唐书载许允宗初仕陈。为新蔡王外兵参军。时柳太后感风不能言。脉沉而口噤。允宗曰
口不下药。宜以汤气蒸之。令药入腠理。周时可瘥。遂造黄 防风汤。煮数十斛。置床下
气如烟雾。熏蒸之而得语。遂超拜义兴太守。
震按书称允宗医术若神。曾曰医者意也。在人思虑。即此条思虑巧矣。然仅可治真中风
内经所谓其有邪者渍形以为汗也。邪从汗解故得语。若概试诸不能言者决无效。又按罗谦
甫治史太尉。冬月坐火炉左侧。觉面热。左颊微汗。旋出外。因左颊疏缓。被风寒客之。右
颊急。口 于右。脉浮紧。按之洪缓。罗用升麻汤加桂枝、白芷、艽、防。兼灸地仓颊
车穴。此治风中阳明经之表证也。赵僧判半身不遂。语言不出。神昏面红。耳聋鼻塞。六脉
弦数。罗谓中藏者多滞九窍。中府者多着四肢。今脏腑俱受邪。先用三化汤行之。通其壅滞
使清气上升。充实四肢。次与至宝丹。安心养神。通利九窍。五日。音声出。语言稍利。
惟行步艰难。又刺十二经之井穴以接经络。随四时脉症加减用药。百日方愈。此治中腑兼中
脏之里证也。皆风邪实证也。张安抚半身不遂。语言謇涩。自汗恶风。痰嗽不寐。罗谓风寒
伤形。忧恐忿怒伤气。经云。形乐志苦。病生于脉。神先病也。邪风加之。动无常处。治病
必求其本。邪气乃服。用加减冲和汤。汗加黄 。嗽加五味。其昼夜不睡。因心事烦冗。心
火上乘阳分。卫气不得入于阴。用朱砂安神丸。遂得寐。诸证渐减。惟右肩臂痛。经云。虚
与实邻。决而通之。又云。下陷者灸之。为阳气下陷入阴中。故肩膊痛不能动。宜以火导之
补之。乃于右肩臂上肩井穴。先针后灸。隔一月。再灸肩井。次于尺泽穴。各灸二十八壮。
引气下行。与正气相接。遂能运动。仲夏用清肺饮子。秋分用益气调营汤。全愈。此治中经
兼中腑。本虚标实之症也。许允宗所治亦系本虚标实者。但病起于暴。故用蒸法。亦如通关
散之取嚏。稀涎散之探痰也。
丹溪治浦江郑君。年近六旬。奉养膏粱。仲夏久患滞下。又犯房劳。一夕如厕。忽然昏
仆。撒手。遗尿。目上视。汗大出。喉如拽锯。呼吸甚微。其脉大而无伦次部位。可畏之甚
此阴虚而阳暴绝也。急令煎人参膏。且与灸气海穴。艾壮如小指。至十八壮。右手能动。
又三壮。唇微动。参膏成。与一盏。至半夜后。尽三盏。眼能动。尽二斤。方能言而索粥。
尽五斤而利止。十数斤全安。
震按此种病。今常有之。医所用参不过一二钱。至一二两而止。亦并不知有灸法。无效
则诿之天命。岂能于数日间用参膏至十余斤者乎。然参膏至十余斤。办之亦难矣。惟能办者
不可不知有此法。
赵以德云。余尝治陈学士敬初。因醮事跪拜间。就倒仆。汗如雨。诊之脉大而空虚。年
当五十。新娶少妇。今又从跪拜之劳役。故阳气暴散。正若丹溪治郑义士之病同。急煎独参
浓汤。连饮半日。汗止。神气稍定。手足俱纵。喑而无声。遂于独参汤中加竹沥。开上涌之
痰。次早悲哭。一日不已。以言慰之。遂笑。复笑五七日。无已时。此哭笑者。为阴虚而劳
火动其精神魂魄之藏。气相并故耳。正内经所谓五精相并者。心火并于肺则喜。肺火并于
肝则悲是也。加连柏之属泻其火。更增荆沥开其闭。八日笑止手动。一月能步矣。
震按此条与前条大同小异。而所以治其小异处。立言用药。绰有精义。可见古人善能模
仿成法又不蹈袭成法也。
以上所选实症虚症。分途异治。误用则死。李士材所谓治中风者。必须分别闭与脱。二
症明白。此下手第一要着。
丹溪治一妇人。年六十余。手足左瘫。不言而健。有痰。以麻黄。羌活、荆、防、南星
全蝎、乳香、没药、木通、茯苓、桔、朴、甘草、红花为末。酒下。未效。时春。脉伏而
微。又以淡盐汤入韭汁。每早一碗吐之。至五日。仍以茯苓、白术、陈皮、甘草、浓朴、菖
蒲。日进二服。又以川芎、豆豉、山栀、瓜蒂、韭汁、盐汤。吐甚快。后以四君子汤服之。
另以川归、酒芩、红花、木通、浓朴、粘子、苍术、南星、牛膝、茯苓为末。酒糊丸服。十
日后。微汗。手足微动而言。
震按前条脱症。脉大无伦。此条闭症。脉伏而微。非有确见。敢用此两路重药乎。须知
症与脉宜合参。如此条左瘫不言矣。而健又有痰。其得间在此。与浦江洪宅妇病疟无脉条相似。
又按丹溪治肥人中风。口 。手足麻废。左右俱作痰治。以蒌、贝、南星、橘、夏、二
术、芩、连、柏、荆、防、羌活、桂枝、威灵仙、甘草、花粉等。好吃面。加附子煎。入竹
沥、姜汁。更加少酒行经。此大法也。故治中风二十六案。用此加减者甚多。其余以四君、
六君。或合四物。或再加连、柏、 、防、天麻、僵蚕、竹沥等。或合风药。更有加全蝎、
地龙者。又有用小续命汤、搜风汤、羌活愈风汤、乌药顺气散、苏合香丸者。皆不载脉象若
何。何以效法。故不并录。
虞恒德治一妇年五十七。身肥白。春初得中风。暴仆不知人事。身僵直。口噤不语。喉
如拽锯。水饮不能入。六脉浮大弦滑。右甚于左。以藜芦末一钱。加麝香少许。灌入鼻窍。
吐痰升许。始知人事。身体略能举动。急煎小续命汤倍麻黄。连进二服。覆以衣被。得汗渐
苏醒。能转侧。但右手足不遂。语言謇涩。复以二陈汤加芎、归、芍药、羌、防等。合竹沥
姜汁。日进二三服。若三四日大便不利。则不能言语。即以东垣导滞丸。或润肠丸微利之
则言语复正。如此调理。至六十余。得他病而卒。
震按此条与上丹溪案。俱以实邪治而效。可见辨证宜真。不得专守景岳非风之论。先有
成见在胸也。如薛立斋善于用补。而治艾郭武牙关紧。不能言。左体瘫。口眼牵动。神昏欲
绝。六脉沉细而涩。谓此中寒湿。非中风也。亦用吐痰药及至宝丹。继以五积散加木香、南
