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Qian: Suffering from Lei Zhong Feng (stroke-like syndrome) for five years, with right-sided hemiplegia. Deficiency of Yuan Qi (Primordial Qi), phlegm flowing into the meridians. In the past two months, appetite has increased significantly; although this is a good sign, it also indicates Stomach Fire. Fire can digest food, hence the tendency to eat well and feel hungry easily. The treatment method involves nourishing essence and blood, extinguishing wind and unblocking collaterals, harmonizing the stomach and resolving phlegm.
Prepared Polygonum multiflorum (Zhi Shou Wu), Angelica sinensis (Dang Gui), large prepared Rehmannia root (Da Shu Di), Tribulus terrestris (Ci Ji Li), Sesamum indicum (San Jiao Hu Ma), Taxillus chinensis (Sang Ji Sheng), Poria cocos (Fu Ling), fermented Pinellia ternata (Ban Xia Qu), Ophiopogon japonicus (Mai Dong Rou), Xinhui tangerine peel (Xin Hui Pi).

Commentary by Yuan: This is a case of deficiency of Liver-Kidney Yin water with flourishing deficient fire; therefore, the treatment focuses on nourishing water to extinguish wind.

Zhao: Wind strikes the Lianquan point (Ren-23), phlegm obstructs the tongue base, causing drooling from the corner of the mouth, stiff and slurred speech, numbness in the right limbs, and signs of impending stroke. Proposed treatment: Extinguish wind and harmonize Yang, resolve phlegm and unblock collaterals.
Antelope horn (Ling Yang Jiao), Abalone shell (Shi Jue Ming), Arisaema cum Bile (Dan Xing), processed Pinellia ternata (Fa Ban Xia), Poria cocos (Fu Ling), Chrysanthemum morifolium carbonized (Gan Ju Tan), Polygala tenuifolia (Yuan Zhi), roasted Gastrodia elata (Wei Tian Ma), Tangerine peel (Ju Hong).

Commentary by Yuan: Phlegm-fire is the pathogenic factor; thus, clearing fire and resolving phlegm, unblocking collaterals and extinguishing wind are employed. Chrysanthemum should not be used in carbonized form.

Certain patient: Left-sided facial paralysis, right hand dysfunction, Liver wind and Stomach dampness pulling against each other. Stiff tongue and slurred speech, phlegm lingering in the collaterals of Heart and Spleen, clearly indicating Lei Zhong Feng (stroke-like syndrome).
Codonopsis pilosula (Dang Shen), Angelica sinensis (Dang Gui), Pinellia ternata (Ban Xia), Poria cocos with Salvia miltiorrhiza roots (Fu Shen), Uncaria rhynchophylla (Gou Gou), Abalone shell (Shi Jue Ming), Dipsacus asper (Chuan Duan), Gentiana macrophylla (Qin Jiao), Arisaema cum Bile (Dan Xing), Mulberry twig (Sang Zhi).

Commentary by Yuan: Spleen deficiency generates phlegm, Liver deficiency generates wind. Regulating the Spleen is tantamount to resolving phlegm; nourishing the Liver assists in extinguishing wind. This is a treatment balancing deficiency and excess.

Wang: Both Guan pulses exhibit a rolling, trembling sensation like a single grain, indicating Spleen deficiency with Wood hyperactivity, a sign of internal wind stirring. Numbness and insensitivity in the left half of the body, dizziness and facial numbness, belong to Pian Ku (hemiplegia); there is concern about progression to sudden collapse (stroke).
Prepared Polygonum multiflorum (Zhi Shou Wu), Angelica sinensis (Dang Gui), White Peony Root (Bai Shao), Poria cocos (Fu Ling), Tangerine peel (Chen Pi), roasted Gastrodia elata (Wei Tian Ma), Gentiana macrophylla (Qin Jiao), Abalone shell (Shi Jue Ming), Tribulus terrestris (Ci Ji Li), Hangzhou Chrysanthemum (Chi Ju), Uncaria rhynchophylla (Gou Gou), Mulberry twig (Sang Zhi).

