凡非风口眼歪斜，有寒热之辨。在经曰∶足阳明之筋，引缺盆及颊，卒口僻，急者，目
不合。热则筋纵，目不开。颊筋有寒，则急引颊移口；有热则筋弛纵缓，不胜收，故僻。此
经以病之寒热言筋之缓急也。然而血气无亏，则虽热未必缓，虽寒未必急，亦总由血气之衰
可知也。尝见有引《内经》之意而曰∶偏于左者，以左寒而右热；偏于右者，以右寒而左热
，诚谬言也。不知偏左者，其急在左，而右本无恙也；偏右者亦然。故无论左右，凡其拘急
之处，即血气所亏之处也。以药治者，左右皆宜从补。以艾治者，当随其急处而灸之。盖经
脉既虚，须借艾火之温以行其气，气行则血行，故筋可舒而歪可正也。凡诸灸法，有言左灸
右，右灸左者。此亦《内经·缪刺论》之法，从之亦无不可。至若经言寒热，则凡如唇缓流
涎，声重，语迟含糊者，是皆纵缓之类。纵缓者多由乎热，而间亦有寒者，气虚故也。歪斜
牵引，抽搐反张者，皆拘急之类。拘急者多由乎寒，而间亦有热者，血虚故也。盖经所言者
，言理之常，余所言者，言病之变，亦无非理也。使读经不明理，必反害经意矣。故临此证
者，不可不加之详审。
一、非风螈 等证，亦有寒热之辨。观之经曰∶寒则反折筋急，热则筋弛纵不收，此固
其常也。然寒热皆能拘急，亦皆能弛纵，此又不可不知。如寒而拘急者，以寒盛则血凝，血
凝则滞涩，滞涩则拘急，此寒伤其营也。热而拘急者，以火盛则血燥，血燥则筋枯，筋枯则
拘急，此热伤其营也。又若寒而弛纵者，以寒盛则气虚，气虚则不摄，不摄则弛纵，此寒伤
其卫也。热而弛纵者，以热盛则筋软，筋软则不收，不收则弛纵，此热伤其卫也。以此辨之
，岂不明析，且或寒或热，必有脉证可据，但宜因证而治之。若病无寒热，则当专治血气无
疑矣。
凡是并非由外感风邪引起的口眼歪斜，存在寒证与热证的辨别。《内经》记载：足阳明经的筋脉，牵引缺盆和面颊，突然发生口角歪斜，拘急的一侧眼睛不能闭合。若属热证，则筋脉松弛纵缓，眼睛无法睁开。如果面颊部的筋脉受寒，就会拘急牵引导致口角歪斜；若受热，则筋脉弛缓松弛，不能收摄，所以出现歪斜。这段经文是以病性的寒热来论述筋脉的缓急。然而，如果气血没有亏损，那么即使是热证未必会导致筋脉松弛，即使是寒证也未必会导致筋脉拘急，这也总归是因为气血衰弱的缘故。我曾经见到有人引用《内经》的意思说：偏左的口眼歪斜，是因为左边寒右边热；偏右的口眼歪斜，是因为右边寒左边热，这确实是荒谬的说法。不知道偏左者，其拘急在左侧，而右侧本来没有病变；偏右者也是如此。所以无论左右，凡是拘急的地方，就是气血亏损的地方。用药物治疗时，左右两侧都应当采用补法。用艾灸治疗时，应当随着拘急的部位进行艾灸。因为经脉既然虚弱，必须借助艾火的温热来推动气机运行，气行则血行，所以筋脉可以舒展，歪斜可以矫正。至于各种灸法中，有说左病灸右、右病灸左的，这也是《内经·缪刺论》中的方法，遵循它也没有不可以的。至于经文所说的寒热表现，像嘴唇松弛流口水、声音沉重、说话迟缓含糊不清的，这些都是筋脉纵缓类的症状。纵缓多由热引起，但间或有因寒引起的，这是气虚的缘故。口眼歪斜牵引、抽搐反张的，都是筋脉拘急类的症状。拘急多由寒引起，但间或有因热引起的，这是血虚的缘故。大概经文所言的是常理，我所讲的是病情的变化，也都符合医理。如果读经不明白医理，反而会损害对经文原意的理解。所以面对这种病症，不可不加以详细审察。
一、非风引起的抽搐等证候，也有寒热的辨别。观察经文说：寒则导致肢体反折、筋脉拘急，热则导致筋脉松弛纵缓不能收持，这固然是常态。然而寒和热都能导致拘急，也都能导致弛纵，这一点也是不可不知道的。比如寒邪导致的拘急，是因为寒盛则血液凝滞，血液凝滞则运行涩滞，运行涩滞则导致筋脉拘急，这是寒邪损伤了营血。热邪导致的拘急，是因为火盛则血液燥热，血液燥热则筋脉枯槁，筋脉枯槁则导致拘急，这是热邪损伤了营血。又如寒邪导致的弛纵，是因为寒盛则气虚，气虚则不能固摄，不能固摄则导致筋脉弛纵，这是寒邪损伤了卫气。热邪导致的弛纵，是因为热盛则筋脉软弱，筋脉软弱则不能收持，不能收持则导致弛纵，这是热邪损伤了卫气。以此来进行辨别，难道不是清晰明了吗？而且或者是寒证或者是热证，必定有脉象和症状作为依据，只应当根据证候进行治疗。如果疾病没有明显的寒热属性，那么就应当专门治疗气血问题，毫无疑问了。
For facial paralysis (facial deviation) not caused by external wind pathogens, there is a differentiation between Cold patterns and Heat patterns. The *Neijing* states: "The sinews of the Foot-Yangming channel draw from the clavicle to the cheek; sudden deviation of the mouth occurs, and on the tight side, the eye cannot close." If it is a Heat pattern, the sinews become flaccid and relaxed, and the eye cannot open. If the sinews of the cheek are affected by Cold, they contract and pull the mouth to one side; if affected by Heat, the sinews become lax and relaxed, unable to maintain tension, thus causing deviation. This passage in the classic text discusses the slackness or tension of sinews based on the Cold or Heat nature of the disease. However, if Blood and Qi are not deficient, even Heat may not necessarily cause relaxation, and even Cold may not necessarily cause tension; this ultimately points to the decline of Blood and Qi. I have seen some cite the meaning of the *Neijing* to say: for left-sided deviation, it is due to Cold on the left and Heat on the right; for right-sided deviation, it is due to Cold on the right and Heat on the left. This is indeed an erroneous statement. One fails to realize that in left-sided deviation, the tension is on the left, while the right is originally unaffected; the same applies to right-sided