（附∶建瓴汤）
脑充血证即《内经》之所谓厥证，亦即后世之误称中风证，前论已详辩之矣。而论此证者谓其猝发于
一旦，似难为之预防。不知凡病之来皆预有朕兆，至脑充血证，其朕兆之发现实较他证为尤显著。且有在数
月之前，或数年之前，而其朕兆即发露者。今试将其发现之朕兆详列于下∶
（一）其脉必弦硬而长，或寸盛尺虚，或大于常脉数倍，而毫无缓和之意。
（二）其头目时常眩晕，或觉脑中昏愦，多健忘，或常觉疼，或耳聋目胀。
（三）胃中时觉有气上冲，阻塞饮食不能下行，或有气起自下焦，上行作呃逆。
（四）心中常觉烦躁不宁，或心中时发热，或睡梦中神魂飘荡。
（五）或舌胀、言语不利，或口眼歪斜，或半身似有麻木不遂，或行动脚踏不稳、时欲眩仆，或自觉
头重足轻，脚底如 棉絮。
上所列之证，偶有一二发现，再参以脉象之呈露，即可断为脑充血之朕兆也。愚十余年来治愈此证颇多，
曾酌定建瓴汤一方，服后能使脑中之血如建瓴之水下行，脑充血之证自愈。爰将其方详列于下，以备医界采用。
【建瓴汤】
生怀山药（一两） 怀牛膝（一两） 生赭石（八钱轧细） 生龙骨（六钱捣细）
生牡蛎（六钱捣细） 生怀地黄（六钱） 生杭芍（四钱） 柏子仁（四钱）
磨取铁锈浓水以之煎药。
方中赭石必一面点点有凸，一面点点有凹，生轧细用之方
效。若大便不实者去赭石，加建莲子（去心）三钱。若畏凉者，以熟地易生地。
在津曾治迟××之母，年七旬有四，时觉头目眩晕，脑中作疼，心中烦躁，恒觉发热，两臂觉撑
胀不舒，脉象弦硬而大，知系为脑充血之朕兆，治以建瓴汤。连服数剂，诸病皆愈，惟脉象虽不若从前之大，
而仍然弦硬。因苦于吃药，遂停服。后月余，病骤反复。又用建瓴汤加减，连服数剂，诸病又愈。脉象仍未和
平，又将药停服。后月余，病又反复，亦仍用建瓴汤加减，连服三十余剂，脉象和平如常，遂停
药勿服，病亦不再反复矣。
天津王姓叟，年过五旬，因头疼、口眼歪斜，求治于西人医院，西人以表测其脉，言其脉搏之力已达
百六十毫米汞柱，断为脑充血证，服其药多日无效，继求治于愚。其脉象弦硬而大，知其果系脑部充血，治
以建瓴汤，将赭石改用一两，连服十余剂，觉头部清爽，口眼之歪斜亦愈，惟脉象仍未复常。复至西人医院
以表测脉，西医谓较前低二十余毫米汞柱，然仍非无病之脉也。后晤面向愚述之，劝其仍须多多服药，必服
至脉象平和，方可停服。彼觉病愈，不以介意。后四阅月未尝服药。继因有事出门，劳碌数旬，甫归后又
连次劳累，一旦忽眩仆于地而亡。观此二案，知用此方以治脑充血者，必服至脉象平和，毫无弦硬之意，
而后始可停止也。
友人朱钵文，未尝业医而实精于医。尝告愚曰∶“脑充血证，宜于引血下行药中加破血之药以治之。”
愚闻斯言，恍有悟会。如目疾其疼连脑者，多系脑部充血所致，至眼科家恒用大黄以泻其热，其脑与目即
不疼，此无他，服大黄后脑充血之病即愈故也。夫大黄非降血兼能破血最有力之药乎？由斯知凡脑充血证
其身体脉象壮实者，初服建瓴汤一两剂时，可酌加大黄数钱。其
身形脉象不甚壮实者，若桃仁、丹参诸药，亦可酌加于建瓴汤中也。
天津于氏少妇，头疼过剧，且心下发闷作疼，兼有行经过多症，以建瓴汤加减治愈。
至唐宋以来名此证为中风者，亦非无因。尝征以平素临症实验，知脑充血证恒因病根已伏于内，继又风
束外表，内生燥热，遂以激动其病根，而猝发于一旦。是以愚临此证，见有夹杂外感之热者，恒于建瓴汤中
加生石膏一两；或两三日后见有阳明大热、脉象洪实者，又恒治以白虎汤或白虎加人参汤，以清外感之热，
而后治其脑充血证。此愚生平之阅历所得，而非为唐宋以来之医家讳过也。然究之此等证，谓其为中风兼脑
充血则可，若但名为中风仍不可也。迨至刘河间出，谓此证非外袭之风，乃内生之风，实因五志过极，动火
而猝中。大法以白虎汤、三黄汤沃之，所以治实火也；以逍遥散疏之，所以治郁火也；以通圣散、凉膈
散双解之，所以治表里之邪火也，以六味汤滋之，所以壮水之源以制阳光也；以八味丸引之，所谓从治之法，
