作者(zhe)：江蘇(su)省東(dong)臺市中醫院眼科 孔(kong)祥蘊(yun)
關于(yu)神(shen)光(guang)(guang)的(de)記載，較早(zao)見(jian)于(yu)《證治準繩》，《審視瑤函》引用并整理。最近出版的(de)《中(zhong)醫眼(yan)科(ke)備讀》一書，對古籍(ji)中(zhong)關于(yu)神(shen)光(guang)(guang)的(de)論說進(jin)行了分折和(he)發揮，其中(zhong)有不少獨到的(de)見(jian)解(jie)和(he)認識。
1.“火之用事”即陽氣升騰
《審(shen)(shen)(shen)視(shi)瑤(yao)函·目(mu)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)至寶論(lun)》載(zai)(zai)：“神(shen)(shen)光(guang)者，謂(wei)目(mu)中(zhong)(zhong)自然(ran)能(neng)視(shi)之(zhi)精(jing)華(hua)也”。由此(ci)(ci)明顯的(de)(de)看出(chu)，神(shen)(shen)光(guang)即指(zhi)(zhi)視(shi)覺(jue)功能(neng)。自《內經(jing)》以來，歷(li)代醫(yi)家對(dui)(dui)視(shi)覺(jue)功能(neng)的(de)(de)認(ren)識，大(da)多(duo)從血(xue)、精(jing)、氣(qi)(qi)(qi)(qi)、神(shen)(shen)四個(ge)方(fang)面論(lun)述，唯《證(zheng)治(zhi)準繩(sheng)》、《審(shen)(shen)(shen)視(shi)瑤(yao)函》等書從“皆(jie)火(huo)(huo)(huo)之(zhi)用(yong)(yong)(yong)事(shi)(shi)”立論(lun)，突出(chu)一個(ge)“火(huo)(huo)(huo)”字(zi)。《審(shen)(shen)(shen)視(shi)瑤(yao)函·目(mu)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)至寶論(lun)》載(zai)(zai)：“夫神(shen)(shen)光(guang)原于(yu)(yu)(yu)命(ming)(ming)門(men)，通于(yu)(yu)(yu)膽(dan)，發(fa)(fa)于(yu)(yu)(yu)心，皆(jie)火(huo)(huo)(huo)之(zhi)用(yong)(yong)(yong)事(shi)(shi)”。《中(zhong)(zhong)醫(yi)眼科備讀》卷一目(mu)論(lun)語摘在(zai)分折(zhe)該(gai)條時指(zhi)(zhi)出(chu)，“皆(jie)火(huo)(huo)(huo)之(zhi)用(yong)(yong)(yong)事(shi)(shi)”是指(zhi)(zhi)神(shen)(shen)光(guang)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)體內陽(yang)(yang)氣(qi)(qi)(qi)(qi)升(sheng)騰(teng)而(er)產(chan)生(sheng)(sheng)。并認(ren)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)，自然(ran)界(jie)中(zhong)(zhong)，火(huo)(huo)(huo)能(neng)生(sheng)(sheng)光(guang)照明，火(huo)(huo)(huo)與(yu)光(guang)互相(xiang)依存，按(an)照天人合(he)一的(de)(de)理論(lun)分折(zhe)，體內陽(yang)(yang)氣(qi)(qi)(qi)(qi)與(yu)神(shen)(shen)光(guang)有(you)著(zhu)密切的(de)(de)關系。《內經(jing)》將火(huo)(huo)(huo)分為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)少(shao)(shao)(shao)火(huo)(huo)(huo)與(yu)壯(zhuang)(zhuang)火(huo)(huo)(huo)，原義為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)藥食氣(qi)(qi)(qi)(qi)味的(de)(de)分類(lei)，后世醫(yi)家，把(ba)少(shao)(shao)(shao)火(huo)(huo)(huo)定(ding)義為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)生(sheng)(sheng)理之(zhi)火(huo)(huo)(huo)，把(ba)壯(zhuang)(zhuang)火(huo)(huo)(huo)定(ding)義為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)病理之(zhi)火(huo)(huo)(huo)，“皆(jie)火(huo)(huo)(huo)之(zhi)用(yong)(yong)(yong)事(shi)(shi)”之(zhi)火(huo)(huo)(huo)即為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)少(shao)(shao)(shao)火(huo)(huo)(huo)。