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Wind pathogen causing disease typically manifests as hemiplegia (half-body paralysis); if only the arms are unable to move, this is classified as Bi syndrome (obstruction syndrome). The pulse is faint and rapid, which is caused by wind-stroke.

[Annotation] Regarding wind diseases, the *Neijing* (Inner Canon) has discussed them in detail. However, they were often discussed together with Bi syndrome, leading to confusion among later generations. Therefore, Zhang Zhongjing reiterates: Wind pathogen causing disease should result in hemiplegia, which is what the Classics call "Pian Ku" (hemiplegia); if only both arms are unable to move, it is not wind-stroke, but Bi syndrome. Generally, Bi syndrome is a Yin disease, with pulses that are often deep and choppy; wind disease is a Yang disease, with pulses that are often floating and moderate. Now, the pulse is faint and rapid, which is due to wind-stroke. A faint pulse indicates deficiency of healthy Qi; a rapid pulse indicates excess of pathogenic factors. Thus, those who contract wind due to deficiency invariably show a faint pulse; those who generate wind due to heat invariably show a rapid and urgent pulse.

[Collected Annotations] Shen Mingzong said: This section distinguishes between wind-stroke and Bi syndrome. Wind pathogen causing disease, whether injuring the Wei (Defensive) level or invading the Ying (Nutritive) level, should result in hemiplegia, meaning the Qi of half the body is damaged and non-functional. If only the arms are unable to move, this is Bi syndrome; "Bi" means obstruction, referring to the obstruction of Qi in a specific segment leading to loss of sensation. Upon palpating the pulse, it must be faint and rapid. Faint indicates weak Yang; rapid indicates frequent wind. This is caused by wind-stroke, meaning wind enters due to deficiency, subsequently causing hemiplegia.

The Cun Kou (radial artery at the wrist) pulse is floating and tight. Tightness indicates cold; floating indicates deficiency. Cold and deficiency interact, placing the pathogen in the skin. Floating indicates blood deficiency and emptiness of collateral vessels. The thief pathogen cannot be expelled, affecting either the left or right side. The side affected by the pathogen becomes flaccid, while the side of healthy Qi becomes tense. Healthy Qi pulls toward the pathogen, resulting in deviation of the mouth and eye and inability to move freely. If the pathogen is in the collaterals, the skin and muscles become numb and insensitive; if in the meridians, the body feels heavy and difficult to lift; if entering the Fu organs, the person loses consciousness and fails to recognize others; if entering the Zang organs, the tongue becomes stiff and speech is difficult, accompanied by drooling.

[Commentary] The five sentences "Cun Kou pulse floating and tight, tightness indicates cold, floating indicates deficiency, cold and deficiency interact, pathogen in the skin" do not belong to the context of this paragraph and should be placed at the beginning of the next paragraph. The six sentences from the next paragraph, "Cun Kou pulse slow and moderate, slowness indicates cold, moderation indicates deficiency; moderate Ying indicates blood loss, moderate Wei indicates wind-stroke; pathogen strikes the meridians," also do not fit the current context and should be moved to the beginning of this paragraph to ensure logical coherence. This is likely due to bamboo slip dislocation. The phrase "Floating indicates blood deficiency" is likely an interpolation. The two instances of "deficiency" in "Floating indicates deficiency, cold and deficiency interact" should be "wind," indicating a transcription error.

[Annotation] The pulses for wind-stroke and deficient pathogens should all be floating and moderate, as floating governs wind and moderation governs deficiency. Seeing a moderate pulse in the Ying level indicates depletion of blood in the meridians; seeing it in the Wei level indicates emptiness of Qi in the meridians. Generally, when wind pathogen invades humans, it does so through the emptiness of Qi and blood in the meridians. When the thief pathogen cannot be expelled and remains stagnant, it causes disease on the left if located on the left, and on the right if located on the right. Superficially, it affects meridians and collaterals; deeply, it affects Zang and Fu organs. Pathogen in collaterals causes numbness and insensitivity in skin and muscles; pathogen in meridians causes heaviness of the body and limbs, and deviation of the mouth and eye with immobility; pathogen entering Fu organs causes nine orifices to close and loss of recognition; pathogen entering Zang organs causes aphasia and drooping lips with salivation.

