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Zhang Huan and others included discussions on stroke in their medical formulas. However, I have observed that infants and children rarely suffer from this disease. The medications used at the time often involved aromatic and drying substances, which might generate wind from blood heat or present as symptoms resembling stroke. Misusing these remedies would cause significant harm; therefore, I have omitted all such content and do not record it here. Xue Ji stated: True stroke occurs mainly in the northwest regions. In the southeast, where the climate is warm, the cou li (skin pores) are loose and prone to sweating. People there suffer from conditions resembling stroke rather than true stroke. Moreover, children's primordial qi (Yuan Qi) is not yet fully developed, and their skin and hair are not solid. Their condition easily shifts from deficiency to excess or vice versa. When external pathogens invade, they may experience high fever, convulsive twitching, coarse breathing, and surging phlegm-saliva. In severe cases, they may become comatose with locked jaws, appearing similar to stroke. If mistakenly treated with decoctions like Xuming Tang (Minor Continue Life Decoction), death is often the result. Even adults rarely suffer from true stroke, let alone children. For any of the aforementioned symptoms, one must differentiate the etiology. If it is due to deficiency of qi in the Yangming channel, allowing wind pathogens to invade and causing stiffness and tension of the tendons and vessels, it is classified as an external cause. If it is due to blazing fire of the Foot Jueyin Liver channel, causing unilateral stiffness and tension of the tendons and vessels, it is classified as an internal cause. If it is due to weakness of the Spleen and Lung, with loose cou li allowing external pathogens to enter, or if excessive use of mineral medicines during convulsions damages Liver blood, or if vomiting and diarrhea lead to loss of body fluids that can no longer nourish the Liver, resulting in deviation of the mouth and eyes, all these belong to the category of conditions resembling stroke caused by insufficient Liver blood and wind generated by Liver fire.

Qian Yi stated: When the Liver has wind, in severe cases, the body becomes arched backward and rigid without convulsions. If the Heart is not affected by heat, one should tonify the Kidney and treat the Liver. Tonifying the Kidney uses Dihuang Wan (Rehmannia Pill); treating the Liver uses Xieqing Wan (Drain the Green Pill). Zhu Danxi stated: Spasm (Jing) is more deficient than epilepsy (Xian) and treatment should include tonification. It is mostly due to qi deficiency with fire and phlegm, treated with Ren Shen (Ginseng Root) and Zhuli (Bamboo Sap), avoiding wind-dispelling herbs. This theory truly elucidated insights previously unexplored by earlier scholars. Although Tang Shi claimed that ten out of ten cases of spasm were fatal, it was likely because this method had not been applied clinically. Xue Ji added: Qian Zhongyang (Qian Yi) stated that opisthotonos (arched back) is caused by wind pathogens lodging in the Taiyang channel. The Classic says: Wind enters from above. The Foot-Taiyang Bladder channel governs the qi of the whole body; its vessel originates from the inner canthus and runs along the back. Since the Liver belongs to Wood and governs wind, wind pathogens easily invade. Children's skin and flesh are not dense, making them susceptible to external pathogens. The Liver contains ministerial fire, and anger easily triggers Liver fire. If the body arches backward and becomes rigid with fever but no convulsions, it is wind injuring the Taiyang channel, suitable for treatment with Renshen Qianghuo San (Ginseng and Notopterygium Powder) or Xiao Xuming Tang (Minor Continue Life Decoction). If triggered by sudden rage stirring up Liver fire, Xieqing Wan (Drain the Green Pill) is suitable. If symptoms worsen after taking the former prescriptions, it indicates that the pathogen has departed but Spleen qi is deficient; Yigong San (Extraordinary Efficacy Powder) plus Chuanxiong (Szechwan Lovage Rhizome) and Danggui (Chinese Angelica Root) should be used to tonify. If due to deficiency-heat in the Liver channel, or if attacking true qi generates deficiency-heat and wind, Yigong San and Dihuang Wan should be used to tonify. If diarrhea leads to exhaustion of Spleen qi and abdominal distension, this is damage to Middle Qi, suitable for Baizhu San (Atractylodes Macrocephala Powder). If the person is constitutionally weak in qi and blood, or after taking attacking agents, exhibits grasping at clothing collars, grinding teeth, and yawning, it indicates extreme deficiency of the Liver channel; Dihuang Wan should be urgently administered to tonify, referring also to discussions on the Liver organ.

One child suddenly presented with opisthotonos, upward gaze, and a cyanotic-red complexion. I said cyanosis belongs to the Liver and governs wind, while redness belongs to the Heart and governs fire; this is wind and fire clashing. Using Chaihu Zhizi San (Bupleurum and Gardenia Powder) with doubled Gouteng (Uncaria Ramulus), taken in one dose, brought immediate relief, but phlegm remained; subsequently, Baolong Wan (Embrace Dragon Pill) cured the condition. Another child suddenly presented with opisthotonos, recurring intermittently after taking anti-convulsant medicines, with a yellowish-white complexion and extreme limb fatigue. I used Wuyi Yigong San (Five-Agent Extraordinary Efficacy Powder) for over ten doses, resulting in recovery. Later, due to fright and irregular diet, symptoms recurred intermittently; using the previous prescription led to recovery. Thus, daily administration of powdered Renshen (Ginseng Root) and Baizhu (Atractylodes Macrocephala Rhizome), 5-7 fen per dose, mixed with decoction of Paojiang (Prepared Ginger) and Dazao (Jujube Fruit), resulted in cessation of symptoms after two liang were consumed. Both cases above involved deficiency of primordial qi and excess of pathogenic qi; using attacking herbs would have been erroneous.

Another child, suffering from the aforementioned condition with abundant phlegm, had a pale white complexion with a bluish tint. I reasoned that Lung qi failed to control Liver wood, Liver qi attacked Spleen earth, and Spleen deficiency generated phlegm. Initially, two doses of Baolong Wan (Embrace Dragon Pill) were used to calm the Liver, followed by Liujunzi Tang (Six Gentlemen Decoction) to tonify the Spleen and Lung, leading to recovery after more than a month. Six months later, it relapsed. I believed that only by purging phlegm could full recovery be achieved, so I used a purgative formula. Abundant phlegm-saliva was expelled, accompanied by a sawing sound in the throat. I stated this was due to the Spleen's inability to control saliva, and the throat noise indicated extreme Lung qi deficiency. I prescribed Renshen (Ginseng Root) 5 qian and Paojiang (Prepared Ginger) 3 fen, decocted in water. The child regained consciousness. After the fourth dose, two Zao (Jujube Fruit) were added. Consuming several liang of Renshen led to complete recovery. Subsequent episodes did not respond to Dushen Tang (Single Ginseng Decoction); adhering to standard formulas would rarely avoid error.

Renshen Qianghuo San (see Convulsions chapter); Xiao Xuming Tang (see Miscellaneous Diseases Stroke chapter); Xieqing Wan (see Liver chapter); Yigong San (see Vomiting and Diarrhea chapter); Chaihu Zhizi San (see Accumulated Heat chapter); Baolong Wan (see Convulsions chapter); Liujunzi Tang (see Vomiting and Diarrhea chapter).