星、附子而人苏。后大便洞利痰积而全愈。临斯证者。治虚寒。治风痰。固宜对勘。
薛立斋治一人。年六十余。素善饮酒。两臂作痛。服祛风治痿之药。更加麻木发热。体
软痰涌。腿膝拘痛。口噤语涩。头目晕重。口角流涎。身如虫行。痒起白屑。立斋曰。臂麻
体软。脾无用也。痰涎自出。脾不能摄也。口斜语涩。脾气伤也。头目晕重。脾气不能升也
痒起白屑。脾气不能荣也。遂用补中益气汤加神曲、半夏、茯苓。三十余剂。诸症悉退。
又用参术膏而愈。
一妇人怀抱郁结。筋挛骨痛。喉间似有一核。服乌药顺气散等药。口眼 斜。臂难伸举
痰涎愈甚。内热晡热。食少体倦。立斋云。郁火伤脾。血燥生风所致。用加味归脾汤。二
十余剂。形体渐健。饮食渐加。又服加味逍遥散十余剂。痰热少退。喉核少利。更用升阳益
胃汤数剂。诸证渐愈。但臂不能伸。此肝经血少。用地黄丸而愈。
秀才刘允功。形体魁伟。不慎酒色。因劳怒头晕仆地。痰涎上涌。手足麻痹。口干引饮
六脉洪数而虚。薛以为肾经亏损。不能纳气归源而头晕。不能摄水归源而为痰。阳气虚
热而麻痹。虚火上炎而作渴。用补中益气合六味丸。治之而愈。其后或劳役。或入房。其病
即作。用前药随愈。
宪幕顾斐斋左半身并手不遂。汗出神昏。痰涎上涌。王竹西用参 大补之剂。汗止而神
思渐清。颇能步履。后不守禁。左腿自膝至足肿胀甚大。重坠如石。痛不能忍。其痰甚多。
肝脾肾脉洪大而数。重按则软涩。立斋朝用补中益气汤加黄柏、知母、麦冬、五味。煎送地
黄丸。晚用地黄丸料加知、柏。数剂诸证悉退。但自弛禁。不能全愈耳。
震按此四案。理精法密。学人所当熟玩。
车驾王用之。卒中昏愦。口眼 斜。痰气上涌。咽喉有声。六脉沉伏。此真气虚而风邪
所乘。以三生饮一两。加人参一两。煎服即苏。立斋曰。若遗尿撒手。口开鼾睡为不治。
用前药亦有得生者。夫前饮乃行经络治寒痰之药。有斩关夺旗之功。每服必用人参两许。驾
驭其邪而补助真气。否则不惟无益。适足以取败矣。
震按此治中寒寒痰壅塞气道之药。肥人脉沉伏。无火象者。可用之。若脉微细者。必加
人参。实非中风药也。折肱漫录云。三生饮施于中风之寒症。妙矣。或有虚火冲逆。热痰壅
塞。以致昏愦颠仆者。状类中风。恐乌附非所宜服。立斋治王进士失于调养。忽然昏愦。谓
是元气虚。火妄发。挟痰而作。急灌童便。神思渐爽。更用参、 各五钱。芎、归各三钱。元
参、柴胡、山栀、炙草各一钱。服之少定。察其形倦甚。又以十全大补汤加麦冬、五味治之
而安。予从弟履中。年方强壮。以劳心忧郁而得斯证。痰升遗溺。眼斜视。超时不醒。竟类
中风。亦灌以童便而苏。此等证候。皆火挟痰而作。断非三生饮所可治者。并姜汤亦不相宜
也。同一卒然昏愦。而所因不同。须细审之。
太平广记载唐梁新。见一朝士。诊之曰。风疾已深。请速归去。其朝士复见 州高医赵
鄂。诊之。言疾危。与梁说同。惟云只有一法。请吃消梨。不限多少。咀啮不及。绞汁而饮
到家旬日。根据法治之而愈。此亦降火消痰之验也。
孙东宿治程晓山。年四十。诞辰庆贺。宴乐月余。忽谓孙曰。近觉两手小指及无名指。
掉硬不舒。亦不为用。口角一边常牵扯引动。幸为诊之。六脉皆滑大而数。浮而不敛。其
体肥。其面色苍紫。乃曰。据脉滑大为痰。数为热。浮为风。盖湿生痰。痰生热。热生风也
君善饮。故多湿。近又荒于色。故真阴竭而脉浮。此手指不舒。口角牵扯。中风之兆也。
所喜面色苍紫。其神藏。虽病犹可治。切宜戒酒色以自保爱。立方用二陈汤加滑石为君。芩
连为臣。健脾消痰。撤湿使从小便出。加胆星、天麻以定其风。将竹沥、姜汁三拌三晒。仍
以竹沥糊丸。取竹沥引诸药入经络化痰。外又以天麻丸滋补其筋骨。标本两治。服二料。几
半年。不惟病痊。且至十年无恙。迨五十岁。贺寿如旧。召妓宴乐亦如旧。甘酒嗜饮。荒淫
而忘其旧之致疾也。手指掉硬。口角牵引尤甚。月余中风。右体瘫痪矣。再邀孙诊之。脉皆
洪大不敛。汗多不收。呼吸迫促。孙曰。此下虚上竭之候。盖肾虚不能纳气归元。故汗出如
油。喘而不休。虽和缓无能为矣。阅二十日而卒。
震按医书谓凡人大指次指麻木不仁者。三年内须防中风。当远房帏。绝嗜欲。戒酒戒浓
味。以杜其患。观此案可为养生者之金鉴矣。
东宿曰。潘见所年四十七。微觉阳痿。其脉上盛下虚。上盛为痰与火。下虚为精元弱。
宜戒色慎怒。恐痰生热而热生风。将有中风之患。次年中秋。连宵酒色。渠于色后。惯用鹿
角胶三钱。人参一钱。酒送下。至是加倍服之。十七日。左手陡然颤动。重不能举。十八日
左边半体手足皆不用矣。予始观面色赤。口微 向右。唇麻。左瘫。诊之左弦大。右滑大
先用乌药顺气散一帖。服后昏睡半日。醒觉面更加赤。 亦稍加。知痰盛使然。即以二陈
汤加全蝎、僵蚕。天麻。黄芩、石菖蒲、红花、秦艽。煎冲竹沥、姜汁。一日两进。晚更与
活络丹。服至第六日。手指稍能运动。足可根据棹而立。予喜曰。机动矣。改用归芍六君子汤
加红花、钩藤、天麻、竹沥、姜汁。服二十帖。行可二十步矣。手指先麻木不知痛痒。至是
能执物。继用天麻丸、五子全鹿丸调理。幸其断酒绝欲。百日全愈。此证予历治历效者。良
由先为疏通经络。活血调气。然后以补剂收功。惟经络疏通。宿痰磨去。补之必效。此治类
中风之法也。
震按此条先散后补。亦缘病初无卒仆昏愦之症。且脉滑大。故可从容施治耳。若云必先
疏通经络。磨去宿痰。然后补之得效。又属呆板方法矣。
杨季衡禀丰躯伟。年近七旬。得半身不遂证二年矣。病发左半。口往右 。昏厥遗溺。
