《病机机要》曰∶治风须分在脏、在腑、在经之异。云风本为热，热胜则风动，宜以静
胜其燥，是养血也。治须少汗，亦宜少下。多汗则虚其卫，多下则损其营，宜治在经，虽有
汗、下之戒，而有中脏、中腑之分。中腑者，多着四肢，有表证而脉浮，恶风，拘急不仁。
中脏者，多滞九窍，唇缓失音，耳聋，鼻塞，目瞀，大便结闭。中腑者宜汗之，中脏者宜下
之，表里已和宜治之在经，当以大药养之。
《发明》云∶中血脉则口眼 斜，中腑则肢节废，中脏则性命危，治各不同。中血脉，
外有六经之形证，则从小续命加减；中腑，内有便溺之阻隔，宜三化汤等通利之；外无六经
之形证，内无便溺之阻隔，宜养血通气，大秦艽汤、羌活愈风汤主之。
刘宗浓曰∶按此分在表、在里、在经之三证，立汗、下、调养之三法，可谓开后世之盲
聋。但所用诸方，学人宜详审之。
河间曰∶风病多因热甚，俗云风者，言末而忘其本也。所以中风有瘫痪者，非谓肝木之
风实，甚而猝中之也，亦非外中于风，良由将息失宜而心火暴甚，肾水虚衰，不能制之，则
阴虚阳实，而热气怫郁，心神昏冒，筋骨不用而猝倒无知也。多因喜、怒、悲、忧、恐五志
过极，而猝中者，皆为热甚故也。若微，则但僵仆，气血流通，筋脉不挛。缓者，发过如故，
或热气大盛，郁滞不通，阴气暴绝，阳气后竭而死。
痰涎者，由热甚则水化制火而生。
偏枯者，由经络一侧得通，痞者痹而瘫痪也。
口筋噤急者，由风热太甚，以胜水湿。又津液滞于胸膈，以为痰涎，则筋太燥，然燥金
主于收敛，劲切故也。或筋反缓者，乃燥之甚，血液衰少也。诸筋挛易愈，诸筋痿难复，以
见燥之微甚也。
丹溪云∶案《内经》以下，皆谓外中风邪，然地有南北之殊，不可一概而论。往刘守真
作将息失宜，水不能制火，极是。由今而言之，西北二方，亦有真为风所中者，但极少尔。
东南之人，多是湿土生痰，痰生热，热生风也。邪之所凑，其气必虚，风之伤人在肺脏为多。
许学士谓∶气中者，亦有七情所伤。脉微而数，或浮而紧、缓而迟必也。脉迟浮可治，
大数而极者死。若果外中者，则东垣所谓中血脉、中腑、中脏之理。其于四肢不举，亦有与
痿相类者，当细分之。《局方》风、痿同治，大谬，《发挥》甚详。子和用三法，如的系邪气
猝中、痰盛实热者可用，否则不可。
河间曰∶中风之人，不宜用龙、麝、犀朱，譬之提铃巡于街，使盗者伏而不出，益使邪
入于骨髓，如油入而莫能出也，此之类焉。若痰潮不省，昏愦不知事，宜用药下其痰涎。故
风者，乃百病之长，虽审经意，故莫不有疑者也。吁！医之不明运气造化地理病机之微，而
欲行通变之法者，难矣哉！
《病机机要》说：治疗风病必须区分是在脏、在腑、还是在经络的不同。认为风的本性是热，热盛则风动，应当用静（阴）来战胜燥，这就是养血的方法。治疗时发汗不宜过多，攻下也不宜过猛。发汗过多会耗伤卫气，攻下过多会损伤营血。适宜治疗在经络的病证，虽然对汗法和下法有禁忌，但仍有中脏和中腑的区别。中腑的病证，多表现为四肢受累，有表证且脉浮，恶风，肢体拘急麻木不仁。中脏的病证，多导致九窍阻滞，口唇松弛失音，耳聋，鼻塞，视物模糊，大便秘结不通。中腑者适宜用汗法，中脏者适宜用下法，如果表里症状已经调和，则适宜治疗在经络的病证，应当用大药来调养身体。
《发明》说：邪中血脉则出现口眼歪斜，邪中腑则肢节废用，邪中脏则性命垂危，治疗方法各不相同。邪中血脉，外部有六经的形证，则用小续命汤加减治疗；邪中腑，内部有大便小便的阻隔，适宜用三化汤等方剂通利二便；外部没有六经的形证，内部也没有二便的阻隔，适宜养血通气，以大秦艽汤、羌活愈风汤为主治方。
刘宗浓说：按照这种分法，将病位分为在表、在里、在经三种证候，确立汗、下、调养三种治法，可以说是开启了后世医家的眼界。但是所使用的各个方剂，学习者应当仔细审慎地考察。
河间（刘完素）说：风病多因热势极盛引起，世俗所说的“风”，是只言其末梢症状而忘记了根本原因。所以中风导致瘫痪的人，并不是因为肝木之风实证严重而突然击中人体，也不是外感风邪所致，确实是由于调摄失当导致心火暴亢，肾水虚衰，不能制约心火，从而造成阴虚阳实，热气郁结，心神昏乱冒昧，筋骨失去功能而突然倒下无知觉。大多是因为喜、怒、悲、忧、恐五志情绪过度极端，而突然中风的，都是因为热势极盛的原因。如果病情轻微，只是暂时僵仆倒地，气血流通，筋脉不痉挛。病情缓和的，发作过后如常；或者热气极盛，郁滞不通，阴气突然断绝，阳气随后耗尽而死。
偏枯（半身不遂），是由于一侧经络通畅，痞痹则是经络闭塞导致的瘫痪。
口部筋脉拘急紧张，是由于风热太甚，克制了水湿。另外津液停滞在胸膈，形成痰涎，导致筋脉过于干燥，然而燥金主收敛，劲切有力，所以会出现这种情况。或者筋脉反而松弛的，乃是干燥太过，血液衰少的缘故。各种筋脉痉挛容易治愈，各种筋脉痿软难以恢复，以此可见干燥程度的轻重。
丹溪（朱震亨）说：查阅《内经》以下的论述，都认为这是外感中风邪气，然而地理有南北的差异，不可一概而论。过去刘守真（刘完素）认为是调摄失当，水不能制火，非常正确。从当今的情况来说，西北两个地区，也有真正被风邪击中的，但极少见。东南地区的人，多是湿土生痰，痰生热，热生风。邪气聚集的地方，正气必然虚弱，风邪伤人以肺脏为多。
许学士（许叔微）说：气中（情志致病），也有七情所伤的情况。脉象微弱而数，或浮紧、缓迟。脉象迟而浮的可治，脉象大而数且极度的预后不良致死。如果是真正的外感风邪，则符合东垣（李杲）所说的中血脉、中腑、中脏的道理。对于四肢不能举动的情况，也有与痿证相似的，应当仔细分辨。《局方》将风和痿同治，是大错特错的，《发挥》一书阐述得很详细。子和（张从正）使用汗、吐、下三法，如果是确切的邪气猝中、痰盛实热的情况可以使用，否则不可以使用。
河间说：中风患者，不宜使用龙脑（冰片）、麝香、犀角、朱砂，这好比提着铃铛在街上巡逻，使盗贼潜伏不出来，反而会使邪气深入骨髓，像油渗入一样无法排出，就是这类情况。如果痰涎上涌不省人事，昏迷不知事理，适宜用药攻下其痰涎。所以说，风是百病之长，虽然审察了经络之意，但仍然难免有疑问。唉！医生如果不明白运气、造化、地理、病机的微妙之处，想要施行通变之法，太难了！
