王安道中风辨
人有卒暴僵仆。或偏枯。或四肢不举。或不知人。或死或不死者。世以中风呼之。而方书以中风治之。余
考诸内经。则曰风之伤人也。或为寒热。或为热中。或为寒中。或为疠风。或为偏枯。或为风也。其卒暴僵
仆。不知人。四肢不举者。并无所论。止有偏枯一论而已。及观千金方。则引岐伯曰。中风大法有四。一
曰偏枯。二曰风痱。三曰风 。四曰风痹。金匮要略中风篇云。寸口脉浮而紧。紧则为寒。浮则为虚。寒虚相
搏。邪在皮肤。浮者血虚。络脉空虚。贼邪不泻。或左或右。邪气反缓。正气即急。正气引邪。 僻不遂。
邪在于络。肌肤不仁。邪在于经。即重不胜。邪入于腑。即不识人。邪入于脏。舌即难言。口吐涎沫。由是
观之。知卒暴僵仆。不知人。偏枯四肢不举等证。固为因风而致
者矣。故用大小续命。西州续命。排风八风等诸汤散治之。及近代刘河间李东垣朱彦修三子者出。所论始与昔
人异矣。河间主乎火。东垣主乎气。彦修主乎湿。反以风为虚象。而大异于昔人矣。以予观之。昔人三子之
论。皆不可偏废。但三子以相类中风之病。视为中风而立论。故使后人狐疑而不能决。殊不知因于
风者。真中风。因于火因于气因于湿者。类中风而非中风也。三子之所论者。自是因火因气因湿。而为暴病暴
死之证。与风何相干哉。如内经所谓三阴三阳发病。为偏枯痿易。四肢不举。亦未尝必因于风而后然也。夫风
火气湿之殊。望闻问切之间。岂无所辨乎。辨之为风。则从昔人以治之。辨之为火气湿。则从三子以治之。如
此庶乎析理明而用法当矣。惟其以因火因气因湿之证。强引风而合论之。所以真伪不分而名实相紊。若以因火
因气因湿证分出之。则真中风病彰矣。
王氏之论甚妙。但类中风与真中风并论。无轻重缓急之分。亦不能无弊。愚意邪之所凑。其气必虚。
内伤者间而有之间字。当作五百年间出之间。当专主虚论。不必兼风。河间东垣各发前人所未发。至为精妙。
但有论无方。后人何所根据从。而彦修以阴虚立论。亦发前人所未发。惜乎以气血湿痰为主。而不及真阴。不能
无遗弊于后世焉。
东垣云。有中风者。卒然昏愦。不省人事。痰涎壅盛。语言謇涩等证。此非外来风邪。乃本气自病也。凡
人年逾四旬。气衰之际。或忧喜忿怒伤其气者。多有此证。壮岁之时无有也。若肥
盛者。则间而有之。亦是形盛气衰而如此耳。
观东垣之论。当以气虚为主。纵有风邪。亦是乘虚而袭。经曰。邪之所凑。其气必虚是也。当此之时。
岂寻常药饵能通达于上下哉。急以三生饮一两。加人参一两。煎服即苏。夫三生饮乃行经治
痰之剂。斩关夺旗之将。每服必用人参
两许。驾驱其邪。而补助真气。否则不惟无益。适以取败。观先哲用 附参附。其义可见矣。若遗尿手撒口开
鼾睡为不治。然用前药。多有得生者。不可不知。
河间曰。所谓中风瘫痪者。非为肝木之风实甚而卒中之。亦非外中于风。良由将息失宜。心火暴甚。肾水
虚衰。不能制之。则阴虚阳实。而热气拂郁。心神昏冒。筋骨不用。而卒倒无知也。亦有因喜怒思悲恐五志有
所过极而卒中者。夫五志过极。皆为热甚。俗云风者。言末而忘其本也。
观刘氏之论。则以风为末。而以火为本。世之尊刘氏者。专以为刘氏主火之说。殊不知火之有余。水之不
足也。刘氏原以补肾为本。观其地黄饮子之方可见矣。故治中风。又当以真阴虚为本。
注云。舌暗不能言。足废不能行。此谓少阴气厥不至。急当温之。名口痱证。
但阴虚有二。有阴中之水虚。有阴中之火虚。火虚者专以河间地黄饮子为主。水虚者。又当以六味地黄
为主。果是水虚。则辛热之药。与参 之品。俱不可加。
河间东垣专治本而不治风。可为至当不易之论。学人必须以阴虚阳虚为主。自后世医书杂出。而使后学
狐疑不决。丹溪篡要曰。有气虚。有血虚。有湿痰。左手脉不足。及左半身不遂者。以四物汤补血之剂为主。
而加以竹沥姜汁。右手脉不足。及右半身不遂者。以四君子补气之剂。而佐以竹沥姜汁。如气血两虚。而挟痰
盛者。以八物汤为主。而加南星半复竹沥姜汁之类。丹溪之论。平正通达。宜世之人盛宗之。但持此以治中风。
而多不效。或少延而久必毙。何也。盖治气血痰之标。而不治气血痰之本也。人之有是四肢也。如木之有枝干
也。人之气血。荣养乎四肢也。犹木之浆水。灌溉乎枝叶也。木有枝叶。必有
根本。人之气血。岂无根本乎。人有半身不遂。而迁延不死者。如木之根本未甚枯。而一边之枝干先萎耳。
人有形容肥壮。忽然倒仆。而即毙者。如木之根本已绝。其枝叶虽滋荣。犹枯杨生华。何可久也。忽遇大风
而摧折矣。观此则根本之论明矣。然所谓气血之根本者何。盖火为阳气之根。水为阴气之根。而火与水之总根。
两肾间动气是也。此五脏六腑之本。十二经之源。呼吸之门。三焦之根。又名守邪之神。经曰。根于中者命曰
神机。神去则机息。根于外者名曰气立。气止则化绝。今人纵情嗜欲。以致肾气虚衰。根先绝矣。一或内伤劳
役。或六淫七情。少有所触。皆能卒中。此阴虚阳暴绝也。须以参附大剂。峻补其阳。继以地黄丸十补丸之类。
填实真阴。又有心火暴甚。肾水虚衰。又兼之五志过极。以致心神昏闷。卒倒无知。其手足牵掣。口眼
斜。乃水不能荣筋急而纵也。俗云风者。乃风淫末疾之假象。风自火出也。须以河间地黄饮子。峻补其阴。继
