大率主血虚。有痰以治痰为先，或虚挟火与湿；亦有死血留滞者，外中于风者；亦有中气者，当从痰治，
顺气化痰。若口开、手撒、眼合、遗尿、吐沫直视、喉如鼾睡、肉脱筋痛者，皆不治。
半身不遂，大率多痰。在左属死血、无血；在右属痰、有热、气虚。
病若在左者，四物汤等加桃仁、红花、竹沥、姜汁；在右者，二陈汤、四君子等加竹沥、姜汁。
痰壅盛者、口眼 斜者、不能言者，皆当吐。
吐法∶轻用瓜蒂、虾汁、皂角；重用藜芦半钱或三分，加麝香灌入鼻内或口内，吐痰出。一吐不已，再吐
之。亦有虚而不可吐者。
气虚卒倒，参 补之。
气虚有痰，浓参汤合竹沥、姜汁。
血虚，宜四物汤，俱用姜汁炒；恐泥痰，再加竹沥、姜汁入内服；能食者，去竹沥，加荆沥。
又法∶以猪牙皂角、白矾等分为末，姜汤调下，名稀涎散。
血虚者，四物汤补之。挟痰者，亦用姜汁、竹沥。
脉诀内言诸不治证，见则不可治，筋枯者不治。举动则
筋痛者，是筋枯，以其无血滋润故也。
治痰∶气实能食，用荆沥；气虚少食，用竹沥。此二味用开经络，行血气。入四物汤中，必用姜汁助之。
肥白人多湿，少用附子、乌头行经。
初昏倒，急掐人中至醒，然后用去痰药，二陈汤、四物、四君子等汤加减用。
Apoplexy is generally rooted in Blood deficiency. If Phlegm is present, treatment should prioritize resolving Phlegm; this may involve deficiency combined with Fire and Dampness; there are also cases caused by stagnant Dead Blood (stasis); or those affected by external Wind invasion; and some due to Qi disorder (Qi stagnation/reversal), which should be treated from the perspective of Phlegm, regulating Qi and resolving Phlegm. If symptoms such as an open mouth, relaxed hands, closed eyes, urinary incontinence, foaming at the mouth, fixed gaze, snoring-like phlegm rattle in the throat, muscle wasting, and tendon pain appear, these are all considered incurable.
Hemiplegia is mostly caused by Phlegm. Lesions on the left side usually indicate Dead Blood (stasis) or Blood deficiency; lesions on the right side usually indicate Phlegm, Heat, and Qi deficiency.
For lesions on the left, use Siwu Tang (Four Substances Decoction) etc., added with Taoren (Peach Kernel), Honghua (Safflower), Zhuli (Bamboo Sap), and Jiangzhi (Ginger Juice). For lesions on the right, use Erchen Tang (Two Aged Things Decoction), Sijunzi Tang (Four Gentlemen Decoction) etc., added with Zhuli (Bamboo Sap) and Jiangzhi (Ginger Juice).
For those with excessive Phlegm obstruction, facial deviation, or inability to speak, emesis (vomiting method) should be employed.
Emesis Method: Use mild agents such as Gengdi (Melon Stalk), Shazhi (Shrimp Juice), Zaojiao (Gleditsia Sinensis Fruit); for severe cases, use Lili (Veratrum Nigrum) half a qian or 3 fen, mixed with Shexiang (Musk), and instilled into the nose or mouth to induce expectoration of Phlegm. If one dose does not suffice, repeat the emesis. However, there are cases of deficiency where emesis is contraindicated.
For sudden collapse due to Qi deficiency, use Renshen (Ginseng Root) to tonify.
For Qi deficiency with Phlegm, use concentrated Renshen Tang (Ginseng Decoction) combined with Zhuli (Bamboo Sap) and Jiangzhi (Ginger Juice).
For Blood deficiency, Siwu Tang (Four Substances Decoction) is suitable, all ingredients stir-fried with Ginger Juice; to prevent cloying and generating Phlegm, add Zhuli (Bamboo Sap) and Jiangzhi (Ginger Juice) for oral administration; if the patient can eat, remove Zhuli (Bamboo Sap) and add Jingli (Acanthopanacis Trichocanthi Sap).
Another method: Mix Zhu Ya Zao Jiao (Gleditsia Sinensis Fruit) and Bai Fan (Alumen) in equal parts into powder, taken with Ginger Decoction, named Xixian San (Thin Saliva Powder).
For Blood deficiency, tonify with Siwu Tang (Four Substances Decoction). For cases complicated by Phlegm, also use Jiangzhi (Ginger Juice) and Zhuli (Bamboo Sap).
The Mai Jue (Pulse Classic) mentions various incurable conditions; if seen, they are untreatable, such as Withered Tendons. Pain in tendons upon movement indicates Withered Tendons, due to the lack of Blood nourishment.
Treating Phlegm: For excess Qi with good appetite, use Jingli (Acanthopanacis Trichocanthi Sap); for deficient Qi with poor appetite, use Zhuli (Bamboo Sap). These two substances open meridians and promote the circulation of Blood and Qi. When added to Siwu Tang (Four Substances Decoction), Ginger Juice must be used to assist.
Individuals who are fat and pale often have Dampness; use Fuzi (Prepared Aconite Lateral Root) and Wu Tou (Aconitum Carmandii Root) sparingly to unblock meridians.
In initial sudden collapse, urgently pinch Renzhong (GV26) until consciousness returns, then administer Phlegm-resolving medicines, using modified formulas such as Erchen Tang (Two Aged Things Decoction), Siwu Tang (Four Substances Decoction), and Sijunzi Tang (Four Gentlemen Decoction).