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Treatment for Internal Wind-Stroke Syndrome (also known as Quasi-Wind-Stroke, i.e., Cerebral Hyperemia as termed by Western medicine), characterized by a wiry, long, and forceful pulse (i.e., hypertension as termed by Western medicine), or excess in the upper part and deficiency in the lower part. Symptoms include frequent dizziness of the head and eyes, frequent pain and heat sensation in the brain, distending pain in the eyes with tinnitus, vexation and heat in the heart, frequent belching, gradual impairment of limb mobility, gradual deviation of the mouth and eyes, facial appearance resembling intoxication, severe cases may involve fainting leading to sudden collapse, unconsciousness, recovering after some time, or inability to return to normal state after waking, shortness of spirit, flaccid paralysis of limbs, or hemiplegia.

Huai Niuxi (Folium et Radix Achyranthis Bidentatae) 1 liang, Sheng Zhe Shi (Hematitum Preparatum) 1 liang (finely ground), Sheng Long Gu (Os Draconis et Ossis Mastodi) 5 qian (crushed), Sheng Mu Li (Concha Ostreae) 5 qian (crushed), Sheng Gui Ban (Carapax et Plastrum Testudinis) 5 qian (crushed), Sheng Hang Shao (Radix Paeoniae Alba) 5 qian, Xuan Shen (Radix Scrophulariae) 5 qian, Tian Dong (Rhizoma Asparagi) 5 qian, Chuan Lian Zi (Fructus Toosendan) 2 qian (crushed), Sheng Mai Ya (Germen Hordei Vulgaris) 2 qian, Yin Chen (Herba Artemisiae Scopariae) 2 qian, Gan Cao (Radix Glycyrrhizae Uralensis) 1.5 qian.

If there is severe heat in the heart, add Sheng Shi Gao (Gypsum Fibrosum) 1 liang. If there is much phlegm, add Dan Xing (Arisaematis Cum Bile) 2 qian. If the Chi pulse is deficient upon heavy pressure, add Shu Di Huang (Radix Rehmanniae Preparata) 8 qian and Jing Yu Rou (Fructus Corni) 5 qian. If stool is loose, remove Gui Ban and Zhe Shi, and add Chi Shi Zhi (Halloysit Rubrum) 1 liang (Yu Jiayan stated that Shi Zhi can replace Zhe Shi).

The term "Internal Wind" implies that wind arises from within, not from external invasion. The *Nei Jing* states: "All wind tremors and dizziness belong to the Liver." The Liver is a Wood organ; when Wood fire blazes, wind naturally arises. This occurs because Liver Wood loses harmony, causing wind to originate from the Liver. Additionally, Lung Qi fails to descend, Kidney Qi fails to secure, and Chong Qi and Stomach Qi rebel upward. Consequently, the Qi transformation of all organs rises excessively, and blood pouring into the brain also becomes excessive, leading to vascular congestion and affecting the nerves. In severe cases, nerve function is lost, resulting in coma and unconsciousness. Western medicine calls this Cerebral Hyperemia, a conclusion derived from anatomical experiments. Therefore, the formula heavily uses Niuxi (Achyranthes Root) to guide blood downward, which is the main drug for treating the branch symptoms. Furthermore, investigating the root cause, it uses Long Gu (Dragon Bone), Mu Li (Oyster Shell), Gui Ban (Turtle Shell), and Shao Yao (Peony Root) to calm and extinguish Liver Wind, Zhe Shi (Hematite) to direct Stomach and Chong Qi downward, and Xuan Shen (Scrophularia Root) and Tian Dong (Asparagus Rhizome) to clear Lung Qi. When the clear and descending Qi of the Lung moves downward, it naturally restrains Liver Wood. For those with deficient pulses at both Chi positions, it indicates damage to the True Yin of the Kidneys, unable to maintain connection with True Yang. The True Yang escapes and rushes upward, carrying Qi and Blood to surge into the brain. Thus, Shu Di Huang (Prepared Rehmannia Root) and Yu Rou (Cornus Fruit) are added to tonify and astringe the Kidneys. The originally proposed formula contained only these ingredients. Later, although many were effective, some experienced aggravated conditions with Qi and Blood rushing upward after the first dose. Adding Sheng Mai Ya (Barley Sprout), Yin Chen (Artemisia Scoparia Herb), and Chuan Lian Zi (Toosendan Fruit) eliminated this drawback. The Liver is the General Officer, possessing a rigid nature. If merely suppressed by medication, it might trigger reactive forces. Yin Chen, the tender shoot of Qing Hao (Artemisia Annua), possesses the rising Qi of early spring Shaoyang, resonating with Liver Wood. It clears Liver Heat and soothes Liver Depression, effectively accommodating the nature of Liver Wood. Sheng Mai Ya, the sprout of grain, also accommodates the nature of Liver Wood when used raw, preventing stagnation. Chuan Lian Zi guides Liver Qi downward and counters reactive forces. Adding these three herbs ensures safety when using this formula. Severe heat in the heart suggests external pathogenic factors transforming into heat; thus, Shi Gao (Gypsum) is added. Phlegm may obstruct Qi transformation; thus, Dan Xing (Arisaema with Bile) is added.

