当内外夹攻，方尽其妙。
【钩割针烙说】钩者，钩起之谓。割，割去也。针非砭针之针，乃针拨瞳神
之针。烙即熨烙之烙。此四者，犹斩刈之刑，剪戮凶顽之法也。要在审鞫明而详夺定，然后加刑，先
灭巨魁，次及从恶，则情真罪当，而良善无侵滥之忧，强暴无猖獗之患。在治法，乃开泄郁滞涤除瘀
积之术也。要在证候明而部分当，始可施治，先伐标病，后去本病，则气和血宁，而精膏无伤耗之患，
轮廓无误损之失。如钩，先须识定何处皮肉筋脉浮浅，而手力亦随病轻重行之。如针，先须识定内障
证候可针，岁月已足，气血宁定者方与之，庶无差谬。针后当照证内治其本，或补或泻，各随其证之
所宜。若只治其标，不治其本，则气不定，不久复为害矣。割，如在气、血、肉三轮者可割。而大
一块红肉，乃血之英，心之华也，若误割之则目盲，因神在而伤者死。有割伤因而惹风，及元虚之人，
犯燥湿盛者，溃烂为漏，为目枯丸障。若掩及风轮之重浓者，虽可割，亦宜
轻轻从旁浅浅披起，及诸病如攀睛 肉，鸡冠蚬肉，鱼子石榴，赤脉虬筋，内睥粘轮等证可割。余病
及在风轮之浅者，误割之则珠破而目损。烙能治残风溃弦、疮烂湿热久不愈者。轻则不须烙而治自愈。
若红障血分之病，割去者必须用烙定，否则不久复生。在气分之白者，不须用烙。凡针烙皆不可犯及
乌珠，不惟珠破，亦且甚痛。虽有恶障浓者，钩割亦宜轻轻，浅浅披去外边，其内边障底，只点药缓
伐，久自潜消。若镰割风毒流毒瘀血等证，当以活法审视，不可拘于一定。针瞳神反背，又与内障之
针不同，在心融手巧，轻重得宜，须口传亲见，非笔下之可形容。大抵钩割针烙之治，功效最速，虽
有拨乱反正，乃乘险救危，要在心小而胆大，证的而部当，必兼内治，方尽其术。
当内外兼治时，才能发挥其妙用。
【关于钩、割、针、烙的论述】“钩”，是指将组织钩起的意思。“割”，是指切除的意思。“针”并非砭石之针，而是用于拨正瞳神的针具。“烙”即熨烫灼烧之法。这四种疗法，犹如斩刈刑罚，是剪除凶顽恶疾的手段。关键在于审查清楚、判决明确且决定果断，然后才施加治疗；先消除主要的病灶，再处理次要的从属病变，这样就能做到罪证确凿、处罚得当，使良善无辜者不受侵扰滥伤，让强暴有害之物不再猖獗危害。在治疗方法上，这是开通宣泄郁滞、涤除瘀积的技术。关键在于证候明确且部位准确，才可以实施治疗；先攻伐标病，后去除本病，这样就能使气和血宁，而精膏（眼球内部精华物质）没有损伤耗竭的祸患，眼球轮廓没有误损的过失。
如使用“钩”法，首先必须认清何处皮肉筋脉浮浅，手法力度也要随病情轻重而定。如使用“针”法，首先必须确认内障证候适合针刺，且病程已久、气血安宁稳定者方可施针，这样才不会有差错谬误。针刺之后应当根据证候内服药物调理根本，或补或泻，各随其证候适宜而定。如果只治标不治本，则气机不能安定，不久又会为害。
“割”法，适用于在气轮、血轮、肉轮（指眼睑及周围组织）部位的病变可以施行。但有一大块红肉，那是血的精华、心的荣华表现，如果误割它，会导致失明，因为神气所在之处受伤就会死亡。如果有因割伤而引发风邪，以及元气虚弱之人，犯了燥湿盛行的情况，会出现溃烂形成瘘管，或导致眼球干枯、出现翳障。如果遮蔽到黑睛（风轮）严重的浓重翳障，虽然可以割，也宜轻轻从旁边浅浅地挑起剥离，以及诸种病症如胬肉攀睛、鸡冠蚬肉、鱼子石榴状赘生物、赤脉虬筋、内眦粘连眼轮等证候可以割除。其余病症及在黑睛浅层的，误割会导致眼球破裂而损害视力。
“烙”法能治疗残留的风邪导致的弦急溃烂、疮疡湿热久不愈合者。轻症不需要烙法，治疗即可自愈。如果是红障属于血分的病，割去后必须用烙法固定，否则不久会再生。属于气分的白色翳障，不需要用烙法。凡是针法和烙法都不可触犯乌珠（黑睛），不仅会导致眼球破裂，而且非常疼痛。虽然有恶重的翳障浓重者，钩割也宜轻轻浅浅地挑去外层，其内部的翳障底部，只点药缓慢攻伐，久而久之自然潜消。如果是镰刀割除法治疗风毒、流毒、瘀血等证候，应当以灵活的方法审视，不可拘泥于一定的规则。针拨瞳神反背（晶状体脱位等），又与内障的针刺不同，在于用心融汇、手法灵巧，轻重得宜，必须口传身教、亲眼所见，不是笔头文字可以形容的。大抵钩、割、针、烙的治疗，功效最快，虽然是拨乱反正，乃是乘险救危之举，关键在于心思缜密而胆识过人，证候确切且部位恰当，必须兼用内治法，才能穷尽其技艺。
When internal and external treatments are combined, their efficacy can be fully realized.
