偏枯之风，以四方之位定八风之寒热，伤寒之风，以四时之序分六气之寒热者绝然不同
。盖八风之寒热，不拘四时皆有也。夫八方之风，其几微渺，非神圣不能察识。如黄帝明堂
一篇，后来诸家俱茫然，不知其所指，又安能察识八风哉？吾辈虽不能审之于未形，未尝不
可辨之于已着，则当据初起之症为断。如风之变乎常者∶从东来，则面必青，舌必紫，甚者
舌卷囊缩，筋必惕（惕者，动也。俗言肉跳），目珠多斜转。从南来，则面必赤，舌必焦，甚
者生芒刺，肌必热，目之白珠必有红处。从西来，则面必白，舌必燥，甚者如白霜、积粉，皮
必粟起（谓毛发竖立也），目珠多上视翻白。从北来，则面必紫，舌必黑，甚者裂缝，息必鼾
（如寐者呼吸有声，俗言寒睡也），目之白珠必有黑处。从中央来（此四维合并者也），则面必
黄，舌必黄黑，甚者多涎垢，肌必潮湿粘手，目之白珠必黄。其东南、西南、东北、西北来者
，各以其方之法为断。
以上诸症，但见一二症便是，不必悉具也。此皆从所受之风而定其寒热也。
（初起时所必有者，凡七症。或有或无者，凡十七症）
初起猝发，必昏不知人。
必有痰涎壅盛。痰涎即人身津液，本随卫气布一身者也。风伤卫，则不能行津布液，于
是津液皆随宗气迸居膈中，与呼吸之气相上下，故壅于喉间也。凡风之寒者有之（此宜温），
即风之热者亦有之（此宜凉）。俗医多用热药开痰者，非也。（笏）尝治此症，投以大凉剂立开。
必有皮肤发亮。八风虽有寒热之不同，然总为阳邪。以阳邪而动卫阳，两阳相合，故发
亮。
必有短气。卫气不能行津布液，则津液皆聚膈中，而宗气之呼吸为之不利，故短气。
必有自汗。风为阳邪，不闭腠理，故自汗。汗即卫气所布之液也，风邪伤卫，不能约束
皮毛，汗孔空，故汗自出（亦有无汗者，热甚也）。
必有半身不动（详论八风）。
必有体重。两边卫气皆用则身轻，有一边不用则身重。
以上七症，初起时所必有者也。若无以上诸症，则非中风矣。
或语言蹇涩，或喑不能言。少阴为卫气出入门户，其脉上贯膈，络会厌穴（此发声之地
，如笙之有簧也），萦于舌本，卫为风所伤，重则喑不能言，轻则蹇涩。
或大便自遗，或大便燥结。卫气间行于腑者，为三焦原气，伤重则不能约束，故自遗，
伤轻则不能传送，故闭结。常见有仅闭一二日，而大便干燥如石者，此热胜也。有闭至二十
余日
或小便遗溺，或小便癃闭。卫气唯下焦为盛，其间行于腑者为三焦，然必先从膀胱起，
故《内经》以三焦与膀胱并称。膀胱有出窍，而无入窍，凡三焦水液之注入膀胱，全凭下焦
卫气蒸渗而入，乃从小便而出。若风伤卫，则卫外之卫气（即行于经络者）皆迸入膀胱。渗
利太过，则为遗溺；不能渗利，则为癃闭。俗书谓遗溺为肾绝者，非也。尝见有遗溺而仍愈
者矣。凡小便中久澄之而有如膏发粉者，乃下焦有热，蒸铄水液，有如煎膏者然。故初出甚
清，澄久则稠。盖初出尚热，如膏之热则不凝也。澄久则冷，如膏之冷则必凝也。不可认此
为虚寒（小孩小便初出清澄，久变色如白浆，亦此义。以小孩纯阳，下焦多热也。书指为寒
，则误
或阳事暴举。卫出下焦，即肾间动气。卫之在外者，虽为风伤，而在下焦者，反郁闭不
泄，故暴举。尝见有中风偏枯之后，反连生数子者矣。然其偏枯犹不愈者，以卫气不能行于
表也。
或阳事痿弱。此因在外卫阳已伤，挹取其下焦卫气，外泄则肾间动气不强，然其偏枯转
易愈者。昔一友患此，竟不药而偏枯愈，愈后半年，阳事复强。可知此症当缓，以俟其生发
，不可用热药损筋。
或心悸善忘。悸，即怔忡也。卫不行津，则津停为水，水停胸下，则令人悸（详《内经
》）。
或智虑多疑。卫阳伤，则不能取决，其神不足故也。
或嗳气不食。此非不食，乃腹中不甚饥耳。卫伤一边，则三焦气化不速，不能消水谷也
。
或消谷善饥。此惟风淫于内者有之，《内经》所谓风能消谷也。昔一友患此，治以咸寒
之药，一日而偏枯 僻皆愈。
或心烦不寐。卫气浮于外，与风相合，不得行于阴，则目为之不瞑（详《内经》）。
或贪眠嗜卧。此惟风入少阴者有之，仲师曰∶少阴之为病，但欲寐。
或呵欠不止。一边已伤之卫气不行于阳，但欲入于阴，一边未伤之卫气能行于阳，阳引
而上，阴引而下，阴阳相引，故呵欠。此症最多。
或头痛如箍。此邪风盛于三阳阳经也。三阳之脉皆上行于头，风性上僭，故头痛。
或背反如折。此邪风盛于太阳、督脉、阳跷也。此三脉行于背，风邪入之，则三脉皆急
。背
搦（即抽掣。中风之搐搦只一边动）。此症较重，乃风邪兼入营分，故兼见此症。专在卫分者
，无此症也。
以上十七症，初起时或有或无者也。
凡所必有之症，乃偏枯中风之本症，无此则非矣。或有或无之症，乃因其人受邪有轻重
，经络有虚实。人之形体起居不同，故病情亦有不同也。此皆从其初起而言之耳。若夫缠延
