例一张××，女，27岁，病历号：75753，会诊日期，1959年11月6日。今年八月初曾感冒发烧，伴有偏头痛。15天后左眼视力急剧下降，5天后右眼视力相继减退，头痛绵绵，右眼胀肩，睡眠、纳食均差，懒动少言。发病前工作紧张，有过度劳累史。检查：右眼视力0．5，近视力耶格表2；左眼视力0.7，近视力耶格表2。双视乳头色泽全部苍白，边缘清楚，动脉细，动静脉比例为1：2，其他大致正常。双眼周边视野白色视标在20度以内，红色视标在10度以内，双眼中心视野约有10度比较暗点。脉细有力，舌体胖。辨证：脾虚气弱，中气不足，清阳下陷，清窍失养。（双眼视瞻昏渺，双眼视瞻有色）治法：益气升阳为主，辅以清肝明目。方药：补中益气汤加味。柴胡3克升麻2克归身10克白术10克陈皮5克党参12克黄芪10克炙甘草3克蔓荆子3克生石决明15克（先煎）夜明砂12克（包煎）杞子12克五味子5克川芎3克14剂11月20日
（二诊）：服药后视力明显进步，暗影已不明显。检查：双眼视力1.0，近视力耶格表1。双眼底大致同前，脉细，舌质淡，舌体稍胖。仍守前方加减。方药：补中益气汤加桑叶6克、石决明15克（先煎）、杞子10克，7剂。11月27日
（末诊）：双眼视力已恢复正常，眼前暗影已消。检查：双眼视力1．2，近视力耶格表1。眼底大致同前。双眼周边视野已基本正常，中心暗点已消，停止治疗。（《韦文贵眼科临床经验选》
例二魏ｘ，女，27岁，初诊日期：1973年10月13日。患者1971年3月行人工流产术后，患子宫内膜炎及附件炎，继之左眼视物不清，诊后未再介意，1973年8月目疾复发，左眼视物不清逐渐加重，伴头痛，眼胀，曾经检查诊为“左眼中心性陈旧性视网膜脉络膜炎”。曾经西药治疗效不着。现症：头昏眼胀，视物不清，心悸气短，神疲肢软，常自汗出，失眠，腰脊酸痛，关节疼痛，下肢微浮肿。舌质淡，脉弦涩。辨证：气虚夹瘀，络道瘀滞，兼肝阴不足。治法：益气化瘀，滋肝通络。方药：党参60克鸡血藤18克生黄芪60克仙鹤草60克阿胶珠10克女贞子24克旱莲草24克钩藤3Q克蜈蚣2条乌梢蛇10克、地鳖虫12克水蛭6克全蝎10克三七粉（冲）3克蒲黄10克五味子12克金樱子60克槟榔10克每周6剂，连二周。10月27日
（二诊）：除视力未见好转外，一般病情均有所缓解，上方去槟榔，加木贼草24克，楮实子24克，生鳖甲24克，更加麝香0.5克（冲服）。每周6剂，嘱服四周。12月10日
（三诊）：上方共服24剂，视力显著好转，能自行走路就诊，全身诸症相继消退，拟下方巩固疗效。党参30克鸡血藤18克生黄芪30克木贼24克楮实子24克蜈蚣2条乌梢蛇10克蒲黄10克五味子10克柴胡3克每周六剂，每周另服云南白药一瓶（分六次服，每日一次）。一月后复查左0.07,微斜可眺远，右眼0．8，已上班，嘱再服上方一个月，以巩固疗效。
（冯显逊整理:王渭川运用益气化瘀法的经验，《中医杂志》4：14，1981）、
【评按】视神经萎缩属于中医视瞻昏渺范围。多因肝肾不足，气血虚弱而致。
例一证属脾虚气弱,中气不足为本，治以益气升阳为主,辅以清肝明目。方以补中益气汤为主，气足血充，精气得以上承，目得血而能视。盖目为肝窍，瞳神属肾，凡瞳神内部慢性病，多以补肝肾为主，而脾为后天之本，生化之源，久思易伤脾，过劳易伤气。补中益气实乃洽本之法，且与滋补肝肾、舒肝解郁，养血活血相辅相成。
例二诊为中心性陈旧性视网膜脉络膜炎，据其证候，也属于视瞻昏渺范围。中医辨证为气虚夹瘀，络道瘀滞，兼见肝阴不足。治以益气化瘀，滋肝通络。因其气血虚滞，“若欲通之，必先充之”，故在补气血的基础上，重用搜剔走窜之虫类药物，更加麝香等开窍通闭之品，视力显好，“全身症状相继消退。观其药剂较重,关键在于识证精确，否则病重药轻，难以奏效。
（五）暴盲
例一钱××，男，45岁，初诊日期：1964年5月11日。厥阴失条，郁火上逆，两眼觉胀，视物模糊，方寸大字，分不清楚，胸闷纳少，口渴不饮，大便干燥，小便浑浊，经××医院诊断为急性球后视神经炎。使用多种西药，治疗罔效。审察脉证，肝经风火并挟湿邪，留阻中州。现予疏肝明目，清火法风，佐以渗湿为治。春柴胡4．5克全当归9克杭白芍9克粉丹皮9克滁菊花9克谷精珠9克草决明9克蜜蒙花9克净蝉衣3克金银花9克西滑石9克云茯苓9克制熟军6克焦山楂9克5剂。6月2日
（复诊）：前剂进完，证情好转，前次来诊，遂以前方又投5剂，目前报上小字已能看清，胸字不闷。饮食增加，苔脉均见好转，原方去茯苓、滑石、熟军、山楂，又投5剂，而完全恢复健康。
（张笑平整理：陈粹吾医案选录，《江苏中医》5：29，1965）
例二沈××，女，23岁。初诊日期：1960年2月22日。双目骤然不睹，将近十日，曾经西医检查，云为急性球后视神经炎；此属暴盲，症询危笃，年轻体力应壮，但脉来虚软，形体不实。辨证、阴亏水不涵木，精气不能上达，目系失所荣养。治法：益阴填精，肝肾同治。方药：生地山药茯苓泽泻萸肉丹皮杞子菊花当归麦冬5剂。二诊：前予补益肝肾之剂，目病未瘥，且感头部偏痛，眼珠亦痛。据述病由郁抑，情志不遂而起，是乃郁抑伤肝，木不条达：气血逆而元府闭塞，故神气出入无路，光华不能发越，治当疏肝解郁为先。生白芍茯苓全当归柴胡炒白术薄荷炙甘草白芷蔓荆子5剂以后又服5剂。四诊：头痛已愈，眼病已差，目视恢复，但感不足，病根尚在，再守上法。生白芍茯苓全当归柴胡炒白术炙甘草生地杞子5剂以后又服5剂。六诊：经治后，目视恢复，检查视力，二眼皆为1．0，病愈，但防再燃，唯有清心寡欲，借视缄光，去除一切杂念，可保无虞。杞菊地黄丸。
（姚芳蔚等整理：眼科姚和清的学术经验，《上海中医药杂志》3：1，1964y
例三文ｘｘ，女，12岁，门诊号：70309，初诊日期：1959年4月24日。双眼视力急剧下降，伴有眼球胀痛半月余。涸初，感冒发烧后双眼视力模糊，眼胀痛。11日双眼视力急剧下降，仅有光感。12日双眼视力光感消失。14日在××医院住院确诊为急性视神经乳头炎。经治疗效果不明显，转本院治疗。现仍头痛眼胀。检查、双眼视力眼前指数。双眼瞳孔稍大；对光反应较迟钝。双眼底视乳头充血色红，边缘模糊不清，乳头水肿隆起约2个屈光度；周围网膜有放线样水肿，鼻上及颞侧有点条状出血；视网膜静脉扩张，动脉无明显改变，黄斑部及周边部所见范围未发现异常。脉弦，舌质红而苔薄白。辨证：肝经郁热，风邪外侵，玄府郁滞。（双侧暴盲）治法：舒肝解郁，活血破瘀为主，辅以平肝明目。方药：丹栀逍遥散加茺蔚子6克，石决明12克，五味子2克，7剂，水煎服。5月4日
（二诊）：药后视力提高，眼胀已消，惟口眼发干。检查：双眼视力0.2，近视力耶格表7+1。脉细而稍数，舌质梢红，少苔。证属热病伤阴，肝肾阴虚。治宜滋肝肾明目。方药：杞菊地黄汤加减。杞子6克菊花3克熟地10克山药6克丹皮2克茯苓6克泽泻6克五味子5克桑叶3克青葙子10克7剂，水煎服。5月11日
（三诊）：眼药后，视力明显进步，全身无明显不适。检查：双眼视力0．6+2，近视力那格表4+1。原方去青葙子加女贞子川克，熟地加重为15克，以助滋阴益肾之效。14剂，水煎服。5月25日
（末诊）：视力已正常，有时视物模糊。检查：双眼视力1．2，近视力耶格表1。双瞳孔大小，反应均正常，视野未查。双眼底视乳头色淡，边缘稍模糊，水肿消退，出血吸收，动静脉比例大致正常，黄斑中心凹反射可见，周边部正常。仍以滋补肝肾为治则。杞菊地黄汤七剂，巩固疗效，停止治疗。（《韦文贵眼科临床经验选》）
