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What are the clinical manifestations of stroke (Zhong Feng)? The answer is: In true stroke (Zhen Zhong Feng), the pathology is confined to the meridians and collaterals. When wind pathogen drives away the Qi of the meridians, Qi movement becomes rebellious. Due to this rebellious Qi flow, the Qi and Blood of the Zang-Fu organs cannot reach the exterior, causing the patient to suddenly collapse and lose consciousness. In milder cases, it manifests as hemiplegia (Ban Shen Bu Sui) and deviation of the mouth and eyes, with the pathogen remaining within the meridians.

In apoplectic syndrome resembling stroke (Lei Zhong Feng), the wind originates from within the body. (Zhang Jingyue therefore named it "Fei Feng" [Non-wind]. Dongzhuang stated that slow convulsion and slow spleen in infants share this etiology, though the treatment differs.) This results from excessive indulgence in the Seven Emotions and invasion by the Six Exogenous Pathogens, leading to the failure of True Yin to remain secure. Over time, Kidney Water declines while Fire flares up; Wind arises from Fire, departing from its original residence (Liver and Kidney), flying wildly, and causing sudden collapse. Consequently, the area between the two Kidneys, the loins, hips, and below the umbilicus will be cold as iron. Generally, other diseases start in other Zang-Fu organs and slowly progress to the Kidney Meridian. (When five Zang organs injure each other, the damage inevitably reaches the Kidneys. However, there are also many cases where Kidney disease precedes and affects other organs.) Only in stroke does the invisible Water and Fire of the Kidney Meridian and Mingmen (Gate of Life) become self-diseased, leading directly to critical condition upon onset. At the moment of onset, a wave of deficient Qi rises from between the two Kidneys, ascends along the spine, passes through Kunlun (referring to the pathway or acupoint concept along the bladder meridian on the back), goes through Niwan Palace (the brain), and reaches Mingmen. Mingmen is the gathering point of the Three Yin and Three Yang meridians. Once this Qi rushes through, the Qi of the Three Yin and Three Yang scatters abruptly, resulting in loss of consciousness externally, while the Qi of the internal Zang-Fu organs dissipates simultaneously. With the departure of Zang-Fu Qi, symptoms such as hand relaxation (Shou Sa), eye closure, urinary incontinence, stertorous breathing, and open mouth follow. This Mingmen is the root of Supreme Yin mentioned in *Su Wen*, located at Mingmen, one cun away from the upper, lower, left, and right of the two Kidneys; the space between them is what Daoists call Yuan Shen (Original Spirit). (The meaning of Mingmen is explained in detail by Zhang Jingyue in *Lei Jing: San Jiao Bian* and Lu's commentary on *Handan Xingjing Tu*.) This deficient Qi is what is referred to as Formless Fire. Because Formless Water (Kidney Yin) is deficient and unable to hold, it transforms into cold wind and ascends into the void.

True stroke is treated with Xiao Xuming Decoction (Minor Continuation of Life Decoction). It applies to patients with a robust physique who do not exhibit signs of apoplectic syndrome resembling stroke but collapse suddenly. This condition is common in the North but rare in Jiangnan. (Northern winds are harsh, and the Zang-Fu and meridians are strong and thick; Southern winds are mild, and the Zang-Fu and meridians are soft and thin. Thus, true stroke is more common in the North, while apoplectic syndrome resembling stroke is more common in the South, and their treatments differ significantly. However, there are overlapping cases; it is not that the South never has true stroke nor the North never has apoplectic syndrome resembling stroke, but rather that the treatment methods should vary slightly. Siming said "exists" for the North and "rare" for Jiangnan, which is very precise. Ultimately, treatment should be tailored to the individual, not restricted by geography. Those who appear physically robust but show one or two pulse/symptom patterns of apoplectic syndrome resembling stroke also suffer from excess form and deficient Qi. Do not treat them mistakenly.)

Apoplectic syndrome resembling stroke is a state of severe deficiency. Symptoms include sudden collapse, closed eyes, deviated mouth corner, relaxed hands, and urinary incontinence. Generally, if only one symptom is present, it is treatable; if multiple symptoms appear together, it is difficult to cure. One should urgently press the lower abdomen with the hand; if it feels cold as stone, urgent moxibustion should be applied to Qihai (CV-6) (located 1.5 cun below the umbilicus). Additionally, use the Umbilical Steaming Method. (Xue Ji treated internal cold invasion with pungent-hot herbs, but when Shen (Spirit) escapes and the pulse vanishes, making oral medication impossible, he urgently fried salt, Artemisia argyi leaves, and Aconite, applying heat to the umbilicus and abdomen to dispel cold and restore Yang. He also used breath to supplement the Qi, and placed hot Aconite cakes on the umbilicus for about the time it takes to eat a meal, after which the Shen slightly recovered. Siming's description of the Umbilical Steaming Method is roughly like this. Appended here for reference.) The pulse will likely be two or three beats per respiration, wide, large, deficient, and soft like cotton. Urgently decoct Ren Shen (Ginseng Root) 1-2 liang and Fu Zi (Prepared Aconite Lateral Root) 1 liang; raw Aconite may be used if available. (It can be saved if treated early; otherwise, it is too late.) Once the condition stabilizes, use Ren Shen 5 qian, Huang Qi (Astragalus Root) 2 liang, and Fu Zi 5 qian, administered in small frequent doses. Treatment is effective when warmth is felt below the umbilicus, limbs move, and mouth/eyes can move. When diet returns to normal and excretion is regular, administer a large dose of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Fu Zi 3 qian, and swallow Bawei Wan (Eight-Ingredient Pill) approximately 1 liang.

For those suffering from severe dizziness and difficulty opening the eyes, where opening them causes objects in the room to appear inverted, with a sensation of nausea and urge to vomit, these are precursors to apoplectic syndrome resembling stroke. (Urgently regulate diet, restrain the Seven Emotions, and avoid sexual activity to prevent progression.) The treatment method is the same as above, but moxibustion is unnecessary; herbal medicine suffices. (For preventive medication, observe the pulse. If the Chi pulses at both wrists are deficient, use Liuwei Wan or Bawei Wan to nourish Liver and Kidney. If Cun and Guan pulses are weak, use Liujunzi Tang or Shiquan Dabu Tang to tonify Spleen and Lung. Any tonic effect is acceptable; using herbs that search for wind and promote Qi flow or clear heat and resolve phlegm will merely attract wind and induce stroke.)

Xiao Xuming Decoction (Minor Continuation of Life Decoction)
Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), Xingren (Armeniacae Semen Amarum), Fangfeng (Saposhnikoviae Radix), Fangji (Stephaniae Tetrandrae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baishao (Paeoniae Radix Alba), Huangqin (Scutellariae Radix), Renshen (Ginseng Radix), Fuzi (Aconiti Lateralis Radix Praeparata), Gancao (Glycyrrhizae Radix et Rhizoma).