经所谓痱之为病,身无痛,四肢不收,志乱不甚,其言微知,可治,甚则不能言者是也。
〔丹〕∶今世所谓风病,多与痿证滚同论治,良由《局方》多以治风之药通治诸痿也。古圣
论风痿各有篇目,源流不同,治法亦异,不得不辨。按风论,风者百病之长,至其变化,乃
为它病。又曰善行数变,曰因于露风,曰先受邪,曰在腠理,曰客,曰入,曰伤,曰中。历
陈五脏与胃之伤,皆多汗而恶风,其发明风邪,系外感之病,有脏腑内外寒热虚实之不同,
若是之明且尽也。别无瘫缓痿弱,卒中不省,僵仆 斜,挛缩眩运,语涩不言之文也。
或曰∶吾子谓《内经·风论》主于外感,《局方》用麻黄桂附辈,将以解风寒也;用脑、麝
、威灵仙、黑牵牛辈,将以行凝滞也,子之言过矣。曰∶风病外感,善行数变,其病多实少
虚,发表行滞,有何不可。治风之外,何为又历述神魂恍惚,起便须人,手足不随,神志昏
愦,瘫缓 曳,手足筋挛,眩运倒仆,半身不遂,膝脚缓弱,四肢无力,颤掉拘挛,不
语,语涩等诸痿症兼治之。考诸痿论∶肺热叶焦,五脏因而受之,发为痿 。心气热生
脉痿,故胫纵不任地。肝气热生筋痿,故宗筋弛纵。脾气热生肉痿,故痹而不仁。肾气热生
骨痿,故足不任身。又曰∶诸痿皆生于上。谓之上者,指病之本在肺也。又曰昏惑,曰螈
,曰瞀昧,曰暴病,曰郁冒,曰蒙昧暴喑,曰瞀螈,皆属于火。又曰四肢不举,曰舌本
强,曰足痿不收,曰痰涎有声,皆属于上。又《礼记》注曰∶鱼肉天产也,以养阳作阳德。
以为倦怠悉是湿热内伤之病,当作诸痿治之。何《局方》治风之方,兼治痿者十居八九?不
思诸痿皆起于肺热,传入五脏,散为诸症,大抵只宜补养。若以外感风寒治之,宁免实实虚
虚之祸乎!风病外感之邪,有寒热虚实,而挟寒者多。痿病内热之伤,皆是虚证,无寒可散
,无实可泻。《局方》本为外感立方,而以内伤热证,滚同一治,其为害也。似非细故。
上丹溪诸论,盖因《局方》治中风,孟浪用发表行湿之药,戕贼血气,诛伐根本,不知
补养之法,故引痿病以救《局方》之失,而其言如此。然《局方》所述中风,手足不随,起
便须人,神魂恍惚,不语,语涩等证,即《内经》热病相同。至于异处,不得不察。《针经
·刺节真邪》云∶真气去,邪独留,发为偏枯。《痿论》云∶阳明虚则宗筋纵,带脉不引,
而足痿不用。由是知手足不随者在偏枯,手足为邪气阻塞脉道而然。在痿病,则阳明虚,宗
筋纵,带脉不引而然也。痱病有言变志乱之症,痿病则无之也。痱病又名风痱,而内伤外感
兼备,痿病独得于内伤也。痱病发于击仆之暴,痿病发于怠惰之渐也。凡此皆明痱与痿,明是
两疾也。
大率治风,主血虚有痰,治痰为先,或作属虚挟火与湿,半身不遂者,大率多痰。在左
属死血,在右属痰。左以四物汤等加桃仁、红花、竹沥、姜汁;上以二陈、四君子汤等加竹
沥、姜汁;气虚有痰者,浓煎独参汤加竹沥、姜汁;声如鼾者属气虚,以人参一两煎汤一盏
,入竹沥、姜汁;遗尿者亦属气虚,以参、 、竹沥、姜汁与之;少食者亦为气虚,宜参、
、竹沥;血虚有痰,宜四物汤,俱用姜汁炒,恐泥痰再加竹沥入内服;治痰若气虚少食者
用竹沥;气实能食者加荆沥,此二味开经络,行气血,入四物汤中必少用姜汁;肥人多湿,
用附子、乌头行经;肥人中风口 ,手足麻木,左右俱作痰治。用贝母、栝蒌、南星、
半夏、陈皮、黄芩、白术、黄连、羌活、黄柏、防风、荆芥、威灵仙、薄荷、桂心、甘草、
天花粉;多食湿面,加附子、竹沥、羌汁,酒一匙行经;瘦人脉虚火实,四物汤加牛膝、竹
沥一匙,行经,黄芩、黄柏,有痰加痰药;痰壅盛者,口眼 斜者,不能言者,皆当用
吐法。轻者用瓜蒂、虾汁、皂角,急者用藜芦五分或三分,加麝香灌入鼻内吐痰出。如口不
噤者,灌入口内吐痰出,一吐不已,再吐之。亦有虚而不可吐者。有痰者先吐,后用药。
〔罗〕风中腑兼中脏治验 顺德府张安抚耘夫,年六十一岁。于己未闰十一月初患风证,
半身不遂,语言謇涩,心神昏愦,烦躁自汗,表虚恶风,如洒冰雪,口不知味,鼻不闻香臭
,耳闻木音则惊怖,小便频多,大便结燥。欲用大黄之类下之,则平日饮食减少,不敢用。
不然则又满闷,昼夜不得瞑目而寐,最苦于此。约有三月余,凡三易医,病全不减。至庚申
三月七日,又因风邪,加之痰嗽,咽干燥疼痛不利,唾多,中脘气痞似噎。予思《内经》云
∶风寒伤形,忧恐忿怒伤气,气伤脏乃病,脏病形乃应。又云∶人之气,以天地之疾风名之
。此风气下陷入阴中,不能生发上行,则为疾矣。又云∶形乐志苦,病生于脉,神先病也。
邪风加之,邪入于经,动无常处,前证互相出见,治病必求其本,邪气乃服。论时月则宜升
阳,神脾胃,泻风木,论病则宜实表里,养卫气,泻肝木,润燥,益元气,慎怒,是治其本
也。宜以加减冲和汤主之。
柴胡 黄 (各五钱) 升麻 当归 甘草(炙,各三钱) 半夏 黄柏(酒洗) 黄芩 陈皮
人参 芍药(各二分)
上 咀。作一服,水二盏,煎至一盏,去渣温服。自汗加黄 五分、五味子二十粒
。昼夜不得睡,乃因心事烦扰,心火内动,上乘阳分,卫气不得交入阴分,故使然也。以朱
砂安神丸服之,由是昼亦得睡。十日后,安抚曰∶不得睡三月有余,今困睡不已,莫非它病
生否?予曰∶不然,卫气者昼则行阳二十五度,夜则行阴二十五度,此卫气交入阴分,循其
天度,故安抚得睡也,何病之有焉。止有眼白睛红,隐涩难开,宜以当归连翘汤洗之。
黄连 黄柏(各五分) 连翘(四分) 当归 甘草(各三分)
上作一服,水二盏,煎至一盏,去渣时时热洗。十三日后,至日晡微有闷乱不安,于前
冲和汤中又加柴胡三分,以升少阳之气,饮三服。至十五日,全得安卧,减自汗恶寒躁热胸
膈痞。原小便多服药后小便减少,大便一二日一行,鼻闻香臭,口知味,饮食如常,脉微弦
而柔和,按之微有力。止有咽喉中妨闷,会厌后肿,舌赤,早晨语言快利,午后微涩,宜以
玄参升麻汤治之。
升麻 黄连(各五分) 黄芩(炒,四分) 连翘 桔梗(各三分) 鼠粘子 玄参 甘草 僵蚕(各
三分) 防风(一分)
上 咀。总作一服,水二盏,煎至七分去渣,稍热噙漱,时时咽之,前症良愈。
止有牙齿无力,不能嚼物,宜以牢牙散。
牢牙散 治牙齿无力,不能嚼物。
羊胫骨灰 升麻(各二钱) 生地 黄连 石膏(各一钱) 白茯苓 人参(各五分) 梧桐泪(三分)
上为细末,入麝香研匀。临卧擦牙,后以温水漱之。
安抚初病时,右肩臂膊痛无主持,不能举动,多汗出,肌肉瘦,不能正卧,卧则痛甚。
经云∶汗出偏沮,使人偏枯。余思《针经》云∶虚与实邻,决而通之。又云∶留瘦不移,节
而刺之,使经络通和,血气乃复。又云∶陷下者,灸之,为阴气下陷入阴中。肩膊时痛不能
运动,以火导之,火引而上,补之温之,以上症皆宜灸刺。为此先刺十二经之井穴,于四月
十二日,右肩臂上肩井穴内,先针后灸二七壮,及至灸疮发,于枯瘦处渐添肌肉,汗出少,
肩臂微有力。至五月初八日再灸左肩井,次于尺泽穴各灸二十八壮。引气下行,与正气相接
。次日臂膊又添气力,自能摇动矣。时值仲夏,暑热渐盛,以清肺饮子补肺气,养脾胃,定
心气。
白芍药(五分) 人参 升麻 柴胡(各四分) 天门冬 麦门冬(各三分) 陈皮(二分半) 甘草(