云间施笠泽以参附疗之。稍安。喻嘉言曰。其脉软滑中时带劲疾。是痰与风杂合之症。又内
热与外寒杂合之症。房帏不节。精气内虚。膏粱蕴热。久蒸脾湿为痰。痰阻窍隧。而卫气不
周。外风易入。是以杂合而成是症。及今大理右半脾胃之气。以运出左半之热痰虚风。此其
间有微细曲折。非只温补一端所能尽也。或曰。痰热先宜中右。何以反中左。既已中左。何
以反治右耶。喻曰。此正病机之最要者。向为丹溪等说病在左血多。病在右气多。教人如此
认症。不知内经但言左右者。阴阳之道路。夫左右既为阴阳往还之道路。何尝可偏执哉。
左半虽血为主。非气以统之则不流。右半虽气为主。非血以丽之则易散。故病在一偏者。治
宜从阴引阳。从阳引阴。从左引右。从右引左。譬之树木有偏枯者。将溉其枯者乎。抑溉其
未枯者。使荣茂而因以条畅其枯者乎。此证之脉。软为虚。滑为痰。劲疾为风。病因杂合。
必须用杂合之药。而随时令以尽无穷之变。参、术是主药。冬月佐干姜、附子。以暂撤外寒
《唐书》记载，许允宗在陈朝初出仕时，担任新蔡王的外兵参军。当时柳太后因中风不能说话，脉象沉伏且牙关紧闭。许允宗说：“患者口不能服药，适宜用汤药的蒸汽熏蒸，使药力进入腠理，大约一个时辰就可以痊愈。”于是配制黄耆防风汤，煮了几十斛，放在床下，药气如烟雾般弥漫，通过熏蒸使太后能够说话。因此被破格提拔为义兴太守。
俞震按语：书中称许允宗的医术神妙，他曾说“医者意也”，关键在于人的思虑。这一条案例中他的思虑非常巧妙。但这仅适用于真中风，《内经》所说的“有邪者，渍形以为汗”，邪气随汗而解，所以能说话。如果一概尝试用于所有不能说话的患者，肯定无效。另外，罗谦甫治疗史太尉，冬天坐在火炉左侧，觉得面部发热，左脸颊微微出汗，随即走出室外，因为左脸颊肌肉松弛舒缓，风寒之邪侵袭，导致右脸颊拘急，口角歪向右侧，脉象浮紧，重按洪缓。罗谦甫使用升麻汤加桂枝、白芷、羌活、防风，并兼灸地仓、颊车穴。这是治疗风邪侵犯阳明经表证的方法。赵僧判半身不遂，不能说话，神志昏蒙，面红，耳聋鼻塞，六脉弦数。罗谦甫认为，病在中脏的多阻滞九窍，病在中府的多留着四肢。现在脏腑都受邪气侵袭，先用三化汤通导，疏通壅滞，使清气上升，充实四肢；其次给予至宝丹，安心养神，通利九窍。五天后，声音发出，语言稍显流利，只是行走艰难。又针刺十二经的井穴以连接经络，根据四季脉症加减用药，一百天才痊愈。这是治疗中腑兼中脏里证的方法。这些都是风邪实证。张安抚半身不遂，语言謇涩，自汗恶风，咳嗽痰多失眠。罗谦甫认为风寒损伤形体，忧恐忿怒损伤气机。《内经》说：“形乐志苦，病生于脉”，神气先病了。邪风加上，变动无常处，治病必须求其根本，邪气才能服从。使用加减冲和汤，汗多加黄耆，咳嗽加五味子。因为他昼夜不睡，是因为心事烦冗，心火上乘阳分，卫气不得入于阴，使用朱砂安神丸，才得以入睡。各种症状逐渐减轻，只有右肩臂疼痛。《内经》说：“虚与实邻，决而通之”，又说：“下陷者灸之”，因为阳气下陷入阴中，所以肩膊痛不能活动，应当用火引导它、补益它。于是在右肩臂上的肩井穴，先针后灸，隔一个月，再灸肩井穴，接着在尺泽穴，各灸二十八壮，引气下行，与正气相接，于是能够运动。仲夏用清肺饮子，秋分用益气调营汤，完全痊愈。这是治疗中经兼中腑，本虚标实的病症。许允宗所治疗的也是本虚标实的情况，但病起于暴急，所以用蒸法，也像通关散取嚏、稀涎散探吐痰一样。
朱丹溪治疗浦江郑君，年龄近六十岁，平时饮食肥甘厚味，仲夏长期患有痢疾，又犯房事劳损。一天晚上上厕所，突然昏倒，撒手遗尿，眼睛上视，大汗淋漓，喉间痰声如拉锯，呼吸非常微弱。他的脉象大而无伦次部位，非常可怕。这是阴虚而阳气暴绝。急忙让人煎人参膏，同时灸气海穴，艾炷如小指大小，灸到十八壮，右手能动弹。又灸三壮，嘴唇微动。人参膏制成后，给服一盏，到半夜后，喝完三盏，眼睛能动，吃完两斤，才能说话要粥，吃完五斤痢疾停止，吃十几斤才完全康复。
俞震按语：这种病，现在常有发生，医生所用的人参不过一二钱，最多一两而已，也不知道有灸法，无效就推说是天命，怎么能几天内用人参膏到十几斤呢？然而人参膏到十几斤，准备起来也很难。只有能办到的人，不可不知道这种方法。
赵以德说：我曾经治疗陈学士敬初，因为参加醮事跪拜之间，突然跌倒，汗如雨下。诊脉大而空虚，年龄五十岁，刚娶年轻妻子，现在又从跪拜的劳役中受损，所以阳气暴散，正像丹溪治疗郑义士的病一样。急忙煎独参浓汤，连续饮用半天，汗止，神气稍定，手足松软，失音无声。于是在独参汤中加入竹沥，开通上涌之痰。第二天早上悲伤哭泣，一天不停，用言语安慰他，于是笑了，又笑五七天，没有停止的时候。这哭笑，是因为阴虚而劳火动摇了精神魂魄之藏，气相并的缘故。正是《内经》所说的“五精相并”，心火并于肺则喜，肺火并于肝则悲。加入黄连、黄柏之类泻其火，更增加荆沥开通闭塞，八天笑声停止手部能动，一个月能走路了。
俞震按语：这一条与前一条大同小异，而治疗其小异之处，立言用药，颇有精义。可见古人善于模仿成法又不蹈袭成法。
以上所选的实证虚证，分途异治，误用就会死亡。李士材所谓治疗中风，必须分别闭证与脱证，这两个症状明白，这是下手的第一要点。
朱丹溪治疗一位妇人，六十多岁，左手足瘫痪，不说话但健忘，有痰，用麻黄、羌活、荆芥、防风、南星、全蝎、乳香、没药、木通、茯苓、桔梗、厚朴、甘草、红花研末，酒送服，未见效。当时是春季，脉伏而微，又用淡盐汤加入韭菜汁，每早一碗催吐，到第五天，仍用茯苓、白术、陈皮、甘草、厚朴、石菖蒲，每天进两服。又用川芎、豆豉、山栀、瓜蒂、韭菜汁、盐汤，催吐非常快。后来用四君子汤服用。另外用当归、酒黄芩、红花、木通、厚朴、粘子、苍术、南星、牛膝、茯苓研末，酒糊丸服用。十日后，微汗，手足微动并能说话。