引火归原也；又用地黄饮子治舌喑不能言，足废不能行。此等议论，似高于从前误认脑充血为中风者一筹。
盖脑充血证之起点，多由于肝气肝火妄动。肝属木能生风，名之为内中风，亦颇近理。然因未悟《内经》
所谓血之与气并走于上之旨，是以所用之方，未能丝丝入扣，与病证吻合也。至其所载方中有防风、柴
胡、桂、附诸品，尤为此证之禁药。
《金匮》有风引汤除热瘫痫。夫瘫既以热名，明其病因热而得也。其证原似脑充血也。方用石药六味，多
系寒凉之品，虽有干姜、桂枝之辛热，而与大黄、石膏、寒水石、滑石并用，药性混合，仍以凉论（细按之桂枝干
姜究不宜用）。且诸石性皆下沉，大黄性尤下降，
原能引逆上之血使之下行。又有龙骨、牡蛎与紫石英同用，善敛冲气，与桂枝同用，善平肝气。肝冲之气
不上干，则血之上充者自能徐徐下降也。且其方虽名风引，而未尝用祛风之药，其不以热瘫痫为中风明矣。
特后世不明方中之意，多将其方误解耳。拙拟之建瓴汤，重用赭石、龙骨、牡蛎，且有加石膏之时，实窃师
风引汤之义也（风引汤方下之文甚简，似非仲景笔墨，故方书多有疑此系后世加入者，故方中之药品不纯）。
【附录】湖北天门崔××来函∶张港一人患脑充血证，忽然仆地，上气喘急，身如角弓，两目直视。
全家惶恐，众医束手，殓服已备，迎为延医。遵建瓴汤原方治之，一剂病愈强半。后略
有加减，服数剂，脱然全愈。按∶镇肝熄风汤，实由建瓴汤加减而成。
（附：建瓴汤方）
脑充血证，就是《黄帝内经》中所说的厥证，也是后世错误地称为中风证的病证，前面的论述中已经详细辨析过了。但讨论这个病证的人说它突然发作于一旦，似乎难以预防。不知道凡是疾病的到来都预先有征兆，至于脑充血证，它的征兆表现实际上比其他病证更为显著。而且有的在数月之前，或数年之前，其征兆就已经显露了。现在试着将其出现的征兆详细列举如下：
（一）其脉象必然弦硬而长，或者寸口脉盛而尺部脉虚，或者比正常脉象大数倍，而完全没有缓和的意思。
（二）头部和眼睛时常感到眩晕，或者觉得头脑昏沉糊涂，容易健忘，或者经常感到疼痛，或者耳聋、眼睛胀痛。
（三）胃中时常感觉有气向上冲逆，阻塞饮食不能下行，或者有气从下焦升起，上行导致呃逆。
（四）心中常常感觉烦躁不安，或者心中时常发热，或者在睡梦中神魂飘荡不定。
（五）或者舌头肿胀、言语不利，或者口眼歪斜，或者半身似乎麻木不遂，或者行动时脚踏不稳、时常想要跌倒，或者自觉头重脚轻，脚底像踩着棉絮一样。
上面所列的症状，偶然出现一二项，再结合脉象的表现，就可以断定为脑充血的征兆。我十多年来治愈此证很多，曾斟酌拟定建瓴汤一方，服用后能使脑部之血如从高屋建瓴之水般下行，脑充血的病证自然痊愈。于是将该方详细列出如下，以备医学界采用。
【建瓴汤】
生怀山药（一两） 怀牛膝（一两） 生赭石（八钱，轧细） 生龙骨（六钱，捣细）
生牡蛎（六钱，捣细） 生怀地黄（六钱） 生杭芍（四钱） 柏子仁（四钱）
磨取铁锈浓水来煎药。
方中的赭石必须一面有点点凸起，一面有点点凹陷，生用并轧细才有效。如果大便不成形者，去掉赭石，加入建莲子（去心）三钱。如果怕冷者，用熟地黄代替生地黄。
在天津曾治疗迟某某的母亲，年龄七十四岁，时常感觉头目眩晕，头脑作痛，心中烦躁，经常感觉发热，两臂感觉撑胀不适，脉象弦硬而大，知道这是脑充血的征兆，用建瓴汤治疗。连续服用几剂，所有病症都痊愈了，只是脉象虽然不像从前那样大，但仍然弦硬。因为苦于吃药，于是停止服药。后来一个多月，病情突然反复。又用建瓴汤加减，连续服用几剂，所有病症又痊愈了。脉象仍未平和，又将药停服。后来一个多月，病情又反复，仍然用建瓴汤加减，连续服用三十多剂，脉象平和如常，于是停药不服，病也不再反复了。