*Ji Bing Ji Yao* (Essentials of Disease Mechanisms) states: In treating wind diseases, one must distinguish whether the pathogen is in the Zang organs, Fu organs, or meridians. It is held that wind originates from heat; when heat prevails, wind moves. One should use stillness (Yin) to overcome dryness, which refers to nourishing the blood. Treatment requires inducing little sweating and using purgatives sparingly. Excessive sweating will weaken Wei Qi (Defensive Qi), while excessive purgation will damage Ying Qi (Nutritive Qi). It is appropriate to treat disorders in the meridians. Although there are contraindications for sweating and purging methods, there remains a distinction between Zhong Zang (Stroke involving Zang organs) and Zhong Fu (Stroke involving Fu organs). Zhong Fu typically manifests in the four limbs, presenting with exterior syndrome symptoms such as floating pulse, aversion to wind, limb stiffness, numbness, and lack of sensation. Zhong Zang typically causes obstruction of the nine orifices, characterized by flaccid lips, loss of speech, deafness, nasal congestion, blurred vision, and constipation. For Zhong Fu, diaphoresis (sweating method) is suitable; for Zhong Zang, purgation is suitable. If both exterior and interior conditions have harmonized, treatment should focus on the meridians, employing major tonifying herbs to nourish the body.
*Fa Ming* (Inventions/Elucidations) states: When pathogens strike the blood vessels, facial paralysis (deviation of mouth and eyes) occurs; when they strike the Fu organs, limb joints become useless; when they strike the Zang organs, life is endangered. Treatments differ accordingly. For pathogens striking the blood vessels, if there are exterior manifestations corresponding to the Six Meridians, Xiao Xuming Tang (Minor Continuation of Life Decoction) should be modified and used. For pathogens striking the Fu organs, if there is internal obstruction of defecation and urination, Sanhua Tang (Three Transformations Decoction) or similar formulas should be used to promote unblocking and lubrication. If there are no exterior Six Meridian manifestations and no internal obstruction of excretion, nourishing blood and promoting Qi circulation is indicated, primarily using Da Qinjiao Tang (Major Gentian Root Decoction) or Qianghuo Yufeng Tang (Notopterygium Wind-Dispelling Decoction).
