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(Appendix: Three Cases and the Routine Conditioning Prescription for Gong Zhao-shi)

Lei Zhong (Apoplexy-like syndrome) is mostly caused by wind generated from liver deficiency, known as internal wind, rather than external wind. Occasionally, external wind may trigger internal wind, but such cases are rare.

Generally, wind arises from within the body; therefore, Zhang Jingyue directly referred to it as "Fei Feng" (Non-Wind Syndrome). He stated: "Regarding all Fei Feng syndromes, manifestations such as facial paralysis (deviation of mouth and eyes), hemiplegia, weakness in the four limbs, tremors, spasms, and contractures belong to diseases of the sinews and bones. The Liver governs the sinews, and the Kidney governs the bones. The Liver stores Blood, and the Kidney stores Essence. When Essence and Blood are depleted, they fail to nourish the entire skeletal structure. Consequently, the sinews suffer from laxity or tension, and the bones suffer from atrophy and weakness. This is fundamentally due to the damage of Essence and Blood. It is like a decaying tree: if the fluids do not reach one branch, that branch withers." Zhang Jingyue generally emphasized warm tonification, but for Lei Zhong, he particularly valued nourishing Blood. As stated in the *Neijing* (Inner Canon): "The feet can walk when nourished by Blood; the palms can grasp when nourished by Blood; the fingers can hold when nourished by Blood." In treating hemiplegia, how can one not prioritize nourishing Blood? Mr. Chen Linchuan said: "To treat wind, first treat the Blood; when Blood flows, wind extinguishes itself." This is indeed concise and essential. For decades, I have adhered to this method in treating Lei Zhong without failure. Although initially there may be phlegm-fluid obstruction requiring unblocking, formulas like Huoluo Dan (Collateral-Activating Pill) should not be used excessively, lest Yin-nourishing effects be insufficient and Yin fluid be further consumed.

During the Qianlong reign, salt merchants in Yangzhou,不知 (unknown to us which doctor), formulated Zaizao Wan (Rebirth Pill). It contained over fifty mixed ingredients, mostly aromatic and drying herbs, purported to open collaterals and orifices. They completely failed to consider that Lei Zhong often stems from Essence-Blood insufficiency, Liver malnourishment, stirring of deficient wind, and emptiness of collaterals. Excessive dryness and heat would further injure Yin-Blood, making it impossible to extinguish wind. A native of my hometown, Mr. Wu, formerly a Tongzhi (Assistant Prefect) of Chizhou Prefecture, suffered from hemiplegia and sought my treatment. He indulged in sexual activity, causing the Kidney to fail to nourish the Liver, resulting in Yin deficiency with hyperactive fire. He had a large appetite, specifically craving rich and fatty foods, leading to strong Stomach fire. I exclusively employed methods to nourish the Liver and clear heat, combined with clearing the Stomach and resolving phlegm. His condition improved daily, except for slurred speech. Someone advised him to take Zaizao Wan. I repeatedly explained this was incompatible with his condition. Seeing his limbs function normally, he temporarily complied, taking paste prescriptions regularly and ceasing medical visits for several years. Suddenly, he urgently summoned me. Upon arrival, he was bedridden, claiming he could not feel his left leg. Inquiry revealed that a certain physician had advised taking Zaizao Wan. Since the patient himself sold this pill, he took five pills consecutively, after which his left leg seemed to vanish. He regretted immensely and begged for rescue. I said, "I can restore sensation to your leg, but walking normally again is impossible." I continued with the previous modified prescription. After more than ten days of treatment, sensation gradually returned to the leg. After a few more days, he could barely stand with assistance, though weak. Now over seventy, he survives but has been bedridden for years. Such is the harm of Zaizao Wan! Those who prescribe blindly without understanding medicine must exercise extreme caution!

Modern people often have congenital insufficiency and Qi-Blood deficits. Added to this are desires clouding the mind and wine/sex depleting the Kidneys. The Liver loses nourishment, Wood becomes dry and generates wind; thus, Lei Zhong often arises from this. If prevented beforehand, treated immediately upon onset, and conditioned properly, recovery is possible, or one may live with the disease for extended years. I have treated many such cases. Generally, except for stroke with aphasia (which is difficult to treat and I often decline), others rarely fail, provided Zaizao Wan is never used. For instance, Zhuang Yiji suffered from Lei Zhong for nearly twenty years and still lives. Liu Songfen suffered for ten years and can still travel. Gong Zhao-shi, my adopted daughter, recovered from Lei Zhong and has remained relapse-free for over ten years. I also treated Duke Xiong of Dantu County, who has been relapse-free for over ten years. Similarly, this year, Zhu Huichou and Wang Xinlou showed signs of stroke and recovered after one course of treatment. In all these cases, I first instructed them not to take Zaizao Wan rashly. Zaizao Wan is not entirely useless; for obese patients with phlegm-dampness blocking collaterals, or those with concurrent external wind, its aromatic and dispersing ingredients can be effective. However, for conditions involving Kidney failing to nourish Liver, Wood dryness generating wind, it is harmful. Recently, such cases are common. Whenever encountered, patients, doctors, and bystanders alike desire to take Zaizao Wan. Alas! Medical principles are profound; can one single pill cure all Lei Zhong cases worldwide? I clarify this distinction and hope fellow physicians will discern similarly. Otherwise, let Mr. Wu’s case serve as a warning.

In treating Lei Zhong, I once used Shiwai Wendan Tang (Ten-Ingredient Warm Gallbladder Decoction) with modifications. This formula combines opening and closing methods, using opening to facilitate tonification and tonification to aid opening. It is neither cooling nor warming, making it ideal for conditioning, especially for Lei Zhong. However, if phlegm is present in the initial stage, Ginseng should be avoided; instead, use Sha Shen (Glehniae Radix) and Hai'er Shen (Pseudostellariae Radix). If wind-fire is intense initially, replace Shu Di Huang (Prepared Rehmanniae Radix) with Sheng Di Huang (Rehmanniae Radix). If Heart-Lung fire is hyperactive, replace Yuan Zhi (Polygalae Radix) with Mai Dong (Ophiopogonis Radix), and replace Suan Zao Ren (Ziziphi Spinosae Semen) with Bai Shao (Paeoniae Radix Alba) or Nv Zhen Zi (Ligustri Lucidi Fructus). If muscle twitching occurs, Ling Yang Jiao (Capricornis Cornu) is essential, regarded as the supreme herb for entering the Liver and relaxing sinews. Combined with Quan Xie (Scorpio) and Wu Gong (Scolopendra), even facial paralysis responds swiftly. For disharmony of collaterals and blood stasis, add Ren Shen Xu (Ginseng Radix et Rhizoma Ramulus) and Dang Gui Xu (Angelicae Sinensis Radix Ramulus), termed Er Xu Yin (Two-Ramulus Drink); or assist with Ju Luo (Citri Reticulatae Pericarpium Retinervum) and Si Gua Luo (Luffae Fructus Retinervum), termed Er Luo Yin (Two-Collateral Drink). For constipation, nourishing Yin moistens dryness, leading to natural passage over time; alternatively, use Wu Ren Wan (Five-Seed Pill). Do not use purgatives, lest you commit the error of "depleting the deficient." There are many formulas, too numerous to list fully. The general principle is as described; it remains for future practitioners to understand profoundly and apply creatively.