【评按】暴盲系指视力急剧下降甚至失明，视力逐渐减退甚至失明者则属“青盲症”。急性球后视神经炎属于暴盲范畴。例一证属肝经风火，脾经湿浊，当以清火祛风导湿为正治。丹溪云：“气有余便是火”。方中柴胡、当归意虽疏肝，实能清火；熟军、山楂取其下通上达，清下撤上而收“上病下取”之功。例二初诊辨证为阴亏水不涵木，精气不能上达而致暴盲，治以益阴填精之法，方用杞菊地黄之属而无效，后进一步审证求因，始知病由情志不遂而起，气血逆乱而玄府闭塞，改用疏肝解郁之法，遂以逍遥之辈而建奇功。例三诊为视神经乳突炎。证属肝经郁热，风邪外侵，玄府郁滞而致双眼暴盲。《审视瑶函》用丹栀逍遥散治疗“怒气伤肝，并脾虚血少，致暗不明”的暴盲症。本案另加茺蔚子、石决明、五味子以助活血破瘀，平肝滋阴明目之力，服药后视力进步，但口眼发干，见有肝肾阴虚之证，故改用杞菊地黄滋补肝肾而收功。实属师古而不泥古之例证。
（六）青风内障袁××，女，25岁，门诊号869118，初诊日期：1964年2月26日。右眼二年半前因胀痛，经检查诊为青光眼，曾行手术，术后眼压尚稳定。近半年床眼压又波动，伴虹视，头痛，眼胀，恶心，疲劳后加重，视野亦有改变。左眼亦有类似症状，虹视明显，经××医院检查，确诊为慢性单纯性青光眼，目前用1％匹罗卡品服药水，右眼一日六次，左眼一日二次。晚上均用2％匹罗卡品眼膏涂眼。近来时有偏头痛，性情急躁，平时大便干结，4～5日一行，月经量多，约40天一次。检查：右眼视力0．3（矫正0．8-2），近视力耶格表1。右眼无滤泡，虹膜于11～12点根部缺损，双眼瞳孔药物性缩小。右眼压7．5／3＝35．76毫米汞柱，左眼压7．5／5＝25．81毫米汞柱。右眼乳头有病理性凹陷扩大，其它正常，左眼底大致正常。左眼鼻侧视野缩小25～30度，颞侧在60度，脉弦细，舌色稍红，苔薄带黄。辨证，阴虚肝旺，外风挟内风上犯空窍，发为双眼青风内障。洽法：滋阴平肝，祛风止痛。方药：经验方青光眼三方。石决明24克白蒺藜10克决明子15克防风6克羌活6克蝉蜕6克蒙花6克白术10克白芷6克细辛3克生地20克石斛夜光丸，每日1丸。3月23日
（二诊），药后眼胀头痛减轻，虹视已基本消失，昨夜看电影后又出现虹视，二天来食欲不佳，夜寐不安，脉细弦，舌苔薄。检查：右眼压5．5／3.5＝22．38毫米汞柱，左眼5．5／4．5＝18．86毫米汞柱。原方加炒谷芽25克，车前子10克（包煎）。石斛夜光丸，每日一丸。右眼每日点匹罗卡品眼药水4次，左眼每日点二次，晚上不再涂匹罗卡品眼药膏。6月5日
（三诊）：上药又服30剂后，自感眼胀已减，虹视偶尔出现，有时头沉，胃纳进步，脉弦细，舌质略红，证属风邪未尽，肝阴不足，治宜法风止痛，滋阴平肝。方药：青光眼三方加减。生地22克白术6克白芷6克防风6克白蒺藜10克蝉衣3克蒙花10克羌独活各5克决明子12克生石决明25克（先煎）细辛3克黄芩6克车前子12克（包煎）杜仲10克丹皮12克隔日1剂明目地黄丸早晚各一丸，和汤药交替服。7月17日
（四诊）：上药20剂后，视力增进，眼压亦降，头痛眼胀已消，虹视亦消失，匹罗卡品眼药水已停用，纳可，二便畅调，脉细，舌稍红，苔薄。检查：右眼矫正视力1．0，近视力耶格表1；左眼矫正视力1．2，近视力耶格表1。双眼眼压5．5／5=17．30毫米汞柱，眼压已正常，停药观察。（《韦文贵眼科临床经验选》）
【评按】青风内障相当于青光眼。多因风、火、痰、湿，与肝肾阴虚或脾虚气弱所致。本
例证属阴虚肝旺，外风挟内风上犯空窍。使用韦氏经验方——青光眼三方效果尚称满意。据称本方对慢性单纯性青光眼，时发时止，眼压在25～35毫米汞柱者，疗效较好。
（七）枣花翳内障程ｘｘ，女，67岁。门诊号：69390，初诊日期：1964年3月4日。患者右眼前有黑影已二年，左眼前有黑影已一年。二年前右眼出现黑影，左眼一年前也出现黑影，并较右眼为重，曾于××医院诊断为老年性白内障，治疗无效。平时夜寐欠安，耳鸣，大便干结。检查：双眼视力0．5，近视力耶格表4。双眼晶体皮层呈楔状混浊。双眼屈光间质欠清，可见视乳头色泽及血管、黄斑大致正常。脉弦细，舌质淡红。辨证：肝肾阴亏。（双眼枣花翳障）治法：滋补肝肾。方药：杞菊地黄汤加桑叶16克黑芝麻15克，每日或隔日1剂。30剂。4月22日
【背景信息】
书名：近现代名医验案类编 章节：正文(50/53) 类别：医论
【待处理原文】
病例一 患者张某某，女性，27岁，病历号：75753，会诊日期为1959年11月6日。今年八月初曾患感冒发烧，伴有偏头痛。15天后左眼视力急剧下降，5天后右眼视力相继减退，头痛持续不断，右眼发胀且牵连肩部，睡眠和饮食均差，懒于活动，言语减少。发病前工作紧张，有过度劳累史。检查：右眼视力0.5，近视力耶格表（Jaeger chart）第2行；左眼视力0.7，近视力耶格表第2行。双视乳头色泽全部苍白，边缘清晰，动脉变细，动静脉比例为1:2，其他大致正常。双眼周边视野中白色视标在20度以内，红色视标在10度以内，双眼中心视野约有10度的比较暗点。脉象细而有力，舌体胖大。辨证：脾虚气弱，中气不足，清阳下陷，清窍失养。（诊断为双眼视瞻昏渺、双眼视瞻有色）。治法：以益气升阳为主，辅以清肝明目。方药：补中益气汤加味。柴胡3克，升麻2克，当归身10克，白术10克，陈皮5克，党参12克，黄芪10克，炙甘草3克，蔓荆子3克，生石决明15克（先煎），夜明砂12克（包煎），枸杞子12克，五味子5克，川芎3克。共14剂。11月20日
（二诊）：服药后视力明显进步，暗影已不明显。检查：双眼视力1.0，近视力耶格表第1行。双眼眼底情况大致同前，脉细，舌质淡，舌体稍胖。仍守前方加减。方药：补中益气汤加桑叶6克、石决明15克（先煎）、枸杞子10克，7剂。11月27日
（末诊）：双眼视力已恢复正常，眼前暗影已消。检查：双眼视力1.2，近视力耶格表第1行。眼底大致同前。双眼周边视野已基本正常，中心暗点已消，停止治疗。（出自《韦文贵眼科临床经验选》）
病例二 患者魏某，女性，27岁，初诊日期：1973年10月13日。患者于1971年3月行人工流产术后，患子宫内膜炎及附件炎，继之出现左眼视物不清，诊后未再介意，1973年8月目疾复发，左眼视物不清逐渐加重，伴头痛，眼胀，曾经检查诊断为“左眼中心性陈旧性视网膜脉络膜炎”。曾经西药治疗效不着。现症：头昏眼胀，视物不清，心悸气短，神疲肢软，常自汗出，失眠，腰脊酸痛，关节疼痛，下肢微浮肿。舌质淡，脉弦涩。辨证：气虚夹瘀，络道瘀滞，兼肝阴不足。治法：益气化瘀，滋肝通络。方药：党参60克，鸡血藤18克，生黄芪60克，仙鹤草60克，阿胶珠10克，女贞子24克，旱莲草24克，钩藤30克，蜈蚣2条，乌梢蛇10克，地鳖虫12克，水蛭6克，全蝎10克，三七粉（冲服）3克，蒲黄10克，五味子12克，金樱子60克，槟榔10克。每周6剂，连服两周。10月27日
（二诊）：除视力未见好转外，一般病情均有所缓解，上方去槟榔，加木贼草24克，楮实子24克，生鳖甲24克，更加麝香0.5克（冲服）。每周6剂，嘱服四周。12月10日
（三诊）：上方共服24剂，视力显著好转，能自行走路就诊，全身诸症相继消退，拟下方巩固疗效。党参30克，鸡血藤18克，生黄芪30克，木贼24克，楮实子24克，蜈蚣2条，乌梢蛇10克，蒲黄10克，五味子10克，柴胡3克。每周六剂，每周另服云南白药一瓶（分六次服，每日一次）。一月后复查左眼视力0.07，微斜可眺远，右眼0.8，已上班，嘱再服上方一个月，以巩固疗效。
（冯显逊整理：王渭川运用益气化瘀法的经验，《中医杂志》4：14，1981）
【评按】视神经萎缩属于中医视瞻昏渺范围。多因肝肾不足，气血虚弱而致。
例一证属脾虚气弱，中气不足为本，治以益气升阳为主，辅以清肝明目。方以补中益气汤为主，气足血充，精气得以上承，目得血而能视。盖目为肝窍，瞳神属肾，凡瞳神内部慢性病，多以补肝肾为主，而脾为后天之本，生化之源，久思易伤脾，过劳易伤气。补中益气实乃洽本之法，且与滋补肝肾、舒肝解郁，养血活血相辅相成。
例二诊为中心性陈旧性视网膜脉络膜炎，据其证候，也属于视瞻昏渺范围。中医辨证为气虚夹瘀，络道瘀滞，兼见肝阴不足。治以益气化瘀，滋肝通络。因其气血虚滞，“若欲通之，必先充之”，故在补气血的基础上，重用搜剔走窜之虫类药物，更加麝香等开窍通闭之品，视力显好，“全身症状相继消退。观其药剂较重，关键在于识证精确，否则病重药轻，难以奏效。
