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Hemiplegia (hemiplegic stroke), a type of wind-stroke, determines the cold and heat nature of the eight winds based on the positions of the four directions; whereas diseases of cold damage distinguish the cold and heat nature of the six qi according to the sequence of the four seasons. These two are completely different. Generally, the cold and heat nature of the eight winds is not restricted to specific seasons. The winds from the eight directions have subtle and elusive signs; only those with divine wisdom can perceive and identify them. For instance, in Huangdi's "Mingtang" chapter, later medical scholars were all at a loss, unaware of its specific reference, so how could they possibly identify the eight winds? Although we cannot examine the condition before it manifests, we can certainly differentiate it once symptoms are obvious. Therefore, judgment should be made based on the initial symptoms. For example, regarding abnormal wind variations: Wind coming from the East will cause the face to turn green and the tongue purple; in severe cases, the tongue may curl up and the scrotum retract, muscles will twitch ("Ti" means movement, commonly known as muscle jumping), and the eyeballs often deviate to one side. Wind from the South will cause the face to turn red and the tongue coating to become scorched yellow; in severe cases, prickles may form on the tongue, muscles will feel hot, and the whites of the eyes will show redness. Wind from the West will cause the face to turn white and the tongue coating to become dry; in severe cases, the coating may resemble white frost or accumulated powder, the skin will raise goosebumps (indicating hair standing erect), and the eyeballs will often look upward with rolled-back whites. Wind from the North will cause the face to turn purple and the tongue to turn black; in severe cases, cracks may appear on the tongue, breathing will be accompanied by snoring sounds (resembling breathing sounds during sleep, commonly called "cold sleep"), and the whites of the eyes will show dark spots. Wind from the Center (which merges the four diagonal directions) will cause the face to turn yellow and the tongue coating to be yellow-black; in severe cases, there will be excessive saliva and dirt, the skin will feel moist and sticky, and the whites of the eyes will turn yellow. Winds coming from the Southeast, Southwest, Northeast, and Northwest are judged according to the methods corresponding to their respective directions.

Among the above symptoms, observing one or two is sufficient for diagnosis; it is not necessary for all to be present. These are all determined by the cold and heat nature of the wind pathogen received.

(There are seven symptoms that must be present at the onset, and seventeen symptoms that may or may not be present.)

At the onset, sudden coma and unconsciousness must occur.
There must be copious phlegm-rheum accumulation. Phlegm-rheum is essentially the body's fluids, which originally circulate throughout the body following Wei Qi (Defensive Qi). When wind damages Wei Qi, it fails to transport fluids, causing fluids to gather in the diaphragm along with Zong Qi (Pectoral Qi), clashing with respiratory air, thus obstructing the throat. This occurs in cold wind cases (requiring warming treatment) and also in hot wind cases (requiring cooling treatment). Secular doctors often use hot herbs to resolve phlegm, which is incorrect. I (Xiong Hu) once treated such cases with major cooling formulas, achieving immediate results.
The skin must appear shiny. Although the eight winds differ in cold and heat, they are collectively Yang pathogens. Since Yang pathogens disturb Wei Yang, the combination of two Yangs causes the skin to shine.
Shortness of breath must be present. Because Wei Qi fails to transport fluids, fluids accumulate in the diaphragm, impairing the respiration of Zong Qi, leading to shortness of breath.
Spontaneous sweating must be present. Wind is a Yang pathogen that does not close the Couli (pores), leading to spontaneous sweating. Sweat is the fluid distributed by Wei Qi; when wind damages Wei Qi, it fails to control the skin and hair follicles, leaving pores open, thus causing sweat to flow out spontaneously (there are cases without sweating due to extreme heat).
Hemiplegia (paralysis of one side) must be present (see detailed discussion on Eight Winds).
Body heaviness must be present. If Wei Qi functions on both sides, the body feels light; if it fails on one side, the body feels heavy.
These seven symptoms are necessarily present at the onset. Without these, it is not wind-stroke.