The Cun Kou pulse is slow and moderate. Slowness indicates cold; moderation indicates deficiency. Moderate Ying indicates blood loss; moderate Wei indicates wind-stroke. If the pathogen strikes the meridians, the body itches and urticaria appears. If Heart Qi is insufficient, and the pathogen enters the center, chest fullness and shortness of breath occur.

[Commentary] In "Cun Kou pulse slow and moderate, slowness indicates cold," the two characters "slow" should be "floating," and "cold" should be "wind," to make the meaning clear. Furthermore, slow and moderate pulses cannot coexist, confirming a transcription error.

[Annotation] The previous paragraph elucidated diseases caused by deficient and thief winds; this paragraph elucidates diseases caused by Ying-Wei, wind, and cold. Cun Kou pulse floating and tight: tightness indicates cold, floating indicates wind. Wind and cold pathogens interact at the exterior, stagnating in the skin and meridians, causing body itching and urticaria. If the person's Heart Qi is insufficient, meaning the Qi of the heart and chest is lacking, and the pathogen enters the heart and chest, it causes chest fullness and shortness of breath.

The Cun Kou pulse is deep and weak. Deepness governs bones; weakness governs sinews. Deep corresponds to Kidney; weak corresponds to Liver. Sweating and then entering water damages the Heart. Li Jie (Joint Pain) presents with yellow sweat, hence called Li Jie.

[Annotation] Cun Kou pulse deep and weak indicates insufficiency of Liver and Kidney Qi. The Liver governs sinews, and the Kidney governs bones. Insufficiency of Liver and Kidney leads to flaccidity and laxity of sinews and bones. Once attacked by wind, cold, and damp pathogens, disease occurs at the junctions of sinews, bones, and joints. When sweating, the pores open, making it easy for wind to enter; bathing in water exacerbates cold injury. Water damages the Heart; the Heart governs sweat. Sweat stagnation forms dampness. Thus, wind dominance causes Li Jie, and damp dominance causes yellow sweat.

[Collected Annotations] Zhao Liang said: The Kidney governs water and combines with bones, so a deep pulse indicates bone disease. The Liver stores blood and combines with sinews; blood deficiency leads to a weak pulse, indicating sinew disease. The Heart governs sweat. Entering water while sweating blocks the sweat with water. Water and sweat interact, gathering into dampness, which eventually transforms into heat. The steaming of damp-heat causes yellow sweat in Li Jie.

Sour taste injures sinews; injured sinews become flaccid, termed "Xie" (leakage/relaxation). Salty taste injures bones; injured bones become atrophic, termed "Ku" (withered/dry). The interaction of Ku and Xie is termed "Duan Xie" (severance and leakage). Ying Qi becomes obstructed, Wei Qi cannot circulate independently, both Ying and Wei become deficient, the San Jiao (Triple Burner) loses control, the four extremities are severed from nourishment, and the body becomes emaciated. Only the feet swell, and the calves feel cold. If fever occurs, it is Li Jie. For Li Jie characterized by inability to flex and extend joints and pain, Wu Tou Tang (Aconite Decoction) is the primary treatment.

[Commentary] The character "Xie" in "termed Duan Xie" should be "Jue" (severance) to connect with the following text, indicating a transcription error.

