半身不遂，病本一体，诸家立论，竟不相同。始而《灵枢经》曰∶虚邪偏客于身半，其
入深
∶风中五脏六腑之俞，所中则为偏风。张仲景曰∶夫风之为病，当令人半身不遂。三书立论
，本源皆专主于风。至刘河间出世，见古人方论无功，另出手眼，云∶中风者，非肝木之风
内动，亦非外中于风，良由将息失宜，内火暴甚，水枯莫制，心神昏昧，卒倒无所知。其论
专主于火。李东垣见河间方论矛盾。又另立论曰∶中风者，气虚而风邪中之，病在四旬以后
，壮盛稀有，肥白气虚者间亦有之。论中有中腑、中脏、中血脉、中经络之分，立法以本气
虚外受风邪，是其本也。朱丹溪见东垣方症不符，又分途立论，言西北气寒有中风，东南气
湿非真中风，皆因气血先虚，湿生痰，痰生热，热生风也。其论专主于痰，湿痰是其本也。
王安道见丹溪论中有东南气湿非真中风一句，便云《灵枢》、《素问》、仲景所言是真中风
，河间、东垣、丹溪所言是类中风。虞天民言∶王安道分真中风、类中风之说，亦未全是，
四方病此者，尽因气湿痰火挟风而作，何尝见有真中、类中之分？独张景岳有高人之见，论
半身不遂大体属气虚，易中风之名，着非风之论，惟引用《内经》厥逆，并辨论寒热、血虚
、及十二经之见症，与症不符，其方不效者，可惜先生于此症阅历无多。其余名家所论病因
，皆是因风、因火、因气、因痰之论。所立之方，俱系散风、清火、顺气、化痰之方。有云
气血虚弱而中风邪者，于散风清火方中，加以补气养血之药；有云阴虚亏损而中风邪者，于
滋阴补肾药内，佐以顺气化痰之品。或补多而攻少，或补少而攻多，自谓攻补兼施，于心有
得。今人遵用，仍然无效。又不敢议论古人之非，不曰古方不合今病，便云古今元气不同。
既云方不合病，元气不同，何得伤寒病，麻黄、承气、陷胸、柴胡，应手取效，何得中风门
愈风、导痰、秦艽、三化，屡用无功？总不思古人立方之本，效与不效，原有两途。其方效
者，必是亲治其症，屡验之方；其不效者，多半病由议论，方从揣度，以议论揣度，定论立
方，如何能明病之本源。因何半身不遂，口眼歪邪；因何语言蹇涩，口角流涎，大便干燥，
小便频数，毫无定见，古今混猜。以一亏损五成元气之病，反用攻发克消之方，安得不错？
溯本穷源，非错于医，乃错自着书者之手。嗟乎！此何等事，而竟以意度，想当然乎哉！
半身不遂，本质上是一个病证，但各家医家的论述却各不相同。起初，《灵枢经》说：虚邪（致病的外邪）偏客于身体的一半，侵入很深；风邪中伤五脏六腑的俞穴，所中的部位就会发生偏风。张仲景说：风这种病，应当使人半身不遂。这三本书立论的本源，都专门主张是“风”邪致病。到了刘河间出世，看到古人的方剂理论没有功效，便另辟蹊径，声称：中风病，不是肝木之风内动，也不是外感风邪，实在是因为调养失当，体内火气突然亢盛，肾水枯竭无法制约，心神昏乱不明，突然跌倒失去知觉。他的论点专门主张是“火”。李东垣看到刘河间的方论存在矛盾，又另外立论说：中风病，是因为气虚而风邪乘虚而入，发病多在四十岁以后，身体壮盛的人很少见，肥胖面白、气虚的人偶尔也有。他的论述中有中腑、中脏、中血脉、中经络的区别，立法以本气虚弱、外受风邪为根本原因。朱丹溪看到李东垣的方剂与症状不符，又分道扬镳立论，说西北气候寒冷会有中风，东南气候潮湿的不是真正的中风，都是因为气血先虚，湿气生痰，痰生热，热生风。他的论点专门主张是“痰”，湿痰是其根本。王安道看到朱丹溪的论述中有“东南气湿非真中风”这句话，便说《灵枢》、《素问》、张仲景所说的是真中风，刘河间、李东垣、朱丹溪所说的是类中风。虞天民说：王安道区分真中风和类中风的说法，也不完全正确，四方患此病的人，全都是因为气、湿、痰、火挟带风邪而发作，何曾见过有真中和类中的区别？只有张景岳有高明的见解，论述半身不遂大体属于气虚，改“中风”之名，撰写了“非风”的论述，只是引用《内经》中的厥逆，并辨析寒热、血虚以及十二经脉的症状表现，但与症状不符，其方剂无效，可惜先生对此病的临床经验不多。其余名家所论述的病因，都是因风、因火、因气、因痰的理论。所立的方剂，都属于散风、清火、顺气、化痰的方子。有的说气血虚弱而中风邪，便在散风清火的方子中，加上补气养血的药物；有的说阴虚亏损而中风邪，便在滋阴补肾的药内，佐以顺气化痰的物品。或者补多攻少，或者补少攻多，自认为攻补兼施，心中有所心得。今人遵照使用，仍然无效。却又不敢议论古人的错误，不说古方不合今病，便说古今元气不同。既然说方子不合病症，元气不同，为什么伤寒病用麻黄汤、承气汤、陷胸汤、小柴胡汤，能应手取效？为什么中风门用的愈风汤、导痰汤、秦艽汤、三化汤，屡用无功？总不思考古人立方的本意，有效与无效，原本就有两条途径。那些有效的方子，必定是亲自治疗该症状，经过多次验证的方子；那些无效的方子，多半是因为基于议论，方剂出于揣测，用议论来揣测，定论后立方形，怎么能明白疾病的本源。为何会出现半身不遂、口眼歪斜？为何出现语言蹇涩、口角流涎、大便干燥、小便频数，毫无定见，古今混猜。用一个亏损了五成元气的病，反而使用攻伐发散克消的方子，怎么会不错误呢？追溯本源，不是医生错了，而是著书立说的人错了。唉！这是多么严肃的事情，竟然凭主观臆断，想当然地处理吗！
Hemiplegia is fundamentally a single disease entity, yet various schools of thought have proposed differing theories. Initially, the *Ling Shu Jing* (Spiritual Pivot) states: "When empty pathogens (pathogenic external factors) reside partially on one side of the body and penetrate deeply, wind evil strikes the Shu points of the five zang and six fu organs; the affected area results in hemifacial palsy or partial wind." Zhang Zhongjing stated: "The disease caused by wind should manifest as hemiplegia." The foundational arguments of these three texts all exclusively attribute the cause to wind. Later, Liu Wansuj emerged; observing that ancient prescriptions were ineffective, he adopted a new perspective, claiming: "Stroke is not due to internal stirring of liver wood wind, nor external contraction of wind. Rather, it arises from improper regimen leading to sudden excessive internal fire, with depleted kidney water unable to control it, causing mental confusion and sudden collapse with loss of consciousness." His theory exclusively attributes the cause to fire. Li Dongyuan, seeing contradictions in Liu's theories, proposed another view: "Stroke occurs when qi deficiency allows wind evil to invade. It typically affects individuals after age forty, rarely those in robust health, though occasionally seen in obese, pale, qi-deficient persons." His discussion distinguishes between invasion of the fu organs, zang organs, blood vessels, and meridians, establishing that the root lies in intrinsic qi deficiency