（五）暴盲
病例一 患者钱某某，男性，45岁，初诊日期：1964年5月11日。厥阴失条达，郁火上逆，两眼觉胀，视物模糊，方寸大字，分不清楚，胸闷纳少，口渴不饮，大便干燥，小便浑浊，经××医院诊断为急性球后视神经炎。使用多种西药，治疗罔效。审察脉证，肝经风火并挟湿邪，留阻中州。现予疏肝明目，清火祛风，佐以渗湿为治。春柴胡4.5克，全当归9克，杭白芍9克，粉丹皮9克，滁菊花9克，谷精珠9克，草决明9克，蜜蒙花9克，净蝉衣3克，金银花9克，西滑石9克，云茯苓9克制熟军6克，焦山楂9克。5剂。6月2日
（复诊）：前剂进完，证情好转，前次来诊，遂以前方又投5剂，目前报上小字已能看清，胸字不闷。饮食增加，苔脉均见好转，原方去茯苓、滑石、熟军、山楂，又投5剂，而完全恢复健康。
（张笑平整理：陈粹吾医案选录，《江苏中医》5：29，1965）
病例二 患者沈某某，女性，23岁。初诊日期：1960年2月22日。双目骤然不睹，将近十日，曾经西医检查，云为急性球后视神经炎；此属暴盲，症询危笃，年轻体力应壮，但脉来虚软，形体不实。辨证：阴亏水不涵木，精气不能上达，目系失所荣养。治法：益阴填精，肝肾同治。方药：生地、山药、茯苓、泽泻、萸肉、丹皮、杞子、菊花、当归、麦冬。5剂。二诊：前予补益肝肾之剂，目病未瘥，且感头部偏痛，眼珠亦痛。据述病由郁抑，情志不遂而起，是乃郁抑伤肝，木不条达：气血逆而元府闭塞，故神气出入无路，光华不能发越，治当疏肝解郁为先。生白芍、茯苓、全当归、柴胡、炒白术、薄荷、炙甘草、白芷、蔓荆子。5剂以后又服5剂。四诊：头痛已愈，眼病已差，目视恢复，但感不足，病根尚在，再守上法。生白芍、茯苓、全当归、柴胡、炒白术、炙甘草、生地、杞子。5剂以后又服5剂。六诊：经治后，目视恢复，检查视力，二眼皆为1.0，病愈，但防再燃，唯有清心寡欲，借视缄光，去除一切杂念，可保无虞。杞菊地黄丸。
（姚芳蔚等整理：眼科姚和清的学术经验，《上海中医药杂志》3：1，1964）
病例三 患者文某某，女性，12岁，门诊号：70309，初诊日期：1959年4月24日。双眼视力急剧下降，伴有眼球胀痛半月余。涸初，感冒发烧后双眼视力模糊，眼胀痛。11日双眼视力急剧下降，仅有光感。12日双眼视力光感消失。14日在××医院住院确诊为急性视神经乳头炎。经治疗效果不明显，转本院治疗。现仍头痛眼胀。检查：双眼视力眼前指数。双眼瞳孔稍大；对光反应较迟钝。双眼底视乳头充血色红，边缘模糊不清，乳头水肿隆起约2个屈光度；周围网膜有放线样水肿，鼻上及颞侧有点条状出血；视网膜静脉扩张，动脉无明显改变，黄斑部及周边部所见范围未发现异常。脉弦，舌质红而苔薄白。辨证：肝经郁热，风邪外侵，玄府郁滞。（诊断为双侧暴盲）。治法：舒肝解郁，活血破瘀为主，辅以平肝明目。方药：丹栀逍遥散加茺蔚子6克，石决明12克，五味子2克，7剂，水煎服。5月4日
（二诊）：药后视力提高，眼胀已消，惟口眼发干。检查：双眼视力0.2，近视力耶格表7+1。脉细而稍数，舌质梢红，少苔。证属热病伤阴，肝肾阴虚。治宜滋肝肾明目。方药：杞菊地黄汤加减。杞子6克，菊花3克，熟地10克，山药6克，丹皮2克，茯苓6克，泽泻6克，五味子5克，桑叶3克，青葙子10克。7剂，水煎服。5月11日
（三诊）：眼药后，视力明显进步，全身无明显不适。检查：双眼视力0.6+2，近视力那格表4+1。原方去青葙子加女贞子10克，熟地加重为15克，以助滋阴益肾之效。14剂，水煎服。5月25日
（末诊）：视力已正常，有时视物模糊。检查：双眼视力1.2，近视力耶格表第1行。双瞳孔大小，反应均正常，视野未查。双眼底视乳头色淡，边缘稍模糊，水肿消退，出血吸收，动静脉比例大致正常，黄斑中心凹反射可见，周边部正常。仍以滋补肝肾为治则。杞菊地黄汤七剂，巩固疗效，停止治疗。（出自《韦文贵眼科临床经验选》）
【评按】暴盲系指视力急剧下降甚至失明，视力逐渐减退甚至失明者则属“青盲症”。急性球后视神经炎属于暴盲范畴。例一证属肝经风火，脾经湿浊，当以清火祛风导湿为正治。丹溪云：“气有余便是火”。方中柴胡、当归意虽疏肝，实能清火；熟军、山楂取其下通上达，清下撤上而收“上病下取”之功。例二初诊辨证为阴亏水不涵木，精气不能上达而致暴盲，治以益阴填精之法，方用杞菊地黄之属而无效，后进一步审证求因，始知病由情志不遂而起，气血逆乱而玄府闭塞，改用疏肝解郁之法，遂以逍遥之辈而建奇功。例三诊为视神经乳突炎。证属肝经郁热，风邪外侵，玄府郁滞而致双眼暴盲。《审视瑶函》用丹栀逍遥散治疗“怒气伤肝，并脾虚血少，致暗不明”的暴盲症。本案另加茺蔚子、石决明、五味子以助活血破瘀，平肝滋阴明目之力，服药后视力进步，但口眼发干，见有肝肾阴虚之证，故改用杞菊地黄滋补肝肾而收功。实属师古而不泥古之例证。
（六）青风内障 患者袁某某，女性，25岁，门诊号869118，初诊日期：1964年2月26日。右眼二年半前因胀痛，经检查诊为青光眼，曾行手术，术后眼压尚稳定。近半年床眼压又波动，伴虹视，头痛，眼胀，恶心，疲劳后加重，视野亦有改变。左眼亦有类似症状，虹视明显，经××医院检查，确诊为慢性单纯性青光眼，目前用1％匹罗卡品服药水，右眼一日六次，左眼一日二次。晚上均用2％匹罗卡品眼膏涂眼。近来时有偏头痛，性情急躁，平时大便干结，4～5日一行，月经量多，约40天一次。检查：右眼视力0.3（矫正0.8-2），近视力耶格表第1行。右眼无滤泡，虹膜于11～12点根部缺损，双眼瞳孔药物性缩小。右眼压7.5／3＝35.76毫米汞柱，左眼压7.5／5＝25.81毫米汞柱。右眼乳头有病理性凹陷扩大，其它正常，左眼底大致正常。左眼鼻侧视野缩小25～30度，颞侧在60度，脉弦细，舌色稍红，苔薄带黄。辨证：阴虚肝旺，外风挟内风上犯空窍，发为双眼青风内障。治法：滋阴平肝，祛风止痛。方药：经验方青光眼三方。石决明24克，白蒺藜10克，决明子15克，防风6克，羌活6克，蝉蜕6克，蒙花6克，白术10克，白芷6克，细辛3克，生地20克，石斛夜光丸，每日1丸。3月23日
（二诊），药后眼胀头痛减轻，虹视已基本消失，昨夜看电影后又出现虹视，二天来食欲不佳，夜寐不安，脉细弦，舌苔薄。检查：右眼压5.5／3.5＝22.38毫米汞柱，左眼5.5／4.5＝18.86毫米汞柱。原方加炒谷芽25克，车前子10克（包煎）。石斛夜光丸，每日一丸。右眼每日点匹罗卡品眼药水4次，左眼每日点二次，晚上不再涂匹罗卡品眼药膏。6月5日
（三诊）：上药又服30剂后，自感眼胀已减，虹视偶尔出现，有时头沉，胃纳进步，脉弦细，舌质略红，证属风邪未尽，肝阴不足，治宜法风止痛，滋阴平肝。方药：青光眼三方加减。生地22克，白术6克，白芷6克，防风6克，白蒺藜10克，蝉衣3克，蒙花10克，羌独活各5克，决明子12克，生石决明25克（先煎），细辛3克，黄芩6克，车前子12克（包煎），杜仲10克，丹皮12克。隔日1剂，明目地黄丸早晚各一丸，和汤药交替服。7月17日
（四诊）：上药20剂后，视力增进，眼压亦降，头痛眼胀已消，虹视亦消失，匹罗卡品眼药水已停用，纳可，二便畅调，脉细，舌稍红，苔薄。检查：右眼矫正视力1.0，近视力耶格表第1行；左眼矫正视力1.2，近视力耶格表第1行。双眼眼压5.5／5=17.30毫米汞柱，眼压已正常，停药观察。（出自《韦文贵眼科临床经验选》）
【评按】青风内障相当于青光眼。多因风、火、痰、湿，与肝肾阴虚或脾虚气弱所致。本
例证属阴虚肝旺，外风挟内风上犯空窍。使用韦氏经验方——青光眼三方效果尚称满意。据称本方对慢性单纯性青光眼，时发时止，眼压在25～35毫米汞柱者，疗效较好。