天津王姓老人，年过五十，因头痛、口眼歪斜，求治于西医医院，西医用水银血压计测其脉搏，说其脉搏压力已达一百六十毫米汞柱，诊断为脑充血证，服用西药多天无效，继而来找我治疗。其脉象弦硬而大，知道确实是脑部充血，用建瓴汤治疗，将赭石改为一两，连续服用十余剂，感觉头部清爽，口眼歪斜也好了，只是脉象仍未恢复正常。再次到西医医院用水银血压计测脉，西医说较前降低了二十余毫米汞柱，然而仍然不是无病的脉象。后来见面向他叙述此事，劝他必须多多服药，一定要服到脉象平和，才可以停药。他觉得病已好，不以为意。后来四个月未曾服药。接着因有事出门，劳累了几十天，刚回来后又多次劳累，有一天忽然眩晕跌倒在地而亡。看这两个医案，就知道用此方治疗脑充血者，必须服到脉象平和，毫无弦硬之意，然后才可以停止服药。
友人朱钵文，未曾学医但实际上精通医术。曾经告诉我：“脑充血证，适宜在引血下行的药物中加入破血的药物来治疗。”我听到这话，恍然有所领悟。比如眼疾疼痛牵连到脑部的，多是脑部充血所致，到了眼科医生那里常用大黄来泻热，这样脑与眼睛就不疼了，这没有别的原因，是因为服用大黄后脑充血的病就好了的缘故。大黄不就是既能降血又能破血最有力的药物吗？由此可知凡是脑充血证，身体脉象壮实的人，初服建瓴汤一两剂时，可以酌情加入大黄数钱。身形脉象不甚壮实的人，像桃仁、丹参等药物，也可以酌情加入建瓴汤中。
天津于氏少妇，头痛剧烈，且心窝下发闷作痛，兼有月经量过多的症状，用建瓴汤加减治愈。
至于唐宋以来将此证称为中风，也不是没有原因。我曾根据平时临症实验的经验，知道脑充血证往往因病根已潜伏在内，接着又被风邪束于外表，内生燥热，从而激动了病根，而突然发作于一旦。所以我诊治此证时，见到夹杂外感热邪的，常在建瓴汤中加入生石膏一两；或者在两三天后见到有阳明经大热、脉象洪实的，又常用白虎汤或白虎加人参汤，以清解外感的热邪，然后再治疗其脑充血证。这是我生平阅历所得的经验，并不是为了替唐宋以来的医家掩饰过错。然而究其实质，这些病证，说它是中风兼脑充血是可以的，但如果只命名为中风仍然是不可以的。等到刘河间出来，说此证不是外袭的风，而是内生的风，实在是因为五志过极，动火而突然中倒。大法是用白虎汤、三黄汤浇灌它，所以是治疗实火；用逍遥散疏解它，所以是治疗郁火；用通圣散、凉膈散表里双解它，所以是治疗表里的邪火；用六味丸滋养它，所以是壮水之源以制约阳光；用八味丸引导它，所谓从治之法，引火归原；又用地黄饮子治疗舌喑不能言，足废不能行。这些议论，似乎比从前误认脑充血为中风者高明一筹。大概脑充血证的起点，多由于肝气肝火妄动。肝属木能生风，称之为内中风，也颇为接近事理。然而因为没有领悟《黄帝内经》所说的“血与气并走于上”的宗旨，所以所用的方剂，未能丝丝入扣，与病证完全吻合。至于他所记载的方剂中有防风、柴胡、桂枝、附子等药品，尤其为此证所禁用的药物。
《金匮要略》中有风引汤治疗除热瘫痫。既然瘫痫以热命名，明确说明病因是热所致。其证候原本类似脑充血。方中用了六种石药，多是寒凉之品，虽然有干姜、桂枝的辛热，但与大黄、石膏、寒水石、滑石并用，药性混合，总体仍以凉性为主（仔细分析，桂枝、干姜终究不宜使用）。而且诸石药性质皆下沉，大黄性质尤以下降为主，原本能引导逆上的血使其下行。又有龙骨、牡蛎与紫石英同用，善于收敛冲气，与桂枝同用，善于平抑肝气。肝冲之气不上干，则血之上充者自然能徐徐下降。而且该方虽然名为风引，却未曾使用祛风的药物，其不以热瘫痫为中风是很明显的。只是后世不明白方中的意义，大多误解了这个方子。我拟定的建瓴汤，重用赭石、龙骨、牡蛎，并且有时加入石膏，实际上是私下效法风引汤的含义（风引汤方下的文字很简略，似乎不是张仲景的笔法，所以方书中多有怀疑这是后世加入的，因此方中的药品不纯粹）。
【附录】湖北天门崔某某来信：张港有一人患脑充血证，忽然仆倒在地，上气喘急，身体像角弓反张，两眼直视。全家惶恐，众医束手无策，殓服都已备好，迎接我去诊治。遵照建瓴汤原方治疗，一剂病愈大半。后来略有加减，服用几剂，彻底痊愈。按语：镇肝熄风汤，实际上是由建瓴汤加减而成的。
(Attachment: Jianling Decoction)
