经义
风中五脏六腑之俞，亦为脏腑之风；各入其门户所中，则为偏风。○三阳三阴发病，为偏枯痿易，四肢
不举。○汗出偏沮，使人偏枯。○偏枯、痿厥，肥贵人，高粱之疾也。○内夺而厥，则为喑痱。○胃脉沉鼓涩，胃
外鼓大，心脉小坚急，皆鬲偏枯。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。○急虚身中卒至，五脏绝闭，脉道不通，气不往来，譬于堕溺，不可为期。（《素问》）
邪之中于人也，无有常。中于阴，则溜于腑；中于阳，则溜于经。○中于面，则下阳明；中于项，则下太
阳；中于颊，则下少阳。其中于膺、背、两胁，亦中其经。○中于阴者，常从臂 始，其阴皮薄，其肉淖泽，
故俱受于风，独伤其阴。○虚邪客于身半，其入深，内居营卫，营卫稍衰，则真气去，邪气独留，发为偏枯，
其邪气浅者，脉偏痛。○痱之为病，身无痛者，四肢不收，智乱不甚，其言微知，可治；甚则不能言，不可治也。
○偏枯，身偏不用而痛，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。（《灵枢》）
哲言
夫风之为病，当半身不遂，但臂不遂者，此为痹。脉微而数，中风使然。○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。○侯氏黑散，治大风四肢
烦重，心中恶寒不足者。（《金匮》）
《内经》曰∶风者，百病之长也，至其变化，乃为他病。故有偏风、脑风、目风、漏风、首风、肠风、
泄风，又有肺风、心风、肝风、脾风、肾风、胃风、劳风等证。（《医学正传》）
风中于人，曰卒中，曰暴仆，曰暴喑，曰蒙昧，曰口眼 僻，曰手足瘫痪，曰不省人事，曰言语謇涩，
曰痰涎壅盛。（《古今医鉴》）
卒然仆倒者，《经》称为击仆，世称为卒中，乃国中之证也。口眼 斜，半身不遂，《经》称为偏枯，世
称为瘫痪及 腿风，乃中倒后之证也。舌强不言，唇吻不收，《经》称为痱病，世称为风懿，亦中倒后之证也。
（《得效方》）
《宝鉴》云∶凡人初觉大指、次指麻木不仁，或不用者，三年内有中风之疾。宜先服愈风汤、天麻丸，
此治未病之法也。薛己云∶预防之理，当养气血、节饮食、戒七情、远帏幕可也。若服前方，以为预防，适所
以招风取中也。（《证治准绳》）
自古论中风者，悉主于外感，而刘、李诸子，则主于内伤。今详此病，盖因先伤于内，而后感于外，相
兼成病者也。但有标本轻重不同耳。百病皆有因有证，因则为本，证则为标。古论中风者，言其证也；诸子论
中风者，言其因也。岂可以一证歧而为二哉？故古人所论外感风邪者，未必不由本体虚弱，营卫失调之所致；
诸子所论火盛、气虚、湿痰者，未必绝无风邪外侵之所作。若无风邪外侵，则因火、因气、因湿，各为他证，
岂有暴仆、暴喑、口服 斜、手足不遂、昏不识人之候乎？治法，外感重者，宜先祛外邪，而后补正气；内伤
重者，宜先补正气，而后祛外邪。或以风药为君，而补药为佐使；或以补药为君，而风药为佐使。全在活法，
量标本轻重而治之。（《赤水玄珠》）
风为阳邪，人身卫外之阳不固，阳邪乘阳，尤为易入。即如
偏枯不仁，要皆阳气虚馁，不能充灌所致。又如中风卒倒，其阳虚更审。设非阳虚，其人必轻矫便捷，何得卒
倒耶？仲景之谓脉微而数，微者，指阳之微也；数者，指风之炽也。所出诸脉、诸证，字字皆本阳虚为言。然
非仲景之言，乃《内经》之言也。《内经》谓∶天明则日月不明，邪害空窍。可见风性善走，空窍阳虚，则风
居空窍，渐入腑脏，此惟离照当空，群邪始得毕散。若胸中之阳不治，风必不出矣。扁鹊谓虢太子尸厥之病曰∶
上有绝阳之络，下有破阴之纽。见五络之络于头者，皆为阳络，而邪阻绝于上，其阳之根于阴，阴阳相纽之处，
而正复破散于下，故为是病。古人立言之精若此。仲景以后，医脉斩焉中断，后贤之特起者，如河间则主火为
训，是火召风入，火为本，风为标矣；东垣则主气为训，是气召风入，气为本，风为标矣；丹溪则主痰为训，
是痰召风入，痰为本，风为标矣。然一人之身，每多兼三者而有之，曷不曰阳虚邪害空窍为本，而风从外入者，
必挟身中素有之邪，或火、或气、或痰而为标耶？仲景所重在驱风之中，兼填空窍，为第一义也。空窍一实，
庶风出而不复入，其病瘳矣。古方有候氏黑散深得此意，仲景取为主方，后人目睹其方，心炫其指，讵知仲景
所为心折者，原有所本，乃遵《内经》久塞其空是良工之语耶？○中络，邪止入卫，犹在经脉之外，故但肌肤不
仁；中经，则邪入于营脉之中，骨肉皆失所养，故躯壳为之重着，然犹在躯壳之间；至入腑入脏，则离躯壳而
内入，邪中深矣。腑邪必归于胃者，胃为六腑之总司也。风入胃中，胃热必盛，蒸其津液，结为痰涎，壅塞隧
道，堵其神气出入之窍，故不识人。诸脏受邪至盛，必迸入于心，而乱其神明，神明无主，则舌纵难言，廉泉
开而流涎沫也。○风邪从外入者，必躯之使从外出。然挟虚者，非补虚则风不出；挟火者，非清热则风不出；
挟气者，非开郁则风不出；挟湿者，非导湿则风不出；挟痰者，非豁痰则风不出。河间、东垣、丹溪各举一端，
以互明其治，后学不知变通，
但宗一家为主治，倘一病兼此五者，成方果安在哉？况不治其所有，反治其所无，岂不伤人乎？○治中风，
一如治伤寒，不但邪在三阳，引入三阴，为犯大禁，即邪在太阳，引入阳明、少阳，亦为犯禁也。故风国中络，
即不可引之入经；中经，即不可引之入腑；中腑，即不可引之入脏。引邪深入，酿患无穷。（喻嘉言）
人有卒暴僵仆，或偏枯，或四肢不举，或不知人，或死，或则不死者，世以中风呼之，方书以中风治之。
余考之《内经》，则曰∶风之伤人也，或为寒热，或为寒中，或为热中，或为疠风，或为偏枯，或为风痫。其
卒暴僵仆、不知人、四肢不举者，并无所论。及观《千金方》，则引岐伯曰∶中风大法有四∶一曰偏枯，二曰
风痱，三曰风懿，四曰风痹。《金匮》中风篇云云。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、小续命诸汤散治之。及河间、东垣、丹溪出，所论始与昔人异矣。河间主乎火，
东垣主乎气，丹溪主乎湿，反以风为虚象。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
为真中风而立论，故使后人狐疑耳。殊不知因于风者，真中风也；因于火、气、湿者，类中风也。望、闻、
问、切之间，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。
（《赵氏医贯》）
中风有三∶中腑、中脏、中血脉也。中腑者，中在表也。外有六经之形证，治与伤寒同。中脏者，中在
里也。其证眩仆昏迷，痰如曳锯，治分闭、脱二证。闭证，切牙握手，治当疏通；脱证，手撒脾绝，眼合肝绝，
口张心绝，声如鼾肺绝，遗尿肾绝，治当温补。间有寒痰壅塞，介乎闭、脱之间，不便骤补者，用半夏、橘红
浓煎，以姜汁对冲，灌之即苏，然后按证调之。中血脉者，中在经络之中，口眼 斜，半身不遂，方书虽有左
右之分，然总皆血气之虚，计惟补益，不必泥也。（程钟龄）
《机要》云∶中腑宜汗，中脏宜下。此腑、脏二字，实是指
经、腑言。腑无汗法，入脏亦岂有下法？五脏者，藏精气而不泻，故满而不能实；六腑者，传化物而不藏，故
实而不能满。此脏宜补腑宜通之要旨也。考长沙三百九十七法，邪归中土，乃可议下。其少阴急下三条，指转
入阳明腑者言，仍是土郁夺之之义。如已脏真失守，而复泻之，是虚虚也。古于汗、下之法，禁例綦严，岂宜
如是之倒行逆施乎？观其论中腑曰脉浮恶风寒，则明是中经；论中脏曰大便秘结，则明是中腑。辨明正误，庶
于立言之旨有合云。（《吴医汇讲》）
风邪中人，本皆表证，考之《内经》所载诸风，皆指外邪为言，并无神魂昏愦、直视僵仆、口眼 斜、牙
紧言謇、失音烦乱、摇头吐沫、痰涎壅盛、半身不遂、瘫痪拘挛、抽搐遗尿等说。可见此等证候，原非外感风
邪，总由内伤血气也。夫风自外入者，必有表证，方可治以疏散。而今之所谓中风者，但见卒倒昏迷，无论有
无表邪，有无寒热，及有无筋骨疼痛等证，便皆谓之中风，误亦甚矣。虽《热病篇》有偏枯一证，曰∶身偏不
