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Use Suhexiang Wan (Suhexiang Pill), Niuhuang (Calculus Bovis), Zhibao Dan (Zhibao Pill) and similar medicines to administer orally. If signs of Tuozheng (a critical syndrome characterized by the collapse of vital energy) are observed, only large doses of Lizhong Tang (Regulate the Middle Decoction) should be administered, along with moxibustion applied below the navel. Although it is said to be incurable, there is still a one-in-ten chance of rescue. If Suhexiang Wan or Niuhuang are mistakenly administered, survival will be impossible. These potent agents, described as "generals breaking through gates," are originally intended for Bizheng (a excess syndrome characterized by obstruction of the heart orifices). Applying them to Tuozheng is like dropping stones on someone who has already fallen into a well. Countless people have died due to this error. (*Yilin Shengmo*) (Zhou Jing stated: In cases of Tuo syndrome, treatment is generally considered futile; only massive administration of Renshen (Ginseng Radix et Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata) might offer a slim hope. Note: *Yixue Gangmu* states: When the Qi of the five Zang organs fails, large doses of Renshen should be decocted into a thick liquid and administered immediately, and strong moxibustion should be applied below the navel; this can also reverse death and restore life. *Nuke Zhunsheng* analyzes the treatment of Bi and Tuo syndromes, combining content from *Shengmo* and *Gangmu*, but changing Niuhuang and Zhibao to Sansheng Yin (Sansheng Decoction) is incorrect. *Yizong Bidu* fully adopts the view of *Shengmo*.)

Regarding sudden collapse and violent syncope, regardless of gender, whether caused by Wind-Cold, Qi stagnation, Food retention, Phlegm-Dampness, the key is to clearly distinguish between Bi syndrome and Tuo syndrome. (*Nuke Zhunsheng*)

Bi syndrome involves pathogenic factors obstructing the exterior while Yuanqi (Original Qi) remains within; treating with methods to open orifices and regulate Qi allows pathogens to dissipate naturally, making it easier to treat. Tuo syndrome involves the leakage of Yuanqi to the exterior and mixing of pathogens within; even with drastic tonification, the Zang organs are already damaged, making it difficult to treat. This applies to all such syndromes, not just stroke. (*Zhengzhi Huibu*)

Cold, Heat, Deficiency, and Excess: The six pulses being deep and hidden or floating and vigorous at the fingertips indicate the distinction between Yin-within-Yang and Yang-within-Yin, referred to in classics as Hanzhong (Cold Stroke) and Rezong (Heat Stroke). If the pulse is deep and rapid, with a blue-white complexion and a slack, lethargic demeanor, this is Hanzhong. Treatment principles include using Tianxiong (Aconitum) and Fuzi, such as Sanjian Tang (Three Jian Decoction) and Xingfu Tang (Pinellia and Aconite Decoction). If the pulse is floating, surging, and rapid, with red cheekbones and a dark-red face, appearing drunk or angry, this is Rezong. Treatment principles include using Fangfeng (Saposhnikoviae Radix) and Duhuo (Angelicae Pubescentis Radix), such as Da Xiao Shengfeng Tang (Large and Small Wind-Dispersing Decoctions) and Zidou Tang (Purple Bean Decoction). (*Xu Yijian Fang Houji*) (Note: *Yonglei Qianfang* is slightly similar. Rezong may also present with locked jaw, upward gaze, stiffness, tremors, and vertigo.)

*Waitai Mi Yao* states: Regarding stroke, where limbs cannot hold themselves, hands and feet flail, spirit is confused and dull, eyes do not recognize people, speech is slurred, restlessness and aversion to clothing occur, and administering medicine causes confusion, these diseases mostly arise from Heat. Wang Shuhe stated that accumulated heat generates Wind. (Note: The source of this citation should be verified.) Therefore, ancient sages used Zhibao Dan, Hongxue Tongzhong San (Red Snow Unblocking Middle Powder), Longnao Xiongxi Wan (Borneol and Rhinoceros Horn Pill), Bohe Jian (Mint Decoction), and Niuhuang Qingxin Wan (Calculus Bovis Clear Heart Pill) to treat it. Drinking Zhuli (Bamboo Sap) alone or Da Xiao Zhuli Tang (Large and Small Bamboo Sap Decoctions), or Baidu San (Defeat Toxin Powder) added with Fangfeng and Jingjie (Schizonepetae Herba) decocted and taken orally is also effective. If one fails to ascertain that it is Heat accumulating to generate Wind, and indiscriminately administers Sansheng Yin, Sanjian Tang, or Yangzheng Dan (Nourish Righteousness Pill), disaster will follow immediately. (*Guanjian Liangfang*)