以人参麦门冬五味之类。滋其化源。此根阳根阴之至论也。若夫所谓痰者。凡人将死之时。必有痰。何独中风
为然。要之痰从何处来。痰者水也。其原出于肾。张仲景曰。气虚痰泛。以肾气丸补而逐之。观此凡治中风
者。既以前法治其根本。则痰者不治而自去矣。若初时痰涎壅盛。汤药不入。少用稀涎散之类。使喉咽疏通。
能进汤液即止。若欲必尽攻其痰。顷刻立毙矣。戒之哉。戒之哉。
或问人有半肢风者。必须以左半身属血。右半身属气。岂复有他说乎。曰未必然。人身劈中分阴阳水火。
男子左属水。右属火。女子左属火。右属水。男子半肢风者多患左。女子半肢风者多患右。即此观之。可见
以阴虚为主。又有一等人。身半以上俱无恙如平人。身半以下。软弱麻痹。小便或涩或自遗。果属气
乎。属血乎。此亦足三阴之虚证也。不可不知。
经曰。胃脉沉鼓涩。胃外鼓大。心脉小坚急。皆得偏枯。男
子发左。女子发右。不喑舌转可治。三十日起。其从者喑三岁起。年不满二十者。三岁死。盖胃与脾为表里。
阴阳异位。更实更虚。更逆更从。或从内。或从外。是故胃阳虚。则内从于脾。内从于脾。则脾之阴盛。故
胃脉沉鼓涩也。涩为多血少气胃之阳盛。则脾之阴虚。虚则不得与阳主内。反从其胃。越出于部分之
外。故胃脉鼓大于臂外也。大为多气少血。心者元阳君主宅之。生血生脉。因元阳不足。阴寒乘之。故心脉
小坚急。小者阳不足也。坚急者阴寒之邪也。夫如是心胃脾三脉。凡有其一。即为偏枯者何也。盖心是天真
神机开发之本。胃是谷气充大真气之标。标本相得。则胸膈间之膻中气海。所留宗气盈溢。分布四脏
三焦。上下中外。无不周遍。若标本相失。则不能致其气于气海。而宗气散矣。故分布不周于经脉。则偏枯。
不周于五脏则喑。即此言之。是一条。可为后之诸言偏枯者纲领也。未有不因真气不周而病者也。
乾坤生气云。凡人有手足渐觉不遂。或臂膊及髀股指节麻痹不仁。或口眼歪斜。语言謇涩。或胸膈迷
闷。吐痰相续。或六脉弦滑而虚软无力。虽未至于倒仆。其中风晕厥之候。可指日而决矣。须预防之。愚谓
预防之理。当节饮食。戒七情。远房事。此至要者也。如欲服饵预防。须察其脉证之虚实。如两尺虚衰
者。以六味地黄八味地黄。培补肝肾。如寸关虚弱者。以六君子十全大补之类。急补脾肺。才有补益。若
以搜风顺气。及清气化痰等药。适所以招风取中也。不可不知。
岐伯谓中风大法有四。一曰偏枯。谓半身不遂而痛也。如木之根本未甚枯。而一边枝干先萎者是也。
言不变。志不乱。病在分腠之间。巨针取之。益其不足。损其有余。乃可复也。二曰风痱。谓身无疼痛。四肢
不收也。如瘫痪是也。瘫者坦也。筋脉弛纵。坦然而不举也。痪者涣也。血气涣散而无用也。志乱不
甚。其言微知可治。甚则不能言。不可治也。三曰风 。谓奄然忽不知人也。咽中塞窒。舌强不能言。则是急
中风。而其候也。发汗身软者生。若汗不出。身硬唇干者死。视其鼻。人中左右上下白者可治。一黑一赤吐沫
者死。四曰风痹。谓诸痹。类风状也。经曰。风寒湿三气。合而成痹。曰痛痹。筋骨掣痛。曰着痹。着而不行。
曰行痹。走注疼痛。曰周痹。身疼痛。又曰行痹属风。痛痹属寒。着痹属湿。如正气不足之证。只补正气。不
必祛邪。如邪气有余。若痹证之类。虽以扶正气为主。不可不少用祛邪之法。如易老天麻丸之类。
口眼 斜
灵枢言足阳明之筋。其病颊筋有寒。则急引颊移口。热则筋弛。纵缓不能收。故僻。是左寒右热。则左急
而右缓。右寒左热。则右急而左缓。故偏于左者。左寒而右热。偏于右者。右寒而左热也。夫寒不可径用辛热
之剂。盖左中寒。则逼热于右。右中寒。则迫热于左。阳气不得宣行故也。
口之 。炙以地仓。目之斜。炙以承泣。苟不效。当炙人迎。夫气虚风入而为偏。上不得出。下不得
泄。真气为风邪所陷。故宜灸。经曰。陷下则灸之是也。
惟外中风邪者。方有 斜等证。若夫热则生风者。不可谓尽得病于窗隙之风。纵有 斜等证。乃假象也。亦不甚。
盖火胜则金衰。金衰则木盛。木盛则生风。惟润燥则风自息。不必用前灸法。
素问曰。诸风掉眩支痛强直筋缩。为厥阴风木之气。自大寒至小满。风木君火二气之位。风主动。善行数
变。木旺生火。风火属阳。多为兼化。且阳明燥金。主于紧敛缩劲。风木为病。反见燥金之化。由亢则害承乃
制。谓己极过。则反似胜己之化。故木极似金。况风能胜湿而为燥。风病势甚而成筋缩燥之甚
也。此等证候。正所谓风淫所胜。治以清凉者也。不宜用桂附。
或问曰。当此之时。小续命汤可用乎。曰未必然。小续命汤此仲景金匮要略治冬月直中风寒之的方。即
麻黄桂枝汤之变方也。其间随六经之形证。逐一加减。未便可按方统用其全方也。如太阳无汗。于本方中倍麻
黄杏仁防风。如有汗恶风。于本方中倍桂枝芍药杏仁。如阳明无汗身热不恶风。于本方中加石膏知母甘草。有
汗身热不恶风。于本方中加葛根桂枝黄芩。如太阳无汗身凉。于本方中加附子干姜甘草。少阴经中有汗
无热。于本方中加桂枝附子甘草。凡中风无此四证。六经混淆。系于少阳厥阴。或肢节挛痛。或麻木不仁。每
续命八两。加羌活四两。连翘六两。此系六经有余之表证。须从汗解。如有便溺阻隔。宜三化汤。或局方麻
仁丸通利之。虽然。邪之所凑。其气必虚。世间内伤者多。外感者间而有之。此方终不可轻用也。
