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Internal cataract (Nei Zhang) refers to the dimness and cloudiness inside the eyeball. Its external appearance is similar to that of a healthy eye, except that there is a faint bluish-white opacity within the pupil (Tong Shen). Lou Quanshan stated: Internal cataract usually affects one eye first, then sequentially involves the other, leading to damage in both eyes. This occurs because an opacity (Yi) inside the cornea (Hei Jing) blocks the pupil. Detailed analysis indicates that the visual pathway (Mu Xi), which connects to the cornea, belongs to the Foot Jueyin Liver Meridian, Foot Taiyin Spleen Meridian, and Hand Shaoyin Heart Meridian. Generally, when the zang organs associated with these three meridians are deficient, pathogenic factors enter due to this deficiency, stagnate within the meridians, and enter the cornea via the visual pathway to form an opacity. The "Brain Fat Flowing Down" mentioned in the *Longmu Lun* refers to pathogenic factors from the Foot Taiyang Bladder Meridian; the "Liver Qi Rushing Upward" refers to pathogenic factors from the Foot Jueyin Liver Meridian. In terms of treatment, acupuncture should target the Shu points of these three meridians. Pharmacologically, one should tonify the middle jiao and unblock the stagnation in these three meridians, preventing pathogens from invading the visual pathway, thereby achieving cure.

Ni Zhongxian said: The Heart is the essence of the five zang organs, and the eyes are its orifice, as well as the orifice of the Liver. The Kidneys govern bones, and the essence of bones transforms into Divine Water (Shen Shui, referring to the clear fluid in the eye). Therefore, if Liver Wood is imbalanced and harbors internal Heart Fire, the fire acts recklessly. Unchecked flaming fire damages the Divine Water, rising upward to cause internal cataract; this is a disease of the five zang organs. The meridians of the Bladder, Small Intestine, Sanjiao, and Gallbladder all ascend around the eyes. If any of these six fu organs declines, the essential qi fails, and pathogenic fire attacks, causing internal cataract upward; this is a disease of the six fu organs. In the initial stage, vision is slightly blurred, often seeing black flowers floating in the air, and the Divine Water appears pale green. Subsequently, diplopia (seeing double) occurs, and the Divine Water becomes pale white. One may administer Chonghe Yangwei Tang (Harmonizing and Stomach-Nourishing Decoction) or Yiqi Congming Tang (Benefiting Qi and Brightening Eyes Decoction). If heat signs are present, combine with Huanglian Yanggan Wan (Coptis and Sheep Liver Pill). If left untreated for a long time, vision is lost completely, the Divine Water turns pure white, resulting in permanent disability.

Internal cataract presents as small bluish-white opacities or larger ones showing slight white opacity. Symptoms include headache, dilated pupils, upper body heat intolerance, dry and difficult defecation. In warm environments, headaches and eye distension worsen, and vision dims further after sunset or in dark places. Treat with Liuwei Wan (Six-Ingredient Rehmannia Pill) added with Maidong (Ophiopogon Tuber) and Wuweizi (Schisandra Berry).

Shiwan stated: For various syndromes of internal cataract, the opacities form inside the black cornea, so they are suitable for treatment by golden needle extraction. After extraction, use nourishing agents to assist vision recovery, such as Liuwei Wan or Cizhu Wan (Magnetite and Cinnabar Pill). For qi deficiency, supplement with Bazhen Tang (Eight-Treasure Decoction) or Shenxiao Huangqi Tang (Miraculous Astragalus Decoction). If the opacity is tender and unsuitable for extraction, only medication should be used. Although treatment methods vary, the general principle revolves around Zaojiao Wan (Gleditsia Sinensis Pill) and Shengshu Dihuang Wan (Raw and Cooked Rehmannia Pill). The differentiation of deficiency/excess and cold/heat, and adjustments for severity, depend on the clinician's flexibility and cannot be fully described in writing. For patients with Yin deficiency of the abdomen and kidneys without any membrane opacity, only true Yin nourishment is appropriate; never mistakenly use anti-opacity drugs. For those with chronic migraines developing opacities over time, use dried snake skin roasted until crisp and powdered, taken one qian per dose with wine infused with fried black beans and three stalks of scallion white, decocted together, removing the scallion before taking with the dregs.