Follow-up: The rolling, trembling sensation in both Guan pulses has greatly diminished, indicating that internal wind is secretly subsiding. Flexion and extension of the left hand have slightly improved, but numbness in the left foot persists. Now proposing to tonify Kidney to generate Liver, as a fundamental treatment.
Di Huang Yin Zi (Rehmannia Decoction for the Kidney) minus Cinnamon Twig (Gui Zhi) and Aconite Root (Fu Zi).

Commentary by Yuan: Removing Aconite and Cinnamon is because the fire within the Water (Kidney) is not yet sufficiently deficient.

Jin: Left hand pulse is deep, wiry, choppy, rapid, and irregular, indicating Blood deficiency with latent Liver wind stirring; the right Guan pulse alone is slow and slippery, indicating damp-phlegm in the Stomach; Cun and Chi pulses are both weak, indicating deficiency of Metal (Lung) and Water (Kidney). Symptoms include deafness, heaviness in both shoulders making lifting difficult, excessive phlegm, and dry, greasy feeling in the mouth. These are the signs.
Large Prepared Rehmannia Root (Da Sheng Di), Ophiopogon japonicus (Mai Dong), Angelica sinensis root tip (Gui Shen), Abalone shell (Shi Jue Ming), Pinellia ternata (Ban Xia), Tribulus terrestris (Bi Li), Uncaria rhynchophylla (Gou Gou), Tangerine peel (Ju Hong), Oyster shell (Mu Li), Scrophularia ningpoensis (Yuan Shen), Zhi Mi Fu Ling Wan (Pinellia Pill for Resolving Phlegm).

Ding: Weak left pulse indicates Blood deficiency; weak right pulse indicates Qi deficiency. Both Qi and Blood are deficient, leading to dizziness above and numbness progressing to paralysis below the waist. Severe cases involve mental confusion and unconsciousness, caused by Liver wind carrying phlegm. The method should be to clear the upper and tonify the lower.
Cistanche deserticola (Dan Cong Rong), Large Prepared Rehmannia Root (Da Sheng Di), Asparagus cochinchinensis (Tian Dong), Achyranthes bidentata (Niu Xi), Scrophularia ningpoensis (Yuan Shen), Acorus tatarinowii (Chang Pu), Hemp seed (Da Ma), Dioscorea hypoglauca (Bi Xie), Poria cocos (Fu Ling), Tangerine peel (Chen Pi), Phellodendron amurense (Huang Bo), American Ginseng (Yang Shen).

Commentary by Yuan: Clearing Yangming heat to benefit the joints, nourishing Liver and Kidney to tonify Yin and Blood, regulating Spleen Qi to transform damp-phlegm; every step is precise.

Sun: Blood fails to nourish tendons, Liver wind travels through collaterals, causing soreness and pain in the left arm, intermittent. Treatment should nourish Blood and unblock collaterals.
Prepared Polygonum multiflorum (Zhi Shou Wu), Angelica sinensis (Dang Gui), Lycium barbarum (Qi Zi), Soybean coat (Dou Yi), Salvia miltiorrhiza (Dan Shen), Tribulus terrestris (Bi Li), Coix seed (Yi Ren), Poria cocos (Fu Ling), Gentiana macrophylla (Qin Jiao), Mulberry twig (Sang Zhi), Red date (Hong Zao).

Jiang: Wine drinkers often have deficient Middle Jiao and epigastric discomfort; Wood hyperactivity causes wind stirring, leading to dizziness and vertigo, accompanied by hand tremors. This is internal wind carrying phlegm. Abstaining from alcohol and moderating sexual desire is essential.
Gastrodia elata (Tian Ma), Atractylodes macrocephala (Dong Zhu), Poria cocos (Fu Ling), Lycium barbarum (Qi Zi), Astragalus complanatus (Sha Yuan Zi), Uncaria rhynchophylla (Gou Gou), Prepared Polygonum multiflorum (Zhi Shou Wu), Angelica sinensis (Dang Gui), White Peony Root (Bai Shao), Pinellia ternata (Ban Xia), Abalone shell (Shi Jue Ming), Hangzhou Chrysanthemum (Chi Ju).

