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Deviation of the mouth and eye, also known as "deviation of mouth," "hanging thread wind," "crooked mouth wind," etc., is characterized by the inability to close the mouth and eye due to their deviation.

This condition is referred to as "mouth deviation," "deviation," and "sudden devation of mouth" in Lingshu; Jingui Yaolue calls it "deviation of eye and mouth"; Zhubing Yuanhou Lun includes an entry for "wind mouth deviation syndrome"; by the Song Dynasty, it was termed "deviation of the mouth and eye" (Sanyin Jiyi Bingzheng Fanglun); the Ming Dynasty's Yixue Gangmu referred to this condition as "perverse," and since then, various works have mostly called it "deviation of the mouth and eye."

The condition of deviation of the mouth and eye was previously categorized under apoplexy. Since apoplexy is divided into apoplexy involving meridians and apoplexy involving zang-organs, wind apoplexy involving meridians only presents with devation of the mouth and eye, whereas wind apoplexy involving zang-organs often accompanies sudden collapse and unconsciousness. This article will discuss apoplexy involving meridians with devation of the mouth and eye, wind paralysis with devation of the mouth and eye, and other causes of devation of the mouth and eye, excluding other conditions from the discussion.

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1. Exogenous Wind Invasion︰Sudden deviation of the mouth and eyes, abnormal facial sensation, accompanied by headache, nasal congestion, neck tightness and discomfort, facial muscle twitching, floating pulse, thin white tongue coating, etc. Due to wind Xieke invading the Yangming meridians of the face, causing abnormal circulation of qi and blood, and cervical malignancy with cachexia in the meridians, resulting in deviation of the mouth and eyes. However, in clinical practice, there are distinctions between wind-cold, wind-heat, and wind-dampness. The common features of the three are sudden onset of deviation of the mouth and eyes, obvious symptoms of external contraction, floating pulse, and thin white tongue coating. The differences are: in the pattern of wind and cold, the affected facial muscles feel tight or painful, and the skin is thick and stiff; in the pattern of wind and heat, the affected facial muscles are relaxed, and the skin has a burning sensation; in the pattern of wind and dampness, the affected facial muscles are swollen, and the eyelids may be puffy. The pattern of wind and cold should be treated by dispersing wind and dissipating cold, with the prescription Pueraria Decoction modified as needed; the pattern of wind and heat should be treated by dispersing wind and dissipating heat, with the prescription Bupleurum and Pueraria Flesh-Releasing Decoction; the pattern of wind and dampness should be treated by dispersing wind and dissipating dampness, with the prescription Notopterygium Overcoming Dampness Decoction.
2. Internal Stirring of Liver Wind︰The sudden onset of wry eye and mouth, facial flushing, limb numbness, distending pain at the root of the ear, aggravated vertigo, heavy head and light feet, a wiry, rapid, and forceful pulse, a dark red tongue with yellow coating or scanty coating and lack of fluid. The liver, being a firm-characterized zang organ, is yin in substance and yang in function. If anger causes qi counterflow, liver yang transforms into wind and ascends to the face, injuring the Yangming meridian collaterals, pulling at the cheek and jaw, leading to wry eye and mouth, or even facial muscle twitching or muscular flickering and tendon spasms. Although this pattern and wry eye and mouth caused by external wind invasion both manifest sudden onset, the former is due to internal wind while the latter to external wind. Internal wind is preceded by signs of internal stirring of liver wind (such as preexisting vertigo, tinnitus, or limb numbness), whereas external wind is accompanied by exterior patterns. Internal wind is invariably associated with a wiry pulse, while external wind often presents with a floating pulse. Internal wind mostly occurs in the elderly, while external wind is more common in young and middle-aged individuals. Treating internal wind primarily involves "extinguishing wind," whereas treating external wind focuses on "dispersing and dissipating." Therefore, for internal stirring of liver wind, the approach should be liver-calming and wind-extinguishing, with prescriptions such as Gastrodia and Uncaria Drink or Antelope Horn and Uncaria Decoction.