生(sheng)(sheng)理之(zhi)火(huo)(huo)(huo)是人體正(zheng)氣(qi)(qi)(qi)(qi)之(zhi)一，當其(qi)謐藏于(yu)(yu)(yu)臟(zang)腑(fu)之(zhi)內，具有(you)溫煦(xu)生(sheng)(sheng)化作(zuo)(zuo)用(yong)(yong)(yong)時，是為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)陽(yang)(yang)氣(qi)(qi)(qi)(qi)。《審(shen)(shen)(shen)視(shi)瑤(yao)函·能(neng)近怯遠(yuan)癥》載(zai)(zai)：“夫氣(qi)(qi)(qi)(qi)之(zhi)所用(yong)(yong)(yong)謂(wei)之(zhi)火(huo)(huo)(huo)，在(zai)身為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)運用(yong)(yong)(yong)，在(zai)目(mu)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)神(shen)(shen)光(guang)”。所謂(wei)“氣(qi)(qi)(qi)(qi)之(zhi)所用(yong)(yong)(yong)”，即指(zhi)(zhi)陽(yang)(yang)氣(qi)(qi)(qi)(qi)的(de)(de)推動(dong)生(sheng)(sheng)化作(zuo)(zuo)用(yong)(yong)(yong)，能(neng)夠(gou)形(xing)(xing)成行(xing)、握、嗅、聽等機(ji)體的(de)(de)活動(dong)，陽(yang)(yang)氣(qi)(qi)(qi)(qi)升(sheng)騰(teng)于(yu)(yu)(yu)目(mu)則(ze)形(xing)(xing)成視(shi)覺(jue)。陽(yang)(yang)氣(qi)(qi)(qi)(qi)的(de)(de)升(sheng)騰(teng)，有(you)賴于(yu)(yu)(yu)多(duo)個(ge)臟(zang)器的(de)(de)協調(diao)和(he)作(zuo)(zuo)用(yong)(yong)(yong)，其(qi)中(zhong)(zhong)主(zhu)要(yao)(yao)關系到命(ming)(ming)門(men)、心和(he)膽(dan)三(san)者。《中(zhong)(zhong)醫(yi)眼科備讀》對(dui)(dui)此(ci)(ci)作(zuo)(zuo)了(le)較詳的(de)(de)闡(chan)述。命(ming)(ming)門(men)又稱(cheng)命(ming)(ming)門(men)火(huo)(huo)(huo)，即腎中(zhong)(zhong)陽(yang)(yang)氣(qi)(qi)(qi)(qi)，為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)人體陽(yang)(yang)氣(qi)(qi)(qi)(qi)之(zhi)根本，是神(shen)(shen)光(guang)發(fa)(fa)生(sheng)(sheng)的(de)(de)本源；心中(zhong)(zhong)陽(yang)(yang)氣(qi)(qi)(qi)(qi)，稱(cheng)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)君火(huo)(huo)(huo)，是全(quan)身陽(yang)(yang)氣(qi)(qi)(qi)(qi)的(de)(de)重要(yao)(yao)組成部分。心主(zhu)神(shen)(shen)明（精(jing)神(shen)(shen)、意識、思維活動(dong)），在(zai)目(mu)則(ze)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)視(shi)。