Naochongxue Zheng (Cerebral Hyperemia Syndrome), which is referred to as Jue Zheng (Reversal Syndrome) in the *Huangdi Neijing* (Yellow Emperor's Inner Canon), is also the condition erroneously called Fengzhong Zheng (Apoplexy/Stroke Syndrome) by later generations. This has been thoroughly discussed in previous sections. However, those who discuss this syndrome claim that it occurs suddenly and thus seems difficult to prevent. They do not realize that all diseases have prodromal signs before onset. In the case of Naochongxue Zheng, its prodromal signs are actually more prominent than those of other syndromes. Moreover, these signs may appear months or even years in advance. The following lists the specific prodromal signs:
(1) The pulse must be Xian Ying Er Chang (Wiry, stiff, and long), or Cun Sheng Chi Xu (Excess at the Cun position and Deficiency at the Chi position), or several times larger than a normal pulse, without any sense of moderation.
(2) Frequent dizziness and vertigo of the head and eyes, or a sensation of mental confusion, frequent forgetfulness, constant headache, deafness, or distending pain in the eyes.
(3) A sensation of Qi rushing upward in the stomach, obstructing food and drink from descending, or Qi rising from the Lower Jiao causing hiccups.
(4) Constant irritability and restlessness, or intermittent heat sensation in the heart/mind, or a feeling of the spirit wandering during sleep.
(5) Swollen tongue, slurred speech, deviation of the mouth and eyes, hemibody numbness and motor impairment, unsteady gait with a tendency to fall, a sensation of heavy head and light feet, or soles of the feet feeling like cotton.
