顺德府张安抚。字耘夫。年六十一岁。于己未闰十一月初。患风证。半身不遂。语言謇涩。心
神昏愦。烦躁自汗。表虚恶风。如洒冰雪。口不知味。鼻不闻香臭。闻木音则惊悸。小便频多。大
便结燥。若用大黄之类下之。却便饮食减少不敢用。不然则满闷。尽夜不得瞑目而寐。最苦。于此
约有三月余。凡三易医。病全不减。至庚申年三月初七日。又因风邪。加之痰嗽。咽干燥。疼痛不
利。唾多。中脘气痞似噎。予思内经有云。风寒伤形。忧恐忿怒伤气。气伤脏乃病。脏病形乃应。
又云。人之气以天地之疾风名之。此风气下陷入阴中。不能生发上行。则为病矣。又云。形乐志苦。
病生于脉。神先病也。邪风加之。邪入于经。动无常处。前证互相出见。治病必求其本。邪气乃覆。
论时月则宜升阳、补脾胃。泻风木。论病则宜实表里。养卫气。泻肝木。润燥益元气。慎喜怒。是
治其本也。宜以加减冲和汤治之。
【加减冲和汤】
柴胡 黄 （各五分） 升麻 当归
甘草（炙。各三分） 半夏 黄柏 黄芩
人参 陈皮 芍药（各二分）
上十一味。 咀。作一服。水二盏。煎至一盏。去渣。温服。如自汗。加黄 半钱。嗽者加五
味子二十粒。昼夜不得睡。乃因心事烦扰。心火内动。上乘阳分。卫气不得交入阴分。故使然也。
以朱砂安神丸服之。由是昼亦得睡。十日后。安抚曰。不得睡三月有余。今困睡不已。莫非他病生
否。予曰。不然卫气者。昼则行阳二十五度。夜则行阴亦二十五度。此卫气交入阴分。循其天度。
故安抚得睡也。何病之有焉。止有眼白睛红。隐涩难开。宜以当归连翘汤洗之。
【当归连翘汤】
黄连 黄柏（各五分） 连翘（四分） 当归
甘草（各三分）
上作一服。水二盏。煎至一盏。去渣。时时热洗之。十三日后。至日晡。微有闷乱不安。于前
冲和汤中。又加柴胡三分。以升少阳之气。饮三服。至十五日。全得安卧。减自汗恶寒躁热。胸膈
痞。元小便多。服药之后。小便减少。大便一二日一行。鼻闻香口。知味。饮食如常。脉微弦而柔
和。按之微有力。止有咽喉中妨闷。会厌后肿。舌赤。早晨语言快利。午后微涩。宜以玄参升麻汤
治之。
【玄参升麻汤】
升麻 黄连（各五分） 黄芩（炒。四分） 连翘
桔梗（各三分） 鼠粘子 玄参 甘草
白僵蚕（各二分） 防风（一分）
上十味。 咀。作一服。水二盏。煎至七分。去渣。稍热噙漱。时时咽之。前证良愈。止有牙
齿无力。不能嚼物。宜用牢牙散治之。
【牢牙散】
羊筒骨灰 升麻（各三钱） 生地黄 黄连
石膏（各一钱） 白茯苓 人参（各五分） 胡桐泪（三分）
上为极细末。入麝香少许。研匀。临卧擦牙后以温水漱之。安抚初病时。右肩臂膊痛无主持。
不能举动。多汗出。肌肉瘦不能正卧。卧则痛甚。经曰。汗出偏沮。使人偏枯。予思内经云。虚
与实邻。决而通之。又云。留瘦不移。节而刺之。使经络通和。血气乃复。又言陷下者灸之。为阳
气下陷入阴中。肩膊时痛。不能运动。以火导之。火引而上。补之温之。以上证皆宜灸刺。谓此
先刺十二经。之井穴。于四月十二日右肩臂上肩井穴内。先针后灸二七壮。及至疮发。于枯瘦处渐
添肌肉。汗出少。肩臂微有力。至五月初八日。再灸肩井。次于尺泽穴各灸二十八壮。引气下行。
与正气相接。次日臂膊又添气力。自能摇动矣。时值仲夏。暑热渐盛。以清肺饮子补肺气。养脾胃
。定心气。
【清肺饮子】
白芍药（五分） 人参 升麻 柴胡（各四分）
天门冬 麦门冬（去心。各三分） 陈皮（二分半） 甘草（生）
黄芩 黄柏 甘草（炙。各二分）
上十一味。 咀。作一服。水二盏。煎至一盏。去渣。温服。食后。汗多者加黄 五分。后
以润肠丸治胸膈痞闷。大便涩滞。
【润肠丸】
麻子仁（另研） 大黄（酒煨。各一两半） 桃仁泥子 当归尾
枳实（麸炒） 白芍药 升麻（各半两） 人参
生甘草 陈皮（各三钱） 木香 槟榔（各二钱）
上十二味。除麻仁、桃仁外。为末。却入二仁泥子。蜜丸桐子大。每服七八十丸、温水食前送下