许学士云。气中者。因七情所伤。
经曰。神伤于思虑则肉脱。意伤于忧愁则肢废。魂伤于悲哀则筋挛。魄伤于喜乐则衰槁。志伤于盛怒则腰
脊重。难俯仰也。又曰。暴怒伤阴。暴喜伤阳。故忧愁不已。气多厥逆。牙关紧急。若作中风误治杀人多矣。
盖中风者。身温且多痰涎。中气者。身凉而无痰涎。宜苏合香丸灌之即苏。经曰。无故而喑脉不至者。虽不治
自已。谓气暴逆也。气复自愈。
王节斋云。饮食过伤。变为异常急暴之病。人所不识。多有饮食醉饱之后。或感风寒。或着气恼。食填太
阴胃气不行。须臾厥逆。昏迷不省。若误作中风中气治之立毙。惟以阴阳淡盐汤探吐之。食出即愈。经曰。上
部有脉。下部无脉。法当吐。不吐则死。详见格致余论木郁则达之条下。以上二条论。当与厥门互看。
有一等形体肥胖。平素善饮。忽一日舌本硬强。语言不清。
口眼 斜。痰气上涌。肢体不遂。此肥人多中。以气盛于外而歉于内也。兼之酒饮湿热之证。须用六君子
加煨葛根山栀神曲而治之。
有一人久病滞下。忽一日昏仆。目上视。溲注而汗泻。脉无伦。丹溪先生曰。此阴虚阳暴绝也。得之病后
而酒且内。急治人参膏。而促灸其气海。顷之手动。又顷之唇动。参膏成三饮之而苏。后服尽数斤而愈。予观
此。凡人大病后。及妇人产后。多有此证。不可不知。
按丹田气海与肾脉相通。人于有生之初。先生命门。胞系在脐。故气海丹田。实为生气之源。十二经
之根本也。故灸而效。
有一妇人先胸胁胀痛。后四肢不收。自汗如雨。小便自遗。大便不实。口紧目 。饮食颇进。十余日。或
王安道关于中风的辨析
有人突然僵硬倒仆，或者半身不遂，或者四肢无法抬起，或者神志不清，或者死亡或者存活。世人称之为“中风”，而医方书籍也按照“中风”来治疗。我考证《黄帝内经》，其中说风邪伤人，有的表现为寒热，有的表现为热中，有的表现为寒中，有的表现为疠风，有的表现为偏枯，有的表现为风病。至于突然僵硬倒仆、神志不清、四肢无法抬起的情况，《内经》并没有专门论述，只有关于偏枯的论述罢了。等到查看《千金方》，引用岐伯的话说：中风的大法有四种，一是偏枯，二是风痱，三是风痓（抽搐痉挛），四是风痹。《金匮要略·中风篇》说：寸口脉浮而紧，紧脉主寒，浮脉主虚。寒与虚相互搏结，邪气在皮肤。浮脉表示血虚，络脉空虚，贼邪不能排出，邪气或左或右侵袭。邪气所在的一侧肌肉松弛，正气所在的一侧则拘急，正气牵引着邪气，导致口眼歪斜、肢体活动不利。邪气在络脉，肌肤麻木不仁；邪气在经脉，身体沉重难以抬举；邪气进入腑，就不识人；邪气进入脏，舌头僵硬难以说话，口吐涎沫。由此看来，知道突然僵硬倒仆、神志不清、偏枯、四肢无法抬起等证候，固然都是因风引起的。所以使用大小续命汤、西州续命汤、排风散、八风散等各种汤剂散剂来治疗。到了近代，刘河间、李东垣、朱彦修三位医家出现，他们的论述开始与前人不同。河间主张火，东垣主张气，彦修主张湿，反而将风视为虚象，这与前人截然不同。在我看来，前人的论述和这三位医家的观点，都不可以偏废。只是这三位医家将类似中风的病症，都当作中风来立论，使得后人疑惑而不能决断。殊不知，因风引起的，是真正的中风；因火、因气、因湿引起的，是类中风而不是真中风。这三位医家所论述的，自然是因为火、因为气、因为湿，而导致暴病暴死的证候，与风有什么关系呢？如《内经》所说的三阴三阳发病，导致偏枯、痿易、四肢无法抬起，也未尝一定非因风而后才这样。风、火、气、湿的区别，在望闻问切之间，难道没有辨别的方法吗？辨明是风，就依从前人的方法治疗；辨明是火、气、湿，就依从这三位医家的方法治疗。像这样，才能析理明确而用法得当。正因为把因火、因气、因湿的证候，强行引用来与风合并讨论，所以真伪不分而名实混乱。如果把因火、因气、因湿的证候区分出来，那么真中风的病机就彰明了。
王氏的论述非常精妙，但是将类中风与真中风并列讨论，没有轻重缓急的区分，也不能没有弊端。我的意思是，邪气聚集的地方，正气必定虚弱。（“间而有之”中的“间”字，应理解为五百年间的“间”）。应当专门主张虚损的理论，不必兼谈风邪。河间、东垣各自阐发了前人未曾发现的理论，极为精妙，但只有论述没有方剂，后人依据什么去遵循呢？而彦修以阴虚立论，也阐发了前人未曾发现的理论，可惜他以气血湿痰为主，而没有涉及真阴，难免给后世留下弊端。
李东垣说：有中风的，突然昏愦，不省人事，痰涎壅盛，语言謇涩等证候。这不是外来的风邪，而是本气自病。凡是人年过四十，气衰的时候，或者忧喜忿怒损伤了气的，多有这种证候。壮年时是没有的。如果形体肥盛的，偶尔也有，这也是形盛气衰才这样的。
看东垣的论述，应当以气虚为主。纵然有风邪，也是乘虚而入。《内经》说：邪气聚集的地方，正气必定虚弱。在这个时候，难道寻常的药物能通达上下吗？紧急时用三生饮一两，加人参一两，煎服就能苏醒。三生饮是行经治痰的药剂，如同斩关夺旗的将领，每服必须用人参一两许，驾驭邪气并补助真气，否则不仅无益，反而招致失败。看先哲用附子、人参（参附），其中的义理就可以明白了。如果出现遗尿、手撒、口开、鼾睡，属于不治之症，然而使用前药，多有人得救，不可不知道。
