中风之病形何如。曰。真中风者。其病不过在经络。经络之气。为风所逐。则气逆行。气逆
行则脏腑之气血。不能外达。故多卒然仆倒。不省人事。感轻者半身不遂。口眼歪斜。及经而止
也。类中风者。其风自内出。（景岳
故以匪风名之。东庄云。小儿慢惊慢脾皆此义。但治法不同耳）七情纵恣。六淫外侵真阴
不守。久之水衰火盛。风从火出。离其故宫。飞扬飘逐。卒然仆倒。故其人两肾腰胯间及脐下。必
冰冷如铁。盖别病必他脏先病。缓缓穷到肾经。（五脏相伤。穷必及肾也。然由肾经先病以及他脏
者亦多。）惟中风竟是肾经与命门无形之水火自病。故一病竟绝也。当其发病之际。必有一股虚
气。从两肾中间。上夹脊。穿昆仑。过泥丸。直到命门。命门为三阴三阳聚处。此股气一冲。三阴三阳
之气。亦突然而散。遂外不省人事。而在五内腑之气。亦随之而去。脏腑之气既去。而手撒眼合。
（亦有开而直视者） 遗尿声 口开等症。又相随而来矣。此命门即素问至阴之根。结于命门。
乃两肾之上下左右。各相去一寸。其中
间便是丹家之元神也。（命门之义。景岳类经三焦辨。并吕批邯郸形景图最详）此股虚气。是
即所谓无形之火也。缘无形之水。虚不能守。遂化作冷风。腾空而去。
真中风者。小续命汤。其人形体实。无类中风症。卒然仆倒者。北方有之。江南少见。（北
方风厉。而脏腑经络刚浓。南方风温。而脏腑经络柔薄。故北多真而南多类。其治迥不同也。
然其间亦有互见者。非谓南必无真北必无类也。特治法宜稍变耳。四明于北方曰有之。于江南曰
少见。语意甚圆。总当因人以施治。不必域地以论症也。其有形体似刚浓。而若见一两种类中脉症
者。亦是形盛气衰也。慎勿误治。）类中风者。乃大虚也。其症卒然仆倒。眼合口角 斜。手撒遗尿
。大抵见一种犹可。数种俱见不治。尤当急以手按其少腹。冰冷如石者。当急灸气海。（穴在脐下
一寸五分） 并用蒸脐法。（薛氏治寒淫于内。治宜辛热。而神脱脉绝。药不能下者。急炒盐艾
附子。热熨脐腹。以散寒回阳。又以口气补接其气。又以附子作饼。热贴脐间。时许。神气少苏
。四明所谓蒸脐法。大略如此。附录以备参用）脉必二三至。阔大虚软如棉花。急煎人参一二两。
附子一两。或有生者。（初发时可救。迟则无及矣。） 俟其势定。方用人参五钱。黄 二两。
附子五钱。不数饮之。但觉脐下温和。手足运动。口眼能动是矣。待饮食如常。二便如故。大剂
补中益气汤。加附子三钱。吞八味丸至两许。其有头目眩晕难开。开即见居室百物俱倒转。胸中
漾漾。恶心欲吐。即类中风之渐也。（急须节饮食。戒七情。远房事。以预防之。）治法同上。但
不必灸药物足矣。（服药预防。当察其脉。如两尺虚衰者。六味八味等丸培补肝肾。寸关虚弱者。
六君十全等剂调补脾肺。才有补益。若服搜风顺气及清气化痰等药。适所以招风取中也。）
小续命汤
麻黄 桂枝 杏仁 防风 防己 川芎 白芍
黄芩 人参 附子 甘草
中风病的症状表现是怎样的？回答说：真中风的病位仅在经络。经络之气被风邪驱逐，导致气机逆乱。气机逆乱则脏腑的气血不能外达体表，因此患者多突然仆倒在地，不省人事。病情较轻的，表现为半身不遂、口眼歪斜，病邪停留在经络层面即止。
类中风的病邪是从体内产生的。（张景岳因此将其命名为“匪风”。东庄认为，小儿慢惊风和慢脾风也是这个道理，只是治疗方法不同罢了。）由于七情过度放纵，加上六淫外邪侵袭，导致真阴不能固守。久而久之，肾水亏虚而心火亢盛，风从火出，脱离其原本的根基（肝肾），飞扬飘忽，突然使人仆倒。因此，这类患者两肾、腰胯部及脐下部位，必定冰冷如铁。因为其他疾病通常先由其他脏腑发病，然后逐渐传变至肾经。（五脏相互损伤，最终必然累及肾脏。然而，由肾经先病进而影响其他脏腑的情况也很多见。）唯独中风是肾经与命门中无形的水火自病，所以一旦发病，往往直接导致生命垂危。在其发病之际，必定有一股虚气，从两肾中间升起，沿脊柱两侧上行，穿过昆仑穴（此处指足太阳膀胱经循行部位或特定穴位概念，结合上下文指代脊柱旁路），经过泥丸宫（脑部），直抵命门。命门是三阴三阳经气汇聚之处，这股气一冲，三阴三阳之气便突然散乱，于是对外失去知觉，而在体内的脏腑之气也随之耗散。脏腑之气既已耗散，手撒肢冷、眼睛闭合、遗尿、鼾声大作、口开等症状便随之而来。此命门即是《素问》中所说的至阴之根，结于命门，位于两肾上下左右各一寸处，其中间便是道家所说的元神。（关于命门的含义，张景岳在《类经·三焦辨》以及吕氏批注的《邯郸形景图》中解释得最为详细。）这股虚气，就是所谓的无形之火。因为无形之水（肾阴）虚弱不能固守，遂化作冷风，腾空而去。