生) 甘草(炙) 黄芩 黄柏(各三分)
上 咀。作一服,水三盏,煎至一盏,去渣温服。
食后汗多,加黄 五分,后以润肠丸。
润肠丸 治胸膈痞满,大便涩滞。
麻子仁(另研) 大黄(酒煨各一两半) 归尾 枳实 白芍药 桃仁泥 升麻(半两) 人参
甘草(生) 陂皮(各三钱) 木香 槟榔(各二钱)
上除桃仁麻仁外,为末。却入二仁泥,蜜和丸,如桐子大。每服七、八十丸,温水食前
服。初六日得处暑节,暑犹未退,宜微收,实皮毛,益胃气。秋以胃气为本,以益气调荣汤
主之,药中加时药,使邪气不能伤也。
人参(三分,为臣,益气和中) 陈皮(二分,为佐,顺气和中) 熟地(二分,为佐,养血润燥
泻阴火) 白芍药(四分,为佐,补脾微收肝木之邪) 白术(三分,为佐,养胃和中浓肠胃) 升
麻(二分为使,使阳明气上升,滋荣百脉) 当归(二分,为佐,和血润燥) 黄 (五分,为君,
实皮毛,止自汗,益元气) 半夏(三分,疗风痰,强胃进食) 甘草(二分,炙,为佐,调和胃气
,温中益气) 柴胡(二分,为使,引少阳之气使出于胃中,乃风行于天上) 麦门冬(三分,为佐
,犹有暑气未退,故加之安肺气,至秋分节不用)
上 咀。作一服,水二盏,煎至一盏,去渣温服。忌食辛热之物,反助暑邪。秋气
不能收,正气得复而安矣。
〔《素》〕太阴所谓入中为喑者,阳盛已衰,故为喑也。内夺而厥,则为喑痱,此肾虚也
,少阴不至者厥也。(脉解篇。王注云∶痱,废也。肾气内夺,则舌喑足废)
〔河〕地黄饮子 治舌喑不能言,足废不能用,肾虚弱,其气厥不至舌下。
熟地 巴戟 山茱萸 肉苁蓉(酒浸,焙) 石斛 附子(炮) 五味子 白茯苓 菖蒲
远志(去心) 官桂 麦冬(去心各等分)
上为末。水一盏半,每服三钱,生姜五片,枣一枚,薄荷同煎,至八分,不拘时服。
〔《肘》〕治中风四肢逆冷,吐清水,婉转啼呼者。取桂二两, 咀。以水三升,煮
取二升,去渣,适寒温尽服。
〔《千》〕地黄煎 治热风心烦闷,及脾胃热不下食,冷补方。
生地汁(二升) 枸杞根汁(二升) 生姜汁 酥(各三升) 荆沥 竹沥(各五升) 天门冬 人参(各
八两) 茯苓(六两) 大黄 栀子(各四两)
上十一味捣,后五味为细末。先煎地黄等汁成煎,次纳药末搅匀。每服一匕,日再,渐
加至三匕,觉利减之。
荆沥汤 治患风人多热,宜服。
荆沥 竹沥 生姜汁(各五合)
上三味相和,温暖为一服。每日旦服煮散,午后进此,平复乃止。(煮散见后解表杂
方条)
〔《衍》〕唐王太后中风不能言,脉沉而口噤。医人许胤宗曰∶既不能下药宜汤气熏之,
药入腠理,周时可瘥。乃煎黄 防风汤数斛,置床下,气如烟雾熏之。其夕便得语,药力熏
蒸,其效如此。
丹溪云∶人之口通乎地,鼻通乎天。口以养阴,鼻以养阳。天主清,故鼻不受有形而受
无形。地主浊,故口受有形而兼乎无形。王太后病风不言而脉沉,其急非大补不可也,若以
有形之药汤,缓不及事。今以黄 防风煎汤,气如烟雾满室,则口鼻俱受,非智者通神之法
,不可为也。
〔《食》〕主风中心气风热,手足不遂,及风痹不任,筋脉五缓,恍惚烦躁。熊肉二斤,
切,如常法,调和作腌腊,空肚服之。
〔《肘》〕中缓风,四肢不收者。豉三升,水九升,煮三升,分为三服,日二服亦可。酒
渍饮之。治卒风中不得语。煮豆煎汁如饴含之。亦可浓煮饮之佳。
〔《圣》〕治卒风中不语,舌根强硬。陈酱五合,三年者妙,人乳汁五合,二件相和研,
以生布绞取汁,不计时候,少少与服,久当愈。
〔《肘》〕治中风卒不得语。以苦酒煮白芥子,附颈一周,以绵裹之,一日夕而瘥。
凡治中风,莫如续命之类,然此可扶持初病。若要收全功,火艾为良。中风皆因脉道不
利,血气闭塞也。灸则唤醒脉道而血气得通,故收全功。
〔《本》〕凡中风,续命、排风、风引、竹沥诸汤,及神精丹、茵芋酒之类,更加以灸,
无不愈者。然此疾积聚之久,非一日所能攻。皆大剂久而取效。《唐书》载王太后风喑不语
,医者蒸黄 防风汤数斛以熏之,得瘥,盖此类也。今人服三五盏求效,则责医也亦速矣。
孟子曰∶七年之病,必求三年之艾,久而后知尔。
〔仲〕续命汤 治中风痱,身体不能自收,口不能言,冒昧不知痛处,或拘挛不能转侧。
麻黄(六两) 桂枝(二两) 当归 人参(各一两) 石膏(四两) 干姜 甘草 芎 (各一两) 杏仁
(三十枚)
上九味,以水一斗,煮取四升,温服一升当小汗。薄覆脊,凭几坐,汗出则愈。不汗,
更服。无所禁,勿当风。并治肺风,但服不得卧,咳逆上气,面目浮肿。
〔洁〕治中风,外有六经之形症,先以加减续命汤随证治之。
麻黄(去节) 人参 黄芩 芍药 甘草(炙) 川芎 杏仁(麦炒,去皮尖) 防己 官桂
防风(各一两) 附子(炮,去皮脐半两)
经文所说的“痱”这种病,身体没有疼痛感,四肢不能随意运动,神志虽然混乱但不严重,说话声音微弱但还能让人听懂,这是可以治疗的;如果病情严重到完全不能说话,就是这种情况。
〔朱丹溪〕:当今世人所说的风病,大多与痿证混在一起论治,这确实是因为《太平惠民和剂局方》(简称《局方》)多用治疗风的药物来通治各种痿证。古代圣贤论述风和痿时各有专门的篇章,它们的源流不同,治疗方法也各异,不得不加以辨别。按照《内经·风论》的说法,风是百病的先导,至于它的变化,才成为其他疾病。又说风善行而数变,说因受风寒侵袭,说先受邪气,说在腠理,说客邪,说侵入,说受伤,说中邪。详细陈述了五脏与胃的损伤,都多汗且恶风,这些阐明了风邪属于外感病,有脏腑内外、寒热虚实的不同,如此明确详尽。并没有关于瘫痪缓弱、猝然昏倒不省人事、僵仆口眼歪斜、抽搐眩晕、言语涩滞不能说话的条文。
有人说:您说《内经·风论》主要讲外感,《局方》用麻黄、桂枝、附子之类,是用来解表散风寒的;用脑子(脑麝)、威灵仙、黑牵牛之类,是用来行气破滞的,您的话错了。我说:风病如果是外感,善行数变,其病多实少虚,发表行滞,有什么不可以呢?但在治疗风病之外,为什么又详细叙述神魂恍惚、起床小便需要人搀扶、手足不能随意运动、神志昏乱、瘫缓无力拖曳、手足筋脉拘挛、眩晕跌倒、半身不遂、膝盖脚部缓弱无力、四肢无力、颤抖拘挛、不说话、言语涩滞等各种痿症兼治的情况?考察《内经·痿论》:肺热叶焦,五脏因此受累,发为痿证。心气热生脉痿,所以小腿纵弛不能站立。肝气热生筋痿,所以宗筋弛缓纵弛。脾气热生肉痿,所以麻木不仁。肾气热生骨痿,所以双脚不能支撑身体。又说:各种痿证都生于上。所谓“上”,是指病的根本在肺。又说昏惑、抽搐、视物模糊、暴病、郁冒、蒙昧暴喑、瞀螈,都属于火。又说四肢不能举起、舌根强直、足痿不能收摄、痰涎有声,都属于上。又《礼记》注解说:鱼肉是天产之物,用来滋养阳气,成就阳德。认为倦怠都是湿热内伤的疾病,应当按各种痿证来治疗。为什么《局方》治疗风的方子,兼治痿证的占了十之八九?不考虑各种痿证都起于肺热,传入五脏,散为各种症状,大体只宜补养。如果用治疗外感风寒的方法来治它,难道不会犯虚实误治的错误吗!风病如果是外感邪气,有寒热虚实,而挟寒的多。痿病是内热损伤,都是虚证,无寒可散,无实可泻。《局方》本是为外感立方的,却把内伤热证混同一起治疗,其危害不小。
