侄 肾开窍于耳，胆脉亦络于耳。夜读神劳，素有遗泄，弱冠内真阴未充，虚阳易于升动，故气闭清窍，
若闻鸣响。宜用轻剂清少阳胆火之郁。鲜桑叶、丹皮、栀皮、连翘、甘菊（炒），食后泡汤服，久之，一日耳中忽清
亮，如凉风卷雾，豁然朗彻矣。
王 七旬耳猝刺痛，伏枕不减，右尺沉按有力。凡来势骤者莫如火，老人真阴涸，故相火易炎。权用镇
摄法。灵磁石（一钱）、黄柏（酒炒五分）、山栀（钱半）、熟地（三钱），二剂效。
经云∶五脏六腑之精气上注于目而为之睛，睛之窠为眼，骨之精为瞳子，筋之精为黑眼，血之精为白眼，
肉之精为约束裹撷。故肝属木，为黑睛，曰风轮；心属火，为二 ，曰血轮；脾属土，为上下胞，曰肉轮；
肺属金，为白仁，曰气轮；肾属水，为瞳神，曰水轮；此五轮也。胆之府为山廓；大肠之府为天廓；膀胱之府
为泽廓；肝之府为风廓；肾之府为水廓；命门之府为火廓；脾胃之府为地廓；小肠之府为雷廓，此八廓也。八
廓有名无位。或蕴积风热，或郁结七情之气，各随五脏所属而见。风则散之，热则清之，气结则调之。瞳胞自
痒，清泪赤痛，是谓风眼。洗肝散。乌轮突起，胞硬红肿，是谓热眼。黄连汤、泻青丸。眼昏而泪，胞肿而软，
酸涩微赤，怒则目疼，是谓气眼。宜石决明、草决明、楮实、蝉蜕、香附、木贼、川芎、甘草等。子和云∶目
不因火则不病。气轮赤，肺火也；肉轮赤，脾火也；水风轮翳遮，肝肾火
也；赤脉贯目，火自甚也。治目者专主治火，一句可了。东垣云∶目得血而能视，五脏六腑之精，皆禀受于脾，
治目者宜理脾胃，养血安神为主。二者皆有见地，不可执一也。
〔目痛〕目痛有二，一目 白眼痛，一目珠黑眼痛。 白属阳，昼痛，点苦寒药则效。珠黑属阴，夜痛，
点苦寒药反剧。治目珠夜痛，夏枯草散。风热痛，泻青丸、洗肝散。天行赤热，怕热羞明，涕泪交流，酒煎散、
大黄当归散。暴风客热，白仁壅起，包小乌睛，疼痛难开，泻肺汤。赤肿痛甚，泻肺汤加黄连。目赤痛而头
目浮肿，普济消毒饮。怕热羞明，头目肿痛，选奇汤。珠疼如针刺，心经实火，洗心散。热结膀胱，小便不通，五
苓散。雷头风，目痛便秘，清震汤。阳邪风症，眉棱骨痛，兼火者，选奇汤、还睛丸。阴邪风症，脑后枕骨疼，
三因芎辛汤。巅顶风症，顶骨内痛，连及目珠胀急瘀赤，外症之恶候也，若昏眇则内症成矣。外症，用羌活胜
风汤。内症，用冲和养胃汤。
〔目赤〕戴复庵云∶眼赤皆血壅肝经所致，属表者，羌活胜风汤。属里者，泻肝散。赤久生翳膜者，春
雪膏、蕤仁膏，并用碧云散吹鼻。凡赤而肿痛，当散湿热；赤而干痛，当散火毒；赤而多泪，当散风邪；赤而
不痛，当利小便。其或血灌瞳神，大黄当归散。赤脉贯睛，凡外障有此，颇为难治。洗心散、导赤散。赤丝乱
脉，点以石燕丹，服用大黄当归散，酒煎散。
〔目肿〕肿有胞肿珠肿不同，胞肿多湿，珠肿多火，暴风客邪，胞肿如杯。洗肝散、龙胆饮。五轮壅起，
目胀不能转，若鹘之睛，酒煎散。风毒湿热，瘀血灌睛，胞与珠胀出如拳，石膏散加羌、辛、芎、芍、薄荷。
若珠烂则无及矣。至于气轮平，水轮亦明，惟风轮泛起，或半边泛起，服以凉膈散，点以石燕丹。若水轮高而
绽起如螺，为肝热甚，点以石燕丹、春雪膏、内服双解散，或六味丸加知、柏。神珠自胀，麻木泪痛，因五
脏毒风所蕴，大黄当归散。
〔目痒〕风热，四生散。血虚，四物汤加羌、防、蒺藜、黄 。大凡有病之目，痒一番则重一番，而病源
非一，微痒则属虚火。治宜姜粉、枯矾、硼砂，津唾调如米大，时将一丸纳大 ，
及盐汤蒸洗，或用珍珠膏点之。
〔外障〕属风热上壅，上下胞 肉菩蕾，磨荡其睛，久之生翳，宜消风散热，外用点药退之。或如云雾，
如丝缕，如秤星，在睛外遮暗，皆凉药过多，脾胃受伤，生气不能上升所致。自内 而出者，羌活胜风汤加蔓
荆。自锐 而入者，上汤加胆草、 本。自上而下者，上汤加黄连、倍柴胡。自下而上者，上汤加木通。搐鼻，
以碧云散。点药，皆用春雪膏、蕤仁膏，或以地栗粉和人乳点之。如去老翳，则以石燕丹、春雪膏、熊胆膏选
用。张石顽曰∶外障内治之药虽多，咸以神消散、皂角丸为主。外治之药不一，莫如石燕丹为最。血翳包睛，
破血药兼硝黄下之，或红翳如轻霞映日之状，治宜去风散血。若黄膜上冲，服以神消散，点以石燕丹。黄膜下
垂，遮满瞳神，蝉花散加石膏、胆草、大黄，点以石燕丹。赤膜下垂，神消散去二蜕，加皂荚、石决明，点绛
雪膏。凝脂翳在风轮上，急用神消散、皂荚丸。花翳白陷，龙胆饮。破坏风轮，神膏绽出，凸如蟹睛，防风泻
肝散。斑脂翳色白而带青黑，内服神消散，外点石燕丹。有翳从上而下，贯及瞳神，状如悬胆，服以石膏散，
点以石燕丹。乌珠上白颗如星，蝉花散去苍术，加蒺藜、谷精，并用碧云散吹鼻。乌珠上细颗，或白或黄，或
聚或散，或顿起，或渐生，多由痰火。服羚羊角散，或补肾丸。 肉起于大 ，渐侵风轮，掩过瞳神，宜和血
清火。点以石燕丹。大 起红肉如鸡冠一块，害及气轮，宜三黄丸加芒硝、点以绛雪膏。此治外障法也。
〔内障〕属虚挟气郁，外似好眼，而不能照物，不痛不痒，惟瞳神里面有隐隐青白者，皆脏腑中邪，乘虚
入而为翳也。青风障，内有气色，如晴山笼淡烟之状，急宜治之，免变绿色。羚羊角汤。绿风障，瞳神浊而不
清，久则变为黄风。方同上。黑风障，与绿风相似，但时时黑花起。先与去风，后用补肾磁石丸。黄风银风障，
不治。丝风障，瞳神内隐隐有一丝横经。宜六味丸加细辛、蒺藜。偃月障，如新月复垂。先与三因芎辛汤，
后用补肾丸。仰月障，瞳神下半边，有白气一湾，如新月仰从下而上。补肾丸。银障，瞳神白色如银。初服羚
羊补肝散，次服补肾丸。金障，治
同上。绿映瞳神，瞳神内隐隐绿色。先服黄连羊肝丸，后服补肾磁石丸。其自视如蝇飞花堕，旌 飘扬，或
黄或白，或青或黑。黄白者痰火伤肺，皂荚丸。青黑者宜补肾，补肾磁石丸。瞳神散大，六味丸加五味子、
石决明，或补肾磁石丸。瞳神紧小，先服黄连羊肝丸，后服六味丸加二冬，或用滋肾丸。瞳神欹侧，六味丸加
