内伤亏败日久，极则必发，不必有所感触也。（久病或产后，多有暴脱之症，
深居密室，岂有外感哉？）
刘河间则主乎火，谓热甚生风，非肝木之风，（如云不必泥定肝风耳。）亦非外感之风。
由将息失宜，五志过极，心火暴盛，肾水虚衰，不能制之，热气郁怫，心神昏冒，
故卒倒无知。病微则但僵仆，气血流通，筋脉不挛，发过如故。重则气血郁结不通。
阴气暴绝，阳气后竭而死。其说甚是。然既曰火盛由于火虚，则当用六味，乃
反用地黄饮子热剂者，以火发而阳暴脱也。若肾火未虚者，只以降心火为主，
清心汤、泻心汤大剂与之。俟心火既降，次以防风通圣散汗之。（内火亦用汗散者，盖火虽
已降，而浮盛于表者未散，故汗之使外越也。）或大便门塞者，三化汤下之。内外火邪
已尽，以羌活愈风汤调之，宣其气血，导其经络。（通痰滞也。）若肾水虚亏，命门真火挟
肝风上冲者，大剂六味地黄丸料（见虚损）煎服。若竟至阳脱，宜先用参附大剂峻补
其阳，而后实其阴，继以生脉散（见中暑。）滋其化源。
东垣则主乎气，谓人身之阳气，以天地之疾风名之。中风证非外来之风，此本
气衰也。四旬气衰之后，或再伤其气，（七情、劳役、房事、饮食，皆足伤之。）多有此证，
壮时无有也、肥盛者间亦有之，亦形盛气衰而然耳。此证非大剂参、 ，何以挽回。若
不仆，但舌强、语謇、痰壅、支体不遂，六君子（见气）加诸汁治之。（此为气虚内夺之证。盖虚
弱之人，多有卒然昏眩而倒者，与下《中气篇》气逆者下同。）
丹溪则主于痰，谓土湿生痰，痰郁成热极生风。
问∶内风亦有中血脉、中腑、脏之分乎？曰∶病自内发，未有不伤其腑、脏者。
由于火盛，则火发而血与痰壅矣；由于气虚，则气滞而血与痰凝矣。痰血壅滞，食
亦不化，填塞于腑，则二便不通，阻碍脏气，则昏迷不醒，其重者也。轻者中后，
邪散布经络，而血脉之行不利，固有之矣。岂必兼外风乃然哉？至于下文所举各症，
亦多内伤所致，不必兼涉外感也。
口噤，即牙关不开也。由气血凝结于牙关，筋脉不能活动，以苏合丸或生南星、
冰片、乌梅肉为末擦牙，或以郁金、藜芦末搐鼻，或针人中、颊车各四分，或白矾
半两、盐花一分，细研，擦点牙根下，更以绵裹半钱匕，安牙尽头。用甘草，比中
指节截作五截，生油内浸过，炭火上炙，候油入甘草，斡开牙关，令咬定甘草，
如人行十里许时，又换一截，后灌药，极效。
口眼 斜。胃经细筋为目下纲，膀胱经细筋为目上纲，胆经脉起于目锐 ，其
筋亦结焉，小肠、三焦筋脉俱至目锐 。又胃经、大肠经脉俱挟唇口左右。风寒之
邪，视诸经筋脉之虚而中之，左虚则左受寒，筋脉急引而 斜，右虚反此。以清阳汤、
秦艽升麻汤散之。内有热者，宜加辛凉。患处宜灸，目斜灸承泣，（承泣禁灸，再考。）
口灸地仓，不效，更灸人迎、颊车。若纯是内风火邪而 斜者，则为热灼筋枯短
缩，与寒而收引者相反，不可灸，亦不可用温散之药，须苦寒降火，有用承气汤（见
大便不通）下之而愈者是也。通用牵正散∶白附子、（辛热，专去头面之风。内火盛者，宜加清凉之品。）
僵蚕、全蝎（二味去风破结痰，痰结筋脉间，非去痰筋不舒）等分为末，每二钱酒调服，外捣萆麻子
一两，冰片三分，为膏，寒月加干姜、附子各一钱，右 贴左，左 贴右。旧谓左
寒则右热，左热则右寒，此为内有热而外感寒者言。若止外寒而内不热，或止内热
而外无寒，则左寒者不必右热，左热者不必右寒也。大抵纯是内风而热不甚者，
必无此证，热甚者乃有之，然 斜不甚，以火即暴甚，不至遽枯其根也。若兼外感
风寒，则甚矣。以寒热相激，其势愈暴也。纯感风寒者亦甚，以寒之收引易也，然
亦必虚人乃有之。（凡遇旋风而 斜者，皆虚人也。）
半身不遂。《经》云∶胃脉沉鼓涩，胃外鼓大，（外鼓，犹云浮而鼓指。）心脉小坚（坚，即实
也。）急，（急，即紧也。）皆偏枯。男子发左，女子发右，不喑舌转，可治。（以其病止在血脉，未
及脏腑也。）盖胃与脾为表里，更实更虚，（更，迭也。）胃阳虚则脾阴盛，而胃从于脾，故胃
脉沉鼓涩也。涩，为多血少气。（气少，故血虽多而不流走也。）胃阳盛则脾阴虚，而脾从于胃，
故胃脉鼓大于臂外也。大，为多气少血。（气多，故血虽少而脉亦大，然必大而兼虚。）心之元阳
不足，阴寒乘之，故脉小坚急者，者阳不足也；坚急者，阴寒之邪也。心、胃、
脾三等脉，凡有其一，即为偏枯者。何也？盖心之神无处不周者也，胃之气无
处不行者也，神行气流，充足盈溢，何有于病。若神气受伤，则营运不能周遍，而
筋脉偏枯矣。所谓未有不因真气不周而病者也，然岂特心、胃为然哉？五脏六腑，
凡有一不周，皆足以致偏枯，固可推耳。丹溪谓∶左半多属死血与血虚，四物等补
血之剂。右半多属气虚与痰，四君等补气之剂，并加竹沥、姜汁以行痰。是大概如
此，不可泥。古方顺风匀气散、虎骨散、虎胫骨酒、黄 酒，可选用。外用蚕沙两
石，分三袋蒸热，一袋着患处，冷则再换一袋。羊肚酿粳米、葱白、姜、椒、豉等，
煮烂，日食一具，十日止。
失音不语。《经》谓内夺（精血亏败亡失，如被人夺去者然）而厥，（逆而上行名厥，火气上冲也。）则为
音痱，此肾虚也。（肾水虚，故火上炎。）少阴（肾脉）不至者，（不至，谓不能上通也，即肾水不上润意。）厥也。