以上是丹溪的论述,大概是因为《局方》治疗中风,鲁莽地使用发表行湿的药物,伤害气血,诛伐根本,不知道补养的方法,所以引用痿病来纠正《局方》的失误,他的言论就是这样。然而《局方》所述的中风,手足不能随意运动,起床小便需要人搀扶,神魂恍惚,不说话,言语涩滞等症状,即与《内经》中的热病相同。至于不同之处,不得不仔细考察。《针经·刺节真邪》说:真气离去,邪气独留,发为偏枯。《痿论》说:阳明虚则宗筋弛纵,带脉不能牵引,而足痿不能使用。由此可知,手足不能随意运动,在偏枯病中,是由于手足被邪气阻塞脉道所致;在痿病中,则是由于阳明虚,宗筋弛纵,带脉不能牵引所致。痱病有言语改变、神志混乱的症状,痿病则没有。痱病又名风痱,内外伤兼备,痿病仅得于内伤。痱病发于击打扑倒的突发情况,痿病发于懈怠懒惰的逐渐积累。凡此都说明痱与痿,明明是两种疾病。
大率治疗风病,主因血虚有痰,以治痰为先,或者认为是属虚挟火与湿,半身不遂者,大率多痰。在左侧属死血,在右侧属痰。左侧用四物汤等加桃仁、红花、竹沥、姜汁;上部用二陈汤、四君子汤等加竹沥、姜汁;气虚有痰者,浓煎独参汤加竹沥、姜汁;声音像打呼噜的属气虚,用人参一两煎汤一盏,入竹沥、姜汁;遗尿的也属气虚,用人参、白术、竹沥、姜汁给他服用;吃得少的也为气虚,宜用人参、白术、竹沥;血虚有痰,宜用四物汤,都用姜汁炒制,恐怕滋腻生痰再加竹沥内服;治痰若气虚吃得少的用竹沥;气实能吃的加荆沥,这两味药开通经络,运行气血,加入四物汤中必少用姜汁;肥胖人多湿,用附子、乌头通行经脉;肥胖人中风口眼歪斜,手足麻木,左右都作痰治。用贝母、栝蒌、南星、半夏、陈皮、黄芩、白术、黄连、羌活、黄柏、防风、荆芥、威灵仙、薄荷、桂心、甘草、天花粉;多吃湿面,加附子、竹沥、羌活汁,酒一匙通行经脉;瘦人脉虚火实,四物汤加牛膝、竹沥一匙,通行经脉,黄芩、黄柏,有痰加化痰药;痰壅盛的,口眼歪斜的,不能说话的,都应当用吐法。轻的用瓜蒂、虾汁、皂角,急的用藜芦五分或三分,加麝香灌入鼻内吐出痰液。如果牙关紧闭的,灌入口内吐出痰液,一次吐不完,再吐。也有虚而不能吐的。有痰的先吐,后用药。
〔罗天益〕风中腑兼中脏治验 顺德府张安抚耘夫,六十一岁。在己未年闰十一月初患风证,半身不遂,语言謇涩,心神昏乱,烦躁自汗,表虚恶风,如洒冰雪,口不知味道,鼻不闻香臭,听到木头声音就惊恐害怕,小便频多,大便干结燥硬。想用大黄之类攻下,但他平日饮食减少,不敢用。不然又觉得满闷,昼夜不能闭目睡觉,最痛苦于此。约有三月多,换了三个医生,病全没减轻。到了庚申年三月七日,又因风邪,加上痰嗽,咽喉干燥疼痛不利,唾沫多,中脘气痞塞似噎住。我想《内经》说:风寒伤形,忧恐忿怒伤气,气伤脏乃病,脏病形乃应。又说:人之气,以天地之疾风名之。此风气下陷入阴中,不能生发上行,则为病了。又说:形体安逸而精神苦闷,病生于脉,神先病了。邪风加之,邪入于经,动无常处,前证互相出现,治病必求其本,邪气乃服。论时月则宜升阳,醒脾胃,泻风木,论病则宜实表里,养卫气,泻肝木,润燥,益元气,慎怒,是治其本。宜以加减冲和汤为主。
柴胡、黄芪(各五钱),升麻、当归、甘草(炙,各三钱),半夏、黄柏(酒洗)、黄芩、陈皮、人参、芍药(各二分)。
以上锉碎。作一服,水二盏,煎至一盏,去渣温服。自汗加黄芪五分、五味子二十粒。昼夜不得睡,是因为心事烦扰,心火内动,上乘阳分,卫气不得交入阴分,所以这样。用朱砂安神丸服用,从此白天也能睡了。十日后,安抚说:不得睡三月有余,现在困睡不停,莫非生了别的病吧?我说:不是的,卫气白天行阳二十五度,夜晚行阴二十五度,这是卫气交入阴分,遵循天道,所以安抚能睡,有什么病呢。只有眼白睛红,隐涩难开,宜用当归连翘汤清洗。
以上作一服,水二盏,煎至一盏,去渣时时热洗。十三日后,傍晚微有闷乱不安,在前冲和汤中又加柴胡三分,以升少阳之气,饮三服。到十五日,完全安卧,减少自汗恶寒躁热胸膈痞闷。原来小便多,服药后小便减少,大便一二日一行,鼻闻香臭,口知味道,饮食如常,脉微弦而柔和,按之微有力。只有咽喉中妨闷,会厌后肿,舌赤,早晨语言快利,午后微涩,宜用玄参升麻汤治疗。
升麻、黄连(各五分),黄芩(炒,四分),连翘、桔梗(各三分),鼠粘子、玄参、甘草、僵蚕(各三分),防风(一分)。
以上锉碎。总作一服,水二盏,煎至七分去渣,稍热噙漱,时时咽之,前症良愈。
羊胫骨灰、升麻(各二钱),生地、黄连、石膏(各一钱),白茯苓、人参(各五分),梧桐泪(三分)。
以上为细末,入麝香研匀。临睡前擦牙,后用温水漱口。
安抚初病时,右肩臂膊痛无主持,不能举动,多汗出,肌肉消瘦,不能正卧,卧则痛甚。经云:汗出偏沮,使人偏枯。我想《针经》说:虚与实邻,决而通之。又说:留瘦不移,节而刺之,使经络通和,血气乃复。又说:陷下者,灸之,为阴气下陷入阴中。肩膊时痛不能运动,以火导之,火引而上,补之温之,以上症皆宜灸刺。为此先刺十二经之井穴,于四月十二日,右肩臂上肩井穴内,先针后灸十四壮,及至灸疮发,于枯瘦处渐添肌肉,汗出少,肩臂微有力。至五月初八日再灸左肩井,次于尺泽穴各灸二十八壮。引气下行,与正气相接。次日臂膊又添气力,自能摇动矣。时值仲夏,暑热渐盛,以清肺饮子补肺气,养脾胃,定心气。
白芍药(五分),人参、升麻、柴胡(各四分),天门冬、麦门冬(各三分),陈皮(二分半),甘草(生)、甘草(炙)、黄芩、黄柏(各三分)。
以上锉碎。作一服,水三盏,煎至一盏,去渣温服。
麻子仁(另研),大黄(酒煨各一两半),归尾、枳实、白芍药、桃仁泥、升麻(半两),人参、甘草(生)、陂皮(各三钱),木香、槟榔(各二钱)。
以上除桃仁麻仁外,为末。却入二仁泥,蜜和丸,如桐子大。每服七、八十丸,温水食前服。初六日得处暑节,暑犹未退,宜微收,实皮毛,益胃气。秋以胃气为本,以益气调荣汤主之,药中加时药,使邪气不能伤也。
人参(三分,为臣,益气和中),陈皮(二分,为佐,顺气和中),熟地(二分,为佐,养血润燥泻阴火),白芍药(四分,为佐,补脾微收肝木之邪),白术(三分,为佐,养胃和中浓肠胃),升麻(二分为使,使阳明气上升,滋荣百脉),当归(二分,为佐,和血润燥),黄芪(五分,为君,实皮毛,止自汗,益元气),半夏(三分,疗风痰,强胃进食),甘草(二分,炙,为佐,调和胃气,温中益气),柴胡(二分,为使,引少阳之气使出于胃中,乃风行于天上),麦门冬(三分,为佐,犹有暑气未退,故加之安肺气,至秋分节不用)。
以上锉碎。作一服,水二盏,煎至一盏,去渣温服。忌食辛热之物,反助暑邪。秋气不能收,正气得复而安矣。
〔《素问》〕太阴所谓入中为喑者,阳盛已衰,故为喑也。内夺而厥,则为喑痱,此肾虚也,少阴不至者厥也。(脉解篇。王冰注云:痱,废也。肾气内夺,则舌喑足废)
〔河间〕地黄饮子 治舌喑不能言,足废不能用,肾虚弱,其气厥不至舌下。
