白附子(炮) 石菖莆(去毛) 远志(去心,甘草水炮炒) 天麻 全蝎(去尾,甘草水洗) 羌
活南星(牛胆制多次更佳,各一两) 木香(五钱
上为末,面糊丸,龙眼大。每服一丸,薄荷汤下。
陈皮 茯苓 半夏(姜汁炒) 甘草(炙,各一钱五分
水煎服。
六味汤 (见后类中门)
熟地(九蒸晒,二钱) 巴戟(去心) 山萸肉(去核) 肉苁蓉(酒浸焙) 石斛 附子(炮) 五
味子(杵炒) 白茯苓(各一钱) 石菖蒲(去毛) 桂心 麦冬(去心) 远志(去心,甘草水炮炒
入薄荷少许,姜一片,枣二枚,水煎服。气虚,加人参二钱。
甘桔汤 (见伤寒咽痛。
类中风者,谓火中、虚中、湿中、寒中、暑中、气中、食中、恶中也,共有八种。与真
中相类而实不同也。然类中有与真中相兼者,须细察其形证而辨之。凡真中之证,必连经络
多见歪斜偏废之候,与类中之专气致病者,自是不同。然而风乘火势,邪乘虚入。寒风相
搏,暑风相炫,饮食招风,种种变证,所在多有,务在详辨精细,果其为真中也,则用前驱
风法,果其为类中也,则照本门施治,果其为真中、类中相兼也,则以两门医法合治之,斯
无弊耳。兹举类中诸证,详列于下,俾学人触目洞然也。
一曰火中。火之自外来者,名曰贼,实火也。火之自内出者,名曰子,虚火也。中火之
证,良由将息失宜,心火暴盛,肾水虚衰,不能制之,故卒然昏倒,不可作实火论。假如怒
动肝火,逍遥散。心火郁结,牛黄清心丸。肺火壅遏,贝母栝蒌散。思虑伤脾,加味归脾汤
肾水枯涸,虚火上炎者,六味地黄汤。若肾经阳虚,火不归原者,八味地黄汤,刘河间
地黄饮子并主之。此治火中之法也。或问∶火中而用桂、附者,何也?答曰∶肾阳风越,则
丹田虚冷,其痰涎上壅者,水不归原也。面赤烦躁者,火不归原也。惟桂附八味能引火归原
火归水中,则水能生木,木不生风,而风自熄矣。
二曰虚中。凡人体质虚弱,过于作劳,伤损元气,以致痰壅气浮,卒然昏倒,宜用六君
子汤主之。中气下陷者,补中益气汤主之。
三曰湿中。湿中者,即痰中也。凡人嗜食肥甘,或醇酒乳酪,则湿从内受。或山岚瘴气
久雨阴晦,或远行涉水,坐卧湿地,则湿从外受。湿生痰,痰生热,热生风,故卒然昏倒
无知也。苍白二陈汤主之。
四曰寒中。凡人暴中于寒,卒然口鼻气冷,手足厥冷,或腹痛,下利清谷,或身体强硬
口噤不语,四肢战摇,此寒邪直中于里也。宜用姜附汤,或附子理中汤加桂主之。
五曰暑中。凡人务农于赤日,行旅于长途,暑气逼迫,卒然昏倒,自汗面垢,昏不知人
急用千金消暑丸灌之,其人立苏。此药有回生之功,一切暑药,皆不及此,村落中各宜预
备。灌醒后,以益元散清之,或以四味香薷饮,去浓朴,加丹参、茯苓、黄连治之。虚者,
加人参。余详论伤暑门。
六曰气中。七情气结,或怒动肝气,以致气逆痰壅,牙关紧急,极与中风相似,但中风
身热,中气身凉。中风脉浮,中气脉沉。且病有根由,必须细究。宜用木香调气散主之。
七曰食中。醉饱过度,或着恼怒,以致饮食填塞胸中,胃气不行,卒然昏倒,宜用橘红
二两,生姜一两,炒盐一撮,煎汤,灌而吐之,次用神术散和之。其最甚者,胸高满闷,闭
而不通,或牙关紧急,厥晕不醒,但心头温者,即以独行丸攻之,药即下咽,其人或吐或泻
自应渐苏。若泻不止者,以冷粥汤饮之,即止。
八曰恶中。登冢入庙,冷屋栖迟,以致邪气相侵,卒然错语妄言,或头面青黯,昏不知
人,急用葱姜汤灌之,次以神术散调之。苏合丸亦佳。
白附子(炮制) 石菖蒲(去毛) 远志(去心,用甘草水炮炒) 天麻 全蝎(去尾,用甘草水洗) 羌活 胆南星(用牛胆汁多次炮制效果更佳,以上各一两) 木香(五钱)
将上述药物研为细末,用面糊制成丸药,大小如龙眼核。每次服用一丸,用薄荷汤送服。
陈皮 茯苓 半夏(用姜汁炒) 甘草(炙,以上各一钱五分)
加水煎煮后服用。
六味汤 (见后文类中风门)
熟地黄(九蒸九晒,二钱) 巴戟天(去心) 山茱萸肉(去核) 肉苁蓉(酒浸焙干) 石斛 附子(炮制) 五味子(捣碎炒) 白茯苓(以上各一钱) 石菖蒲(去毛) 桂心 麦冬(去心) 远志(去心,用甘草水炮炒)
加入少许薄荷、一片生姜、两枚大枣,加水煎煮后服用。气虚者,加人参二钱。
甘桔汤 (见于伤寒篇咽痛证)
所谓类中风,是指火中、虚中、湿中、寒中、暑中、气中、食中、恶中这八种情况,共有八种类型。它们与真中风相似但实质不同。然而类中风中有与真中风兼夹的情况,必须仔细察辨其症状和体征。凡是真中风的证候,必定牵连经络,多见口眼歪斜、半身不遂等症状,这与类中风仅由气机致病者自然不同。然而风邪乘火势而起,邪气乘虚而入。寒风相搏,暑风相激,饮食招致风邪,种种变证,到处都有,务必详细辨别精细。如果确是真中风,则使用前面提到的驱风法;如果确实是类中风,则按照本门的方法施治;如果是真中风与类中风兼夹,则将两门的治疗方法合而治之,这样就没有弊病了。现列举类中风的各种证候,详细列在下面,使学习者一目了然。