刘河间说：所谓中风瘫痪，不是因为肝木之风实盛而突然中伤，也不是外感风邪。确实是由于调养失宜，心火暴甚，肾水虚衰，不能制约，导致阴虚阳实，热气拂郁，心神昏冒，筋骨不用，而突然倒下无知觉。也有因为喜怒思悲恐五志有过极而猝然中风的。五志过极，都化为热盛。俗话说的风，是说末节而忘记了根本。
看刘氏的论述，是以风为末，以火为本。世上尊崇刘氏的人，专门认为刘氏主张火说，殊不知火有余，就是水不足。刘氏原本以补肾为本，看他的地黄饮子方剂就可以知道了。所以治疗中风，又应当以真阴虚为本。
注解说：舌暗不能说话，足废不能行走，这叫少阴气厥不至，紧急应当温补，名叫痱证。
但是阴虚有两种，有阴中之水虚，有阴中之火虚。火虚的专门以河间的地黄饮子为主；水虚的，又当以六味地黄丸为主。如果是水虚，那么辛热的药物，以及人参、附子之类的药品，都不可添加。
河间、东垣专门治疗根本而不治疗风邪，可以说是至当不易的言论。学医的人必须以阴虚阳虚为主。自从后世医书杂出，使后学疑惑不决。丹溪篡要说：有气虚，有血虚，有湿痰。左手脉不足，及左半身不遂的，以四物汤补血剂为主，加上竹沥、姜汁。右手脉不足，及右半身不遂的，以四君子补气剂为主，佐以竹沥、姜汁。如果气血两虚，且挟痰盛的，以八物汤为主，加上南星、半夏、竹沥、姜汁之类。丹溪的论述，平正通达，应该被世人广泛尊崇。但是拿着这个来治疗中风，大多无效，或者稍微延缓病情但最终必死。为什么呢？因为这是治疗气血痰的标，而不治疗气血痰的本。人有四肢，就像树有枝干一样。人的气血，荣养四肢，就像树的浆水灌溉枝叶一样。树有枝叶，必有根本；人的气血，岂无根本吗？人有半身不遂，迁延不死，就像树的根本没有完全枯萎，只是一边的枝干先萎谢。人有形容肥壮，突然倒仆，立即死亡的，就像树的根本已经断绝，其枝叶虽然滋荣，还是像枯杨生花，怎么能长久呢？忽然遇到大风就摧折了。看这个，根本的理论就明确了。然而所谓气血的根本是什么？火是阳气的根，水是阴气的根，而火与水的总根，是两肾间的动气。这是五脏六腑的本，十二经的源，呼吸的门，三焦的根，又名守邪之神。《内经》说：根于内的叫做神机，神去则机息；根于外的叫做气立，气止则化绝。现在人纵情嗜欲，导致肾气虚衰，根本先绝了。一旦内伤劳役，或者六淫七情，稍微有所触动，都能卒中。这是阴虚阳暴绝。必须用大剂量的参附，峻补其阳，继用地黄丸、十补丸之类，填实真阴。又有因为心火暴甚，肾水虚衰，又兼五志过极，导致心神昏闷，卒倒无知，手足牵掣，口眼歪斜，这是水不能荣养筋脉，导致筋急而纵。俗话说的风，乃是风淫末疾的假象，风自火出。必须用河间的地黄饮子，峻补其阴，继以人参、麦门冬、五味子之类，滋其化源。这是根阳根阴的最高理论。至于所谓的痰，凡人将死的时候，必有痰，何独中风是这样？总之痰从哪里来？痰就是水，其源头出于肾。张仲景说：气虚痰泛，用肾气丸补而逐之。看这个，凡治疗中风的人，既然用前面的法治其根本，那么痰不治而自去了。如果初起时痰涎壅盛，汤药进不去，少量用稀涎散之类，使喉咽疏通，能进汤液就停止。如果想要一定要攻尽痰，顷刻就会死亡。切记啊，切记啊。
有人问：人有半肢风的，必须以左半身属血，右半身属气，难道还有别的说法吗？回答说：未必如此。人身劈开分为阴阳水火，男子左属水，右属火；女子左属火，右属水。男子半肢风的多患左侧，女子半肢风的多患右侧。由此看来，可见以阴虚为主。又有一等人，身半以上全无恙像正常人，身半以下，软弱麻痹，小便或涩或自遗。这属于气吗？属于血吗？这也是足三阴的虚证，不可不知道。
《内经》说：胃脉沉鼓涩，胃外鼓大，心脉小坚急，都会导致偏枯。男子发于左，女子发于右。如果不哑，舌还能转动，可治，三十天起效；如果伴随哑，三年起效。年龄不满二十岁的，三年死。胃与脾为表里，阴阳异位，更实更虚，更逆更从，或从内，或从外。所以胃阳虚，则内从于脾，内从于脾，则脾之阴盛，所以胃脉沉鼓涩。涩是多血少气。胃之阳盛，则脾之阴虚，虚则不得与阳主内，反从其胃，越出于部分之外，所以胃脉鼓大于臂外。大为多气少血。心是元阳君主之宅，生血生脉，因为元阳不足，阴寒乘之，所以心脉小坚急。小是阳不足，坚急是阴寒之邪。像这样，心、胃、脾三脉，凡有其一，就是偏枯，为什么呢？因为心是天元神机开发之本，胃是谷气充大真气之标，标本相得，则胸膈间膻中气海所留宗气盈溢，分布四脏三焦，上下中外，无不周遍。如果标本相失，则不能致其气于气海，而宗气散矣。所以分布不周于经脉，则偏枯；不周于五脏则喑。就此而言，是一条纲领，可以作为后来诸言偏枯者的纲领。没有不因真气不周而生病的。
乾坤生气说：凡人有手足渐渐觉得不遂，或者臂膊及大腿手指关节麻痹不仁，或者口眼歪斜，语言謇涩，或者胸膈迷闷，吐痰相续，或者六脉弦滑而虚软无力，虽未至于倒仆，其中风晕厥的征候，可以指日而决了。必须预防。我认为预防的道理，应当节制饮食，戒除七情，远离房事，这是最重要的。如果想服药预防，必须察其脉证的虚实。如果两尺脉虚衰的，用六味地黄、八味地黄，培补肝肾。如果寸关脉虚弱的，用六君子、十全大补之类，急补脾肺。才有补益，如果用搜风顺气，及清气化痰等药，正好是招风取中，不可不知道。
