而内热反得宣泄。春夏秋则佐以羚羊角、柴胡、知母、石膏。使内蕴之热不与时令之热相蒸
灼。再刺手足四末以泄荣血而通气。恐热痰虚风。久而成疠也。
震按偏枯昔人多谓左属血虚。右属气虚。自得嘉言之论。其理始明。而随时换药。及刺
四末。尤见巧妙。因思幼读内经。至九宫八风篇曰。风从太乙所居之乡来。为实风。主生长
万物。从其冲后来。为虚风。伤人者也。圣人避虚风如避矢石。岂非确指外风乎。又云。其
有三虚而偏中于邪风。则为击扑偏枯。击仆者如人被击而仆。即今之卒倒者是。击仆以偏枯
连举。则猝倒而不偏枯者非中风矣。但所谓三虚者。乘年之衰。逢月之空。失时之和。是运
气时令之虚。而非人身之虚也。何以中风皆作人虚治乎。及读生气通天论。曰。风者百病之
始也。清静则肉腠闭拒。虽有大风苛毒。弗之能害。又云。风雨寒热。不得虚邪。不能独伤
人。又曰。虚邪之风。与其身形。两虚相得。乃客其形。是确指虚人而后中于虚风也。然犹
因虚受风。故灵枢又有真气去。邪气独留。发为偏枯之说。偏枯难疗。二语尽之。再读通评
虚实论。曰。凡治消瘅仆击。偏枯痿厥。气满发逆。肥贵人则膏粱之疾也。此条暗包痰饮湿
热阴虚阳虚诸候。并未尝偏中于邪风矣。盖肥贵人自然慎避邪风。而膏粱之变。风从内生。
刘李朱三家从此悟入。大凡治病必求于本。击仆偏枯。以虚为本也。
刘宗浓玉机微义曰。予尝居凉州。即汉之武威郡也。其地高阜。四时多风少雨。土艺黍
粟。引泉灌溉。天气常寒。人之气实腠密。每见中风暴死者有之。盖折风燥烈之甚也。时洪
武乙亥秋八月。大风起自西北甘州城外。路死者甚众。予始悟经谓西北之折风伤人。至病暴
死之旨不诬。人未经其所。虽读经文。莫不有疑者也。医可易言哉。又王肯堂灵兰要览曰。
里中一老医。右手足废而不起床者二年矣。人皆传其必不起。过数月。遇诸途。讯之。曰。
吾之病几危矣。始服顺气行痰之药。了无应验。薄暮神志辄昏。度不可服。命家人煎进十全
大补汤。即觉清明。遂服之。浃数日。能扶策而起。无何。则又能舍策而步矣。经云。邪之
所凑。其气必虚。吾治其虚。不理其邪。而邪自去。吾所以获全也。余曰。有是哉。使服顺
气疏风之散不辍者。墓木拱矣。然此犹拘于成法。不能因病而变通。随时而消息。故奏功稍
迟。使吾早为之。当不至是也。姑书之以俟明者采焉。读此二则。益信塞外多真中。江南多
类中。刘李朱三家之说。张景岳非风之论。洵为轩岐功臣。至明季缪仲淳立论。谓真阴亏而
内热甚者。煎熬津液。凝结为痰。壅塞气道。不得通利。热极生风。亦致猝然僵仆。类中风
症。此即内虚暗风。初用清热顺气开痰。次用治本。或益阴。或补阳。其药以二冬、二地、
菊花、枸杞、胡麻、桑叶、首乌、柏仁、蒺藜、花粉、参、 、归、芍、鹿茸、虎骨胶、霞
天膏、梨膏、竹沥、桑沥、人乳、童便等。出入互换。另制机杼。今临症指南中风一门。大
半宗此。又可补刘李朱张所未备矣。至喻西昌论侯氏黑散。谓用矾石以填空窍。堵截风路。
此好奇之谈。最足误人。夫药之入胃。不过气味传布脏腑经络耳。岂能以矾嵌刷之耶。冷食
四十日。药积腹中不下。肠胃诚填塞矣。谷不纳而粪不出。将如之何。学医者慎勿妄试。
而体内的热邪反而得以宣泄。在春、夏、秋三季，则辅以羚羊角、柴胡、知母、石膏（生石膏）。使体内蕴结的热邪不与当令季节的暑热相互蒸腾灼烧。再针刺手足四肢末端，以泄出营血中的热邪并疏通气机。担心热痰和虚风日久不散，会演变成恶疾（如疠风/麻风）。
俞震按语：对于半身不遂（偏枯），过去多认为左侧病变属于血虚，右侧病变属于气虚。自从得到嘉言先生（戴元礼）的理论阐释后，其中的道理才变得明晰。而且根据时节更换药物，以及针刺四肢末端的方法，尤其显得巧妙。由此联想到幼年阅读《黄帝内经》时，读到《九宫八风篇》说：“风从太乙神所居的方向吹来，称为实风，主司生长万物；从冲后方向（即与太乙相对的方向）吹来，称为虚风，是伤人的邪风。”圣人躲避虚风就像躲避箭石一样，这难道不是确指外感风邪吗？又说：“如果人体处于‘三虚’状态，又偏中于邪风，就会发生击仆偏枯。”“击仆”是指像被人打击一样突然跌倒，也就是现在的猝然昏倒。将“击仆”与“偏枯”连举，那么猝然昏倒却没有出现半身不遂的，就不属于中风了。只是所谓的“三虚”，是指乘上年运衰退、逢月相亏空、失时令调和，这是运气和时令的虚弱，而非人体自身的虚弱。为什么治疗中风都当作人体正气虚弱来处理呢？等到阅读《生气通天论》时说：“风是百病的起始，保持清静则肌肉腠理闭合拒邪，即使有大风苛毒，也不能伤害人。”又说：“风雨寒热，如果不是虚邪贼风，不能单独伤人。”又说：“虚邪之风，与其身形，两虚相得，乃客其形。”这是确切地指出只有身体虚弱的人才会被虚风所中。然而这仍然是因为体虚而受风，所以《灵枢》又有“真气离去，邪气独留，发为偏枯”的说法。“偏枯难疗”这四个字概括了这种情况。再读《通评虚实论》说：“凡是治疗消瘅、仆击、偏枯、痿厥、气满发逆等病，肥贵之人患的是膏粱之疾（饮食厚味所致疾病）。”这一条暗中包含了痰饮、湿热、阴虚、阳虚等各种证候，并没有提到偏中于邪风。大概肥贵之人自然谨慎躲避邪风，而膏粱之变，风从内生。刘完素、李东垣、朱丹溪三家从此悟入医理。大凡治病必须探求根本，击仆偏枯，以虚为本。
刘宗浓在《玉机微义》中说：“我曾经居住在凉州，即汉代的武威郡。那里地势高亢，四季多风少雨，土地种植黍粟，引用泉水灌溉，天气常寒冷，人的气血充实，腠理致密。我常见到因中风突然死亡的案例。大概是折风（西北风）燥烈之极的缘故。当时是洪武乙亥年秋八月，大风从西北甘州城外刮起，路上死者很多。我开始领悟到经文所说的西北折风伤人，导致暴死的宗旨是没有错误的。人如果没有亲身经历那种环境，虽然阅读经文，无不存有疑虑。医学岂能轻易谈论呢？”