Qingfeng Neizhang Syndrome (Green Wind Internal Cataract): Observation reveals a hazy color inside the pupil, resembling misty mountains on a clear day. Vision remains but is progressively dimmer than usual. Urgent treatment is required to prevent progression to green discoloration, which signifies severe disease and loss of light perception. This condition commonly affects individuals with Yin deficiency and blood insufficiency, or those who overwork mentally, suffer from depression, anger, or excessive mental exertion. It does not occur without the attack of wind-phlegm and head wind. At this critical stage, urgently use Lingyangjiao Tang (Antelope Horn Decoction).

Lvfeng Neizhang Syndrome (Green Wind Internal Cataract - Severe): The pupil is turbid and unclear, colored like yellow clouds covering green peaks or indigo mixed with gamboge. This is a worsening of Qingfeng syndrome. Over time, it may transform into Huangfeng (Yellow Wind). Although caused by head wind, it is also driven by phlegm-dampness attacking, combined with fire stagnation, worry, and anger. Initial symptoms include vertigo, pulling pain in the temples, and pain extending from the pupil to the nose. Red and white spots may appear intermittently, affecting one or both eyes. Heat in the Liver causes onset in the left eye first; heat in the Lung causes the right eye first; simultaneous Liver and Lung pathology causes bilateral onset. Use Lingyangjiao San (Antelope Horn Powder).

Heifeng Neizhang Syndrome (Black Wind Internal Cataract): Similar to Green Wind, but characterized by frequent black spots. This results from Kidney exposure to wind pathogens and heat attacking the eyes. Initially, use 3-4 doses of wind-heat dispelling herbs such as Jingjie (Schizonepeta), Fangfeng (Saposhnikovia), Qianghuo (Notopterygium), Muzei (Equisetum), Jili (Tribulus), and Ganju (Chrysanthemum). Follow up with Bushen Cishi Wan (Kidney-Nourishing Magnetite Pill).

Huangfeng Neizhang Syndrome (Yellow Wind Internal Cataract): The pupil is significantly dilated and turbid with a yellow hue. At this stage, the prognosis is fatal for almost all patients.

Yinfeng Neizhang Syndrome (Silver Wind Internal Cataract): The pupil is fully dilated into a single patch, white as silver. This condition typically affects individuals with head wind and phlegm-fire who suffer from suppressed anger and depression, damaging true qi. It is a stubborn disease; no elixir can restore vision.

Sifeng Neizhang Syndrome (Silk Wind Internal Cataract): Inside the pupil, a faint line is visible horizontally or diagonally. Objects appear fragmented. This is due to wind attacking the collaterals, obstructing true qi, and diminishing visual clarity. Use Liuwei Wan added with Xixin (Asarum) and Baijili (White Tribulus). Intermittently administer Zaojiao Wan. Delay leads to worsening and deep internal pathology.

Wufeng Neizhang Syndrome (Black/Dark Wind Internal Cataract): The color is turbid and stagnant, like thick smoke in evening rain. It affects individuals with wind-phlegm constitutions and excessive desires, leading to damaged blood and essence, injured Kidney collaterals, depleted bile, exhausted true qi, and fallen divine light.

Yanyue Neizhang Syndrome (Reclining Moon Internal Cataract): A faint bay of white gas appears in the upper half of the pupil, resembling a new moon hanging down. This is a precursor sign of internal cataract formation. Once formed, it resembles a silver opacity. It occurs in patients with nasal discharge (brain leakage) or brain wind-cold with Yin stagnation. First use Xiongxin Tang (Ligusticum and Asarum Decoction), then Xiao Neizhang Wan (Eliminate Internal Cataract Pill). Note: This differs from Yanyue Qinjing (Reclining Moon Invading Cornea), which originates from the sclera/cornea membrane.

