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Currently, those who treat hemiplegia (pian ku) mostly adhere to the theory of Qi deficiency and habitually use Bu Yang Huan Wu Tang from *Yi Lin Gai Cuo*. However, this formula is effective in some cases but ineffective in others, and there are even instances where its administration leads to disaster or death. What is the reason for this?

The movement of human limbs is originally controlled by the brain marrow nerves as the central hub. The ability of these nerves to govern movement actually relies on the nourishment provided by the blood vessels in the brain and the rotation/pivoting action of the Da Qi (Grand Qi / Zong Qi) in the chest. Sometimes, excessive congestion of the blood vessels in the brain, or even their rupture, can affect the brain marrow nerves, causing them to lose their normal function of governing movement. Alternatively, if the Da Qi in the chest is severely deficient or sinks downward, failing to pivot and support the brain marrow nerves, these nerves will also frequently lose their normal function of governing movement. These two conditions, one being deficiency and the other excess, both manifest as hemiplegia, yet their etiological causes are worlds apart. If medication is misapplied, perilous and critical conditions will appear immediately. Therefore, when facing such a condition, one must carefully examine the pulse and inquire in detail about the patient's condition prior to the onset of illness.

If the pulse is fine, weak, and forceless, or if the patient occasionally feels shortness of breath, and after the onset of the disease, there are no symptoms such as heat in the heart or headache, administering Bu Yang Huan Wu Tang often yields results. Even if it is ineffective, it certainly will not cause harm. If the pulse is surging, large, and forceful, or wiry, stiff, and forceful, and the patient has a history of headache and dizziness, which worsen at the time of onset, accompanied by a sensation of heat in the heart, this indicates that excessive ascending blood has caused severe congestion in the brain's blood vessels. Blood may seep through the vessel walls or leak out from minor fissures. If the leaked blood adheres to the nerves on the left side responsible for movement, the right half of the body becomes paralyzed; if it adheres to the nerves on the right side, the left half becomes paralyzed.

At this time, if Jian Ling Tang (Jian Ling Decoction), as I propose, is administered, headache and dizziness will resolve after one or two doses. Continued administration, combined with herbs that resolve stasis and unblock collaterals, will gradually restore limb function. If one does not understand this treatment method and solely believes in Wang Qingren’s (Zixun) theory of Bu Yang Huan Wu Tang, heavily using Huangqi (Astragali Radix) in the formula, the ascending blood will increase further, likely leading to continuous rupture of the brain's blood vessels. Can one be too cautious? If you do not agree with my words, the lessons of the past are evidenced by medical cases.

A gentleman in our county, over sixty years old, suffered from mild hemiplegia. He wished to consult a doctor in the city, but the doctor was unavailable. An elderly physician returning from Tianjin happened to visit and offered his services. After taking the prescribed medicine, the patient fell into a coma and died half a day later. Later, the family brought the prescription to question me. It was modeled after Bu Yang Huan Wu Tang, with Huangqi (Astragali Radix) heavily used at eight qian. I knew he must have suffered from hemiplegia due to excessive cerebral congestion; otherwise, how could such medication lead to disaster and death?

I once treated Wang XX from Zhili, who had slight deviation of the mouth and eyes, slight difficulty in the left half of the body, frequent headaches, and occasional dizziness. His pulse was surging and solid, especially on the right side, indicating cerebral congestion. He reported feeling heat in his heart. I treated him with Jian Ling Tang (Jian Ling Decoction). After more than twenty doses, he was completely cured. Wang XX was very pleased after recovery but then turned sad and told me: "My fifth brother previously suffered from this same condition. The doctor administered tonics containing Renshen (Ginseng Radix), and he passed away. I previously thought the disease was incurable and that the medication was not at fault. Now, seeing the formula you used, I realize the previous prescription was fundamentally wrong." Considering these two cases and Wang XX's words, it is evident that treating hemiplegia requires caution against lightly using Bu Yang Huan Wu Tang. Furthermore, those encountering this condition might mistakenly diagnose it as wind-stroke and use dispersing herbs like Qianghuo (Notopterygii Rhizoma) and Fangfeng (Saposhnikoviae Radix). This would similarly drive blood upward, creating the same detriment as misusing Renshen (Ginseng Radix). Although this condition can sometimes arise from external contraction, it must be that the heat from the external pathogen transmits to the Yangming channel, thereby agitating the root of the disease and causing sudden onset. Therefore, even if accompanied by an external contraction, dispersing (releasing the exterior) medications should not be administered.