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Ancient texts discuss internal cataracts, mentioning large round cataracts (Da Yuan Yi) and small round cataracts (Xiao Yuan Yi). Humans inherit the prenatal essence from their parents, resulting in variations in pupil size. Those with larger pupils tend to develop larger cataracts, while those with smaller pupils develop smaller ones. This condition arises when brain lipid flows downward and condenses over years to form an opacity. When physicians use acupuncture needles for treatment, the depth must be appropriate: if the cataract is large but the needle insertion is shallow, the opacity will not detach; if the cataract is small but the needle insertion is too deep, it may damage the eyeball. Physicians must exercise extreme caution to avoid misdiagnosis and mistreatment!

When performing "Lian Xi" (a traditional ophthalmic external therapy), one must consult the daily location of the "Ren Shen" (vital spirit) in the meridians and avoid using knives or needles on those specific meridians.

If the cataract recurs after subsiding, one should soothe the Liver Qi and regulate the flow of Qi, which will naturally cause the opacity to detach. If it does not detach, re-acupuncture may be performed.

After needling, Chuanxiong Rhizome (Chuanxiong) should be avoided as its blood-invigorating properties may induce pain. If pain occurs, prepared Rehmannia Root (Shu Di Huang), Angelica Sinensis Radix (Dang Gui), and White Peony Root (Bai Shao) may be used.

If the pupil is clear but the sclera (white part of the eye) is red, use Mulberry Cortex (Sang Bai Pi), Saposhnikovia Root (Fang Feng), Bupleurum Root (Chai Hu), and Red Peony Root (Chi Shao).

If there is oily turbidity within the pupil, soothe the Liver Qi using Bupleurum Root (Chai Hu) and Aurantium Fructus (Zhi Ke).

For nausea, use Agastache Herba (Huo Xiang), Magnolia Bark (Hou Po), Pinellia Tuber (Ban Xia), and Fermented Soybean (Dan Dou Chi).

For headache or Taiyang meridian pain, use Saposhnikovia Root (Fang Feng), Angelica Dahurica Root (Bai Zhi), Notopterygium Rhizome (Qiang Huo), and Gypsum Fibrosum (Shi Gao).

For severe Taiyang pain, apply hot stir-fried salt as a compress.

For red sclera, use Bupleurum Root (Chai Hu), Carthamus Flower (Hong Hua), Red Peony Root (Chi Shao), Angelica Sinensis Tail (Gui Wei), Peach Kernel (Tao Ren), and Mulberry Cortex (Sang Bai Pi).

For dilated pupils, use White Peony Root (Bai Shao), Poria Sclerotium (Fu Shen), Ginseng Radix (Ren Shen), Ophiopogon Tuber (Mai Dong), Angelica Sinensis Radix (Dang Gui), Ziziphus Seed (Suan Zao Ren), and Schisandra Fruit (Wu Wei Zi).

For cases where heat causes pupil constriction, use Angelica Sinensis Radix (Dang Gui), Chuanxiong Rhizome (Chuanxiong), Coptis Rhizome (Huang Lian), Ophiopogon Tuber (Mai Dong), Leonurus Fruit (Chong Wei Zi), Bupleurum Root (Chai Hu), and Gardenia Fruit (Shan Zhi).

[Large Round Cataract] This syndrome initially stems from Kidney Water deficiency, followed by Liver injury due to anger. The eyes are related to the Zang-Fu organs, with the Liver and Kidneys as the root. The Kidney is the source of water, and the eyes are the essence of water. Excessive sexual activity weakens Kidney Water, failing to nourish Liver Wood and the eyeballs. Additionally, violent anger causes heat from the heart and chest to rush upward into the brain, destabilizing brain lipids, which then flow down to the eyes, condensing and covering the pupil to form an internal cataract. Initially, patients see floating spots like flies or thin mist/smoke, without pain, gradually losing vision, starting in one eye and potentially spreading to the other. The lipid appears blue-white. Inherited from parental essence, those with larger pupils develop larger opacities, hence the name "Large Round Cataract." It appears larger when viewed in shade and smaller in sunlight. Early treatment should involve Chonghe Yangwei Decoction (Chai Hu, Dang Gui, Bai Shao, Gan Cao, Ge Gen, Ren Shen, Huang Qin, Bai Zhu, Wu Wei Zi, Qiang Huo, Fang Feng, Fu Ling; add Huang Lian and Huang Qin if thirsty) and Shihu Yeguang Pill (Ren Shen, Shan Yao, Niu Xi, Tu Si Zi, Wu Wei Zi, Mai Men Dong, Ling Yang Jiao, Rou Cong Rong, Chuan Xiong, Sheng Di, Tian Men Dong, Bai Ji Li, Gou Qi Zi, Qing Xiang Zi, Jue Ming Zi, Xing Ren, Shi Hu, Zhi Ke, Xi Jiao, Fu Ling, Gan Cao, Fang Feng, Huang Lian). For long-standing cases, gold needle extraction is indicated.

