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Wind pathogen invades from the exterior, damaging the limbs; phlegm-fire erupts from the interior, disturbing the Heart organ. Damage to the body results in numbness and paralysis (loss of movement); disturbance of the Heart spirit results in coma and aphasia (inability to speak). One must differentiate whether the pathogen has struck the Collaterals (Luo), Channels (Jing), Fu organs, or Zang organs, and further examine the patterns of deficiency/excess, cold/heat, and phlegm. The Collapse syndrome is characterized by open hands (Spleen exhaustion), open mouth and closed eyes (Heart and Liver exhaustion), urinary incontinence (Kidney exhaustion), and stertorous breathing (Lung exhaustion). The Closure syndrome is characterized by clenched fists and tightly shut teeth. Initially, use Tongguan San (Pass-the-Gate Powder) to induce sneezing; if phlegm obstruction prevents downward movement, emesis (inducing vomiting) is prioritized.

[Note] "Wind" refers to empty evils and thief winds invading from the exterior to damage the four limbs and trunk, hence named Stroke (Zhong Feng). "Phlegm-fire" refers to phlegm-fire erupting from the interior, disturbing the official function of the Heart Master, hence named Phlegm-Fire. When the body suffers wind pathogen, mild cases present with stiff numbness and insensitivity, while severe cases present with paralysis and immobility. When the Heart disease is caused by phlegm-fire, mild cases present with a stiff tongue and difficulty speaking, while severe cases present with phlegm obstruction and coma. This condition may originate internally or externally; single diseases are milder, while combined diseases are heavier. One must carefully distinguish between striking the Collaterals, Channels, Fu organs, and Zang organs, as well as striking the Channels/Collaterals combined with Fu/Zang organs. Furthermore, carefully examine concomitant deficiency, excess, cold, heat, and phlegm, as well as the depth and urgency of the Collapse and Closure syndromes to determine treatment. For such conditions, it is appropriate to first use Tongguan San to induce sneezing; if sneezing occurs, it is treatable; if not, death is likely. For trismus (lockjaw), use Kaiguan San (Open-the-Gate Powder) to rub the teeth to soften them; for excessive phlegm-saliva, use various emetic methods to purge it. If trismus persists and decoctions cannot be swallowed, prepare the prescribed medicine mixed with guiding herbs into a paste like strong tea, place it inside the patient's mouth, insert a reed tube or pen tube into the patient's nostril, and blow gently so that breath carries the medicine down, allowing it to enter the throat naturally. Do not use metal instruments to pry the mouth open, lest teeth be damaged.

[Commentary] The classification of Stroke into striking the Blood Vessels, Fu organs, and Zang organs originated with Li Dongyuan. Striking the Blood Vessels uses Da Qin Jiao Tang (Great Notopterygia Decoction); striking the Fu organs uses Xiao Xu Ming Tang (Minor Continuation of Life Decoction); striking the Zang organs uses San Hua Tang (Three Transformations Decoction). However, there have rarely been cases of Zang organ strike suitable for San Hua Tang. Only the *Jin Gui Yao Lue* (Essential Prescriptions from the Golden Cabinet) divides it into four syndromes: Collateral, Channel, Fu, and Zang. This theory is most accurate and can serve as a standard for later generations. Generally, facial paralysis (deviation of mouth and eyes) and cutaneous numbness indicate pathogen in the Collaterals; hemiplegia and inability to move limbs indicate pathogen in the Channels; coma with loss of recognition and bowel/bladder retention indicate pathogen in the Fu organs; coma with aphasia, flaccid lips, and drooling indicate pathogen in the Zang organs. Students who carefully read the discussions of various schools will know that this is without error.