Stroke causing weak limbs and inability to move, accompanied by spontaneous sweating, is Xu Zhongfeng (Deficiency Stroke). If limbs are stiff and spasmodic, with facial paralysis and pain upon extension/flexion, it is Shi Zhong (Excess Stroke). (*Shoushi Baoyuan*)

Distinction between Zhongfeng (Wind Stroke) and Zhongqi (Qi Stroke) (Refer to Qi Disease Section): Zhongqi resembles Zhongfeng; the difference is that in Wind Stroke the body is warm, while in Qi Stroke the body is cold. (*Zhengzhi Yaojue*)

There is also Zhongqi resembling Zhongfeng, with slurred speech, flooding saliva, coma, locked jaw, differing only in that limbs are not paralyzed. (*Qixiao Liangfang*)

Zhongqi is commonly known as Qi Jue (Qi Collapse); the pulse must be deep, whereas a floating pulse indicates Wind. Zhongfeng and Lei Zhongfeng (Similar Wind Stroke) present with a warm body and much phlegm-saliva; Zhongqi presents with a cold body and no phlegm-saliva. (*Danxi Zuanyao*)

Wind Stroke pulse is floating and surging; Qi Stroke pulse is deep and choppy. (*Yiyue*)

Zhongfeng and Zhongqi have similar appearances but different etiologies. Zhongfeng occurs due to weakened Yuanqi and loose interstices, allowing Wind pathogen to strike suddenly, resulting in collapse with a stiff and hot body. Zhongqi is caused by emotional injury, leading to Qi collapse and fainting, necessarily with a cold body and without stiffness/spasms; after regaining consciousness, rebellious Qi persists. (*Yuanbing Ji*)

Similar Syndromes (Also see Jue and Phlegm-Food Retention sections): Heavy limbs resembling wind stroke originate from Spleen-Stomach deficiency and insufficient Ying-Wei (Nutritive and Defensive Qi). The Stomach is the sea of water and grain; the Spleen grinds and digests it, transforming essence into Ying-Wei to nourish the four limbs. Irregular lifestyle and diet lead to Spleen-Stomach Qi deficiency, causing inadequate nourishment by Ying-Wei, allowing Wind pathogen to invade. Since the Spleen governs the limbs and its meridians connect to the tongue root and end at the lips/mouth, both limbs and mouth/lips become numb, causing slurred speech. Treatment should prioritize Spleen-Stomach herbs and minimize Wind-dispelling herbs to achieve stability. Untreated long-term, it becomes Wei Ji (Atrophy Syndrome), as the Classics state: "Treat Atrophy by focusing solely on the Yangming channel," which refers to the Stomach meridian. (*Jifeng*)

Unexplained facial paralysis unresponsive to stroke medication is likely due to bone deficiency allowing Wind invasion; seek cause here rather than treating as ordinary stroke. Chuanwu (Aconiti Radix) is essential, properly processed. (*Zhengzhi Yaojue*)

Those with inherent weak Yuanqi, overwork, or sexual indulgence may suffer sudden collapse resembling stroke, with open mouth and relaxed hands. Only massive doses of Renshen (up to one jin/catty) can restore Yuanqi. Cases without collapse but with stiff tongue, slurred speech, phlegm obstruction, facial paralysis, and limb immobility treated as stroke will likely result in danger. (*Zhengzhi Zhunsheng*)

Danxi treated Wang Congyi, aged 42, with numbness in all ten fingers and face, diagnosed as Qi deficiency. Healed with Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) plus Muxiang (Aucklandiae Radix) and Fuzi each 0.5 fen. (*Mingyi Leian*)

Zhu Juquan treated the Duke of Ying with left-sided hemiplegia, aphasia, and Qi congestion. Physicians thought it was stroke and used Qi-regulating/Wind-dispelling formulas without effect. Zhu stated it was caused by Phlegm-Fire and Damp-Heat. He prescribed clearing dryness and resolving phlegm; drinking several sheng of bamboo sap cured him. (Same source)

