Strabismus refers to the condition where one or both eyes deviate to one side when looking straight ahead, and in severe cases, the black of the eye is partially or completely obscured by the orbit on that side, leaving only the white of the eye visible.

This condition was first described in Zhubing Yuanhou Lun, and later medical texts also referred to it as "strabismus wind-induced," "wind-induced deviation," or "partial vision." Depending on the degree and direction of the eye deviation, it can also cause double vision, which is why some literature groups it under conditions such as "seeing one as two," "divergent strabismus," "pupil inversion," "convergent squint," "drooping eye," "heavenly rotation," or "upward gaze."

However, cases of strabismus caused by tumors are not within the scope of this discussion.

bubble_chart Pattern Analysis

1. Wind Invading the Collaterals︰The eyes are neither red nor swollen, with strabismus, or ptosis of the eyelids, weakness of the eyelashes, restricted movement of the eyeballs, and diplopia. It often occurs unilaterally. Accompanied by deviation of the corners of the eyes and mouth, it is usually noticed upon waking in the morning or after a nap. Additional symptoms include aversion to wind, spontaneous sweating, headache, dizzy vision, a thin white tongue coating, and a floating, slow pulse. External wind invades the collaterals in apoplexy involving collaterals. Wind, being a yang pathogen, tends to affect the exterior, often accompanied by spontaneous sweating, mild aversion to wind and cold, a floating and slow pulse, and other signs of exterior deficiency apoplexy. The treatment response is relatively quick and favorable. The treatment principle is expelling wind and dredging collaterals. The recommended formula is Notopterygium Wind-Conquering Decoction combined with Pull Aright Powder with modifications.
2. Damp Phlegm︰Sudden onset of strabismus, either inward or outward, often unilateral, accompanied by ptosis, restricted eyeball movement, or diplopia. The patient usually experiences chest tightness, dizziness, nausea, vomiting, mental fatigue, poor appetite, and loose stools. The tongue coating is white and greasy, and the pulse is wiry and slippery. This is caused by internal phlegm-dampness obstructing the meridians of the eyeball, leading to imbalanced tension of the tendons and resulting in strabismus. Systemic symptoms such as chest tightness, nausea, dizziness, mental fatigue, poor appetite, and loose stools indicate internal obstruction and upward disturbance of phlegm-turbidity. Treatment should focus on dispelling phlegm, eliminating dampness, and harmonizing the collaterals, using a modified Shengfeng Decoction.
3. Wind-heat Attacking Upward︰Double strabismus or upward gaze, fever headache, even unconsciousness convulsion, opisthotonos. Red tongue with yellow coating, thin and rapid or wiry and rapid pulse. It is caused by wind-heat pathogens attacking the head and eyes, injuring ocular muscles and membranes, belonging to an excess-heat syndrome, commonly seen in children with high fever, unconsciousness, and after convulsions. This differs from symptoms and signs of liver and kidney yin deficiency with rising yang and wind stirring. Treatment should focus on dispelling wind and clearing heat, relaxing tendons and harmonizing collaterals, supplemented by nourishing yin. Prescriptions such as Cow-Bezoar Dragon-Embracing Pill or Zhengrong Decoction can be used with additions like Skullcap Root, Common Clubmoss Herb, Earthworm, Dendrobium, and Ophiopogon Tuber as appropriate.
4. Internal Stirring of Liver Wind︰Strabismus in one or both eyes, with the eyes deviating inward or outward. Accompanied by red eyes, headache, vertigo, weak legs, bitter taste in the mouth, irritability, numbness in the hands and feet, muscle twitching, red tongue, and wiry rapid pulse. Internal wind disturbing the sinews and damaging the ocular muscles, attributed to liver and kidney yin deficiency, where yin fails to restrain yang, with the disease leaning toward the interior. Often accompanied by vertigo, weak legs, numbness in the hands and feet, muscle twitching, wiry and rapid pulse, and other signs of liver yang transforming into wind, requiring gradual treatment. Treatment should focus on nourishing yin and subduing yang, pacifying the liver and extinguishing wind. Prescriptions include Antelope Horn and Uncaria Decoction or the liver-pacifying and wind-extinguishing blood pressure-lowering formula. For tidal fever with red eyes and irritability, Liver-Tonifying Powder can be used. For cases accompanied by hemiplegia in the late stage [third stage], Yang-Tonifying Five-Returning Decoction may be applied.
5. Static Blood︰After trauma to the eyelid, orbital region, or head, the injured eye may deviate inward or outward (black of the eye). In children, this is often accompanied by restlessness, night crying, sleep disturbances (fright and vigilance), bluish-purple finger veins, and a wiry pulse. Static blood obstructing the ocular collaterals and ocular muscles becoming slack and dysfunctional lead to ocular deviation. Treatment should focus on invigorating blood and removing stagnation to unblock the collaterals, supplemented with calming agents. The recommended formula is Peach Kernel, Carthamus and Four-Ingredient Decoction with the addition of Luffa Vegetable Sponge, Earthworm, Coptis Rhizome, and Cinnabar.
6. Insufficient Innate Endowment︰Most cases are congenital, with unilateral or bilateral strabismus. Affected children often exhibit delayed development, late walking and teething, and lower intelligence. Alternatively, it may result from abnormal eyeball development and incomplete visual function, leading to strabismus over time. Some infants, due to physical weakness, develop strabismus from prolonged side-lying positions, causing sinew and vessel stagnation, ultimately forming strabismus. It is mostly a congenital disorder, often accompanied by delayed walking and teething, poor intelligence, and weak constitution. Treatment should focus on tonifying the liver and kidneys, relaxing sinew and activating collaterals. For yang deficiency as the primary pattern, use Golden Chamber Kidney Qi Pill with Luffa Vegetable Sponge, Common Clubmoss Herb, and Earthworm. For yin deficiency as the primary pattern, use Six-Ingredient Rehmannia Decoction with Luffa Vegetable Sponge, Common Clubmoss Herb, and Earthworm.
7. Hemiplegia︰The black of the eye deviates outward, often accompanied by internal and external ophthalmopathy, with very poor vision. Prolonged disuse leads to relaxation of the ocular muscles, causing the affected eye to deviate outward. This condition is mostly caused by internal visual obstruction or old nebula (corneal scar) of the black of the eye, resulting in poor vision, loss of function in the eye, and relaxation of the meridians. Clinical treatment should be based on pattern identification according to different conditions, combined with acupuncture. If ineffective, surgical treatment is required.

bubble_chart Documentation

1. Shenshi Yaohan．Looking up: "The child has spasms and convulsions, with eyes rolling and staring upwards, resembling a divine affliction, with the head and eyes raised high. This is called Tian Gou, also a type of infantile convulsion. It is advisable to take Jiulong Kongxian Powder."
2. Zhengzhi Zhunsheng．Pupil reversed: "The pupil is tilted and turned sideways, with the white part facing outward and the black part facing inward."