用而痛。此以痛痹为言，非今之所谓中风也。《阴阳别论》曰∶三阴三阳发病，为偏枯痿易，四肢不举。此以
经病为言，亦非所谓风也。继自越人、仲景，亦皆以外感言风，初未尝以非风言风也。迨至华元化所言五脏之
风，稍与《内经》不同，始有吐沫、身直、口噤、筋急、舌强不能言、手足不遂等说。然犹不甚相远。再自隋
唐以来，巢氏《病源》，孙氏《千金》，以至宋元诸家，所列风证日多日详，是风非风，始混乱莫辨，而愈失
其真矣。○风，有真风、类风，不可不辨。凡风寒之中于外者，乃为风邪，如《九宫八风篇》之风占病候，
《岁露论》之虚风实风，《金匮真言论》之四时风证，《风论》之脏腑中风，《玉机真脏论》之风痹、风瘅，
《痹论》、《贼风篇》之风邪为痹，《疟论》、《岁露论》之疟生于风，《评热病论》之风厥、劳风，《骨空
论》之大风，《热病篇》之风痉，《病能论》之酒风，是皆外感风邪之病也。其有不由外感，而亦名为
风者，如病机所云诸暴强直，皆属于风∶诸风掉眩，皆属于肝之类，是皆属风而实非外中之风也。夫既无所中，
何谓之属？此以五运之气，各有所主，如诸湿肿满，皆属于脾；诸寒收引，皆属于肾。是皆以所属为言，而风
之属于肝者，即此谓也。盖肝藏血，其主风，肝病则血病而筋失所养，筋病则掉眩强直之类无所不至。夫中风
者，真风也；属风者，木邪也。真风者，外感之表证；属风者，内伤之里证，即厥逆内夺之属也。后世不能明
辨，遂致方论混传，表里误治，千古之弊，莫此为甚。○历代相传治中风之方，皆以续命等汤为主，考其所自，
则始于《金匮要略》附方中，然必宋时校正所增，而非仲景本方也。隋唐以来，孙氏《千金》乃有小续命、大
续命、西川续命、排风等汤，后世宗之。夫续命汤以麻黄为君，姜、桂并用，本发散外邪之佳方也；至小续
命等汤，则复加黄芩以兼桂、附，虽曰相制，而水火冰炭，道本不同。其他无论，独怪乎河间、东垣、丹溪三
子者，既于中风门皆言此病非风矣，而何于本门皆首列小续命汤，而附以加减之法？何前后之言不相应耶？○非
风一证，实时人所谓中风也。此证多见卒倒昏愦，本皆内伤积损而然，原非外感所致，而古今相传，咸以中风
名之，其误甚矣。余欲易去中风二字，拟名类风，又拟名属风，然类风、属风仍与风字相近，故竟以非风名之，
庶乎使人易晓。○今人之所谓中风者，则以《内经》之厥逆悉指为风，延误至今，未有辨者。虽丹溪云今世所谓
风病，大率与痿证混治。此说固亦有之，然何不云误以厥逆为风也？惟徐东皋云痉厥类风，言若近之，殊亦未
善。使果风、厥相类，则临是证曰风可也，曰厥亦可也，疑似未决，将从风乎？从厥乎？不知《经》言风自
风，厥自厥，风之与厥，一表一里，岂得相类？后人不察《经》义，悉以厥为风而从风治，以风药而散厥证，
所散者非元气乎？因致真气愈伤，真阴愈耗，是速其死矣。若知厥非外感，与风无涉，此名之不可不正，而证
之不可不辨也。凡非风等证，其为强
直掉眩者，皆肝邪风木之化也；其为四肢不用，痰涎壅盛者，皆胃败脾虚之候也。然虽曰东方之实，又岂果肝
气之有余耶？正以肝邪之见，本由脾肾之虚。使脾胃不虚，则肝木虽强，必无乘脾之患；使肾水不虚，则肝木
得养，又何强直之虞？所谓胃气者，即二十五阳也，非独指阳明为言也；所谓肾水者，即五脏六腑之精也，非
独指少阴为言也。然则真阳败者，真脏见；真阴败者，亦真脏见。所谓真脏者，即肝邪也，即无胃气也。此即
非风、类风病之大本也。○河间曰∶此非肝木之风，亦非外中于风。东垣亦曰∶此非外来之邪，乃本气自病。
夫既皆曰非风，而又皆曰中腑、中脏，不知所中者为何物，则分明又指为风矣。夫曰将息失宜，又曰气衰所致，
本皆言其虚也，而治法皆用汗下，则分明又作实邪矣。名目混乱，泾渭不分，曰是曰非，含糊可否，致后学
【经文原义】
风邪侵入五脏六腑的背俞穴，也就成了脏腑之风；风邪顺着各经脉的门户侵入，就形成偏风。○三阳经和三阴经发病，会导致半身不遂、肢体痿废弛缓或僵硬、四肢不能抬举。○身体一侧出汗而另一侧无汗（偏沮），会使人发生半身不遂。○半身不遂、肢体痿厥，是富贵之人因饮食肥甘厚味过度而得的疾病。○体内精气被夺且发生厥逆，就会导致失音和足废不行（喑痱）。○胃脉沉取鼓指而涩滞，胃脉浮取鼓指而盛大，心脉小且坚急，这些脉象都预示膈部病变及半身不遂。男子发病在左侧，女子发病在右侧。如果不失音且舌头转动灵活，可以治疗，三十天可起效。如果伴有失音，则需要三年才能恢复。年龄不满二十岁的患者，三年内会死亡。○突然遭受极度虚损，病邪猝然侵袭身体，导致五脏功能闭塞，脉道不通，气机无法往来，这种情况就像从高处坠落或溺水一样危急，难以预测预后。（出自《素问》）
邪气侵犯人体，没有固定的规律。侵入阴分，就会流注于腑；侵入阳分，就会流注于经。○邪气中于面部，则下行至阳明经；中于项部，则下行至太阳经；中于颊部，则下行至少阳经。邪气中于胸膺、背部、两侧胁肋，也分别中于相应的经脉。○邪气中于阴经，通常从手臂开始，因为阴经部位的皮肤薄，肌肉柔润滑泽，所以虽然风邪俱受，却唯独损伤阴经。○虚邪客居身体一半，深入体内，居于营卫之中，当营卫稍微衰弱时，真气离去，邪气独留，从而发为半身不遂；邪气较浅的，表现为半身疼痛。○痱病的症状是身体无痛，四肢不能收持，神志混乱但不严重，说话还能让人听懂一部分，可以治疗；如果严重到不能说话，就无法治疗了。○偏枯的症状是身体一侧不能使用且疼痛，言语不变，神志不乱，病位在分肉腠理之间。用巨针针刺治疗，补其不足，泻其有余，才可以恢复。（出自《灵枢》）
【名家言论】
大凡风病，应当出现半身不遂，如果只是手臂不能活动，这属于痹证。脉象微而数，这是中风所致。○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，导致患侧经络松弛，健侧经络紧张，健侧牵引患侧，导致口眼歪斜、肢体不能随意运动。邪气在络脉，肌肤麻木不仁；邪气在经脉，肢体沉重无力；邪气入腑，就不认识人；邪气入脏，舌头僵硬难言，口吐涎沫。○侯氏黑散，治疗大风引起的四肢烦重、心中恶寒不足等症状。（出自《金匮要略》）
《内经》说：风是百病的先导，到了变化阶段，就成为其他疾病。所以有偏风、脑风、目风、漏风、首风、肠风、泄风，还有肺风、心风、肝风、脾风、肾风、胃风、劳风等证候。（出自《医学正传》）
风邪中人，称为卒中、暴仆、暴喑、神志蒙昧、口眼歪斜、手足瘫痪、不省人事、言语謇涩、痰涎壅盛。（出自《古今医鉴》）
突然仆倒的，《内经》称为击仆，世俗称为卒中，属于“中风”类的证候。口眼歪斜、半身不遂，《内经》称为偏枯，世俗称为瘫痪及腿风，属于中风仆倒后的证候。舌强不能言、嘴唇闭合不全，《内经》称为痱病，世俗称为风懿，也是中风仆倒后的证候。（出自《得效方》）
《宝鉴》说：凡人刚开始觉得大拇指、食指麻木不仁，或者不能活动的，三年内会有中风疾病。应该先服用愈风汤、天麻丸，这是治未病的方法。薛己说：预防的道理，应当调养气血、节制饮食、戒除七情、远离房事即可。如果服用前面的方剂作为预防，反而招致风邪入侵致病。（出自《证治准绳》）
自古以来讨论中风的，都主张外感风邪；而刘完素、李东垣等诸子，则主张内伤致病。现在详细考察此病，大概是因为先有内伤，后感外邪，内外相兼而成病。只是有标本轻重的不同罢了。百病都有病因和证候，病因是本，证候是标。古人论中风，说的是证候；诸子论中风，说的是病因。怎么能因为一个证候就将其分裂为二呢？所以古人所论述的外感风邪，未必不是由于本体虚弱、营卫失调所致；诸子所论述的火盛、气虚、湿痰，也未必完全没有风邪外侵的因素。如果没有风邪外侵，那么因火、因气、因湿，各自成为其他证候，怎么会有突然仆倒、突然失音、口眼歪斜、手足不能随意运动、昏迷不认识人的症状呢？治疗方法，外感严重的，宜先祛除外邪，而后补益正气；内伤严重的，宜先补益正气，而后祛除外邪。或者以风药为主药，补药为辅佐；或者以补药为主药，风药为辅佐。全在于灵活运用，衡量标本轻重来治疗。（出自《赤水玄珠》）