日久，则人情百变，病情亦百变，虽大禹神圣，亦不能铸鼎象物，穷尽怪相也。然可愈、不
可愈，尚可以约略言之，今并附数则于下。
一、偏枯日久，以致骨节之间、肌肤之内，渐生痰涎，外见浮肿者，难愈。人身生气寄
于津液，亦犹天地生气寄于水也。凡天下之无形而有形者，皆水也。《易》曰∶天一生水。试
看
体必瘦。若津液停而为痰涎，注于肢节、肌肤之间，则必始瘦而后肿。《内经》谓∶风气客
于诸经之络，迫切而为沫。又谓∶沃沫聚之则极，肌肤而为肿者是也。沃沫即痰涎也。俗书
不知此理，或指为寒湿，或指为脾虚，误矣。殊不知此症多生于热，譬如以水擦手，热则生
泡，以火炙肌，亦生水泡。可知热从风生，沃沫微聚亦如水泡而已。此因日久，卫气大耗，
一时难于复旧，故难愈。若无此，则易矣。
一、偏枯日久，手足拘挛，不能屈伸者，难愈。《内经》曰∶阳气者，精则养神，柔则
养筋。筋虽为血所养，必得卫气以温之，而后舒卷自如。《难经》谓∶血主濡之，气主煦之
。若日久，卫衰营血耗，无以养筋，是由气分而累及血分，由浅入深，故难治。
一、偏枯日久，脉见沉细数急者，难治。凡中风之脉，必浮大而缓。考之《灵》、《素
》、
独见四时平脉者，有变见迟脉者，皆属易愈。惟变成沉细数急者，最为难愈。所以然者，以
其病已分入血分也。沉主血分，细为血少，数急为有气无血。盖脉本宗气，领营血而行，宗
气无形而悍急，营血有形而迟缓，二者相配，而后脉均。若无血，则宗气独行，故数急也。
血不足以充之，故细也。一见此脉，便是营血已伤，故难愈。凡病已入营者，为重也。
以上皆节取大概言之，尚有风痱、风懿、风痹等名，未能详及。然而中风诸义，则已括
尽无遗矣。其左瘫右痪等名目，皆立自后人，徒有其名，羌无实义。夫营卫行度，经络浅深
，《灵》、《素》、仲师皆言之甚详，后人不知，此处探求，辄暗中摸索。或谓中风为虚，或谓
为火，或谓为痰，或谓为气，或谓为风、痰、气三者并合，或谓风、痰、火诸邪夹发，究不
能得病源实在。更有以中魔、中暑、中毒，一切混杂邪病，而分为类中、直中者，此皆源流
不
偏枯（半身不遂）这类中风病，通过八个方位的风来确定八风的寒热性质；而伤寒类疾病，则是按照四季的顺序来区分六气的寒热，这两者截然不同。大概八风的寒热属性，并不局限于特定的季节出现。八方之风，其征兆细微渺茫，除非是具备神圣智慧的人，否则无法察觉识别。像黄帝《明堂》一篇中所述的内容，后来的各家医家都感到茫然，不知道它所指的具体含义，又怎么能去察识八风呢？我们虽然不能在病症未显现时进行审视，但并非不能在病症已经明显时加以辨别，因此应当根据初起时的症状来进行判断。例如风邪变化异常的情况：从东方来的风，患者面色必定发青，舌色必定发紫，严重的会出现舌头卷缩、阴囊收缩，筋脉必定跳动（“惕”就是动的意思，俗称肉跳），眼珠多向一侧斜转。从南方来的风，患者面色必定发红，舌苔必定焦黄，严重的舌面生出芒刺，肌肉必定发热，眼白部分必定有红血丝。从西方来的风，患者面色必定发白，舌苔必定干燥，严重的舌苔如白霜或积粉堆积，皮肤必定起鸡皮疙瘩（指汗毛竖立），眼珠多向上看且翻白眼。从北方来的风，患者面色必定发紫，舌色必定发黑，严重的舌头出现裂缝，呼吸必定带有鼾声（像熟睡时呼吸有声，俗称“寒睡”），眼白部分必定有黑点。从中央来的风（这是四维方向合并而来的），患者面色必定发黄，舌苔必定黄黑，严重的口多涎液污垢，肌肤必定潮湿粘手，眼白部分必定发黄。从东南、西南、东北、西北方向来的风，各自依据对应方位的方法来判断。
以上各种症状，只要见到一两个即可确诊，不必全部具备。这些都是根据所感受的风邪来确定其寒热性质的。
（初起时必然出现的症状共有七种，或有或无的症状共有十七种）
初起突然发作，必定昏迷不省人事。
必定伴有痰涎壅盛。痰涎就是人身体的津液，原本随着卫气布散全身。风邪损伤卫气，导致卫气不能运行津液，于是津液都随着宗气迸聚在膈中，与呼吸之气上下相搏，所以壅塞在喉间。凡是寒性风邪导致的会有这种情况（此时适宜用温法），即使是热性风邪导致的也会有这种情况（此时适宜用凉法）。世俗医生多用热药来化痰开窍，这是错误的。（熊笏）曾经治疗这种病症，投以大凉之剂，立刻见效。
必定伴有皮肤发亮。八风虽然有寒热的不同，但总归属于阳邪。因为阳邪扰动卫阳，两阳相合，所以皮肤发亮。
必定伴有短气。卫气不能运行津液，津液便聚集在膈中，导致宗气的呼吸不畅利，所以出现短气。
必定伴有自汗。风为阳邪，不会闭塞腠理，所以自汗。汗就是卫气所布散的津液，风邪损伤卫气，不能约束皮毛，汗孔空虚，所以汗自然流出（也有不出汗的，是因为热邪极盛）。
