张飞畴曰。内障一证。皆由本虚邪入。肝气冲上。不得外越。凝结而成。故多患于躁急善怒
之辈。初起之时。不痛不痒。视物微昏。或朦胧如轻烟薄雾。次则空中常见黑花。或如蝇飞蚁垂。
睹一成二。瞳神渐渐变色。而至失明。初时一眼先患。次则相牵俱损。能睹三光者可治。若三光
已绝。虽龙树复出。亦难挽回。古人虽立多名。终不越有水无水之辨。若有水而光泽莹彻者易明。
无水而色不鲜明者难治。忽大忽小。收放如气蒸动者。针之立明。若久视定而不动者为死翳。纵
水未枯。治之亦难全复。翳色白或带青。或如炉灰色。糙米色者易明。若真绿正黄色者不治。凡
翳不拘何色。但有棱角。拨即难落。翳状破散。及中心浓重者。非拨可除。若犹能视物者。其翳
尚嫩。不可便针。俟翳老。然后针之。又一种翳色虽正。水纵不枯。目珠软塌者。此必不治。不
可轻用金针。如一眼先暗。而三光已绝。其后眼续患。亦难针治。若夫瞳神散大。或紧小。或浑
黑。或变色而无障翳。至不睹三光者。此内水亏乏。不在证治。倪仲贤所云。圆翳冰翳。滑翳涩
翳。散翳浮翳。沉翳横翳。枣花翳。白翳黄心。黑水凝翳。惊振内障等证。金针拨之。俱可复明。
但针后数日中。宜
服磁朱消翳等药。后则常服补肾调养气血之剂。以助其光。其翳状龙木论中已悉。不暇再述。姑
以针时手法言之。若江西流派。先用冷水洗眼。使翳凝定。以开锋针先刺一穴。续进圆针拨翳。
或有开孔拨翳。俱用鸭舌针者。云虽龙树真传。但针粗穴大。每至痛极欲晕。余所用毫针。细而
尖锐。取穴轻捷。全无痛楚。然必择吉日。避风雨阴晦日。酷暑严寒日。令病患先食糜粥。不可
过饱。少停向明端坐。一人扶定其首。禁止傍人喧杂。医者凝神澄虑。慎勿胆怯手颤。以左手大
次二指。按开眼胞。使其转睛向鼻。睁目如努出状。右手大次中三指。捻正金针镶处之上。看准
穴道。从外 一边。离黑珠约半米长许。平对瞳神。下针最便。必须手准力完。一针即进。切勿
挠动。使之畏忍。所以开单瞽。须遮蔽好眼。方可进针。进针之后。以下唇略抵针柄。轻轻移手
于针柄尽处。徐徐捻进。第一宜轻。稍重则痛。俟针进约可拨至瞳神时。以名指曲附大指次节。
承其针柄。虚虚拈着。向上斜回针锋至瞳神内夹道中。贴翳内面往下拨之。翳即随落。若不落。
再如前手法。从上往下拨之。倘三五拨不下。须定稳念头。轻轻拨去自落。惟死翳拨之不动者忌
拨。有拨落而复起者当再拨之。其翳随针捺于黑珠之下。略顿起针。缓缓捻出。但元气虚人。针
后每多作呕。以托养神膏者属胃气也。须预备乌梅之类。勿使其呕为妙。呕则防翳复上。上则一
两月后复针。翳既尽。不可贪功多拨。多拨则有伤损神膏。呕动胃气之害。凡翳嫩如浆。不沾针
首。而不能拨下。或拨下而复泛上满珠者。服补养兼消翳药自明。先与千金磁朱丸七服。次与皂
荚丸。生熟地黄丸并进。否则俟凝定再针。不可限以时日。有种翳虽拨落。圆滑而捺下复滚上者。
必略缩针头。穿破其翳。捺之自下。不下。亦如前用药自消。或有目珠难于转内者。针内 亦得。
此名过梁针。取穴较外 稍远一线。针法与外 无异。但略觉拗手。然鼻梁高者。难于转针。不
可强也。若针右眼外 。下
针之后。换左手转针拨翳。手法亦须平日演熟。庶无失误。出针之后。令病者垂垂闭目。用绵纸
五七重。量纸浓薄。及天时寒暖封固。更以软帛裹黑豆数粒。以线系定镇眼。使目珠不能动移。
动则恐翳复上。是以咳嗽之人不宜用针。亦是此意。又肝虚人时有泪出。勿用黑豆。宜以决明子
代之。则无胀压珠痛之患。然觉紧则宜稍松。觉宽则宜稍收。以平适为主。封后静坐时许。然后
轻扶。高枕仰卧。不须饮食。若饥则不妨少与。周时后以糜粥养之。戒食震牙之物。及劳动多言。
不可扳动露风。露风则疼痛。疼痛则复暗。不可不慎。过七日方可开封看物。切勿劳视。亦有针
时见物。开封时反不见者。本虚故也。保元汤、六味丸。补养自明。针后微有咳嗽。难用黄 者。
以生脉散代之。若形白气虚者。大剂人参以补之。肥盛多痰湿者。六君子加归、芍以调之。一月
之内。宜美味调摄。毒物禁食。不得高声叫唤。及洗面劳神。百日之中。禁犯房劳恼怒。周年勿
食五辛酒面等物。若犯前所禁诸条。致重丧明者。不可归罪于医也。其有进针时。手法迟慢。目
珠旋转。针尖划损白珠外膜之络而见血。及伤酒客辈。目中红丝血缕者。虽为小过。切勿惊恐。
如法针之。所谓见血莫惊休住手是也。又进针后触着黄仁。而血灌瞳神。急当出针。而服散血之
药。所谓见血莫针须住手是也。法虽若此。医者能无咎乎。又年高卫气不固。针时神膏微出者。
即与保元汤调补之。开卦时白睛红色。勿讶。以封固气闭。势使然也。其用针未熟者。量针穴与
瞳神。相去几许。以墨点针上。庶指下无过浅过深之惑。凡初习针时。不得以人目轻试。宜针羊
眼。久久成熟。方可治人。谚云。羊头初试。得其轻重之宜。正初习金针之要法。不可以其鄙而忽诸。
造金针法 用上赤不脆金。抽作金丝。粗如底针。约长三寸。敲作针形。以小光铁槌。在镦上缓缓磋之。令尖圆若
绣针状。亦不可太细。细则易曲易断。如觉柔软。再磋令坚。不可锉击。恐脆则有伤。断入目中。
为害不浅。缘金银之性。经火则柔。磋击则坚。务令刚柔得宜。以坚细中空慈竹三寸作柄。则轻
便易转。且不滑指。柄中以蜡入满。嵌入大半。留锋寸余。针根用银镶好。无使动摇。针锋以银
管护之。先用木贼草擦令圆锐。更以羊肝石磨令滑泽。穿肤不疼。则入目不痛。方可用之。造成
后。亦宜先针羊眼。试其柔脆。庶几无失。
飞畴治画师吴文玉母。年五十四。失明数年。诸治罔效。余偶见之曰。此内障眼。可以复明。
何弃之也。曰。向来力能给药。治而不灵。今纵有仙术可回。力莫支也。予曰。无汝费。但右眼
之翳尚嫩。迟半载可拨。遂先与针左眼。针入拨时。其翳下而珠尚不清。卦后因与磁朱丸七日。
开封视物模糊。又与皂荚丸服而渐明。其后自执鄙见。谓一眼复明。已出望外。若命犯带疾而全
疗之。于寿有阻。遂不欲更治右眼。虽是知足。诚亦愚矣。
又治孙捣。年七十。茹素五十余年。内障失明四载。余用金针。先针左眼。进针时外膜有血。
针入微有膏出。观者骇然。余于膏血中进针。拨去翳障。次针右眼。出针两眼俱明。遂与封固。
用黑豆包系镇眼。因向来肝虚多泪。是夕泪湿豆胀。不敢宽放。致右眼痛而作呕。明晨告予。令
稍宽其系。先以乌梅止其呕。用六味丸调服。以补其肝。遂痛止安谷。至七日开封。其右眼因呕
而翳复上。侵掩瞳神之半。视物已灼然矣。许其来春复拨。以收十全之功。但针时有神膏漏出。
稠而不粘。知寿源无几为惜耳。
又治徐天锡。内障十五年。三载前曾有医针之。其翳拨下复上。如是数次。翳不能下。委之
不治。乃甥周公来。见余针吴之寰内障。两眼俱一拨而明。因详述其故。予曰。此圆翳也。遂同
往与针。其翳拨下。果复滚上。即缩针穿破其
翳。有白浆灌满风轮。因谓之曰。过七日其浆自澄。设不澄。当俟结定再针。则翳不复圆也。过
七日开封。已能见物。但瞳神之色不清。其视未能了了。令多服补肾药。将三月而视清。
又沈倩若。年二十五。患内障年余。翳状白润而正。能辨三光。许其可疗。临时见其黑珠不