[Small Round Cataract] This syndrome shares the same etiology as the Large Round Cataract. Both result from desire and anger injuring the Liver and Kidneys, causing heat to rush upward and brain lipids to flow down, forming a blue-white opacity covering the pupil. The pupil's divine water connects to the Gallbladder. When Zang-Fu organs are harmonious and Qi and Blood circulate smoothly, bile flows upward, enabling clear vision. However, Liver and Kidney injury prevents this flow, causing lipid condensation. Named "Small Round Cataract" because inherited smaller pupils result in smaller opacities. Patients may see light sources (Three Lights) but cannot distinguish objects. Early treatment involves Chonghe Yangwei Decoction and Shihu Yeguang Pill. Long-standing cases require mouse-tail shaped gold needle extraction.

[Floating Internal Cataract] Initially caused by excessive sexual activity depleting Kidney Water, leading to Water deficiency and Fire hyperactivity attacking the eyes. Vision becomes blurry like looking through fog/mist, without pain. Gradually, emotional stagnation and liver injury from lust cause heat to rush to the brain, infusing brain lipids into the eye, forming a bright, silver-foil-like opacity floating on the pupil. Starts in one eye, spreads later, blocking the Three Lights. Difficult to extract with gold needle. Early treatment: Tonify Kidney and soothe Liver (same as above).

[Sinking Internal Cataract] Caused by Kidney Meridian deficiency and excess Fire in Liver and Heart, leading to blurry vision and frequent black spots. Malignant Qi from the brain gradually invades the pupil. After 2-3 years, a blue-white opacity forms, appearing as if sinking in water. If the Three Lights are still visible, needle extraction is suitable (treatment same as above).

[Astringent Internal Cataract] Caused by lust injuring the Kidney and anger injuring the Liver, damaging both and depleting the source of Qi and Blood production. Qi and Blood become weak, failing to nourish the eyes. Over time, pathogenic heat rises, and brain lipids flow down, forming a large, yellow, stagnant opacity without contraction ability, hence "Astringent Cataract." Early treatment is similar; long-term cases should not undergo needle extraction.

[Slippery Internal Cataract] Caused by dual deficiency of Liver and Kidney, allowing brain lipids to infuse the eyeball, resembling mercury beads that move and absorb unpredictably. No pain or itch, only blurry vision. Spreads over time, causing gradual blindness. Though Three Lights may be seen, objects cannot be distinguished. Treatment is the same. For long-standing cases, lotus-seed shaped gold needle extraction is used.

[Scattered Internal Cataract] Caused by five Zang organs' deficiency and exhaustion, excessive alcohol and sex, plus worry and anger causing Liver Qi to rush upward. Malignant brain Qi flows down, condensing before the pupil into an opacity of varying density and yellow-white color, scattered and lacking contraction. Though Three Lights may be seen, needle extraction is contraindicated as it is incurable.

[Ice Internal Cataract] Caused by Liver and Kidney deficiency, with Wind and Fire rising, stirring phlegm. Symptoms include dizziness, facial pain, temporal/forehead pain, red and gritty eyes, variable colors (yellow, white, black), or seeing fireflies at night. Eventually, an internal cataract forms, with lipids resembling melting ice or broken porcelain. Early treatment: Dispel Wind and Phlegm using Banxia Baizhu Tianma Decoction (Ren Shen, Bai Zhu, Ban Xia, Tian Ma, Gan Jiang, Chen Pi, Shen Qu, Ze Xie, Cang Zhu, Mai Dong, Huang Qin, Huang Bo, Huang Qin) and Shenxiao Bugan Powder (Xiakucao, Xiangfu each 2 liang, Gan Cao 4 qian, powdered; take 3 qian with tea). Needle extraction is contraindicated.