Death Signs: In stroke, if the area below the nose shows mixed red and black, with foaming and rigid body, death occurs in seven days. (*Zhongzang Jing*)

If the pulse in wind disease is tight, rapid, floating, or deep, with incessant sweating and audible breathing, death ensues; otherwise, survival. (Same source)

Head shaking and fixed gaze indicate Heart-Kidney collapse. With Yang remaining alone and Yin exhausted, fixed gaze and head shaking signify Heart Qi failure and True Zang pathology; regeneration is rare. (*Zhushi Jiyuan Fang*)

Wang Shuo stated: Open mouth, relaxed hands, closed eyes, urinary incontinence, and snoring sound indicate difficult-to-treat cases. However, saying any single sign means incurability is wrong. Classics state that when severe stroke leads to five Zang closure, meridians block, and Qi stops, it is like falling from height; expectation is futile. Why? Open mouth = Heart Qi closure; relaxed hands = Spleen Qi closure; closed eyes = Liver Qi closure; incontinence = Kidney Qi closure; snoring = Lung Qi closure. Only when all five are present is it incurable. If only one is seen, examine other signs/pulses for rescue. Closed eyes and snoring are common; only combined incontinence and open mouth are ominous. Heart is ruler of Zang; Kidney is root of body; their closure is truly dangerous. (*Xu Yijian Fang Houji*)

Any stroke patient, whether unconscious, conscious, newly ill, or chronically ill, suddenly vomiting purple-red blood indicates death. (*Zhengzhi Yaojue*)

Prevention Method (Refer to Prodrome Section): *Baojian* states: If one initially feels numbness or loss of function in the thumb and index finger, stroke will occur within three years. Preventively take Yufeng Tang (Wind-Preserving Decoction) and Tianma Wan (Gastrodia Pill) for one course. This is treating disease before it arises. (Note: Originally from *Baoming Ji*). Xue Ji stated: Prevention relies on nourishing Qi and Blood, regulating diet, controlling emotions, and avoiding sexual activity. Using preventive formulas merely attracts Wind. (*Zhunsheng*)

If wind disease heals but roots remain, recurrence in 1-2 years or more is inevitable, worsening each time, potentially fatal. Thus, prevention is crucial: avoid sexual exhaustion, rage, and depression; regulate Qi/Blood, nourish Spirit; maintain with regular medication for stability. (*Shenshi Zunsheng Shu*)

General Treatment Principles: Assess true vs. similar stroke, meridian vs. Zang-Fu involvement, and imbalances in Yin/Yang, Left/Right, Cold/Heat, Qi/Blood, and Damp-Phlegm evidence before prescribing. General methods include expelling Wind/driving out Phlegm, consolidating Qi/moxa for collapse, opening orifices/resolving obstruction, inducing vomiting/unblocking collaterals, clearing Fire/nourishing Blood, moistening dryness/tonifying Origin, and tonifying Qi/restoring Yang. (*Yiji*)

For coma, aphagia, and locked jaw: Immediately blow powdered raw Banxia (Pinelliae Rhizoma) into the nose, or powder of Xixin (Asari Radix) and Zhaojiao (Gleditsiae Sinensis Fructus Spina) into the throat. Sneezing restores consciousness. (Note: From *Yijian Fang*). This tests depth of illness to determine prognosis. If slightly conscious, administer Bawei Shunqi San (Eight-Ingredient Qi-Regulating Powder) with wind-dispelling herbs, but do not stop Qi-regulating herbs. Use Xiaoxuming Tang (Minor Xu-Ming Decoction) strained, mixed with one pill of Suhexiang Wan. Or Wujie San (Five Accumulations Powder) with Musket (Moschus), or Xingxiang San (Pinellia and Aucklandia Powder), or Xingfeng Tang with Muxiang 1 qian. If ineffective, with increased stubborn phlegm or worsening symptoms, use Xingfu Tang or Sansheng Yin with Quanxie (Scorpio) 3 units, alternating with Chenxiang (Aquilaria) soup and Yangzheng Dan. (Note: Wujie San with Moschus from *Baiyi Xuanfang*). (*Yaojue*)

