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Fei Chou said: The syndrome of internal cataract (Neizhang) is caused by deficiency of the root and invasion of pathogenic factors. Liver Qi rushes upward and cannot disperse outward, condensing to form the opacity. Therefore, it mostly affects those who are irritable and prone to anger. In the initial stage, there is no pain or itching, vision is slightly dim, or blurred like light smoke and thin fog. Subsequently, black spots are often seen flying in the air, resembling flies moving or ants hanging down. One object appears as two, the pupil gradually changes color, leading to blindness. Initially, only one eye is affected, then the other is involved. If the "Three Lights" (Sun, Moon, Stars) can still be perceived, it is treatable; if the Three Lights are completely lost, even if Bodhisattva Nagarjuna were reborn, it would be difficult to reverse. Although ancients established many names, they ultimately do not exceed the distinction between having fluid and lacking fluid. If there is fluid and the luster is crystal clear, it is easy to clarify and treat; if there is no fluid and the color is not bright, it is difficult to treat. Opacities that fluctuate in size, contracting and expanding like steaming vapor, will clear immediately after acupuncture. Those that remain fixed and motionless for a long time are considered dead opacities (irreversible scars); even if the ocular fluids are not exhausted, complete recovery through treatment is difficult. White opacities or those with a bluish tint, or resembling furnace ash or brown rice color, are easy to remove and restore vision. True green or pure yellow opacities are untreatable. Regardless of the color, if the opacity has sharp edges and is difficult to dislodge upon manipulation, or if the opacity shape is broken and scattered, or dense in the center, it cannot be removed by needling alone. If vision is still possible, the opacity is still tender and should not be needled immediately. Wait until the opacity matures before needling. Another condition involves opacities that appear normal and ocular fluids are not depleted, but the eyeball is soft and collapsed; this is definitely untreatable, and golden needles should not be used lightly. If one eye goes blind first and the Three Lights are lost, and subsequently the other eye is affected, it is also difficult to treat with acupuncture. As for the pupil being dilated, constricted, turbid black, or changed in color without opacity, to the point of not seeing the Three Lights, this is due to deficiency of internal Yin fluids and is not within the scope of symptomatic treatment. Ni Zhongxian mentioned syndromes such as Round Cataract (Yuan Yi), Ice Cataract (Bing Yi), Slippery Cataract (Hua Yi), Rough Cataract (Se Yi), Scattered Cataract (San Yi), Floating Cataract (Fu Yi), Sunken Cataract (Chen Yi), Horizontal Cataract (Heng Yi), Date Flower Cataract (Zao Hua Yi), White Opacity with Yellow Center (Bai Yi Huang Xin), Black Water Congealed Cataract (Hei Shui Ning Yi), and Shock-induced Internal Cataract (Jing Zhen Neizhang). These can all be restored to vision by golden needle manipulation. However, for several days after needling, medicines such as Cishi Zhu Wan (Magnetite and Cinabar Pill) for eliminating opacities should be taken, followed by regular intake of formulas that tonify the Kidney and regulate Qi and Blood to assist vision. The shapes of opacities are fully described in *Long Mu Lun* (Dragon Tree Treatise), so I will not repeat them here. I will briefly discuss the manual techniques during needling. The Jiangxi school first washes the eye with cold water to stabilize the opacity, uses an open-blade needle to puncture a point, and then advances a round needle to manipulate the opacity. Some use duck-tongue needles for opening holes and manipulating opacities, claiming it is the true transmission from Nagarjuna. However, the needles are thick and the points large, often causing extreme pain and fainting. My method uses fine and sharp filiform needles, allowing for precise and gentle point selection with no pain. Nevertheless, auspicious days must be chosen, avoiding rainy, windy, cloudy, extremely hot, or extremely cold days. The patient should first eat porridge, not too full, wait a moment, sit upright facing light. An assistant holds the patient's head steady, prohibiting noise. The physician must concentrate, calm their mind, and avoid fear or trembling hands. Use the thumb and index finger of the left hand to hold open the eyelids, directing the eyeball toward the nose, with eyes wide open as if straining. The right hand's thumb, index, and middle fingers twist the golden needle, aiming above the insertion point, carefully targeting the acupoint. From the lateral canthus side, about half a cun away from the cornea (black pearl), level with the pupil, the needle is inserted most conveniently. Accuracy and sufficient force are required; insert in one go, do not wiggle, to prevent patient fear and tension. For monocular blindness, cover the good eye before inserting the needle. After insertion, rest the lower lip against the needle handle, gently move the hand to the end of the handle, and slowly advance by twisting. Lightness is paramount; slight heaviness causes pain. When the needle reaches near the pupil, bend the ring finger to support the base of the thumb, holding