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The theory of "Fire Stroke" originates from Liu Hejian. Hejian proposed that extreme excess of the five emotions stirs up internal fire, leading to sudden collapse (stroke). The general treatment principle is to use Baihu Tang and Sanhuang Tang to purge it; this is for treating Excess Fire. Use Xiaoyao San to soothe it; this is for treating Stagnant Fire. Use Tongsheng San and Liange San to resolve both exterior and interior pathogens simultaneously; this is for treating Exterior-Interior Pathogenic Fire. Use Liuwei Dihuang Wan to nourish it; this is to strengthen the source of Water to control the Yang brilliance. Use Bawei Wan to guide it; this is the so-called contrary treatment method, guiding fire back to its origin. Additionally, Dihuang Yinzi treats symptoms where the tongue is stiff and speechless, and the feet are useless and immobile, with miraculous efficacy.

Dihuang Yinzi

Xu Lingtai, a contemporary expert, stated: This formula treats Shaoyin Qi Jue (Qi reversal of the Shaoyin channel). Quack doctors, failing to examine carefully, actually use it to treat all types of stroke cases. For mild cases, there will be no hope of recovery; for severe cases, it exacerbates the disease and causes death. Both doctors and patients' families remain unaware throughout their lives.

Sun Xindian commented: Tongue stiffness and inability to speak can be caused by phlegm-fire blocking the Upper Jiao, suitable for Zhuan She Gao. It can also be caused by wind-stroke leading to Spleen flaccidity, tongue stiffness, and aphasia, suitable for Zishou Jieyu Tang. Only when the Shaoyin meridian winds around the root of the tongue, and Qi reversal prevents its arrival, named Feng Fei (Wind Paraplegia), is it suitable to use Dihuang Yinzi for warming treatment. Yu Jiayan used Zishou Jieyu Tang, removing Qiang Huo and Fang Feng, adding Shu Di Huang, He Shou Wu, Gou Qi Zi, Gan Ju Hua, Hei Zhi Ma, and Tian Men Dong for treatment.

Zishou Jieyu Tang (Both seen in *Shi Fang*)
Treats wind-stroke with Spleen flaccidity, tongue stiffness and aphasia, and hemiplegia.

The theory of "Qi Deficiency Similar Stroke" originates from Li Dongyuan. Dongyuan believed that insufficient Yuan Qi allows pathogens to gather, causing people to suddenly fall and stiffen as if struck by wind. The general treatment principle is to use Liujunzi Tang added with Huang Qi, Zhu Li, and Jiang Zhi; Buzhong Yiqi Tang also treats it. If sudden collapse occurs with urinary incontinence, indicating severe Yuan Qi deficiency, one must heavily use Bai Zhu, Ren Shen, and Huang Qi, adding Yi Zhi Ren as the main prescription. There are also cases of Qi reversal due to anger, with a blue face and large pulse, resembling wind-stroke; these should be treated primarily with Jingyue's Jie Gan Jian. For deficiency patterns, use Liujunzi Tang added with Wu Yao, Qing Pi, and Bai Zhi.

The theory of "Dampness Stroke" originates from Zhu Danxi. Danxi argued that the southeast region has warm temperatures and high humidity. Those suffering from wind-like diseases are not affected by true wind, but rather dampness generates phlegm, phlegm generates heat, and heat generates wind. Erchen Tang added with Sha Shen, Cang Zhu, Bai Zhu, Zhu Li, and Jiang Zhi is the primary treatment. Alternatively, use Ban Xia alone, six qian, decocted to half a cup, adding two drops of Sheng Jiang Zhi and two qian of Fenghua Xiao, to first treat the branch symptoms, or take Gun Tan Wan intermittently.

This is also called "Phlegm Stroke," and emetic therapy can be used, followed by regulating the Spleen and Stomach, and first adjusting the meridians, primarily using Zhu Li Tang.

