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(Note on Bi Yuan (Nasal Sinusitis). Cases presenting with sudden collapse are termed "Zhong" (Stroke/Severe Wind Strike), while those without such symptoms are termed "Shang" (Injury/Mild Wind Strike); subsequent chapters follow this convention.)

In severe cases, the pathogen spreads throughout the meridians, as discussed in *Shanghan Lun* (Treatise on Cold Damage). This passage refers to mild and superficial cases where the pathogen only affects the skin and hair. The skin and hair are the exterior correspondence of the Lung. When the skin pores are closed, Lung Qi cannot diffuse outward, causing it to congest upward and resulting in sneezing. Heat steams fluids into nasal discharge, blocking the nose, thus making the voice sound heavy and turbid. Lung Qi stagnates and transforms into heat, causing itching in the lungs and coughing. Individuals with a constitutionally cold Qi will have no sweat, while those with a hot constitution will have sweat. Some may have fever, others not; some may have headache, others not. Although these are mild conditions, they can be further divided into degrees of severity. For deficiency patterns, Shen Su Yin (Ginseng and Perilla Decoction) is used (see Fever chapter); for excess patterns, Chuanxiong Chatiao San (Ligusticum Chuanxiong Tea-Powder Powder) is used. This condition resembles Bi Yuan but differs: Shang Feng (Wind Injury) involves the Lung and presents with sneezing, caused by Cold pathogen, resulting in clear discharge; Bi Yuan involves the Brain, presents without sneezing, is caused by Heat pathogen, and results in turbid discharge. In severe cases, there may be foul odor or epistaxis (nosebleed). Generally, Bi Yuan is due to Wind-Heat entering the brain; surging heat damages the nasal mucosa and discharge, breath from both nostrils feels like fire, causing pain or ulceration. If Heat cannot dissipate, it injures the Ying and Blood vessels along its pathway, leading to epistaxis. At the onset, Cang Er San (Xanthium Powder) is used to disperse; for chronic cases with deep-seated heat, Fangfeng Tongsheng San (Saposhnikovia Universal Relief Powder) is used to clear heat (see Stroke chapter); for epistaxis, Xijiao Dihuang Tang (Rhinoceros Horn and Rehmannia Decoction) is used to cool blood (see Blood Disorders chapter); for painful ulcers in the nostrils, Zhuyedan Zhi Bingpeng San (Pig Bile mixed with Ice Borax Powder) is applied externally (see Oral Diseases chapter). (This is stated in *Yizong Jinjian*. However, stating that Bi Yuan, which belongs to Brain Heat, has no sneezing is theoretically inaccurate; see the chapter on Sneezing for details.)

If the skin is broken or an ulcer has ruptured, Wind enters through the wound, obstructing Zheng Qi (Upright Qi) and transforming into Heat, following the same mechanism as Shang Han (Cold Damage). If more severe, it is because previous blood loss accompanied deficiency, often leading to convulsions and spasms. First, one must examine the wound: if flat and without exudate, it is merely stagnant Heat. If swollen with exudate, Heat stagnation has steamed into Dampness. If the pulse is floating (superficial), sweating therapy is indicated, using Qianghuo Fangfeng Tang (Notopterygium and Saposhnikovia Decoction) or Jiwei Qianghuo Tang (Eight-Ingredient Notopterygium Decoction). After the exterior is resolved, Baizhu Fangfeng Tang (Atractylodes Macrocephala and Saposhnikovia Decoction) is used to tonify. If the pulse is wiry, the pathogen is at the Shaoyang level (half-exterior, half-interior), requiring harmonizing therapy, using Xiao Chaihu Tang (Minor Bupleurum Decoction), Qianghuo Tang, or Diyü Fangfeng San (Sanguisorba and Saposhnikovia Powder). If the pulse is deep and solid with constipation, the pathogen is interior, requiring purgative therapy, using Da Xionghuang Tang (Large Ligusticum and Rhubarb Decoction) or Jiangbiao Wan, followed by Qianghuo Tang. Exterior-releasing herbs should be Acrid-Cool, not Acrid-Hot. If excessive use of Wind-dispelling herbs causes unceasing sweating, Baizhu Huangqi Tang (Atractylodes Macrocephala and Astragalus Decoction) is used. If convulsions and spasms persist, Juan Jing Tang (Spasm-Relieving Decoction) is used. For all spasms, nourishing Blood and moistening dryness with meridian-guiding herbs is necessary. For spasms at the back, use Qianghuo, Duhuo, Fangfeng, Gancao; for spasms at the front of the face, use Shengma, Baizhi, Duhuo, Fangfeng, Gancao; for spasms on the sides, use Chaihu, Fangfeng, Gancao, adding Huashi (Pyrophyllite) for right-sided spasms (Right side relates to Spleen Dampness). For incessant trembling of hands and feet, Zhusha Zhijia San (Cinnabar and Nail Powder) is used. If the head and eyes appear dark/blue, sweat beads on the forehead do not flow, eyes are small and staring, and pain is not at the wound site, the meridians and collaterals are damaged, and it is incurable. There are also cases where ulcer heat stagnates, forming white crusts, closing the wound, preventing Qi circulation, and generating internal Wind from stagnant Heat. This is Internal Wind, requiring clearing Heat and resolving stagnation. External treatment: Initially, take one larva of *Alphitobius diaperinus* (wireworm/Tenebrio molitor larva) from a manure pile or rotten straw roof elsewhere. Pinch its back until fluid exudes from its mouth, then apply this fluid directly to the wound. Numbness will occur, followed by sweating and immediate recovery. Alternatively, apply Yuzhen San (True Jade Powder), or chew peeled almonds thoroughly, mix with Xionghuang (Realgar) and wheat flour, and apply until swelling subsides. For trismus (lockjaw), roast one centipede, grind into powder, rub on teeth; salivation will follow, and consciousness will return immediately.