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Do not allow (the body's Qi mechanism) to deviate or shift; thus the form will be manifest, and the vital energy will grow. This is called the Sage King. Therefore, *Da Yao* states: "Do not substitute for natural transformation, do not violate the seasons; one must nourish and harmonize, waiting for recovery. This is what is meant."

(Vomiting, overflowing fluids, inability to eat)
Vomiting, overflowing fluids, and inability to eat: This occurs because Fire Qi flares upward, causing severe heat in the Stomach and Diaphragm, leading to dysfunction of transmission and transformation.

(Blurred vision)
Blurred vision, red and swollen eyes, eyelid pterygium, and ulcers are all due to Heat; closing the eyes and experiencing darkness (colloquially called "eye black") is also due to Heat. However, if one suddenly loses sight completely without prior symptoms, it indicates severe stagnation of Heat. Some claim that blurred vision is caused by deficiency-cold of the Liver and Kidney, which is erroneous. They falsely assert that the Liver governs the eyes and the Kidney governs the pupils, thus claiming that visual impairment is due to deficiency-cold. Yet, Kidney Water belongs to Winter Yin; when deficient, it should manifest as Heat. Liver Wood belongs to Spring Yang; when deficient, it should manifest as Coolness. How can Kidney Yin and Liver Yang simultaneously be deficient and manifest as Cold? Or, generally speaking, even if there is Excess-Yin and Deficiency-Yang within the Liver and Kidney, there is no reason for visual impairment. Laypeople falsely claim that the Qi of the Liver and Kidney declines and fails to reach the eyes. They fail to know that the *Classic* states that severe Heat causes eye closure and darkness, not Cold. Furthermore, Zhang Zhongjing stated: "In Shanghan disease, extreme Heat leads to confusion and inability to recognize people," which constitutes blindness or loss of vision. *Zheng Li* states: "This is caused by severe Heat stagnating in the eyes."

Regarding the sweat pores of the skin, they are apertures for discharging Qi and fluids, also known as Qi Gates (men of Qi discharge). They are also called Couli (interstices), referring to the channels and textures through which Qi and fluids exit. They are also called Ghost and Spirit Gates, meaning gates of the obscure and profound. They are also called Xuanfu (Mysterious Mansion), meaning the mansion of subtle mysteries. The Xuanfu exists everywhere: in human Zang-Fu organs, skin, hair, flesh, sinews, bones, nails, and indeed in all things of the world. It is the pathway and gate for the entry, exit, ascent, and descent of Qi. Qi is the master of form, the mother of spirit, the root of the Three Powers (Heaven, Earth, Man), the origin of all things, and the manifestation of Dao. Thus, Yuan Yang Zi explained the *Qingjing Jing*: "The Great Dao is formless; without Qi, it cannot nourish all things. Through Qi transformation, things are born; through Qi change, things alter; when Qi is abundant, things flourish; when Qi is weak, things decline; when Qi is upright, things are harmonious; when Qi is chaotic, things become diseased; when Qi ceases, things die." The *Classic* says: "If entry and exit cease, the Shen Ji (spiritual mechanism) perishes. If ascent and descent stop, the Qi Li (Qi establishment) stands alone in danger. Therefore, without entry and exit, there is no birth, growth, transformation,收 (harvest), or storage. Thus, ascent, descent, entry, and exit are present in every vessel." The functions of human eyes, ears, nose, tongue, body, mind, and consciousness rely on the smooth flow of ascent, descent, entry, and exit. If blocked, they cannot function. If one cannot see with the eyes, hear with the ears, smell with the nose, taste with the tongue, suffers from sinew atrophy and bone bi, decaying teeth, falling hair, insensate skin, or intestinal failure to permeate and excrete, all these are caused by Heat stagnation, where the Xuanfu becomes closed and dense, preventing the ascent, descent, entry, and exit of Qi, fluids, blood vessels, Ying-Wei, and spirit. By observing the severity of the stagnation, one can assess the severity of the disease.