真中风的治疗用小续命汤。适用于形体壮实、没有类中风症状、突然仆倒的患者。这种情况北方较多见，江南少见。（北方风气猛烈，且脏腑经络刚强厚实；南方风气温和，且脏腑经络柔弱单薄。所以北方多见真中风，南方多见类中风，两者的治疗方法截然不同。但其中也有互相兼见的情况，并非说南方一定没有真中风，北方一定没有类中风，只是治疗方法应当稍作变化而已。四明先生对北方说“有之”，对江南说“少见”，措辞非常周全。总之应当因人施治，不必拘泥于地域来论症。那些形体看似刚强厚实，却出现一两种类中风脉症的人，也是形盛气衰的表现。千万不要误治。）
类中风则是大虚之证。其症状为突然仆倒，眼睛闭合，口角歪斜，手撒肢冷，遗尿。大体上见到一种症状尚可救治，如果数种症状同时出现，则难以治愈。尤其应当紧急用手按压患者的少腹部，若感觉冰冷如石头，应当紧急艾灸气海穴。（该穴位位于脐下一寸五分处）并配合使用蒸脐法。（薛己治疗寒邪内侵，主张用辛热药物，但如果神气脱失、脉象绝微，药物无法服下的情况下，急炒盐、艾叶、附子，热敷脐腹以散寒回阳；又用口气补接其元气；又将附子做成饼状，趁热贴敷脐间，约一顿饭的时间，神气稍微苏醒。四明先生所说的蒸脐法，大致如此。附录于此以备参考使用）此时脉象必定是一息二三至，脉形阔大虚软如棉花。急需煎煮人参一二两，附子一两，如果有生附子更好。（初发时还可挽救，迟了就无济于事了。）等到病情稳定后，才用人参五钱，黄芪二两，附子五钱，少量多次服用。只要觉得脐下温暖，手足能活动，口眼能动，就可以了。待饮食恢复正常，大小便如常，再用大剂量的补中益气汤，加入附子三钱，吞服八味丸（金匮肾气丸）约一两重。
对于那些头部和眼睛眩晕难睁，睁开就看见房屋里的物品都颠倒旋转，心中荡漾不安，恶心欲吐的人，这是类中风的前兆。（必须紧急节制饮食，戒除七情波动，远离房事，以预防其发作。）治疗方法同上，但不必艾灸，药物即可。（服药预防时，应当观察脉象。如果两尺脉虚衰，应用六味地黄丸、八味丸等培补肝肾；如果寸关脉虚弱，应用六君子汤、十全大补汤等调补脾肺。只要有补益作用即可，如果服用搜风顺气及清气化痰等药，恰恰是招致风邪、诱发中风的错误做法。）
What are the clinical manifestations of stroke (Zhong Feng)? The answer is: In true stroke (Zhen Zhong Feng), the pathology is confined to the meridians and collaterals. When wind pathogen drives away the Qi of the meridians, Qi movement becomes rebellious. Due to this rebellious Qi flow, the Qi and Blood of the Zang-Fu organs cannot reach the exterior, causing the patient to suddenly collapse and lose consciousness. In milder cases, it manifests as hemiplegia (Ban Shen Bu Sui) and deviation of the mouth and eyes, with the pathogen remaining within the meridians.
