口噤目张痰涎着,气塞手握难下药,闭症宜开主白矾(散),稀涎散亦得要略(一曰开关。)若
见目合口又开,遗尿自汗脱症作,无论有邪与无邪,脱则宜固参附汤嚼二曰固脱。六经形证
应汗条,加减续命(汤)法亦约。内有便溺阻隔之,三化(汤)攻下非克削,此旨专重泄大邪,内外
峻攻两不错(三曰泄大邪。)若还大气不转旋,顺气匀气二散托(四曰转大气。)中风必见痰阵阵,
清心(散)涤痰汤可进(五曰涤痰涎。)且风多从热化生,风火相煽无余烬,惟有前人竹沥汤,熄风
妙在柔而润(六曰除风热。)风与痰气互相搏,神昏目绝一转瞬,通其窍隧苏合香丸,至宝丹之
功亦奋迅(七曰通经隧。)又恐汤丸效太迟,急灸俞穴倍雄峻。阴阳二气不相维,此次阴阳顷刻
顺(八曰灸俞穴。
按∶尤在泾自定八法,余既存其说,而又不能尽绚其意者,谅在泾有知,当亦许余为直
友也。一曰开关,尤氏以搐鼻探吐为开,而余则以华佗愈风散追以驷马而为开,祛风至
宝丹彻其上下表里而为开也。二曰固脱,尤氏以参附汤加竹沥而为固,而余则以侯氏黑散遵
《内经》填窍息风而为固也。三曰泄大邪,尤氏遵刘河间法以续命汤泄其外邪,以三化汤泄
其内邪而为泄,而余则用防风通圣散一方,并力以两泄之也。四曰转大气,尤氏以八味顺气
汤、匀气散以涤之,调之未必能转,而余则用生 一、二两,陈皮、人参、防风各三钱,助
其大气,再加天门冬五钱,附子三钱,俾水火之气循环不息以为转也。五曰逐痰涎,尤氏以
涤痰汤开壅塞而平水饮之逆行,余则以三因白散治横流,而为北门之坐镇也。六曰除风热,
尤氏以竹沥汤滋液以除热,而余则以白虎汤、竹叶石膏汤、黄连阿胶汤直探阳明少阴之本源
以除大热也。七曰通经隧,尤氏以苏合香丸,至宝丹集诸香之气以通神,而余则用风引汤炼
五色之石以补天也。八曰灸俞穴,以中风卒倒,邪风暴加,真气反陷,表里之气不相通,则
阴阳之气不相系,艾灸速于汤药,但尤氏之取穴太多,而余则取穴较少耳。
口噤(牙关紧闭)、目张(眼睛睁开)、痰涎阻滞,气机闭塞、手握紧难以给药,闭证适宜采用开窍法,主药为白矾散,稀涎散也颇为关键(第一种方法:开关)。如果见到眼睛闭合、嘴巴张开,伴有遗尿、自汗等脱证表现,无论是否有外邪侵袭,脱证则宜用固脱法,参附汤嚼服(第二种方法:固脱)。六经的形证应当遵循发汗解表的原则,加减续命汤的方法也较为简略。如果体内有大小便不通的阻隔,三化汤攻下并非刻薄峻猛之剂,此旨意重在泄除大邪,内外峻攻两不差错(第三种方法:泄大邪)。如果大气不能运转,可用顺气散、匀气散来托举(第四种方法:转大气)。中风必然见到阵发性痰鸣,清心散、涤痰汤可以使用(第五种方法:涤痰涎)。况且风邪多从热化而生,风火相煽无余烬,只有前人留下的竹沥汤,熄风的妙处在于柔和滋润(第六种方法:除风热)。风与痰气互相搏结,神志昏迷、目睛上视转瞬即至,需通其窍隧,苏合香丸、至宝丹的功效也奋迅有力(第七种方法:通经隧)。又担心汤药和丸药见效太慢,急需艾灸俞穴加倍雄峻。阴阳二气不相维系,此次艾灸可使阴阳顷刻间调和(第八种方法:灸俞穴)。
按语:尤在泾自行制定了八法,我虽然保留了这种说法,但又不能完全详尽阐述其意,想必尤在泾若有知,也会允许我为直率的朋友吧。第一种方法叫开关,尤氏以搐鼻探吐作为开窍,而我则以华佗愈风散追加以驷马汤作为开窍,祛风至宝丹彻治其上下表里作为开窍。第二种方法叫固脱,尤氏以参附汤加竹沥作为固脱,而我则以侯氏黑散遵循《内经》填窍息风作为固脱。第三种方法叫泄大邪,尤氏遵循刘河间法以续命汤泄除外邪,以三化汤泄除内邪作为泄法,而我则用防风通圣散一方,并力同时泄除内外之邪。第四种方法叫转大气,尤氏以八味顺气汤、匀气散来涤荡、调理,未必能转运,而我则用生黄芪一两、二两,陈皮、人参、防风各三钱,助其大气,再加天门冬五钱,附子三钱,使水火之气循环不息以起到转运作用。第五种方法叫逐痰涎,尤氏以涤痰汤开壅塞而平水饮之逆行,我则以三因白散治疗横流,作为北门的坐镇。第六种方法叫除风热,尤氏以竹沥汤滋液以除热,而我则以白虎汤、竹叶石膏汤、黄连阿胶汤直探阳明少阴之本源以除大热。第七种方法叫通经隧,尤氏以苏合香丸、至宝丹集诸香之气以通神,而我则用风引汤炼五色之石以补天。第八种方法叫灸俞穴,因为中风卒倒,邪风暴加,真气反陷,表里之气不相通,则阴阳之气不相系,艾灸速度快于汤药,但尤氏选取的穴位太多,而我选取的穴位较少罢了。
Jaw lock (trismus), eyes open, phlegm-saliva obstruction; qi stagnation with clenched hands making medication difficult. For Bi syndrome (Obstruction Syndrome), opening the orifices is appropriate, primarily using Bai Fan San (White Alum Powder); Xi Xian San (Thin Phlegm Powder) is also essential (Method 1: Opening Orifices). If one observes eyes closed and mouth open, accompanied by urinary incontinence and spontaneous sweating indicating Tuo syndrome (Collapse Syndrome), regardless of the presence or absence of pathogenic factors, Tuo syndrome requires consolidation. Shen Fu Tang (Ginseng and Aconite Decoction) should be chewed and swallowed (Method 2: Consolidating Collapse). The six meridians' morphological syndromes should follow the principle of diaphoresis (sweating to release the exterior); the method of Jia Jian Xu Ming Tang (Modified Continuation of Life Decoction) is also concise. If there is internal obstruction due to constipation or urinary retention, San Hua Tang (Three Transformations Decoction) for purgation is not overly harsh; this principle emphasizes draining major pathogens, with both internal and external aggressive attacks being correct (Method 3: Draining Major Pathogens). If the Great Qi fails to circulate, Shun Qi San (Smooth Qi Powder) and Yun Qi San (Uniform Qi Powder) can be used to support it (Method 4: Rotating Great Qi). Stroke inevitably presents with paroxysmal phlegm rattle; Qing Xin San (Clear Heart Powder) and Di Tan Tang (Phlegm-Scouring Decoction) may be administered (Method 5: Scouring Phlegm-Saliva). Moreover, wind often transforms into heat; wind and fire fan each other leaving no embers. Only the ancient Bamboo Juice Decoction (Zhu Li Tang) remains, where