凡拨金针之时，须看患目者人之老弱肥壮。若气盛者，欲行针之际，前二三日先服退气
散血之剂数服，平其五脏；弱者不必服之。临拨，新汲井水一盆，放于桌上，令患目者，对
盆就洗，医家侧坐，以手蘸水，频频于眼上连眉棱骨淋洗，使眼内脑脂得水乃凝，以洗透数
十遍，冷定睛珠为度，然后用针，庶几随手而下，并不粘滞矣。
退气散血饮
大黄 当归身 乳香 没药 连翘 穿山甲 白芷（各等分）
上锉剂。白水二钟，煎至八分，去滓，食远服。
凡拨眼要知八法，六法易传，惟二法巧妙，在于医者手眼心眼，隔垣见症，手法探囊取
物，方得其法，临拨，先令患者以水洗眼如冰，使血气不行为度，两手各握纸团，端坐椅上
后用二人将头扶定，医人先用左手大指二指，分开眼皮，按定黑珠，不令转动。次用右手
持金针，如拨右眼，令患者视右，方好下针，庶鼻梁骨不碍手，离黑珠与大 两处相平，分
中，慢慢将针插下，然后斜回针首，至患处，将脑脂拨下，复放上去，又拨下来，试问患者
看见指动，或青白颜色，辨别分明，然后将脑脂送至大 近开穴处，护睛水内尽处，方徐
徐出针，不可早出，恐脑脂复还原位，拨左眼则左锐 。
预收芙蓉半老绿叶，晒干为末，用井花凉水调匀，以绵纸剪圆块，如茶钟口大，先将敷
药敷眼上眉棱骨及下眶，以纸一层，封贴药上，又上药一层，盖纸一层封定，俟将干，以笔
蘸水润之，日夜数次，夏月倍之，一日一换，仰面而卧。若将针眼向下就枕，防脑脂从上复
下也，起坐饮食，大小二便俱宜缓，不可用力震动。三日内，只用温和稀粥，烂熟稀馔，不
可震动牙齿。三日后，开封视物，服药静养而已。
针后若目疼痛，急取生艾，或干艾，同生葱各半，共捣，铜锅内炒热，布包熨太阳穴，
三五次即止。若瞳神有油气不清，当平肝气，用槟榔、枳壳、柴胡之类；作呕吐，用藿香、
淡豆豉、姜制浓朴、半夏之类；火旺体浓者，宜清火顺气消痰，用黄连、枳壳、槟榔、半夏
麦冬、栝蒌之类；老弱者，用茯神、熟地、枸杞、麦冬、枣仁、贝母、白术、橘红、五味
子、白芍、当归之类；针后忌用川芎，恐行血作痛；太阳头疼，用防风、白芷、羌活、石膏
之类；痛甚，用炒盐熨之；若白睛赤，用柴胡、红花、赤芍、归尾、栀仁、桑皮、防风之类
瞳神微散，用白芍、五味子、麦冬、茯神、人参、当归、酸枣仁之类；受热致瞳神细小者
用寒水石、当归、黄连、麦冬、茺蔚子、柴胡、炒栀仁之类。若障复朦，宜服平肝顺气之
剂，其障自退，如不速退，复再针拨亦可。
愚按∶此症乃湿热郁积，蒸烁脑脂下垂，故珠内有膜遮蔽瞳仁之光，犹如布幔悬于明窗
之内，外人虽见其窗似明，孰知窗内有幔悬挂而不明也。但今人以讹传讹，皆谓瞳仁反背，
其讹相延已久，一时难以正之。当知此症惟用金针入珠内，拨去脂膜，顷刻能明，此论惟可
与知者道，难与俗人言也。谨辨之，以为后人垂鉴。
上《龙木论》金针开内障大法，谨按其法，初患眼内障之时，其眼不痛不涩不痒，头不
旋不痛，而翳状已结成者，必俟岁月障老，始宜金针拨去其翳，如拨云见日而光明也。今具
其略于后。
凡是进行金针拨障手术时，必须观察患者的体质是年老体弱还是年轻强壮。如果患者气血旺盛，在准备施针前的两三天，先服用几剂退气散血的药剂，以平抑五脏之气；身体虚弱者则不必服用。临行手术前，准备一盆新汲取的井水放在桌上，让患者对着盆清洗眼睛，医生侧身坐着，用手蘸水，频繁地在患者眼睛及连眉毛棱骨处淋洗，使眼内的脑脂（晶状体混浊物）遇水后凝固，反复冲洗数十遍，直到眼球冷却固定为止，然后再用针操作，这样针就能顺利刺入，不会粘滞。
退气散血饮方：
大黄、当归身、乳香、没药、连翘、穿山甲、白芷（各等分）。
以上药材切碎成剂。用白水二钟，煎至八分，去渣，饭后服用。
凡是进行眼部拨障手术要掌握八种技法，其中六种容易传授，唯有两种技法精妙，关键在于医生的手法、眼法和心法，如同隔墙能看见病症一样，手法熟练得如同探囊取物，才算掌握了精髓。临行手术前，先令患者用水将眼睛洗得像冰一样冷，使局部气血运行停止为度。两手各握一个纸团，端正坐在椅子上，然后由两人扶定患者头部。医生先用左手的大拇指和食指分开眼皮，按住黑珠（瞳孔/晶状体），不让其转动。接着用右手持金针，如果是拨右眼，令患者向右看，这样才好下针，以免鼻梁骨阻碍手部动作，针尖与黑珠和大眦（内眼角）两处相平，位于中间位置，慢慢将针插入，然后将针头斜回，到达患处，将脑脂拨下，再放上去，又拨下来，询问患者是否看见手指晃动，或青白色颜色辨别分明，然后将脑脂送至大眦近开穴处，护睛水（泪液/房水）尽处，才徐徐拔出针来，不可过早拔出，恐怕脑脂恢复原位。拨左眼则向左看。
预先收集半老不老的芙蓉绿叶，晒干研成粉末，用井花凉水调匀，用绵纸剪成圆形块，大小如茶钟口，先将敷药敷在患者眼睛上方的眉棱骨及下方眼眶上，盖一层纸，封贴药物，再上一层药，盖一层纸封定，等到快干时，用笔蘸水润湿，日夜数次，夏季加倍，一天更换一次，患者需仰卧。如果针刺后将眼向下就枕，防止脑脂从上重新下垂。起坐饮食，大小便都宜缓慢，不可用力震动。三日内，只吃温和稀粥、烂熟稀软食物，不可震动牙齿。三日后，开封视物，服药静养即可。