In apoplectic syndrome resembling stroke (Lei Zhong Feng), the wind originates from within the body. (Zhang Jingyue therefore named it "Fei Feng" [Non-wind]. Dongzhuang stated that slow convulsion and slow spleen in infants share this etiology, though the treatment differs.) This results from excessive indulgence in the Seven Emotions and invasion by the Six Exogenous Pathogens, leading to the failure of True Yin to remain secure. Over time, Kidney Water declines while Fire flares up; Wind arises from Fire, departing from its original residence (Liver and Kidney), flying wildly, and causing sudden collapse. Consequently, the area between the two Kidneys, the loins, hips, and below the umbilicus will be cold as iron. Generally, other diseases start in other Zang-Fu organs and slowly progress to the Kidney Meridian. (When five Zang organs injure each other, the damage inevitably reaches the Kidneys. However, there are also many cases where Kidney disease precedes and affects other organs.) Only in stroke does the invisible Water and Fire of the Kidney Meridian and Mingmen (Gate of Life) become self-diseased, leading directly to critical condition upon onset. At the moment of onset, a wave of deficient Qi rises from between the two Kidneys, ascends along the spine, passes through Kunlun (referring to the pathway or acupoint concept along the bladder meridian on the back), goes through Niwan Palace (the brain), and reaches Mingmen. Mingmen is the gathering point of the Three Yin and Three Yang meridians. Once this Qi rushes through, the Qi of the Three Yin and Three Yang scatters abruptly, resulting in loss of consciousness externally, while the Qi of the internal Zang-Fu organs dissipates simultaneously. With the departure of Zang-Fu Qi, symptoms such as hand relaxation (Shou Sa), eye closure, urinary incontinence, stertorous breathing, and open mouth follow. This Mingmen is the root of Supreme Yin mentioned in *Su Wen*, located at Mingmen, one cun away from the upper, lower, left, and right of the two Kidneys; the space between them is what Daoists call Yuan Shen (Original Spirit). (The meaning of Mingmen is explained in detail by Zhang Jingyue in *Lei Jing: San Jiao Bian* and Lu's commentary on *Handan Xingjing Tu*.) This deficient Qi is what is referred to as Formless Fire. Because Formless Water (Kidney Yin) is deficient and unable to hold, it transforms into cold wind and ascends into the void.
