天津孙××，年四十六岁，得脑充血证遂至偏枯。
病因 禀性褊急，又兼处境不顺，恒触动肝火致得斯证。
证候 未病之先恒觉头疼，时常眩晕。一日又遇事有拂意，遂忽然昏倒，移时醒后，左手足皆不
能动，并其半身皆麻木，言语謇涩。延医服药十个月，手略能动，其五指则握而不伸，足可任地而不
能行步，言语仍然謇涩，又服药数月病仍如故。诊其脉左右皆弦硬，右部似尤甚，知虽服药年余，脑
充血之病犹未除也。问其心中发热乎？脑中有时觉疼乎？答曰∶心中有时觉有热上冲胃口，其热再
上升则脑中可作疼，然不若病初得时脑疼之剧也。问其大便两三日一行，证脉相参，其
脑中犹病充血无疑。
诊断 按此证初得，不但脑充血实兼脑溢血也。其溢出之血，着于左边司运动之神经，则右半
身痿废，着于右边司运动之神经，则左半身痿废，此乃交叉神经以互司其身之左右也。想其得病
之初，脉象之弦硬，此时尤剧，是以头疼眩晕由充血之极而至于溢血，因溢血而至于残废也。即现时之
证脉详参，其脑中溢血之病想早就愈，而脑充血之病根确未除也。宜注意治其脑充血，而以通活经
络之药辅之。
处方 生怀山药（一两） 生怀地黄（一两） 生赭石（八钱研细） 怀牛膝（八钱）
生杭芍（六钱） 柏子仁（四钱炒捣） 白术（三钱炒） 滴乳香（三钱）
明没药（三钱） 土鳖虫（四大个捣） 生鸡内金（钱半黄色的捣） 茵陈（一钱）
共煎汤一大盅，温服。
复诊 将药连服七剂，脑中已不作疼，心中间有微热之时，其左半身自觉肌肉松活，不若从前
之麻木，言语之謇涩稍愈，大便较前通顺，脉之弦硬已愈十之七八，拟再注意治其左手足之痿废。
处方 生箭 （五钱） 天花粉（八钱） 生赭石（六钱轧细） 怀牛膝（五钱）
滴乳香（四钱） 明没药（四钱） 当归（三钱） 丝瓜络（三钱）
土鳖虫（四大个捣） 地龙（二钱去土）
共煎汤一大盅，温服。
三诊 将药连服三十余剂（随时略有加喊），其左手之不伸者已能伸，左足之不能迈步者今已
举足能行矣。病患问从此再多多服药可能撤消否？答曰∶此病若初得即治，服药四十余剂即能脱
然，今已迟延年余，虽服数百剂亦不能保全愈，因关节经络之间瘀滞已久也。然再多服数十剂，仍
可见愈，遂即原方略为加减，再设法以 动其神经补助其神经当更有效。
处方 生箭 （六钱） 天花粉（八钱） 生赭石（六钱轧细） 怀牛膝（五钱）
滴乳香（四钱） 明没药（四钱） 当归（三钱） 土鳖虫（四大个捣）
地龙（二钱去土） 真鹿角胶（二钱轧细） 广三七（二钱轧细） 制马钱子末（三分）
药共十二味，先将前九味共煎汤一大盅，送服后三味各一半，至煎渣再服时，仍送服其余一半。
方解 方中用鹿角胶者，因其可为左半身引经，且其角为督脉所生，是以其性善补益脑髓以滋
养脑髓神经也，用三七者，关节经络间积久之瘀滞，三七能融化之也。用制马钱子者，以
其能 动神经使灵活也。
效果 将药又连服三十余剂，手足之举动皆较前便利，言语之謇涩亦大见愈，可勉
强出门作事矣。遂俾停服汤药，日用生怀
山药细末煮作茶汤，调以白糖令适口，送服黄色生鸡内金细末三分许。当点心用之以善其后。此欲用山
药以补益气血，少加鸡内金以化瘀滞也。
帮助 按脑充血证，最忌用黄 ，因黄 之性补而兼升，气升则血必随之上升，致脑中之血充而
益充，排挤脑中血管可至溢血，甚或至破裂而出血，不可救药者多矣。至将其脑充血之病治愈，而
肢体之痿废仍不愈者，皆因其经络瘀塞血脉不能流通也。此时欲化其瘀塞，通其血脉，正不妨以黄 辅之，
特是其脑中素有充血之病，终嫌黄 升补之性能助血上升，故方中仍加生赭石、牛膝，以防血之上
升，即所以监制黄 也。又虑黄 性温，温而且补即能生热，故又重用花粉以调剂之也。
天津孙××，四十六岁，患脑充血证，进而导致偏瘫（半身不遂）。
病因 禀赋性格急躁，加之处境不顺，经常触动肝火，从而引发此病。
