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The "Shen Shui" (aqueous humor) on the outer layer of the eyeball is dry, astringent, and lacks luster. This is the most difficult syndrome to identify; even verbal description cannot capture its precise appearance. It arises because Fire pathogen stagnation steams and evaporates the nourishing fluids, causing the essence and fluids to become turbid, thus making the eyeball lose its luster and the juices nearly exhausted internally. Although tears may fill the eye, they do not provide moisture. Observing the patient's complexion and gaze, the eyes appear dry and astringent with a sheen like snail slime. Whenever this syndrome is seen, it indicates that a critical illness is imminent. If treatment is delayed or erroneous, the "Shen Gao" (lens and vitreous body) will become dry; once the Shen Gao is dry, the Tong Shen (pupil and its associated functions) will be in danger. The Shen Shui is the key mechanism of the eye; its pathology is subtle and profound, often unknown to people, leading to critical syndromes appearing before rescue efforts begin, by which time it is too late. The presentation is difficult to recognize; unless one has a focused mind and precise vision, even a teacher pointing it out cannot fully explain its subtleties. If a child has had Gan syndrome (malnutrition due to parasitic infection or poor digestion) since early life, with stools resembling duck feces (watery), and the eye disease presents as the Shen Shui about to wither, death ensues. For individuals over fifty years old, if stools resemble sheep pellets (dry and hard), and the eye disease presents as the Shen Shui about to wither, death ensues. In cases of Heat binding the Bladder, if the Shen Shui is about to wither, it is because the water in the lower jiao is steamed by heat and becomes turbid, consequently causing the upper fluids to be turbid as well; clarifying the source will naturally clear the flow. (Another view states this is the Tong Shen Gan Que syndrome [irregular pupil shape], where the eye is dry and astringent with no tears, appearing white or black. Initially painful, later stabilizing but with loss of vision in the black area. This syndrome is untreatable; use Xie Dan San [Gallbladder-Draining Powder].)

Eye diseases caused by disharmony of the Six Qi (Wind, Cold, Summer-heat, Dampness, Dryness, Fire) or attack by Wind pathogen can cause a sensation of the brain nerves being pulled. The eyeball may suddenly look up or down without waiting for voluntary movement, unable to move down when intended to go up, or vice versa, shifting left or right unpredictably. This is due to unstable Qi agitation, trembling and spasms of the sinews and vessels, and irregular tension, resulting in harm from traction. Mildly, after the Qi settles, the pulse may be deviant and the eyeball tilted, resembling the state of the Shen Zhu (divine pearl/eyeball) about to reverse. Severely, it may flip completely, resulting in Tong Shen Fan Bei (reverse deviation of the pupil). (Treatments include Tian Dong Men Yin Zi [Asparagus Decoction], Xie Gan San [Liver-Draining Powder], Ju Bao Dan [Treasure-Gathering Pill], Xiong Zhu San [Male Pig Powder], Niu Bang Zi Wan [Burdock Seed Pill], Huan Jing Wan [Restore Vision Pill], Tui Xue San [Blood-Removing Powder].)

This is also called Mu Pian Shi (Oblique Deviation of the Eye). The *Jia Yi Jing* states: "Mu Pian Shi is treated by Shui Gou (GV26)." This syndrome refers to ocular deviation present since childhood, where vision is abnormal, which fails to resolve upon reaching adulthood. The etiology varies: some cases arise when the body is tender and vulnerable, and an eye disease affected by Wind-Heat attacks and damages the brain nerves, causing rapid contraction; some cases result from Jing Feng Tian Diao (infantile convulsions with upward deviation of the eyes), involving the sinews and collaterals, where failure to disperse Wind-Heat leads to stagnation in the meridians fixing the deviation; some cases occur because children sleep near bright windows and stare sideways for long periods, causing stagnation in the sinews and vessels leading to deviation. For any such disease, urgent treatment should be administered while the condition is still tender and the Qi and Blood have not yet stabilized. If one waits until adulthood, when the sinews, collaterals, Qi, and Blood are fixed, recovery is no longer possible. This section specifically discusses conditions originating in childhood that are incurable in adulthood, distinct from acute syndromes like Shen Zhu Jiang Fan (impending reversal of the eyeball).