蒺藜、当归。暴盲，经云∶气脱者，目不明。急用大剂独参膏。雀盲，蛤粉丸、煮肝散。至于膏伤珠陷，神
水将枯，并宜大补肾精，不可寒凉。又有目珠上下转运如辘轳，甚则瞳神反背，补中益气汤加羌活。此治内
障法也。
〔杂症〕能远视，不能近视，阴气不足也，治在心肾。加减地芝丸，或六味丸。能近视，不能远视，阳
气不足也，治在胆肾。加味定志丸，或八味丸。倒睫拳毛，由目紧皮缩所致，久则赤烂，神水不清。以三棱针
刺目眶，泻其湿热。后服防风饮子。搐鼻，以碧云散，更以木鳖子一枚为末，左塞右，右塞左，一夜即直。睥翻
粘睑，血壅于内，皮急吊于外，宜镰剔开导法。风沿烂眼，年久不愈而多痒者，服柴胡饮子，点蕤仁膏。
若迎风赤烂，川芎茶调散、洗肝散。因风流泪，菊花散。其实热生疮，宜泻心火，祛风热。椒疮生于睥内，
红粒如椒而坚硬者，是也，宜祛风热。粟疮亦生睥内，色黄而软如粟，宜退湿热。五疳症，木疳生于风轮，
青碧色。实者，泻青丸。虚者，补肾丸。火疳生于睥 及气轮，初起如椒疮，三黄汤、导赤散。土疳俗呼偷
针眼，泻黄散。金疳生于睥内，与玉粒相似，失治则变漏。泻肺汤。水疳生睥 及气轮，状如黑豆，若在风轮，
目必破损，头风人多有此。清空膏。至于疮久成大 漏，金花丸加羌活、蝎尾。小 漏，导赤散加透风清热药。
正漏生风轮上，流脓如痰，急宜泻肝。偏漏生气轮上，流出白水，急宜泻肺。更有精神乱而妄见，视定反动，
视正反邪，生晕变色，皆阴精亏也。驻景丸、益气聪明汤，或点百草膏。又或目为物伤，积血青紫，撞破白仁
黄仁，宜酒煎散。渐生翳障，犀角地黄汤加大黄、当归。飞丝入目，宜头垢点之。上论根据石顽《医通》，与
其大略如此。
侄子：肾开窍于耳，胆经的脉络也联络于耳。夜间读书导致神志劳损，素来有遗精滑泄的病史，二十岁时体内真阴尚未充盈，虚阳容易升动，因此气机闭塞清窍，出现耳鸣声响的症状。适宜使用轻剂以清泻少阳胆火的郁结。用鲜桑叶、丹皮、栀子皮、连翘、甘菊（炒），饭后泡汤服用，久而久之，一天耳中忽然清爽明亮，如同凉风卷走雾气，豁然开朗通透了。
王姓患者：七十岁老人耳朵突然剧烈刺痛，伏在枕头上疼痛不减，右尺脉沉取有力。凡是发病急骤的病症没有比得上火邪的，老人真阴枯竭，所以相火容易炎上。权且采用镇摄的方法。灵磁石（一钱）、黄柏（酒炒五分）、山栀（一钱半）、熟地（三钱），服用两剂后见效。
经文说：五脏六腑的精气向上灌注于目而形成眼珠，眼珠所在的窝称为眼，骨之精气为瞳子，筋之精气为黑眼，血之精气为白眼，肉之精气为约束包裹眼睑的组织。所以肝属木，对应黑睛，称为风轮；心属火，对应上下眼睑内的赤脉部分，称为血轮；脾属土，对应上下眼睑，称为肉轮；肺属金，对应白仁，称为气轮；肾属水，对应瞳神，称为水轮；这称为五轮。胆的府舍为山廓；大肠的府舍为天廓；膀胱的府舍为泽廓；肝的府舍为风廓；肾的府舍为水廓；命门的府舍为火廓；脾胃的府舍为地廓；小肠的府舍为雷廓，这称为八廓。八廓有名而无固定位置。或是蕴积风热，或是七情之气郁结，各自随着所属的五脏而显现症状。风邪则发散它，热邪则清解它，气机郁结则调理它。眼睑自痒，流出清泪，眼睛红肿疼痛，这称为风眼。用洗肝散治疗。乌轮突起，眼睑坚硬红肿，这称为热眼。用黄连汤、泻青丸治疗。眼睛昏花流泪，眼睑肿胀柔软，酸涩微红，发怒时眼睛疼痛，这称为气眼。适宜用石决明、草决明、楮实子、蝉蜕、香附、木贼、川芎、甘草等药。张子和说：眼睛不因火邪就不会生病。气轮发红，是肺火；肉轮发红，是脾火；水轮和风轮上有翳膜遮蔽，是肝肾之火；赤色血脉贯穿眼球，说明火邪极盛。治疗眼病专门主治火邪，一句话就可以概括。李东垣说：眼睛得到血液滋养才能视物，五脏六腑的精气都禀受于脾，治疗眼病应当以调理脾胃、养血安神为主。这两种观点都有见地，不可偏执一端。
【目痛】目痛有两种，一是白眼痛，一是黑眼珠痛。白眼属阳，白天痛，点苦寒药物有效。黑眼珠属阴，夜晚痛，点苦寒药物反而加重。治疗黑眼珠夜间疼痛，用夏枯草散。风热引起的疼痛，用泻青丸、洗肝散。天行赤眼热症，怕热羞明，鼻涕眼泪交流，用酒煎散、大黄当归散。暴风客热，白仁壅起，包裹小黑眼珠，疼痛难以睁开，用泻肺汤。红肿疼痛严重，泻肺汤加黄连。眼睛红肿疼痛且头目浮肿，用普济消毒饮。怕热羞明，头目肿痛，用选奇汤。眼珠疼痛如针刺，是心经实火，用洗心散。热结膀胱，小便不通，用五苓散。雷头风，眼睛疼痛便秘，用清震汤。阳邪风症，眉棱骨疼痛，兼有火邪的，用选奇汤、还睛丸。阴邪风症，脑后枕骨疼痛，用三因芎辛汤。巅顶风症，头顶骨内疼痛，牵连到眼珠胀急瘀红，这是外症的恶候，如果视力昏花模糊则内症形成了。外症，用羌活胜风汤。内症，用冲和养胃汤。
【目赤】戴复庵说：眼睛发红都是血壅滞于肝经所致，属于表证的，用羌活胜风汤。属于里证的，用泻肝散。发红久了生出翳膜的，用春雪膏、蕤仁膏，同时用碧云散吹鼻。凡是发红且肿痛，应当散除湿热；发红且干痛，应当散除火毒；发红且多泪，应当散除风邪；发红但不痛，应当利小便。如果是血灌瞳神，用大黄当归散。赤脉贯穿眼球，凡是外障有此症状，颇为难治。用洗心散、导赤散。赤丝乱脉，点用石燕丹，服用大黄当归散、酒煎散。
【目肿】肿胀有胞肿和珠肿的不同，胞肿多由湿引起，珠肿多由火引起，暴风客邪侵袭，胞肿像杯子一样。用洗肝散、龙胆饮。五轮壅起，眼睛胀痛不能转动，像鹘鸟的眼睛一样，用酒煎散。风毒湿热，瘀血灌睛，眼睑和眼珠胀出像拳头大，用石膏散加羌活、细辛、川芎、芍药、薄荷。如果眼珠腐烂就来不及救治了。至于气轮平坦，水轮也清明，只有风轮泛起，或者半边泛起，服用凉膈散，点用石燕丹。如果水轮高耸绽起像螺蛳壳，是肝热很甚，点用石燕丹、春雪膏，内服双解散，或者六味丸加知母、黄柏。神珠自己肿胀，麻木流泪疼痛，是因为五脏毒风蕴积，用大黄当归散。