the needle handle lightly. Angle the needle tip upward and backward into the space within the pupil, pressing against the inner surface of the opacity and pushing downward. The opacity falls with the movement. If it does not fall, repeat the technique from top to bottom. If it does not drop after three to five attempts, stabilize your intention and gently push again; it will naturally fall. Dead opacities that do not move when manipulated should not be forced. If an opacity falls off and rises again, it should be manipulated again. The opacity is pressed below the cornea by the needle, pause briefly, withdraw the needle slowly by twisting. Patients with deficient Yuan Qi often vomit after needling because the stomach Qi supports the Shen Gao (divine paste/vitreous humor). Prepare sour plums (Wumei) to prevent vomiting. Vomiting may cause the opacity to rise again; if so, re-needle in one or two months. Once the opacity is cleared, do not greedily manipulate excessively, as this damages the Shen Gao and disturbs Stomach Qi. For tender opacities like paste that do not adhere to the needle tip and cannot be pushed down, or that rise and fill the cornea after being pushed down, administer tonifying and opacity-resolving medicines to restore vision naturally. First give Qianjin Cishi Wan (Thousand Golden Magnetite Pill) for seven doses, then combine Zaoying Wan (Soap Pod Pill) with Sheng Shu Dihuang Wan (Raw and Prepared Rehmannia Pills). Otherwise, wait for stabilization before needling; do not limit by time. For some opacities that fall off but are smooth and roll back up after being pressed down, slightly retract the needle tip to pierce the opacity, then press it down; it will naturally stay down. If it does not, resolve it with medication as before. If the eyeball is difficult to rotate inward, needling the medial canthus is effective. This is called Guoliang Needle (Crossing Beam Needle). The point is slightly further than the lateral canthus, and the technique is similar but feels awkward. High nasal bridges make rotation difficult; do not force it. When needling the lateral canthus of the right eye, switch to the left hand to rotate and manipulate the needle; practice this skill daily to avoid errors. After withdrawal, instruct the patient to close their eyes gently. Seal with five to seven layers of cotton paper, depending on thickness and weather temperature. Wrap a few black beans in soft cloth, tie securely to weigh down the eye, preventing eyeball movement. Movement risks the opacity rising again. Thus, patients with coughs are unsuitable for needling. For those with Liver deficiency and frequent tearing, do not use black beans; substitute with Cassia Seed (Juemingzi) to avoid swelling and pressure pain. Adjust tightness or looseness as needed for comfort. Sit quietly for a while after sealing, then gently help them lie down with high pillows. No food is needed initially; if hungry, give a little. Nourish with porridge after a week. Avoid hard foods, physical labor, and excessive talking. Do not expose the eyes to wind; wind causes pain, and pain leads to darkness again. Be cautious. Open the seal after seven days to check vision; avoid visual strain. Some see clearly during needling but not after opening the seal due to root deficiency. Baoyuan Tang and Liuwei Wan (Six-Ingredient Rehmannia Pill) for tonification will restore clarity. If mild cough occurs post-needling and Huangqi (Astragalus) is contraindicated, replace with Shengmai San (Generate the Pulse Powder). For pale and Qi-deficient individuals, use large doses of Renshen (Ginseng) to tonify. For obese individuals with phlegm-dampness, use Liujunzi Tang (Six Gentlemen Decoction) plus Danggui (Angelica Sinensis) and Shaoyao (Peony) to regulate. Within one month, maintain a nutritious diet, avoid toxic substances, shouting, and mental fatigue from face washing. Within 100 days, avoid sexual exertion and anger. For one year, avoid five pungent spices, alcohol, and wheat products. Violating these prohibitions and resulting in blindness is not the physician's fault. If slow technique causes eyeball rotation, damaging the vessels of the sclera (white pearl) with the needle tip and causing bleeding, or injuring wine drinkers with red streaks in the eyes, although minor errors, do not panic. Continue needling according to method, as the saying goes: "Seeing blood, do not be startled, do not stop the hand." If the needle touches the iris (yellow ren) causing blood flooding the pupil, withdraw the needle immediately and administer blood-dispersing medicines, as the saying goes: "Seeing blood, do not needle, must stop the hand." Although the method is thus, can the physician avoid blame? For elderly patients with insecure Wei Qi, if Shen Gao leaks slightly during needling, administer Baoyuan Tang to regulate and tonify. Redness of the sclera upon opening the seal is not surprising; it is due to trapped Qi from sealing. For inexperienced practitioners, measure the distance between the needle point and the pupil, mark the needle with ink to avoid going too shallow or deep. Novices should not test on human eyes; practice on sheep eyes until proficient, then treat humans. The proverb says: "First trial on sheep heads," mastering the appropriate weight and pressure, is the essential method for learning golden needle therapy; do not neglect it because it seems humble.

