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(Attached: Qiwei Decoction and Yangnao Lizhi Decoction)

The *Huangdi Neijing* (Yellow Emperor's Inner Canon) states: "Diseases of the five zang organs can all cause flaccidity syndrome in humans." In later medical texts, some argue that this is caused by wind-stroke (Zhongfeng), stating that if wind pathogen attacks the left side, the left half of the body becomes hemiplegic and flaccid; if it attacks the right side, the right half becomes hemiplegic and flaccid. Some attribute it to deficiency of qi (Qi Xu), claiming that if the left hand and foot are hemiplegic and flaccid, the qi on the left must be deficient; if the right hand and foot are affected, the qi on the right must be deficient. Others suggest it is due to phlegm turbidity and blood stasis. Some specifically cite blood stasis. Still others propose it results from wind-cold-dampness combining to form bi-syndrome (Bi Zheng); severe cases of bi-syndrome can lead to whole-body flaccidity, as phlegm, blood stasis, and wind-cold-dampness bi-syndrome can all obstruct the meridians. Since Western medicine proposed that the brain marrow and nerves govern perception and movement, some have claimed that human limb flaccidity is entirely due to damage to the brain marrow and nerves. Based on my lifelong experience, neither the Chinese nor the Western perspectives should be discarded. I now list some cases from my personal experience below to demonstrate this.

I recall that when I was at home, I once saw a pig whose two front legs suddenly became immobile and had to be fed where it lay. It gradually recovered after half a month. Ten days later, when dissecting this pig, I could clearly distinguish fresh scar marks of healed sores on its lungs, along with some that were nearly but not fully healed. Inferring from animals to humans, analogy is possible; this corresponds to what the *Huangdi Neijing* describes as flaccidity syndrome arising from lung heat causing the leaves to wither. From this, we know that diseases of the five zang organs indeed cause flaccidity, which is certainly correct.

In Fengtian (now Shenyang), I treated a woman nearing thirty years of age. Because she slept facing a window during summer nights, she was attacked by wind pathogen, resulting in numbness in half her body. The skin on the numb side wasted away, eventually progressing to immobility of the limbs on that side, approaching hemiplegia. Her pulse was normal on the left side but weak and powerless on the right, corresponding to the numb side being on the right. This was due to wind pathogen attacking the meridians, causing obstruction and lack of communication between them. If the wind was not dispelled early, it would long-term lead to flaccidity. I prescribed a formula containing raw Astragali Radix (Sheng Huangqi) 2 liang, Angelicae Sinensis Radix (Danggui) 8 qian (used for its ability to invigorate blood so wind disperses naturally), Notopterygii Rhizoma et Radix (Qianghuo), Anemarrhenae Rhizoma (Zhimu), Frankincense (Ruxiang), and Myrrh (Moyao) each 4 qian, Scorpio (Quanxie) 2 qian, and Centipede (Quangu) 3 pieces. After one dose decocted and taken, symptoms lightened; after several more doses, she was completely cured. This is clear evidence that wind-stroke can lead to flaccidity.

In my county, I treated an elderly woman over sixty years old who suffered from chronic qi deficiency, often feeling short of breath. Due to excessive labor, she suddenly experienced flaccidity of all four limbs, unable to rise from bed, with worsening shortness of breath. Her pulse was very weak at both cun positions, but both chi positions had a root upon deep pressure. I diagnosed sinking of the great qi in the chest, unable to rotate the whole body. I prescribed raw Astragali Radix (Sheng Huangqi) 1 liang, Angelicae Sinensis Radix (Danggui) and Anemarrhenae Rhizoma (Zhimu) each 6 qian, Cimicifugae Rhizoma (Shengma), Bupleuri Radix (Chaihu), and Platycodonis Radix (Jiegeng) each 1.5 qian, Frankincense (Ruxiang) and Myrrh (Moyao) each 3 qian. After one dose, her breathing normalized, and her limbs could slightly flex and extend. With slight modifications to the original formula continued for several doses, she recovered completely. This is clear evidence that qi deficiency can lead to flaccidity.

In my county, I treated another elderly woman, aged fifty, who suddenly fainted and lost consciousness in mid-winter. Phlegm-fluid seemed present in her chest, severely hindering breathing. Her pulse was faint and thin, almost imperceptible, and very slow. Her family said she usually felt cold in her heart and coughed up sticky saliva. I determined she had chronic cold-fluid retention in her chest, aggravated by winter cold air, causing further condensation and blockage. I urgently used Piperis Longi Fructus (Hujiao) 3 qian crushed, boiled briefly, took most of a cup of thick juice, and administered it orally; her breathing immediately smoothed out. Then I used dried Ginger (Ganjiang) 6 qian, Cinnamomi Ramulus (Guizhi Jiantou), and Angelicae Sinensis Radix (Danggui) each 3 qian, taken for three doses. She could then moan, and her limbs gradually moved, though her left hand and foot remained immobile. Subsequent treatment with formulas to assist qi, resolve phlegm, and unblock collaterals gradually restored function to her left hand and foot. This is clear evidence that phlegm and blood stasis can lead to flaccidity.