（七）枣花翳内障 患者程某某，女性，67岁。门诊号：69390，初诊日期：1964年3月4日。患者右眼前有黑影已二年，左眼前有黑影已一年。二年前右眼出现黑影，左眼一年前也出现黑影，并较右眼为重，曾于××医院诊断为老年性白内障，治疗无效。平时夜寐欠安，耳鸣，大便干结。检查：双眼视力0.5，近视力耶格表第4行。双眼晶体皮层呈楔状混浊。双眼屈光间质欠清，可见视乳头色泽及血管、黄斑大致正常。脉弦细，舌质淡红。辨证：肝肾阴亏。（诊断为双眼枣花翳障）。治法：滋补肝肾。方药：杞菊地黄汤加桑叶16克黑芝麻15克，每日或隔日1剂。30剂。4月22日
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Book Title: Compilation of Verified Cases by Famous Modern Doctors Chapter: Main Text (50/53) Category: Medical Discussion
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Case 1 Patient Zhang XX, female, 27 years old, Medical Record No.: 75753, Consultation Date: November 6, 1959. In early August this year, she suffered from a cold with fever, accompanied by migraine. Fifteen days later, vision in the left eye dropped sharply; five days later, vision in the right eye successively declined. The headache was continuous, the right eye felt distended and radiated to the shoulder. Sleep and appetite were poor, with reluctance to move and speak little. Before onset, work was stressful, with a history of overexertion. Examination: Right eye visual acuity 0.5, near vision Jaeger chart 2; Left eye visual acuity 0.7, near vision Jaeger chart 2. Both optic discs were entirely pale with clear margins, arteries were thin, arteriovenous ratio was 1:2, other findings roughly normal. In the peripheral fields of both eyes, white targets were within 20 degrees, red targets within 10 degrees; there was a relatively dark spot of about 10 degrees in the central field of both eyes. Pulse was fine and forceful, tongue body was fat. Syndrome Differentiation: Spleen deficiency and Qi weakness, insufficiency of Middle Qi, sinking of Clear Yang, malnourishment of the clear orifices. (Diagnosed as Bilateral *Shi Zhan Hun Miao* [Blurred Vision], Bilateral *Shi Zhan You Se* [Colored Vision]). Treatment Method: Primarily tonify Qi and raise Yang, supplemented by clearing Liver heat and brightening the eyes. Prescription: Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) modified. Chai Hu (Bupleuri Radix) 3g, Sheng Ma (Cimicifugae Rhizoma) 2g, Dang Gui Shen (Angelicae Sinensis Radix Corium) 10g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Chen Pi (Citri Reticulatae Pericarpium) 5g, Dang Shen (Codonopsis Radix) 12g, Huang Qi (Astragali Radix) 10g, Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma) 3g, Man Jing Zi (Vittadiniae Fructus) 3g, Sheng Shi Jue Ming (Concha Arcae Præparata) 15g (decocted first), Ye Ming Sha (Chrysochroae Fulgidus) 12g (wrapped), Gou Qi Zi (Lycii Fructus) 12g, Wu Wei Zi (Schisandrae Chinensis Fructus) 5g, Chuan Xiong (Ligustici Chuanxiong Rhizoma) 3g. Total 14 doses. November 20
(Second Visit): After taking the medicine, vision improved significantly, and the dark shadows were no longer obvious. Examination: Visual acuity in both eyes 1.0, near vision Jaeger chart 1. Fundus condition roughly same as before, pulse fine, tongue pale, tongue body slightly fat. Still adhering to the previous prescription with modifications. Prescription: Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) plus Sang Ye (Mori Folium) 6g, Shi Jue Ming (Concha Arcae) 15g (decocted first), Gou Qi Zi (Lycii Fructus) 10g, 7 doses. November 27