Internal Wind-Stroke appears in the *Nei Jing*, though not named as such nor as Cerebral Hyperemia, but rather as Jian Jue (Boiling Decoction Syncope), Da Jue (Great Syncope), and Bo Jue (Thin Syncope). Translating the *Nei Jing*: The *Mai Jie Pian* says: "When Liver Qi should be regulated but is not, one becomes easily angry; easy anger is called Jian Jue." The Liver is the General Officer; if unregulated, it leads to anger. Anger generates heat, boiling and consuming Liver Blood, causing the Ministerial Fire residing in the Liver to erupt suddenly, carrying Qi and Blood to surge into the brain, resulting in syncope. Is this not the origin of Internal Wind-Stroke due to internal stirring of Liver Wind?

The *Tiao Jing Lun* says: "When Blood and Qi move together upward, this is Da Jue; syncope leads to sudden death. If Qi returns, life is preserved; if Qi does not return, death ensues." Blood does not rise on its own but follows Qi. Extreme upward movement causes cerebral hyperemia. "Qi returning" means Qi reverses and descends, bringing Blood down, allowing survival. If Qi continues upward without reversal, Blood becomes increasingly congested until vessels rupture; recovery is unlikely.

Reading this passage clarifies the principles of Internal Wind-Stroke and Cerebral Hyperemia.

The *Sheng Qi Tong Tian Lun* says: "Yang Qi, under great anger, suffers form severance; Blood stagnates above, causing Bo Jue." Without explanation, this indicates Liver Wind stirring internally leading to cerebral hyperemia. "Bo Jue" refers to stagnant blood in the brain pressing against the brain, causing syncope. Reflecting on these three passages reveals that Internal Wind-Stroke corresponds to Western Cerebral Hyperemia, and treatment methods can be deduced from the classics to formulate effective prescriptions.

The name "Internal Wind-Stroke" distinguishes it from externally acquired wind. Since Tang and Song dynasties, both external and internal winds were indiscriminately called Wind-Stroke. External wind is True Wind-Stroke; internal wind is Quasi-Wind-Stroke. Etiologies differ greatly, so treatments must differ. Misdiagnosing Internal Wind-Stroke as external and using diaphoretic drugs will drive blood upward, worsening cerebral hyperemia, potentially causing vessel rupture and untreatable conditions. This lack of distinction was a major obstacle for Tang and Song physicians. Liu Hejian (Song Dynasty) realized wind is not always external, proposing that extreme emotions generate fire leading to sudden stroke, derived from "All wind tremors and dizziness belong to the Liver." Liver belongs to Wood, containing Ministerial Fire; excessive Wood and Fire generate wind. The general method uses Bai Hu Tang (White Tiger Decoction) and San Huang Tang (Three Yellow Decoction) to treat Excess Fire; Xiao Yao San (Free and Easy Wanderer Powder) to treat Depressed Fire (note: Chai Hu in Xiao Yao San guides blood upward and is contraindicated here; hence Zhen Gan Xi Feng Tang uses Yin Chen and Sheng Mai Ya instead); Tong Sheng San (Universal Salvation Powder) and Liang Ge San (Cool the Chest Powder) to treat exterior-interior pathogenic fire; Liu Wei Di Huang Wan (Six Ingredient Pill with Rehmannia) to nourish Water to control Yang; Ba Wei Wan (Eight Ingredient Pill) to guide fire back to its source (though called guiding fire back, Gui Zhi and Fu Zi are unsuitable). Although Liu's formulas are not perfect, they surpass those who fail to distinguish internal/external wind. His use of Bai Hu Tang for excess heat is precise. I have treated this syndrome many times; most recover consciousness after collapse. Within 3-4 days post-recovery, Bai Hu Tang syndrome appears in 60-70% of cases. This suggests an underlying latent stroke condition triggered by external pathogens. Former physicians called it Wind-Stroke generally. However, internal wind stirring, though triggered by external factors, is actually ignited by heat generated from external wind, combining internal and external heat to stir internal storm. At this stage, one should treat external heat, not disperse external wind. This explains why Liu borrowed Bai Hu Tang to clear external excess heat, avoiding Ma Huang and Gui Zhi, as diaphoretics aid blood ascent. This is Liu's unique insight. My friend Zhang Shanlei (Jiading, Jiangsu) wrote *Zhong Feng Quan*, detailing Internal Wind-Stroke, favoring Liu's approach, which complements my discussion.

