Synopsis of the Golden Chamber, Volume 1

Chapter 5: Stroke, Li-Jie Disease, Pulse Signs and Treatments — Plain-Language Translation

Overall Interpretation

This chapter discusses two categories of disease: first, stroke (zhòng fēng), primarily referring to wind-evil invasion manifesting as hemiplegia, facial distortion with deviated mouth and eyes, and mental disturbances; second, li-jie disease (calendar-joint disease), referring to joints being eroded one by one with pain, swelling, and difficulty in flexion and extension.

General Discussion of Stroke with Pulse Signs

The ancients held that when wind-evil injures the human body, the typical manifestation is hemiplegia (inability to move one side of the body voluntarily). If only a single arm is affected, it mostly belongs to bi syndrome (impediment). A pulse that is faint and rapid indicates stroke caused by wind. The cunkou pulse being floating and tight: tightness indicates cold, floating indicates deficiency. When cold-evil and upright deficiency contend, the pathogen settles in the skin and superficial muscles. The floating pulse also indicates blood deficiency and emptiness of the collaterals (fine pathways). The external pathogen cannot be discharged and invades either the left or right side. The side where the pathogen lodges becomes flaccid, while the side where upright qi is relatively un-deficient becomes tense and contracts, pulling toward the affected side — hence the appearance of facial deviation and hemiplegia.

Pathogen location progresses from shallow to deep: when the pathogen is in the collaterals, the skin and muscles become numb; when in the main channels, the limbs feel heavy and difficult to lift; when it enters the six bowels, consciousness becomes clouded and the person fails to recognize others; when it enters the five viscera, the tongue becomes stiff with difficulty speaking, and drooling occurs. This is the model of progressive deepening in stroke.

Another pulse pattern: the cunkou pulse is slow and relaxed. Slowness indicates cold; relaxation indicates deficiency. Relaxation-weakness in the nutritive (ying) level suggests blood loss; relaxation-weakness in the defensive (wei) level suggests wind strike. When wind-evil strikes the channels, skin itching and yinzhen (urticaria-like rash) may appear. If heart qi is insufficient and pathogen enters internally, there will be chest oppression and shortness of breath.

Formulas Recorded (At the Textual Level)

• Hou's Black Powder: Recorded by the ancients for "great wind," manifesting as heaviness and vexation of the four limbs, with aversion to cold and deficiency sensation in the chest and heart. The Waitai Miyao also records its use for wind-epilepsy. Ingredients include Dried Chrysanthemum, Atractylodes, Asarum, Poria, Oyster Shell, Platycodon, Saposhnikovia, Ginseng, Alum, Scutellaria, Chinese Angelica, Dried Ginger, Chuanxiong (Ligusticum), and Cinnamon Twig. The ancient method was to grind into powder, administer with wine, once daily. For the first twenty days, warm wine was used to take it, with prohibitions on fish, meat, and garlic. Cold food was emphasized to assist the medicinal power. ⚠️ These methods of administration and dietary restrictions are as recorded in ancient literature. Modern readers must not mechanically imitate them, especially the "cold food to assist medicinal power," which lacks reliable evidence and may irritate the gastrointestinal tract.

• Wind-Drawing Decoction: Recorded in ancient texts for clearing heat, wind-paralysis, and epilepsy-like convulsive disorders. Ingredients include Rhubarb, Dried Ginger, Dragon Bone, Cinnamon Twig, Licorice, Oyster Shell, Glauberite (Cold-Water Stone), Talc, Red Halloysite, White Halloysite, Fluorite, and Gypsum. The ancients stated it could treat adult wind-drawing and pediatric convulsions with recurrent seizures.

• Fangji Rehmannia Decoction: Recorded for manic-like mental states, aimless wandering, incessant talking to oneself, absence of pronounced chills or fever (the phrase "tiān hán rè" is commonly understood as "no chills or fever"), and a floating pulse. Method: Fangji (Stephania), Cinnamon Twig, Saposhnikovia, and Licorice are soaked in wine overnight to extract the juice; fresh Rehmannia is steamed and juiced. The two juices are mixed and taken in two divided doses.

• Head Wind Rubbing Powder: Af-external formula. Prepared Aconite root and salt are ground in equal parts. After washing the head, the powder is rubbed on the affected area to help the medicinal force disperse.