(Final Visit): Visual acuity in both eyes has returned to normal, dark shadows in front of eyes have disappeared. Examination: Visual acuity in both eyes 1.2, near vision Jaeger chart 1. Fundus roughly same as before. Peripheral fields of both eyes basically normal, central dark spots disappeared. Treatment stopped. (From "Selected Clinical Experience of Ophthalmologist Wei Wengui")
Case 2 Patient Wei X, female, 27 years old, First Visit Date: October 13, 1973. After undergoing artificial abortion in March 1971, the patient suffered from endometritis and adnexitis, followed by blurred vision in the left eye. She did not pay much attention after diagnosis. In August 1973, the eye disease recurred, with gradual worsening of blurred vision in the left eye, accompanied by headache and eye distension. Previous examination diagnosed "Left Eye Central Old Retinochoroiditis". Western medicine treatment had no effect. Current symptoms: Dizziness and eye distension, blurred vision, palpitations and shortness of breath, mental fatigue and limb weakness, spontaneous sweating, insomnia, soreness and pain in waist and spine, joint pain, slight edema in lower limbs. Tongue pale, pulse wiry and choppy. Syndrome Differentiation: Qi deficiency with blood stasis, obstruction of collaterals, combined with Liver Yin deficiency. Treatment Method: Tonify Qi and resolve stasis, nourish Liver and unblock collaterals. Prescription: Dang Shen (Codonopsis Radix) 60g, Ji Xue Teng (Spatholobi Caulis) 18g, Sheng Huang Qi (Raw Astragali Radix) 60g, Xian He Cao (Agrimoniae Herba) 60g, E Jiao Zhu (Colla Asini Pellet) 10g, Nu Zhen Zi (Ligustri Lucidi Fructus) 24g, Han Lian Cao (Ecliptae Herba) 24g, Gou Teng (Uncariae Ramulus cum Uncis) 30g, Wu Gong (Scolopendra) 2 pieces, Wu Shao She (Zaocys) 10g, Di Bie Chong (Eupolyphaga Seu Steleophaga) 12g, Shui Zhi (Hirudo) 6g, Quan Xie (Scorpio) 10g, San Qi Fen (Notoginseng Powder) (mixed in) 3g, Pu Huang (Typhae Pollen) 10g, Wu Wei Zi (Schisandrae Chinensis Fructus) 12g, Jin Ying Zi (Chrysanthemi Indici Fructus) 60g, Bing Lang (Arecae Semen) 10g. 6 doses per week, taken for two consecutive weeks. October 27
(Second Visit): Except for no improvement in vision, general condition has alleviated. Remove Bing Lang (Arecae Semen) from the previous prescription, add Mu Zei Cao (Equiseti Herba) 24g, Chu Shi Zi (Broussonetiae Fructus) 24g, Sheng Bie Jia (Testudinis Carapax et Plastrum) 24g, plus She Xiang (Moschus) 0.5g (mixed in). 6 doses per week, instructed to take for four weeks. December 10
(Third Visit): Taken total 24 doses of the above prescription, vision improved significantly, able to walk to clinic independently, all systemic symptoms subsided sequentially. Prescribe below to consolidate efficacy. Dang Shen (Codonopsis Radix) 30g, Ji Xue Teng (Spatholobi Caulis) 18g, Sheng Huang Qi (Raw Astragali Radix) 30g, Mu Zei (Equiseti Herba) 24g, Chu Shi Zi (Broussonetiae Fructus) 24g, Wu Gong (Scolopendra) 2 pieces, Wu Shao She (Zaocys) 10g, Pu Huang (Typhae Pollen) 10g, Wu Wei Zi (Schisandrae Chinensis Fructus) 10g, Chai Hu (Bupleuri Radix) 3g. 6 doses per week, additionally take one bottle of Yunnan Baiyao per week (divided into six doses, once daily). One month later re-examination: Left eye 0.07, slight deviation but can see far, Right eye 0.8, back to work. Instructed to continue taking the above prescription for another month to consolidate efficacy.