证候 发病前常感觉头痛，时常眩晕。有一天又遇到不如意的事，突然昏倒，过了一段时间醒来后，左手足都不能动，并且半边身体都麻木，说话口齿不清。请医生服药十个月，手稍微能活动，但五个手指紧握不能伸展，脚能支撑地面但不能行走，说话仍然口齿不清，又服药几个月病情依旧。诊察其脉象左右都弦硬，右部似乎更严重，知道虽然服药一年多，脑充血的病根仍未去除。问他心中发热吗？脑中有时疼痛吗？回答说：心中有时觉得有热感上冲至胃口，热再上升则脑中会作痛，但不像刚得病时脑疼那么剧烈。问大便两三天一次，结合症状和脉象分析，脑中仍有充血无疑。
诊断 按照这个病例初发时，不仅是脑充血，还兼有脑溢血。溢出的血液，附着在左边主管运动的神经上，则右半身痿废；附着在右边主管运动的神经上，则左半身痿废，这是因为交叉神经互相主管身体左右侧的缘故。想他得病之初，脉象的弦硬此时尤为剧烈，所以因充血至极而导致溢血，因溢血而导致残废。即根据现在的症状和脉象详细参详，脑中溢血的病症想必早已痊愈，而脑充血的病根确实未除。应当注意治疗脑充血，并用疏通活络的药物辅助。
处方 生怀山药（一两） 生怀地黄（一两） 生赭石（八钱研细） 怀牛膝（八钱）
生杭芍（六钱） 柏子仁（四钱炒捣） 白术（三钱炒） 滴乳香（三钱）
明没药（三钱） 土鳖虫（四大个捣碎） 生鸡内金（一钱半黄色的捣碎） 茵陈（一钱）
共煎成一大盅汤，温服。
复诊 将药连续服用七剂，脑中已不疼痛，心中偶尔有微热的时候，左半身自觉肌肉松软灵活，不像从前那样麻木，说话口齿不清稍有好转，大便比以前通顺，脉象的弦硬已好转十分之七八，打算再重点治疗左手足的痿废。
处方 生箭芪（五钱） 天花粉（八钱） 生赭石（六钱轧细） 怀牛膝（五钱）
滴乳香（四钱） 明没药（四钱） 当归（三钱） 丝瓜络（三钱）
土鳖虫（四大个捣碎） 地龙（二钱去土）
共煎成一大盅汤，温服。
三诊 将药连续服用三十多剂（随时略有增减），左手不能伸展的已经能伸展，左脚不能迈步的现在已能抬脚行走了。病人问从此再多服药可能消除吗？回答说：这病如果初得时就治疗，服药四十多剂就能彻底痊愈，现在已经拖延了一年多，虽然服用几百剂也不能保证完全治愈，因为关节经络之间的瘀滞时间太久了。然而再多服几十剂，仍可见效，于是就在原方基础上略微加减，再设法以药物刺激神经、补助神经，应该更有效果。
处方 生箭芪（六钱） 天花粉（八钱） 生赭石（六钱轧细） 怀牛膝（五钱）
滴乳香（四钱） 明没药（四钱） 当归（三钱） 土鳖虫（四大个捣碎）
地龙（二钱去土） 真鹿角胶（二钱轧细） 广三七（二钱轧细） 制马钱子末（三分）
药共十二味，先将前九味共同煎成一大盅汤，送服后三味各一半，等到煎渣再服时，仍送服剩余的一半。
方解 方中使用鹿角胶，是因为它可以作为引导药进入左半身，且其角为督脉所生，因此其性质善于补益脑髓以滋养脑髓神经。使用三七，是因为关节经络间积久存在的瘀滞，三七能够融化它。使用制马钱子，是因为它能刺激神经使其灵活。
效果 将药又连续服用三十多剂，手足的活动都比以前便利，说话口齿不清也大有好转，可以勉强出门做事了。于是让他停服汤药，每天用生怀山药细末煮成茶汤，调入白糖使口感适宜，送服黄色生鸡内金细末约三分。当作点心食用以善后调理。这是想用山药来补益气血，少加鸡内金来化瘀滞。
帮助 按脑充血证，最忌讳使用黄芪，因为黄芪的性质补益且兼有升提作用，气升则血必随之上升，导致脑中的血充而更充，排挤脑中血管可导致溢血，甚至破裂出血，不可救药的很多。至于将其脑充血的病治愈，而肢体的痿废仍不愈者，都是因为经络瘀塞血脉不能流通。此时想要化解瘀塞，通利血脉，正不妨用黄芪辅助它，只是因为他脑中素有充血的病，终究嫌弃黄芪升补的性能会助血上升，所以方中仍加生赭石、牛膝，以防止血之上升，这就是用来监制黄芪的方法。又担心黄芪性温，温而且补就能生热，所以又重用花粉来调剂它。
Tianjin patient Sun XX, aged forty-six, suffered from Brain Congestion Syndrome (Nao Chong Xue Zheng), which subsequently led to Hemiplegia (Pian Ku).