肾脉不至于上，则不得循喉咙挟舌本，故不能言也。地黄饮子、六味、八味等（六、八
味见虚损）主之。或用竹沥、荆沥（去痰）、梨汁（去热，各三杯）、生葛汁（去热）、人乳汁（润燥，各二杯）、陈
酱汁（半杯）和匀，隔汤顿温服。（舌为心之苗，痰火盛则心脉干燥拘急，故舌强而不能言。又痰迷心窍，则心
脉不用，故不能掉舌，且神昏不能语也。）有痰者，涤痰汤。内热者，凉膈散（见发热）加石菖蒲、远
志，（以通心窍也）为末，炼蜜丸，弹子大，朱砂为衣，每服一丸，薄荷汤化下，名转舌
膏。或《宝鉴》诃子汤（见喑）、正舌散、茯神散，外用龟尿点舌，神效。（置龟新荷叶上，猪
鬃戮其鼻立出。）语涩，有舌纵、舌麻，皆以痰火治之，乌药、僵蚕、胆星、芩、连、枳
壳、防风、竹沥、姜汁。
痰盛者。橘红一斤，逆流水五碗，煮数滚，去橘红，再煮至一碗，顿服，
白汤导之，（后又饮白汤，以手探喉，导令吐也。）吐痰之圣药也。中后气未尽顺，痰未尽
除，当以藿香正气散和星香散煎服。中气、中恶、霍乱尤宜之。中后体虚有痰，四君子
（见气。）和星香散，或六君子、（见气。）养正丹，（见气。）坠痰镇气，气实者，以星香散吞之，
气虚者，六君子汤吞之。
四肢不举。实者，脾湿盛，令筋脉缓软，宜去湿。虚者，脾燥热，壮火食气，
无气以动，十全大补汤（见虚损。）加减，去邪留正。
身体疼痛。风寒湿三气留滞经脉，故不通而痛。铁弹丸、十味锉散、（有热药，无
热者宜之。）蠲痹汤。（见痹。）
昏冒。活命金丹、至宝丹、至圣保命金丹、牛黄清心丸。
小便不通。《三因》白散子，加木通、灯心、茅根煎，热盛去附子。洁古云∶如
自汗，津液外亡，小便自少，不可利之，使营卫枯竭，无以制火，当退热止汗，小
便自利。
遗尿。浓煎参 汤，少加益智子，频啜之。
多食。火盛则脾阴虚而燥，故能消食，当泻火，脾阴复则食减，是其验也。旧
谓脾虚则求助于食。《经》云∶实则梦与，虚则梦取。即其义也，亦通。（食以养血，故
脾阴虚则思食。然食而能消、则有火也。）
中风须分阴阳。（气虚者多寒，火盛者多热。）阴中，面色青白，手足厥冷，多汗。（风火内生，
亦有转为寒症者。盖风火发越，汗出过多，阳随外泄，症转阴寒，固有之矣。昔人谓中风之痰始为热痰，后为寒痰，
亦此意也。）阳中，面赤如醉，怒目上视，强直掉眩。《经》云∶掉眩支痛，强直筋缩，
为厥阴风木之气。木旺生火，风火属阳，多为兼化，皆热气也。又风能胜湿，而为
干燥，风病势甚，因而筋缩强直，燥热之甚也。《宝鉴》云∶凡人初觉大指、次指、
次指麻木不仁，或不用者，三年内必中风，（肺脉终大指，大肠脉起食指，金病则皮毛不固，
易于受风也。）宜先服愈风汤、天麻丸各一料，以预防之。薛立斋云∶预防之理，当养气
血，节饮食，戒七情，远房帏。若服前药以预防，适所以招风取中也。《乾坤生意》
云∶凡人手足渐觉不遂，麻痹不仁，或口眼 斜，（此皆经络之病，易中外风。）语言謇滞，
或胸膈迷闷，吐痰相续，（此痰火之病，易中内风。）六脉弦滑而无力，其去卒厥仆倒亦不远
矣，须防之。
有妇人先胸胁胀痛，（肝血虚，肝火盛而郁也。）后四肢不收，（血虚不能养筋也。）自汗如雨，
（肝热津泄。）小便自遗，（肝热阴挺，疏泄不藏。）大便不实，（火蒸脾土湿动。）口紧目 ，（筋脉收引。）饮食
颇进，（脏腑未伤。）十余日，或以为中脏。立斋曰∶非也。若风中脏，真气既脱，（指汗遗
言。）恶症既见，祸在反掌，安能延至十日。（中风陡然而发，亦无先见胸胁之证。）视其色则青
赤，（木火之色。）诊其脉洪数，而肝尤甚，乃用犀角散四剂，顿愈。又用加味逍遥散（见郁。）
调之。后因郁怒复作，兼发热、呕吐，月经不止，饮食少思。乃木克土，脾不摄血
也。用加味归脾，佐以逍遥散而愈。又有人，素无疾苦，忽如死人，身不动，目闭
不开，口噤不言，恶闻人声，状如冒眩，移时方寤。此由出汗过多，血少阳气郁胃
于上不行所致。移时气下而寤，名曰郁胃，白薇汤、仓公散。引此二证，以为
辨证之法。
内伤亏损败坏日久，发展到极点必然发作，不一定需要受到外邪感触。（久病或产后，多有突然虚脱的症状，深居密室之中，哪里会有外感呢？）
刘河间主张病因在于火，认为热极生风，这并非肝木之风，（意思是不要拘泥于一定是肝风），也不是外感的风。这是由于调养失当，七情过极，心火暴盛，肾水虚衰，不能制约心火，热气郁结，心神昏乱冒昧，所以突然跌倒无知觉。病情轻的只是僵倒，气血流通，筋脉不痉挛，发作后如常。病情重的则气血郁结不通。阴气突然断绝，阳气随后竭尽而死。他的说法很有道理。然而既然说是火盛由于火虚（命门火衰），那么应当用六味地黄丸，却反而用地黄饮子这种热剂，是因为火发而阳气突然暴脱。如果肾火没有虚弱，只以降心火为主，给予大剂量的清心汤、泻心汤。等到心火下降后，再用防风通圣散发汗。（内火也用汗法疏散，是因为火虽已降，但浮盛在表的热邪未散，所以发汗使其向外发散。）如果大便闭塞不通的，用三化汤攻下。内外火邪都已清除，用羌活愈风汤调理，宣通气血，疏导经络。（兼通痰滞）。如果肾水虚亏，命门真火挟带肝风上冲的，用大剂量六味地黄丸药料煎服。（见虚损篇）。如果竟然到了阳气脱失的地步，宜先用参附汤大剂量峻补其阳，然后充实其阴，继而生脉散（见中暑篇）滋养其化源。