Alternatively, speech may be slurred or aphasic (inability to speak). The Shaoyin meridian is the gateway for Wei Qi entry and exit; its vessel passes through the diaphragm, connects to the Huiyan acupoint (the site of sound production, like the reed in a sheng), and wraps around the base of the tongue. When Wei Qi is damaged by wind, severe cases result in aphasia, while mild cases result in slurred speech.

Stool incontinence or fecal impaction may occur. The portion of Wei Qi circulating among the Fu organs is the Yuan Qi of the Sanjiao (Triple Burner). Severe damage leads to loss of control and incontinence; mild damage leads to inability to transport waste, resulting in constipation. It is common to see patients with only one or two days of constipation having stools as hard as stones, indicating excess heat. Some may have constipation for over twenty days.

Urinary incontinence or strangury (difficulty urinating) may occur. Wei Qi is most abundant in the Lower Jiao. The part circulating among Fu organs is the Sanjiao, but it must start from the Bladder. Thus, the *Neijing* mentions Sanjiao and Bladder together. The Bladder has an outlet but no inlet. All fluids from the Sanjiao entering the Bladder rely on the steaming and percolation of Lower Jiao Wei Qi to exit via urination. If wind damages Wei Qi, the exterior Wei Qi (circulating in meridians) floods into the Bladder. Excessive percolation causes incontinence; failure to percolate causes strangury. Secular texts claim incontinence indicates Kidney exhaustion, which is wrong. I have seen cases of incontinence that still recovered. If urine sediment resembles paste or hair powder after standing, it indicates Lower Jiao heat steaming the fluids, similar to boiling paste. Fresh urine is clear; aged urine becomes thick because fresh urine is hot (like hot paste, it doesn't coagulate), while aged urine is cold (like cold paste, it coagulates). Do not mistake this for deficiency-cold (children's urine is clear when fresh and turns milky white when aged due to pure Yang constitution and Lower Jiao heat; labeling this as cold is an error).

Sudden erection may occur. Wei Qi originates from the Lower Jiao, specifically the Moving Qi of the Kidneys. While external Wei Qi is damaged by wind, the internal Lower Jiao Wei Qi may become郁闭 (stagnant and closed), preventing release, thus causing sudden erection. I have seen cases where hemiplegia persisted, yet the patient fathered several children, because Wei Qi failed to circulate to the exterior.

Impotence may occur. This happens because external Wei Yang is damaged, drawing upon Lower Jiao Wei Qi. External leakage weakens the Moving Qi of the Kidneys, but hemiplegia is easier to cure. A friend of mine suffered from this, cured hemiplegia without medicine, and regained strong sexual function half a year later. This indicates the condition should be treated gently, waiting for vitality to regenerate, avoiding hot herbs that damage sinews.

Palpitations and forgetfulness may occur. Palpitation is Zhengchong. When Wei Qi fails to move fluids, fluids stagnate into water-dampness. Water accumulating below the chest causes palpitations (see *Neijing*).

Excessive suspicion and worry may occur. Damaged Wei Yang loses the ability to make decisions due to insufficient Shen (Spirit).

Belching and loss of appetite may occur. This is not true anorexia but rather a lack of hunger. Damage to Wei Qi on one side slows Sanjiao Qi transformation, impairing digestion of food and water.

Hyperphagia (excessive hunger) may occur. This only happens when wind invades internally, as stated in the *Neijing*: "Wind can digest grain." A friend of mine was cured of hemiplegia and deformity in one day using salty-cold herbs.

Restlessness and insomnia may occur. Wei Qi floats on the exterior and combines with wind, failing to enter Yin, causing the eyes to remain open (see *Neijing*).

Somnolence and desire to lie down may occur. This only happens when wind enters the Shaoyin meridian. Zhang Zhongjing said: "The disease of Shaoyin is characterized by a desire to sleep."

Uncontrollable yawning may occur. On the injured side, Wei Qi cannot circulate to Yang and desires to enter Yin; on the uninjured side, Wei Qi circulates to Yang. Yang pulls upward, Yin pulls downward, and the interaction of Yin and Yang causes yawning. This symptom is very common.

Headache feeling like a tight band may occur. This is due to evil wind flourishing in the Three Yang meridians. All Three Yang vessels ascend to the head, and wind tends to rise, causing headache.