风是阳邪，人身卫外的阳气不固，阳邪乘袭阳气，尤其容易侵入。就像半身不遂、麻木不仁，都是阳气虚弱衰馁，不能充养濡润所致。又如中风突然仆倒，其阳气更虚显而易见。如果不是阳虚，此人必定轻健敏捷，怎么会突然仆倒呢？张仲景说脉微而数，微，是指阳气微弱；数，是指风邪炽盛。所列举的各种脉象、各种证候，字字都以阳虚为本而言。然而这不是仲景的话，而是《内经》的话。《内经》说：天明则日月不明，邪害空窍。可见风性善行，空窍阳气虚，则风居于空窍，逐渐进入腑脏，只有像烈日当空，群邪才能彻底消散。如果胸中之阳不治理，风邪必然不能排出。扁鹊说虢太子尸厥的病时说：上有绝阳之络，下有破阴之纽。见到头部五条络脉，都是阳络，而邪气阻绝于上，其阳根于阴，阴阳相连之处，而正气复破散于下，所以得此病。古人立言的精妙如此。张仲景之后，医脉斩断中断，后辈贤者特起，如刘河间主张火为训，是火召风入，火为本，风为标；李东垣主张气为训，是气召风入，气为本，风为标；朱丹溪主张痰为训，是痰召风入，痰为本，风为标。然而一个人的身体，往往同时兼有这三者，为什么不说是阳虚邪害空窍为本，而风从外入，必挟带体内素有的邪气，或是火、或是气、或是痰作为标呢？张仲景重在驱风的同时，兼填空窍，是第一要义。空窍充实了，风邪出去而不再进入，病就好了。古方中有候氏黑散深得此意，张仲景取其为主方，后人目睹其方，心眩其旨，哪里知道张仲景之所以心服，原本有所本，乃是遵循《内经》“久塞其空”是良工之语的原则吗？○邪气中于络，邪气只进入卫分，还在经脉之外，所以只是肌肤麻木不仁；中于经，则邪气进入营脉之中，骨肉都失去滋养，所以躯壳为之沉重着着，但还在躯壳之间；至于入腑入脏，则离开躯壳向内深入，邪气中得很深了。腑邪必归于胃，因为胃是六腑的总司。风入胃中，胃热必盛，蒸腾津液，凝结为痰涎，壅塞通道，堵塞神气出入的窍道，所以不认识人。诸脏受邪太盛，必然迸入于心，扰乱神明，神明无主，则舌头松弛难言，廉泉穴开而流涎沫。○风邪从外入，必须引导它从外出。但是挟虚的，不补虚则风出不去；挟火的，不清热则风出不去；挟气的，不开郁则风出不去；挟湿的，不导湿则风出不去；挟痰的，不豁痰则风出不去。河间、东垣、丹溪各举一端，互相阐明治法，后学不知变通，只尊奉一家作为主治，如果一个病兼有这五种情况，成方又在哪里呢？况且不治其已有的病邪，反而治疗其没有的病邪，岂不是伤害人吗？○治疗中风，如同治疗伤寒，不但邪在三阳，引入三阴，是大禁忌，就是邪在太阳，引入阳明、少阳，也是犯禁。所以风中于络，不可引之入经；中于经，不可引之入腑；中于腑，不可引之入脏。引邪深入，酿成无穷祸患。（喻嘉言）
人有突然僵仆，或者半身不遂，或者四肢不能抬举，或者不认识人，或者死亡，或者不死的情况，世人称之为中风，医书按中风治疗。我考证《内经》，说：风伤人，有的表现为寒热，有的表现为寒中，有的表现为热中，有的表现为疠风，有的表现为偏枯，有的表现为风痫。那些突然僵仆、不认识人、四肢不能抬举的，都没有论述。等到看《千金方》，引用岐伯的话说：中风大法有四：一是偏枯，二是风痱，三是风懿，四是风痹。《金匮要略》中风篇等等。由此看来，知道突然僵仆、不认识人、偏枯、四肢不能抬举等证候，确实是由风引起的，所以用大、小续命汤等方剂发散治疗。到了河间、东垣、丹溪出现，他们的论述才开始与前人不同。河间主火，东垣主气，丹溪主湿，反而把风看作虚象。在我看来，前代这三子的论述，都不可以偏废，只是三子将类似中风的病，视为真中风而立论，所以使后人狐疑。殊不知因于风的，是真中风；因于火、气、湿的，是类中风。在望、闻、问、切之间，辨明是风，就依从前人以治之；辨明是火、气、湿，就依从三子以治之。这样或许就能分析道理明确而用法得当了。（赵献可《赵氏医贯》）
中风有三种：中腑、中脏、中血脉。中腑，是在表。外在有六经的形证，治疗与伤寒相同。中脏，是在里。其症状眩晕仆倒昏迷，痰声如拉锯，治疗分为闭、脱两证。闭证，咬牙握手，治疗应当疏通；脱证，手撒肢冷脾绝，眼合肝绝，口张心绝，声如鼾肺绝，遗尿肾绝，治疗应当温补。间或有寒痰壅塞，介于闭、脱之间，不便骤补的，用半夏、橘红浓煎，以姜汁对冲，灌服即苏醒，然后按证调理。中血脉，是在经络之中，口眼歪斜，半身不遂，医书虽然有左右之分，但总归都是血气之虚，计算起来唯有补益，不必拘泥。（程钟龄）
《机要》说：中腑宜汗，中脏宜下。这里的腑、脏二字，实际上是指经、腑而言。腑没有汗法，入脏难道有下法吗？五脏，藏精气而不泻，所以满而不能实；六腑，传化物而不藏，所以实而不能满。这是脏宜补、腑宜通的要旨。考察张仲景三百九十七法，邪气归入中土，才可议下。其少阴急下三条，指的是转入阳明腑的情况，仍是土郁夺之的意思。如果已经脏真失守，而又泻之，这是虚虚之误。古人对汗、下之法，禁忌非常严格，怎么能如此倒行逆施呢？看他论中腑说脉浮恶风寒，那明显是中经；论中脏说大便秘结，那明显是中腑。辨明正误，才符合立言之旨。（《吴医汇讲》）
风邪中人，本来都是表证，考证《内经》所载诸风，都指外邪而言，并没有神魂昏愦、直视僵仆、口眼歪斜、牙关紧闭言语謇涩、失音烦乱、摇头吐沫、痰涎壅盛、半身不遂、瘫痪拘挛、抽搐遗尿等说法。可见这些证候，原本不是外感风邪，总由内伤血气所致。风自外入，必有表证，才可以治以疏散。而现在所谓的中风，只要见到突然仆倒昏迷，无论有无表邪，有无寒热，以及有无筋骨疼痛等证，便都称为中风，错误也太大了。虽然《热病篇》有偏枯一证，说：身偏不用而痛。这是以痛痹而言，不是现在所谓的中风。《阴阳别论》说：三阴三阳发病，为偏枯痿易，四肢不举。这是以经病而言，也不是所谓的风。从此以后，越人、仲景，也都以外感言风，起初未曾以非风言风。等到华元化所言五脏之风，稍与《内经》不同，开始有吐沫、身直、口噤、筋急、舌强不能言、手足不遂等说法。然而还不太远。再从隋唐以来，巢元方《病源》，孙思邈《千金》，直到宋元诸家，所列风证日益增多详尽，是风非风，开始混乱莫辨，而越来越失去其真相了。○风，有真风、类风，不可不辨。凡是风寒中于外者，才是风邪，如《九宫八风篇》的风占病候，《岁露论》的虚风实风，《金匮真言论》的四时风证，《风论》的脏腑中风，《玉机真脏论》的风痹、风瘅，《痹论》、《贼风篇》的风邪为痹，《疟论》、《岁露论》的疟生于风，《评热病论》的风厥、劳风，《骨空论》的大风，《热病篇》的风痉，《病能论》的酒风，这些都是外感风邪的病。那些不由外感，而也名为风的，如病机所说诸暴强直，皆属于风：诸风掉眩，皆属于肝之类，这些都是属风而实际不是外中的风。既然没有中，为什么叫属？这是以五运之气，各有所主，如诸湿肿满，皆属于脾；诸寒收引，皆属于肾。这都是以所属而言，而风之属于肝者，就是这个意思。盖肝藏血，其主风，肝病则血病而筋失所养，筋病则掉眩强直之类无所不至。夫中风者，真风也；属风者，木邪也。真风者，外感之表证；属风者，内伤之里证，即厥逆内夺之类。后世不能明辨，遂致方论混传，表里误治，千古之弊，没有比这个更严重的了。○历代相传治中风的方，都以续命等汤为主，考证其来源，则始于《金匮要略》附方中，然而必是宋时校正所增，而非仲景本方。隋唐以来，孙氏《千金》乃有小续命、大续命、西川续命、排风等汤，后世宗之。夫续命汤以麻黄为君，姜、桂并用，本是发散外邪的好方；至小续命等汤，则又加黄芩以兼桂、附，虽说相互制约，而水火冰炭，道理本不同。其他不论，独怪乎河间、东垣、丹溪三子，既于中风门都说此病非风了，为何在本门都首列小续命汤，而附以加减之法？为何前后之言不相应呢？○非风一证，实时人所谓中风也。此证多见卒倒昏愦，本皆内伤积损而然，原非外感所致，而古今相传，咸以中风名之，其误甚矣。我想去掉中风二字，拟名类风，又拟名属风，然而类风、属风仍与风字相近，所以竟以非风名之，或许能使人容易明白。○今人之所谓中风者，则以《内经》之厥逆悉指为风，延误至今，未有辨者。虽然丹溪云今世所谓风病，大率与痿证混治。此说固然也有，然而何不云误以厥逆为风也？只有徐东皋云痉厥类风，言若近之，殊亦未善。如果果真是风、厥相类，则临是证曰风可也，曰厥亦可也，疑似未决，将从风乎？从厥乎？不知道《经》言风自风，厥自厥，风之与厥，一表一里，岂得相类？后人不察《经》义，悉以厥为风而从风治，以风药而散厥证，所散的难道是元气吗？因而导致真气愈伤，真阴愈耗，这是加速其死亡了。如果知道厥非外感，与风无涉，这个名字不可不正，而这个证候不可不辨啊。凡非风等证，其为强直掉眩者，都是肝邪风木的化生；其为四肢不用，痰涎壅盛者，都是胃败脾虚的征候。然而虽说是东方之实，又难道是肝气之有余吗？正是因为肝邪之见，本由脾肾之虚。使脾胃不虚，则肝木虽强，必无乘脾之患；使肾水不虚，则肝木得养，又何强直之虞？所谓胃气者，即二十五阳也，不仅指阳明而言；所谓肾水者，即五脏六腑之精也，不仅指少阴而言。然而真阳败者，真脏见；真阴败者，也真脏见。所谓真脏者，即肝邪也，即无胃气也。这就是非风、类风病的根本所在。○河间说：此非肝木之风，亦非外中于风。东垣也说：此非外来之邪，乃本气自病。既然都说非风，而又都说中腑、中脏，不知道中所中的是什么东西，则分明又指为风了。夫曰将息失宜，又说气衰所致，本来都是言其虚，而治法都用汗下，则分明又作实邪了。名目混乱，泾渭不分，说是与非，含糊可否，致使后学……