第一种叫火中。火从外来者,名叫贼邪,属于实火。火从内生者,名叫子病,属于虚火。患火中证,大多是因为调养失当,心火暴盛,肾水虚衰,不能制约心火,所以突然昏倒,不可当作实火来论治。假如是愤怒触动肝火,用逍遥散。心火郁结,用牛黄清心丸。肺火壅遏,用贝母栝蒌散。思虑伤脾,用加味归脾汤。肾水枯涸,虚火上炎者,用六味地黄汤。若是肾经阳虚,火不归原者,用八味地黄汤,刘河间的地黄饮子也主治此证。这是治疗火中的方法。有人问:火中使用桂枝、附子,为什么呢?回答说:肾阳浮越,则丹田虚冷,痰涎上壅,是水不归原。面赤烦躁,是火不归原。只有桂附八味能引火归原。火回归水中,则水能生木,木不生风,而风自熄了。
第二种叫虚中。凡是人体质虚弱,过度劳累,损伤元气,导致痰壅气浮,突然昏倒,宜用六君子汤主治。中气下陷者,用补中益气汤主治。
第三种叫湿中。湿中,就是痰中。凡人嗜好食用肥甘厚味,或浓酒乳酪,则湿气从内受入。或是山岚瘴气,久雨阴晦,或是远行涉水,坐卧湿地,则湿气从外受入。湿生痰,痰生热,热生风,所以突然昏倒无知觉。用苍白二陈汤主治。
第四种叫寒中。凡人突然遭受寒邪侵袭,突然口鼻气息寒冷,手足厥冷,或腹痛,下利清谷,或身体强硬,牙关紧闭不语,四肢颤抖摇动,这是寒邪直中于里。宜用姜附汤,或附子理中汤加桂枝主治。
第五种叫暑中。凡人在烈日下务农,在长途旅行,暑气逼迫,突然昏倒,自汗面色污垢,昏迷不知人,急用千金消暑丸灌服,其人立即苏醒。此药有起死回生的功效,一切暑药,都不及此药,乡村中应当预先准备。灌醒后,用益元散清解,或用四味香薷饮,去掉厚朴,加丹参、茯苓、黄连治疗。体虚者,加人参。其余详见伤暑门论述。
第六种叫气中。七情气结,或愤怒触动肝气,导致气逆痰壅,牙关紧急,极像中风,但中风身热,中气身凉。中风脉浮,中气脉沉。且病有根由,必须仔细探究。宜用木香调气散主治。
第七种叫食中。醉饱过度,或恼怒,导致饮食填塞胸中,胃气不行,突然昏倒,宜用橘红二两,生姜一两,炒盐一撮,煎汤,灌服使其呕吐,其次用神术散调和。最严重的,胸高满闷,闭塞不通,或牙关紧急,厥晕不醒,只要心头尚温的,就用独行丸攻逐,药即下咽,其人或者吐或者泻,自然会渐渐苏醒。如果泻不止,喝冷米汤,即可停止。
第八种叫恶中。登坟墓入庙宇,在冷屋停留,导致邪气相侵,突然胡言乱语,或头面青暗,昏迷不知人,急用葱姜汤灌服,其次用神术散调理。苏合丸也很好。
Fuzi (Prepared) (Aconiti Lateralis Radix Praeparata), Shichangpu (Stemonae Rhizoma), Yuanzhi (Polygalae Radix, heart removed, processed with licorice water and stir-fried), Tianma (Gastrodiae Rhizoma), Quanxie (Scorpio, tail removed, washed with licorice water), Qianghuo (Notopterygii Rhizoma et Radix), Nanxing (Arisaematis Rhizoma cum Bile Bovis, processed multiple times with bovine bile for better effect, each 1 liang), Muxiang (Aucklandiae Radix, 5 qian).
Grind the above herbs into fine powder, make pills with wheat paste, size of a longan fruit. Take one pill per dose, swallow with mint decoction.
Chenpi (Citri Reticulatae Pericarpium), Fuling (Poria), Banxia (Pinelliae Rhizoma, stir-fried with ginger juice), Gancao (Licorice Root, honey-fried, each 1.5 qian).
Decoct in water and take orally.
Liuwei Tang (See later section on Lei Zhong Feng)