熟地、巴戟、山茱萸、肉苁蓉(酒浸,焙)、石斛、附子(炮)、五味子、白茯苓、菖蒲、远志(去心)、官桂、麦冬(去心各等分)。
以上为末。水一盏半,每服三钱,生姜五片,枣一枚,薄荷同煎,至八分,不拘时服。
〔《肘后备急方》〕治中风四肢逆冷,吐清水,婉转啼呼者。取桂二两,锉碎。以水三升,煮取二升,去渣,适寒温尽服。
〔《千金方》〕地黄煎 治热风心烦闷,及脾胃热不下食,冷补方。
生地汁(二升),枸杞根汁(二升),生姜汁、酥(各三升),荆沥、竹沥(各五升),天门冬、人参(各八两),茯苓(六两),大黄、栀子(各四两)。
以上十一味捣,后五味为细末。先煎地黄等汁成煎,次纳药末搅匀。每服一匕,日再,渐加至三匕,觉利减之。
荆沥汤 治患风人多热,宜服。
以上三味相和,温暖为一服。每日旦服煮散,午后进此,平复乃止。(煮散见后解表杂方条)
〔《衍义》〕唐王太后中风不能言,脉沉而口噤。医人许胤宗曰:既不能下药宜汤气熏之,药入腠理,周时可瘥。乃煎黄芪防风汤数斛,置床下,气如烟雾熏之。其夕便得语,药力熏蒸,其效如此。
丹溪云:人之口通乎地,鼻通乎天。口以养阴,鼻以养阳。天主清,故鼻不受有形而受无形。地主浊,故口受有形而兼乎无形。王太后病风不言而脉沉,其急非大补不可也,若以有形之药汤,缓不及事。今以黄芪防风煎汤,气如烟雾满室,则口鼻俱受,非智者通神之法,不可为也。
〔《食疗本草》〕主风中心气风热,手足不遂,及风痹不任,筋脉五缓,恍惚烦躁。熊肉二斤,切,如常法,调和作腌腊,空肚服之。
〔《肘后备急方》〕中缓风,四肢不收者。豉三升,水九升,煮三升,分为三服,日二服亦可。酒渍饮之。治卒风中不得语。煮豆煎汁如饴含之。亦可浓煮饮之佳。
〔《圣济总录》〕治卒风中不语,舌根强硬。陈酱五合,三年者妙,人乳汁五合,二件相和研,以生布绞取汁,不计时候,少少与服,久当愈。
〔《肘后备急方》〕治中风卒不得语。以苦酒煮白芥子,附颈一周,以绵裹之,一日夕而瘥。
凡治中风,莫如续命之类,然此可扶持初病。若要收全功,火艾为良。中风皆因脉道不利,血气闭塞也。灸则唤醒脉道而血气得通,故收全功。
〔《本草纲目》〕凡中风,续命、排风、风引、竹沥诸汤,及神精丹、茵芋酒之类,更加以灸,无不愈者。然此疾积聚之久,非一日所能攻。皆大剂久而取效。《唐书》载王太后风喑不语,医者蒸黄芪防风汤数斛以熏之,得瘥,盖此类也。今人服三五盏求效,则责医也亦速矣。孟子曰:七年之病,必求三年之艾,久而后知尔。
〔仲景〕续命汤 治中风痱,身体不能自收,口不能言,冒昧不知痛处,或拘挛不能转侧。
麻黄(六两),桂枝(二两),当归、人参(各一两),石膏(四两),干姜、甘草、川芎(各一两),杏仁(三十枚)。
以上九味,以水一斗,煮取四升,温服一升当小汗。薄覆脊,凭几坐,汗出则愈。不汗,更服。无所禁,勿当风。并治肺风,但服不得卧,咳逆上气,面目浮肿。
麻黄(去节),人参,黄芩,芍药,甘草(炙),川芎,杏仁(麦炒,去皮尖),防己,官桂,防风(各一两),附子(炮,去皮脐半两)。
The classic states that the disease called "Fei" (Flaccidity/Paralysis) is characterized by no pain in the body, inability to control the limbs, mild confusion of mind, and whispering speech where meaning can still be understood; this is treatable. If the condition worsens to the point of complete muteness, it refers to this situation.
[Danxi]: The wind diseases discussed in modern times are often treated together with Wei syndrome (Flaccidity Syndrome), largely because the *Ju Fang* (Formulary of the Bureau of People's Welfare) uses wind-dispelling herbs to treat various flaccidity syndromes indiscriminately. The ancient sages had separate chapters for discussing wind and flaccidity, as their origins and treatments differ; thus, they must be distinguished. According to the *Wind Discussion* in the classics, wind is the leader of a hundred diseases; its transformations lead to other illnesses. It is said that wind moves swiftly and changes frequently, arises from exposure to wind, invades first, resides in the interstices (Cou Li), acts as an intruding pathogen, enters, injures, or strikes. It details injuries to the five Zang organs and the Stomach, all involving sweating and aversion to wind, clarifying that wind pathogens belong to external contraction diseases, varying by internal/external location, cold/heat, and deficiency/excess. There are no texts describing paralysis, sudden collapse with loss of consciousness, rigidity, falling, deviation of mouth and eyes, spasms, dizziness, slurred speech, or muteness in this context.
