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1. Wind pathogen invades from the exterior, damaging the limbs; phlegm-fire erupts from the interior, disturbing the Heart Master (心主). Damage to the body manifests as numbness and loss of function; Heart disease leads to coma and inability to speak. One must differentiate between involvement of the Collaterals (络), Channels (经), Fu-organs (腑), and Zang-organs (脏), and further examine for deficiency, excess, cold, heat, and phlegm. The Collapse syndrome (脱证) is characterized by open hands, open mouth, and closed eyes, indicating exhaustion of the Heart and Liver Qi; incontinence and snoring indicate exhaustion of the Kidney and Lung Qi. The Closure syndrome (闭证) is characterized by clenched fists and locked jaw. In the initial stage, use Tongguan San (Passing Through the Obstruction Powder) to induce sneezing first; if phlegm obstruction is severe and does not descend, emesis (吐法) is prioritized.

[Note] "Wind" refers to deficient evil and thief wind invading from the exterior, harming the four limbs and trunk, hence named Stroke (中风). "Phlegm-fire" refers to phlegm-fire erupting from the interior, affecting the Heart Master organ, hence named Phlegm-Fire. When the body suffers wind pathogen, mild cases present with stiff numbness and insensitivity, while severe cases present with paralysis and loss of movement. When Heart disease involves phlegm-fire, mild cases present with stiff tongue and difficulty speaking, while severe cases present with phlegm obstruction and coma. This condition may be internal or external; single pathology is mild, combined pathology is severe. One must carefully distinguish between involvement of the Collaterals, Channels, Fu-organs, and Zang-organs, as well as combined involvement of Channels/Collaterals with Fu/Zang organs. Furthermore, one must carefully examine accompanying deficiency, excess, cold, heat, phlegm, and the depth and urgency of Collapse or Closure syndromes to determine treatment. For early-stage stroke, Tongguan San should be used initially to induce sneezing; presence of sneezing indicates treatability, absence suggests high mortality. For trismus (口噤), use Kaiguan San (Open the Gate Powder) applied to the teeth to soften them. For excessive phlegm-saliva, various emetic methods should be used to expel it. If trismus prevents opening the mouth and decoctions cannot be swallowed, the prescribed medicine should be mixed with a guiding agent into a paste resembling tea slurry, placed in the mouth of a healthy person, and a reed tube or pen tube inserted into the patient's nostril. Air pressure should blow the medicine through the tube so that it naturally enters the throat. Do not use metal instruments to pry the mouth open, as this may damage the teeth.

[Commentary] The differentiation of Stroke into involvement of Blood-Vessels (血脉), Fu-organs, and Zang-organs originated with Li Dongyuan. For involvement of Blood-Vessels, Da Qin Jiao Tang (Great Gentian Decoction); for involvement of Fu-organs, Xiao Xu Ming Tang (Minor Life-Preserving Decoction); for involvement of Zang-organs, San Hua Tang (Three Transformations Decoction). However, cases of Zang-involvement treated with San Hua Tang have never been seen. Only the *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) divides it into four syndromes: Collateral, Channel, Fu-organ, and Zang-organ. This theory is most appropriate and can serve as a model for later generations. Generally, facial deviation and skin numbness indicate pathogen in the Collaterals; hemiplegia on either side and inability of sinews and bones to function indicate pathogen in the Channels; unconsciousness and inability to recognize people, along with urinary/fecal retention, indicate pathogen in the Fu-organs; coma, inability to speak, flaccid lips, and dribbling saliva indicate pathogen in the Zang-organs. Scholars who carefully review the theories of various masters will know that this is correct.