〔《灵》〕虚邪偏客于身半，其入深，内居荣卫。荣卫稍衰，则真气去，邪气独留，发为
偏枯。故其邪气浅者，脉偏痛。（刺节真邪篇）
偏枯，身偏不用而痛，言不变，志不乱，病在分腠之间。巨针取之，益其不足，损其有
余，乃可复也。痱之为病也，身无痛者，四肢不收，志乱不甚，其言微知，可治；甚则不能
言，不可治也。（痱，废也，痱即偏枯之邪气深者，痱与偏枯是二疾，以其半身无气荣运。
故名偏枯，以其手足废而不收或名痱，或偏废或全废皆曰痱也。“巨针取之”《千金》作“
温卧取汗”）
上《内经》论中风之浅深也。其偏枯身偏痛，而言不变，志不乱者，邪在分腠之间，即
仲景、东垣所谓邪中腑是也。痱病无痛，手足不收而言喑志乱者，邪入于里，即仲景、东垣
所谓邪中脏是也。
〔仲〕寸口脉浮而紧，紧则为寒，浮则为虚，寒虚相搏，邪在皮肤。浮者血气虚，络脉空
虚，贼邪不泻，或左或右，邪气反缓，正气即急，正气引邪， 僻不遂。邪在于络，肌
肤不仁。邪在于经，即重不胜。邪入于腑，即不识人。邪入于脏，舌即难言，口遂吐涎。
〔洁〕风者，百病之始，善行而数变。行者，动也，风本为热，热胜则风动，宜以静胜其躁
，养血是也，治须少汗，亦宜少下。多汗则虚其卫，多下则损其荣，汗下各得其宜，然后可
治。其在经，虽有汗下之戒，而有中脏中腑之分。中腑者宜汗之，中脏者宜下之，此虽合汗
下，亦不可过也。仲景云∶汗多则亡阳，下多则亡阴。亡阳则损气，亡阴则损形。故经言血
气者人之神，不可不谨养也。所谓表里不和，须汗下之，表里已和，是宜治之在经也。其中
腑者，面颜显五色，有表证而脉浮，恶风恶寒，拘急不仁，或中身之后，或中身之前，或中
身之侧，皆曰中腑也，其病多易治。其中脏者，唇吻不收，舌不转而失音，鼻不闻香臭，耳
聋而眼瞀，大小便秘结，皆曰中脏也。其病多难治。若风中腑者，先以加减续命汤随证发其
表。如兼中脏，则大便多秘涩，宜以三化汤通其滞。表里证已定，别无变端，后以大药和而
治之。大抵中腑者，多着四肢；中脏者，多滞九窍。虽中腑者，多兼中脏之证。至于舌强失
音，久服大药，能自愈也。
〔垣〕中血脉则口眼 斜，中腑则肢节废，中脏则性命危急，此三者治各不同。如中
血脉，外有六经之形证，则从小续命汤加减，及疏风汤治之。如中腑，内有便溺之阻隔，宜
三化汤或《局方》中麻仁丸通利之；外无六经之形证，内无便溺之阻隔，宜养血通气，大秦
艽汤、羌活愈风汤治之。中脏，痰涎昏冒，宜至宝丹之类镇坠。若中血脉中腑之病，初不宜
用龙、麝、牛黄。为麝香入脾治肉，牛黄入肝治筋，龙脑入肾治骨，恐引风深入骨髓，如油
入面，莫之能出。又不可一概用大戟、芫花、甘遂泻大便，损其阴血，则真气愈虚。（洁古
言中脏者大小秘涩，东垣言中腑者有便溺阻隔，二说当以东垣为主，盖大小秘结不中脏者亦
有之，中脏者亦有大小便不秘结者也）
《灵枢》记载：虚邪（致病的外邪）偏侧侵袭人体半身，若侵入较深，内居于营卫之中。当营卫之气逐渐衰弱时，真气就会离去，只有邪气独自停留，从而引发偏枯（半身不遂）。因此，如果邪气位置较浅，表现为身体一侧疼痛。（出自《刺节真邪篇》）
偏枯的症状是身体一侧不能活动且伴有疼痛，但言语正常，神志清晰，病位在分腠之间（肌肉与皮肤之间的间隙）。可用巨针进行治疗，补益不足的正气，削减有余的邪气，这样身体才能恢复。痱病（一种严重的中风后遗症）的症状是身体没有疼痛感，四肢无法收持使用，神志有些混乱但不严重，说话声音微弱但还能让人听懂，这种情况可以治疗；如果病情严重到不能说话，则属于不可治的情况。（注：痱，意为废弛不用。痱即偏枯中邪气深入者。痱与偏枯是两种疾病名称，因为它们都是半身无气血运行滋养。所以叫偏枯，是因为手足废弛不能收持，或者叫痱。无论是部分瘫痪还是完全瘫痪，都称为痱。“用巨针治疗”在《千金方》中作“温暖卧床取汗”）
以上是《内经》关于中风深浅的论述。那种身体一侧疼痛、言语不变、神志不乱的情况，是邪气在分腠之间，也就是张仲景和李东垣所说的邪中腑。痱病没有疼痛，手足不能收持且失语、神志混乱的情况，是邪气入里，也就是张仲景和李东垣所说的邪中脏。
张仲景说：寸口脉浮而紧，紧脉主寒，浮脉主虚，寒与虚相互搏结，邪气在皮肤。浮脉表示血气虚弱，络脉空虚，贼邪（外邪）不得宣泄，或出现在左侧或右侧，邪气所在的一侧肌肉松弛无力，正气所在的一侧肌肉紧张拘急，正气牵引着邪气，导致口眼歪斜、肢体运动不利。邪气在络脉，肌肤麻木不仁。邪气在经脉，身体沉重难以抬举。邪气入腑，就会不识人。邪气入脏，舌头僵硬难以言语，口角流涎。
李东垣（注：此处原文标注为“洁”，指李杲字东垣，号洁古，实为张元素之弟子，通常“洁古”指张元素，“东垣”指李杲，但文中内容多归于李东垣或其师承体系，此处依原文“洁”翻译，通常指李东垣或其学术观点，结合后文“垣”字，此处“洁”可能指代李东垣或张元素学派观点，鉴于后文有“垣”，此处暂译为李东垣/洁古学派观点）风是百病的开端，善于游走且变化多端。所谓“行”，就是动。风的本质属热，热盛则风动，应当用静来克制躁动，养血即是此理。治疗应当少发汗，也应当少攻下。多汗会耗伤卫气，多下会损伤营血。汗法和下法都要掌握适宜的程度，然后才可以治疗。邪气在经，虽然有汗法和下法的禁忌，但有中脏和中腑的区别。中腑的应当用汗法，中脏的应当用下法。这虽然符合汗下之法，但也不可以过度。张仲景说：汗多则亡阳，下多则亡阴。亡阳就会损伤气，亡阴就会损伤形质。所以经文说血气是人的精神所在，不可不谨慎调养。所谓表里不和，需要用汗下法调和；表里已经调和，就应当在经治疗。其中于腑的，面色显现五色异常，有表证且脉浮，怕风怕冷，拘急麻木，或者是身体后面受邪，或者是身体前面受邪，或者是身体侧面受邪，都叫中腑，这种病大多容易治疗。其中于脏的，口唇松弛不收，舌头转动失灵而失音，鼻子闻不到香臭，耳聋眼花，大小便便秘结，都叫中脏。这种病大多难治。如果是风中腑，先用加减续命汤根据证候发散表邪。如果兼有中脏，大便多秘涩，宜用三化汤通导积滞。表里证候确定后，没有其他变证，再用大药调和治疗。大抵中腑的病，多侵犯四肢；中脏的病，多阻滞九窍。即使是中腑，也多兼有中脏的症状。至于舌强失音，长期服用大药，也能自愈。