Xie: Long-term Liver wind vertigo, complicated by autumn wind causing malaria. After malaria subsided, muscle twitching occurred throughout the body, sometimes leading to syncope. This is due to Blood deficiency failing to anchor Wood, tendons and collaterals losing nourishment, virtual wind traveling through collaterals, and accumulation of saliva-phlegm. Proposed treatment: Nourish Blood and extinguish wind, resolve phlegm and unblock collaterals.
Prepared Polygonum multiflorum (Zhi Shou Wu), Purple Quartz (Zi Shi Ying), White Tribulus (Bai Bi Li), Pinellia ternata (Ban Xia), Poria cocos with Salvia miltiorrhiza roots (Fu Shen), American Ginseng (Yang Shen), Tangerine peel (Chen Pi), Antelope horn (Ling Yang Jiao), Abalone shell (Shi Jue Ming), roasted Gastrodia elata (Wei Tian Ma), Ziziphus jujuba seed (Zao Ren), Bamboo sap (Zhu You), Ginger juice (Jiang Zhi).

Commentary by Yuan: After malaria, Spleen Qi must be deficient. Although wind stirring stems from Dryness of Wood, phlegm accumulation results from Spleen deficiency. If the tongue coating is turbid and greasy, regulating the Spleen and resolving phlegm is indispensable.

Xue: At sixty years old, Essence and Blood of Kidney and Liver are severely depleted. Internal wind and saliva-phlegm travel through collaterals, causing weakness in right-hand and foot, stiff tongue and slurred speech, marking the onset of Lei Zhong Feng (stroke-like syndrome). Warm-tonify Essence and Blood, simultaneously resolve saliva-phlegm, hoping to avoid the burden of hemiplegia. However, this is not easy; patient patience in regulation is advisable.
Cistanche deserticola (Cong Rong Gan), Morinda officinalis (Ba Ji Rou), Poria cocos with Salvia miltiorrhiza roots (Fu Shen), Papaya (Mu Gua), Pinellia ternata (Ban Xia), Lycium barbarum (salt-fried), Polygala tenuifolia (Yuan Zhi Rou, prepared with Licorice decoction), Sea grapevine (Hai Feng Teng), Cornus officinalis (Yu Rou, wine-fried), Achyranthes bidentata (Niu Xi), Eucommia ulmoides (Du Zhong, salt-fried).

Second prescription: Kidney stores Essence, Liver stores Blood. Depletion of Kidney-Liver Essence and Blood leaves bones and tendons with gaps; damp-heat and saliva-phlegm enter collaterals exploiting these deficiencies. Weakness in right-hand and foot, stiffness at tongue base, are roots of stroke. Warm-tonify Essence and Blood, diffuse and unblock meridians, simultaneously resolve saliva-phlegm. Persist in taking without懈怠, combined with tranquil nurturing, to hopefully dispel disease and prolong life.
Cistanche deserticola (Cong Rong Gan), Codonopsis pilosula (Yuan Mi fried), Achyranthes bidentata (Niu Xi), Pinellia ternata (Ban Xia), Lycium barbarum (salt-fried), Tangerine peel (Chen Pi), Dipsacus asper (Xu Duan), Poria cocos (Fu Ling), Morinda officinalis (Ba Ji Rou), Mulberry twig (Sang Zhi).