定。针下觉软。遂止针不进。曰。风轮动。是肝虚有风。目珠软。是神水不固。辞以不治。病者
恻然曰。予得遇龙树。许可复明。今辞不治。则终为长夜之人也。免慰之曰。汝姑服药。俟元气
充足。方可用针。后闻一医不辨而与针治。翳韧不能拨下。终属无功。胡似不针之为上也。
又治楚商马化龙。患内障三月。色含淡绿。白珠红赤而头痛。究其根。是舟中露卧。脑受风
邪而成。因其翳色低。不欲与针。复思本风而致。青绿有之。且证未久。犹为可治。遂先与疏风。
次与清肝。头痛止目赤退。然后针之。其翳难落。稍用力始开。内泛黄绿沙于风轮。似属难愈。
服补肾养正药两月。翳色变正。再拨而明。
又陈彦锡夫人内障。何宇昭内障。李能九内障。陈顺源内障。俱年远一拨即明。但服磁朱消
翳药。后之调治各异。彦锡夫人多郁不舒。散结养神为主。字昭肥白多痰。理脾渗湿养神为主。
能九劳心沉默。宣达补血养神为主。顺源善饮性暴。开封时风轮红紫。瞳神散阔。视物反不若针
时明了。此火盛燔灼。瞳神散漫。平肝降火敛神为主。凡此不能枚举。总在临证变通。非执成见
之可获全功也。
又治赵妪内障。进针一拨。浆泛风轮全白。两目皆然。服消翳药。一月后能视。此属包浆内
障。与圆翳似同而别。并识以晓未经历者。
张飞畴说：内障这一类病证，都是由本元虚弱、邪气侵入所致。肝气冲逆向上，不能向外发散，凝结而成。所以多发生在急躁易怒的人身上。初起时，不痛不痒，视物轻微昏花，或者朦胧如轻烟薄雾。随后则常看见空中有黑花飞舞，或者像苍蝇飞动、蚂蚁垂挂。看一个物体变成两个，瞳神渐渐变色，直至失明。起初是一只眼睛先患病，随后牵连另一只眼睛也受损。如果能看见“三光”（日、月、星）的，可以治疗；如果三光已绝，即使龙树菩萨再世，也难以挽回。古人虽然立了很多名称，终究不离有水无水（指眼内津液盈亏）的辨别。如果有水且光泽晶莹透彻的，容易看清并治疗；无水且色泽不鲜明的，难治。忽大忽小，收缩扩张如气体蒸腾波动的，针刺后可立即复明。如果久视固定不动的，属于死翳（不可逆的瘢痕），即使眼中津液未枯，治疗也难以完全恢复。翳色白或带青色，或者像炉灰颜色、糙米颜色的，容易拨除复明。如果是真绿色或正黄色的，则无法治疗。凡是翳障不论什么颜色，只要有棱角，拨动时难以脱落，或者翳状破碎散乱，以及中心浓重的，不是拨法可以去除的。如果还能视物，说明翳尚嫩，不可立即针刺。等到翳变老后，然后再针刺。又有一种情况，翳色虽正，眼中津液也未枯竭，但眼球软塌的，这必定无法治疗，不可轻易使用金针。如果一只眼睛先失明，且三光已绝，后来另一只眼睛接着患病，也难用针刺治疗。至于瞳神散大，或紧小，或浑黑，或变色但没有障翳，直到看不见三光的，这是内部阴水亏乏，不属于针灸治疗的范畴。倪仲贤所说的圆翳、冰翳、滑翳、涩翳、散翳、浮翳、沉翳、横翳、枣花翳、白翳黄心、黑水凝翳、惊振内障等证候，用金针拨治，都可以复明。但在针刺后数日内，宜服用磁朱消翳等药物，之后常服补肾调养气血的方剂，以助视力恢复。其翳的形状在《龙木论》中已有详述，此处不再赘述。姑且谈谈针刺时的手法。如果是江西流派，先用冷水洗眼，使翳凝定，先用开锋针刺入一个穴位，然后进圆针拨翳。或者有开孔拨翳，都使用鸭舌针的，声称是龙树真传。但针粗穴大，往往导致疼痛剧烈甚至晕厥。我所用的毫针，细而尖锐，取穴轻捷，完全没有痛楚。然而必须选择吉日，避开风雨阴晦、酷暑严寒的日子。让病人先吃稀粥，不可过饱，稍停片刻，面向光亮端正坐好。一人扶住病人的头部，禁止旁人喧哗。医者凝神静虑，切勿胆怯手颤。用左手大拇指和食指，按开眼睑，使其眼球转向鼻侧，睁目用力状。右手大拇指、食指和中指，捻正金针，对准镶处上方，看准穴位，从外眦一边，距离黑珠（黑睛）约半寸长许，平对瞳神，下针最方便。必须手准力完，一针即进，切勿挠动，使病人畏惧忍耐。所以开单瞽（单眼失明），须遮蔽好眼，方可进针。进针之后，以下唇略抵针柄，轻轻移手于针柄尽处，徐徐捻进。第一宜轻，稍重则痛。等到针进约可拨至瞳神时，以无名指弯曲附在大指次节，承托针柄，虚虚拈着，向上斜回针锋至瞳神内夹道中，贴翳内面往下拨之。翳即随落。如果不落，再如前手法，从上往下拨之。倘若三五拨不下，须定稳念头，轻轻拨去自落。只有死翳拨之不动者忌拨。有拨落而复起的，应当再拨之。其翳随针捺于黑珠之下，略顿起针，缓缓捻出。但元气虚的人，针后每多作呕，因为托养神膏的属于胃气。须预备乌梅之类，勿使其呕吐为妙。呕吐则防止翳复上，若翳复上，则一两月后再针刺。翳既尽，不可贪功多拨，多拨则有伤损神膏、呕动胃气的危害。凡是翳嫩如浆，不沾针首，而不能拨下，或拨下而复泛上满珠的，服用补养兼消翳的药物自然复明。先给予千金磁朱丸七服，其次与皂荚丸、生熟地黄丸并进。否则等待凝定后再针，不可限定时日。有种翳虽拨落，圆滑而捺下复滚上的，必须略缩针头，穿破其翳，捺之自下。不下，也如前用药自消。或有眼球难于转内（向内转动困难）的，针内眦也得效。此名过梁针，取穴较外眦稍远一线，针法与外眦无异，但略觉拗手。然而鼻梁高者，难于转针，不可强求。若针右眼外眦，下针之后，换左手转针拨翳，手法亦须平日演熟，庶无失误。出针之后，令病人垂闭目，用绵纸五七层，根据纸的厚薄及天时寒暖封固，更以软帛包裹黑豆数粒，以线系定镇眼，使眼球不能动移。动则恐翳复上。因此咳嗽之人不宜用针，也是这个意思。又有肝虚人时常流泪，勿用黑豆，宜以决明子代替，则无胀压珠痛之患。然而觉得紧则宜稍松，觉得宽则宜稍收，以平适为主。封后静坐时许，然后轻扶，高枕仰卧，不须饮食，若饥则不妨少给。周时（一周时间）后以糜粥养之。戒食震牙之物，及劳动多言，不可扳动露风。露风则疼痛，疼痛则复暗，不可不慎。过七日方可开封看物，切勿劳视。也有针时见物，开封时反不见的，是本虚的缘故。保元汤、六味丸，补养自明。针后微有咳嗽，难用黄芪的，以生脉散代替。若形白气虚者，大剂人参以补之。肥盛多痰湿者，六君子加归、芍以调之。一月之内，宜美味调摄，毒物禁食，不得高声叫唤，及洗面劳神。百日之中，禁犯房劳恼怒。周年勿食五辛酒面等物。若犯前所禁诸条，致重新丧明的，不可归罪于医生。其有进针时，手法迟慢，眼球旋转，针尖划损白珠（白睛）外膜之络而见血，及伤酒客辈，目中红丝血缕的，虽为小过，切勿惊恐。如法针之，所谓“见血莫惊休住手”是也。又进针后触着黄仁（虹膜），而血灌瞳神，急当出针，而服散血之药，所谓“见血莫针须住手”是也。法虽若此，医者能无咎乎？又年高卫气不固，针时神膏微出的，即与保元汤调补之。开卦（开封）时白睛红色，勿讶，以封固气闭，势使然也。其用针未熟者，量针穴与瞳神，相去几许，以墨点针上，庶指下无过浅过深之惑。凡初习针时，不得以人目轻试，宜针羊眼，久久成熟，方可治人。谚语云：“羊头初试”，得其轻重之宜，正是初习金针的要法，不可以其鄙而忽视它。