李东垣说：邪中血脉则口眼歪斜，邪中腑则肢节废用，邪中脏则性命危急，这三种情况治疗方法各不相同。如邪中血脉，外有六经的形证，则用小续命汤加减，以及疏风汤治疗。如邪中腑，内有二便阻隔，宜用三化汤或《局方》中的麻仁丸通利；外无六经的形证，内无二便的阻隔，宜养血通气，用大秦艽汤、羌活愈风汤治疗。邪中脏，痰涎昏蒙，宜用至宝丹之类镇坠。如果是中血脉或中腑的病，初期不宜使用龙脑、麝香、牛黄。因为麝香入脾治肉，牛黄入肝治筋，龙脑入肾治骨，恐怕引风邪深入骨髓，像油渗入面中一样，无法取出。也不可一概使用大戟、芫花、甘遂泻下大便，损伤阴血，会使真气更加虚弱。（洁古说中脏者大小便秘涩，东垣说中腑者有二便阻隔，这两种说法应当以东垣为主，因为大小便秘结并非只有中脏才有，中脏者也有大小便不秘结的情况）
[From *Ling Shu*] When empty pathogenic factors (Xu Xie, external pathogens) invade one side of the body and penetrate deeply, residing internally within Ying (Nutritive Qi) and Wei (Defensive Qi). As Ying and Wei gradually decline, the True Qi departs, leaving only the pathogenic factor to remain alone, resulting in Pian Ku (hemiplegia). Therefore, when the pathogenic factor is shallow, it manifests as pain on one side of the body. (From "Ci Jie Zhen Xie" Chapter)
Pian Ku is characterized by inability to move and pain on one side of the body, while speech remains unchanged and mental state is orderly; the disease lies between the Fen Cou (interstices of skin and muscle). It can be treated with large needles (Ju Zhen), tonifying deficiency and reducing excess, so that recovery is possible. Fei Bing (a severe form of stroke sequelae) presents with no body pain and flaccid paralysis of the four limbs. The mental state is somewhat confused but not severely so; speech is faint but understandable, and this condition is treatable. If severe, where speech is lost, it is untreatable. (Note: Fei means dysfunction or waste. Fei refers to the deep penetration of pathogenic factors in Pian Ku. Although related, Fei and Pian Ku are named differently due to the lack of Qi and Blood circulation in half the body. Pian Ku is named for hemiplegia, while Fei is named for the loss of function in hands and feet. Whether partial or total paralysis, it is called Fei. "Treating with Ju Zhen" appears as "warming the bed and inducing sweat" in *Qian Jin Fang*)
The above discusses the depth of Zhong Feng (stroke) from *Nei Jing*. Cases with unilateral pain, unchanged speech, and orderly mind indicate pathogenic factors in the Fen Cou, which corresponds to what Zhang Zhongjing and Li Dongyuan call "Pathogen entering the Fu organs." Fei Bing has no pain, features limb flaccidity, aphasia, and confusion, indicating pathogenic factors entering the interior, corresponding to "Pathogen entering the Zang organs."
