头眩目花。身转耳聋。如立舟车之上。起则欲倒。此虚极乘寒也。或七情郁而生痰动火
。随
气上厥。此七情致虚也。酒色过度。肾虚不能纳气归元。使气逆奔而上。此气虚也。吐衄崩
后。或产后失血。脾虚不能收摄营气。使诸血失道妄行。此血虚眩晕也。
一有每遇风寒。即发眩晕不省。冷汗时流者。名曰郁冒。亦名血厥。妇人多有之。宜白
薇汤。
白薇 当归(各一两) 人参 甘草(各一钱)分为五服水煎
止眩汤 治头眩疼。恐畏胸满。
茯神(一钱) 远志 防风 细辛 白术 前胡 人参 桂心 熟地 甘菊(各七分) 枳
壳(五分)
清阳汤 治目眩梦斗。恐惧色变。此属胆虚。
防风(一钱) 人参(七分) 细辛 川芎 甘草 茯苓 独活 前胡(各五分)
张子和曰。圣人虽言目得血而能视。然血亦有太过不及也。太过则目壅塞而发痛。不及
。则
目耗竭而失明故少年之人多太过。年老之人多不及。但年老之人间有太过者。不可不察也。
夫目之内 。足太阳经所起。血多气少。目之锐 。足少阳经。血少气多。目之上纲。手太
阳经。亦血多气少。目之下纲。足阳明经。血气俱多然阳明经起于目两旁交额之中。与太阳
少阳俱会于目惟足厥阴经连于目系而已。故血太过者太阳阳明之实也。血不及者。厥阴之虚
也。刺太阳阳明出血则愈明。刺少阳出血则愈昏。要知无使太过不及。以血养目而已。凡血
太多则溢。太少则枯。人热则血行疾而多。寒则血行迟而少。此常理也目者。肝之外候也肝
主血。在五行属木。木之为物。太茂则蔽密。太衰则枯瘁矣。夫目五轮。乃五脏六腑之精华
。宗脉之所聚。其白睛属肺曰气轮。两胞属脾曰肉轮。两 属心曰血输。瞳神属肾曰水轮。
乌珠属肝曰风轮。气轮病赤。火乘肺也。肉轮赤肿。火乘脾也。黑水(即瞳神)神光(即乌珠)
被翳。火乘肝与肾也。赤脉贯目涩痛。心火甚也。凡目暴赤肿痛。羞明隐涩。泪出不止。暴
寒目瞒。皆大热之所为也。(此言目病皆因火邪。然有阴虚冷泪昏眇脱阳等症)外障者。乃睛
外为云翳所遮。多由赤痛而成或为攀睛。或为 肉。治以宽中开郁。顺气清痰。滋阴降火。
补肾疏风为主。外视其翳色从何经来而刺之。盖目之为病。肝热则昏暗。心热则烦痛。风湿
则痒。血少则涩。肾虚则睛损。甚则陷突。微则翳膜矣。
内障之病。无眵泪痛痒羞明。紧涩之症。但有如薄纱笼者。有如雾露中者。有如见黑花
者。
有如见飞蝇者。有如见悬珠者。然其二目光明同于无病者。最难分别。惟目珠不动。微可辨
耳。徐彦纯曰。内障乃瞳神黑小。神光昏昧也。纲目谓。其有翳在黑睛内遮瞳子。龙木论曰
。有脑脂流下作翳。有肝风冲上作翳。(此足太阳厥阴之邪)刺天柱风府通里太冲等穴。又有
用金针于黑眼内拨去云翳。能使顷刻复明。夫目属肝。肝主怒。怒则火动生痰。痰火阻隔肝
胆脉道。则通光之窍遂蔽。是以二目昏朦如烟如雾。目既昏花。逾生郁闷。故云久病生郁。
久郁生病。不达此理者。惟以补肝肾药投之。其肝胆脉道之邪气。逾甚逾蔽。致目日昏。必
究其肝肾果无邪而虚。则以补剂投之。倘正气虚而邪气有余。先驱其邪气。而后补其正气。
斯无助邪害正之弊。(无论内症外疡目疾善类先要以内科恚中揣摩盖此涉猎在陷症时以免胸
中无把握)眼之为病。在府为表。当除风散热在脏为里。当养血安神暴发者为表易治。久病
者
为里难疗。如男子先伤左目。而右目屡发定不可保女先伤右目而左目屡发亦不能救。必须
观人老少壮弱为主。先将难易预定。如瞳神凸凹者不治。青绿白色者不治。纯黑者不治。睛
少光彩者不治。此老人及血衰之症。若翳障如半月之状亦难治之。若睛圆不损。不论星多少
。翳浓薄。皆可治之。翳怕光滑。星怕在瞳神。总宜翳障轻薄。星点细小。若遇翳障未尽。
不可用刀割。盖目得血而能视。刀割则伤血翳膜。生自肝火。不可以火灸。惟服药于先。兼
用点药。则病渐退而不复发也。
凡眼上午不疼下午大痛。是虚热也。上午大痛。下午不疼是实热也。眼泪多者是虚热。
少者是实热也。
眼有翳膜渐渐遮睛不痛不疼。冷也有疼痛者。热也。
眼内膜翳。带白色。冷也。眼膜带红色者。热也。