Therefore, knowing that Heat stagnating in the eyes causes blindness: if vision is slightly blurred, objects are harder to distinguish up close, because the Xuanfu in the eyes has narrowed, resembling viewing objects through fine silk. Seeing flies flying may indicate partial closure of the Xuanfu. Blurred vision with seeing black spots is due to severe Heat emanating from the eyes; when Excess leads to harm, Control (Cheng) acts to restrain it, causing tears to flow. The turbidity of Qi and fluids makes vision unclear; since the distance is near, vision appears as black spots. Crying in the wind leading to dim vision is due to severe Heat being controlled by Water. Thus, the *Classic* says: "Jue syndrome results in loss of vision. In Jue syndrome, Yang Qi gathers above, and Yin Qi gathers below. Yang Qi gathering above is like fire illuminating; Yin Qi gathering below causes cold feet, and cold feet cause distension. One water cannot overcome five fires, hence blindness, and continuous tearing in the wind. When Wind strikes the eyes, Yang Qi remains internally guarding the Jingming acupoint; this is Fire burning the eyes, hence tearing upon exposure to wind."

(Sudden diarrhea)
Baozhu (sudden projectile diarrhea): The principle is the same as Jun Huo (Monarch Fire).

(Trembling/Jumping)
Trembling/jumping refers to palpitations or twitching. Fire moves, so in summer heat, the pulse is surging, large, and long, which is the image of trembling. Moreover, the pulse is nourished by Heart Fire.

(Sudden illness and sudden death)
Sudden illness and sudden death: This is due to the rapid nature of Fire. It often arises from improper clothing, diet, rest, movement, and emotional states (essence, soul, spirit, will, temperament, likes/dislikes) over time, violating proper norms and losing constancy. Long-term deviation causes Qi changes, leading to decline and disease. For instance, if Heart Fire becomes violently excessive while Kidney Water is weak and unable to control it, Heat stagnates, confusing the Heart Spirit. The sinews and bones lose function, leading to sudden collapse and unconsciousness, known as Jiangpu (rigid fall).

In severe cases, Water controls Fire; excessive Heat generates phlegm/saliva, and at the extreme, death occurs. In mild cases, the patient recovers as before; in very mild cases, only dizziness occurs, colloquially called "An Feng" (Hidden Wind), caused by Fire excessively controlling Metal, failing to subdue Wood, so Wind-Wood becomes excessive.

Or, severe Wind-Heat causes sinew twitching and convulsions, rigid falls, and foaming at the mouth, colloquially called Wind Epilepsy. To know if a disease involves Wind is to understand the way of Yin-Yang transformation. Thus, Yin and Yang contend, Hard and Soft rub against each other, Five Phases intermix, and Six Qi interact; transformations into disease are infinite. The general rule is: If my "Child" (Metal) controls the "Ghost Thief" (Wood), then I (Earth) will naturally become substantial. Diseases involving the Child are not always like this, due to inequalities in the Six Qi and Yin-Yang.

Thus, the Classic states: Wind, Heat, and Fire belong to Yang; Cold, Dryness, and Dampness belong to Yin. Dryness and Dampness differ slightly; although Dryness-Metal belongs to Autumn Yin, it differs from Cold-Dampness, so it aligns more with Wind-Heat. Therefore, when Fire-Heat prevails, Metal declines, generating Wind; Wind can overcome Dampness, and Heat consumes fluids, causing Dryness. Yang Excess and Yin Deficiency mean Wind-Heat surpasses Water-Dampness to create Dryness.

Most Wind diseases in humans are due to severe Heat, with Wind-Dryness as a secondary transformation, where Heat is primary. Laypeople speak of "Wind," focusing on the branch and forgetting the root. Therefore, stroke paralysis is not due to excessive Liver-Wind striking suddenly, nor is it external Wind invasion. It is due to improper care leading to violent Heart Fire; Kidney Water is deficient and cannot control it, resulting in Yin Deficiency and Yang Excess, Heat stagnation, confused Heart Spirit, loss of sinew/bone function, and sudden collapse. This is often triggered by extremes of the Five Emotions (Joy, Anger, Worry, Sorrow, Fear); extremes of the Five Emotions all generate severe Heat!

If mild, only rigid fall occurs, Qi and Blood flow, sinews do not spasm, and the patient recovers. If Heat is too severe, stagnation blocks Qi and Blood, Yin Qi suddenly cuts off, followed by Yang exhaustion and death. Colloquial "stroke" is merely this.

