头痛 脱色善洁 耳无闻 两胁下痛引小腹 颊肿 肝逆面青 挺长热 善螈节时肿
眩冒 四肢满闷 足逆寒 腰痛不可俯仰 转筋 目赤肿痛 呕逆血 遗沥淋溲便难 妇人
小腹肿 血在胁下喘 阴缩两筋挛 肿睾疝 胸痛背下则两胁肿痛 癃狐疝涸泄大小人癫疝
善恐胸中喘骂詈
善嚏 小便数 背肩痛 两手交而瞀 悲愁欲哭 溏泄 脐下痛 洒淅寒热 脐右小腹
胀引腹中痛 皮肤痛及麻木 缺盆中痛
消渴 浸淫 善惊 后 腰背痛 两肾内痛善忘 咳吐 眩仆 身热而腹痛 下气泄
善笑 悲
风为百病之长猝然中之令人迷闷涎潮壅上焦心腑盖由脾胃不和不能收涎故也轻则为感重
则为中感则手足缓弱拘挛中则半身不遂口眼歪斜肌肉疼痛痰涎壅盛瘫痪不仁舌强不语精神恍
惚至于人事不知口噤无汗涎不作声者尚易治焉若夫眼闭口开手足不收汗出如珠发直吐沫面赤
气粗喉中涎响声如拽锯或如鼾睡摇头上窜目瞪遗尿此皆恶候药无益矣大抵中风之病须识表里
中腑中脏之分治有汗吐下之三法然汗宜少汗下宜少下盖多汗则伤卫多下则损营是故经有汗下
之戒焉善疗者错综斟酌而药之思过半矣
迨考近代三子之论与昔人之论不同河涧云中风非中风也由乎将理失宜心火暴盛肾水虚衰
不能制之阴虚阳实热气怫郁心神昏冒筋骨无用猝倒无知因喜怒思悲恐五志过极热甚火动而作
也东垣云中风者非外来风邪乃本气病也凡人年逾四旬气衰之际或因忧喜忿怒伤其气则多此疾
壮岁之人罕有也或肥甚者间有之亦由形盛气衰故如此丹溪云西北气寒为风所中诚有之矣东南
气溽而地多湿有风者非风病也皆是土湿生痰痰盛生热热甚生风噫予尝究心于三子之论矣河涧
主乎火东垣主乎气丹溪主乎湿惟昔人专主乎风三子皆不言风而昔人言之是非将何定乎以三子
之言是则昔人非也以昔人之言是则三子非也要以古今之论皆不可偏废昔人言风者以其时恬澹
虚无精神内守七情少干饮食澹薄内伤者少惟外来风邪不正之气感之今时则异于是也七情挠其
中肥甘悦其口炙爆浓味无厌于时内伤多门所以各执一说而不同昔人之论也为之辩者果因于风
真中风也因于火因于气因于湿者类中风非中风也若风火气湿之殊望闻问切之间岂无辨哉辨为
风从风治辨为火气湿从三子治庶乎析理明而无他岐之惑用法当而无不中之剂矣
头痛,面色苍白且易惊,听力丧失,两胁下疼痛并牵引至小腹,面颊肿胀,肝气上逆导致面色发青,身体发热且肢体抽搐、关节定时肿胀。
眩晕昏倒,四肢胀满憋闷,足部寒冷逆冷,腰部疼痛无法弯腰或转身,筋脉拘挛,眼睛红肿疼痛,呕吐带血,小便淋漓不尽、排尿困难,妇女小腹肿胀,胁下有瘀血导致气喘,阴器收缩、两条筋脉拘挛,睾丸肿痛及疝气,胸痛放射至背部则引起两胁肿痛,癃闭、狐疝、泄泻、癫狂、疝气等病证,容易恐惧,胸中气喘,骂人叫喊。
容易打喷嚏,小便频数,背部和肩部疼痛,双手交叉交握且神志昏乱,悲伤忧愁想哭,大便稀溏,脐下疼痛,忽冷忽热,脐右侧小腹肿胀并牵引腹中疼痛,皮肤疼痛及麻木,缺盆穴部位疼痛。
消渴病,浸淫疮,容易受惊,腰背疼痛,两侧肾脏内部疼痛,容易健忘,咳嗽吐痰,眩晕跌倒,身体发热且腹痛,气机上逆泄泻,爱笑,悲伤,笑个不停,手心发热,心中疼痛,心中大热,面色发黄,眼睛发红。
风是百病的先导,突然侵袭人体使人昏迷闷乱,涎液如潮水般涌向并壅塞上焦心腑。这主要是因为脾胃不和,不能收摄涎液所致。病情轻的称为“感”,重的称为“中”。“感”则手足软弱无力、拘挛;“中”则半身不遂、口眼歪斜、肌肉疼痛、痰涎壅盛、瘫痪无知觉、舌强不能言语、精神恍惚,甚至人事不知。若出现牙关紧闭、无汗、涎液不出声者,尚属易治。如果是眼闭口开、手足松弛不收、出汗如珠、头发直立、吐沫、面色红赤、呼吸粗重、喉中痰鸣声如拉锯或像打鼾睡觉、摇头上窜、两眼直视、遗尿,这些都是恶候,药物已无益处了。大抵中风之病,必须识别表里、中腑与中脏的区别,治疗有汗、吐、下三种方法。然而发汗宜少,攻下宜少,因为多汗会损伤卫气,多下会损耗营血,所以经典中有对过汗过下的戒律。善于治疗的人,综合权衡斟酌而用药,就能掌握大半的治疗要领了。