岐伯说中风大法有四：一曰偏枯，谓半身不遂而痛。就像树的根本没有完全枯萎，而一边的枝干先萎谢。言语不变，神志不乱，病在分腠之间，用巨针取之，益其不足，损其有余，才可以恢复。二曰风痱，谓身无疼痛，四肢不收。就像瘫痪。瘫者坦也，筋脉弛纵，坦然而不举；痪者涣也，血气涣散而无用。神志乱得不厉害，言语微弱可知可治；厉害到不能说话，不可治。三曰风痓，谓突然不知人，咽喉堵塞，舌强不能说话，这是急中风。其征候是：发汗后身体软的生，如果汗不出，身体硬唇干的死。看鼻子，人中左右上下白者可治，一黑一赤吐沫的死。四曰风痹，谓各种痹证，类似风状。《内经》说：风寒湿三气，合而成痹。叫痛痹，筋骨掣痛；叫着痹，着而不行；叫行痹，走注疼痛；叫周痹，身疼痛。又说行痹属风，痛痹属寒，着痹属湿。如果是正气不足的证候，只补正气，不必祛邪。如果邪气有余，像痹证之类，虽然以扶正气为主，不可不少用祛邪之法，如易老天麻丸之类。
口眼歪斜
《灵枢》说足阳明之筋，其病颊筋有寒，则急引颊移口；热则筋弛，纵缓不能收，故僻。是左寒右热，则左急而右缓；右寒左热，则右急而左缓。所以偏于左者，左寒而右热；偏于右者，右寒而左热。寒不可径用辛热之剂，因为左中寒，则逼热于右；右中寒，则迫热于左，阳气不得宣行故也。
口的歪斜，灸地仓穴；眼的斜视，灸承泣穴。如果无效，应当灸人迎穴。因为气虚风入而为偏，上不得出，下不得泄，真气为风邪所陷，所以宜灸。《内经》说：陷下则灸之。
只有外中风邪的，才有歪斜等证。如果是热则生风的，不能说全部得病于窗隙之风。纵然有歪斜等证，乃是假象，也不严重。因为火胜则金衰，金衰则木盛，木盛则生风。只有润燥则风自息，不必用前面的灸法。
《素问》说：诸风掉眩支痛强直筋缩，为厥阴风木之气。自大寒至小满，风木君火二气之位。风主动，善行数变。木旺生火，风火属阳，多为兼化。且阳明燥金，主于紧敛缩劲。风木为病，反见燥金之化，由亢则害承乃制，谓己极过，则反似胜己之化。故木极似金。况且风能胜湿而为燥，风病势甚而成筋缩燥之甚也。这些证候，正所谓风淫所胜，治以清凉者也。不宜用桂枝、附子。
有人问：在这个时候，小续命汤可用吗？回答说：未必。小续命汤是张仲景《金匮要略》治疗冬月直中风寒的确切方剂，即麻黄桂枝汤的变方。其间随六经的形证，逐一加减，不可简单地按方统用其全方。如太阳无汗，于本方中倍麻黄、杏仁、防风；如有汗恶风，于本方中倍桂枝、芍药、杏仁；如阳明无汗身热不恶风，于本方中加石膏、知母、甘草；有汗身热不恶风，于本方中加葛根、桂枝、黄芩；如太阳无汗身凉，于本方中加附子、干姜、甘草；少阴经中有汗无热，于本方中加桂枝、附子、甘草。凡中风没有这四证，六经混淆，系于少阳厥阴，或肢节挛痛，或麻木不仁，每续命八两，加羌活四两，连翘六两。这是六经有余之表证，须从汗解。如果有便溺阻隔，宜三化汤，或局方麻仁丸通利之。虽然如此，邪之所凑，其气必虚，世间内伤者多，外感者间或有之，此方终不可轻用。
许学士说：气中者，因七情所伤。
《内经》说：神伤于思虑则肉脱，意伤于忧愁则肢废，魂伤于悲哀则筋挛，魄伤于喜乐则衰槁，志伤于盛怒则腰脊重，难俯仰也。又说：暴怒伤阴，暴喜伤阳。所以忧愁不已，气多厥逆，牙关紧急。如果作中风误治，杀人很多。因为中风者，身温且多痰涎；中气者，身凉而无痰涎。宜苏合香丸灌之即苏。《内经》说：无故而喑脉不至者，虽不治自已，谓气暴逆也。气复自愈。
王节斋说：饮食过伤，变为异常急暴之病，人所不识。多有饮食醉饱之后，或感风寒，或着气恼，食填太阴，胃气不行，须臾厥逆，昏迷不省。如果误作中风、中气治之，立毙。惟以阴阳淡盐汤探吐之，食出即愈。《内经》说：上部有脉，下部无脉，法当吐，不吐则死。详见《格致余论》木郁则达之条下。以上两条论述，应当与厥门互看。
有一等形体肥胖，平素善饮，忽一日舌本硬强，语言不清，口眼歪斜，痰气上涌，肢体不遂。此肥人多中，以气盛于外而歉于内也。兼之酒饮湿热之证，须用六君子加煨葛根、山栀、神曲而治之。
有一人久病滞下（痢疾），忽一日昏仆，目上视，溲注而汗泻，脉无伦次。丹溪先生说：此阴虚阳暴绝也。得之病后而酒且内（饮酒且行房事）。急治人参膏，而促灸其气海。顷之手动，又顷之唇动，参膏成三饮之而苏。后服尽数斤而愈。我看这个，凡人大病后，及妇人产后，多有此证，不可不知道。
按丹田气海与肾脉相通，人于有生之初，先生命门，胞系在脐，故气海丹田，实为生气之源，十二经之根本也。所以灸而有效。
有一妇人先胸胁胀痛，后四肢不收，自汗如雨，小便自遗，大便不实，口紧目闭，饮食颇进。十余日，或
Wang Andao's Analysis of Stroke