李东垣主张病因在于气，认为人身之阳气，可以用天地之疾风来命名。中风证不是外来的风，这是本气衰弱所致。四十岁以后气衰，或者再次损伤其气，（七情、劳役、房事、饮食，都足以损伤正气），多有此证，年轻时是没有的。肥胖的人偶尔也有，也是形体盛实而气虚所致。此证如果不是大剂量人参、黄芪，怎么能挽回。如果不跌倒，只是舌强、言语謇涩、痰壅、肢体不遂，用六君子汤（见气篇）加各种汁液治疗。（这是气虚内夺的证候。大概虚弱之人，多有突然昏眩而倒下的，与下文《中气篇》气逆者相同）。
朱丹溪主张病因在于痰，认为土湿生痰，痰郁结成热极而生风。
问：内风也有中血脉、中腑、中脏的区别吗？回答说：病从内部发生，没有不伤害其腑、脏的。由于火盛，则火发而血与痰壅塞；由于气虚，则气滞而血与痰凝结。痰血壅滞，食物也不能消化，填塞于腑，则二便不通，阻碍脏气，则昏迷不醒，这是重症。轻的中之后，邪气散布经络，而血脉运行不利，本来就有这种情况。难道一定要兼夹外风才这样吗？至于下文所列举的各种症状，也多由内伤所致，不一定兼涉外感。
口噤，就是牙关不开。由于气血凝结于牙关，筋脉不能活动，用苏合丸或生南星、冰片、乌梅肉研末擦牙，或用郁金、藜芦末吹鼻，或针刺人中、颊车穴各四分，或用白矾半两、盐花一分，细研，擦点牙根下，再用棉裹半钱匕，安放在牙尽头。用甘草，比中指节截作五截，在生油内浸过，在炭火上炙烤，等油渗入甘草，撬开牙关，令其咬定甘草，如人行十里路的时间，再换一截，然后灌药，极有效。
口眼歪斜。胃经细筋为目下纲，膀胱经细筋为目上纲，胆经脉起于目锐眦，其筋也结聚于此，小肠、三焦筋脉俱至目锐眦。又胃经、大肠经脉俱挟唇口左右。风寒之邪，视诸经筋脉之虚而侵袭，左虚则左受寒，筋脉急引而歪斜，右虚则相反。用清阳汤、秦艽升麻汤疏散。内有热的，宜加辛凉药。患处宜灸，目斜灸承泣穴，（注：承泣禁灸，需再考证），口歪灸地仓穴，无效，再加灸人迎、颊车穴。如果是纯是内风火邪而歪斜的，则为热灼筋枯短缩，与寒而收引者相反，不可灸，也不可用温散之药，须用苦寒降火，有用承气汤（见大便不通篇）攻下而痊愈的例子。通用牵正散：白附子、（辛热，专去头面之风。内火盛者，宜加清凉之品）、僵蚕、全蝎（这两味药去风破结痰，痰结在筋脉间，不去痰筋就不舒展）等分为末，每二钱酒调服，外用捣烂蓖麻子一两，冰片三分，制成膏，寒月加干姜、附子各一钱，右歪贴左，左歪贴右。旧说左寒则右热，左热则右寒，这是指内有热而外感寒者说的。如果只是外寒而内不热，或者只是内热而外无寒，则左寒者不必右热，左热者不必右寒也。大抵纯是内风而热不甚的，必无此证，热甚的才有此证，然而歪斜不甚，因为火即暴甚，不至立即枯其根本。如果兼夹外感风寒，那就严重了。以寒热相激，其势更暴烈。纯感风寒者也严重，因为寒之收引容易，但也必须是虚人才会有。（凡是遇到旋风而歪斜的，都是虚人）。
半身不遂。《内经》说：胃脉沉鼓涩，胃外鼓大，（外鼓，犹如脉浮而鼓指），心脉小坚（坚，即实也）急，（急，即紧也），都是偏枯。男子发于左侧，女子发于右侧，不喑哑舌能转动，可治。（因为其病只在血脉，未及脏腑）。盖胃与脾为表里，更实更虚，（更，迭也），胃阳虚则脾阴盛，而胃从于脾，故胃脉沉鼓涩也。涩，为多血少气。（气少，故血虽多而不流走也）。胃阳盛则脾阴虚，而脾从于胃，故胃脉鼓大于臂外也。大，为多气少血。（气多，故血虽少而脉亦大，然必大而兼虚）。心之元阳不足，阴寒乘之，故脉小坚急者，者是阳不足也；坚急者，阴寒之邪也。心、胃、脾三等脉，凡有其一，即为偏枯者。为什么呢？盖心之神无处不周遍，胃之气无处不行，神行气流，充足盈溢，哪里有病。若神气受伤，则营运不能周遍，而筋脉偏枯矣。所谓没有不因真气不周而病的，然而岂止心、胃是这样呢？五脏六腑，凡有一不周，都足以导致偏枯，固可推知。丹溪说：左半多属死血与血虚，用四物汤等补血之剂。右半多属气虚与痰，用四君子汤等补气之剂，并加竹沥、姜汁以行痰。这是大概如此，不可拘泥。古方顺风匀气散、虎骨散、虎胫骨酒、黄芪酒，可选用。外用蚕沙两石，分三袋蒸热，一袋敷患处，冷则再换一袋。羊肚酿粳米、葱白、姜、椒、豉等，煮烂，日食一具，十日止。
失音不语。《内经》谓内夺（精血亏败亡失，如被人夺去者然）而厥，（逆而上行名厥，火气上冲也），则为音痱，这是肾虚。（肾水虚，故火上炎）。少阴（肾脉）不至者，（不至，谓不能上通也，即肾水不上润意），厥也。肾脉不至于上，则不得循喉咙挟舌本，故不能言也。地黄饮子、六味地黄丸、八味地黄丸等（六、八味见虚损篇）主之。或用竹沥、荆沥（去痰）、梨汁（去热，各三杯）、生葛汁（去热）、人乳汁（润燥，各二杯）、陈酱汁（半杯）和匀，隔汤顿温服。（舌为心之苗，痰火盛则心脉干燥拘急，故舌强而不能言。又痰迷心窍，则心脉不用，故不能掉舌，且神昏不能语也）。有痰者，用涤痰汤。内热者，用凉膈散（见发热篇）加石菖蒲、远志，（以通心窍也），为末，炼蜜丸，弹子大，朱砂为衣，每服一丸，薄荷汤化下，名转舌膏。或《宝鉴》诃子汤（见喑哑）、正舌散、茯神散，外用龟尿点舌，神效。（置龟新荷叶上，猪鬃戳其鼻立出）。语涩，有舌纵、舌麻，都以痰火治之，用乌药、僵蚕、胆星、芩、连、枳壳、防风、竹沥、姜汁。
