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Children under five years of age have not yet developed vigorous *Qi* and blood, and their meridians are not yet filled, making it impossible to distinguish their pulse conditions. Therefore, diagnosis is made by observing the manifestation of collateral vessels on the index finger.

The first segment of the index finger, located at the Yin position, is called the Wind Gate (Feng Guan). The second segment, at the Mao position, is called the Qi Gate (Qi Guan). The third segment, at the Chen position, is called the Life Gate (Ming Guan). Diagnosis follows different standards for males and females, left and right hands.

A purple color in the vessel indicates Heat; red indicates Cold Damage (Shang Han); green/blue indicates Wind Convulsion (Jing Feng); white indicates Infantile Malnutrition (Gan Ji); a faint yellow hue indicates health; black indicates critical condition. If the vessel is at the Wind Gate, the illness is mild; at the Qi Gate, it is severe; at the Life Gate, it is critical. If the vessel extends into the palm, it is termed "Internal Hook" (Nei Diao). A vessel curving inward indicates Wind-Cold; curving outward indicates Food Stagnation. For children over five years old, the pulse at the Cun, Guan, and Chi positions is taken with one finger. The normal rate is six beats per respiration. An increased rate indicates Heat; a decreased rate indicates Cold. These methods are the same as those used for adults.

If a child has a chaotic pulse, fever, sweating, anorexia, and vomiting immediately after eating, it is likely due to Bian Zheng (a physiological developmental process in infants). If a child's four extremities are cold while the rest of the body is warm, accompanied by shivering, aversion to cold, flushed face, coarse breathing, and copious nasal discharge and tears, it indicates Dui Zhen (smallpox or measles).

For infants under half a year old, diagnosis is performed at the hairline between the forehead and eyebrows using three fingers. The index finger near the hairline represents the upper area; the ring finger near the eyebrows represents the lower area; the middle finger represents the middle area. If all three areas are hot, it indicates external Wind invasion with nasal congestion and cough. If all three are cold, it indicates external Cold invasion or internal injury from diet, leading to fever, vomiting, and diarrhea. Heat in the middle and index fingers indicates upper heat and lower cold. Heat in the ring and middle fingers indicates concurrent Wind Convulsion. Heat in the index finger alone indicates Food Stagnation.

Sudden collapse with loss of consciousness, locked jaw, and phlegm-saliva obstructing the airways constitute a critical emergency known as Stroke (Zhong Feng). Li Dongyuan attributed it to Qi deficiency; Liu Hejian to Fire excess; Zhu Danxi to Dampness generating Phlegm. All three explained the etiology of Stroke like tracing the origin in writing. Xue Lizhai and Zhao Yangkui attributed it to exhaustion of True Water (Kidney Yin), deficiency of True Fire (Kidney Yang), Liver Qi stagnation, Spleen injury, and various deficiencies. Further elaborating, these views do not address the acute phase directly. "Wind" here refers to exogenous pathogenic Wind; "Zhong" means being struck, like an arrow or stone hitting a person. At this moment, treating the Wind is urgent; other theories are secondary. Xiao Xuming Tang is the primary formula; other theories are unreliable. If Stroke were caused by chronic Qi deficiency, Fire excess, Phlegm, water exhaustion, etc., treatment should have begun long before the attack with large doses over months. It is illogical to expect a single dose to reverse Qi deficiency, calm Fire, clear Phlegm, nourish Kidney Water, warm Mingmen Fire, soothe the Liver, strengthen the Spleen, and tonify all deficiencies during the acute, life-threatening moments of Stroke. Medicines like Niuhuang Naoxue Wan (Calculus Bovis, Borneol, Moschus pills) are known to deplete Yuan Qi and are not lightly administered. Yet, these books present seemingly reasonable arguments that are actually more harmful than open falsehoods. (Chen Nianzu) dares to offend predecessors to save lives, directly refuting these errors.