针后如果眼睛疼痛，急忙取生艾草或干艾草，同生葱各一半，共同捣碎，在铜锅内炒热，用布包裹熨烫太阳穴，三五次即可停止。如果瞳神（瞳孔/视力）有油气不清，应当平抑肝气，使用槟榔、枳壳、柴胡之类；出现呕吐，使用藿香、淡豆豉、姜制厚朴、半夏之类；火旺体质壮实者，宜清火顺气消痰，使用黄连、枳壳、槟榔、半夏、麦冬、栝蒌之类；年老体弱者，使用茯神、熟地、枸杞、麦冬、枣仁、贝母、白术、橘红、五味子、白芍、当归之类；针后忌用川芎，恐怕活血导致疼痛；太阳穴头痛，使用防风、白芷、羌活、石膏之类；疼痛剧烈，用炒盐熨烫；如果白睛（巩膜）发红，使用柴胡、红花、赤芍、归尾、栀仁、桑皮、防风之类；瞳神微散，使用白芍、五味子、麦冬、茯神、人参、当归、酸枣仁之类；受热导致瞳神细小者，使用寒水石、当归、黄连、麦冬、茺蔚子、柴胡、炒栀仁之类。如果内障复发模糊，宜服用平肝顺气的药剂，内障自然会消退，如果不迅速消退，再次进行针拨也可以。
我按语：此症乃是湿热郁积，蒸灼脑脂下垂，因此珠内有膜遮蔽瞳仁之光，犹如布幔悬挂在明窗之内，外人虽然看见窗户似乎明亮，谁知道窗内有幔悬挂而不明亮呢。只是如今人们以讹传讹，都说瞳仁反背，这种错误流传已久，一时难以纠正。应当知道此症只有用金针进入珠内，拨去脂膜，顷刻间就能复明，此论只可与懂行的人说，难以与俗人言说。谨此辨析，作为后人的借鉴。
以上是《龙木论》中关于金针开通内障的大法，谨依其法：初患眼内障之时，眼睛不痛不涩不痒，头不晕不痛，而翳状已经结成者，必须等待岁月使障老化，才适宜用金针拨去其翳，如同拨云见日而重获光明。现将大概内容列于后。
Whenever performing the golden needle cataract extraction surgery, one must observe whether the patient is old and weak or young and robust. If the patient has vigorous qi and blood, two to three days before the procedure, administer several doses of a decoction that reduces qi and disperses blood (Tuiqi Sanxue Yin) to calm the five zang organs; those who are weak need not take it. Immediately before the procedure, place a basin of fresh well water on the table and have the patient wash their eyes facing the basin. The physician sits sideways, dips their hand in the water, and frequently rinses the patient's eyes and eyebrow ridge with the water. This causes the brain fat (lens opacity) inside the eye to coagulate upon contact with the water. Rinse thoroughly dozens of times until the eyeball becomes cold and fixed, then proceed with the needle. This ensures the needle penetrates smoothly without sticking.
**Decoction for Reducing Qi and Dispersing Blood (Tuiqi Sanxue Yin):**
Da Huang (Rhei Radix et Rhizoma), Dang Gui Shen (Angelicae Sinensis Radix), Ru Xiang (Olibanum), Mo Yao (Myrrha), Lian Qiao (Forsythiae Fructus), Chuan Shan Jia (Manis Squama), Bai Zhi (Angelicae Dahuricae Radix) (equal parts).
Crush the herbs into pieces. Add two zhong of clear water, boil down to eight fen, remove the dregs, and take after meals.