必定伴有半身不动（详细论述见八风章节）。
必定伴有身体沉重。如果两边卫气都能发挥作用，身体就轻健；如果有一边卫气不起作用，身体就会沉重。
以上七种症状，是初起时必然存在的。如果没有以上这些症状，那就不是中风了。
或者语言蹇涩，或者失音不能说话。少阴经是卫气出入的门户，其经脉上行穿过膈，联络会厌穴（这是发声的地方，就像笙中有簧片一样），环绕舌根，卫气被风邪所伤，重则失音不能说话，轻则语言蹇涩。
或者大便失禁，或者大便燥结。卫气间行于腑脏的部分称为三焦原气，损伤重则不能约束，所以大便失禁；损伤轻则不能传送糟粕，所以便秘闭结。常见有人仅仅便秘一两天，大便却干燥如石头，这是热邪胜的表现。有的人便秘长达二十多天。
或者小便失禁，或者小便癃闭（排尿困难）。卫气在下焦最为旺盛，其中间行于腑脏的是三焦，然而必须先从膀胱开始，所以《内经》将三焦与膀胱并称。膀胱只有出窍（尿道口），没有入窍，凡三焦水液注入膀胱，全凭下焦卫气的蒸腾渗透作用进入，然后从小便排出。如果风邪损伤卫气，那么体表的卫气（即行于经络的卫气）都会迸入膀胱。如果渗利太过，就会导致小便失禁；如果不能渗利，就会导致癃闭。世俗书籍说小便失禁是肾气绝的表现，这是错误的。我曾经见过有小便失禁但仍然痊愈的案例。凡是小便中久置沉淀后有像膏状或头发粉末样的东西，这是下焦有热，蒸灼水液，就像熬膏一样。所以刚排出的时候很清，久置沉淀后变稠。这是因为刚排出时还热，像膏状物热的时候就不会凝固；久置后变冷，像膏状物冷的时候就会凝固。不可将此误认为是虚寒（小孩小便刚排出时清澄，久置后变色如白浆，也是这个道理。因为小孩纯阳，下焦多热。书籍将其指为寒证，就错了）。
或者性功能突然勃起。卫气出于下焦，也就是肾间的动气。卫气在体外的部分，虽然被风邪所伤，但在下焦的部分反而郁闭不能泄出，所以性功能突然勃起。我曾经见过中风偏枯之后，反而连续生育几个孩子的案例。然而他的偏枯仍然没有痊愈，是因为卫气不能行于体表。
或者性功能痿弱。这是因为在外的卫阳已经受伤，汲取了下焦的卫气，外泄导致肾间动气不强，但是他的偏枯反而容易痊愈。以前有一位朋友患此症，竟然不吃药而偏枯痊愈，痊愈后半年，性功能恢复强劲。可知这种病症应当缓治，以等待其生机生发，不可用热药损伤筋脉。
或者心悸、容易遗忘。悸，就是怔忡。卫气不行津液，津液停滞变成水饮，水饮停聚胸下，就会让人心悸（详见《内经》）。
或者思虑多疑。卫阳受伤，就不能决断，这是因为神气不足的缘故。
或者嗳气、不想吃东西。这并不是真的不想吃，而是腹中不是很饿罢了。卫气在一侧受伤，导致三焦气化不迅速，不能消化水谷。
或者消谷善饥（吃得多饿得快）。这只有在风邪淫溢于体内的情况下才会出现，《内经》所谓“风能消谷”。以前有一位朋友患此症，用咸寒药物治疗，一天之内偏枯和肢体歪斜都痊愈了。
或者心烦、不能入睡。卫气浮越于外，与风邪相合，不能行于阴分，所以眼睛不能闭合（详见《内经》）。
或者贪睡嗜卧。这只有在风邪侵入少阴经的情况下才会出现，张仲景说：“少阴病的表现，就是只想睡觉。”
或者呵欠不止。一边受伤的卫气不能行于阳分，只想要进入阴分；另一边未受伤的卫气能行于阳分，阳气牵引向上，阴气牵引向下，阴阳相互牵引，所以呵欠。这种症状最多见。
或者头痛像被箍住一样。这是邪风盛于三阳阳经所致。三阳经脉都上行于头部，风性上僭（向上冲逆），所以头痛。
或者背部反折像折断一样。这是邪风盛于太阳经、督脉、阳跷脉所致。这三条经脉行于背部，风邪侵入它们，导致这三条经脉都拘急。
或者抽搐掣引（即抽掣。中风的抽搐只有一侧活动）。这种症状较重，是风邪兼入营分，所以兼见此症。只在卫分的，没有这个症状。
以上十七种症状，是初起时或有或无的。
凡是必然存在的症状，是偏枯中风的本症，没有这些就不是中风。或有或无的症状，是因为个人受邪有轻重，经络有虚实。人的形体起居不同，所以病情也有不同。这都是从初起时来说的。至于缠绵日久，那么人情万变，病情也万变，即使是像大禹那样神圣的人，也不能铸鼎象物，穷尽所有怪异的现象。然而可愈与不可愈，还可以大致说明，现在一并附上几条在下面。
第一，偏枯日久，导致骨节之间、肌肤之内，逐渐产生痰涎，外表出现浮肿的，难以痊愈。人身上的生气寄托于津液，也如同天地的生气寄托于水一样。天下所有无形而有形的物质，都是水。《易经》说：“天一生水。”试看人体，必定先消瘦。如果津液停滞变成痰涎，注流于肢节、肌肤之间，那么必定是先瘦而后肿。《内经》说：“风气客于诸经之络，迫切而为沫。”又说：“沃沫聚之则极，肌肤而为肿者是也。”沃沫就是痰涎。世俗书籍不懂这个道理，有的指为寒湿，有的指为脾虚，都错了。殊不知这种病症多生于热，譬如用水擦手，热则生泡，用火炙烤肌肤，也会生水泡。可知热从风而生，沃沫微聚也像水泡一样。这是因为日久，卫气大量耗损，一时难以恢复旧观，所以难愈。如果没有这种情况，就容易治愈了。