If one or two of the above symptoms appear, combined with the corresponding pulse presentation, it can be diagnosed as a prodrome of Naochongxue Zheng. Over the past ten-plus years, I have cured many cases of this syndrome. I devised the Jianling Tang (Jianling Decoction). After taking it, blood in the brain flows downward like water poured from a high vessel, and the cerebral hyperemia resolves spontaneously. Therefore, I list the prescription below for reference by the medical community.
[Jianling Tang]
Sheng Huai Shan Yao (Raw Dioscoreae Hypoglaucae Rhizoma, 30g)
Huai Niu Xi (Achyranthis Bidentatae Radix, 30g)
Sheng Zhe Shi (Raw Haematitum, 24g, finely crushed)
Sheng Long Gu (Raw Os Draconis, 18g, finely crushed)
Sheng Mu Li (Raw Ostreae Concha, 18g, finely crushed)
Sheng Huai Di Huang (Raw Dioscoreae Oppositae Rhizoma, 18g)
Sheng Hang Shao (Raw Paeoniae Radix Alba, 12g)
Bai Zi Ren (Biota Seed, 12g)
Decoct with thick rusted iron water.
The Zhe Shi (Haematitum) used must have both convex and concave surfaces; it must be raw and finely crushed to be effective. If loose stools occur, remove Zhe Shi and add San Qian Jian Lian Zi (Three-thousand-year-old Lotus Seeds, core removed, 9g). If there is aversion to cold, replace Sheng Di Huang with Shu Di Huang (Prepared Dioscoreae Oppositae Rhizoma).
In Tianjin, I treated the mother of Chi XX, aged 74. She frequently experienced dizziness, headache, irritability, heat sensations, and distending discomfort in both arms. Her pulse was wiry, stiff, and large. I identified this as a prodrome of Naochongxue Zheng and treated her with Jianling Tang. After several doses, all symptoms resolved, although the pulse remained wiry and stiff despite being less full than before. Due to fatigue from medication, she stopped taking it. More than a month later, the illness relapsed severely. I prescribed modified Jianling Tang again. After several doses, symptoms resolved again, but the pulse remained unpacified. She stopped the medication again. A month later, it relapsed once more. I prescribed modified Jianling Tang for over thirty doses until the pulse became peaceful and normal. She then stopped the medicine, and no further relapses occurred.
An elderly surnamed Wang in Tianjin, over fifty years old, sought treatment at a Western hospital for headache and facial paralysis. The physician measured his blood pressure at 160 mmHg and diagnosed Naochongxue Zheng. After days of Western medicine with no effect, he came to me. His pulse was wiry, stiff, and large, confirming cerebral hyperemia. I treated him with Jianling Tang, increasing Zhe Shi to 30g. After more than ten doses, his head felt clear, and facial deviation improved, though the pulse had not normalized. He visited the Western hospital again, where the pressure dropped by over 20 mmHg, yet the physician noted the pulse was still abnormal. I advised him to continue medication until the pulse normalized. He believed he was cured and ignored my advice. Four months passed without medication. After returning from a strenuous trip, he suddenly fainted and died. These two cases demonstrate that when using this formula for Naochongxue Zheng, one must continue until the pulse is completely peaceful and free of wiriness/stiffness before stopping.
My friend Zhu Bowen, though not a practitioner, was proficient in medicine. He told me, "For Naochongxue Zheng, it is advisable to add blood-breaking herbs to the blood-descending formula." I was enlightened by this statement. For instance, eye pain radiating to the brain is often caused by cerebral hyperemia. Ophthalmologists often use Da Huang (Rhei Radix et Rhizoma) to purge heat, after which the brain and eye pain cease. This is because Da Huang cures the cerebral hyperemia. Is Da Huang not the most potent herb for both descending and breaking blood? Thus, for patients with Naochongxue Zheng who have strong constitution and pulse, one may add a few qian of Da Huang to the first one or two doses of Jianling Tang. For those with weaker constitutions, herbs like Tao Ren (Persicae Semen) or Dan Shen (Salviae Miltiorrhizae Radix et Rhizoma) may be added.