3. Liver Qi Depression︰Facial distortion often occurs following emotional stimulation, accompanied by sighing, fullness and discomfort in the chest and hypochondrium, loss of appetite, sorrow and a tendency to weep, a wiry pulse, and thin white tongue coating. This condition is commonly seen in women with emotional depression and a melancholic disposition. There is usually a clear trigger before onset, such as quarrels with others, unfulfilled contemplation, or exposure to unpleasant events, leading to liver qi stagnation and disharmony in the Yangming collaterals, resulting in facial distortion. The clinical features include unhappiness before onset, a distressed expression and dull mental state after onset, or audible crying, occasional facial muscle twitching. Acupuncture at the philtrum and other points may correct the distortion. Treatment should aim to soothe the liver and relieve depression, harmonizing the collaterals, with Liver-Restraining Powder as the recommended formula.
4. Deficiency of Both Qi and Blood︰Facial deviation, flaccid facial muscles, eyelid weakness, shortage of qi with reluctance to speak, thin and weak pulse, tongue texture pale and tender, tongue coating thin and white. Qi governs warmth, while blood governs moisture and nourishment. Qi, belonging to yang, is active, whereas blood, belonging to yin, is static. Qi deficiency prevents its ascent to the face, and yin-blood also struggles to infuse the Yangming channels, leading to the loss of qi and blood's warming and nourishing effects on facial muscles, resulting in facial deviation. This condition is commonly seen in sequelae of apoplexy, postpartum, or late stages [third stage] of other diseases. Clinically, there are no signs of cold or heat to observe, nor wind manifestations to examine. Based on past symptoms and accompanying signs such as shortage of qi with reluctance to speak, bodily fatigue and drowsiness, flaccid facial muscles, thin pulse, and pale tongue, it can be diagnosed as dual deficiency of qi and blood. For cases with predominant qi deficiency, the treatment should focus on replenishing qi and invigorating blood to relieve spasms, using Yang-Tonifying Five-Returning Decoction taken with Er Chong Powder. For cases with predominant blood deficiency, the approach should emphasize nourishing blood and dispelling wind, using Major Gentian Decoction. For dual deficiency of qi and blood, the treatment should strongly tonify qi and blood, using Ten Major Tonics Decoction, or combined with acupuncture therapy.
5. Wind Phlegm︰Facial deviation, numbness of facial muscles, unclear speech, phlegm rales in the throat, a stiff sensation in the tongue, wiry and slippery or wiry and moderate pulse, and a white greasy tongue coating. The patient usually has qi deficiency and latent phlegm-fluid retention, or qi depression disturbing phlegm, leading to phlegm movement generating wind; or occasionally encountering wind-cold, with wind attacking and phlegm moving, resulting in the binding of wind and phlegm, which flows and spreads through the meridians, disturbing the face and causing stagnation and obstruction of the Yangming collateral vessels, leading to facial deviation. Latent phlegm-fluid retention is often seen in individuals with obesity, dull eyes, a gloomy complexion, or dark stagnation around the eyes, or puffy eyelids, or a dirty and unclean face, a swollen tongue, and a white slippery and moist coating. The clinical characteristics include numbness of the affected facial muscles, a crawling sensation, tight jaw, accompanied by dizziness, blurred vision, nausea and vomiting, a white greasy tongue coating, and a wiry and slippery pulse. The treatment should focus on resolving phlegm and dispelling wind, opening the orifices, and unblocking the collaterals. The recommended formulas are Qingzhou White Pill or Phlegm-Guiding Decoction with modifications.

The treatment of facial paralysis (口眼喎斜) with acupuncture is characterized by simplicity, convenience, affordability, and effectiveness. Based on the prescriptions and acupoints used by medical practitioners throughout history, the following two categories have shown better results.

1. The main acupoints are located along the six yang meridians Jingmai multiple abscess on the face;
2. the facial area is most extensively covered by the Foot Yangming Meridian and Jingjin, so predecessors primarily selected acupoints from the Yangming Meridian.

