冷丹 血风也,血热也,痰血相搏也。
通圣散 消风散 治血风血热。
蝉蜕 姜蚕 荆芥
南星散 治痰血相搏。又用吐法。
肺风皮燥开折,血出大痛,乃肺热生风也。
苦参 皂角 蛇肉 荆芥 黄芩 沙参
中风涎壅,口目 斜,语言謇涩。热甚生风,血虚有痰。
中府者 面加五色有表证着四肢,脉浮,恶风寒,拘急不仁,先以小续命汤
加减,发其表,调以通圣散辛凉之剂。
中藏者 唇吻不收,舌不转而失音,耳聋而眼盲,鼻不闻香臭,便秘,宜三
化汤通其滞,调以十全四物。
血虚有痰半身不遂,涎潮昏塞,宜以四物四君子随气虚血虚加二陈汤用之,
调以凉剂导痰行气也,或权宜吐之。
中经者 内无便溺之阻,外无留结之患,宜大秦艽调之。
手足拳挛,筋脉抽掣,中于风冷者也,脉应弦急,治宜缓风之药。
手足弹曳,四肢痈缓,中于风热者也,脉应浮缓,治宜凉热消风之剂。
口目 斜,乃风贼阳明胃土者也,有寒则急引颊移,有热则筋缓不收,偏于
左则左寒而右热,偏于右则右寒而左热也。
小续命汤 治表。
麻黄 桂枝 芍药 甘草 人参 黄芩 防己 川芎 杏仁(一两) 防风(半两) 附子(半两)
无汗恶寒加麻黄、杏仁、防风。
无汗身热加白虎。
无汗身凉加姜附。
有汗恶风加桂枝、杏仁、芍药。
有汗身热加葛根、黄芩、桂。
有汗无热加桂附。
三化汤
朴硝(浓朴是) 大黄 枳实
大秦艽汤 养血荣筋。
四物汤 秦艽(三两) 独活 羌活 白茯苓(一两) 防风 甘草 白芷 白术(一两)
石膏(二两) 细辛(半两)
独圣散 吐痰潮。
瓜蒂(一两炒黄为末) 茶末(三钱) 齑汁调下则吐。
如风痫加全蝎,有虫加狗油、雄黄、芫花,立吐,后须降火安神。
泻青丸 治风热,泻肝安神。
川芎 川归 防风 羌活 栀子 龙胆 大黄 蜜丸竹叶汤下。
通圣散
泻青丸去羌活、龙胆,加麻黄、薄荷、荆芥、芍药、芒硝、连翘、白术(半两)
桔梗、黄芩、石膏(各一两) 甘草(二两) 滑石(二两) 姜煎服。
二陈汤加竹沥姜汁治痰,气虚加四君子,血虚加四物汤。
中风有急中不省 口角流涎,喉中作声,脉浮缓者,先去其痰,后治风热,
又次养血益阳,其证有不同者,皆风热涎潮,随其何藏有虚而袭之。
如肝虚中风 脉应左关,面色青,诊在目,左胁偏痛,筋急,头目 。
如心虚中风 脉应左寸,面色赤,诊在舌,不能言,不可转侧,呼怒叫。
如脾虚中风 脉应右关,面色黄,诊在唇,怠惰不能饮食,嗜卧如醉。
如肺虚中风 脉应右寸,面色白,诊在鼻,喘逆面肿。
如肾虚中风 脉应左尺,面色黑,诊在耳,面庞然浮肿,腰脊痛。
胃虚中风 脉应人迎两关,并浮而大。饮食不下,腹胀,食寒则泄, 斜不随。
邪中心肺,涎潮逼塞。
四肢纵缓 以风散涎注于关节,气不能行,故四肢不遂。
舌强不能言 风入心脾涎中之,口噤不能言,以风冷客滞心肺,涎塞也。
四肢拘挛 以风冷邪气中肝藏,使筋挛也。
风柔 以风热中肝藏,使筋缓也。
冷丹,即血风,也是血热,是痰与血相互搏结所致。
通圣散、消风散,用于治疗血风和血热。
蝉蜕、姜蚕、荆芥。
南星散,用于治疗痰血相搏。另外还可以使用吐法。
肺风表现为皮肤干燥开裂,血液渗出且剧烈疼痛,这是肺热生风所致。
苦参、皂角、蛇肉、荆芥、黄芩、沙参。
中风导致痰涎壅盛,口眼歪斜,语言謇涩。热邪极盛而生风,或血虚兼有痰湿。
中于表者(中府),面部出现五色变化并伴有表证,四肢受累,脉象浮,恶风寒,肢体拘急麻木不仁,先用小续命汤加减,发散表邪,再用通圣散这类辛凉的药物调理。
