Squint

A disease of vision marked by a deviation from the normal direction of one or both eyeballs that prevents the eyes from being directed at one object at the same time. One or both eyes may point toward the inner or outer canthus and are restricted in movement. The patient experiences what was traditionally called seeing one as two, i.e., double vision. The Level-Line of Pattern Identification and Treatment (证治准绳 zhèng zhì zhǔn shéng) refers to squint as backward turning spirit ball (神珠将反 shén zhū jiāng fǎn) and severe squint with the pupil disappearing into the socket as backward turned pupil spirit (瞳神反背 tóng shén fǎn bèi). The term wind-induced squint (风牵偏视 fēng qiān piān shì) highlights the underlying cause of nearly all squints. The terms converging eyes (双目通睛 shuāng mù tōng jīng), dropped eye (坠睛 zhuì jīng), heaven-turned [eye] (天旋 tiān xuán), and upward-looking eye (目仰视 mù yǎng shì) refer to various kinds of squint. Squint patterns include wind evil striking the network vessels either due to insecurity of exterior defense, or due to insufficiency of liver blood, wind-phlegm obstructing the network vessels, liver yáng transforming into wind, static blood, and wind-heat attacking upward.

Biomedical correspondence: strabism.

Patterns

Wind evil striking the network vessels (风邪中络 fēng xié zhòng luò) owing to insecurity of external defense causes a sudden squint and restricted movement of the eyeballs. It is associated at onset with aversion to cold with heat effusion, headache, a thin white tongue fur, and a floating pulse. Wind striking the network vessels due to insufficiency of liver blood causes a squint with exterior signs such as aversion to cold with heat effusion. It differs from the first pattern by the fact that it is observed in patients with lusterless complexion, dizziness, tinnitus, a pale tongue, and a fine pulse.

Medicinal therapy: For insecurity of external defense, course wind and free the network vessels; support right and dispel evil. Use Minor Life-Prolonging Decoction (小续命汤 xiǎo xù mìng tāng). For insufficiency of liver blood, nourish the blood and dispel wind. Use Blood-Nourishing Chinese Angelica and Rehmannia Decoction (养血当归地黄汤 yǎng xuè dāng guī dì huáng tāng).

Acumoxatherapy: Base treatment on BL, GB, and ST. The main points for squint are: For an inward squint, select Back of the Ball (球后 qiú hòu), Greater yáng (tài yáng) (太阳 tài yáng), and GB-1 (Pupil Bone-Hole, 瞳子髎 tóng zǐ liáo). For an outward squint, select BL-1 (Bright Eyes, 睛明 jīng míng), BL-2 (Bamboo Gathering, 攒竹 zǎn zhú), and ST-2 (Four Whites, 四白 sì bái). Use a mild stimulus at points in the region of the eye.

• For wind evil striking the network vessels due to insecurity of external defense, add GB-20 (Wind Pool, 风池 fēng chí), LI-4 (Union Valley, 合谷 hé gǔ), and TB-5 (Outer Pass, 外关 wài guān); needle with drainage.
• For wind striking the network vessels due to insufficiency of liver blood, add GB-20 (Wind Pool, 风池 fēng chí), LR-3 (Supreme Surge, 太冲 tài chōng), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), LR-8 (Spring at the Bend, 曲泉 qū quán), and KI-1 (Gushing Spring, 湧泉 yǒng quán); needle with even supplementation and drainage.

Wind-phlegm obstructing the network vessels (风痰阻络 fēng tán zǔ luò) causes a squint when externally contracted wind evil carries phlegm upward to obstruct the network vessels. It occurs in patients with small food intake, torpid intake, ejection of phlegm-drool, thick slimy tongue fur, and a slippery stringlike pulse.

Medicinal therapy: Fortify the spleen and transform phlegm; dispel wind and free the network vessels. Use Bupleurum and Peony Six Gentlemen Decoction (柴芍六君子汤 chái sháo liù jūn zǐ tāng) combined with Face-Righting Decoction (正容汤 zhèng róng tāng).

Acumoxatherapy: To the main points given above add GB-20 (Wind Pool, 风池 fēng chí), LI-4 (Union Valley, 合谷 hé gǔ), LR-3 (Supreme Surge, 太冲 tài chōng), ST-40 (Bountiful Bulge, 丰隆 fēng lóng), and ST-36 (Leg Three Lǐ, 足三里 zú sān lǐ); needle with drainage.