[Scriptural Meaning]
When wind pathogen invades the back-shu points of the zang and fu organs, it becomes the wind of the zang and fu organs; entering through their respective gateways, it forms Pi Feng (Pi Wind, hemiplegic wind). ○ When the three yang meridians and three yin meridians are affected, it leads to Pian Ku (Pian Paralysis, hemiplegia), Wei Yi (Wei Flaccidity with stiffness or laxity), and inability to lift the four limbs. ○ If sweating occurs on only one side of the body (Pian Ju), it causes hemiplegia. ○ Pian Ku (hemiplegia) and Wei Jue (flaccidity and coldness of limbs) are diseases of wealthy and obese individuals caused by excessive consumption of rich and sweet foods. ○ When internal essence is depleted and jue (cold extremities/fainting) occurs, it results in Yin Fei (aphasia and foot paralysis). ○ If the Stomach pulse is deep, forceful yet choppy when pressed, and forceful and large when lightly touched, and the Heart pulse is small, firm, and rapid, these indicate Ge Pian Ku (obstruction leading to hemiplegia). In men, onset is on the left; in women, on the right. If there is no aphasia and the tongue moves freely, it is treatable, and recovery may begin within thirty days. If accompanied by aphasia, recovery takes three years. For those under twenty years old, death occurs within three years. ○ Sudden severe deficiency with abrupt pathogenic invasion causes closure of the five zang organs, blockage of the vessel pathways, and cessation of qi circulation, resembling a fall from height or drowning, making prognosis difficult. (From *Su Wen*)
Pathogens invading humans have no fixed pattern. Invading the yin, they flow into the fu organs; invading the yang, they flow into the meridians. ○ Invasion on the face descends to the Yangming meridian; on the nape to the Taiyang meridian; on the cheek to the Shaoyang meridian. Invasion on the chest, back, or flanks also affects their respective meridians. ○ Invasion of the yin often starts from the arms because the skin is thin and muscles are soft and moist; thus, although wind affects both, it uniquely damages the yin. ○ Deficient pathogens lodging in half the body penetrate deeply, residing in Ying and Wei. As Ying and Wei decline, true qi departs, leaving pathogenic qi alone, causing Pian Ku (hemiplegia); if the pathogen is shallow, it causes unilateral pain. ○ The disease Fei (apoplexy with limb paralysis) presents with no body pain, inability to control limbs, mild mental confusion, and partially intelligible speech, which is treatable; if severe speech loss occurs, it is untreatable. ○ Pian Ku (hemiplegia) presents with unilateral immobility and pain, unchanged speech, and clear mind, indicating the disease is in the interstices of flesh and skin. Treatment with large needles tonifies deficiency and drains excess, allowing recovery. (From *Ling Shu*)
[Expert Opinions]
