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and the internal heat is thereby vented. In spring, summer, and autumn, add Antelope Horn (Lingyangjiao), Bupleurum Root (Chaihu), Anemarrhena Rhizome (Zhimu), and Gypsum Fibrosum (Shigao) to assist. This prevents the internally accumulated heat from steaming and scorching together with the seasonal heat. Additionally, prick the four extremities of the hands and feet to drain the Ying (Nutritive) blood and unblock the Qi mechanism. One must fear that if phlegm-heat and deficiency wind persist for a long time, they may develop into leprosy-like diseases (Li Feng).

Yu Zhen's commentary: For hemiplegia (Piangu), many in the past believed that left-sided involvement belongs to Blood deficiency, while right-sided involvement belongs to Qi deficiency. Only after receiving the theoretical exposition by Mr. Jiayan (Dai Yuanli) did the rationale become clear. Furthermore, changing herbs according to the season and pricking the four extremities are particularly ingenious methods. This reminds me of reading the *Huangdi Neijing* (Yellow Emperor's Inner Canon) in my youth, specifically the chapter on Nine Palaces and Eight Winds, which states: "Wind coming from the direction where Taiyi resides is called Real Wind (Shi Feng), governing the growth of all things; wind coming from the opposite direction (Chonghou) is called Empty Wind (Xu Feng), which injures people." The sages avoided Empty Wind as they would avoid arrows and stones. Does this not clearly refer to exogenous wind pathogens? It further says: "If one suffers from 'Three Deficiencies' and is partially struck by evil wind, it results in being struck down and falling into hemiplegia (Jipu Piangu)." "Jipu" refers to suddenly collapsing as if struck by someone, which corresponds to sudden fainting or collapse today. Since "Jipu" and "Piangu" are mentioned together, sudden collapse without hemiplegia should not be classified as stroke. However, the so-called "Three Deficiencies" refer to the decline of annual luck, the emptiness of the moon phase, and the disharmony of seasons—these are deficiencies in cosmic timing and climate, not deficiencies in the human body itself. Why is stroke always treated as a condition of human deficiency? Upon reading the *Shengqi Tongtian Lun* (Treatise on Vital Energy Connecting to Heaven), it says: "Wind is the beginning of all diseases. If one maintains clarity and tranquility, the flesh and pores close and resist; even great wind and severe toxins cannot harm." It also states: "Wind, rain, cold, and heat, if not empty evil winds, cannot injure people alone." And again: "Empty evil wind and the human body, when both are deficient, meet, and then the pathogen enters the form." This clearly indicates that only those with a deficient constitution are struck by empty wind. Nevertheless, this still implies contracting wind due to deficiency. Thus, the *Ling Shu* (Spiritual Pivot) also has the theory that "when True Qi departs and Evil Qi remains alone, it develops into hemiplegia." The phrase "hemiplegia is difficult to treat" summarizes this perfectly. Re-reading the *Tong Ping Xu Shi Lun* (Treatise on Uniform Evaluation of Deficiency and Excess), it says: "In treating Xiao Dan (Wasting-Thirst), Jipu (Collapse), Piangu (Hemiplegia), Wei Jue (Atrophy and Cold Limbs), and Qi Man Fa Ni (Fullness of Qi with rebellious flow), these are diseases of rich and noble people caused by rich food and fine grains (Gao Liang)." This passage implicitly includes various syndromes such as Phlegm-Dampness, Damp-Heat, Yin Deficiency, and Yang Deficiency, without mentioning partial striking by evil wind. Presumably, rich and noble people naturally take care to avoid evil winds, and changes arising from rich diets generate wind from within. Liu Wansu, Li Dongyuan, and Zhu Danxi entered medical understanding through this insight. Generally, treating disease requires seeking the root. Collapse and hemiplegia have deficiency as their root.