Ge neral Discussion of Li-Jie Disease and Its Causes

Cunkou pulse deep and weak: deep pertains to bone and corresponds to the kidneys; weak pertains to sinews and corresponds to the liver. If one enters cold water while sweating, dampness damages the blood vessels, resulting in joint pain and yellow sweat (yellowish perspiration) — hence the name li-jie. Fuyang pulse floating and slippery: slippery indicates exuberance of grain qi; floating indicates spontaneous sweating. Shaoyin pulse floating and weak: weak indicates blood insufficiency; floating indicates wind-evil. When wind-evil and blood deficiency interact, pulling joint pain occurs. In obese persons, the pulse is rough and small with shortness of breath, spontaneous sweating, and joint pain unbearable on flexion and extension — often related to drinking alcohol and then being exposed to wind while sweating.

Li-Jie Disease Formulas

• Cinnamon Twig and Paeonia with Anemarrhena Decoction: Anciently used for multiple joint pain, emaciation or joint swelling with deformity, foot swelling as if detached, dizziness with shortness of breath, and a warm, nauseated sensation in the chest. Ingredients: Cinnamon Twig, Paeonia, Licorice, Ephedra, Fresh Ginger, Atractylodes, Anemarrhena, Saposhnikovia, and Prepared Aconite.
• The text adds: Excessive preference for sour flavor damages the sinews; when sinews are damaged, they become flaccid — this is called "xie" (release). Excessive preference for salty flavor damages the bones; when bones are damaged, they become weak and atrophic — this is called "ku" (withered). When withered and release combine, it is called "duan xie" (broken release). When nutritive and defensive flow is impeded, the triple burner loses its command, the four limbs lose nourishment, and the body wastes away — except the feet become swollen, with yellow sweat and cold lower legs. If fever appears, it is by then li-jie.
• Aconite Decoction: Anciently used for li-jie with pain preventing flexion and extension; also used for "foot qi" pain. Ingredients: Ephedra, Paeonia, Astragalus, Honey-Fried Licorice, and Sichuan Aconite. The Aconite must be decocted with honey; it is highly toxic, and the ancient preparation was complex.
• Alum Decoction: For external foot soaking, anciently used for "foot qi" surging toward the heart. Alum is dissolved in rice-washed water (jiang shui), boiled for three to five turns, and used warm for soaking the feet.

Appended Formulas

• Restorative Decoction — Gu Jin Lu Yan: Anciently used for wind-induced paralysis with the body unable to control itself, inability to speak, clouded consciousness unaware of painful areas, or spasmodic rigidity preventing turning. Also used for postpartum blood loss in women, and for the elderly and children. Ingredients: Ephedra, Cinnamon Twig, Chinese Angelica, Ginseng, Gypsum, Dried Ginger, Licorice, Chuanxiong, and Apricot Kernel. After taking, light sweating should be induced; avoid wind exposure.
• Three Yellow Decoction — Qian Jin: Anciently used for stroke with hand and foot spasmodic rigidity, joint pain, vexation with a disturbed heart, aversion to cold, and days without desire for food. Ingredients: Ephedra, Du Huo (Doubleteeth Angelica), Asarum, Astragalus, and Scutellaria; with addition and subtraction rules included.
• Atractylodes and Aconite Decoction — Jin Xiao Prescription: Anciently used for wind-deficiency with heavy head and vertigo, bitter dizziness, and loss of appetite. Its function is to warm the flesh, supplement the middle, and boost essence and qi. Ingredients: Atractylodes, Prepared Aconite, Honey-Fried Licorice, with Fresh Ginger and Chinese Dates.
• Cui's Eight-Flavor Pill: Anciently used for "foot qi" rising upward into the lower abdomen with numbness and absence of sensation. Ingredients: Dried Rehmannia, Cornus (Fruit), Dioscorea, Alisma, Poria, Moutan Bark, Cinnamon Twig, and Prepared Aconite. Made into honey pills and taken with wine.
• Yuebi Plus Atractylodes Decoction — Qian Jin Fang: Anciently used for extreme heat in the muscles, escape of body fluids, opening of the interstices with profuse sweating, li-jie wind, and weakness of the lower limbs. Ingredients: Ephedra, Gypsum, Fresh Ginger, Licorice, Atractylodes, and Chinese Dates; if aversion to wind is present, Prepared Aconite is added.

All the above formulas derive from ancient literature and reflect the experiential understanding of those times. They are provided for scholarly study only and do not constitute medication guidance.