Etiology: His innate temperament was irritable and impatient. Coupled with unfavorable circumstances, he frequently stirred up Liver Fire (Gan Huo), thereby inducing this condition.
Symptoms: Prior to the onset of the illness, he often felt headaches and experienced frequent dizziness. One day, after encountering an unpleasant event, he suddenly fainted. After regaining consciousness some time later, his left hand and foot were immobile, and half of his body was numb. His speech was slurred. He consulted a physician and took medicine for ten months; his hand could move slightly, but his five fingers remained clenched and unable to extend. His leg could bear weight on the ground but he could not walk. His speech remained slurred. He continued taking medicine for several more months, yet the condition remained unchanged. Palpation revealed that both left and right pulses were wiry and hard (Xian Ying), with the right side appearing even more severe. It was known that despite over a year of medication, the root cause of Brain Congestion had not been eliminated. When asked if he felt heat in the heart region or pain in the head, he replied: "Sometimes I feel heat rising from the stomach area to the throat; if this heat rises further, it causes pain in the head, though not as severe as when the disease first began." Regarding bowel movements occurring every two to three days, combined with the symptoms and pulse, there was no doubt that congestion in the brain still existed.
Diagnosis: Upon initial onset, this case involved not only Brain Congestion but also Cerebral Hemorrhage (Nao Yi Xue). The extravasated blood adhered to the motor nerves on the left side, causing paralysis of the right half of the body; conversely, adherence to the right-side motor nerves would cause paralysis of the left half. This is due to the cross-innervation of nerves controlling the left and right sides of the body. At the onset, the wiry and hard pulse was likely even more pronounced. Thus, extreme congestion led to hemorrhage, and hemorrhage led to disability. Based on current symptoms and pulse, the cerebral hemorrhage has likely healed, but the root of Brain Congestion remains. Treatment should focus on resolving Brain Congestion, assisted by herbs that unblock and activate the meridians.
Prescription:
Raw Huai Yam (Sheng Huai Shan Yao) - 1 liang
Raw Huai Rehmannia Root (Sheng Huai Di Huang) - 1 liang
Raw Oyster Shell/Heavy Descending Stone (Sheng Zhe Shi) - 8 qian, finely ground
Huai Achyranthes Root (Huai Niu Xi) - 8 qian
Raw Hang Peony Root (Sheng Hang Shao) - 6 qian
Biota Seed (Bai Zi Ren) - 4 qian, stir-fried and crushed
Atractylodes Macrocephala Rhizome (Bai Zhu) - 3 qian, stir-fried
Dripping Frankincense (Di Ru Xiang) - 3 qian
Bright Myrrh (Ming Mo Yao) - 3 qian
Ground Beetle (Tu Bie Chong) - 4 large specimens, crushed
Raw Chicken Gizzard Lining (Sheng Ji Nei Jin) - 1.5 qian (yellow variety), crushed
Artemisia Capillaris Herb (Yin Chen) - 1 qian
Decoct together in one large bowl of water, take warm.
Second Visit: After seven doses, head pain ceased. Occasional mild heat in the chest appeared. The left half of the body felt looser and less numb than before. Slurred speech improved slightly. Bowel movements became smoother. The wiry and hard pulse improved by seventy to eighty percent. The plan shifted to focusing on treating the flaccidity of the left hand and foot.