If one does not die immediately but suffers hemiplegia, it is because meridians run bilaterally, but severe Heat stagnation blocks Qi and Blood. When the stagnation erupts, if one side opens, the other becomes blocked and paralyzed. The person already has stagnant Heat, with uneven Qi and Blood distribution. Hence, the Classic says: "Uneven sweating leads to hemiplegia." Uneven sweating is due to stagnant Heat blocking Qi and Blood. Sudden stroke causes Qi-Blood blockage and hemiplegia.

Obese people often suffer stroke because obesity results from Blood Excess and Qi Deficiency. Qi is Yang and light; Blood is Yin and forms the body. West Metal and North Water are Yin and firm; East Wood and South Fire are Yang and flexible. Thus, Blood Excess/Qi Deficiency leads to obesity; Qi Excess/Blood Deficiency leads to thinness. Obese people tolerate Cold but not Heat; thin people tolerate Heat but not Cold, because Cold injures Blood and Heat injures Qi. Damaging deficiency increases Yin-Yang imbalance, making tolerance impossible; balancing excess restores harmony. Thin people have open Couli, sweat easily, have deficient Blood, and suffer Dryness-Heat, often leading to consumptive cough. Laypeople call acute severe illness "Heat Consumption" and chronic mild illness "Cold Consumption"; however, the disease is Heat, varying only in degree.

Claiming obese people get stroke due to Deficiency is wrong. Their Couli are dense with stagnation; if Yang-Heat is excessive and stagnant, sudden stroke occurs. Obesity turning into consumption is due to sudden fluid loss and extreme Blood damage. Thin people getting stroke is due to sudden extreme Yang-Heat stagnation.

Stroke with jaw lock and tight sinews is due to sudden internal Yang-Heat excess. Excess harms, Control restrains; fluids surge, gathering in the chest/diaphragm, drying into phlegm-saliva. Chu Yushi said saliva is the lipid-fluid of the whole body. With Yang Excess/Yin Deficiency and severe Wind-Heat overcoming Water-Dampness to create Dryness, Liver governs sinews and Wind is strong; added Dryness-Heat concentrates in the chest, drying sinews. Dryness-Metal governs contraction and tension, causing stiff sinews and jaw lock.

Traumatic wind-stroke is similar but progresses from mild to severe without hemiplegia. Traumatic wind-stroke arises from severe Heat in wounds stagnating, blocking Ying-Wei, causing pervasive stagnant Heat and white scabs. Closed wound pores trap Qi, allowing Yang-Heat to stagnate and generate Wind. If unchecked, exterior transmits to interior, similar to head/face exposed to Cold causing systemic stagnant Heat. Differences lie in the degree of Wind-Heat transformation.

General rule for traumatic wind-stroke: If Wind-Heat-Dryness is severe, stagnant in the Exterior with Interior peaceful, symptoms include frequent stretching/yawning, sinew stiffness, occasional chills, or twitching, with floating-rapid-wiry pulse. Use pungent-hot Wind-dispelling drugs to open stagnation and restore Ying-Wei flow, curing the disease. Similar to Shanghan exterior Heat stagnation treated with Mahuang Tang. However, using pungent-hot drugs may intensify Wind-Heat, as seen in Shanghan Lun where hot exterior-releasing drugs fail and Heat worsens. Therefore, when using Mahuang/Guizhi Tang for fever, add Cold drugs; otherwise, severe Heat causes jaundice or rashes. Exterior-releasing formulas should be assisted with Huangqin, Shigao, Zhimu, Chaihu, Dihuang, Shaoyao, Zhizi, Yinchen, Congbai, Douchi, etc., used judiciously. Using Gancao, Huashi, Cong, Douchi as cold dispersants is excellent: Gancao is sweet, easing urgency and moistening dryness; Huashi is bland, opening apertures and promoting flow; Cong is pungent-sweet-mildly cold; Douchi is salty-cold, moistening dryness and dissipating knots. These are agents that ease urgency, moisten dryness, and clear Heat.

Taking them due to Heat allows the Xuanfu to open, preventing further stagnant Heat recurrence. Even if the condition is severe and not instantly cured, minor benefits are gained without harm. This formula dissipates knots anywhere in the body, beneficial and harmless. Why must knot-dissolving formulas be only pungent-hot?