眼淡白红者是虚热也。
头目眩晕，视物模糊。身体旋转感，耳鸣耳聋。感觉如同站在行驶的车船之上。起身时想要跌倒。这是极度虚弱又受寒邪侵袭所致。或者是由于七情（喜、怒、忧、思、悲、恐、惊）郁结而生痰，引动火气，随着气机上逆冲犯头部。这是七情导致正气亏虚。饮酒和房事过度，导致肾气虚弱，不能纳气归元，使气机逆乱奔涌而上。这是气虚。呕吐或鼻出血，以及崩漏之后，或者产后失血过多，脾气虚弱不能收摄营气，使血液失去常道妄行。这是血虚引起的眩晕。
有一种情况是每当遇到风寒，就发作眩晕甚至昏迷不省人事，冷汗时时流出。这种病症名叫“郁冒”，也叫做“血厥”。妇女中多见。适宜使用白薇汤。
白薇 当归（各一两） 人参 甘草（各一钱），分为五服，水煎服。
止眩汤：治疗头目眩晕疼痛，心中恐惧畏惧，胸中满闷。
茯神（一钱） 远志 防风 细辛 白术 前胡 人参 桂心 熟地黄 甘菊花（各七分） 枳壳（五分）。
清阳汤：治疗目眩，梦中争斗惊恐，面色改变。这属于胆气虚弱。
防风（一钱） 人参（七分） 细辛 川芎 甘草 茯苓 独活 前胡（各五分）。
张子和说：圣人虽然说过眼睛得到血的滋养才能看见，但是血也有太过和不及的情况。血太过则眼部壅塞而引发疼痛。血不及，则眼部耗竭而导致失明。所以年轻人多表现为血太过，老年人多表现为血不及。只是老年人群中偶尔也有血太过的情况，不可不仔细辨别。
眼的内眦（眼角内侧），是足太阳膀胱经起始的地方，这里血多气少。眼的外眦（眼角外侧），是足少阳胆经经过的地方，这里血少气多。眼的上眼睑，由手太阳小肠经主管，也是血多气少。眼的下眼睑，由足阳明胃经主管，这里气血都多。然而阳明经起于眼睛两旁，交会于额部中间，与太阳经、少阳经都在眼部会合。只有足厥阴肝经直接连接着眼系（眼球连系脑部的脉络）。所以血太过的病证，是太阳经和阳明经的实证；血不及的病证，是厥阴经的虚证。针刺太阳经和阳明经放出少量血液，视力就会明亮；如果针刺少阳经放出血液，视力反而会昏花。要知道不要使血太过或不及，只要用血来滋养眼睛就可以了。凡是血太多就会溢出，太少就会干枯。人受热则血行速度快且多，受寒则血行速度慢且少。这是常理。
眼睛是肝脏的外在表现。肝主藏血，在五行中属木。木这种植物，生长过于茂盛就会遮蔽严密，过于衰败就会干枯憔悴。
眼睛的五轮，分别是五脏六腑精华所在，也是宗脉汇聚之处。白睛（眼白）属于肺，称为气轮；两胞睑（眼皮）属于脾，称为肉轮；两眦（内外眼角）属于心，称为血输（注：原文此处可能有误或特指，通常血轮指两眦，但原文写“两...属心”，结合上下文及中医理论，此处应指两眦或血轮相关部位，依原文直译）；瞳神（瞳孔）属于肾，称为水轮；乌珠（黑眼球/虹膜部分）属于肝，称为风轮。气轮发病发红，是火邪乘袭肺脏。肉轮发红肿胀，是火邪乘袭脾脏。黑水（即瞳神）和神光（即乌珠/眼神）被翳膜遮挡，是火邪乘袭肝和肾。赤色血脉贯穿眼睛，伴有涩痛，是心火极盛。凡是眼睛突然红肿疼痛，怕光隐涩，流泪不止，突然受寒导致视线模糊，都是大热邪气造成的。（这里说的是眼病大多因火邪引起，但也有阴虚冷泪、昏花、脱阳等症状）。
外障眼病，是指眼球外部被云翳遮挡，多由红痛发展而成，或者形成胬肉攀睛，或者生成息肉。治疗以宽中开郁、顺气清痰、滋阴降火、补肾疏风为主。观察外部翳膜的色泽是从哪条经络传来的，然后进行针刺。大概来说，眼睛患病，肝热则视物昏暗，心热则烦躁疼痛，风湿则瘙痒，血少则干涩，肾虚则眼球受损，严重的会出现眼球凹陷或突出，轻微的则形成翳膜。
内障眼病，没有眼屎、眼泪、疼痛、瘙痒、怕光、紧涩等症状，只觉得眼前像笼罩着薄纱，像处在雾露之中，像看到黑花飞舞，像看到飞蝇，像看到悬挂的珠子。然而双眼目光依然明亮，如同无病之人，最难分辨。只有观察眼珠转动是否灵活，稍微可以辨别。徐彦纯说：内障就是瞳神变小，神光昏昧。《纲目》说，有翳在黑睛内部遮挡瞳孔。《龙木论》说，有脑脂流下形成翳，有肝风冲上形成翳。（这是足太阳经和足厥阴经的邪气）。可以针刺天柱、风府、通里、太冲等穴位。又有使用金针在黑眼球内拨去云翳的方法，能使顷刻间恢复光明。