造金针法：用上好的赤金（不脆的金），抽作金丝，粗如底针，约长三寸。敲作针形，用小光铁槌，在镦上缓缓磋之，令尖圆若绣针状，也不可太细，细则易曲易断。如觉柔软，再磋令坚，不可锉击，恐脆则有伤，断入目中，为害不浅。缘金银之性，经火则柔，磋击则坚，务令刚柔得宜。以坚细中空慈竹三寸作柄，则轻便易转，且不滑指。柄中以蜡入满，嵌入大半，留锋寸余。针根用银镶好，无使动摇。针锋以银管护之。先用木贼草擦令圆锐，更以羊肝石磨令滑泽，穿肤不疼，则入目不痛，方可用之。造成后，亦宜先针羊眼，试其柔脆，庶几无失。
飞畴治疗画师吴文玉的母亲，年龄五十四岁，失明数年，各种治疗无效。我偶然见到她说：这是内障眼，可以复明，为何放弃呢？她说：向来力气能供养医药，但治疗不灵验。现在纵有仙术可挽回，财力也支撑不住了。我说：不用你花钱，只是右眼的翳尚嫩，延迟半年可拨。于是先针刺左眼。针入拨时，其翳下而眼球尚不清澈。开封后因与磁朱丸七日，开封视物模糊。又与皂荚丸服用而渐明。其后她自己执持偏见，认为一眼复明，已出乎意料之外，若命犯带疾而全疗之，对寿命有阻碍，遂不想再治右眼。虽是知足，诚亦愚昧啊。
又治疗孙捣，年龄七十岁，吃素五十多年，内障失明四年。我用金针，先针左眼。进针时外膜有血，针入微有膏出。观者骇然。我在膏血中进针，拨去翳障。次针右眼，出针两眼俱明。遂与封固，用黑豆包系镇眼。因向来肝虚多泪，是晚泪水湿透豆胀，不敢放松，导致右眼痛而作呕。次日早晨告知我，令稍松其系。先以乌梅止其呕，用六味丸调服，以补其肝。遂痛止安谷。至七日开封，其右眼因呕而翳复上，侵掩瞳神之半，视物已清晰了。许诺来年春天再拨，以收十全之功。但针时有神膏漏出，稠而不粘，知道寿命将尽，为之惋惜。
又治疗徐天锡，内障十五年。三年前曾有医生针刺过，其翳拨下复上，如是数次，翳不能下，委托不治。乃其外甥周公来，见我针刺吴之寰的内障，两眼俱一拨而明，于是详细陈述其缘由。我说：这是圆翳。遂同往与他针刺。其翳拨下，果复滚上。即缩针穿破其翳，有白浆灌满风轮（黑睛）。因而对他说：过七日其浆自澄。若不澄，当等待结定再针，则翳不复圆也。过七日开封，已能见物。但瞳神之色不清，其视未能了了。令多服补肾药，将三月而视清。
又沈倩若，年龄二十五岁，患内障年余。翳状白润而正，能辨三光。许其可疗。临时见其黑珠不定，针下觉软，遂止针不进。说：风轮动，是肝虚有风。目珠软，是神水不固。辞以不治。病者恻然说：我得以遇到龙树菩萨，许可复明。如今辞以不治，则终为长夜之人也。我安慰他说：你暂且服药，等待元气充足，方可用针。后听说一医不辨而与针治，翳韧不能拨下，终属无功。胡似不针之为上也。
又治疗楚地商人马化龙，患内障三月，色含淡绿，白珠红赤而头痛。究其根源，是舟中露卧，脑受风邪而成。因其翳色低，不欲与针。复思本风而致，青绿有之，且证未久，犹为可治。遂先与疏风，次与清肝。头痛止目赤退，然后针之。其翳难落，稍用力始开。内泛黄绿沙于风轮，似属难愈。服补肾养正药两月，翳色变正，再拨而明。
又陈彦锡夫人内障，何宇昭内障，李能九内障，陈顺源内障，俱年远一拨即明。但服磁朱消翳药，后之调治各异。彦锡夫人多郁不舒，散结养神为主。字昭肥白多痰，理脾渗湿养神为主。能九劳心沉默，宣达补血养神为主。顺源善饮性暴，开封时风轮红紫，瞳神散阔，视物反不若针时明了。此火盛燔灼，瞳神散漫，平肝降火敛神为主。凡此不能枚举，总在临证变通，非执成见之可获全功也。
又治疗赵妪内障。进针一拨，浆泛风轮全白，两目皆然。服消翳药，一月后能视。此属包浆内障，与圆翳似同而别，并识以晓未经历者。
Fei Chou said: The syndrome of internal cataract (Neizhang) is caused by deficiency of the root and invasion of pathogenic factors. Liver Qi rushes upward and cannot disperse outward, condensing to form the opacity. Therefore, it mostly affects those who are irritable and prone to anger. In the initial stage, there is no pain or itching, vision is slightly dim, or blurred like light smoke and thin fog. Subsequently, black spots are often seen flying in the air, resembling flies moving or ants hanging down. One object appears as two, the pupil gradually changes color, leading to blindness. Initially, only one eye is affected, then the other is involved. If the "Three Lights" (Sun, Moon, Stars) can still be perceived, it is treatable; if the Three Lights are completely lost, even if Bodhisattva Nagarjuna were reborn, it would be difficult to reverse. Although ancients established many names, they ultimately do not exceed the distinction between having fluid and lacking fluid. If there is fluid and the luster is crystal clear, it is easy to clarify and treat; if there is no fluid and the color is not bright, it is difficult to treat. Opacities that fluctuate in size, contracting and expanding like steaming vapor, will clear immediately after acupuncture. Those that remain fixed and motionless for a long time are considered dead opacities (irreversible scars); even if the ocular fluids are not exhausted, complete recovery through treatment