【目痒】风热，用四生散。血虚，用四物汤加羌活、防风、蒺藜、黄芩。大凡有病的眼，痒一次病情就重一次，而病源不止一种，微痒则属于虚火。治疗适宜用姜粉、枯矾、硼砂，用唾液调成米粒大小，时常将一粒纳入大眦角，并用盐汤蒸洗，或者用珍珠膏点眼。
【外障】属于风热上壅，上下眼睑肌肉增生，磨荡眼球，时间久了生成翳膜，适宜消风散热，外用点药退除。或者像云雾，像丝缕，像秤星，在眼球外部遮蔽昏暗，这都是因为凉药过多，脾胃受伤，清气不能上升所致。从内眦而出的，用羌活胜风汤加蔓荆子。从锐眦而入的，用上汤加胆草、本草（注：此处原文“本”可能指藁本或某特定草药，依原文保留）。从上而下的，用上汤加黄连、倍量柴胡。从下而上的，用上汤加木通。搐鼻，用碧云散。点药，都用春雪膏、蕤仁膏，或者用地栗粉和人乳点眼。如果要去除老翳，则选用石燕丹、春雪膏、熊胆膏。张石顽说：外障内治的药物虽然多，都以神消散、皂角丸为主。外治的药物不一，没有比石燕丹最好的。血翳包睛，用破血药兼硝黄攻下，或者红翳像轻霞映日一样的形状，治疗适宜祛风散血。如果黄膜上冲，服用神消散，点用石燕丹。黄膜下垂，遮蔽满瞳神，用蝉花散加石膏、胆草、大黄，点用石燕丹。赤膜下垂，神消散去掉两个蜕类药，加皂荚、石决明，点绛雪膏。凝脂翳在风轮上，急用神消散、皂荚丸。花翳白陷，用龙胆饮。破坏风轮，神膏绽出，凸出像蟹睛，用防风泻肝散。斑脂翳色白而带青黑，内服神消散，外点石燕丹。有翳从上而下，贯穿到瞳神，形状像悬胆，服用石膏散，点用石燕丹。黑眼珠上有白色颗粒像星星，蝉花散去苍术，加蒺藜、谷精草，并用碧云散吹鼻。黑眼珠上有细小颗粒，或白或黄，或聚或散，或突然兴起，或逐渐生长，多由痰火引起。服用羚羊角散，或者补肾丸。肉起于大眦角，逐渐侵犯风轮，掩过瞳神，适宜和血清火。点用石燕丹。大眦角起红肉像鸡冠一块，危害及气轮，宜用三黄丸加芒硝、点用绛雪膏。这是治疗外障的方法。
【内障】属于虚证夹杂气郁，外表看起来像好眼睛，但不能视物，不痛不痒，只有瞳神里面有隐隐的青白色，都是脏腑中的邪气，乘虚侵入而形成翳膜。青风障，内部有气色，像晴天山峦笼罩淡烟的样子，急需治疗，以免变成绿色。用羚羊角汤。绿风障，瞳神浑浊不清，久了会变成黄风。方剂同上。黑风障，与绿风相似，只是时时出现黑花。先用祛风药，后用补肾磁石丸。黄风银风障，无法治愈。丝风障，瞳神内隐隐有一丝横贯。宜用六味丸加细辛、蒺藜。偃月障，像新月倒垂。先用三因芎辛汤，后用补肾丸。仰月障，瞳神下半边，有一湾白气，像新月仰起从下而上。用补肾丸。银障，瞳神白色像银。初服羚羊补肝散，次服补肾丸。金障，治疗同上。绿映瞳神，瞳神内隐隐绿色。先服黄连羊肝丸，后服补肾磁石丸。其自视如苍蝇飞舞、花朵坠落，旗帜飘扬，或黄或白，或青或黑。黄白色的属于痰火伤肺，用皂荚丸。青黑色的适宜补肾，用补肾磁石丸。瞳神散大，用六味丸加五味子、石决明，或者补肾磁石丸。瞳神紧小，先服黄连羊肝丸，后服六味丸加天冬、麦冬，或者用滋肾丸。瞳神歪斜，用六味丸加蒺藜、当归。暴盲，经文说：气脱的人，眼睛不明亮。急需用大剂量独参膏。雀盲（夜盲），用蛤粉丸、煮肝散。至于膏液损伤眼珠凹陷，神水将枯竭，都适宜大补肾精，不可用寒凉药物。又有眼珠上下转动像辘轳一样，甚至瞳神反背，用补中益气汤加羌活。这是治疗内障的方法。
【杂症】能看远不能看近，是阴气不足，治疗在心肾。用加减地芝丸，或者六味丸。能看近不能看远，是阳气不足，治疗在胆肾。用加味定志丸，或者八味丸。倒睫拳毛，由于眼睛紧缩皮肤收缩所致，久了会红肿溃烂，神水不清。用三棱针刺眼眶，泻其湿热。后服防风饮子。搐鼻，用碧云散，再用木鳖子一枚研末，左眼塞右边鼻孔，右眼塞左边鼻孔，一夜即可伸直。睑翻粘睑，血壅滞于内，皮肤紧张吊于外，适宜用镰刀剔开导引法。风沿烂眼，年久不愈且多痒的，服柴胡饮子，点蕤仁膏。如果是迎风赤烂，用川芎茶调散、洗肝散。因风流泪，用菊花散。如果是实热生疮，适宜泻心火，祛风热。椒疮生于眼睑内，红色颗粒像花椒而且坚硬的，就是这种，适宜祛风热。粟疮也生于眼睑内，颜色黄而软像粟米，适宜退湿热。五疳症，木疳生于风轮，呈青碧色。实证，用泻青丸。虚证，用补肾丸。火疳生于眼睑边缘及气轮，初起像椒疮，用三黄汤、导赤散。土疳俗呼偷针眼，用泻黄散。金疳生于眼睑内，与玉粒相似，失治则会变成漏症。用泻肺汤。水疳生于眼睑边缘及气轮，形状像黑豆，如果在风轮，眼睛必定破损，头风病人多有此症。用清空膏。至于疮久成大漏，用金花丸加羌活、蝎尾。小漏，用导赤散加透风清热药。正漏生在风轮上，流脓像痰，急需泻肝。偏漏生在气轮上，流出白水，急需泻肺。更有精神错乱而妄见，注视静止物体反而觉得在动，注视正面反而觉得是邪物，产生晕影变色，都是阴精亏损。用驻景丸、益气聪明汤，或者点百草膏。又或者是眼睛被物体伤害，积血青紫，撞破白仁黄仁，适宜用酒煎散。逐渐生成翳障，用犀角地黄汤加大黄、当归。飞丝入目，适宜用头垢点眼。上述论述根据石顽《医通》，大致情况如此。