Generally, wind disease manifests as hemiplegia; if only the arm is immobile, it is Bi syndrome (impediment). A pulse that is faint and rapid indicates Zhong Feng (wind stroke). ○ An inch-position pulse that is floating and tight: tight indicates cold, floating indicates deficiency. Cold and deficiency combine, placing the pathogen in the skin. Floating indicates blood deficiency. Empty collateral vessels fail to expel the thief pathogen; whether on the left or right, the pathogenic side becomes slack while the healthy side becomes tense, pulling the face to the unaffected side, causing deviation and immobility. Pathogen in collaterals causes insensitivity of skin and muscle; in meridians, heaviness and weakness; in fu organs, loss of recognition; in zang organs, difficulty speaking and drooling. ○ Hou Shi Hei San treats Da Feng (severe wind) causing heavy limbs and inner cold/insufficiency. (From *Jin Gui Yao Lue*)
*Nei Jing* states: Wind is the chief of all diseases; its transformations lead to other illnesses. Thus, there are Pian Feng, Nao Feng, Mu Feng, Lou Feng, Shou Feng, Chang Feng, Xie Feng, as well as Lung, Heart, Liver, Spleen, Kidney, Stomach, and Lao Feng syndromes. (From *Yi Xue Zheng Chuan*)
Wind invading the human body is called Cu Zhong (sudden apoplexy), Bao Pu (sudden collapse), Bao Yin (sudden aphonia), Meng Mei (mental clouding), Kou Yan Pian Pi (deviation of mouth and eye), Shou Zu Tan Huan (limb paralysis), Bu Xing Ren Shi (loss of consciousness), Yan Yu Jian Se (slurred speech), and Tan Xian Yong Sheng (profuse phlegm-saliva). (From *Gu Jin Yi Jian*)
Sudden collapse is called Ji Pu in classics and Cu Zhong in common parlance, belonging to "Zhong Feng" syndromes. Deviation of mouth and eye, hemiplegia are called Pian Ku in classics and Tan Huan or Tui Feng commonly, being post-collapse syndromes. Tongue stiffness with inability to speak and lip relaxation are called Fei Bing in classics and Feng Yi commonly, also post-collapse syndromes. (From *De Xiao Fang*)
*Bao Jian* states: If one initially feels numbness or immobility in the thumb and index finger, wind stroke will occur within three years. One should take Yu Feng Tang or Tian Ma Wan first; this is preventive treatment. Xue Ji said: Prevention involves nourishing qi and blood, moderating diet, regulating emotions, and avoiding sexual indulgence. Taking previous formulas for prevention merely invites wind pathogen. (From *Zheng Zhi Zhun Sheng*)
Historically, discussions on Zhong Feng emphasized external contraction, while Liu, Li, and others emphasized internal injury. Detailed analysis shows this disease arises from prior internal injury followed by external contraction, combining to form illness, differing only in root and branch severity. All diseases have causes (root) and manifestations (branch). Ancients discussed manifestations; later scholars discussed causes. How can one manifestation be split? Ancient external wind theories likely stem from constitutional weakness and disharmony of Ying-Wei; later theories on fire, qi deficiency, and damp-phlegm likely involve external wind invasion. Without external wind, fire, qi, or damp would form other syndromes, not sudden collapse, aphonia, deviation, or coma. Treatment: if external contraction is severe, dispel pathogen first, then tonify qi; if internal injury is severe, tonify qi first, then dispel pathogen. Use wind-dispersing herbs as sovereign or minister depending on flexibility and balance. (From *Chi Shui Xuan Zhu*)
