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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.