwan Wan (Liver-Calming Pill), which yield immediate effects.
Poem:
When the pupil dries and lacks Water and Metal,
It takes shapes black or white, distorted and grotesque.
Whiteness indicates blockage by brain fluid,
Blackness reveals inherent emptiness within.
This state follows severe pain,
Where Gallbladder wind-heat causes exhaustion.
Famous doctors fold their hands, helpless,
Sighing that one must live long in dark rooms.
[Xiegan Tang / Liver-Draining Decoction]
Ophiopogonis Radix (Mendong, 麦门冬), Scrophulariae Radix (Xushen/Heishen, 黑参), Scutellariae Radix (Huangqin, 黄芩), Anemarrhenae Rhizoma (Zhimu, 知母), Lycii Cortex (Goubipi, 地骨皮) (each 1 liang); Paeoniae Rubra Radix (Chishaoyao, 赤芍药), Viticis Fructus (Chongweizi, 茺蔚子) (each 1.5 liang).
Grind the above into fine powder. For each dose, take 1 qian of the powder, add 1 cup of water, boil until reduced to 0.5 cup. Strain and take warm after meals.
[Zhenwan Wan / Liver-Calming Pill]
Plantaginis Semen (Cheqianzi, 车前子), Ginseng Radix (Renshen, 人参), Poria (Fuling, 茯苓), Concha Haliotidis (Shiejue ming, 石决明), Schisandrae Fructus (Wuweizi, 五味子), Asari Radix et Rhizoma (Xixin, 细辛) (each 1.5 liang); Dioscoreae Rhizoma (Shanyao, 干山药) (2 liang).
Grind the above into powder. Each day, on an empty stomach, take 1 qian mixed with rice soup.
The second condition is Yellow Membrane Rushing Up to Cover the Eye External Obstruction. At the onset, pain occurs intermittently. During attacks, the eye becomes red, gritty, and tears flow. Gradually, a yellow membrane forms, directly covering the cornea (Heijing), making it difficult to recognize people. This is caused by Wind-Cold invading the Kidneys combined with extreme Heat in the Stomach. Treatment strictly requires surgical intervention using a blade and cautery (Lianggou Yunluo), followed by applying Zengqing Gao (Azurite Ointment) and taking Tongpi Xiewei Tang (Splea-Strengthening and Stomach-Draining Decoction) for immediate effect.
Poem:
A yellow membrane grows from below the cornea,
Wind-heat accumulates in the Spleen and Stomach.
Painful attacks require careful calculation,
Asparagus and Rhinoceros Horn can manifest the cure.
Whether using blades or drops depends on severity,
Do not contend with evil shamans.
If cauterization fails,
Seek further treatment to proceed.
[Zengqing Gao / Azurite Ointment]
Azurite (Zengqing, 曾青), Fraxini Cortex (Qinpi, 秦皮), Asari Radix et Rhizoma (Xixin, 细辛), Angelicae Dahuricae Radix (Baizhi, 白芷), Boswellia Carteri (Nuru xiang, 乳头香), Borneolum Syntheticum (Longnao, 龙脑) (each 1 fen); Coptidis Rhizoma (Huanglian, 黄连) (0.5 fen); Terminalia Chebulae Fructus (Hezi, 诃子), Costi Rhizoma (Muxiang, 木香) (each 1 liang).
Grind the above into powder and mix evenly. Soak in 2 bowls of water for three days, then boil until reduced to 1 bowl. Filter through cotton to remove residue, then add 4 liang of honey and boil together to form an ointment. Store in a porcelain jar and seal tightly to prevent leakage. Apply to the eye for immediate effect.
[Tongpi Xiewei Tang / Splea-Strengthening and Stomach-Draining Decoction]
Ophiopogonis Radix (Mendong, 麦门冬), Viticis Fructus (Chongweizi, 茺蔚子) (each 1 liang); Saposhnikoviae Radix (Fangfeng, 防风), Rheomi Radix et Rhizoma (Dahuang, 大黄), Scrophulariae Radix (Heishen, 黑参), Anemarrhenae Rhizoma (Zhimu, 知母) (each 1 liang); Asparagi Radix (Tianmendong, 天门冬), Scutellariae Radix (Huangqin, 黄芩) (each 1.5 liang).
Grind the above into fine powder and mix evenly. For each dose, take 1 qian of the powder, add 1 cup of water, boil until reduced to 0.5 cup. Strain and take warm after meals.