俞震按语：前一条脱证，脉大无伦次，这一条闭证，脉伏而微，没有确切的见解，敢用这两路重药吗？须知症与脉宜合参，像这一条左瘫不言，但健忘又有痰，其得效的关键在此。与浦江洪宅妇患疟疾无脉条相似。
另外按：丹溪治疗肥胖之人中风，口眼歪斜，手足麻木废用，左右都作为痰证治疗，用瓜蒌、贝母、南星、橘皮、半夏、二术、黄芩、黄连、黄柏、荆芥、防风、羌活、桂枝、威灵仙、甘草、花粉等。如果喜欢吃面食，加附子煎煮，加入竹沥、姜汁，再加少量酒行经。这是大法。所以治疗中风二十六案，用此加减的很多。其余用四君子汤、六君子汤，或合四物汤，或再加黄连、黄柏、防风、天麻、僵蚕、竹沥等，或合风药，更有加全蝎、地龙的。又有用小续命汤、搜风汤、羌活愈风汤、乌药顺气散、苏合香丸的，都没有记载脉象如何，怎么效法？所以不一并收录。
虞恒德治疗一妇人五十七岁，身体肥胖白皙，春初得中风，突然仆倒不知人事，身体僵硬挺直，口噤不语，喉间痰声如拉锯，水饮不能入。六脉浮大弦滑，右甚于左。用藜芦末一钱，加麝香少许，灌入鼻窍，吐出痰液一升多，才知道人事，身体略能举动。急忙煎小续命汤倍加麻黄，连进两服，盖上衣被，得汗逐渐苏醒，能转侧，但右手足不遂，语言謇涩。再用二陈汤加川芎、当归、芍药、羌活、防风等，合竹沥姜汁，每天进二三服。如果三四天大便不利，就不能言语，就用东垣导滞丸，或润肠丸轻微通便，则言语恢复正常。如此调理，到六十多岁，得其他病而死。
俞震按语：这一条与上面丹溪案，都以实邪治疗而有效，可见辨证宜真，不得专守景岳非风之论，先有成见在胸中。如薛立斋善于用补，而治疗艾郭武牙关紧闭，不能说话，左体瘫痪，口眼牵动，神志昏蒙欲绝，六脉沉细而涩，认为是中寒湿，不是中风。也用吐痰药及至宝丹，继以五积散加木香、南星、附子而人苏醒。后来大便洞泄痰积而痊愈。遇到这种证候，治虚寒、治风痰，固然应该对照勘验。
薛立斋治疗一人，六十多岁，素来喜欢饮酒，两臂作痛，服用祛风治痿的药，更加麻木发热，身体松软痰涌，腿膝拘痛，口噤语涩，头目晕重，口角流涎，身体如虫行，痒起白屑。薛立斋说：“臂麻体软，脾无用也；痰涎自出，脾不能摄也；口斜语涩，脾气伤也；头目晕重，脾气不能升也；痒起白屑，脾气不能荣也。”于是用补中益气汤加神曲、半夏、茯苓，三十余剂，各种症状全部消退。又用参术膏而痊愈。
一妇人怀抱郁结，筋挛骨痛，喉间似有一核，服用乌药顺气散等药，口眼歪斜，手臂难伸举，痰涎更多，内热午后热，食少体倦。薛立斋说：“郁火伤脾，血燥生风所致。”用加味归脾汤，二十余剂，形体渐健，饮食渐加。又服加味逍遥散十余剂，痰热少退，喉核少利。更用升阳益胃汤数剂，各种症状渐愈，但手臂不能伸，这是肝经血少，用地黄丸而痊愈。
秀才刘允功，形体魁伟，不慎酒色，因劳累愤怒头晕仆地，痰涎上涌，手足麻痹，口干引饮，六脉洪数而虚。薛立斋认为是肾经亏损，不能纳气归源而头晕，不能摄水归源而为痰，阳气虚热而麻痹，虚火上炎而作渴。用补中益气合六味丸，治疗而痊愈。其后或因劳役，或因房事，病即发作，用前面的药随即痊愈。
宪幕顾斐斋左半身连同手不遂，汗出神昏，痰涎上涌，王竹西用人参等大补之剂，汗止而神思渐清，颇能步履。后来不守禁忌，左腿从膝至足肿胀很大，重坠如石，痛不能忍，痰很多。肝脾肾脉洪大而数，重按则软涩。薛立斋早晨用补中益气汤加黄柏、知母、麦冬、五味子，煎送地黄丸；晚上用地黄丸料加知母、黄柏，数剂各种症状全部消退，但因为放松禁忌，不能全愈罢了。
俞震按语：这四个案例，理精法密，学人应当熟读玩味。
车驾王用之，卒中昏愦，口眼歪斜，痰气上涌，咽喉有声，六脉沉伏。这是真气虚而风邪所乘，用三生饮一两，加人参一两，煎服即苏醒。薛立斋说：“若遗尿撒手，口开鼾睡为不治。”用前面的药也有得生的。那三生饮是行经络治寒痰的药，有斩关夺旗之功，每服必用人参一两许，驾驭其邪而补助真气，否则不惟无益，适足以取败矣。
俞震按语：这是治疗中寒寒痰壅塞气道之药，肥胖人脉沉伏，无火象者，可用之。若脉微细者，必加人参，实在不是中风药。折肱漫录说：三生饮施于中风之寒症，妙啊。或有虚火冲逆，热痰壅塞，以致昏愦颠仆者，状类中风，恐怕乌头附子不适合服用。薛立斋治疗王进士失于调养，忽然昏愦，认为是元气虚，火妄发，挟痰而作。急忙灌童便，神思渐爽。更用人参、黄芪各五钱，川芎、当归各三钱，元参、柴胡、山栀、炙甘草各一钱，服之稍定。察其形倦甚，又以十全大补汤加麦冬、五味子治疗而安。我的堂弟履中，年方强壮，因劳心忧郁而得此证，痰升遗溺，眼斜视，超时不醒，竟类中风，也灌以童便而苏醒。这种证候，都是火挟痰而作，断非三生饮所可治者，连姜汤也不相宜。同一卒然昏愦，而所因不同，须仔细审察。
《太平广记》记载唐代梁新，见到一位朝士，诊脉说：“风疾已深，请速回去。”那位朝士又去见婺州高医赵鄂，诊断说病情危急，与梁新的说法相同，只说只有一法，请吃消梨，不限多少，嚼不及，绞汁而饮。到家十天，照此法治而痊愈。这也是降火消痰的验证。