(Organized by Feng Xianxun: Wang Weichuan's experience in applying Qi-tonifying and Stasis-resolving method, *Journal of Traditional Chinese Medicine* 4:14, 1981)
[Commentary] Optic atrophy belongs to the category of *Shi Zhan Hun Miao* (Blurred Vision) in TCM. It is mostly caused by insufficiency of Liver and Kidney, and deficiency of Qi and Blood.
Case 1 Syndrome belongs to Spleen deficiency and Qi weakness, with insufficiency of Middle Qi as the root. Treatment primarily focuses on tonifying Qi and raising Yang, supplemented by clearing Liver heat and brightening the eyes. The formula centers on Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction). When Qi is sufficient and Blood is充盈 (full), Essence and Qi can ascend, and the eyes can see when nourished by Blood. The eyes are the orifice of the Liver, and the pupil belongs to the Kidney. For chronic diseases inside the pupil, tonifying Liver and Kidney is usually primary. However, the Spleen is the foundation of acquired constitution and the source of production and transformation. Prolonged thinking easily injures the Spleen, and overexertion easily injures Qi. Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction) is indeed a method treating the root, and it complements tonifying Liver and Kidney, soothing Liver and resolving depression, nourishing Blood and invigorating Blood.
Case 2 Diagnosis is Central Old Retinochoroiditis. Based on its syndrome, it also belongs to the category of *Shi Zhan Hun Miao* (Blurred Vision). TCM syndrome differentiation is Qi deficiency with stasis, obstruction of collaterals, combined with Liver Yin deficiency. Treatment focuses on tonifying Qi and resolving stasis, nourishing Liver and unblocking collaterals. Because of Qi and Blood deficiency and stagnation, "if you wish to unblock it, you must first fill it." Therefore, on the basis of tonifying Qi and Blood, heavy use of insect drugs that search and eliminate is employed, plus opening orifices and unblocking blockage items like Moschus. Vision improves significantly, "systemic symptoms subside sequentially." Observing that the dosage is heavy, the key lies in precise syndrome identification; otherwise, if the disease is severe and the medication light, efficacy is difficult to achieve.
(V) Bao Mang (Sudden Blindness)
Case 1 Patient Qian XX, male, 45 years old, First Visit Date: May 11, 1964. Jueyin (Liver Channel) fails to maintain free flow, depressed Fire rebels upward, both eyes feel distended, vision is blurred, large characters within a square inch cannot be distinguished clearly. Chest fullness, poor appetite, thirst without desire to drink, dry stool, turbid urine. Diagnosed at XX Hospital as Acute Retrobulbar Optic Neuritis. Used various Western medicines, treatment ineffective. Examining pulse and syndrome, Wind-Fire of Liver Channel combined with Dampness pathogen, lingering and obstructing the Middle Jiao. Now giving soothing Liver and brightening eyes, clearing Fire and dispelling Wind, assisted by promoting urination to drain Dampness as treatment. Chun Chai Hu (Spring Bupleuri Radix) 4.5g, Quan Dang Gui (Whole Angelicae Sinensis Radix) 9g, Hang Bai Shao (Hang White Peony Root) 9g, Fen Dan Pi (Moutan Cortex) 9g, Chu Ju Hua (Chrysanthemi Flos) 9g, Gu Jing Zhu (Valerianae Jatamansi Rhizoma? Note: Usually refers to Valeriana or similar, here likely Gu Jing Zi/Euphrasiae Herba contextually but text says Gu Jing Zhu) 9g, Cao Jue Ming (Cassiae Semen) 9g, Mi Meng Hua (Glochidionis Flos) 9g, Jing Chan Yi (Periostracum Cicadae) 3g, Jin Yin Hua (Lonicerae Japonicae Flos) 9g, Xi Hua Shi (Talcum) 9g, Yun Fu Ling (Poria) 9g, Zhi Shu Jun (Prepared Rheum Radix et Rhizoma) 6g, Jiao Shan Zha (Fried Crataegi Fructus) 9g. 5 doses. June 2
(Revisit): Finished previous dose, condition improved. Since last visit, prescribed previous formula again for 5 doses. Currently can read small print in newspapers, chest is not stuffy. Diet increased, coating and pulse both improved. Remove Fu Ling (Poria), Hua Shi (Talcum), Shu Jun (Prepared Rheum), Shan Zha (Crataegi Fructus) from original formula, prescribe another 5 doses, and completely recover health.
(Organized by Zhang Xiaoping: Selected Medical Cases of Chen Cuiwu, *Jiangsu Journal of Traditional Chinese Medicine* 5:29, 1965)
Case 2 Patient Shen XX, female, 23 years old. First Visit Date: February 22, 1960. Both eyes suddenly unable to see, for nearly ten days. Previously examined by Western medicine, stated as Acute Retrobulbar Optic Neuritis; this belongs to Bao Mang (Sudden Blindness), symptoms appear critical. Young and physically strong, yet pulse is deficient and soft, physique not solid. Syndrome Differentiation: Yin deficiency, Water fails to nurture Wood, Essence and Qi cannot reach upwards, optic nerve system loses nourishment. Treatment Method: Benefit Yin and fill Essence, treat Liver and Kidney together. Prescription: Sheng Di (Rehmanniae Radix), Shan Yao (Dioscoreae Rhizoma), Fu Ling (Poria), Ze Xie (Alismatis Rhizoma), Yu Rou (Corni Fructus), Dan Pi (Moutan Cortex), Qi Zi (Lycii Fructus), Ju Hua (Chrysanthemi Flos), Dang Gui (Angelicae Sinensis Radix), Mai Dong (Ophiopogonis Tuber). 5 doses. Second Visit: Previously given Liver-Kidney tonifying agents, eye disease did not heal, and feels lateral head pain, eyeball also painful. Reported illness arose from depression and emotional frustration, thus depression injures Liver, Wood fails to flow freely: Qi and Blood rebel and Yuan Fu (Primary Gates) close, so Spirit Qi has no way in or out, brilliance cannot emit. Treatment should prioritize soothing Liver and resolving depression. Sheng Bai Shao (Raw White Peony Root), Fu Ling (Poria), Quan Dang Gui (Whole Angelicae Sinensis Radix), Chai Hu (Bupleuri Radix), Chao Bai Zhu (Stir-fried Atractylodis Macrocephalae Rhizoma), Bo He (Menthae Haplocalycis Herba), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma), Bai Zhi (Angelicae Dahuricae Radix), Man Jing Zi (Vittadiniae Fructus). 5 doses, then take another 5 doses. Fourth Visit: Headache healed, eye disease improved, vision restored, but feels insufficient, root cause remains. Continue previous method. Sheng Bai Shao (Raw White Peony Root), Fu Ling (Poria), Quan Dang Gui (Whole Angelicae Sinensis Radix), Chai Hu (Bupleuri Radix), Chao Bai Zhu (Stir-fried Atractylodis Macrocephalae Rhizoma), Zhi Gan Cao (Prepared Glycyrrhizae Radix et Rhizoma), Sheng Di (Rehmanniae Radix), Qi Zi (Lycii Fructus). 5 doses, then take another 5 doses. Sixth Visit: After treatment, vision restored, examination shows visual acuity 1.0 in both eyes, disease cured. But to prevent recurrence, only by clearing heart and reducing desires, sparing eyesight, eliminating all distracting thoughts, can safety be ensured. Qi Ju Di Huang Wan (Lycium and Chrysanthemum Rehmannia Pill).