Nephew: The Kidney opens into the ears, and the Gallbladder meridian also connects to the ears. Reading at night causes mental fatigue; historically prone to seminal emission, his True Yin (Zhen Yin, 真阴) was not yet fully developed in his early twenties, making Deficient Yang (Xu Yang, 虚阳) prone to rising. Thus, Qi closure affects the clear orifices, resulting in tinnitus. It is appropriate to use a mild preparation to clear the depression of Shaoyang (Lesser Yang, 少阳) Gallbladder fire. Fresh Mulberry Leaf (Sang Ye, 桑叶), Moutan Cortex (Dan Pi, 丹皮), Gardenia Bark (Zhi Zi Pi, 栀皮), Forsythia Fruit (Lian Qiao, 连翘), and Chrysanthemum Flower (Ju Hua, 菊花 - stir-fried) are steeped in water and taken after meals. Over time, one day his ears suddenly became clear and bright, as if cool wind swept away the fog, revealing a sudden clarity and transparency.
Mr. Wang: At seventy years old, he experienced sudden severe stabbing pain in the ear, which did not subside even when lying on a pillow. The Right Chi (Kidney/Ministerial Fire pulse position, 尺脉) pulse was forceful upon deep pressure. For conditions with sudden onset, none are more like Fire (Huo, 火). In the elderly, True Yin is depleted, so Ministerial Fire (Xiang Huo, 相火) easily flares up. Temporarily employ a method of calming and anchoring. Magnetite (Ci Shi, 磁石 - 1 qian), Phellodendron Bark (Huang Bo, 黄柏 - wine-fried, 0.5 fen), Gardenia Fruit (Zhi Zi, 栀子 - 1.5 qian), and Prepared Rehmannia Root (Shu Di Huang, 熟地黄 - 3 qian) were prescribed. Two doses resulted in efficacy.
The Classics state: The essence of the five Zang and six Fu organs ascends to the eyes to form the eyeball. The cavity housing the eyeball is called the eye. The essence of Bone forms the pupil (Tong Zi, 瞳子); the essence of Sinews forms the black part of the eye (Hei Yan, 黑眼); the essence of Blood forms the white part of the eye (Bai Yan, 白眼); the essence of Flesh forms the eyelids that constrain and wrap the eye. Therefore, the Liver belongs to Wood, corresponds to the Black Pupil (Hei Jing, 黑睛), and is called the Wind Wheel (Feng Lun, 风轮); the Heart belongs to Fire, corresponds to the red vessels within the eyelids, and is called the Blood Wheel (Xue Lun, 血轮); the Spleen belongs to Earth, corresponds to the upper and lower eyelids, and is called the Flesh Wheel (Rou Lun, 肉轮); the Lung belongs to Metal, corresponds to the white sclera (Bai Ren, 白仁), and is called the Qi Wheel (Qi Lun, 气轮); the Kidney belongs to Water, corresponds to the pupil spirit (Tong Shen, 瞳神), and is called the Water Wheel (Shui Lun, 水轮); these are the Five Wheels (Wu Lun, 五轮). The mansion of the Gallbladder is Shan Kuo; the mansion of the Large Intestine is Tian Kuo; the mansion of the Bladder is Ze Kuo; the