🧠 Deeper Understanding

Core Principles 💡

• Stroke framed through "external wind invasion": The chapter holds that wind-evil takes advantage of insufficiency of upright qi and emptiness of the collaterals to enter, progressing gradually from skin → collaterals → channels → six bowels → five viscera, with severity increasing accordingly. This progression model emphasizes that "where the pathogen collects, the qi must be deficient."
• Distinguishing stroke from bi syndrome: Hemiplegia indicates stroke; single-arm paralysis belongs mostly to bi disorder. Both manifest impaired limb function, but the location and extent differ.
• Li-jie disease emphasizes "internal deficiency with external pathogen": Liver-kidney insufficiency and deficiency of nutritive/defensive and qi/blood form the foundation. Wind, cold, and damp pathogen take advantage of this weakness to attack the joints, producing pain, swelling, and inability to flex or extend. Dietary excess of sour and salty flavors can also damage the sinews and bones.
• Treatment logic: For stroke, the emphasis is on dispelling wind and scattering pathogen, supporting the upright, and freeing the collaterals — also clearing heat, settling with heavy substances, and nourishing blood. For li-jie, emphasis falls on warming the channels and dispersing cold, dispelling wind and eliminating dampness; formulas commonly contain warming and freeing agents like Prepared Aconite and Aconite, as well as cooling agents such as Anemarrhena and Gypsum — demonstrating the simultaneous use of cold and warm medicines rather than uniformly heating-drying approaches.
• The appended formulas reflect Han-Tang clinical experience: Restorative Decoction, Three Yellow Decoction, Atractylodes-Aconite Decoction, Eight-Flavor Pill, and Yuebi Plus Atractylodes Decoction indicate overlapping concepts of "stroke," "foot qi," and "li-jie" in antiquity, with rich therapeutic experience that had not yet been systematized into one unified framework.

Modern Perspectives 🌟

• The ancient "stroke" does not equate to the modern medical definition of cerebrovascular accident, yet the recorded signs — hemiplegia, facial deviation, slurred speech, mental clouding — parallel modern cerebrovascular events, facial nerve palsy, and similar conditions, and represent an important body of symptomatic knowledge.
• The "external wind" theory is a historical explanatory model. Modern medicine holds that most strokes relate to vascular pathology, thrombosis, hemorrhage, and related mechanisms rather than simple wind exposure. However, cold, infection, and other triggers may precipitate or worsen some neuromuscular conditions.
• "Li-jie" is closer to modern rheumatic disease, rheumatoid arthritis, and gout — particularly the migratory joint pain, swelling, deformity, and inability to flex or extend — partially overlapping with autoimmune and metabolic joint diseases, though not strictly corresponding.
• The Aconite, Prepared Aconite, Ephedra, Asarum, and Alum in this chapter are toxic or potent agents with narrow safety windows. They must never be self-administered according to ancient formulas. Some of these drugs require modern toxicological and evidence-based research.
• The ancient "foot qi" differs from beriberi disease due to vitamin B1 deficiency in Western medicine. In this chapter, it refers mostly to conditions of lower limb swelling, pain, weakness, or rushing sensations toward the chest and heart, and should not be conflated.
• Ancient administration methods such as "cold food to assist drug power" lack modern scientific support and may stimulate the gastrointestinal tract; they warrant a rational perspective.

Wellness Insights ⚡

• 🚿 Avoid wind and cold after sweating: After exercise or sweating in hot weather, do not immediately expose yourself to cold drafts, cold showers, or remain long in damp and cold environments.
• 🧥 Keep joints warm: The knees, ankles, fingers, and similar areas should be protected from prolonged cold-damp exposure.
• 🍺 Moderate alcohol intake: In particular, expose to wind while sweating after drinking. This is a repeatedly cited trigger for li-jie in this chapter.
• 🥗 Eat with balance: Refrain from long-term preference for overly sour or salty food. Keep the five flavors in balance.
• 🩺 Seek medical attention promptly: Sudden hemiplegia, facial distortion, slurred speech, or joint swelling — painful or deformed with limited range of motion — warrant immediate medical assessment. These conditions cannot be resolved through wellness practice or ancient formulas alone.

📚 Related Knowledge

• Related Concepts: Stroke, bi syndrome, li-jie disease, yellow sweat, nutritive-defensive system, channel-vessel and viscus-bowel pattern differentiation, the warming-freeing approach of Aconite Decoction and Cinnamon Twig-Paeonia-Anemarrhena Decoction, and the shared origin of Cui's Eight-Flavor Pill with the Kidney Qi Pill.
• Further Reading:
  • Plain Questions · Discourse on Wind; Plain Questions · Discourse on Bi; Miraculous Pivot · Heat Diseases
  • Synopsis of the Golden Chamber · Chapter on Blood Bi and Consumptive Disease
  • Treatise on Cold Damage sections on Greater Yang and Lesser Yin diseases
  • Treatise on the Origins and Manifestations of Diseases sections on wind disease and li-jie disease patterns

Pugu Note: This content is based on classical Chinese medical texts and is offered solely for traditional cultural study and investigation. It does not constitute any form of medical diagnosis, medication guidance, or treatment advice. Seek timely professional medical care if you feel unwell.