A floating and large pulse is favorable. (Floating indicates the pathogen is still in the Fu organs; Large indicates Wind is a Yang pathogen, and a Yang syndrome presents with a Yang pulse. However, if the pulse is floating, large, and forceful upon pressure, it suggests pathogen excess and Zheng Qi depletion, with Yuan Qi about to escape.) A deep and small pulse is unfavorable. (Deep indicates the pathogen has entered the Zang organs; Small indicates Zheng Qi decline. However, if the pulse is deep and small but gentle, regular, and distinct, it is a good omen.)

When the pathogen enters the Meridians (Zhong Jing), presenting with Six Meridian symptoms, Xiao Xuming Tang is indicated.

When the pathogen enters the Viscera (Zhong Zang), it often blocks the nine orifices, causing symptoms such as flaccid lips, aphasia, nasal congestion, deafness, blurred vision, and constipation. Since the Wind comes from outside, Ma Huang Tang or Gui Zhi Tang derivatives are used. For limb twitching and spasms, Dang Gui and Bai Shao are added to nourish blood. For obstruction of urination and defecation, Hua Shi, Mang Xiao, and Da Huang are used. Fang Feng Tong Sheng San is indicated.

When the pathogen enters the Fu organs (Zhong Fu), it tends to affect the limbs, causing hemiplegia, inability to move limbs, left paralysis, or right hemiparesis.

When the pathogen affects the Blood Vessels (Zhong Xue Mai), there are no Six Meridian exterior symptoms nor internal obstruction of bowels/bladder, only facial deviation (mouth and eyes skewing to one side). If deviated to the left, Liu Jun Zi Tang is indicated because the left side is governed by Blood, which requires Qi to circulate. If deviated to the right, Si Wu Tang is indicated because the right side is governed by Qi, which requires Blood to anchor. Both formulas should be combined with Zhu Li (Bamboo Sap) and Jiang Zhi (Ginger Juice) to resolve meridian Phlegm, plus Jiang Can, Gou Teng, Tian Ma, and Ling Yang Jiao to extinguish Wind and unblock collaterals. Fuzi may be added to secure Yin, Rou Gui to unblock Yang, and Huang Qi to dispel Wind.

For stroke-induced aphasia, Zi Jie Jie Yu Tang is indicated.

For tongue stiffness preventing speech and leg weakness preventing walking, Di Huang Yin Zi is indicated.

Fatal cases of stroke are often Wind combined with Cold. Symptoms include: open mouth indicating Heart failure; relaxed hands indicating Spleen failure; closed eyes indicating Liver failure; urinary incontinence indicating Kidney failure; snoring sound indicating Lung failure; oily sweat indicating internal collapse of Yuan Qi; straightened hair, upward staring eyes, flushed face like makeup, and pearl-like beads of sweat indicate untreatable conditions. Delay in medication by even minutes leads to death. Immediately administer San Sheng Yin (1 liang) with Ren Shen (1 liang).

Note: In modern San Sheng Yin, Fuzi is often salted Aconitum carmichaelii root lateral preparations, which lack potency unless sourced from Sichuan. I use Shu Fu Zi (1 liang), Gan Jiang (5 qian), and Zhi Gan Cao (4 qian). After one dose, sweating stops slightly; after two doses, eyes move slightly; after three doses, add Ren Shen (3 qian), and vitality gradually returns. Three doses must be taken within half a day.

After recovery from stroke, gradual调理 (regulation) should follow the methods of Liu, Zhu, Li, and Xue.

My commentary: Opening orifices to drive out Wind is not the orthodox method. Nei Jing emphasizes filling the orifices. Jin Gui Yao Lue contains Hou Shi Hei San and Feng Yin Tang, which are superior methods for tonifying Heaven (Congenital Essence).

Appendix: Modifications of Xiao Xuming Tang for the Six Meridians and Acupuncture Methods

If stroke presents with no sweat and aversion to cold, follow the base formula, doubling Ma Huang, Xing Ren, and Fang Feng. Also, prick Zhi Yin (BL67) to bleed. (Location: lateral corner of the fifth toenail, needle 1 fen.) Kunlun (BL60). (Location: posterior to the lateral malleolus, needle through to Taixi.) ○ If stroke presents with sweat and aversion to wind, follow the base formula, doubling Gui Zhi, Bai Shao, and Xing Ren. Also, prick Fengfu (DU16). (Location: 1 cun below the posterior hairline, needle 3 fen, moxibustion prohibited.) These two conditions are both Taiyang Meridian stroke.