Later, Li Dongyuan and Zhu Danxi (Yuan Dynasty) proposed Qi deficiency and Dampness theories alongside Liu's Fire theory. Li Dongyuan stated that insufficient Yuan Qi allows evil to invade, causing sudden collapse like wind. Blood follows Qi; excessive upward Qi causes cerebral hyperemia and compression of brain tissue/nerves, leading to syncope (as per *Nei Jing*). Insufficient upward Qi causes cerebral anemia, failing to nourish brain tissue/nerves, also leading to syncope. *Nei Jing* says: "Deficiency of upper Qi leads to incomplete filling of the brain, bitter ringing in ears, tilting of the head, and dizziness." Severe cases lead to syncope. "Incomplete filling" refers to cerebral anemia. Thus, Li's theory of Qi deficiency relates to cerebral anemia, distinct from Liu's cerebral hyperemia (Excess vs. Deficiency). Zhu Danxi argued that in the warm, damp southeast, wind diseases are not true wind but arise from Dampness generating Phlegm, Phlegm generating Heat, and Heat generating Wind. This is the "Danxi emphasizes Dampness" view. However, this describes Tan Jue (Phlegm Syncope), unrelated to cerebral hyperemia or anemia. Even if phlegm accompanies syncope in those conditions, it is a concurrent symptom, not the primary pathology.

Analysis: Danxi's view of Heat generating wind seems similar to Liu's Fire theory but differs essentially. Liu's Fire arises from Dryness, so his drugs focus on moistening dryness and nourishing Yin. Danxi's Heat arises from Dampness, so his drugs focus on resolving dampness and draining phlegm. While Dampness can generate Heat, Dampness-induced Liver Wind is rare (Liver Wind usually stems from Dryness-Heat). Thus, Liu's theory is superior.

In mid-Qing Dynasty, Wang Xunchen focused on Qi deficiency. He posited that human Yuan Qi totals ten parts; losing five leaves five, insufficient to fill the body but supporting it. Qi deficiency leads to meridian deficiency. If Qi passes through weak meridians and concentrates on one side, the other side lacks Qi, causing hemiplegia. He created Bu Yang Huan Wu Tang (Tonify Yang and Restore Five Tenths Decoction), heavily using Huang Qi (Astragalus Root) 4 liang to vigorously tonify Qi, following Li Dongyuan's Qi theory. However, Wang did not specify pulse conditions. If the pulse is deficient and weak, his formula works. If the pulse is solid and forceful, indicating cerebral hyperemia, using warming and ascending Huang Qi will drive blood further upward, causing immediate danger. Caution is essential. A case in our county involved a man with right-hand paralysis but walking ability. His grandson consulted a doctor returning from Tianjin, who claimed easy cure. The diagnosis noted a surging, solid pulse, confirming paralysis. The prescription imitated Bu Yang Huan Wu Tang with 8 qian of Huang Qi. After taking it, the patient fell into coma. A non-fatal condition became critical due to misused Huang Qi. How cautious must we be!

Liu XX came to Tianjin in Ding Mao year. He felt frequent heat in the brain, occasional dizziness, and inner restlessness. Pulse was wiry, long, and forceful bilaterally, indicating cerebral hyperemia caused by long-standing frustration and anxiety. For brain heat, he used green beans in a pillow as external therapy. Internally, he took Zhen Gan Xi Feng Tang (Settle the Liver and Extinguish Wind Decoction) with added Di Huang (Rehmannia Root) 1 liang. After several doses, brain heat subsided. Chuan Lian Zi was removed, and Sheng Di Huang was reduced to 6 qian. After ten days, the pulse normalized, and inner restlessness ceased. Medication stopped.

Another case: The new bride of the Yu family in Tianjin suffered sudden headache over a week after marriage. Doctors suspected external wind and administered diaphoretics, worsening the pain significantly. I was consulted. The pulse was wiry, hard, and long, especially on the left, indicating excessive upward rush of Liver and Gallbladder Fire. I prescribed Zhen Gan Xi Feng Tang with Long Dan Cao (Gentiana Root) 3 qian to drain Liver/Gallbladder Fire. One dose improved symptoms by half; two more doses stopped the headache, though the pulse remained forceful. Long Dan Cao was removed, and Sheng Di Huang 6 qian was added. After several doses, the pulse normalized, and medication stopped.