is difficult. White opacities or those with a bluish tint, or resembling furnace ash or brown rice color, are easy to remove and restore vision. True green or pure yellow opacities are untreatable. Regardless of the color, if the opacity has sharp edges and is difficult to dislodge upon manipulation, or if the opacity shape is broken and scattered, or dense in the center, it cannot be removed by needling alone. If vision is still possible, the opacity is still tender and should not be needled immediately. Wait until the opacity matures before needling. Another condition involves opacities that appear normal and ocular fluids are not depleted, but the eyeball is soft and collapsed; this is definitely untreatable, and golden needles should not be used lightly. If one eye goes blind first and the Three Lights are lost, and subsequently the other eye is affected, it is also difficult to treat with acupuncture. As for the pupil being dilated, constricted, turbid black, or changed in color without opacity, to the point of not seeing the Three Lights, this is due to deficiency of internal Yin fluids and is not within the scope of symptomatic treatment. Ni Zhongxian mentioned syndromes such as Round Cataract (Yuan Yi), Ice Cataract (Bing Yi), Slippery Cataract (Hua Yi), Rough Cataract (Se Yi), Scattered Cataract (San Yi), Floating Cataract (Fu Yi), Sunken Cataract (Chen Yi), Horizontal Cataract (Heng Yi), Date Flower Cataract (Zao Hua Yi), White Opacity with Yellow Center (Bai Yi Huang Xin), Black Water Congealed Cataract (Hei Shui Ning Yi), and Shock-induced Internal Cataract (Jing Zhen Neizhang). These can all be restored to vision by golden needle manipulation. However, for several days after needling, medicines such as Cishi Zhu Wan (Magnetite and Cinabar Pill) for eliminating opacities should be taken, followed by regular intake of formulas that tonify the Kidney and regulate Qi and Blood to assist vision. The shapes of opacities are fully described in *Long Mu Lun* (Dragon Tree Treatise), so I will not repeat them here. I will briefly discuss the manual techniques during needling. The Jiangxi school first washes the eye with cold water to stabilize the opacity, uses an open-blade needle to puncture a point, and then advances a round needle to manipulate the opacity. Some use duck-tongue needles for opening holes and manipulating opacities, claiming it is the true transmission from Nagarjuna. However, the needles are thick and the points large, often causing extreme pain and fainting. My method uses fine and sharp filiform needles, allowing for precise and gentle point selection with no pain. Nevertheless, auspicious days must be chosen, avoiding rainy, windy, cloudy, extremely hot, or extremely cold days. The patient should first eat porridge, not too full, wait a moment, sit upright facing light. An assistant holds