第二，偏枯日久，手足拘挛，不能屈伸的，难以痊愈。《内经》说：“阳气者，精则养神，柔则养筋。”筋虽然由血滋养，但必须得到卫气的温煦，才能舒卷自如。《难经》说：“血主濡之，气主煦之。”如果日久，卫气衰弱，营血耗损，无以养筋，这是由气分累及血分，由浅入深，所以难治。
第三，偏枯日久，脉象出现沉细数急的，难治。凡是中风的脉象，必定浮大而缓。考证《灵枢》、《素问》，单独见到四时平脉的，有变为迟脉的，都属于易愈。唯独变成沉细数急的，最为难愈。之所以这样，是因为病已深入血分。沉主血分，细为血少，数急为有气无血。脉本源于宗气，统领营血而行，宗气无形而悍急，营血有形而迟缓，二者相配，脉象才均匀。如果没有血，宗气独行，所以脉数急。血不足以充盈脉道，所以脉细。一见这种脉象，就是营血已伤，所以难愈。凡是病已入营的，属于重症。
以上都是节取大概而言，还有风痱、风懿、风痹等名称，未能详细涉及。然而中风的诸般义理，已经概括无遗了。像左瘫右痪等名目，都是后人设立的，徒有其名，毫无实义。关于营卫的运行度数和经络的浅深，《灵枢》、《素问》以及张仲景都讲得很详细，后人不知，在这里探求，往往暗中摸索。有人说中风是虚证，有人说中风是火证，有人说中风是痰证，有人说中风是气证，有人说中风是风、痰、气三者并合，有人说中风是风、痰、火诸邪夹发，终究不能得到病源的实际情况。更有将中魔、中暑、中毒等一切混杂的邪病，分为类中和直中的，这都是源流不清……
Hemiplegia (hemiplegic stroke), a type of wind-stroke, determines the cold and heat nature of the eight winds based on the positions of the four directions; whereas diseases of cold damage distinguish the cold and heat nature of the six qi according to the sequence of the four seasons. These two are completely different. Generally, the cold and heat nature of the eight winds is not restricted to specific seasons. The winds from the eight directions have subtle and elusive signs; only those with divine wisdom can perceive and identify them. For instance, in Huangdi's "Mingtang" chapter, later medical scholars were all at a loss, unaware of its specific reference, so how could they possibly identify the eight winds? Although we cannot examine the condition before it manifests, we can certainly differentiate it once symptoms are obvious. Therefore, judgment should be made based on the initial symptoms. For example, regarding abnormal wind variations: Wind coming from the East will cause the face to turn green and the tongue purple; in severe cases, the tongue may curl up and the scrotum retract, muscles will twitch ("Ti" means movement, commonly known as muscle jumping), and the eyeballs