There are cases where individuals suddenly stiffen and fall, or suffer from hemiplegia, or find their limbs unable to move, or lose consciousness, resulting in either death or survival. The general public calls this "stroke" (Zhong Feng), and medical texts also treat it as such. Upon examining the *Huangdi Neijing* (Yellow Emperor's Inner Canon), I found that it states wind pathogenic factors injuring the human body may manifest as chills and fever, heat in the middle jiao, cold in the middle jiao, leprosy, hemiplegia, or various wind diseases. However, regarding sudden stiffening and falling, loss of consciousness, and inability to move limbs, the *Neijing* offers no specific discussion, except for a section on hemiplegia. Later, reviewing the *Qianjin Fang* (Prescriptions Worth a Thousand Gold), which quotes Qibo, it is stated that there are four major categories of stroke: first, hemiplegia; second, wind fei (flaccidity); third, wind chi (spasm); fourth, wind bi (painful obstruction). The *Jingui Yaolue* (Essential Prescriptions of the Golden Cabinet) chapter on stroke states: "The pulse at the cunkou position is floating and tight. Tightness indicates cold, while floating indicates deficiency. Cold and deficiency combine, placing the pathogen in the skin. Floating indicates blood deficiency, leaving the collaterals empty. The thief pathogen cannot be expelled. The pathogen attacks either the left or right side. The qi on the affected side becomes slack, while the healthy qi becomes tense. The healthy qi pulls the pathogen, causing deviation of the mouth and eyes and inability to move freely. If the pathogen is in the collaterals, the skin and muscles become numb. If in the meridians, the body feels heavy and difficult to lift. If entering the fu organs, consciousness is lost. If entering the zang organs, the tongue becomes stiff and speech is impaired, with saliva dribbling from the mouth." From this, we know that symptoms such as sudden stiffening and falling, loss of consciousness, hemiplegia, and limb paralysis are indeed caused by wind. Therefore, treatments such as Da Xuming Tang (Large Continuation Life Decoction), Xiao Xuming Tang (Small Continuation Life Decoction), Xizhou Xuming Tang, Paifeng San (Dispel Wind Powder), and Bafeng San were used.