。初六日得处暑节。暑犹未退。宜微收实皮毛。益卫气。秋以胃气为本。以益气调荣汤主之。本药
中加时药。使邪气不能伤也。
【益气调荣汤】
人参（三分臣） 益气和中。 当归（二分佐） 和血润燥。
陈皮（二分佐。去白） 顺气和中。 熟地黄（二分佐） 养血润燥。泻阴火。
白芍（四分臣） 补脾胃。微收。治肝木之邪。
升麻（二分使） 使阳明气上升。滋荣百脉。
黄 （五分君） 实皮毛。止自汗。益元气。半夏（泡三分佐） 疗风痰。强胃进食。
白术（二分佐） 养胃和中。浓肠胃。 甘草（炙。二分佐。引用） 调和胃气。温中益气。
柴胡（二分使） 引少阳之气。使出于胃中。乃风行于天上。
麦门冬（三分。去心。佐） 犹有暑气未退。故加之。安肺气。得秋分节不用。
上十二味 咀。作一服。水二盏。煎至一盏。去渣。温服。忌食辛热之物。反助暑邪。秋气不
能收也。正气得复而安矣。
顺德府安抚张耘夫，六十一岁。在己未年闰十一月初，患风证，表现为半身不遂、语言謇涩（言语不清）、心神昏愦（神志昏迷）、烦躁自汗、表虚恶风（体表虚弱怕风），感觉如洒冰雪般寒冷。口不知味，鼻不闻香臭，听到木音则惊悸。小便频多，大便结燥。若用大黄之类攻下，则饮食减少不敢用；否则便满闷，整夜无法入睡，最为痛苦。此症持续约三月余，更换三位医生，病情全未减轻。
至庚申年三月初七日，又因风邪侵袭，加之痰嗽，咽喉干燥、疼痛不利，唾沫多，中脘气痞似噎。我思考《内经》有云：“风寒伤形，忧恐忿怒伤气。气伤脏乃病，脏病形乃应。”又说：“人之气以天地之疾风名之。”此风气下陷入阴中，不能生发上行，则为病矣。又说：“形乐志苦，病生于脉。”神先病也。邪风加之，邪入于经，动无常处，前证互相出见。治病必求其本，邪气乃覆。论时月则宜升阳、补脾胃、泻风木；论病则宜实表里、养卫气、泻肝木、润燥益元气、慎喜怒。这是治其本。宜以加减冲和汤治疗。
【加减冲和汤】
柴胡、黄芩（各五分），升麻、当归、甘草（炙，各三分），半夏、黄柏、黄芩、人参、陈皮、芍药（各二分）。
上十一味，切碎，作一服。水二盏，煎至一盏，去渣，温服。如自汗，加黄芪半钱；咳嗽者加五味子二十粒。昼夜不得睡，乃因心事烦扰，心火内动，上乘阳分，卫气不得交入阴分，故使然也。以朱砂安神丸服之。由是昼亦得睡。十日后，安抚说：“不得睡三月有余，今困睡不已，莫非他病生否？”我说：“不然。卫气者，昼则行阳二十五度，夜则行阴亦二十五度。此卫气交入阴分，循其天度，故安抚得睡也。何病之有焉？”止有眼白睛红，隐涩难开，宜以当归连翘汤洗之。
【当归连翘汤】
黄连、黄柏（各五分），连翘（四分），当归、甘草（各三分）。
上作一服，水二盏，煎至一盏，去渣，时时热洗之。十三日后，至日晡（傍晚），微有闷乱不安。于前冲和汤中，又加柴胡三分，以升少阳之气。饮三服，至十五日，全得安卧，减自汗恶寒躁热，胸膈痞，元小便多。服药之后，小便减少，大便一二日一行，鼻闻香口，知味，饮食如常。脉微弦而柔和，按之微有力。止有咽喉中妨闷，会厌后肿，舌赤，早晨语言快利，午后微涩。宜以玄参升麻汤治之。
【玄参升麻汤】
升麻、黄连（各五分），黄芩（炒，四分），连翘、桔梗（各三分），鼠粘子、玄参、甘草、白僵蚕（各二分），防风（一分）。
上十味，切碎，作一服，水二盏，煎至七分，去渣，稍热噙漱，时时咽之。前证良愈。止有牙齿无力，不能嚼物，宜用牢牙散治之。
【牢牙散】
羊筒骨灰、升麻（各三钱），生地黄、黄连、石膏（各一钱），白茯苓、人参（各五分），胡桐泪（三分）。
上为极细末，入麝香少许，研匀。临卧擦牙后以温水漱之。
安抚初病时，右肩臂膊痛无主持，不能举动，多汗出，肌肉瘦不能正卧，卧则痛甚。经曰：“汗出偏沮，使人偏枯。”予思《内经》云：“虚与实邻，决而通之。”又云：“留瘦不移，节而刺之。”使经络通和，血气乃复。又言“陷下者灸之”。为阳气下陷入阴中，肩膊时痛，不能运动，以火导之，火引而上，补之温之。以上证皆宜灸刺。谓此先刺十二经之井穴。于四月十二日右肩臂上肩井穴内，先针后灸二七壮（十四壮）。及至疮发，于枯瘦处渐添肌肉，汗出少，肩臂微有力。至五月初八日，再灸肩井，次于尺泽穴各灸二十八壮，引气下行，与正气相接。次日臂膊又添气力，自能摇动矣。