[Venus Star Internal Cataract] Initial symptoms include headache, slight facial swelling, red eyes, chaotic black spots, and gradually dimming/constricting pupils containing gold-foil-like brain lipids. Contraindicated for needle extraction and incurable. Caused by Water deficiency and Fire excess. Normally Water controls Fire, but Water deficiency allows Fire to dominate, intensifying Fire and depleting Water. Early treatment focuses on nourishing and cooling Blood, tonifying Kidney, and clearing Fire. This is considered very difficult to treat.

[Horizontal Sword Internal Cataract] Caused by Liver and Kidney depletion and unregulated sexual activity, leading to dimness without pain or itch. Starts in one eye, spreads to both. Resembles a sword across the pupil. Though Three Lights are visible, needle extraction is contraindicated. Early treatment: Shihu Yeguang Pill.

[Jujube Flower Internal Cataract] Caused by Liver and Kidney insufficiency, Water deficiency, and Fire excess. Symptoms include headache, dizziness, flying flowers of varying colors, and serrated pupil margins. Early mild dimness allows vision. Treatment: Chonghe Yangwei Decoction and Shihu Yeguang Pill, removing Wu Wei Zi and adding Chong Wei Zi as the chief herb. If a blue star appears internally after a long time, it is incurable and cannot be extracted.

[Crescent Moon Internal Cataract] Caused by Liver deficiency and Kidney damage, with deficient Fire rising, causing brain lipids to flow down and cover the pupil, turning white like the crescent moon (half thin/thick, half bright/dark). Starts in one eye, spreads, damaging both pupils. Needle extraction is contraindicated.

[Startle/Vibration Internal Cataract] Caused by Liver and Kidney deficiency/exhaustion, combined with physical trauma startling brain lipids downward, causing gradual blurring and whitening. May enter the Liver Meridian from below or dissipate with the startle. Pupils lack contraction; though Three Lights are visible, needle extraction is contraindicated. Treatment follows Round Cataract protocols.

[Thunder Head Wind Internal Cataract] Initial symptoms: headache, cold feet, nausea/vomiting, thunderous sensation in the head, dilated pupils, gradual blindness, loss of Three Lights. Caused by violent anger injuring the Liver, weak constitution, invasion of Wind-Cold, rebellion in San Jiao, and attacking the head. As the head is the meeting point of all Yang meridians, evil and righteous Qi struggle, remaining trapped, causing thunder-like pain. Stomach invaded by cold causes nausea/vomiting. Pupil's divine water is gathered Qi; anger scatters Qi, preventing gathering. Early urgent treatment: Fuzi Zhuling Decoction (Ren Shen, Bai Shao, Bai Fu Ling, Qiang Huo, Shu Di, Zhu Ling, Shu Fu Zi), Xiangxiong Powder (Chuan Xiong, Shi Gao, Xiang Fu, Bo He, Bai Zhi, Chuan Wu, Gan Cao, powdered; take 2 qian), and Shihu Yeguang Pill (double Wu Wei Zi) to gather dilated pupils. For extreme pain, blow Rushing Ding Tong San (Ru Xiang, Mo Yao, Xiong Huang, Shi Gao, Chuan Xiong each 5 qian, Yan Xiao 1.5 fen, finely powdered; sniff with water) into the nose. Long-term cases are incurable.

[Green Wind Internal Cataract] Initial symptoms: urgent forehead/hemicranial pain, smoky sensation in nose, nausea/vomiting, cold feet, red-black vision, gradually dilated pupils, pale green divine water. Etiology resembles Thunder Head Wind but is triggered by extreme anger/headache causing heat to rush up, mixing malignant brain Qi with divine water to turn green. Long-term loss of Three Lights is incurable. Early treatment: Stop pain with Fuzi Zhuling Decoction, then Chonghe Decoction, and modified Yeguang Pill (remove Rou Cong Rong, double Wu Wei Zi).

[Yellow Wind Internal Cataract] Initial headache due to Liver/Kidney deficiency, Wind-Toxin invasion, and Spleen/Lung heat accumulation. Sclera turns yellow. Often evolves from Green Wind Internal Cataract where vomiting damages the Stomach. Long-term yellowing is incurable.