痰盛者。橘红一斤，逆流水五碗，煮数滚，去橘红，再煮至一碗，顿服，白汤导之，（后又饮白汤，以手探喉，导令吐也），吐痰之圣药也。中后气未尽顺，痰未尽除，当以藿香正气散和星香散煎服。中气、中恶、霍乱尤宜之。中后体虚有痰，四君子汤（见气篇）和星香散，或六君子汤（见气篇）、养正丹（见气篇），坠痰镇气，气实者，以星香散吞之，气虚者，六君子汤吞之。
四肢不举。实者，脾湿盛，令筋脉缓软，宜去湿。虚者，脾燥热，壮火食气，无气以动，十全大补汤（见虚损篇）加减，去邪留正。
身体疼痛。风寒湿三气留滞经脉，故不通而痛。铁弹丸、十味锉散、（有热药，无热者宜之）、蠲痹汤。（见痹证篇）。
昏冒。活命金丹、至宝丹、至圣保命金丹、牛黄清心丸。
小便不通。《三因方》白散子，加木通、灯心、茅根煎，热盛去附子。洁古云：如自汗，津液外亡，小便自少，不可利之，使营卫枯竭，无以制火，当退热止汗，小便自利。
遗尿。浓煎人参汤，少加益智子，频啜之。
多食。火盛则脾阴虚而燥，故能消食，当泻火，脾阴复则食减，是其验也。旧谓脾虚则求助于食。《内经》云：实则梦与，虚则梦取。即其义也，亦通。（食以养血，故脾阴虚则思食。然食而能消、则有火也）。
中风须分阴阳。（气虚者多寒，火盛者多热）。阴中，面色青白，手足厥冷，多汗。（风火内生，亦有转为寒症者。盖风火发越，汗出过多，阳随外泄，症转阴寒，固有之矣。昔人谓中风之痰始为热痰，后为寒痰，亦此意也）。阳中，面赤如醉，怒目上视，强直掉眩。《内经》云：掉眩支痛，强直筋缩，为厥阴风木之气。木旺生火，风火属阳，多为兼化，皆热气也。又风能胜湿，而为干燥，风病势甚，因而筋缩强直，燥热之甚也。《宝鉴》云：凡人初觉大指、次指、次指麻木不仁，或不用者，三年内必中风，（肺脉终大指，大肠脉起食指，金病则皮毛不固，易于受风也），宜先服愈风汤、天麻丸各一料，以预防之。薛立斋云：预防之理，当养气血，节饮食，戒七情，远房帏。若服前药以预防，适所以招风取中也。《乾坤生意》云：凡人手足渐觉不遂，麻痹不仁，或口眼歪斜，（此皆经络之病，易中外风），语言謇滞，或胸膈迷闷，吐痰相续，（此痰火之病，易中内风），六脉弦滑而无力，其去卒厥仆倒亦不远矣，须防之。
有妇人先胸胁胀痛，（肝血虚，肝火盛而郁也），后四肢不收，（血虚不能养筋也），自汗如雨，（肝热津泄），小便自遗，（肝热阴挺，疏泄不藏），大便不实，（火蒸脾土湿动），口紧目斜，（筋脉收引），饮食颇进，（脏腑未伤），十余日，或以为中脏。立斋曰：非也。若风中脏，真气既脱，（指汗遗言），恶症既见，祸在反掌，安能延至十日。（中风陡然而发，亦无先见胸胁之证）。视其色则青赤，（木火之色），诊其脉洪数，而肝尤甚，乃用犀角散四剂，顿愈。又用加味逍遥散（见郁证篇）调之。后因郁怒复作，兼发热、呕吐，月经不止，饮食少思。乃木克土，脾不摄血也。用加味归脾汤，佐以逍遥散而愈。又有人，素无疾苦，忽如死人，身不动，目闭不开，口噤不言，恶闻人声，状如冒眩，移时方寤。此由出汗过多，血少阳气郁胃于上不行所致。移时气下而寤，名曰郁胃，白薇汤、仓公散。引此二证，以为辨证之法。
When internal injury and depletion have persisted for a long time, it will inevitably manifest when it reaches its extreme; there is no need for external pathogenic factors to trigger it. (Patients with chronic illness or postpartum often suffer from sudden collapse. Living in a sealed room, how could they contract an external pathogen?)
Liu Wansu attributed the cause to Fire, stating that extreme heat generates Wind. This is not the Wind of Liver Wood (meaning one should not rigidly adhere to Liver Wind), nor is it external Wind. It arises from improper regimen and excessive emotional stimulation, causing the Heart Fire to flare up violently while Kidney Water becomes deficient and unable to control it. The heat qi