【清肺饮子】
白芍药（五分），人参、升麻、柴胡（各四分），天门冬、麦门冬（去心，各三分），陈皮（二分半），甘草（生），黄芩、黄柏、甘草（炙，各二分）。
上十一味，切碎，作一服，水二盏，煎至一盏，去渣，温服。食后，汗多者加黄芪五分。后以润肠丸治胸膈痞闷，大便涩滞。
【润肠丸】
麻子仁（另研）、大黄（酒煨，各一两半），桃仁泥子、当归尾、枳实（麸炒）、白芍药、升麻（各半两），人参、生甘草、陈皮（各三钱），木香、槟榔（各二钱）。
上十二味，除麻仁、桃仁外，为末，却入二仁泥子，蜜丸桐子大。每服七八十丸，温水食前送下。
初六日得处暑节，暑犹未退，宜微收实皮毛，益卫气。秋以胃气为本，以益气调荣汤主之。本药中加时药，使邪气不能伤也。
【益气调荣汤】
人参（三分臣）：益气和中。当归（二分佐）：和血润燥。陈皮（二分佐，去白）：顺气和中。熟地黄（二分佐）：养血润燥，泻阴火。白芍（四分臣）：补脾胃，微收，治肝木之邪。升麻（二分使）：使阳明气上升，滋荣百脉。黄芪（五分君）：实皮毛，止自汗，益元气。半夏（泡三分佐）：疗风痰，强胃进食。白术（二分佐）：养胃和中，浓肠胃。甘草（炙，二分佐，引用）：调和胃气，温中益气。柴胡（二分使）：引少阳之气，使出于胃中，乃风行于天上。麦门冬（三分，去心，佐）：犹有暑气未退，故加之，安肺气。得秋分节不用。
上十二味，切碎，作一服，水二盏，煎至一盏，去渣，温服。忌食辛热之物，反助暑邪，秋气不能收也。正气得复而安矣。
Zhang Yunfu, Pacification Commissioner of Shunde Prefecture, aged 61. In the early days of the intercalary eleventh month of the Jiwei year, he suffered from a wind syndrome, manifesting as hemiplegia (paralysis of one side of the body), dysarthria (slurred speech), mental confusion, irritability, spontaneous sweating, and aversion to wind due to exterior deficiency, feeling as if sprinkled with ice and snow. He lost taste sensation and olfactory function; hearing the sound of wood caused palpitations and fright. Urination was frequent, and stool was dry and constipated. If purgatives such as Rhubarb were used, food intake would decrease and he dared not use them; otherwise, he experienced fullness and oppression, unable to sleep all night, which was most distressing. This condition persisted for about three months. Three physicians were changed, but the disease did not diminish at all.
