Stroke is one of the common critical illnesses in clinical practice and is characterized by high rates of death, disability and recurrence. Chinese medicine attaches great importance to the diagnosis and treatment of stroke disease, and has accumulated rich theoretical and clinical experience, because of the complexity of the pathogenesis and the many changes in the symptoms, there are many different opinions. The author has occasional insights in clinical treatment, which are briefly discussed below. 1, identification of disease and evidence, combined with modern medicine Stroke disease is a modern medical cerebrovascular disease, Chinese medicine on the identification of stroke disease is mainly based on clinical manifestations, that is, hemiplegia, mouth and tongue distortion, speech is awkward or inarticulate, etc., which is due to the scientific conditions at the time, it is impossible to have other diagnostic methods. In recent years, with the development of modern medicine, in-depth research on the etiology and pathology of stroke, and the widespread use of CT and MRI, diagnostic methods have become more advanced and scientific. Therefore, the diagnosis of stroke disease must be combined with modern medicine to form a new diagnostic model that combines the characteristics of Chinese and Western medicine. We should combine the diagnosis of Western medicine focusing on etiology and pathology with the diagnosis of Chinese medicine focusing on systemic physiopathology and disease response, so that we can have a more comprehensive understanding of the whole disease and enhance the depth and breadth of diagnosis. For example, if the disease is the same as stroke, how to distinguish between hemorrhagic stroke and ischemic stroke, practice has proved that the judgment of clinical manifestations alone is not enough, and a clearer diagnosis can be given only with the help of modern medical examination. Another example is lacunar cerebral infarction, because of the small scope of lesions, patients often do not have clinical manifestations such as hemiplegia, or even behave like normal people, if the traditional diagnostic analysis method of Chinese medicine is used, it is very easy to cause a missed diagnosis or misdiagnosis. However, through the examination of modern medicine, we can easily come up with a diagnosis. For example, according to the results of CT examination, we can observe the lesion site, the nature of the lesion (hemorrhagic or ischemic), the size of the lesion, and combine with the four diagnoses to analyze and summarize, we can more accurately understand the cause of the disease, the pathogenesis, the location, the nature of the disease, and the prognosis and regression. 2, the pathogenesis of the disease focuses on the deficiency of Qi and blood stasis Stroke disease mostly occurs in the middle-aged and elderly, “forty years of age, Yin Qi since half, living decay.” Therefore, it is important to take the internal deficiency of qi and blood as the root, and the stagnation of blood in brain veins and meridians as the standard. The “Spiritual Pivot – Stabbing the real evil” cloud: “the deficiency of evil in the half of the body, its entry deep, the internal residence of the Ying and Wei, Ying and Wei slightly weakened, then the real qi go, the evil qi alone, the hair for the partial withering.” The medical scripture retrospective collection – stroke discernment cloud: “stroke, not external wind evil, is the original gas disease, all people over forty years old, gas failure, or because of worry, happiness, anger and injury to its gas, many have this disease, the strong age of the time is not also.” The Jing Yue Quanshu – non-wind “cloud:” “the fainting of many from the fainting, the original are internal injuries accumulation loss of decay and defeat.” The medical compendium – wind evidence identification of differences” cloud: “Stroke are due to adverse pulse paths, blood and gas occlusion.” Although the mechanism of stroke is complex, it is due to the internal deficiency of qi and blood, as well as the inappropriateness of emotion and will, labor and thought and injury to the mind, poor diet and other causative factors, causing the imbalance of yin and yang in the viscera, the deficiency of qi and blood does not rise and move, the stasis of blood cannot be transformed, and the phlegm is congested and stagnant, directly offending the brain. This causes paralysis of the cerebral veins or blood overflow outside the cerebral veins. Wang Renqing, in his “Medical Lin Correction”, also believed that hemiplegia and paraplegia in stroke were caused by Qi deficiency and blood stasis, and created the first “Tonic Yang Returning Five Soup”. Most of the modern medicine blood rheology examination has hypercoagulability and hyperviscosity; the brain histopathological changes caused by blood stasis are very easy to form ischemic and hypoxic edema bands, which can cause secondary damage in a longer period of time. It is also consistent with the theory of stasis of blood in Chinese medicine. Therefore, internal deficiency of qi and blood and stasis of blood are the focus of the pathogenesis of stroke. 