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The method of opening and guiding (Kai Dao). This is established for conditions characterized by Yin deficiency with flourishing fire, and stagnation in the meridians preventing smooth flow. There are five operative sites: Yingxiang (LI20), the inner canthus (Nei Pi), Shangxing (GV23), the sides of the ears, and the two Taiyang acupoints. The inner canthus serves as the vanguard of a frontal assault; although its effect is slow, it gradually achieves results smoothly. The two Taiyang points attack the flanks of the enemy; their efficacy is secondary. Shangxing cuts off the enemy's supply lines. The inner Yingxiang strikes directly at the enemy's nest; while success is rapid, it involves a risky advance. The area around the ears targets the enemy's cavalry on the move; the distance is far and the merit is low, so wise practitioners do not adopt this. This is indeed an excellent technique for extremely critical conditions and a key mechanism to挫败 (defeat) the pathogen. Rather than closing the door to catch thieves, it is better to open the door to drive them out. If the disease is mild and the healthy Qi is sufficient to overcome the pathogen, internal treatment will naturally cause the pathogen to recede. However, if the heat of the six Yang channels is blazing, it is preferable to use the opening and guiding method to promote unobstructed flow. Even if some injury occurs, subsequent internal medication can tonify the deficiencies, thereby avoiding the risk of extreme stagnation leading to ulceration, dryness, or protrusion.

Diseases have internal and external aspects, and treatments differ accordingly. If an internal disease has formed but there are no external signs, what benefit is there in pricking? If red threads and crimson vessels appear externally, if they are newly emerged, they represent minor pathogens; after receding, they represent residual pathogens. Pricking can eliminate them, and taking medication yields even better results. If the internal pathology is flourishing but only external pricking is employed without internal treatment, not only will the pricking be futile, but it may also provoke the disease. When both internal diseases have formed and external symptoms are visible, simultaneous internal and external attacks—combining pricking and medication—are necessary. Unfortunately, many people are stubbornly foolish: some prefer medication but fear pricking, while others prefer pricking but fear medication. They fail to realize that once internal manifestations arise, they cannot be eliminated without medication; once external ailments form, they cannot recede without pricking. For external obstructions, if only medication is taken without pricking during the initial stage when the condition is floating, tender, and unstable, it may still recede. However, once nodules have formed, medication may prevent further growth but cannot remove the existing nodules; in such cases, internal and external combined therapy is required to achieve optimal efficacy.

The four methods of hooking, cutting, needling, and cauterizing are akin to execution by chopping and weeding, serving as methods to eliminate fierce and obstinate pathogens. For hooking, one must first identify the location, assessing whether the skin, flesh, sinews, and vessels are superficial, and adjusting manual force according to the severity of the disease. For needling, one must first confirm that the internal obstruction syndrome is suitable for needling, that the duration of the disease is sufficient, and that Qi and Blood are stable before proceeding, thus avoiding errors. After needling, the root cause should be treated internally according to the syndrome, either by tonifying or reducing, as appropriate. If only the branch symptoms are treated without addressing the root, Qi will remain unsettled, and harm will recur shortly. For cutting, incisions may be made in the three wheels of Qi, Blood, and Flesh. However, a large piece of red flesh represents the essence of blood and the brilliance of the Heart; accidental cutting here causes blindness, and severe injury leads to death. If wind pathogens invade due to cutting wounds, it may result in dryness, ulceration, fistulas, or ocular atrophy. Cutting is permissible when opacities heavily cover the Wind Wheel (cornea/pupil area), such as in pterygium, chicken-comb fleshy growths, fish-roe or pomegranate-like opacities, crimson veins like twisted tendons, and eyelid adhesion to the globe. Whenever hooking or cutting produces bleeding, or needling damages blood vessels, cotton soaked in ink should be used to stop the bleeding. Accidental cutting of other lesions or those shallow on the Wind Wheel will rupture the eyeball and damage vision. Cauterization treats residual wind causing ulceration and vertigo, as well as chronic ulcers and damp-heat. Mild cases heal spontaneously without cauterization. Red opacities belonging to the Blood level must be cauterized after excision, otherwise they will regrow quickly. White opacities belonging to the Qi level do not require cauterization. Neither needling nor cauterization should infringe upon the Black Pearl (pupil/cornea). Even with severe opacities, hooking and cutting should be gentle and shallow, removing only the outer layers; the base of the opacity on the inner side should be slowly dissipated using topical medications over time. For conditions involving wind-toxicity, flowing toxicity, or stasis requiring scissor-cutting, flexible assessment is necessary, and rigid adherence to fixed rules should be avoided. Needling the pupil resulting in whitening, and all internal obstructions, depend on mental integration and manual dexterity, with appropriate weight and pressure. These skills must be transmitted orally and demonstrated visually; they cannot be fully described in writing.