Treatment Should Regulate Qi and Invigorate Blood: Determine etiology. Internal causes (Seven Emotions) require Qi regulation, not Wind treatment. External causes (Six Climates) also start with Qi regulation, then treat based on specific climatic factors. This is a good method. (*Jisheng Fang*)

Treatment prioritizes Qi regulation. Classics say: "Skillful treatment of Wind regulates Wind via Qi." Smooth Qi eliminates Phlegm; gradually address Wind for efficacy. First, mix Suhexiang Wan with Sesame Oil, Ginger Juice, or plain water. If locked jaw, pry open and administer. Upon slight recovery, give Bawei Shunqi San. (*Yaojue*)

Treating Wind: Initially regulate Qi; later invigorate Blood. This is an eternal principle. Chronic wind disease cured by Simo Siwu Tang (Four Substances Decoction) swallowing Huoluo Dan (Collateral-Activating Pill) exemplifies this. Without prior Qi regulation, rashly using Wu Tou (Aconitum) and Fu Zi without invigorating Blood, or merely using Fangfeng, Tianma, Qianghuo, etc., is ineffective. (Same source) (*Zhunsheng* adds: Regulating Qi herbs are acceptable; breaking/reducing Qi herbs are not.)

My successful treatments relied on first unblocking meridians, invigorating Blood, and regulating Qi, then concluding with tonics. Once meridians are clear and old phlegm removed, new phlegm won't form; what disease won't heal? (*Chishui Xuanzhu*)

Large Doses and Long-Term Administration: For stroke, using Xuming, Paifeng, Fengyin, Zhuli decotions, Shenjing Dan, Yinyu Jiu, plus moxibustion, ensures cure. This disease accumulates over time; large doses over long periods are needed. *Book of Tang* records Empress Dowager Wang with stroke aphasia cured by steaming several hu of Huangqi (Astragali Radix) for fumigation. Modern patients expect results from 3-5 cups, demanding too fast results. Mencius said: "Seven-year illness requires three-year mugwort"; patience is key. (*Benshi Fang*)

Opening Orifices Methods: Sudden locked jaw, open eyes, clenched fists, phlegm-Qi obstruction preventing medication is Bi syndrome. Bi requires opening; failure to open leads to death. Nasal insufflation, tooth wiping, and induced vomiting are opening methods. (*Jingui Yi*)

Empirical formula for acute stroke with closed eyes/locked jaw: Use Zhongzhi (Middle Finger) to apply Sanzi powder to wipe teeth 20-30 times, wiping molars left/right until mouth opens. Then administer medicine. Longnao (Borneolum Syntheticum) and Tiannanxing (Arisaematis Rhizoma) equal parts, ground in mortar, dose 1 zi to half qian, named Kaiguan San (Open Orifice Powder). (*Bencao*)

*Jianyao Jizhong*: For locked jaw, wipe teeth with Bai Mei (White Plum); once open, administer medicine. (*Shengji* names this Baishen San; another Baifan San uses Baifan and Yanhua.)

Formula for Stroke Locked Jaw:
Gancao (Licorice Root): Cut to length of middle finger joint, into 5 pieces, soak in raw sesame oil, roast over charcoal fire until oil penetrates.
Take this single herb, use instrument to pry jaw open, let patient bite Gancao for duration of walking one li, replace piece, then administer medicine effectively. (*Shengji*)

Male/Female stroke with phlegm flooding Heart, sudden collapse: Immediately move to warm room, sit upright, burn vinegar-soaked charcoal near face to inhale vapor. After time, phlegm returns to normal; mild cases recover instantly, severe cases regain some awareness. **Crucial**: Do not allow any water/broth down throat. Water binds phlegm to heart collaterals permanently, causing permanent disability. Vinegar fumigation separates phlegm from Heart; gradual recovery follows. Then administer Shengliao Wujie San (Raw Material Five Accumulations Powder) with Moschus decocted and taken orally. (*Danliao Jiyuan Fang* citing *Chuanxin Fang*)

Initial sudden collapse, critical unconsciousness: Check for death signs. If none, and constitution/Qi intact without phlegm-Qi obstruction, press Renzhong (GV26) firmly; gradual awakening expected. Alternatively, slowly administer plain water or ginger water. Wait for recovery, then diagnose and treat. (*Jingyue Quanshu*)