Someone says: You state that the *Nei Jing*'s *Wind Discussion* focuses on external contraction, while the *Ju Fang* uses Ephedrae Herba (Mahuang), Cinnamon Twig (Guizhi), and Aconite Root (Fuzi) to release the exterior and scatter cold-wind; and uses animal brains/musk, Notopterygii Rhizoma et Radix (Qianghuo/Wanglingxian - note: text says Wanglingxian but context implies dispersive herbs), and Black Bindweed Seed (Heiqian Niu) to move stagnation. Your words are wrong. I reply: If wind disease is due to external contraction, moving swiftly and changing frequently, with pathology being mostly excess and little deficiency, what is wrong with releasing the exterior and moving stagnation? However, beyond treating wind, why does the *Ju Fang* detail treating symptoms like spirit confusion, needing assistance for urination/defecation, limb immobility, mental dullness, flaccid paralysis dragging, limb tendon spasms, dizziness and falling, hemiplegia, knee and foot weakness, limb powerlessness, tremors and spasms, muteness, and slurred speech—various flaccidity symptoms? Examining the *Flaccidity Discussion*: Lung heat scorches the leaves, affecting the five Zang organs, leading to flaccidity. Heart heat generates Mai Wei (Vessel Flaccidity), causing legs to relax and not bear weight. Liver heat generates Jin Wei (Tendon Flaccidity), causing the sinews to relax. Spleen heat generates Rou Wei (Muscle Flaccidity), causing numbness and insensitivity. Kidney heat generates Gu Wei (Bone Flaccidity), causing feet unable to support the body. It also says: All flaccidities originate from above. "Above" refers to the root being in the Lung. It further states: Confusion, convulsions, visual obscuration, acute illness, depression/suffocation, sudden muteness, and visual-motor disturbance all belong to Fire. Also: Inability to raise limbs, stiffness of the tongue root, foot flaccidity unable to grasp, and noisy phlegm all belong to "above". The commentary on the *Book of Rites* states: Fish and meat are products of heaven, used to nourish Yang and cultivate Yang virtue. Fatigue is considered a disease of internal injury due to damp-heat, and should be treated as various flaccidities. Why do eight or nine out of ten wind-treating formulas in the *Ju Fang* also treat flaccidity? They fail to consider that all flaccidities arise from Lung heat, transmit to the five Zang, and manifest as various symptoms, generally requiring only tonification. Using external cold-wind treatment for this would surely cause the error of reinforcing excess and depleting deficiency! Wind diseases from external pathogens have cold, heat, deficiency, and excess, with cold-binding being common. Flaccidity diseases result from internal heat injury and are all deficiency patterns, with no cold to scatter and no excess to purge. The *Ju Fang* was originally formulated for external contractions, yet treats internal heat injuries identically, causing significant harm.