眼睛属于肝，肝主怒。发怒则火动生痰，痰火阻隔肝胆经脉通道，使得通光的窍穴闭塞。因此双眼昏朦如烟如雾。眼睛既然昏花，更加产生郁闷情绪。所以说久病生郁，久郁生病。不明白这个道理的人，只用补肝肾的药物投治，这样肝胆经脉中的邪气会更加严重和闭塞，导致眼睛日益昏花。必须探究肝肾究竟是否有邪气还是真正虚损。如果是真正的虚损，才使用补剂。如果是正气虚弱而邪气有余，先驱除邪气，然后再补益正气。这样就没有助长邪气伤害正气的弊端。（无论内症还是外疡，治疗眼疾的高手首先要在内科辨证中揣摩，因为涉及陷症时要避免心中没把握）。
眼睛的疾病，在腑为表证，应当祛风散热；在脏为里证，应当养血安神。突然发作的是表证，容易治疗；久病的是里证，难以治愈。比如男子先损伤左眼，右眼屡次复发，一定无法保全；女子先伤右眼，左眼屡次复发，也不能挽救。必须以观察人的老少强弱为主，先将治疗的难易预先判定。比如瞳神凸凹不平的不治，呈现青绿白色的不治，纯黑色的不治，眼球缺少光彩的不治。这是老人及血衰的症状。如果翳障形状像半月一样，也难治疗。如果眼球圆润未受损，不论星点多少，翳膜浓薄，都可以治疗。翳膜怕光滑，星点怕长在瞳神上。总体宜于翳障轻薄，星点细小。如果遇到翳障未尽，不可用刀割。因为眼睛得血才能视物，刀割会伤血和翳膜。翳膜生于肝火，不可以用火灸。只能先服药，兼用点眼药，则病渐退而不复发。
凡是眼睛上午不疼下午大痛，是虚热。上午大痛下午不疼，是实热。眼泪多的是虚热，少的是实热。
眼睛有翳膜渐渐遮挡瞳孔，不痛不痒，感觉冷的是寒证，有疼痛的是热证。
眼内膜带白色，是寒证。眼膜带红色，是热证。
眼睛淡白偏红，是虚热证。
Dizziness and blurred vision. A sensation of body rotation, tinnitus, and deafness. Feeling as if standing on a moving boat or carriage. Desire to fall when rising. This is caused by extreme deficiency combined with cold pathogen invasion. Alternatively, it may arise from the stagnation of the Seven Emotions (Joy, Anger, Worry, Thought, Sorrow, Fear, Fright) generating phlegm and stirring fire, which ascends with Qi to rebel upwards. This is deficiency induced by emotional factors. Excessive indulgence in alcohol and sexual activity leads to Kidney Qi deficiency, failing to grasp Qi and return it to its source, causing Qi to rebel and surge upward. This is Qi deficiency. After vomiting or epistaxis, metrorrhagia, or postpartum blood loss, Spleen deficiency fails to control Ying Qi, causing blood to wander recklessly outside its vessels. This is vertigo due to Blood deficiency.
