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Tianjin patient Sun XX, aged forty-six, suffered from Brain Congestion Syndrome (Nao Chong Xue Zheng), which subsequently led to Hemiplegia (Pian Ku).

Etiology: His innate temperament was irritable and impatient. Coupled with unfavorable circumstances, he frequently stirred up Liver Fire (Gan Huo), thereby inducing this condition.

Symptoms: Prior to the onset of the illness, he often felt headaches and experienced frequent dizziness. One day, after encountering an unpleasant event, he suddenly fainted. After regaining consciousness some time later, his left hand and foot were immobile, and half of his body was numb. His speech was slurred. He consulted a physician and took medicine for ten months; his hand could move slightly, but his five fingers remained clenched and unable to extend. His leg could bear weight on the ground but he could not walk. His speech remained slurred. He continued taking medicine for several more months, yet the condition remained unchanged. Palpation revealed that both left and right pulses were wiry and hard (Xian Ying), with the right side appearing even more severe. It was known that despite over a year of medication, the root cause of Brain Congestion had not been eliminated. When asked if he felt heat in the heart region or pain in the head, he replied: "Sometimes I feel heat rising from the stomach area to the throat; if this heat rises further, it causes pain in the head, though not as severe as when the disease first began." Regarding bowel movements occurring every two to three days, combined with the symptoms and pulse, there was no doubt that congestion in the brain still existed.

Diagnosis: Upon initial onset, this case involved not only Brain Congestion but also Cerebral Hemorrhage (Nao Yi Xue). The extravasated blood adhered to the motor nerves on the left side, causing paralysis of the right half of the body; conversely, adherence to the right-side motor nerves would cause paralysis of the left half. This is due to the cross-innervation of nerves controlling the left and right sides of the body. At the onset, the wiry and hard pulse was likely even more pronounced. Thus, extreme congestion led to hemorrhage, and hemorrhage led to disability. Based on current symptoms and pulse, the cerebral hemorrhage has likely healed, but the root of Brain Congestion remains. Treatment should focus on resolving Brain Congestion, assisted by herbs that unblock and activate the meridians.

Prescription:
Raw Huai Yam (Sheng Huai Shan Yao) - 1 liang
Raw Huai Rehmannia Root (Sheng Huai Di Huang) - 1 liang
Raw Oyster Shell/Heavy Descending Stone (Sheng Zhe Shi) - 8 qian, finely ground
Huai Achyranthes Root (Huai Niu Xi) - 8 qian
Raw Hang Peony Root (Sheng Hang Shao) - 6 qian
Biota Seed (Bai Zi Ren) - 4 qian, stir-fried and crushed
Atractylodes Macrocephala Rhizome (Bai Zhu) - 3 qian, stir-fried
Dripping Frankincense (Di Ru Xiang) - 3 qian
Bright Myrrh (Ming Mo Yao) - 3 qian
Ground Beetle (Tu Bie Chong) - 4 large specimens, crushed
Raw Chicken Gizzard Lining (Sheng Ji Nei Jin) - 1.5 qian (yellow variety), crushed
Artemisia Capillaris Herb (Yin Chen) - 1 qian
Decoct together in one large bowl of water, take warm.

Second Visit: After seven doses, head pain ceased. Occasional mild heat in the chest appeared. The left half of the body felt looser and less numb than before. Slurred speech improved slightly. Bowel movements became smoother. The wiry and hard pulse improved by seventy to eighty percent. The plan shifted to focusing on treating the flaccidity of the left hand and foot.

Prescription:
Raw Astragalus Root (Shen Qi / Sheng Jian Qi) - 5 qian
Trichosanthes Root (Tian Hua Fen) - 8 qian
Raw Oyster Shell (Sheng Zhe Shi) - 6 qian, finely ground
Huai Achyranthes Root (Huai Niu Xi) - 5 qian
Dripping Frankincense (Di Ru Xiang) - 4 qian
Bright Myrrh (Ming Mo Yao) - 4 qian
Angelica Sinensis Root (Dang Gui) - 3 qian
Luffa Reticulate Fruit (Si Gua Luo) - 3 qian
Ground Beetle (Tu Bie Chong) - 4 large specimens, crushed
Earthworm (Di Long) - 2 qian, cleaned
Decoct together in one large bowl of water, take warm.

Third Visit: After more than thirty doses (with minor adjustments), the previously immobile left hand could now extend, and the left foot could lift and walk. The patient asked if continued medication could lead to complete recovery. I replied: "If treated at the onset, forty doses would suffice for full recovery. Having delayed for over a year, even hundreds of doses may not guarantee complete cure due to long-standing stasis in joints and meridians. However, dozens more doses will show improvement." Therefore, the original formula was slightly modified, aiming to stimulate and support nerve function for better efficacy.

Prescription:
Raw Astragalus Root (Shen Qi / Sheng Jian Qi) - 6 qian
Trichosanthes Root (Tian Hua Fen) - 8 qian
Raw Oyster Shell (Sheng Zhe Shi) - 6 qian, finely ground
Huai Achyranthes Root (Huai Niu Xi) - 5 qian
Dripping Frankincense (Di Ru Xiang) - 4 qian
Bright Myrrh (Ming Mo Yao) - 4 qian
Angelica Sinensis Root (Dang Gui) - 3 qian
Ground Beetle (Tu Bie Chong) - 4 large specimens, crushed
Earthworm (Di Long) - 2 qian, cleaned
True Deer Antler Glue (Zhen Lu Jiao) - 2 qian, finely ground
Panax Notoginseng Root (Guang San Qi) - 2 qian, finely ground
Processed Strychnos Nux-vomica Seed Powder (Zhi Ma Qian Zi Mo) - 3 fen
Total twelve ingredients. First, decoct the first nine ingredients in one large bowl of water. Take this decoction while administering half of each of the last three powders. When re-decocting the dregs, administer the remaining half of the powders.

Formula Analysis: Deer Antler Glue (Lu Jiao Jiao) is used because it acts as a guiding herb to the left half of the body. As its horn originates from the Du Meridian (Governor Vessel), its nature tonifies the Marrow of the Brain to nourish brain nerves. Panax Notoginseng (San Qi) is used to resolve long-standing stasis in joints and meridians. Processed Strychnos Nux-vomica (Ma Qian Zi) is used to stimulate nerves and enhance flexibility.

Outcome: After another thirty-plus doses, limb movement became significantly easier, and slurred speech greatly improved. The patient could勉强 go out and work. Soup medicines were then stopped. Instead, raw Huai Yam powder was boiled into a tea-like consistency, sweetened with white sugar, and taken with about 3 fen of raw yellow Chicken Gizzard Lining powder as a snack for convalescence. This approach uses Huai Yam to tonify Qi and Blood, and a small amount of Ji Nei Jin to resolve stasis.

Note: In cases of Brain Congestion, the use of Astragalus (Huang Qi) is strictly contraindicated initially. Astragalus is tonifying and ascending; ascending Qi draws Blood upward, exacerbating cerebral congestion and potentially causing hemorrhage or rupture, which can be fatal. Once Brain Congestion is cured but hemiplegia persists, it is due to meridian blockage preventing blood circulation. At this stage, using Astragalus to assist in resolving stasis and unblocking vessels is acceptable. However, since the patient has a history of cerebral congestion, the ascending nature of Astragalus is risky. Therefore, Raw Oyster Shell (Zhe Shi) and Achyranthes (Niu Xi) are added to prevent upward rush of Blood, effectively restraining Astragalus. Furthermore, fearing that Astragalus's warmth and tonification might generate heat, Trichosanthes Root (Tian Hua Fen) is heavily used to balance this effect.