On the seventh day of the third month of the Gengshen year, due to an invasion of wind pathogen, accompanied by phlegm-cough, his throat became dry, painful, and difficult to swallow, with excessive salivation and a sensation of qi stagnation in the middle jiao resembling choking. I reflected on the *Neijing* (Inner Canon), which states: "Wind and cold damage the form; worry, fear, anger, and rage damage the qi. When qi is damaged, the zang organs become diseased; when zang organs are diseased, the form responds." It also says: "The qi of humans is named after the fierce winds of heaven and earth." This wind qi sinks into the yin level and cannot ascend and generate, thus becoming pathological. It further states: "When the body is comfortable but the mind is suffering, disease arises in the vessels; the spirit is diseased first." With the addition of evil wind, the pathogen enters the meridians, moving without fixed location, causing previous symptoms to appear alternately. To treat disease, one must seek its root, so that the pathogenic factor may be reversed. Regarding the season, it is appropriate to raise yang, tonify the spleen and stomach, and drain liver wood. Regarding the disease, it is appropriate to solidify the interior and exterior, nourish defensive qi, drain liver wood, moisten dryness, benefit primordial qi, and guard against excessive joy and anger. This treats the root. It is suitable to treat with Modified Chonghe Decoction.
[Modified Chonghe Decoction]
Bupleurum Root (Chaihu) and Scutellaria Root (Huangqin) (each 5 fen), Cimicifuga Rhizome (Shengma) and Angelica Sinensis Root (Danggui), Honey-fried Licorice Root (Gancao) (each 3 fen), Pinellia Tuber (Banxia), Phellodendron Bark (Huangbai), Scutellaria Root (Huangqin), Ginseng Root (Renshen), Tangerine Peel (Chenpi), and White Peony Root (Shaoyao) (each 2 fen).
The above eleven ingredients are coarsely crushed. Prepare as one dose. Add two cups of water, decoct until one cup remains, remove dregs, and take warm. If there is spontaneous sweating, add Astragalus Root (Huangqi) 0.5 qian; if coughing, add Schisandra Berry (Wuweizi) 20 grains. Insomnia day and night is due to mental disturbance, internal movement of heart fire ascending to the yang level, preventing defensive qi from entering the yin level at night. Therefore, administer Cinnabar Anshen Pill (Zhusha Anshen Wan). Consequently, he could sleep during the day. Ten days later, the commissioner said, "I had not slept for over three months; now I am constantly sleepy. Could another disease have arisen?" I replied, "No. Defensive qi circulates through the yang twenty-five times during the day and through the yin twenty-five times at night. Here, defensive qi enters the yin level, following its natural cycle, hence the commissioner can sleep. What disease is there?" There was only redness in the whites of the eyes, with a gritty sensation and difficulty opening them. It is suitable to wash with Angelica and Forsythia Decoction (Danggui Lianqiao Tang).
[Angelica and Forsythia Decoction]
Coptis Rhizome (Huanglian) and Phellodendron Bark (Huangbai) (each 5 fen), Forsythia Fruit (Lianqiao) (4 fen), Angelica Sinensis Root (Danggui), and Licorice Root (Gancao) (each 3 fen).