Back arching like a broken bow may occur. This is due to evil wind flourishing in the Taiyang meridian, Du Mai (Governing Vessel), and Yang Qiao Mai. These three vessels run along the back; wind invasion causes spasms in all three.

Twitching and convulsions (only on one side in stroke) indicate a heavier condition where wind pathogen has entered the Ying (Nutritive) level. Pure Wei-level cases do not have this symptom.

The above seventeen symptoms are those that may or may not be present at onset.

Symptoms that must be present are the fundamental signs of hemiplegic stroke; without them, it is not stroke. Symptoms that may or may not be present depend on the severity of the pathogen and the deficiency/excess of the meridians. Differences in physique and lifestyle lead to different clinical presentations. These descriptions apply to the onset. As the disease lingers, human conditions and symptoms change infinitely; even a sage like Yu the Great could not catalog every variation. However, prognosis (curable vs. incurable) can be roughly discussed. Several cases follow.

First, if hemiplegia persists for a long time, causing phlegm-rheum to generate between bones/joints and under the skin, leading to external edema, it is difficult to cure. Vital Qi resides in fluids, just as Heaven and Earth's vital Qi resides in water. Everything formless yet taking form is water. The *I Ching* says: "Heaven generates One Water." Observe the body: it must first emaciate. If stagnant fluids turn to phlegm-rheum and deposit in joints/skin, emaciation precedes swelling. The *Neijing* states: "Wind pathogen lodging in collateral vessels compresses fluids into foam." And: "Accumulated foam reaches extremity, causing skin swelling." Foam is phlegm-rheum. Secular texts misunderstand this, attributing it to cold-damp or Spleen deficiency. In fact, this condition often arises from heat. Like rubbing hands with water creates bubbles when hot, or fire creates blisters on skin. Heat generates from wind; slight accumulation of foam is like bubbles. Due to prolonged duration, Wei Qi is greatly depleted and cannot recover quickly, making it hard to cure. Without this, it is easy to cure.

Second, if hemiplegia persists for a long time, causing contracture of hands/feet and inability to flex/extend, it is difficult to cure. The *Neijing* says: "Yang Qi nourishes the Spirit when refined, and nourishes Sinews when soft." Sinews are nourished by Blood but require Wei Qi warmth to move freely. The *Nan Jing* says: "Blood moistens, Qi warms." Prolonged illness depletes Wei Qi and Ying Blood, failing to nourish sinews. This progresses from Qi level to Blood level, shallow to deep, making it hard to treat.

Third, if hemiplegia persists for a long time, presenting with a deep, fine, rapid, and urgent pulse, it is difficult to treat. Stroke pulses are typically floating, large, and slow. Examining *Ling Shu* and *Su Wen*, seeing normal seasonal pulses or delayed pulses indicates easy recovery. Only when the pulse becomes deep, fine, rapid, and urgent is it hardest to cure. This is because the disease has entered the Blood level. Deep indicates Blood level; fine indicates Blood deficiency; rapid/urgent indicates Qi without Blood. Pulse originates from Zong Qi, leading Ying Blood. Zong Qi is formless and swift; Ying Blood is substantial and slow. They match to create a balanced pulse. Without Blood, Zong Qi moves alone, causing rapidity. Lack of Blood to fill the vessel causes fineness. Seeing this pulse means Ying Blood is damaged, hence difficult to cure. Disease entering Ying level is severe.

The above covers general principles. Other terms like Feng Fei, Feng Yi, and Feng Bi are not detailed here. However, the core theories of stroke are fully covered. Terms like left paralysis/right flaccidity were coined by later generations, lacking substantive meaning. The circulation of Ying/Wei and depth of meridians are detailed in *Ling Shu*, *Su Wen*, and Zhang Zhongjing's works. Later generations, ignorant of these, grope in the dark. Some claim stroke is deficiency, some fire, some phlegm, some Qi, some a combination of wind/phlegm/Qi, or wind/phlegm/fire. None grasp the true source. Others confuse demonic possession, heatstroke, or poisoning with stroke, classifying them as "Classified Stroke" or "Direct Strike," reflecting a confusion of origins...