(Organized by Yao Fangwei et al.: Academic Experience of Ophthalmologist Yao Heqing, *Shanghai Journal of Traditional Chinese Medicine* 3:1, 1964)
Case 3 Patient Wen XX, female, 12 years old, Outpatient No.: 70309, First Visit Date: April 24, 1959. Sharp decline in vision in both eyes, accompanied by eyeball distending pain for over half a month. Initially, after cold and fever, vision in both eyes blurred, eyeball distending pain. On the 11th, vision in both eyes dropped sharply, only light perception remained. On the 12th, light perception disappeared in both eyes. On the 14th, hospitalized at XX Hospital and confirmed as Acute Papillitis. Treatment effect not obvious, transferred to our hospital. Currently still headache and eye distension. Examination: Visual acuity in both eyes counting fingers. Pupils slightly large; light reaction sluggish. Fundus shows optic disc hyperemia and redness, margins unclear, papilla edema elevated about 2 diopters; surrounding retina has radial edema, nasal-superior and temporal sides have streak hemorrhages; retinal veins dilated, arteries no obvious change, macula and peripheral area range found no abnormality. Pulse wiry, tongue red with thin white coating. Syndrome Differentiation: Depressed Heat in Liver Channel, external Wind pathogen invading, Xuan Fu (Mysterious Gates) stagnant. (Diagnosed as Bilateral Bao Mang [Sudden Blindness]). Treatment Method: Soothe Liver and resolve depression, invigorate Blood and break stasis as primary, supplement with calming Liver and brightening eyes. Prescription: Dan Zhi Xiao Yao San (Moutan and Gardenia Free Wanderer Powder) plus Chong Wei Zi (Leonuri Fructus) 6g, Shi Jue Ming (Concha Arcae) 12g, Wu Wei Zi (Schisandrae Chinensis Fructus) 2g, 7 doses, decocted in water. May 4
(Second Visit): After medicine, vision improved, eye distension disappeared, only mouth and eyes feel dry. Examination: Visual acuity in both eyes 0.2, near vision Jaeger chart 7+1. Pulse fine and slightly rapid, tongue slightly red, scant coating. Syndrome belongs to Heat disease injuring Yin, Liver and Kidney Yin deficiency. Treatment suitable for nourishing Liver and Kidney and brightening eyes. Prescription: Qi Ju Di Huang Tang (Lycium and Chrysanthemum Rehmannia Decoction) modified. Qi Zi (Lycii Fructus) 6g, Ju Hua (Chrysanthemi Flos) 3g, Shu Di (Prepared Rehmanniae Radix) 10g, Shan Yao (Dioscoreae Rhizoma) 6g, Dan Pi (Moutan Cortex) 2g, Fu Ling (Poria) 6g, Ze Xie (Alismatis Rhizoma) 6g, Wu Wei Zi (Schisandrae Chinensis Fructus) 5g, Sang Ye (Mori Folium) 3g, Qing Xin Zi (Celosiae Semen) 10g. 7 doses, decocted in water. May 11
(Third Visit): After eye medicine, vision improved significantly, no obvious discomfort in whole body. Examination: Visual acuity in both eyes 0.6+2, near vision Nage table 4+1. Original formula remove Qing Xin Zi (Celosiae Semen), add Nu Zhen Zi (Ligustri Lucidi Fructus) 10g, increase Shu Di (Prepared Rehmanniae Radix) to 15g, to assist effect of nourishing Yin and benefiting Kidney. 14 doses, decocted in water. May 25
(Final Visit): Vision already normal, sometimes vision blurred. Examination: Visual acuity in both eyes 1.2, near vision Jaeger chart 1. Both pupils size and reaction normal, field not checked. Fundus shows optic disc pale, margins slightly blurred, edema subsided, hemorrhage absorbed, arteriovenous ratio roughly normal, foveal reflex visible, periphery normal. Still using nourishing Liver and Kidney as treatment principle. Qi Ju Di Huang Tang (Lycium and Chrysanthemum Rehmannia Decoction) 7 doses, consolidate efficacy, stop treatment. (From "Selected Clinical Experience of Ophthalmologist Wei Wengui")
[Commentary] Bao Mang (Sudden Blindness) refers to sharp decline in vision even to blindness; those with gradual decline in vision even to blindness belong to "Qing Mang" (Green Cataract/Glaucoma-like blindness). Acute retrobulbar optic neuritis belongs to the category of Bao Mang (Sudden Blindness). Case 1 syndrome belongs to Wind-Fire of Liver Channel, Damp-Turbidity of Spleen Channel. Clearing Fire, dispelling Wind, and guiding Dampness should be the correct treatment. Danxi said: "Excess Qi becomes Fire." In the formula, Chai Hu (Bupleuri Radix) and Dang Gui (Angelicae Sinensis Radix) intend to soothe Liver, but actually can clear Fire; Shu Jun (Prepared Rheum Radix et Rhizoma) and Shan Zha (Crataegi Fructus) take advantage of descending through and reaching up, clearing lower and withdrawing upper to achieve the merit of "treating upper disease by lowering". Case 2 initial diagnosis syndrome was Yin deficiency, Water fails to nurture Wood, Essence and Qi cannot reach upwards causing Bao Mang (Sudden Blindness). Treatment used benefit Yin and fill Essence method, formula used Qi Ju Di Huang (Lycium and Chrysanthemum Rehmannia) type but ineffective. Later further examining syndrome seeking cause, realized illness arose from emotional frustration, Qi and Blood chaotic and Xuan Fu (Mysterious Gates) closed. Changed to soothing Liver and resolving depression method, thus using Xiao Yao (Free Wanderer) type achieved miraculous results. Case 3 diagnosed as Papillitis. Syndrome belongs to Liver Channel Depressed Heat, external Wind pathogen invading, Xuan Fu (Mysterious Gates) stagnant causing bilateral Bao Mang (Sudden Blindness). *Shen Shi Yao Han* uses Dan Zhi Xiao Yao San (Moutan and Gardenia Free Wanderer Powder) to treat Bao Mang (Sudden Blindness) caused by "Anger injuring Liver, and Spleen deficiency Blood less, leading to darkness and unclear vision". This case additionally adds Chong Wei Zi (Leonuri Fructus), Shi Jue Ming (Concha Arcae), Wu Wei Zi (Schisandrae Chinensis Fructus) to assist power of invigorating Blood and breaking stasis, calming Liver, nourishing Yin and brightening eyes. After taking medicine, vision improved, but mouth and eyes dry, showing Liver and Kidney Yin deficiency syndrome. Thus changed to Qi Ju Di Huang (Lycium and Chrysanthemum Rehmannia) to nourish Liver and Kidney and conclude success. Truly an example of learning from ancients without being bound by them.