[Discussion on Hooking, Cutting, Needling, and Cauterization] "Hooking" refers to the act of lifting tissues with a hook. "Cutting" refers to excision. "Needling" here does not refer to Bian stones (Bian needles), but specifically to needles used for manipulating the pupil (Tongshen). "Cauterization" refers to the method of burning or searing with heat. These four techniques are akin to capital punishment by chopping; they are methods to eliminate fierce and stubborn pathogenic factors. The key lies in thorough examination, clear diagnosis, and decisive judgment before applying treatment. First, eliminate the major culprits (primary lesions), then address the accomplices (secondary lesions). This ensures that the evidence is true and the penalty appropriate, preventing harm to the innocent and stopping the rampant aggression of harmful factors. In terms of therapeutic methods, these are techniques to open up and vent stagnation and to cleanse away blood stasis and accumulation. The prerequisite is that the syndrome differentiation must be clear and the anatomical location accurate before treatment can be administered. By first attacking the branch symptoms (biao) and subsequently removing the root disease (ben), the Qi and Blood will become harmonious and tranquil, sparing the essence and marrow (referring to the internal structures of the eye) from damage or depletion, and avoiding injury to the contours of the eye.
For the "hooking" technique, one must first identify where the skin, flesh, sinews, and vessels are superficial, and the manual force should vary according to the severity of the disease. For the "needling" technique, one must first confirm that the internal cataract syndrome is suitable for needling, that sufficient time has passed, and that the Qi and Blood are stable and calm. Only then should it be performed to avoid errors. After needling, internal treatment should be applied to address the root cause, whether tonifying or reducing, according to the specific syndrome. If only the branch is treated without addressing the root, the Qi will remain unsettled, and harm will recur shortly.
The "cutting" technique can be applied to lesions in the Qi wheel (sclera/conjunctiva), Blood wheel (palpebral conjunctiva/vessels), and Flesh wheel (eyelids). However, a large piece of red tissue represents the essence of blood and the floral manifestation of the Heart; if mistakenly cut, it causes blindness because injury to the seat of the Spirit leads to death. If cutting induces wind pathogens, or if performed on patients with deficient Yuan Qi who are prone to dryness or dampness, it may lead to ulceration forming fistulas, or result in a withered eyeball and opacity formation. If the opacity heavily obscures the Wind Wheel (cornea), although cutting may be considered, it should be done gently, lifting superficially from the side. Other conditions such as pterygium (fleshy growth climbing onto the cornea), chicken-comb-like or clam-meat-like proliferations, fish-roe or pomegranate-seed-like nodules, red coiled vessels, and adhesion of the inner canthus to the globe can also be cut. Lesions other than these, or those shallow on the Wind Wheel, if mistakenly cut, will rupture the eyeball and cause visual impairment.
"Cauterization" treats residual wind causing limbal ulceration and chronic wounds due to damp-heat that do not heal. Mild cases do not require cauterization and will heal with treatment alone. For red opacities belonging to the Blood level, after excision, cauterization must be used to fix the area; otherwise, recurrence is likely. For white opacities belonging to the Qi level, cauterization is unnecessary. Neither needling nor cauterization should touch the Black Pearl (cornea/pupil), as this not only ruptures the eyeball but also causes severe pain. Even for severe, dense opacities, hooking and cutting should be gentle and superficial, removing only the outer layer. The base of the opacity inside should be treated with topical medications for slow reduction, which will gradually dissipate over time. For conditions like wind-toxin, flowing toxin, and blood stasis treated with scissor-like cutting, flexible assessment is required, and rigid adherence to fixed rules is inappropriate. Needling for inverted pupillary axis differs from needling for internal cataracts; it requires mental integration and dexterous hands, with appropriate weight and pressure. This must be transmitted orally and seen personally, as it cannot be fully described in writing. Generally, the therapies of hooking, cutting, needling, and cauterization have the fastest effects. Although they serve to restore order amidst chaos, they are risky emergency measures. They require meticulous caution coupled with boldness, accurate syndrome differentiation, correct anatomical targeting, and must be combined with internal medicine to fully realize their therapeutic potential.