the patient's head steady, prohibiting noise. The physician must concentrate, calm their mind, and avoid fear or trembling hands. Use the thumb and index finger of the left hand to hold open the eyelids, directing the eyeball toward the nose, with eyes wide open as if straining. The right hand's thumb, index, and middle fingers twist the golden needle, aiming above the insertion point, carefully targeting the acupoint. From the lateral canthus side, about half a cun away from the cornea (black pearl), level with the pupil, the needle is inserted most conveniently. Accuracy and sufficient force are required; insert in one go, do not wiggle, to prevent patient fear and tension. For monocular blindness, cover the good eye before inserting the needle. After insertion, rest the lower lip against the needle handle, gently move the hand to the end of the handle, and slowly advance by twisting. Lightness is paramount; slight heaviness causes pain. When the needle reaches near the pupil, bend the ring finger to support the base of the thumb, holding the needle handle lightly. Angle the needle tip upward and backward into the space within the pupil, pressing against the inner surface of the opacity and pushing downward. The opacity falls with the movement. If it does not fall, repeat the technique from top to bottom. If it does not drop after three to five attempts, stabilize your intention and gently push again; it will naturally fall. Dead opacities that do not move when manipulated should not be forced. If an opacity falls off and rises again, it should be manipulated again. The opacity is pressed below the cornea by the needle, pause briefly, withdraw the needle slowly by twisting. Patients with deficient Yuan Qi often vomit after needling because the stomach Qi supports the Shen Gao (divine paste/vitreous humor). Prepare sour plums (Wumei) to prevent vomiting. Vomiting may cause the opacity to rise again; if so, re-needle in one or two months. Once the opacity is cleared, do not greedily manipulate excessively, as this damages the Shen Gao and disturbs Stomach Qi. For tender opacities like paste that do not adhere to the needle tip and cannot be pushed down, or that rise and fill the cornea after being pushed down, administer tonifying and opacity-resolving medicines to restore vision naturally. First give Qianjin Cishi Wan (Thousand Golden Magnetite Pill) for seven doses, then combine Zaoying Wan (Soap Pod Pill) with Sheng Shu Dihuang Wan (Raw and Prepared Rehmannia Pills). Otherwise, wait for stabilization before needling; do not limit by time. For some opacities that fall off but are smooth and roll back up after being pressed down, slightly retract the needle tip to pierce the opacity, then press it down; it will naturally stay down. If it does not, resolve it with medication as before. If the eyeball is difficult to