mansion of the Liver is Feng Kuo; the mansion of the Kidney is Shui Kuo; the mansion of the Gate of Vitality (Ming Men, 命门) is Huo Kuo; the mansion of the Spleen and Stomach is Di Kuo; the mansion of the Small Intestine is Lei Kuo; these are the Eight Palaces (Ba Kuo, 八廓). The Eight Palaces have names but no fixed location. Symptoms may arise from accumulated Wind-Heat or stagnation of Qi due to the Seven Emotions, manifesting according to their associated Zang organs. For Wind, disperse it; for Heat, clear it; for Qi stagnation, regulate it. Itching eyelids, clear tearing, and red painful swelling constitute Wind Eye (Feng Yan, 风眼). Treat with Xi Gan San (Liver-Washing Powder). Protrusion of the Black Wheel, hard and red swollen eyelids constitute Heat Eye (Re Yan, 热眼). Treat with Huang Lian Tang (Coptis Decoction) and Xie Qing Wan (Drain Green Pill). Blurred vision with tearing, soft swollen eyelids, soreness, slight redness, and eye pain upon anger constitute Qi Eye (Qi Yan, 气眼). Use Stone Conch Shell (Shi Jue Ming, 石决明), Cassia Seed (Cao Jue Ming, 草决明), Eucommia Bark (Chu Shi, 楮实子), Cicada Slough (Chan Tui, 蝉蜕), Cyperus Rhizome (Xiang Fu, 香附), Equisetum (Mu Zei, 木贼), Ligusticum Rhizome (Chuan Xiong, 川芎), and Licorice Root (Gan Cao, 甘草). Zhang Hezi said: Eyes do not become diseased without Fire. Redness of the Qi Wheel indicates Lung Fire; redness of the Flesh Wheel indicates Spleen Fire; opacity covering the Water and Wind Wheels indicates Liver-Kidney Fire; red vessels traversing the eye indicate intense Fire. Treating eye diseases focuses on treating Fire; this can be summarized in one sentence. Li Dongyuan said: The eyes see only when nourished by Blood; the essence of all Zang and Fu organs is derived from the Spleen. Treating eye diseases should prioritize regulating the Spleen and Stomach, nourishing Blood, and calming the Spirit. Both perspectives have merit and should not be adhered to exclusively.
[Eye Pain] There are two types of eye pain: White Eye Pain and Black Eyeball Pain. The White Eye belongs to Yang; daytime pain responds to bitter-cold drops. The Black Eyeball belongs to Yin; nighttime pain worsens with bitter-cold drops. For nighttime pain of the black eyeball, use Xia Ku Cao San (Prunella Powder). For Wind-Heat pain, use Xie Qing Wan (Drain Green Pill) and Xi Gan San (Liver-Washing Powder). For epidemic red-hot eye, photophobia, tearing