Wind is a yang pathogen. If defensive yang is insecure, yang pathogens easily invade. Hemiplegia and insensitivity result from deficient yang failing to nourish. Sudden collapse indicates even greater yang deficiency; otherwise, the person would be agile. Zhang Zhongjing’s “faint and rapid pulse”: faint refers to weak yang; rapid refers to blazing wind. All pulses and symptoms described originate from yang deficiency. This aligns with *Nei Jing*: “When heaven is bright, sun and moon are obscured; pathogens harm empty cavities.” Wind travels easily; empty cavities with deficient yang harbor wind, which gradually enters fu and zang. Only with strong yang (like the sun) can pathogens disperse. If chest yang is not treated, wind remains. Bian Que described Guo Crown Prince’s Shi Jue (corpse-like trance): “Upper绝 yang collaterals, lower broken yin knots.” Head collaterals are yang; pathogen blocks above, breaking the link between yin-rooted yang and yin below, causing disease. Ancient wisdom is profound. After Zhang Zhongjing, medical lineage broke. Later experts like Liu Hejian emphasized fire (fire summons wind, fire is root, wind is branch); Li Dongyuan emphasized qi (qi summons wind, qi is root, wind is branch); Zhu Danxi emphasized phlegm (phlegm summons wind, phlegm is root, wind is branch). However, bodies often have all three. Why not say yang deficiency and pathogen harming empty cavities is root, while external wind carrying internal fire, qi, or phlegm is branch? Zhang Zhongjing prioritized filling empty cavities while dispersing wind. Once cavities are filled, wind exits and does not return, curing the disease. Hou Shi Hei San embodies this; Zhang Zhongjing used it as main formula. Later scholars missed its intent, not realizing it follows *Nei Jing*’s principle of “plugging empty cavities.” ○ Pathogen in Luo (collaterals) stays in Wei, outside meridians, causing only insensitivity. In Jing (meridians), it enters Ying vessels, depriving bones and muscles, causing heaviness, but still within the body shell. Entering Fu and Zang means penetrating deep inside. Fu pathogens return to Stomach (master of fu organs). Wind in Stomach generates heat, steams fluids into phlegm-saliva, blocking channels and spirit gates, causing unconsciousness. Excessive pathogen in other zang organs rushes to Heart, disturbing Shen (spirit), causing tongue relaxation, speech difficulty, and drooling. ○ External wind must be guided out. With deficiency, tonify to expel wind; with fire, clear heat; with qi stagnation, open depression; with damp, drain damp; with phlegm, resolve phlegm. Hejian, Dongyuan, and Danxi each highlighted one aspect. Later students rigidly follow one school, ignoring combined patterns. Treating non-existent conditions harms patients. ○ Treating Zhong Feng is like treating Shang Han (cold damage). Inviting pathogen from Yang to Yin meridians is forbidden; even moving from Taiyang to Yangming/Shaoyang is risky. Do not invite pathogen from Luo to Jing, Jing to Fu, or Fu to Zang. Deepening pathogen causes endless trouble. (Yu Jiayan)