rotate inward, needling the medial canthus is effective. This is called Guoliang Needle (Crossing Beam Needle). The point is slightly further than the lateral canthus, and the technique is similar but feels awkward. High nasal bridges make rotation difficult; do not force it. When needling the lateral canthus of the right eye, switch to the left hand to rotate and manipulate the needle; practice this skill daily to avoid errors. After withdrawal, instruct the patient to close their eyes gently. Seal with five to seven layers of cotton paper, depending on thickness and weather temperature. Wrap a few black beans in soft cloth, tie securely to weigh down the eye, preventing eyeball movement. Movement risks the opacity rising again. Thus, patients with coughs are unsuitable for needling. For those with Liver deficiency and frequent tearing, do not use black beans; substitute with Cassia Seed (Juemingzi) to avoid swelling and pressure pain. Adjust tightness or looseness as needed for comfort. Sit quietly for a while after sealing, then gently help them lie down with high pillows. No food is needed initially; if hungry, give a little. Nourish with porridge after a week. Avoid hard foods, physical labor, and excessive talking. Do not expose the eyes to wind; wind causes pain, and pain leads to darkness again. Be cautious. Open the seal after seven days to check vision; avoid visual strain. Some see clearly during needling but not after opening the seal due to root deficiency. Baoyuan Tang and Liuwei Wan (Six-Ingredient Rehmannia Pill) for tonification will restore clarity. If mild cough occurs post-needling and Huangqi (Astragalus) is contraindicated, replace with Shengmai San (Generate the Pulse Powder). For pale and Qi-deficient individuals, use large doses of Renshen (Ginseng) to tonify. For obese individuals with phlegm-dampness, use Liujunzi Tang (Six Gentlemen Decoction) plus Danggui (Angelica Sinensis) and Shaoyao (Peony) to regulate. Within one month, maintain a nutritious diet, avoid toxic substances, shouting, and mental fatigue from face washing. Within 100 days, avoid sexual exertion and anger. For one year, avoid five pungent spices, alcohol, and wheat products. Violating these prohibitions and resulting in blindness is not the physician's fault. If slow technique causes eyeball rotation, damaging the vessels of the sclera (white pearl) with the needle tip and causing bleeding, or injuring wine drinkers with red streaks in the eyes, although minor errors, do not panic. Continue needling according to method, as the saying goes: "Seeing blood, do not be startled, do not stop the hand." If the needle touches the iris (yellow ren) causing blood flooding the pupil, withdraw the needle immediately and administer blood-dispersing medicines, as the saying goes: "Seeing blood, do not needle, must stop the hand." Although