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(Attachment: Jianling Decoction)

Naochongxue Zheng (Cerebral Hyperemia Syndrome), which is referred to as Jue Zheng (Reversal Syndrome) in the *Huangdi Neijing* (Yellow Emperor's Inner Canon), is also the condition erroneously called Fengzhong Zheng (Apoplexy/Stroke Syndrome) by later generations. This has been thoroughly discussed in previous sections. However, those who discuss this syndrome claim that it occurs suddenly and thus seems difficult to prevent. They do not realize that all diseases have prodromal signs before onset. In the case of Naochongxue Zheng, its prodromal signs are actually more prominent than those of other syndromes. Moreover, these signs may appear months or even years in advance. The following lists the specific prodromal signs:

(1) The pulse must be Xian Ying Er Chang (Wiry, stiff, and long), or Cun Sheng Chi Xu (Excess at the Cun position and Deficiency at the Chi position), or several times larger than a normal pulse, without any sense of moderation.

(2) Frequent dizziness and vertigo of the head and eyes, or a sensation of mental confusion, frequent forgetfulness, constant headache, deafness, or distending pain in the eyes.

(3) A sensation of Qi rushing upward in the stomach, obstructing food and drink from descending, or Qi rising from the Lower Jiao causing hiccups.

(4) Constant irritability and restlessness, or intermittent heat sensation in the heart/mind, or a feeling of the spirit wandering during sleep.

(5) Swollen tongue, slurred speech, deviation of the mouth and eyes, hemibody numbness and motor impairment, unsteady gait with a tendency to fall, a sensation of heavy head and light feet, or soles of the feet feeling like cotton.

If one or two of the above symptoms appear, combined with the corresponding pulse presentation, it can be diagnosed as a prodrome of Naochongxue Zheng. Over the past ten-plus years, I have cured many cases of this syndrome. I devised the Jianling Tang (Jianling Decoction). After taking it, blood in the brain flows downward like water poured from a high vessel, and the cerebral hyperemia resolves spontaneously. Therefore, I list the prescription below for reference by the medical community.

[Jianling Tang]
Sheng Huai Shan Yao (Raw Dioscoreae Hypoglaucae Rhizoma, 30g)
Huai Niu Xi (Achyranthis Bidentatae Radix, 30g)
Sheng Zhe Shi (Raw Haematitum, 24g, finely crushed)
Sheng Long Gu (Raw Os Draconis, 18g, finely crushed)
Sheng Mu Li (Raw Ostreae Concha, 18g, finely crushed)
Sheng Huai Di Huang (Raw Dioscoreae Oppositae Rhizoma, 18g)
Sheng Hang Shao (Raw Paeoniae Radix Alba, 12g)
Bai Zi Ren (Biota Seed, 12g)
Decoct with thick rusted iron water.

The Zhe Shi (Haematitum) used must have both convex and concave surfaces; it must be raw and finely crushed to be effective. If loose stools occur, remove Zhe Shi and add San Qian Jian Lian Zi (Three-thousand-year-old Lotus Seeds, core removed, 9g). If there is aversion to cold, replace Sheng Di Huang with Shu Di Huang (Prepared Dioscoreae Oppositae Rhizoma).

In Tianjin, I treated the mother of Chi XX, aged 74. She frequently experienced dizziness, headache, irritability, heat sensations, and distending discomfort in both arms. Her pulse was wiry, stiff, and large. I identified this as a prodrome of Naochongxue Zheng and treated her with Jianling Tang. After several doses, all symptoms resolved, although the pulse remained wiry and stiff despite being less full than before. Due to fatigue from medication, she stopped taking it. More than a month later, the illness relapsed severely. I prescribed modified Jianling Tang again. After several doses, symptoms resolved again, but the pulse remained unpacified. She stopped the medication again. A month later, it relapsed once more. I prescribed modified Jianling Tang for over thirty doses until the pulse became peaceful and normal. She then stopped the medicine, and no further relapses occurred.

An elderly surnamed Wang in Tianjin, over fifty years old, sought treatment at a Western hospital for headache and facial paralysis. The physician measured his blood pressure at 160 mmHg and diagnosed Naochongxue Zheng. After days of Western medicine with no effect, he came to me. His pulse was wiry, stiff, and large, confirming cerebral hyperemia. I treated him with Jianling Tang, increasing Zhe Shi to 30g. After more than ten doses, his head felt clear, and facial deviation improved, though the pulse had not normalized. He visited the Western hospital again, where the pressure dropped by over 20 mmHg, yet the physician noted the pulse was still abnormal. I advised him to continue medication until the pulse normalized. He believed he was cured and ignored my advice. Four months passed without medication. After returning from a strenuous trip, he suddenly fainted and died. These two cases demonstrate that when using this formula for Naochongxue Zheng, one must continue until the pulse is completely peaceful and free of wiriness/stiffness before stopping.