另外王肯堂在《灵兰要览》中说：“乡里有一位老医生，右手足废用不能起床已有两年。人们都传说他必死无疑。过了几个月，在路上遇到他，询问他，他说：‘我的病几乎危及生命。起初服用顺气行痰的药物，毫无疗效。傍晚时分神志就昏沉，估计不能再服药了，便让家人煎服十全大补汤（温补气血方剂）。服后即觉得神志清明，于是继续服用。过了几天，就能扶着拐杖起来了。不久，又能扔掉拐杖行走了。’经文说：‘邪之所凑，其气必虚。’我治疗他的虚损，而不理会邪气，邪气自然去除。这就是我痊愈的原因。我说：‘确实如此啊！如果让他继续服用顺气疏风的散剂不停止，恐怕坟上的树都长高了。’然而这位老医仍然拘泥于成法，不能因病而变通，随时间而斟酌损益，所以见效稍慢。如果我早点为他诊治，应当不至于这样。暂且记录下来，等待高明者采纳。读了这两则医案，更加相信塞外地区多真中风，江南地区多类中风。刘、李、朱三家的学说，张景岳关于非风的论述，确实是轩辕岐伯医学的功臣。到了明代末年，缪希雍立论，认为真阴亏损而内热甚者，煎熬津液，凝结为痰，壅塞气道，不得通利，热极生风，也导致猝然僵仆，属于类中风症。这就是内虚暗风。初起用清热顺气开痰的方法，随后用治本的方法，或是益阴，或是补阳。用药以天冬、麦冬、生地、熟地、菊花、枸杞、胡麻、桑叶、首乌、柏子仁、蒺藜、花粉、人参、茯苓、当归、白芍、鹿茸、虎骨胶、霞天膏、梨膏、竹沥、桑沥、人乳、童便等，出入互换，另创一格制。如今《临证指南医案》中风一门，大半遵循此法。又可以补充刘、李、朱、张四家所未完备之处。至于喻嘉言论述侯氏黑散，认为使用矾石以填空窍，堵截风路，这是好奇的言论，最足以误导人。药物进入胃中，不过是气味传布于脏腑经络罢了，岂能用矾石嵌入刷涂呢？如果冷食四十日，药积腹中不下，肠胃诚然填塞了，谷米不纳而粪便不出，那该怎么办呢？学医者千万不要妄加尝试。”
and the internal heat is thereby vented. In spring, summer, and autumn, add Antelope Horn (Lingyangjiao), Bupleurum Root (Chaihu), Anemarrhena Rhizome (Zhimu), and Gypsum Fibrosum (Shigao) to assist. This prevents the internally accumulated heat from steaming and scorching together with the seasonal heat. Additionally, prick the four extremities of the hands and feet to drain the Ying (Nutritive) blood and unblock the Qi mechanism. One must fear that if phlegm-heat and deficiency wind persist for a long time, they may develop into leprosy-like diseases (Li Feng).
Yu Zhen's commentary: For hemiplegia (Piangu), many in the past believed that left-sided involvement belongs to Blood deficiency, while right-sided involvement belongs to Qi deficiency. Only after receiving the theoretical exposition by Mr. Jiayan (Dai Yuanli) did the rationale become clear. Furthermore, changing herbs according to the season and pricking the four extremities are particularly ingenious methods. This reminds me of reading the *Huangdi Neijing* (Yellow Emperor's Inner Canon) in my youth, specifically the chapter on Nine Palaces and Eight Winds, which states: "Wind coming from the direction where Taiyi resides is called Real Wind (Shi Feng), governing the growth of all things; wind coming from the opposite direction (Chonghou) is called Empty Wind (Xu Feng), which injures people." The sages avoided Empty Wind as they would avoid arrows and stones. Does this not clearly refer to exogenous wind pathogens? It further says: "If one suffers from 'Three Deficiencies' and is partially struck by evil wind, it