Method for Making Golden Needles: Use pure red gold (non-brittle), draw into gold wire, thick as a sewing machine needle base, about three cun long. Hammer into needle shape. Use a small smooth iron hammer to slowly file on an anvil, making the tip round like an embroidery needle, but not too thin, as thin wires bend and break easily. If too soft, file again to harden. Do not file aggressively, lest it become brittle and break inside the eye, causing great harm. Gold and silver soften when heated and harden when filed; ensure proper balance of hardness and flexibility. Use hollow, firm, fine慈 bamboo (Cibi Bamboo) three cun long as the handle for lightness and ease of rotation, preventing slipping. Fill the handle with wax, embed most of it, leaving over one cun of the tip exposed. Secure the needle root with silver wrapping to prevent shaking. Protect the needle tip with a silver tube. First rub with Equisetum Herba (Mu Zei Cao) to make it round and sharp, then polish with Sheep Liver Stone (Yang Gan Shi) to make it smooth, ensuring painless skin penetration and thus painless eye entry. After creation, test on sheep eyes to check flexibility and brittleness to avoid mistakes.

Fei Chou treated the mother of painter Wu Wenyu, aged 54, blind for years, unresponsive to various treatments. I saw her and said: This is internal cataract, which can be restored to vision. Why abandon it? She replied: Previously, I could afford medicine, but it was ineffective. Now, even with immortal skills, I lack the means. I said: No cost to you. The opacity in the right eye is still tender; delay six months for manipulation. So, I first needled the left eye. Upon insertion and manipulation, the opacity descended, but the eye remained unclear. After seven days of Cishi Wan, vision was blurry upon opening the seal. Then, Zaoying Wan was administered, and vision gradually clarified. Later, she held her own view that restoring vision to one eye was beyond expectations; treating both might shorten her lifespan, so she refused further treatment of the right eye. While contentment is virtuous, it is indeed foolish.

I also treated Sun Dao, aged 70, vegetarian for over 50 years, blind from internal cataract for four years. Using golden needles, I first needled the left eye. During insertion, there was blood on the outer membrane, and a small amount of vitreous humor leaked upon shallow insertion. Observers were shocked. I proceeded through the blood and humor, manipulated the needle to remove the opacity. Then I needled the right eye. Upon withdrawal, both eyes were clear. I sealed them, using black bean packs to weigh down the eyes. Due to chronic Liver deficiency and tearing, tears soaked the bean pack that night. I did not loosen it, causing right eye pain and vomiting. The next morning, he reported this, and I loosened the binding. First, I used sour plums to stop vomiting, then administered Liuwei Wan to tonify the Liver. Pain ceased, and appetite returned. Upon opening the seal on the seventh day, the right eye's opacity had risen again due to vomiting, covering half the pupil, but vision was clear. I promised to manipulate it again in spring to achieve perfect recovery. However, the leakage of Shen Gao during needling was thick but non-sticky, indicating limited longevity, which I regretted.

