Library

Huangdi Neijing (Yellow Emperor's Inner Canon) discusses stroke, noting that symptoms and etiologies vary. In some cases, wind pathogen invades the couli (skin texture and interstices); when couli open, there is a sensation of cold; when they close, there is stuffiness and oppression, termed Cold-Heat syndrome. This refers to chills and fever caused by Wind-Cold at the exterior. In other cases, wind pathogen enters the Stomach and cannot diffuse outward, resulting in Heat-in-the-Middle syndrome. This refers to fever caused by wind pathogen entering the interior. In thin individuals, heat diffuses outward causing coldness and tearing, termed Cold-in-the-Middle syndrome. This refers to deficiency-cold arising from excessive sweating due to weakness, allowing heat to escape with sweat. When wind pathogen enters along with the Taiyang meridian energy and scatters between the muscle layers, muscles become swollen and develop sores; this refers to wind-toxin counterflowing within the muscles causing ulcers. When Wei Qi (Defensive Qi) stagnates and fails to circulate, muscles become insensate; this refers to malignant wind damaging Wei Qi, blocking blood vessels, leading to leprosy or numbness. Above, Huangdi Neijing summarizes the various symptoms caused by wind pathogen.

It further states: When wind pathogen strikes the Shu points (Back-Shu acupoints) of the Zang-Fu organs, entering their respective gates, it causes Pi Feng (Partial Wind). This means wind pathogen striking the Shu points of various meridians, affecting either the left or right side, results in sudden onset partial wind and hemiplegia. It also states: When wind pathogen ascends along the Fengfu point (GV16), it causes Brain Wind and Eye Wind. This refers to headache disorders that can impair vision. If one contracts wind after drinking alcohol, presenting with profuse sweating, aversion to wearing single garments, panting, aversion to wind, dry mouth, and frequent thirst, it is called Lou Feng (Leaking Wind). This refers to symptoms involving both exterior and interior, where wine-heat combined with wind causes sweating, aversion to wind, and thirst. If wind is contracted during sweating after sexual intercourse, it is called Internal Wind. This implies that wind entering internally during post-coital sweating will cause symptoms such as urinary incontinence and dysuria. If wind is contracted immediately after bathing, with head sweating and aversion to wind, and if headache worsens the next day, it is called Shou Feng (Head Wind). This refers to headache caused by wind exposure after bathing. If wind remains long-term and enters inward, it causes Chang Feng (Intestinal Wind) and Sun Xie (undigested food diarrhea). This refers to diarrhea caused by external wind injury. If wind stays in the couli, accompanied by sweating, leakage of fluids, and generalized body pain, it is called Xie Feng (Draining Wind). This refers to gout-like pain caused by spontaneous sweating. Above, Huangdi Neijing discusses externally contracted wind.

It further states: Injury by wind on Jia/Yi days in Spring causes dry throat, irritability, and aversion to women, termed Liver Wind. Injury by wind on Bing/Ding days in Summer causes fright, red complexion, and speech difficulty, termed Heart Wind. Injury by wind on Wu/Ji days in Late Summer causes desire to keep limbs still, slight yellowish complexion, and poor appetite, termed Spleen Wind. Injury by wind on Geng/Xin days in Autumn causes sweating, aversion to wind, cough, and shortness of breath, termed Lung Wind. Injury by wind on Ren/Gui days in Winter causes facial edema and inability to stand upright, termed Kidney Wind. It also states: Inability to eat or drink, chest obstruction, abdominal distension upon removing clothes, diarrhea after eating cold food, emaciation with abdominal distension, is termed Stomach Wind. Above, Huangdi Neijing discusses internally injured wind.

The Qianjin Fang (Essential Prescriptions Worth a Thousand Gold) takes the stroke-related sections from Neijing’s wind discussion to establish the name "Zhong Feng" (Stroke). It names hemiplegia as Pian Ku (Half-Body Withering); body without pain but inability to control limbs as Feng Fei (Wind Paraplegia); sudden unconsciousness as Feng Yi (Wind Obscurity); and bi-syndrome with insensibility as Feng Bi (Wind Bi). These categories became the ancestors of modern stroke concepts.