[Annotation] This section elaborates on the previous paragraph, mutually expounding its meaning to clarify treatment. Li Jie disease belongs to Liver and Kidney deficiency. Internal insufficiency of Liver and Kidney fails to nourish sinews and bones externally, allowing external pathogens to invade and cause disease. The causes of this deficiency are manifold. Prolonged excessive consumption of flavors can also lead to this disease. Excessive sour flavor injures the Liver; Liver injury injures sinews; sinew injury leads to flaccidity and inability to grasp, termed "Xie." Excessive salty flavor injures the Kidney; Kidney injury injures bones; bone injury leads to atrophy and inability to stand, termed "Ku." The interaction of Ku and Xie is termed "Duan Jue" (complete severance). Severance means Ying Qi is obstructed, Wei Qi cannot circulate independently, Ying and Wei are both deficient, the San Jiao loses its foundation, the four limbs are severed, and the body is emaciated. Isolated foot swelling and cold calves indicate cold dominance stagnating below; spontaneous yellow sweat indicates damp dominance manifesting in the middle. If fever occurs, it belongs to wind, constituting Li Jie. For Li Jie with joint pain and immobility, Wu Tou Tang is used to promote Ying and Wei circulation and expel wind, cold, and damp pathogens. Honey-processing of Wu Tou (Radix Aconiti Lateralis Preparata) is a method to mitigate toxicity.

[Collected Annotations] Shen Mingzong said: *Jinkui Yaolue* supplements that internal injuries from diet affect the Spleen, Stomach, Heart, Lung, Liver, and Kidney, causing Li Jie. However, the presented pulses and symptoms arise from alcohol consumption, where internal dampness and heat attract external pathogens. This is caused by sweating after drinking and exposing oneself to wind, illustrating the principle that "where pathogen gathers, Qi is deficient." External wind combining with internal dampness, external cold with internal dampness, internal cold attracting external dampness, and internal heat attracting external dampness are critical distinctions one must understand. One must differentiate the predominance of wind, cold, and dampness and apply methods such as releasing the exterior, warming the interior, promoting Yang, tonifying deficiency, and dispersing pathogens. Therefore, treating this condition requires integrating insights from *Ling Shu*, *Su Wen*, and *Jinkui Yaolue*. Blindly using fixed prescriptions is not the work of a skilled physician.

Wu Tou Tang Formula
Mahuang (Ephedrae Herba), Shaoyao (Paeoniae Radix Alba), Huangqi (Astragali Radix) (each 3 liang), Gancao (Glycyrrhizae Radix et Rhizoma, honey-fried, 3 liang), Chuanwu (Aconiti Radix Praeparata, crushed, boiled in 2 sheng of honey until 1 sheng remains, remove Chuanwu, 5 pieces).
Take the above five herbs. Crush the first four. Boil in 3 sheng of water until 1 sheng remains. Strain. Add the honey decoction. Simmer further. Take 7 ge. If ineffective, take the entire dose.

For pain in various limb joints, emaciation of the body, swollen feet as if detached, dizziness, shortness of breath, and a feeling of nausea, Guizhi Shaoyao Zhimu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction) is the primary treatment.

[Commentary] "Wen wen" should be "Yun yun" (feeling of stifled heat/nausea).

[Annotation] The symptom of Li Jie is pain in various limb joints. "Body emaciation" refers to the severe emaciation mentioned in the previous paragraph. "Feet swollen as if detached" refers to the isolated foot swelling mentioned previously, emphasizing the severity of the edema. Dizziness and shortness of breath indicate Yang Qi deficiency. Nausea indicates excess cold pathogen. Wu Tou Tang is not used because there is no yellow sweat indicating damp dominance. Guizhi Shaoyao Zhimu Tang is used to strengthen Yang Qi and urgently dispel cold and dampness. Hence, the dosage of Guizhi (Cinnamon Twig) and Shaoyao (Peony Root) is double that of Mahuang (Ephedra) and Fangfeng (Saposhnikoviae Radix). Large doses of Baizhu (Atractylodis Macrocephalae Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata) are added. The intent is primarily to warm and circulate Yang Qi, secondarily to dispel cold and dampness. More Shengjiang (Zingiberis Rhizoma Recens) is used because of the desire to vomit. Zhimu (Anemarrhenae Rhizoma) and Gancao (Licorice Root) are added to counteract the excessive pungent and hot nature of the formula.

