中风，世俗之称也。其症卒然仆倒，口眼 斜，半身不遂，或舌强不言，唇吻不收
是也。然名各有不同，其卒然仆倒者，经称为击仆，世又称为卒中，乃国中风时如此也。其
口眼 斜，半身不遂者，经称为偏枯。世又称为左瘫右痪，及 腿风，乃中倒后之
证，邪之浅者如此也；其舌强不言，唇吻不收者，经称为痱病，世又称为风懿风气，亦中倒
后之症，邪之深者如此也。东垣以邪浅为中脉，中腑而易治；邪深为中脏而难治者，得之矣
。凡病偏枯，必先仆倒，故《内经》连名称为击仆偏枯也。后世迷失经意，以偏枯痱病之旨
，一以中风名之，遂指偏枯为枯细之枯，而非左瘫右痪之症，习俗之弊，至于如此也。殊不
知仲景云∶骨伤则痿，名曰枯。盖痿缓不收，是筋骨肌肉无气以生，脉道不利，手足不禀水
谷之气，故曰枯，非细之谓也。或积日累月，渐成细者间有之，非可便指枯为细也。
〔《素》〕凡治消瘅仆击，偏枯痿厥，气满发逆，肥贵人则膏粱之疾也（通评虚实论）
。三阴三阳发病，为偏枯痿易，四肢不举。（全文见诊病传变。《灵枢》云∶真气去，
邪气独留，发为偏枯）
〔《灵》〕其有三虚，而偏中于邪风，则为击仆偏枯矣。（九宫八风篇）
风中五脏六腑之俞，亦为脏腑之风，各入其门户所中，则为偏风。（全文见诸风）
上经四节论偏枯，前二节属内伤，后二节属外感，盖此症内伤外感相兼而成也。至于河
间、东垣、丹溪则专主内伤，仲景、陈无择、孙思邈则专主外感。今详偏枯邪浅者，宜泻外
感为主，补内伤佐之；痱病邪深者，宜补内伤为主，泻外感佐之也。
〔垣〕中风为百病之长，乃气血闭而不行，此最重疾。凡治风之药，皆辛温上通天气，以
发生为体，是元气始出地之根蒂也。
〔河〕风病多因热盛，俗云风者，言末而忘其本也。所以中风而有瘫痪诸症者，非谓肝木
之风实甚而卒中之也，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，筋骨不为用，而卒倒无所知也。多因喜怒思悲恐之五
志，有所过极而卒中者，由五志过极，皆为热甚故也。所谓肥人多中风者，肥则腠理致
密，而多郁滞，气血难以通利，若阳热又甚而郁结甚，故多卒中也。其瘦者腠理疏通而多汗
泄，血液衰少而为燥热，故多有劳嗽之疾也。然肥人反劳者，由暴然亡液，损血过极故也。
瘦人反中风者，由暴然阳热太甚而郁结不通故也。经云∶人之气，以天地之疾风名之。故中
风者，非外来风邪，乃本气病也。凡人年逾五旬，气衰者多有此疾，壮岁之际无有也。若肥
盛则间有之，亦形盛气衰如此。治法宜和脏腑，通经络，便是治风。（东垣论中风从内出，
其治法则如外入之证，亦以发表攻里行中道三法也）
〔仲〕夫风之为病，当半身不遂，或但臂不遂者，此为痹。脉微而数，中风使然。无择诸方
论中，所谓左瘫右痪者，盖邪气中人，邪气反缓，正气即急，正气引邪， 僻不遂也。
风懿者，以心闷闭不能言，俱噫噫作声。盖肺气入心则能言，邪中心肺，涎潮塞故使然也。
四肢缓纵为风痱者，以风涎散注于关节，气不能行，故使四肢不遂也。舌强不能言者，以风
入心脾经，心之别脉系于舌本，脾之脉侠咽连舌本散舌下，今风涎入其经络，故舌不转而不
能言也。四肢拘挛者，以中风冷，邪气入肝脏，使诸经挛急，屈而不伸也。风柔者，以风热
入于肝脏，使诸经张缓而不收也。故经曰∶寒则挛急，热则弛张。风颤者，以风入于肝脏经
络，上气不守正位，故使头招面摇，手足颤掉也。风喑者，以风冷之气客于中，滞而不能发
，故使口噤不能言也。与前所谓涎塞心肺同候，此以口噤为瘥耳。 腿风者，半身不遂
，失音不语，临事不前，亦偏中于心肺经所致也。（以上皆言风从外入）
中风，是世俗的称呼。其症状表现为突然仆倒，口眼歪斜，半身不遂，或者舌体僵硬不能言语，口唇闭合无力。然而名称各不相同：那些突然仆倒的，医经称为“击仆”，世人又称为“卒中”，这是中风发作时的表现。那些口眼歪斜、半身不遂的，医经称为“偏枯”。世人又称为“左瘫右痪”及“腿风”，这是中风仆倒后的证候，属于邪气较浅的情况；那些舌体僵硬不能言语、口唇闭合无力的，医经称为“痱病”，世人又称为“风懿风气”，也是中风仆倒后的症候，属于邪气较深的情况。李东垣认为邪气浅在中脉、中腑则容易治疗；邪气深在中脏则难以治疗，这种观点是正确的。凡是患偏枯病的，必定先有仆倒，所以《内经》将二者连称为“击仆偏枯”。后世医者迷失了医经的本意，将偏枯和痱病的旨意，一概统称为中风，于是将“偏枯”理解为肢体枯细萎缩，而非左瘫右痪的症状，习俗的弊端竟然到了如此地步。殊不知张仲景说：“骨骼受伤则痿废，名为枯。”所谓痿缓不收，是因为筋骨肌肉缺乏气血滋生，脉道不通利，手足得不到水谷精微之气的滋养，所以称为“枯”，并非指肢体细小。或者经过日积月累，逐渐形成肢体细小的情况间或有之，但不能因此就将“枯”直接等同于“细”。
〔《素问》〕凡是治疗消瘅、仆击、偏枯、痿厥、气满发逆等病，这些都是富贵之人因饮食膏粱厚味所致的疾病（出自《通评虚实论》）。三阴三阳发病，会导致偏枯、肢体功能改变、四肢不能举动。（全文见《诊病传变》。《灵枢》说：“真气离去，邪气独留，就会发生偏枯”。）
〔《灵枢》〕如果有三种虚损，且偏中于邪风，就会发生击仆偏枯。（出自《九宫八风篇》）
风邪侵入五脏六腑的俞穴，也会成为脏腑之风，各自进入其门户而受邪，就会成为偏风。（全文见《诸风》篇）
以上经文四节论述偏枯，前两节属于内伤，后两节属于外感，大概此症是由内伤和外感相互兼夹而成的。至于刘河间、李东垣、朱丹溪则专门主张内伤学说，张仲景、陈无择、孙思邈则专门主张外感学说。现在详细分析，偏枯邪气浅的，应当以泻外感为主，补内伤为辅；痱病邪气深的，应当以补内伤为主，泻外感为辅。
〔李东垣〕中风是百病之长，是气血闭阻而不运行，这是最严重的重疾。凡是治风的药物，都是辛温上行通达天气，以生发为体性，这是元气初出地下的根蒂。