and nasal discharge, use Jiu Jian San (Decoction Fried in Wine) and Da Huang Dang Gui San (Rhubarb and Angelica Powder). For violent wind-external heat, swelling of the sclera enveloping the iris, severe pain preventing opening, use Xie Fei Tang (Drain Lung Decoction). For severe redness and swelling, add Coptis Rhizome (Huang Lian, 黄连) to Xie Fei Tang. For red swollen eyes with head and eye edema, use Pu Ji Xiao Du Yin (Universal Rescue Detoxification Decoction). For photophobia and head/eye swelling, use Xuan Qi Tang (Select Marvelous Decoction). For needle-like eyeball pain indicating Heart Excess Fire, use Xi Xin San (Heart-Washing Powder). For Heat binding the Bladder with urinary retention, use Wu Ling San (Five-Ling Powder). For Thunder Head Wind (severe headache with eye pain and constipation), use Qing Zhen Tang (Clear Shake Decoction). For Yang-pathogen Wind syndrome with brow bone pain accompanied by Fire, use Xuan Qi Tang and Huan Jing Wan (Restore Clarity Pill). For Yin-pathogen Wind syndrome with occipital bone pain, use San Yin Xiong Xin Tang (Three Causes Ligusticum and Asarum Decoction). For vertex Wind syndrome with inner vertex pain radiating to distended, purple-red eyeballs, this is a malignant external sign; if vision dims, internal signs develop. For external signs, use Qiang Huo Sheng Feng Tang (Notopterygium Victory-over-Wind Decoction). For internal signs, use Chong He Yang Wei Tang (Harmonize and Nourish Stomach Decoction).
[Red Eyes] Dai Fu'an stated: Red eyes result from Blood congestion in the Liver Meridian. For exterior patterns, use Qiang Huo Sheng Feng Tang. For interior patterns, use Xie Gan San (Drain Liver Powder). If redness persists and membranes form, use Chun Xue Gao (Spring Snow Ointment) and Rui Ren Gao (Buckthorn Seed Ointment), combined with Bi Yun San (Green Cloud Powder) insufflated into the nose. For redness with swelling and pain, scatter Damp-Heat; for dry pain, scatter Fire-Toxin; for excessive tearing, scatter Wind-Evil; for redness without pain, promote urination. For Blood flooding the pupil, use Da Huang Dang Gui San. For red vessels traversing the pupil, especially in external obstructions, treatment is difficult. Use Xi Xin San and Dao Chi San (Guide Out Red Powder). For chaotic red filaments, apply Shi Yan Dan (Swallowstone Pill) topically, and take Da Huang Dang Gui San and Jiu Jian San.
