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The syndrome of stroke (Zhong Feng) is distinguished into involvement of the Fu organs (Zang-Fu: hollow organs), Zang organs (Zang-Fu: solid organs), and the channels and vessels (Mai-Xue). Involvement of the Fu organs indicates the pathogen is at the exterior, corresponding to what Zhang Zhongjing termed "Taiyang Wind Strike" (Taiyang Zhong Feng), treated with formulas such as Guizhi Tang (Cinnamon Twig Decoction). The external manifestations present as syndromes of the Six Channels, similar to the transmission patterns between the Three Yang and Three Yin channels in Cold Damage (Shang Han). Since the clinical presentations are identical to those of Cold Damage, the treatment methods are also no different from the management of Cold Damage transmission.

Involvement of the Zang organs indicates the pathogen is at the interior. For instance, aphasia indicates strike upon the Heart; flaccid lips indicate strike upon the Spleen; nasal congestion indicates strike upon the Lung; visual blurring indicates strike upon the Liver; deafness indicates strike upon the Kidney. This results from wind pathogens directly invading the interior, categorized into Obstruction Syndrome (Bi Zheng) and Collapse Syndrome (Tuo Zheng). In Obstruction Syndrome, there is lockjaw and clenched fists; treatment should focus on unblocking orifices. For Heat Obstruction, Niuhuang Wan (Calculus Bovis Pill) is used; for Cold Obstruction, Ju Ban Jiang Zhi Tang (Citrus Peel, Pinellia, and Ginger Juice Decoction) is used. If Heat Obstruction is severe with chest fullness and constipation, Sanhua Tang (Three Transformations Decoction) may be used to purge. In Collapse Syndrome, an open mouth indicates Heart collapse; closed eyes indicate Liver collapse; relaxed hands indicate Spleen collapse; snoring voice indicates Lung collapse; urinary incontinence indicates Kidney collapse. Additionally, straightened hair, head shaking, opisthotonos (body arching backward), ruddy complexion like makeup, and sweat droplets like pearls are all signs of terminal collapse. At this stage, Lizhong Tang (Regulate the Middle Decoction) with more than one tael of Renshen (Ginseng Radix et Rhizoma) must be used to warm and tonify Yuan Qi (Primordial Qi). If cold phlegm obstruction exists, Sansheng Yin (Three Lives Infusion) added with Renshen may be administered via gavage, potentially saving two or three out of ten patients.

Involvement of the channels and vessels indicates the pathogen is at the half-exterior and half-interior, manifesting as facial deviation and hemiplegia. Treatment should harmonize, using Da Qin Jiao Tang (Great Gentian Decoction) added with Zhuli (Bamboo Sap), Jiang Zhi (Ginger Juice), and Gouteng (Uncariae Ramulus cum Uncis). Differentiation is made between Qi deficiency and Blood deficiency. Qi deficiency manifests predominantly on the right side, assisted by Sijunzi Tang (Four Gentlemen Decoction). Blood deficiency manifests predominantly on the left side, with doubled dosage of Siwu Tang (Four Substances Decoction). Combined Qi and Blood deficiency affects both sides, assisted by Bazhen Tang (Eight Treasures Decoction). These are the general principles for treating stroke.

One might ask: Cold pathogens striking the Zang organs are purely cold; why do wind pathogens striking the Zang organs present as either cold or heat? I posit that cold is a Yin pathogen, and Yin governs stillness; thus, it injures humans solely as Cold Strike. Wind is a Yang pathogen, and Yang governs movement; it travels swiftly and changes frequently. Therefore, when it injures humans, it may cause Cold Strike or Heat Strike, having no fixed form. However, its lack of fixed form depends on the state of the person's Zang-Fu organs. Why? If the person’s Zang-Fu organs harbor latent heat, the wind rides the fire’s momentum, and the fire borrows the wind’s power. Heat qi stagnates and cannot circulate freely, turning the wind into Hot Wind. If the person’s Zang-Fu organs are inherently deficient and cold, wind and water collide; cold qi is biting, water freezes and ice congeals, True Yang declines, and the wind becomes Cold Wind. Hot Wind often presents as Obstruction Syndrome, requiring dredging and unblocking as the priority. Cold Wind often presents as Collapse Syndrome, requiring warming and tonifying as the urgency. Although both involve striking the Zang organs, the distinction between cold and heat is vast. The reasons behind becoming hot or cold are not sought by the world; thus, how can the cold nature of Sanhua Tang and the hot nature of Sansheng Yin stand firmly together in the same book? Therefore, the medical Dao values profound contemplation and prudent judgment leading to personal insight, which cannot be fully expressed through language.