People suddenly stiff/collapsed, hemiplegic, limb-paralyzed, unconscious, dead, or alive are called Zhong Feng by world, treated as such in books. I checked *Nei Jing*: wind causes cold/heat, cold-middle, heat-middle, leprosy, Pian Ku, Feng Xian. It does not mention sudden collapse/unconsciousness/limb paralysis. *Qian Jin Fang* cites Qibo: Four methods of Zhong Feng: 1. Pian Ku, 2. Feng Fei, 3. Feng Yi, 4. Feng Bi. *Jin Gui* mentions Zhong Feng chapters. Thus, sudden collapse etc. are wind-induced, treated with Da/Xiao Xu Ming Tangs. Hejian, Dongyuan, Danxi differed: Hejian focused on fire, Dongyuan on qi, Danxi on damp, viewing wind as deficiency. I believe all three are valid but confused similar syndromes with true Zhong Feng. True Zhong Feng is wind-induced; Lei Zhong Feng (simulated wind) is fire/qi/damp-induced. Differentiate via observation, listening/smelling, inquiry, palpation. If wind, treat per ancients; if fire/qi/damp, treat per three masters. This clarifies theory and application. (Zhao Xuke)
Zhong Feng has three types: Zhong Fu (invading Fu), Zhong Zang (invading Zang), Zhong Xue Mai (invading Blood Vessels). Zhong Fu is exterior, with six-meridian signs, treated like Shang Han. Zhong Zang is interior, with dizziness/collapse/coma and sawing breath sounds, divided into Bi (closed) and Tuo (collapsed) syndromes. Bi: clenched teeth/hands, treat with unblocking. Tuo: limp hands/liver failure, closed eyes/liver failure, open mouth/heart failure, snoring/lung failure, incontinence/kidney failure, treat with warming/tonifying. Intermediate cold-phlegm blocking between Bi/Tuo requires Ban Xia and Ju Hong decoction with ginger juice to wake patient, then adjust. Zhong Xue Mai is in meridians, with facial deviation and hemiplegia; though left/right distinctions exist, it is fundamentally qi/blood deficiency, requiring tonification without rigidity. (Cheng Zhongling)
*Ji Yao* says: Zhong Fu needs sweating, Zhong Zang needs purging. But “Fu/Zang” here refers to meridians/fu. Fu has no sweating method; Zang has no purging method. Zang stores essence (full but not solid); Fu transmits substances (solid but not full). This is the key: Zang needs tonification, Fu needs unblocking. Zhang Zhongjing’s 397 methods allow purging only when pathogen reaches central earth (Stomach/Intestines). Shaoyin urgent purging refers to transformation into Yangming Fu, following “earth stagnation requires seizure.” If Zhen Qi is lost, purging causes double deficiency. Ancient prohibitions on sweating/purging were strict; reversing them is disastrous. His description of Zhong Fu (floating pulse, aversion to wind) implies Jing invasion; Zhong Zang (constipation) implies Fu invasion. Clarifying errors aligns with original intent. (*Wu Yi Hui Jiang*)
Wind invading humans is originally exterior syndrome. *Nei Jing*’s winds refer to external pathogens, lacking descriptions of mental confusion, staring, collapse, facial deviation, locked jaw, aphonia, restlessness, head shaking, foaming, phlegm obstruction, hemiplegia, spasms, or incontinence. These are internal blood/qi injuries, not external wind. External wind requires exterior signs for dispersing treatment. Modern “Zhong Feng” diagnoses sudden collapse/coma regardless of exterior signs, cold/heat, or pain, which is erroneous. *Re Bing* chapter mentions Pian Ku (“body unusable and painful”) referring to Bi pain, not modern Zhong Feng. *Yin Yang Bie Lun* mentions Pian Ku due to meridian disease, not wind. Yue Ren and Zhang Zhongjing also viewed wind as external. Hua Yuanhua’s “five zang