becomes stagnant and depressed, leading to confusion and clouding of the Spirit, resulting in sudden collapse and loss of consciousness. In mild cases, the patient merely collapses stiffly; Qi and Blood flow freely, sinews and vessels do not spasm, and the patient returns to normal after the episode. In severe cases, Qi and Blood become stagnant and blocked. Yin Qi suddenly perishes, followed by the exhaustion of Yang Qi, leading to death. His theory is quite sound. However, since he stated that Fire excess stems from Fire deficiency (Mingmen Fire decline), one should use Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill). Instead, he used Dihuang Yinzi (Rehmannia Decoction), a hot formula, because the Fire flare-up caused a sudden violent collapse of Yang. If Kidney Fire is not deficient, treatment should focus primarily on descending Heart Fire, administering large doses of Qingxin Tang (Clear Heart Decoction) or Xiexin Tang (Drain Heart Decoction). Once Heart Fire has descended, Fangfeng Tongsheng San (Saposhnikovia Powder for Unblocking the Whole Body) can be used to induce sweating. (Internal Fire is also treated with diaphoresis because although the Fire has been lowered, the heat floating and abundant at the exterior has not dissipated; thus, sweating allows it to escape outward.) If stool is obstructed, Sanhua Tang (Three Transformations Decoction) is used to purge. After both internal and external Fire pathogens are cleared, Qianghuo Yufeng Tang (Notopterygium Decoction for Preventing Wind) is used to regulate, promoting Qi and Blood circulation and unblocking meridians. (It also resolves Phlegm stagnation.) If Kidney Water is deficient and Mingmen True Fire carries Liver Wind upward, a large dose of Liuwei Dihuang Wan material should be decocted and taken. (See Deficiency Damage section). If Yang collapse occurs, Shenfu Tang (Ginseng and Aconite Decoction) should be used first in large doses to vigorously tonify Yang, followed by tonifying Yin, and then Shengmai San (Generate Pulse Powder) to nourish the source of transformation. (See Heatstroke section).
