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When internal and external treatments are combined, their efficacy can be fully realized.

[Discussion on Hooking, Cutting, Needling, and Cauterization] "Hooking" refers to the act of lifting tissues with a hook. "Cutting" refers to excision. "Needling" here does not refer to Bian stones (Bian needles), but specifically to needles used for manipulating the pupil (Tongshen). "Cauterization" refers to the method of burning or searing with heat. These four techniques are akin to capital punishment by chopping; they are methods to eliminate fierce and stubborn pathogenic factors. The key lies in thorough examination, clear diagnosis, and decisive judgment before applying treatment. First, eliminate the major culprits (primary lesions), then address the accomplices (secondary lesions). This ensures that the evidence is true and the penalty appropriate, preventing harm to the innocent and stopping the rampant aggression of harmful factors. In terms of therapeutic methods, these are techniques to open up and vent stagnation and to cleanse away blood stasis and accumulation. The prerequisite is that the syndrome differentiation must be clear and the anatomical location accurate before treatment can be administered. By first attacking the branch symptoms (biao) and subsequently removing the root disease (ben), the Qi and Blood will become harmonious and tranquil, sparing the essence and marrow (referring to the internal structures of the eye) from damage or depletion, and avoiding injury to the contours of the eye.

For the "hooking" technique, one must first identify where the skin, flesh, sinews, and vessels are superficial, and the manual force should vary according to the severity of the disease. For the "needling" technique, one must first confirm that the internal cataract syndrome is suitable for needling, that sufficient time has passed, and that the Qi and Blood are stable and calm. Only then should it be performed to avoid errors. After needling, internal treatment should be applied to address the root cause, whether tonifying or reducing, according to the specific syndrome. If only the branch is treated without addressing the root, the Qi will remain unsettled, and harm will recur shortly.

The "cutting" technique can be applied to lesions in the Qi wheel (sclera/conjunctiva), Blood wheel (palpebral conjunctiva/vessels), and Flesh wheel (eyelids). However, a large piece of red tissue represents the essence of blood and the floral manifestation of the Heart; if mistakenly cut, it causes blindness because injury to the seat of the Spirit leads to death. If cutting induces wind pathogens, or if performed on patients with deficient Yuan Qi who are prone to dryness or dampness, it may lead to ulceration forming fistulas, or result in a withered eyeball and opacity formation. If the opacity heavily obscures the Wind Wheel (cornea), although cutting may be considered, it should be done gently, lifting superficially from the side. Other conditions such as pterygium (fleshy growth climbing onto the cornea), chicken-comb-like or clam-meat-like proliferations, fish-roe or pomegranate-seed-like nodules, red coiled vessels, and adhesion of the inner canthus to the globe can also be cut. Lesions other than these, or those shallow on the Wind Wheel, if mistakenly cut, will rupture the eyeball and cause visual impairment.

"Cauterization" treats residual wind causing limbal ulceration and chronic wounds due to damp-heat that do not heal. Mild cases do not require cauterization and will heal with treatment alone. For red opacities belonging to the Blood level, after excision, cauterization must be used to fix the area; otherwise, recurrence is likely. For white opacities belonging to the Qi level, cauterization is unnecessary. Neither needling nor cauterization should touch the Black Pearl (cornea/pupil), as this not only ruptures the eyeball but also causes severe pain. Even for severe, dense opacities, hooking and cutting should be gentle and superficial, removing only the outer layer. The base of the opacity inside should be treated with topical medications for slow reduction, which will gradually dissipate over time. For conditions like wind-toxin, flowing toxin, and blood stasis treated with scissor-like cutting, flexible assessment is required, and rigid adherence to fixed rules is inappropriate. Needling for inverted pupillary axis differs from needling for internal cataracts; it requires mental integration and dexterous hands, with appropriate weight and pressure. This must be transmitted orally and seen personally, as it cannot be fully described in writing. Generally, the therapies of hooking, cutting, needling, and cauterization have the fastest effects. Although they serve to restore order amidst chaos, they are risky emergency measures. They require meticulous caution coupled with boldness, accurate syndrome differentiation, correct anatomical targeting, and must be combined with internal medicine to fully realize their therapeutic potential.