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The methods of hooking, cutting, needling, and cauterization originated with Hua Tuo. Nowadays, people imitate these methods without recognizing the severity of the disease or distinguishing whether the treatment site is appropriate. Quack doctors treat blindly, arbitrarily inflicting pain on patients. Such reckless actions cause great harm by delaying proper treatment for patients, which is a grave sin. I now intend to elaborate in detail on the appropriateness of sites and conditions for using hooking, cutting, needling, and cauterization, to serve as rules and standards for future learners, hoping to avoid errors from arbitrary treatment, and perhaps offering some minor assistance in clinical practice.

"Hooking" refers to lifting tissue; "cutting" refers to excising lesions; "needling" here does not refer to Bian stones (stone needles), but to needles used for displacing the pupil (Zhenbo Tongshen); "cauterization" refers to the method of hot iron application. These four methods are akin to the penal measures of executing the violent and eliminating rebellion. The key lies in thorough examination and decisive judgment before applying the technique. By first eliminating the major culprit and then addressing accomplices, one ensures that justice is served, preventing innocent people from suffering unjust harassment and stopping violent elements from causing chaos. In terms of therapeutic principles, this is actually a method to open up and drain stagnation, and cleanse away accumulated blood stasis. Only when symptoms are clear and the anatomical part is appropriate can treatment be administered. Treating the branch (symptoms) first and then the root (cause) allows Qi and Blood to settle, preventing the depletion, dryness, and damage of Jing Gao (ocular essence), and avoiding defects or damage to the ocular contours.

Regarding hooking, one must first identify where the skin, flesh, tendons, and vessels are superficial, determining whether hooking is feasible, and treating accordingly. Even the manual force applied should vary according to the severity of the disease. Regarding needling, it must be used for internal cataracts (Nei Zhang), i.e., conditions suitable for needling. One must wait until the duration of the illness is sufficient and the Qi and Blood have stabilized before needling, to avoid errors. One must not act recklessly, causing patients unnecessary pain and inviting ridicule from peers. After needling, medication should be administered based on the condition to treat the root internally, whether tonifying or purging, warming or cooling, according to the specific symptoms. If only the branch is treated without addressing the root, Qi will remain unstable, and the disease will likely recur soon.

Regarding cutting, it can be performed on the Qi Wheel, Blood Wheel, and Flesh Wheel (layers of the eye). However, a large piece of red meat, which is the essence of blood and the manifestation of the Heart, must absolutely not be cut. Mistaken cutting leads to blindness. Injury to the seat of Shen (Spirit) is fatal. For those with wounds prone to wind invasion, or those with deficient Yuan Qi, irritability, and dampness, cutting may lead to ulceration, fistula formation, or ocular atrophy. Conditions such as Panning (Pterygium), Rou Li (Caruncle hypertrophy), Ji Guan Xian Rou (Chicken-comb-like growths), Yu Zi Shi Liu (Fish-egg/Pomegranate-like nodules), Chi Mai Qiu Jin (Red coiled vessels), and Bao Rou Zhan Lun (Palpebral adhesion) are suitable for cutting. If the Wind Wheel (Cornea) is superficial, mistaken cutting will rupture the eyeball and damage vision.

Regarding cauterization, it is only suitable for residual wind causing ulcerative vertigo, sores, damp-heat, and severe, chronic cases that do not heal. Mild cases do not require cauterization and will heal with medication alone. If a red opacity is due to blood-level pathology, cutting must be followed by cauterization to sever the root; otherwise, it will regrow soon. Cauterization should not be used on the Qi-level White Pearl (Sclera/Conjunctiva). On the Black Pearl (Cornea/Iris), both needling and cauterization are contraindicated, as they not only risk rupturing the eyeball but also cause severe pain. For malignant opacities densely covering the Black Pearl, hooking and cutting should be shallow, removing only the superficial red filaments and stasis. For opacities adhering closely to the globe internally, one should slowly apply drops and oral medications, treating patiently until they gradually dissipate. One must not be impatient for quick results.

For conditions like wind-toxicity, flowing toxicity, and blood stasis requiring scissor-cutting, one must examine flexibly, not adhering rigidly to fixed rules. This knowledge must be transmitted orally and taught personally, observed clinically, and cannot be fully described in writing. Generally, the treatments of hooking, cutting, needling, and cauterization yield the fastest results. Although they have the power to restore order from chaos, they are methods of rescuing danger amidst peril, used only as a last resort. They require meticulous care and boldness, ensuring symptoms are clear and sites are appropriate. Combined with internal medication, this achieves the best outcome. If only external symptoms are treated without internal regulation, although there may be immediate benefit, it may become a detriment later. Practitioners of this art must not neglect this warning.