心之(zhi)神(shen)(shen)，賴陽(yang)(yang)氣(qi)(qi)(qi)(qi)所生(sheng)(sheng)，所以說神(shen)(shen)光(guang)發(fa)(fa)于(yu)(yu)(yu)心；肝膽(dan)相(xiang)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)表里，內寄相(xiang)火(huo)(huo)(huo)，相(xiang)火(huo)(huo)(huo)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)機(ji)體活動(dong)動(dong)力之(zhi)一，為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)君火(huo)(huo)(huo)之(zhi)輔(fu)助。而(er)膽(dan)為(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)(wei)陽(yang)(yang)腑(fu)，主(zhu)少(shao)(shao)(shao)陽(yang)(yang)春生(sheng)(sheng)之(zhi)氣(qi)(qi)(qi)(qi)，能(neng)載(zai)(zai)相(xiang)火(huo)(huo)(huo)循(xun)肝經(jing)上行(xing)于(yu)(yu)(yu)目(mu)，因此(ci)(ci)謂(wei)神(shen)(shen)光(guang)通于(yu)(yu)(yu)膽(dan)。由此(ci)(ci)可見，“皆(jie)火(huo)(huo)(huo)之(zhi)用(yong)(yong)(yong)事(shi)(shi)”之(zhi)火(huo)(huo)(huo)，包括了(le)機(ji)體的(de)(de)“命(ming)(ming)火(huo)(huo)(huo)”、“君火(huo)(huo)(huo)”和(he)“相(xiang)火(huo)(huo)(huo)”三(san)種“少(shao)(shao)(shao)火(huo)(huo)(huo)”，實(shi)質上泛(fan)指(zhi)(zhi)了(le)機(ji)體內陽(yang)(yang)氣(qi)(qi)(qi)(qi)。
2.陽氣升騰必需陰精凝聚
《審視(shi)瑤函·目(mu)為(wei)至寶論(lun)》在(zai)論(lun)述(shu)眼(yan)的(de)(de)(de)(de)生(sheng)理功(gong)(gong)能(neng)(neng)(neng)(neng)時(shi)說：“究(jiu)其源，實陰(yin)陽(yang)(yang)蘊氣之始，二(er)五(wu)(wu)凝(ning)(ning)精(jing)(jing)之際”。《中醫眼(yan)科備讀》按(an)照五(wu)(wu)運主(zhu)五(wu)(wu)時(shi)的(de)(de)(de)(de)順(shun)序，將“二(er)五(wu)(wu)”解釋為(wei)代指火(huo)(huo)、水。視(shi)覺的(de)(de)(de)(de)產生(sheng)，是個復雜的(de)(de)(de)(de)過程，主(zhu)要是由(you)(you)(you)體內火(huo)(huo)（陽(yang)(yang)氣）、水（陰(yin)精(jing)(jing)）兩(liang)種精(jing)(jing)華(hua)物質(zhi)的(de)(de)(de)(de)結聚和(he)相(xiang)互作用(yong)的(de)(de)(de)(de)結果。命火(huo)(huo)、君火(huo)(huo)、相(xiang)火(huo)(huo)相(xiang)互作用(yong)形成神光，同時(shi)需要得到(dao)腎陰(yin)、心陰(yin)、肝陰(yin)的(de)(de)(de)(de)滋養和(he)制(zhi)約，這樣才能(neng)(neng)(neng)(neng)維(wei)護(hu)生(sheng)理上的(de)(de)(de)(de)平衡，保持少火(huo)(huo)的(de)(de)(de)(de)溫(wen)煦之性。《靈樞·大(da)惑(huo)論(lun)》載：“故陰(yin)陽(yang)(yang)合傳而(er)睛明也”。視(shi)覺的(de)(de)(de)(de)產生(sheng)，主(zhu)要是由(you)(you)(you)于(yu)陽(yang)(yang)氣的(de)(de)(de)(de)蒸騰(teng)，但(dan)陽(yang)(yang)氣的(de)(de)(de)(de)蒸騰(teng)必須以(yi)(yi)陰(yin)精(jing)(jing)為(wei)基(ji)礎，眼(yan)之所以(yi)(yi)遠近(jin)發用(yong)，各得其宜，正是由(you)(you)(you)于(yu)陰(yin)陽(yang)(yang)合摶(tuan)的(de)(de)(de)(de)結果。眼(yan)之視(shi)遠功(gong)(gong)能(neng)(neng)(neng)(neng)來(lai)自(zi)陽(yang)(yang)氣的(de)(de)(de)(de)發越，而(er)視(shi)近(jin)功(gong)(gong)能(neng)(neng)(neng)(neng)則(ze)由(you)(you)(you)于(yu)陰(yin)精(jing)(jing)的(de)(de)(de)(de)凝(ning)(ning)靜。陽(yang)(yang)氣發越，有陰(yin)精(jing)(jing)鎮(zhen)守(shou)而(er)不散(san)；陰(yin)精(jing)(jing)凝(ning)(ning)靜，有陽(yang)(yang)氣布散(san)而(er)能(neng)(neng)(neng)(neng)視(shi)。