My friend Zhu Bowen, though not a practitioner, was proficient in medicine. He told me, "For Naochongxue Zheng, it is advisable to add blood-breaking herbs to the blood-descending formula." I was enlightened by this statement. For instance, eye pain radiating to the brain is often caused by cerebral hyperemia. Ophthalmologists often use Da Huang (Rhei Radix et Rhizoma) to purge heat, after which the brain and eye pain cease. This is because Da Huang cures the cerebral hyperemia. Is Da Huang not the most potent herb for both descending and breaking blood? Thus, for patients with Naochongxue Zheng who have strong constitution and pulse, one may add a few qian of Da Huang to the first one or two doses of Jianling Tang. For those with weaker constitutions, herbs like Tao Ren (Persicae Semen) or Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) may be added.

A young woman of the Yu family in Tianjin suffered from severe headache, epigastric stuffiness and pain, and menorrhagia. She was cured with modified Jianling Tang.

As for naming this syndrome Fengzhong since the Tang and Song dynasties, there is some reason. Based on clinical experience, I know that Naochongxue Zheng often has an internal root cause, followed by external wind constraint and internal dry-heat generation, which agitates the root cause and triggers sudden onset. Therefore, when treating this syndrome with concurrent exterior heat, I often add 30g of Sheng Shi Gao (Gypsum Fibrosum) to Jianling Tang. If Yangming excess heat and a洪 Shi (Surging and Excess) pulse appear after two or three days, I often use Baihu Tang (White Tiger Decoction) or Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction) to clear the exterior heat before treating the cerebral hyperemia. This is based on my experience, not to cover up the errors of past physicians. Ultimately, while it is acceptable to call this syndrome "Fengzhong accompanied by cerebral hyperemia," calling it merely "Fengzhong" is incorrect.

When Liu Hejian appeared, he argued that this syndrome is not caused by external wind but by internal wind, resulting from extreme emotional agitation generating fire. His main methods included using Baihu Tang and Sanhuang Tang to purge excess fire; Xiaoyao San to soothe constrained fire; Tongsheng San and Liangge San to resolve exterior-interior pathogenic fire; Liuwei Dihuang Wan to nourish Water to control Fire; Bawei Wan to guide fire back to its source (treating according to the disease); and Dihuang Yinzi for aphasia and leg paralysis. These discussions seemed superior to earlier misidentifications of cerebral hyperemia as Fengzhong. The starting point of Naochongxue Zheng is often reckless movement of Liver Qi and Liver Fire. Since the Liver belongs to Wood and generates Wind, naming it "Internal Fengzhong" is quite reasonable. However, failing to grasp the *Neijing* principle of "Blood and Qi moving upward together," his prescriptions were not perfectly matched to the pathology. Notably, formulas containing Fangfeng (Saposhnikoviae Radix), Chaihu (Bupleuri Radix), Guizhi (Cinnamomi Ramulus), and Fuzi (Aconiti Lateralis Radix Praeparata) are strictly contraindicated for this syndrome.

The *Jin Gui Yao Lue* contains Fengyin Tang for treating heat-induced paralysis and epilepsy. Since "paralysis" is named with heat, the etiology is clearly heat. The presentation resembles cerebral hyperemia. The formula uses six mineral drugs, mostly cooling. Although Ganjiang (Zingiberis Rhizoma) and Guizhi are acrid-warm, they are combined with Da Huang, Shigao, Hanshuishi (Halloysitum Rubrum), and Huashi (Kaolin), making the overall nature cool (Note: Guizhi and Ganjiang are arguably unsuitable). All minerals sink; Da Huang descends vigorously. Together, they guide rebellious blood downward. Longgu and Muli combined with Zixuanqu (Pyritum) constrain Chong Qi; combined with Guizhi, they pacify Liver Qi. When Liver-Chong Qi does not rebel upward, ascending blood naturally descends. Although named Fengyin (Wind-Guiding), it contains no wind-expelling herbs, proving it does not view heat-paralysis as Fengzhong. Later generations misunderstood the formula. My Jianling Tang heavily uses Zhe Shi, Longgu, and Muli, and sometimes adds Shigao, effectively borrowing the meaning of Fengyin Tang (The text under Fengyin Tang is brief, suggesting it may not be Zhang Zhongjing's original work, hence potential later additions impure ingredients).

[Appendix] Letter from Cui XX of Tianmen, Hubei: A person in Zhanggang suffered Naochongxue Zheng, suddenly collapsed, with rapid upper-body breathing, opisthotonos (body arched like a bow), and fixed gaze. The family panicked, doctors were helpless, and funeral clothes were prepared. I was summoned. Following the original Jianling Tang, one dose improved the condition by half. With slight modifications over several doses, he recovered completely. Note: Zhen Gan Xi Feng Tang (Pacify the Liver and Extinguish Wind Decoction) was actually derived from modified Jianling Tang.