often deviate to one side. Wind from the South will cause the face to turn red and the tongue coating to become scorched yellow; in severe cases, prickles may form on the tongue, muscles will feel hot, and the whites of the eyes will show redness. Wind from the West will cause the face to turn white and the tongue coating to become dry; in severe cases, the coating may resemble white frost or accumulated powder, the skin will raise goosebumps (indicating hair standing erect), and the eyeballs will often look upward with rolled-back whites. Wind from the North will cause the face to turn purple and the tongue to turn black; in severe cases, cracks may appear on the tongue, breathing will be accompanied by snoring sounds (resembling breathing sounds during sleep, commonly called "cold sleep"), and the whites of the eyes will show dark spots. Wind from the Center (which merges the four diagonal directions) will cause the face to turn yellow and the tongue coating to be yellow-black; in severe cases, there will be excessive saliva and dirt, the skin will feel moist and sticky, and the whites of the eyes will turn yellow. Winds coming from the Southeast, Southwest, Northeast, and Northwest are judged according to the methods corresponding to their respective directions.
Among the above symptoms, observing one or two is sufficient for diagnosis; it is not necessary for all to be present. These are all determined by the cold and heat nature of the wind pathogen received.
(There are seven symptoms that must be present at the onset, and seventeen symptoms that may or may not be present.)
At the onset, sudden coma and unconsciousness must occur.