Prescription:
Raw Astragalus Root (Shen Qi / Sheng Jian Qi) - 5 qian
Trichosanthes Root (Tian Hua Fen) - 8 qian
Raw Oyster Shell (Sheng Zhe Shi) - 6 qian, finely ground
Huai Achyranthes Root (Huai Niu Xi) - 5 qian
Dripping Frankincense (Di Ru Xiang) - 4 qian
Bright Myrrh (Ming Mo Yao) - 4 qian
Angelica Sinensis Root (Dang Gui) - 3 qian
Luffa Reticulate Fruit (Si Gua Luo) - 3 qian
Ground Beetle (Tu Bie Chong) - 4 large specimens, crushed
Earthworm (Di Long) - 2 qian, cleaned
Decoct together in one large bowl of water, take warm.
Third Visit: After more than thirty doses (with minor adjustments), the previously immobile left hand could now extend, and the left foot could lift and walk. The patient asked if continued medication could lead to complete recovery. I replied: "If treated at the onset, forty doses would suffice for full recovery. Having delayed for over a year, even hundreds of doses may not guarantee complete cure due to long-standing stasis in joints and meridians. However, dozens more doses will show improvement." Therefore, the original formula was slightly modified, aiming to stimulate and support nerve function for better efficacy.
Prescription:
Raw Astragalus Root (Shen Qi / Sheng Jian Qi) - 6 qian
Trichosanthes Root (Tian Hua Fen) - 8 qian
Raw Oyster Shell (Sheng Zhe Shi) - 6 qian, finely ground
Huai Achyranthes Root (Huai Niu Xi) - 5 qian
Dripping Frankincense (Di Ru Xiang) - 4 qian
Bright Myrrh (Ming Mo Yao) - 4 qian
Angelica Sinensis Root (Dang Gui) - 3 qian
Ground Beetle (Tu Bie Chong) - 4 large specimens, crushed
Earthworm (Di Long) - 2 qian, cleaned
True Deer Antler Glue (Zhen Lu Jiao) - 2 qian, finely ground
Panax Notoginseng Root (Guang San Qi) - 2 qian, finely ground
Processed Strychnos Nux-vomica Seed Powder (Zhi Ma Qian Zi Mo) - 3 fen
Total twelve ingredients. First, decoct the first nine ingredients in one large bowl of water. Take this decoction while administering half of each of the last three powders. When re-decocting the dregs, administer the remaining half of the powders.
Formula Analysis: Deer Antler Glue (Lu Jiao Jiao) is used because it acts as a guiding herb to the left half of the body. As its horn originates from the Du Meridian (Governor Vessel), its nature tonifies the Marrow of the Brain to nourish brain nerves. Panax Notoginseng (San Qi) is used to resolve long-standing stasis in joints and meridians. Processed Strychnos Nux-vomica (Ma Qian Zi) is used to stimulate nerves and enhance flexibility.
Outcome: After another thirty-plus doses, limb movement became significantly easier, and slurred speech greatly improved. The patient could勉强 go out and work. Soup medicines were then stopped. Instead, raw Huai Yam powder was boiled into a tea-like consistency, sweetened with white sugar, and taken with about 3 fen of raw yellow Chicken Gizzard Lining powder as a snack for convalescence. This approach uses Huai Yam to tonify Qi and Blood, and a small amount of Ji Nei Jin to resolve stasis.
Note: In cases of Brain Congestion, the use of Astragalus (Huang Qi) is strictly contraindicated initially. Astragalus is tonifying and ascending; ascending Qi draws Blood upward, exacerbating cerebral congestion and potentially causing hemorrhage or rupture, which can be fatal. Once Brain Congestion is cured but hemiplegia persists, it is due to meridian blockage preventing blood circulation. At this stage, using Astragalus to assist in resolving stasis and unblocking vessels is acceptable. However, since the patient has a history of cerebral congestion, the ascending nature of Astragalus is risky. Therefore, Raw Oyster Shell (Zhe Shi) and Achyranthes (Niu Xi) are added to prevent upward rush of Blood, effectively restraining Astragalus. Furthermore, fearing that Astragalus's warmth and tonification might generate heat, Trichosanthes Root (Tian Hua Fen) is heavily used to balance this effect.