the method is thus, can the physician avoid blame? For elderly patients with insecure Wei Qi, if Shen Gao leaks slightly during needling, administer Baoyuan Tang to regulate and tonify. Redness of the sclera upon opening the seal is not surprising; it is due to trapped Qi from sealing. For inexperienced practitioners, measure the distance between the needle point and the pupil, mark the needle with ink to avoid going too shallow or deep. Novices should not test on human eyes; practice on sheep eyes until proficient, then treat humans. The proverb says: "First trial on sheep heads," mastering the appropriate weight and pressure, is the essential method for learning golden needle therapy; do not neglect it because it seems humble.
Method for Making Golden Needles: Use pure red gold (non-brittle), draw into gold wire, thick as a sewing machine needle base, about three cun long. Hammer into needle shape. Use a small smooth iron hammer to slowly file on an anvil, making the tip round like an embroidery needle, but not too thin, as thin wires bend and break easily. If too soft, file again to harden. Do not file aggressively, lest it become brittle and break inside the eye, causing great harm. Gold and silver soften when heated and harden when filed; ensure proper balance of hardness and flexibility. Use hollow, firm, fine慈 bamboo (Cibi Bamboo) three cun long as the handle for lightness and ease of rotation, preventing slipping. Fill the handle with wax, embed most of it, leaving over one cun of the tip exposed. Secure the needle root with silver wrapping to prevent shaking. Protect the needle tip with a silver tube. First rub with Equisetum Herba (Mu Zei Cao) to make it round and sharp, then polish with Sheep Liver Stone (Yang Gan Shi) to make it smooth, ensuring painless skin penetration and thus painless eye entry. After creation, test on sheep eyes to check flexibility and brittleness to avoid mistakes.
Fei Chou treated the mother of painter Wu Wenyu, aged 54, blind for years, unresponsive to various treatments. I saw her and said: This is internal cataract, which can be restored to vision. Why abandon it? She replied: Previously, I could afford medicine, but it was ineffective. Now, even with immortal skills, I lack the means. I said: No cost to you. The opacity in the right eye is still tender; delay six months for manipulation. So, I first needled the left eye. Upon insertion and manipulation, the opacity descended, but the eye remained unclear. After seven days of Cishi Wan, vision was blurry upon opening the seal. Then, Zaoying Wan was administered, and vision gradually clarified. Later, she held her own view that restoring vision to one eye was beyond expectations; treating both might shorten her lifespan, so she refused further treatment of the right eye. While contentment is virtuous, it is indeed foolish.
