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[Symptoms of Paralysis of the Four Limbs] The body presents with aversion to cold and fever, internal heat with thirst, red and scanty urine and stool, complete inability to move both hands and feet, or accompanied by pain or numbness. This is paralysis of the four limbs caused by external pathogens.

[Etiology of Paralysis of the Four Limbs] Internal deficiency of healthy Qi, imprudent daily living habits, leading to a deficiency of Wei Yang (Defensive Yang) that protects the exterior. When external pathogens invade, the hands and feet become paralyzed and unusable.

[Pulse Signs of Paralysis of the Four Limbs] A floating and rapid pulse indicates Wind-Heat; a floating and tight pulse indicates Cold injury; a floating and relaxed pulse indicates Wind injury; a floating and slippery pulse indicates Phlegm-fluid retention. If the pulse is not palpable upon initial pressing, it is a diagnostic sign of latent pathogens.

[Treatment of Paralysis of the Four Limbs] For a floating and rapid pulse, use Fangfeng Tongsheng San (Saposhnikovia Universal Relief Powder) or Qinjiao Tang (Gentian Decoction). For a floating and tight pulse, use Mahuang Xuming Tang (Ephedra Revival Decoction). For a floating and relaxed pulse, use Guizhi Xuming Tang (Cinnamon Twig Revival Decoction). For a string-taut and slippery pulse, use Danxing Tang (Calculus Bovis Decoction). For a large and floating pulse on the left side, use Qiangfang Chaihu Tang (Notopterygium, Saposhnikovia, and Bupleurum Decoction). If the pulse is deep and hidden initially but there are exterior pathogens, use Xuming Tang to disperse the pathogens. If the pulse remains slippery and rapid upon prolonged pressing, it is appropriate to unblock stagnation using Sanhua Tang (Three Transformations Decoction) to purge.

Fangfeng Tongsheng San (Saposhnikovia Universal Relief Powder)
Da Qinjiao Tang (Great Gentian Decoction)
Mahuang Xuming Tang (Ephedra Revival Decoction)
Sanhua Tang (Three Transformations Decoction)
Guizhi Xuming Tang (Cinnamon Twig Revival Decoction)
Danxing Tang (Calculus Bovis Decoction) [The above six formulas are cited from previous sections.]
Qiangfang Chaihu Tang (Notopterygium, Saposhnikovia, and Bupleurum Decoction)
Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Guangpi (Exocarpium Citri Reticulatae), Gancao (Glycyrrhizae Radix et Rhizoma), Qianghuo (Notopterygii Rhizoma et Radix), Fangfeng (Saposhnikoviae Radix)

[Symptoms of Paralysis of the Four Limbs] Sudden collapse, with hemiplegic atrophy of the hands and feet. There are no Six Channels exterior symptoms, only internal heat, constipation, and red urine. This is a symptom of Excess Earth (Spleen-Stomach Damp-Heat Excess Syndrome). If it gradually progresses to weakness of the four limbs without hemiplegia, with clear spirit and refreshing mind, and clear, free urination and defecation, this is a Deficiency Earth (Spleen-Stomach Weakness Deficiency Syndrome) symptom.

[Similar Etiology of Paralysis of the Four Limbs] Accumulation of internal heat from rich and greasy food, causing Earth to be trapped in the Middle Jiao. The hands and feet belong to the Yangming Stomach Meridian; when Earth is excessive, the meridians and collaterals become obstructed, leading to paralysis of the four limbs. The Qi and Blood of the hands and feet are also derived from Spleen Earth; when Earth is deficient, Spleen Qi becomes depleted.

[Pulse Signs of Paralysis of the Four Limbs] A full, large, or deep-rapid pulse at the Right Guan position indicates Excess Earth. A deficient, large, thin, slow, or deep-slow pulse indicates Deficient Earth.