These are Danxi's arguments, likely because the *Ju Fang* recklessly uses exterior-releasing and damp-draining drugs for stroke, damaging Qi and Blood and attacking the root, lacking knowledge of tonification methods. Thus, he cites flaccidity to correct the *Ju Fang*'s errors. However, the stroke symptoms described in the *Ju Fang*—limb immobility, needing help for toileting, spirit confusion, muteness, slurred speech—are identical to the Heat Diseases in the *Nei Jing*. The differences must be examined. The *Needle Classic · True Evil of Acupuncture* states: When true Qi departs and evil remains alone, hemiplegia develops. The *Flaccidity Discussion* states: Yangming deficiency leads to relaxation of the sinews and failure of the Dai Mai to draw them, resulting in foot flaccidity and non-use. Thus, limb immobility in hemiplegia is caused by evil blocking the meridians, whereas in flaccidity, it is due to Yangming deficiency, relaxed sinews, and Dai Mai failure. Fei disease has symptoms of speech alteration and mind confusion, which flaccidity lacks. Fei disease, also called Wind Fei, involves both internal and external injuries, while flaccidity stems solely from internal injury. Fei arises from sudden blows or falls, while flaccidity arises gradually from laziness or debility. These clearly show Fei and Flaccidity are two distinct diseases.
Generally, treating wind disease involves addressing blood deficiency with phlegm, prioritizing phlegm resolution. It may be considered deficiency with fire and dampness. Hemiplegia usually involves much phlegm. Left-sided cases involve dead blood; right-sided cases involve phlegm. For the left, use Siwu Tang (Four Substances Decoction) plus Persicae Semen (Taoren), Carthami Flos (Honghua), Bamboo Sap (Zhuli), and Ginger Juice (Jiangzhi). For upper body issues, use Erchen Tang (Two Aged Things Decoction) or Sijunzi Tang (Four Gentlemen Decoction) plus Zhuli and Jiangzhi. For Qi deficiency with phlegm, decoct Dushen Tang (Single Ginseng Decoction) strongly, adding Zhuli and Jiangzhi. Snoring voice indicates Qi deficiency; use one liang of Ren Shen (Ginseng) decocted in one zhan of water, adding Zhuli and Jiangzhi. Enuresis also indicates Qi deficiency; give Ren Shen, Baizhu (Atractylodis Macrocephalae Rhizoma), Zhuli, and Jiangzhi. Poor appetite indicates Qi deficiency; use Ren Shen, Baizhu, and Zhuli. For blood deficiency with phlegm, use Siwu Tang, stir-fried with Jiangzhi to prevent cloying/phlegm generation, adding Zhuli. For phlegm treatment: if Qi deficient and poor appetite, use Zhuli; if Qi excess and good appetite, add Jingli (Schizonepeta Sap). These two open meridians and move Qi/Blood; when added to Siwu Tang, use less Jiangzhi. Obese people have much dampness; use Aconitum Carmandi Radix Praeparata (Fuzi) and Aconitum Kusnezoffii Radix (Wutou) to move meridians. Obese people with stroke, deviation of mouth/eyes, and limb numbness are treated as phlegm on both sides. Use Fritillariae Bulbus (Beimu), Trichosanthis Fructus (Gualou), Pinelliae Rhizoma Preparatum (Banxia), Pinelliae Rhizoma (Banxia), Citri Reticulatae Pericarpium (Chenpi), Scutellariae Radix (Huangqin), Atractylodis Macrocephalae Rhizoma (Baizhu), Coptidis Rhizoma (Huanglian), Notopterygii Rhizoma et Radix (Qianghuo), Phellodendri Cortex (Huangbai), Saposhnikoviae Radix (Fangfeng), Schizonepetae Spica (Jingjie), Notopterygii Rhizoma et Radix (Weilingxian), Menthae Haplocalycis Herba (Bohe), Cinnamomi Cortex (Guixin), Glycyrrhizae Radix et Rhizoma (Gancao), and Trichosanthis Radix (Tianguafen). If eating much damp wheat noodles, add Fuzi, Zhuli, Qianghuo juice, and one spoonful of wine to move meridians. Thin people with deficient pulses and excess fire use Siwu Tang plus Achyranthis Bidentatae Radix (Niuxi) and one spoonful of Zhuli to move meridians, plus Huangqin and Huangbai; if phlegm exists, add phlegm-resolving herbs. For severe phlegm obstruction, deviation of mouth/eyes, or muteness, emesis (vomiting) method is required. For mild cases, use Cucumeris Fructus (Gua Di), Shrimp Juice, and Gleditsiae Sinensis Fructus (Zao Jiao); for urgent cases, use Veratrum Nigrum Rhizoma (Lilu) 5 fen or 3 fen mixed with Moschus (Shexiang), insufflated into the nose to induce vomiting of phlegm. If the jaw is locked, pour into the mouth to induce vomiting; repeat if necessary. Some are too deficient to vomit. Those with phlegm should vomit first, then medicate.
[Luo Tianyi]: Clinical Case of Wind Striking Fu and Zang. Zhang Yunfu, Pacifier of Shunde Prefecture, aged 61. In the leap 11th month of Jiwei year, he suffered wind syndrome: hemiplegia, slurred speech, mental confusion, irritability, spontaneous sweating, exterior deficiency with aversion to wind (feeling like ice/snow poured on him), loss of taste, anosmia, fear at the sound of wood, frequent urination, and dry constipation. He wanted to use Da Huang (Rhei Radix et Rhizoma) to purge, but his diet was poor, so he dared not. Otherwise, he felt full/stuffy and could not sleep day or night, which was his greatest suffering. After three months and three doctors, the illness did not improve. On March 7th of Genshen year, exposed to wind again, complicated by phlegm-cough, dry/painful throat, excessive saliva, and epigastric Qi blockage resembling dysphagia. I recalled the *Nei Jing*: "Cold and wind damage the form; worry, fear, anger damage Qi. Qi damage affects Zang, Zang disease manifests in form." Also: "Human Qi is named after the swift wind of Heaven and Earth." This wind Qi sinks into Yin, failing to rise and generate, causing disease. Also: "Form at ease but mind bitter, disease arises in vessels; Spirit is diseased first." With evil wind added, evil enters vessels, moving unpredictably, symptoms appearing mutually. Treating disease requires seeking the root, then evil submits. Considering the season, one should raise Yang, awaken Spleen/Stomach, and drain Wind-Wood. Considering the disease, one should solidify interior/exterior, nourish Wei Qi, drain Liver-Wood, moisten dryness, benefit Yuan Qi, and avoid anger. This treats the root. Use Modified Chonghe Tang as the main formula.
Chai Hu (Bupleuri Radix), Huang Qi (Astragali Radix) [5 qian each]; Sheng Ma (Cimicifugae Rhizoma), Dang Gui (Angelicae Sinensis Radix), Zhi Gan Cao (Prepared Licorice Root) [3 qian each]; Ban Xia (Pinelliae Rhizoma), Jiu Xi Huang Bo (Phellodendri Cortex washed with wine), Huang Qin (Scutellariae Radix), Chen Pi (Citri Reticulatae Pericarpium), Ren Shen (Ginseng Radix), Bai Shao (Paeoniae Radix Alba) [2 fen each].