I also treated Xu Tianxi, suffering from internal cataract for 15 years. Three years prior, another doctor had needled him, but the opacity rose again multiple times and could not be lowered, so he gave up. His nephew Zhou Gong came, saw me successfully treat Wu Zhihuan's bilateral internal cataract with a single manipulation, and explained the situation. I said: This is Round Cataract. We went together to treat him. The opacity fell but rolled back up. I slightly retracted the needle tip to pierce the opacity. White fluid filled the cornea. I told him: The fluid will clear in seven days. If not, wait for it to solidify before re-needling, so the opacity will not reform. After seven days, vision was restored, though the pupil color was unclear and vision not yet sharp. He was instructed to take more Kidney-tonifying herbs. After three months, vision cleared.

Shen Qianruo, aged 25, suffered from internal cataract for over a year. The opacity was white, moist, and regular, and he could distinguish the Three Lights. I deemed it treatable. However, upon examination, the cornea was unstable, and the eyeball felt soft under the needle. I stopped and did not proceed. I stated: Instability of the cornea indicates Liver deficiency with Wind. Softness of the eyeball indicates instability of Shen Water. I declined treatment. The patient sadly said: I have met Nagarjuna and was promised restoration. If you decline, I will remain in darkness forever. I comforted him: Take medicine for now. Wait until Yuan Qi is sufficient before needling. Later, I heard another doctor, without proper differentiation, attempted needling. The opacity was tough and could not be manipulated, resulting in failure. It seems better not to needle at all.

I also treated Chu merchant Ma Hualong, who had internal cataract for three months. The color was pale green, sclera red and painful headache. Investigating the root, it was caused by sleeping outdoors on a boat, exposing the brain to Wind pathogen. Because the opacity was low, I initially hesitated to needle. Recalling it was caused by Wind, and green hues are associated with Wind/Liver, and the syndrome was recent, it was still treatable. I first prescribed Wind-dispersing herbs, then Liver-clearing herbs. Headache ceased, redness subsided, then I needled. The opacity was difficult to dislodge, requiring slight force to open. Yellow-green sand-like particles appeared in the cornea, seeming difficult to cure. After two months of Kidney-tonifying and Righteousness-nourishing herbs, the opacity color normalized. Re-manipulation restored vision.

Madam Chen Yanxi, He Yuzhao, Li Nenjiu, and Chen Shunyuan all had internal cataracts of long duration, restored to vision with a single manipulation. All took Cishi Wan for opacity resolution, but subsequent regulation varied. Madam Chen had much depression; treatment focused on resolving stagnation and nourishing the Spirit. He Yuzhao was fat, white, and phlegm-heavy; treatment focused on regulating Spleen, leaching dampness, and nourishing the Spirit. Li Nenjiu was mentally overworked and silent; treatment focused on promoting circulation, tonifying Blood, and nourishing the Spirit. Chen Shunyuan drank heavily and had a violent temper. Upon opening the seal, the cornea was red-purple, pupil dilated, and vision seemed less clear than during needling. This indicated Fire excess scorching and pupil scattering; treatment focused on calming Liver, descending Fire, and gathering the Spirit. These cases cannot be exhaustively listed; success depends on clinical adaptation, not rigid adherence to preconceptions.

I also treated Old Woman Zhao with internal cataract. One manipulation caused fluid to flood the cornea, turning both eyes white. After taking opacity-resolving medicine, she could see after one month. This belongs to Baojiang Internal Cataract (Envelope Paste Internal Cataract), which resembles Round Cataract but is distinct. I record this to inform those without experience.