Li Dongyuan attributed the cause to Qi, describing human Yang Qi as akin to the fierce wind of heaven and earth. Stroke is not caused by external Wind but by the weakness of intrinsic Qi. After the age of forty, when Qi declines, or if Qi is further damaged (by emotions, overwork, sexual indulgence, or diet), this condition often occurs; it does not happen in youth. Obese individuals may occasionally suffer from it due to robust physique but weak Qi. This condition cannot be reversed without large doses of Renshen (Ginseng) and Huangqi (Astragalus). If the patient does not collapse but presents with tongue stiffness, slurred speech, Phlegm obstruction, and limb paralysis, Liujunzi Tang (Six-Gentleman Decoction) plus various juices should be used. (This is a syndrome of Qi deficiency and internal depletion. Weak individuals often experience sudden dizziness and collapse, similar to the Qi reversal described in the "Zhong Qi Chapter".)
Zhu Danxi attributed the cause to Phlegm, stating that dampness in Earth generates Phlegm, which stagnates and turns into extreme heat, generating Wind.
Question: Does Internal Wind also differentiate between invasion of collaterals, Fu organs, and Zang organs? Answer: Since the disease originates internally, it inevitably damages the Fu and Zang organs. Due to Fire excess, Fire flares up causing blood and Phlegm to obstruct; due to Qi deficiency, Qi stagnates causing blood and Phlegm to coagulate. Stagnant Phlegm and blood prevent food digestion, filling the Fu organs, leading to constipation and urinary retention, obstructing Zang Qi, causing coma and unconsciousness—this is severe. In mild cases, after the onset, pathogens scatter into collaterals, impairing blood vessel flow, which is inherent. Must it involve external Wind? Most symptoms listed below are caused by internal injury and do not necessarily involve external pathogens.
"Kou Jin" (Jaw lock) refers to the inability to open the jaw. It is caused by Qi and Blood coagulating at the jaw, preventing sinew movement. Suhe Wan (Styrax Pill) or a powder of raw Xingren (Areca Seed - *Note: Text says Sheng Nanting/Banlian Nanxing likely implies Pinellia*, Bingpian (Borneol), and Wumei Rou (Mume Fruit Flesh) can be rubbed on the teeth. Or Yujin (Curcuma Rhizome) and Lili (Veratrum) powder can be insufflated into the nose. Acupuncture points Renzhong (GV26) and Jiache (ST6) can be needled 0.4 cun. Alternatively, half liang of Baifan (Alum) and one fen of Yanhua (Salt flower), finely ground, can be applied to the gum root. A cotton-wrapped half-qian bi can be placed at the end of the teeth. Use Gancao (Licorice Root), cut into five segments matching the middle finger joint, soaked in sesame oil, and roasted over charcoal fire until oil penetrates. Use it to pry open the jaw, letting the patient bite down on the licorice. After walking about ten li, replace with another segment, then administer medicine. This is highly effective.
"Mouth and Eye Deviation" (Facial Paralysis). The fine tendons of the Stomach Meridian form the lower eyelid margin; those of the Bladder Meridian form the upper margin. the Gallbladder Meridian starts at the outer canthus, where its tendons also gather. Small Intestine and Sanjiao tendons also reach the outer canthus. Stomach and Large Intestine meridians flank the lips and mouth. Wind-Cold pathogens attack where meridian tendons are deficient. Left deficiency leads to left Cold, causing tendon contraction and deviation to the left; right deficiency causes deviation to the right. Qingyang Tang (Clear Yang Decoction) or Qinjiao Shengma Tang (Gentian and Cimicifuga Decoction) can disperse it. If there is internal heat, add acrid-cool herbs. Moxibustion is suitable for the affected area: Chengqi (ST1) for eye deviation (Note: Chengqi is contraindicated for moxa, requires re-examination), Dicang (ST4) for mouth deviation. If ineffective, add Yingtang (ST9) and Jiache (ST6). If deviation is purely due to Internal Wind-Fire, it results from heat scorching sinews, causing shortening and contraction, opposite to Cold-induced contraction. Moxibustion and warm-dispersing herbs are contraindicated. Bitter-cold herbs to descend Fire are needed; Chengqi Tang (Major Order of the Yellow Emperor Decoction) has cured such cases. General prescription Qianzheng San (Straighten Correct Powder): Baifuzi (Typhonii Rhizoma), Jiangcan (Bombyx Batryticatus), Quanxie (Scorpio) in equal parts, powdered, taken with wine. Externally, mash one liang of Bibo (Ricini Semen) with three fen of Bingpian (Borneolum Syntheticum) into a paste. In cold months, add one qian each of Ganjiang (Zingiberis Rhizoma) and Fuzi (Aconiti Lateralis Radix Praeparata). Apply right deviation to the left side, left deviation to the right side. Old theory states "Left Cold requires Right Heat," referring to internal heat with external Cold. If only external Cold without internal heat, or only internal heat without external Cold, then Left Cold does not require Right Heat treatment. Generally, pure Internal Wind with mild heat does not cause this; severe heat does. Mild deviation is rare because even violent Fire does not immediately wither the root. If combined with external Wind-Cold, it is more severe due to the clash of Cold and Heat. Pure Wind-Cold is also severe due to easy contraction, but only affects deficient persons. (Those who develop deviation in whirlwinds are always deficient).