results in being struck down and falling into hemiplegia (Jipu Piangu)." "Jipu" refers to suddenly collapsing as if struck by someone, which corresponds to sudden fainting or collapse today. Since "Jipu" and "Piangu" are mentioned together, sudden collapse without hemiplegia should not be classified as stroke. However, the so-called "Three Deficiencies" refer to the decline of annual luck, the emptiness of the moon phase, and the disharmony of seasons—these are deficiencies in cosmic timing and climate, not deficiencies in the human body itself. Why is stroke always treated as a condition of human deficiency? Upon reading the *Shengqi Tongtian Lun* (Treatise on Vital Energy Connecting to Heaven), it says: "Wind is the beginning of all diseases. If one maintains clarity and tranquility, the flesh and pores close and resist; even great wind and severe toxins cannot harm." It also states: "Wind, rain, cold, and heat, if not empty evil winds, cannot injure people alone." And again: "Empty evil wind and the human body, when both are deficient, meet, and then the pathogen enters the form." This clearly indicates that only those with a deficient constitution are struck by empty wind. Nevertheless, this still implies contracting wind due to deficiency. Thus, the *Ling Shu* (Spiritual Pivot) also has the theory that "when True Qi departs and Evil Qi remains alone, it develops into hemiplegia." The phrase "hemiplegia is difficult to treat" summarizes this perfectly. Re-reading the *Tong Ping Xu Shi Lun* (Treatise on Uniform Evaluation of Deficiency and Excess), it says: "In treating Xiao Dan (Wasting-Thirst), Jipu (Collapse), Piangu (Hemiplegia), Wei Jue (Atrophy and Cold Limbs), and Qi Man Fa Ni (Fullness of Qi with rebellious flow), these are diseases of rich and noble people caused by rich food and fine grains (Gao Liang)." This passage implicitly includes various syndromes such as Phlegm-Dampness, Damp-Heat, Yin Deficiency, and Yang Deficiency, without mentioning partial striking by evil wind. Presumably, rich and noble people naturally take care to avoid evil winds, and changes arising from rich diets generate wind from within. Liu Wansu, Li Dongyuan, and Zhu Danxi entered medical understanding through this insight. Generally, treating disease requires seeking the root. Collapse and hemiplegia have deficiency as their root.