Third prescription: Pill formula.
Cistanche deserticola (2 liang, boiled in wine until soft, pounded in), Codonopsis pilosula (3 liang, fried with millet), Prepared Rehmannia Root (4 liang, mixed with Amomum kravanh powder and aged wine, steamed until soft and pounded in), Ophiopogon japonicus (2 liang, heart removed, fried with millet), Ziziphus jujuba seed (3 liang, fried and ground), Morinda officinalis (3 liang, salt-fried), Angelica sinensis root tip (2 liang, wine-fried), Dioscorea hypoglauca (3 liang, fried), Prepared Polygonum multiflorum (4 liang, fried), Poria cocos with Salvia miltiorrhiza roots (3 liang), Achyranthes bidentata (3 liang, salt-fried), Asparagus cochinchinensis (2 liang, heart removed, fried with millet), Pinellia ternata (2 liang), Tangerine peel (2.5 liang), Eucommia ulmoides (3 liang, salt-fried), Tiger bone (3 liang, roasted), Acorus tatarinowii (1 liang), Lycium barbarum (4 liang, salt-fried).
Select authentic herbs for each ingredient, process according to method, grind into fine powder. Mix with 4 liang of Bamboo sap and 3 liang of Ginger juice, then bind with white honey into pills the size of millet seeds. Store in porcelain vessels. Take 5 qian each morning, washed down with boiling water.

Tang: Wind-phlegm enters collaterals, causing distending pain at the back of the head, stiffness at tongue base, difficulty speaking, and reduced intake of food. Long-term prevention of Fei Zhong (severe stroke) is needed.
Antelope horn (Ling Yang Jiao), Saposhnikovia divaricata (Fang Feng), Processed Bombyx batryticatus (Zhi Jiang Can), Raw Licorice root (Sheng Gan Cao), Notopterygium incisum (Qiang Huo), Polygala tenuifolia (Yuan Zhi Rou), Ligusticum chuanxiong (Chuan Xiong), Platycodon grandiflorus (Jie Geng), Mulberry leaf (Sang Ye), Mentha haplocalyx (Bo He), Uncaria rhynchophylla (Gou Gou).

Second prescription: Neck stiffness is Wind; tongue base stiffness is Phlegm. Wind and Phlegm combine; long-term prevention of Lei Zhong Feng is needed.
Prepared Rehmannia Root (Shu Di), White Peony Root (Bai Shao), Dipsacus asper (Xu Duan), Lycium barbarum (Qi Zi), Eucommia ulmoides (Du Zhong), Gentiana macrophylla (Qin Jiao), Angelica sinensis (Dang Gui), Achyranthes bidentata (Niu Xi).

Commentary by Yuan: Excess is greater than deficiency; the first prescription fits well. The second prescription is strongly tonifying, which is unsuitable for cases with phlegm obstructing the tongue base.

Fei: Post-stroke, limb incontinence, tongue base stiffness, caused by wind-phlegm entering collaterals. Prevent recurrence of stroke.
Codonopsis pilosula (Dang Shen), Large Prepared Rehmannia Root (Da Sheng Di), Processed Arisaema (Zhi Nan Xing), White Peony Root (Bai Shao), Gentiana macrophylla (Qin Jiao), Atractylodes macrocephala (Dong Zhu), Prepared Polygonum multiflorum (Zhi Shou Wu), Antelope horn (Ling Yang Jiao), Tiger bone (Hu Gu), Angelica sinensis root tip (Gui Shen), Achyranthes bidentata (Niu Xi), Sea grapevine (Hai Feng Teng), Astragalus complanatus (Sha Yuan Zi), Poria cocos (Fu Ling), Ziziphus jujuba seed (Zao Ren), Eucommia ulmoides (Du Zhong), Raw Coix seed (Sheng Yi Ren), Tangerine peel (Chen Pi), Fritillaria thunbergii (Chuan Bei), Pinellia ternata (Ban Xia).
Decoct the above herbs three times until concentrated. Add 2 teacups of Bamboo sap, 20 spoons of Ginger juice, 2 cups of white honey, and 4 liang of Donkey-hide gelatin (E Jiao), melt and collect as paste.