There must be copious phlegm-rheum accumulation. Phlegm-rheum is essentially the body's fluids, which originally circulate throughout the body following Wei Qi (Defensive Qi). When wind damages Wei Qi, it fails to transport fluids, causing fluids to gather in the diaphragm along with Zong Qi (Pectoral Qi), clashing with respiratory air, thus obstructing the throat. This occurs in cold wind cases (requiring warming treatment) and also in hot wind cases (requiring cooling treatment). Secular doctors often use hot herbs to resolve phlegm, which is incorrect. I (Xiong Hu) once treated such cases with major cooling formulas, achieving immediate results.
The skin must appear shiny. Although the eight winds differ in cold and heat, they are collectively Yang pathogens. Since Yang pathogens disturb Wei Yang, the combination of two Yangs causes the skin to shine.
Shortness of breath must be present. Because Wei Qi fails to transport fluids, fluids accumulate in the diaphragm, impairing the respiration of Zong Qi, leading to shortness of breath.
Spontaneous sweating must be present. Wind is a Yang pathogen that does not close the Couli (pores), leading to spontaneous sweating. Sweat is the fluid distributed by Wei Qi; when wind damages Wei Qi, it fails to control the skin and hair follicles, leaving pores open, thus causing sweat to flow out spontaneously (there are cases without sweating due to extreme heat).
Hemiplegia (paralysis of one side) must be present (see detailed discussion on Eight Winds).
Body heaviness must be present. If Wei Qi functions on both sides, the body feels light; if it fails on one side, the body feels heavy.
These seven symptoms are necessarily present at the onset. Without these, it is not wind-stroke.
Alternatively, speech may be slurred or aphasic (inability to speak). The Shaoyin meridian is the gateway for Wei Qi entry and exit; its vessel passes through the diaphragm, connects to the Huiyan acupoint (the site of sound production, like the reed in a sheng), and wraps around the base of the tongue. When Wei Qi is damaged by wind, severe cases result in aphasia, while mild cases result in slurred speech.