If traumatic wind-stroke exterior symptoms persist and move inward, the condition worsens. If Interior is not too full and the pulse is at the muscle level, use Cold drugs to reduce Wind-Heat and open stagnation, or slightly add pungent-hot Wind drugs, adjusting carefully. This is like Shanghan half-exterior/half-interior stage treated with Xiaochaihu Tang. If Interior is severely full with stiff tongue, jaw lock, opisthotonos, convulsions, thick saliva, chest/abdominal fullness, urinary/fecal retention, occasional sweating, and surging-rapid-wiry pulse: Sweating occurs because Wind-Heat stagnates deeply in the Interior, while Exterior Heat subsides, opening Couli; Heart Fire is severe, causing sweat. Generally, Wind-Heat stagnation should resolve with sweat. If it does not, and Interior Heat emerges to the Exterior, sweat dissipates Heat and cures the disease. But if Wind-Heat is deeply stagnant in the Interior and does not emerge to the Exterior, sweat will not resolve the Heat. This is like Yangming syndrome with severe Interior Heat and tidal fever; despite heavy sweating, Heat persists, requiring Dachengqi Tang to purge. The Interior Heat follows the principle: Excess harms, Control restrains. Now Fire is extremely excessive, causing stiff sinews and jaw lock. Added Wind-Heat causes convulsions.

Wind, Heat, and Dryness all stagnate severely in the Interior, causing irritability, fullness, and binding. The method is to dispel Wind, dissipate knots, and purge with Cold drugs to unblock stagnation, then regulate with Cold drugs reducing Wind-Heat and opening knots. Once Heat retreats and knots scatter, Wind heals itself. Alas! Lay doctors treating traumatic wind-stroke ignore depth/shallowness, using only pungent-hot-dry drugs, leaving fate to chance!

If initially feeling Wind-Heat stagnating in the Exterior with Interior peaceful, it is acceptable, or assisting with Cold substances is good. Lingbao Dan treats Wind-Bi; although it uses sulfur, zhongru, muxiang, guixin (pungent-hot), it opens knots. Assisted by Niuhuang, naozi, Kushen, mangxiao (Cold), it dissipates knots without re-stagnation. Zhibao Dan is a Cold drug for dispersing Wind-Heat stagnation. When treating Wind-Heat knot-stagnation, avoid excessive Hot drugs. For traumatic wind-stroke, early guidance, massage, and manipulation are advised. If the patient cannot do it themselves, others should assist with flexion-extension massage to relax sinews and promote Qi flow. Frequently use a wedge to pry the jaw open to prevent lockjaw, ensuring medicine/food can enter. Wind epilepsy attacks are due to severe Heat with Wind-Dryness as secondary transformation; saliva floods the chest/diaphragm, Dryness-Heat causes convulsions, confusion, and rigid falls. Convulsive wind is also due to violent Heart Fire controlling Metal, failing to subdue Wood, so Wind-Fire contend, causing confusion, palpitations, and tidal convulsions.

All these syndromes arise from severe Heat generating Wind-Dryness; differences depend on the varying degrees of Wind, Heat, and Dryness.

Stroke with flaccid sinews is due to Wind-Heat overcoming Dampness to create Dryness, an extreme of Dryness. Flaccid sinews failing to contract lead to Wei-Bi syndromes. All stagnation-induced Wei syndromes belong to Metal-Lung, the transformation of Dryness. Just as late autumn dryness causes plants to wither and drop leaves, so does disease. Hands grasp due to Blood; feet walk due to Blood. Dryness disease is Blood deficiency combined with poor Qi-Blood circulation. Claiming tense sinews are Excess-Heat and flaccid sinews are Deficiency-Cold is wrong. Claiming Cold causes contraction and Heat causes relaxation, thus tense sinews are Cold and flaccid are Heat, is also wrong. All Wind formulas treat sinew/tendon tension or flaccidity without distinguishing Cold/Heat or Excess/Deficiency; it is only a matter of degree. Tense sinews, though severe, are easy to cure; flaccid sinews are hard to recover, which is obvious.