中于里者(中藏),唇口松弛不收,舌体转动失灵而失音,耳聋目盲,鼻不知香臭,便秘,宜用三化汤通导积滞,再用十全四物汤调理。
血虚兼有痰湿导致的半身不遂,痰涎上潮昏闷堵塞,宜用四物汤合四君子汤,根据气虚或血虚的情况加入二陈汤使用,并用凉剂调理以导痰行气,或者权宜采用吐法。
中于经络者(中经),体内没有大小便的阻滞,体外没有留滞凝结的病患,宜用大秦艽汤调理。
手足蜷缩挛急,筋脉抽搐掣动,是感受风冷之邪所致,脉象应当弦急,治疗宜用缓风药物。
手足震颤牵引,四肢痈肿弛缓,是感受风热之邪所致,脉象应当浮缓,治疗宜用清热消风的药剂。
口眼歪斜,是风邪侵犯阳明胃土所致,有寒邪则牵引脸颊肌肉紧缩,有热邪则筋脉弛缓不收,偏左则左侧寒右侧热,偏右则右侧寒左侧热。
小续命汤,用于治疗表证。
麻黄、桂枝、芍药、甘草、人参、黄芩、防己、川芎、杏仁(一两)、防风(半两)、附子(半两)。
无汗恶寒,加麻黄、杏仁、防风。
无汗身热,加白虎汤。
无汗身凉,加干姜、附子。
有汗恶风,加桂枝、杏仁、芍药。
有汗身热,加葛根、黄芩、桂枝。
有汗无热,加桂枝、附子。
三化汤:朴硝(此处指厚朴,注:原文可能有误,通常三化汤含朴硝,但括号内注明“浓朴是”,依原文翻译)、大黄、枳实。
大秦艽汤,养血荣筋。
四物汤、秦艽(三两)、独活、羌活、白茯苓(一两)、防风、甘草、白芷、白术(一两)、石膏(二两)、细辛(半两)。
独圣散,用于催吐痰涎上潮。
瓜蒂(一两炒黄研末)、茶末(三钱),用醋汁调服即可催吐。
如患风痫,加全蝎;如有虫积,加狗油、雄黄、芫花,可立即催吐,之后必须降火安神。
泻青丸,治疗风热,泻肝火以安神。
川芎、当归、防风、羌活、栀子、龙胆、大黄,蜜丸,竹叶汤送服。
通圣散:由泻青丸去掉羌活、龙胆,加入麻黄、薄荷、荆芥、芍药、芒硝、连翘、白术(半两)、桔梗、黄芩、石膏(各一两)、甘草(二两)、滑石(二两)组成,生姜煎服。
二陈汤加竹沥、姜汁治疗痰证,气虚加四君子汤,血虚加四物汤。
中风急症神志不清,口角流涎,喉中作声,脉象浮缓的,先去其痰,后治风热,再次养血益阳。其证候有所不同,都是风热痰涎上潮,随其所乘脏腑之虚而侵袭。
如肝虚中风,脉象应在左关部,面色青,诊察在目,左胁偏痛,筋脉拘急,头晕目眩。
如心虚中风,脉象应在左寸部,面色赤,诊察在舌,不能言语,身体不可转侧,呼怒大叫。
如脾虚中风,脉象应在右关部,面色黄,诊察在唇,怠惰嗜卧不能饮食,嗜睡如醉。
如肺虚中风,脉象应在右寸部,面色白,诊察在鼻,气喘逆满面部浮肿。
如肾虚中风,脉象应在左尺部,面色黑,诊察在耳,面部浮肿,腰脊疼痛。
胃虚中风,脉象应在人迎穴及左右关部,并见浮大脉象。饮食不下,腹胀,食生冷则泄泻,口眼歪斜不能自主。
邪气中心肺,痰涎上潮逼迫堵塞。
四肢纵缓无力,因风邪散漫,痰涎注入关节,气机不能运行,所以四肢不能随意运动。
舌强不能言语,风邪入于心脾,痰涎蒙蔽,口噤不能言语,因风冷客滞心肺,痰涎阻塞所致。
四肢拘挛,因风冷邪气中伤肝脏,使筋脉拘挛。
风柔(筋脉弛缓),因风热中伤肝脏,使筋脉弛缓。
Cold Dan is Blood Wind, also Blood Heat, caused by the struggle between Phlegm and Blood.