Certain patient: Overwork injures Qi, causing Liver wind and Yang Qi to relax and expand; obesity leads to Qi deficiency, with damp-heat, phlegm, and fire disturbing. Sudden sleepiness, nearly falling, stiff tongue and blurred speech, right-sided hemiparesis. This belongs to Pian Zhong (lateral stroke). Fortunately, consciousness is still clear, phlegm-saliva has not surged; perhaps lucky recovery is possible. Treatment: Extinguish wind and resolve phlegm, calm spirit and clear fire, hoping for efficacy.
Antelope horn (Ling Yang), Cassia seed (Jue Ming), Gastrodia elata (Tian Ma), Arisaema cum Arisaematis Rhizoma (Zhu Huang), Poria cocos with Salvia miltiorrhiza roots (Fu Shen), Acorus tatarinowii (Chang Pu), Fritillaria thunbergii (Chuan Bei), Arisaema cum Bile (Dan Xing), Pinellia ternata (Ban Xia), Tangerine peel (Ju Hong), Tender Uncaria rhynchophylla (Nen Gou), Bamboo sap (Zhu Li), Light Ginger juice (Dan Jiang Zhi).

Fan: Shock disturbs Liver and Gallbladder, Wind-Yang interacts with turbid phlegm in Stomach, entering collaterals together. The Qi of Ying and Wei circulation, and the mechanism of ascending and descending, are obstructed and stagnant. Numbness and insensitivity in skin, muscles, and joints throughout the body, chest and epigastrium uncomfortable, loss of taste, excessive salivation, dizziness and palpitations. Wind-Yang depressed and unable to extend, turbid phlegm diffusing and unable to transform. Tongue coating white and cracked, dry stool. Although Stomach has dampness, Intestinal fluids are dried up. Proposed treatment: Clear fire and extinguish wind, resolve phlegm and leach out dampness, supplemented by nourishing Blood and moistening fluids.
Antelope horn (Ling Yang), Cistanche deserticola (Cong Rong Gan), Gastrodia elata (Tian Ma), Cassia seed (Jue Ming), Pinellia ternata (Ban Xia), Hemp seed (Ma Ren), Processed Arisaema (Zhi Nan Xing), Alisma orientale (Ze Xie), Tangerine peel (Ju Hong), Poria cocos with Salvia miltiorrhiza roots (Fu Shen), Angelica sinensis (Dang Gui), Tender Uncaria rhynchophylla (Nen Gou), Ginger juice (Jiang Zhi), Bamboo sap (Zhu Li).

Commentary by Yuan: Food failing to transform into refined essence but instead generating turbid phlegm leads to Stomach dampness and Intestinal dryness, due to constipation of Qi movement and loss of normal ascending-descending function in the Middle Jiao.

He: Right Guan pulse alone is slippery and rolling like a bean, indicating turbid phlegm in the Middle Jiao. Sensation of heaviness in skin and flesh at Zhongwan (CV-12), occasional twitching of tendons and vessels in hands and feet, signs of phlegm traveling through meridians. Treatment should combine attacking and tonifying.
Morning: Take Xiang Sha Liu Jun Wan (Aucklandia and Amomum Six Gentlemen Pills) 3 qian. Night: Take Kong Yan Dan (Phlegm-Draining Pill) 14 grains, coated with Cinnabar.

Lu: Chronic history of phlegm-fluid cough, weak Earth and deficient Metal. Deficient Metal cannot control Wood, nor generate Water; weak Earth cannot resist Wood's invasion, nor generate Metal to resolve phlegm. Symptoms resemble wind-phlegm paralysis, weak legs difficult to walk, drooling, no coating on left half of tongue, constant lack of thirst, empty-wiry-slippery pulse, hard dry stool. Various symptoms show insufficiency of Metal, Earth, and Water, with excess wind-phlegm. Disease root is long-standing, difficult to regulate; tentatively prescribing one formula for reference.
Cistanche deserticola (Cong Rong Gan), Pinellia ternata (Ban Xia), Schisandra chinensis (Wu Wei), Achyranthes bidentata (salt-fried), Ophiopogon japonicus (fried with millet), Morinda officinalis (Ba Ji Tian), Hemp seed (Ma Ren), Prepared Rehmannia Root (Shu Di), Poria cocos with Salvia miltiorrhiza roots (Fu Shen), Tangerine peel (Chen Pi), Cinnamon bark (Rou Gui), Bamboo sap (Zhu Li), Ginger juice (Jiang Zhi).