孙东宿治疗程晓山，四十岁，诞辰庆贺，宴乐月余，忽然对孙说：“最近觉得两手小指及无名指，掉硬不舒，也不为用，口角一边常牵扯引动，幸为诊之。”六脉皆滑大而数，浮而不敛。其人体肥，面色苍紫。孙说：“据脉滑大为痰，数为热，浮为风。盖湿生痰，痰生热，热生风也。君善饮，故多湿。近又荒于色，故真阴竭而脉浮。此手指不舒，口角牵扯，中风之兆也。所喜面色苍紫，其神藏，虽病犹可治。切宜戒酒色以自保爱。”立方用二陈汤加滑石为君，黄芩、黄连为臣，健脾消痰，撤湿使从小便出。加胆星、天麻以定其风。将竹沥、姜汁三拌三晒，仍以竹沥糊丸，取竹沥引诸药入经络化痰，外又以天麻丸滋补其筋骨，标本两治。服二料，将近半年，不但病痊，而且十年无恙。等到五十岁，贺寿如旧，召妓宴乐亦如旧，甘酒嗜饮，荒淫而忘记旧病之源。手指掉硬，口角牵引尤甚，月余中风，右体瘫痪。再邀孙诊之，脉皆洪大不敛，汗多不收，呼吸迫促。孙说：“此下虚上竭之候。盖肾虚不能纳气归元，故汗出如油，喘而不休，虽和缓无能为矣。”阅二十日而卒。
俞震按语：医书谓凡人大指次指麻木不仁者，三年内须防中风，当远房帏，绝嗜欲，戒酒戒浓味，以杜其患。观此案可为养生者之金鉴矣。
东宿说：潘见所年四十七，微觉阳痿，其脉上盛下虚。上盛为痰与火，下虚为精元弱。宜戒色慎怒，恐痰生热而热生风，将有中风之患。次年中秋，连宵酒色，他在房事后，惯用鹿角胶三钱，人参一钱，酒送下。至此加倍服用。十七日，左手陡然颤动，重不能举。十八日左边半体手足皆不用矣。我开始观察面色赤，口微向右歪，唇麻，左瘫。诊之左弦大，右滑大。先用乌药顺气散一帖，服后昏睡半日，醒觉面更加赤，歪斜亦稍加重，知痰盛使然。即以二陈汤加全蝎、僵蚕、天麻、黄芩、石菖蒲、红花、秦艽，煎冲竹沥、姜汁，一日两进。晚更与活络丹。服至第六日，手指稍能运动，足可根据棹而立。我高兴地说：“机动矣。”改用归芍六君子汤加红花、钩藤、天麻、竹沥、姜汁，服二十帖，行可二十步矣。手指先麻木不知痛痒，至此能执物。继用天麻丸、五子全鹿丸调理。幸其断酒绝欲，百日全愈。此证我历治历效者，良由先为疏通经络，活血调气，然后以补剂收功。惟经络疏通，宿痰磨去，补之必效。此治类中风之法也。
俞震按语：这一条先散后补，也是因为病初无卒仆昏愦之症，且脉滑大，故可从容施治耳。如果说必须先疏通经络，磨去宿痰，然后补之得效，又属呆板方法矣。
杨季衡禀赋丰躯伟，年近七旬，得半身不遂证二年矣。病发左半，口往右歪，昏厥遗溺。云间施笠泽以参附疗之，稍安。喻嘉言说：“其脉软滑中时带劲疾，是痰与风杂合之症。又内热与外寒杂合之症。房帏不节，精气内虚，膏粱蕴热，久蒸脾湿为痰，痰阻窍隧，而卫气不周，外风易入，是以杂合而成是症。及今大理右半脾胃之气，以运出左半之热痰虚风，此其间有微细曲折，非只温补一端所能尽也。”或曰：“痰热先宜中右，何以反中左？既已中左，何以反治右耶？”喻曰：“此正病机之最要者。向为丹溪等说病在左血多，病在右气多，教人如此认症，不知内经但言左右者，阴阳之道路。夫左右既为阴阳往还之道路，何尝可偏执哉？左半虽血为主，非气以统之则不流；右半虽气为主，非血以丽之则易散。故病在一偏者，治宜从阴引阳，从阳引阴，从左引右，从右引左。譬之树木有偏枯者，将溉其枯者乎？抑溉其未枯者，使荣茂而因以条畅其枯者乎？此证之脉，软为虚，滑为痰，劲疾为风，病因杂合，必须用杂合之药，而随时令以尽无穷之变。参、术是主药，冬月佐干姜、附子，以暂撤外寒”
The *Book of Tang* records that Xu Yuzong, when first entering official service in the Chen Dynasty, served as the External Military Staff Officer for Prince Xincai. At that time, Empress Dowager Liu suffered from stroke (Zhong Feng) and could not speak; her pulse was deep (Chen) and her jaw was locked (Kou Jin). Xu Yuzong said, "Since the patient cannot take medicine by mouth, it is appropriate to use the steam of decoction to fumigate, allowing the medicinal properties to enter the interstices (Cou Li). Recovery can be expected in about one hour." He then prepared Huangqi Fangfeng Decoction (Astragalus and Saposhnikovia Decoction), boiled several hundred hu (a unit of volume), placed it under the bed, and the medicinal vapor filled the air like smoke. Through fumigation, the Empress Dowager regained her speech and was subsequently promoted to Governor of Yixing.