[Black Wind Internal Cataract] Caused by excessive lust damaging Yuan Qi. Qi deficiency leads to Hyperactive Heart Fire, causing frequent black spots, soreness in eye sockets/nose/eyebrows, raised green bean-like spots on sclera, and gradually constricting pupils with unclear vision. Pupil belongs to Kidney Water; normally Water controls Fire, but here Fire dominates, causing dimness and constriction. Fire insults Lung Metal (sclera), causing stagnant protective fluid, uneven sclera, flying flowers, and soreness due to stifled Fire and Blood deficiency with Wind. Early treatment: Shenxiao Bugan Powder and Xuanqi Tang (Chen Pi, Ban Xia, Gan Cao, Qiang Huo, Bai Fu Ling, Huang Qin, Fang Ji, Ginger; decoct) to scatter Wind and nourish Blood. Later: Buzhong Yiqi Decoction and Shihu Yeguang Pill to tonify Qi and Yin. Loss of Three Lights is incurable.

[Black Wind Internal Cataract - Variant] Caused by weak Qi, Liver/Kidney insufficiency, emotional stagnation, and excess Evil Fire rushing to head/eyes. Symptoms: dizziness, headache, gritty eyes, black spots, gradually dilating pupils leading to blindness. Pupil is formed by gathered Qi; Fire excess scatters Qi, causing blindness. Incurable.

[Five Winds Changing Internal Cataract] Caused by dual Qi/Blood deficiency, Zang-Fu exhaustion, toxic Wind attacking upward, and brain heat invasion. Symptoms: dizziness, headache, vomiting, leading to blindness. Incurable.

[Dilated Pupil Internal Cataract] Caused by Liver/Kidney deficiency; anger injures Liver, fear injures Kidney. Pupil belongs to Kidney and gathers Qi; anger scatters Qi. Early symptoms: blurry vision like walking in fog, black spots in air, diplopia, eventually irretractable, becoming a disability. Divine water gradually disperses completely. Early treatment: Chonghe Decoction, Yeguang Pill (remove Rou Cong Rong, double Wu Wei Zi) to gather. Once slight light returns, combine with Qianjin Cizhu Wan (Magnetite treated with vinegar 7 times, dried, powdered 2 liang; Cinnabar powder 2 liang; raw Shen Qu 3 liang; mix with water to make cakes, boil until floating; mix with previous powders and honey into pill size of paulownia seeds; take 10-30 pills empty stomach with rice soup. Effect: looks down unseen, looks up sees Three Lights. Take empty stomach, then Shihu Yeguang Pill at noon). This is a sedative for deficiency; do not take early to avoid damaging Yuan Qi. For Qi scattered by anger: Yiyin Shenqi Wan (Shu Di, Shan Yao, Shan Yu Rou, Sheng Di, Bai Fu Ling, Mu Dan Pi, Ze Xie, Wu Wei Zi, Dang Gui, Chai Hu, honey pills, Cinnabar coating; take 5-7 pills empty stomach with light salt water). This strengthens Water to control Fire. Must combine with Cizhu Wan for efficacy. Trauma causing divine water dispersion is incurable.

[Tightly Constricted Pupil Internal Cataract] Caused by weak Kidney Water and strong Minister Fire. Water weakness allows Fire dominance, causing gradual pupil constriction. Pupil is Kidney Water. Early stage has no pain/itch/discharge, only a sense of tightness, irregular pupil margin, and green-yellow Liver water. Treatment: Huan Yin Jiu Ku Tang (Chuan Xiong, Gan Cao, Huang Bo, Jie Geng, Chai Hu, Fang Feng, Qiang Huo, Huang Lian, Zhi Mu, Huang Qin, Hong Hua, Sheng Di, Long Dan Cao, Dang Gui Wei, Lian Qiao, Sheng Ma, Xi Xin, Cang Zhu, Cao Ben; decoct in water) to suppress Minister Fire. Yeguang Pill tonifies Kidney and strengthens Water (remove Wu Wei Zi, add Chong Wei Zi to avoid excessive astringency). If unregulated diet/lifestyle continues, sudden brow bone pain may lead to pupil shrinking to seed size with internal lipid condensation (yellow/white), permanently incurable.

[Pediatric Prenatal Internal Cataract] Caused by maternal anger/fear during pregnancy, improper diet/care, consumption of wheat, five pungents, roasted foods, and toxic elixirs, accumulating heat in abdomen, attacking fetal eyes. Infants aged 2-3 show no speech/crying/gaze. Parents notice later; diagnosed as internal cataract with blue-white opacity covering pupil. If Three Lights can be distinguished, gold needle extraction may work. Generally, pediatric internal cataracts are difficult to treat.