In my county, I treated an unmarried young woman who was constitutionally weak. A physician had used too much tonifying and astringent medicine, causing amenorrhea and flaccidity of both legs, progressing to insensitivity to pain and itching upon scratching. All six pulses showed a choppy quality, indicating collateral obstruction by blood stasis. I prescribed Huoluo Xiaoling Dan (My Formula for Unblocking Collaterals and Efficacy), adding Achyranthis Bidentatae Radix (Huainiuxi) 5 qian, Carthami Flos (Honghua) 1.5 qian, and Leech (Shuizhongyi) 5 pieces. After several doses, menstruation flowed, her legs could slightly flex and extend, and sensation returned. I then added raw Astragali Radix (Sheng Huangqi) and Anemarrhenae Rhizoma (Zhimu) each 3 qian. After several doses, her legs could bear weight. However, such conditions cannot be cured hastily. I advised converting the decoction into pills for long-term use, leading to complete recovery. This is clear evidence that blood stasis can lead to flaccidity.

My clan brother XX suffered leg pain in winter, with walnut-sized lumps on his legs. He recalled that in his youth, relying on his strong physique, he often fished in semi-ice, semi-water environments during winter. One day, while fishing, a north wind arose suddenly, penetratingly cold. He hurried home to rest. Within moments, his leg pain became unbearable, preventing him from standing. He lay on a heated kang bed and covered himself with thick quilts. Days later, the pain felt deep in the bones, and his skin became numb and insensitive, progressing to inability to flex or extend his legs. Medical treatment combined with external application of hot liquor and bran helped alleviate pain and numbness, allowing some movement, though his legs could not straighten. Someone taught him to sit on a chair and roll a round wooden stick back and forth with his feet, rotating it over time, which eventually allowed his legs to straighten. Following this method, by spring when the weather warmed, his legs recovered shape. Yet, thirty years later, every harsh winter brings leg pain, relieved only by several doses of warming medicines. The lumps on his legs remain unresolved, formed by freezing at that time. I stated: "This disease can still be eradicated. However, the cold is in the bone, and herbal medicines alone cannot achieve this effect; mineral medicines must be taken, as human bones contain many minerals." I instructed him to take fine powder of native Sulfur (Sheng Liuhuang) 5 fen before meals, twice daily, gradually increasing the dose until he felt mild warmth in his heart. Indeed, this formula eradicated his leg pain. This is clear evidence that wind-cold-dampness bi-syndrome can lead to flaccidity.

Regarding the Western view that this condition relates to brain marrow and nerves, I also have definite experience. The injury to nerves is largely caused by cerebral congestion. Extreme cerebral congestion can rupture blood vessels in the brain. Severe rupture leads to continuous bleeding, causing coma and death. If vessels do not rupture, congestion may force blood through the vessel wall, or slight rupture may stop spontaneously. If the leaked blood adheres to the left motor nerve, the right limbs become flaccid; if it adheres to the right motor nerve, the left limbs become flaccid, because nerves cross-control each other. This condition involves viscera qi and blood rushing upward with heat, known in the *Huangdi Neijing* as "Great Jue" where blood and qi move together upward. Patients必有 severe headache, internal heat sensation, and a surging or string-taut and forceful pulse. The *Huangdi Neijing* states, "If qi reverses, life is preserved; if not, death ensues." Reversal means qi descends, blood follows, unruptured vessels are safe, and minor ruptures heal via downward flow. If qi does not reverse, blood continues rising, rupturing intact vessels or worsening existing ones. Studying the *Huangdi Neijing*, I realized treatment should heavily use Achyranthis Bidentatae Radix (Huainiuxi) around 1 liang to guide brain blood downward, assisted by herbs that clear fire, descend stomach qi, and calm liver yang, preventing qi and fire from ascending together. After several doses, severe headaches cease, and pulses normalize. Then, treat with blood-resolving herbs to dissolve brain stasis, aided by qi-invigorating and meridian-unblocking agents, allowing gradual recovery of flaccid limbs. Specifically, flaccidity due to cerebral congestion is dangerous. Misdiagnosing it as qi deficiency and using heavy tonics like Buyang Huanwu Tang (Wang Xunchen) or misdiagnosing it as wind-stroke and using heavy diaphoretics like Xuming Tang (*Qianjin Fang*) will exacerbate upward flow, leading to immediate danger. Even after curing cerebral congestion, if flaccidity persists, small amounts of Ginseng Radix et Rhizoma (Renshen) may aid qi, but must be accompanied by liver-calming, stomach-descending, heat-clearing, and meridian-unblocking herbs to be effective. Thus, I propose two formulas below.