Zhu Li Tang
Zhu Li (Two wine cups) Sheng Ge Zhi (One wine cup) Sheng Jiang Zhi (One tablespoon)
Combine them, make into two doses.

Beyond the elaborations by Liu, Zhu, and Li, later generations added four more conditions: Evil Stroke, Food Stroke, Cold Stroke, and Heat Stroke.

Regarding "Food Stroke," excessive fullness blocks the Taiyin, preventing the flow of upper and lower Qi, leading to Jue. Pingwei San modified and decocted is taken, or induced vomiting, or Guan Tan (forced feeding) with Beijji Wan.

Beijji Wan Xiaoshu Wan (Both seen in *Shi Fang*)

Regarding "Evil Stroke," entering ancient temples, forests, mountains, or tombs, or seeing extraordinary monsters, one feels strange Qi, leading to fainting and loss of consciousness. The pulse on both hands seems to come from two different people, fluctuating between large and small. Suhe Xiang Wan is forced down, or Pingwei San is added with Lei Wan (two qian), Xiong Huang Jing (five fen), and Huo Xiang (one to two qian) to resolve filth. Alternatively, burn Jiang Zhen Xiang, Huo Xiang, Sheng Gan Jiang, Chuan Xiong, Cang Zhu, Zao Jiao, and Hong Zao, allowing righteous Qi to enter through the mouth and nose.

Regarding "Cold Stroke," violent cold Qi enters directly inside, causing cold limbs, abdominal pain, continuous vomiting and diarrhea, leading to fainting and loss of consciousness. The six pulses are fine and small, or deep and hidden. The four limbs, lips, and mouth are cyanotic and dark. One bundle of fresh scallion white is placed in the umbilicus and warmed with a fire pot, or Guanyuan acupoint is moxibusted for thirty moxa cones, followed by forcing down Sini Tang.

Regarding "Heat Stroke," feeling summer heat in the summer months leads to fainting and unconsciousness, spontaneous sweating, dirty complexion, vomiting, diarrhea, and a deficient pulse. Xiaoshu Wan from *Qianjin Fang* is forced down, resulting in immediate revival. There are also cases of sudden collapse and unconsciousness after long journeys under the scorching sun. Hot earth is taken to surround the umbilicus, and hot urine is poured into it, leading to immediate revival. Alternatively, raw garlic is mashed with water and forced down.

Continued Discussion on the Error of Attacking Phlegm in True Wind-Stroke and Similar Stroke

At the moment of impending death, when Yang Qi is about to escape, there must be gurgling phlegm sounds. This is because the body's Jin Ye and Blood are gradually transforming into phlegm before death. Contemporary doctors, upon encountering this condition, immediately use Dan Nan Xing and Shi Chang Pu to directly attack the phlegm. This is directly attacking the Jin Ye and Blood, thereby hastening death.

*Yixue Zhenchuan* states: *Ben Cao Jing* only mentions Nan Xing. There is no Dan Xing. Nan Xing is white and pungent, inheriting Metal Qi to dispel wind and resolve phlegm, with effects similar to Ban Xia. Nowadays, people use ox bile to process it into Dan Xing, which is bitter and cold in nature. (Quack doctors all say that pill-form processed ones are better; they do not know that further processing destroys its nature even more, causing greater harm.) In wind-stroke with phlegm-saliva surging upward, it mostly belongs to the decline of Fire in the Three Jiao, with Earth collapsing and Water flooding. At this time, assisting righteousness and dispersing pathogens, strengthening Fire to drive out Cold, one still fears insufficiency. Taking bitter-cold Dan Xing, combined with cooling Zhu Li, will inevitably lead to the extinction of Sheng Yang (Life-generating Yang) and death.

Sun Xindian commented: Zhu Li is an essential medicine for wind-stroke, chosen for its softness and moisture to extinguish wind, and its lightness and clarity to activate collaterals. Driving out phlegm in the meridians is secondary. Jing Li and Sheng Ge Zhi share this meaning.