Shudi (Rehmanniae Radix Praeparata, steamed and sun-dried nine times, 2 qian), Bajitian (Morindae Officinalis Radix, heart removed), Shanzhuyu (Corni Fructus, pit removed), Roucongrong (Cistanche Deserticola), Shihu (Dendrobii Caulis), Fuzi (Aconiti Lateralis Radix Praeparata), Wuweizi (Schisandrae Chinensis Fructus, crushed and stir-fried), Baifuling (Poria, each 1 qian), Shichangpu (Stemonae Rhizoma, hair removed), Guixin (Cinnamomi Cortex), Maidong (Ophiopogonis Radix, heart removed), Yuanzhi (Polygalae Radix, heart removed, processed with licorice water and stir-fried).
Add a small amount of Bohe (Menthae Haplocalycis Herba), one slice of Shengjiang (Zingiberis Rhizoma Recens), and two dates (Jujubae Fructus). Decoct in water and take orally. For Qi deficiency, add Renshen (Ginseng Radix et Rhizoma) 2 qian.
Ganjie Tang (See Shanghan Lun for throat pain)
Lei Zhong Feng (Stroke-like syndrome) refers to Huo Zhong (Fire stroke), Xu Zhong (Deficiency stroke), Shi Zhong (Dampness stroke), Han Zhong (Cold stroke), Shu Zhong (Summerheat stroke), Qi Zhong (Qi stroke), Shi Zhong (Food stroke), and E Zhong (Evil/Toxic stroke), totaling eight types. They are similar to Zhen Zhong (True Stroke) but essentially different. However, Lei Zhong may coexist with Zhen Zhong; one must carefully observe symptoms and signs to differentiate them. True Stroke syndromes invariably involve meridians, often presenting with facial deviation or hemiplegia, which naturally differs from Lei Zhong caused solely by Qi disorders. Nevertheless, wind exploits fire, pathogens enter via deficiency. Cold wind clashes, summer heat wind conflicts, diet attracts wind; various complications occur frequently. One must distinguish meticulously. If it is truly Zhen Zhong, use the previously mentioned wind-dispelling methods. If it is indeed Lei Zhong, treat according to this chapter's methods. If it is a combination of both, combine treatments from both chapters to avoid errors. Here, we list the various syndromes of Lei Zhong in detail below, so that students may understand clearly at a glance.