3.溫陽明目法的運用
神(shen)(shen)(shen)光(guang)(guang)(guang)“皆(jie)(jie)火(huo)之(zhi)(zhi)(zhi)(zhi)(zhi)用事”的(de)(de)(de)(de)理(li)論，為(wei)溫(wen)(wen)陽(yang)(yang)明(ming)(ming)目(mu)法(fa)的(de)(de)(de)(de)應用奠定了(le)理(li)論基(ji)(ji)(ji)礎，《中(zhong)醫(yi)眼(yan)(yan)科(ke)(ke)備(bei)讀》在這(zhe)個基(ji)(ji)(ji)礎上(shang)制定了(le)相關(guan)治(zhi)(zhi)則(ze)和方(fang)(fang)(fang)劑(ji)(ji)。該書(shu)卷(juan)二目(mu)病(bing)條(tiao)辨(bian)在“中(zhong)心(xin)性(xing)漿(jiang)液性(xing)脈絡(luo)膜(mo)視(shi)網膜(mo)病(bing)變(bian)，黃(huang)(huang)(huang)(huang)斑部(bu)水腫基(ji)(ji)(ji)本吸收，滲出仍多，視(shi)力恢復緩(huan)慢，舌淡苔(tai)薄”條(tiao)中(zhong)說：“夫神(shen)(shen)(shen)光(guang)(guang)(guang)乃體(ti)內(nei)陽(yang)(yang)氣(qi)升騰所生，欲增神(shen)(shen)(shen)光(guang)(guang)(guang)者，當于(yu)陰(yin)中(zhong)求(qiu)陽(yang)(yang)”。提(ti)出了(le)“陰(yin)中(zhong)求(qiu)陽(yang)(yang)”的(de)(de)(de)(de)治(zhi)(zhi)療法(fa)則(ze)。根據這(zhe)一(yi)治(zhi)(zhi)則(ze)，《中(zhong)醫(yi)眼(yan)(yan)科(ke)(ke)備(bei)讀》列出了(le)明(ming)(ming)目(mu)地(di)黃(huang)(huang)(huang)(huang)湯(tang)加肉桂方(fang)(fang)(fang)、益火(huo)明(ming)(ming)目(mu)湯(tang)、明(ming)(ming)目(mu)珠還散(san)、腎(shen)(shen)氣(qi)丸等(deng)(deng)方(fang)(fang)(fang)劑(ji)(ji)。明(ming)(ming)目(mu)地(di)黃(huang)(huang)(huang)(huang)湯(tang)（熟地(di)黃(huang)(huang)(huang)(huang)、生地(di)黃(huang)(huang)(huang)(huang)、澤瀉、山萸(yu)肉、牡丹(dan)皮、柴胡(hu)、茯神(shen)(shen)(shen)、當歸、五味(wei)子）補(bu)益肝(gan)(gan)腎(shen)(shen)、滋(zi)陰(yin)明(ming)(ming)目(mu)，加一(yi)味(wei)肉桂溫(wen)(wen)補(bu)命(ming)門之(zhi)(zhi)(zhi)(zhi)(zhi)火(huo)，以壯神(shen)(shen)(shen)光(guang)(guang)(guang)，為(wei)典型(xing)的(de)(de)(de)(de)陰(yin)中(zhong)求(qiu)陽(yang)(yang)之(zhi)(zhi)(zhi)(zhi)(zhi)劑(ji)(ji)，以使“陽(yang)(yang)得陰(yin)助(zhu)而(er)生化(hua)無窮(qiong)”。益火(huo)明(ming)(ming)目(mu)湯(tang)專門針對(dui)神(shen)(shen)(shen)光(guang)(guang)(guang)“原(yuan)(yuan)于(yu)命(ming)門，通于(yu)膽，發(fa)于(yu)心(xin)，皆(jie)(jie)火(huo)之(zhi)(zhi)(zhi)(zhi)(zhi)用事”的(de)(de)(de)(de)理(li)論而(er)設，彌補(bu)了(le)原(yuan)(yuan)著(zhu)中(zhong)有理(li)無方(fang)(fang)(fang)的(de)(de)(de)(de)缺陷(xian)。