[Qiwei Decoction] For flaccidity due to cerebral congestion, after congestion resolves and pulse normalizes, but limbs remain flaccid. Take slowly for long-term cure.
Raw Astragali Radix (Sheng Huangqi) 4 qian, Raw Oolithum (Sheng Zhe Shi) 6 qian ground fine, Achyranthis Bidentatae Radix (Huainiuxi) 6 qian, Trichosanthis Radix (Tianhuafen) 6 qian, Scrophulariae Radix (Xuanshen) 5 qian, Biota Seed (Baiziren) 4 qian, Raw Paeoniae Radix Alba (Sheng Baishao) 4 qian, Raw frankincense (Sheng Ming Moyao) 3 qian, Raw myrrh (Sheng Ming Ruxiang) 3 qian, Leech (Shuizhongyi) 4 large pieces, Processed Strychni Semen (Zhi Maqianzi) powder 2 fen.
Eleven ingredients. Decoct the first ten, swallow Maqianzi powder with the liquid. When re-decocting dregs, also swallow 2 fen of Maqianzi powder.

[Yangnao Lizhi Decoction] For the same condition, or when limbs move but feel weak after previous formula.
Wild Codonopsis Radix (Yetaishen) 4 qian, Raw Oolithum (Sheng Zhe Shi) 6 qian ground fine, Achyranthis Bidentatae Radix (Huainiuxi) 6 qian, Trichosanthis Radix (Tianhuafen) 6 qian, Scrophulariae Radix (Xuanshen) 5 qian, Raw Paeoniae Radix Alba (Sheng Baishao) 4 qian, Raw myrrh (Sheng Ming Ruxiang) 3 qian, Raw frankincense (Sheng Ming Moyao) 3 qian, Salvia Miltiorrhiza Radix et Rhizoma (Weilingxian) 1 qian, Leech (Shuizhongyi) 4 large pieces, Processed Strychni Semen (Zhi Maqianzi) powder 2 fen.
Eleven ingredients. Decoct the first ten, swallow Maqianzi powder with the liquid. When re-decocting dregs, also swallow 2 fen of Maqianzi powder. These two new formulas are quite effective. I cite one case to illustrate.

Mr. He from Tianjin suffered cerebral congestion with sudden flaccidity of left hand and foot. His pulses were string-taut, hard, and long on both sides. He had brain pain and heat, with extreme irritability.
I administered Jianling Tang (Building Dam Decoction). Due to brain pain/heat and irritability, I added Trichosanthis Radix (Tianhuafen) 8 qian. After three doses, he felt pain in left tendons and bones, likely because the previously numb left side regained sensation. Pulse hardness decreased slightly. Modifying the original formula slightly, he took several more doses; pulse approached normalcy, limbs moved slightly, and he no longer needed assistance for turning in bed. At this point, I switched to Qiwei Decoction. After several doses, limb movement strengthened, but pulse hardness increased slightly, and mild brain pain/heat recurred, indicating intolerance to the ascending nature of Astragalus.
I removed Astragalus from the original formula. After several doses, his left hand could hold objects, left foot could bear weight, and head pain/heat vanished. Pulse normalized. I then re-added Astragalus, changed Trichosanthis Radix (Tianhuafen) to 8 qian, added Asparagi Radix (Tian Dong) 8 qian. After six doses, he could walk with a cane, though still weak. I then prescribed Yangnao Lizhi Decoction. After several doses, mild internal heat returned. I changed Trichosanthis Radix (Tianhuafen) to 8 qian and added Ophiopogonis Radix with Heart (Daixin Maidong) 7 qian. After ten doses, he was fully cured.

Note: The cause of this condition is not only cerebral congestion but extreme congestion leading to hemorrhage. Even after resolving congestion/hemorrhage, flaccidity persists because residual blood remains in the brain untransformed, and systemic meridians are blocked. Hence, the formula uses many qi-moving and blood-resolving herbs. To prevent qi/blood damage from long-term use, small amounts of Ginseng Radix et Rhizoma (Renshen) are added, balanced by Scrophulariae Radix (Xuanshen) and Trichosanthis Radix (Tianhuafen) to counteract Renshen's heat, and Raw Oolithum (Sheng Zhe Shi) and Achyranthis Bidentatae Radix (Huainiuxi) to prevent Renshen's ascending tendency, showing thorough consideration. However, patients may still feel heat or have slightly string-taut pulses. Adjusting Renshen dosage or adding cooling herbs carefully, aligning with pathology, ensures cure. Although these formulas are generally cooling, heat sensations persist because Ginseng generates heat when tonifying, and the condition originates from visceral heat driving qi and blood upward.