A young woman of the Yu family in Tianjin suffered from severe headache, epigastric stuffiness and pain, and menorrhagia. She was cured with modified Jianling Tang.
As for naming this syndrome Fengzhong since the Tang and Song dynasties, there is some reason. Based on clinical experience, I know that Naochongxue Zheng often has an internal root cause, followed by external wind constraint and internal dry-heat generation, which agitates the root cause and triggers sudden onset. Therefore, when treating this syndrome with concurrent exterior heat, I often add 30g of Sheng Shi Gao (Gypsum Fibrosum) to Jianling Tang. If Yangming excess heat and a洪 Shi (Surging and Excess) pulse appear after two or three days, I often use Baihu Tang (White Tiger Decoction) or Baihu Jia Renshen Tang (White Tiger plus Ginseng Decoction) to clear the exterior heat before treating the cerebral hyperemia. This is based on my experience, not to cover up the errors of past physicians. Ultimately, while it is acceptable to call this syndrome "Fengzhong accompanied by cerebral hyperemia," calling it merely "Fengzhong" is incorrect.
When Liu Hejian appeared, he argued that this syndrome is not caused by external wind but by internal wind, resulting from extreme emotional agitation generating fire. His main methods included using Baihu Tang and Sanhuang Tang to purge excess fire; Xiaoyao San to soothe constrained fire; Tongsheng San and Liangge San to resolve exterior-interior pathogenic fire; Liuwei Dihuang Wan to nourish Water to control Fire; Bawei Wan to guide fire back to its source (treating according to the disease); and Dihuang Yinzi for aphasia and leg paralysis. These discussions seemed superior to earlier misidentifications of cerebral hyperemia as Fengzhong. The starting point of Naochongxue Zheng is often reckless movement of Liver Qi and Liver Fire. Since the Liver belongs to Wood and generates Wind, naming it "Internal Fengzhong" is quite reasonable. However, failing to grasp the *Neijing* principle of "Blood and Qi moving upward together," his prescriptions were not perfectly matched to the pathology. Notably, formulas containing Fangfeng (Saposhnikoviae Radix), Chaihu (Bupleuri Radix), Guizhi (Cinnamomi Ramulus), and Fuzi (Aconiti Lateralis Radix Praeparata) are strictly contraindicated for this syndrome.
The *Jin Gui Yao Lue* contains Fengyin Tang for treating heat-induced paralysis and epilepsy. Since "paralysis" is named with heat, the etiology is clearly heat. The presentation resembles cerebral hyperemia. The formula uses six mineral drugs, mostly cooling. Although Ganjiang (Zingiberis Rhizoma) and Guizhi are acrid-warm, they are combined with Da Huang, Shigao, Hanshuishi (Halloysitum Rubrum), and Huashi (Kaolin), making the overall nature cool (Note: Guizhi and Ganjiang are arguably unsuitable). All minerals sink; Da Huang descends vigorously. Together, they guide rebellious blood downward. Longgu and Muli combined with Zixuanqu (Pyritum) constrain Chong Qi; combined with Guizhi, they pacify Liver Qi. When Liver-Chong Qi does not rebel upward, ascending blood naturally descends. Although named Fengyin (Wind-Guiding), it contains no wind-expelling herbs, proving it does not view heat-paralysis as Fengzhong. Later generations misunderstood the formula. My Jianling Tang heavily uses Zhe Shi, Longgu, and Muli, and sometimes adds Shigao, effectively borrowing the meaning of Fengyin Tang (The text under Fengyin Tang is brief, suggesting it may not be Zhang Zhongjing's original work, hence potential later additions impure ingredients).
[Appendix] Letter from Cui XX of Tianmen, Hubei: A person in Zhanggang suffered Naochongxue Zheng, suddenly collapsed, with rapid upper-body breathing, opisthotonos (body arched like a bow), and fixed gaze. The family panicked, doctors were helpless, and funeral clothes were prepared. I was summoned. Following the original Jianling Tang, one dose improved the condition by half. With slight modifications over several doses, he recovered completely. Note: Zhen Gan Xi Feng Tang (Pacify the Liver and Extinguish Wind Decoction) was actually derived from modified Jianling Tang.