Liu Zongnong, in *Yuji Wei Yi*, stated: "I once resided in Liangzhou, which was Wuwei Commandery in the Han Dynasty. The terrain is high and elevated, with much wind and little rain throughout the four seasons. The soil grows millet and sorghum, irrigated by springs. The weather is often cold. People's Qi is substantial, and their pores are dense. I frequently saw cases of sudden death from stroke. It was likely due to the extreme dryness and ferocity of the Northwest wind (Zhe Feng). At that time, in the eighth month of autumn during the Yihai year of Hongwu, a strong wind rose from outside Ganzhou City in the northwest, and many died on the roads. I began to realize that the scriptural statement regarding the Northwest wind injuring people and causing sudden death was not false. People who have not experienced such places, despite reading the scriptures, always harbor doubts. How can medicine be discussed lightly?"
Additionally, Wang Kentang, in *Linglan Yaolan*, said: "An old physician in our village had been bedridden with paralysis of the right hand and foot for two years. Everyone predicted he would certainly die. Several months later, I met him on the road and asked him. He said: 'My illness was nearly fatal. Initially, I took herbs to regulate Qi and resolve phlegm, but there was no effect. By dusk, my consciousness became confused, and I judged I could not take more medicine. I instructed my family to decoct Shiquan Dabu Decoction (Complete Great Tonifying Decoction). Immediately after taking it, I felt clear-headed. I continued taking it. After several days, I could rise supporting myself with a cane. Soon after, I could walk without the cane.' The scripture says: 'Where the pathogen gathers, the Qi must be deficient.' I treated his deficiency and did not focus on the pathogen, so the pathogen naturally dispersed. This is why I recovered." I said: "Indeed! If he had continued taking Qi-regulating and wind-dispersing powders without cessation, the trees on his grave would already be tall. However, this case still adhered to established formulas, lacking flexibility to adapt to the disease and adjust over time, hence the slower efficacy. Had I treated him earlier, it would not have reached this state. I record this temporarily for the discerning to consider." Reading these two cases reinforces the belief that regions beyond the Great Wall have more true wind-stroke, while Jiangnan has more stroke-like conditions. The theories of Liu, Li, and Zhu, and Zhang Jingyue’s discussion on non-wind disorders, are indeed merits to the medical legacy of Xuanyuan and Qibo. Towards the late Ming Dynasty, Miao Zhichun proposed that severe deficiency of True Yin leading to intense internal heat boils down body fluids, condensing them into phlegm, blocking the airways, preventing smooth flow. Extreme heat generates wind, also causing sudden stiffness and collapse, classified as stroke-like syndrome. This is internal deficiency dark wind. Initially, use clearing heat, regulating Qi, and resolving phlegm methods; subsequently, treat the root by nourishing Yin or tonifying Yang. Herbs used include Asparagus Tuber (Dongguamen/Dongchongxiaocaobingdong... wait, Er Dong refers to Tian Dong and Mai Dong), Rehmannia Root (Di Huang), Chrysanthemum Flower, Goji Berry, Sesame Seed, Mulberry Leaf, Polygonum Multiflorum, Biota Seed, Sea Buckthorn (or Tribulus), Trichosanthes Root, Ginseng, Poria, Angelica Sinensis, White Peony Root, Deer Antler, Tiger Bone Glue, Xiataian Paste, Pear Syrup, Bamboo Sap, Mulberry Sap, Human Milk, and Child Urine, among others, used interchangeably. This created a new paradigm. Today, the Stroke section in *Lin Zheng Zhi Nan Yi An* (Guide to Clinical Practice Medical Cases) largely follows this approach, supplementing what Liu, Li, Zhu, and Zhang did not cover. Regarding Yu Jiyang’s discussion on Hou’s Black Powder, claiming that Alum (Fan Shi) fills apertures and blocks wind pathways, this is fanciful talk that misleads people most. When herbs enter the stomach, it is merely their aroma and flavor that spread through the Zang-Fu organs and meridians. How can Alum be embedded or brushed like paste? If one eats cold food for forty days, accumulating medicine in the abdomen without digestion, the intestines and stomach would indeed be blocked. Grain would not be taken in, and feces would not exit. What then? Practitioners must not rashly try this.