[Treatment of Paralysis of the Four Limbs] For a slippery and full right pulse indicating Excess Earth, use Zhishi Wan (Immature Bitter Orange Pill) to digest and guide out stagnation. For a deep-rapid right pulse with dry stool, use Sanhua Tang (Three Transformations Decoction). For a deep-slow Chi pulse indicating deficiency of True Fire, use Bawei Wan (Eight-Ingredient Pill) to warm and tonify primordial Yuan Qi.

Zhishi Wan (Immature Bitter Orange Pill)
Chen Zhishi (Aged Immature Bitter Orange), Houpo (Magnoliae Officinalis Cortex), Binglang (Arecae Semen), Muxiang (Aucklandiae Radix)
If urination is blocked, add Huanglian (Coptidis Rhizoma) and Mutong (Akebiae Caulis).
Sanhua Tang (Three Transformations Decoction) [See section on External Contraction Stroke.]
Daotan Tang (Great Phlegm Resolving Decoction) [See section on Hemiplegia.]
Gange Qingwei Tang (Kudzu Clearing Stomach Decoction) i.e., Qingwei Tang (Clear Stomach Decoction) plus Gange (Puerariae Radix).
Liujunzi Tang (Six Gentlemen Decoction) i.e., Sijunzi Tang (Four Gentlemen Decoction) plus Chenpi (Tangerine Peel) and Banxia (Pinelliae Tuber).
Bawei Wan (Eight-Ingredient Pill) i.e., Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) plus Rougui (Cinnamomi Cortex) and Fuzi (Aconiti Lateralis Radix Praeparata).

Note: Hemiplegia and paralysis of the four limbs are significantly different. Paralysis of the four limbs can be either deficiency or excess; hemiplegia is always treated as an excess pathogen. How can one person's body have half that is deficient and half that is not? This condition should be viewed alongside facial paralysis (deviation of mouth and eyes). It is neither an external contraction of the Six Heterogeneous Pathogens nor an internal injury of Phlegm-Fire or fixed blood stasis. Although the previous two paragraphs mention Qi deficiency and Blood deficiency, these are merely warnings against aggressive purging of pathogens, not instructions to use tonic medicines. If caused by external contraction, presenting with fever and aversion to cold, this is Wind-Cold, and Qiangdu Baidu San (Notopterygium and Angelica Detoxification Powder) should be used to acridly disperse exterior pathogens. If presenting with fever, profuse sweating, and thirst, this is Wind-Heat, and Ji Jian Fangfeng Tang (Modified Saposhnikovia Decoction) should be used. If presenting with drooling from the corner of the mouth and nausea/chest oppression, this is internal injury due to Phlegm-Fire, and Daotan Tang (Great Phlegm Resolving Decoction) should be used, added with Gange (Puerariae Radix) and mixed with Zhuli (Bambusae Caulis in Taenia Succus). If there is no gastric stagnation, add Zhizi (Gardeniae Fructus) and Huanglian (Coptidis Rhizoma); if there is stagnation, combine with Jiami Bahe San (Secret Formula Harmonizing Preservation Powder). If stool is dry, use Zhimi Wan (Pointing to Rice Pill) added with Xuanmingfen (Mirabilite). If fixed blood stasis congeals causing night pain, use Huoxue Tang (Invigorate Blood Decoction) added with Tao Ren (Persicae Semen). If latent fire in the blood causes night sweats during sleep, concurrently use Danggui Dahuang Tang (Angelica and Rhubarb Decoction).

Regarding paralysis of the four limbs, medical texts state that obstruction of urination and defecation indicates blockage of all orifices. If the limbs are cold or numb and completely immobile, it is an Excess Earth syndrome; use Sanhua Tang (Three Transformations Decoction) etc. to reduce the turbidity of Earth. If urination and defecation are smooth, orifices are open, limbs feel weak but without other pain or numbness, and originally able to move slightly, it is a Deficient Earth deficiency syndrome. Tonify Qi and Blood. Regarding paralysis of the four limbs, although distinctions exist among Qi, Blood, and various meridians, here only "Earth" is discussed because the hands and feet are governed by the Yangming Stomach Earth, and the four limbs derive their mandate from the Spleen and Stomach. By citing Earth, the rest can be inferred by analogy.