等到考察近代刘河间、李东垣、朱丹溪三位医家的论述,与古人的论述不同。河间说:中风并非外来的风邪致病,而是因为调护失当,心火暴盛,肾水虚衰,不能制约心火,导致阴虚阳实,热气郁结,心神昏乱,筋骨失去作用,突然倒下无知觉。这是由于喜怒思悲恐五志过极,热甚火动而发作的。东垣说:中风不是外来风邪,而是本气生病。凡是人年过四十,元气衰弱之际,或者因为忧喜忿怒损伤其气,就容易得这种病。壮年人很少得此病,或者是形体肥胖的人偶尔也有,也是因为形盛气衰的缘故。丹溪说:西北气候寒冷,被风所中,确实有这种情况。但东南气候潮湿闷热,地面多湿,有风者并非风病,都是土湿生痰,痰盛生热,热甚生风。
唉!我曾经深入研究过三位医家的论述。河间主火,东垣主气,丹溪主湿。只有古人专门主张风邪致病。三位医家都不谈风,而古人谈风,是非该如何判定呢?如果认为三子的言论正确,那么古人的就是错误的;如果认为古人的言论正确,那么三子就是错误的。总之,古今的论述都不可偏废。古人谈风,是因为那时人们恬淡虚无,精神内守,七情干扰少,饮食淡薄,内伤少,主要是被外来的不正之风邪所感。现在的时代不同了,七情扰乱内心,肥甘美味满足口腹,炙烤爆裂浓味无厌于时,内伤的途径很多,所以大家各执一说而不同。古人的论述,如果是因于风,那是真中风;如果是因于火、因于气、因于湿,那属于类中风,并非真正的中风。在望闻问切之间,难道没有辨别的方法吗?辨为风就从风治,辨为火、气、湿就按三子的理论治疗,这样就能分析道理明确而没有其他歧途的困惑,用法得当就没有不中的药剂了。
Headache, pale complexion prone to fright, hearing loss, pain in the hypochondrium radiating to the lower abdomen, swelling of the cheeks, liver qi rebellion causing cyanotic face, body heat with convulsions and periodic joint swelling.
Vertigo and fainting, fullness and oppression in the four limbs, cold feet (Zu Ni Han), low back pain preventing bending or turning, tendon spasms (Zhuan Jin), red and swollen painful eyes, vomiting blood, dribbling urine and difficult urination, women's lower abdominal swelling, blood stasis in the hypochondrium causing asthma, retraction of the yin organ and spasm of two tendons, swollen testicles and hernia, chest pain radiating to the back causing bilateral hypochondriac swelling, strangury, fox hernia, dry diarrhea, epilepsy, hernia, fearfulness, chest asthma, cursing and shouting.