Liu Zongnong states: By classifying these into three syndromes—exterior, interior, and meridian—and establishing three treatment methods—diaphoresis, purgation, and regulation/nourishment—it can be said that this approach opened the eyes and ears of later generations. However, practitioners should carefully examine the various formulas employed.
Hejian (Liu Wansu) states: Wind diseases are often caused by extreme heat. The common term "wind" describes the terminal symptoms while forgetting the root cause. Therefore, stroke patients with paralysis are not suffering from an excess condition of Liver Wood wind suddenly striking the body, nor are they affected by external wind invasion. Rather, it is indeed due to improper regimen leading to a sudden flare-up of Heart Fire, coupled with deficiency and decline of Kidney Water, which fails to control the fire. This results in Yin deficiency and Yang excess, with hot qi stagnating and郁结 (depressing/stagnating), causing the Heart Spirit to become confused and overwhelmed, leading to sudden collapse and loss of consciousness due to the dysfunction of sinews and bones. This is mostly caused by the five emotions (joy, anger, sorrow, worry, fear) reaching their extremes. Such sudden strokes are all due to extreme heat. If mild, there is only temporary rigidity and falling, but Qi and Blood flow freely, and sinews do not spasm. In milder cases, the patient returns to normal after the episode; however, if heat becomes extremely abundant and stagnates without relief, Yin Qi may suddenly cease, followed by the exhaustion of Yang Qi, leading to death.
Phlegm and saliva arise because extreme heat causes Water to be controlled by Fire, thereby generating phlegm.
Hemiplegia (partial paralysis) occurs when one side of the meridians is obstructed; Bi syndrome (obstruction) leads to paralysis.
Stiffness and spasms of the oral muscles occur because wind-heat is too severe, overcoming dampness. Additionally, if body fluids stagnate in the chest and diaphragm, forming phlegm, the sinews become excessively dry. Since Dryness Metal governs contraction, it results in forceful tension. Conversely, if sinews become flaccid, it is due to excessive dryness and depletion of blood. Sinew spasms are easy to cure, whereas sinew flaccidity is difficult to recover from, indicating the severity of dryness.
Danxi (Zhu Zhenheng) states: Reviewing texts below *Neijing* (The Inner Canon), all attribute this to external wind-stroke pathogens. However, geography differs between north and south, so generalizations are inappropriate. Previously, Liu Shouzhen (Liu Wansu) argued that improper regimen leads to water failing to control fire, which is very accurate. Speaking from the present perspective, in the northwest regions, there are indeed cases of true wind-stroke, though they are rare. People in the southeast are mostly affected by damp earth generating phlegm, phlegm generating heat, and heat generating wind. Where evil gathers, Qi must be deficient; wind pathogens injure the Lung organ most frequently.
Xu Xueshi (Xu Shumi) states: Qi Zhong (illness caused by emotional disturbance) also involves injury from the Seven Emotions. The pulse may be weak and rapid, or floating and tight, or slow and delayed. A slow and floating pulse is treatable; a large, rapid, and extreme pulse indicates death. If it is truly an external wind strike, it aligns with Dongyuan's (Li Gao) principles of striking blood vessels, Fu organs, or Zang organs. Regarding inability to move the four limbs, there are similarities with Wei Syndrome (Flaccidity Syndrome), which must be carefully differentiated. *Ju Fang* (Formulas of the Bureau) treating wind and flaccidity together is a major error, as detailed extensively in *Fa Hui*. Zihe (Zhang Congzheng) uses the three methods (sweating, vomiting, purging); these are applicable only if it is indeed a sudden strike by evil qi with abundant phlegm and excess heat; otherwise, they should not be used.
Hejian states: Stroke patients should not use Long Nao (Borneol), She Xiang (Musk), Xi Jiao (Rhinoceros Horn), or Zhu Sha (Cinnabar). Using them is like patrolling the streets with a bell, causing thieves to hide and not emerge, which instead allows the pathogen to penetrate into the bone marrow, becoming inseparable like oil entering dough. This is an example of such harm. If phlegm surges and the patient loses consciousness, appearing comatose and unaware, it is appropriate to use medication to purge the phlegm. Thus, wind is the leader of a hundred diseases. Even with careful examination of meridian theories, doubts inevitably remain. Alas! It is difficult for physicians who do not understand the subtleties of Yun Qi (Five Movements and Six Qi), creation/transformation, geography, and disease mechanisms to apply flexible and adaptive treatments!