Prepare as one dose. Add two cups of water, decoct until one cup remains, remove dregs, and wash frequently while hot. Thirteen days later, towards dusk, he felt slightly restless and uneasy. In the previous Chonghe Decoction, add Bupleurum Root (Chaihu) 3 fen to raise Shaoyang qi. Take three doses. By the fifteenth day, he slept peacefully, with reduced spontaneous sweating, aversion to cold, restlessness, heat, chest and diaphragm oppression, and frequent urination. After taking the medicine, urination decreased, bowel movements occurred every one or two days, smell and taste returned, and diet normalized. The pulse was slightly wiry and soft, with slight strength upon pressure. Only a sensation of obstruction in the throat, swelling behind the epiglottis, and a red tongue remained. Speech was fluent in the morning but slightly slurred in the afternoon. It is suitable to treat with Scrophularia and Cimicifuga Decoction (Xuanshen Shengma Tang).
[Scrophularia and Cimicifuga Decoction]
Cimicifuga Rhizome (Shengma) and Coptis Rhizome (Huanglian) (each 5 fen), Fried Scutellaria Root (Huangqin) (4 fen), Forsythia Fruit (Lianqiao), Platycodon Root (Jiegeng) (each 3 fen), Burdock Fruit (Niubangzi), Scrophularia Root (Xuanshen), Licorice Root (Gancao), and Silkworm (Baijiangcan) (each 2 fen), Saposhnikovia Root (Fangfeng) (1 fen).
The above ten ingredients are coarsely crushed. Prepare as one dose. Add two cups of water, decoct until seven-tenths remain, remove dregs, gargle while slightly hot, and swallow occasionally. Previous symptoms healed well. Only weakness in teeth and inability to chew remained. It is suitable to treat with Tooth-Fortifying Powder (Laoya San).
[Tooth-Fortifying Powder]
Bone ash from sheep marrow bones (Yangtongguhui) and Cimicifuga Rhizome (Shengma) (each 3 qian), Rehmannia Root (Shengdihuang), Coptis Rhizome (Huanglian), and Gypsum (Shigao) (each 1 qian), Poria (Baifuling) and Ginseng Root (Renshen) (each 5 fen), Poplar Tears (Hutonglei) (3 fen).
Grind into an extremely fine powder, add a small amount of Camphor (Shexiang), and mix evenly. Before bed, brush teeth, then rinse with warm water.
At the beginning of his illness, the commissioner suffered from pain in the right shoulder and arm without support, inability to move, excessive sweating, emaciation preventing normal lying position, and severe pain when lying down. The Classics state: "Sweating on one side leads to hemiplegia." I reflect on the *Neijing*: "Where deficiency and excess are adjacent, resolve and unblock them." It also says: "Where wasting and thinning persist without moving, puncture according to joints/segments." This makes meridians smooth and blood and qi recover. It also states: "For sinking conditions, apply moxibustion." Since yang qi sank into yin, causing shoulder and arm pain and immobility, guide it with fire. Fire draws upwards, tonifying and warming. All these conditions are suitable for moxibustion and acupuncture. First, puncture the Jing-well points of the twelve meridians. On the twelfth day of the fourth month, at the Jianjing point on the right shoulder/arm, first needle, then moxa for fourteen moxa cones (two sets of seven). As the sores appeared, muscles gradually filled in the emaciated areas, sweating decreased, and the shoulder/arm gained slight strength. On the eighth day of the fifth month, moxa Jianjing again, then moxa Chize point, twenty-eight cones each, to draw qi downward and connect with healthy qi. The next day, the arm gained more strength and could move independently.
It was mid-summer, with increasing summer heat. Use Lung-Clearing Drink (Qingfei Yinzi) to tonify lung qi, nourish spleen and stomach, and calm heart qi.
