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Treatment of Zhong Feng (Wind Stroke).

Fangfeng (Radix Saposhnikoviae, 6 qian), Zhen Liaoshenren (Ginseng Radix et Rhizoma from Liaodong region, 4 qian, decocted separately and mixed with other decoctions for administration; alternatively, Yetaishenren [Ginseng Radix] can be used at 7 qian; Gaolishenren [Korean Ginseng] is not suitable), Qing Banxia (Rhizoma Pinelliae Preparatum, 3 qian), Sheng Shigao (Gypsum Fibrosum, 8 qian), Jiangcan (Bombyx Batryticatus, 2 qian), Shishuang Bing (Pyrus Sinkiangensis Frost, 5 qian, dissolved in the decoction), Shexiang (Moschus, 1 fen, taken with decoction).

The syndrome of Zhong Feng (Wind Stroke) is mostly caused by extreme deficiency within the five Zang organs, or innate constitutional weakness, or excessive physical labor and mental exertion. Wind pathogen invades via the meridians, penetrates directly through the Membranous Origin (the space between the exterior and interior) to reach the Zang-Fu organs, causing each organ to lose its normal function. Symptoms may include sudden collapse into unconsciousness, dysarthria (slurred speech), difficulty in urination and defecation, loss of sensation over urination and defecation, or accompanied by flaccid paralysis or hemiplegia. These are extremely critical syndromes. Mild cases of Zhong Feng may linger for years; severe cases, if treated improperly, face imminent danger. Therefore, a heavy dose of Fangfeng (Radix Saposhnikoviae) guided by Shexiang (Moschus) is used to penetrate deeply into the Zang-Fu organs to search out and expel wind. Fearing that the Yuan Qi (Primary Qi) is too weak to transform the medicinal power to drive out the wind, Renshen (Radix Ginseng) is used to greatly tonify the Yuan Qi, supporting the Righteous Qi to overcome the Pathogenic Qi. Shigao (Gypsum Fibrosum) is used because wind stagnating in the Zang-Fu often generates internal heat; furthermore, Renshen (Radix Ginseng) tonifies Qi and assists Yang, which can also generate heat. Shigao (Gypsum Fibrosum) is heavy in substance but light in aroma, with a slightly cold nature. Its heaviness allows it to penetrate deeply into the Zang-Fu organs; its lightness allows it to reach the skin and hair externally; its coldness clears heat from the Zang-Fu organs and simultaneously resolves the heat generated by Renshen (Radix Ginseng). Jiangcan (Bombyx Batryticatus) is used because Xu Lingtai stated that when pathogens enter the human body, they are "Qi-like but formless," penetrating meridians and collaterals, becoming deeper over time. If drugs with opposite properties to the pathogen are administered, the pathogen will reject them. It is necessary to use drugs of the same category as the pathogen to act as guides among the other herbs. Then, when the medicine reaches the disease site, the pathogen follows the medicine. As the medicinal properties gradually take effect, the pathogen may exit through the pores or via urination and defecation, unable to remain. This is the method of "concordant treatment" (treating according to the nature of the pathogen). Jiangcan (Bombyx Batryticatus) becomes stiff due to wind and belongs to the same category as wind; thus, it is good at guiding wind-expelling medicines to the disease site to achieve success. Banxia (Rhizoma Pinelliae Preparatum) and Shishuang Bing (Pyrus Sinkiangensis Frost) are used because this syndrome invariably involves phlegm-fluid retention. Banxia (Rhizoma Pinelliae Preparatum) descends and transforms phlegm, while Shishuang Bing (Pyrus Sinkiangensis Frost) moistens dryness, allowing the phlegm-fluids to subside naturally.

If this syndrome presents with unresolved exterior symptoms progressing to internal heat, sweating agents should be urgently used to release the exterior while simultaneously clearing internal heat. If there is also agitation of internal wind, one should refer to the treatment methods for Internal Zhong Feng (Internal Wind Stroke) discussed later, integrating them. The formula should include herbs that extinguish internal wind alongside those treating external pathogens to be complete.

