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(Attached: Gan Tui Tang [Dry Atrophy Decoction], Bu Nao Zhen Wei Tang [Tonify Brain and Revitalize Paralysis Decoction])

Limb paralysis (Wei Fei, 痿废) is actually caused by cerebral anemia (Brain Anemia). According to physiological experiments, all movements of the human body are governed by the brain marrow nerves. Although this is a Western theory, it can be firmly trusted. Therefore, Western medicine attributes cases of limb paralysis to the brain. However, there is a distinction between cerebral congestion (Brain Congestion) and cerebral anemia. This is because the brain marrow nerves originally rely on blood for nourishment and moisture, and the amount of blood required is most valuable when appropriate. In cases of cerebral congestion, too much blood flows into the brain, exerting force that displaces the brain marrow nerves, causing them to lose their function. In cases of cerebral anemia, too little blood flows into the brain, failing to nourish the brain marrow nerves, which also leads to a loss of their normal function. Regarding why anemia occurs in the brain, one cannot solely blame the blood itself. I once read the *Huangdi Neijing* (Yellow Emperor's Inner Canon) and realized the principle therein.

The *Huangdi Neijing* states: "When the Qi of the upper part is insufficient, the brain feels empty, the ears suffer from ringing, the head tilts, and the eyes become dizzy." What is meant by an "empty brain" is a lack of blood. Due to this emptiness leading to anemia, symptoms such as tinnitus, head tilting, and dizziness follow. In severe cases, limb paralysis ensues, which goes without saying. Thus, the Western assertion that cerebral anemia can cause paralysis aligns with the *Huangdi Neijing*. However, while Western medicine identifies cerebral anemia as the cause of paralysis, the *Huangdi Neijing* further investigates the cause of this cerebral anemia, identifying it as insufficiency of the Upper Qi. What is Upper Qi? It is the Great Qi in the chest (also known as Zong Qi / Pectoral Qi). This Qi governs the whole body, facilitates circulation in the brain, and promotes the flow of blood vessels. In cases of cerebral congestion, Liver and Stomach Qi rebel upwards, carrying blood with it; this has nothing to do with the Great Qi. In contrast, cerebral anemia is actually due to the deficiency and damage of the Great Qi in the chest, which fails to assist the ascent of blood. Therefore, to treat this condition, one should primarily use Qi-tonifying herbs, secondarily use Blood-nourishing herbs, and use herbs that unblock and activate meridians as guides. Based on this principle, I have formulated the following prescriptions.

[Gan Tui Tang] Treats limb paralysis or hemiplegia, where the pulse is extremely fine, weak, and powerless.
Sheng Huang Qi (Raw Astragali Radix, 5 liang)
Dang Gui (Angelicae Sinensis Radix, 1 liang)
Gan Gou Qi Guo (Sweet Goji Berry, 1 liang)
Jing Hang Yu Rou (Cleaned Cornus Officinalis Fruit, 1 liang)
Sheng Di Ru Xiang (Raw Frankincense, 3 qian)
Sheng Ming Mo Yao (Raw Myrrh, 3 qian)
Zhen Lu Jiao Jiao (True Deer Antler Glue, 6 qian, crushed)

First, decoct Huang Qi for about ten boils, then remove the dregs. Then add Dang Gui, Gou Qi, Yu Rou, Ru Xiang, and Mo Yao to the liquid and decoct for another ten boils, removing the dregs. Add the Lu Jiao Jiao powder, melt it, and obtain two large bowls of decoction. Take half warm twice daily.

The rationale of this formula relies heavily on Huang Qi to ascend and tonify the Great Qi in the chest, assisting Qi to rise and reach the brain, allowing blood to follow and pour into the brain. Its side effect is penetrating the muscle surface with a dispersing nature. By removing dregs and re-decocting, this dispersing nature is reduced, focusing solely on tonifying and ascending Qi. Dang Gui is the primary herb for generating Blood. Used together with Huang Qi, it is anciently named Bu Xue Tang (Blood Tonifying Decoction), because when Qi is vigorous, Blood is easily generated. Furthermore, Huang Qi, moistened by Dang Gui, does not become dry or hot. Yu Rou tonifies the Liver effectively; Gou Qi tonifies the Kidney effectively. When Liver and Kidney are sufficient, Yuan Qi (Original Qi) becomes robust. Yuan Qi is the root of the Great Qi in the chest. Moreover, when Liver and Kidney are sufficient, the Du Mai (Governing Vessel) flowing up from the spine becomes smooth. The Du Mai is the root of the brain marrow nerves. Additionally, both herbs are rich in viscous juice and assist Dang Gui in generating Blood. Ru Xiang and Mo Yao are used because they effectively open Blood Bi (Blood Stasis obstruction). Once Blood Bi is opened, the long-standing stasis in the meridions of paralysis patients naturally flows. Lu Jiao Jiao is used because if the brain is anemic, the brain marrow must also be empty. Glue made from deer antlers effectively tonifies brain marrow. When brain marrow is sufficient, cerebral anemia heals easily. After taking dozens of doses of this formula, if the body gradually strengthens but paralysis persists, proceed to the next formula.

