Library

(One treatise, forty-one treatment methods, six prohibitions)

Yu Chang said: The syndrome of Zhong Feng (Wind Stroke), which concerns life and death and safety and danger, is a major and severe disease, with none being more serious than this. In the *Nei Jing* (Inner Canon), the four syndromes of Wind, Bi (Obstruction), Wei (Atrophy), and Jue (Reversal) each have their own dedicated discussions. Only in the discussion on Wind are miscellaneous winds mentioned generally. As for discussing Zhong Feng, it only states that "wind pathogen invades the Shu (Transporting) points of the five Zang organs and six Fu organs, also called wind of the Zang and Fu organs; entering through their respective gates, it becomes Pian Feng (Hemiplegia)," merely stating the names. Later discussions on wind of the five Zang organs and the Stomach Fu organ also only describe their respective manifestations. Fortunately, Zhang Zhongjing's *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet) expounded upon the ancient sages' principles, stating: "For diseases caused by Wind, there should be hemiplegia; or if only one arm cannot move, this is Bi syndrome. The pulse is faint and rapid, caused by Zhong Feng." It further states: "The Cun Kou (Radial artery at the wrist) pulse is floating and tight; tight indicates Cold, floating indicates Deficiency. Cold and Deficiency contend together, the pathogen is in the skin. Floating indicates Blood Deficiency, collaterals are empty. The thief pathogen cannot be expelled, affecting either the left or right side. The pathogen side becomes relaxed, while the healthy Qi side becomes tense. Healthy Qi pulls the pathogen, causing deviation of the mouth and eye and inability to move freely. If the pathogen is in the Luo (Collateral) vessels, the skin and muscles become insensible. If the pathogen is in the Jing (Meridian) vessels, the body feels heavy and difficult to lift. If the pathogen enters the Fu organs, the person loses consciousness and does not recognize others. If the pathogen enters the Zang organs, the tongue becomes stiff and speech is difficult, and saliva flows from the mouth." It also says: "The Cun Kou pulse is slow and moderate; slow indicates Cold, moderate indicates Deficiency. Moderate Ying (Nutrient) Qi indicates loss of Blood, moderate Wei (Defensive) Qi indicates Zhong Feng. If the pathogen strikes the Jing vessels, the body itches and urticaria appears. If Heart Qi is insufficient and the pathogen enters centrally, there is chest fullness and shortness of breath, as well as the fatal pulse signs of wind of the five Zang organs. Every word is a golden needle [key insight], offering clear threads to follow." After Zhongjing, heroes emerged in succession, and medical books piled up like beams, yet why was there no consistent selection? This has resulted in the syndrome of Zhong Feng lacking a unified method, with treatments failing in nearly all cases. I, Yu Chang, born late, dare not decline my dullness, but will extend the sacred methods of the *Nei Jing* and Zhongjing item by item as treatment examples, first establishing a treatise to summarize the essentials. However, the world knows Zhongjing as the ancestor of formula creation, but regarding Zhong Feng, Zhongjing's formulas first recommend Hou Shi Hei San (Black Powder of Hou Shi) as the main formula. Later generations did not understand its meaning; I hereby clarify it. The eight winds are all named Xu Xie (Empty Pathogens). Those whose meridians, Ying Qi, and Wei Qi are inherently strong have no entry for them. Those who enter do so because of their deficiency. The *Nei Jing* states that when bodily deficiency meets heavenly deficiency, the two emptinesses interact, the Qi reaches the bone, and entering inside damages the five Zang organs. Skilled physicians observe contraindications, preventing damage. It also states that thief winds come frequently, empty pathogens attack morning and night, entering internally to the five Zang organs and marrow, and externally to the orifices and skin. The *Ling Shu* (Spiritual Pivot) also states that sages avoid pathogens as they would avoid arrows and stones. Thus, the arrival of empty pathogens is extremely harmful. Only good physicians know how to prevent it, and sages know how to avoid it. However, Wind is a Yang pathogen. If the external-protecting Yang of the body is not solid, Yang pathogen attacking Yang makes it particularly easy to enter. Just as in hemiplegia and insensitivity, these are all caused by Yang Qi deficiency and inability to nourish and irrigate. Similarly, in sudden collapse due to Zhong Feng, Yang deficiency is even more evident. If it were not Yang deficiency, the person would surely be agile and quick, how could they suddenly collapse? Zhongjing's