In Zhang Zhongjing’s Jingui Yaolue (Essential Prescriptions from the Golden Cabinet), Article 1 states: Wind disease should present with hemiplegia, or only arm paralysis, which is a Bi syndrome. The pulse is subtle and rapid; this is caused by wind strike. This elaborates on Neijing’s description of partial wind, using the subtle-rapid pulse to distinguish it from Cold or Damp strike. Article 2 states: The Cun Kou (Radial) pulse is floating and tight. Tight indicates Cold; Floating indicates Deficiency. Deficiency and Cold contend, placing the pathogen in the skin. Floating indicates Blood deficiency and empty collaterals. The thief pathogen cannot be expelled, attacking either left or right. The pathogen causes flaccidity, while healthy Qi becomes tense; Healthy Qi pulls the pathogen, causing deviation of the mouth and eye and limb immobility. If the pathogen is in the Collaterals, the skin and muscles are insensate. If in the Meridians, heaviness and inability to lift occur. If entering the Fu organs, consciousness is lost. If entering the Zang organs, speech is difficult, and saliva dribbles. This elaborates on Pian Ku and Stroke symptoms. A subtle-rapid pulse indicates Wind-Heat; a floating-tight pulse without rapidity indicates Wind-Cold. If Wind-Cold lingers in the skin and is untreated, it leads to deviation and immobility. Thus, pathogen in Collaterals causes insensibility; in Meridians, heaviness; in Fu organs, unconsciousness; in Zang organs, speech difficulty. This clarifies the sequence and severity of wind pathogen invading meridians and organs. Article 3 states: The Cun Kou pulse is slow and relaxed. Slow indicates Cold; Relaxed indicates Deficiency. Relaxed Ying Qi indicates Blood loss; Relaxed Wei Qi indicates Wind strike. Pathogen striking meridians causes itching and hidden rashes. Insufficient Heart Qi allows pathogen to enter centrally, causing chest fullness and shortness of breath. Note: The previous article used floating-tight pulse to show Wind-Cold moving from exterior to interior; this article uses slow-relaxed pulse to show the same progression. Article 4 states: The Cun Kou pulse is deep and weak. Deep governs bones; Weak governs sinews. Deep relates to Kidney; Weak relates to Liver. Sweating and entering water damages the Heart, causing Li Jie (Joint) pain and Yellow Sweat, hence named Li Jie. This explains that deep pulse governs bones and weak pulse governs sinews; sweating into water with wind invasion causes joint pain and yellow sweat. It also states: The Shao Yin pulse is floating and weak. Weak indicates Blood insufficiency; Floating indicates Wind. Wind and Blood contend, causing pain like pulling. This describes gout caused by wind strike in Blood deficiency. It also states: Robust persons with choppy-small pulses, shortness of breath, spontaneous sweating, Li Jie pain, and inability to flex/extend joints. This describes robust persons who usually have large-full pulses but now show choppy-small pulses with shortness of breath, sweating, and severe joint pain, similar to Neijing’s description of wind after drinking. It also states: Pain in all joints, emaciated body, swollen feet feeling detached, dizziness, shortness of breath, and nausea are treated with Guizhi Shaoyao Zhimu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction). This reiterates that joint pain gout is an external contraction, suitable for Guizhi Shaoyao Zhimu Tang to harmonize Ying and Wei and disperse exterior pathogens. It also states: Sour taste injures sinews, leading to flaccidity, termed Xie. Salty taste injures bones, leading to atrophy, termed Ku. Ku and Xie contend, termed Duan Xie. Ying Qi does not flow, Wei Qi does not move alone; both Ying and Wei are deficient. San Jiao (Triple Burner) loses control, Four Belongings (limbs) are severed. Body is emaciated, feet are swollen, yellow sweat occurs, calves are cold. If fever occurs, it is Li Jie. This describes internal injury to sinews and bones, resembling Li Jie/Gout, but true Li Jie/Gout is external and must involve fever. If yellow sweat and cold calves are present with fever, it is Li Jie/Gout, treatable by dispersing exterior. Subsequently, it states: For Li Jie with inability to flex/extend and pain, use Wutou Tang (Aconite Decoction) to disperse pathogen. Above is Jingui Yaolue’s discussion on stroke.