In one type, dizziness and unconsciousness occur upon exposure to wind-cold, accompanied by profuse cold sweat. This condition is named "Yu Mao" (Depression and Daze), also known as "Xue Jue" (Blood Syncope). It is common in women. Baiwei Tang (Baiwei Decoction) is appropriate.
Baiwei (Radix Wittemanniae), Danggui (Radix Angelicae Sinensis) (each 1 liang); Renshen (Radix Ginseng), Gancao (Radix Glycyrrhizae) (each 1 qian). Divide into five doses, decoct in water.
Zhixuan Tang (Zhi Xuan Decoction): Treats dizziness and headache, fearfulness, and chest fullness.
Fushen (Poria Cum Radix Pini) (1 qian), Yuanzhi (Radix Polygalae), Fangfeng (Radix Saposhnikoviae), Xixin (Rhizoma Asari), Baizhu (Rhizoma Atractylodis Macrocephalae), Qianhu (Radix Peucedani), Renshen (Radix Ginseng), Guixin (Cortex Cinnamomi), Shudi (Radix Rehmanniae Preparata), Ganju (Flos Chrysanthemi Indici) (each 7 fen), Zhike (Fructus Aurantii) (5 fen).
Qingyang Tang (Qing Yang Decoction): Treats visual dizziness, fighting in dreams, fear, and facial color changes. This belongs to Gallbladder deficiency.
Fangfeng (Radix Saposhnikoviae) (1 qian), Renshen (Radix Ginseng) (7 fen), Xixin (Rhizoma Asari), Chuanxiong (Rhizoma Chuanxiong), Gancao (Radix Glycyrrhizae), Fuling (Poria), Duhuo (Radix Angelicae Pubescentis), Qianhu (Radix Peucedani) (each 5 fen).
Zihezi stated: Although sages say that the eyes can see only when nourished by blood, blood can also be in excess or insufficient. Excess causes ocular congestion and pain. Insufficiency leads to ocular exhaustion and blindness. Therefore, young people often have excess, while old people often have insufficiency. However, occasional cases of excess in the elderly must not be overlooked.
The inner canthus is the starting point of the Foot-Taiyang Bladder Meridian, where there is abundant blood and scarce Qi. The outer canthus is traversed by the Foot-Shaoyang Gallbladder Meridian, where there is scarce blood and abundant Qi. The upper eyelid is governed by the Hand-Taiyang Small Intestine Meridian, also having abundant blood and scarce Qi. The lower eyelid is governed by the Foot-Yangming Stomach Meridian, where both blood and Qi are abundant. However, the Yangming Meridian originates at the sides of the eyes and meets at the middle of the forehead, converging with the Taiyang and Shaoyang meridians at the eyes. Only the Foot-Jueyin Liver Meridian connects directly to the eye system (ocular connection to the brain). Thus, conditions of blood excess are excess patterns of the Taiyang and Yangming meridians; conditions of blood insufficiency are deficiency patterns of the Jueyin meridian. Pricking the Taiyang and Yangming meridians to bleed cures the condition and brightens vision. Pricking the Shaoyang meridian to bleed worsens vision. One must know not to allow excess or insufficiency, but simply to nourish the eyes with blood. When blood is too much, it overflows; when too little, it dries up. Heat accelerates blood flow and increases volume; cold slows it down and decreases volume. This is the general principle.
The eyes are the external manifestation of the Liver. The Liver governs blood storage and corresponds to Wood in the Five Elements. Wood, as a plant, becomes dense and obscuring when overly lush, and withers when excessively depleted.
The Five Wheels of the eye represent the essence of the Zang-Fu organs and the gathering point of the Zong Mai (Gathering Vessels). The white sclera belongs to the Lung and is called the Qi Wheel. The eyelids belong to the Spleen and are called the Flesh Wheel. The canthi belong to the Heart and are called the Blood Outlet. The pupil belongs to the Kidney and is called the Water Wheel. The iris/black part belongs to the Liver and is called the Wind Wheel. Redness of the Qi Wheel indicates Fire attacking the Lung. Redness and swelling of the Flesh Wheel indicate Fire attacking the Spleen. Opacity covering the Black Water (pupil) and Shen Guang (spirit light/iris) indicates Fire attacking the Liver and Kidney. Red vessels penetrating the eye with dryness and pain indicate excessive Heart Fire. Sudden redness, swelling, and pain of the eyes, photophobia, grittiness, and continuous tearing are all caused by severe Heat pathogens. (This states that eye diseases are mostly due to Fire pathogens, but there are also conditions like Yin deficiency with cold tears, dimness, and Yang collapse).