statement of "faint and rapid pulse," faint refers to the faintness of Yang, rapid refers to the intensity of Wind. All the pulses and symptoms listed are based on Yang deficiency. But this is not just Zhongjing's words, but the words of the *Nei Jing*. The *Nei Jing* states that if heaven is bright, the sun and moon are not clear, and pathogens harm the orifices. This shows that Wind nature likes to travel through orifices; with Yang deficiency, Wind occupies the orifices, gradually entering the Fu and Zang organs. Only when the sun shines brightly can the myriad pathogens disperse. If the Yang in the chest is not treated, the Wind will certainly not exit. Bian Que said regarding Guo Taizi's disease of Shi Jue (Corpse-like Reversal): "Above, there are severed Yang collaterals; below, there are broken Yin knots. Seeing the five collaterals connecting to the head, all belong to Yang collaterals. And since the pathogen blocks above, its Yang root is in Yin. At the place where Yin and Yang knot together, the upright Qi breaks down below, hence this disease." The precision of the ancients' statements is such. After Zhongjing, the medical lineage was severed. Among later virtuous ones who stood out, Liu Hejian advocated Fire as the principle, meaning Fire summons Wind in, Fire is the root, Wind is the branch. Li Dongyuan advocated Qi as the principle, meaning Qi summons Wind in, Qi is the root, Wind is the branch. Zhu Danxi advocated Phlegm as the principle, meaning Phlegm summons Wind in, Phlegm is the root, Wind is the branch. However, in one person's body, often all three are present simultaneously. Why not say that Yang deficiency and pathogen harming orifices is the root, and Wind entering from outside necessarily carries inherent pathogens within the body, whether Fire, Qi, or Phlegm, as the branch? Wang Andao said that if examining it as Wind, follow the *Nei Jing*; if examining it as Fire, Qi, or Phlegm, follow the three masters. Is this not merely comparing between them, lacking flexibility and sticking to one view? Moreover, following the three masters, although each has formulas and theories to adhere to, if following the *Nei Jing*, where exactly does one start? In the Zhong Feng section, Da Xiao Xu Ming Tang (Large and Small Continuation Life Decoctions) and the Six Meridians modification methods, although said to treat Wind, are still methods of later generations. The *Jin Gui* takes Gu Jin Lu Yan Xu Ming Tang to treat Feng Fei (Wind Paralysis) characterized by painless body and inability to control the four limbs. What Zhongjing valued originally was not here. What did he value? Driving out Wind while simultaneously filling the orifices is the primary principle. Once the orifices are filled, Wind exits and does not re-enter, and the illness heals. Among ancient formulas, Hou Shi Hei San deeply grasps this meaning. Zhongjing took it as the main formula, subsequently creating several formulas to supplement its incompleteness. Later generations saw the formula but were dazzled by its intent. Did they know that what Zhongjing admired had its origin, namely complying with the *Nei Jing*'s "long-term plugging of the orifices"? This is the language of skilled physicians. Looking at the note under the formula: "Take until the end of sixty days, the medicine accumulates in the abdomen and does not pass down." Long-term plugging of the orifices, is this not manifestly clear? Later generations, relying on untaught wisdom, disrupted established laws. At the beginning of Zhong Feng, treating both exterior and interior, the Wind pathogen does not fail to go out, but with the heavy doors wide open, it goes out and then re-enters, leading to situations where it cannot be controlled, many such cases exist! Also saying "a slight sweat with one Qi cycle, a slight purge over ten days," this is merely fifty steps laughing at a hundred steps. It is just like building a dike to hold back water; ten days per cycle is precisely when normal engineering work shows results. How could there be a logic of temporarily opening the dike to drain water and then reinforcing it again? Therefore, later generations' approaches were tortuous and biased, unlike the precise and pure teachings of the ancient sages. The Zhong Fang (Zhong Feng) formulas and theories of various schools are truly copying the gourd without knowing its shape, unworthy of observation. Not so, among three people walking, there must be my teacher. Especially compiling various formulas, praising their strengths, and examining their weaknesses. So that learners can read one scroll and have a clear mind, advancing in this way, using them as effectively as Zhongli's elixir turning copper and iron into gold. Is it not great to learn from former sages? Respectfully discussed.