[Eye Swelling] Swelling differs between eyelid swelling (Bao Zhong, 胞肿) and eyeball swelling (Zhu Zhong, 珠肿). Eyelid swelling is mostly Damp; eyeball swelling is mostly Fire. Violent wind-external pathogens cause cup-shaped eyelid swelling. Use Xi Gan San and Long Dan Yin (Gentian Drink). When the Five Wheels are congested, causing eye distension and inability to rotate, resembling a hawk's eye, use Jiu Jian San. For Wind-Toxin, Damp-Heat, and Blood stasis flooding the eye, causing eyelids and eyeballs to swell like fists, use Shi Gao San (Gypsum Powder) plus Qiang Huo, Xi Xin, Chuan Xiong, Bai Shao, and Bo He. If the eyeball ulcerates, it is too late. If the Qi Wheel is flat and the Water Wheel is clear, but the Wind Wheel rises or half-rises, take Liang Ge San (Cool Chest Powder) and apply Shi Yan Dan. If the Water Wheel bulges like a snail shell, indicating severe Liver Heat, apply Shi Yan Dan and Chun Xue Gao, and take Shuang Jie San (Double Resolution Powder) or Liu Wei Wan (Six-Ingredient Pill) plus Zhi Mu and Huang Bo. Spontaneous eyeball distension, numbness, tearing, and pain due to accumulation of Toxin-Wind in the Five Zang organs: take Da Huang Dang Gui San.
[Itchy Eyes] For Wind-Heat, use Si Sheng San (Four Raw Substances Powder). For Blood Deficiency, use Si Wu Tang (Four Substances Decoction) plus Qiang Huo, Fang Feng, Ji Li, and Huang Qin. Generally, each episode of itching aggravates the disease, though the root cause varies; slight itching indicates Deficient Fire. Treatment involves Ginger Powder, Calcined Alum (Ku Fan, 枯矾), and Borax (Peng Sha, 硼砂), mixed with saliva to rice-grain size, inserted into the outer canthus frequently, washed with salt water steam, or applied with Pearl Ointment.
[External Obstruction] Caused by Wind-Heat congestion upward, causing fleshy growths on eyelids that rub the eyeball, eventually forming opacities. Dispel Wind and clear Heat; use topical medications to remove them. Opacities resembling clouds, threads, or star scales outside the eye are caused by excessive cold medicines injuring the Spleen and Stomach, preventing Clear Qi from ascending. From the inner canthus: Qiang Huo Sheng Feng Tang plus Man Jing Zi. From the outer canthus: Base Decoction plus Dan Cao and Ben Cao. From above downward: Base Decoction plus Huang Lian and doubled Chai Hu. From below upward: Base Decoction plus Mu Tong. Insufflate Bi Yun San. Topical applications use Chun Xue Gao, Rui Ren Gao, or Di Li Powder mixed with human milk. To remove old opacities, select Shi Yan Dan, Chun Xue Gao, or Bear Bile Ointment. Zhang Shiwang stated: Although many internal treatments exist for external obstructions, Shen Xiao San and Zao Jiao Wan are primary. For external treatment, Shi Yan Dan is best. For Blood Opacity Enveloping the Pupil, use blood-breaking herbs with Xiao Shi and Da Huang to purge, or if red opacity resembles light mist reflecting the sun, dispel Wind and scatter Blood. For Yellow Membrane Ascending, take Shen Xiao San and apply Shi Yan Dan. For Yellow Membrane Descending covering the pupil, use Chan Hua San plus Shi Gao, Dan Cao, and Da Huang, applying Shi Yan Dan. For Red Membrane Descending, modify Shen Xiao San by removing two sloughing agents, adding Zao Jiao and Shi Jue Ming, and applying Jiang Xue Gao. For Greasy Fat Opacity on the Wind Wheel, urgently use Shen Xiao San and Zao Jiao Wan. For Flower Opacity with White Depression, use Long Dan Yin. For destruction of the Wind Wheel with protrusion of the Divine Fluid resembling Crab Pupil, use Fang Feng Xie Gan San. For Speckled Greasy Opacity white with green-black tints, take Shen Xiao San internally and apply Shi Yan Dan externally. For opacity descending from above through the pupil resembling a hanging gallbladder, take Shi Gao San and apply Shi Yan Dan. For white star-like spots on the black pupil, modify Chan Hua San by removing Cang Zhu, adding Ji Li and Gu Jing, and insufflating Bi Yun San. For fine spots on the black pupil, varying in color or distribution, often due to Phlegm-Fire, take Ling Yang Jiao San or Bu Shen Wan. Fleshy growths starting at the outer canthus invading the Wind Wheel and covering the pupil require harmonizing Blood and clearing Fire; apply Shi Yan Dan. Red flesh like a chicken comb at the outer canthus affecting the Qi Wheel: use San Huang Wan plus Mang Xiao, applying Jiang Xue Gao. This treats external obstructions.
