Abstract：Objective：To observe the differences in the correlation between tessellated fundus （FT） and fundus tessellated density （FTD）， and macular choroidal thickness （CT） in young and middle-aged patients with high myopia （HM） of different Chinese medicine syndrome types. Methods： A total of 109 HM patients treated at the Ophthalmology Department of Guangdong Provincial Hospital of Intergrated Traditonal Chinese and Western Medicine from February 2023 to December 2023 were selected for Chinese medicine syndrome differentiation. They were divided into three groups： liver and kidney deficiency （33 cases）， qi and blood deficiency （44 cases）， and heart yang insufficiency （32 cases）. The differences in axial length （AL）， spherical equivalent （SE）， FT， FTD， and macular CT among HM patients with different syndromes were analyzed and compared. Results： A total of 109 HM patients （ 109 eyes） were included ， with 54 males and 55 females. The heart yang insufficiency group had 32 cases （32 eyes，29.4%），the qi and blood deficiency group had 44 cases （44 eyes，40.4%），and the liver and kidney deficiency group had 33 cases （33 eyes，30.3%）. There was no significant difference in general data among the three groups （P＞0.05），indicating comparability. The absolute value of SE in the qi and blood deficiency group was smaller than those in the heart yang insufficiency and the liver and kidney deficiency groups （P＜0.05）. The AL in the liver and kidney deficiency group was greater than those in the heart yang insufficiency and the qi and blood deficiency groups（ P＜0.05），and the AL in the heart yang insufficiency group was greater than that in the qi and blood deficiency group （P＜0.05）. The central CT in the qi and blood deficiency group was greater than that in the liver and kidney deficiency group （P＜0.05）. The inner ring CT and outer ring CT in the qi and blood deficiency group were greater than those in the liver and kidney deficiency and the heart yang insufficiency groups （P＜0.05）. The average thickness of the Choriocapillaris's layer，Sattler's layer，and Haller's layer in the qi and blood deficiency group were greater than those in the heart yang insufficiency and the liver and kidney deficiency groups （P＜0.05）. Using the non-parametric ranksum test for comparison， the FT grading among the three groups showed that the liver and kidney deficiency group mostly had grade two and three FT， the qi and blood deficiency group mostly had grade one FT， and the heart yang insufficiency group mostly had grade two and three FT， with a significant difference （P＜0.05）. Using the paired sample Wilcoxon rank-sum test for comparison，there were significant differences in the FTD of the posterior pole and macular area within the three groups （P＜0.05）. Conclusion： Among young and middle-aged HM patients， the distribution of traditional Chinese medicine syndrome types is mainly qi and blood deficiency. Young and middle-aged HM patients with qi and blood deficiency have the least degree of fundus atrophy， while those with liver and kidney deficiency have a more severe degree of fundus atrophy.