In later times, Liu Wansu, Li Dongyuan, and Zhu Danxi emerged, offering theories that differed from predecessors. Liu emphasized fire, Li emphasized qi, and Zhu emphasized dampness, viewing wind as a sign of deficiency, which contrasted sharply with earlier views. In my opinion, neither the ancient theories nor those of these three masters should be discarded entirely. However, because these three masters categorized similar conditions under the umbrella of "stroke," it has caused confusion among later practitioners. It must be understood that conditions caused by wind are true stroke (Zhen Zhong Feng), whereas those caused by fire, qi stagnation, or dampness are pseudo-stroke (Lei Zhong Feng) rather than true stroke. The conditions discussed by these three masters arose from fire, qi, or dampness leading to sudden severe illness or death, having little to do with wind itself. As the *Neijing* states, disorders of the three yin and three yang meridians can cause hemiplegia, flaccidity, and limb paralysis without necessarily involving wind. The distinctions between wind, fire, qi, and dampness can certainly be discerned through observation, listening, inquiry, and palpation. If diagnosed as wind, one should follow the ancient methods; if diagnosed as fire, qi, or dampness, one should follow the methods of these three masters. This approach ensures clear reasoning and appropriate treatment. The confusion arises from forcing conditions caused by fire, qi, and dampness into the category of wind, blurring the lines between true and false stroke. Differentiating them clarifies the pathology of true stroke.
Wang's analysis is profound, but grouping pseudo-stroke and true stroke together without distinguishing severity or urgency has drawbacks. My view is that where pathogenic factors gather, qi must be deficient. One should focus primarily on deficiency theory rather than incorporating wind. Liu Wansu and Li Dongyuan made brilliant contributions by uncovering previous unknowns, yet they provided theories without formulas, leaving later generations without guidance. Zhu Danxi’s theory of yin deficiency was also innovative, but his focus on qi, blood, dampness, and phlegm, neglecting true yin, has led to limitations in subsequent practice.
Li Dongyuan stated that stroke characterized by sudden coma, unconsciousness, copious phlegm, and slurred speech is not due to external wind but is a disease of the internal qi itself. This commonly occurs in individuals over forty whose qi is declining, or those injured by emotional extremes like worry, joy, or anger. It is rare in youth. Even in obese individuals, it occurs occasionally due to excess form but deficient qi. Thus, treatment should prioritize qi deficiency. Even if wind is present, it exploits this deficiency. As the *Neijing* says, "Where pathogenic factors gather, qi is deficient." At such times, ordinary medicines cannot effectively circulate throughout the body. Urgently using Sansheng Yin (Three Lives Decoction) combined with Ren Shen (Ginseng Radix) can restore consciousness. Sansheng Yin is a potent formula for moving meridians and resolving phlegm. Ren Shen is essential to drive out pathogens and support true qi; otherwise, treatment may fail. This aligns with the wisdom of using Fu Zi (Aconite Lateral Root) and Ren Shen. Symptoms like urinary incontinence, open hands, open mouth, and snoring indicate a poor prognosis, though prior treatments have saved some lives.
Liu Wansu argued that stroke paralysis is not due to excessive liver wood wind striking suddenly, nor external wind invasion. Rather, it results from improper lifestyle, causing heart fire to flare up and kidney water to decline, failing to control the fire. This leads to yin deficiency and yang excess, with heat obstructing the spirit, causing sudden collapse and unconsciousness. Emotional extremes (joy, anger, worry, thought, fear) can also trigger stroke by generating intense heat. The common term "wind" refers to the manifestation, forgetting the root. Liu’s theory places wind as the branch and fire as the root. While followers emphasize Liu’s "fire" theory, it implies water insufficiency. Liu actually prioritized tonifying the kidneys, as seen in Dihuang Yinzi (Rehmannia Decoction). Therefore, treating stroke should prioritize true yin deficiency.
Annotations note that a dark tongue preventing speech and leg weakness indicating Shaoyin qi reversal requires urgent warming, termed Fei syndrome. Yin deficiency has two types: deficiency of water within yin and deficiency of fire within yin. For fire deficiency, Liu’s Dihuang Yinzi is primary. For water deficiency, Liuwei Dihuang Wan (Six-Ingredient Rehmannia Pill) is primary. If water is deficient, acrid-hot drugs and Ren Shen/Fu Zi are contraindicated.
Liu and Li’s focus on the root rather than wind is sound. Practitioners must prioritize yin and yang deficiency. Later eclectic texts have caused confusion. Zhu Danxi suggested treating qi/blood deficiency and damp-phlegm based on pulse and side of paralysis, using Siwu Tang (Four Substance Decoction) or Sijunzi Tang (Four Gentlemen Decoction) with bamboo juice and ginger juice. While Zhu’s approach is balanced, applying it strictly to stroke often fails or delays inevitable death because it treats the branch (qi/blood/phlegm) rather than the root. Limbs are like tree branches; qi and blood are like sap. If the root (kidneys/origin) is intact, partial paralysis may persist; if the root is severed, sudden collapse and death occur, like a withered tree blooming briefly before breaking. The root of qi and blood lies in fire (yang) and water (yin), ultimately rooted in the vital qi between the kidneys. This is the source of the twelve meridians and the gate of respiration. Modern indulgence depletes kidney qi, severing the root. Internal injury or external pathogens then trigger stroke, representing sudden yin deficiency and yang collapse. Large doses of Renshen Fuzi Tang (Ginseng and Aconite Decoction) should tonify yang, followed by Dihuang Wan to fill true yin. Similarly, if heart fire flares and kidney water declines due to emotional extremes, causing spasms and facial deviation, this is water failing to nourish tendons. The "wind" is merely a symptom of fire generating wind. Treat with Dihuang Yinzi to tonify yin, followed by Ren Shen, Maidong (Ophiopogon Rhizome), and Wuweizi (Schisandra Fruit) to nourish the source. This is the ultimate theory of rooting yin and yang. Regarding phlegm, all dying patients produce phlegm; it originates from kidney water. Zhang Zhongjing advised using Shenqi Wan (Kidney Qi Pill) for qi deficiency with floating phlegm. By treating the root, phlegm resolves naturally. Only use Xixian San (Clear Saliva Powder) initially if phlegm blocks the throat and prevents medication intake; stop once swallowing resumes. Attempting to aggressively purge phlegm can cause immediate death.
