Library

[From *Ling Shu*] When empty pathogenic factors (Xu Xie, external pathogens) invade one side of the body and penetrate deeply, residing internally within Ying (Nutritive Qi) and Wei (Defensive Qi). As Ying and Wei gradually decline, the True Qi departs, leaving only the pathogenic factor to remain alone, resulting in Pian Ku (hemiplegia). Therefore, when the pathogenic factor is shallow, it manifests as pain on one side of the body. (From "Ci Jie Zhen Xie" Chapter)

Pian Ku is characterized by inability to move and pain on one side of the body, while speech remains unchanged and mental state is orderly; the disease lies between the Fen Cou (interstices of skin and muscle). It can be treated with large needles (Ju Zhen), tonifying deficiency and reducing excess, so that recovery is possible. Fei Bing (a severe form of stroke sequelae) presents with no body pain and flaccid paralysis of the four limbs. The mental state is somewhat confused but not severely so; speech is faint but understandable, and this condition is treatable. If severe, where speech is lost, it is untreatable. (Note: Fei means dysfunction or waste. Fei refers to the deep penetration of pathogenic factors in Pian Ku. Although related, Fei and Pian Ku are named differently due to the lack of Qi and Blood circulation in half the body. Pian Ku is named for hemiplegia, while Fei is named for the loss of function in hands and feet. Whether partial or total paralysis, it is called Fei. "Treating with Ju Zhen" appears as "warming the bed and inducing sweat" in *Qian Jin Fang*)

The above discusses the depth of Zhong Feng (stroke) from *Nei Jing*. Cases with unilateral pain, unchanged speech, and orderly mind indicate pathogenic factors in the Fen Cou, which corresponds to what Zhang Zhongjing and Li Dongyuan call "Pathogen entering the Fu organs." Fei Bing has no pain, features limb flaccidity, aphasia, and confusion, indicating pathogenic factors entering the interior, corresponding to "Pathogen entering the Zang organs."

[Zhang Zhongjing] A floating and tight pulse at the Cun Kou position indicates tightness representing Cold and floating representing Deficiency. Cold and Deficiency combine, placing the pathogen in the skin. Floating indicates deficiency of Blood and Qi, and emptiness of collateral vessels. The thief pathogen cannot be expelled. It may appear on the left or right. On the affected side, the pathogen causes relaxation/slackness, while the healthy side becomes tense/spastic. The healthy Qi pulls toward the pathogen, causing deviation of the mouth and eyes and inability to move freely. If the pathogen is in the Luo Collaterals, there is numbness of skin and muscle. If in the Jing Meridians, there is heaviness and inability to bear weight. If entering the Fu organs, there is loss of recognition of people. If entering the Zang organs, the tongue becomes stiff making speech difficult, and saliva dribbles from the mouth.

[Jie Gu/Li Dongyuan School] Wind is the beginning of all diseases; it moves swiftly and changes frequently. "Movement" implies activity. Wind originates from Heat; when Heat prevails, Wind moves. One should use stillness to overcome restlessness; nourishing Blood is the method. Treatment requires sparing sweating and sparing purgation. Excessive sweating damages Wei Qi; excessive purgation injures Ying Blood. Only when sweating and purgation are applied appropriately can treatment proceed. Although there are contraindications for sweating and purgation when the pathogen is in the Meridians, there is a distinction between entering Zang and Fu organs. For pathogen entering Fu organs, sweating is appropriate; for entering Zang organs, purgation is appropriate. While combining sweating and purgation, one must not overdo it. Zhang Zhongjing said: Excessive sweating leads to loss of Yang; excessive purgation leads to loss of Yin. Loss of Yang damages Qi; loss of Yin damages Form. Thus, the classics state that Blood and Qi are the spirit of humans and must be carefully nurtured. When exterior and interior are disharmonious, sweating and purgation are needed to harmonize them; once harmonized, treatment should focus on the meridians. Pathogen entering Fu organs manifests as discoloration of the face, exterior syndrome symptoms with a floating pulse, aversion to wind and cold, stiffness, and numbness. Whether affecting the back, front, or sides of the body, it is called "entering Fu organs," and these cases are generally easier to treat. Pathogen entering Zang organs manifests as flaccid lips and mouth, immobility of the tongue leading to aphonia, anosmia, deafness, blurred vision, and constipation of both bowels and bladder. These are called "entering Zang organs," and such cases are generally difficult to treat. If wind enters Fu organs, first use Jia Jian Xu Ming Tang to release the exterior according to the syndrome. If accompanied by entry into Zang organs, bowel obstruction is common; use San Hua Tang to unblock stagnation. Once exterior and interior syndromes are stabilized without further changes, treat with major tonic medicines. Generally, pathogen entering Fu organs affects the four limbs; pathogen entering Zang organs obstructs the nine orifices. Even Fu organ involvement often includes Zang organ symptoms. However, tongue stiffness and aphonia may resolve spontaneously with long-term use of major tonics.

[Dong Yuan] Pathogen entering blood vessels causes facial deviation; entering Fu organs causes limb joint dysfunction; entering Zang organs endangers life. These three require different treatments. If entering blood vessels and presenting with Six Channels syndromes externally, treat with Xiao Xu Ming Tang modified or Shu Feng Tang. If entering Fu organs with internal obstruction of urine and stool, use San Hua Tang or Ma Ren Wan from *Ju Fang* to promote unblocking. If there are no Six Channels symptoms externally and no internal obstruction, nourish Blood and circulate Qi using Da Qin Jiao Tang or Qiang Huo Yu Feng Tang. For pathogen entering Zang organs with phlegm-saliva and coma, use Zhi Bao Dan to settle and anchor. For diseases of blood vessels or Fu organs, avoid using Long Nao (Borneol), She Xiang (Musk), and Niu Huang (Calculus Bovis) initially. Musk enters the Spleen to treat flesh; Niu Huang enters the Liver to treat sinews; Borneol enters the Kidney to treat bones. Using them might draw wind deeper into the bone marrow, like oil penetrating dough, impossible to remove. Do not indiscriminately use Da Ji, Yuan Hua, or Gan Sui to purge bowels, as this damages Yin Blood and further weakens True Qi. (Jie Gu stated that Zang organ entry involves constipation; Dong Yuan stated Fu organ entry involves obstruction. The latter view should prevail, as constipation occurs in non-Zang cases, and Zang cases may not always present with constipation.)