I also treated Sun Dao, aged 70, vegetarian for over 50 years, blind from internal cataract for four years. Using golden needles, I first needled the left eye. During insertion, there was blood on the outer membrane, and a small amount of vitreous humor leaked upon shallow insertion. Observers were shocked. I proceeded through the blood and humor, manipulated the needle to remove the opacity. Then I needled the right eye. Upon withdrawal, both eyes were clear. I sealed them, using black bean packs to weigh down the eyes. Due to chronic Liver deficiency and tearing, tears soaked the bean pack that night. I did not loosen it, causing right eye pain and vomiting. The next morning, he reported this, and I loosened the binding. First, I used sour plums to stop vomiting, then administered Liuwei Wan to tonify the Liver. Pain ceased, and appetite returned. Upon opening the seal on the seventh day, the right eye's opacity had risen again due to vomiting, covering half the pupil, but vision was clear. I promised to manipulate it again in spring to achieve perfect recovery. However, the leakage of Shen Gao during needling was thick but non-sticky, indicating limited longevity, which I regretted.
I also treated Xu Tianxi, suffering from internal cataract for 15 years. Three years prior, another doctor had needled him, but the opacity rose again multiple times and could not be lowered, so he gave up. His nephew Zhou Gong came, saw me successfully treat Wu Zhihuan's bilateral internal cataract with a single manipulation, and explained the situation. I said: This is Round Cataract. We went together to treat him. The opacity fell but rolled back up. I slightly retracted the needle tip to pierce the opacity. White fluid filled the cornea. I told him: The fluid will clear in seven days. If not, wait for it to solidify before re-needling, so the opacity will not reform. After seven days, vision was restored, though the pupil color was unclear and vision not yet sharp. He was instructed to take more Kidney-tonifying herbs. After three months, vision cleared.
Shen Qianruo, aged 25, suffered from internal cataract for over a year. The opacity was white, moist, and regular, and he could distinguish the Three Lights. I deemed it treatable. However, upon examination, the cornea was unstable, and the eyeball felt soft under the needle. I stopped and did not proceed. I stated: Instability of the cornea indicates Liver deficiency with Wind. Softness of the eyeball indicates instability of Shen Water. I declined treatment. The patient sadly said: I have met Nagarjuna and was promised restoration. If you decline, I will remain in darkness forever. I comforted him: Take medicine for now. Wait until Yuan Qi is sufficient before needling. Later, I heard another doctor, without proper differentiation, attempted needling. The opacity was tough and could not be manipulated, resulting in failure. It seems better not to needle at all.
I also treated Chu merchant Ma Hualong, who had internal cataract for three months. The color was pale green, sclera red and painful headache. Investigating the root, it was caused by sleeping outdoors on a boat, exposing the brain to Wind pathogen. Because the opacity was low, I initially hesitated to needle. Recalling it was caused by Wind, and green hues are associated with Wind/Liver, and the syndrome was recent, it was still treatable. I first prescribed Wind-dispersing herbs, then Liver-clearing herbs. Headache ceased, redness subsided, then I needled. The opacity was difficult to dislodge, requiring slight force to open. Yellow-green sand-like particles appeared in the cornea, seeming difficult to cure. After two months of Kidney-tonifying and Righteousness-nourishing herbs, the opacity color normalized. Re-manipulation restored vision.
Madam Chen Yanxi, He Yuzhao, Li Nenjiu, and Chen Shunyuan all had internal cataracts of long duration, restored to vision with a single manipulation. All took Cishi Wan for opacity resolution, but subsequent regulation varied. Madam Chen had much depression; treatment focused on resolving stagnation and nourishing the Spirit. He Yuzhao was fat, white, and phlegm-heavy; treatment focused on regulating Spleen, leaching dampness, and nourishing the Spirit. Li Nenjiu was mentally overworked and silent; treatment focused on promoting circulation, tonifying Blood, and nourishing the Spirit. Chen Shunyuan drank heavily and had a violent temper. Upon opening the seal, the cornea was red-purple, pupil dilated, and vision seemed less clear than during needling. This indicated Fire excess scorching and pupil scattering; treatment focused on calming Liver, descending Fire, and gathering the Spirit. These cases cannot be exhaustively listed; success depends on clinical adaptation, not rigid adherence to preconceptions.
I also treated Old Woman Zhao with internal cataract. One manipulation caused fluid to flood the cornea, turning both eyes white. After taking opacity-resolving medicine, she could see after one month. This belongs to Baojiang Internal Cataract (Envelope Paste Internal Cataract), which resembles Round Cataract but is distinct. I record this to inform those without experience.