The pulse of Zhong Feng has various combinations; combining increases the bias, but it must manifest in the pulse. Generally, new Wind carries old pathogens, whether exogenous or endogenous, the pulse changes suddenly accordingly. Combining with Cold, the pulse is floating and tight; combining with Wind, floating and loose; combining with Heat, floating and rapid; combining with Phlegm, floating and slippery; combining with Qi, deep and choppy; combining with Fire, large and vigorous; combining with Yang Deficiency, faint, also large and empty; combining with Yin Deficiency, rapid, also fine as silk; Yin and Yang both deficient, faint and rapid, or faint and fine; deficiency-slippery indicates headache in the head. Slow and delayed indicates decline of Ying and Wei Qi. Generally, Yang pulses float and are rapid, Yin pulses are soft and weak. Floating-slippery, deep-slippery, faint-deficient, scattered-rapid, all indicate Zhong Feng. However, floating-slow-delayed indicates insufficient healthy Qi, which can still be remedied. Rapid-large-rapid-fast indicates the pathogen is uncontrollable, definitely fatal. If large-rapid has not reached rapid-fast, death can still be avoided. The classic says diseases of Wind Qi seem like the Seven Diagnoses but are not, thus saying death is avoided. This shows that large-rapid is a necessary pulse for Wind Qi, and cannot be definitely determined as a fatal pulse.

Qi Bo said entering through their respective gates becomes Pian Feng (Hemiplegia). Zhongjing said for diseases caused by Wind, there should be hemiplegia, or only the arm unable to lift, this is Bi syndrome, pulse faint and rapid, caused by Zhong Feng. "Gates" refer to entering Luo, Jing, Fu, and Zang. The Classic says the generation of all diseases begins in the skin and hair. When pathogens strike, the pores open; opening allows pathogens to enter and lodge in the Luo vessels, staying without departing, transmitting to the Jing vessels. Staying without departing, transmitting to the Fu organs. Lodging in the intestines and stomach, this is Wind invading humans gradually deepening, the person's gates not yet wide open, unlike sudden collapse and reversal, entering Zang organs abruptly. Zhongjing understood this, so he described arm inability to lift as Bi, placing it below hemiplegia. Saying Wind enters from above, the arm receives it first, the entry is still shallow. Tradition says numbness in only the thumb indicates Zhong Feng within three years, which is even shallower. However, Wind invading humans must enter through Ying and Wei Qi. Wind entering Ying and Wei, the Ying pulse becomes faint, the Wei pulse becomes rapid. Observing the pulse, the person must have empty Blood residence and blazing Qi heat. The origin of Wind is not overnight. The *Nei Jing* mentions Pian Ku (Hemiplegia) in various ways: sweating on one side blocking; Yang excess and Yin insufficiency; Stomach pulse internal/external size difference; Heart pulse small, firm, and urgent; Kidney Water deficiency. The *Ling Shu* also describes Pian Ku in the Heat Disease chapter, never mentioning Wind. Never mentioning its origin in which pathogen, isn't it because emotions, hunger/fullness, and sexual activity, anything that can weaken Zang Qi, causing Ying Wei meridian obstruction and blockage, can all be called pathogens? Hejian's theory of Fire is one aspect of Kidney Water deficiency, Yang excess, and Yin insufficiency. Dongyuan's theory of Qi is one aspect of emotional depression. Danxi's theory of Phlegm is one aspect of dietary injury to the Spleen. In one disease, often all three are present; how can one be raised to encompass the others? The Classic says: If you cannot ask about the deficiency, how can you ask about the rest? For Pian Ku, Yang excess and Yin insufficiency certainly exist, but Yang Qi deficiency and blockage are even more common; can you ask about the rest?