Liver yáng transforming into wind (肝阳化风 gān yáng huà fēng) and carrying phlegm upward to harass the upper body causes a squint in patients suffering from dizziness, tinnitus, profuse dreaming, limp aching lumbus and knees, red tongue with yellow fur, and a fine stringlike or slippery stringlike pulse.

Medicinal therapy: Calm the liver and subdue yáng; transform phlegm and extinguish wind. Use Gastrodia and Uncaria Beverage (天麻钩藤饮 tiān má gōu téng yǐn).

Acumoxatherapy: To the main points given above add BL-18 (Liver Transport, 肝俞 gān shù), GB-20 (Wind Pool, 风池 fēng chí), LR-3 (Supreme Surge, 太冲 tài chōng), GB-43 (Pinched Ravine, 侠溪 xiá xī), BL-23 (Kidney Transport, 肾俞 shèn shù), KI-6 (Shining Sea, 照海 zhào hǎi), SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo), and ST-40 (Bountiful Bulge, 丰隆 fēng lóng); needle with drainage or with even supplementation and drainage.

Static blood (瘀血 yū xuè) due to qì vacuity and blood stagnation can cause a squint in wind stroke patients. It may be accompanied by hemiplegia or numbness of the limbs.

Medicinal therapy: Boost qì and quicken the blood; transform stasis and free the network vessels. Use Yáng-Supplementing Five-Returning Decoction (补阳还五汤 bǔ yáng huán wǔ tāng).

Acumoxatherapy: To the main points given above add BL-17 (Diaphragm Transport, 膈俞 gé shù), SP-10 (Sea of Blood, 血海 xuè hǎi), LI-4 (Union Valley, 合谷 hé gǔ), LR-3 (Supreme Surge, 太冲 tài chōng), and SP-6 (Three Yīn Intersection, 三阴交 sān yīn jiāo); needle with even supplementation and drainage.

Wind-heat attacking upward (风热上攻 fēng rè shàng gōng) causes a squint in child fright wind with high fever and clouded spirit.

Medicinal therapy: Dispel wind and clear heat; soothe the channels and quicken the network vessels. Use Bovine Bezoar Dragon-Embracing Pill (牛黄抱龙丸 niú huáng bào lóng wán) or Face-Righting Decoction (正容汤 zhèng róng tāng) with the addition of scutellaria (Scutellariae Radix, 黄芩 huáng qín), ground pine (Lycopodii Herba, 伸筋草 shēn jīn cǎo), limestone (Calx, 石灰 shí huī), and ophiopogon (Ophiopogonis Radix, 麦门冬 mài mén dōng).

Acumoxatherapy: To the main points given above add GB-20 (Wind Pool, 风池 fēng chí), LI-4 (Union Valley, 合谷 hé gǔ), LI-11 (Pool at the Bend, 曲池 qū chí), GV-14 (Great Hammer, 大椎 dà zhuī), and PC-6 (Inner Pass, 内关 nèi guān), and prick LU-11 (Lesser Shang, 少商 shào shāng) to bleed; needle with drainage.

Poor constitution: Squint may occur congenitally and is usually associated with slowness to teethe and walk, low I.Q., and weak health.

Medicinal therapy: Supplement the liver and boost the kidney; soothe the sinews and quicken the network vessels. If yáng vacuity is prominent, use Golden Cabinet Kidney Qì Pill (金匮肾气丸 jīn guì shèn qì wán); if yīn vacuity is prominent, use Six-Ingredient Rehmannia Pill (六味地黄丸 liù wèi dì huáng wán). In either case, add loofah (丝瓜络 sī guā luò)1Luffae Fructus Retinervus, ground pine (Lycopodii Herba, 伸筋草 shēn jīn cǎo), and earthworm (Pheretima, 地龙 dì lóng).

Acumoxatherapy: To the main points given above add BL-18 (Liver Transport, 肝俞 gān shù), BL-23 (Kidney Transport, 肾俞 shèn shù), LR-3 (Supreme Surge, 太冲 tài chōng), KI-3 (Great Ravine, 太溪 tài xī), KI-7 (Recover Flow, 复溜 fù liū), and GV-4 (Life Gate, 命门 mìng mén); for yáng vacuity needle with supplementation and moxa; add BL-18 (Liver Transport, 肝俞 gān shù), BL-23 (Kidney Transport, 肾俞 shèn shù), LR-3 (Supreme Surge, 太冲 tài chōng), KI-3 (Great Ravine, 太溪 tài xī), KI-6 (Shining Sea, 照海 zhào hǎi), and BL-52 (Will Chamber, 志室 zhì shì); for yīn vacuity, needle with supplementation.