Stool incontinence or fecal impaction may occur. The portion of Wei Qi circulating among the Fu organs is the Yuan Qi of the Sanjiao (Triple Burner). Severe damage leads to loss of control and incontinence; mild damage leads to inability to transport waste, resulting in constipation. It is common to see patients with only one or two days of constipation having stools as hard as stones, indicating excess heat. Some may have constipation for over twenty days.
Urinary incontinence or strangury (difficulty urinating) may occur. Wei Qi is most abundant in the Lower Jiao. The part circulating among Fu organs is the Sanjiao, but it must start from the Bladder. Thus, the *Neijing* mentions Sanjiao and Bladder together. The Bladder has an outlet but no inlet. All fluids from the Sanjiao entering the Bladder rely on the steaming and percolation of Lower Jiao Wei Qi to exit via urination. If wind damages Wei Qi, the exterior Wei Qi (circulating in meridians) floods into the Bladder. Excessive percolation causes incontinence; failure to percolate causes strangury. Secular texts claim incontinence indicates Kidney exhaustion, which is wrong. I have seen cases of incontinence that still recovered. If urine sediment resembles paste or hair powder after standing, it indicates Lower Jiao heat steaming the fluids, similar to boiling paste. Fresh urine is clear; aged urine becomes thick because fresh urine is hot (like hot paste, it doesn't coagulate), while aged urine is cold (like cold paste, it coagulates). Do not mistake this for deficiency-cold (children's urine is clear when fresh and turns milky white when aged due to pure Yang constitution and Lower Jiao heat; labeling this as cold is an error).
Sudden erection may occur. Wei Qi originates from the Lower Jiao, specifically the Moving Qi of the Kidneys. While external Wei Qi is damaged by wind, the internal Lower Jiao Wei Qi may become郁闭 (stagnant and closed), preventing release, thus causing sudden erection. I have seen cases where hemiplegia persisted, yet the patient fathered several children, because Wei Qi failed to circulate to the exterior.
Impotence may occur. This happens because external Wei Yang is damaged, drawing upon Lower Jiao Wei Qi. External leakage weakens the Moving Qi of the Kidneys, but hemiplegia is easier to cure. A friend of mine suffered from this, cured hemiplegia without medicine, and regained strong sexual function half a year later. This indicates the condition should be treated gently, waiting for vitality to regenerate, avoiding hot herbs that damage sinews.
Palpitations and forgetfulness may occur. Palpitation is Zhengchong. When Wei Qi fails to move fluids, fluids stagnate into water-dampness. Water accumulating below the chest causes palpitations (see *Neijing*).
Excessive suspicion and worry may occur. Damaged Wei Yang loses the ability to make decisions due to insufficient Shen (Spirit).
Belching and loss of appetite may occur. This is not true anorexia but rather a lack of hunger. Damage to Wei Qi on one side slows Sanjiao Qi transformation, impairing digestion of food and water.
Hyperphagia (excessive hunger) may occur. This only happens when wind invades internally, as stated in the *Neijing*: "Wind can digest grain." A friend of mine was cured of hemiplegia and deformity in one day using salty-cold herbs.
Restlessness and insomnia may occur. Wei Qi floats on the exterior and combines with wind, failing to enter Yin, causing the eyes to remain open (see *Neijing*).
Somnolence and desire to lie down may occur. This only happens when wind enters the Shaoyin meridian. Zhang Zhongjing said: "The disease of Shaoyin is characterized by a desire to sleep."
Uncontrollable yawning may occur. On the injured side, Wei Qi cannot circulate to Yang and desires to enter Yin; on the uninjured side, Wei Qi circulates to Yang. Yang pulls upward, Yin pulls downward, and the interaction of Yin and Yang causes yawning. This symptom is very common.
Headache feeling like a tight band may occur. This is due to evil wind flourishing in the Three Yang meridians. All Three Yang vessels ascend to the head, and wind tends to rise, causing headache.
Back arching like a broken bow may occur. This is due to evil wind flourishing in the Taiyang meridian, Du Mai (Governing Vessel), and Yang Qiao Mai. These three vessels run along the back; wind invasion causes spasms in all three.