Striking Luo vessels causes skin and muscle insensitivity. Striking Jing vessels causes heaviness of the body shell. Striking Fu organs causes unconsciousness; striking Zang organs causes tongue stiffness and difficulty speaking, flowing saliva. However, striking Fu organs must return to the Stomach Fu, striking Zang organs must return to the Heart Zang.

When striking Luo vessels, the pathogen enters Wei Qi, still outside the meridian vessels, so only skin and muscle insensitivity occur. Striking Jing vessels means the pathogen enters Ying vessels; internally bones and externally flesh lose nourishment, so the body shell becomes heavy, yet still within the body shell. Upon entering Fu and Zang organs, it leaves the body shell and enters inward, the pathogen strikes deeply. Fu pathogens must return to the Stomach because the Stomach is the commander of the six Fu organs. Lodging in the intestines and stomach, not emphasizing large and small intestines equally, is because Wind nature likes traveling through orifices. When food and water enter the Stomach, the Stomach is full and intestines empty; Wind pathogens burst into the intestines. Shortly after, food and water enter the intestines, intestines full and Stomach empty. Wind bursts into the Stomach again. Seeing Wind in the Stomach, it must rush between the two intestines. Wind entering the Stomach, Stomach Heat becomes vigorous, steaming fluids, condensing into Phlegm-Saliva, blocking tunnels. The Stomach's branch collaterals connecting to the Heart, once blocked, seal the orifices of Spirit-Qi entry and exit, hence unconsciousness. When pathogens strike other Zang organs intensely, they must burst into the Heart and disturb its Spirit-Mind. With Spirit-Mind having no master, the tongue relaxes and speech is difficult, Lian Quan opens and saliva flows.

In Pian Ku disease, slow and delayed pulses appear at the Cun Kou, indicating Ying and Wei Qi movement is lagging. Externally, body itching and urticaria; internally, chest fullness and shortness of breath. Ying vessel internal and external, pathogens fill everywhere, close to the Fu organs.

Pulse circulation completes a day and night, returning to the Cun Kou. Ying and Wei Qi decline, Cun Kou pulse is slow and delayed. Body itching and urticaria are not just Wind appearing externally, but due to weak Ying and Wei Qi causing fluid stasis and blood coagulation. Chest fullness is not just Wind appearing internally, but due to Ying and Wei Qi not moving, pathogens mixing in the chest, obstructing healthy Qi. With declining Ying and Wei Qi, who can stop pathogens entering Fu and Zang organs? Therefore, distinguishing pulse respiration rate at the Cun Kou allows us to ascertain the depth of pathogen entry accurately. Ancients said: Striking Fu organs often affects the four limbs. Using the word "often" clearly indicates speculation. Yet some held to this phrase as a symptom of striking Fu organs, how negligent! The four extremities are outside the body shell, not Fu organs. If one says Spleen governs the four limbs, the Spleen belongs to Zang, not Fu. Generally, Wind causing limb diseases, whenever Wind invades internally, regardless of striking Jing, Fu, or Zang, the four extremities will be unusable, clearly not exclusive to striking Fu organs. Then why don't the four limbs lift? Human Ying and Wei Qi circulate within the body shell. Wind entering Ying and Wei means pathogens are vigorous and original Qi is weak, like tree branches in the wind, shaking or breaking. Thus, knowing that inability to lift limbs is caused by Ying and Wei Qi shrinking and failing to move.