One must master eight techniques for eye extraction surgeries. Six of these are easily transmitted, but the remaining two are subtle and depend on the physician's manual skill, visual acuity, and mental focus—seeing the pathology as if through a wall. The technique should be as effortless as taking something from a bag. Before the procedure, instruct the patient to wash their eyes with ice-cold water until local qi and blood circulation cease. Have the patient sit upright on a chair, holding a paper ball in each hand. Two assistants stabilize the patient's head. The physician uses the thumb and index finger of the left hand to separate the eyelids and press firmly on the black pearl (pupil/lens) to prevent rotation. Then, using the right hand to hold the golden needle: if operating on the right eye, instruct the patient to look to the right so the nasal bone does not obstruct the hand. Align the needle tip level with the black pearl and the inner canthus (Da Nao), positioned centrally. Slowly insert the needle, then curve the needle head obliquely back to the lesion site. Dislodge the brain fat, replace it, dislodge it again, and ask the patient if they see finger movement or distinct blue-white colors. Once confirmed, move the brain fat towards the opening near the inner canthus, to the limit of the protective fluid (tears/humor), then slowly withdraw the needle. Do not withdraw early, lest the brain fat return to its original position. For the left eye, the patient looks to the left.
Pre-collect half-mature hibiscus leaves, dry them, and grind into powder. Mix with cool well water to form a paste. Cut mulberry paper into circular patches the size of a teacup rim. Apply the medicament to the eyebrow ridge and lower orbit above the eye. Cover with a layer of paper, apply another layer of medicament, and seal with another layer of paper. When the patch begins to dry, moisten it with a brush dipped in water. Repeat several times day and night, doubling frequency in summer. Change once daily. The patient must lie supine. If the eye rests downward on the pillow after needling, prevent the brain fat from sliding down again. Movements such as rising, sitting, eating, and defecating should be slow and gentle, avoiding forceful vibration. For three days, consume only warm, thin porridge and soft food; avoid chewing motions that vibrate the teeth. After three days, uncover the eye to view objects, and continue with medication and rest.
