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Patient Yang, busy with official duties in winter, suddenly collapsed under the bed at midnight, unconscious, with body heat and phlegm obstruction, stiff tongue, and limbs unable to hold themselves. The pulse was deficient and choppy on the left, and floating and slippery on the right.

First, warm ginger juice was administered, causing the phlegm to clear immediately. Temporarily, wind-dispersing and phlegm-resolving medicines were used to unblock the meridians; consciousness gradually cleared, and the right side of the body could move slightly, but the left side remained paralyzed, with slurred speech.

The syndrome belongs to a constitutional deficiency of True Yin (Zhen Yin). Dihuang Yinzi (Rehmannia Decoction) from Hejian was used, removing Cinnamon Twig (Guizhi), Aconite Root (Fuzi), and Morinda Root (Bajitian), adding Goji Berry (Gouqi), Achyranthes Root (Niuxi) (both wine-steamed), Quince (Mugua), and Polygonum Multiflorum Root (Heshouwu). After dozens of doses, various symptoms gradually receded, and walking became possible, except for the left hand which remained unusable. Adding Cinnamon Twig (Guizhi) and Turmeric Rhizome (Jianghuang) to the previous formula for several doses caused slight sweating in the left axilla; within a month, the left hand recovered normally.

Note: This syndrome arises from wind generated by fire, and fire generated by Yin deficiency. Water fails to nourish Wood, leading to internal stirring of Liver Wind (Gan Feng). Phlegm-fire ascends, blocking the clear orifices, causing sudden collapse and loss of consciousness. Facial deviation occurs because the Stomach meridian encircles the lips; cold causes tendon contraction, heat causes tendon relaxation, resulting in either left contraction/right relaxation or vice versa. (*Zhangshi Yitong* states: Left cold and right heat cause left contraction and right relaxation; right cold and left heat cause right contraction and left relaxation; this is because cold on one side forces heat to the other, preventing the free flow of Yang Qi.) Tongue stiffness occurs because the tongue is the sprout of the Heart, and the Kidney meridian connects to the root of the tongue; excessive Heart Fire and depleted Kidney Water lead to tongue stiffness. The Liver governs tendons, and the Stomach governs the four limbs; Blood deficiency in the Liver and Stomach leads to tendons lacking nourishment, resulting in flaccidity. A choppy left pulse indicates Water deficiency; a slippery right pulse indicates abundant Phlegm. These are signs of hemiplegia (Piangu). However, without temporarily using phlegm-expelling medicines, the meridians would not open, and decoctions could not be swallowed. Using Dihuang Yinzi minus warming Yang medicines addresses the fact that extreme emotional excess generates fire; the method should be to nourish Yin so that wind and fire extinguish naturally. Hejian stated that stroke paralysis is not due to Liver Wood wind nor external wind invasion, but rather violent Heart Fire and depleted Kidney Water failing to control it, leading to qi stagnation, mental confusion, and sudden collapse. Some cases result from extreme emotional excess. These are not due to severe heat; the common term "wind" refers to the manifestation while forgetting the root. Dihuang Yinzi originally aims to tonify the True Yin of the Kidneys. However, Yin deficiency has two types: deficiency of Water within Yin, and deficiency of Fire within Yin. For Fire deficiency, Cinnamon Twig, Aconite, and Morinda can be fully used; for Water deficiency, they are unsuitable.

A clan member presented with numbness on the left side, stabbing pain in the tibia, weak and flaccid waist and knees, ability to drink but excessive phlegm. The pulse was large on the left and soggy on the right, indicating Heat generated by Yin deficiency complicated by Damp-Phlegm. Xueshi Liuwei Dihuang Wan was prepared as a decoction, with Poria (Fuling) as the sovereign herb, added with Atractylodes Macrocephala Rhizome (Baizhu), Coix Seed (Yiren), Achyranthes Root (Niuxi), and Phellodendron Bark (Huangbai) (all wine-fried). After more than ten doses, all symptoms receded, and walking returned to normal. Danxi considered numbness as Qi deficiency, and limb rigidity as Damp-Phlegm and ruined blood. The stabbing pain in the tibia indicates Kidney deficiency with accompanying Fire; weak waist and knees indicate impending Kidney exhaustion. The treatment method requires abstaining from alcohol, using Liuwei Dihuang Tang to nourish the source of transformation, with Poria as the sovereign, assisted by Baizhu and Yiren, and guided by Niuxi and Huangbai to drain Damp-Heat and benefit the waist and knees, avoiding the precedent of ancient sages prohibiting drying-wind medicines in treating stroke-like syndromes.

Patient Li suffered from paralysis on the right side and difficulty walking, a chronic disease of three years, dismissed as incurable. Upon inquiry about his distress, he replied: Defecation is very difficult; just having smooth bowel movements is a relief. His pulse showed complete hiding of the right three positions and boundless flooding of the left three positions. Considering the long-term dryness on the right, Fu-Yang must be declining. The large intestine curves to the right side, making transportation slow. It is appropriate to treat according to the method for Wind Constipation (Feng Mi), using acrid-unblocking and moistening approaches, such as Sousun Fengqi Wan. However, since Mingmen Fire is weak and the right body is cold, Cuishi Guifu Bawei Wan was first prepared as a decoction. After two doses, defecation became smooth, and right limb movement became slightly flexible. Later, Cistanche Stem (Rongshu) and Angelica Sinensis Root (Danggui) were added to Bawei Wan, made into honey pills. Effective.

Patient Sun, of advanced age, presented with upper excess and lower deficiency, dizziness, limb numbness, tinnitus, and stiff tongue. Coinciding with the Shao Yang command period, internal Liver Wind trembled. The pulse was floating and flooding. He had rapid digestion with easy hunger, loose stools, and sweating. All these were due to fluid deficiency and wind movement. Entering summer when Fire is prosperous, he developed facial deviation and slurred speech, clearly indicating Stroke-like Syndrome (Lei Zhong) due to Wind-Fire attacking the collaterals. One must most fear falling and phlegm gurgling. At noon, when Fire rises, head sweating and body heat occurred. The origin lies in Yin failing to interact with Yang; there is no rationale for attacking Wind or劫夺 (robbing) Phlegm. Treatment focused on Water nourishing Wood and capturing deficient Yang. Prepared Rehmania Root (Shudi, 5 qian), Schisandra Fruit (Wuweizi, 0.5 qian), Ophiopogon Tuber (Maidong, 1.5 qian), Spirit of Poria (Fushen, 3 qian), Oyster Shell (Muli, vinegar-ground 3 qian), Chrysanthemum Flower (Ganju, stir-fried 1.5 qian), Fresh Dendrobium Stem (Shihu, 3 qian), White Peony Root (Baishao, 2 qian), Fritillaria Bulb (Chuanbeimu, 1.5 qian), Moutan Cortex (Danpi, 1 qian), Donkey-hide Gelatin (Ejiao, dissolved in water, 2 qian). After three doses, all symptoms receded, and the pulse gradually normalized. Only night sleep remained slightly restless, indicating Liver deficiency with the Hun (Ethereal Soul) losing stillness. Dragon Bone (Longgu, 0.7 fen) was added to the original formula, taken continuously without interruption. Additionally, a paste prescription was formulated using the above ingredients plus American Ginseng (Yangshen), Cornus Fruit (Yurou), Lotus Seed (Lianshi), and Mulberry Twig (Sangzhi, tender parts), boiled into a paste for storage, after removing Fire Qi. Each dose was 5 qian. With careful regulation and maintenance, recovery is expected.