Wu: Obesity implies much dampness; dry temperament implies much fire. Ten years ago, miscarriage and bloody discharge led to Yin deficiency and fire hyperactivity, latent Liver wind stirring, tendons and collaterals losing nourishment; the root has existed for days. Last autumn, latent summerheat caused triple malaria. Long-lasting malaria made Ying and Wei partially deficient, leading to internal wind carrying phlegm disturbing collaterals, right-side hemiparesthesia resembling hemiplegia, gradually improving with regulation. Now only right foot feels numbing, burning, hot, and painful, starting from the big toe, clearly indicating Liver meridian malnourishment due to Blood deficiency. It is said that legs and knees are often cold, while foot joints are often hot. It is not that foot joints have fire and legs/knees have cold. Rather, pain sites feel hot; where Qi and Blood are insufficient in the upper leg, it feels cold. Regarding the lump inside the skin and flesh on the outer left shin, cotton-seed sized, very painful when occurring, this belongs to Jin Jian (tendon tumor), formed by congealing of wind-phlegm and stasis-blood entering collaterals, different from the hot-numbing pain of the right foot. For now, treat the right foot first; tentatively prescribing one formula for correction.
Large Prepared Rehmannia Root (Da Sheng Di), Dioscorea hypoglauca (Bi Xie), Poria cocos (Fu Ling), Donkey-hide gelatin (E Jiao), Gastrodia elata (Tian Ma), Eucommia bark (Wu Jia Pi), Angelica sinensis root tip (Gui Shen), Achyranthes bidentata (Niu Xi), Atractylodes macrocephala (Dong Zhu), Angelica pubescens (Du Huo), Luffa cylindrica network (Si Gua Luo), Papaya (Mu Gua).

Commentary by Yuan: The name "Jin Jian" is very new. Ren Yuan says: Regarding stroke, He Jian spoke of Fire, Dong Yuan of Qi, Dan Xi of Phlegm, each holding their view. From my perspective, it is nothing more than Yin Essence and Yang Qi failing to transport and transform, allowing Phlegm, Fire, or Qi to take advantage and emerge secretly, blocking orifices, tunnels, and meridians, causing sudden fainting, locked jaw and slurred speech, or hemiplegia. Although there are distinctions of Zang-Fu and meridians, it is always Root Deficiency with Branch Excess. Because of Root Deficiency, it is easy to be invaded by pathogens; Wind, Fire, and Phlegm, though named external pathogens, are actually: Wind is transformed from rebellious Qi, Phlegm is generated from diet, Fire is also excessive Yang Qi transforming. They turn good citizens into bandits. *Neijing* says: When a person reaches forty, Yin Qi halves. Yin Qi refers to the Essence-Qi of the Five Zang organs. Secret depletion of Essence-Qi makes the three pathogens prone to emerge; thus, patients are mostly over forty, rarely young and strong. Wang Qingren's *Yi Lin Gai Cuo* states it is entirely a deficiency syndrome, treated with large doses of Astragalus. Although biased, it is not without reason. But considering the condition closely, if not true Zang organ severe deficiency, how could it be so sudden? How can it be compared to external wind-cold or stroke? The former is a thief coming from outside; the latter is a rift arising from within. Ancients used Xiao Xu Ming Tang (Minor Life-Preserving Decoction) modified for all strokes; I often doubt this. Using acrid-warm dispersing formulas to treat internal injury of Essence-Qi diseases. Zhu Danxi said: Northwest climate is cold and soil dry, possibly true stroke; Southeast generates phlegm from dampness, phlegm generates fire, fire generates wind. If so, Northwest disease is still external wind-pathogen named stroke, vastly different from sudden fainting and hemiplegia, how can they be treated identically! I grew up in the Southeast, never seeing Northwest disease; reading the stroke chapter, I am often dissatisfied with ancients.