Library

Apoplexy (Zhong Feng) is the first major disease among humans, yet *Jingui Yaolue* (Essential Prescriptions from the Golden Cabinet) discusses it very briefly. I initially also blamed Zhang Zhongjing for being too cursory. Upon careful examination of its principles, one realizes that the methods of observing the pulse and assessing symptoms, as well as applying treatment, have already grasped the main points without omission. Later generations discussing apoplexy divided it into stroke affecting the meridians (Zhong Jing) and stroke affecting the viscera (Zhong Fu), categorizing symptoms such as deviation of the mouth and eyes (Kou Yan Wa Xie), drooling and foaming at the mouth (Liu Xian Tu Mo), hemiplegia (Pian Ku Bu Sui), spasticity of the four limbs (Si Zhi Ju Ji), flaccid paralysis (Wei Ruan Tan Huan), and panting respiration (Hu Xi Chuan Cu) collectively as signs of apoplexy affecting the viscera, without distinguishing between Yin deficiency and Yang deficiency or excess and deficiency. Formulas such as Da Qin Jiao Tang (Great Sophora Root Decoction), Pai Feng Tang (Expel Wind Decoction), Ba Feng Tang (Eight Winds Decoction), and Xu Ming Tang (Continue Life Decoction) were collectively listed as treatments for apoplexy, also without distinguishing between Yin/Yang or excess/deficiency. Liu Hejian attributed it to Fire (Huo), Li Dongyuan to Qi deficiency (Qi Xu), and Zhu Danxi to damp-heat generating phlegm (Shi Re Sheng Tan); none distinguished between Yin deficiency and Yang deficiency; the formulas they established ultimately did not go beyond the scope of Xiao Xu Ming Tang (Minor Continue Life Decoction). Wang Jiezhai was the first to expound on the theory of Yin deficiency, and Ye Tianshi was the first to emphasize the treatment of Yin deficiency, washing away the previous habit of using acrid-warm and drying herbs, yet they omitted the aspect of Yang deficiency. Later, upon quietly studying *Jingui Yaolue*, I found that "pulse slow and tight" indicates a cold syndrome of Yang deficiency, associated with symptoms like deviation of the mouth and eyes, spasticity of the four limbs, and foaming at the mouth; "pulse slow and moderate" indicates a heat syndrome of Yin deficiency, associated with symptoms like insufficiency of Heart Qi (Xin Qi Bu Zu), chest fullness and shortness of breath, and flaccidity with inability to control movement. Huang Lian Xie Xin Tang (Coptis Decoction to Drain the Heart) treats vomiting blood due to insufficiency of Heart Qi, sharing the same principle. What predecessors called "True Apoplexy" (Zhen Zhong Feng) caused by excessive pathogenic factors refers to syndromes in the section on Yang deficiency with cold; what they called "Similar Apoplexy" (Lei Zhong Feng) caused by righteous Qi deficiency refers to syndromes in the section on Yin deficiency generating dryness. Thus, we know that Yin deficiency and Yang deficiency are the two key aspects of apoplexy, and the distinction between True and Similar is unnecessary to debate minutely. Why? The root of both syndromes lies in severe deficiency of Righteous Qi (Zheng Qi), where the power of transformation and transportation loses autonomy, suddenly disrupted by the ascending-descending, condensing-dispersing Qi of the seasons, thereby losing its normal rhythm. Those with Yang deficiency, encountering cold weather, find their Yang Qi unable to withstand the condensing and inhibiting influence of Heaven's Qi, so they often fall ill in autumn and winter; those with Yin deficiency, encountering warm weather, find their Yin Qi unable to withstand the dispersing and ascending influence of Heaven's Qi, so they often fall ill in spring and summer. Those with cold pathogens have internal Qi knotting, presenting external contraction-like phenomena, leading the world to consider them True Apoplexy; those with warm pathogens have external Qi leakage, presenting internal deficiency-like phenomena, leading the world to consider them Similar Apoplexy. The method of treatment: if deficiency is slight or severe, the weight of medication varies accordingly, which needs no further explanation. What particularly requires differentiation is that Yang deficiency can involve either Yin excess or non-excess of Yin; Yin deficiency can involve either Yang excess or non-excess of Yang. Yin excess manifests as cold, treated with heavy hot herbs; non-excess of Yin manifests as cold-dryness, treated with warm-moistening herbs; Yang excess manifests as dry-heat, treated with cool-moistening herbs; non-excess of Yang manifests as deficiency-dryness, also treated with warm-moistening herbs. Generally, treating Yang deficiency involves utilizing the "Qi" (aroma/volatile nature) of herbs, emphasizing the Acrid (Xin) flavor; treating Yin deficiency involves utilizing the "Flavor" (substance/taste) of herbs, emphasizing the Sour (Suan) flavor. Furthermore, one must always heavily assist with Blood-invigorating (Huo Xue) methods. Why? In Yang deficiency, Blood inevitably stagnates; without this, the mechanism cannot be activated; in Yin deficiency, Blood inevitably becomes stagnant; without this, the pathways cannot be unblocked. Some ask: If Qi is already deficient, why invigorate Blood? Will it not cause Qi collapse? I reply: By securing Qi, collapse will not occur. Moreover, invigorating Blood serves to unblock the joints/mechanisms, clearing the path for returning Qi. Western medicine posits that patients with this condition have water in the brain or dead blood. They do not understand that "water" results from Yang decline causing Water Qi to overwhelm, and "dead blood" results from Yin deficiency causing Blood to boil and rush recklessly; both stem from a sudden chaos of Middle Qi (Zhong Qi) agitating upwards to the brain. In ancient times, so-called True Apoplexy was definitely caused by contracting abnormal winds, suddenly injuring Brain Qi, leading to collapse; if delayed slightly, it would internally damage the Five Viscera (Wu Zang) and become incurable. Such syndromes were rare, so Zhang Zhongjing did not discuss them. Moxibustion methods appear in Hua Tuo's *Zhongzang Jing* (Classic of Internal Viscera) and Chao Yuanfang's *Zhubing Yuanhou Lun* (General Treatise on the Origins and Symptoms of All Diseases), which should be studied together.