Yangyue Neizhang Syndrome (Upright Moon Internal Cataract): A faint bay of white gas appears in the lower half of the pupil, resembling a new moon rising from below. Over time, it fills the pupil, becoming a silver-like internal cataract. This is due to water (Kidney Yin) insufficiency, failing to nourish wood (Liver), leading to excess metal (Lung Qi) and fluid depletion. Fire stagnates in the collaterals. Select Bushen Wan (Kidney-Nourishing Pill) or Bushen Cishi Wan.

Ruyin Neizhang Syndrome (Like-Silver Internal Cataract): The pupil is white as silver. Mild cases show a bright white spot like a star; severe cases involve total whiteness. Also known as Yuanyi (Round Opacity). Some evolve from Yangyue/Yanyue into round opacities, starting as a central point that enlarges causing blindness. This is caused by cold-dampness in the brain obstructing qi, blocking sunlight manifestation. Unlike Yinfeng where dilation is irreversible, if qi and blood are not yet exhausted, extraction may be attempted. First take Lingyang Bugan San (Antelope Horn Liver-Nourishing Powder), then Bushen Wan. There is hope for vision recovery.

Rujin Neizhang Syndrome (Like-Gold Internal Cataract): The pupil size is normal, but yellow and bright. This is caused by damp-heat damaging yuan qi, leading to phlegm-damp and yin-fire aggression changing the color. Unlike Huangfeng which is dilated and incurable, this is treatable. Use Shensan San, Zaojiao Wan, or Lingyang Bugan San.

Lvying Tongshen Syndrome (Green Reflection in Pupil): The pupil looks normal at first glance, but careful observation reveals a faint green hue deep inside. Self-perception gradually dims. Severe cases show deep green. This is due to phlegm-fire and damp-heat harming pure qi. First take Huanglian Yanggan Wan, then Bushen Cishi Wan or Zaojiao Wan. Untreated, it may become Rujin or Qingmang (Green Blindness). Note: If red light reflects on the pupil making it look green to others but the patient sees clearly, it is merely reflection, not Green Wind. True Lvying syndrome presents with dimness and green hue regardless of lighting conditions, indicating turbid qi.

Yunwu Yijing Syndrome (Clouds and Mist Moving in the Eye): Patients see flies, falling flowers, banners, or chaotic colors (blue, yellow, black, white) moving in the air, shifting direction with gaze. This is caused by depletion and stagnation of fluids in the collaterals, obstructing pure qi. The root lies in the Gallbladder and Kidneys. Black floaters indicate Gallbladder/Kidney pathology; treat with Bushen Cishi Wan. White or yellow floaters indicate phlegm-fire damaging Lung/Spleen pure qi; treat with Zaojiao Wan.

Yuanyi Neizhang Syndrome (Round Opacity Internal Cataract): A round opacity on the cornea. Early stages present as seeing flies, ants, thin smoke, or light fog. Starts in one eye, spreading to the other. Resembles oil droplets in water: appearing smaller in daylight and larger in shade. Vision fluctuates between clear and dim. Misdiagnosis as cold-pathogen and treatment with cold herbs may worsen symptoms (increased black spots). This is caused by dual deficiency of Liver and Kidney. First use Zaojiao Wan combined with Shengshu Dihuang Wan, followed by Lingyang Bugan San and Bushen Wan.

Bingyi Neizhang Syndrome (Ice Opacity Internal Cataract): Hard and solid like ice, visible through the pupil from the side. Shape remains constant in shade or sunlight. Accompanied by pain and tearing. Caused by Gallbladder heat attacking the brain. Use Zaojiao Wan combined with Shengshu Dihuang Wan.

Huayi Neizhang Syndrome (Slippery Opacity Internal Cataract): Resembles mercury beads, slightly yellowish. No pain or tearing. Surrounds the pupil. Use Zaojiao Wan and Shengshu Dihuang Wan.