Yu Zhen's commentary: The book states that Xu Yuzong's medical skills were miraculous. He once said, "Medicine lies in intention (Yi), relying on human thought." This case demonstrates exquisite thinking. However, this method applies only to true stroke (Zhen Zhong Feng). As stated in the *Neijing* (Inner Canon): "For those with pathogenic factors, soak the body to induce sweating" (Qi you xie zhe, zi xing yi wei han). Since the pathogen resolves through sweating, speech is restored. If applied indiscriminately to all patients unable to speak, it would certainly be ineffective. Additionally, Luo Qianfu treated Grand Commandant Shi. In winter, sitting on the left side of a stove, he felt facial heat and slight sweating on his left cheek. Upon going outside, due to the relaxation of the left cheek muscles, wind-cold invaded, causing rigidity on the right cheek and deviation of the mouth to the right. His pulse was floating-tight (Fu Jin), and deep pressure revealed a surging-slow (Hong Huan) quality. Luo used Shengma Decoction (Cimicifuga Decoction) added with Guizhi (Cinnamon Twig), Baizhi (Angelica Dahurica), Qianghuo (Notopterygium Rhizome), and Fangfeng (Saposhnikovia Root), combined with moxibustion at Dicang (ST4) and Jiache (ST6) acupoints. This treats the exterior syndrome of wind invading the Yangming Meridian. Zhao Sengpan suffered hemiplegia, aphasia, mental confusion, red face, deafness, and nasal congestion. His six pulses were wiry-numerous (Xian Shu). Luo reasoned that disease in the Zang organs often obstructs the nine orifices, while disease in the Fu organs often affects the four limbs. Since both Zang and Fu were affected, he first used Sanhua Decoction (Three Transformations Decoction) to clear stagnation, allowing clear qi to ascend and nourish the limbs. Next, he administered Zhibao Dan (Precious Treasure Pill) to calm the mind, nourish the spirit, and unblock the nine orifices. After five days, voice returned, speech became slightly fluent, though walking remained difficult. He then needled the Jing-Well acupoints of the twelve meridians to connect the collaterals, adjusting herbs according to seasonal pulses and symptoms. Full recovery took one hundred days. This treats the interior syndrome of middle Fu involving middle Zang. These are all excess syndromes of wind pathogens. Zhang Anfu suffered hemiplegia, dysarthria, spontaneous sweating, aversion to wind, cough with phlegm, and insomnia. Luo reasoned that wind-cold damages the form, while worry, fear, anger, and rage damage Qi. The *Jingsui Jing* says, "When the body is comfortable but the mind is bitter, disease arises in the vessels," indicating the spirit is diseased first. Wind pathogens move unpredictably; treating disease requires addressing the root so that pathogens submit. He used Jiajian Chonghe Decoction (Modified Harmonizing Decoction), adding Huangqi (Astragalus) for sweating and Wuweizi (Schisandra) for cough. For his insomnia caused by mental distress and heart fire harassing the yang, preventing Wei Qi from entering Yin, he used Zhusha Anshen Wan (Cinnabar Calming the Spirit Pill), allowing sleep. Symptoms improved, except for right shoulder-arm pain. The *Jingsui Jing* states, "Where deficiency and excess neighbor, resolve and unblock them," and "For sinking [Qi], apply moxibustion." Because Yang Qi sank into Yin, causing shoulder pain and immobility, he used fire to guide and tonify. He needled then moxa'd Jianjing (GB21) on the right shoulder-arm, repeated after a month, then moxa'd Chize (LU5) with 28 moxa cones each, guiding Qi downward to meet Zheng Qi, restoring movement. In early summer, he used Qingfei Yinzi (Lung-Clearing Drink); at the Autumn Equinox, Yiqi Tiaoying Decoction (Qi-Nourishing and Blood-Regulating Decoction), achieving full recovery. This treats middle Jing involving middle Fu, a syndrome of root deficiency with branch excess. Xu Yuzong's case was also root deficiency with branch excess, but since onset was sudden, he used fumigation, similar to Tongguan San (Pass-the-Gate Powder) inducing sneezing or Xixian San (Phlegm-Descending Powder) inducing vomiting.
Zhu Danxi treated Mr. Zheng from Pujiang, nearly sixty years old, accustomed to rich foods, suffering from chronic dysentery in midsummer, compounded by sexual exhaustion. One night, while defecating, he suddenly fainted, released his hands, lost urine control, eyes rolled up, sweated profusely, had rattling throat sounds like a saw, and very faint respiration. His pulse was large without distinct position, highly alarming. This was Yin deficiency with sudden collapse of Yang. Zhu urgently ordered Ginseng Paste prepared and moxa'd Qihai (CV6), using cones the size of a little finger, totaling eighteen cones. Right hand moved. Three more cones allowed lip movement. Once the paste was ready, one cup was given; by midnight, three cups consumed, eyes moved. After two jin (approx. 1 kg), speech returned and he asked for porridge. Five jin stopped diarrhea; over ten jin led to full recovery.
Yu Zhen's commentary: This condition occurs frequently today. Doctors use only one or two qian (3-6g) of Ginseng, rarely exceeding one liang (30g), and ignore moxibustion. When ineffective, they blame fate. How can anyone consume ten-plus jin of Ginseng Paste in days? Yet preparing such amounts is difficult. Those capable must know this method exists.
Zhao Yi-de stated: I once treated Academician Chen Jingchu, who collapsed during Taoist ritual prostrations, sweating profusely. Pulse was large and empty. Age fifty, recently married young wife, further depleted by physical labor, leading to sudden dispersion of Yang Qi, identical to Danxi's treatment of Knight Zheng. Urgently brewed concentrated Dushen Tang (Single Ginseng Decoction), drank continuously for half a day until sweating stopped and spirit stabilized. Limbs were flaccid, aphonic. Added Zhuli (Bamboo Juice) to open upward-rising phlegm. Next morning, he wept uncontrollably for a day; verbal comfort made him laugh, continuing for five to seven days. This laughing/crying results from Yin deficiency stirring Fire disturbing the Spirit/House of Soul, causing Qi merging. As per *Neijing*: "Five Essences merge"; Heart Fire merging with Lung causes joy; Lung Fire merging with Liver causes grief. Added Lianbai (Coptis and Phellodendron) to drain fire, Jingli (Arisaema juice) to open closure. Eight days later, laughter ceased, hand moved; one month later, walking resumed.
Yu Zhen's commentary: Similar to the previous case, but treatment of minor differences shows refined reasoning and prescription logic, proving ancients imitated methods without rigidly copying them.
The selected excess and deficiency cases above are treated differently; misuse leads to death. Li Shicai stated that treating stroke requires distinguishing Bi (Closed) and Tuo (Collapsed) syndromes. Clarifying these two is the primary step.
Danxi treated a woman, over sixty, with left-sided hemiplegia, aphasia, forgetfulness, and phlegm. She used Mahuang (Ephedra), Qianghuo (Notopterygium), Jingjie (Schizonepeta), Fangfeng (Saposhnikovia), Nanting (Pinellia processed with alum), Quanxie (Scorpion), Ruxiang (Frankincense), Moyao (Myrrh), Mutong (Akebia), Fuling (Poria), Jiegeng (Platycodon), Houpo (Magnolia Bark), Gancao (Licorice), Honghua (Safflower) powdered, taken with wine. No effect. It was spring, pulse deep-faint. Then used light salt water with chive juice, one bowl morning, inducing vomiting. On the fifth day, used Fuling (Poria), Baizhu (Atractylodes), Chenpi (Tangerine Peel), Gancao (Licorice), Houpo (Magnolia Bark), Changpu (Acorus), two doses daily. Then used Chuanxiong (Ligusticum), Douchi (Fermented Soybean), Shanzhi (Gardenia), Gudia (Melon Seed), chive juice, salt water for rapid vomiting. Later used Sijunzi Tang (Four Gentlemen Decoction). Separately, Danggui (Angelica Sinensis), Jiu Qin (Wine-processed Scutellaria), Honghua (Safflower), Mutong (Akebia), Houpo (Magnolia Bark), Niuzi (Arnebia/Cynanchum seed), Cangzhu (Atractylodes lancea), Nanting (Pinellia), Niuxi (Achyranthes), Fuling (Poria) powdered, wine-ball pills. Ten days later, slight sweating, slight limb movement, and speech returned.
Yu Zhen's commentary: The previous case (Collapse) had a large, chaotic pulse; this case (Closure) had a deep-faint pulse. Without firm insight, one dares not use such heavy medications. Symptoms and pulses must be combined. Here, left hemiplegia and aphasia coexist with forgetfulness and phlegm; this is the key to efficacy, similar to the Pujiang Hong family woman with malaria and absent pulse.