Prone to sneezing, frequent urination, pain in the back and shoulders, hands crossed and confused (Mao), sadness and sorrow wanting to cry, loose stools, pain below the umbilicus, chills and fever alternating, distension on the right side of the umbilicus and lower abdomen radiating to abdominal pain, skin pain and numbness, pain in the clavicular fossa (Que Pen).
Xiao Ke (Wasting and Thirsting Syndrome), impetigo-like sores, susceptibility to fright, low back pain, internal pain in both kidneys, forgetfulness, coughing and expectoration, vertigo and falling, body heat with abdominal pain, rebellious qi and diarrhea, excessive laughing, sadness, unceasing laughter, hot palms, heart pain, intense heat in the heart, yellow complexion, red eyes.
Wind is the leader of a hundred diseases; sudden invasion causes confusion and stagnation, with saliva surging upward to obstruct the Upper Jiao and Heart Fu. This is primarily due to disharmony of the Spleen and Stomach, failing to control saliva. Mild cases are termed "Gan" (Influence), severe cases "Zhong" (Stroke). "Gan" presents with weak and spasmodic limbs; "Zhong" presents with hemiplegia, deviation of the mouth and eye, muscle pain, copious phlegm-saliva, paralysis and insensibility, stiff tongue and inability to speak, mental confusion, even loss of consciousness. If there is locked jaw, no sweat, and silent saliva, it is relatively easy to treat. However, if there are closed eyes and open mouth, flaccid limbs, sweating like pearls, erect hair, foaming at the mouth, flushed face, coarse breathing, rattling phlegm in the throat like sawing or snoring, head shaking and upward staring, fixed gaze, and urinary incontinence, these are all ominous signs, and medicine is of no benefit. Generally, for Wind Stroke (Zhong Feng), one must distinguish between exterior/interior, involvement of the Fu organs vs. Zang organs, and apply diaphoresis, emesis, or purgation methods. However, diaphoresis should be mild, and purgation mild, as excessive sweating damages Wei Qi (Defensive Qi) and excessive purgation injures Ying Qi (Nutritive Qi). Thus, classics warn against excessive sweating and purgation. Skilled practitioners weigh and balance treatments, mastering half the art of healing.
Examining the theories of the three modern masters (He Jian, Dong Yuan, Dan Xi) differs from ancient views. He Jian stated that Zhong Feng is not caused by external wind but by improper management: violent Heart Fire and deficient Kidney Water failing to control it, leading to Yin deficiency and Yang excess, heat stagnation, mental confusion, uselessness of sinews and bones, sudden collapse and unconsciousness, triggered by extreme emotions (Five Wills). Dong Yuan stated that Zhong Feng is not external wind but a disease of the vital Qi itself. People over forty with declining Qi, or those injured by emotional distress, often suffer this; young adults rarely do. Obese individuals may also suffer due to excess form and deficient Qi. Dan Xi stated that while northwest cold winds can cause illness, southeast humid climates generate dampness. There, wind symptoms are not true wind diseases but result from earth dampness generating phlegm, phlegm generating heat, and heat generating wind.
I have studied the three masters' theories. He Jian emphasizes Fire, Dong Yuan emphasizes Qi, Dan Xi emphasizes Dampness. Ancients emphasized Wind exclusively. The three masters omit Wind, while ancients emphasize it. How to judge? If the three are right, ancients are wrong; if ancients are right, three are wrong. Both eras' theories should not be discarded. Ancients spoke of Wind because people were tranquil, spirits guarded internally, emotions minimal, diet plain, with little internal injury, mostly affected by external pathogenic wind. Times have changed: emotions disturb internally, rich foods satisfy desires, heavy flavors dominate, internal injuries arise from many sources, hence differing views. If caused by Wind, it is True Zhong Feng; if caused by Fire, Qi, or Dampness, it is Similar Zhong Feng (Lei Zhong Feng), not true Zhong Feng. Through observation, listening, inquiry, and palpation, can we not distinguish? Treat Wind according to Wind; treat Fire, Qi, Dampness according to the three masters. Thus, principles are clear, avoiding confusion, and prescriptions will be effective.