winds” introduced foaming, stiffness, locked jaw, tendon tension, tongue stiffness, limb paralysis, closer to reality. Since Sui/Tang, Chao Yuanfang’s *Bing Yuan*, Sun Simiao’s *Qian Jin*, and Song/Yuan families expanded wind syndromes, confusing true vs. simulated wind, losing truth. ○ Distinguish Zhen Feng (true wind) and Lei Feng (simulated wind). External cold/wind is Zhen Feng (e.g., *Jiu Gong Ba Feng*, *Sui Lu*, *Jin Gui Zhen Yan Lun*, *Feng Lun*, *Yu Ji Zhen Zang Lun*, *Bi Lun*, *Zei Feng Pian*, *Nue Lun*, *Ping Re Bing Lun*, *Gu Kong Lun*, *Re Bing Pian*, *Bing Neng Lun*). Non-external winds named “wind” include “all sudden stiffness belongs to wind,” “all wind tremors/dizziness belong to liver.” These are “belonging to wind” (internal wood pathology), not external invasion. “Belonging” refers to Five Movements/Qi associations (e.g., damp/spleen, cold/kidney). Liver stores blood, governs wind; liver disease affects blood/tendons, causing tremors/stiffness. Zhong Feng is Zhen Feng (exterior); Shu Feng is Mu Xie (interior/yue-ni). Later confusion led to mixed prescriptions and misdiagnosis of interior/exterior, a major historical error. ○ Past Zhong Feng formulas relied on Xu Ming Tangs, originating from *Jin Gui* appendices (Song additions, not Zhang Zhongjing’s originals). Sui/Tang *Qian Jin* had Xiao/Da Xu Ming, Xi Chuan Xu Ming, Pai Feng tangs. Xu Ming Tang uses Ephedra as sovereign, Ginger/Cinnamon for dispersing external pathogen. Xiao Xu Ming adds Scutellaria to Cinnamon/Aconite; water/fire clash. Hejian, Dongyuan, Danxi claimed “this disease is not wind” yet listed Xiao Xu Ming Tang first in their chapters—contradictory. ○ “Fei Feng” (Non-Wind) is modern Zhong Feng. Sudden collapse/coma stems from internal depletion, not external wind. Naming it Zhong Feng is erroneous. I propose “Lei Feng” or “Shu Feng,” but chose “Fei Feng” for clarity. ○ Modern Zhong Feng confuses *Nei Jing*’s Jue Ni (jue) with wind, delaying correction. Danxi noted wind disease mixed with Wei syndrome (flaccidity), but failed to identify the error of calling jue “wind.” Xu Donggao said “spasm/jue resembles wind,” but unclear. If wind/jue are similar, diagnosis is ambiguous. *Jing* states wind and jue are distinct (exterior vs. interior). Later students mistook jue for wind, using wind-dispersing herbs for jue, depleting yuan qi and yin, accelerating death. Knowing jue is not external wind, we must correct names and differentiate syndromes. Fei Feng syndromes with stiffness/tremors are Liver Wood pathology; limb paralysis/phlegm are Stomach/Spleen failure. Though seemingly Liver excess, it stems from Spleen/Kidney deficiency. If Spleen/Stomach strong, Liver cannot overact; if Kidney water sufficient, Liver nourished, no stiffness. “Stomach qi” refers to twenty-five yangs (not just Yangming); “Kidney water” refers to essence of all zang-fu (not just Shaoyin). True yang failure shows Zhen Zang pulse; true yin failure shows Zhen Zang pulse. Zhen Zang is Liver pathogen and lack of Stomach qi—the root of Fei Feng/Lei Feng. ○ Hejian: “Not Liver wind, not external wind.” Dongyuan: “Not external pathogen, self-disease of original qi.” Both say “not wind” yet discuss “Zhong Fu/Zang,” implying wind. They cite poor regimen/qi decline (deficiency) but use sweating/purging (excess treatment). Confusion of terms and treatments harms students…