Crush. One dose, decoct in 2 zhan of water to 1 zhan, strain, take warm. Add Huang Qi 5 fen and Wu Wei Zi (Schisandrae Fructus) 20 grains for spontaneous sweating. Insomnia day and night is due to mental disturbance stirring Heart Fire, ascending to Yang portion, preventing Wei Qi from entering Yin. Take Zhusha Anshen Wan (Cinnabar Calming Spirit Pill). From then, he could sleep during the day. Ten days later, the Pacifier said: "Insomnia for over 3 months, now excessively sleepy, is another disease arising?" I said: "No. Wei Qi travels Yang 25 degrees by day and Yin 25 degrees by night. This is Wei Qi entering Yin according to celestial cycles, hence the Pacifier sleeps. What disease?" Only red sclera, gritty difficulty opening eyes; wash with Danggui Lianqiao Tang (Angelica and Forsythia Decoction).
Huang Lian (Coptidis Rhizoma), Huang Bo (Phellodendri Cortex) [5 fen each]; Lian Qiao (Forsythiae Fructus) [4 fen]; Dang Gui, Gan Cao [3 fen each].
One dose, decoct in 2 zhan water to 1 zhan, strain, wash hot frequently. Thirteen days later, slight restlessness in late afternoon; add Chai Hu 3 fen to previous Chonghe Tang to raise Shaoyang Qi, drink 3 doses. By 15th day, fully rested, reduced spontaneous sweating, aversion to cold, irritability, chest stuffiness. Urination decreased, bowel movement once every 1-2 days, smell/taste restored, normal diet, pulse slightly wiry and soft, faintly forceful on pressure. Only throat obstruction, swelling behind epiglottis, red tongue; fast speech morning, slightly stiff afternoon. Use Xuanshen Shengma Tang (Scrophulariae Radix and Cimicifugae Rhizoma Decoction).
Sheng Ma, Huang Lian [5 fen each]; Chao Huang Qin (Scutellariae Radix fried) [4 fen]; Lian Qiao, Jie Geng (Platycodonis Radix) [3 fen each]; Niu Bang Zi (Arctii Fructus), Xuan Shen (Scrophulariae Radix), Gan Cao, Jiang Can (Bombyx Batryticatus) [3 fen each]; Fang Feng (Saposhnikoviae Radix) [1 fen].
Crush. One dose, decoct in 2 zhan water to 0.7 zhan, strain, hold warm in mouth and swallow frequently. Previous symptoms greatly improved.
Only tooth weakness, inability to chew; use Laoya San (Teeth-Strengthening Powder).
Laoya San treats tooth weakness and inability to chew.
Yang Jing Gu Hui (Ash of Sheep Tibia Bone), Sheng Ma [2 qian each]; Sheng Di (Rehmanniae Radix), Huang Lian, Shi Gao (Gypsum Fibrosum) [1 qian each]; Bai Fu Ling (Poria), Ren Shen [5 fen each]; Wu Tong Lei (Liquidambar Resin) [3 fen].
Grind to fine powder, mix with Shexiang (Moschus). Rub teeth before bed, rinse with warm water.
When initially ill, the Pacifier had right shoulder/arm pain without support, inability to move, profuse sweating, muscle wasting, inability to lie flat (pain worsened lying down). Classics say: "Sweating on one side causes hemiplegia." I recalled *Needle Classic*: "Deficiency and Excess neighbor, puncture to connect." Also: "Emaciation remaining unchanged, puncture joints to make meridians smooth and Qi/Blood restore." Also: "Sunken points, moxa them, as Yin Qi sinks into Yin." Shoulder/arm pain preventing movement should be guided by fire; fire draws upward, tonifies and warms. These symptoms suit moxibustion and acupuncture. First puncture Jing-Well points of twelve meridians. On April 12th, at Jianjing (GB21) on right shoulder/arm, needle then moxa 14 burns (2x7). When moxa blisters appeared, muscles gradually filled in wasted areas, sweating decreased, arm gained slight strength. On May 8th, moxa left Jianjing and Cuize (LI11) 28 burns each. Draw Qi downward to connect with righteous Qi. Next day, arm gained more strength, moved independently. Mid-summer, heat increasing; use Qingfei Yinzi (Clear Lung Drink) to tonify Lung Qi, nourish Spleen/Stomach, calm Heart Qi.
Bai Shao [5 fen]; Ren Shen, Sheng Ma, Chai Hu [4 fen each]; Tian Men Dong (Asparagi Radix), Mai Men Dong (Ophiopogonis Radix) [3 fen each]; Chen Pi [2.5 fen]; Sheng Gan Cao, Zhi Gan Cao, Huang Qin, Huang Bo [3 fen each].
Crush. One dose, decoct in 3 zhan water to 1 zhan, strain, take warm. Add Huang Qi 5 fen if sweating after meals; subsequently use Run Chang Wan (Intestine-Moistening Pills).
Run Chang Wan treats chest stuffiness and constipation.
Huo Ma Ren (Euphorbiae Semenus, ground separately), Jiu Wei Da Huang (Rhei Radix et Rhizoma wine-baked) [1.5 liang each]; Gui Wei (Angelicae Sinensis Radix tail), Zhi Shi (Aurantii Fructus Immaturus), Bai Shao, Tao Ren Ni (Persicae Semen paste), Sheng Ma [0.5 liang]; Ren Shen, Sheng Gan Cao, Pi (likely Hou Po or similar bark, text says 'Pi'), Mu Xiang (Aucklandiae Radix), Bing Lang (Arecae Semen) [3 qian each], [2 qian each].
Except Tao Ren and Huo Ma Ren, grind to powder. Mix in the two pastes, honey-pellet, size of paulownia seeds. Take 70-80 pills with warm water before meals. On June 6th, End of Heat solar term arrived, summer heat lingered; gently consolidate, solidify skin/hair, benefit Stomach Qi. Autumn roots in Stomach Qi; use Yiqi Tiarong Tang (Benefit Qi and Harmonize Nutritive Decoction), adding seasonal herbs to prevent pathogenic injury.
Ren Shen [3 fen, Minister, benefits Qi harmonizes middle], Chen Pi [2 fen, Assistant, regulates Qi harmonizes middle], Shu Di (Rehmanniae Radix Preparata) [2 fen, Assistant, nourishes blood moistens dryness drains Yin fire], Bai Shao [4 fen, Assistant, tonifies spleen mildly restrains Liver Wood evil], Bai Zhu [3 fen, Assistant, nourishes stomach harmonizes middle thickens intestines], Sheng Ma [2 fen, Envoy, raises Yangming Qi nourishes hundred vessels], Dang Gui [2 fen, Assistant, harmonizes blood moistens dryness], Huang Qi [5 fen, Sovereign, solidifies skin/hair stops sweating benefits Yuan Qi], Ban Xia [3 fen, treats wind-phlegm strengthens stomach promotes food], Zhi Gan Cao [2 fen, Assistant, harmonizes stomach warms middle benefits Qi], Chai Hu [2 fen, Envoy, guides Shaoyang Qi out of Stomach, like wind moving in sky], Mai Men Dong [3 fen, Assistant, summer heat lingers, soothes Lung Qi, remove at Autumn Equinox].
Crush. One dose, decoct in 2 zhan water to 1 zhan, strain, take warm. Avoid pungent-hot foods, which aid summer-heat evil. Autumn Qi cannot gather, righteous Qi restores and calms.