〔刘河间〕风病多因热盛所致，俗话说的“风”，是说表象而忘记了根本。所以中风而有瘫痪等症状的，并不是因为肝木之风实盛而突然中受的，也不是外来的风邪中伤，确实是由于调养失宜，导致心火暴盛，肾水虚衰，不能制约心火，从而阴虚阳实，热气郁结，心神昏乱冒昧，筋骨失去作用，而突然倒下不知人事。多因喜怒思悲恐这五志情绪过度极端而导致猝然中风的，是因为五志过极都会化为热盛。所谓肥胖人容易中风，是因为肥胖者腠理致密，多有郁滞，气血难以通利，如果阳热又甚而郁结严重，所以容易突然中风。瘦人腠理疏松而多汗泄，血液衰少而为燥热，所以多有劳嗽的疾病。然而肥胖人反而出现劳损症状的，是由于突然亡失津液，损伤血液过于严重所致。瘦人反而中风的，是由于突然阳热太盛而郁结不通所致。医经说：“人的气，用天地疾风来命名。”所以中风，不是外来风邪，而是本气生病。凡人年过五十，气衰者多有此病，壮年之际没有。如果形体肥盛则间或有之，也是形盛气衰的表现。治疗方法应当调和脏腑，疏通经络，这就是治风。（李东垣论述中风从内出，但其治法则如同外入之证，也采用发表、攻里、行中道三法。）
〔张仲景〕风之为病，应当半身不遂，或者只是手臂不遂的，此为痹证。脉象微而数，是中风使然。陈无择在诸方论中，所说的左瘫右痪，大概是邪气中人，邪气所在之处松弛，正气所在之处紧张，正气牵引邪气，导致口眼歪斜、肢体不遂。风懿病，表现为心中闷闭不能言语，都发出噫噫的声音。盖因肺气入心则能言语，邪气中心肺，涎沫潮涌堵塞所致。四肢弛缓纵长为风痱病，是因为风涎散注于关节，气不能运行，所以导致四肢不遂。舌体僵硬不能言语的，是因为风邪入心脾经，心的别脉系于舌本，脾的经脉夹咽连舌本散布舌下，如今风涎进入其经络，所以舌体转动不利而不能言语。四肢拘挛的，是因为中风冷，邪气入肝脏，使各条经脉挛急，屈曲而不能伸展。风柔病，是因为风热入于肝脏，使各条经脉张弛不收。所以医经说：“寒则挛急，热则弛张。”风颤病，是因为风入于肝脏经络，上焦之气不守正位，所以导致头部招摇面部摇晃，手足颤抖。风喑病，是因为风寒之气客于中焦，滞涩而不能发声，所以导致口噤不能言语。与前文所说的涎塞心肺属同一证候，此处以口噤为痊愈迹象。腿风病，表现为半身不遂，失音不语，临事不敢前行，也是偏中心肺经所致。（以上皆言风从外入）
Zhongfeng (Stroke), a term used in common parlance, is characterized by sudden collapse, deviation of the mouth and eyes (facial paralysis), hemiplegia, or stiff tongue with inability to speak, and laxity of the lips. However, the names vary: those who suddenly collapse are termed "Jipu" (Sudden Strike/Collapse) in medical classics, and commonly known as "Zuizhong" (Apoplexy), which represents the manifestation during the onset of Zhongfeng. Those with deviation of the mouth and eyes and hemiplegia are termed "Piangu" (Hemiplegia/Paralysis on one side) in medical classics. The common people also call it "Zuo Tan You Huan" (Left Paralysis and Right Immobility) and "Tui Feng" (Leg Wind). These are syndromes occurring after the collapse, representing cases where the pathogenic factor is shallow. Those with a stiff tongue unable to speak and lax lips are termed "Fei Bing" (Flaccid Disease) in medical classics, and commonly known as "Feng Yi Feng Qi" (Wind Stupor and Wind Qi). These are also syndromes occurring after collapse, representing cases where the pathogenic factor is deep. Li Dongyuan posited that when the pathogen is shallow, affecting the meridians and Fu organs, it is easy to treat; when the pathogen is deep, affecting the Zang organs, it is difficult to treat. This view is correct. Whenever Piangu occurs, there must be prior collapse; thus, the *Neijing* links them as "Jipu Piangu". Later generations lost the original meaning of the classics, categorizing both Piangu