The Classics state: The eyes are the brilliance of the five Zang and six Fu organs, the essence of Ying-Wei, Hun, and Po. All meridians connect to the eyes; eyes see when nourished by Blood. Thus, Zang-Fu essence ascends to the eyes. Sclera belongs to Lung, cornea to Liver, pupil to Kidney, eyelids to Spleen, inner/outer canthi to Heart, inner canthus to Gallbladder/San Jiao. Upper lid relates to Taiyang Bladder/Small Intestine, lower lid to Yangming Large Intestine. Five Zang correspond to five colors: Heart governs Red (excess=real heat, slight=deficient heat); Liver governs Green (excess=heat, slight=deficiency); Spleen governs Yellow (excess=heat, slight=deficiency). Lack of luster, excessive sclera, scant cornea indicates Liver/Kidney insufficiency. Clear day vision but night blindness indicates weak congenital Yang; Yin dominance at night further weakens Yang. Red veins descending belong to Foot Taiyang; ascending to Foot Yangming. Eyelid opacity with black/white cataract indicates Taiyang Cold-Water; outer-to-inner indicates Shaoyang Wind-Heat; bottom-to-top green indicates Foot Yangming/Lung-Kidney combined disease. Membranous cataracts stem from internal Wind-Heat. Undetermined evil is "Heat Cataract" (floating exterior); settled evil is "Ice Cataract" (sinking interior); deep evil is "Sunken Cataract," requiring ascending methods to resolve. Malnutrition eye (Gan Eye) results from Liver Fire/Damp-Heat rushing up and Spleen deficiency failing to ascend clear Qi, causing white cataract, closed eyelids, purulent discharge, and eye damage. Night blindness (Que Mu) allows morning vision but evening blindness due to weak Liver Qi. Wood grows at Zi hour, peaks at Mao, ends at Shen; thus morning vision, evening blindness. Eyes need Blood to see; Liver Qi declines post-noon, Yin deficiency leads to Fire excess, weak Yin cannot overcome strong Fire, worsening at night. Dawn brings Yang activity, clearing turbid Yin, improving vision. Main treatment: Nourish Liver, tonify Blood, regulate Spleen/Stomach. Closed eyes may result from excessive cold herbs trapping Yang downward, or Stomach Qi deficiency causing weak eyelids; both require raising Yang and benefiting Stomach. Acute red/swollen/painful eyes with intense Wind-Fire or tearing/light sensitivity due to Liver/Heart heat require either dispersing Wind/Fire or cooling Blood/clearing Liver. Erosive eye margin indicates Diaphragm Heat; itching indicates pus/worms; adherent eyelids indicate Liver Wind-Heat. Infant jaundice/high fever/constipation/red face/closed eyes indicates Fetal Heat. Post-measles Blood/Yin deficiency with residual toxins invading eyes causes unclear vision without swelling/pain, only black spots/lack of luster, indicating Liver/Kidney deficiency. External membrane absence but internal cloud-like cataract ("Blue Blindness") indicates either Kidney Water exhaustion or chronic malnutrition. Surging pulse requires Blood tonification; deep/thin pulse requires Yang tonification. Without Sunlight, even mirrors cannot reflect light. Post-vomit/diarrhea membrane formation with inability to open/lack of luster indicates depleted essence/spirit, difficult to treat. Heat/toxin-induced small eyes, accumulated toxin small eyes, or epidemic red/swollen eyes all share treatments avoiding cold/herbs and single dispersal agents. Cold causes stagnation; heat disperses; Wind dries. Although eye diseases stem from Fire/Heat, they often begin with Wind-Cold closing pores, trapping Fire/Heat which rises to orifices. Dispersing exterior pathogens releases Fire/Heat and stops pain. Blood-nourishing/cooling/astringent formulas must include Wind-dispelling herbs to reach the head. Stifled Fire requires venting to reduce intensity; indiscriminate cold herbs cause stagnation. Sweating consumes fluids/blood, worsening dryness/disease. Blood stasis/heat conditions treated with blood-breaking/cooling herbs, or spleen-damaging cold herbs, are inadvisable. Spleen is supreme Yin, illuminating the eyes. Eyes need Blood to see; low Blood increases Fire/Heat and blurs vision. Blood is the essence of Wood's vessels; luster is Wood's leaves; Spleen/Stomach are Wood's roots. Therefore, treating upper body diseases via the lower body is preferred.