The first is Huo Zhong (Fire Stroke). Fire coming from outside is called "Thief" (Zei), representing Excess Fire. Fire arising from within is called "Child" (Zi), representing Deficiency Fire. Huo Zhong occurs largely due to improper lifestyle management, where Heart Fire flares up violently while Kidney Water declines, failing to control the Fire, leading to sudden collapse. It should not be treated as Excess Fire. If anger stirs Liver Fire, use Xiaoyao San. If Heart Fire is constrained, use Niuhuang Qingxin Wan. If Lung Fire is obstructed, use Beimu Gualou San. If overthinking injures Spleen Qi, use Jiawei Guipi Tang. If Kidney Water is depleted with Deficiency Fire flaming upward, use Liuwei Dihuang Tang. If Kidney Yang is deficient with Fire not returning to its source, use Bawei Dihuang Tang; Liu Hejian's Dihuang Yinzi also treats this. This is the method for treating Huo Zhong. One might ask: Why use Guizhi (Cinnamon Twig) and Fuzi in Huo Zhong? The answer is: When Kidney Yang floats away, the Dantian becomes cold and empty, causing phlegm-saliva to obstruct upwards (Water not returning to source). Red face and irritability indicate Fire not returning to source. Only Guizhi and Fuzi in Bawei can guide Fire back to its source. Once Fire returns to Water, Water generates Wood; Wood does not generate Wind, and Wind extinguishes itself.
The second is Xu Zhong (Deficiency Stroke). In cases of weak constitution, excessive labor damages Yuan Qi, leading to phlegm obstruction and floating Qi, resulting in sudden collapse. Use Liujunzi Tang as the main formula. If Middle Qi sinks, use Buzhong Yiqi Tang.
The third is Shi Zhong (Dampness Stroke). Shi Zhong is synonymous with Tan Zhong (Phlegm Stroke). People who indulge in rich, sweet foods, strong wine, or dairy products accumulate Dampness internally. Or, exposure to mountain miasma, prolonged rainy gloom, traveling through water, or sitting/sleeping on damp ground causes external Dampness invasion. Dampness generates Phlegm, Phlegm generates Heat, Heat generates Wind, leading to sudden collapse and unconsciousness. Treat with Cangbai Erchen Tang.
The fourth is Han Zhong (Cold Stroke). Sudden invasion by Cold pathogen causes cold breath from mouth and nose, cold extremities, abdominal pain, diarrhea with undigested food, stiff body, locked jaw without speech, and trembling limbs. This is Cold pathogen directly invading the interior. Use Jiangfu Tang or Fuzi Lizhong Tang plus Guizhi.
The fifth is Shu Zhong (Summerheat Stroke). Farmers working under the scorching sun or travelers on long journeys suffer from oppressive Summerheat, leading to sudden collapse, spontaneous sweating, dirty complexion, and coma. Immediately administer Qianjin Xiaoshu Wan; the patient will revive instantly. This medicine has life-restoring power, superior to all other summerheat remedies. Villages should keep it in reserve. After reviving, clear residual heat with Yiyuan San, or Siwei Xiangru Yin removing Houpo, adding Danshen, Fuling, and Huanglian. For deficiency, add Renshen. See Shangshu Men for details.
The sixth is Qi Zhong (Qi Stroke). Emotional stagnation or anger stirring Liver Qi leads to rebellious Qi and phlegm obstruction, tight jaw, resembling stroke closely. However, Stroke presents with fever, while Qi Zhong presents with coolness. Stroke pulse is floating, Qi Zhong pulse is deep. The root cause must be investigated. Use Muxiang Tiaoqi San.
The seventh is Shi Zhong (Food Stroke). Overeating/drinking or anger causes food to block the chest, Stomach Qi fails to descend, leading to sudden collapse. Use 2 liang Juhong (Tangerine Peel), 1 liang Shengjiang, and a pinch of fried salt, decoct and induce vomiting. Then harmonize with Shenzhu San. In severe cases with high chest, fullness, blockage, locked jaw, or coma with warm heart, use Duxing Wan to purge. Upon swallowing, the patient may vomit or have diarrhea and gradually recover. If diarrhea persists, drink cold rice soup to stop it.
The eighth is E Zhong (Evil/Toxic Stroke). Visiting tombs or temples, staying in cold houses allows Evil Qi to invade, causing sudden delirium, dark/blueish face, and coma. Immediately administer Congjiang Tang (Green Onion and Ginger Decoction), then regulate with Shenzhu San. Suhexiang Wan is also excellent.