Zhong Feng (Wind Stroke) syndromes can be biased towards cold, biased towards heat, or show no obvious cold or heat. This formula I proposed is intended for Zhong Feng without significant cold or heat tendencies. If biased towards heat, Fengyin Tang (Wind-Driving Decoction) from *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) should be modified (reduce doses of Ganjiang [Zingiberis Rhizoma] and Guizhi [Ramulus Cinnamomi Cassiae]). If biased towards cold, I have other empirical methods. I once treated an elderly woman, around fifty years old, who suddenly collapsed into unconsciousness due to Zhong Feng in mid-winter. She did not respond to calls, and her chest seemed obstructed by phlegm-fluids, severely hindering respiration. Her pulse was faint, thin, almost imperceptible, and slow. Knowing she had chronic cold-fluid retention, the sudden invasion of wind-cold combined with the cold-fluid to cause illness. Urgently, Hu Jiao (Fructus Piperis Nigris, 3 qian) was crushed and decocted for two or three boils. Half a teacup of thick juice was administered, and respiration immediately improved. Subsequently, Ganjiang [Zingiberis Rhizoma] (6 qian), Guizhi Jian [Ramulus Cinnamomi Cassiae tips] (3 qian), and Danggui [Radix Angelicae Sinensis] (3 qian) were used. After three doses, she could groan, and limb movement gradually returned, though the left hand and foot remained immobile. The dose of Ganjiang [Zingiberis Rhizoma] was then halved, and Sheng Huangqi [Radix Astragali Membranacei] (5 qian), Rushenxiang [Resina Olibani] (3 qian), and Moyao [Resina Myrrhae] (3 qian) were added. After more than ten doses, speech and movement returned to normal.

If the patient's Yuan Qi (Primary Qi) is not deficient and has merely been struck by pathogenic wind, Renshen (Radix Ginseng) can be omitted, and Wugong (Scorpio, 1 unit) and Quanxie (Scorpius, 1 qian) can be added. If the syndrome is very excess and obstruction is severe, such as inability to urinate or defecate, or a choppy and stagnant pulse, Sheng Dahuang [Radix et Rhizoma Rhei] (several qian) can be added to promote internal unblocking and external dispersal, following the principle of Fangfeng Tongsheng San (Saposhnikovia Powder to Unblock and Safeguard).

Xu Lingtai once treated a man who usually had much phlegm and numbness in his hands and feet. He suddenly fainted, lost urine control, had locked jaws and clenched fists, and produced rattling sounds like sawing. The physician administered Shenfu Wan (Decoction of Ginseng and Aconite) and Shudi (Prepared Rehmannia Root) etc., ground into powder. His pulse was surging, large, and forceful; his face was red, and his breath was coarse. This indicated fullness of Phlegm-Fire closing all orifices; administering Shenfu Wan (Decoction of Ginseng and Aconite) would lead to immediate danger. Thus, Xiao Xuming Tang (Minor Continuation of Life Decoction) was used with Guizhi [Ramulus Cinnamomi Cassiae] and Fuzi [Radix Aconiti Lateralis Preparata] removed, and Sheng Dahuang [Radix et Rhizoma Rhei] (1 qian) added and ground into powder. It was falsely claimed to be another medicine to avoid suspicion or shock from bystanders. After three doses, he made sounds; after five doses, he could speak. Thereafter, blood-nourishing and phlegm-resolving medicines were used for regulation. After one month, his gait returned to normal. Comparing this case with my own case makes the distinction between cooling and warming therapies evident. Additionally, enuresis (urinary incontinence) mostly belongs to deficiency, but the enuresis in this case was due to excess. This shows that those examining syndromes must not be rigidly attached to one aspect. However, true Zhong Feng (Wind Stroke) is extremely rare, while Zhong Feng-like syndromes are very common. Among every hundred Zhong Feng cases, only one or two are true Zhong Feng. Inaccurate syndrome differentiation leads to immediate peril; this must be approached with utmost caution.