deviation. Therefore, regardless of left or right, any area of tension is where Blood and Qi are deficient. When treating with herbs, both sides should generally be treated with tonification. When treating with Moxibustion (Ai Jiu), one should apply moxa directly to the site of tension. Since the channels are deficient, one must rely on the warmth of moxa fire to promote the movement of Qi; when Qi moves, Blood moves, so the sinews can relax and the deviation can be corrected. Regarding various moxibustion methods, some advocate treating the left side by stimulating the right, and vice versa. This is also the method described in the *Miao Ci Lun* chapter of the *Neijing*, and following it is acceptable. As for the Cold and Heat manifestations mentioned in the classics, such as loose lips with drooling, heavy voice, and slow or slurred speech, these are all types of flaccidity/relaxation. Flaccidity is mostly caused by Heat, but occasionally by Cold, due to Qi deficiency. Deviation, pulling, spasms, and opisthotonos are all types of tension/spasm. Tension is mostly caused by Cold, but occasionally by Heat, due to Blood deficiency. What the classics state refers to the general principles, while what I state refers to the variations in disease, both of which conform to medical logic. If one studies the classics without understanding the underlying logic, one will inevitably distort their original meaning. Therefore, when encountering such conditions, careful examination is indispensable.
1. Convulsions and other syndromes associated with Non-Wind (Fei Feng) also require differentiation between Cold and Heat. Observing the classics, it says: "Cold causes the body to arch backward and sinews to tighten; Heat causes sinews to relax and fail to hold." This is indeed the norm. However, both Cold and Heat can cause tension, and both can cause relaxation; this point must also be understood. For instance, tension caused by Cold arises because excessive Cold coagulates Blood; coagulated Blood leads to stagnation and sluggishness; sluggishness leads to tension. This indicates that Cold has damaged the Ying (Nutritive) level. Tension caused by Heat arises because excessive Fire dries out Blood; dried Blood leads to withered sinews; withered sinews lead to tension. This indicates that Heat has damaged the Ying (Nutritive) level. Furthermore, relaxation caused by Cold arises because excessive Cold leads to Qi deficiency; deficient Qi fails to secure and control; failure to secure leads to relaxation. This indicates that Cold has damaged the Wei (Defensive) level. Relaxation caused by Heat arises because excessive Heat makes sinews soft; soft sinews fail to hold; failure to hold leads to relaxation. This indicates that Heat has damaged the Wei (Defensive) level. By using this method of differentiation, is it not clear? Moreover, whether it is a Cold or Heat pattern, there must be pulse signs and symptoms as evidence; treatment should simply follow the syndrome. If the disease presents no obvious Cold or Heat characteristics, then one should exclusively treat the deficiency of Blood and Qi without doubt.