Striking Zang organs often stagnates the nine orifices, this is also speculative. Five Zang organs open into eyes, ears, nose, mouth, and tongue, indeed. But the anterior and posterior yin orifices belong to Fu, not Zang, cannot be grouped together. Five Zang organs are not struck simultaneously; observing which orifice is dysfunctional verifies which Zang is affected. However, various schools discard external signs, lacking internal diagnostic methods. And lacking unified formulas, how negligent? Since Wind entering Zang organs relates to life and death, if syndrome differentiation is unclear, medication will be inappropriate. Therefore, I specifically cite the profound meanings of the *Nei Jing* and *Jin Gui*, detailed below.

Wind striking the five Zang organs has been ignored by later generations. Various school formulas and theories offer no guidance; here I synthesize Classic intent to clarify treatment. The Classic says: Lung struck by Wind, excessive sweating, aversion to wind, occasional cough, better during day, worse at night. Diagnosis at the brow, color white, this cites external signs. The *Jin Gui* says: Lung Wind stroke appearance, dry mouth and panting, dizziness and heaviness. Stomach deficiency and swelling, detailing internal signs. The Classic says: Dead Lung pulse comes like floating objects, like wind blowing feathers. Describing its floating and scattering state. To the *Jin Gui* it says: Dead Lung Zang, floating void, pressing weak like green onion leaf, lacking root below, death. Combining sinking to refine its floating, whether Zang Qi survives becomes clear without doubt. Generally, Zhongjing expounding the *Nei Jing* uses independent insight, transforming narration into creation. Learners should know this, imitating for other Zang organs.

Once Wind strikes the Lung, Fire and Heat follow, consuming fluids, constraining breathing, dry mouth and panting are inevitable. Before entering, it already damaged muscles governed by Ying and Wei, and the Stomach Fu containing food and water. When Wind enters the Lung and disturbs its Po (Corporeal Soul), the mechanism of operation is lost, hence dizziness, heaviness, Stomach deficiency, and swelling appear mutually. However, if Zang Qi is not exhausted, survival is possible. If the pulse floats void, the Zang Essence is about to scatter. Adding floating without sinking, pressing weak like green onion leaf, Yang above does not descend into Yin below. Lacking root below, lone Yin gradually perishes. The *Nei Jing*'s category of dead Yin, dying within three days, precisely refers to such rootless pulses.

The Classic says: Liver struck by Wind, excessive sweating, aversion to wind, prone to sadness, pale complexion, dry throat, prone to anger, occasionally hating women. Diagnosis under the eyes, color green. The *Jin Gui* says: Liver Wind strike, head and eyes moving, hypochondriac pain, walking usually stooped, making one crave sweet foods. Dead Liver Zang, floating weak, pressing like a cord that does not return, or winding like a snake, death.

Wood Zang, struck again by Wind, Wind nature shakes upward, causing head and eye movement. Wind consumes Blood, causing sinews and vessels to relax or spasm. Its dead pulse floating weak, pressing like a cord not returning, means between floating and sinking, Yin and Yang see separation. Or winding like a snake, still upper and lower immobile, only the middle striving desperately, all images of Zang Qi nearing extinction.

The Classic says: Heart struck by Wind, excessive sweating, aversion to wind, scorched and severed, prone to angry fright, severe illness causes speech slowness. Diagnosis at the mouth, color red. The *Jin Gui* divides into two conditions: One says: Heart Wind strike, mild fever, inability to eat, hunger in the heart, vomiting immediately after eating, this is exogenous. The other says: Heart injury, fatigue causes red head and face and lower heaviness, heart pain, spontaneous vexation and fever, pulsation at the umbilicus, pulse string-taut, this is endogenous. Dead Heart Zang, floating solid like hemp seeds, pressing increasingly restless, death.