Also: Danxi treated obese stroke patients with facial deviation and limb numbness/paralysis, treating both sides as phlegm. Used Gualou (Trichosanthes), Beimu (Fritillaria), Nanting (Pinellia), Ju (Citrus), Banxia (Pinellia), Er Zhu (Atractylodes), Qin (Scutellaria), Lian (Coptis), Bai (Phellodendron), Jing (Schizonepeta), Fang (Saposhnikovia), Qianghuo (Notopterygium), Guizhi (Cinnamon Twig), Weilingxian (Clematis), Gancao (Licorice), Huafen (Trichosanthes Root). If fond of noodles, add Fuzi (Aconite) decocted, with Zhuli (Bamboo Juice), Jiangzhi (Ginger Juice), and small amount of wine to circulate channels. This is the general principle. Of twenty-six stroke cases, many used modifications. Others used Sijunzi Tang, Liujunzi Tang, combined with Siwu Tang, or added Lian, Bai, Fangfeng, Tianma, Jiangcan, Zhuli, etc., or wind-dispelling herbs, some adding Quanxie (Scorpion), Dilong (Earthworm). Some used Xiao Xuming Tang (Minor Rescue Decoction), Sofeng Tang (Wind-Searching Decoction), Qianghuo Yufeng Tang (Notopterygium Preventing Wind Decoction), Wuyao Shunqi San (Litsea Regulating Qi Powder), Suhexiang Wan (Styrax Pill). None recorded pulse qualities, making replication impossible; thus not included.
Yu Hengde treated a fifty-seven-year-old obese, fair-skinned woman. Early spring, sudden stroke, unconscious, stiff body, locked jaw, rattling throat, unable to drink. Six pulses floating-large-wiry-slippery, right stronger than left. Used Licori root powder (Lilu) one qian with musk, insufflated into nose, expelling over one sheng (approx. 200ml) of phlegm. Consciousness returned, slight movement possible. Urgently brewed Xiao Xuming Tang doubled with Mahuang (Ephedra), two doses, covered with blankets, induced sweating, gradual awakening, able to turn. Right limbs still paralyzed, dysarthric. Used Erchen Tang (Two Aged Substances Decoction) plus Chuanxiong (Ligusticum), Danggui (Angelica), Shaoyao (Peony), Qianghuo (Notopterygium), Fangfeng (Saposhnikovia), combined with Zhuli (Bamboo Juice), Jiangzhi (Ginger Juice), 2-3 doses daily. If constipation for 3-4 days prevented speech, used Dongyuan Daoshi Wan (Dongyuan Stagnation-Resolving Pill) or Runchang Wan (Intestine-Moistening Pill) for mild purgation, restoring speech. Managed thus until age sixty-plus, died of other illness.
Yu Zhen's commentary: Both this and Danxi's case treated effectively with real-pathogen methods, proving accurate differentiation is essential, avoiding preconceived notions like Jingyue's "Non-Wind" theory. Xue Lizhai, skilled in tonification, treated Ai Guowu with locked jaw, aphasia, left hemiplegia, facial deviation, near-coma, deep-thin-choppy pulses. Diagnosed Cold-Damp, not Stroke. Used expectorants and Zhibao Dan (Precious Treasure Pill), followed by Wuji San (Five Accumulations Powder) plus Muxiang (Costus), Nanting (Pinellia), Fuzi (Aconite), resulting in revival. Post-purgation of phlegm-stasis, full recovery. Such cases require careful comparison between deficiency-cold and wind-phlegm treatments.
Xue Lizhai treated a man, over sixty, habitual drinker, arm pain. Took wind-dispelling/withered-tendon herbs, worsening numbness, fever, flaccidity, phlegm surge, knee cramps, locked jaw, dysarthria, dizziness, drooling, skin crawling sensation, white scales. Xue said: "Arm numbness/flaccidity indicates Spleen uselessness; drooling indicates Spleen inability to control; facial deviation/dysarthria indicates Spleen Qi injury; dizziness indicates Spleen Qi failure to ascend; itching/scales indicates Spleen failure to nourish." Prescribed Buzhong Yiqi Tang (Middle-Boosting Qi-Enriching Decoction) plus Shenqu (Massa Fermentata), Banxia (Pinellia), Fuling (Poria). Over thirty doses, symptoms resolved. Followed by Shenzhu Gao (Ginseng-Atractylodes Paste) for cure.
A woman with emotional stagnation, tendon cramping, bone pain, globus sensation, took Wuyao Shunqi San (Litsea Regulating Qi Powder), developing facial deviation, arm immobility, increased phlegm, internal heat, afternoon fever, poor appetite, fatigue. Xue said: "Depressive fire injures Spleen, blood dryness generates wind." Used Jiawei Guipi Tang (Augmented Restore the Spleen Decoction) for over twenty doses, improving physique/appetite. Then Jiawei Xiaoyao San (Augmented Free Wanderer Powder) for ten doses, reducing phlegm-heat/globus. Finally Shengyang Yiwang Tang (Yang-Raising Stomach-Nourishing Decoction) for several doses, resolving most symptoms, but arm extension failed due to Liver Blood deficiency, cured by Dihuang Wan (Rehmannia Pill).
Scholar Liu Yun Gong, robust, careless with alcohol/sex, collapsed from exertion/anger, phlegm surge, limb numbness, thirst, large-numerous-empty pulses. Xue diagnosed Kidney Essence deficiency failing to grasp Qi (dizziness) and Water (phlegm), Yang deficiency heat (numbness), Deficient Fire flaming up (thirst). Used Buzhong Yiqi Tang combined with Liuwei Wan (Six-Ingredient Pill with Rehmannia), cured. Recurrence with exertion/sex responded to same formula.
Official Gu Feizhai, left hemiplegia, sweating, coma, phlegm surge. Wang Zhuxi used massive tonics (Ginseng, etc.), stopping sweat, clearing spirit, enabling walking. Non-compliance led to severe left leg swelling/pain, copious phlegm. Liver/Spleen/Kidney pulses large-numerous superficially, soft-choppy deeply. Morning: Buzhong Yiqi Tang plus Huangbai (Phellodendron), Zhimu (Anemarrhena), Maidong (Ophiopogon), Wuweizi (Schisandra), decocted with Dihuang Wan (Rehmannia Pill). Evening: Dihuang Wan ingredients plus Zhimu, Huangbai. Several doses resolved symptoms, but lack of discipline prevented full cure.
Yu Zhen's commentary: These four cases are logically precise and methodically dense, worthy of study.
Chejia Wang Yongzhi, sudden stroke, coma, facial deviation, phlegm surge, throat noise, deep-hidden pulses. True Qi deficiency, wind invasion. Used Sansheng Yin (Three Lives Drink) one liang plus Ren Shen (Ginseng) one liang, decocted, immediate revival. Xue said: "Urination/hand release/open mouth/snoring indicate incurable." Using prior herbs saved some. Sansheng Yin moves collaterals, treats cold-phlegm, has decisive power. Must use one liang Ginseng per dose to guide pathogens and boost True Qi; otherwise, harmful.