and Fei Bing under the single name of Zhongfeng. Consequently, they interpreted "Piangu" as referring to atrophy and thinness of the limbs, rather than left paralysis and right immobility. Such customs have led to such errors. They fail to realize what Zhang Zhongjing stated: "When bones are injured, flaccidity ensues, named 'Ku' (Atrophy)." What is meant by flaccidity and inability to retract is that the sinews, bones, muscles, and flesh lack Qi and Blood for nourishment, the pulse pathways are obstructed, and the hands and feet do not receive the Qi from water and grain; hence it is called "Ku", not referring to smallness or thinness. Occasionally, through accumulation over days and months, limbs may gradually become thin, but one cannot simply equate "Ku" with "thinness".
*[Suwen]* Regarding the treatment of Xiaodan (Wasting-Thirst), Jipu, Piangu, Weijue (Flaccidity and Cold Limbs), and Qiman Fani (Fullness and Rebellious Qi), these are diseases of wealthy individuals caused by rich and greasy diets (from *Tong Ping Xu Shi Lun*). When San Yin and San Yang are affected, it leads to Piangu, alteration of limb function, and inability to move the four limbs. (Full text see *Zhen Bing Chuan Bian*. *Lingshu* states: "When True Qi departs and Pathogenic Qi remains alone, Piangu develops.")
*[Lingshu]* If there are three types of deficiency, and the body is partially struck by wind pathogens, then Jipu and Piangu will occur. (From *Jiu Gong Ba Feng Pian*)
If wind pathogens enter the Shu points of the Zang and Fu organs, they become Wind of the Zang and Fu organs. Entering their respective gates, they result in Pian Feng (Partial Wind). (Full text see *Zhu Feng*)
The above four sections of the classics discuss Piangu. The first two sections belong to internal injury, and the latter two to external contraction. Generally, this syndrome arises from a combination of internal injury and external contraction. Liu Hejian, Li Dongyuan, and Zhu Danxi specifically emphasized internal injury, whereas Zhang Zhongjing, Chen Wuyue, and Sun Simiao specifically emphasized external contraction. Upon detailed analysis, for Piangu with shallow pathogens, treatment should primarily focus on draining external contraction, supplemented by tonifying internal injury; for Fei Bing with deep pathogens, treatment should primarily focus on tonifying internal injury, supplemented by draining external contraction.