Exterior obstructions refer to cloudiness blocking the exterior of the eyeball, often resulting from redness and pain, or forming pterygium (fleshy growth climbing onto the cornea) or polyps. Treatment focuses on relaxing the middle and opening depression, regulating Qi and clearing phlegm, nourishing Yin and descending Fire, tonifying the Kidney, and dispersing Wind. Observe the color of the external opacity to determine the affected meridian and prick accordingly. Generally, Liver heat causes dim vision; Heart heat causes irritability and pain; Wind-Dampness causes itching; Blood deficiency causes dryness; Kidney deficiency damages the eyeball, leading to protrusion or retraction in severe cases, or membrane formation in mild cases.
Interior obstructions lack discharge, tearing, pain, itching, photophobia, or tightness. Patients perceive vision as if covered by thin gauze, immersed in fog or dew, seeing black spots, seeing flying flies, or seeing suspended pearls. Yet the gaze remains bright, similar to a healthy person, making differentiation difficult. Only by observing slight immobility of the eyeball can it be distinguished. Xu Yanchun said: Interior obstruction involves a small pupil and dim spirit light. *Bencao Gangmu* states there are opacities inside the black cornea blocking the pupil. *Longmu Lun* states that brain fluid flowing down creates opacities, and Liver wind rushing up creates opacities. (These are pathogens of the Foot-Taiyang and Foot-Jueyin meridians). Acupoints such as Tianzhu, Fengfu, Tongli, and Taichong can be pricked. Another method uses a gold needle to push aside the opacity within the black eye, restoring sight instantly.
The eyes belong to the Liver, and the Liver governs anger. Anger stirs Fire and generates Phlegm. Phlegm-Fire blocks the channels of the Liver and Gallbladder, obstructing the apertures for light transmission. Thus, both eyes become hazy like smoke or fog. Since the eyes are dim, depression arises. Hence, chronic illness generates depression, and chronic depression generates illness. Those who do not understand this principle merely administer herbs to tonify the Liver and Kidney. This exacerbates the pathogenic qi in the Liver and Gallbladder channels, further obstructing them and worsening vision daily. One must investigate whether the Liver and Kidney truly have pathogenic qi or are genuinely deficient. If truly deficient, administer tonics. If Zheng Qi (Upright Qi) is deficient but Pathogenic Qi is excessive, first expel the pathogen, then tonify the upright Qi. This avoids the drawback of aiding the pathogen and harming the upright Qi. (Regardless of internal or external lesions, experts in eye diseases first deliberate using Internal Medicine principles, especially when dealing with complex cases, to avoid uncertainty).
Eye diseases in the Fu organs are Exterior patterns, requiring dispersion of Wind and clearance of Heat. Eye diseases in the Zang organs are Interior patterns, requiring nourishment of Blood and calming of the Spirit. Sudden onset indicates an Exterior pattern, which is easy to treat. Chronic illness indicates an Interior pattern, which is difficult to treat. For example, if a man injures his left eye first and the right eye repeatedly recurs, it cannot be saved. If a woman injures her right eye first and the left eye repeatedly recurs, it cannot be saved. One must primarily observe the age and strength of the patient to predetermine the difficulty. Conditions with convex/concave pupils, green/white/red discoloration, pure black pupils, or lackluster eyeballs are untreatable. These are signs of aging and Blood depletion. Opacities shaped like half-moons are also difficult to treat. If the eyeball is round and undamaged, regardless of the number of star-like spots or thickness of the opacity, it is treatable. Smooth opacities are feared; star spots located on the pupil are feared. Generally, thin opacities and fine star spots are favorable. If opacities remain incomplete, knife surgery must not be used. Because the eyes need blood to see, cutting damages blood and membranes. Opacities arising from Liver Fire should not be treated with moxibustion. Medication should be administered first, combined with topical drops, so the disease gradually recedes without recurrence.
If the eye does not hurt in the morning but hurts severely in the afternoon, it is Deficient Heat. If it hurts severely in the morning but not in the afternoon, it is Excess Heat. Profuse tearing indicates Deficient Heat; scant tearing indicates Excess Heat.
If an opacity gradually covers the pupil without pain or itch, and feels cold, it is Cold. If painful, it is Heat.
An interior membrane that is white indicates Cold. An interior membrane that is red indicates Heat.
Eyes that are pale white with redness indicate Deficient Heat.