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[Stroke (Continued)]

The Liver Wood governs Wind, and Spleen Dampness generates Phlegm. When Wind and Phlegm invade the human body, they originally do not distinguish between the left and right sides. However, if Essence and Blood are excessively depleted, causing a deficiency in the left half first, then the Phlegm generated from dietary intake on the right half, along with the Wind entering from the skin and hair, will gradually accumulate in the empty viscera, only becoming apparent when it suddenly erupts. The pulse of Wind is forceful and rapid; the pulse of Phlegm is soft and slippery. Because it is forceful and rapid, the large tendons shorten upon onset, and even the tendons of the tongue shorten, leading to dysarthria; the small tendons become flaccid and elongated, resulting in traction pulling from left to right or right to left, indicating that the small tendons on the left are flaccid and unable to tense. If the tendons on the left are tense, then the left side will be contracted. For treating hemiplegia (Hemiplegia), the method should follow "drawing Yang from Yin, drawing Yin from Yang, drawing from the left to the right, and drawing from the right to the left." This is like observing a tree with partial withering: do we water the withered part? Or do we water the non-withered part to make it flourish, thereby indirectly promoting the recovery of the withered part? (Yu Jiayan)

[Mouth Lock]

Mouth lock (Trismus) is a disease of the Foot-Yangming Stomach Meridian, treated by selecting the Jiache acupoint (Jiache, ST6). This is because the Yangming meridians surround the mouth and lips and pass through Jiache. All Yang tendon-meridians ascend to the head, and the tendons of the Three Yang meridians connect to the mandible and cheeks, clamping the mouth. When Wind-Cold invades the meridians due to deficiency, the tendons become spasmodic and tight, the jaw locks tightly, causing trismus; alternatively, excessive Wind-Heat may injure the Liver (as Wind tends to injure the Liver), and Heat dries objects, causing the tendons to become dry and tense, leading to trismus. These are all diseases caused by Excess pathogens, belonging to the Closed Syndrome in the Stroke category. In the case of the Open Syndrome, the Qi of all Yang meridians has escaped, and the body loses its controlling constraint, resulting in an open mouth and a relaxed, uncontrolled tongue. (*Feng Shi Jin Nang*)

[Aphasia/Inability to Speak]

An-yin (Loss of voice) refers to the inability to speak. The Heart meridian connects to the root of the tongue, the Spleen meridian connects to the sides of the tongue, the Liver meridian networks the tongue base, and the Shaoyin Kidney meridian follows the throat and clamps the tongue base. The Qi of these four meridians all ascends to the tongue. When pathogens strike these meridians, Phlegm-Saliva blocks the meridian pathways, preventing the tongue base from moving freely, thus causing loss of voice. There is Hou-yin (Hoarseness), caused by chronic coughing leading to voice loss, with hoarseness in the throat but no pathology in the tongue base; stroke-induced An-yin involves both the tongue and throat, where sound cannot emanate from the epiglottis. The Heart is the master of voice, the Lung is the door of voice, and the Kidney is the root of voice. The *Classic* states: The Qi of the Sanjiao communicates with the throat; if Qi is weak, it cannot ascend. If the practitioner focuses on the root, the Qi of the Dantian will naturally revive, which is why ancient physicians often used Du Shen Tang (Single Ginseng Decoction) and Dihuang Yinzi (Rehmannia Decoction) with success. However, there are six types of aphasia in stroke: those with loss of voice and inability to speak; those with a stiff tongue and inability to speak; those with coma and inability to speak; those with trismus and inability to speak; those with a relaxed tongue and slurred speech; and those with numb tongue and dysarthria. Must one not examine these in detail? (*Feng Shi Jin Nang*)

When the Taiyin chapter mentions "pathogens entering internally causing loss of voice," it is because Yang was excessive and has now declined, hence the loss of voice. Internal depletion leading to Jue (Revulsion) results in Yin-fei (Aphasia accompanied by paralysis), which is due to Kidney deficiency. The absence of Shaoyin pulse indicates Jue. The Kidney stores Essence and governs the Lower Jiao, with the Chong and Ren meridians connected to it. These two meridians emerge from the Kidney along with the great collateral of the Shaoyin Kidney, originating below from the Baozhong (Uterus/Metropolis), serving as the Sea of the Twelve Meridians. The ascending branch of the Chong meridian seeps into the Yang meridians and irrigates the channels; the descending branch seeps into the Yang meridians and irrigates the collaterals. Due to Kidney deficiency, the Kidney collaterals and Bao collaterals are internally severed and cannot communicate upward, causing aphasia; if the Kidney meridian does not ascend to follow the throat and clamp the tongue base, speech is impossible; if the two collaterals do not communicate downward, Fei-Jue (Paralysis and Revulsion) occurs. (*Zheng Zhi Zhun Sheng*)