Se Yi Neizhang Syndrome (Astringent Opacity Internal Cataract): Slightly reddish, aggregating or dispersing, with peripheral light. Coagulated fat-like color on the pupil. Intermittent aching pain without tearing. Use Zaojiao Wan and Shengshu Dihuang Wan.

Sanyi Neizhang Syndrome (Scattered Opacity Internal Cataract): Shape like scales, alternating blue and white. May have millet-like eruptions under eyelids. Day and night pain, severe pupil pain, hot tears. Or scattered opacity like rotting cotton. Use Zaojiao Wan and Shengshu Dihuang Wan.

Fuyi Neizhang Syndrome (Floating Opacity Internal Cataract): Upper part like ice sheen, white ring surrounding the pupil. Visible upon close inspection from the inner canthus to the cornea. No itching or pain, no blood mixing. Use Zaojiao Wan and Shengshu Dihuang Wan.

Chenyi Neizhang Syndrome (Sunken Opacity Internal Cataract): White hidden beneath the aqueous humor, visible only when looking closely at sunlight. Pain may alternate between eyes, worse at night. Occasional tearing. Use Zaojiao Wan and Shengshu Dihuang Wan. Of the seven syndromes below Yuanyi, although treatments exist, efficacy is low; golden needle extraction is superior.

Yanyue Qinjing Syndrome (Reclining Moon Invading Cornea): Faint white patches at the junction of the wind wheel (cornea) and qi wheel (sclera), thin and pinkish-blue, originating from the membrane. Harm develops slowly and is often ignored. Caused by wind-damp stagnation in the brain, with fire driving brain fat to drip down. Use Lingyang Bugan San.

Jianji Yi Syndrome (Sword Ridge Opacity): Also called Hengyi (Horizontal Opacity). Color white, rough rice-colored, or slightly scorched yellow. Shape like a sword ridge, high center, thin edges, sharp tip, horizontal across the cornea. Thickness varies. Thick opacities cover the pupil entirely, obscuring vision. Thin opacities also obscure vision, causing blurriness. Even if tender and superficial, scars remain. If covered by fine red vessels, removal is difficult and requires prolonged treatment. Use Zaojiao Wan and Shengshu Dihuang Wan.

Zaohua Zhang Syndrome (Date Blossom Obstruction): Very thin and white, arising from the cornea, spreading from the inner white membrane. Despite the name "date blossom sawtooth," it has no fixed shape. Early symptoms include mild vertigo, eye darkness, itching, and pain. Common in irritable individuals or those with phlegm-fire, alcohol injury, or damp-heat. Long-term effects include eye urgency, dryness, blurriness. Neglect leads to constricted pupil, fire entering blood level, dimness, tearing, and red pain. Consider a complication. Use Zaojiao Wan and Shengshu Dihuang Wan.

Baiyi Huangxin Syndrome (White Opacity Yellow Center): White edges with a yellow center, slightly red at the poles, intermittent astringent tearing, circular on the cornea. Caused by transmission between Spleen and Lung, retaining wind-heat. Use Zaojiao Wan combined with Shengshu Dihuang Wan.

Heihua Yi Syndrome (Black Flower Opacity): Also known as Heishui Ningyi (Black Water Coagulated Opacity). Early symptoms: vertigo, dry eyes, seeing yellow/black flowers. Opacity coagulates blue-green, painful poles, frequent tearing, bitter taste, poor appetite. Caused by Liver exposure to wind-cold. Use Lingyangjiao San, Zaojiao Wan, and Shengshu Dihuang Wan.

Wufeng Biancheng Neizhang Syndrome (Five Winds Transforming into Internal Cataract): Early symptoms: vertigo, swelling, severe pain. Starts in one eye or both eyes darken after vomiting. Pupil turns white like frost, no tearing. Caused by toxic wind and brain heat. First use Chufeng Tang (Dispel Wind Decoction), then Zaojiao Wan and Shengshu Dihuang Wan.