"Hemiplegia". The Classic states: Stomach pulse sinking and drumming with choppy quality, or bulging large externally (bulging means floating and drumming under finger); Heart pulse small, firm, and rapid (firm means excess, rapid means tight) all indicate hemiplegia. Men develop it on the left, women on the right. If aphasic but tongue moves, it is treatable (pathology limited to vessels, not Zang-Fu). Stomach and Spleen are interior-exterior pairs, alternating excess and deficiency. Stomach Yang deficiency leads to Spleen Yin abundance, so Stomach follows Spleen, resulting in a sinking, drumming, choppy pulse. Choppy indicates much blood but little Qi (Qi is scarce, so blood does not flow freely). Stomach Yang excess leads to Spleen Yin deficiency, so Spleen follows Stomach, resulting in a bulging, large pulse externally. Large indicates much Qi but little blood (Qi is abundant, so pulse is large despite little blood, but must be large and deficient). Heart Yuan Yang is insufficient, allowing Yin-Cold to invade, causing small, firm, rapid pulses (small/rapid indicates Yang deficiency; firm/rapid indicates Yin-Cold pathogen). Presence of any of these three pulse types (Heart, Stomach, Spleen) indicates hemiplegia. Why? Because Heart Spirit pervades everywhere, Stomach Qi flows everywhere. When Spirit moves and Qi flows, full and overflowing, there is no disease. If Spirit and Qi are injured, circulation fails to pervade, leading to hemiplegia. Thus, no disease occurs without Qi deficiency. But is it only Heart and Stomach? Any Zang-Fu dysfunction can cause hemiplegia. Zhu Danxi said: Left side often involves static blood and Blood deficiency, treated with Siwu Tang (Four Substances Decoction) etc. Right side often involves Qi deficiency and Phlegm, treated with Sijunzi Tang (Four Gentlemen Decoction) etc., plus Zhuli (Bamboo Juice) and Jiangzhi (Ginger Juice) to move Phlegm. This is generally true but should not be rigidly applied. Ancient formulas like Shunfeng Yunqi San, Hugu San, Hu Jinggu Jiu, and Huangqi Jiu can be selected. Externally, steam two shi of Can Sha (Mulberry Midge Frass) in three bags. Apply one bag to the affected area, replacing when cool. Cook lamb stomach stuffed with rice, green onion, ginger, pepper, and fermented soybeans until soft; eat one daily for ten days.
"Aphonia". The Classic states: Internal depletion (loss of essence and blood) leading to Jue (reversal, Qi/Fire rushing upward) causes "Yin Fei" (aphonia), due to Kidney deficiency (Kidney Water deficiency allows Fire to flare upward). Shaoyin (Kidney) pulse failing to reach the top (failure to ascend, meaning Kidney Water does not moisten) indicates Jue. If Kidney pulse does not ascend, it cannot follow the throat and grasp the tongue base, hence inability to speak. Dihuang Yinzi, Liuwei Dihuang Wan, Bawei Dihuang Wan etc. are indicated. Alternatively, mix Zhuli (Bamboo Juice), Jingli (Phyllostachys Juice) [to resolve Phlegm], Lizhi (Pear Juice) [to clear heat, 3 cups each], Shengge Zhi (Pueraria Juice) [to clear heat], Renru Zhi (Human Milk) [to moisten dryness, 2 cups each], and Chenjiang Zhi (Aged Soy Sauce Juice, 0.5 cup). Warm in a water bath and take. (Tongue is the sprout of the Heart. Excess Phlegm-Fire dries and contracts Heart vessels, causing tongue stiffness and aphasia. Phlegm confusing Heart orifices renders Heart vessels useless, preventing tongue movement and speech due to Spirit confusion). For Phlegm, use Tantan Tang (Eliminate Phlegm Decoction). For internal heat, use Liangge San (Cool Diaphragm Powder) plus Shichangpu (Acori Tatarinowii Rhizoma) and Yuanzhi (Polygalae Radix) [to open Heart orifices], powdered, honey-pilled, cinnabar-coated, taken one pill dissolved in mint tea, named Zhanshe Gao (Tongue-Straightening Paste). Or Hezi Tang (Persimmon Sepal Decoction), Zhengshe San, Fushen San. Externally, apply turtle urine to the tongue for miraculous effect. Slurred speech, tongue protrusion, or tongue numbness are all treated as Phlegm-Fire using Wayao (Litseae Fructus), Jiangcan, Danning (Arisaema cum Bile), Huangqin (Scutellariae Radix), Huanglian (Coptidis Rhizoma), Zhike (Aurantii Fructus), Fangfeng (Saposhnikoviae Radix), Zhuli, and Jiangzhi.
For excessive Phlegm: One jin of Juhong (Citri Reticulatae Pericarpium Rubrum) boiled in five bowls of reverse-flowing water, boiled several times, remove Juhong, boil remaining liquid to one bowl, take at once, guided by white water (drink white water afterwards, stimulate throat to vomit). This is the holy medicine for vomiting Phlegm. After stroke, if Qi is not smooth and Phlegm not fully removed, use Huoxiang Zhengqi San harmonized with Xingxiang San. Especially suitable for Zhong Qi, Zhong E, and Huoluan. For post-stroke deficiency with Phlegm, use Sijunzi Tang or Liujunzi Tang harmonized with Xingxiang San, or Yangzheng Dan. To settle Phlegm and calm Qi: use Xingxiang San for excess Qi, Liujunzi Tang for deficient Qi.