If eye pain occurs post-needling, immediately take raw mugwort or dried mugwort mixed with equal parts raw green onion. Pound together, stir-fry in a copper pot until hot, wrap in cloth, and apply as a compress to the Taiyang acupoint (Temple). Three to five applications will stop the pain. If vision is cloudy due to "oil gas," soothe liver qi using Bing Lang (Arecae Semen), Zhi Ke (Aurantii Fructus), and Chai Hu (Bupleuri Radix). For vomiting, use Huo Xiang (Pogostemonis Herba), Dan Dou Chi (Sojae Semen Praeparatum), Jiang Zhi Hou Po (Magnoliae Officinalis Cortex processed with ginger), and Ban Xia (Pinelliae Tuber). For patients with excessive fire and robust constitutions, clear fire, smooth qi, and resolve phlegm using Huang Lian (Coptidis Rhizoma), Zhi Ke, Bing Lang, Ban Xia, Mai Dong (Ophiopogonis Tuber), and Gua Lou (Trichosanthis Fructus). For the elderly and weak, use Fu Shen (Poria Cum Radice), Shu Di Huang (Rehmanniae Radix Preparata), Gou Qi Zi (Lycii Fructus), Mai Dong, Suan Zao Ren (Ziziphi Spinosae Semen), Bei Mu (Fritillariae Bulbus), Bai Zhu (Atractylodis Macrocephalae Rhizoma), Ju Hong (Citri Reticulatae Pericarpium), Wu Wei Zi (Schisandrae Fructus), Bai Shao (Paeoniae Radix Alba), and Dang Gui. Avoid Chuan Xiong (Ligustici Chuanxiong Rhizoma) post-needling, as it may invigorate blood and cause pain. For Taiyang headache, use Fang Feng (Saposhnikoviae Radix), Bai Zhi, Qiang Huo (Notopterygii Rhizoma et Radix), and Shi Gao (Gypsum Fibrosum). For severe pain, apply roasted salt compresses. For redness of the white sclera (Bai Jing), use Chai Hu, Hong Hua (Carthami Flos), Chi Shao (Paeoniae Radix Rubra), Gui Wei (Angelicae Sinensis Radix tail), Zhi Ren (Gardeniae Fructus), Sang Bai Pi (Mori Cortex), and Fang Feng. For slight dilation of the pupil (Tong Shen), use Bai Shao, Wu Wei Zi, Mai Dong, Fu Shen, Ren Shen (Ginseng Radix), Dang Gui, and Suan Zao Ren. For pupils constricted due to heat, use Han Shui Shi (Halloysitum Rubrum), Dang Gui, Huang Lian, Mai Dong, Chong Wei Zi (Leonuri Fructus), Chai Hu, and Chao Zhi Ren (Gardeniae Fructus processed). If opacity recurs and blurs vision, administer formulas to soothe liver qi and smooth qi flow; the opacity will naturally recede. If it does not recede quickly, repeat the needle extraction.
**Commentary:** This condition arises from damp-heat accumulation steaming and scorching the brain fat, causing it to sag. Consequently, a membrane within the lens obscures the light of the pupil, like a curtain hanging inside a bright window. Outsiders see the window seems bright, unaware of the curtain inside. However, modern people spread errors, claiming the pupil is reversed. This misconception has persisted for a long time and is hard to correct. One must know that this condition requires inserting the golden needle into the lens to dislodge the fatty membrane, restoring sight instantly. This theory is suitable only for those who understand, not for the vulgar masses. I hereby clarify this for future generations' reference.
The above outlines the major principles of golden needle treatment for internal cataracts from the *Longmu Lun*. Following these principles: when internal cataracts first appear, the eye is neither painful, gritty, nor itchy, and there is no dizziness or headache, yet the opacity has formed. One must wait for the opacity to mature over time before extracting it with the golden needle, akin to parting clouds to see the sun and regain brightness. The summary follows below.