*[Li Dongyuan]* Zhongfeng is the leader of a hundred diseases, resulting from the obstruction and stagnation of Qi and Blood, making it the most severe and critical illness. All herbs for treating wind are acrid and warm, ascending to connect with Heaven's Qi, possessing the nature of generation, which is the root of Yuan Qi emerging from the earth.
*[Liu Hejian]* Wind diseases often arise from excessive heat. The common term "wind" refers to the manifestation while forgetting the root. Therefore, the occurrence of paralysis and other symptoms in Zhongfeng is not due to excessive Liver Wood wind striking suddenly, nor is it an external wind pathogen invading. It is truly due to improper regimen, causing Heart Fire to flare up violently while Kidney Water declines, failing to control it. This results in Yin deficiency and Yang excess, with hot Qi stagnating and depressing, leading to confusion of the Shen (Spirit) and sudden collapse without consciousness. It is often caused by the extreme excess of the Five Emotions (Joy, Anger, Worry, Sorrow, Fear), as extreme emotions all transform into excessive heat. As for why obese people frequently suffer from Zhongfeng, it is because obesity leads to dense interstices (Cou Li) and much stagnation, making Qi and Blood difficult to circulate freely. If Yang Heat is severe and stagnation is profound, sudden Zhongfeng occurs easily. Thin people have loose interstices and sweat profusely, leading to blood deficiency and dry-heat, so they often suffer from chronic coughs due to consumption. However, if obese people show signs of consumption, it is due to sudden loss of fluids and excessive damage to blood. If thin people suffer from Zhongfeng, it is due to sudden excessive Yang Heat and blockage of stagnation. The classics state: "Human Qi is named after the swift wind of heaven and earth." Thus, Zhongfeng is not an external wind pathogen, but a disease of the primary Qi. People over fifty years old, whose Qi is declining, often suffer from this disease, whereas young adults do not. Obese individuals may occasionally suffer from it, also reflecting the condition of robust form but declining Qi. The treatment method should harmonize the Zang and Fu organs and unblock the meridians; this is the way to treat wind. (Li Dongyuan discussed Zhongfeng originating internally, but his treatment methods were similar to those for externally acquired conditions, employing the three methods of releasing the exterior, purging the interior, and regulating the middle.)
*[Zhang Zhongjing]* Diseases caused by wind typically present with hemiplegia. If only one arm is paralyzed, it is considered Bi Syndrome (Obstruction). A pulse that is faint and rapid indicates Zhongfeng. In the formulas and discussions of Chen Wuyue, "Zuo Tan You Huan" (left paralysis and right immobility) is described as follows: when pathogenic factors invade the person, the area affected by the pathogen becomes slack, while the healthy side becomes tense. The healthy side pulls toward the diseased side, causing deviation of the face and inability to move the limbs. Feng Yi (Wind Stupor) is characterized by chest stuffiness, inability to speak, and gurgling sounds. This is because Lung Qi entering the Heart enables speech; when pathogens affect the Heart and Lung, saliva floods and blocks the orifices, causing this. Si Zhi Huan Zong (flaccid paralysis of the four limbs) is called Feng Fei (Wind Flaccidity). It occurs because wind-phlegm disperses into the joints, Qi cannot circulate, leading to inability to move the limbs. A stiff tongue and inability to speak occur because wind enters the Heart and Spleen meridians. The collateral vessels of the Heart connect to the base of the tongue, and the Spleen meridian runs along the throat to the base of the tongue and spreads under it. Now, wind-phlegm enters these meridians, causing the tongue to be immobile and speechless. Spasticity of the four limbs occurs because cold wind invades the Liver, causing spasms in all meridians, leading to flexion without extension. Feng Rou (Wind Flaccidity/Laxity) occurs because wind-heat enters the Liver, causing laxity and inability to contract in all meridians. Hence the classics say: "Cold causes spasm, heat causes laxity." Feng Chan (Wind Tremor) occurs because wind enters the Liver meridians, causing Upper Qi to lose its proper position, leading to nodding of the head, shaking of the face, and trembling of the hands and feet. Feng Yin (Wind Aphasia) occurs because cold wind lodges in the Middle Jiao, causing stagnation and inability to produce sound, leading to locked jaw and inability to speak. This shares the same pattern as the previously mentioned phlegm blocking the Heart and Lung, but here the locked jaw indicates a better prognosis. Tui Feng (Leg Wind) presents with hemiplegia, aphonia, inability to speak, and hesitation to advance. It is also caused by partial invasion of the Heart and Lung meridians. (All the above describe wind entering from the exterior.)