Twitching and convulsions (only on one side in stroke) indicate a heavier condition where wind pathogen has entered the Ying (Nutritive) level. Pure Wei-level cases do not have this symptom.
The above seventeen symptoms are those that may or may not be present at onset.
Symptoms that must be present are the fundamental signs of hemiplegic stroke; without them, it is not stroke. Symptoms that may or may not be present depend on the severity of the pathogen and the deficiency/excess of the meridians. Differences in physique and lifestyle lead to different clinical presentations. These descriptions apply to the onset. As the disease lingers, human conditions and symptoms change infinitely; even a sage like Yu the Great could not catalog every variation. However, prognosis (curable vs. incurable) can be roughly discussed. Several cases follow.
First, if hemiplegia persists for a long time, causing phlegm-rheum to generate between bones/joints and under the skin, leading to external edema, it is difficult to cure. Vital Qi resides in fluids, just as Heaven and Earth's vital Qi resides in water. Everything formless yet taking form is water. The *I Ching* says: "Heaven generates One Water." Observe the body: it must first emaciate. If stagnant fluids turn to phlegm-rheum and deposit in joints/skin, emaciation precedes swelling. The *Neijing* states: "Wind pathogen lodging in collateral vessels compresses fluids into foam." And: "Accumulated foam reaches extremity, causing skin swelling." Foam is phlegm-rheum. Secular texts misunderstand this, attributing it to cold-damp or Spleen deficiency. In fact, this condition often arises from heat. Like rubbing hands with water creates bubbles when hot, or fire creates blisters on skin. Heat generates from wind; slight accumulation of foam is like bubbles. Due to prolonged duration, Wei Qi is greatly depleted and cannot recover quickly, making it hard to cure. Without this, it is easy to cure.
Second, if hemiplegia persists for a long time, causing contracture of hands/feet and inability to flex/extend, it is difficult to cure. The *Neijing* says: "Yang Qi nourishes the Spirit when refined, and nourishes Sinews when soft." Sinews are nourished by Blood but require Wei Qi warmth to move freely. The *Nan Jing* says: "Blood moistens, Qi warms." Prolonged illness depletes Wei Qi and Ying Blood, failing to nourish sinews. This progresses from Qi level to Blood level, shallow to deep, making it hard to treat.
Third, if hemiplegia persists for a long time, presenting with a deep, fine, rapid, and urgent pulse, it is difficult to treat. Stroke pulses are typically floating, large, and slow. Examining *Ling Shu* and *Su Wen*, seeing normal seasonal pulses or delayed pulses indicates easy recovery. Only when the pulse becomes deep, fine, rapid, and urgent is it hardest to cure. This is because the disease has entered the Blood level. Deep indicates Blood level; fine indicates Blood deficiency; rapid/urgent indicates Qi without Blood. Pulse originates from Zong Qi, leading Ying Blood. Zong Qi is formless and swift; Ying Blood is substantial and slow. They match to create a balanced pulse. Without Blood, Zong Qi moves alone, causing rapidity. Lack of Blood to fill the vessel causes fineness. Seeing this pulse means Ying Blood is damaged, hence difficult to cure. Disease entering Ying level is severe.
The above covers general principles. Other terms like Feng Fei, Feng Yi, and Feng Bi are not detailed here. However, the core theories of stroke are fully covered. Terms like left paralysis/right flaccidity were coined by later generations, lacking substantive meaning. The circulation of Ying/Wei and depth of meridians are detailed in *Ling Shu*, *Su Wen*, and Zhang Zhongjing's works. Later generations, ignorant of these, grope in the dark. Some claim stroke is deficiency, some fire, some phlegm, some Qi, some a combination of wind/phlegm/Qi, or wind/phlegm/fire. None grasp the true source. Others confuse demonic possession, heatstroke, or poisoning with stroke, classifying them as "Classified Stroke" or "Direct Strike," reflecting a confusion of origins...