Heart Zang Wind strike divided into two. One is exogenous Wind, must burst from other Zang organs, because the Heart does not accept pathogens directly. Should follow Zang Qi, simultaneously removing Wind. One is emotional internal injury disturbing Spirit-Mind, True Yin not guarded, Heart Fire flares upward, head and eyes turn red. Zang Essence flaring up with Fire, Yin below lacks Yang to lift, hence lower heaviness. External-protecting Yang cannot enter and connect to the Heart, hence fever. The receiving and transforming Fu, Zang Qi does not intersect, stagnates and drums internally, hence pulsation at the umbilicus. Dead Heart pulse descriptions in the *Nei Jing* vary; Zhongjing summarizes the gist, stating Heart Zang near-extinction pulse, lifting and pressing, short and rapid movement, floating and sinking impossible to count, such is the state.

The Classic says: Spleen Wind strike appearance, excessive sweating, aversion to wind, body lethargy, four limbs unwilling to move, thin pale yellow color, lack of appetite. Diagnosis on the nose, color yellow. The *Jin Gui* says: Spleen Wind strike, mild fever. Form like a drunk person, abdominal烦重 (vexation and heaviness), eyelid twitching and shortness of breath. Dead Spleen Zang, floating large and firm, pressing like an overturned cup, clean shaking like swaying, death.

Wind entering Spleen Zang is a thief pathogen. Externally pulling eyelids, internally disturbing consciousness, limb lethargy, form like a drunk person, are inevitable. Added to chest shortness of breath, Spleen Zang injury is visible. If pulse comes and goes irregularly, floating increasingly large and firm, this is Lone Yang. Pressing clean and shaking, this is Lone Yin. Thus its movement is not active, rotation is not round, unless Zang Qi nearing extinction, what else?

The Classic says: Kidney Wind appearance, excessive sweating, aversion to wind, face puffy like swollen, back pain unable to stand straight, dark color, urinary difficulty. Diagnosis on the muscle, color black. *Jin Gui* omits this. Dead Kidney Zang, floating firm, pressing chaotic like rolling pills, extending down into Chi position, death.

Face puffy swelling is Kidney Qi unable to store and seal, turbid Qi rising to the face. Back pain unable to stand straight is Kidney-originating Vital Qi not stirring, waist府 (residence) exhausted and stooping, same source as urinary difficulty. Although *Jin Gui* has missing text, the general idea is both Kidneys store Essence and house Spirit, the root of the body. Excessive desire leads to deficiency, Wind easily enters. Bent waist, drooping spine, curled tongue, urinary incontinence, are all signs. Striking Kidney always combines these four, the root is known to be shaken. However, Kidney stores True Yang; if Kidney foundation is not ruined, True Yang can reside, definitely no death pulse. If floating firm, Yang has separated from Yin position. Pressing chaotic like rolling pills, True Yang beats out and cannot stay. If extending down into Chi position, True Yang leaves first, remaining lone Yin also chaotically descends. Precisely as stated: Yang escapes from above, Yin escapes from below.

Wind entering Zang organs most fears bursting into the Heart. Later generations all use Musk and Amber, guiding Wind into the Heart, imitating this, none knowing it is wrong. Here I cite two formulas from *Jin Gui* to clarify treatment.

Hou Shi Hei San (Black Powder of Hou Shi) treats Great Wind with heavy and vexed four limbs, and heart feeling cold and insufficient. *Wai Tai Mi Yao* uses it to treat Wind Epilepsy. Zhongjing's formula creation is unique craftsmanship, yet in Zhong Feng syndrome, he first cites this powder, isn't this deep appreciation of its strength! Creating formulas merely to drive Wind and tonify deficiency, who cannot do this? But within driving and tonifying, employing blocking methods, exceeds thought and imagination. The formula uses Alum to astringe other medicines, making them accumulate and not disperse, gradually filling orifices. Taking it for long days, Wind gradually extinguishes itself. Hence initial twenty days of taking, warm wine must be used.