Conditions such as Summerheat, Cold, Dampness, Phlegm Jue, Qi Jue, Food Jue, Heat Jue, and Deficiency Syncope all present with sudden collapse and inability to speak, but stroke is distinguished by accompanying symptoms of facial deviation, convulsions, and hemiplegia. (*Yi Xue Ru Men*)

[Phlegm]

Excessive Phlegm in Non-Wind diseases (Stroke-like conditions) is entirely due to Middle Jiao deficiency. Phlegm is essentially water; its root lies in the Kidney, and its branch in the Spleen. Regarding the Kidney, it is because water fails to return to its source and overflows to form Phlegm; regarding the Spleen, it is because food is not transformed, and Earth fails to control Water. Strong individuals who consume much food digest it immediately without forming Phlegm; those who cannot eat反而 generate Phlegm, because Spleen deficiency fails to transform food, causing stagnation to turn into Phlegm. Thus, patients with Consumption diseases always have much Phlegm, and as the condition becomes critical, the Phlegm increases, precisely because the more deficient the Spleen Qi is, the less food is transformed, and all fluids turn into Phlegm. It can be seen that true Excess Phlegm is rare, and Phlegm requiring purging is also rare. Therefore, treating Phlegm must involve warming the Spleen and strengthening the Kidney to treat the root; as the root gradually fills, the Phlegm will disappear without direct treatment. ○ Folk saying: Phlegm throughout the body causes unpredictable diseases. Paralysis, convulsions, and hemiplegia are all caused by latent Phlegm stagnation; without removing the Phlegm stagnation, how can the disease heal? I say: Do you know the origin of Phlegm? Phlegm in the meridians is transformed from Jing and Blood. If Ying and Wei are harmonious, Jing remains Jing and Blood remains Blood; where would Phlegm come from? Only when Yuan Yang is depleted and Shen Ji (Spirit Mechanism) is exhausted does the water lack Qi, causing Jing to coagulate and Blood to deteriorate, all turning into Phlegm. Is this truly Phlegm? Is it truly Essence and Blood? Are there Phlegms other than Essence and Blood? If one claims that Phlegm in the meridians cannot be removed without attacking, must one remove Essence and Blood entirely as well? Otherwise, how can one attack only the Phlegm without damaging Essence and Blood? If Essence and Blood are further injured, Yuan Qi becomes more exhausted, Phlegm regenerates as soon as it is removed, and Phlegm becomes worse. This is why treating Phlegm fails to eliminate it completely, while what is actually exhausted is Yuan Qi. (*Jing Yue Quan Shu*)

Ren Shen (Ginseng) renews Yuan Qi at the brink of death, Fu Zi (Aconite Root) restores True Fire in an instant; their power can reverse heaven. Adding Gan Jiang (Dried Ginger) to the formula, known as Pi Li San (Thunderbolt Powder), describes the speed of its action. Yu Jiayan opposed this, seemingly going too far. Human life relies entirely on a spark of True Yang; since the illness is acute and deficiency is sudden and severe, how dare one not urgently rescue? How many stroke patients succeed by opening Phlegm and benefiting orifices? Fortunately, the presence of surging Phlegm indicates that Yuan Qi is not yet completely extinct. If one insists on removing all this Phlegm, which is tied to life, before attempting remediation, it is impossible. There is no scenario where Phlegm is gone but Qi remains. Let me ask: Does Phlegm cause Stroke? Or does Stroke cause Phlegm? Is the acute deficiency caused by Phlegm pathology? Or is the Phlegm rising and Qi exhausting caused by acute deficiency and impending death? Commonly, in acute deficiency stroke, urine and feces are involuntarily discharged alternately. Would one then say "urine stroke" or "feces stroke"? Thus, for acute deficiency stroke and True Cold Stroke, without massive warming and tonification, nothing can be done. One only worries that the condition is too rapid, and even boiling takes too long. Shu Fu Tang (Atractylodes and Aconite Decoction), Jiang Fu Tang (Ginger and Aconite Decoction), and Hei Shun Pian (Prepared Black Aconite) can all be prepared for emergencies. For those with chronic Yang deficiency, continue with Rou Gui (Cinnamon Bark), Du Zhong (Eucommia Bark), and Gu Zhi (Psoralea Fruit); for Yin deficiency, continue with Shu Di (Prepared Rehmannia Root), Dang Gui (Angelica Sinensis), Gou Qi (Goji Berry), and Shan Zhu Yu (Cornus Fruit); for Deer Antler, Placenta, Deer Glue, and Gecko, these fleshy substances can tonify both Yin and Yang, administered in alternating doses based on assessment. Ultimately, use large doses of warming and tonifying herbs to protect the Spleen and Kidney, and success will follow naturally. With any doubt or fear, one cannot discuss supreme virtue and skill. (*Yi Bu*)