Claiming stroke is due to excessive Liver-Wood warns against organ leakage; if Spleen-Stomach Earth is deficient, it suffers from Liver-Wood "Ghost Thief" evil and dies. Treating by warming Spleen and tonifying Stomach to strengthen Earth, preventing Liver conquest, is "treating disease before it arises." This is specious reasoning. Claiming Spleen, as Central Earth, should be warmed is also wrong. The Six Qi correspond to the Twelve Meridians and Zang-Fu; their original transformation can tonify, while contrary ones can drain. Spleen-Stomach Earth is originally Damp; excessive Dampness causes fluid accumulation, obstruction, or edema. Using drying drugs to remove Dampness drains the Spleen-Stomach Earth. If Dryness-Heat is excessive, causing Spleen-Stomach dryness and Xiao Ke (wasting-thirst), the Dampness of Earth is depleted. Using Cold-Warm drugs to tonify Yin, drain Yang, clear Heat, and moisten Dryness balances Earth, tonifying its root. Thus, Zhang Zhongjing said for Shanghan with severe Interior Heat causing stomach dryness and thirst, urgent purging saves Stomach Qi using Gancao, Dahuang, Mangxiao (great Cold) in Tiaowei Chengqi Tang, reaching the ultimate truth.

Yin and Yang have different uses, but Cold and Dampness share similarity. Earth is Yin, differing from Wind, Heat, and Dryness. Earth is the mother of all things; Water is the origin. Water and Earth reside below, forming the root. If earth is dry without Water-Dampness, roots do not moisten, and branches decline. The Classic says: "Animal Shen Ji has its root in the Middle." Food enters the Stomach, Spleen grinds and transforms flavors to nourish Zang-Fu Qi and blood the body, securing the root, keeping stomach contents moist. Water-Dampness must not be excessive or insufficient, like drought or flood. All Zang-Fu and limbs receive Qi from Spleen-Stomach, relying on Earth's moisture. The Classic says: Accumulated Dampness becomes Heat; how can Warm drugs tonify Damp-Earth? Warmth belongs to Spring Wood, which overcomes Dampness!

Some confuse Zang-Fu with the Six Qi, treating hypothetical Dampness as if Yang Excess is Heat-Excess and Yang Deficiency is Cold-Deficiency. This confuses Cold/Heat Yin-Yang Excess/Deficiency with the Five Phases' rise/fall and mutual restraint. Zang-Fu meridian diseases need not stem from original Qi decline but from Six Qi interference. For example, Stomach Cold as Deficiency-Cold means Stomach Yin-Water is Excess and Yang-Fire is Deficient. One should warm-tonify Stomach Yang-Fire deficiency and reduce Yin-Water excess, not because Stomach Earth is originally deficient and needs Dampness tonification. Tonifying/draining Spleen-Stomach root: drying Dampness is draining; moistening Dryness is tonifying. Earth is originally Damp. If Yang Excess/Yin Deficiency causes Wind-Heat to overcome Water-Dampness creating Dryness, Water-Dampness is depleted. One should reduce Wind-Heat, nourish fluids, moisten Dryness, and save depleted Yin-Dampness. Conversely, using Warm-tonics to prevent organ congestion is highly erroneous!

Claiming stroke is due to Kidney-Water deficiency-cold is wrong. Since Yin-Water is depleted, Yang-Fire naturally becomes excessive and Hot; how can it reverse to Cold? Clinical evidence confirms Heat. If stroke is due to severe Heat, why use Hot drugs like Wu Tou/Fu Zi? Answer: To open meridians and promote Qi-Blood flow without stagnation. However, assist with Cold drugs like Wind-Heat reducers and knot-openers to counteract the drug's heat. If severe Hot drugs worsen Heat signs, they must not be used. Forcing treatment on blocked stagnation causes sudden Yin Qi cutoff and death. Among formulas, Zhibao Dan and Lingbao Dan are best.

Examining Bencao, Zhibao Dan combines Cold drugs. Lingbao Dan uses Warm-Hot ingredients but is controlled by Cold drugs, resulting in a neutral formula. Both disperse Wind congestion, open knots, promote Qi-Blood flow, eliminate stagnant Heat, and cure. Although containing Wind-treating Hot drugs, they must be adjusted appropriately, supporting deficiency and reducing excess. Do not solely use severe Hot drugs to attack Bi, thereby cutting off already depleted Yin Qi.