Unblocking Orifices Methods: Wind pathogen attacking body, combing with Phlegm-Qi, blocking meridians, sudden spirit dimming and pulse cutoff: urgently use Suhexiang, Zhibao type herbs to unblock. Only aromatic herbs can reach meridians and clarify spirit. (*Jingui Yi*)

Suhexiang Wan.
Ingredients: Suhexiang (Styrax), Baizhu (Atractylodis Macrocephalae Rhizoma), Zhusha (Cinnabar), Chenxiang (Aquilaria Resina), Hezi Rou (Terminalia Chebula Pericarpium), Dingxiang (Caryophylli Flos), Muxiang (Aucklandiae Radix), Xiangfuzi (Cyperi Rhizoma), Bantanxiang (Santalum Album Lignum), Wuxijiao (Rhinocerotis Cornu - substitute Buffalo Horn), Ruxiang (Olibanum), Bibo (Long Pepper), Anshixiang (Benzoin), Muxiang (Moschus), Longnao (Borneolum Syntheticum). Dosages provided.
Process: Grind to powder, honey pills size of chicken egg. Take one pill, chew with warm wine or Renshen Tang. Widely available but efficacy unknown. Originally *Guangji Fang* called Baizhu Wan, later included in *Waitai*. (*Heji Jufang* variation provided). Ancient formulas used wine; often ineffective. Adding Renshen Tang doubles efficacy. For stroke coma/locked jaw, add 1-2 fen Moschus, mix with pure sesame oil, administer. Sesame oil transforms phlegm effectively. If mouth open and pulse absent, incurable. (Note: Moschus/Sesame oil from *Shizhai*).

Seven Treasure Pill for Stroke regardless of urgency, with phlegm flooding, confusion, unconsciousness.
Ingredients: Zhusha, Niuhuang, Shuiyin (Mercurius), Longnao, Nifen (Calomel), Muxiang, Jinbo (Gold Foil).
Process: Grind together until Mercury disappears, form pills with Jujube flesh size of mung bean. Mild cases divide into 4 doses; severe cases single dose. Warm water or dissolve. After phlegm clears, use Pingqi Wan/San, gradually treat wind. (*Chuanjia Mibao*)

Treating Phlegm Methods: Stomach contains saliva for nourishment. Internal Wind movement and rebellious Qi cause saliva to rise as Phlegm-rattle. Wind stroke involves deficiency but half is Phlegm pathogen. Deficient vs. Excess Phlegm treated differently. If obstruction is severe, treat branch/symptom urgently; thus inducing vomiting, opening, and descending Phlegm is necessary. (*Yiji*)

Wind moves Phlegm; Phlegm generates Wind; Wind attaches to stubborn Phlegm; Phlegm disease mimics Wind. Tremors, vertigo, collapse, coma can be Wind or Phlegm. Differentiate by presence of exterior signs and floating/slipping pulse. Treating Wind with Phlegm resolution is okay; treating Phlegm with Wind dispersal is not. (*Jingui Yi*)

*Biyong Fang* argues against vomiting in stroke, citing Jinhu Bixia as warning. But for sudden phlegm surge, sawing sound, locked jaw, Qi blockage, imminent death, refusing vomiting is unreasonable. Just avoid Silver Powder (Calomel) to prevent spleen damage and limb harm. (*Benshi Fang*)

Treating Phlegm: For non-wind initial illness with mild phlegm-Qi, never guess Phlegm and misuse Phlegm-resolving drugs; this is a major taboo. If Phlegm is excessive, filling chest/diaphragm, preventing food/medicine intake, must first resolve Phlegm to open passage. Vomiting is fastest method. Ancient formulas: Dusheng San, Chatiao San, Xixian San are emetics. Caution: If Yuanqi is very deficient, harsh emetics are dangerous. Safer to use new formulas (Radish seed, Salt water) or Niuhuang Wan, Baolong Wan. Stop once throat opens and swallowing resumes; do not exhaust all Phlegm causing crisis. Must assess if attackable before using. (Note: New formulas refer to Radish seed and Salt water).
If eyes fixed, teeth grinding, limb spasm, red face, strong strength, though comatose, treatable. Pry mouth open with chopsticks, secure jaw with pen handle, slowly pour weak ginger-salt water, then induce vomiting with two fingers. If fingers cannot enter, use goose feather dipped...