[Pulse Diagnosis]

The Cun Kou pulse is slow and moderate. Slow indicates Cold; moderate indicates Deficiency. Moderate Ying pulse indicates Blood loss; moderate Wei pulse indicates Wind Strike. (*Jin Gui Yao Lue*)

For Non-Wind pulses, slow and moderate indicate survival; rapid, numerous, wiry, and large pulses indicate death. (Zhang Jingyue)

For Stroke pulses, hidden, choppy, and irregular pulses are most taboo, especially hard, large, and rapid pulses. (Zhang Luyu)

[Selected Cases]

Empress Dowager Liu of Tang suffered from Wind disease, with a deep, nearly imperceptible pulse, rendering decoctions ineffective. Huang Qi (Astragalus Root) and Fang Feng (Saposhnikovia Root) were boiled into dozens of hu of soup, placed under the bed for fumigation, and she revived. Subsequent medication led to full recovery. (Xu Yinzong)

Wang Shoudao suffered from stroke with trismus and aphasia. Hot charcoal was burned on the floor, medicinal soup was sprinkled on it, and the patient was placed on top. After a moment, he slightly revived. (Wang Keming)

Wang Yongzhi suffered from stroke with coma, facial deviation, surging Phlegm, and hidden pulse. This was True Qi deficiency allowing Wind pathogen to invade. Using San Sheng Yin (Three Lives Decoction) 1 liang, added with Ren Shen 1 liang, decocted and taken orally, he revived immediately. Urination, hand relaxation, open mouth, and snoring indicate incurable cases. Using the aforementioned San Sheng Yin also yielded survivors. San Sheng Yin travels through meridians, treats Cold diseases, and has the power of breaking through gates and capturing flags. However, Ren Shen must be used to guide it, supplementing True Qi; otherwise, it is not only useless but leads to defeat. Observing the ancients' use of Fu Zi Tang and Shen Fu Tang reveals this principle. (Xue Lizhai)

Merchant Wang Huaquan from Huizhou suddenly collapsed, with urinary incontinence, hand relaxation, and sweat like pearls. Everyone considered the signs of extinction present and decided there was no hope. I said: Hand relaxation indicates Spleen extinction; urinary incontinence indicates Kidney extinction. By law, it is incurable. Only massive administration of Shen Fu Tang might offer a slim chance. Thus, Ren Shen 3 liang and Shu Fu Zi 5 qian were decocted thickly and灌ed down. By evening, sweating decreased. Then, Ren Shen 2 liang, Huang Qi (Astragalus Root), Bai Zhu (Atractylodes Rhizome), and Fu Zi each 5 qian were decocted. Taken fully that night, the body could move. Then, Shen Fu Gao (Ginseng and Aconite Paste) added with Jiang Zhi (Ginger Juice) and Zhu Li (Bamboo Sap) was taken continuously for three days. Spirit gradually refreshed, and after 100 days of recuperation, he recovered. (*Yi Zong Bi Du*)

[Appendix Formulas]

Formula for Treating Stroke Trismus: Use Su He Xiang Wan (Styrax Pill), or powder of Nan Xing (Arisaema Rhizome) and Bing Pian (Borneol), or rub teeth with Wu Mei Rou (Mume Fruit Flesh). ○ Soap bean and raw Ban Xia powder, insufflated into nose. ○ Also, use Gan Cao (Licorice Root), cut into segments matching the number of finger joints, soaked in oil and fire-roasted. Pry open the jaw with an object, let the patient bite the licorice firmly. Replace every ~10 li walking distance. Extremely effective for administering medicine.

Formula for Treating Stroke Facial Deviation: Boil Gui Zhi (Cinnamon Twig) in wine, take the juice, soak cloth in it, and apply to the face. Apply to the right if deviated to the left, and to the left if deviated to the right. ○ Another method: First smoke with roasted soap bean to expel external pathogens; then smoke with Ru Xiang (Frankincense) to smooth blood vessels.

Another Formula: Take one large eel, prick the head to release blood. Apply to the opposite side (right deviation to left, left deviation to right). Wash off once alignment is restored. Release the eel after taking blood.