[Lung-Clearing Drink]
White Peony Root (Shaoyao) (5 fen), Ginseng Root (Renshen), Cimicifuga Rhizome (Shengma), and Bupleurum Root (Chaihu) (each 4 fen), Asparagus Fern Root (Tianmendong) and Ophiopogon Tuber (Maidong) (deveined, each 3 fen), Tangerine Peel (Chenpi) (2.5 fen), Raw Licorice Root (Gancao), Scutellaria Root (Huangqin), Phellodendron Bark (Huangbai), and Honey-fried Licorice Root (Gancao) (each 2 fen).
The above eleven ingredients are coarsely crushed. Prepare as one dose. Add two cups of water, decoct until one cup remains, remove dregs, and take warm. After meals, if sweating is excessive, add Astragalus Root (Huangqi) 5 fen. Later, use Intestine-Moistening Pills (Runchang Wan) to treat chest and diaphragm oppression and dry, obstructed bowels.
[Intestine-Moistening Pills]
Hemp Seed (Maziren) (separately ground), Wine-baked Rhubarb Radix et Rhizoma (Dahuang) (each 1.5 liang), Peach Kernel Paste (Taoren ni), Angelica Sinensis Tail (Dangguiwei), Bran-fried Immature Bitter Orange (Zhishi), White Peony Root (Shaoyao), and Cimicifuga Rhizome (Shengma) (each 0.5 liang), Ginseng Root (Renshen), Raw Licorice Root (Shenggancao), and Tangerine Peel (Chenpi) (each 3 qian), Aucklandia Root (Muxiang), and Areca Seed (Binglang) (each 2 qian).
The above twelve ingredients, excluding Hemp Seed and Peach Kernel, are ground into powder, then mixed with the two pastes. Form pills with honey, size of Chinese quince seeds. Take 70-80 pills before meals with warm water.
On the sixth day, the End of Heat solar term arrived, but summer heat had not yet receded. It is appropriate to slightly consolidate the skin and pores, benefit defensive qi. Autumn prioritizes stomach qi. Use Qi-Benefiting and Blood-Nourishing Decoction (Yiqi Tiaorong Tang) as the main treatment. Add seasonal herbs to this formula to prevent pathogenic factors from causing harm.
[Qi-Benefiting and Blood-Nourishing Decoction]
Ginseng Root (Renshen) (3 fen, Minister): Benefits qi and harmonizes the middle. Angelica Sinensis Root (Danggui) (2 fen, Assistant): Harmonizes blood and moistens dryness. Tangerine Peel (Chenpi) (2 fen, Assistant, peeled): Smooths qi and harmonizes the middle. Prepared Rehmannia Root (Shudihuang) (2 fen, Assistant): Nourishes blood and moistens dryness, drains deficient fire. White Peony Root (Shaoyao) (4 fen, Minister): Tonifies spleen and stomach, slightly astringent, treats liver wood pathogen. Cimicifuga Rhizome (Shengma) (2 fen, Envoy): Causes Yangming qi to ascend, nourishing hundred vessels. Astragalus Root (Huangqi) (5 fen, Sovereign): Solidifies skin and pores, stops spontaneous sweating, benefits primordial qi. Processed Pinellia Tuber (Banxia) (3 fen, Assistant): Treats wind-phlegm, strengthens stomach and promotes appetite. Atractylodes Macrocephala Rhizome (Baizhu) (2 fen, Assistant): Nourishes stomach and harmonizes middle, thickens intestines and stomach. Honey-fried Licorice Root (Gancao) (2 fen, Assistant, guiding): Harmonizes stomach qi, warms middle and benefits qi. Bupleurum Root (Chaihu) (2 fen, Envoy): Guides Shaoyang qi out from the stomach, like wind moving in the sky. Ophiopogon Tuber (Maidong) (3 fen, deveined, Assistant): Since summer heat has not fully receded, add it to calm lung qi. Discontinue at the Autumn Equinox.
The above twelve ingredients are coarsely crushed. Prepare as one dose. Add two cups of water, decoct until one cup remains, remove dregs, and take warm. Avoid pungent and hot foods, which would assist summer heat pathogen and prevent autumn qi from gathering. Healthy qi recovered and peace was restored.