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Facial spasm refers to the spasm of the eyelid, corner of the mouth, and cheek muscles, usually occurring on one side only. If the crooked mouth and eyes persist for a long time and do not heal, it may also be complicated by facial spasm, but there is a distinction between primary and secondary symptoms in clinical presentations. If the crooked mouth and eyes are the main symptoms, they are discussed in a separate section.

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1. Liver Qi Depression︰Facial convulsion, dizziness, tinnitus, irritability, or accompanied by crying, wiry and slow pulse, red tongue with thin white coating. It presents as chronic episodes, prolonged duration inevitably consumes liver blood, often triggered by emotional fluctuations, especially during arguments, frequently accompanied by depression, crying, dullness, and reticence, dizziness, tinnitus. Treatment should aim to soothe the liver and regulate qi, commonly using the formula Peripatetic Powder with modifications.
2. Liver Blood Deficiency︰Facial convulsion, occurring intermittently, accompanied by dizziness, blurred vision, wiry and thin weak pulse, red tongue with scant coating. It manifests as a chronic condition, which can lead to liver qi disharmony. There is no obvious trigger for the episodes, as they are caused by insufficient liver blood failing to nourish the sinews. The patient often experiences dizziness and dizzy vision. During episodes, there is slight twitching of facial muscles, a thin pulse, and a pale tongue. The treatment should focus on nourishing blood and relieving spasms. The commonly used formula is modified Peony and Licorice Decoction.
3. Wind-evil Obstructing the Collaterals︰Sudden facial convulsion, accompanied by headache, nasal congestion, aversion to cold, tearing eyes, floating pulse, pale red tongue, thin white coating. It manifests as a sudden onset caused by the invasion of wind-cold obstructing the Yangming collaterals. During the attack, it is accompanied by headache, nasal congestion, aversion to wind and cold, a wind-blowing sensation on the affected side of the face, floating pulse, etc. Treatment should focus on dispersing wind-cold, supplemented by relieving spasms. The commonly used formula is Tea-Blended Chrysanthemum Powder.
4. Internal Stirring of Liver Wind︰Facial convulsion, often accompanied by headache and dizziness, worsens with anger. The pulse is wiry, thin, and forceful, and the tongue is dark red with thin, dry, yellowish coating. Sudden onset is often due to pre-existing liver qi exuberance, which surges upward and transforms into wind, disturbing the facial collaterals and leading to this condition. Therefore, patients with wind often experience dizziness and headache, which frequently occur after intense anger, with aggravated facial convulsion and worsened headache, and a wiry, thin, and forceful pulse. Treatment should focus on liver-calming and wind-extinguishing. Commonly used formulas are Antelope Horn and Uncaria Decoction or Gastrodia and Uncaria Drink.
5. Wind Phlegm︰Facial convulsion, numbness of the facial muscles on the affected side, accompanied by facial puffiness, vertigo, expectoration, dry mouth without desire to drink, wiry and slippery pulse, enlarged tongue with thin white and moist coating. Commonly seen in patients with deviated mouth and eyes or prolonged wind-phlegm vertigo. Due to prolonged illness leading to qi deficiency, wind-phlegm lingering in the meridians, and the struggle between wind and phlegm, the collaterals lose their restraint, resulting in facial convulsion. The key points of differentiation are: occurring after deviated mouth and eyes or wind-phlegm vertigo, facial puffiness, a sensation of insects crawling, accompanied by vertigo, expectoration, dry mouth without desire to drink, lack of strength, enlarged tongue, wiry and slippery pulse, and moist greasy coating. Treatment should focus on tonifying qi and dispelling phlegm to calm wind. The commonly used formula is Qian Min Tang combined with Six Gentlemen Decoction plus Nan Xing.

Facial spasm is often related to emotional factors and is more common in women than in men. Considering the course of the meridians, the six yang meridians of the hands and feet Jingmai converge on the face, hence the saying "the face is the meeting place of all yang" (Zabing Yuanliu Xizhu). In clinical practice, selecting corresponding meridian tropism medications based on the location of the spasm can lead to more effective treatment.