If stroke presents with sweat, fever, and no aversion to cold, follow the base formula, adding Shi Gao and Zhi Mu (2 qian each), doubling Gan Cao, and removing Fuzi. ○ If stroke presents with sweat, fever, and no aversion to wind or cold, double Ge Gen, Gui Zhi, and Huang Qin in the base formula. Prick Xiangu (ST41). (Location: distal to the metatarsophalangeal joint of the second toe, needle 5 fen.) To eliminate the thief of the Yangming Meridian, also prick Lidui (ST45). (Location: lateral corner of the nail of the second toe, width of a leek leaf.) To drain Yangming Excess. These two conditions are both Yangming Meridian stroke.

If stroke presents with no sweat and cool body, follow the base formula, doubling Fuzi, tripling Gan Jiang, and tripling Gan Cao. Also, prick Yinbai (SP1). (Location: medial corner of the nail of the big toe, width of a leek leaf.) To eliminate the thief of the Taiyin Meridian. This is Taiyin Meridian stroke.

If stroke presents with sweat and no fever, follow the base formula, doubling Gui Zhi, Fuzi, and Gan Cao. Also, prick Taixi (KI3). (Location: depression between the medial malleolus and Achilles tendon, needle through to Kunlun.) This is Shaoyin Meridian stroke.

If stroke involves confusion of the Six Meridians, associated with Shaoyang, presenting with severe joint pain or numbness, follow the base formula, adding Qiang Huo and Lian Qiao. Moxa Ji Jing acupoint (Location: 3 cun above the lateral malleolus, 5 moxa cones) to guide heat. Prick Dadun (LR14), the Jing-Well point of Jueyin. (Location: dorsal aspect of the big toe, proximal to the nail margin.) To unblock the meridian. This is Shaoyang-Jueyin Meridian stroke.

New Commentary (Annotated by nephew Feng Teng: Previous texts scatter Wind, scattering Qi along with it, leading to death. This method harmonizes; harmony brings peace, reviving the dead. It supplements what was missing for millennia.) In the year Ren Xu, while serving in Baoding, Governor Xiong summoned me for consultation. His pulses were thick and long, with a slight wiry quality on the left and tightness at both Cun positions. I said: A thick pulse reflects the stability of Earth element; carrying fortune with thickness, longevity follows length. This is not flattery. But wiry indicates Wind, tight indicates Pain. Tightness at the Cun positions suggests Bi pain in the upper body. The Governor replied: Correct. I have had back and wrist pain, intermittent for over five years, and finger numbness, severe ten years ago, now mild. I said: Wind pain in joints is distinguished by pain, caused by the struggle between Qi/Blood and Wind, unlike hemiplegia which is painless. Texts state that numbness of the middle finger predicts stroke within three years, as it belongs to the Hand-Shaoyin Heart Meridian. Now, the thumb and index finger are prominent, indicating imbalance in Lung and Large Intestine Qi. It is not severe but must be treated early.

Xue stated: Using Wind-dispelling drugs to prevent stroke invites Wind. I adopted his intent but not his formula, prescribing Huang Qi Wu Wu Tang for daily use.

Huang Qi, Gui Zhi Jian (tip), Sheng Bai Shao (2 qian each), Sheng Jiang (4 qian), Da Zao (2 pieces), decoct in water and drink.