[Collected Annotations] Li Gao said: This Li Jie disease results from dual deficiency of Qi and Blood. Wind-dampness intermingling causes pain in all joints of the four limbs, which is Li Jie. Body emaciation indicates pathogen excess and healthy Qi decline. Feet swollen as if detached indicates Qi exhaustion below. Dizziness and shortness of breath indicate Qi deficiency above. Nausea indicates Qi rebellion in the middle. This is dual deficiency of Qi and Blood in the San Jiao. Thus, this decoction primarily dispels wind-dampness and warms Qi and Blood.

Guizhi Shaoyao Zhimu Tang Formula
Guizhi (Cinnamomi Ramulus, 4 liang), Shaoyao (Paeoniae Radix, 3 liang), Gancao (Glycyrrhizae Radix et Rhizoma, 2 liang), Mahuang (Ephedrae Herba, 2 liang), Shengjiang (Zingiberis Rhizoma Recens, 5 liang), Baizhu (Atractylodis Macrocephalae Rhizoma, 5 liang), Zhimu (Anemarrhenae Rhizoma, 4 liang), Fangfeng (Saposhnikoviae Radix, 2 liang), Fuzi (Aconiti Lateralis Radix Praeparata, fried, 2 pieces).
Take the above nine herbs. Boil in 7 sheng of water until 2 sheng remains. Take 7 ge warm, three times daily.

The Fu Yang pulse is floating and slippery. Slippery indicates substantial Gu Qi (Grain Qi/Stomach Qi); floating indicates spontaneous sweating.

[Annotation] Fu Yang is the Stomach pulse. Gu Qi refers to Stomach Qi. Floating indicates external pressure by wind; slippery indicates excess heat in the Stomach. Wind and heat steam between the muscle and cutaneous layers, causing spontaneous sweating. This elucidates that Huang Han (Yellow Sweat) can also be caused by wind-heat.

The Shao Yin pulse is floating and weak. Weakness indicates blood insufficiency; floating indicates wind. Wind and blood interact, causing pain like pulling or jerking.

[Annotation] Shao Yin is the Heart pulse; the Heart governs blood. Floating and weak Heart pulse indicates blood deficiency and wind pathogen. Wind and blood interact and contend within the meridians, causing radiating, jerking pain. This elucidates that Li Jie can also be caused by blood deficiency.

[Collected Annotations] Li Gao said: When wind is in the blood, it becomes fierce and penetrating, reaching everywhere, termed wind-blood interaction. Blood primarily nourishes sinews and bones. If wind dries it, blood is further depleted, and sinews and bones lose their nourishment, causing jerking pain. Ancients said: To treat wind, first nourish blood; when blood is generated, wind extinguishes itself. This is the treatment principle.

In robust individuals, the pulse is choppy and small, accompanied by shortness of breath and spontaneous sweating. Li Jie pain prevents flexion and extension. This is all caused by sweating after drinking and exposing oneself to wind.

[Annotation] Robust individuals should have a strong pulse, not choppy and small; they should have long breath, not shortness of breath. Here, the robust individual has a choppy and small pulse and shortness of breath, indicating a mismatch between form, Qi, pulse, and respiration. Examining the symptoms: spontaneous sweating, Li Jie pain with immobility. Asking the cause: it resulted from sweating after drinking and exposure to wind. This further elucidates that Li Jie has multiple etiologies.

[Collected Annotations] Xu Bin said: "Sheng ren" refers to obese people. Obese people have much dampness. A choppy and small pulse is a sign of Bi syndrome. Qi is obstructed by dampness, causing shortness of breath. Wind acts as an agent, causing spontaneous sweating. Qi and Blood are bi-zhou (obstructed) by pathogens, causing pain and immobility. Although obese people are prone to dampness, why is the pulse suddenly choppy and small? Is it not due to alcohol-dampness confinement? Why does pain worsen and sweating persist? Is it not dampness combined with wind? Although pulses and symptoms differ, the role of wind is consistent. Hence, it is stated: "This is all caused by sweating after drinking and exposure to wind."