Tongsheng San (Total Salvation Powder) and Xiaofeng San (Wind-Dispersing Powder) treat Blood Wind and Blood Heat.
Cicada Slough (Chan Tui), Ginger-treated Silkworm (Jiang Can), Schizonepeta (Jing Jie).
Nanxing San (Arisaema Powder) treats the struggle between Phlegm and Blood. Additionally, emetic therapy can be used.
Lung Wind manifests as dry, cracked skin, bleeding with severe pain; this is Wind generated from Lung Heat.
Sophora Root (Ku Shen), Gleditsia Sinensis Fruit (Zao Jiao), Snake Meat, Schizonepeta (Jing Jie), Scutellaria Root (Huang Qin), Glehnia Root (Sha Shen).
Stroke leads to Phlegm-Saliva congestion, deviation of the mouth and eyes, and slurred speech. Extreme Heat generates Wind, or there is Blood Deficiency with Phlegm.
When struck at the exterior (Zhong Fu), the face shows five colors with exterior syndrome signs affecting the limbs, pulse is floating, aversion to wind and cold, stiffness and numbness. First use Xiao Xuming Tang (Minor Continuation Decoction) with modifications to release the exterior, then regulate with Tongsheng San, a pungent-cool agent.
When struck at the interior (Zhong Zang), the lips and corners of the mouth relax and cannot close, the tongue loses mobility causing aphonia, deafness and blindness, loss of smell in the nose, constipation. Use Sanhua Tang (Three Transformations Decoction) to unblock stagnation, then regulate with Shiquan Siwu Decoction.
For hemiplegia due to Blood Deficiency with Phlegm, where Phlegm-Saliva surges causing coma and blockage, use Siwu Tang (Four Substances Decoction) combined with Sijunzi Tang (Four Gentlemen Decoction), adding Erchen Tang (Two Aged Decoction) according to Qi or Blood deficiency. Regulate with cool agents to guide out Phlegm and move Qi, or alternatively use emesis temporarily.
When struck at the meridians (Zhong Jing), there is no internal obstruction of stool or urine, nor external accumulation of stagnation. Use Da Qinjiao Tang (Great Notopterygium Decoction) for regulation.
Clenched fists and legs, twitching of sinews and vessels indicate invasion by Cold-Wind; the pulse should be wiry and rapid. Treatment requires Wind-calming herbs.
Trembling and dragging of hands and feet, flaccidity of limbs indicates invasion by Wind-Heat; the pulse should be floating and moderate. Treatment requires cooling and Wind-dispersing agents.
Deviation of the mouth and eyes indicates Wind attacking the Stomach Earth of the Yangming channel. With Cold, it pulls the cheek muscles tightly; with Heat, the sinews relax and cannot retract. Left-sided deviation implies left Cold and right Heat; right-sided deviation implies right Cold and left Heat.
Xiao Xuming Tang (Minor Continuation Decoction) treats exterior syndromes.
Ephedrae Herba (Mahuang), Cinnamon Twig (Guizhi), White Peony Root (Baishao), Licorice Root (Gancao), Ginseng Radix (Renshen), Scutellaria Root (Huangqin), Stephania Root (Fangji), Ligusticum Chuanxiong Rhizome (Chuanxiong), Apricot Seed (Xingren, 1 liang), Saposhnikovia Root (Fangfeng, 0.5 liang), Aconite Lateral Root Preparata (Fuzi, 0.5 liang).
If no sweat and aversion to cold, add Mahuang, Xingren, Fangfeng.
If no sweat and body heat, add Baihu Tang (White Tiger Decoction).
If no sweat and cool body, add Jiang (Dried Ginger) and Fuzi.
If sweating and aversion to wind, add Guizhi, Xingren, Baishao.
If sweating and body heat, add Puerariae Radix (Gegen), Huangqin, Guizhi.
If sweating without heat, add Guizhi and Fuzi.