*[Su Wen]*: Taiyin speaking of entering middle causing aphonia: Yang excess has declined, thus aphonia occurs. Internal depletion and reversal causes aphonia and fei, this is Kidney deficiency. Shaoyin not reaching causes reversal. (Mai Jie Pian. Wang Bing notes: Fei means waste. Kidney Qi internal depletion causes tongue aphonia and foot waste.)
*[Hejian]*: Dihuang Yinzi (Rehmannia Decoction) treats tongue aphonia unable to speak, foot waste unable to use, Kidney deficiency, Qi reversal not reaching under tongue.
Shu Di (Prepared Rehmannia Root), Bajiji (Morinda Officinalis Root), Shanzhuyu (Cornus Fruit), Roushourong (Cistanche Stem), Shihu (Dendrobium Stem), Pao Fuzi (Prepared Aconite Root), Wuweizi (Schisandra Fruit), Bai Fuling (Poria), Changpu (Acorus Tatarinowii Rhizome), Yuanzhi (Polygalae Radix, heart removed), Guanzi Gui (Cinnamon Bark), Maidong (Ophiopogon Tuber, heart removed, equal parts).
Grind to powder. 1.5 zhan water, 3 qian per dose, 5 slices ginger, 1 jujube, Bohe (Mint) decoct together to 0.8 zhan, take anytime.
*[Zhouhou]*: Treats stroke with cold limbs, vomiting clear fluid, writhing crying. Take 2 liang Gui (Cinnamon), crush. Decoct in 3 sheng water to 2 sheng, strain, take warm completely.
*[Qianjin]*: Dihuang Jian (Rehmannia Paste) treats wind-heat vexation, stomach/spleen heat with no desire to eat, cold tonic formula.
Sheng Di汁 (Fresh Rehmannia Juice) 2 sheng, Gouqi Gen汁 (Goji Root Juice) 2 sheng, Shengjiang汁 (Ginger Juice) 3 sheng, Su (Butter/Ghee) 3 sheng, Jingli (Schizonepeta Sap) 5 sheng, Zhuli (Bamboo Sap) 5 sheng, Tianmendong 8 liang, Ren Shen 8 liang, Fuling 6 liang, Da Huang 4 liang, Zhizi 4 liang.
Ten ingredients pounded, last five ground to fine powder. First decoct Rehmannia juices into paste, then add powder, stir well. Take one bi daily twice, gradually increase to three bi, reduce if loose stools occur.
Jingli Tang (Schizonepeta Sap Decoction) treats wind patients with much heat, suitable for taking.
Jingli, Zhuli, Shengjiang汁 (each 5 he).
Mix three, warm as one dose. Take boiled powder in morning, this in afternoon, stop when recovered. (Boiled powder see Exterior-Releasing Miscellaneous Formulas section).
*[Yanyi]*: Empress Dowager Wang of Tang suffered stroke, unable to speak, pulse deep, jaw locked. Physician Xu Yinzong said: Since oral medication is impossible, fumigate with decoction vapor; medicine enters Cou Li, recovery possible in one cycle. Decocted Huang Qi (Astragalus) and Fangfeng (Saposhnikovia) soup several hu, placed under bed, vapor like smoke fumigated her. That evening she could speak. Medicine power fumigation, efficacy thus.
Danxi said: Human mouth connects to Earth, nose to Heaven. Mouth nourishes Yin, nose nourishes Yang. Heaven is clear, so nose receives formless, not formed. Earth is turbid, so mouth receives formed and formless. Empress Dowager Wang wind disease mute, pulse deep, urgency requires major tonification. If using formed medicine soup, slow to act. Now Huang Qi/Fangfeng decocted, vapor fills room like smoke, mouth/nose both receive. Not wise man's divine method, cannot be done.
*[Shiliao]*: Main wind striking center Qi wind-heat, limbs not following, wind-bi unbearable, five tendons slack, confusion irritability. Bear meat 2 jin, cut, prepare normally, mix as cured meat, take on empty stomach.
*[Zhouhou]*: Middle slow wind, limbs not receiving. Dou (Fermented Soybean) 3 sheng, water 9 sheng, boil to 3 sheng, divide 3 doses, twice daily also. Soak in wine and drink. Treats sudden wind strike unable to speak. Boil beans, decoct juice like syrup, hold in mouth. Also strong decoction drink is good.
*[Shengji]*: Treats sudden wind strike mute, tongue root stiff. Chen Jiang (Aged Soybean Paste) 5 he (best 3 years), Ren Ru (Human Milk) 5 he, mix and grind, squeeze juice through raw cloth, take small amounts anytime, long time will heal.
*[Zhouhou]*: Treats sudden wind strike mute. Cook Bai Jiezi (White Mustard Seed) in Ku Jiu (Bitter Wine), wrap around neck, cover with cotton, heal in one night/day.
Generally treating stroke, nothing beats Xuming (Continuing Life) type, but this supports early disease. To achieve full success, Moxa/Ai (Artemisia Argyi) is best. Stroke all due to vessel path unsmooth, Qi/Blood blocked. Moxa awakens vessels, Qi/Blood gets through, thus full success.
*[Bencao]*: All stroke, Xuming, Paifeng, Fengyin, Zhuli various soups, and Shenjing Dan, Yinyu Jiu types, plus moxa, none not healing. But this disease accumulates long, not one day attack. All large dose long time to effect. *Tang Shu* records Empress Dowager Wang wind aphonia mute, doctor steamed Huang Qi/Fangfeng soup several hu to fumigate, healed, this category. Now people take 3-5 cups seeking effect, blaming doctor is too fast. Mencius said: Seven-year disease, must seek three-year Ai, long time then know you.
*[Zhongjing]*: Xuming Tang treats stroke Fei, body cannot self-control, mouth cannot speak, confused unaware of pain, or spasms unable to turn.
Mahuang (Ephedrae Herba) 6 liang, Guizhi (Cinnamomi Ramulus) 2 liang, Dang Gui (Angelicae Sinensis Radix), Ren Shen (Ginseng Radix) [1 liang each], Shigao (Gypsum Fibrosum) 4 liang, Ganjiang (Zingiberis Rhizoma), Gancao (Licorice Radix), Xiong (Ligustici Rhizoma et Radix) [1 liang each], Xingren (Pruni Armeniaci Semen) 30 pieces.
Nine ingredients, water 1 dou, boil to 4 sheng, take 1 sheng warm should produce slight sweat. Lightly cover spine, sit leaning on table, sweat then heal. No sweat, take more. No prohibition, avoid wind. Also treats Lung Wind, but take unable to lie, cough reverse Qi, face/eye swelling.
*[Jiegu]*: Treats stroke, exterior has six-channel symptoms, first use Modified Xuming Tang follow symptom treat.
Mahuang (remove nodes), Ren Shen, Huang Qin (Scutellariae Radix), Shaoyao (Paeoniae Radix), Zhi Gancao (Prepared Licorice), Chuanxiong (Ligustici Chuanxiong Rhizoma), Xingren (wheat fried, peel tip), Fangji (Stephaniae Tetrandrae Radix), Guanzi Gui (Cinnamon Bark), Fangfeng (Saposhnikoviae Radix) [1 liang each], Fuzi (Prepared Aconite Root, peel navel half liang).