the subtlety of extinguishing wind lies in its softness and moistening nature (Method 6: Eliminating Wind-Heat). Wind and phlegm-qi struggle against each other; unconsciousness and upward deviation of the eyes occur in an instant. One must unblock the orifices and channels; Su He Xiang Wan (Styrax Pill) and Zhi Bao Dan (Precious Treasure Pellet) exert vigorous effects (Method 7: Unblocking Channels and Collaterals). Fearing that decoctions and pills act too slowly, urgent moxibustion on Shu points (Back-Shu points) is required with greater intensity. When Yin and Yang Qi fail to sustain each other, this moxibustion can harmonize Yin and Yang instantly (Method 8: Moxibustion on Shu Points).
Note: You Zaijing independently formulated eight methods. Although I retained his theory, I could not fully elaborate on its meaning; presumably, if You Zaijing were aware, he would permit me as a straightforward friend. Method 1 is called Opening Orifices. You used nasal insufflation and induced vomiting for opening, whereas I use Hua Tuo Yu Feng San (Hua Tuo's Wind-Dispelling Powder) followed by Si Ma Tang (Four Horses Decoction) for opening, and Qu Feng Zhi Bao Dan (Wind-Dispersing Precious Treasure Pill) to thoroughly treat the interior and exterior for opening. Method 2 is called Consolidating Collapse. You used Shen Fu Tang plus Zhu Li (Bamboo Juice) for consolidation, whereas I use Hou Shi Hei San (Doctor Hou's Black Powder) following the *Neijing* to fill orifices and extinguish wind for consolidation. Method 3 is called Draining Major Pathogens. You followed Liu Hejian's method using Xu Ming Tang to drain external pathogens and San Hua Tang to drain internal pathogens. I use Fang Feng Tong Sheng San (Saposhnikovia Releasing the Surroundings Powder) to drain both simultaneously. Method 4 is called Rotating Great Qi. You used Ba Wei Shun Qi Tang (Eight-Ingredient Smooth Qi Decoction) and Yun Qi San to cleanse and regulate, which may not necessarily rotate the Qi. I use Sheng Huang Qi (Astragali Radix) 1–2 liang, Chen Pi (Citri Reticulatae Pericarpium), Ren Shen (Ginseng Radix), and Fang Feng (Saposhnikoviae Radix) each 3 qian to assist the Great Qi, adding Tian Dong (Asparagi Radix) 5 qian and Fu Zi (Aconiti Lateralis Radix Praeparata) 3 qian, so that Water and Fire Qi circulate endlessly to achieve rotation. Method 5 is called Expelling Phlegm-Saliva. You used Di Tan Tang to open blockages and calm the reverse flow of fluid retention. I use San Yin Bai San (Three Causes White Powder) to treat rampant flow, acting as a stronghold at the northern gate. Method 6 is called Eliminating Wind-Heat. You used Zhu Li Tang to nourish fluids and eliminate heat. I use Bai Hu Tang (White Tiger Decoction), Zhu Ye Shi Gao Tang (Bamboo Leaf and Gypsum Decoction), and Huang Lian E Jiao Tang (Coptis and Donkey-Hide Gelatin Decoction) to directly probe the root sources of Yangming and Shaoyin to eliminate major heat. Method 7 is called Unblocking Channels and Collaterals. You used Su He Xiang Wan and Zhi Bao Dan, gathering the qi of various aromatics to unblock the spirit. I use Feng Yin Tang (Wind-Guiding Decoction) refining five-colored stones to supplement Heaven. Method 8 is called Moxibustion on Shu Points. In sudden stroke collapse, pathogenic winds strike violently, true Qi sinks inversely, and interior-exterior Qi do not communicate, causing Yin-Yang Qi to lose connection. Moxibustion acts faster than decoctions; however, You selected too many points, whereas I select fewer points.