Sanhua Tang: Mangxiao (Mirabilite, note: text says "Nongpo shi" implying confusion with Houpo, but standard formula uses Mangxiao), Rhei Radix et Rhizoma (Dahuang), Aurantii Fructus Immaturus (Zhishi).
Da Qinjiao Tang nourishes Blood and benefits sinews.
Siwu Tang (Four Substances Decoction), Notopterygii Rhizoma et Radix (Qinjiao, 3 liang), Angelica Dahurica Root (Duhuo), Notopterygii Rhizoma et Radix (Qianghuo), Poria (Fuling, 1 liang), Fangfeng, Gancao, Angelica Dahurica Root (Baizhi), Atractylodis Macrocephalae Rhizoma (Baizhu, 1 liang), Gypsum Fibrosum (Shigao, 2 liang), Asarum Root (Xixin, 0.5 liang).
Dusheng San induces vomiting for Phlegm-Saliva surge.
Melon Seed (Gua Di, 1 liang fried yellow and powdered), Tea Powder (3 qian), mixed with vinegar juice to induce vomiting.
If Wind-Epilepsy, add Scorpion (Quanxie); if parasites, add Dog Oil, Realgar (Xionghuang), Genkwa Flower (Yuanhua) to induce immediate vomiting, followed by Fire-clearing and Spirit-calming treatment.
Xieqing Wan (Drain Green Pill) treats Wind-Heat, drains Liver Fire and calms the Spirit.
Chuanxiong, Danggui, Fangfeng, Qianghuo, Gardeniae Fructus (Zhizi), Gentiana Scabra Root (Longdan), Dahuang, honey pills taken with Bamboo Leaf Decoction.
Tongsheng San: Derived from Xieqing Wan by removing Qianghuo and Longdan, adding Mahuang, Bohe (Mint), Jingjie, Baishao, Mangxiao, Forsythiae Fructus (Lianqiao), Baizhu (0.5 liang), Platycodon Root (Jiegeng), Huangqin, Shigao (each 1 liang), Gancao (2 liang), Talcum (Huashi, 2 liang), decocted with Fresh Ginger.
Erchen Tang plus Zhuli (Bamboo Juice) and Jiangzhi (Ginger Juice) treats Phlegm. Add Sijunzi Tang for Qi Deficiency, Siwu Tang for Blood Deficiency.
In acute stroke with unconsciousness, drooling from the mouth corner, sound in the throat, and floating-moderate pulse, first remove Phlegm, then treat Wind-Heat, subsequently nourish Blood and benefit Yang. Although symptoms vary, they are all due to Wind-Heat and Phlegm-Saliva surging, attacking deficient organs.
If Liver Deficiency Stroke, pulse corresponds to Left Guan, complexion is green, diagnosis relates to eyes, pain in left hypochondrium, tendon stiffness, dizziness.
If Heart Deficiency Stroke, pulse corresponds to Left Cun, complexion is red, diagnosis relates to tongue, inability to speak, inability to turn body, shouting and anger.
If Spleen Deficiency Stroke, pulse corresponds to Right Guan, complexion is yellow, diagnosis relates to lips, lethargy, inability to eat,嗜睡 like drunkenness.
If Lung Deficiency Stroke, pulse corresponds to Right Cun, complexion is white, diagnosis relates to nose, panting, facial swelling.
If Kidney Deficiency Stroke, pulse corresponds to Left Chi, complexion is black, diagnosis relates to ears, puffy face, lower back and spine pain.
Stomach Deficiency Stroke, pulse corresponds to Renying point and both Guan positions, floating and large. Inability to eat, abdominal distension, diarrhea after cold food, deviation of mouth/eyes.
Evil strikes Heart and Lung, Phlegm-Saliva surges and blocks.
Flaccidity of four limbs: Wind scatters, Phlegm-Saliva enters joints, Qi cannot flow, hence limbs are paralyzed.
Stiff tongue unable to speak: Wind enters Heart and Spleen, Phlegm-Saliva obstructs, mouth clamped shut unable to speak, due to Wind-Cold lodging in Heart and Lung blocking Phlegm-Saliva.
Contraction of four limbs: Wind-Cold evil strikes Liver Organ, causing tendon contraction.
Wind-Rou (Sinew Relaxation): Wind-Heat strikes Liver Organ, causing sinew relaxation.