Commonly used acupoints include: Jiache (ST6), Dicang (ST4), Shuigou (GV26), Xiaguan (ST7), Sibai (ST2), Yangbai (GB14), Taiyang (EX-HN5), Yingxiang (LI20), Chengjiang (CV24), Fengchi (GB20), Hegu (LI4), Zanzhu (BL2), and others. Commonly used penetrating techniques include: Dicang penetrating Jiache, Yangbai penetrating Yuyao, Zanzhu penetrating Jingming, Yingxiang penetrating Sibai, philtrum penetrating Dicang, and Chengjiang penetrating Dicang, with Dicang penetration being the preferred method. However, it is crucial to avoid the needle tip penetrating the skin and to ensure strict disinfection.

Facial paralysis is not uncommon in clinical practice, and most cases can be cured with treatment. For patients with prolonged illness and physical weakness, or those with insufficient qi and blood, the treatment should focus on tonifying qi, nourishing blood, calming wind, and harmonizing collaterals, with a balanced approach of supplementation and drainage. Avoid excessive use of wind-dispelling herbs, as their pungent and drying nature may damage yin. For cases requiring wind-calming and spasm-relieving, Pull Aright Powder can be prescribed based on pattern identification. If misdiagnosed or improperly treated, the facial condition may not fully recover, or secondary symptoms such as facial muscle rigidity and atrophy may occur. Through long-term clinical practice, predecessors observed that facial paralysis is one of the precursors of apoplexy. Therefore, actively treating facial paralysis not only alleviates the patient's suffering but also plays a proactive role in preventing the onset of apoplexy.

bubble_chart Documentation

1. Lingshu．Jingmai Chapter: "The stomach meridian of foot yangming,... is responsible for blood-related diseases,... called wry mouth..."
2. Lingshu．Jingjin Chapter: "The sinew of foot yangming,... its disease..., sudden deviation of mouth,..."
3. Zhubing Yuanhou Lun．Various Symptoms of Wind Diseases: "When wind evil enters the meridians of foot yangming and hand yangming, encountering cold causes the sinews to tighten and pull the cheek, thus causing deviation of eye and mouth, improper speech, and inability to look straight. Diagnose the pulse, if it is floating and slow, it can be treated."
4. Jingyue Quanshu．Non-Wind: "All cases of non-wind with wry mouth and eyes have distinctions of cold and heat. In the meridians it is said: 'The sinew of foot yangming pulls the supraclavicular fossa and cheek, sudden deviation of mouth, in acute cases the eyes do not close, heat causes the sinews to relax, the eyes do not open. The cheek sinew, if cold, tightens, pulling the cheek and moving the mouth. If hot, the sinew relaxes and cannot contract, hence the deviation.' This meridian speaks of the relaxation and tightening of sinews in terms of the disease's cold and heat. However, if the blood and qi are not deficient, then even heat may not necessarily cause relaxation, nor cold necessarily cause tightening, and it is also generally known from the decline of blood and qi."
5. Yilin Gaicuo．Discussion on Wry Mouth and Eyes: "Some say: half-body paralysis, since there is no wind, how can there be wry mouth and eyes? I say: The ancients established the name 'wry' because they were not careful in clinical observation. Wry mouth and eyes are not truly wry. It is because the half of the face affected by disease has no qi, and without qi, the half of the face shrinks. One eye lacks the strength to open fully, the corner of the eye pulls down, the mouth on one side lacks the strength to open, the corner of the mouth pulls up, and the upper and lower parts come together, appearing at first glance to be wry, but in fact, it is not a true left-right wryness..." "It is also said: Is wry mouth and eyes entirely due to half of the face lacking qi? I say: The previous discussion refers to cases accompanied by half-body paralysis. If a strong fat person with qi deficiency, without half-body paralysis, suddenly has wry mouth and eyes, it is a symptom of wind evil obstructing the meridians. When the meridians are obstructed by wind evil, qi will not rise. If qi does not reach the head and face, it can also cause wry mouth and eyes. Using a formula to unblock the meridians and disperse wind, one dose can cure, and it is not something that a formula for half-body paralysis can achieve."