Ancients said: One is in the Wind but does not see it, like a fish in water. Wind is Qi. Humans live in the intersection of Qi; benefiting from Wind is like Song Confucius saying "gentle wind brings spring." Harm from Wind is like Buddhist teaching "karmic wind destroys metal and stone." Among the five viscera, the Liver is the Wind Organ, the gate of life and death. Healthy: Wind is harmonious, breath and pulse are harmonious, Wind is invisible. Sick: Wind is rapid, breath and pulse are rapid, revealing Wind signs like staring eyes, limb spasms, oily sweat, surging phlegm. Treatment becomes futile. Only when numbness, dizziness, or joint pain occurs, before severity, can the Liver be nourished to prevent Wind disease. Liver belongs to Wood and governs Spring. Spring comes and goes; there is a way to retain it. I learned this from Shao Yong's poetry. Nei Jing says: Spirit in Heaven is Wind; Great Qi supports it. Zhuangzi says: All things breathe together. Mencius says: Fills heaven and earth. Buddhism says: Wind Wheel supports the earth. There is a consistent Dao. This formula identifies the Liver as the Wind Organ. Gui Zhi unblocks Liver Yang; Bai Shao nourishes Liver Yin. Balance creates Harmonious Qi, i.e., Gentle Wind. Everything is Wind and Qi. Qi needs nurturing. Huang Qi tonifies, following the "do not forget" principle of nurturing Qi. Da Zao moderates, following the "do not force" principle. Ginger restores the robust, vast nature. Sages' words contain everything.

Another Pill Formula (for daily maintenance, different from emergency treatment, using mild herbs like food):

Shu Di Huang (6 liang), Zhi He Shou Wu (6 liang, soaked in rice water overnight, peeled, sliced, steamed), Huai Shan Yao (3 liang, stir-fried with ginger juice), Gan Gou Qi (3 liang, dried between paper), Chuan Fu Zi (2 liang, fried), Shang Rou Gui (1 liang, peeled, ground without fire exposure), Ren Shen (2 liang, steamed until soft, sliced, dried between paper, ground), Lu Rong (antler, sliced, fried in butter, avoid burning), Mai Dong (2 liang, moistened with Shaoxing wine, sun-dried), Wu Wei Zi (2 liang, stir-fried with salt water). Grind into powder, make pills with refined honey the size of tung seeds, coat with Cinnabar (Zhu Sha).

This formula corresponds to Huang Qi Wu Wu Tang. The latter tonifies Qi to treat Wind, focusing on the Liver (Wind Organ). Wind is the sigh of Heaven and Earth. Harmonious Qi is Gentle Wind, moving everywhere, like Mencius' description. This formula tonifies Kidney, which also nourishes Liver. Liver is Wood, Eastern Vital Qi. Zhuangzi: Wild horses [vapor], dust, living beings breathe together. Wood grows from Water; Yi and Gui share the same source; emphasis is on Kidney. Nei Jing: Kidney stores Zhi (Will). Kidney is the Official of Strength. "Strength" is the root of robust Qi, like Mencius' "Commander of Will and Qi." Sages' words encompass all. Although nurturing Qi focuses on learning, the Way of preserving life is included. No one discussed this since Han dynasty; my theory seems innovative but has roots.

In the formula, Shu Di tonifies congenital Kidney Water; Bai Zhu tonifies acquired Spleen Earth. To tonify Kidney, gather essence; Gou Qi completes essence, assisting Shu Di. To tonify Spleen, thicken Earth; Shan Yao provides Earth's harmony, assisting Bai Zhu. The root of Spleen and Kidney is Mingmen. Outside Mingmen are the two Kidneys (Yin lines of Kan trigram); inside is Mingmen (Yang line of Kan trigram). Fu Zi enters Mingmen Blood level; Rou Gui enters Mingmen Qi level. They warm the Water Organ, the root of life, like Shao Kangjie's "thunder underground, spring light fills the universe." Combined with Sheng Mai San (Ren Shen, Wu Wei Zi, Mai Dong) to transform sour/sweet into Yin, preventing the dryness of pungent-hot Yang herbs. Lu Rong enhances Blood and Qi, more effective than plants. Coating with Zhu Sha (Cinnabar) uses its red color to enter the Heart. Nei Jing: Heart stores Shen (Spirit); Kidney stores Zhi (Will). Zhu Xi on Analects: Where the heart goes is Zhi. Other theories are unreliable; Nei Jing is one of the Three Fens, matching sages' teachings. Medicine and Confucianism are one Dao.