[Internal Obstruction] Due to Deficiency with Qi Stagnation. Externally normal eyes but unable to see objects, without pain or itching, but with faint blue-white hues inside the pupil. These are pathogenic factors from Zang-Fu entering due to deficiency and forming opacities. For Qing Feng Zhang (Blue Wind Obstruction), internal colors resemble mountains shrouded in light smoke; treat urgently to prevent turning green. Use Ling Yang Jiao Tang (Antelope Horn Decoction). For Lv Feng Zhang (Green Wind Obstruction), the pupil is turbid; long-term it becomes Huang Feng (Yellow Wind). Same formula. For Hei Feng Zhang (Black Wind Obstruction), similar to Green Wind but with intermittent black flowers. First dispel Wind, then use Bu Shen Ci Shi Wan (Kidney-Nourishing Magnetite Pill). Huang Feng and Yin Feng Zhang are incurable. For Si Feng Zhang (Silk Wind Obstruction), a faint horizontal thread inside the pupil. Use Liu Wei Wan plus Xi Xin and Ji Li. For Yan Yue Zhang (Reclining Moon Obstruction), resembling a crescent moon hanging down. First use San Yin Xiong Xin Tang, then Bu Shen Wan. For Yang Yue Zhang (Ascending Moon Obstruction), a bay of white Qi in the lower half of the pupil, like an ascending crescent. Use Bu Shen Wan. For Yin Zhang (Silver Obstruction), the pupil is silver-white. Initially take Ling Yang Bu Gan San, then Bu Shen Wan. For Jin Zhang (Gold Obstruction), same treatment. For Lv Ying Tong Shen (Green Reflecting Pupil), faint green inside the pupil. First take Huang Lian Yang Gan Wan, then Bu Shen Ci Shi Wan. Visual disturbances like flying flies, falling flowers, or fluttering banners, yellow/white/blue/black: Yellow/White indicates Phlegm-Fire injuring the Lung; use Zao Jiao Wan. Blue/Black requires Kidney tonification; use Bu Shen Ci Shi Wan. For dilated pupil, use Liu Wei Wan plus Wu Wei Zi and Shi Jue Ming, or Bu Shen Ci Shi Wan. For constricted pupil, first take Huang Lian Yang Gan Wan, then Liu Wei Wan plus Tian Dong and Mai Dong, or Zi Shen Wan. For tilted pupil, use Liu Wei Wan plus Ji Li and Dang Gui. For Sudden Blindness, the Classics state: Qi depletion leads to unclear vision. Urgently use large dose Du Shen Gao (Single Ginseng Paste). For Nyctalopia (Night Blindness), use Ha Fen Wan and Zhu Gan San. For damaged essence and sunken eyeballs with drying Divine Fluid, strongly tonify Kidney Essence; avoid cold-cooling herbs. For eyeballs rotating like a winch or reversed pupils, use Bu Zhong Yi Qi Tang plus Qiang Huo. This treats internal obstructions.
[Miscellaneous Conditions] Seeing far but not near indicates Yin Qi Deficiency; treat Heart and Kidney. Use Jia Jian Di Zhi Wan or Liu Wei Wan. Seeing near but not far indicates Yang Qi Deficiency; treat Gallbladder and Kidney. Use Jia Wei Ding Zhi Wan or Ba Wei Wan. Entropion and trichiasis result from tight skin around the eyes; long-term redness and ulceration lead to unclear Divine Fluid. Prick the orbital rim with a three-edged needle to drain Damp-Heat, then take Fang Feng Yin Zi. Insufflate Bi Yun San; alternatively, powder one Momordica seed, insert left into right nostril and right into left, straightening overnight. Ectropion with adhesion: Blood congestion internally, tight skin externally; use scalpel incision and drainage. Marginal blepharitis chronic with itching: take Chai Hu Yin Zi, apply Rui Ren Gao. For wind-induced redness/ulceration, use Chuan Xiong Cha Tiao San and Xi Gan San. For wind-induced tearing, use Ju Hua San. For excess heat sores, clear Heart Fire and dispel Wind-Heat. Jiao Chuang (Pepper Granules) inside the eyelid, red/hard like pepper: dispel Wind-Heat. Su Chuang (Millet Granules) inside the eyelid, yellow/soft like millet: resolve Damp-Heat. Wu Gang Syndromes: Mu Gang on Wind Wheel, blue-green. Excess: Xie Qing Wan. Deficiency: Bu Shen Wan. Huo Gang at eyelid margin/Qi Wheel, initial stage like Jiao Chuang: San Huang Tang, Dao Chi San. Tu Gang (Stolen Needle Eye): Xie Huang San. Jin Gang inside eyelid, resembling jade grains; if untreated, becomes fistula: Xie Fei Tang. Shui Gang at eyelid margin/Qi Wheel, bean-shaped; if on Wind Wheel, eye breaks; common in headache patients: Qing Kong Gao. For chronic sores becoming large fistulas: Jin Hua Wan plus Qiang Huo and Scorpion Tail. Small fistulas: Dao Chi San plus wind-dispelling/clearing herbs. Zheng Fistula on Wind Wheel, purulent like phlegm: urgently drain Liver. Pian Fistula on Qi Wheel, clear fluid: urgently drain Lung. Mental confusion, visual hallucinations, moving static objects, inverted perception, halos/color changes: Yin Essence Deficiency. Use Zhu Jing Wan, Yi Qi Cong Ming Tang, or Bai Cao Gao. Trauma with bruising, rupture of sclera/iris: Jiu Jian San. Gradual opacity: Xi Jiao Di Huang Tang plus Da Huang and Dang Gui. Foreign body (fly filament) in eye: apply scalp scurf. The above follows Shiwan's "Yi Tong", summarized generally.