[Zhang Zhongjing] A floating and tight pulse at the Cun Kou position indicates tightness representing Cold and floating representing Deficiency. Cold and Deficiency combine, placing the pathogen in the skin. Floating indicates deficiency of Blood and Qi, and emptiness of collateral vessels. The thief pathogen cannot be expelled. It may appear on the left or right. On the affected side, the pathogen causes relaxation/slackness, while the healthy side becomes tense/spastic. The healthy Qi pulls toward the pathogen, causing deviation of the mouth and eyes and inability to move freely. If the pathogen is in the Luo Collaterals, there is numbness of skin and muscle. If in the Jing Meridians, there is heaviness and inability to bear weight. If entering the Fu organs, there is loss of recognition of people. If entering the Zang organs, the tongue becomes stiff making speech difficult, and saliva dribbles from the mouth.
[Jie Gu/Li Dongyuan School] Wind is the beginning of all diseases; it moves swiftly and changes frequently. "Movement" implies activity. Wind originates from Heat; when Heat prevails, Wind moves. One should use stillness to overcome restlessness; nourishing Blood is the method. Treatment requires sparing sweating and sparing purgation. Excessive sweating damages Wei Qi; excessive purgation injures Ying Blood. Only when sweating and purgation are applied appropriately can treatment proceed. Although there are contraindications for sweating and purgation when the pathogen is in the Meridians, there is a distinction between entering Zang and Fu organs. For pathogen entering Fu organs, sweating is appropriate; for entering Zang organs, purgation is appropriate. While combining sweating and purgation, one must not overdo it. Zhang Zhongjing said: Excessive sweating leads to loss of Yang; excessive purgation leads to loss of Yin. Loss of Yang damages Qi; loss of Yin damages Form. Thus, the classics state that Blood and Qi are the spirit of humans and must be carefully nurtured. When exterior and interior are disharmonious, sweating and purgation are needed to harmonize them; once harmonized, treatment should focus on the meridians. Pathogen entering Fu organs manifests as discoloration of the face, exterior syndrome symptoms with a floating pulse, aversion to wind and cold, stiffness, and numbness. Whether affecting the back, front, or sides of the body, it is called "entering Fu organs," and these cases are generally easier to treat. Pathogen entering Zang organs manifests as flaccid lips and mouth, immobility of the tongue leading to aphonia, anosmia, deafness, blurred vision, and constipation of both bowels and bladder. These are called "entering Zang organs," and such cases are generally difficult to treat. If wind enters Fu organs, first use Jia Jian Xu Ming Tang to release the exterior according to the syndrome. If accompanied by entry into Zang organs, bowel obstruction is common; use San Hua Tang to unblock stagnation. Once exterior and interior syndromes are stabilized without further changes, treat with major tonic medicines. Generally, pathogen entering Fu organs affects the four limbs; pathogen entering Zang organs obstructs the nine orifices. Even Fu organ involvement often includes Zang organ symptoms. However, tongue stiffness and aphonia may resolve spontaneously with long-term use of major tonics.
[Dong Yuan] Pathogen entering blood vessels causes facial deviation; entering Fu organs causes limb joint dysfunction; entering Zang organs endangers life. These three require different treatments. If entering blood vessels and presenting with Six Channels syndromes externally, treat with Xiao Xu Ming Tang modified or Shu Feng Tang. If entering Fu organs with internal obstruction of urine and stool, use San Hua Tang or Ma Ren Wan from *Ju Fang* to promote unblocking. If there are no Six Channels symptoms externally and no internal obstruction, nourish Blood and circulate Qi using Da Qin Jiao Tang or Qiang Huo Yu Feng Tang. For pathogen entering Zang organs with phlegm-saliva and coma, use Zhi Bao Dan to settle and anchor. For diseases of blood vessels or Fu organs, avoid using Long Nao (Borneol), She Xiang (Musk), and Niu Huang (Calculus Bovis) initially. Musk enters the Spleen to treat flesh; Niu Huang enters the Liver to treat sinews; Borneol enters the Kidney to treat bones. Using them might draw wind deeper into the bone marrow, like oil penetrating dough, impossible to remove. Do not indiscriminately use Da Ji, Yuan Hua, or Gan Sui to purge bowels, as this damages Yin Blood and further weakens True Qi. (Jie Gu stated that Zang organ entry involves constipation; Dong Yuan stated Fu organ entry involves obstruction. The latter view should prevail, as constipation occurs in non-Zang cases, and Zang cases may not always present with constipation.)