3. Treatment starts from benefiting Qi and invigorating Blood The pathogenesis of stroke disease focuses on Qi deficiency and Blood stasis, so the key to treatment is to benefit Qi and invigorate Blood. Tang Rongchuan’s “Theory of Blood Evidence” says: “The blood is transported by the qi, that is, the stasis of blood is also the movement of qi.” Therefore, benefiting Qi and invigorating Blood should be the basic treatment method, but it should be applied flexibly in clinical practice. In the acute stage, when the evil is predominant, on the one hand, we should actively dispel the evil, so that the evil does not harm the positive, and on the other hand, we should also pay attention to supporting the positive, that is, to benefit the Qi and nourish the Blood, which means that “the evil is removed and the positive is restored, and the positive is restored and the evil is removed.” And after the acute period, the method of benefitting Qi should be added with full force. Commonly used drugs are Astragalus, Radix et Rhizoma Ginseng, Bei Sha Shen, etc. Especially Astragalus, modern medical research shows that Astragalus has immunomodulation, protection of brain blood flow, anti-oxidant free radicals, anti-brain cell hypoxia effect. According to different stages, different diagnosis, the dosage of Astragalus can be gradually increased to 60g, or even 150g, to the recovery period also manifested as qi deficiency, yin deficiency, often with He Shou Wu, Du Zhong, Sang Sang Sang, Sheng Di, Yam meat and other kidney nourishing Yin products. Activating blood stasis can remove blood stasis and create new blood, promote the dissipation of blood stasis, improve local blood circulation, release cerebrovascular spasm, and have anticoagulation and antithrombosis effects. The application of activating blood circulation and resolving blood stasis for ischemic stroke has been recognized by everyone. For hemorrhagic stroke, some physicians are cautious about the use of blood activation and stasis removal, fearing that it may aggravate bleeding or rebleed. However, blood that has left the menstrual flow is stagnant blood and dead blood. If the stagnant blood is not removed, new blood will not be generated, so the method of invigorating blood and removing stasis should be used early. Modern medicine also proves that the treatment of hemorrhagic stroke by activating blood circulation and removing stasis can promote the absorption of hematoma and reduce the damage of biotoxic substances (such as thrombin and collagenase) released by the hematoma. It reduces the inflammatory reaction and cerebral edema around the hematoma, relieves the increase of intracranial pressure, and also facilitates the recovery of neurological function. Commonly used are leech, dilong, panax notoginseng, danshen, Chuanxiong, etc. Among them, leech is an important medicine to break blood and expel blood stasis, its taste is salty and enters the blood, “Shen Nong Ben Cao Jing” said: “Mainly expel evil blood, blood stasis, closed moon, break blood obstruction accumulation …… benefit water channels.” The “Medical Heart of the Chinese Ginseng West Record” that “but break the blood stasis, not hurt the new blood.” Therefore, it is the first choice of treatment. On the basis of benefiting the Qi and invigorating the Blood, the medicine should be added or subtracted according to the clinical symptoms. In case of concurrent stasis and heat, cool the Blood, such as Scutellaria baicalensis, Gardenia jasminoides, Radix Rehmanniae, Radix Salviae Miltiorrhizae, etc.; in case of cerebral edema, activate the Blood and induce diuresis, such as Ze Lan and Yimu Cao, etc.; in the recovery period, use the method of benefiting the Qi and invigorating the Blood to nourish the Blood, based on the method of Tonic Yang Returning Five Soup. Although the basic treatment of stroke disease is to benefit Qi and invigorate Blood, the clinical evidence of stroke disease is highly variable and the pathology is complex, with deficiency (Qi deficiency, Yin deficiency), fire (liver fire, heart fire), wind (liver wind, external wind), phlegm (wind phlegm, damp phlegm), Qi (Qi rebellion), and Blood (stasis of Blood) all intermingled. The combination of overall identification and local identification. If there is phlegm-dampness and confusion in the mind, add Tianzhu Huang, Bile Nanxing, Shi Calamus, and Yu Jin to open the orifice and awaken the mind; if liver Yang is disturbed by liver wind, use Tianma and Hooked Vine to quench liver wind; if phlegm is leaking in the throat, add Zhu Li, Chuan Bei Mu, and Han Xia to resolve phlegm; if yin deficiency is obvious, add Tortoise, Dragon Bone, Lady’s Mantle, and Dry Lotus Grass to nourish yin and clear heat; stroke is often caused by wind, fire, phlegm, and stasis, and Qi is out of balance, or The common medicine is raw rhubarb, if the internal qi has been passed, the stool can be lowered, then stop using or change to system rhubarb. Be careful not to kill and injure the righteousness, and stop the disease. 5, emphasize the care of the spleen and stomach, throughout the treatment process of stroke disease, should pay attention to the care of the spleen and stomach, which is the stroke patients are mostly due to wind, fire, phlegm, stasis congestion, resulting in abnormal lifting and lowering of the qi, the middle jiao transportation and transformation; or vegetarian alcohol, fat, sweet and thick taste, damp heat congestion in the middle jiao; or vegetarian yin deficiency, heat and yin, the spleen is not healthy and cause abnormal transportation and transformation; treatment commonly used in the heavy town submerged Yang Jin Shi Jie class of drugs are not easy to digest; clearing the heat of the drug The bitter-cold medicine hurts the spleen, and the medicine for nourishing the liver and kidneys is greasy to the stomach. The spleen and stomach are located in the middle jiao, the pivot of qi lift, only the pivot can be beneficial, in order to pass up and down, the treatment has effect. Therefore, attention must be paid to the spleen and stomach at all times, available fried grain buds, wheat sprouts, jiao hawthorn, jiao Shenqu to eliminate the guide to strengthen the spleen; sand, cardamom, white atractylodes aromatic wake up the spleen; maitong, dendrobium benefit stomach nourish yin.