True stroke is treated with Xiao Xuming Decoction (Minor Continuation of Life Decoction). It applies to patients with a robust physique who do not exhibit signs of apoplectic syndrome resembling stroke but collapse suddenly. This condition is common in the North but rare in Jiangnan. (Northern winds are harsh, and the Zang-Fu and meridians are strong and thick; Southern winds are mild, and the Zang-Fu and meridians are soft and thin. Thus, true stroke is more common in the North, while apoplectic syndrome resembling stroke is more common in the South, and their treatments differ significantly. However, there are overlapping cases; it is not that the South never has true stroke nor the North never has apoplectic syndrome resembling stroke, but rather that the treatment methods should vary slightly. Siming said "exists" for the North and "rare" for Jiangnan, which is very precise. Ultimately, treatment should be tailored to the individual, not restricted by geography. Those who appear physically robust but show one or two pulse/symptom patterns of apoplectic syndrome resembling stroke also suffer from excess form and deficient Qi. Do not treat them mistakenly.)
Apoplectic syndrome resembling stroke is a state of severe deficiency. Symptoms include sudden collapse, closed eyes, deviated mouth corner, relaxed hands, and urinary incontinence. Generally, if only one symptom is present, it is treatable; if multiple symptoms appear together, it is difficult to cure. One should urgently press the lower abdomen with the hand; if it feels cold as stone, urgent moxibustion should be applied to Qihai (CV-6) (located 1.5 cun below the umbilicus). Additionally, use the Umbilical Steaming Method. (Xue Ji treated internal cold invasion with pungent-hot herbs, but when Shen (Spirit) escapes and the pulse vanishes, making oral medication impossible, he urgently fried salt, Artemisia argyi leaves, and Aconite, applying heat to the umbilicus and abdomen to dispel cold and restore Yang. He also used breath to supplement the Qi, and placed hot Aconite cakes on the umbilicus for about the time it takes to eat a meal, after which the Shen slightly recovered. Siming's description of the Umbilical Steaming Method is roughly like this. Appended here for reference.) The pulse will likely be two or three beats per respiration, wide, large, deficient, and soft like cotton. Urgently decoct Ren Shen (Ginseng Root) 1-2 liang and Fu Zi (Prepared Aconite Lateral Root) 1 liang; raw Aconite may be used if available. (It can be saved if treated early; otherwise, it is too late.) Once the condition stabilizes, use Ren Shen 5 qian, Huang Qi (Astragalus Root) 2 liang, and Fu Zi 5 qian, administered in small frequent doses. Treatment is effective when warmth is felt below the umbilicus, limbs move, and mouth/eyes can move. When diet returns to normal and excretion is regular, administer a large dose of Buzhong Yiqi Tang (Tonify the Middle and Augment the Qi Decoction) with added Fu Zi 3 qian, and swallow Bawei Wan (Eight-Ingredient Pill) approximately 1 liang.
For those suffering from severe dizziness and difficulty opening the eyes, where opening them causes objects in the room to appear inverted, with a sensation of nausea and urge to vomit, these are precursors to apoplectic syndrome resembling stroke. (Urgently regulate diet, restrain the Seven Emotions, and avoid sexual activity to prevent progression.) The treatment method is the same as above, but moxibustion is unnecessary; herbal medicine suffices. (For preventive medication, observe the pulse. If the Chi pulses at both wrists are deficient, use Liuwei Wan or Bawei Wan to nourish Liver and Kidney. If Cun and Guan pulses are weak, use Liujunzi Tang or Shiquan Dabu Tang to tonify Spleen and Lung. Any tonic effect is acceptable; using herbs that search for wind and promote Qi flow or clear heat and resolve phlegm will merely attract wind and induce stroke.)
Xiao Xuming Decoction (Minor Continuation of Life Decoction)
Mahuang (Ephedrae Herba), Guizhi (Cinnamomi Ramulus), Xingren (Armeniacae Semen Amarum), Fangfeng (Saposhnikoviae Radix), Fangji (Stephaniae Tetrandrae Radix), Chuanxiong (Ligustici Chuanxiong Rhizoma), Baishao (Paeoniae Radix Alba), Huangqin (Scutellariae Radix), Renshen (Ginseng Radix), Fuzi (Aconiti Lateralis Radix Praeparata), Gancao (Glycyrrhizae Radix et Rhizoma).