益火(huo)明(ming)(ming)目(mu)湯(tang)中(zhong)以肉桂溫(wen)(wen)腎(shen)(shen)陽(yang)(yang)，干姜、炙甘草(cao)溫(wen)(wen)心(xin)陽(yang)(yang)，一(yi)以壯命(ming)門之(zhi)(zhi)(zhi)(zhi)(zhi)火(huo)，一(yi)以壯君主之(zhi)(zhi)(zhi)(zhi)(zhi)火(huo)，而(er)益神(shen)(shen)(shen)光(guang)(guang)(guang)之(zhi)(zhi)(zhi)(zhi)(zhi)源。柴胡(hu)升發(fa)肝(gan)(gan)膽之(zhi)(zhi)(zhi)(zhi)(zhi)氣(qi)，以疏通神(shen)(shen)(shen)光(guang)(guang)(guang)之(zhi)(zhi)(zhi)(zhi)(zhi)道(dao)。黃(huang)(huang)(huang)(huang)芪補(bu)益宗(zong)氣(qi)，壯氣(qi)以助(zhu)陽(yang)(yang)。熟地(di)黃(huang)(huang)(huang)(huang)、當歸滋(zi)腎(shen)(shen)補(bu)肝(gan)(gan)，以配(pei)溫(wen)(wen)腎(shen)(shen)之(zhi)(zhi)(zhi)(zhi)(zhi)品(pin)。茯神(shen)(shen)(shen)、遠志養(yang)心(xin)寧神(shen)(shen)(shen)，以配(pei)溫(wen)(wen)心(xin)之(zhi)(zhi)(zhi)(zhi)(zhi)藥(yao)。明(ming)(ming)目(mu)珠還散(san)（人參、肉蓯蓉(rong)、菟絲子、白術(shu)、海狗腎(shen)(shen)、枸(gou)杞子、菊花(hua)(hua)、密蒙花(hua)(hua)、珍(zhen)珠、牡丹(dan)皮、楮實(shi)子、紫(zi)河車）原(yuan)(yuan)系治(zhi)(zhi)療視(shi)神(shen)(shen)(shen)經炎(yan)的(de)(de)(de)(de)驗方(fang)(fang)(fang)，功能(neng)溫(wen)(wen)腎(shen)(shen)填精，補(bu)氣(qi)益血(xue)，清肝(gan)(gan)明(ming)(ming)目(mu)。益火(huo)明(ming)(ming)目(mu)湯(tang)與(yu)明(ming)(ming)目(mu)珠還散(san)二方(fang)(fang)(fang)均為(wei)溫(wen)(wen)補(bu)之(zhi)(zhi)(zhi)(zhi)(zhi)劑(ji)(ji)，但前者側(ce)重于(yu)溫(wen)(wen)，后(hou)者側(ce)重于(yu)補(bu)。腎(shen)(shen)氣(qi)丸則(ze)為(wei)溫(wen)(wen)補(bu)腎(shen)(shen)陽(yang)(yang)的(de)(de)(de)(de)祖方(fang)(fang)(fang)，目(mu)前臨床上(shang)使用的(de)(de)(de)(de)濃縮丸，很便于(yu)服用。溫(wen)(wen)陽(yang)(yang)明(ming)(ming)目(mu)法(fa)可用于(yu)中(zhong)漿(jiang)、中(zhong)滲、視(shi)神(shen)(shen)(shen)經炎(yan)等(deng)(deng)眼(yan)(yan)底(di)病(bing)后(hou)期或恢復階段，以及高(gao)度近視(shi)眼(yan)(yan)底(di)改變(bian)、老(lao)年性(xing)黃(huang)(huang)(huang)(huang)斑變(bian)性(xing)等(deng)(deng)病(bing)，其目(mu)的(de)(de)(de)(de)是(shi)溫(wen)(wen)補(bu)陽(yang)(yang)氣(qi)，使神(shen)(shen)(shen)光(guang)(guang)(guang)充(chong)沛，而(er)有助(zhu)于(yu)視(shi)力的(de)(de)(de)(de)提(ti)高(gao)，不(bu)同于(yu)治(zhi)(zhi)療虛寒(han)眼(yan)(yan)病(bing)時溫(wen)(wen)陽(yang)(yang)法(fa)的(de)(de)(de)(de)使用，因此，《中(zhong)醫(yi)眼(yan)(yan)科(ke)(ke)備(bei)讀》在卷(juan)四眼(yan)(yan)科(ke)(ke)藥(yao)對(dui)“附子、肉桂”條(tiao)下(xia)指出，使用時不(bu)必刻意要(yao)求(qiu)必須有全身陽(yang)(yang)虛證狀。但是(shi)，如(ru)果陰(yin)虛證狀明(ming)(ming)顯(xian)，見有舌紅無苔(tai)、潮熱盜汗等(deng)(deng)證則(ze)忌之(zhi)(zhi)(zhi)(zhi)(zhi)，實(shi)為(wei)經驗之(zhi)(zhi)(zhi)(zhi)(zhi)談。
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