🌿 Folk Prescriptions

Ophthalmic surgery in the Tang Dynasty reached a remarkably advanced level. In addition to gold needle cataract extraction, procedures such as removal of pterygium and correction of trichiasis were already common. Two factors contributed to this advancement: First, following the Wei, Jin, and Northern and Southern Dynasties, academic and cognitive freedom broke free from classical Confucian constraints, and medicine increasingly valued technique and practicality—physicians no longer viewed surgical procedures involving the body as taboo. Second, due to cross-cultural exchange and absorption, especially Indian medicine. By the Tang Dynasty, *Longshu Lun* (translated from Sanskrit, ancient India) had become widely circulated. Though lost in the Song Dynasty, fragments survive in works like *Yixin Fang* and *Yifang Leijù*. While *Qianjin Fang* and *Waitai Miao Yao* contain discussions on ophthalmic diseases, detailed descriptions of surgical operations are rare. However, some poems and prose offer vivid accounts.
In Du Mu’s *Fan Chuan Wenji*, two physicians skilled in gold needle cataract surgery are mentioned, including their ability to assess disease characteristics, select appropriate surgical candidates, and master procedural techniques. In Zhao Lin’s anecdotal novel *Yin Hua Lu*, the story of Prime Minister Cui Shenyou is recorded: His left eye developed a flesh tumor nearly blocking the pupil, severely affecting vision. After successful surgical removal by physician Tan Jian, he regained sight. At the time, Cui Shenyou served as a provincial inspector in Zhexi. Hearing that a physician named Mu in Yangzhou excelled at treating eye diseases, he sent official Yang Shou to invite him. The reply stated: “Mu is careless and unreliable. Tan Jian, however, is meticulous and far superior.” Thus, Cui Shenyou invited Tan Jian. After diagnosis, Tan Jian said: “This is a simple procedure, but concentration is essential for success.” Cui Shenyou replied: “I won’t even tell my wife during the operation.” Tan Jian insisted on scheduling the surgery at noon on a clear day in a quiet room. He inquired about Cui’s diet—Cui responded that although his appetite was small, he could still eat adequately. Tan Jian was satisfied and specified that the surgery be conducted on the north tower of Cui’s residence, with only a young servant present, keeping it secret from others. Tan Jian first had Cui drink alcohol as anesthesia, then used a scalpel to remove the tumor, wiped away blood with gauze, applied powder, and only afterward informed Cui’s wife. Later, when Cui Shenyou was transferred to Jinling and eventually became prime minister, Tan Jian had already passed away. This case is also documented in *New Tang History·Biography of Cui Shenyou*: “Initially, Shenyou suffered from severe eye disease, unable to see. The physician treated him by scraping, and he recovered just in time for appointment.” This serves as verification. The account in *Yin Hua Lu* is far more detailed than historical records, making it a precious medical document. Notably, it emphasizes preoperative inquiry about diet, using midday sunlight for illumination, using alcohol to reduce pain, and requiring the patient to “remain calm and undisturbed”—all scientifically sound principles.
Among the celebrated verses of the “Prosperous Age,” several describe gold needle cataract surgery. For instance, Du Fu wrote: “Gold needle scrapes the eye, mirror image yet unseparated.” Li Shangyin wrote: “Tying brows, admiring green feathers, imagining the gold needle scraping the membrane.” Several such poems appear in *Complete Tang Poems*, offering poetic evidence of historical facts. Here are two examples:
Bai Juyi: *Two Poems on Eye Disease, Part II*
Eye damage has lasted long, the root of illness firmly entrenched, hard to remove.
Doctors advise stopping wine first, fellow disciples urge retiring from office early.
On the desk, the *Longshu Lun* lies scattered; in the box, I gently roll up the juice-clear pills.
If ordinary remedies prove ineffective, why not try the gold needle to scrape it?
Bai Juyi suffered from cataracts in old age. Besides *Two Poems on Eye Disease*, he also wrote *Eye Disease and Flowers* and *New Year’s Eve* to describe his condition. The line “box contains stored juice-clear pills” appears in another version as “container holds stored juice-clear pills.”
Liu Yuxi: *Gift Poem to a Brahmin Eye Doctor*
Three autumns have dimmed my sight, daily I weep in despair.
Both eyes now darken, middle-aged, like an old man.
Red turns to green, ashamed of sunlight, unable to withstand wind.
Master, you possess the gold needle skill—how can you lift my veil?
“Gold needle technique” was the Tang term for cataract surgery—clearly a more elegant and concise expression. Liu Yuxi composed this poem to honor an Indian ophthalmologist, reflecting the extent of Sino-foreign medical exchange at the time.
Notably, the gold needle cataract technique did not spread widely after the Tang Dynasty but continued in a continuous lineage, mainly preserved within Daoist and Buddhist medical traditions. Later records confirm this. For example, in the Yuan Dynasty, Guo Yi’s *Xue Lv Zhai Bi Ji* records that Empress Wei, wife of Emperor Xianren of Song, had lost her sight. Despite many physicians being summoned, none succeeded. A Daoist stepped forward and used the gold needle technique, restoring “left eye clarity instantly.” In the Qing Dynasty, Zhao Lian’s *Xiao Ting Za Lu* recounts how a doctor from Gaoyou, Mr. Zeng, used the gold needle technique to restore vision to the renowned scholar Wang Mingsheng, author of *Seventeen Histories Commentary*. Historian Zhao Yi praised this feat in verse. In Hu Shengfu’s *Donghu Ji*, a monk named Wu Huanzhao from Lingyan Temple performed a needle extraction on Yang Yihuang. He carefully chose the timing: During the initial visit, after examination, Wu said: “The cataract is still soft; it’s not yet suitable for treatment. Go home and eat stimulating foods to thicken the opacity, so that vision becomes as dark as night—then treatment will succeed. Please wait a year!” The patient complied. When the time arrived, he had already gone blind. Wu then performed the surgery: Inserting the needle between the black and white parts, rotating it around to fully remove the membrane. Then inserting the needle into the center of the black part, outside the pupil, rotating again—skillfully and smoothly, with minimal discomfort. After completion, he wrapped the eye with a single piece of cloth and prescribed several doses of medicine, saying: “Avoid wind. After three days, you’ll be healed.” On the way home, the patient wore extra clothing. Three days later, his eyes turned red. Upon questioning, he said: “A slight warmth.” After taking one or two more doses, he fully recovered, with clear vision once again. This account constitutes a complete medical case and a remarkably detailed surgical record—its thoroughness rivals that of Huang Tingjing, the renowned ophthalmic surgeon of the early Qing Dynasty, described in *Mujing Dacheng*. Such anecdotes provide invaluable reference for modern specialists.