Thus, Neijing discusses wind broadly, not just sudden collapse. Qianjin Fang elaborated on four stroke types (Pian Ku, Feng Fei, Feng Yi, Feng Bi) and added treatments. Zhongjing’s Jingui elaborated on these using Qianjin’s framework. Hou Shi Hei San treats Cold; Feng Yin Tang treats Heat, becoming standards for stroke. However, they only discussed external Wind-Cold, neglecting internal injuries. Later, Liu Hejian emphasized Fire causing sudden collapse; Li Dongyuan emphasized Qi stagnation and deficiency; Zhu Danxi emphasized Phlegm generating Heat and vice versa. Since Qianjin and Zhongjing focused on external Wind-Cold, Liu, Li, and Zhu supplemented internal stroke theories. Yu Jiayan proposed treating stroke via “pathogen harming empty orifices” with tonification and blockage methods, which is a partial view that may cause harm if retained. Stroke has deficiency/excess patterns: Qi/Blood deficiency allowing wind entry; Qi/Blood stagnation (e.g., after drinking) allowing wind entry; pre-existing wind/cold generating phlegm/heat; or pre-existing phlegm/heat attracting wind/cold. Everyone knows deficiency allows external invasion; few know excess (drinking/eating) allows external invasion. Therefore, exterior Six Channels symptoms require dispersing formulas like Jiajian Xuming Tang; interior constipation requires purging formulas like San Hua Tang. After pathogen dispersal, tonify deficiency. Ancients distinguished Bi (Closed) and Tuo (Collapse) to verify deficiency/excess. “Treating wind by treating blood” refers to severe wind damaging blood stasis, requiring blood-invigorating methods, not merely tonifying blood. “Regulating Qi first in stroke” refers to Qi blockage requiring Qi regulation, not universal application. One must distinguish exterior Cold (treat with dispersing formulas like Hou Shi Hei San or Jiajian Xuming Tang) from interior Heat (treat with clearing formulas like Feng Yin Tang or San Hua Tang). Internal Yin Fire rising follows Hejian’s methods; Phlegm stagnating in Middle Jiao follows Danxi/Jiezai’s methods. Do not adhere to one school. Limb paralysis differs from hemiplegia. Limb paralysis can be deficiency or excess; hemiplegia is mostly pathogenic obstruction. Limb paralysis due to Earth (Spleen/Stomach) deficiency involves Qi/Blood lack causing weakness without pain/numbness; Earth excess involves Qi/Blood stagnation causing pain/numbness/cold. Hemiplegia is mostly stagnation, rarely deficiency; it is illogical for half the body to be deficient while the other is not. Even if hemiplegia is due to external wind/cold, it requires acrid-dispersing methods, not warming-tonifying. Zhunsheng correctly identified Spleen pulse deep-choppy as deficiency and drum-large as excess. However, noting small-firm-tight Heart pulse only as Yuan Yang deficiency ignores cases of large-pulsating Heart pulse indicating Heart Fire. Neijing states: Heart heat moves Yang internally, causing Muscle Bi and Pulse Wei (Flaccidity); Yang excess, Yin deficiency causes Pian Ku; Heat causes large sinews to shorten/tether and small sinews to relax/flaccid. Thus, hemiplegia cannot be solely attributed to Yuan Yang deficiency. Using hot medicines mistakenly treating Pian Ku/Wei leads to disaster; the root of this error lies here.