Regarding hemiplegia, some claim the left side relates to blood and the right to qi. However, the body divides into yin/yang and water/fire. Men: left is water, right is fire. Women: left is fire, right is water. Men often suffer left-sided stroke; women, right-sided. This supports the primacy of yin deficiency. Another condition involves lower body weakness and urinary issues, indicating deficiency of the three yin foot meridians.
The *Neijing* states that stomach pulses (deep, choppy, or large) and heart pulses (small, firm, rapid) can lead to hemiplegia. Men affect the left, women the right. If not aphasic, recovery is possible in 30 days; if aphasic, in 3 years. Under 20 years old, death occurs in 3 years. Stomach and spleen are interior-exterior pairs. Stomach yang deficiency leads to spleen yin excess (choppy pulse). Stomach yang excess leads to spleen yin deficiency, causing the pulse to appear large outside the arm (excess qi, deficient blood). Heart pulse small/firm/rapid indicates insufficient yuan yang and invading yin-cold. If any of these heart/stomach/spleen pulses appear, hemiplegia results because the heart is the root of spiritual mechanism, and the stomach is the source of grain qi. If root and branch mismatch, Zong Qi (Pectoral Qi) scatters, failing to distribute to meridians (hemiplegia) or organs (aphasia). True qi distribution is key.
Prevention involves diet control, emotional regulation, and sexual restraint. For prevention, assess pulse deficiency. Weak chi pulses require Liuwei Dihuang Wan or Shennian Dihuang Wan to tonify liver/kidney. Weak cun/guan pulses require Liujunzi Tang or Shiquan Dabu Tang to tonify spleen/lung. Using wind-dispelling or phlegm-clearing herbs invites pathogenic wind.
Qibo’s four stroke types: 1. Hemiplegia (paralysis with pain, mind clear): treat with large needles to balance excess/deficiency. 2. Wind Fei (paralysis without pain, limb flaccidity): mild cases treatable; severe aphasia untreatable. 3. Wind Chi (sudden unconsciousness, throat blockage, stiff tongue): acute stroke. Sweating with soft body indicates survival; no sweat with hard body/dead lips indicates death. Nasal/inion color diagnosis applies. 4. Wind Bi (painful obstruction resembling wind): caused by wind/cold/damp. Treat deficiency by tonifying qi; treat excess by dispelling pathogens (e.g., Tianma Wan).
For facial deviation (*Kou Yan Xie*), *Ling Shu* explains that cold in Yangming meridions causes pulling, while heat causes flaccidity. Left cold/right heat causes left tension/right laxity. Acupuncture points Dicang (ST4) for mouth, Chengqi (ST1) for eye, and Yingchang (LI18) if ineffective, especially for qi deficiency with sunken true qi ("Sunken conditions require moxibustion"). External wind causes deviation; internal heat generating wind does not benefit from moxibustion; moistening dryness extinguishes wind.
*Sù Wèn* states wind symptoms (tremors, dizziness, stiffness) relate to Jueyin wind-wood. Wind moves quickly; wood generates fire. Wind-fire are yang. Pathological wind may mimic Metal (dryness) due to extreme excess ("Excess harms, succession controls"). Treat wind excess with cooling methods; avoid Guizhi (Cinnamon Twig) and Fuzi.
Xiao Xuming Tang is for winter wind-cold, a variation of Mahuang Guizhi Tang. Adjust based on six stages: Taiyang (no sweat: increase Mahuang, Xingren, Fangfeng; sweat/aversion to wind: increase Guizhi, Shaoyao, Xingren); Yangming (no sweat/heat: add Shigao, Zhimu, Gancao; sweat/heat: add Gegen, Guizhi, Huangqin); Shaoyin (no heat/sweat: add Guizhi, Fuzi, Gancao). For mixed six-stage patterns with joint pain/numbness, modify with Qianghuo, Lianqiao. For constipation, use Sanhua Tang or Haren Wan. Due to high prevalence of internal deficiency, this formula should not be used lightly.
Xu Xueshi noted "Qi Stroke" caused by emotions. *Neijing* links emotions to organ damage (worry to limbs, grief to sinews, anger to waist). Sudden rage injures yin, sudden joy injures yang. Qi stroke presents with cool body and no phlegm; treat with Suhexiang Wan. Stroke presents with warm body and phlegm.
Wang Jiezhai noted food injury causing sudden coma after overeating/drinking, possibly compounded by wind/cold or anger. Food stagnation in Taiyin/Spleen blocks stomach qi. Treat with salty water emesis. Do not mistake for stroke/qi stroke.
Obese drinkers may experience sudden tongue stiffness, slurred speech, facial deviation, and phlegm rising due to internal qi deficiency and external damp-heat from alcohol. Treat with Liujunzi Tang plus Wei Gegen, Shanzhi, Shenqu.
A patient with chronic dysentery who collapsed with upward-gazing eyes, incontinence, sweating, and chaotic pulse suffered sudden yin deficiency and yang collapse due to post-illness weakness, alcohol, and sex. Treat with Renshen Gao (Ginseng Paste) and moxa on Qihai (CV6). Recovery follows. Post-illness/postpartum patients are prone to this. Qihai connects to Kidney meridian and is the source of life qi.
A woman with chest/hypochondriac pain progressing to limb flaccidity, profuse sweating, incontinence, loose stools, tight mouth, and closed eyes, eating well for ten days...