[Bu Nao Zhen Wei Tang] Treats limb paralysis and hemiplegia with an extremely fine, weak, and powerless pulse, in cases where previous treatments have failed over a long period.
Sheng Huang Qi (Raw Astragali Radix, 2 liang)
Dang Gui (Angelicae Sinensis Radix, 8 qian)
Long Yan Rou (Longan Aril, 8 qian)
Hang Yu Rou (Cornus Officinalis Fruit, 5 qian)
Hu Tao Rou (Walnut Kernel, 5 qian)
Tu Bie Chong (Eupolyphaga/Scolopendra, 3 large specimens)
Di Long (Pheretima/Earthworm, 3 qian, cleaned)
Sheng Ru Xiang (Raw Frankincense, 3 qian)
Sheng Mo Yao (Raw Myrrh, 3 qian)
Lu Jiao Jiao (Deer Antler Glue, 6 qian)
Zhi Ma Qian Zi Mo (Processed Strychnos Seed Powder, 3 fen)

There are eleven ingredients in total. Decoct the first nine ingredients in water to yield two and a half bowls of liquid, remove the dregs, dissolve the Lu Jiao Jiao in the liquid, and take half twice daily, washing down with 1.5 fen of Zhi Ma Qian Zi Mo.

This formula differs from the previous one only by omitting Gou Qi, because Hu Tao Rou can replace Gou Qi to tonify the Kidney and has the effect of strengthening sinews and bones. I once read the *Shubin Yibao* (Shanghai Medical Report), which stated that Di Long can reconnect severed blood vessels and nerves in the brain. I believe this effect requires the assistance of Tu Bie Chong. Earthworms (Di Long) are good at guiding, while Tu Bie Chong is good at connecting (severed parts can reconnect themselves). Using these two herbs together can guide and reconnect severed blood vessels and nerves, hence their addition to the formula. Zhi Ma Qian Zi is added because it can stimulate nerves to make them flexible. If either this formula or the previous one causes heat sensations upon ingestion, Tian Hua Fen (Trichosanthes Root) and Tian Dong (Asparagus Cochinchinensis Rhizome) can be added in small amounts (several qian).

Mr. Yu from Tianjin, over forty years old, complained of difficulty breathing, chest fullness and oppression, gradual difficulty in speech and movement, heavy-headedness, and occasional vertigo. A doctor treated him with herbs to open the chest and regulate Qi, resulting in sudden paralysis of the four limbs. Another doctor was consulted, who switched to tonic herbs but still included Qi-moving herbs. After ingestion, the paralysis worsened, and he lost his voice entirely. Upon examination, his pulse was deep and faint, especially on the right side, indicating deficiency and sinking of the Great Qi in the chest and the Qi of the Middle Jiao (Spleen and Stomach). I prescribed my own Sheng Xian Tang (Ascending the Sinking Decoction) with added Bai Zhu (Atractylodes Macrocephala Rhizome) and Dang Gui, each 3 qian. After two doses, symptoms improved slightly, but the pulse remained unchanged. I then doubled the dosage of Huang Qi, Bai Zhu, Dang Gui, and Zhi Mu (Anemarrhenae Rhizoma), changed Sheng Ma (Cimicifugae Rhizoma) to 1.5 qian, and added Dang Shen (Codonopsis Radix) and Tian Dong, each 6 qian. After three consecutive doses, he could produce sounds but still could not speak; limbs could move slightly but not walk; the pulse showed improvement and became palpable. I then increased Huang Qi to 4 liang, added Tian Hua Fen 8 qian, decocted the Huang Qi thoroughly in six large bowls of water first, removed the dregs, added other herbs, and obtained two large bowls of clear decoction. Taken twice daily for three consecutive doses, he could勉强 speak, though sentences were often incomplete. With support, he could take steps. I then switched to Gan Tui Tang, keeping Huang Qi at 4 liang. After ten doses, the pulse became stronger. Although walking still required assistance, he could rise and lie down independently. Speech improved enough to convey meaning; previously unclear statements could occasionally be written down. His previous symptoms of heavy-headedness and vertigo also lightened. He was instructed to continue with Bu Nao Zhen Wei Tang, advised that if tolerated well, he should take more, promising eventual complete recovery.

Note: During the period of chest fullness and oppression, the patient indeed had difficulty breathing. The reason for this breathing difficulty was the deficiency and sinking of the Great Qi in the chest and the Qi of the Middle Jiao. The physician mistakenly administered dispersing and breaking herbs, causing the disease to worsen suddenly. Later, the second physician used mostly tonics with few Qi-moving herbs, yet the condition worsened because, during extreme Qi deficiency, tonifying herbs struggle to work, while dispersing herbs easily cause harm. In my experience treating Sinking of Great Qi, patients often complain of fullness, but this is not true fullness; it is actually shortness of breath. Careful clinical investigation prevents errors.