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Hemiplegia is fundamentally a single disease entity, yet various schools of thought have proposed differing theories. Initially, the *Ling Shu Jing* (Spiritual Pivot) states: "When empty pathogens (pathogenic external factors) reside partially on one side of the body and penetrate deeply, wind evil strikes the Shu points of the five zang and six fu organs; the affected area results in hemifacial palsy or partial wind." Zhang Zhongjing stated: "The disease caused by wind should manifest as hemiplegia." The foundational arguments of these three texts all exclusively attribute the cause to wind. Later, Liu Wansuj emerged; observing that ancient prescriptions were ineffective, he adopted a new perspective, claiming: "Stroke is not due to internal stirring of liver wood wind, nor external contraction of wind. Rather, it arises from improper regimen leading to sudden excessive internal fire, with depleted kidney water unable to control it, causing mental confusion and sudden collapse with loss of consciousness." His theory exclusively attributes the cause to fire. Li Dongyuan, seeing contradictions in Liu's theories, proposed another view: "Stroke occurs when qi deficiency allows wind evil to invade. It typically affects individuals after age forty, rarely those in robust health, though occasionally seen in obese, pale, qi-deficient persons." His discussion distinguishes between invasion of the fu organs, zang organs, blood vessels, and meridians, establishing that the root lies in intrinsic qi deficiency combined with external wind evil. Zhu Danxi, finding discrepancies between Li's prescriptions and symptoms, diverged further, stating: "In the cold climate of the northwest, stroke occurs; in the damp climate of the southeast, it is not true stroke. Both result from prior deficiency of qi and blood, where dampness generates phlegm, phlegm generates heat, and heat generates wind." His theory exclusively attributes the cause to phlegm, specifically damp-phlegm as the root. Wang Andao, noting Zhu's statement that "southeast dampness is not true stroke," argued that the *Ling Shu*, *Su Wen*, and Zhang Zhongjing described true stroke, whereas Liu, Li, and Zhu described pseudo-stroke. Yu Tianmin commented: "Wang's distinction between true and pseudo-stroke is not entirely correct. Patients everywhere suffer from wind carried by qi stagnation, dampness, phlegm, and fire; there is no such division as true versus pseudo." Only Zhang Jingyue offered a superior insight, arguing that hemiplegia largely belongs to qi deficiency, renaming the condition "non-wind" and writing treatises on it. He cited *Jue Ni* (rebellious qi) from the *Nei Jing* and differentiated cold/heat, blood deficiency, and manifestations of the twelve meridians, but his descriptions did not match symptoms, and his prescriptions were ineffective. It is a pity that this gentleman had limited clinical experience with this condition. Other famous doctors' discussions on etiology all focused on wind, fire, qi, and phlegm. Their prescribed formulas were all for dispersing wind, clearing fire, regulating qi, and resolving phlegm. Some claimed that for stroke due to qi and blood deficiency, tonifying qi and nourishing blood should be added to wind-dispersing and fire-clearing formulas; others claimed that for stroke due to yin deficiency, regulating qi and resolving phlegm should be assisted within yin-nourishing and kidney-tonifying medicines. Whether tonifying more and attacking less, or tonifying less and attacking more, they claimed to combine attack and tonification, believing themselves to be insightful. Modern practitioners follow these methods but still find them ineffective. Yet, they dare not criticize ancient errors, instead claiming that ancient formulas do not fit modern diseases or that the primordial qi differs across eras. If formulas are mismatched and primordial qi differs, why do Ma Huang Tang (Ephedra Decoction), Cheng Qi Tang (Order the Qi Decoction), Xian Xiong Tang (Pit-in-the-Chest Decoction), and Xiao Chai Hu Tang (Minor Bupleurum Decoction) work effectively for Tai Yang disease (Exterior Syndrome)? Why do Yu Feng Tang (Wind-Nourishing Decoction), Dao Tan Tang (Phlegm-Guiding Decoction), Qin Jiao Tang (Gentian Decoction), and San Hua Decoction repeatedly fail for stroke? They never reflect on the original intent of ancient formula creation. Effectiveness and ineffectiveness originally follow two paths. Effective formulas must have been personally tested on specific symptoms; ineffective ones mostly stemmed from theoretical speculation rather than clinical observation. Formulas derived from speculation cannot clarify the source of disease. Why does hemiplegia occur? Why facial deviation? Why speech impediment and drooling? Why dry stool and frequent urination? With no fixed views, past and present are confusedly guessed. For a disease where half the primordial qi is depleted, using attacking, dispersing, and reducing formulas is bound to be erroneous. Tracing to the root, the error lies not with the physician, but with the author. Alas! How serious a matter is this, yet treated with mere conjecture and assumption!