"Limbs unable to rise". Excess type: Spleen Dampness is abundant, making sinews soft; treat by removing Dampness. Deficient type: Spleen Dryness-Heat, Strong Fire consumes Qi, leaving no Qi to move; use Shiquan Dabu Tang (Ten Complete Tonification Decoction) modified to eliminate evil and preserve righteousness.
"Body Pain". Wind, Cold, and Dampness stagnate in meridians, causing blockage and pain. Tidanz Wan, Shiwei Cuo San (suitable if no heat), Juanbi Tang.
"Coma/Clouding". Huoming Jin Dan, Zhibao Dan, Zhisheng Baoming Jin Dan, Niuhuang Qingxin Wan.
"Urinary Retention". Bai San Zi from San Yin Fang, add Mutong (Akebiae Caulis), Dengxincao (Junci Medulla), Maogen (Imperatae Rhizoma) to decoct. Remove Fuzi if heat is severe. Jiegu said: If spontaneous sweating, fluids escape externally, urine is naturally scant; do not promote urination, as this depletes Ying and Wei, leaving no power to control Fire. Instead, reduce heat and stop sweating; urine will flow naturally.
"Incontinence". Decoct Renshen (Ginseng) strongly, add a little Yizhiren (Alpiniae Oxyphyllae Fructus), sip frequently.
"Polyphagia". Excess Fire causes Spleen Yin deficiency and dryness, enabling digestion. Clear Fire; when Spleen Yin recovers, appetite decreases, proving the diagnosis. Old theory says Spleen deficiency seeks help from food. Classic: "Excess dreams giving, deficiency dreams taking." This aligns. (Food nourishes Blood; Spleen Yin deficiency craves food. Ability to digest indicates Fire).
"Stroke must distinguish Yin and Yang". (Qi deficiency tends toward Cold, Fire excess tends toward Heat). Yin Stroke: Face blue-white, cold limbs, profuse sweating. (Internal Wind-Fire can turn into Cold syndrome. Wind-Fire dissipating causes excessive sweating, Yang escapes outward, turning to Yin-Cold. Ancient view: Stroke Phlegm starts as Hot Phlegm, becomes Cold Phlegm later). Yang Stroke: Face red as drunk, angry eyes staring up, stiffness, tremors, vertigo. Classic: Tremors, pain, stiffness, and sinew contraction belong to Jueyin Wind-Wood Qi. Wood excess generates Fire; Wind-Fire belongs to Yang, often transforming together into Heat. Wind conquers Dampness, causing dryness. Severe Wind disease causes sinew contraction and stiffness, indicating extreme Dryness-Heat. Baojian states: If one initially feels numbness or paralysis in thumb and index finger, stroke will occur within three years (Lung Meridian ends at thumb, Large Intestine starts at index finger; Metal disease makes skin/hair insecure, prone to Wind). Take Yufeng Tang and Tianma Wan prophylactically. Xue Lizhai said: Prevention requires nourishing Qi and Blood, regulating diet, controlling emotions, avoiding sexual indulgence. Taking medicines for prevention actually invites Wind and Stroke. Qiankun Shengyi states: If hands/feet gradually feel clumsy, numb, or deviated (Meridian diseases, prone to external Wind), speech slurred, chest oppression, continuous Phlegm (Phlegm-Fire diseases, prone to internal Wind), and six pulses are wiry, slippery, and powerless, stroke/collapse is imminent. Must prevent.
Case: A woman first had chest/hypochondriac distension/pain (Liver Blood deficiency, Liver Fire excess with stagnation), then limbs flaccid (Blood deficiency failing to nourish sinews), profuse sweating like rain (Liver Heat leaking fluids), urinary incontinence (Liver Heat causing Yin prolapse, failure to store), loose stools (Fire steaming Spleen Earth moving Dampness), jaw lock and eye deviation (Sinew contraction), good appetite (Zang-Fu not injured). After ten days, some thought it was Zang Stroke. Lizhai said: Incorrect. If Wind hit Zang, True Qi would collapse, bad signs would appear, death would be imminent, not lasting ten days. (Stroke strikes suddenly, no prior chest symptoms). Color was blue-red (Wood-Fire colors), pulse was surging and rapid, especially Liver. Used Xijiao San (Rhinoceros Horn Powder) for four doses, cured instantly. Then regulated with Jiawei Xiaoyao San. Later relapsed due to depression/anger, with fever, vomiting, menorrhagia, poor appetite. Wood overacting on Earth, Spleen failing to control blood. Used Jiawei Guipi Tang assisted by Xiaoyao San, cured.
Another case: Person previously healthy, suddenly appeared dead, immobile, eyes closed, jaw locked, silent, aversion to sound, dizzy-like, woke after some time. Caused by excessive sweating, Blood deficiency, Yang Qi stagnating in Stomach above, failing to descend. Qi descended later, waking him. Named Yuwei (Stagnant Stomach). Treat with Baiwei Tang or Cangong San. These two cases illustrate differentiation methods.