Liu Zongnong, in *Yuji Wei Yi*, stated: "I once resided in Liangzhou, which was Wuwei Commandery in the Han Dynasty. The terrain is high and elevated, with much wind and little rain throughout the four seasons. The soil grows millet and sorghum, irrigated by springs. The weather is often cold. People's Qi is substantial, and their pores are dense. I frequently saw cases of sudden death from stroke. It was likely due to the extreme dryness and ferocity of the Northwest wind (Zhe Feng). At that time, in the eighth month of autumn during the Yihai year of Hongwu, a strong wind rose from outside Ganzhou City in the northwest, and many died on the roads. I began to realize that the scriptural statement regarding the Northwest wind injuring people and causing sudden death was not false. People who have not experienced such places, despite reading the scriptures, always harbor doubts. How can medicine be discussed lightly?"

Additionally, Wang Kentang, in *Linglan Yaolan*, said: "An old physician in our village had been bedridden with paralysis of the right hand and foot for two years. Everyone predicted he would certainly die. Several months later, I met him on the road and asked him. He said: 'My illness was nearly fatal. Initially, I took herbs to regulate Qi and resolve phlegm, but there was no effect. By dusk, my consciousness became confused, and I judged I could not take more medicine. I instructed my family to decoct Shiquan Dabu Decoction (Complete Great Tonifying Decoction). Immediately after taking it, I felt clear-headed. I continued taking it. After several days, I could rise supporting myself with a cane. Soon after, I could walk without the cane.' The scripture says: 'Where the pathogen gathers, the Qi must be deficient.' I treated his deficiency and did not focus on the pathogen, so the pathogen naturally dispersed. This is why I recovered." I said: "Indeed! If he had continued taking Qi-regulating and wind-dispersing powders without cessation, the trees on his grave would already be tall. However, this case still adhered to established formulas, lacking flexibility to adapt to the disease and adjust over time, hence the slower efficacy. Had I treated him earlier, it would not have reached this state. I record this temporarily for the discerning to consider." Reading these two cases reinforces the belief that regions beyond the Great Wall have more true wind-stroke, while Jiangnan has more stroke-like conditions. The theories of Liu, Li, and Zhu, and Zhang Jingyue’s discussion on non-wind disorders, are indeed merits to the medical legacy of Xuanyuan and Qibo. Towards the late Ming Dynasty, Miao Zhichun proposed that severe deficiency of True Yin leading to intense internal heat boils down body fluids, condensing them into phlegm, blocking the airways, preventing smooth flow. Extreme heat generates wind, also causing sudden stiffness and collapse, classified as stroke-like syndrome. This is internal deficiency dark wind. Initially, use clearing heat, regulating Qi, and resolving phlegm methods; subsequently, treat the root by nourishing Yin or tonifying Yang. Herbs used include Asparagus Tuber (Dongguamen/Dongchongxiaocaobingdong... wait, Er Dong refers to Tian Dong and Mai Dong), Rehmannia Root (Di Huang), Chrysanthemum Flower, Goji Berry, Sesame Seed, Mulberry Leaf, Polygonum Multiflorum, Biota Seed, Sea Buckthorn (or Tribulus), Trichosanthes Root, Ginseng, Poria, Angelica Sinensis, White Peony Root, Deer Antler, Tiger Bone Glue, Xiataian Paste, Pear Syrup, Bamboo Sap, Mulberry Sap, Human Milk, and Child Urine, among others, used interchangeably. This created a new paradigm. Today, the Stroke section in *Lin Zheng Zhi Nan Yi An* (Guide to Clinical Practice Medical Cases) largely follows this approach, supplementing what Liu, Li, Zhu, and Zhang did not cover. Regarding Yu Jiyang’s discussion on Hou’s Black Powder, claiming that Alum (Fan Shi) fills apertures and blocks wind pathways, this is fanciful talk that misleads people most. When herbs enter the stomach, it is merely their aroma and flavor that spread through the Zang-Fu organs and meridians. How can Alum be embedded or brushed like paste? If one eats cold food for forty days, accumulating medicine in the abdomen without digestion, the intestines and stomach would indeed be blocked. Grain would not be taken in, and feces would not exit. What then? Practitioners must not rashly try this.