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As Liu Zongnong stated in *Yuji Wei Yi* (Subtle Meanings of the Jade Mechanism): I once resided in Liangzhou, where the terrain is high and elevated, with much wind and little rain throughout the four seasons, and the weather is often cold. I frequently observed cases of stroke or sudden death. This is likely due to the extreme dryness and ferocity of the "Zhe Feng" (cutting wind from the northwest). At that time, in the eighth month of autumn during the Yihai year of the Hongwu era, a strong wind rose from the northwest, and several people died on the roads outside Ganzhou City. It was then that I realized the principle stated in the *Classic of Internal Medicine* (*Huangdi Neijing*)—that the cutting wind from the northwest injures humans and leads to sudden death—is not false, and that Zhu Danxi’s statements had a basis. Alas! If physicians do not understand the subtleties of *Yunqi* (Five Movements and Six Qi), geography, creation/nature, and the mechanisms of disease, yet wish to practice adaptive methods, it would be extremely difficult!

Based on this perspective, it is indeed the wind that kills. However, when wind qi combines with warmth, although fierce, it may not necessarily kill; only when it carries the might of cold does it cause death. Moreover, since the northwestern region is cold, and the frontier winds arise in the eighth month, cold arrives with the wind, penetrating deeply into the bones. For those exposed to the elements, although it is said they have contracted wind, in reality, they have been infected by the toxin of Yin-Cold. In robust individuals, this can certainly be endured, but how could weak individuals survive? This is recorded specifically because of the differences in circumstances encountered. If these formulas were truly treating genuine wind-stroke, such occurrences would happen only once or twice in a century. From this, we can understand why this syndrome is rarely seen. Furthermore, injuries caused by thief-wind and deficient evil occur every year and everywhere; these are merely exterior-constraint diseases. It has never been heard that sudden fainting and death result solely from exterior constraints. Besides, what modern people call "stroke," sometimes occurs in still, windless times, or in places where food and drink are consumed closely, without prior exterior constraint, yet suddenly leading to collapse or hemiplegia. That this is or is not wind is evident. Yet, treating all such cases with wind-dispelling methods—can they bear it?

According to prescriptions for treating stroke passed down through generations, the primary formulas are the Xuming Decoctions (Continuing Life Decoctions) and similar ones. Examining their origin, they began with the *Xuming Tang* (Continuing Life Decoction) from *Gujin Luyan* found in the attached formulas of *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet). However, this was likely added during the Song Dynasty medical text corrections, rather than being Zhang Zhongjing’s original formula. Since the Sui and Tang dynasties, Sun Simiao’s *Qianjin Fang* (Prescriptions Worth a Thousand Gold) included Xiao Xuming Tang (Minor Continuing Life Decoction), Da Xuming Tang (Major Continuing Life Decoction), Xichuan Xuming Tang, Paifeng Tang (Dispersing Wind Decoction), etc., so later generations followed suit. All regarded these as the main treatments for stroke. Xuming Tang uses Ephedrae Herba (Mahuang, 麻黄) as the sovereign herb, combined with Ginger Rhizome (Shengjiang, 生姜) and Cinnamon Twig (Guizhi, 桂枝); it is an excellent formula for dispersing exterior pathogens. As for Xiao Xuming Tang, Da Xuming Tang, and Xichuan Xuming Tang, they add Scutellariae Radix (Huangqin, 黄芩) alongside Cinnamon Twig and Aconite Root (Fuzi, 附子). Although it is said they mutually restrain each other, water and fire, ice and charcoal, follow fundamentally different principles. Even if miraculous, they are ultimately not convincing to me. Leaving aside others, I am particularly puzzled by He Jian, Dong Yuan, and Dan Xi. Although they stated in the Stroke section that this disease is not wind, why did they list Xiao Xuming Tang first in that same section, along with modification methods? They stated: For no sweat and aversion to cold, use Mahuang Xuming Tang; for sweating, aversion to wind, and no heat, use Guizhi Xuming Tang; for sweating, body heat, and no aversion to cold, use Baihu Xuming Tang; for sweating, body heat, and no aversion to wind, use Gegen Xuming Tang; for no sweat and cool body, use Fuzi Xuming Tang. Such methods are suitable only for treating exterior constraints, not interior injuries. Yet, these three scholars clung tightly to these few formulas in their works. Why do their preceding and subsequent statements not correspond?

Furthermore, regarding Da Qin Jiao Tang (Large Gentian Decoction) and others, both *Jiyao* (Essentials) and *Faming* (Clarifications) state they treat stroke where there are no exterior signs of the Six Channels and no internal obstruction of urination or defecation. If blood deficiency fails to nourish the sinews, one should nourish the blood, and the sinews will naturally flourish, primarily using Da Qin Jiao Tang and Qianghuo Yufeng Tang (Notopterygium Wind-Relieving Decoction). Although Da Qin Jiao Tang contains blood-nourishing herbs, half of its ingredients are cooling and dispersing. If there are no exterior pathogens of the Six Channels, why use dispersing agents? If there is no obstructing Fire-Evil, why use cooling agents? With so many cooling and dispersing herbs, can they truly nourish blood and qi and strengthen sinews and bones? Da Qin Jiao Tang is already questionable, and Yufeng Tang is even more unacceptable. I do not know what intention lies behind using such methods.