(VI) Qing Feng Nei Zhang (Green Wind Internal Obstruction) Patient Yuan XX, female, 25 years old, Outpatient No. 869118, First Visit Date: February 26, 1964. Right eye, two and a half years ago due to distending pain, examined and diagnosed as Glaucoma, underwent surgery, post-op intraocular pressure stable. Recent half year intraocular pressure fluctuated again, accompanied by halos, headache, eye distension, nausea, aggravated after fatigue, visual field also changed. Left eye also has similar symptoms, halos obvious. Examined at XX Hospital, confirmed as Chronic Simple Glaucoma. Currently using 1% Pilocarpine eye drops, right eye 6 times a day, left eye 2 times a day. At night both use 2% Pilocarpine ointment applied to eyes. Recently occasional migraine, irritable temperament, usually dry stool, once every 4-5 days, menstrual volume large, about once every 40 days. Examination: Right eye visual acuity 0.3 (corrected 0.8-2), near vision Jaeger chart 1. Right eye no bleb, iris root defect at 11-12 o'clock, both eyes pupils drug-induced miosis. Right IOP 7.5/3 = 35.76 mmHg, Left IOP 7.5/5 = 25.81 mmHg. Right optic disc pathological cupping enlarged, others normal, left fundus roughly normal. Left eye nasal field narrowed 25-30 degrees, temporal at 60 degrees. Pulse wiry and fine, tongue color slightly red, coating thin with yellow. Syndrome Differentiation: Yin deficiency Liver hyperactivity, external Wind carrying internal Wind attacking empty orifices, developing into bilateral Qing Feng Nei Zhang (Green Wind Internal Obstruction). Treatment Method: Nourish Yin and calm Liver, dispel Wind and relieve pain. Prescription: Empirical Formula Glaucoma Formula Three. Shi Jue Ming (Concha Arcae) 24g, Bai Ji Li (Tribuli Fructus) 10g, Jue Ming Zi (Cassiae Semen) 15g, Fang Feng (Saposhnikoviae Radix) 6g, Qiang Huo (Notopterygii Rhizoma et Radix) 6g, Chan Tui (Periostracum Cicadae) 6g, Meng Hua (Glochidionis Flos) 6g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 10g, Bai Zhi (Angelicae Dahuricae Radix) 6g, Xi Xin (Asari Radix et Rhizoma) 3g, Sheng Di (Rehmanniae Radix) 20g, Shi Hu Ye Guang Wan (Dendrobium Night-Glory Pill), 1 pill daily. March 23
(Second Visit): After medicine, eye distension and headache reduced, halos basically disappeared. Last night after watching movie halos appeared again, poor appetite for two days, restless sleep at night, pulse fine and wiry, coating thin. Examination: Right IOP 5.5/3.5 = 22.38 mmHg, Left 5.5/4.5 = 18.86 mmHg. Add Chao Gu Ya (Stir-fried Coix Seed Sprout) 25g, Che Qian Zi (Plantaginis Semen) 10g (wrapped) to original formula. Shi Hu Ye Guang Wan (Dendrobium Night-Glory Pill), 1 pill daily. Right eye drop Pilocarpine eye drops 4 times daily, left eye drop twice daily, do not apply Pilocarpine ointment at night. June 5
(Third Visit): After taking above medicine 30 doses more, self-feels eye distension reduced, halos occasionally appear, sometimes head heavy, stomach appetite improved, pulse wiry and fine, tongue slightly red. Syndrome belongs to Wind pathogen not exhausted, Liver Yin insufficient. Treatment suitable for dispelling Wind and relieving pain, nourishing Yin and calming Liver. Prescription: Glaucoma Formula Three modified. Sheng Di (Rehmanniae Radix) 22g, Bai Zhu (Atractylodis Macrocephalae Rhizoma) 6g, Bai Zhi (Angelicae Dahuricae Radix) 6g, Fang Feng (Saposhnikoviae Radix) 6g, Bai Ji Li (Tribuli Fructus) 10g, Chan Yi (Periostracum Cicadae) 3g, Meng Hua (Glochidionis Flos) 10g, Qiang Huo (Notopterygii Rhizoma et Radix) and Du Huo (Angelicae Pubescentis Radix) each 5g, Jue Ming Zi (Cassiae Semen) 12g, Sheng Shi Jue Ming (Concha Arcae Præparata) 25g (decocted first), Xi Xin (Asari Radix et Rhizoma) 3g, Huang Qin (Scutellariae Radix) 6g, Che Qian Zi (Plantaginis Semen) 12g (wrapped), Du Zhong (Eucommiae Cortex) 10g, Dan Pi (Moutan Cortex) 12g. One dose every other day, Ming Mu Di Huang Wan (Brighten Eyes Rehmannia Pill) one pill morning and evening, alternating with decoction. July 17
(Fourth Visit): After 20 doses of above medicine, vision increased, IOP also dropped, headache and eye distension disappeared, halos also disappeared, Pilocarpine eye drops stopped, appetite okay, bowel and bladder smooth, pulse fine, tongue slightly red, coating thin. Examination: Right corrected visual acuity 1.0, near vision Jaeger chart 1; Left corrected visual acuity 1.2, near vision Jaeger chart 1. Both eyes IOP 5.5/5 = 17.30 mmHg, IOP already normal, stop medication observe. (From "Selected Clinical Experience of Ophthalmologist Wei Wengui")
[Commentary] Qing Feng Nei Zhang (Green Wind Internal Obstruction) corresponds to Glaucoma. Mostly caused by Wind, Fire, Phlegm, Dampness, combined with Liver-Kidney Yin deficiency or Spleen deficiency Qi weakness. This
case syndrome belongs to Yin deficiency Liver hyperactivity, external Wind carrying internal Wind attacking empty orifices. Using Wei's empirical formula - Glaucoma Formula Three effect is quite satisfactory. It is said this formula for Chronic Simple Glaucoma, occurring intermittently, IOP between 25-35 mmHg, has good efficacy.
(VII) Zao Hua Yi Nei Zhang (Date Flower Opacity Internal Obstruction) Patient Cheng XX, female, 67 years old. Outpatient No.: 69390, First Visit Date: March 4, 1964. Patient black shadow in front of right eye for two years, black shadow in front of left eye for one year. Two years ago black shadow appeared in right eye, left eye one year ago also appeared black shadow, and heavier than right eye. Previously diagnosed at XX Hospital as Senile Cataract, treatment ineffective. Usually sleep uneasy, tinnitus, dry stool. Examination: Visual acuity in both eyes 0.5, near vision Jaeger chart 4. Bilateral lens cortex wedge-shaped opacity. Bilateral refractive media unclear, visible optic disc color and vessels, macula roughly normal. Pulse wiry and fine, tongue pale red. Syndrome Differentiation: Liver and Kidney Yin deficiency. (Diagnosed as Bilateral Zao Hua Yi Zhang [Date Flower Opacity]). Treatment Method: Nourish Liver and Kidney. Prescription: Qi Ju Di Huang Tang (Lycium and Chrysanthemum Rehmannia Decoction) plus Sang Ye (Mori Folium) 16g, Hei Zhi Ma (Sesami Fructus Niger) 15g, one dose daily or every other day. 30 doses. April 22