combined with external wind evil. Zhu Danxi, finding discrepancies between Li's prescriptions and symptoms, diverged further, stating: "In the cold climate of the northwest, stroke occurs; in the damp climate of the southeast, it is not true stroke. Both result from prior deficiency of qi and blood, where dampness generates phlegm, phlegm generates heat, and heat generates wind." His theory exclusively attributes the cause to phlegm, specifically damp-phlegm as the root. Wang Andao, noting Zhu's statement that "southeast dampness is not true stroke," argued that the *Ling Shu*, *Su Wen*, and Zhang Zhongjing described true stroke, whereas Liu, Li, and Zhu described pseudo-stroke. Yu Tianmin commented: "Wang's distinction between true and pseudo-stroke is not entirely correct. Patients everywhere suffer from wind carried by qi stagnation, dampness, phlegm, and fire; there is no such division as true versus pseudo." Only Zhang Jingyue offered a superior insight, arguing that hemiplegia largely belongs to qi deficiency, renaming the condition "non-wind" and writing treatises on it. He cited *Jue Ni* (rebellious qi) from the *Nei Jing* and differentiated cold/heat, blood deficiency, and manifestations of the twelve meridians, but his descriptions did not match symptoms, and his prescriptions were ineffective. It is a pity that this gentleman had limited clinical experience with this condition. Other famous doctors' discussions on etiology all focused on wind, fire, qi, and phlegm. Their prescribed formulas were all for dispersing wind, clearing fire, regulating qi, and resolving phlegm. Some claimed that for stroke due to qi and blood deficiency, tonifying qi and nourishing blood should be added to wind-dispersing and fire-clearing formulas; others claimed that for stroke due to yin deficiency, regulating qi and resolving phlegm should be assisted within yin-nourishing and kidney-tonifying medicines. Whether tonifying more and attacking less, or tonifying less and attacking more, they claimed to combine attack and tonification, believing themselves to be insightful. Modern practitioners follow these methods but still find them ineffective. Yet, they dare not criticize ancient errors, instead claiming that ancient formulas do not fit modern diseases or that the primordial qi differs across eras. If formulas are mismatched and primordial qi differs, why do Ma Huang Tang (Ephedra Decoction), Cheng Qi Tang (Order the Qi Decoction), Xian Xiong Tang (Pit-in-the-Chest Decoction), and Xiao Chai Hu Tang (Minor Bupleurum Decoction) work effectively for Tai Yang disease (Exterior Syndrome)? Why do Yu Feng Tang (Wind-Nourishing Decoction), Dao Tan Tang (Phlegm-Guiding Decoction), Qin Jiao Tang (Gentian Decoction), and San Hua Decoction repeatedly fail for stroke? They never reflect on the original intent of ancient formula creation. Effectiveness and ineffectiveness originally follow two paths. Effective formulas must have been personally tested on specific symptoms; ineffective ones mostly stemmed from theoretical speculation rather than clinical observation. Formulas derived from speculation cannot clarify the source of disease. Why does hemiplegia occur? Why facial deviation? Why speech impediment and drooling? Why dry stool and frequent urination? With no fixed views, past and present are confusedly guessed. For a disease where half the primordial qi is depleted, using attacking, dispersing, and reducing formulas is bound to be erroneous. Tracing to the root, the error lies not with the physician, but with the author. Alas! How serious a matter is this, yet treated with mere conjecture and assumption!