Yu Zhen's commentary: Treats cold-phlegm blocking airways in obesity with deep pulses/no heat signs. If pulse is fine-thin, add Ginseng. Not a standard stroke drug. *Zhe Gong Man Lu* notes Sansheng Yin is excellent for cold-stroke. But for deficient-fire rising, hot-phlegm obstruction mimicking stroke, Aconite/Cimicifuga may be unsuitable. Xue treated Scholar Wang's neglect-induced coma as Yuan Qi deficiency, wild fire, phlegm. Gave child urine, spirit cleared. Then Renshen (Ginseng), Huangqi (Astragalus) 5 qian each, Chuanxiong (Ligusticum), Danggui (Angelica) 3 qian each, Xuanshen (Scrophularia), Chaihu (Bupleurum), Shanzhi (Gardenia), Zhigancao (Honey-fried Licorice) 1 qian each. Settled. Observing extreme fatigue, used Shiquan Dabu Tang (Ten Substance Great Tonifying Decoction) plus Maidong (Ophiopogon), Wuweizi (Schisandra), stabilized. My cousin Lv Zhong, strong, struck by mental stress/depression, phlegm surge, enuresis, eye deviation, prolonged unconsciousness, mimicking stroke, revived with child urine. These are fire-phlegm cases, not suitable for Sansheng Yin or Ginger Soup. Same sudden coma, different etiology; must examine carefully.
*Tai Ping Guang Ji* records Tang Liang Xin diagnosing an official: "Wind disease deep, return quickly." Official sought Zhao E in Wuzhou. Diagnosis critical, same prognosis, but advised eating pears unlimitedly, juiced if chewing difficult. Cured in ten days. Proof of descending fire/resolving phlegm.
Sun Dongsu treated Cheng Xiaoshan, forty, post-celebration feast, complained of stiff/unresponsive ring/little fingers, mouth corner pulling. Pulses slippery-large-numerous, floating-unrestrained. Obese, purple complexion. Sun said: Slippery-large = Phlegm; Numerous = Heat; Floating = Wind. Damp generates Phlegm, Phlegm generates Heat, Heat generates Wind. Alcoholism causes damp; recent sexual excess depletes True Yin, causing floating pulse. Finger stiffness/mouth pull are stroke precursors. Purple complexion indicates stored spirit, treatable. Advise abstaining from alcohol/sex. Formula: Erchen Tang (Two Aged Substances Decoction) + Huashi (Pyrophyllite) as sovereign, Qinlian (Scutellaria/Coptis) as minister, strengthening Spleen, resolving phlegm, draining damp via urine. Add Dansheng (Artemisia/Arisaema?), Tianma (Gastrodia) to settle wind. Bamboo juice/Ginger juice mixed/shaded three times, pilled with bamboo juice paste to guide herbs into collaterals resolving phlegm. Externally Tianma Wan (Gastrodia Pill) for sinews/bones. Treating root and branch. Two prescriptions, nearly half a year, cured, healthy for ten years. At fifty, resumed feasting/drinking, forgetting cause. Finger stiffness/mouth pull worsened, stroke ensued, right hemiplegia. Re-examined: Pulses large-unrestrained, profuse sweating,急促 breathing. Sun said: Lower deficiency, upper exhaustion. Kidney fails to grasp Qi, oily sweat, panting. Even Huan Bian (ancient sage physician) could not help. Died in twenty days.
Yu Zhen's commentary: Medical texts warn that numbness of index/radial fingers predicts stroke within three years. Avoid sex, desires, alcohol, rich food. This case is a golden mirror for health preservation.
Dongsu stated: Pan Jiansuo, forty-seven, mild impotence. Pulse upper-full lower-empty. Upper-full = Phlegm/Fire; Lower-empty = Essence deficiency. Advise abstinence/anger control to prevent Phlegm-Heat-Wind stroke. Mid-autumn next year, excessive sex/alcohol. Habitually took Deer Antler Glue 3 qian, Ginseng 1 qian with wine. Doubled dose. 17th: Left hand trembled, heavy. 18th: Left hemiplegia. Face red, mouth deviated right, lip numb. Left pulse wiry-large, right slippery-large. First Wuyao Shunqi San (Litsea Regulating Qi Powder). Slept half day, woke redder face, worse deviation. Recognized phlegm excess. Used Erchen Tang (Two Aged Substances Decoction) + Quanxie (Scorpion), Jiangcan (Silkworm), Tianma (Gastrodia), Huangqin (Scutellaria), Shichangpu (Acorus), Honghua (Safflower), Qinjiao (Gentiana), decocted with Zhuli (Bamboo Juice), Jiangzhi (Ginger Juice), twice daily. Evening: Huoluo Dan (Collateral-Activating Pill). Day 6: Finger movement, foot support. Joyful: "Movement initiated!" Changed to Guishao Liujunzi Tang (Angelica Peony Four Gentlemen Decoction) + Honghua (Safflower), Gouteng (Uncaria), Tianma (Gastrodia), Zhuli (Bamboo Juice), Jiangzhi (Ginger Juice). Twenty doses, walked twenty steps. Fingers regained sensation/grasp. Continued Tianma Wan (Gastrodia Pill), Wuzi Quanlu Wan (Five Seeds Complete Deer Pill). Abstinence from alcohol/sex led to full recovery in 100 days. My success here stems from first unblocking collaterals, invigorating blood/regulating Qi, then tonifying. Only with unblocked collaterals and ground phlegm does tonification work. This is the method for pseudo-stroke.
Yu Zhen's commentary: Dispersing then tonifying works because no sudden collapse/coma initially, and slippery-large pulse allows leisurely treatment. Insisting on unblocking/grinding phlegm before tonifying is rigid.
Yang Jiheng, robust, nearly seventy, hemiplegia two years. Left side onset, mouth deviated right, syncope, enuresis. Shi Lizewei (Yunjian) treated with Renshen (Ginseng), Fuzi (Aconite), slight improvement. Yu Jiayan said: Pulse soft-slippery with occasional forceful-rapid beats indicates mixed Phlegm-Wind. Internal heat mixed with external cold. Sexual indiscretion depletes essence; rich diet steams Spleen damp into phlegm; phlegm blocks orifices, Wei Qi fails to circulate, external wind enters easily. Now regulate right Spleen/Stomach Qi to transport left-side heat-phlegm/deficient wind. Nuances exist beyond simple warming/tonifying. Question: Why treat right for left-sided phlegm-heat? Answer: Key pathology. Danxi taught left=Blood, right=Qi. *Neijing* says left/right are pathways of Yin-Yang interchange. Cannot be biased. Left dominated by Blood needs Qi to move; Right dominated by Qi needs Blood to anchor. Treatment should draw Yin from Yang, Left from Right. Like watering a withered tree: water the healthy side to promote growth, which revitalizes the withered side. Pulse: Soft=Deficiency, Slippery=Phlegm, Forceful=Rapid=Wind. Mixed etiology requires mixed herbs, adapting to seasons. Renshen (Ginseng), Baizhu (Atractylodes) main. Winter add Ganjiang (Dried Ginger), Fuzi (Aconite) to temporarily dispel external cold.